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Journal Cover International Journal of Surgery and Medicine
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   ISSN (Print) 2367-7414 - ISSN (Online) 2367-699X
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    • Abstract: 2017-01-03T23-19-18Z
      Source: International Journal of Surgery and Medicine
      Birhanemeskel Tegene Adankie, Tadesse Belayneh Melekie, Gashaw Mesele Getahune.
      Background: Surgical safety checklists (SSCs) are designed to improve inter professional communications and ultimately avoiding catastrophic errors that often characterizes the culture of surgical teams. However, data on effect of surgical checklists implementation are scarce in the study area. The purpose of this research project was to directly examine the effect of utilization surgical safety checklist on patient outcomes at University of Gondar Hospital, in Northwest Ethiopia.Material and methods: Institution based cross sectional study was done at Gondar university teaching hospitals from January to May 2013. We reviewed medical records of all consecutive patients admitted to the surgery department (N=403). For those who have clinical symptoms of surgical site infection a laboratory diagnosis were performed to compare occurrences of all postoperative complication among patients with and without utilization of surgical safety checklist.Results: During the study period from 403 patients operated, SSCs were attached for only 158 (39.2%) of the surgical patients. Post-operative complication were observed in 238 (59 %) of the patients and postoperative fever was the major complication accounting for 70 (17.3%) of all the complication. Surgical wound infection and pneumonia accounted for 47(16.6%) and 33(11.7%) respectively. S. aurous was the predominant isolated bacteria accounted for 7(30%), In addition, a statistically non-significant 11.2% decline the rate of surgical wound infection in the checklist group. In a logistic regression model of postoperative fever, the SSCs emerged as a significant independent predictor of this outcome: (OR = 0.49, 95% CI 0.31–0.75, and P value = 0.001).Conclusions and recommendation: patients with checklist have observed significant reductions of post operative complication particularly bacterial infection. It is possible to some extent that the improved usage of check list and preoperative prophylactic antibiotics may be implicated in the reduction of postoperative fever and bacterial infection.

      PubDate: Tue, 03 Jan 2017 05:13:20 GMT
  • A case of laparoscopic-assisted treatment of small bowel intussusception
           due to metastases from malignant melanoma - a word of caution

    • Abstract: 2016-10-31T05-33-55Z
      Source: International Journal of Surgery and Medicine
      Ventsislav Mutafchiyski, Georgi Kotashev, Mihail Tabakov, Jasmina Mihailova, Georgi Popivanov.
      During the last four decades the laparoscopic surgery gradually underwent a full recognition and nowadays it is a “gold standard” treatment for many elective conditions and recently in wide variety of emergent conditions. However, its use in bowel obstruction is still under debate and high-level evidence are lacking.Herein we present a case of 36-year-old man with small bowel intussusception due to metastases from melanoma initially treated laparoscopically. Diagnostic challenges and pitfalls of laparoscopic treatment are discussed.Multiple gastrointestinal metastases should be considered in all cases with small bowel obstruction and a history of melanoma. Although laparoscopy is increasingly used in emergency setting and appears to be feasible and safe treatment of small bowel obstruction it should be used with a caution in cases with suspected metastasized malignant melanoma.

      PubDate: Fri, 28 Oct 2016 05:43:11 GMT
  • Three Ports Laparoscopic Repair of Adult Morgagni Hernia and Rare
           Simultaneous Presentation of Para-esophageal Hernia with Morgagni Hernia

    • Abstract: 2016-10-24T08-45-07Z
      Source: International Journal of Surgery and Medicine
      Salman Assad, Ahsan Zil-E-Ali, Furrukh Jabbar.
      We report two case reports of Morgagni hernia repair. Our first case was on 65 year old white male who presented with abdominal pain in right upper quadrant and right side of chest for last 3 days. He was having 3 episodes of dark appearing vomiting associated with pain. He also had two episodes of hematemesis. Patient had gastric outlet obstruction with severe distension of stomach because of incarcerated small bowel and colon in the right sided anterior diaphragmatic Morgagni hernia. Laparoscopic repair of incarcerated Morgagni hernia under general anesthesia was planned. We report our second case on rare simultaneous presentation of Morgagni Hernia with type 3 Para esophageal hernia. 60 years old female patient presented in clinic with a follow up of chest discomfort which was progressively increasing with shortness of breath and a chronic gastric reflux. Her vitals were within normal limits and had body mass index (BMI= 29.52kg/m2) (overweight category). Previous past medical history included multiple episodes of gastric regurgitation and cardiovascular intervention for coronary stenting. CT scan showed type 3 paraesophageal hernia (gastro esophageal junction with fundus of stomach displaced above diaphragm). The patient had more than 30% of her stomach incarcerated in the chest as a paraesophageal hernia. The gastro esophageal junction was intra-abdominal after lysis of adhesion. Mesh was placed after posterior crural repair, followed by Nissen fundoplication over a 54 French bougie patient also had an incidental finding of a reducible Morgagni hernia through an anterior defect, followed by a repair without mesh. Esophago-gastro-duodenoscopy showed there was no evidence of any air leak with good valve creation on retroflexion through a fundoplication.

      PubDate: Sun, 23 Oct 2016 08:43:55 GMT
  • Brain metastasis from uterine malignancies: treatment modalities and
           prognostic factors

    • Abstract: 2016-10-24T08-45-07Z
      Source: International Journal of Surgery and Medicine
      Naoual Benhmidou , Fadoua Rais , Abdellah Aissa , Otman Akkar, Khadija Bellahammou, Hasna Loughlimi, Abdelhak Maghous, Fadila Kouhen , Tayeb Kebdani , Hanan Elkacemi , Sanaa Elmajjaoui , Noureddine Benjaafar .
      Isolated brain metastases from gynecologic malignancies are unusual. Advances in therapeutic modalities including surgery, whole brain radiotherapy stereotactic radiosurgery and chemotherapy improved survival and quality of life in this population. Therapeutic decision is based on patients’ specific prognostic factors. We report three cases of isolated brain metastases from gynecologic cancers and discuss treatment modalities in the light of a literature review.

