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MEDICAL SCIENCES (1850 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 4)
ABCS Health Sciences     Open Access   (Followers: 1)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Full-text available via subscription   (Followers: 43)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access   (Followers: 1)
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access  
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access  
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 3)
Addiction Science & Clinical Practice     Open Access   (Followers: 7)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 7)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 5)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Medical Education and Practice     Open Access   (Followers: 26)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Medicine     Open Access   (Followers: 2)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9)
Advances in Parkinson's Disease     Open Access  
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Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6)
Advances in Wound Care     Hybrid Journal   (Followers: 10)
African Health Sciences     Open Access   (Followers: 2)
African Journal of Biomedical Research     Open Access  
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 1)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 2)
African Journal of Trauma     Open Access  
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
AJOB Primary Research     Partially Free   (Followers: 3)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 12)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 5)
American Journal of Clinical Medicine Research     Open Access   (Followers: 6)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 12)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 3)
American Journal of Medicine     Hybrid Journal   (Followers: 45)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access  
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 10)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 4)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 4)
Anatomical Science International     Hybrid Journal   (Followers: 2)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 1)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 9)
Annals of Family Medicine     Open Access   (Followers: 13)
Annals of Fundeni Hospital     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 10)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 17)
Anthropological Review     Open Access   (Followers: 24)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 2)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 10)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Biomedical Sciences     Open Access   (Followers: 7)
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Trauma Research     Open Access   (Followers: 2)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 10)
Arterial Hypertension     Open Access  
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 12)
Artificial Organs     Hybrid Journal   (Followers: 1)
Asia Pacific Family Medicine     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 9)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Journal of Cell Biology     Open Access   (Followers: 6)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 3)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 1)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Audiology - Communication Research     Open Access   (Followers: 8)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 2)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Aviation, Space, and Environmental Medicine     Full-text available via subscription   (Followers: 10)
Avicenna     Open Access   (Followers: 2)
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 3)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 3)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 1)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     Open Access  
Basal Ganglia     Hybrid Journal  
Basic Sciences of Medicine     Open Access   (Followers: 2)
BBA Clinical     Open Access  
BC Medical Journal     Free  
Benha Medical Journal     Open Access  
Bijblijven     Hybrid Journal  
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 1)
BioDiscovery     Open Access   (Followers: 2)
Bioelectromagnetics     Hybrid Journal   (Followers: 1)
Bioengineering & Translational Medicine     Open Access  
Bioethics     Hybrid Journal   (Followers: 14)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
Biologics in Therapy     Open Access  

        1 2 3 4 5 6 7 8 | Last

Journal Cover Annals of Medicine and Surgery
  [SJR: 0.221]   [H-I: 4]   [7 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2049-0801
   Published by Elsevier Homepage  [3177 journals]
  • Water in the human body: An anesthesiologist's perspective on the
           connection between physicochemical properties of water and physiologic

    • Authors: Efraín Riveros-Perez; Ricardo Riveros
      Pages: 1 - 8
      Abstract: Publication date: February 2018
      Source:Annals of Medicine and Surgery, Volume 26
      Author(s): Efraín Riveros-Perez, Ricardo Riveros
      The unique structure and multifaceted physicochemical properties of the water molecule, in addition to its universal presence in body compartments, make water a key player in multiple biological processes in human physiology. Since anesthesiologists deal with physiologic processes where water molecules are critical at different levels, and administer medications whose pharmacokinetics and pharmacodynamics depend on interaction with water molecules, we consider that exploration of basic science aspects related to water and its role in physiology and pharmacology is relevant to the practice of anesthesiology. The purpose of this paper is to delineate the physicochemical basis of water that are critical in enabling it to support various homeostatic processes. The role of water in the formation of solutions, modulation of surface tension and in homeostasis of body temperature, acid-base status and osmolarity, is analyzed. Relevance of molecular water interactions to the anesthesiologist is not limited to the realm of physiology and pathophysiology. Deep knowledge of the importance of water in volatile anesthetic effects on neurons opens a window to a new comprehensive understanding of complex cellular mechanisms underlying the practice of anesthesiology.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.12.007
      Issue No: Vol. 26 (2018)
  • Pattern of changes in quality of life of obese patients after sleeve
           gastrectomy in Sulaimani provence –Kurdistan-Iraq, based on 4 years
           experience in two bariatric centers

    • Authors: Hiwa Omer Ahmed
      Pages: 9 - 14
      Abstract: Publication date: February 2018
      Source:Annals of Medicine and Surgery, Volume 26
      Author(s): Hiwa Omer Ahmed
      Background Obesity influences all aspects of the life of obese patients physically, psychologically, socially and monetarily, it is not only a disease but rather a beginning point of a group of ailments and inabilities, which gradually impacts and changes all aspects of their life. Objectives The changes in the Quality of life in respect to the amount of access weight lost after sleeve gastrectomy. Patients, materials and methods A prospective longitudinal study evaluating 40 female patients who underwent laparoscopic sleeve gastrectomy within 4 years, starting from July 4th, 2012 up to July 5th, 2016. Results More than three-quarter of the patients were not satisfied with their body before their operation, but six to twelve months after their weight loss; (N = 36, 90%) of them were satisfied with their new body image. Half of the patients were unhappy before their operation, but twelve months later (N = 31, 77.5%) of them became much happier. Regarding satisfaction with the body image, noticeable improvement occurred since (N = 36, 90%) of them were satisfied with their new body image. While, most of them have had low self-esteem and (N 27, 67.5%) of the patients had no self-esteem at all, 12 months after the operation (N = 35, 87.5%) felt great improvement in their self-esteem (p-value = .040). A significant decrease in appetite was noticed in (N = 39, 97.5%) of the patients after 12 months. Conclusion Significant changes in the parallel pattern to the extent of EWL were noticed in the quality of life of morbidly obese patients after laparoscopic sleeve gastrectomy.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.12.008
      Issue No: Vol. 26 (2018)
  • Does a hospital diabetes inpatient service reduce blood glucose and HbA1c
           levels' A prospective cohort study

    • Authors: Fergus William Gardiner; Ezekiel Uba Nwose; Phillip Taderera Bwititi; Judith Crockett; Lexin Wang
      Pages: 15 - 18
      Abstract: Publication date: February 2018
      Source:Annals of Medicine and Surgery, Volume 26
      Author(s): Fergus William Gardiner, Ezekiel Uba Nwose, Phillip Taderera Bwititi, Judith Crockett, Lexin Wang
      Background Diabetes education is believed to bring about sustained benefits in diabetes mellitus (DM) patient outcomes. These benefits have not been widely studied in an inpatient hospital setting, and as such the aim was to determine whether a hospital diabetes in-service, and specifically diabetes education, results in reduced blood glucose and HbA1c levels after hospital discharge. Methods and materials A cohort review was performed at a large teaching hospital, in Canberra, Australia. Sixty seven patients comprising 35 males and 32 females who were referred upon discharge to the Diabetes Services as having a history of uncontrolled DM from February 1st, 2015 until January 31st, 2016 were evaluated. The retrospective discharge blood glucose level (BGL) was compared to prospective BGL 3 months after hospital discharge. HbA1c was prospectively taken before and 3 months after Diabetes Service education. A between subjects t-Test was used to compare patients' glucose and HbA1c averages. Results The average discharge BGL result was 13.3 mmol/L, compared to the post-discharge result of 11.2 mmol/L, indicating a significant decrease (p = < 0.01). The average pre-HbA1c result was 10.45%, and decreased to the post-HbA1c result of 8.96%, which was significant (p = <0.05). Conclusion This study is the first to measure the direct glucose adherence benefits associated DM education within Australia and provides evidence on the effectiveness of a Diabetes Service in reducing patient BGLs. Utilisation of Diabetes Services to control glycaemia encourages ongoing efforts and translates to reduced micro and macro cardiovascular risk factors associated with DM.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.12.010
      Issue No: Vol. 26 (2018)
  • A decade bibliometric analysis of global research on leishmaniasis in Web
           of Science database

    • Authors: Masoud Soosaraei; Ali Akbar Khasseh; Mahdi Fakhar; Hajar Ziaei Hezarjaribi
      Pages: 30 - 37
      Abstract: Publication date: Available online 8 January 2018
      Source:Annals of Medicine and Surgery
      Author(s): Masoud Soosaraei, Ali Akbar Khasseh, Mahdi Fakhar, Hajar Ziaei Hezarjaribi
      Background Leishmaniasis is an extremely relevant tropical disease, with global distribution. It still remains a main public health concern in low-income countries, and it is necessary to support more research on this common disease. Thus, a bibliometric analysis of the global scientific production on leishmaniasis was carried out. Methods All the articles registered in Web of Science with the subject of leishmaniasis between 2006 and 2015 were analysed, using Pajek and VOS viewer as tools. Results 13,658 records in the field of leishmaniasis were indexed in the Web of Science database for this ten-year study period (2006-2015). This shows that studies on leishmaniasis have been growing, from 1,071 in 2006 to 1,537 in 2015. “Sundar S” is the most active researcher in the field of leishmaniasis, compiling and participating in 232 Articles. Brazil ranks first in scientific production, by performing 3,315 studies on leishmaniasis. The United States, United Kingdom and Australia had the most collaboration in performing the studies of leishmaniasis with each other. In addition, PLOS NEGLECTED TROPICAL DISEASES published the most articles, with 483. Conclusion Our data shows an increase in the number of publications in the field of leishmaniasis. In addition, Brazil, USA, and India lead scientific production on leishmaniasis research.

