International Journal of Surgery & Surgical Techniques
Role of Preoperative MRCP in the Management of Biliary Pancreatitis: A Retrospective Study from Saudi Arabia
Background: Gallstones are the leading cause of acute pancreatitis worldwide. Acute biliary pancreatitis occurs when distal common bile duct stones obstruct the ampulla. This can result in severe consequences for some patients, including significant fluid loss, metabolic imbalances, hypotension, and sepsis. Definitive management strategies for choledocholithiasis include laparoscopic cholecystectomy and/or endoscopic retrograde pancreatography. Magnetic resonance cholangiopancreatography (MRCP) has been increasingly used to evaluate bile duct pathology, leading to more frequent pre-operative biliary duct evaluations for patients with acute gallstone pancreatitis. Despite its widespread use, there have been conflicting reports in the literature regarding its effectiveness and impact on hospital stay duration and healthcare-associated costs. Aim: The aim of this study was to compare the impact of performing MRCP in biliary pancreatitis and its utility, measure its cost-effectiveness, and assess the sensitivity and specificity of different laboratory and radiological investigations in diagnosing impacted biliary stones. Methods: This study followed a retrospective design and analyzed, the records of all patients diagnosed with acute biliary pancreatitis during the study period (2015-2019). Data regarding the following variables were obtained and analyzed from patients’ records: age, comorbidities, and previous medications of the patients; BISAP pancreatitis severity score; serum amylase, at the time of admission; serial recordings for biomarkers and liver function test results (for Day, 1, 3, and 6); ultrasonography results; computed tomography results; MRCP and ERCP results; postoperative complications; length of hospital stay in days; and the time waiting for surgery in days. Results: 133 participants were found in the hospital admission registry and included in this analysis, with an average age of 51.73 years. At the time of admission, the average serum amylase level was 1310 units/liter. Regarding the length of hospital stay, 8.9 days was the average among the patients, with a maximum length of stay of 48 days. Our analysis revealed that MRCP has a sensitivity of 77% and a specificity of 64% for detecting CBD stones. Patients who had MRCP stayed longer at the hospital with an average of 9.21 days, although the difference was not statistically significant (p-value: 0.570), compared withan average of 6.15 among patients who did not have MRCP. As for the days to surgery, the average time until surgery was 3.79 (standard deviation 3.73), with a maximum of 16 days until surgery. Patients who had MRCP had to wait for a longer period of time until surgery than their counterparts who waited for less than a day for their surgery (p-value: &lt; 0.001). Conclusion: Our results revealed that patients who underwent MRCP preoperatively had a longer hospital stay and significantly waited longer for surgery than their counterparts. However, more multi-centered, large studies are needed to further support our findings.
Copyright (c) 2023 Abdulaziz Shaher https://creativecommons.org/licenses/by/4.0
Talar Extrusion Injury: Anatomy, Diagnosis, Treatment, and Outcomes
Talar extrusion is a very rare injury and is defined as talar dislocation from surrounding tibiotalar, subtalar, and talonavicular joints. It often results from high energy trauma. These injuries often have poor outcomes and serious complications including avascular necrosis, infection, and osteoarthritis. There are limited case reports and case series in the literature regarding talar extrusion injuries. In this review, we discuss the complex anatomy, diagnosis, treatment options, complications, and outcomes for patients with talar extrusion injuries.
Copyright (c) 2023 Daniel T DeGenova https://creativecommons.org/licenses/by/4.0
Sensitivity, Specificity of Vessel Involvement in Pancreatic Head Adenocarcinoma by Imaging Modality per Treatment Effect
Background: In patients with pancreatic adenocarcinoma, the accuracy of identifying vascular involvement via EUS and MDCT remains unclear, especially in the setting of neoadjuvant therapy. Methods: We conducted a retrospective analysis of patients who underwent a pancreaticoduodenectomy between 2012 and 2016 at Advent Health Orland Hospital. Sensitivity, specificity, positive predictive value and negative predictive value of MDCT and EUS with respect to vessel involvement (SMV, PV, SMA) in a given treatment setting (no treatment, neoadjuvant chemotherapy, neoadjuvant chemotherapy/radiation) were analyzed. Results: In the setting of no treatment, MDCT has the highest sensitivity, specificity, PPV, NPV in the evaluation of the SMA: 22%, 94%, 50%, and 83% respectively. In the setting of no treatment, EUS has the highest sensitivity, specificity, PPV, NPV in the evaluation of the SMV: 33%, 95%, 33% and 95% respectively. The modality with the highest specificity in the assessment of PV involvement is intra-operative evaluation regardless of treatment setting. In the setting of neoadjuvant therapy, either EUS or intra-operative evaluation is preferred over MDCT for the evaluation of the SMA, SMV and PV. Discussion: In the setting of no treatment, the SMA is best evaluated via MDCT, the SMV via EUS, and the PV is best evaluated intra-operatively.