      PubDate: Sat, 22 Oct 2016 16:41:05 GMT
  • Phyllodes tumor of the breast : A clinicopathological analysis from a
           single institution

    • Abstract: 2016-10-24T08-45-07Z
      Source: International Journal of Surgery and Medicine
      Naoual Benhmidou, Fadoua Rais, Fadila Kouhen, Abdelhak Maghous, Hasna Loughlimi, Khadija Bellahammou, Hanan Elkacemi, Tayeb Kebdani, Sanaa Elmajjaoui, Noureddine Benjaafar.
      The aim of our study is to examine the clinical and pathological features of patients with breast phyllodes tumors and to determine features that are correlated to outcome. Forty four phyllodes tumors were assessed. There were 11 benign, 11 borderline and 22 malignant tumors. 10 of 44 patients (22.72 %) relapsed at any site. Seven patients (15.9 %) had a local recurrence and 3 patients experienced local and metastatic relapse. The 5-year and 10-year survival rates are 97% and 95 % respectively. The 5 years and 10 years DFS are 81% and 77% respectively. Grade, histological size, margin involvement impacted disease free survival. Adjuvant radiation therapy improved local control in high grade tumors although it didn’t reach significance.

      PubDate: Sat, 22 Oct 2016 16:40:06 GMT
  • Clinical Value of Two Scoring Systems, C-reactive protein and Lactate
           Clearance in Patients with Severe Sepsis at the Emergency Department

    • Abstract: 2016-10-24T08-45-07Z
      Source: International Journal of Surgery and Medicine
      Sameh Saad, Ahmed Abou Zied, Amany El shemally, Salah Ismail.
      Introduction: More recently the grading system of sepsis was modified to include severe sepsis, septic shock, and refractory septic shock. Several indexes were found to be significantly related to short-term clinical outcome; as sequential organ failure assessment score (SOFA) and the mortality in emergency department sepsis (MEDS) score. Methods: Observational cohort study with prospective data collection. Severity of sepsis was assessed according to SOFA score, MEDS score. C-reactive protein (CRP) and 6 hours lactate clearance were measured. The outcome of patients was noticed according to the detected SOFA score, MEDS score, CRP, and lactate clearance levels in the survivors and non-survivors as well as their correlation with the severity of the disease. Results: Fifty patients with age range from 20 to 92 years. The mortality rate was 24% (12 patients). Six hours lactate clearance mean value was 21.04 ± 9.48%. Mean SOFA score at presentation was 6.56 ± 2.99 while after 72 hours, it was 5.28 ± 3.94. Mean MEDS score was 2.72. Six hours lactate clearance was significantly lower among the dead cases. MEDS score was significantly higher among the mortality cases. SOFA score whether measured at admission or after 72 hours and MEDS score were significantly higher among the dead cases. Both delta SOFA score and 6 hour lactate clearance were found to have the highest predictive characteristics with 100% sensitivity and specificity. There was statistically significant difference between area under the curve of SOFA 72 hours and 6 hours-lactate clearance when compared to CRP area under the curve. Conclusion: Both delta SOFA score and six hour lactate clearance had the highest predictive characteristics with 100% sensitivity and specificity.

      PubDate: Sat, 22 Oct 2016 16:38:39 GMT
  • Predictive Value of Simple Biomarkers of Mortality in Patients with Severe
           Heart Failure in Emergency Department in Suez Canal University Hospital in

    • Abstract: 2016-10-24T08-45-07Z
      Source: International Journal of Surgery and Medicine
      Khaled Moursy Salama, Monira T. Ismail, Hanan Kamal, Basant Mousa.
      Background : Heart failure (HF) has become one of the most important problems in health care in the western world. There are over 26 million people who suffer from heart failure in the world. Half of all patients diagnosed with heart failure die within four years. It is very important to predict if a patient will die soon so that an effective prevention can be employed. However, characteristics and outcome of HF patients are not well investigated in developing countries like Egypt. Patients & Methods: was to assess the short term predictive value of simple biomarkers (such as d-dimer, CRP & ESR) regarding cardiovascular mortality and major cardiovascular events in patients with severe heart failure. This is cross sectional study, the study included 141 patients.Results: according to ESR, CRP, d-dimer as predictors of hospital admission within one month follow-up:45.9 % of the patients had moderately elevated ESR, 72.1% of the patients had high CRP and 13.1 % of the patients had positive D-dimer. According to ESR, CRP, D-dimer as predictors of mortality within one month follow up: 83.3% of the patients had moderately elevated ESR within first hour, 83.3% of the patients had high CRP and 33.3% of the patients had positive D-dimer. Conclusion: ESR may be a good predictor of mortality within one month follow up, while CRP, D-dimer are not.

      PubDate: Sat, 22 Oct 2016 15:13:03 GMT

    • Abstract: 2016-09-26T23-20-06Z
      Source: International Journal of Surgery and Medicine
      Marco Corzani, Luigi Meccariello, Michele Bisaccia, Pellegrino Ferrrara, Giuseppe Rinonapoli, Luigi Piscitelli, Maria Liberata Meccariello, Auro Caraffa.
      ABSTRACTBackgroundOsteocondrithisdissecans (OCD) is an acquired disease due to a subcondral boneischaemia that affects generally the medial femoral condyle as well as above lyingcartilage.Though the incidence of OCD is only 6/10,000 in the general population, in the later stages of disease, OCD fragment can break off inside the articular cavity it is the mostFrequently reported cause of free endoarticular bodyThe etiology has been hypothesized as being multi-factored due to traumas ormicrotraumas along with metabolic, endocrine and genetic disorders leading to subchondral ischemia .Description of caseA 15-year old male amateur soccer player presented to our department complaining of recurrent episodes of pain at rest in both knees, swelling and articular blockage occurring over the past 3 years. RX and MRIrevealed bilateral lesions on both medial condyles.A ONE-STEP surgical technique was performed that incorporated the drawing ofmesenchymal staminal cells (MSCs) and their implantation.ConclusionThis case report deals with a rare case of bilateral OCD of the knee treated with the latest technique in regenerative medicine. At 6-month follow up there was a complete return of muscular tonality in both knees andthe patient was allowed to return to light physical activity. These results are noteworthyfor the fact they were obtained from a combined surgical approach that when compared toalternative approaches lead to a shorter hospital stay and a reduced hospital burden. Each of the osteochondral lesions was evaluated from imaging results and arthroscopic findings.

      PubDate: Sun, 25 Sep 2016 15:54:39 GMT
  • Small-Cell neuroendocrine carcinoma of nasopharynx: A case report

    • Abstract: 2016-09-26T23-20-06Z
      Source: International Journal of Surgery and Medicine
      Khadija Bellahammou, Asmaa Lakhdissi, Othman Akkar,Fadila Kouhen, Fadoua Rais, Souhail Dahraoui, Hind M'rabti, Hassan Errihani.
      Extra pulmonary small cell carcinomas are extremely rare, accounting for 0.1-0.4% of all malignancies and 2.5-4% of small cell carcinomas. In the head and neck region, the most common primary sites are the larynx, salivary gland, nasal cavity, paranasal sinus, tonsil, and oral cavity. Small cell carcinomas occurring in nasopharynx are extremely rare, to our best knowledge, only four cases of primary nasopharyngeal small cell carcinoma has been described in English literature. We report another case of nasopharyngeal small cell carcinoma arising in a 46-year-old woman. She accused, for five months, nasal blockage, right hypoacousia, exophthalmos and reduced visual acuity. Cerebral and facial magnetic resonance imaging showed an extensive mass of the nasopharynx with the invasion of sphenoidal body, the diagnosis of disseminated small cell carcinoma of nasopahrynx was established. The patient received three courses of systemic chemotherapy; unfortunately, she died after the third course. The prognosis of such entity is poor and is similar to that for patients with extensive small cell lung cancer.

