Introduction. Variations in the branching pattern of the aortic arch constitute important anatomical differences with implications for surgical interventions involving the head, neck, and upper extremities, as well as for endovascular procedures and radiological evaluations. The aim of this study was to present a retroesophageal aberrant right subclavian artery accompanied by an additional arterial branch identified during routine cadaveric dissection. Case Outline. The branching pattern of the aortic arch was examined during the thoracic dissection of a 69-year-old male cadaver used for educational purposes at the Department of Anatomy, Faculty of Medicine, Kafkas University. Examination revealed the absence of the brachiocephalic trunk. The aortic arch gave rise sequentially to the right common carotid artery, left common carotid artery, and left subclavian artery. The right subclavian artery originated from the distal portion of the aortic arch and coursed posterior to the esophagus before passing to the right side and continuing toward the upper limb. In addition, an additional arterial branch arising from the right subclavian artery was identified. This branch coursed superior to the anterior scalene muscle and rejoined the right subclavian artery distally. Conclusion. An aberrant right subclavian artery is a rare but clinically significant vascular variation. In cases exhibiting a retroesophageal course, it may cause various clinical manifestations, particularly dysphagia. Furthermore, altered anatomical relationships may result in diagnostic and surgical challenges during thoracic surgery, vascular interventions, and radiological procedures. The presence of an additional arterial branch accompanying the aberrant right subclavian artery in the present case highlights the diversity of vascular variations in the upper extremity. Awareness of such variations is important for preventing potential complications during diagnostic and interventional procedures.
Introduction/Objective. Preoperative fear and anxiety in children are associated with unfavorable postoperative outcomes. Oral midazolam is commonly used for pediatric premedication, but may not always effectively prevent postoperative agitation and delirium. Inhaled dexmedetomidine, due to its sedative and anxiolytic properties, represents a promising alternative. The aim of this study was to compare inhaled dexmedetomidine and oral midazolam regarding emergence time from anesthesia, postoperative recovery, and the incidence of postoperative delirium in children. Methods. This prospective randomized study included 60 children aged 2-12 years, ASA physical status I-II, undergoing surgical procedures. Participants were divided into two groups: the dexmedetomidine group (group D) received inhaled dexmedetomidine 2 μg/kg, while the midazolam group (group M) received oral midazolam 0.3 mg/kg. We assessed emergence time, recovery, and the incidence of postanesthetic delirium. Results. Emergence time did not differ significantly between the groups (Group D: median 8 min, IQR 7-10; Group M: median 7 min, IQR 5-10; Mann-Whitney U test, p = 0.121). Aldrete score improved similarly in both groups during the first 20 minutes, with no significant differences between the groups at the observed time points (p > 0.05). Delirium occurred in 3.3% of patients in Group D and 6.7% in Group M, without a statistically significant difference (Fisher’s exact test, p = 1). Conclusion. Inhaled dexmedetomidine used as a premedication in children was associated with slower emergence, faster recovery, and a lower incidence of delirium compared with oral midazolam, although differences were not statistically significant.
Introduction. Waugh syndrome (WS) is a rare condition characterized by association of intussusception and gut malrotation. Due to non-operativne management for intussusception in certain number of patients, it still remains undiagnosed. So far, only less than hundred casses have been reported in literature, most of them treated surgicaly, with good outcome and no complication if surgery is done timely after symptoms appeared. Case presentation. We present a five month old infant which was admited due to vomiting, blood and mucus in stool. Clinical findings revealed abdomen which was painful on palpation, without distension and abdominal mass. Blood and mucus were noted on rectal examination. After native X ray, abdominal ultrasound was done and confirmed intussusception. After unsuccessful attempt of hydrostatic reduction, ultrasound was repeated, the target sign persisted, this time accompanied by obvious “whirlpool sign” and inverse ratio of superior mesentery artery and vein. Infant underwent emergency surgery, and bowel resection with ileo-colic T-T anastomosis. Recovery was complete after two weeks. Conclusion. Waugh syndrome should be considered whenever hydrostatic reduction fails in a patient with previously diagnosed intussusception, and ultrasound verification of the superior mesenteric artery and vein relationship should be insisted upon to confirm the diagnosis off associated malrotation. In proven Waugh syndrome, timely surgical intervention is indicated to prevent bowel resection.
Introduction /Aim. This study evaluated the association between implementation of a Donabedian-based management protocol and short-term laboratory, renal-function, urine-output, and fluid-management outcomes in patients with acute kidney injury receiving continuous renal replacement therapy. Methods. This retrospective before-and-after cohort study screened 155 consecutive patients aged ≥ 50 years with KDIGO-defined acute kidney injury who received continuous renal replacement therapy between January 2021 and January 2025. The analytical cohort comprised 100 patients who survived to hospital discharge, recovered sufficient kidney function to remain dialysis-independent at discharge, and had complete baseline and 72-h data; 43 patients treated from January 2021 to December 2022 constituted the routine group, whereas 57 patients treated after protocol implementation, from January 2023 to January 2025, constituted the intervention group. The primary outcome was serum IL-6 concentration 72 h after continuous renal replacement therapy initiation; secondary outcomes included other inflammatory and stress-response biomarkers, blood-gas and coagulation indices, renal-function markers, serial urine output, fluid-balance compliance, and ICU length of stay. Results. Of the 155 patients who received continuous renal replacement therapy, 110 survived to discharge, corresponding to an overall hospital survival rate of 71.0%; 100 dialysis-independent survivors were included in the comparative analysis. At 72 h, serum IL-6 was lower in the intervention group than in the routine group (60.39 ± 16.37 vs. 73.89 ± 18.04 pg/mL; P <0.001). After adjustment for baseline IL-6, age, sex, sepsis, the sequential organ failure assessment (SOFA) score, vasopressor support, baseline urine output, and baseline serum creatinine, the adjusted between-group difference was −13.21 pg/mL (95% confidence interval, −20.34 to −6.07; P <0.001). The intervention group also had more favorable inflammatory, stress-response, blood-gas, coagulation, renal-function, urine-output, and fluid-balance indices, although ICU length of stay was slightly longer (13.84 ± 3.67 vs. 12.40 ± 3.43 days; p = 0.047). Conclusions. Among selected hospital survivors who were dialysis-independent at discharge, Donabedian-based management was associated with more favorable 72-h laboratory, urine-output, and fluid-management outcomes, but not with a shorter ICU stay; survivor selection, the before-and-after design, and the multicomponent nature of the protocol preclude causal interpretation.
Introduction. Invasive pulmonary mucormycosis is one of the most severe and potentially fatal fungal infections in immunocompromised patients, particularly in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Diagnosis and treatment of pulmonary mucormycosis remain challenging. Case outline. We present a 19-year-old male patient with relapsed acute myeloid leukemia (AML) following allo-HSCT whose treatment was complicated by proven pulmonary mucormycosis. The infection was managed using an integrated medical and surgical approach, including liposomal amphotericin B with dose escalation, prolonged treatment with oral isavuconazole, and right lower lobectomy. Postoperatively, the patient developed Pseudomonas aeruginosa sepsis and pneumothorax requiring drainage; both complications were successfully managed. Subsequent computed tomography (CT) scans demonstrated regression and complete radiological resolution of the pulmonary lesion. Conclusion. This case illustrates the complexity of managing pulmonary mucormycosis in a severely immuno-compromised patient with relapsed AML after allo-HSCT and concomitant graft-versus-host disease (GVHD). Successful management required a multidisciplinary approach combining antifungal therapy and thoracic surgery, followed by prolonged antifungal treatment and close radiological monitoring.