Copyright (c) 2023 Lusine Mesropyan https://creativecommons.org/licenses/by/4.0
Reasoning about Ilo-Mediastinal Lymphectomy during Lung Metastasectomy for Colorectal Cancer: Appropriate or Unnecessary Effort?
Abstract Lymph node dissection following lung metastasectomy is still debated, although it is considered necessary to achieve complete resection or at least gather prognostic information. When radical lymph node dissection is performed, the average rate of unexpected lymph node involvement in colorectal cancer is less than 20%. Lymph node co-involvement is an adverse prognostic factor, and preoperative mediastinal disease usually leads to patient exclusion from metastatic surgery. The authentic prognostic influence of systematic nodal dissection remains unclear. Unfortunately, many studies demonstrate no positive effect of lymphadenectomy during lung metastasectomy other than a pseudo-stage migration effect. Future studies should focus not only on survival but also on local and lymph node recurrence.
Copyright (c) 2023 Paolo Albino Ferrari https://creativecommons.org/licenses/by/4.0
The Gut-Brain Axis: How the Microbiome may Influence Brain Tumors, A Narrative Review
Abstract Aim: To review the current literature and demonstrate the potential relationship between gut microbiome and brain tumor. Methods: A comprehensive search of the available literature was conducted using the PubMed, Google Scholar, OVID, Embase and other database to identify studies investigating the relationship between the gut microbiome and brain cancer. The search was limited to articles published in English between 2010 and 2022. Conclusion: While the research on the relationship between the gut microbiome and brain cancer is limited, the studies that have been conducted suggest that there may be a connection. The gut microbiome has been shown to play roles in a number of diseases, and some evidence suggests that it may also be involved in the development and progression of brain cancer. The gut microbiome may suggest a new method for the prevention, diagnosis, and treatment of brain cancer and further research in this area has the potential to lead to new and innovative strategies for managing this disease.
Copyright (c) 2023 Mohammad Farajirad https://creativecommons.org/licenses/by/4.0
Hook Wire Localization Failure of Peripheral Pulmonary Nodules during Perioperative Video-Assisted Thoracoscopic Surgery Period
Abstract Introduction: Computed tomography (CT) guided Hook wire localization is often used to identify peripheral small nodules prior to video-assisted thoracoscopic surgery (VATS). Pneumothorax, intrapulmonary hemorrhage, systemic air embolism, and wire dislodgement are well-known complications associated with the former procedure. Still, in this report, the situation of the Hook wire detached from the anchor point during perioperative operation is an infrequent and potentially fatal complication. We encountered four cases of Hook wire dislocation. The abnormal position needle of three cases was successfully removed during the operation, while the other one was successfully removed through reoperation, and all patients recovered smoothly after the operation and were discharged from the hospital.
Copyright (c) 2023 Shouqiang Yu https://creativecommons.org/licenses/by/4.0
Symptomatic Adnexal Cyst with Pregnancy – Laparoscopic Management with a Surprise Revelation
Large cystic masses are rare in pregnancy and are usually ovarian cysts. Surgical removal of the cyst can be performed electively in the 2nd trimester or at any time if acute symptoms are present. In this case report, we present the case of a pregnant women who presented with a symptomatic cyst which was reported as an adnexal cyst on imaging. Preoperatively it was found to be arising from the mesentery of the transverse colon. Histopathological examination was consistent with benign mesenteric cyst.