      PubDate: Sun, 25 Sep 2016 09:16:13 GMT

    • Abstract: 2016-09-21T23-21-46Z
      Source: International Journal of Surgery and Medicine
      Retroperitoneal abscess is a serious complication of diverticular disease. Its management involves several options, ranging from conservative management to surgery. Elective colectomy is most often thought to be mandatory after a percutaneous drainage given the high rate of recidive. However, in patients with high risk for surgery, percutaneous drainage is often the main therapeutic alternative. We report a case of a 80-year-old woman, who was diagnosed to have a retroperitoneal abscess complicating a sigmoid diverticulitis. Ultrasound-guided percutaneous drainage allowed to drain 1500cc of pus and gas. The cytobacteriological examination was positive for: Streptococcus spp and Alkalescens dispar. The therapeutic outcomes were uneventful and despite we did not realize a colectomy because the patient was at high risk for surgery, there was no recidive after a 2-year-follow-up period. Percutaneous drainage can be a therapeutic alternative in patients with high risk for surgery in diverticular abscess of big size.

      PubDate: Wed, 21 Sep 2016 12:09:34 GMT
  • Calcium and vitamin D status in morbidly obese patients and in patients
           after biliopancretic diversion/duodenal switch

    • Abstract: 2016-09-07T14-24-25Z
      Source: International Journal of Surgery and Medicine
      Natalya Mazurina, Ekaterina Troshina, Natalya Ogneva, Yury Yashkov, Alexander Iliyn, Galina Melnichenko, Ivan Dedov.
      Objective: The objective was to estimate the prevalence of inadequate vitamin D status and secondary hyperparathyroidism (SHPT) in morbidly obese patients and in patients who underwent biliopancreatic diversion/duodenal switch surgery (BPD/DS)Design: 3 groups were included in the cross-sectional comparative study: group 1 - morbidly obese (MO) patients with BMI> 40 and without type 2 diabetes mellitus (n=22), group 2 – patients in the long-term period after BPD/DS (n=23); group 3 – healthy normal weight controls (n=22).Results: 25(OH)D levels were significantly different in the controls (21.8 ng/dl), in the MO (8.8 ng/dl) and in the BPD/DS patients (8.6 ng/dl). Parathyroid hormone (PTH) elevation was found in 4 (18%) MO patients, in 12 (52 %) patients after BPD/DS, and was not detected in the control group. The frequency of SHPT was significantly higher in the operated group (52 %) in comparison with the MO group (18 %) (р=0.029).Conclusions: Vitamin D deficiency and secondary hyperparathyroidism are significantly more prevalent in MO patients than in normal weight subjects. In the long-term period after BPD secondary hyperthyroidism is more frequent than in MO and is not always accompanied by vitamin D depletion. Special attention should be paid for adequate control of calcium metabolism and supplementation by calcium and vitamin D.

      PubDate: Tue, 06 Sep 2016 00:50:22 GMT
  • The occurrence of sieve-like duodenum due to Helicobacter pylori infection
           in a cirrhotic patient: Current insights, management, and the importance
           of H. pylori infection and its associations with cirrhosis

    • Abstract: 2016-09-07T14-24-25Z
      Source: International Journal of Surgery and Medicine
      Cyriac Abby Philips, Chhagan Bihari.
      Helicobacter pylori infection is prevalent world-wide. Involvement of H. pylori in the etiopathogenesis of liver diseases are a matter of debate. Treatment options vary widely between different regions with regards to microbial sensitivity patterns. In this short review, we present the case of an alcoholic cirrhosis patient, who presented with a rare ‘sieve-like’ appearance of the duodenum secondary to multiple ulcers, due to H. pylori infection.. We review briefly, but concisely, the different associations and strengths of H pylori with liver disease and recent guidelines and recommendations on treatment of this widely present infection.

      PubDate: Sun, 04 Sep 2016 04:23:32 GMT
  • The advancement and history of breast cancer surgical therapy at a glance

    • Abstract: 2016-09-07T14-24-25Z
      Source: International Journal of Surgery and Medicine
      George Dimitrov, George Baytchev, Ivan Inkov, Dimitar Dimitrov.
      For decades now breast cancer tissue resection has been the primary method of choice for treating the disease, however this was not the case throughout the history of medicine. For centuries breast cancer was considered to be incurable via surgical approaches and that only early, low grade, lesions can be removed safely. Not until the 19th century, was there an evident increase in surgical therapy for the disease (mainly radical mastectomies) due to the teaching of Morgagni, in addition to completely redefining the etiological process of the disease by Le Dran. Currently, practitioners have achieved a very high level of proficiency in treating the disease via continues refinement of the aforementioned facts. This resulted in tissue and organ sparing local surgical approaches, including wide local excisions through para-areolar incisions and even skin and areolar-complex spearing mastectomies, which have long overpassed the unnecessary and primitive high morbidity approaches performed in the earlier attempts to treat breast cancer.

      PubDate: Sat, 03 Sep 2016 14:12:46 GMT

    • Abstract: 2016-09-07T14-24-25Z
      Source: International Journal of Surgery and Medicine
      Andrea Schiavone, Michele Bisaccia, Luigi Meccariello, Giuseppe Rinonapoli, Luigi Piscitelli, Mattia Manni, Cristina Ibáñez Vicente, Olga Bisaccia, Auro Caraffa.
      Chronic exertional anterior compartment syndrome is debilitating disease of lower limb. The clinical picture is characterised by limited symptomology at rest, pain during sporting activities, tumefaction and contractures of limb as well impotency by pain of the entire forefoot and hypoesthesia. Usually the most affected patients are athletes. We analyse a case of chronic post traumatic compartment syndrome of the anterior tibial muscle in an unsportsmanlike patient.

