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MEDICAL SCIENCES (1808 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)
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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: 39)
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Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
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Acta Informatica Medica     Open Access   (Followers: 1)
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African Health Sciences     Open Access   (Followers: 2)
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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: 11)
American Journal of Biomedical Research     Open Access   (Followers: 2)
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American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 5)
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American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
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American Journal of Medicine     Hybrid Journal   (Followers: 46)
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American Journal of Medicine Studies     Open Access  
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American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 9)
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: 3)
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)
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Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 8)
Annals of Family Medicine     Open Access   (Followers: 12)
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: 5)
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: 18)
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 Medical Informatics     Open Access   (Followers: 11)
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 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  
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: 2)
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: 2)
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: 2)
Asian Journal of Transfusion Science     Open Access   (Followers: 2)
Asian Medicine     Hybrid Journal   (Followers: 4)
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: 2)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     Open Access  
Bangladesh Medical Research Council Bulletin     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  
Biology of Sex Differences     Open Access   (Followers: 3)
Biomarker Research     Open Access   (Followers: 2)

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Journal Cover Annals of Medicine and Surgery
  [SJR: 0.221]   [H-I: 4]   [5 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2049-0801
   Published by Elsevier Homepage  [3089 journals]
  • 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)
  • 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: Available online 13 October 2017
      Source:Annals of Medicine and Surgery
      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: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.10.003
      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)
  • 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: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.09.013
      Issue No: Vol. 23 (2017)
  • 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: Available online 28 September 2017
      Source:Annals of Medicine and Surgery
      Author(s): G.C. Kirby, C.A.W. Macano, S.M. Nyasavajjala, M. Sahloul, 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: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.09.015
      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)
  • 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: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.08.009
      Issue No: Vol. 22 (2017)
  • 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: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.08.013
      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)
  • 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: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.08.024
      Issue No: Vol. 22 (2017)
  • Comparison between CT Net enhancement and PET/CT SUV for N staging of
           gastric cancer: A case series

    • Authors: Amato Antonio Stabile Ianora; Michele Telegrafo; Nicola Maria Lucarelli; Valentina Lorusso; Arnaldo Scardapane; Artor Niccoli Asabella; Marco Moschetta
      Pages: 1 - 6
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Amato Antonio Stabile Ianora, Michele Telegrafo, Nicola Maria Lucarelli, Valentina Lorusso, Arnaldo Scardapane, Artor Niccoli Asabella, Marco Moschetta
      Background The therapeutic approach of gastric cancer strictly depends on TNM staging mainly provided by CT and PET/CT. However, the lymph node size criterion as detected by MDCT causes a poor differential diagnosis between reactive and metastatic enlarged lymph nodes with low specificity values. Our study aims to compare 320-row CT Net enhancement and fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (F-FDG PET/CT) SUV for N staging of gastric cancer. Materials and methods 45 patients with histologically proven gastric cancer underwent CT and F-FDG PET/CT. Two radiologists in consensus evaluated all images and calculated the CT Net enhancement and F-FDG PET/CT SUV for N staging, having the histological findings as the reference standard. CT and F-FDG PET/CT sensitivity, specificity, diagnostic accuracy, positive and negative predictive values (PPV and NPV) were evaluated and compared by using the Mc Nemar test. Results The histological examination revealed nodal metastases in 29/45 cases (64%). CT Net enhancement obtained sensitivity, specificity, accuracy, PPV and NPV of 90%, 81%, 87%, 90% and 81%, respectively. F-FDG PET/CT SUV obtained sensitivity, specificity, accuracy, PPV and NPV of 66%, 88%, 73%, 90% and 58%, respectively. No statistically significant difference between the two imaging modalities was found (p = 0.1). Conclusion CT Net enhancement represents an accurate tool for N staging of gastric cancer and could be considered as the CT corresponding quantitative parameter of F-FDG PET/CT SUV. It could be applied in the clinical practice for differentiating reactive lymph nodes from metastatic ones improving accuracy and specificity of CT.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.033
      Issue No: Vol. 21 (2017)
  • Rationale for a new registry on EVAR: The EXTREME study

    • Authors: Pasqualino Sirignano; Wassim Mansour; Laura Capoccia; Francesco Speziale
      Pages: 7 - 8
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Pasqualino Sirignano, Wassim Mansour, Laura Capoccia, Francesco Speziale
      To report rationale of a physician-initiated study: Expanding Indications for Treatment with Standard EVAR in Patients with Challenging Anatomies, a Multi-Centric Prospective Evaluation - EXTREME.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.035
      Issue No: Vol. 21 (2017)
  • Predictive and diagnostic value of serum intestinal fatty acid binding
           protein in neonatal necrotizing enterocolitis (case series)

    • Authors: Omima M. Abdel-Haie; Eman G. Behiry; Eman R. Abd Almonaem; Enas S. Ahmad; Effat H. Assar
      Pages: 9 - 13
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Omima M. Abdel-Haie, Eman G. Behiry, Eman R. Abd Almonaem, Enas S. Ahmad, Effat H. Assar
      Objectives In this study, we aimed to investigate the value of serum intestinal fatty acid binding protein (I-FABP) in early diagnosis and predicting the severity of Necrotizing enterocolitis (NEC). Methods This prospective study was performed on 160 preterm neonates ageing less than 35 weeks and weighting less than 2000 gm selected from the Neonatal Intensive Care Units (NICUs) of the Pediatric Department at Benha University hospital and Benha children hospital to evaluate which of them will develop NEC, after follow-up these neonates were divided into two groups: Group one compromised eighteen preterm neonates with symptoms and signs of NEC. Group two compromised ten preterm neonates as a control group. All participants were subjected to full clinical examination, abdominal X-ray and serum I-FABP. Results The 1st values of IFABP taken at birth showed that mean serum IFABP concentrations of the study group were higher than that of the control group. The 2nd values of serum IFABP taken at the start of feeding showed that mean IFABP concentrations of the study group were higher in comparison with IFABP at birth. In the 3rd values of serum, IFABP taken at the time of diagnosing NEC showed that mean serum IFABP concentrations of the study group were higher than the control group. In the 4th values of serum, IFABP taken one week after diagnosing NEC showed that the mean serum IFABP concentrations of the study group became significantly decreased in comparison with IFABP at the time of diagnosis in stage 1 and 2. Conclusions Serial measurements of serum I-FABP levels may be a useful marker for early diagnosis and prediction of disease severity in NEC.