Copyright (c) 2023 Swati Agrawal https://creativecommons.org/licenses/by/4.0
Assessing the Management of Varicose Vein Using Individualized Medicine: An Empirical Study
Varicose vein is one of the most common clinical condition presented by abnormal blood flow in the lower extremities and it remains an open question as to which inciting factor is responsible for their development, if any one particular factor is in fact solely responsible. It is unclear whether local dysfunction in the vein wall leads to valvular incompetence or whether the reverse is true. The abnormal vessel of the varicosity is invariably dilated, and luminal diameter is larger than in normal vein. Importantly, varicose vein disease is characterized by skip lesions, areas of normal vein between varicosities. Homoeopathy is a complementary system of medicine that follows a holistic approach. Homeopathy follows a personalized approach in treatment of chronic disease such as varicose veins Here 30 cases of varicose vein was used for the study and in each case complete case taking was done and after evaluated using Revised Venous Clinical Severity Score an and medicine was selected according to the totality. Potency and dose was determined based on the susceptibility of the patient. Follow up was done. Since p value &lt;0.05, it indicates that the test is statistically significant and hence the null hypothesis is rejected.
Copyright (c) 2023 Nivedha KS https://creativecommons.org/licenses/by/4.0
Is there an Association of Glycosylated Haemoglobin A1c and Anthropometric Measurements in Premenopausal and Postmenopausal Breast Cancer Patients?
Background: Breast cancer is the commonest malignancy among women globally. It is a leading cause of cancer death in less developed countries and the second leading cause of cancer death in developed countries. Diabetes and breast cancer are two conditions that frequently coexist, and menopause may be a metabolic watershed. The purpose of this study is to examine the relationship between glycosylated haemoglobin (HbA1c) and anthropometric measurements in premenopausal and postmenopausal breast cancer patients Methods: 100 patients diagnosed with breast cancer between December 2020 to November 2022 were evaluated and their HbA1c levels were correlated with anthropometric measurements and tumour characteristics Results: In our study mean age of the patients was 47.75 ±11.77 SD years. In patients with normal HbA1c 64% patients were pre-menopausal. In Pre-diabetic HbA1c group 70% were post-menopausal and in diabetic HbA1c group 93% were postmenopausal. Mean waist circumference was 84.56 ± 6.64 SD cms; more in pre-diabetic and diabetic patients; (p value 0.000). Most of the patients (71%) had waist to hip ratio ≥0.85 (p value 0.349). Pre-diabetic and diabetic patients were overweight (p value 0.000). 6 patients were known cases of type II diabetes mellitus and were on insulin/OHAs. T3 tumours were more common in both premenopausal and postmenopausal patients followed by T4 tumours. Stage IIB breast cancer was present in 39% of premenopausal and stage IIIA was seen in 30% of the postmenopausal patients. Grade II disease was more common in both premenopausal and postmenopausal (p value 0.858). Invasive ductal carcinoma-No special type (IDC-NST) was seen in 77% of the patients (p value 0.156). Estrogen Receptor (ER) positivity was seen in 42% of premenopausal and 33% of postmenopausal patients, negative Progesterone Receptor (PR) seen in 86% in premenopausal and 89% in postmenopausal patients and positive Her2 neu receptor was observed in 30% in premenopausal and 56% in postmenopausal patients. Conclusion: Our study demonstrated that a considerable proportion of breast cancer patients were prediabetic. Glycaemic status and HbA1c were clearly associated with measures of visceral obesity in carcinoma of breast patients. Postmenopausal patients had higher levels of HbA1c compared to premenopausal cases. However; clinicopathological and tumour characteristics in our study didn’t demonstrate any significant correlation with glycaemic status and need more research and randomized controlled trials. Collectively, findings from our study particularly emphasize the need to control hyperglycemia and identify vulnerable groups of breast cancer patients who might benefit from interventions to improve glycaemic control.
Copyright (c) 2023 Prashant Kumar Rai https://creativecommons.org/licenses/by/4.0
A Case Report of Norrie Disease with Congenital Sensorineural Hearing Loss
Norrie Disease (ND) is a rare X-linked recessive genetic disorder caused by mutations in the Norrie disease protein (NDP) gene on the X chromosome. This disorder leads to congenital or neonatal blindness, progressive hearing loss in adolescence, and cognitive or behavioral problems. Although hearing loss is a characteristic feature of ND, it is often overlooked due to the prominence of ocular symptoms. This article presents a rare case of ND in a 3-month-old boy who failed the universal newborn hearing screening (UNHS) bilaterally, further audiological evaluation revealed bilateral sensorineural hearing loss. Suggests that patients with ND may be born with congenital hearing loss, earlier than the previous reports. Addressing hearing loss at an early stage can help minimize the compounding effect on cognitive functioning and improve overall mental well-being.