      PubDate: 2018-01-09T19:11:36Z
      DOI: 10.1016/j.amsu.2017.12.014
      Issue No: Vol. 26 (2018)
  • Complications during removal of stainless steel versus titanium nails used
           for intramedullary nailing of diaphyseal fractures of the tibia

    • Authors: Mustafa Seyhan; Olcay Guler; Mahir Mahirogullari; Ferdi Donmez; Arel Gereli; Serhat Mutlu
      Pages: 38 - 42
      Abstract: Publication date: Available online 9 January 2018
      Source:Annals of Medicine and Surgery
      Author(s): Mustafa Seyhan, Olcay Guler, Mahir Mahirogullari, Ferdi Donmez, Arel Gereli, Serhat Mutlu
      Objectives Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of the tibia. Patients and Methods Sixty-two patients (26 females, 36 males) were included in this retrospective study. Of the removed nails, 24 were of stainless steel and 38 of titanium. Preoperative and intraoperative parameters, such as implant discomfort, anterior knee pain, operating time and amount of bleeding, and postoperative outcomes were evaluated for each patient. Results Titanium nail group had more, but not statistically significant, intraoperative complications than stainless steel group during the removal of nails (p=0.4498). Operating time and amount of intraoperative bleeding were significantly higher in titanium group than stainless steel group (p=0.0306 and p<0.001, respectively). Preoperative SF-36 physical component and KSS scores were significantly lower in patients who had removal of titanium nails than those of stainless steel nails, whereas there was no difference in terms of postoperative SF-36 and KSS scores. Conclusion In conclusion, although greater bone contact with titanium increases implant stability, nail removal is more difficult, resulting in more longer surgical operation and more intraoperative bleeding. Therefore, we do not recommend titanium nail removal in asymptomatic patients.

      PubDate: 2018-01-09T19:11:36Z
      DOI: 10.1016/j.amsu.2017.12.012
      Issue No: Vol. 26 (2018)
  • Ocular tuberculosis in Hospital Universiti Sains Malaysia – A case

    • Authors: M. Shahidatul-Adha; E. Zunaina; A.T. Liza-Sharmini; W.H. Wan-Hazabbah; I. Shatriah; I. Mohtar; Y. Azhany; H. Adil
      Pages: 25 - 30
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): M. Shahidatul-Adha, E. Zunaina, A.T. Liza-Sharmini, W.H. Wan-Hazabbah, I. Shatriah, I. Mohtar, Y. Azhany, H. Adil
      Introduction Ocular tuberculosis (TB) encompasses a broad spectrum of clinical manifestations affecting different structures of the eye. It is caused by Mycobacterium tuberculosis, a great ancient organism that induces various types of diseases and unfavorable outcomes if unrecognized and not well treated. Purpose To report the clinical profile of 34 ocular TB cases observed during 6 years period in Hospital Universiti Sains Malaysia (HUSM). Method A retrospective review of medical records from 34 patients diagnosed with ocular TB in HUSM from January 2011 until December 2016. Results The mean age was 43 ± 14.6 years old. Both male and female affected in about 1:1 ratio. The majority of subjects were local Malays (91.2%). Risk factors included previous contact with pulmonary TB patients (38.2%), and patients with underlying diabetes mellitus (26.5%). Most patients showed normal chest radiography (79.4%). However they had positive Mantoux test (94.1%) and raised erythrocyte sedimentation rate (ESR) value (58.8%). Uveitis was the most common ocular manifestation of ocular TB (70.6%) while the rare ocular manifestations included optic perineuritis and optic neuritis, orbital apex syndrome, orbital cellulitis, sclerokeratitis, corneal ulcer and conjunctival abscess. All patients responded well to anti-TB treatment, but visual outcome was variable. Conclusions This review shows the diverse entity of ocular TB spectrum in an endemic area. Good clinical response to anti-tuberculous therapy supported the presumed diagnosis of ocular TB in majority of the cases.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.10.003
      Issue No: Vol. 24 (2018)
  • Does surgeon volume affect the outcome of total knee arthroplasties in a
           developing country' - A retrospective cohort study

    • Authors: Azeem Tariq Malik; Syed Hamza Mufarrih; Arif Ali; Shahryar Noordin
      Pages: 38 - 43
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Azeem Tariq Malik, Syed Hamza Mufarrih, Arif Ali, Shahryar Noordin
      Introduction Recent studies have shown that in addition to patient factors, surgeon volume has influenced total knee arthroplasty (TKA) outcomes greatly. With recent propositions of regionalization of arthroplasties to higher volume centers, the need for further evidence is warranted. Materials and methods Retrospective Cohort Study done at Aga Khan University Hospital, Pakistan from January 2007 to December 2015. High Volume (HV) group was set as at least 50 TKAs/year and Low Volume (LV) was set as at most 25 TKAs/year. A total of 615 patients undergoing a unilateral or bilateral TKA were included in our study. Results LV group was associated with a higher length of stay (LOS) as compared to HV group in patients undergoing a bilateral TKA after adjusted logistic regression [OR 2.395 (1.47,3.91)]. We found no association between surgeon volume and postoperative complications. Conclusion Patients getting a bilateral TKA by LV surgeons were twice more likely to have a longer LOS as compared to HV group. Further research is warranted comparing all aspects and possible confounders to different variables before a conclusion can be made.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.10.025
      Issue No: Vol. 24 (2018)
  • Patient outcome of emergency laparotomy improved with increasing “number
           of surgeons on-call” in a university hospital: Audit loop

    • Authors: Anwar Hussain; Fahad Mahmood; Chui Teng; Sadaf Jafferbhoy; David Luke; Achilleas Tsiamis
      Pages: 21 - 24
      Abstract: Publication date: November 2017
      Source:Annals of Medicine and Surgery, Volume 23
      Author(s): Anwar Hussain, Fahad Mahmood, Chui Teng, Sadaf Jafferbhoy, David Luke, Achilleas Tsiamis
      Aim Emergency laparotomy is a commonly performed high-mortality surgical procedure. The National Emergency Laparotomy Network (NELA) published an average mortality rate of 11.1% and a median length of stay equivalent to 16.3 days in patients undergoing emergency laparotomy. This study presents a completed audit loop after implementing the change of increasing the number of on-call surgeons in the general surgery rota of a university hospital. The aim of this study was to evaluate the outcomes of emergency laparotomy in a single UK tertiary centre after addition of one more consultant in the daily on-call rota. Methods This is a retrospective study involving patients who underwent emergency laparotomy between March to May 2013 (first audit) and June to August 2015 (second audit). The study parameters stayed the same. The adult patients undergoing emergency laparotomy under the general surgical take were included. Appendicectomy, cholecystectomy and simple inguinal hernia repair patients were excluded. Data was collected on patient demographics, ASA, morbidity, 30-day mortality and length of hospital stay. Statistical analysis including logistic regression was performed using SPSS. Results During the second 3-month period, 123 patients underwent laparotomy compared to 84 in the first audit. Median age was 65(23–93) years. 56.01% cases were ASA III or above in the re-audit compared to 41.9% in the initial audit. 38% patients had bowel anastomosis compared to 35.7% in the re-audit with 4.2% leak rate in the re-audit compared to 16.6% in the first audit. 30-day mortality was 10.50% in the re-audit compared to 21% and median length of hospital stay 11 days in the re-audit compared to 16 days. The lower ASA grade was significantly associated with increased likelihood of being alive, as was being female, younger age and not requiring ITU admission post-operatively. However, having a second on-call consultant was 2.231 times more likely to increase the chances of patients not dying (p = 0.031). Conclusion Our audit-loop suggests that adding a second consultant to the daily on-call rota significantly reduces postoperative mortality and morbidity. Age, ASA and ITU admission are other independent factors affecting patient outcomes. We suggest this change be applied to other high volume centres across the country to improve the outcomes after emergency laparotomy.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.09.013
      Issue No: Vol. 23 (2018)
  • The Birmingham experience of high-pressure methylene blue dye test during
           primary and revisional bariatric surgery: A retrospective cohort study

    • Authors: G.C. Kirby; C.A.W. Macano; S.M. Nyasavajjala; M. Sahloul; R. Nijjar; M. Daskalakis; M. Richardson; R. Singhal
      Pages: 32 - 34
      Abstract: Publication date: November 2017
      Source:Annals of Medicine and Surgery, Volume 23
      Author(s): G.C. Kirby, C.A.W. Macano, S.M. Nyasavajjala, M. Sahloul, R. Nijjar, M. Daskalakis, M. Richardson, R. Singhal
      Introduction Leak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks. Methods A retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed. All patients had routine HPMB at the end of the procedure. Demographics, HPMB positivity, and post operative leaks were recorded. Results 924 patients underwent bariatric surgery: 696(75.3%) RYGB, and 225(24.3%) SG. 85(9.2%) were revisional procedures. Two HPMB were positive, which necessitated staple or suture line reinforcement with sutures intra-operatively. The patients had an uneventful recovery. 5 patients had postoperative leaks, all of whom had negative intraoperative HPMB: 3 SG patients; and 2 RYGB patients (gastro-jejunostomy anastomotic leaks). There was no statistically significant relationship between positive HPMB and anastomotic leak (Fishers exact test; p = 1). Conclusion Despite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.09.015
      Issue No: Vol. 23 (2018)
  • Peritoneal metastases of rare carcinomas treated with cytoreductive
           surgery and HIPEC – A single center case series