      PubDate: Sat, 03 Sep 2016 14:03:33 GMT
  • Implementing a quality improvement framework for major amputation in a
           Scottish health board (Patterns of peri-operative mortality and
           amputation level)

    • Abstract: 2016-09-01T23-19-53Z
      Source: International Journal of Surgery and Medicine
      Bryce Renwick, Colette Pickard, Marta Madurska, Michael Burns, Joshua Fultang, James Horton, Adam MacDonald, Khalid Irshad, Donald J Bain, Donald B Reid.
      To the esteemed editors of IJSM,We present a large contemporary series of patients presenting with unreconstructable critical limb ischaemia and requiring amputation. As well as being an insight into the challenges faced with the implementation of a quality improvement framework, We also feel the results will better inform the practising vascular surgeon and patients about the risks of limb loss in the 21st century.Best wishes, Bryce Renwick

      PubDate: Mon, 29 Aug 2016 13:34:03 GMT
  • Radiation protection in complex endovascular procedures

    • Abstract: 2016-09-01T23-19-53Z
      Source: International Journal of Surgery and Medicine
      Bryce Renwick, Nimra Zaidi, Nimra Zaidi, Marta Madurska, Marta Madurska, Khalid Irshad, Donald J Bain, Donald B Reid.
      Endovascular procedures are becoming more complex and intricate as technology evolves. This is very favourable for patients, who can have mora advanced procedures performed with minimal morbidity and mortality. However these advances come at the cost of increased radiation dosage to the operating surgeon, interventionist and angiosuite team. We present a review article of the current problems facing the interventional team and of possible solutions.

      PubDate: Mon, 29 Aug 2016 11:14:36 GMT
  • Persistent Compromised Hemodynamic Function, due to single ventricular
           epicardial pacing, after aortic valve replacement surgery: A Case Report

    • Abstract: 2016-08-28T14-33-29Z
      Source: International Journal of Surgery and Medicine
      Konstantinos Giakoumidakis, Christos Charitos.
      We report the case of a 69-year old woman, who was admitted to the cardiac surgery intensive care unit (ICU) of a tertiary hospital, after surgical aortic valve replacement, due to severe aortic stenosis. During the early postoperative period, the patient was hemodynamically stable and her cardiac rhythm was supported by temporary epicardial ventricular pacing. One hour after her ICU admission, the woman presented compromised hemodynamics, characterized by severe hypotension with poor response to aggressive inotropic, vasopressor and fluid therapy. After 15 minutes of her significant clinical worsening, the change of the pacing mode from single ventricular to single atrial effected immediate hemodynamic stabilization, improved arterial blood pressure and optimum patient cardiovascular function. This could be explained by the significantly reduced cardiac output in the absence of atrial contraction to assist ventricular preloading, which characterized some patients with impaired ventricular function, as those with severe aortic stenosis.

      PubDate: Sat, 27 Aug 2016 14:10:52 GMT
  • Prospective, Randomized Controlled Trial of LigaSureTM versus Conventional
           Hemorrhoidectomy for Grade III and IV Hemorrhoids

    • Abstract: 2016-08-24T04-19-49Z
      Source: International Journal of Surgery and Medicine
      wagih mommtaz ghnnam.
      Background Performing hemorrhoidectomy with LigaSure™ vessel sealing system is a rapid and simple new technique. The aim of this study was to evaluate LigaSure™ hemorrhoidectomy (LH) to open hemorrhoidectomy (OH) performed by the conventional diathermy. Patients and methods One hundred and sixteen patients with grades III and IV hemorrhoids were prospectively randomized to either LigaSure™ or open conventional diathermy hemorrhoidectomy. Primary end point was postoperative pain. Secondary end points were operative time, blood loss, complications, need for analgesics and time to achieve complete wound healing. Results The LigaSure™ group achieved a significant reduction in operative time, blood loss, first postoperative day pain score, seventh day pain score and overall pain score. Patients in the LigaSure™ group required less pethidine analgesia on the first postoperative day. Time to achieve complete wound healing were shorter in the LigaSure™ group. There was no difference in postoperative complications. Conclusion LigaSure hemorrhoidectomy provides a valid alternative to conventional hemorrhoidectomy. Based on our results, further studies addressing long-term functional results are needed to prove that LigaSure™ hemorrhoidectomy is the ideal method of hemorrhoidectomy for the patients.

      PubDate: Mon, 22 Aug 2016 01:51:05 GMT

    • Abstract: 2016-08-02T04-17-43Z
      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: Sun, 31 Jul 2016 10:36:57 GMT

    • Abstract: 2016-08-02T04-17-43Z
      Source: International Journal of Surgery and Medicine
      Thulasikumar Ganapathy,Marunraj Gnanasekaran, Aravind Moorthy.
      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: Sun, 31 Jul 2016 10:36:57 GMT

    • Abstract: 2016-08-02T04-17-43Z
      Source: International Journal of Surgery and Medicine
      Zuvdija Cecunjanin, Amina Selimovi&#;, Selma Miliši&#;, Ermina Muji&#;i&#;.
      Objective: The purpose of our retrospective study was to investigate the necessity of some laboratory testing in patients with acute bronchiolitis before and after treatment. Methods: We have taken blood samples of all children puncturing the cubital vein, and analyzed it using the Colter appliances-automatic counter blood count, for analyzes of a number of erythrocytes, leukocytes, platelets, differential blood count, Hct, Hb. CRP concentration in serum of patients determined by laser nephelometry with CardioPhase® high sensitivity C-reactive protein (hsCRP). For assessment of acid-base status and arterial blood gas analysis were used ABL5 and ABL700 Radiometer Copenhagen. We monitored the following parameters: pH, pCO2, HCO3-, total CO2, base excess, pO2, SpO2. Results: There was a significant improvement of hypoxemia after management of acute bronchiolitis in the form of a significant increase in average values of pO2 and SpO2 after treatment of acute bronchiolitis. The average value of the number of leukocytes and value of CRP in children were significantly decreased before and after management of acute bronchiolitis. There was no significant difference in duration of hospitalization in term and preterm newborns.Conclusion: No routine diagnostic tests are used routinely. However, there is an improvement of hypoxemia after management of acute bronchiolitis in children.