Copyright (c) 2023 Lihui Huang https://creativecommons.org/licenses/by/4.0
Telemedicine for the Surgical Management of Abdominal Trauma in the District Hospitals
The outcomes of the 51 patients with blunt abdominal trauma after the car crash treated in the district hospital were analyzed. 25 patients in a basic group, underwent surgery during which the distant specialist consultation was led via Telemedicine. Telemedicine allowed the specialist surgeon clearly evaluate the degree of the spleen injury and give a suggestion to conduct the organ-preserved operation. In a control group, patients with spleen injury underwent the conventional splenectomy. The short- and long-term outcomes in the basic group were better than in the control group. Telemedicine served as a good tool for performing organ-preserved surgeries in the district hospital and improving the outcomes of patients with intra-abdominal hemorrhage.
Copyright (c) 2023 Emil Iskandarov https://creativecommons.org/licenses/by/4.0
Basal Cell Carcinoma of the Prostate: Case Reports Including an Unusual Presentation
Basal cell carcinoma of the prostate is a rare tumor subtype arising from the prostatic basal cells and follows a variable clinical course. We describe two cases of patients with basal cell carcinoma of the prostate treated at our center. One case involves a patient with prior radiation with brachytherapy for prostatic adenocarcinoma, who subsequently developed a locally aggressive and invasive basal cell carcinoma of the prostate that eventually required pelvic exenteration. To our knowledge, we are the first to describe a case of basal cell carcinoma of the prostate in a patient with prior radiation with brachytherapy for prostatic adenocarcinoma.
Copyright (c) 2023 Gregory T Chesnut https://creativecommons.org/licenses/by/4.0
A Study of Improvement in the Gastro Intestinal Symptoms and Quality of Life after Laparoscopic Cholecystectomy
Objective: To observe the effects of laparoscopic cholecystectomy on gastrointestinal symptoms and improvement in Health- Related Quality of Life. Methods: 100 symptomatic patients with cholelithiasis who underwent laparoscopic cholecystectomy between November 2020 to December 2022 were evaluated for improvement in their gastrointestinal symptoms and Quality of life using the standard questionnaire entailing the Gastrointestinal Symptom Survey (GISS) score and Short Form Survey (SF-36) score from preoperative to 3 months of postoperative follow up. Results: Of 100 patients with mean age 35.16 years SD ±11.98, 82% were females with chronic cholecystitis. Laparoscopic cholecystectomy resulted in significant improvement of gastrointestinal symptoms as revealed by GISS mean scores which showed a decline. The quality of life emblematised by the mean SF-36 scores (84.11±17.31 SD) that showed slight decline from pre- operative (76.55±23.19 SD) till discharge (73.30±16.36 SD) maximally reflected in mean physical function, role limitations due to physical health and social function scores with trend towards gradual improvement from 3 weeks (83.05±15.55 SD) to 12 weeks (91.55±11.89 SD). As regards the individual symptoms constituting GISS, 15 of the 16 gastrointestinal symptoms showed significant improvement with de novo appearance of bloating (10%) and fullness after meals (8%). Conclusion: Laparoscopic cholecystectomy is immensely effective in improvement of Gastrointestinal symptoms and HRQOL.
Copyright (c) 2023 Surbhi Chawla https://creativecommons.org/licenses/by/4.0
Igg4 Pseudo tumors Mimicking Urologic Malignancies: Comprehensive Review and Management of a Rare Infiltrative Upper Tract Lesion
Objectives: Immune-mediated fibroinflammatory conditions are known to affect multiple organ systems, as seen in the IgG-4 related disease. While tubulointerstitial nephritis and membranous glomerulonephritis are the more common intrinsic renal diseases, IgG-4 mediated disease can mimick urologic malignancies and can pose a significant management dilemma. Our goal is to understand how to better diagnose, exclude malignancy, and preserve renal function in a rare Urologic disease. Materials and Methods: A review of current literature was obtained to provide additional insight and understanding on this rarely observed Urologic disease. In discussing the case presented, a pertinent clinical history, physical exam, and review of cross-sectional imaging is presented. Immunohistochemical analysis of the specimen was thoroughly performed with expert analysis by our consulting pathologist. Results: Very rare reports of renal, ureteral, pelvic, or scrotal IgG4 mediated pseudotumors have been published. In the absence of pathologic tissue analysis of biopsy samples, the diagnosis of this rare disease can be significantly challenging. In our presentation, a male patient was noted to have a 7cm mass replacing the left renal sinus and causing moderate left hydronephrosis. Initial concern was for upper tract urothelial cell carcinoma. However, left ureteropyeloscopy demonstrated normal left renal and ureteral architecture and excisional biopsy of a PET avid left cervical lymph node was performed however pathologic diagnosis was not able to be confirmed. This led to a management dilemma due to the progressing mass size, worsening renal drainage, and symptoms. The patient opted for surgical excision. Final pathology from a left radical nephrectomy was significant for an IgG-4 related inflammatory pseudotumor. Conclusions: IgG-4 related diseases are known to represent a systemic disease that leads to lymphoplasmacystic inflammation and fibrosis within the affected tissues. At this time, there is no standardized method for the diagnosis and treatment of patients with retroperitoneal involvement. Additional research is needed to identify improved diagnostic modalities, the role of immunosuppressive therapy, and the surgical management in this disease process.
