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Publisher: ScopeMed   (Total: 99 journals)   [Sort by number of followers]

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Acta Informatica Medica     Open Access   (SJR: 0.217, h-index: 4)
Advance Laboratory Medicine Intl.     Open Access   (Followers: 2)
Advance Tropical Medicine and Public Health Intl.     Open Access   (Followers: 13)
Alexandria J. of Veterinary Sciences     Open Access  
Anatolian J. of Psychiatry     Open Access   (Followers: 2, SJR: 0.183, h-index: 6)
Anatomica Karnataka - an Intl. J.     Open Access   (Followers: 1)
Annals of Ayurvedic Medicine     Open Access   (Followers: 4)
Annals of Paediatric Rheumatology     Open Access   (Followers: 7)
Applied Medical Research     Open Access  
Archives Medical Review J.     Open Access  
Archives of Clinical and Experimental Surgery     Open Access   (Followers: 5)
Asian J. of Medical Research     Open Access   (Followers: 1)
Asian J. of Pharmaceutical and Biological Research     Open Access   (Followers: 3)
Bağımlılık Dergisi - J. of Dependence     Open Access   (Followers: 1)
Balkan Military Medical Review     Open Access   (Followers: 2)
Bulletin of Clinical Psychopharmacology     Open Access   (Followers: 3, SJR: 0.15, h-index: 9)
Case Study and Case Report     Open Access   (Followers: 2)
Cukurova Medical J.     Open Access  
Diagnostic And Therapeutic Study     Open Access   (Followers: 1)
Disease and Molecular Medicine     Open Access   (Followers: 1)
Düşünen Adam : The J. of Psychiatry and Neurological Sciences     Open Access   (Followers: 2, SJR: 0.118, h-index: 2)
Ekonomik Yaklaşım     Open Access   (Followers: 2)
European J. of Forensic Sciences     Open Access   (Followers: 16)
Gaziantep Medical J.     Open Access  
Gulhane Medical J.     Open Access   (SJR: 0.126, h-index: 7)
Hand and Microsurgery     Open Access   (Followers: 1)
Indo American J. of Pharmaceutical Research     Open Access  
Intl. J. for Agro Veterinary and Medical Sciences     Open Access   (Followers: 2)
Intl. J. of Basic & Clinical Pharmacology     Open Access   (Followers: 2)
Intl. J. of Clinical and Surgical Advances     Open Access   (Followers: 1)
Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 2)
Intl. J. of Current Research and Review     Open Access  
Intl. J. of Health and Rehabilitation Sciences     Open Access   (Followers: 13)
Intl. J. of Health Sciences and Research     Open Access  
Intl. J. of Livestock Research     Open Access  
Intl. J. of Medical and Pharmaceutical Sciences     Open Access   (Followers: 3)
Intl. J. of Medical Research     Open Access   (Followers: 2)
Intl. J. of Medical Science and Public Health     Open Access   (Followers: 3)
Intl. J. of Pharmacy and Biotechnology     Open Access   (Followers: 1)
Intl. J. of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 7)
Intl. J. of Research in Medical Sciences     Open Access   (Followers: 1)
Intl. J. of Surgery and Medicine     Open Access   (Followers: 2)
Intl. J. of Therapies and Rehabilitation Research     Open Access   (Followers: 13)
Intl. J. of Tropical Medicine and Public Health     Open Access   (Followers: 3)
Intl. Surgery J.     Open Access   (Followers: 1)
Iranian J. of Applied Animal Science     Open Access  
J. of Advance Researches In Biological Sciences     Open Access  
J. of Animal Production Advances     Open Access   (Followers: 2)
J. of Animal Science Advances     Open Access   (Followers: 3)
J. of Applied Pharmaceutical Science     Open Access  
J. of Behavioral Health     Open Access   (Followers: 5)
J. of Clinical & Experimental Research     Open Access  
J. of Cognitive-Behavioral Psychotherapy and Research     Open Access   (Followers: 2)
J. of Contemporary Medical Education     Open Access   (Followers: 8)
J. of Contemporary Medicine     Open Access  
J. of Environmental and Occupational Science     Open Access   (Followers: 4)
J. of Experimental and Integrative Medicine     Open Access  
J. of Intercultural Ethnopharmacology     Open Access   (Followers: 1)
J. of Interdisciplinary Histopathology     Open Access  
J. of Investigational Biochemistry     Open Access   (Followers: 2)
J. of Islamic Intl. Medical College     Open Access  
J. of Marmara University Institute of Health Sciences     Open Access  
J. of Molecular Pathophysiology     Open Access   (Followers: 1)
J. of Mood Disorders     Open Access   (Followers: 2)
J. of Neurobehavioral Sciences     Open Access  
J. of Ornamental Plants     Open Access   (Followers: 1)
J. of Pakistan Medical Association     Open Access   (Followers: 2)
J. of Physical Therapy     Open Access   (Followers: 25, SJR: 0.101, h-index: 4)
J. of Physiology and Pharmacology Advances     Open Access   (Followers: 1)
J. of Recent Advances in Agriculture     Open Access  
J. of Research and Education in Indian Medicine     Open Access   (Followers: 1)
J. of Research in Medical and Dental Science     Open Access   (Followers: 1)
J. of Veterinary Advances     Open Access   (Followers: 4)
J. Riphah College of Rehabilitaion Sciences     Open Access  
J.-Cardiovascular Surgery     Open Access   (Followers: 1)
Materia Socio Medica     Open Access  
Medical Archives     Open Access   (Followers: 1, SJR: 0.173, h-index: 11)
Medical J. of Umraniye     Open Access  
Medicine Science : Intl. Medical J.     Open Access   (Followers: 1)
Narayana Medical J.     Open Access  
National J. of Clinical Anatomy     Open Access   (Followers: 2)
National J. of Integrated Research in Medicine     Open Access   (Followers: 1)
National J. of Medical Research     Open Access   (Followers: 2)
National J. of Physiology, Pharmacy and Pharmacology     Open Access   (Followers: 2)
Nigerian J. of Basic and Applied Sciences     Open Access   (Followers: 1)
OncoDrugs     Open Access  
Oxidants and Antioxidants in Medical Science     Open Access   (Followers: 2)
Progress in Orthopedic Science     Open Access  
Psikiyatride Güncel Yaklaşımlar     Open Access   (Followers: 1)
Rawal Medical J.     Open Access   (SJR: 0.145, h-index: 4)
Sokoto J. of Veterinary Sciences     Open Access   (Followers: 1)
Southeast Asian J. of Case Report and Review     Open Access   (Followers: 3)
Spatula DD     Open Access  
TAF Preventive Medicine Bulletin     Open Access   (Followers: 1, SJR: 0.119, h-index: 2)
TIPMED     Open Access  
Turkish J. of Family Medicine & Primary Care     Open Access  
Ulutas Medical J.     Open Access   (Followers: 2)
Veterinary Research Forum     Open Access   (Followers: 3)
Veterinary World     Open Access   (Followers: 3, SJR: 0.205, h-index: 8)
Journal Cover International Journal of Surgery and Medicine
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   ISSN (Print) 2367-7414 - ISSN (Online) 2367-699X
   Published by ScopeMed Homepage  [99 journals]
  • Evaluation of Thoracic Trauma Severity Score in Predicting the Outcome of
           Isolated Blunt Chest Trauma Patients

    • Abstract: 2016-05-11T09-19-30Z
      Source: International Journal of Surgery and Medicine
      adel hamed elbaih, islam Mohamed elshapowry, Nancy gharib kalil.
      Background: Chest trauma is a significant cause of mortality and morbidity, especially in the younger population. Injuries to the thorax are the third most common injuries in trauma patients, next to injuries to the head and extremities. Outcome and prognosis for the great majority of patients with chest trauma are excellent. There are many predictors of mortality in chest trauma patients however; the present standards for assessing thoracic trauma vary widely. For this in 2000 Pape et al developed the Thoracic Trauma Severity Score (TTSS), which combines the patient's age, resuscitation parameters, and radiological assessment of the thorax.  Aim of this study: was to assess the validity if any; of the Thorax trauma severity score and its ability to predict mortality in blunt chest trauma patients. Methodology: this was a cross sectional study, the study included 30 patients. Results: the (TTSS) was found to be a good predictor for mortality among the studied patients on initial evaluation; with a score larger than (7), the score is 100% sensitive and 100% specific for prediction of poor outcome (Death and ICU admission) versus good outcome (Discharge from ER and inpatient admission) with 100% positive predictive value and 100% negative predictive value. Conclusio: This study supports the use of the TTSS for predicting mortality in thoracic injury patients, as higher scores were associated with higher mortality and morbidity.