    • Authors: Andreas Brandl; Christina Barbara Zielinski; Wieland Raue; Johann Pratschke; Beate Rau
      Pages: 7 - 11
      Abstract: Publication date: October 2017
      Source:Annals of Medicine and Surgery, Volume 22
      Author(s): Andreas Brandl, Christina Barbara Zielinski, Wieland Raue, Johann Pratschke, Beate Rau
      Introduction In selected cases, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for patients suffering from peritoneal metastases from colorectal, ovarian, gastric or appendiceal origin. The effectiveness of this extensive has not been elucidated within other rare diseases by now. Methods We conducted a retrospective analysis of patients treated with CRS for peritoneal carcinomatosis during the period between July 2010 and September 2015. Exclusion criteria were adenocarcinomas of the stomach, colon, neoplasms of the appendix, mesothelioma and ovarian cancers. Aim of this study was to examine the feasibility, complication rate and survival of patients with rare diseases. Results A total of 14 Patients were included: Four rare gynecological tumors, three adenocarcinomas of the small intestine, three retroperitoneal sarcomas, one cholangiocellular carcinoma, one neuroendocrine gastric tumor, one malignant peripheral nerve sheath tumor and one cancer of unknown primary syndrome. In 12 of 14 patients a macroscopically complete tumorresection could be achieved. No patient died during hospitalization. Seven of 14 patients experienced general complication of grade III according to NCI CTCAE V4.0, while two experienced complications of grade IV. Median follow-up and one year overall survival were 15.5 months and 46.8%, respectively. Conclusion For patients with rare tumors, CRS and HIPEC is feasible with an acceptable perioperative morbidity and mortality. To improve knowledge in patient selection and outcome, rare tumors treated with CRS and HIPEC should be documented in central databases (as for example BIG RENAPE, Pierre-Benite, France).

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.08.009
      Issue No: Vol. 22 (2018)
  • Laparoscopic and open inguinal hernia repair: Patient reported outcomes in
           the elderly from a single centre - A prospective cohort study

    • Authors: K. Bowling; S. El-Badawy; E. Massri; J. Rait; J. Atkinson; S. Leong; A. Stuart; G. Srinivas
      Pages: 12 - 15
      Abstract: Publication date: October 2017
      Source:Annals of Medicine and Surgery, Volume 22
      Author(s): K. Bowling, S. El-Badawy, E. Massri, J. Rait, J. Atkinson, S. Leong, A. Stuart, G. Srinivas
      Background With those over 65 making up over 16% of the UK's population, surgeons are counselling increasing numbers of elderly patients for hernia repair. Data is currently lacking comparing different repair methods of inguinal hernias in the elderly population with regards to patient reported outcomes. Aim To compare open and laparoscopic hernia repair in patients >65 years old and those <65 years old with respect to patient reported outcomes. Method As part of a quality assurance process patients receive a telephone consultation day 2 post procedure. This includes an optional survey with questions to quantify pain, general feeling, nausea, dizziness, drowsiness, satisfaction and vomiting since the operation. Patients were then classified into age ≥ 65 years or <65 years and subclassified into totally extraperitoneal (TEP) or open inguinal hernia repair (IHR). Results Data is presented from patients treated between January 2009 and August 2016, totalling those included 1167 of 2522 (55.5%). Only five patients (4.42%) reported moderate pain; in the >65 TEP group this was significantly lower (10.2% open IHR <65; 6.7% TEP <65; 12.8% open IHR >65). Patient satisfaction with the surgery was satisfied or very satisfied in all patients in all groups. Conclusion Time off work is not an absolute appropriate measure of return to premorbid status with respect to the elderly as a substantial number of >65 year olds have retired. We therefore present this interesting insight into patient perceptions following hernia repair by age group. Overall patients over 65 can expect the same high levels of satisfaction and low levels of pain following either technique for inguinal hernia repair as younger patients.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.08.013
      Issue No: Vol. 22 (2018)
  • Feasibility and safety of single-incision laparoscopic cholecystectomy in
           elderly patients: A single institution, retrospective case series

    • Authors: Masaki Wakasugi; Masahiro Tanemura; Kenta Furukawa; Mitsuyoshi Tei; Yozo Suzuki; Toru Masuzawa; Kentaro Kishi; Hiroki Akamatsu
      Pages: 30 - 33
      Abstract: Publication date: October 2017
      Source:Annals of Medicine and Surgery, Volume 22
      Author(s): Masaki Wakasugi, Masahiro Tanemura, Kenta Furukawa, Mitsuyoshi Tei, Yozo Suzuki, Toru Masuzawa, Kentaro Kishi, Hiroki Akamatsu
      Introduction To evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) for uncomplicated gallbladder in elderly patients. Materials and Methods A retrospective analysis of 810 patients undergoing SILC from May 2009 to October 2016 at Osaka Police Hospital was performed, and the outcomes of the patients aged < 80 years and the patients ≥ 80 years were compared. Results The median operative times of patients <80 years and patients ≥80 years were 100 min and 110 min, respectively (p = 0.4). The conversion rates to a different operative procedure (multi-port laparoscopic cholecystectomy or open cholecystectomy) were 3% (22/763) of patients < 80 years and 0% of patients ≥ 80 years (p = 0.6). Perioperative complications were seen in 6% (46/763) of patients < 80 years and 17% (8/47) of patients ≥ 80 years (p < 0.05). Pneumonia was seen in 0% (0/763) of patients < 80 years and 4% (3/47) of patients ≥ 80 years (p < 0.05). There was no mortality in either group. The median postoperative hospital stay was 4 days for patients <80 years and 5 days for patients ≥80 years (p < 0.05). Conclusion SILC for uncomplicated gallbladder could be performed for patients ≥ 80 years with acceptable morbidity and mortality as compared with the previous reports, though the complication rate of patients ≥ 80 years was higher than that of patients < 80 years.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.08.024
      Issue No: Vol. 22 (2018)
  • Postoperative quality of life and dysfunction in patients after combined
           total gastrectomy and esophagectomy

    • Authors: Shin Saito; Misuzu Nakamura; Yoshinori Hosoya; Joji Kitayama; Alan Kawarai Lefor; Naohiro Sata
      Pages: 34 - 38
      Abstract: Publication date: October 2017
      Source:Annals of Medicine and Surgery, Volume 22
      Author(s): Shin Saito, Misuzu Nakamura, Yoshinori Hosoya, Joji Kitayama, Alan Kawarai Lefor, Naohiro Sata
      Background Patients with esophageal cancer and a history of gastrectomy or concurrent gastric cancer undergo not only esophagectomy but also total gastrectomy. The goal of this study is to evaluate the postoperative quality of life (QOL) and dysfunction of these patients using two postoperative questionnaires. Materials and methods From 1999 to 2015, 41 patients underwent concurrent esophagectomy and total gastrectomy. A jejunal pedicle with the subcutaneous supercharge technique was used for reconstruction. Patients were divided into two groups, including those undergoing concurrent esophagostomy and gastrectomy (Group 1), and those undergoing esophagectomy alone (Group 2, history of previous gastrectomy). Patients were analyzed by time interval, including patients within three years of surgery (Group A) and those more than three years after surgery (Group B). Results Eighteen patients completed the questionnaires. The mean DAUGS20 score was 26.4 ± 13.2. The DAUGS20 scores of groups 1 (N = 7) and 2 (N = 11) were 25.4 ± 12.5 and 27 ± 15.4 (p = 0.58), respectively. Global health status scored by the EORTC QLQC-30 were 71.4 ± 18.5 in group 1 and 67.4 ± 22.8 in group 2 (p = 0.85). DAUGS20 scores of group A (N = 10) and B (N = 8) were 28.1 ± 12.4 and 23.3 ± 14.4 (p = 0.35). No significant differences were found between groups A and B regarding the QLQ-C30 scores. Conclusion DAUGS20 and QLQ-C30 scores showed no significant differences between groups 1 and 2 or groups A and B. These results suggest that postoperative QOL and dysfunction may be influenced more by current status than by surgical history and postoperative interval. Previous reports describe a DAUGS 20 score after gastrectomy of 27.8 and after esophagectomy of 36.1. The DAUGS20 score of these 18 patients is lower than DAUGS20 scores for patients undergoing either operation alone. Reconstruction using a subcutaneously placed jejunal segment seems to be reasonable.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.08.016
      Issue No: Vol. 22 (2018)
  • Impact of Medial-To-Lateral Vs Lateral-To-Medial approach on short-term
           and cancer-related outcomes in Laparoscopic Colorectal Surgery: A
           retrospective cohort study

    • Authors: Anwar Hussain; Fahad Mahmood Andrew DW. Torrance Achilleas Tsiamis
      Abstract: Publication date: Available online 28 December 2017
      Source:Annals of Medicine and Surgery
      Author(s): Anwar Hussain, Fahad Mahmood, Andrew DW. Torrance, Achilleas Tsiamis

      PubDate: 2018-01-04T19:00:37Z
  • Case Series with Literature Review: Surgical Approach to Megarectum and/or
           Megasigmoid in Children with Unremitting Constipation