      PubDate: Sun, 31 Jul 2016 10:36:57 GMT

    • Abstract: 2016-08-02T04-17-43Z
      Source: International Journal of Surgery and Medicine
      Deniz Gokalp, Alpaslan Tuzcu, Ster Irmak, Mithat Bahceci, Ozlem Demirpence.
      Objectives: In the present study, we aimed to determine the prevalence of aspirin resistance in patients with Type 1 and 2 diabetes and to study its association with metabolic parameters. Methods: Aspirin resistance of patients (n=158) with Type 2 Diabetes Mellitus (DM) who presented to the center after 7 days of regular aspirin use were compared to age-mathced (55±19) healthy controls (n=164). Similarly, aspirin resistance of patients (n=30) diagnosed with Type 1 DM were compared to age-matched (27±7) healthy subjects (n=41) as the control group. Platelet Function Analyzer (PFA)-100 was used to evaluate the efficacy of aspirin. Results: Aspirin resistance was identified in 72 of 158 patients with Type 2 DM (45.6%) and in 47 of 164 healthy controls (28.6%) (p=0.001). Aspirin resistance had a prevalence of 50% in patients with Type 1 DM and was significantly higher compared to the control group of 41 healthy subjects (12.2%) (p=0.001). No correlations were noted between aspirin resistance and sex, smoking, HbA1c, hypertension and aspirin dose. There was a significant relation between aspirin resistance and LDL-cholesterol in patients with Type 2 DM (p=0.020). Conclusion: Patients with Type 1 and Type 2 DM had a higher frequency of aspirin resistance than the control group. Therefore, treatment choices including administering higher doses of aspirin or using other antiplatelet agents such as clopidogrel should be considered to prevent thrombocytic events in diabetes mellitus.

      PubDate: Sun, 31 Jul 2016 10:36:57 GMT

    • Abstract: 2016-08-02T04-17-43Z
      Source: International Journal of Surgery and Medicine
      Andrea Cappiello, Verdiana Stano, Michele Bisaccia, Luigi Meccariello, Gabriele Falzarano, Antonio Medici, Marco Pellegrino, Olga Bisaccia, Giuseppe Rinonapoli, Auro Caraffa.
      AbstractPurpose. From prospectively report the 2-year follow-up clinical and real-time sonoelastography (RTSE) outcomes of a group of patients affected by small unilateral supraspinatus tendon tears. Our hypothesis was that patients with lower baseline strain indexes would have worst outcomes at follow-up.Methods. We recruited patients suffering by a unilateral rotator cuff tear. All patients have prospectively scrutinized. Patients were initially managed non-operatively, after at least 3 months of failed conservative treatment patients went under surgery. Our clinical evaluation and follow up was done by: complete physical examination; VAS for pain; Quick DASH; Constant–Murley score; Simple Shoulder Test; ASES score and UCLA score. The mechanical properties of tissues were evalutated by Conventional ultrasounds and RTSE and they were estimated uging the Strain index. Results. Forty-three patients were available for evaluation at 2 years. Fifteen had undergone surgery (operative group), while 28 recovered from pain and dysfunction with conservative management andhad not required surgery (non-operative group). Patients in both groups significantly improved at follow-up, and no differences were found in all considered clinical outcomes. The biomechanical properties of repaired tendons were maintained, while non-operatively treated tendons softened over time. Baseline and follow-up strain indexes were linearly correlated with clinical outcomes at 2 years. Conclusions. Baselinestrain index could be associated with post-operative functional outcomes at 2-year follow-up. The biomechanical properties of surgically repaired tendons were maintained, while non-operatively treated tendons softened over time. At least in this cohort of patients, baseline strain index did not suggest who could be managed conservatively and who will need surgery.

      PubDate: Sun, 31 Jul 2016 10:36:57 GMT

    • Abstract: 2016-08-02T04-17-43Z
      Source: International Journal of Surgery and Medicine
      Roman Romansky, George Baytchev, Ivan Inkov, Stefan Komitski.
      The contemporary tendency for increase of prophylactic surgical procedures as part of the sophisticated treatment of breast cancer is the foundation for the present study. Evaluation of risk factors for developing contralateral breast cancer, factors for an increase in prophylactic mastectomies and indications for performing those operations are briefly commented. Analysis of 12 cases of the authors surgical practice is presented regarding treatment approach from the oncological, reconstructive and aesthetic point of view. Results, complications, alternative methods, clinical importance and possible future aspects are discussed.

      PubDate: Sun, 31 Jul 2016 10:36:57 GMT
  • Multiple Foot Bone Renal Cell Carcinoma Metastases: Feasibility of
           Simultaneous CT-Guided Microwave Ablation

    • Abstract: 2016-07-28T09-22-19Z
      Source: International Journal of Surgery and Medicine
      Daniele Maiettini, Michele Bisaccia, Auro Caraffa, Luigi Meccariello, Gabriele Falzarano, Antonio Medici, Marta Rossi, Luigi Piscitelli, Giulio Metro, Alberto Rebonato.
      Renal tumor has a high incidence of bone metastasis (BM). BM are burdened by a considerable morbidity and are the most common cause of cancer-related pain. Local treatment of metastases remains controversial despite showing promising results for pain control.We would like to report our experience with a patient who developed foot bone metastasis 3 years after a left nephrectomy for a renal cell carcinoma. Metastasis were treated in two session of CT-guided microwave ablation. One lesion in the first session and three, simultaneously, in the second one. Cement augmentation was performed in all cases. No complications were noticed.The patient showed good pain control immediately after the procedure and on follow-up at six months.

      PubDate: Wed, 27 Jul 2016 13:10:07 GMT

    • Abstract: 2016-07-28T09-22-19Z
      Source: International Journal of Surgery and Medicine
      Michele Bisaccia, Luigi Piscitelli, Giovanni Colleruoli, Giuseppe Rinonapoli, Cristina Ibáñez Vicente, Gabriele Falzarano, Antonio Medici, Luigi Meccariello, Olga Bisaccia, Auro Caraffa.
      Background:Rugby is a contact sport and for this reason is very demanding from a physical point of view.Up to now few studies describe the incidence and types of the most frequent traumas. The present study aims to evaluate the epidemiology of the major accidents related to the practice of this sport.Materials and methods:We collected data on a total of 321 players belonging to the Sports Club "CUS Rugby Perugia" for a total of three years taking into consideration the type of injury, the part of the body concerned, if the injury occurred during official competitions or in training, and also the lapse of time necessary for recovery.Results:We had a total of 240 accidents (45.8% of minor gravity, 36.6% of average gravity and 17.6% serious). In relation to the type of trauma, we noticed that minor injuries consisted in most cases and above all in facial injuries, while the average and the serious severity accidents affected in most cases the knees: (sprains, meniscal and ligamentous tears).Discussion:By analyzing the collected data we have noticedthat the highest number of accidents occurred during official competitions, and especially during the last minutes of the game, probably due to a greater muscle fatigue. The role of the players is also important because it correlates to a different type of risk.Conclusions:This study confirms that rugby has a higher accident rate than other contact sports. Therefore specific training strategies and techniques should be implemented, in order to reduce the incidence of injuries, especially at the level of the lower limbs.