Copyright (c) 2023 Sean Q Kern https://creativecommons.org/licenses/by/4.0
Gut Instinct: How the Microbiome Affects Traumatic Brain Injury, A Narrative Review
Objectives: Emerging evidence suggests that the gut microbiome may play a role in the pathophysiology of traumatic brain injury (TBI). The objective of this systematic review is to identify and evaluate studies that investigate the relationship between TBI and gut microbiota alterations. Methods: Using the PRISMA 2020 Checklist, we searched five databases to identify relevant studies. Two independent researchers screened titles and abstracts and identified eligible studies according to the following PICO: studies that investigated the relationship between TBI and gut microbiota AND reported outcomes related to gut microbiome alterations. We assessed the risk of bias for included studies, extracted methodological data and related results of the articles, and used them for qualitative analysis. Results: We screened the titles and abstracts of 23 identified records and assessed the full text of 10 studies. In total, 5 studies met eligibility criteria and were entered into the qualitative analysis. These studies investigated the effects of TBI on gut microbiota in animal models and human patients. Although, we planned to systematic review, lack of adequate quantitively and qualitative data compelled us to write a narrative survey. The majority of studies reported significant alterations in gut microbiota composition and function following TBI, with potential implications for immune function, inflammation, and neurological recovery. Conclusion: This systematic review provides evidence supporting a relationship between TBI and alterations in gut microbiota. While the exact mechanisms underlying this relationship remain unclear, these findings suggest that targeting the gut microbiome may represent a novel therapeutic approach for TBI. Further studies are needed to elucidate the mechanisms involved and to evaluate the potential benefits of gut microbiota-targeted interventions in TBI.
Copyright (c) 2023 Mohammad Faraji-Rad https://creativecommons.org/licenses/by/4.0
Are Nodular Goiter Patients Previously Treated with L-Thyroxine have Unfavorable Outcomes after Surgery Compared to Patients without Medical Treatment?
This systematic review aimed to analyze the literature on PubMed Database regarding studies which compare the patient’s post-thyroidectomy outcomes, between those who were treated with L-Thyroxine prior to surgery and those who underwent to thyroidectomy without hormonal suppressive therapy. 500 articles were screened, 11 articles were selected, which were related to the outcomes of interests. Among all these articles with outcome interests, no article is appropriate to the research question of our investigation. The outcomes of surgical treatment of nodular goiter patients, depending on using L-Thyroxine treatment in anamnesis, are very interesting and could bring light to some issues of endocrinology. There is need for further research on this topic to generate relevant evidence on use of L-Thyroxine.
Surgical Management of Sudden Intrathoracic Hemorrhage in Two Patients with Occult Diaphragmatic Injury and Rib Fracture
Background: A sudden massive hemothorax as the initial manifestation of delayed diagnosis of blunt occult diaphragmatic injuries is extremely rare. We report our experience with two cases of sudden massive thoracic hemorrhage treated surgically for occult blunt diaphragm injury. In the present study, we aimed to present the successful rescue of two cases of sudden massive thoracic hemorrhage due to occult blunt diaphragmatic injury during hospitalization by surgical treatment. Sudden massive hemothorax a few days after hospitalization as an initial manifestation of blunt mysterious diaphragm injury is extremely rare.