      PubDate: Sun, 08 May 2016 08:09:53 GMT

    • Abstract: 2016-05-01T23-19-56Z
      Source: International Journal of Surgery and Medicine
      Ivan Inkov, Desislava Penkova, George Baytchev, Zdravko Kamenov, Mila Kayriakova, Dimo Manov.
      Breast cancer is a diverse disease, demonstrating as several different clinical and histologic types. About 68-78% of breast cancers express estrogen receptor alfa (ER-a), and are viewed as ER-positive (ER+) and progesterone receptors, these are considered as PR-positive (PR+). This offers a rationale for HR-targeted therapy in such cases. Endocrine therapy was the first class of target-directed therapy approved for treating breast cancer and is still very important for the treatment of HR+ breast cancer because of its effectiveness and good toxicity profile. It targets receptor-mediated signaling pathways implicated in cell survival and proliferation, such as those mediated by hormone receptors. Although these approaches have improved the management of advanced breast cancer, many patients either fail to respond to initial therapy (primary or de novo resistance) or eventually become resistant to treatment (secondary or acquired resistance). To expand the use of existing endocrine treatments and their efficiency, new methods are needed. Such new approaches would boost the benefit of existing endocrine therapy by extending time to disease progression, avoiding or overcoming resistance to endocrine treatment, and delaying the use of chemotherapy. This article will review the central role of the PI3K inhibitors in driving ER+/HER2- breast tumors. Also, schemes to combine pathway inhibitors with endocrine therapy for better patient outcome, and approaches to identify patient populations that would benefit most from inhibition of the PI3K/AKT/mTOR pathway will be assessed.

      PubDate: Sat, 30 Apr 2016 10:00:18 GMT
  • The obturator hernia: difficult diagnosis- easy repair

    • Abstract: 2016-05-01T23-19-56Z
      Source: International Journal of Surgery and Medicine
      Poonam Tanwar, Amit Jaiswal, Pritviraj S K, Jaikaran Ruhil, Rajesh Godara.
      Obturator hernia is rare pelvic hernia difficult to diagnose clinically because of non specific symptoms and obscure physical findings. Delayed diagnosis, frequent complications leads to significant mortality. Use of computerised tomography in diagnosis and early repair either suture based or mesh placement depending on circumstances is associated with good outcome.

      PubDate: Fri, 29 Apr 2016 05:37:27 GMT

    • Abstract: 2016-04-27T14-43-32Z
      Source: International Journal of Surgery and Medicine
      Ventsislav Mutafchiyski, Georgi Popivanov, Emilia Naseva, Kyosev Vasil, Kirien Kjossev, Plamen Ivanov, Grigor Grigorov, Georgi Kotashev, Krasimir Vasilev, Marin Penkov.
      Background: Currently, there has been an increasing trend toward transanal endoscopic microsurgery as a definitive treatment of T1 rectal cancer. Despite the promising results from the earlier series, the more recent studies reported a higher rate of local recurrences. Methods: A retrospective analysis of 20 patients with T1 rectal cancer managed by transanal endoscopic microsurgery is presented. Results: The patients were followed-up for mean 39.3 months. Local recurrences occurred in 5.3% of low-risk, 50% of high-risk T1 cases. The 3-year and 5-year cancer-specific survival in T1 group were 94.4% and 73.5%, respectively with mean time without LR was 81.5 months (90.5 months in the low-risk and 21 months in the high-risk group). Conclusion: The results corroborate the excellent prognosis for low-risk T1 cancers treated by TEM alone. For a high-risk T1 cancer adjuvant radiotherapy or conventional resection is highly recommended.

      PubDate: Sun, 24 Apr 2016 13:59:19 GMT

    • Abstract: 2016-04-27T14-43-32Z
      Source: International Journal of Surgery and Medicine
      Francesco Inzirillo, Casimiro Giorgetta, Eugenio Ravalli, Alessia Marziani, Francesco Sangrigoli, Claudio Della Pona.
      The paper present the images about a case of inusual foreign body in the left main bronchus that was removed with a very risky maneuver.

      PubDate: Sun, 24 Apr 2016 13:53:23 GMT
  • Gastrointestinal Metastases of Malignant Skin Melanoma – Report of 2
           Cases and Review of Literature

    • Abstract: 2016-04-18T14-38-59Z
      Source: International Journal of Surgery and Medicine
      Sergey Dimitrov Iliev, Paulina Trifonova Vladova, Savelina Popovska.
      According to the database from the National Cancer Registry malignant skin melanoma is one of the most malignant skin tumors. The prognosis of malignant skin melanoma is bad because of its high degree of aggressiveness and tendency to metastases. Metastases in the gastrointestinal tract are frequently found as 80% of the malignant skin melanoma metastases in the gastrointestinal tract affect the small intestines. We present 2 cases of patients with metastases in the gastrointestinal tract from malignant skin melanoma, where radical surgical interventions on gastrointestinal metastases have been performed. The presence of distant metastases is the most important prognostic indicator for the survival of the patients with diagnosed malignant melanoma. In both cases presented surgical treatment has been made - resection of the small intestines area affected by the tumor metastases with subsequent anastomosis, observing the principles of operative surgical oncology. The patients were monitored during a period of 6 months and 1.5 years and their quality of life has been good. In cases of metastasеs from malignant skin melanoma in GIT surgical interventions must be made. This way the survival rate of the patients can be increased and their quality of life can be improved.

      PubDate: Sun, 17 Apr 2016 00:55:50 GMT
  • Accuracy of Predictive Factors and Focused Assessment with Sonography for
           Trauma (FAST) in Management of Adult Blunt Abdominal Trauma and Its
           Outcome in Suez Canal University Hospital

    • Abstract: 2016-04-05T17-33-20Z
      Source: International Journal of Surgery and Medicine
      Adel Elbaih, Mohammad Ali, Yasmin Attia.
      ABSTRACT Background:Abdominal trauma is a major public health problem for all nations and all socioeconomic strata. Methods:The studyincluded adult patientsattending emergency department in Suez Canal University Hospital,Data was collected in pre-organized data sheet by the researcher. Then, the patients were followed up and recorded till they reached one of these final outcomesLater on, the actual outcome of the patient was compared to the predictors and FAST results, then sensitivity, specificity and accuracy were calculated. Results:Seventy five patients were eligible, of which ten patients had a FAST-positive result, and seven patients underwent a therapeutic laparotomy. In multivariate analysis,the factors correlating with a therapeutic laparotomy were pulse (>100beat/minute), respiratory rate (>29 cycle /minute), O2 saturation, abdominal gardening by examination and a FAST-positive result (sensitivity 80%, Specificity 100%, accuracy 97%, positive predictive value 100% and negative predictive value 97.3%) ,were pulse as the most sensitive predictor (99%) followed by respiratory rate (98%) while the most specific predictors were pulse (97.1%). Conclusions:The management of trauma patients depends upon their clinical status, imaging findings, and the resources and expertise available. Rapid recognition of key abnormalities on FAST and abdominal CT can help select trauma patients for the most appropriate treatment: surgery, interventional radiology or conservative management. Physical examination alone is not sufficient to determine the need for emergent interventions.

      PubDate: Sun, 03 Apr 2016 15:50:27 GMT
  • Neuroblastoma in an adult: a case report of a rare entity with a summary

    • Abstract: 2016-03-26T17-00-49Z
      Source: International Journal of Surgery and Medicine
      Fadoua Rais, Naoual Benhmidou, Ghizlane Rais, Abdelhak Maghous, Hasnaa Loughlimi, Fadila Kouhen, Jihane Aarab, Khadija Bellahammou,Mouna Khmou,Karima Laadam,Fouad Zouaidia, Sanaa Elmejjaoui, Tayeb Kebdani, Hanan Elkacemi, Noureddine Benjaafar.
      Neuroblastoma is a very uncommon neoplasm in adulthood. It occurs almost exclusively in children younger than 10 years (More than 90% of cases). We report the case of a healthy 40-year-old male who complained of a right flank pain in 2010. Clinical examination revealed an enormous abdominal mass involving the adrenal gland as showed at abdominal CT scan. The patient underwent a surgical en-bloc excision of the right adrenal mass, after a laborious dissection of the tumor. Histological and immunohistochemical findings were suggestive of a neuroblastoma. Adjuvant treatment was not indicated since the complete gross excision of the tumor was performed, and subsequently the patient was considered stage 1 disease and because of the unavailability of MYCN status, necessary for achieving risk group stratification and a risk-adapted strategy. The patient remained in good local control, until January 2015 when he accused a locoregional and metastatic relapse consisting of two new para-renal masses and magma of celiac adenomegalies extending into the mediastinum. As the mass was considered unresectable, therapeutic decision of administrating neoadjuvant chemotherapy, followed by local treatment (surgery and / or radiotherapy) based on tumor response was taken. Given the bad tumor response to systemic treatment, a palliative radiotherapy was instaured. Currently the patient is two months after the end of radiation with mild clinical improvement. The purpose of presenting this case is not only to report an uncommon malignancy in adulthood, but also to raise awareness among clinicians adding this clinical entity as a differential diagnosis when a retroperitoneal mass is identified. We also conducted a literature review to enhance clinicians’ acknowledgment about the management of this rare entity in adults.