      PubDate: 2017-07-31T16:53:12Z
      DOI: 10.1016/j.amsu.2017.05.010
      Issue No: Vol. 21 (2017)
  • Frequency, characteristics and outcomes of appendicular neuroendocrine
           tumors: A cross-sectional study from an academic tertiary care hospital

    • Authors: Abdelrahman Abdelaal; Walid El Ansari; Issam Al-Bozom; Mahwish Khawar; Fakhar Shahid; Ammar Aleter; Mohammed Rasoul Abunuwar; Ayman El-Menyar
      Pages: 20 - 24
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Abdelrahman Abdelaal, Walid El Ansari, Issam Al-Bozom, Mahwish Khawar, Fakhar Shahid, Ammar Aleter, Mohammed Rasoul Abunuwar, Ayman El-Menyar
      Background Appendicular neuroendocrine tumors (NET, Carcinoid tumors) of the appendix are rare and mostly diagnosed incidentally on the post-operative histopathological examination. NET are usually associated with good 5-year survival rates. We aimed to assess our experience for the diagnosis and management of NET over 11 years. Method It is a retrospective chart review of all clinically suspected patients with acute appendicitis who underwent emergent appendectomy with intention to treat between January 2004–December 2014, and were clinically followed up until 2016. Results During the study period, a total of 13641 patients underwent emergency appendectomy, of which 32 were histologically confirmed NET. The mean age of the NET cases was 25.3 ± 7.9 years; 78% were males and all were clinically presented with acute appendicitis. The mean leucocyte was 15 ± 14 × 109 per Liter, and mean tumor size was 4.86 ± 3.18 (ranged 1.5–13) mm. The median length of hospital stay was 4 (2–15) days. One patient had right hemicolectomy; diagnosed with right colonic cancer with NET being an incidental finding as part of histopathological assessment. Another patient required a second stage procedure; he was diagnosed as goblet cell carcinoid with positive margin. None of the patients died 30-day postoperatively and all of them survived on clinical follow-up that ranged between 2 and 13 years. Conclusion Carcinoid tumors of the appendix are rare and typically diagnosed incidentally. Detailed examination of routine appendectomy specimens is the key for diagnosis. Simple appendectomy suffices for tumors <2 cm for adequate clearance. Appendicular carcinoid tumors are associated with good long-term outcomes.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.07.043
      Issue No: Vol. 21 (2017)
  • A prospective randomised trial of isolated pathogens of surgical site
           infections (SSI)

    • Authors: Konstantinos Alexiou; Ioannis Drikos; Maria Terzopoulou; Nikolaos Sikalias; Argyrios Ioannidis; Nikolaos Economou
      Pages: 25 - 29
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Konstantinos Alexiou, Ioannis Drikos, Maria Terzopoulou, Nikolaos Sikalias, Argyrios Ioannidis, Nikolaos Economou
      Background Every surgical wound is colonized by bacteria, but only a small percentage displays symptoms of infection. The distribution of pathogens isolated in surgical site infections has not significantly changed over the last decades. Staph. Aureus, Coag(-) Staphylococci, Enterococcus spp and E. Coli are the main strains appearing. In addition, a continuously rising proportion of surgical site infections caused by resistant bacterial species (MRSA, C. Albicans) has been reported. Methods This prospective and randomized clinical study was performed in the 1st Surgical Clinic of Sismanoglion General Hospital of Athens, from February 2009 to February 2015. Patients undergoing elective surgery in the upper or lower digestive system were randomized to receive antimicrobial treatment as chemoprophylaxis. Each patient filled a special monitoring form, recording epidemiological data, surgery related information, surgical site infections (deep and superficial), as well as postoperative morbidity (urinary and respiratory infections included). The monitoring of patients was carried by multiple visits on a daily basis during their hospitalization and continued after they were discharged via phone to postoperative day 30. Results Our overall SSI incidence was 4,3% (31patients out of a whole of 715 patients). Specifically, the incidence of SSIs for scheduled surgery of the upper GI tract was 2,2% (11 out of 500 patients) and for the lower GI tract was 9,3% (20 out of 215 patients). Seven main pathogens were isolated from patients with SSIs: Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Bacteroides fragilis, Staphylococcus aureus and Enterococcus faecalis. Their growth rates were respectively: S. Aureus (17,3%), E. faecalis (19,5%), P. aeruginosa (10,5%), B. Fragilis (13,4%) E. coli (20,4%), Enterobacter cloacae (9,1%) and K. Pneumoniae (9,8%). In addition, all the SSIs were found to be multimicrobial. Several studies have already revealed that patient characteristics and coexisting morbidities such as obesity, smoking, heart or renal failure, pre-existing localized infections and patients' age (especially if age exceeds 65) seem to be independent prognostic factors for surgical field infections. Additionally, classification of the surgical wound, surgical operation complexity, preoperative hospitalization, prolongation of surgical time and need for transfusions have been proved to differentiate the incidence of SSIs. Conclusions In conclusion, surgical site infections are important complications affecting the healthcare services, the cost of hospitalization and the patient himself. Future thorough studies are expected to reveal much more data, regarding predisposing and precautionary patient and hospital characteristics.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.07.045
      Issue No: Vol. 21 (2017)
  • Medicinal plants with promising antileishmanial activity in Iran: a
           systematic review and meta-analysis