      PubDate: Wed, 27 Jul 2016 13:09:45 GMT
  • Prognostic value of blood glucose levels in diabetic patients upon
           admission and its outcomes in patients with acute coronary syndrome

    • Abstract: 2016-07-28T09-22-19Z
      Source: International Journal of Surgery and Medicine
      Adel Hamed Elbaih, Monira Taha Ismail, Mohamed Mohy, Gamela Nasr, Mahmoud Awad.
      AbstractBackground: Coronary heart disease (CHD) is the main leading cause of morbidity and mortality in patients with diabetes mellitus. Hyperglycemia on admission was associated with a worse outcome for all patients admitted with ACS. Aim: To correlate the relationship between hyperglycemia with acute coronary syndrome and poor outcome.Methodology: Clinical evaluation of the patients were carried out on arrival to Emergency Department regarding: Initial assessment of patient general condition either stable or not through; ABCDE (air way and cervical spine control, breathing, circulation, neurological dysfunction and exposure). Then determine the characters and types of chest pain. Assess the condition of the patients either stable or unstable which will determine the needed investigations and plane of management.Results: the mortality was higher in patients with RBG more than 300 mg/dl (68.4 %), (10.5 %) of the patients had ranged from 250 ─ < 300 mg/dl, and the patients had ranged from 200 ─ < 250 mg/dl were (10.5 %). The patients had ranged from 160 ─ < 200 mg/dl were (5.3) and there were (5.3) of the patients had ranged from 70 ─ < 160mg/dl.Conclusions: The data from this study have shown that hyperglycemia on admission was associated with a worse outcome for all patients admitted with ACS. Keywords: Diabetes mellitus; Acute coronary syndromes; CK-MB.

      PubDate: Wed, 27 Jul 2016 13:09:15 GMT

    • Abstract: 2016-07-12T23-24-25Z
      Source: International Journal of Surgery and Medicine
      Sujata Singla, Kusum Meena, O.P. Pathania, Shilpi Agarwal, Nitish Dev, Sneha ` Jha.
      Peritonitis due to peptic ulcer perforation is a frequently encountered surgical emergency. Intake of non steroidal anti inflammatory drugs (NSAIDs), Helicobacter pylori infection and neoplastic etiology are the common causes documented. Uncommonly peptic perforation can be due to fungal infection. If it occurs; it is associated with significantly increased morbidity and mortality. This case report emphasize on considering fungal infection as etiology of gastric perforation, even when other common causes like NSAIDs intake are present. An early diagnosis can prevent fatal complications like shock, fever, wound complications and multiorgan failure. Knowledge of such case reports can help a surgeon in dealing with common pathology but rare etiology.

      PubDate: Sun, 10 Jul 2016 06:33:55 GMT
  • A prospective randomized comparative evaluation of Flupirtine and
           Diclofenac sodium in post inguinal hernia surgery pain

    • Abstract: 2016-07-12T23-24-25Z
      Source: International Journal of Surgery and Medicine
      Jai Karan, R K Karwasra, Rajesh Godara, A R Bansal, Rathindra Tripura.
      Introduction: Effective postoperative pain control is an essential component of care of surgical patients. Nonsteroidal anti-inflammatory drugs are mainstay to treat pain and inflammation. Flupirtine is a novel, non-opiate, non-NSAID, centrally acting analgesic without side effects associated with NSAIDs. Aim and Objectives: Prospective, randomized, double blind comparative study to evaluate and compare analgesic efficacy of flupirtine with diclofenac sodium in inguinal hernia surgery.Methods: The study was conducted in tertiary care teaching hospital on 50 patients aged 15-65 yrs of either sex who underwent inguinal hernia surgery between March 2014 and January 2016. Patients with liver and renal failure, hypersensitivity to flupirtine or diclofenac, pregnant/lactating women, bronchospastic disease, inability to understand pain score, prior history of peptic ulcer were excluded from study. The patients were randomly allocated into two groups consisting of 25 patients each: group-A (tab flupirtine 100mg),group-B (tab diclofenac sodium 50mg). Pain was evaluated in detail using simple and sensitive visual analog scale.Results: The mean age of the participants was 37.57±12.02 yrs in group A and 37.82±13.43 yrs in group B(p>0.05 ) with male-to-female ratio 3:1. The mean weight of the participants was 66.72±12.90 vs 64±13.10 kg (p>0.05). The mean VAS values observed were 1.36±1.77 at baseline, 1.24±2.18 at 6 hours, 0.60±1.65 at 12 hours, 0.40±1.19 at 18 hours, 0.16±0.62 at 24 hours, 0.08±0.4 at 30 hours & 36 hours, at 42 and 48 hours were 0 for group A. For group B values calculated were 2.20±2.58 at baseline, 1.40±1.55 at 6 hours, 1.28±1.72 at 12 hours, 0.76±1.56 at 18 hours, 0.28±0.61 at 24 hours and at 30, 36, 42 and 48 hours were 0. The intergroup comparison between group A and group B by independent t-test at various intervals revealed no statistically significant difference between two groups in mean VAS (p>.05) that means both the drugs are equally efficacious in relieving post-operative pain. Only 1 patient (4%) in group A experienced nausea. A total of 4 patients in group B had side effects, all 4 patients (16%) had heart burn, 2 out these 4 also complains of pain abdomen and 1 patient (4%) had vomiting.Conclusion: Flupirtine could be a better alternative to opioids and NSAIDs in postoperative pain relief

      PubDate: Sat, 09 Jul 2016 08:47:50 GMT
  • Management of extramedullary plasmocytoma of head and neck.

    • Abstract: 2016-07-04T10-00-49Z
      Source: International Journal of Surgery and Medicine
      Naoual Benhmidou, Fadoua Rais, Khadija Bellahammou, Abdelhak Maghous, Hasna Loughlimi, Meryem kamouni, Fadila Kouhen, Sanaa Elmajjaoui, Tayeb Kebdani, Hanan Elkacemi, Noureddine Benjaafar.
      Abstract:Extramedullary plasmocytoma is an expansion of a single clone of immunoglobulin-secreting plasma cells without evidence of multiple myeloma. It is un uncommon entity that occurs usually in head and neck area. It is radiocurable at average doses while adjuvant chemotherapy is still controversial. Progression rates to multiple myeloma are lower than bone plasmacytoma. We report three cases of extramedullary plasmacytoma and through a literature review we discuss radiation modalities as well as evolutionary aspects.