      PubDate: Wed, 23 Mar 2016 14:26:35 GMT
  • Trends in prescribing and utilization of Antidiabetic drugs in primary
           health care in Albania during 2004-2014

    • Abstract: 2016-03-14T00-15-31Z
      Source: International Journal of Surgery and Medicine
      Laerta Kakariqi.
      Abstract Aim: To describe trends in out-of-hospital utilization and prescribing of antidiabetic drugs in Albania using the Anatomic Therapeutic Chemical Classification/ Defined Daily Dose -(ATC/DDD methodology). Methods: The study was retrospective and we analyzed the prescription and consumption of these drugs classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The consumption of all insulins were 1.80-5.64 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of insulin fast-acting were 0.47-2.59 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of insulin intermediate-acting were 0.38-0.70 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of insulin intermediate-acting combined with insulin fast-acting were 0.95-1.18 DDD/1000 inhabitants/day. The consumption of insulin long-acting were 0.00-1.41 DDD/1000 inhabitants/day. The most prescribed oral antidiabetic agent was metformin 3.04-7.45 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of glibenclamide was 3.55-5.76 DDD/1000 inhabitants/day (respectively 2004-2007). Conclusions: There is an increase in Antidiabetic drugs use from HII covering, while there is a significant increase in their use from out-of-pocket expenditure during 2004-2014. There can be noted a visible discrepancy between the consumption of antidiabetic drugs and the diabetes mellitus morbidity, which indicates that only a part of patients with diabetes mellitus do benefit from the reimbursement scheme.

      PubDate: Thu, 10 Mar 2016 14:27:03 GMT
  • Percutaneous endoscopic gastrostomy in dementia suffering Greek

    • Abstract: 2016-03-09T09-20-59Z
      Source: International Journal of Surgery and Medicine
      Dementia in geriatric patients is a major cause of malnutrition. In this article, the impact of Percutaneous Endoscopic Gastrostomy placed in these persons is explored in order to understand the choices of the relatives leading to their placement. A retrospective analysis of the epidemiologic, clinical and demographic data of 51 persons with PEG placement is performed. The patients’ mean age was 74 years, most of them came from another hospital department (64.71%), all returned home but three, who went to a rehabilitation center. All their relatives had a university education or higher, and in 26 cases the relative was a doctor. Lack of major common complications, easier and faster feeding has increased the decision of the PEG placement, according to the family, who can have more “constructive time” with their relative without great psychological burdens.

      PubDate: Mon, 07 Mar 2016 15:15:20 GMT
  • Effectiveness of lidocaine/prilocaine cream on perceived pain during
           mammography: A pilot study

    • Abstract: 2016-03-03T14-17-54Z
      Source: International Journal of Surgery and Medicine
      Arzu Akan Atalay, Serife Simsek, Sedat Kamalı, Serdar Gökay Terzioğlu, Murat Özgür Kılıç.
      Background: Mammography (MG) is an important imaging method in the diagnosis of breast diseases. However, pain during MG is an uncomfortable factor for the majority of women. Aim: The aim of this study is to determine the effectiveness of lidocaine/prilocaine cream on reducing pain during mammography. Methods: This is a prospective clinical study. A total of 60 female patients who had mammographic examination were equally divided into three groups; patients receiving 10 g EMLA cream (EMLA group), patients receiving 10 g Bepanthen cream (placebo group), and patients not receiving any cream (control group). Pain levels were assessed by using visual analogue scale (VAS) before and after MG. RESULTS: Each group was statistically similar in terms of basic patient characteristics. There was also no significant difference between the pre-MG VAS scores of the three groups (p = 0.996). On the other hand, VAS scores during MG was found significantly different between the groups (p = 0.001). When the groups were compared in pairs, the patients in EMLA group had significantly less post-MG VAS score than the Bepanthen and control groups (p = 0.001). There was no significant difference between Bepanthen and control groups (p = 0.678). CONCLUSION: To our knowledge, this is the first study demonstrating that a topical anaesthetic, EMLA, provides an effective analgesia during MG. Reducing the pain can change women’s preconceptions regarding MG.

      PubDate: Sun, 28 Feb 2016 00:32:06 GMT
  • Pancreatic cystic neoplasms: A case series

    • Abstract: 2016-03-03T14-17-54Z
      Source: International Journal of Surgery and Medicine
      Murat Özgür Kılıç, Ahmet Erdoğan, Cengiz Ceylan, Barış Saylam, Mesut Tez.
      Background: Cystic neoplasms of the pancreas are a special heterogeneous group of pancreatic tumors with variable clinical and diagnostic characteristics. Its incidence has dramatically increased in recent years due to technological improvements in cross-sectional imaging methods, rising in awareness of their existence, and increased in human life-spam. Aim: To evaluate the clinical, radiological, and surgical characteristics of pancreatic cystic neoplasm. Methods: The clinical findings, diagnostic features, therapeutic managements, and oncological outcomes of 16 patients with pancreatic cystic neoplasm were retrospectively evaluated. Results: There were nine female and seven male patients, with a mean age of 54 years. More than half of the patients (56.3%) were asymptomatic. Abdominal pain and icterus were the most common symptom and sign, respectively. Computed tomography and magnetic resonance imaging showed the cystic lesion in all patients. Magnetic resonance imaging revealed a connection between cystic tumor with pancreatic duct in 8 (50%) cases. Pancreaticoduodenectomy was the most performed operation. Pancreatic adenocarcinoma with cystic degeneration and solid pseudopapillary neoplasia were the most frequent diagnoses at the final histopathology. Pancreatic fistula was developed in one case. One patient died during the postoperative period. Two patients who had adenocarcinoma developed recurrence during the follow-up period. Conclusion: The discrimination of pancreatic cystic neoplasms is usually difficult preoperatively. Therefore, the structure and the localization of the lesion, and the involvement of pancreatic ductal system should be clearly demonstrated by imaging modalities for a correct surgical planning.

      PubDate: Sun, 28 Feb 2016 00:31:31 GMT

    • Abstract: 2016-02-09T01-03-21Z
      Source: International Journal of Surgery and Medicine
      Lubna Noor, Pudhupalayam Bhaskar.
      Lipofilling is a useful surgical technique for breast reconstruction following cancer surgery. It has a unique place in the correction of both lumpectomy and post-mastectomy reconstruction defects. The procedure is mostly performed as lipofilling without ADRC. In this study, we included patients who had lipofilling with or without ADRC. We divided patients into two groups. Group I comprised of patients with lipofilling for lumpectomy defects and group II included patients with post mastectomy reconstruction defects. We compared the outcome of lipofilling with or without ADRC. The mean time from oncological surgery to the fat grafting procedure was 58 months (range 20 months to 17 years). An average of 232 ml of fat (80-420 ml) was injected. No immediate postoperative complications were seen. The average follow-up was 50 months following lipofilling procedure. Benign imaging changes were observed in 18/53 (33 percent) patients. A percutaneous biopsy was required in 6 patients (11.3%). No local recurrences were seen in either group of patients. Our results suggested no increase in the risk of local recurrence or new cancer development following lipofilling in breast cancer patients. Patients with stage III disease were found to be at a higher risk of distant metastasis.

      PubDate: Sat, 30 Jan 2016 23:43:04 GMT

    • Abstract: 2016-02-09T01-03-21Z
      Source: International Journal of Surgery and Medicine
      Lona Jalini, Dave Fok Nam Fung, Kaushik Kumar Dasgupta, Vijay Kurup.
      Background: Axillary lymph node status is the most important breast cancer prognostic factor. Preoperative axillary ultrasound examination (PAUS) is used to triage patients for sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). We assessed the detection rate of lymph node metastases by PAUS in a screening unit and evaluated associations between clinicopathological factors and PAUS positivity. Patients and Methods: This was a single-centre retrospective analysis of data extracted from a hospital breast cancer database and clinical records. Clinical, radiological, and pathological and prognostic indices were compared between PAUS-positive and PAUS-negative patients subsequently found to have lymph node metastases on histopathological analysis. Results: Two hundred and two patients were eligible for analysis. 50.5% of lymph node-positive patients were correctly identified as PAUS positive. Patients with PAUS-positive lymph nodes had less favorable disease characteristics, namely clinically palpable lymph nodes, higher Nottingham prognostic (NPI) index, high lymph node burden according to the European Society of Medical Oncology (ESMO) group classification, and larger, grade 3 tumors with lymphovascular invasion and extranodal spread. Moreover, PAUS-positive patients had more macrometastases and lymph node involvement than PAUS-negative patients. Conclusion: PAUS-positive patients and PAUS-negative (SLNB-positive) patients have different clinicopathological characteristics. The presence of LVI, extranodal spread, grade 3 histology, or large tumors with poor prognostic indices in PAUS-negative patients should be regarded with caution and perhaps prompt second-look ultrasound examination.