    • Authors: Masoud Soosaraei; Mahdi Fakhar; Saeed Hosseini Teshnizi; Hajar Ziaei Hezarjaribi; Elham Sadat Banimostafavi
      Pages: 63 - 80
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Masoud Soosaraei, Mahdi Fakhar, Saeed Hosseini Teshnizi, Hajar Ziaei Hezarjaribi, Elham Sadat Banimostafavi
      Background Leishmaniasis is a major public health problem worldwide. The aim of the present study was to investigate medicinal plants with anti-Leishmania activity which used in Iran. Methods Data were systematically gathered from five English databases including Ebsco, Science Direct, PubMed, Google Scholar and Scopus, four Persian databases including Magiran, Iran doc, Iran medex and the Scientific Information Database (SID) from 1999 to April 2015. Information obtained included plant family, extraction method, concentrations of extracts, animal models and parasite strains. Results A total of 68 articles including 188 experiments (140 in vitro and 48 in vivo) between 1999 and 2015, met our eligibility criteria. Thoroughly, 98 types of plants were examined against three genera of Leishmania spp. For the heterogeneity study conducted, it was showed that there was a great deal of variation among studies. Based on random effect, meta-analysis pooled mean of IC50 was obtained 456.64 (95% CI: 396.15, 517.12). Conclusion The most Iranian plants used as anti-leishmanial activity were Artemisia species, Allium sativum, Achilleamille folium, Peganum harmala and Thymus vulgaris. The present systematic and meta-analysis review provide valuable information about natural products with anti-Leishmania activity, which would be examined in the future experimental and clinical trials and herbal combination therapy.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.07.057
      Issue No: Vol. 21 (2017)
  • Cost and morbidity analysis of chest port insertion in adults: Outpatient
           clinic versus operating room placement

    • Authors: Claudio F. Feo; Giorgio C. Ginesu; Alessandro Bellini; Giuseppe Cherchi; Antonio M. Scanu; Maria Laura Cossu; Alessandro Fancellu; Alberto Porcu
      Pages: 81 - 84
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Claudio F. Feo, Giorgio C. Ginesu, Alessandro Bellini, Giuseppe Cherchi, Antonio M. Scanu, Maria Laura Cossu, Alessandro Fancellu, Alberto Porcu
      Background Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Materials and methods Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Results Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30–120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Conclusion Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.07.056
      Issue No: Vol. 21 (2017)
  • Bleeding complications post ultrasound guided renal biopsy – A single
           centre experience from Pakistan

    • Authors: Rabeea Azmat; Abdul Basit Siddiqui; M. Tahir Rizwan Khan; Shiyam Sunder; Waqar Kashif
      Pages: 85 - 88
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Rabeea Azmat, Abdul Basit Siddiqui, M. Tahir Rizwan Khan, Shiyam Sunder, Waqar Kashif
      Introduction Renal biopsy is the diagnostic modality of choice for the diagnosis of renal parenchymal diseases. The advent of improved imaging techniques and biopsy needles over the years has increased the safety of the procedure and the ability to obtain adequate renal tissue for diagnosis. However, there is paucity of data in this regard from Pakistan. This study shall help in establishing the local perspective of the frequency of bleeding complications in percutaneous ultrasound guided renal biopsy. Materials and methods This is a prospective case series of hospitalized patients from January till December 2015 at Nephrology Department, Aga Khan University Hospital, Karachi, Pakistan. After enrolment, each participant was followed for 24 h after renal biopsy. Results A total of 220 patients were included. Mean age was 41.65 ± 8.627 years, 82 (37.2%) were male and 138 (62.8%) were female. Pre and post biopsy haemoglobin, pre and post biopsy haematocrit were 10.92 ± 1.25 and 10.60 ± 1.22, and 30.82 ± 4.73 and 30.49 ± 4.68 respectively. Out of 220 patients, 16 (7.27%) developed major complications and 26 (11.8%) developed minor complications in 24 h after renal biopsy. Conclusions Percutaneous kidney biopsy is a relatively safe procedure. Complication rates following the procedure are minimal. It is important that all nephrology programs train the trainees in performing biopsies, so that there is a wider clinical use of this important investigation even in underprivileged & developing countries.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.06.057
      Issue No: Vol. 21 (2017)
  • THD and mucopexy: Efficacy and controversy