      PubDate: Sat, 02 Jul 2016 05:20:08 GMT
  • Leiomyosarcoma of inferior vena cava

    • Abstract: 2016-06-30T00-03-20Z
      Source: International Journal of Surgery and Medicine
      Ventsislav Mutafchiyski, Georgi Popivanov, Dimitar Penchev, Albena Fakirova, Ivan Inkov, Rumen Popov.
      Sarcomas are very rare tumors and in 10-30% of the cases are located in the retroperitoneum. Leiomyosarcomas of inferior vena cava accounts for less than 1% of all sarcomas. Despite the poor prognosis as a whole, some cases with R0 resection might have excellent outcome. So, all attempts for R0 resection should be undertaken. Herein we present a case with tumor located at the border of lower and middle third of the IVC managed by excision, primary suture and preservation of both renal veins. A short review of the basic surgical options and risk factors is given.

      PubDate: Wed, 29 Jun 2016 23:24:24 GMT

    • Abstract: 2016-06-30T00-03-20Z
      Source: International Journal of Surgery and Medicine
      Adel Hamed Elbaih, Monira Taha Ismail, Mohamed Salh, Emad Aldine Abd Algwad, Ahmed Abd Elfatah.
      Inroduction: regular physical activity is essential for the prevention of various diseases and reduces the risk of premature mortality in general and coronary heart disease, hypertension, colon cancer, obesity and diabetes mellitus in particular. Aim of this study was to assess the most common sports causing injuries and to assess the types and mechanisms of these injuries. Patients and  methods: The researcher examined 250 patients attending emergency departmentl.  Results: The study showed that the most common type of sports involved in injury was football .The ankle was the most common affected part in the whole body . Chest contusion and back contusion were the most common types of sports injuries in head, neck and trunk. Fracture scaphoid and fissure radius were the most common sport injuries. Ankle sprain was the most common injury. The study showed that (62.7%) of the studied patients who were playing football had injuries in the lower limbs. Ankle sprain was the most common sport injury that was associated with wearing football shoes . Conclusion: Ankle sprain was the most common sport injury associated with artificial grass court . Wrist sprain was the common sport injury in the upper limbs associated with artificial grass court .  

      PubDate: Wed, 29 Jun 2016 23:24:02 GMT

    • Abstract: 2016-06-24T20-30-26Z
      Source: International Journal of Surgery and Medicine
      Lona Jalini, Jonathan Lund, Vijay Kurup.
      Introduction: Nipple creation using the C-V flap technique is often the final step in breast reconstruction. The aim of this study was to subjectively and objectively assess the cosmetic outcomes and satisfaction of patients undergoing C-V flap nipple reconstruction.Methods: Subjective assessments of patient satisfaction with the neo-nipple were recorded by visual analogue scoring (VAS; 0-10). Objective measurements were performed using a calliper to measure nipple projection relative to the native breast. Descriptive data analysis was performed with differences in projection assessed with the Mann-Whitney test and mean and median VAS scores (with inter-quartile ranges; IQR) calculated to describe satisfaction.Results: Thirty-three C-V flap nipple reconstructions were performed. 87.9% received latissimus dorsi (LD) reconstructions with implants and 12.1% had transverse rectus abdominis muscle (TRAM) reconstructions. The median projection of reconstructed nipples was 4.7 mm (range 4-10.2 mm) at 4.6 years mean follow-up, which was not significantly different from the contralateral nipple (p = 0.34). Patient satisfaction was 9 (IQR: 8-10) with shape, 9 (IQR: 7.5-10) with projection, 5 (IQR: 2-9.6) with sensation, and 8.5 (IQR: 6-9.5) with symmetry. Median overall satisfaction was 9 (IQR: 8-10). Three patients had complete nipple loss, of whom two had undergone nipple piercing post procedure and none had received radiotherapy.Conclusion: C-V flap nipple reconstructions provide a simple and reliable method to reconstruct the nipple that enhances confidence and perception of body image. Satisfaction was high with long-term outcomes in terms of projection equivalent to the contralateral breast.

      PubDate: Tue, 21 Jun 2016 10:26:58 GMT
  • Mesenteric panniculitis in the elderly – update on diagnostic and
           therapeutic approach

    • Abstract: 2016-06-16T09-16-52Z
      Source: International Journal of Surgery and Medicine
      Francisco Irochima Pinheiro, Amália Cinthia Menezes Rêgo, Irami Araújo-Filho.
      The Mesenteric Panniculitis (MP) is a rare, non-specific inflammatory condition, mainly affecting the benign intestinal mesentery. It knew that she is diagnosed primarily during the sixth and seventh decade of life and seems to be two times more common in men than in women. The etiology of SM remains unknown, although several mechanisms have been suggested contributors, including surgery or abdominal trauma before, autoimmunity, paraneoplastic syndrome, ischemic injury, and infections. The major signs and symptoms are abdominal pain, the presence of palpable abdominal mass, nausea and vomiting, bowel changes, weight loss, small bowel obstruction, chylous ascites and peritoneal irritation signals. About of 10% of the patients are asymptomatic. The radiological study, especially computed tomography (CT) and magnetic resonance imaging (MRI), are essential components of the diagnostic evaluation. The ''greasy'' ring signal and the pseudocapsule tomographic findings are considered specific tumoral this pathology. The histopathologic study establishes the diagnosis. There is no specific treatment for SM and should this be empirical and individualized. Although they are described cases of spontaneous remission, some authors have shown benefit with the empirical treatment using corticosteroids, colchicine, immunosuppressants, antibiotics, tamoxifen, alone or in combination. The surgical approach has a limited role and usually aimed at symptomatic relief. In most cases, the prognosis is favorable.

      PubDate: Sat, 11 Jun 2016 11:06:19 GMT
  • Invasive Pulmonary Aspergillosis following bevacizumab treatment for
           Non-Small Cell Lung Cancer

    • Abstract: 2016-06-05T14-20-24Z
      Source: International Journal of Surgery and Medicine
      Khadija Bellahammou, Asmaa Lakhdissi,Akkar Othman,Salmi Narimane, Ibrahim El ghissassi, Fadoua Rais, Naoual Benhmidou, Hind M'rabti, Hassan Errihani.
      Bevacizumab is a recombinant humanized monoclonal antibody targeting the vascular endothelial growth factor; it is actually approved for the treatment of unresectable, locally advanced and metastatic non-small cell lung cancer in association with chemotherapy and as maintenance therapy. Infection risk due to use of bevacizumab is a very rare event. Several cases of aspergillosis in patients treated with monoclonal antibodies have been reported, mostly following treatment with tumor necrosis factor alpha blockers. We present a case of a 60 year-old patient treated for stage IV non-small cell lung cancer, who has been diagnosed with invasive aspergillosis following bevacizumab treatment, and, we postulate that bevacizumab may contribute to this infection.