    • Authors: James G. Glasser; James M. Nottingham; Martin Durkin; Ret Haney; Sean Christensen; Riley Stroman; Tyler Hammett
      Abstract: Publication date: Available online 27 December 2017
      Source:Annals of Medicine and Surgery
      Author(s): James G. Glasser, James M. Nottingham, Martin Durkin, Ret Haney, Sean Christensen, Riley Stroman, Tyler Hammett
      Background The role of surgery in treating children with functional constipation (FC) is controversial, because of the efficacy of bowel management programs. This case series is comprised of failures: 43 children, spanning 25 years’ practice, who had megarectosigmoid (MRS) and unremitting constipation. Purpose To determine whether these children were helped by surgery, and to contribute to formulating a standard of care for children with megarectum (MR) and/or redundancy of the sigmoid colon (MS) who fail medical management. Method We describe our selection criteria and the procedures we utilized – mucosal proctectomy and endorectal pull-through (MP) or sigmoidectomy (SE) with colorectal anastomosis at the peritoneal reflection. The internet (social media) allowed us to contact most of these patients and obtain extremely long follow-up data. Results 30/43 patients had MP and 13/43 had SE. Follow-up was obtained in 83% MP and 70% SE patients. 60% of MP and 78% of SE patients reported regular evacuations and no soiling. 20% MP patients had occasional urgency or soiling or episodic constipation. 12% MP and 22% SE patients required antegrade continence enemas (ACE) or scheduled cathartics and/or stool softeners. 4% MP had no appreciable benefit, frequent loose stools and soiling, presumably from encopresis. Conclusion MR is characterized by diminished sensation, poor compliance and defective contractility. Patients with MR do better with MP, which effectively removes the entire rectum versus SE, where normal caliber colon is anastomosed to MR at the peritoneal reflection; furthermore, MP reliably preserves continence; whereas total proctectomy (trans-anal or trans-abdominal) may cause incontinence.

      PubDate: 2018-01-04T19:00:37Z
      DOI: 10.1016/j.amsu.2017.12.009
  • Streamlined manuscript submission guidelines: Beyond overdue

    • Authors: Zain A. Sobani; Joel Horovitz; Stephan Kamholz
      Pages: 1 - 2
      Abstract: Publication date: January 2018
      Source:Annals of Medicine and Surgery, Volume 25
      Author(s): Zain A. Sobani, Joel Horovitz, Stephan Kamholz

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.11.022
      Issue No: Vol. 25 (2017)
  • Violence against doctors, a serious concern for healthcare organizations
           to ponder about

    • Authors: Farah Ahmed; Muhammad Khizar Memon; Sidra Memon
      Pages: 3 - 5
      Abstract: Publication date: January 2018
      Source:Annals of Medicine and Surgery, Volume 25
      Author(s): Farah Ahmed, Muhammad Khizar Memon, Sidra Memon
      Background Aggression and Violence against primary care physicians is reportedly common in Pakistan but there is no any documented study to-date on this burning issue. Methods A formed written questionnaire was distributed among 769 primary care physicians aged 31 ± 7.68 years. Apart from the demographic data, the questionnaire included questions regarding the level of safety that primary care physicians felt during their work setups and on-call duties, along with the experience of aggression against them by the perpetrators & the support provided by the hospital management in such cases. Result Response rate was 68% i.e. 524 physicians agreed to participate in the study. It was found that majority (85%) of the physicians has faced mild events, 62% have faced moderate events and roughly 38% were subjected to severe violence. Some physicians revealed more than one form of aggression being faced by them in 12 months preceding months which makes the collective percentage greater than 100%. Verbal abuse is the most frequent type of mistreatment faced by the doctors from the patients or their attendants. Conclusion A considerable number of physicians participated have faced mild violence in which verbal abuse was commonest; followed by moderate and severe events.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.11.003
      Issue No: Vol. 25 (2017)
  • Impact of liver volume and liver function on posthepatectomy liver failure
           after portal vein embolization– A multivariable cohort analysis

    • Authors: Patrick H. Alizai; Annabel Haelsig; Philipp Bruners; Florian Ulmer; Christian D. Klink; Cornelis H.C. Dejong; Ulf P. Neumann; Maximilian Schmeding
      Pages: 6 - 11
      Abstract: Publication date: January 2018
      Source:Annals of Medicine and Surgery, Volume 25
      Author(s): Patrick H. Alizai, Annabel Haelsig, Philipp Bruners, Florian Ulmer, Christian D. Klink, Cornelis H.C. Dejong, Ulf P. Neumann, Maximilian Schmeding
      Background Liver failure remains a life-threatening complication after liver resection, and is difficult to predict preoperatively. This retrospective cohort study evaluated different preoperative factors in regard to their impact on posthepatectomy liver failure (PHLF) after extended liver resection and previous portal vein embolization (PVE). Methods Patient characteristics, liver function and liver volumes of patients undergoing PVE and subsequent liver resection were analyzed. Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2). Factors associated with the primary end point PHLF (according to ISGLS definition) were identified through multivariable analysis. Secondary end points were 30-day mortality and morbidity. Results 95 patients received PVE, of which 64 patients underwent major liver resection. PHLF occurred in 7 patients (11%). Calculated postoperative liver function was significantly lower in patients with PHLF than in patients without PHLF (67 vs. 109 μg/kg/h; p = 0.01). Other factors associated with PHLF by univariable analysis were age, future liver remnant, MELD score, ASA score, renal insufficiency and heart insufficiency. By multivariable analysis, future liver remnant was the only factor significantly associated with PHLF (p = 0.03). Mortality and morbidity rates were 4.7% and 29.7% respectively. Conclusion Future liver remnant is the only preoperative factor with a significant impact on PHLF. Assessment of preoperative liver function may additionally help identify patients at risk for PHLF.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.12.003
      Issue No: Vol. 25 (2017)
  • Endovascular laser treatment of incompetent saphenous veins using the
           1470 nm diode laser and radial fiber

    • Authors: Georgios Vourliotakis; Georgios Sahsamanis; Paschalis Evagelidis; Christina Aivatidi
      Pages: 12 - 16
      Abstract: Publication date: January 2018
      Source:Annals of Medicine and Surgery, Volume 25
      Author(s): Georgios Vourliotakis, Georgios Sahsamanis, Paschalis Evagelidis, Christina Aivatidi
      Objectives To assess the technical success, complications, and patients' quality of life (QoL) after treatment of chronic venous disease (CVD) using the 1470 nm radial fiber laser. Methods A total of 170 patients with chronic venous disease, classified as C2 to C4 according to CEAP classification, were treated for incompetent greater (GSV) and small (SSV) saphenous veins, using the 1470 nm radial fiber laser and application of tumescent anesthesia. Additional phlebectomies were performed through stab microincisions, while 11 patients further underwent sclerotherapy intraoperatively. Patients' QoL was recorded using a CIVIQ-20 questionnaire pre and post-operatively. Results Technical success regarding GSV vein occlusion was recorded at 100% and 98% during 12 and 24 month follow up respectively. SSV occlusion rates were recorded at 100% for the same period. 55% of patients were classified as C2. Mean laser application time was 401.1 ± 92.6 s and 169.4 ± 56.8 s, while an average of 3986.6 ± 934.9 and 1643.5 ± 534.1 J were applied during ablation of GSV and SSV respectively. Three incidents of postoperative pain were recorded. Two patients exhibited partial proximal GSV recanalization, while two patients reported mild post-operative temporal paresthesia. No major complications were observed post-operatively. A significant improvement in patients' QoL was demonstrated through the CIVIQ-20 questionnaires. Mean pre-operative CIVIQ-20 total score was recorded at 77 ± 3.9, with a total score of 32.8 ± 2.8 being observed during 12 month follow-up. Conclusions Endovascular laser treatment using the 1470 nm radial fiber laser constitutes an effective and safe modality for treatment of CVD.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.12.002
      Issue No: Vol. 25 (2017)
  • Surgical treatment of aggressive vertebral hemangioma causing progressive

    • Authors: M. Dobran; F. Mancini; D. Nasi; M. Gladi; S. Sisti; M. Scerrati
      Pages: 17 - 20
      Abstract: Publication date: January 2018
      Source:Annals of Medicine and Surgery, Volume 25
      Author(s): M. Dobran, F. Mancini, D. Nasi, M. Gladi, S. Sisti, M. Scerrati
      Vertebral hemangioma is a benign vascular lesion that may onset with neurologic symptoms due to spinal cord compression by epidural extension. Surgical procedure, embolization and radiotherapy are the gold standard for the treatment of this disease. We present a case of a 84 years old woman admitted at our department with worsening paraparesis and urinary retention. Her magnetic resonance images (MRI) showed a lesion involving both anterior and posterior vertebral element of D5, with extension into epidural space and spinal cord compression. The patient was operated for laminectomy and epidural lesion removal. Histological examination confirmed the diagnosis of cavernous hemangioma.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.12.001
      Issue No: Vol. 25 (2017)
  • In-hospital surgical treatment for haemorrhage after aesthetic mandibular
           osteotomy performed as an office-based day surgery: A case report