    • Authors: Haytham Abudeeb; Ajogwu Ugwu; Jamshid Darabnia; Ahmed Hammad; Khurram Khan; Min Maung; Elizabeth McNulty; Abdul Latif Khan; Arijit Mukherjee
      Pages: 89 - 92
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Haytham Abudeeb, Ajogwu Ugwu, Jamshid Darabnia, Ahmed Hammad, Khurram Khan, Min Maung, Elizabeth McNulty, Abdul Latif Khan, Arijit Mukherjee
      Aims Transanal haemorrhoidal dearterialisation and mucopexy has evolved in recent years as a popular minimally invasive non-excisional surgery for symptomatic prolapsing haemorrhoids. The long-term outcome of this procedure however, remains to be established. We aim to analyse the long-term outcome of THD-mucopexy in the management of prolapsing haemorrhoids based on the evidence of a prospective data from a single institution. Methods A prospective data was collected on 100 consecutive cases of grade 3 and 4 symptomatic haemorrhoids between the period 03/2010 and 06/2015 who underwent the procedure as a day case under general anaesthetic. Overall median follow up was for two years with average age of 54.4 ranges from 34 to 79 and gender ratio of 61% Male and 39% Female. Pre-and postoperative symptoms were assessed with a view to evaluate the nature of complications and long-term recurrence rate. Results Preop Post op (6 weeks) Post op (6 months) P value Bleeding 74 (74%) 9 9 P<0.0001 Prolapse 31 (31%) 6 7 P<0.0001 Perianal pain 15 (15%) 3 2 P = 0.006 Discharge 5 (5%) 1 0 P = 0.21 Itching 2 (2%) 0 0 P = 0.47 Anal fissure (Healed) 4 (4%) 0 4 P = 0.71 Postoperative complications Bleeding 7 (7%) Pain 5 (5%) Urgency 1 (1%) Fistula 1 (1%) Discharge 2 (2%) Infection 3 (3%)
      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.07.050
      Issue No: Vol. 21 (2017)
  • Laparoscopic double-tract reconstruction after total gastrectomy for
           postoperative duodenal surveillance: Case series

    • Authors: Ryota Otsuka; Hideki Hayashi; Naoyuki Hanari; Hisashi Gunji; Koichi Hayano; Masayuki Kano; Hisahiro Matsubara
      Pages: 105 - 108
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Ryota Otsuka, Hideki Hayashi, Naoyuki Hanari, Hisashi Gunji, Koichi Hayano, Masayuki Kano, Hisahiro Matsubara
      Introduction When gastric cancer or carcinoid patients have coexisting diseases such as duodenal adenoma, FAP, or Crohn's disease, periodic observation of the duodenum is necessary. Methods Between August 2013 and April 2015, we performed four consecutive laparoscopic total gastrectomies with double tract reconstruction for duodenal surveillance. Three of the patients were diagnosed with gastric cancer, while the remaining patient was diagnosed with gastric carcinoid. Results No deaths occurred, and three of the patients showed no early complications. One patient with Crohn's disease developed anastomotic leakage, but it was successfully managed conservatively. On endoscopy three to seven months later, we were able to observe the duodenum via jejunal anastomosis in all of the patients. Discussion Roux-en-Y reconstruction is one of the options after laparoscopic total gastrectomy. However, given that periodical endoscopic examinations of the duodenum are strongly recommended after surgery, double-tract reconstruction may be preferable in these patients. Conclusion Although more detailed data are required, double-tract reconstruction may be the best choice for patients requiring total gastrectomy with regular check-up of the duodenum.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.07.080
      Issue No: Vol. 21 (2017)
  • Defunctioning stoma- a prognosticator for leaks in low rectal restorative
           cancer resection: A retrospective analysis of stoma database

    • Authors: Haytham Abudeeb; Ahmed Hammad; Ajogwu Ugwu; Jamshid Darabnia; Lee Malcomson; Min Maung; Khurram Khan; Clare Mclaughlin; Arijit Mukherjee
      Pages: 114 - 117
      Abstract: Publication date: September 2017
      Source:Annals of Medicine and Surgery, Volume 21
      Author(s): Haytham Abudeeb, Ahmed Hammad, Ajogwu Ugwu, Jamshid Darabnia, Lee Malcomson, Min Maung, Khurram Khan, Clare Mclaughlin, Arijit Mukherjee
      Aims Low anterior resection (LAR) has higher risk of anastomotic leak with its attendant morbidity -mortality. De-functioning loop ileostomy (DLI), claimed to mitigate the consequences of anastomotic leak, has been questioned in recent years. This study aims to evaluate the impact of ileostomy on LAR. Methods A retrospective analysis of stoma database. 136 patients with stoma (March 2011–July 2015) were assessed. Data was analysed in respect to LAR anastomotic leak rate, impact on morbidity-mortality, short and long-term stoma complications, rate of ileostomy reversal and reasons for non-reversal. Results 45 patients had loop ileostomy for LAR. Male (28) to female (17) ratio was 1.65:1 with median age of 69 (IQR: 56-75.5). Only 3 anastomotic leaks (3/45, 6.5%) occurred, all treated conservatively with no mortality. 29 had reversal, average reversal time is 10 months (3–24) and 5 awaiting. Reasons for non-reversal included patients' choice (7), death from cardiac cause (1), chemotherapy (1), unfit for surgery (1) and failed reversal (1). Acute complications included high output & reversible AKI (1), bleeding (3) and minor complications (6) as skin excoriation, separation and appliance issues. Parastomal hernia was repaired during reversal (12/15). Conclusions De-functioning ileostomy for LAR is a safe procedure with low morbidity. Most stomas are reversible. Series highlights a late reversal contrary to the nationally recommended guidelines. Most interestingly, the study demonstrated de-functioning mitigated clinical consequences of anastomotic leak to an extent that reoperation was avoidable, in keeping with recent meta-analysis indicating a significantly low anastomotic leakage rates and reoperation. Larger study is invaluable to substantiate findings.