      PubDate: Sat, 30 Jan 2016 23:43:04 GMT
  • The comparison of evening primrose oil, fructus agni casti and reassurance
           in the treatment of mastalgia

    • Abstract: 2016-02-09T01-03-21Z
      Source: International Journal of Surgery and Medicine
      Murat Özgür Kılıç, Meral Şen, Duygu İçen.
      Background: Although many therapeutic options have been used in the treatment of mastalgia, none of those has a curative effect. Aim: In this study, we aimed to investigate the effects of evening primrose oil, Fructus Agni Casti and reassurance on mastalgia, in comparison to placebo. Methods: This is a prospective clinical study on the effectiveness of evening primrose oil, Fructus Agni Casti and reassurance in the treatment of mastalgia. One hundred twenty-eight female patients with mastalgia were placed randomly into four groups: (1) evening primrose oil, (2) Fructus Agni Casti, (3) reassurance, and (4) placebo, for the treatment of 3 months. The severity and type of mastalgia were evaluated according to the Breast Pain Questionnaire. Response to treatment was assessed by the Cardiff Breast Pain scoring system. RESULTS: Fructus Agni Casti group had a more effective therapeutic response when compared with other groups. Reassurance and evening primrose oil groups had similar effects on reducing breast pain. The worst response to treatment was obtained in the placebo group. During follow-up, no serious adverse effect was observed. CONCLUSION: Fructus Agni Casti can be used in mastalgia patients with a high success rate and less adverse effect profile. Reassurance may be an important part of mastalgia management, due to the psychological basis of this entity.

      PubDate: Sat, 30 Jan 2016 11:51:56 GMT

    • Abstract: 2016-02-09T01-03-21Z
      Source: International Journal of Surgery and Medicine
      Francesco Inzirillo, Ravalli Eugenio, Casimiro Giorgetta, Francesco Sangrigoli, Alessia Marziani.
      Malpositioning of the nasogastric tube into the airway is one of the most frequent complications and the consequences of improper positioning of the tube in the airways depend on several factors: creation or not of a pleuro-pulmonary fistula, introduction or not of drugs into the tube, the overall clinical condition of the patient. A pneumonia caused by instillation of drugs or a pneumothorax or a mediastinitis may precipitate a clinical situation already basically compromised.

      PubDate: Sat, 30 Jan 2016 07:49:49 GMT
  • The effect of Hydrogen Peroxide on the healing of the laid open wound in
           the treatment of chronic sacrococcygeal pilonidal sinus: A retrospective
           database analysis of 500 patients

    • Abstract: 2016-01-29T13-05-45Z
      Source: International Journal of Surgery and Medicine
      Bader H Shirah, Hamza A Shirah.
      Background: Many clinical studies reported excellent results when the lay open method was used as a treatment of chronic sacrococcygeal pilonidal sinus, despite leaving the wound open for long time, and the increase risk of infection and recurrence. In our study, we aim to analyze the effectiveness of Hydrogen Peroxide use in the postoperative care of the laid open sacrococcygeal pilonidal wound in regard to wound infection, healing, and recurrence. Methods: 500 patients with chronic sacrococcygeal pilonidal sinus were included in our study. 383 were male and 117 were female (age range, 16–39). Lay open was performed to all patients. 250 patients accepted the protocol of Hydrogen Peroxide wound care, the other 250 patients preferred normal saline wound care. Postoperative follow up methods were similar to all patients. Results: Recurrence rate was 0% after 5 years of follow up for the lay open technique in all 250 patients in H2O2 group, and 2% in the normal saline group. Postoperative wound infection rate was 3.2% in the H2O2 group compared to 19.2% in the normal saline group, and the average healing time for the H2O2 group was 21 days, while in the normal saline group was 28 days. Conclusion: We conclude when 3% Hydrogen Peroxide is used for cleaning the laid open wound in treating chronic sacrococcygeal pilonidal sinus, with good postoperative care, and regular follow up, is effective in helping to achieve a zero (0%) recurrence rate, low wound infection rate, and short healing time.

      PubDate: Thu, 28 Jan 2016 06:07:35 GMT
  • Multivisceral Resection for Colo-rectal Cancers: An Analysis of Prognostic
           Factors and Outcomes

    • Abstract: 2016-01-19T14-17-22Z
      Source: International Journal of Surgery and Medicine
      Happykumar Kagathara, Shailendra Lalwani, Vivek Mangla, Amitabh Yadav, Naimish Mehta, Samiran Nundy.
      For colorectal cancer patients, long term survival is achievable only after complete resection of the disease. However the decision to embark on a multi-visceral resection must be made after weighing the risks against the potential benefits. We retrospectively analysed the demographics, tumor parameters, perioperative results, oncological outcomes and survival details of 35 patients who underwent multivisceral resection for colorectal carcinoma between 1996 and 2013. 'Multivisceral resection' was defined as the resection of at least one other organ in addition to the cancer affected colon. There were 19 males and 16 females who had a mean age of 52.7 ± 13.6 years. The most common primary site for the tumor was the rectum, followed by the sigmoid, the left and the right colon. Most frequently resected additional organ was the pancreas followed by the uterus, small bowel, urinary bladder, ureter, vagina, spleen, duodenum, ovary and liver. Postoperative histopathological examination confirmed tumor infiltration in the adjacent organs in 48.5%. Postoperative complication was developed in 21 (60%) patients. There was no surgery-related mortality. 10 patients had evidence of recurrence at last follow-up in June, 2014. The 5-year survival rate was of 73.1% according to Kaplan-Meier survival analysis. Multivisceral resection for colorectal cancer is associated with a high morbidity rate, but the long-term survival is good.

      PubDate: Sat, 16 Jan 2016 02:17:19 GMT

    • Abstract: 2016-01-02T15-06-32Z
      Source: International Journal of Surgery and Medicine
      Casimiro Giorgetta, Francesco Inzirillo, Eugenio Ravalli, Francesco Sangrigoli, Luigi Comandatore, Claudio Della Pona.
      We report a case of a18-year-old male with double aortic arch who underwent surgery for bleeding from a left bulbar cavernous angioma of the medulla oblongata. A tracheostomy tube was positioned but after several days the patient died because of a tracheo-esophageal fistula with left aortic arch erosion due to the decubitus of the tube cuff

      PubDate: Wed, 30 Dec 2015 07:28:20 GMT
  • Spontaneous Splenic Rupture Secondary to Rivaroxaban: Rare but Raising

    • Abstract: 2015-12-25T09-22-53Z
      Source: International Journal of Surgery and Medicine
      Zainab Naseem, Muslim Mustaev, Boris Strekozov.
      A 68-year old male presented to our hospital with sudden onset of left sided chest and abdominal pain. The patient was previously treated for left lower lobe pneumonia and reported no history of chest or abdominal trauma. His medical history included atrial fibrillation which was managed by rivaroxaban 20 mg once daily. Computed tomography of the abdomen demonstrated a splenic haematoma. The patient rapidly deteriorated and developed hypovolaemic shock. Emergency laparotomy revealed haemoperitoneum of 3500 mL and the ruptured spleen. The postoperative course was complicated by pancreatic fistula formation which eventually resolved.

      PubDate: Thu, 24 Dec 2015 00:16:13 GMT
  • Cerebral Phaeohyphomycosis caused by Fonsecaea monophora: First report
           from India

    • Abstract: 2015-12-25T09-22-53Z
      Source: International Journal of Surgery and Medicine
      Prithvi Varghese, Muhammed Jasim Abdul Jalal, Suhail Ahmad, Ziauddin Khan, Molly Johny, Pushpa Mahadevan, Leena Joseph, Rachel Chandy, Susy Paul.
      We report a case of cerebral phaeohyphomycosis caused by a dematiaceous fungus, Fonsecaea monophora, in a patient with type 2 diabetes mellitus and decompensated chronic liver disease. CT brain revealed a 2x2cm hypodense cystic lesion in the right lentiform nucleus region with significant peri-lesional oedema. Stereotactic burr hole aspiration of the lesion with biopsy of the abscess wall was done and the aspirated pus from the lesion showed branched septate hyphae with light brown pigmentation. Culture of the pus grew a dematiaceous fungus, identified by morphological and molecular studies as Fonsecaea monophora. The isolate was susceptible to voriconazole (MIC, 0.004 µg/ml) but showed reduced susceptibility to amphotericin B (MIC, 4 µg/ml). The patient’s caregivers were not willing for a decompressive procedure and hence was treated medically with combined Amphotericin B and voriconazole antifungal therapy. Ultimately, the patient expired due to raised intracranial tension and resultant brain-stem dysfunction. This is the first case of cerebral phaeohyphomycosis caused by Fonsecaea monophora reported from India.