    • Authors: Kosuke Kanke; Takahiro Abe; Masanobu Abe; Yoshiyuki Mori; Kazuto Hoshi; Tsuyoshi Takato
      Pages: 15 - 18
      Abstract: Publication date: Available online 13 October 2017
      Source:Annals of Medicine and Surgery
      Author(s): Kosuke Kanke, Takahiro Abe, Masanobu Abe, Yoshiyuki Mori, Kazuto Hoshi, Tsuyoshi Takato
      In East Asia, a square face is considered unattractive, and mandibular contouring surgery is commonly used to give a smooth contour to the lower jaw. Mandibular contouring surgery occasionally involves not only osteotomy of the mandibular angle but also resection of the masseter muscle via an intraoral approach. This type of mandibular contouring surgery poses a risk of injury to the premasseteric branch of the facial artery and massive haemorrhage. Here we report a patient who presented to our hospital with severe haemorrhage, swelling and airway constriction after bilateral mandibular angle and plane osteotomy with resection of the masseter muscle performed elsewhere as an office-based day surgery. The swelling and haemorrhage were treated successfully with emergency bilateral ligation of the facial artery and vein under general anaesthesia. We concluded that the haemorrhage was caused by rupture of the premasseteric branch of the facial artery during the resection of the masseter muscle in a day surgery.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.10.001
      Issue No: Vol. 24 (2017)
  • Surgical and nonsurgical outcomes for treating a cohort of empyema
           thoracis patients: A monocenteric retrospective cohort study

    • Authors: Mohsen Sokouti; Morteza Ghojazadeh; Massoud Sokouti; Babak Sokouti
      Pages: 19 - 24
      Abstract: Publication date: Available online 13 October 2017
      Source:Annals of Medicine and Surgery
      Author(s): Mohsen Sokouti, Morteza Ghojazadeh, Massoud Sokouti, Babak Sokouti
      Background There are several studies reporting high success rates for surgical and nonsurgical treatments of empyema separately. The aim of current retrospective cohort study is to find the best treatment in low socio-economic areas. Material and methods A total of 149 patients were treated in the referring hospital from January 2002 to December 2008. The current retrospective cohort study was carried out by nonsurgical (medically & thoracenthesis & chest tube drainage with or without fibrinolytic agents) and surgical (VATS &open thoracotomy decortication methods) procedures in single center performed in thoracic and respiratory medicine wards. The independent t-test on demographic data was the statistical test tool. Results The complete cure and mortality rates for 130 patients were 27% (35 out of 130 patients) and 0.3% (1 out of 130 patients), respectively. Thirteen out of 149 patients that were estimated to be at stage II underwent VATS decortication. The results showed zero success rates for this procedure which was then converted to open thoracotomy decortication. And, 113 patients who underwent thoracotomy decortication had a cure rate of 96.4% (109 patients) and mortality rate of 1.8% (2 patients). Four (3.5%) patients needed thoracoplasty, 2 died and 2 (1.8%) needed open window thoracostomy resulted in empyema necessitans that remained uncured. Total hospitalization lengths for the patients treated by tube thoracostomy and thoracotomy decortication were (15.4 ± 2.1) and (6.2 ± 1.8) days (P < 0.001), respectively. The success rates between surgical and nonsurgical treatments were 98.2% and 27.1%. And, the difference between them was significant (P < 0.001). Conclusion Because of the advanced stages of empyema in our patients, thoracotomy decortication procedure is often the first rank choice with success rates higher than nonsurgical techniques. However, nowadays, the success rates of nonsurgical and VATS management of empyema thoracis are mostly reported in the literature.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.10.002
      Issue No: Vol. 24 (2017)
  • The ligament of Parks as a key anatomical structure for safer
           hemorrhoidectomy: Anatomic study and a simple surgical note

    • Authors: Menelaos Zoulamoglou; Ioannis Kaklamanos; Maria Zarokosta; Ioannis Flessas; Vasileios Bonatsos; Theodoros Piperos; Panagiotis Theodoropoulos; Georgia Barla; Ioanna Stathopoulou; Theodoros Mariolis-Sapsakos
      Pages: 31 - 33
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Menelaos Zoulamoglou, Ioannis Kaklamanos, Maria Zarokosta, Ioannis Flessas, Vasileios Bonatsos, Theodoros Piperos, Panagiotis Theodoropoulos, Georgia Barla, Ioanna Stathopoulou, Theodoros Mariolis-Sapsakos
      Hemorrhoids are a common anal disorder which affects both men and women of all ages. One out of ten patients with hemorrhoidal disease, requires surgical treatment. Unfortunately though, hemorrhoidectomy is closely related to complications that can be present early or late postoperatively. In the present manuscript, the safe surgical technique which emphasizes to the identification of the key anatomical structure of the ligament of Parks (Trietz's muscle) is adequately described. A total of 200 patients with grades III and IV hemorrhoids, underwent Milligan-Morgan or Ferguson's hemorrhoidectomy. The mucosal ligament of Parks was identified to all patients and was used as a key anatomical structure through the excision of the hemorrhoids. Its identification guides surgeons during the operation and reduces the major problem of postoperative complications. Finally, since the mucosal ligament of Parks represents a constantly identifiable landmark, it allows simple and reliable identification of the internal sphincter muscle and minimizes the probability of postoperative complications.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.10.004
      Issue No: Vol. 24 (2017)
  • A prospective cohort study on comparison of early outcome of classical
           Ponseti and modified Ponseti post tenotomy in clubfoot management

    • Authors: Joseph Olorunsogo Mejabi; Oluwadare Esan; Olayinka Oladiran Adegbehingbe; Joseph Effiong Asuquo; Akinyele Lawrence Akinyoola
      Pages: 34 - 37
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Joseph Olorunsogo Mejabi, Oluwadare Esan, Olayinka Oladiran Adegbehingbe, Joseph Effiong Asuquo, Akinyele Lawrence Akinyoola
      Introduction Ponseti method has become the main treatment modality for the management of clubfoot producing good long-term results. However, variation in cast application post tenotomy has not been evaluated. Methods A prospective cohort study involving 40 patients with 67 clubfeet were randomized into two groups: 32 above knee cast (AKC) and 35 below knee cast (BKC) after percutaneous tenotomy. All had foot abduction brace after post tenotomy cast. The median age was 21 weeks (range: 1–104 weeks) and 1.9:1 male/female ratio. 27 (67.5%) patients had bilateral clubfoot and unilateral in 13 (32.5%). Patients were followed-up for 6 months with documentation of the Pirani Score and the cost of treatment. Results No significant difference between AKC and BKC mean Pirani score before treatment (p = 0.550) and after treatment (p = 0.702). However, mean Pirani score at 6 months was significantly different (p = 0.038). Overall mean number of casting was 6.4 in AKC group and 4.7 in BKC group (p = 0.003). There was recurrence in 2 feet before completion of treatment (6.3%) among AKC and none among BKC group. However, there was no recurrence at 6 months after treatment in both groups. The mean cost for AKC and BKC were ₦10,427.34 (52.33 US dollars) and ₦7021.54 (35.24 US dollars) respectively (p = 0.002). Conclusion Early results of below knee cast after tenotomy were comparable to the classical above knee cast after tenotomy in Ponseti treatment protocol for clubfoot. There was also reduction in cost of treatment in the modified Ponseti compared to the classical Ponseti. Long-term result will be desirable.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.09.014
      Issue No: Vol. 24 (2017)
  • Off-label use of adipose-derived stem cells

    • Authors: Francesco Simonacci; Nicolò Bertozzi; Edoardo Raposio
      Pages: 44 - 51
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Francesco Simonacci, Nicolò Bertozzi, Edoardo Raposio
      Background Adipose-derived stem cells (ASCs) have a broad range of clinical applications. The ease of cell harvest and high yield with minimal donor-site morbidity makes adipose tissue an ideal source of stem cells. Further, the multi-lineage potential of these cells present significant opportunities within the field of tissue engineering, with studies successfully demonstrating their ability to produce a range of tissue types. Materials and methods Literature review of publications on the use of ASCs, in the context of current European and US regulations. Results According to European and US regulations, many clinical trials reported in literature to date could be considered off-label. Conclusion In Europe, clinical trials involving cultured ASCs and/or the use of collagenase, which causes changes in the structural and functional properties of stem cells, and/or ASCs application in non-homologous tissue, should be considered off-label. ASCs should be non-cultured, isolated mechanically, and used only in the subcutaneous tissue.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.10.023
      Issue No: Vol. 24 (2017)
  • Career planning for future surgeons

    • Authors: Sharaf Sheik-Ali
      First page: 52
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Sharaf Sheik-Ali

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.10.026
      Issue No: Vol. 24 (2017)
  • A journey through liposuction and liposculture: Review

    • Authors: Elisa Bellini; Michele P. Grieco; Edoardo Raposio
      Pages: 53 - 60
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Elisa Bellini, Michele P. Grieco, Edoardo Raposio
      Introduction Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields. Materials and methods This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique. Results Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery. Conclusion Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.10.024
      Issue No: Vol. 24 (2017)
  • Clinical use of adipose-derived stem cells: European legislative issues

    • Authors: Edoardo Raposio; RosaGemma Ciliberti
      Pages: 61 - 64
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Edoardo Raposio, RosaGemma Ciliberti
      Objective With this study we analyse the current European legislation in order to provide guidance for regenerative medicine professionals on correct Adipose-derived Stem Cells (ASCs) isolation and use protocols for clinical applications. Materials and Methods The European Medicines Agency (EMA) considers that ASCs does not fall within the definition of an advanced therapy medicinal product if the cells have not been subjected to a substantial manipulation, and the mode of action of the cells (contribute to and enhance tissue renewal and turnover of the subcutaneous tissue) is considered to be homologous to the donor fat tissue. Results Collagenase digestion, as well as cell culturing, is considered to be a substantial manipulation. Only transplantation of a non-manipulated tissue to another location in the same anatomical or histological environment is considered to be homologous. Conclusions According to these considerations, ASCs should be not-cultured, isolated mechanically and used only in the subcutaneous tissue.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.11.002
      Issue No: Vol. 24 (2017)
  • The science behind autologous fat grafting