      PubDate: 2017-10-13T20:41:23Z
      DOI: 10.1016/j.amsu.2017.07.044
      Issue No: Vol. 21 (2017)
  • The biological and clinical basis for the use of adipose-derived stem
           cells in the field of wound healing

    • Authors: Nicolò Bertozzi; Francesco Simonacci; Michele Pio Grieco; Eugenio Grignaffini; Edoardo Raposio
      Pages: 41 - 48
      Abstract: Publication date: August 2017
      Source:Annals of Medicine and Surgery, Volume 20
      Author(s): Nicolò Bertozzi, Francesco Simonacci, Michele Pio Grieco, Eugenio Grignaffini, Edoardo Raposio
      Worldwide, hard-to-heal lower limb wounds are estimated to affect 1.5–3% of the adult population with a treatment-related annual cost of $10 billion. Thus, chronic skin ulcers of the lower limb are a matter of economic and public concern. Over the years, multiple medical and surgical approaches have been proposed but they are still inadequate, and no effective therapy yet exists. Regenerative medicine and stem cell-based therapies hold great promise for wound healing. Recently, many plastic surgeons have studied the potential clinical application of adipose-derived stem cells (ASCs), which are a readily available adult stem cell population that can undergo multilineage differentiation and secrete growth factors that can enhance wound-healing processes by promoting angiogenesis, and hence increase local blood supply. ASCs have been widely studied in vitro and in vivo in animal models. However, there are few randomized clinical trials on humans, and these are still ongoing or recruiting patients. Moreover, there is no consensus on a common isolation protocol that is clinically feasible and which would ensure reproducible results. The authors aim to provide readers with an overview of the biological properties of ASCs as well as their clinical application, to help better understanding of present and future strategies for the treatment of hard-to-heal wounds by means of stem cell-based therapies.

      PubDate: 2017-07-03T15:34:31Z
      DOI: 10.1016/j.amsu.2017.06.058
      Issue No: Vol. 20 (2017)
  • Procedure, applications, and outcomes of autologous fat grafting

    • Authors: Francesco Simonacci; Nicolò Bertozzi; Michele Pio Grieco; Eugenio Grignaffini; Edoardo Raposio
      Pages: 49 - 60
      Abstract: Publication date: August 2017
      Source:Annals of Medicine and Surgery, Volume 20
      Author(s): Francesco Simonacci, Nicolò Bertozzi, Michele Pio Grieco, Eugenio Grignaffini, Edoardo Raposio
      Objective To systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications. Patients and methods Literature review of publications concerning autologous fat grafting. Results Since its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The “wet” method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification. Conclusions Lipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.

      PubDate: 2017-07-03T15:34:31Z
      DOI: 10.1016/j.amsu.2017.06.059
      Issue No: Vol. 20 (2017)
  • 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
      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: 2017-10-13T20:41:23Z
  • 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
  • Phosphate disturbance in critically ill children: Incidence, associated
           risk factors and clinical outcomes

    • Authors: Ahmed Nabih El Shazly; Doaa Refaey Soliman; Effat Hussien Assar; Eman Gamal Behiry; Ibrahim Abd El Naby Gad Ahmed
      Abstract: Publication date: Available online 9 August 2017
      Source:Annals of Medicine and Surgery
      Author(s): Ahmed Nabih El Shazly, Doaa Refaey Soliman, Effat Hussien Assar, Eman Gamal Behiry, Ibrahim Abd El Naby Gad Ahmed
      Background Hypophosphatemia is one of the common disorders that develop in critically ill patients. It has potential complications and is often unrecognized in those patients. Objective Determining the incidence of hypophosphatemia in critically ill children, its association with clinical outcomes and the possible risk factors. Methods 50 patients were enrolled in the study. Levels of serum phosphate were measured on day 1 and day 7 of PICU (Pediatric intensive care unit) stay. The following variables were analyzed: age, gender, diagnosis on admission, malnutrition, phosphorus intake, clinical severity score on admission OFI (Organ Failure Index) and daily scores PELOD (Pediatric Logistic Organ Dysfunction), sepsis, use of dopamine, furosemide and steroids and assessment of nutrition by z scores. Results The incidence of hypophosphatemia on admission was 42%. On seventh day of admission incidence of hypophosphatemia was 62%. Malnutrition was present in 24% of patients, serum phosphorus level was significantly lower in malnourished than in well-nourished children (p value = 0.018). Hypophosphatemia was associated with prolonged PICU length of stay (p < 0.001) but was not associated with increased mortality (p = 0.13). Cases on parenteral nutrition and insufficient oral intake while on mechanical ventilator significantly showed hypophosphatemia (p = 0.017). Hypophosphatemia was associated with the use of furosemide, dopamine, steroids and β2 agonist. Conclusion Hypophosphatemia was common in the first 7 days of PICU hospitalization and was associated with prolonged PICU stay, Significant association between hypophosphatemia and duration of use of mechanical ventilation, use of furosemide, dopamine, steroids and β2 agonist.

      PubDate: 2017-08-09T17:13:03Z
      DOI: 10.1016/j.amsu.2017.07.079
  • Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly
           patient: A case report

    • Authors: Shuhei Ito; Takaaki Masuda; Noboru Harada; Ayumi Matsuyama; Motoharu Hamatake; Takashi Maeda; Shinichi Tsutsui; Hiroyuki Matsuda; Koshi Mimori; Teruyoshi Ishida
      Abstract: Publication date: Available online 29 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Shuhei Ito, Takaaki Masuda, Noboru Harada, Ayumi Matsuyama, Motoharu Hamatake, Takashi Maeda, Shinichi Tsutsui, Hiroyuki Matsuda, Koshi Mimori, Teruyoshi Ishida
      Introduction Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention. Presentation of case A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively. Discussion Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status. Conclusion Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail geriatric patients with severe conditions in the emergency setting.