      PubDate: Thu, 02 Jun 2016 08:04:24 GMT
  • Aggressive multiple myeloma in a young adult: a case report

    • Abstract: 2016-06-05T14-20-24Z
      Source: International Journal of Surgery and Medicine
      Khadija Bellahammou, Asmaa Lakhdissi, Othman Akkar, Narimane Salmi, Fatima Zahra Zakkouri, Souhail Dahraoui, Fadoua Rais, Hind M'rabti, Hassan Errihani.
      Multiple Myeloma is a blood cancer type B characterized by clonal proliferation of malignant plasma cells, the median age at diagnosis is 70 years, cases among younger patients are rare, and less than 0, 3 % patients are younger than 30 years in most series. We report a case of a 25-year- old women; she was suffering of a sacred pain radiating towards the left lower limb and fatigue for three months, a magnetic resonance imaging for dorso-lumbar spine showed an expansive process and multiple osteolytic lesions in 2nd, 3rd and 4th sacred vertebras. She underwent a laparotomy that revealed a heavy mass invading the sacrum and the rectum. The histological examination with immunocytochemistry analysis revealed a plasmocytoma and the diagnosis of symptomatic multiple myeloma stage III was established then she received 2 courses of chemotherapy. Despite the rarity of multiple myeloma among young patients, this diagnosis should be evoked when clinical, biological and radiological signs are in favor. It appears that there is no difference between younger and elderly patients on the presentation of the disease, although a longer survival has been reported among young patients.

      PubDate: Thu, 02 Jun 2016 08:04:05 GMT
  • Changes in Serum Levels of IL-6 in the Early Postoperative Period after
           Preemptive Analgesia with Nimesulide, Metamizole Sodium and Placebo in
           Removal of Impacted Mandibular Third Molars

    • Abstract: 2016-06-05T14-20-24Z
      Source: International Journal of Surgery and Medicine
      Deyan Zdravkov Neychev, Irina Stanimirova, Kiril Kostov Simitchiev, Mariana Murdjeva, Dimitar Atanasov.
      Abstract Objective: The objective of this study is to determine the change in IL-6 serum levels in patients undergoing preemptive analgesia and surgical removal of an impacted mandibular third molar.Study Design: This is a prospective, double-blind, placebo-controlled study in 80 patients who had an atypical extraction of an impacted mandibular third molar.Results: After surgical removal of impacted mandibular third molars, elevated levels of IL-6 in the early postoperative period were found, and the highest level was 14 pg/ml.Conclusion: Postoperative IL-6 levels rise regardless of the medication used for preemptive analgesia. In the group treated with nimesulide, a trend to reducing IL-6 levels was observed, but further study in a larger number of patients is needed.

      PubDate: Wed, 01 Jun 2016 08:32:20 GMT

    • Abstract: 2016-05-31T14-30-14Z
      Source: International Journal of Surgery and Medicine
      AMEL Harzallah, hayet kaaroud, hamida bezzine, fethi ben hamida, taieb ben abdallah.
      Abstract:Endocarditis is one of the most prevalent forms of cardiac involvement in patients with lupus, as it is considered as one a life-threatening complication. Libman-Sacks endocarditis is common. Infective endocarditis can also cause complications within immunocompromised patients. The aim of this study is to determine particularities of endocarditis in patients with lupus and to look for distinguishing features between infectious or immunological origin. A retrospective study was conducted on patients with lupus presenting endocarditis. Lupus was diagnosed according to the American college of rheumatology criteria. The diagnosis of endocarditis was made based on the modified Duke criteria.The present case report studies seven cases of endocarditis. Six of these patients are women and the other one is a man. They are aged meanly of 29.4 years (extremes: 20-36). Fever was present in all the cases with a new cardiac murmur in six cases and a modification of its intensity in one case. Biologic inflammatory syndrome was present in six cases. Cardiac ultrasound performed in six cases made the diagnosis of endocarditis which involved the left heart valves in five cases and the right heart valves in one case. Valvular insufficiency was identified in six patients. The valve involvement was mitral in two cases, mitro-aortic in two others, aortic in the fifth one and tricuspid in the sixth one. Endocarditis was infectious in 4 cases, thanks to positive blood culture. The germs identified were gram negative bacilli in two cases, anaerobic organism in one case and gram positive cocci in one case. Candida albicans was isolated in one case. Libman-Sacks endocarditis was objectified in three cases. A combination of Libman-Sacks endocarditis with infectious endocarditis was diagnosed in one case. The treatment consisted of antibiotics in four cases with surgery in two cases. The outcome was favorable in five cases and fatal in the two others.Endocarditis in lupus can be infectious or Libman-Sacks endocarditis. These two conditions share several clinical features. The only distinctive argument remains positive blood culture. The treatment should be initiated as early as possible to limit the valve damage and improve the outcome.

      PubDate: Sun, 29 May 2016 13:35:17 GMT
  • Evaluation of nutritional status in hemodialysis patients

    • Abstract: 2016-05-31T14-30-14Z
      Source: International Journal of Surgery and Medicine
      amel Harzallah, hayet kaaroud, fethi el Younsi, fethi ben hamida, taieb ben abdallah.
      Malnutrition is a common problem among hemodialysis patients. This factor leads to increased morbidity and mortality. This study evaluates the nutritional status of patients on dialysis and analyses the various parameters used for assessing malnutrition.It is a cross-sectional study of 35 patients aged 18 years and up who have undergone dialysis three days a week for more than a year. The following were analysed: overall subjective assessment technique, Body Mass Index, anthropometric data and biological parameters (serum albumin, serum cholesterol, rate of alkaline reserves and C-reactive protein levels) with a dietary three-day survey. Analysis of food survey data was performed using the software Bilnut. The patients’ average age was 46.7 years with a sex ratio of 1.18. Average waist size was 92.7±16.68 cm. Average arm circumference was 27.2±5.6 cm and average calf circumference was 32.03±5.87 cm. Malnutrition was found in 48% of cases according to SGA. Average BMI was 24.4 kg/m2. It was less than 23 Kg/m2 in 48% of cases.Average serum albumin concentration was 33.6 g/l and average CRP level was 6.16 mg/l.The average energy intake (Kcal/Kg/day) was 30.87±11.92 the day of dialysis, 27.98±9.31 on a resting day and 29.93±9.42 on another day and the average protein intake (g/kg/day) was 1.02±0.44 the day of dialysis, 0.94±0.36 a resting day and 1.04±0.36 on the other day. Malnutrition was frequent among our patients. The assessment of nutritional status in patients on dialysis requires simultaneous combination of several clinical, biologic and dietetic markers. Dietary management is mainly based on food survey regularly established.

      PubDate: Sun, 29 May 2016 13:33:57 GMT
  • 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
  • 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.
      ABSTRACTBackground: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
  • 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
  • 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
School of Mathematical and Computer Sciences
Heriot-Watt University
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