    • Authors: Elisa Bellini; Michele P. Grieco; Edoardo Raposio
      Pages: 65 - 73
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Elisa Bellini, Michele P. Grieco, Edoardo Raposio
      Introduction Adipose grafting has undergone significant changes over time. Many different techniques have been followed by trying to improve the quality of the lipoaspirate and the survival of the fat graft after implantation. Material and methods The purpose of this review is to analyse the historical evolution of the surgical harvesting and implant technique, describing the changes that have brought significant improvements, revolutionizing the aesthetic and functional results obtainable. Results A standard fat grafting technique is commonly performed in three stages: harvesting of adipose tissue from a suitable donor site; processing of the lipoaspirate to eliminate cellular debris, acellular oil and excess of infiltrated solution, reinjection of the purified adipose tissue. The most widely used surgical technique was described by Coleman. He modified and corrected the methods and results of his predecessors and proposed an atraumatic protocol for the treatment of adipose tissue. He reported that the key to successful fat grafting lies in the technique. In addition, he noticed that adipose tissue was not only a good filler, but improved the quality of the skin. In fact, fat grafts demonstrated to have not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Conclusion Adipose tissue, actually, is the closest to the ideal filler because it is readily available; easily obtainable, with low donor-site morbidity; repeatable; inexpensive; versatile; and biocompatible. There is an abundance of literature supporting the efficacy of fat grafting in both aesthetic and reconstructive cases. Recent studies have shown the utility of adipose-derived stem cells in the improvement of wound healing, describing their ability to regenerate soft tissues and their remodelling capacity provided by their unique cytokine and growth factor profiles. Despite ongoing concerns about survival and longevity of fat grafts after implantation and unpredictability of long-term outcome, fat has been successfully used as a filler in many differ clinic situation.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.11.001
      Issue No: Vol. 24 (2017)
  • Intestinal perforation and peritonitis due to Taenia saginata: A case
           report from Iran

    • Authors: Masoud Soosaraei; Shahriar Alizadeh; Mahdi Fakhar; Elham Sadat Banimostafavi; Hajar Ziaei Hezarjaribi
      Pages: 74 - 76
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): Masoud Soosaraei, Shahriar Alizadeh, Mahdi Fakhar, Elham Sadat Banimostafavi, Hajar Ziaei Hezarjaribi
      Taenia saginata (T. saginata) is one of the most common cestode in human. We report a case of intestinal perforation caused due to T. saginata infection. The patient, 54-year-old female, had intermittent abdominal pain, diarrhea and vomiting on referral. Intestinal obstruction and perforation leading to necrosis, and volvulus due to an impacted tapeworm was observed. Histopathological examinations showed acute inflammation with mucosal ulceration, and luminal exudates accompanied by an elongated and flattened segment of the helminth. Taenia infections should be considered in differential diagnosis of peritonitis and gastrointestinal tumors, particularly in endemic countries including Iran.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.11.021
      Issue No: Vol. 24 (2017)
  • Postoperative enterocutaneous fistula - principles in non-operative

    • Authors: E.A. Sule; M.A. Nzegwu; J.C. Okolo; R.U. Onyemekheia
      Pages: 77 - 81
      Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24
      Author(s): E.A. Sule, M.A. Nzegwu, J.C. Okolo, R.U. Onyemekheia
      Introduction Postoperative enterocutaneous fistulae could constitute a challenge when they occur following an abdominal surgery. Astute application of correct principles in its management is essential for good outcomes. Methods A retrospective review of records of patients with enterocutaneous fistulas managed non-operatively was done. Clinical assessment, anatomic and physiologic classification of fistula, fluid resuscitation, electrolyte correction, parenteral/enteral nutrition, antibiotic use and fistula effluent monitoring, formed the basis of management. Results (4/14)Four out of 14 patients with enterocutaneous fistulae were managed exclusively non-operatively. Their ages ranged between 34 and 63 years. Mean age 46years. All four fistulae occurred postoperatively. Laparatomy for ectopic pregnancy, bowel obstruction constituted the primary surgery. There were two high output cases and two low output cases. Initial parenteral nutrition was employed in two cases while enterals were used solely in two cases. Fistula closure was achieved in all 4 cases at durations ranging from 7 to 16 days, a mean time of 12.5 days. Conclusion Non-operative approach to management for postoperative enterocutaneous fistulas was successful in these cases.

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.09.011
      Issue No: Vol. 24 (2017)
  • Endobronchial ultrasound guided transbronchial needle aspiration combining
           with immunohistochemistry and genotype in lung cancer: A single-center, 55
           cases retrospective study

    • Authors: Aiqun Liu; Liwen Qian; Yi Zhong; Xiaoling Lu; Yongxiang Zhao
      Pages: 1 - 7
      Abstract: Publication date: November 2017
      Source:Annals of Medicine and Surgery, Volume 23
      Author(s): Aiqun Liu, Liwen Qian, Yi Zhong, Xiaoling Lu, Yongxiang Zhao
      Objective The purpose of this study was to evaluate the utility of EBUS-TNA for mediastinal mass or suspected lung cancer patients with mediastinal or hilar lymph node enlarged. Further to investigate the clinical value of EBUS-TBNA combining with immunohistochemistry and genotype in lung cancer. Methods A total of 55 patients with mediastinal, and/or hilar lymphadenopathy, and/or mediastinal mass previously detected by CT or PET/CT scan and who underwent EBUS-TBNA. An additional immunohistological analysis was performed for establishing a reliable diagnosis and sub classification when necessary. Some samples were tested for the EGFR and/or ALK mutations to provide suitable mutational genotyping for adenocarcinoma by using the PCR assays. Results Of the 55 patients, the sensitivity and diagnostic accuracy of EBUS-TBNA in the diagnosis of lung cancer were 92.5% (37/40) and 94.5% (52/55), respectively. 37 samples were further confirmed and obtained particular type by Immunohistochemistry. 6 cases of EBUS-TBNA samples from patients with lung adenocarcinoma referred for EGFR testing were analyzed, 4 patients were found to have EGFR gene mutations. The procedure was uneventful without any complications. Conclusion EBUS-TBNA is a safe and efficient method with high sensitivity and specificity in the diagnosis of lung cancer. Uniquely combining with Immunohistochemistry and molecular testing has significant clinical value in subtype diagnosis and guiding the treatment strategy in lung cancer.

      PubDate: 2017-09-24T19:30:41Z
      DOI: 10.1016/j.amsu.2017.07.055
      Issue No: Vol. 23 (2017)
  • Predisposing factors for seroma formation in patients undergoing
           thyroidectomy: Cross-sectional study

    • Authors: Ali Ramouz; Seyed Ziaeddin Rasihashemi; Faeze Daghigh; Esmaeil Faraji; Shahin Rouhani
      Pages: 8 - 12
      Abstract: Publication date: November 2017
      Source:Annals of Medicine and Surgery, Volume 23
      Author(s): Ali Ramouz, Seyed Ziaeddin Rasihashemi, Faeze Daghigh, Esmaeil Faraji, Shahin Rouhani
      Introduction Seroma is defined as collection of fluid within the surgical site during postoperative period that causes several complications. Recognition of predisposing risk factors can lead to avoid seroma formation after thyroidectomy. Materials and methods A cross-sectional study was carried out during a 3-year period and 678 patients were enrolled the study. We recorded demographic data, past medical history and the type of thyroidectomy were for all patients. We measured total and ionized serum calcium and albumin level in all patients before surgery and a day after it. All patients underwent total or subtotal thyroidectomy and if needed central neck dissection was performed subsequently. Patients underwent serial aspiration If they had seroma formation. Results The overall post-thyroidectomy seroma incidence was 2.2%. There was no statistically significant correlation while evaluating gender, age and body mass index with post-operative seroma formation. However, seroma formation was significantly higher in patients underwent total thyroidectomy (P = 0.041). The results of postoperative laboratory tests showed a significant lower level of ionized calcium in patients with seroma formation (P < 0.0001). Logistic regression showed statistically significant value for variables including age, BMI and decreased ionized calcium level, in developing of seroma. Conclusion We showed that Seroma formation was lower during thyroidectomy via electrical vessel sealing system in comparison with previous studies. In our study, older age, greater body mass index and decreased ionized calcium level were predictors of seroma formation.