      PubDate: 2017-07-31T16:53:12Z
      DOI: 10.1016/j.amsu.2017.07.058
  • WHO Safer Surgery checklist compliance amongst paediatric emergency
           plastic surgery patients in an UK hospital

    • Authors: Welmoed W. Keijzer; Riaz A. Agha; Aina Greig
      Abstract: Publication date: Available online 21 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Welmoed W. Keijzer, Riaz A. Agha, Aina Greig
      Introduction The WHO Safer Surgery checklist has become an important component of perioperative safety. Our objective, was to determine the compliance of completing the checklist for paediatric emergency plastic surgery patients at our unit. Methods An initial baseline was performed with 70 patients over two months at our unit. Following this, we raised awareness at an audit meeting and closed the audit loop using 80 patients over two months. The audit is reported in line with SQUIRE 2.0 criteria. Results Initial compliance was 88% overall and this increased to 91% post-intervention. Compliance with the individual stages in both cycles was for sign-in: 85%–86%, for time-out 92%–98% and for sign-out 86%–89%. Around one in four checklists were not scanned in both periods. Conclusion This audit showed a high overall level of compliance in the checklists that were scanned and available for scrutiny. We have identified the areas that most need improvement and suggest ways for doing so.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.049
  • Tissue expansion for breast reconstruction: Methods and techniques

    • Authors: Nicolò Bertozzi; Marianna Pesce; PierLuigi Santi; Edoardo Raposio
      Abstract: Publication date: Available online 21 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Nicolò Bertozzi, Marianna Pesce, PierLuigi Santi, Edoardo Raposio
      Objective In this work, the authors review recent data on the different methods and techniques of TE/implant-based reconstruction to determine the complication profiles and the advantages and disadvantages of the different techniques. This information will be valuable for surgeons performing breast reconstructions. Materials and methods A thorough literature review was conducted by the authors concerning the current strategy of tissue expander (TE)/implant-based breast reconstruction following breast cancer surgery. Results Loss of the breast can strongly affect a woman's personal and social life while breast reconstruction reduces the sense of mutilation felt by women after a mastectomy, and provides psychosocial as well as aesthetic benefits. TE/implant-based reconstruction is the most common breast reconstructive strategy, constituting almost 65% of all breast reconstructions in the US. Although numerous studies have been published on various aspects of alloplastic breast reconstructions, most studies are single-center observations. No evidence-based guidelines are available as yet. Conventional TE/implant-based reconstruction can be performed as a two-stage procedure either in the immediate or delayed setting. Moreover, the adjunctive use of acellular dermal matrix further broadened the alloplastic breast reconstruction indication and also enhanced aesthetic outcomes. Conclusions TE/implant-based reconstruction has proved to be a safe, cost-effective, and reliable technique that can be performed in women with various comorbidities. Short operative time, fast recovery, and absence of donor site morbidity are other advantages over autologous breast reconstruction.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.048
  • Attitudes of surgeons to the use of postoperative markers of the systemic
           inflammatory response following elective surgery

    • Authors: Ross D. Dolan; Stephen T. McSorley; Donald C. McMillan; Paul G. Horgan
      Abstract: Publication date: Available online 20 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Ross D. Dolan, Stephen T. McSorley, Donald C. McMillan, Paul G. Horgan
      Background Cancer is responsible for 7.6 million deaths worldwide and surgery is the primary modality of a curative outcome. Postoperative care is of considerable importance and it is against this backdrop that a questionnaire based study assessing the attitudes of surgeons to monitoring postoperative systemic inflammation was carried out. Method A Web based survey including 10 questions on the “attitudes of surgeons to the use of postoperative markers of the systemic inflammatory response following elective surgery” was distributed via email. Two cohorts were approached to participate in the survey. Cohort 1 consisted of 1092 surgeons on the “Association of Coloproctology of Great Britain and Ireland (ACPGBI)” membership list. Cohort 2 consisted of 270 surgeons who had published in this field in the past as identified by two recent reviews. A reminder email was sent out 21 days after the initial email in both cases and the survey was closed after 42 days in both cases. Result In total 29 surgeons (2.7%) from cohort 1 and 40 surgeons (14.8%) from cohort 2 responded to the survey. The majority of responders were from Europe (77%), were colorectal specialists (64%) and were consultants (84%) and worked in teaching hospitals (54%) and used minimally invasive techniques (87%). The majority of responders measured CRP routinely in the post-operative period (85%) and used CRP to guide their decision making (91%) and believed that CRP monitoring should be incorporated into postoperative guidelines (81%). Conclusion Although there was a limited response the majority of surgeons surveyed measure the systemic inflammatory response following elective surgery and use CRP measurements together with clinical findings to guide postoperative care. The present results provide a baseline against which future surveys can be compared.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.046
  • Breast reconstruction with anatomical implants: A review of indications
           and techniques based on current literature

    • Authors: Marco Gardani; Nicolò Bertozzi; Michele Pio Grieco; Marianna Pesce; Francesco Simonacci; PierLuigi Santi; Edoardo Raposio
      Abstract: Publication date: Available online 20 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Marco Gardani, Nicolò Bertozzi, Michele Pio Grieco, Marianna Pesce, Francesco Simonacci, PierLuigi Santi, Edoardo Raposio
      One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of “the ideal breast size”, although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.047
  • Solitary ulcer in cecum, mimicking a carcinoma: A case report