      PubDate: Thu, 24 Dec 2015 00:04:05 GMT
  • Treatment of Idiopathic Chronic Orchialgia with Transcutaneous Electrical
           Nerve Stimulation (TENS):A Preliminary Result

    • Abstract: 2015-12-25T09-22-53Z
      Source: International Journal of Surgery and Medicine
      Ekrem Akdeniz, Mustafa Suat Bolat, Sevda Akdeniz.
      Purpose: Unilateral or bilateral testicular pain lasting more than 3 months is called as chronic orchialgia. Aproximately 25-50% of chronic orchialgia is idiopatic origin. This study aimed the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) therapy due to Idiopathic Chronic Orchialgia (ICO). Methods: Five patients were included into this study with ICO that diagnosed with physical examination, urine analyses, urinary system x-ray film, and scrotal doppler ultrasound. Medical history revealed that multiple conservative therapy attempts failed to alleviate the pain. Two of the patients had right sided ICO. Traditional TENS device is placed to the most painful points. TENS applied 3 times in a week with duration 30 minutes for 4 weeks. Before and after TENS application, patients were evaluated by using Visual Analog Scale (VAS) at first and third months. Results: Median age of patients was 26.20±2.38 (22-30). Mean VAS value was 6.52 ± 0.89 before the procedure. After 1 month VAS value was 3.82 ± 0.83 (p0.05). None of the patients needed any analgesics after during the one month. No complications, hyperemia or hypoesthesia of the scrotal or penile skin, occurred after the procedure. Conclusion: TENS reduces pain by increasing endorphin release in the spinal cord dorsal horn. TENS is very effective method for first 1 month in patients with ICO but its effect reduces by the time. There is no standard therapeutic protocol for idiopathic chronic orchialgia. Therefore TENS may be an alternative for patients who do not benefit from medical therapy and do not want invasive procedures. Short-term use of TENS and low number of the patients are the limitations of this study. Randomized, placebo-controlled, and longer follow-up period studies are needed to better assess the efficacy of TENS for ICO.

      PubDate: Wed, 23 Dec 2015 14:02:19 GMT

    • Abstract: 2015-12-21T14-18-20Z
      Source: International Journal of Surgery and Medicine
      Ekrem Akdeniz, Mustafa Suat Bolat, Necmettin Şahinkaya.
      Objective:In this study, we aimed to investigate the impact of percutaneous nephrolitotomy on kidney functions in stage III or higher chronic renal failure patients using glomerular filtration rate and serum creatinine level. Material and Method:Between 2010 and 2014, percutaneous nephrolithotomy was applied to patients who had glomerular filtration rate below 60 mL/min/1.73m2. Pre-operative demographic features, stone burden and localization, urine analysis and microbial test, serum creatinine level, direct urinary system graphy, and spiral non-enhanced computerized tomography were obtained. Intraoperative renal unit counts, anesthesia and surgery time, and X-ray exposure time were calculated. Early and late post-operative complications, hospitalization time, stone-free rate, and glomerular function rate were evaluated, retrospectively. Findings:Pre-operatively, mean creatinine value was 2,42±0.76 mg/dL, mean glomerular filtration rate was 45.3±13mL/min/1.73m2, mean stone burden was 393±40 mm², mean intervention time was 79±34 min and 12 patients were stone free (70.5%). Decrease of hemoglobin 1,6 g/dL and transfusion was done only two patients (11.8%) due to excessive bleeding. In early and long term follow-up, mean creatinine values and glomerular filtration rate were 1.98±0.72mg/dL, 2.16±0.78mL/dL and 54.1±14 mL/min/1.73m2and 51.8±15 mL/min/1.73m2, respectively. Comparison of pre-operative and post-operative creatinine and glomerular filtration rates revealed significant decrease in creatinine level and increase in glomerular filtration rate. Results:Percutaneous nephrolithotomy which eliminates urinary obstruction is safely used in the treatment of kidney stones with minimal damage on kidney functions. Stage III or higher renal failure patients who have obstructive kidney stones or recurrent urinary tract infections can effectively be treated and this may help patients to prevent progression to end-stage renal failure.

      PubDate: Sun, 20 Dec 2015 04:43:55 GMT

    • Abstract: 2015-12-17T14-22-33Z
      Source: International Journal of Surgery and Medicine
      Ekrem Akdeniz, Mustafa Suat Bolat, Necmettin Sahinkaya.
      Introduction:Urethral stricture is characterized by decrease in urethral flow severe enough to cause acute urinary retention. Urethral strictures may develop after traumas to urethral epithelium and/or corpus spongiosum. Complication rates due to untreated urethral stricture are very high. Although various treatment methods have been described, the second most common method after urethral dilation in practice is cold-knife internal urethrotomy. The purpose of this study is to evaluate data of patients who were treated with internal urethrotomy in our clinic. Methods:This study included patients who were treated with internal urethrotomy due to internal stricture between January 2011 and May 2015. Demographic, clinical, radiological, uroflowmetric (maximum and mean urine flow rate) and operative datas of the patients were retrospectively evaluated and recorded. Results:This study included 155 patients with a mean (±standard deviation) age of 71.70 (±13.7). Etiologically the most common reason was urological surgical procedures (67%) and the most common stricture was seen at bulbomembranous urethra region (85.2%). Mean length of stricture was 5.4±2.4mm. Mean duration to remove the catheter was 1.8±1.3 days. Regional anesthesia was used in 67.7% of the patients. Our success rate was 78,1%. Comparison of maximum and mean urine flow rates pre and postoperatively revealed significant increases postoperatively. Conclusion:Internal urethrotomy is a first line treatment method for urethral strictures because it is easily applied, has a low complication rate, and can be applied with local aenesthesia in high risk patients who are unable to take general anesthesia. Although recurrence rate is high, repeatability is its greatest advantage and it causes significant relief in patients with urethral strictures, but it must be kept in mind that definitive treatment is urethroplasty.

      PubDate: Tue, 15 Dec 2015 10:58:51 GMT
  • Penile gangrene following condom catheter urinary drainage : A case report

    • Abstract: 2015-12-04T01-06-20Z
      Source: International Journal of Surgery and Medicine
      Sandhya Gupta, Vinod Tamaknand, Amit Dangi, Bhawan Nangarwal, Rajesh Godara, Pradeep Garg.
      External urine collecting devices have been a boon to patients of urinary incontinence since their invention in late 90s. They have replaced the need for uncomfortable indwelling catheters in these patients. As safe as they may be, ghastly complications have occurred infrequently, mostly due to their inappropriate application. Such penile and urethral complications add to the morbidity of the patients significantly. They can be easily avoided by following few simple steps of catheter care, thus emphasizing the need to aware clinicians and health care workers about the correct application methods. Here we discuss a case of 60 year old male who developed penile skin necrosis and urethral fistula due to chronic use of condom catheter.

      PubDate: Wed, 02 Dec 2015 07:37:55 GMT
  • Persistent Mullerian duct syndrome presenting as an inguinal hernia : A
           case report

    • Abstract: 2015-11-25T14-27-32Z
      Source: International Journal of Surgery and Medicine
      Amit Dangi, Sandhya Gupta, Vinod Tamaknand, Rajesh Godara, Pradeep Garg.
      A brief report of persistent mullerian duct syndrome (PMDS) with 46XY karyotype which is one of the rarest variety of disorders of sexual differentiation (DSD) accounting only 5% cases of all is being presented. A 21 years old male with left inguinal hernia and absent right testis presented in surgical outdoor and was operated. On exploration female genital organs like uterus and fallopian tubes along with contralateral testis were present in left inguinal canal as a content of sliding left inguinal hernia.

      PubDate: Mon, 23 Nov 2015 05:34:21 GMT
  • Intervention or surveillance' Current evidence in visceral artery

    • Abstract: 2015-11-13T09-19-14Z
      Source: International Journal of Surgery and Medicine
      Bryce Renwick, Catherine Joan Beattie, Khurram Khan, Raj Velu, Donald Reid, Donald Bain.
      Visceral artery aneurysms (VAAs) are an increasingly encountered clinical problem. Although their incidence is low at about 0.2% in the general population, they are increasingly found on cross-sectional imaging. Therefore it is justifiable to have a protocol for dealing with such lesions.

      PubDate: Tue, 10 Nov 2015 05:38:41 GMT

    • Abstract: 2015-10-15T13-05-36Z
      Source: International Journal of Surgery and Medicine
      True Popliteal artery aneurysm is the most common of all the peripheral artery aneurysms. We present a case of proximal popliteal artery aneurysm involvement both lower limb presented with gangrene in one lower limb and incapacitating claudication pain on the other lower limb. We have successfully repaired both sides aneurysm in the same sitting with Poly Tetra Fluro Ethylene (PTFE) graft, as the patient also had multiple venous perforators’ involvement on both sides, which left us only with synthetic graft repair option rather than venous graft repair.