Rare Cases of Primary Glioblastoma Multiforme in the Cervical Spinal Cord, Report of Two Cases and Literature Review
Glioblastoma multiforme (GBM) is a highly aggressive and malignant tumor that can arise in the central nervous system, including the spinal cord. We presented two cases of GBM in spinal cord and cerebellum, respectively. First, 36-year-old female who presented to our clinic with a two-month history of progressive lower and upper extremities weakness and numbness. He also reported difficulty with urination and defecation. Second patient was 19 years-old-man with history of extremities weakness and neck pain. MRI demonstrated enhanced intra-medullary tumor in cervical spine. Both patients underwent surgical resection, followed by radiation therapy and chemotherapy. Further researches are needed to identify optimal treatment strategies and improve outcomes for patients with GBM in the spinal cord. Close monitoring and follow-up care are essential to manage potential complications and optimize quality of life for affected individuals.
Foley's Catheter Balloon Avulsion of Posterior Urethral Valve in Children: How Effective?
Background: Endoscopic ablation under direct vision is the gold standard for treatment of posterior urethral valve. However, when the facilities are not available, Foley’s catheter balloon avulsion of the valve suffices. The aim of this study was to evaluate the initial outcome of management of children with posterior urethral valve treated by Foley’s catheter balloon avulsion. Materials and Methods: This was a retrospective study of children, aged 15 years and younger, who were treated for posterior urethral valves at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The parameters evaluated included the age of the patient at presentation, duration of symptoms before presentation, time interval between presentation and intervention, presenting symptoms, procedure performed, post-intervention complications, duration of hospital stay and outcome of treatment. Results: A total of 24 children underwent catheter balloon avulsion during the study period. The mean age of the patients at presentation was 18 months and the mean duration of hospital stay was 18 days. Poor urinary stream and overflow incontinence were the most common presentations of the patients. Twenty-three out of 24 (96%) patients achieved full recovery with marked improvements in urinary stream and resolution of urinary symptoms. Patients who had hydronephrosis and vesicoureteric reflux before treatment, had resolutions of their pathologies during the period of follow up. However, one tenth of the patients each, experienced urethral injury and temporary urinary incontinence. Conclusion: In resource poor settings where the necessary facilities are not available, Foley catheter balloon avulsion of posterior urethral valve is a simple and effective modality of treatment.
Copyright (c) 2023 Chukwubuike Kevin Emeka https://creativecommons.org/licenses/by/4.0
Application of Platelet-Rich Plasma in Nasal Tip Reconstruction with Medpor Prosthesis
Objective: To observe the effect of platelet-rich plasma (PRP) on reducing ear cartilage absorption and nasal tip complications after nasal tip plasty with medpor prosthesis. Methods: During the conventional medpor rhinoplasty, PRP was injected locally around the tip and columella of the nose with medpor material. The morphology of the nasal tip cartilage and the shape of the nasal tip were observed at least 1 year after the surgery, and the status of cartilage absorption was judged. The statistical differences between the control group and the experimental group were analyzed by χ²-test. Results: After observation for 1 year, a total of 71 cases underwent conventional medpor rhinoplasty, of which 21 cases had cartilage resorption, and 10 cases had a prominent shape of the nasal tip prosthesis that required repair; In the platelet-rich plasma treatment group, there were 18 cases, 1 case of cartilage absorption, and 0 case requiring repair. There are significant statistical differences in clinical practice. Conclusion: PRP can significantly reduce the absorption of ear cartilage, maintain the appearance of the nasal tip, and improve the satisfaction of patients with medpor prosthesis rhinoplasty.
Copyright (c) 2023 Bin Xu https://creativecommons.org/licenses/by/4.0
Robotic Simple Prostatectomy for Giant Prostate
Benign prostatic hyperplasia (BPH) is a pathological process that contributes to, but is not the sole cause of lower urinary tract symptoms (LUTS) instead age-related detrusor changes and other common medical conditions are the causative factor in many cases. Despite this, benign prostatic hyperplasia (BPH) is still a significant cause of LUTS. The options for management are variable and include watchful waiting, medical therapy, and surgical intervention. Simple robotic prostatectomy was used as the treatment procedure of choice for the patient in this report since he has a large prostate, and according to the AUA and EAU guidelines, surgical management with prostatectomy is the gold standard for such cases. The benefits of using such a technique include precise removal of the prostate gland, minimal blood loss, a smaller opening, less pain, short stay in the hospital, and a reduced requirement for blood transfusion. In the end, it was one of the preferred methods to be utilized for prostate surgery.
