OBJECTIVE: This systematic review and meta-analysis investigates the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) injections compared to surgical intervention in improving visual acuity (VA) and reducing complications for patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (AMD).
CONCLUSIONS: Determining the optimal intervention for SMH in AMD is crucial for patient care.
METHODS: We included studies on anti-VEGF injections or surgical interventions for SMH in AMD from 7 databases, searched up to May 2024. Data extraction and quality assessment were done by two independent reviewers. Certainty of evidence was assessed GRADE approach. Meta-analysis employed random-effects models. Primary outcomes were pooled mean logMAR VA difference (initial examination minus last follow-up VA) and adverse events rates.
RESULTS: A total of 43 observational studies were included: 21 (960 eyes) on anti-VEGF and 22 (455 eyes) on surgery. Comparisons were made across separate studies due to lack of head-to-head studies. Meta-analysis included 11 anti-VEGF studies (444 eyes) and 12 surgical studies (195 eyes) for VA outcomes. The mean difference (MD) in VA was -0.16 (95%CI: -0.26,-0.07) for anti-VEGF and -0.36 (95%CI: -0.68,-0.04) for surgery, with no significant difference between groups (X2=1.70, df =1, p=0.19). Heterogeneity was high in surgical studies (I2=96.2%, tau2=0.23, p<0.01) and negligible in anti-VEGF studies (I2=7%, tau2=0.003, p=0.38). GRADE certainty was moderate for anti-VEGF and low for surgery. Anti-VEGF had lower rates of cataract (0% vs 4.6%), proliferative vitreoretinopathy (PVR, 0.1% vs 2.0%), and retinal detachment (RD, 0.1% vs 10.6%), but similar rates of recurrent hemorrhage (5.4% vs 5.3%). Complications were summarized descriptively due to zero cell problem.
CONCLUSIONS: Both anti-VEGF and surgery treat SMH in AMD with similar VA outcomes but different safety profiles. Anti-VEGF is preferred for less severe hemorrhage, while surgery is suited for extensive hemorrhage. Despite uncertain comparative VA outcomes, treatment should be guided by clinical judgment and patient factors.

Subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC) occurs in 5-20% of TSC patients, with a subset developing hydrocephalus. We present a case of a 14-year-old male diagnosed with TSC in the neonatal period who developed SEGA and subsequent hydrocephalus. Despite reducing the tumor size with the mammalian target of rapamycin (mTOR) inhibitors, ventricular enlargement persisted, indicating that obstructive hydrocephalus due to the foramen of Monro blockage was not the sole mechanism. Elevated cerebrospinal fluid (CSF) protein levels suggested additional factors like impaired CSF outflow. This case underscores the need for comprehensive treatment strategies and further research to better understand and manage hydrocephalus in TSC patients with SEGA.

Polyacrylamide hydrogel (PAAG) is widely regarded as a safe soft tissue filler and has been extensively utilized for cosmetic enhancements, such as breast and facial augmentation in China from 1997 until its ban in 2006. Common complications associated with its use include inflammation, infection, granulomas, fibrosis, gel migration, and facial and soft tissue deformities. This case report describes a 45-year-old Chinese woman who experienced PAAG migration into her mandible 24 years after facial augmentation, causing irritation of the mandibular alveolar nerve - apparently the first documented instance of this occurrence. Surgical intervention was necessary to remove the migrated gel and associated calcifications. A literature review explored adverse events and management strategies for PAAG complications in cosmetic procedures. While generally considered safe, this report underscores the importance of meticulous injection techniques and careful anatomical site selection to prevent such severe complications.

UNASSIGNED: The surgical removal of unexploded mortar shells is rarely documented in the literature. Since most cases occur within war or conflict regions, reporting such instances is vital for optimizing and enhancing surgical practices, particularly in low-resource settings.
METHODS: We report the case of a 35-year-old man who sustained an injury from a 60 mm unexploded mortar shell, penetrating the patient\'s right posterior chest in the right paravertebral region of the 4th thoracic vertebra, causing intrathoracic injuries, multiple rib fractures, and a right pneumothorax. The patient was immediately resuscitated and transferred to the operating room. The projectile was removed without direct contact with metal instruments. A right chest tube was then inserted and the injured area was repaired, resulting in an uneventful postoperative recovery.
UNASSIGNED: Unexploded mortar shell injuries are infrequently documented in the literature. These injuries are seen within war and conflict regions, that have limited accessibility or availability of experienced explosive ordnance disposal (EOD) teams, transporting personnel, and equipped and separated operating theaters.
CONCLUSIONS: Unexploded ordnance and munitions represent an underrecognized and underreported health risk to patients, healthcare providers, and healthcare facilities. These injuries are commonly encountered within regions that lack experienced transport and EOD staff. The need for the establishment of such experienced teams along with providing adequate training for healthcare providers is necessary.