      PubDate: Tue, 13 Oct 2015 22:59:08 GMT
  • Management of Severe Knee Flexion Contractures in a Child with
           Arthrogryposis Multiplex Congenita

    • Abstract: 2015-09-25T09-22-40Z
      Source: International Journal of Surgery and Medicine
      Bashir M Ibrahim, Abdulrahman A. A. Mamuda, Magaji G Taura, Lawan H Adamu.
      Arthrogryposis multiplex congenita is a syndrome characterized by the presence of congenital contractures involving multiple joints usually with flexion deformities, with or without pterygia or webbing at the joints. The aim of this case report was to highlight the challenges of management of severe knee contractures in AMC and possible solutions in a resource limited setting like ours. We presented a one-year-old child with bilateral severe knee contractures secondary to arthrogryposes. The involvement of knee is present in about 70% of cases with arthrogryposis, with flexion deformity more common than extension deformity. Knee flexion contractures, as seen in our patient, is one of the most disabling deformities. The surgical option adopted in the case presentedwere met with various challenges including abnormal muscles insertions, shortening and fibosis of the muscles, abnormal position and shortening of the neurovascular structures in the popliteal fossa.

      PubDate: Fri, 25 Sep 2015 00:03:58 GMT
  • Watch and wait approach in rectal cancer treatment

    • Abstract: 2015-09-25T09-22-40Z
      Source: International Journal of Surgery and Medicine
      D. Penchev, S. Maslyankov, V. Kostov, L. Dimitrova, V. Ivanova, G.Todorov.
      Introduction: The colorectal carcinoma is the most common gastrointestinal neoplasm worldwide and in Bulgaria. Often the choice of surgical treatment is difficult, and organ-preserving surgery is not feasible. In borderline situations when choosing a surgical approach is difficult, a neoadjuvant chemoradiotherapy may downstage the disease and provide better results and more surgical options. If the treatment response is partial or complete, the possibility of carrying out sphincter-sparing surgery is increased. The aim of the study is to present a clinical case of a patient with rectal carcinoma, submitted to multimodal treatment. Case report: The presented patient is a 65-year old female with alarming symptoms and diagnosed rectal adenocarcinoma. The patient underwent neoadjuvant preoperative treatment. After a full course of treatment, the patient was restaged and reported a complete clinical response to therapy. After recommended period, she underwent an anterior resection of the rectum. This case is an example of the potential possibilities of a multidisciplinary team in surgical oncology. Conclusions: There are certain criteria, regarding the waiting approach in rectal carcinoma and it subjected to a set of indications in case of a complete response to the treatment. The current case is an excellent example of performing a sphincter-spearing surgery, which may lead to higher quality of life for the target patient group. The ESMO guidelines for neoadjuvant treatment of rectal adenocarcinoma are applicable in Bulgaria.

      PubDate: Tue, 22 Sep 2015 05:57:04 GMT
  • Upper Gastro-intestinal bleeding in the Young - Gastric GIST Tumor or
           Peptic Ulcer Disease'

    • Abstract: 2015-09-25T09-22-40Z
      Source: International Journal of Surgery and Medicine
      Ayodele Atolagbe, Rahaman Oloruntobi, Ogunleye Adeyemi, Apakama Chukwuemeka.
      GIST tumors is very unusual in the young and middle aged and a high index of suspicion is needed for the diagnosis in young patients who present with upper gastrointestinal bleeding. Appropriate imaging such as a Computed tomographic scan (CT scan) may identify this tumor which may easily be misdiagnosed as a bleeding Peptic Ulcer Disease in the young. We present a case of a healthy 38 year old man with no alcohol use who presented with epigastric pain and melena and subsequent torrential bleeding uncontrolled during endoscopy necessitating an emergency exploratory laparotomy by the general surgery team. The bleeding intraluminal component of the tumor with gross splenic and pancreatic involvement was identified and surgical management consisted of a wedge resection of the greater curvature of the stomach incorporating the tumor and the spleen with successful dissection of the tumor off the tail of the pancreas. Histology was positive for C-KIT and DOG-1 markers. Postoperative course was uneventful and he is presently on Imatinib Mesylate.

      PubDate: Tue, 22 Sep 2015 05:01:22 GMT
  • Small Bowel Obstruction Secondary to Retrograde Intussusception of the
           Roux Limb: A Complication Following Laparoscopic Roux–en–Y
           Gastric Bypass.

    • Abstract: 2015-09-25T09-22-40Z
      Source: International Journal of Surgery and Medicine
      Ayodele Atolagbe, Ogunleye Adeyemi, Chukwuemeka Apakama.
      Small bowel obstruction secondary to intussusception following a roux-en-Y gastric bypass (RYGB) for morbid obesity is a rare clinical condition. It has become more frequently diagnosed with the increasing utilization of RYGB for the management of morbid obesity world-wide. We present a 34 year old female who presented at the Emergency Room of our facility with complaints of abdominal pain and a history of retro-colic and ante-gastric laparoscopic Roux-en-Y gastric bypass surgery at another Hospital a year prior to presentation. On account of unremitting abdominal pain, a lactate level of 5.4mg/dl and abdominal Computed Tomographic scan which showed evidence of small bowel obstruction with intussusception; an emergency exploratory laparotomy was done which revealed intussusception of the biliopancreatic and common limb into the distal aspect of the roux limb. Surgical intervention entailed resection of both the proximal common limb and distal roux and biliopancreatic limbs and surgical reconstruction of the jejunojejunal anastomosis. She is alive and well two years post surgery without any recurrence.

      PubDate: Tue, 22 Sep 2015 04:59:30 GMT
  • The impact of anxiety on post - dural puncture headache in routine
           neurology practice

    • Abstract: 2015-09-17T09-29-47Z
      Source: International Journal of Surgery and Medicine
      Stefka Mantarova, Spaska Georgieva- Zhostova, Boyko Todorov, Anastasia Trenova, Georgi Slavov, Maria Manova.
      Background: The post-dural puncture headache (PDPH) is the most common complication of lumbar puncture in neurological practice. Although the comorbidity of headache and psychiatric symptoms is well-recognized, the data about the relationship between PDPH and symptoms of anxiety and depression are limited. The aim of the present study was to determine the influence of anxiety symptoms on the risk for PDPH. Methods: Diagnostic lumbar puncture was performed to thirty-nine neurological patients, presented by 26 women and 13 men. All subjects completed the Hospital Anxiety and Depression Scale (HADS) before the procedure. Information about the clinical characteristic of the headache - quality, location, severity, postural nature, duration and associated symptoms (nausea, vomiting, and tinnitus) was collected. Results: Fifteen of the patients (38,5%) developed PDPH. According to the presence of PDPH the patients were divided into two groups – with (group 1) and without headache (group 2). Women with headache were significantly younger (mean age 34,00±11,22 years) compared to females in group 2 (mean age 45,07±12,36 years) (p=0,028). Patients in group 1 had significantly higher levels of reported anxiety symptoms compared to group 2 (p= 0,045). A significant positive correlation was observed between anxiety and PDPH (Spearman’s rho = 0,412, p=0,009). Conclusion: Younger female patients with anxiety had a considerably increased rate of PDPH. This could be of practical benefit in devising an additional treatment strategy for patients with PDPH.

      PubDate: Thu, 17 Sep 2015 02:52:34 GMT
  • Multiple Hepatic Abscesses from a Ruptured Gallbladder Empyema – a
           case report and review of the literature

    • Abstract: 2015-09-09T14-15-33Z
      Source: International Journal of Surgery and Medicine
      Ayodele Atolagbe, Oloruntobi Rahaman.
      An unusual complication of gallbladder empyema is its rupture into the liver forming a giant multiloculated pyogenic abscesses. This condition is rapidly fatal in diabetic and immuno-compromised patients. We present a 79 year old African American woman resident in New York City with a medical history of diabetes mellitus who presented at the ED with constitutional symptoms and right upper quadrant pain of a few days duration. She was tender and had a positive murphy’s sign on clinical examination coupled with tachycardia and a low grade fever.laboratory findings of leukocytosis, and metabolic acidosis, lactic academia and elevated ketones with moderately deranged hepatic function tests and negative tumor markers. Management consisted of broad spectrum antibiotics and an urgent open cholecystectomy and drainage of multiple multi-loculated hepatic abscesses. A repeat ultra-sonogram showed a remnant collection which was drained by interventional radiology and drains left in-situ. She was discharged after four weeks of parenteral antibiotics with repeat sonogram showing complete resolution of hepatic abscess.