      PubDate: 2017-09-24T19:30:41Z
      DOI: 10.1016/j.amsu.2017.09.001
      Issue No: Vol. 23 (2017)
  • The impact of alteplase on pulmonary graft function in donation after
           circulatory death – An experimental study

    • Authors: Annika Liersch-Nordqvist; Mohammed Fakhro; Leif Pierre; Joanna Hlebowicz; Malin Malmsjo; Richard Ingemansson; Sandra Lindstedt
      Pages: 1 - 6
      Abstract: Publication date: October 2017
      Source:Annals of Medicine and Surgery, Volume 22
      Author(s): Annika Liersch-Nordqvist, Mohammed Fakhro, Leif Pierre, Joanna Hlebowicz, Malin Malmsjo, Richard Ingemansson, Sandra Lindstedt
      Objective Lung transplantation is hampered by the lack of organs resulting in deaths on the waiting list. The usage of donation after circulatory death (DCD) lungs would dramatically increase donor availability. The most optimal organ preservation method, and the need for antithrombotic and fibrinolytic treatment to prevent thrombosis in the donor lungs is currently on debate. The present study investigated, in a simulated clinical DCD situation, whether the addition of alteplase in the flush-perfusion solution at the time of pulmonary graft harvesting could prevent thrombosis in the donor lung and thereby improve pulmonary graft function. Methods Twelve Swedish domestic pigs were randomized into two groups. All animals underwent ventricular fibrillation and were then left untouched for 1 h after declaration of death. None of the animals received heparin. The lungs were then harvested and flush-perfused with Perfadex® solution and the organs were then stored at 8 °C for 4 h. In one group alteplase was added to the Perfadex® solution (donation after cardiac death with alteplase (DCD-A)) and in the other, it was not (DCD). Lung function was evaluated, using ex vivo lung perfusion (EVLP), with blood gases at different oxygen levels, pulmonary vascular resistance (PVR), lung weight, and macroscopic appearance. Results During EVLP, there were no significant differences between groups in PaO2 at any investigated FiO2 level (1.0, 0.5, or 0.21). At FiO2 1.0, the PaO2 in the DCD and DCD-A was 51.7 ± 2.05 kPa and 60.3 ± 3.67 kPa, respectively (p = 0.1320). There were no significant differences between groups PVR levels, in the DCD (372 ± 31 dyne x s/cm5) and in the DCD-A (297 ± 37 dyne x s/cm5) groups (p = 0.1720). There was no significant difference between groups in macroscopic appearance. Conclusions All the lungs showed excellent blood gases after EVLP, and they all meet the criteria's for clinical lung transplantation. The use of alteplase did not seem to have any obvious benefit to the donor lungs in a DCD situation. The donor lungs treated with alteplas showed slightly better blood gases and slightly lower PVR compared to the group without alteplas, however the difference was not significant. DCD appears to be a safe and effective method to expand the donor pool.

      PubDate: 2017-08-20T17:38:54Z
      DOI: 10.1016/j.amsu.2017.08.010
      Issue No: Vol. 22 (2017)
  • Evaluation of satisfaction of individuals rehabilitated with zygomatic
           implants as regards anesthetic and sedative procedure: A prospective
           cohort study

    • Authors: Paulo H.T. Almeida; Alexander D'Alvia Salvoni; Fabiana M.G. França
      Pages: 22 - 29
      Abstract: Publication date: October 2017
      Source:Annals of Medicine and Surgery, Volume 22
      Author(s): Paulo H.T. Almeida, Alexander D'Alvia Salvoni, Fabiana M.G. França
      Purpose To evaluate the satisfaction of individuals with atrophic maxilla, rehabilitated with fixed dental prostheses, anchored on zygomatic implants, with variables being the anesthetic procedure: general anesthesia, or local with sedation. Materials and Methods By means of the clinical record charts from the Training Course in Advanced Hospital Surgeries for Implant Dentists conducted at the Campinas-SP unit of the São Leopoldo Mandic School of Dentistry, 30 individuals were randomly selected. They had zygomatic implant placement surgeries performed, and were rehabilitated with fixed implant supported complete dentures, between the years 2005 and 2011. One group of 15 individuals underwent surgery in hospital, under general anesthesia. The other 15 were treated in the post-graduation clinic at the School of Dentistry, under local anesthesia and sedation. Results From the emotional point of view, the Wilcoxon test revealed that irrespective of the anesthesia procedure used, at the beginning of treatment, the emotional condition of individuals differed from that verified after conclusion of the treatment (p < 0.0001). Conclusion There was no difference between the two groups as regards the anesthetic procedure. General satisfaction was high; there was emotional improvement after conclusion of the treatment, thus improving the quality of life.

      PubDate: 2017-09-06T18:31:09Z
      DOI: 10.1016/j.amsu.2017.08.017
      Issue No: Vol. 22 (2017)
  • Acknowledgement to Reviewers 2017

    • Abstract: Publication date: December 2017
      Source:Annals of Medicine and Surgery, Volume 24

      PubDate: 2017-12-26T18:25:17Z
  • Paediatric Dentistry- Novel Evolvement

    • Authors: Saleha Shah
      Abstract: Publication date: Available online 14 December 2017
      Source:Annals of Medicine and Surgery
      Author(s): Saleha Shah

      PubDate: 2017-12-16T17:57:13Z

    • Authors: Jonathan Bartlett
      Abstract: Publication date: Available online 5 December 2017
      Source:Annals of Medicine and Surgery
      Author(s): Jonathan Bartlett

      PubDate: 2017-12-16T17:57:13Z
      DOI: 10.1016/j.amsu.2017.11.024
  • Bartholin's gland abscess in a prepubertal female: A case report

    • Authors: Veerabhadra Radhakrishna; Rachit Goel Gaurav Parashar Ramesh Santhanakrishnan
      Abstract: Publication date: Available online 6 October 2017
      Source:Annals of Medicine and Surgery
      Author(s): Veerabhadra Radhakrishna, Rachit Goel, Gaurav Parashar, Ramesh Santhanakrishnan
      Bartholin's gland abscess is one of the common inflictions of vulva seen in females of reproductive age group with a recurrence rate of up to 38%. Although it's encountered by many Paediatric Surgeons, it's very rarely reported in prepubertal age. Till date, only six cases have been reported to the best of our knowledge. A seven-year-old female child presented with a recurrent labial abscess. She was found to have Bartholin's gland abscess and was treated with partial excision of cyst wall along with the overlying mucosa and drainage. There has been no recurrence for the past six months at follow-up. Bartholin's gland abscess, although rare in children, should be considered as one of the differential diagnosis of a labial swelling. Adequate drainage is essential to prevent recurrence.

      PubDate: 2017-10-10T20:26:42Z
  • Mesenchymal stem cells in human meniscal regeneration: A systematic review

    • Authors: Ernest Chew; Rohan Prakash; Wasim Khan
      Abstract: Publication date: Available online 5 October 2017
      Source:Annals of Medicine and Surgery
      Author(s): Ernest Chew, Rohan Prakash, Wasim Khan
      Background Stem cell regeneration is the holy grail of meniscal tissue repair. Currently, the best treatment is to preserve the original meniscus but if it fails, a partial meniscectomy is indicated to delay the onset of osteoarthritis. Materials and methods The authors present a systematic review to determine the up-to-date evidence underlying the use of mesenchymal stem cells for meniscal regeneration in humans. A search was conducted using the electronic databases of MEDLINE/Pubmed, Google scholar, and the Cochrane Collaboration. Search keywords included human, meniscus, stem cells and regeneration. Results After screening 10 non-duplicate studies, 5 were identified based on title and abstract. 4 were included in the analysis. There were marked differences in the method of stem cell harvest techniques. 3 studies administered stem cells through percutaneous injection into the knee and 1 study used a collagen scaffold. MRI analysis, functional scores and safety were assessed and the longest follow-up period was 2 years. The Visual Analogue Score (VAS) was most commonly used to assess function and patients generally showed an improvement. There were no reported adverse events. Conclusion Despite positive results from animal models, there is currently a lack of evidence in humans to conclude that stem cells can form durable neotissue similar to original human meniscus. There is a need for standardisation of protocol before further trials are considered. Initial outcomes from human studies are promising and mesenchymal stem cells may play an important role in meniscal repair in years to come.

      PubDate: 2017-10-10T20:26:42Z
      DOI: 10.1016/j.amsu.2017.09.018
  • A case report and approach to management in pneumatosis intestinalis

    • Authors: Manon Jenkins; Hannah Courtney; Emma Pope; James Williamson
      Abstract: Publication date: Available online 30 September 2017
      Source:Annals of Medicine and Surgery
      Author(s): Manon Jenkins, Hannah Courtney, Emma Pope, James Williamson
      Pneumatosis Intestinalis (PI) is an uncommon condition in which there is gas present within the wall of the gastrointestinal tract. PI is usually found in the large bowel, but can less commonly occur in the small bowel, and gas may be present in either the subserosal or submucosal layer of the intestine. Its unfamiliarity often means it is under-recognised and not considered as a differential diagnosis when assessing a patient with abdominal symptoms. The spectrum of conditions that produce PI is varied and ranges from the non-urgent to life-threatening. Early appreciation of the overall clinical picture is therefore paramount to enable the practitioner to distinguish between the benign to the fatal cases of PI and enable precise decision-making regarding its management. The challenge facing the clinician is twofold; firstly the accurate identification of the diagnosis of PI, as opposed to other causes of peritoneal gas and secondly judging whether operative or non-operative management should ensue. We present a case of a patient presenting on two separate occasions with PI, abdominal symptoms and radiological signs of acute abdominal pathology which demonstrates the wide spectrum of difficulties faced with this uncommon condition.