A 65-day-old baby boy underwent the Kasai procedure under general and epidural anesthesia. The epidural catheter was inserted between the T11 and T12 vertebrae under general anesthesia, and secured with sterile tape, ethyl-2-cyanoacrylate glue, and film. Intra- and postoperative epidural analgesia was effective and there was no leakage around the insertion site. On the third day post-surgery, we tried to remove the catheter but discovered it was fractured 67mm from the tip. During the ultrasound examination, we observed a hyper-echoic structure located between the laminae of T11/T12. The pediatric orthopedic surgeon recommended removing the catheter to avoid long-term neurological sequelae of leaving the catheter, such as infection, fibrosis, migration, and irritation of neural tissues. It was surgically removed uneventfully on postoperative day 4. We requested the manufacturer to inspect the cross-section of the catheter under a microscope. The cross-section showed that 20% of the area had undergone tearing due to traction, while the remaining 80% was cracked. We also requested the manufacturer simulation after that. The same catheter, fixed on the polyolefin resin plate instead of skin with the same tape and glue, was easily fractured after three days. It is suspected that using ethyl-2-cyanoacrylate glue caused the catheter to fracture. When using glue containing ethyl-2-cyanoacrylate for pediatric epidural catheter fixation, special care is advised.

An infant with a corrected gestational age of 38 weeks, weighing 3.1 kg, was referred to our pediatric surgical department because of a fractured peripherally inserted central venous catheter in the left lower limb with the end retracting into the deep venous system. An operation was undertaken to remove the PICC. Because the central venous catheter was, unintentionally, placed in the left small saphenous vein and thus positioned in the left femoral vein, the left great saphenous vein was incised to gain access. Subsequently, the catheter could be removed successfully. Fracturing of a peripherally inserted central venous catheter is a rare occurance. Removal depends on vessel size, location and experertise.

Pulmonary hydatid disease remains a global public health issue. Symptoms often result from cyst rupture, causing fever, cough, and hemoptysis. Radiographs may show homogeneous masses, air-fluid levels, or the pathognomonic \"water lily\" sign. Surgical removal is the primary treatment, with early diagnosis crucial to prevent acute hypersensitivity reactions and death.

OBJECTIVE: The purpose of this study was to determine how the surgeon\'s decision to perform a mandibular third molar coronectomy or surgical removal is associated with the impaction pattern as classified using Pell and Gregory or Winter\'s system.
METHODS: This observational, cross-sectional study was conducted on 813 mandibular third molars belonging to 565 patients. All patients were referred for removal of the mandibular third molar and had radiographic signs indicating a close relationship with the inferior alveolar nerve. Panoramic images were classified according to the impaction pattern.
RESULTS: A coronectomy was performed on 492 (60.5%) mandibular third molars. Most impacted mandibular third molars were class IIB with a mesioangular inclination. A significant association was found between the Pell and Gregory classification and the surgeon\'s choice (p = 0.002). Winter\'s classification was not significantly associated with surgeon choice (p = 0.425).
CONCLUSIONS: Mandibular third molar coronectomy is chosen more frequently than surgical removal if molars are class III and position B.
BACKGROUND: Not applicable.

Aneurysmal bone cysts are benign but locally aggressive bone tumours, most often affecting children and young adults. In this case report, we present the clinical  picture of a 15-year-old boy with progressive, chronic back pain. An MRI of thoracic spine  confirmed a T2 cystic spinal tumour. After considering potential options surgical removal was our choice and gross total removal was achieved with T1-3 short-segment fixation. Aneurysmal bone cysts are often rapidly expanding lesions with vascular  transformation. In order to avoid irreversible damage, in addition to early diagnosis, it is necessary to carefully consider the therapeutic options, perform surgical removal and stabilization as necessary. In case of the presented patient, extensive surgical removal and short-segmentation were performed. At 18 months of follow-up, he had no complaints and was asymptomatic. Follow-up imaging studies showed no residual or recurrent tumour to date.

.

Az aneurysmás csontcysták benignus, azonban lokálisan agresszíven viselkedő csontdaganatok. Leggyakrabban gyermekeket és fiatal felnőtteket érint. Esetleírásunkban bemutatjuk egy 15 éves fiú progresszív, krónikus háti fájdalmának hátterében igazolódó kórképét. Kivizsgálása során MRI-vizsgálat igazolt a Th II csigolyatest jobb felében is ábrázolódó, mindkét processus transversust és a processus spinosust is involváló cysticus térfoglalást. 
A műtét során a Th II csigolya cysticus tér­fog­lalása in toto eltávolításra ke­rült, Th I–III short-segment rögzítést vé­gez­tünk. Az aneurysmás csontcysták vas­cularis átalakulással járó, gyakran rapidan expandáló laesiók. Az ir­re­verzibilis károsodás elkerülése érdekében a mielőbbi diagnózis mellett szükséges a te­rápiás lehetőségek gondos mérlegelése, szükség szerint sebészi eltávolítás és stabilizáció végzése. A bemutatott páciens esetében kiterjedt sebészi eltávolítást, short-segment rögzítést végeztünk. 18 hónapos utánkövetést tekintve, a beteg panaszmentesen jelent meg az előírt kontrollokon, képalkotó vizsgálatok residualis elváltozást nem mutattak.

.

The presence of supernumerary tooth (SNT) in the nasal cavity is a rare condition with limited literature data. We report two cases with a history of nasal obstruction and difficulty breathing. In both cases, clinical and radiological examination confirmed intranasal SNT. Extractions were executed in general anesthesia using Rochester-Pean instruments transnasally. In addition, a literature review of intranasal SNT was performed. The database search retrieved a total number of 50 cases in time period from 1970 to 2020. Mean age of patients was 22.5 years. Most common symptoms were unilateral obstruction of breathing and headache. Surgical extraction of intranasal SNT is recommended to eliminate the symptoms.