      PubDate: Mon, 07 Sep 2015 12:13:47 GMT

    • Abstract: 2015-09-09T14-15-33Z
      Source: International Journal of Surgery and Medicine
      Rakan Alqahtani, Wagih Ghnnam, Mohammad Alqahtani, Abdulrahman Qatomah, Awdah AlKhathami, Adel Alhashim.
      Laparoscopic cholecystectomy (LC) is one of the most commonly performed laparoscopic procedures. Problems occurring during laparoscopic cholecystectomy include bile duct injury, conversion to open operation, and other postoperative complications. Male gender is a risk factor for LC conversion rate.Our goal is to determine the effect of male gender on the outcome of laparoscopic cholecystectomy for Chronic Cholecystitis. We have done that through a retrospective clinical trial was carried out at our Hospital to evaluate the sex difference as predictor for difficult laparoscopic cholecystectomy. From a total number of 638 patients, who underwent laparoscopic cholecystectomy for Chronic Cholecystitis from 1st January 2012 to 1st of January 2015) two hundred and seventeen patients were excluded according to exclusion criteria and the remaining 421 patients were included.All the operation were done according to standard four-port technique through an open method was used, with first entry port in the periumblical region. 1 Anesthetic technique and perioperative management were the same for all patients during the study period. Results: Patients who were candidates for elective cholecystectomy , were mostly females with (F:M ratio= 4/1), mean age 40 years (range 13-101 years) with mean age of 45 years(range 20-78 years) for the males, 40years (range 13-100 years) for the females. There were more difficult cholecystectomies in males in comparison to female patients for chronic cholecystitis. The out come of this study is male gender is a predictor for difficult laparoscopy for symptomatic gallstones presented as chronic cholecystitis

      PubDate: Sun, 06 Sep 2015 13:52:46 GMT

    • Abstract: 2015-09-09T14-15-33Z
      Source: International Journal of Surgery and Medicine
      George Baitchev, Ivan Ivanov, Ivan Inkov, Emilia Zlateva, Zdravko Kamenov, George Dimitrov.
      Traditionally, mammographic density (MD) of the breast has been assessed by a radiologist visually. This subjective evaluation requires significant experience to distinguish the relative proportions of the fibrous connective tissue and adipose tissue in the mammary gland correctly. The aim of this study is to compare the capabilities of the different methods (visual and computer-assisted) for assessing mammographic density. Our sample in this study consists of 66 patients with digital mammography. The mammographic density has been evaluated using the four-grade scale of the American College of Radiology (ACR); visually, visually using an analog scale and semi-automated using UTHSCSA Image Tool 3.0, Image J and Adobe Photoshop CS6 software. The average mammographic density calculated using the different methods is as follows: 34.8% (from 10% to 70%); 32.1% (from 10% to 60%); 23% (from 0% to 70.9%); 22.7% (from 2.5% to 78.1%) and 22.5% (from 1.5% to 72.4%). There is a strong correlation between the results obtained visually and those calculated using a computer-assisted measurement (p< 0.0001). A strong correlation was found also between the results acquired using the different semi-automated programs (p< 0.0001). Precise measurement of mammographic density is of great importance for the mammographic screening and evaluation of breast cancer risk. The semi-automated methods, used for this purpose are objective, accessible and reproducible tools and have some advantages over the subjective visual assessment.

      PubDate: Sat, 05 Sep 2015 04:07:20 GMT
  • “Little old lady’s hernia” a surgeons challenge

    • Abstract: 2015-09-05T04-05-22Z
      Source: International Journal of Surgery and Medicine
      Ankit Shukla, Ramesh Bharti, Amit Rattan, Rajesh Chaudhary, Usha Chaudhary.
      Obturator hernia also known as “little old lady’s hernia”, is an uncommon entity leading to bowel obstruction usually in thin built elderly females and is often associated with serious comorbid conditions due to advanced age. It is difficult to diagnose preoperatively however diagnosis can be confirmed by CT scan accurately if there is high index of suspicion. Delay in diagnosis and delay in institution of appropriate surgical treatment leads to high morbidity and mortality.

      PubDate: Fri, 04 Sep 2015 01:44:38 GMT

    • Abstract: 2015-08-27T09-21-32Z
      Source: International Journal of Surgery and Medicine
      A R Bansal, Rajesh Godara, Talo Millo, Rathindra Tripura, Jai Karan.
      Application of dressings to surgical wounds is a custom as old as history and has become a ritual marking the completion of surgery. Under certain circumstances a surgical dressing might in fact predispose to the development of wound infection. This study evaluates clinical outcome of clean minor surgical wounds without use of surgical dressing. Material and methods: 100 consecutive patients presenting on an outpatient basis for minor soft tissue surgical procedures were studied with respect to wound infection and wound disruption due to avoidance of post operative surgical dressings. Observations:There was only one case of wound infection which subsequently developed wound dehiscence as well. Conclusion: The results suggest that in clean surgical wounds where good haemostasis, optimal coaptation of wound margins and gentle handling of tissue are achieved, there is no increase in the wound complications with respect to wound infection and wound dehiscence when the dressings are removed early and wounds allowed to heal.

      PubDate: Fri, 21 Aug 2015 22:53:40 GMT

    • Abstract: 2015-08-14T23-16-55Z
      Source: International Journal of Surgery and Medicine
      A descriptive cross sectional study was conducted in an Irish University among undergraduate students in 2012. A web questionnaire consisted of items related to HIV/AIDS knowledge, behaviour and attitudes was sent to all undergraduate students aged 18 years or above. Despite the fact that majority of students were aware about the transmission of HIV/AIDS, this study showed that students were less likely to translate their knowledge about HIV/AIDS transmission into healthy behaviour. In addition, they engaged in risky sexual behaviour which increases the likelihood of acquiring HIV/AIDS and other sexually transmitted diseases.

      PubDate: Fri, 14 Aug 2015 10:38:58 GMT
  • Bilioma Due to Blunt Abdominal Trauma: A Case Report and Review of

    • Abstract: 2015-08-14T23-16-55Z
      Source: International Journal of Surgery and Medicine
      Dr. Parth Vaghela, Dr. Jagrut Patel, Dr. Dharmendra Shah, Dr. Mihir Shah, Dr. Rajshree Vaghela.
      Abstract Background: Bilioma is a rare abnormal localized collection of bile outside biliary tree due to an injury or biliary leak post operatively. Case: A 15 years old male presented to us with complaint of greenish discharge from abdominal scar with generalized abdominal pain. There was supra-umbilical localized bulging and generalized guarding and rigidity since three days. Patient was giving history of blunt abdominal trauma three months back for which he had undergone laparotomy but he is not aware of which procedure done. At laparotomy we found loculated collection of bile measuring 20 x 15 cm. which was drained and its wall sent for histopathological examination. Histopathological report is suggestive of fibrous wall. Conclusion: Intra-abdominal collection points towards traumatic injury to the biliary system. . Biliary injury is to be thoroughly investigated which had led to the formation of the bilioma. The management depends upon whether there is an ongoing bile leak or just an old collection (infected/sterile).

      PubDate: Sun, 09 Aug 2015 13:29:26 GMT

    • Abstract: 2015-08-14T23-16-55Z
      Source: International Journal of Surgery and Medicine
      Yana Feodorova, Dessislava Tashkova, Kiril Simitchiev, Anton Todorov, Gancho Kostov, Rossen Dimov, Victoria Sarafian.
      Colorectal cancer (CRC) is one of the most deadly cancers worldwide. Despite the introduction of targeted molecular therapies in the last 10 years, overall survival has not increased substantially. CRC progression is accompanied by numerous genetic and epigenetic alterations and dysregulation of several signaling pathways, among which activation of Wnt and inactivation of TGF-β signaling. The molecular heterogeneity of CRC, however, hinders the molecular subtyping of CRC and thus the identification of common biomarkers for this pathology. The only three well established biomarkers for advanced-colorectal-cancer drug treatment are negative biomarkers. These are mutations in the genes KRAS, NRAS and BRAF which determine resistance to therapy with anti-EGFR antibodies. YKL-40 is a chitin-binding glycoprotein that has been shown to play a role in extracellular tissue remodeling, angiogenesis, cell migration and inflammation. Increased serum levels of this protein have been detected in patients with CRC but the role of YKL-40 in this neoplastic disease has not been studied extensively and the precise function of YKL-40 in CRC progression is not known. In the present study we determined the KRAS mutation status and measured the mRNA levels of YKL-40 of 24 patients with sporadic CRC. In addition, we assessed the association between these two parameters by statistical analysis. We are the first to show that in CRC YKL-40 mRNA levels are dependent on the presence of KRAS mutations, being prominently elevated in the wild type background. Our results indicate the potential role of YKL-40 as a target molecule for CRC therapy.

      PubDate: Sun, 09 Aug 2015 03:16:03 GMT
           SPLENIC CYST '

    • Abstract: 2015-08-02T09-19-05Z
      Source: International Journal of Surgery and Medicine
      Naveen Verma, Sunil Yadav, Sandhya Gupta, Vinod Tamaknand, Rajesh Godara, Pradeep Garg.
      Congenital splenic cyst is also called epidermoid or epithelial cyst. Most of the cysts are asymptomatic and incidently diagnosed during ultrasound of abdomen. Symptomatic patients generally present with pain in epigastrium and fullness in left upper abdomen, and a palpable mass.
      Authors put up their views in favour of total splenectomy in large splenic cyst.