Copyright (c) 2023 Hani Albadawe https://creativecommons.org/licenses/by/4.0
Past, Present and Future of THA and Hip Surgery: An Expert Opinion
Innovation in Orthopaedic Surgery is motivated by the desire to improve implant longevity, maximise patient function and reduce postoperative complications.
Copyright (c) 2023 Saccomanni Bernardino https://creativecommons.org/licenses/by/4.0
Juvenile Giant Fibroadenoma Vs Phyllodes Tumor Know the Difference in a 14 Years Old Woman Case Report
Fibroadenoma is the most common benign fibroepithelial lesion of the breast in young women, accounting for around 90% of solid lesions of the gland in adolescence. However, juvenile giant fibroadenoma is a rare breast condition that occurs in women under 18 years of age. Due to the similarity of the characteristics of juvenile giant fibroadenoma and phyllodes tumor, both lesions characterized by rapid growth, it is important to establish the differential diagnosis of both pathologies when one of them is suspected, in order to guarantee the most appropriate therapeutic attitude to follow. A 14-year-old woman with no family or personal history of interest, who consulted due to a clinical picture characterized by breast asymmetry secondary to progressive growth of the left breast of 5 months of evolution. An ultrasound-guided core needle biopsy was performed that reported giant juvenile fibroadenoma. Lumpectomy was performed. Histopathological diagnosis compatible with juvenile giant fibroadenoma of the left breast. Based on our case and on the reviewed bibliography, we recommend an early differential diagnosis, as well as an accurate one, and surgical treatment of cases of juvenile giant fibroadenoma. The surgical tactics and technique depend on the age at the time of diagnosis, the clinical and imaging characteristics of the mammary gland and the tumor, as well as the wishes of the patient in question.
Copyright (c) 2023 Padron S Johnny A https://creativecommons.org/licenses/by/4.0
Closure of Abdominal Incisions Following Laparotomy for Peritonitis in Children Primary Closure or Delayed Primary Closure
Background: There is need to determine the optimal management strategy for dirty abdominal surgical wounds. The aim of this study was to evaluate the post-operative wound complications in children whose dirty surgical wounds were closed primarily, in relation to those closed by delayed primary closure. Materials and Methods: This was a prospective evaluation of children, aged 15 years and younger, who had laparotomy for peritonitis in a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were evaluated: patients’ age, gender, presenting symptoms, laboratory results at presentation, duration of symptoms before presentation, time interval between presentation and intervention, intra-operative finding, definitive operative procedure performed, complications of treatment, and outcome of treatment of the 2 groups of patients. Results: A total of 204 cases of peritonitis in children were operated upon during the study period. The incisions were closed by primary closure (Group A) in 104 (51%) while 100 (49%) surgical wounds were closed by delayed primary closure (Group B). More males were involved. All the patients had abdominal pain and about half the patients were anemic and had electrolyte imbalance at presentation. Typhoid intestinal perforation was the most common cause of peritonitis and closure of ileal perforation was the most frequent performed surgical procedure. Comparing the 2 groups of patients, surgical site infection and stitch related were less common in group B patients whose surgical incisions were closed by delayed primary closure. Conclusion: Delayed primary closure of dirty laparotomy incisions has less complication in terms of surgical site infection and stitch related complications. Therefore, delayed primary closure of dirty laparotomy wounds is advocated in pediatric population.
Copyright (c) 2022 Chukwubuike Kevin Emeka https://creativecommons.org/licenses/by/4.0
Testis Sparing Surgery in Double Testicular Tumor in a Child Report of a Case
Mature teratomas are the most common benign testicular tumour during childhood. Epidermoid cyst are rare benign tumours, being more frequent before adolescence. We report so far the only case of ipsilateral and synchronous mature teratoma and epidermoid cyst in paediatric age.