    • Authors: Mauricio González- Urquijo; Javier Rojas- Méndez; Lucas Octavio Tijerina Gomez
      Abstract: Publication date: Available online 19 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Mauricio González- Urquijo, Javier Rojas- Méndez, Lucas Octavio Tijerina Gomez
      Introduction Solitary ulcers in the colon are rare and infrequent; little over 200 cases have been reported in medical literature. We present a case of a patient presenting with a solitary colonic ulcer associated with NSAIDs intake, mimicking a malignant lesion. A review of the literature is also revised. Presentation of case 68- year-old female patient with past history of nonsteroidal anti-inflammatory drugs (NSAID) intake for chronic pain, complaining of severe abdominal pain was admitted to our teaching hospital. The diagnosis of a low-grade dysplasia was made with colonoscopy and biopsy, a malignant lesion could not be ruled out. A laparoscopy right colectomy was performed without complications. The final diagnosis resulted in a solitary cecal ulcer. Discussion The majority of the cases of solitary colonic ulcers occur in the ascending colon, at the cecum, which has been attributed mostly to the intake of NSAIDs. There could be solitary colonic ulcers in other portions of the large intestine, caused by different etiologies: ischemia, inflammatory disease, sterocoraceus ulcers, ulcers caused by infections, among other more uncommon causes. The diagnosis is often made through a biopsy of the tissue during a colonoscopy, with either surgical or conservative care. Conclusion The diagnosis of solitary cecal ulcer should be considered in patients presenting with RLQ abdominal pain and with history of NSAIDs consumption. Recognition of this diagnosis by surgeons, ruling out malignancies, understanding the morphologic features, and carefully taking the patient's history are essential for the diagnosis and treatment of this uncommon disease.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.041
  • Congenital and infantile malignant melanoma of the scalp: A review

    • Authors: Sohaib Tariq; Hussain Shallwani; Muhammad Waqas; Muhammad Ehsan Bari
      Abstract: Publication date: Available online 19 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Sohaib Tariq, Hussain Shallwani, Muhammad Waqas, Muhammad Ehsan Bari
      Congenital and infantile malignant melanomas are rare and typically carry poor prognosis. The purpose of this article was to review the data on congenital and infantile malignant melanomas of the scalp in order to understand its presentation, diagnosis, management, and outcomes of congenital melanoma of scalp. We searched PubMed, CINAHL and Cochrane databases. Ten cases of congenital and 3 cases of infantile malignant melanoma of scalp were identified. The diagnosis was confirmed by biopsy and histological analysis for confirmation. The prognosis depends on the origin of disease (congenital melanocytic nevus, transplacental metastasis, or de-novo), tumor thickness, the presence of ulceration and/or necrosis, and anatomic site (scalp lesions having poor prognosis). The most commonly used treatment of the reported cases of congenital and infantile melanoma was surgical excision of the primary lesion. Further modes of treatment may be extrapolated from the treatment of childhood and adult melanomas.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.042
  • Rapid onset of amiodarone induced pulmonary toxicity after lung lobe
           resection – A case report and review of recent literature

    • Authors: Heiko Baumann; Phillip Fichtenkamm; Thomas Schneider; Jürgen Biscoping; Michael Henrich
      Abstract: Publication date: Available online 19 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Heiko Baumann, Phillip Fichtenkamm, Thomas Schneider, Jürgen Biscoping, Michael Henrich
      Amiodarone-induced pulmonary toxicity (APT) is a severe side effect that can lead to lung fibrosis or fatal respiratory failure. Usually APT occurs during long term therapy after administration of prolonged loading doses or high cumulative doses. We present the case of a 58 year old woman who underwent thoracic surgery with lobe resection. She developed atrial fibrillation with hemodynamic-instability on the first post-operative day. We initiated amiodarone therapy and four days later she developed respiratory failure. The pulmonary function further deteriorated showing signs of an acute respiratory distress syndrome (ARDS). We therefore started mechanical ventilation, but still the gas exchange did not improve. A computer tomography-(CT)-scan presented bilateral interstitial and alveolar infiltrations. The patient also presented with leukocytosis, elevated C-reactive protein (CRP) levels however without elevated procalcitonin (PCT) concentrations. In the tracheal secretion we only harvested foam cells, but got no evidence for pathogens causing pneumonia. We immediately started glucocorticoid therapy with prednisolone 50 mg/d for five days. Almost instantaneously the gas exchange ameliorated. We were able to wean the patient from the respirator within five days. Pulmonary infiltrations were nearly vanished in a CT-scan few days later and completely disappeared in follow up examinations. This case demonstrates a per-acute onset of APT caused by a low loading dose in association with thoracic surgery. The initiation of glucocorticoid therapy in parallel to amiodarone withdrawal led to full recovery of the patient. One should consider APT when signs of pulmonary failure occur during brief periods of amiodarone therapy especially after thoracic surgery.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.034
  • Feasibility and safety of surgical wound remote follow-up by smart phone
           in appendectomy: A pilot study

    • Authors: Juan José Segura Sampedro; Inés Rivero Belenchón; Verónica Pino Díaz; María Cristina Rodríguez Sánchez; Felipe Pareja Ciuró; Javier Padillo Ruiz; Rosa María Jimenez-Rodriguez
      Abstract: Publication date: Available online 18 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Juan José Segura Sampedro, Inés Rivero Belenchón, Verónica Pino Díaz, María Cristina Rodríguez Sánchez, Felipe Pareja Ciuró, Javier Padillo Ruiz, Rosa María Jimenez-Rodriguez
      Introduction The objective of the present study is to assess the safety and feasibility of the use of telemedicine-based services for surgical wound care and to measure patient satisfaction with telemedicine-based follow-up. Material and methods 24 patients were included, they were provided with a corporate mail address. On day 7 after surgery patients sent, via email, an image of their surgical wound together with a completed questionnaire in order to obtain an early diagnosis. Two independent physicians studied this information and the histologic analysis of the specimen. On day 8, all patients underwent face-to-face office examination by a third physician and all of them completed a satisfaction questionnaire at the end of the study. Results The use of telemedicine-based services showed a sensitivity of 100%, a specificity of 91.6%, a positive predictive value of 75% and a negative predictive value of 100%. Degree of concordance between the two physicians, as regards the necessity of face-to-face follow-up yielded a kappa coefficient of 0.42 (standard error 0.25 and confidence interval 95% (0.92–0.08), which means a moderate agreement between the two evaluations. 94% of patients were satisfied with telemedicine-based follow-up and 93% showed their preference for this procedure over conventional methods. Conclusions The telemedicine-based follow-up, has proven to be feasible and safe for the evaluation of early postoperative complications. Patients reported high levels of satisfaction with the procedure. Telemedicine-based follow-up could become standard practice with the development of a specific mobile application.