      PubDate: 2017-10-01T19:57:35Z
      DOI: 10.1016/j.amsu.2017.09.010
  • Intraluminal ileal tumour after right hemicolectomy for cancer: An
           implantation recurrence or a new cancer'

    • Authors: Marco Clementi; Sara Colozzi; Mario Schietroma; Federico Sista; Andrea Della Penna; Alessandro Chiominto; Stefano Guadagni
      Abstract: Publication date: Available online 29 September 2017
      Source:Annals of Medicine and Surgery
      Author(s): Marco Clementi, Sara Colozzi, Mario Schietroma, Federico Sista, Andrea Della Penna, Alessandro Chiominto, Stefano Guadagni
      Introduction Extra-anastomotic intraluminal recurrence of the colon cancer after curative surgery was rarely reported but intraluminal ileal relapse has not been described to date. We report a case of intraluminal ileal tumor arising after curative right hemicolectomy that could be ascribed to an implantation of exfoliated cancer cells. Case report A 71-years old man was admitted with no metastatic stenotic adenocarcinoma of the hepatic flexure and submitted, without preoperative bowel preparation, to right hemicolectomy using a “no-touch” technique. Histology showed moderately differentiated adenocarcinoma without lymph nodes involvement (pT3N0). No adjuvant therapy was prescribed. First colonoscopy three months after surgery was negative but a second endoscopic examination nine months later revealed an ileal neoplasia, presenting like an ulcer 10 cm proximally to ileocolic anastomosis. A new ileo-colic resection including past anastomosis was performed with curative intent. Pathological examination showed moderately differentiated adenocarcinoma extended to peri-visceral fat tissue with 10 tumor-free lymph nodes. (pT3N0). Six courses of Capecitabine adjuvant chemotherapy was prescribed and 32 months after second surgery, the patient is alive without disease. Discussion In the present case, the relatively short time from the primary surgery and the fact that recurrence occurred outside the anastomosis suggest that implantation of exfoliated malignant cells seems to be the main pathogenetic mechanism. We suppose that the high grade of primary cancer and the occlusive condition could have promoted the cancer cells reflux through the ileocecal orifice and in the transverse colon. Conclusion This case seems to confirm the intraluminal implanting capacity of exfoliated carcinoma cells.

      PubDate: 2017-10-01T19:57:35Z
      DOI: 10.1016/j.amsu.2017.09.009
  • Murine genotype impacts pancreatitis severity and systemic inflammation

    • Authors: Gabriel J. Seifert; Karoline C. Sander; Sabine Richter; Uwe A. Wittel
      Abstract: Publication date: Available online 28 September 2017
      Source:Annals of Medicine and Surgery
      Author(s): Gabriel J. Seifert, Karoline C. Sander, Sabine Richter, Uwe A. Wittel
      Background Little is known regarding the impact of host response in acute pancreatitis. Here, we induce murine necrotizing pancreatitis in 9 different mouse strains. Materials and methods We examined 9 different mouse strains: Balb/CB4J, C3H/HEJ, NOD/SHILT, A/J, AKR/J, C57BI/6J, DBA/2J, FVB/NJ, 129S1/SvlmJ. 10 animals per strain were randomly allotted to two groups. Sterile necrotizing pancreatitis was induced by injection of taurocholate into the common bile duct. Control animals were injected with saline. Every 6 h, clinical parameters were examined and scored. After 24 h, animals were sacrificed to examine and compare serum enzymes, histology, bronchoalveolar lavage fluid, and serum IL-6. Results Histologically, taurocholate treated animals scored significantly higher than control animals. Concordantly, serum lipase and amylase were significantly elevated in pancreatitis animals in all strains. NOD/SHILT and AKR/J mice had the highest enzyme activity. 24 h after induction, there were no signs of increased pulmonary vascular leak in taurocholate animals. Remarkably, interleukin 6 was not increased at all in C57BL/6J, C3H/HeJ, and 129S1/SvlmJ mice compared to all other strains. Conclusion The genetic strain has an impact on pancreatitis severity and systemic inflammatory response in a murine taurocholate induction model. Analogous differences in humans may partially account for the disparity in post-ERCP pancreatitis.

      PubDate: 2017-10-01T19:57:35Z
      DOI: 10.1016/j.amsu.2017.09.012
  • Choosing the uterine preservation surgery for placental polyp determined
           by blood flow evaluation: A retrospective cohort study

    • Authors: Sumire Sorano; Tatsuya Fukami; Maki Goto; Sakiko Imaoka; Miho Ando; Yoko To; Sumie Nakamura; Hiroko Yamamoto; Fuyuki Eguchi; Hiroshi Tsujioka
      Abstract: Publication date: Available online 28 September 2017
      Source:Annals of Medicine and Surgery
      Author(s): Sumire Sorano, Tatsuya Fukami, Maki Goto, Sakiko Imaoka, Miho Ando, Yoko To, Sumie Nakamura, Hiroko Yamamoto, Fuyuki Eguchi, Hiroshi Tsujioka
      Background A placental polyp is an intrauterine polypoid mass or pedunculated mass occurring from residual trophoblastic tissue following abortion, cesarean section or vaginal delivery. Recently uterine preservation surgery represented by transcervical resection (TCR) has been performed for placental polyps. However TCR without intravascular intervention, including uterine artery embolization (UAE) may cause profound bleeding which necessitate emergency laparotomy. Methods Seventeen cases of placental polyp were retrospectively examined. We divided cases into two groups: strong vascularity group (n = 13) and weak vascularity group (n = 4). Mass extraction of polyp by TCR was conducted in 16 cases, 6 case without UAE and 10 cases with UAE. Results As for the weak vascularity group, one case was naturally resolved while planning surgery and 3 cases were treated with TCR without UAE without major intra- and/or postoperative bleeding. On the other hand in the strong vascularity group, 2 out of 3 cases of TCR without UAE resulted in major bleeding during and after the surgery, both needed transfusion and one needing postoperative UAE. Ten cases of strong vascularity group, TCR with UAE were performed and all of them were accomplished without major bleeding. TCR without UAE was safely performed in cases where there was absent or mild to moderate blood flow. Conclusions Our report suggests that adding UAE might be safer to treat placental polyps that have strong vascularity.

      PubDate: 2017-10-01T19:57:35Z
      DOI: 10.1016/j.amsu.2017.09.008
  • Surgical assessment clinic – One stop emergency out-patient clinic for
           rapid assessment, reduced admissions and improved acute surgical service

    • Authors: Christina A.W. Macano; George C. Kirby; Blossom Lake; Sitaramachandra M. Nyasavajjala; Robert Clarke
      Abstract: Publication date: Available online 28 September 2017
      Source:Annals of Medicine and Surgery
      Author(s): Christina A.W. Macano, George C. Kirby, Blossom Lake, Sitaramachandra M. Nyasavajjala, Robert Clarke
      Background There is increasing pressure on emergency services within the NHS requiring efficient, rapid assessment and management of patients. A subsequent reduction in hospital admissions reduces overall costs with an aim to improve quality of care. At the Royal Shrewsbury Hospital we run a one stop emergency surgical clinic. With strict criteria for admission to this clinic we have established a care pathway for those patients requiring urgent surgical review but not necessarily hospital admission. Materials and methods We reviewed our initial referral pathway to the emergency surgical assessment clinic. New guidelines were distributed to the local Care Coordination Centre (CCC) through which GP referrals to the clinic were made. A re-audit carried out 6 weeks later assessed change in clinical practice. Results With the introduction of guidelines for referral we significantly increased the percentage of appropriate referrals to the one stop emergency surgical clinic (42.9%–79.4%, p = 0.000017). The majority (75.8%) of appropriate referrals can be successfully managed on an urgent outpatient basis. Appropriate referrals unsuitable for discharge from clinic had genuine reasons for admission such as abnormal results on assessment, or a need for surgery. 97.8% of referrals not deemed appropriate for the clinic were admitted for inpatient management. Conclusion By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

      PubDate: 2017-10-01T19:57:35Z
      DOI: 10.1016/j.amsu.2017.09.016
  • S-shaped versus conventional straight skin incision: Impact on primary
           functional maturation, stenosis and thrombosis of autogenous radiocephalic
           arteriovenous fistula

    • Authors: Ali Kordzadeh; Yiannis Panayiotopolous
      Abstract: Publication date: Available online 30 August 2017
      Source:Annals of Medicine and Surgery
      Author(s): Ali Kordzadeh, Yiannis Panayiotopolous
      Introduction The objective of this study is to test the null hypothesis that an S-shaped surgical incision versus conventional (straight) skin incision in the creation of autogenous radiocephalic arteriovenous fistulas (RCAVFs) have no impact on the primary end-point of primary functional maturation and secondary end points of stenosis and thrombosis. Methods A prospective observational comparative consecutive study with intention-to-treat on individuals undergoing only radiocephalic arteriovenous fistula (RCAVFs) over a period of 12 months was conducted. Variables on patient's demographics, comorbidities, anesthesia type, mean arterial blood pressure, thrill, laterality, cephalic vein and radial artery diameter were collated. The test of probability was assessed through Chi-Square, Kaplan-Meier survival estimator and Log-Rank analysis. Results Total of n = 83 individuals with median age of 67 years (IQR, 20–89) and male predominance 83% during this period were subjected to RCAVF formation. Total of n = 45 patients in straight skin incision were compared to n = 38 individuals in S-shaped group. Despite equal prevalence of demographics, comorbidities, anesthesia type, mean arterial blood pressure (MAP), thrill, laterality, cephalic vein and radial artery diameter (p > 0.05) higher incidence of juxta-anastomotic stenosis was noted in the straight skin incision group (p = 0.029) in comparative and survival analysis (Log-Rank, p = 0.036). The maturation of the entire cohort was 69% (S-shaped 76% vs. straight group 62%) (p > 0.05). Conclusion The outcome of this study demonstrates that S-shaped surgical skin incision is associated with a lower incidence of stenosis in comparison to straight incision type in RCAVF formation.

      PubDate: 2017-08-31T18:14:29Z
      DOI: 10.1016/j.amsu.2017.08.018
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