      PubDate: Sat, 01 Aug 2015 23:03:28 GMT
  • Transmural Migration of a Retained Sponge Through bowel wall causing
           intestinal obstruction.

    • Abstract: 2015-08-02T09-19-05Z
      Source: International Journal of Surgery and Medicine
      Hanief Mohamed Dar, Varun Dogra, Sikender Iqbal Lone, Sheikh Imran Farooq.
      ABSTRACT Gossypiboma (GP) or retained surgical sponge is one of the rare surgical complications which can happen despite precautions. It is an avoidable surgical complication which can lead to increased patient Morbidity and profound Medicolegal implications. Abdominal textiloma may be asymptomatic or present serious gastrointestinal complications such as bowel obstruction, perforation or fistula formation because of misdiagnosis, it may mimic abscess formation in early stage or soft tissue masses in chronic stage.

      PubDate: Wed, 29 Jul 2015 09:49:22 GMT

    • Abstract: 2016-05-11T09-19-30Z
      Source: International Journal of Surgery and Medicine
      Introduction : Lipoma is one of the most common benign mesenchymal tumor which can occur in almost in all organs of the body where fat normally exists, so called as universal tumor or ubiquitous tumor. Lipomas are slow growing that rarely reach a size more than 2-3cms. Lesions larger than 5cms, so called giant lipomas are seldom found inside the muscle compressing nervous-vascular structures. The large and deep seated lipomas represent a real diagnostic and therapeutic challenge. Case report: We report a case of 48 year old man with a giant lipoma involving his left gluteal and thigh region. The patient was managed by wide local excision of the lesion. The key issues surrounding the intramuscular lipoma with literature review is discussed. Conclusion: Intramuscular Giant lipomas are rare and even though they are typical in their presentation, especially when they are large and show findings that can be confused with a well-differentiated low grade liposarcoma, but when they occur an appropriate workup must be done. This should be followed by adequate open surgical excision and repeat examination over time to monitor for recurrence.

      PubDate: Tue, 09 Jun 2015 10:24:37 GMT

    • Abstract: 2015-07-13T09-15-02Z
      Source: International Journal of Surgery and Medicine
      Slavcho Tomov, Grigor Gortchev, Lachezar Tantchev, Margarita Nikolova, Savelina Popovska.
      A 29-year-old patient with cervical ectopic pregnancy (CEP) presented as "suspected" cervical mass, and irregular vaginal bleeding was directed to a gynecologic oncologist for consultation. During the examination a massive bleeding occurred. After an unsuccessful attempt to stop the bleeding with a balloon catheter and vaginal tamponade, a total abdominal hysterectomy was performed. The predisposing factors, the differential diagnostic possibilities and the clinical approaches in CEP are discussed. Total abdominal hysterectomy is the procedure of choice for treatment of cervical pregnancy under conditions of urgency and life-threatening bleeding.

      PubDate: Tue, 09 Jun 2015 10:24:37 GMT

    • Abstract: 2015-07-13T09-15-02Z
      Source: International Journal of Surgery and Medicine
      Ivan Inkov, Pavel Ninov, Nikola Kyuchukov.
      The International Journal of Surgery and Medicine (IJSM) is the official scientific publication of the Bulgarian Association of Young Surgeons (BAYS). IJSM has the goal of providing its readership the highest quality rapid retrieval of information relevant to all medical specialists. The International Journal of Surgery and Medicine offers open access, peer-reviewed coverage of all types of surgery and medicine. Journal publishes Original articles, Points of technique, Review articles, Case reports, Letters and Images. The Journal spans all aspects of surgery and medicine. This is the official publication of the Bulgarian Association of Young Surgeons. This new title would help build emerging fields of study, enhance communication within existing research communities, and stimulate creative discourse at disciplinary interfaces. Our experience and excitement together with ScopeMed's technical background would improve IJSM in a short time. Thank you very much for your interest.

      PubDate: Tue, 09 Jun 2015 10:24:37 GMT

    • Abstract: 2015-07-13T09-15-02Z
      Source: International Journal of Surgery and Medicine
      Daniel Vasilev Kostov, Georgi Kobakov, Daniel Yankov.
      Objective One of the most feared complications after pancreaticoduodenectomy (PD) remains postoperative pancreatic fistula (POPF). In the current study, we demonstrate a new technique for pancreaticogastrostomy (PG), using one continuous seromuscular circular suture without trans pancreas sutures for PG. Material and Methods During the period December 2012 to December 2014, 32 consecutive patients underwent PD (either pylorus-preserving or classical Whipple’s) carried out using the above suture-less PG. Indication for PD was pancreatic duct carcinoma. Procedures were carried out by the same surgeon, same approach and anastomotic method in order to avoid technical changes. Results Postoperative mortality was zero and morbidity was 21.8% (n=7). Pancreatic leakage (Grade A/B) occurred in 2 (6.2%) patients. These pancreatic leaks were managed nonoperative by maintaining the closed drains. The most common postoperative complication delayed gastric emptying (Grade B/C) in 3 (9.3%) patients. Conclusion We conclude that the suture-less PG possesses several advantages over conventional PG and pancreaticojejunostomy (PJ). This technic seems to lessen the risk of a pancreatic leak, probably by diminishing the possibility of suture damage to the pancreas and by embedding the transected stump into the posterior gastric wall. This novel PG is a valid and valuable procedure, especially for soft, nonfibrotic pancreas.

      PubDate: Tue, 09 Jun 2015 10:24:37 GMT

    • Abstract: 2015-07-13T09-15-02Z
      Source: International Journal of Surgery and Medicine
      Atif Naeem, Azher Mushtaq, Mir Mujtaba Ahmad.
      Paraduodenal hernia, a rare congenital anomaly which arises from an error of rotation of the midgut, is the most common type of intra-abdominal hernia. There are two variants, right and left paraduodenal hernia, the right being less common. We report the case of a 41-year-old patient with a right paraduodenal hernia who presented with 2 days history of continuous pain abdomen with multiple episodes of vomiting. Patient was decided to undergo laparotomy in view of Increasing abdominal pain and development of peritonitis. In a planned laparotomy, herniation of the small bowel loops through the fossa of Waldeyer, behind the ascending mesocolon was found which was gangrenous with prolapse of a few gangrenous loops into the peritoneal cavity. Gangrenous bowel was resected and an end to end jejuno ileostomy was performed.

      PubDate: Tue, 09 Jun 2015 10:24:37 GMT

    • Abstract: 2015-07-13T09-15-02Z
      Source: International Journal of Surgery and Medicine
      George Baytchev, Ivan Inkov, Nikola Kyuchukov, Emilia Zlateva.
      The Gail model is a statistical tool, which assesses breast cancer probability, based on nonmodifiable risk factors. In contrast, the evaluation of mammographic breast density is an independent and dynamic risk factor influenced by interventions modifying breast cancer risk incidence. The aim of the present study is to compare the possibilities for risk factor integration and analysis and to search for a correlation between mammographic density and the Gail model for breast cancer risk evaluation. The subject of this prospective study is a cohort of 107 women at ages from 37 to 71 years, who have had benign breast diseases, digital mammograms, and Gail model risk evaluation. Mammographic density is evaluated in craniocaudal projection subjectively visually and objectively using the computer imaging software. (Image J software) The Gail risk evaluation is completed using the standardized NCI questionnaire (Breast Cancer Risk Assessment Tool). In concordance with the Breast Imaging Reporting and Data System (BI-RAD) by ACR, mammographic density is evaluated using a four-grade scale. Low density D1 (less than 25%) was determined in 24 cases, D2 (25-50%) in 36 cases, D3 (51-75%) in 31 cases and high density D4 (greater than 75%) in 16 cases. According to the Gail model, 80 (74,8%) of the examined patients did not have an increased risk (less than 1,67% for a five-year period), whereas the remaining 27 (25,2%) had a statistically significant increase in risk (greater than 1,67% for a five-year period). Women with increased risk more often present with denser breast (34% with D3, D4 versus 18,3% for D1, D2). The Gail model does not adequately explain the correlation between breast density and statistically calculated risk. The development of more detailed tools, which take into consideration breast density, as well as other risk factors, may be helpful for a more accurate evaluation of the individual risk for breast cancer.

      PubDate: Tue, 09 Jun 2015 10:24:37 GMT

    • Abstract: 2015-07-13T09-15-02Z
      Source: International Journal of Surgery and Medicine
      George Dimitrov, Feodor Odzhakov, George Baytchev.
      The first in a series of reviews discusses the literature published so far relating to breast cancer including: epidemiology of the disease, economic impact, pathology of breast cancer as it remains the most common cancer diagnosed in women, the main molecular mechanisms of tumorigenesis accepted today, the invasion & metastasis cascade and the concerning relationship between benign and malignant disease.

      PubDate: Tue, 09 Jun 2015 10:24:37 GMT
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