      PubDate: 2017-07-24T16:33:46Z
      DOI: 10.1016/j.amsu.2017.07.040
  • An extensive swelling in the anterior mandible – A case report

    • Authors: Nikhil M. Kurien; L.K.Surej Kumar; Uma P. B; Vivek. V; Anna P. Joseph
      Abstract: Publication date: Available online 6 July 2017
      Source:Annals of Medicine and Surgery
      Author(s): Nikhil M. Kurien, L.K.Surej Kumar, Uma P. B, Vivek. V, Anna P. Joseph
      Introduction Glandular odontogenic cyst is a rare developmental odontogenic cyst, which often pose a challenge to diagnose it clinically. Presentation of a Case A 32 year old female patient was referred to the oral and maxillofacial surgery department with a chief complaint of a painless swelling in the anterior mandible, extending from mandibular left premolar to right first molar region, with fluctuancy and egg shell crackling at right premolar region. The associated teeth were firm. Radio graphically a large radiolucent lesion was seen extending from mandibular left premolar to right first molar region. Discussion We had many differential diagnoses including keratocystic odontogenic tumour, ameloblastoma and radicular cyst. Incisional biopsy was taken from the most fluctuant area, which was histopathologically suggestive of glandular odontogenic cyst. Enucleation of the cyst, peripheral ostectomy, extraction of teeth and Carnoy's solution application were done under general anaesthesia. Conclusion We often neglect to include uncommon lesions in the differential diagnosis, which may lead to inadequacy in the management protocol. Whenever possible, incisional biopsy should be performed to confirm the lesion before surgical enucleation. Here we present a case in which we were fortunate enough to diagnose the lesion by an incisional biopsy and managed according to the standard protocol.

      PubDate: 2017-07-13T16:01:46Z
      DOI: 10.1016/j.amsu.2017.07.017
  • Maxillary artery based flaps for oral cavity reconstruction, a review

    • Authors: Amin Rahpeyma; Saeedeh Khajehahmadi
      Abstract: Publication date: Available online 20 June 2017
      Source:Annals of Medicine and Surgery
      Author(s): Amin Rahpeyma, Saeedeh Khajehahmadi
      Background There are different flaps based on the branches of the maxillary artery. Flaps based on the maxillary artery branches can be used for oral cavity reconstruction in selected cases, but there is lack of comprehensive review in this topic. Methods A literature review was performed on Medline for maxillary artery based flaps and oral cavity reconstruction. Surgical techniques for each possible variant of maxillary artery based flaps and an example of each situation for oral cavity reconstruction is explained. Result Five variants of soft tissue flaps based on maxillary artery branches are presented. Some of them such as temporal flap, superiorly based masseter flap, palatal flap and posteriorly based buccinator myomucosal flap are famous flaps, while posteriorly based inferior turbinate flap is less noticed for oral cavity reconstruction. Nasoseptal and infraorbital based flaps are two other maxillary artery based flaps but have no role in oral cavity reconstruction. Conclusion Maxillary artery based flaps should be considered as an option especially in previously radiotherapy/surgically operated patients with facial vessels sacrifice.

      PubDate: 2017-06-22T15:05:13Z
      DOI: 10.1016/j.amsu.2017.06.024
  • Diagnostic approaches and treatment of eosinophilic esophagitis. A review

    • Authors: Hossein Akhondi
      Abstract: Publication date: Available online 16 June 2017
      Source:Annals of Medicine and Surgery
      Author(s): Hossein Akhondi
      Eosinophilic Esophagitis (EoE) is a condition that involves eosinophilic influx into the esophageal epithelium. It affects both children and adults; Adults present with dysphagia whereas children with vague abdominal complaints. The clinical symptoms as well as pathologic features of EoE and gastro esophageal reflux disease (GERD) are similar. Since eosinophilia in the esophagus is a non-specific finding, the clinical presentation in conjunction with endoscopic findings and pathology, is crucial in determining a differential diagnosis. Infections such as parasites, allergic phenomenon, Crohn's disease, malignancies, medication, and chemotherapy are all associated with eosinophilia. A primary endoscopic difference to note between EoE and GERD is that EoE often involves long segments of the esophagus, could be patchy or focal and frequently involves the proximal esophagus. GERD, however, typically involves the distal much more frequently than the proximal esophagus. Because of the similarity between them, GERD should be excluded by using high dose proton pump inhibitor (PPI) treatment or through evidence of a normal pH by esophageal testing, prior to treatment with an elimination diet or steroids. Until further research establishes different diagnostic tests and criteria, clinical and pathological response to therapy is considered to be the absolute confirmation of this diagnosis. The following is a more detailed discussion of this entity.

      PubDate: 2017-06-17T14:50:35Z
      DOI: 10.1016/j.amsu.2017.06.022
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