Copyright (c) 2022 Bernardo Nunez https://creativecommons.org/licenses/by/4.0
Epidemiological Study of Molecular and Genetic Classification in Adult Diffuse Glioma
Background: Mutations in isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2) are frequent in lowgrade and high-grade gliomas. However, the diagnostic criteria, in particular for gliomas, are highly various. The aim of our study was to establish genetic profiles for mutation and calcification of diffuse gliomas and to evaluate their predictive factors. Methods: We estimate the different clinical and molecular characterization between IDH1, IDH2 mutant gliomas, p53, ATRX and 1p19q. In addition, whole-transcriptome sequencing and DNA extraction data were used to evaluate the distribution of genetic changes in IDH1 and IDH2 mutant gliomas in a Iranian high grade glioma. Results: Between 2016-2019, among 53 gliomas in our study, 29 cases (54.7% %) harbored an IDH1,2 mutation, 21 cases (39.6 %) harbored an p53 mutation and 19 cases (35.8 %) harbored an ATRX. In addition, 1p19q co-deletion mutation was found in 7 cases (12.2%). We found that IDH1 and IDH2 are mutually entirely in gliomas. There was no significant relation between histopathology, tumor location and clinical finding with diagnosed mutations. Conclusion: Our study discloses an associated distinction between IDH1 and IDH2 mutant gliomas nearly in half of patients, followed by p53. These mutations should be reviewed separately because their differences could have indication for the diagnosis and treatment of IDH1/2 mutant gliomas.
Copyright (c) 2022 Mohammad Faraji-Rad https://creativecommons.org/licenses/by/4.0
Malignant Transformation of Intracranial Epidermoid Cyst to Squamous Cell Carcinoma, Case Report and Literature Review
Intracranial Epidermoid cysts (ECs) are rare, benign tumor of central nervous system that appears from maintain ectodermal implants. Malignant transformation of an EC to squamous-cell carcinoma (SCC) is rarely reported. Intracranial squamous cell carcinoma has known as a poor prognosis condition that optimal modalities remain uncertain. We present the case of 43-years old male complained 3 months severe headache and right eye hemianopia. Primary evaluation depicted right homogenous brain mass which was successfully totally removed. Pathological assessment found epidermoid cyst without any sign of malignancy. Six months later, patient was referred with episodes of intermittent headache and right eye blindness. After initial imaging, new tumor was growth in same site of frontal epidermoid cyst. Second surgery was performed and pathological report discloses to be a malignant SCC. SCC transformation was confirmed by two expert neuro- pathologists. The exact underlying mechanism causing malignant transformation is not definitely known and it seems SCC may have been transformed due to chronic inflammatory respond to epidermoid cyst. Literature reviews demonstrate that, although, optimal total resection in addition adjuvant radiotherapy is the recommended management of choice, patient’s general survival of this condition is generally poor and long-term follow-up is important.
Mesenteric Cystic Lymphangioma Induced Recurrent Abdominal Pain And Signs of Intestinal Obstruction: A Case Report
Mesenteric cystic lymphangioma is an uncommon benign abdominal mass. This is a case of a 40-year-old female who presented to the hospital with recurrent abdominal pain and distention. Computed Tomography and magnetic resonance imaging tests suggested a mesenteric cyst. The patient underwent laparotomy which confirmed the presence of a mesenteric cyst along with small bowel narrowing at the site of the cyst caused by multiple adhesive bands released during the procedure. The cyst was found and excised approximately 200 cm away from the ileocecal junction, and was pathologically confirmed to be a mesenteric cystic lymphangioma. These findings support that mesenteric cystic lymphangioma could cause chronic abdominal pain and intestinal obstruction.
Copyright (c) 2022 Ebrahim Aldouseri https://creativecommons.org/licenses/by/4.0
As a surgeon, few of us know much about ergonomics. However, all of us use ergonomics by instinct. How is that then? When we try to put everything at the “right” place in a surgical field, position the patient in a way that makes working easier for us, and perform fine maneuvers with our instruments in deep cavities with limited space we are using ergonomics; or trying to be ergonomic. Ergonomics is a rapidly growing science and is an essential part in every industrial product; be it the handle of a laparoscopic tool or a sophisticated surgical robot. We should feedback the Industry about what is more ergonomic for us, or what we “expect” from a product. If such a mutual communication develops, then we will be more satisfied by technical innovations in instruments. Ergonomics also applies to technical capabilities of humans; what makes some one better than others at handwork. Generally, this is the matter of inherent talent, which is diverse. However, all of surgeons need to be best at handwork during surgery. This is why we should learn more about ergonomics.
Copyright (c) 2022 Faramarz Karimian https://creativecommons.org/licenses/by/4.0
The Challenges of Achieving Universal Health Coverage by 2030 in a Sub-Saharan African Country (Kenya)
The World Health Organization (WHO) recommends a minimum of 2 Physicians per 10,000 population. Thirty of the 47 sub-Saharan African (SSA) countries are below this level, 7 just qualify and only 10 are above this figure.
Copyright (c) 2022 Mwang’ombe NJM https://creativecommons.org/licenses/by/4.0