International Surgery Journal

Effect of prehabilitation on outcomes following upper gastrointestinal surgery: a systematic review and meta-analysis

2024-07-31T05:26:34+0530

It is accepted in several areas of surgery that prehabilitation can improve post-operative outcomes. Prehabilitation describes preoperative interventions aimed at optimizing patient condition prior to surgery to improve postoperative outcomes. It is hypothesized that prehabilitation reduces postoperative complications in the setting of upper gastrointestinal surgery. A systematic search strategy was performed based on a research question formulated with reference to the PICO framework. Eligible studies were those that included a predefined prehabilitation intervention, a comparison to usual care and conducted on patients undergoing upper gastrointestinal surgery. Included studies were evaluated for bias and underwent data extraction. Meta-analysis was also performed for outcomes where possible. Eight studies met criteria for inclusion in this review. The nature and length of prehabilitation programs varied widely, with interventions lasting from two to six weeks. Reported outcomes included post-operative pulmonary complications, mortality and length of hospital stay. A meta-analysis was undertaken for mortality and postoperative pulmonary complications. Meta-analysis showed postoperative pulmonary complications were reduced (RR0.68, 95% CI 0.50-0.93) in the intervention group compared to the control group, as was mortality (RR 0.59, 95% CI 0.35-1.00). Prehabilitation, especially inspiratory muscle training appears to be effective in reducing pulmonary complications in patients scheduled for upper gastrointestinal surgery. With the available data it is uncertain if this translates to reduced length of stay or mortality. There is scope for further research to better define a role for prehabilitation in upper gastrointestinal surgery, specifically the optimal prehabilitation modality and length.

Outcome of total hip arthroplasty versus hip hemiarthroplasty for femoral neck fractures in the elderly: a meta-analysis of randomized control trial

2024-10-12T08:09:19+0530

Background: Roughly 50% of all hip fractures are femoral neck fractures, these fractures are subtype of intracapsular hip fractures. Elderly patient's femoral neck fracture is typically the consequence of a straightforward fall from standing height with low energy. Total hip arthroplasty (THA) versus hip hemiarthroplasty (HHA) is a topic of controversy that sparked discussions over half century ago, between these two types technique have own advantages and disadvantages.

Methods: A comprehensive search conducted across major electronic databases for relevant studies published from 2014-2024. Studies THA with HA for elderly patients with femoral neck fractures were included. Data regarding study characteristics, surgical techniques, outcomes, and garden classification were extracted and analyzed using appropriate statistical methods. Our primary outcomes were surgical duration, functional outcome and complications.

Results: The initial search yielded total 825 studies, which 7 studies met the inclusion criteria, consisting of total 747 patients THA and HA for elderly patients with femoral neck fractures. THA had longer surgery duration compared with HA (MD=32.48, 95% CI:5.13 to 59.83, p=0.02). THA showed better ratings Harris hip score (HHS) during a year follow-up periods (MD=2.31, 95 CI:0.42 to 4.21, p=0.02). There was no significant difference in complications.

Conclusions: THA advantageous over hemiarthroplasty in the terms of HHS but HA favoured in surgical duration. Ultimately, only large well-conducted studies will result in improvements in the outcomes of treatment and resolve the longstanding controversy of whether THA or HA is the preferred treatment modality for femoral neck fracture in elderly.

A year of public laparoscopic sleeve gastrectomy

2024-09-07T08:17:25+0530

Bariatric surgery is becoming increasingly prominent in Australia, however over 90% is still performed in the private sector. We examined the outcomes of the first year of our publicly funded bariatric surgery program, which includes regular review in a metabolic clinic by an Endocrinologist and Allied Health. The characteristics and outcomes of 22 consecutive patients who underwent publicly funded Laparoscopic Sleeve Gastrectomy with a single surgeon at a South-West Sydney public hospital between March 2023 and May 2024 were retrospectively collected. Data on patient characteristics, operative details and post-operative outcomes was collected and analysed. The majority of patients were women (77%), with a mean age of 48±10.6. Mean initial weight at program commencement was 136.7±25.7 kg, and mean BMI 49±6 kg/m2. All patients had >2 obesity related comorbidities; 45% were diabetic. There were no complications or re-admissions. At 6 months post-op, mean weight loss from baseline weight was 34.3±17 kg, with mean TBWL 24.8% ± 9.6% and EBWL 52%±17.7%. For patients with 12 month follow up data, mean weight loss was 46.6 kg±27.9, with mean TBWL of 33%±14% and EBWL of 68 %±23%. Our first year of public Laparoscopic Sleeve Gastrectomy, in conjunction with a comprehensive metabolic program, has been shown to be safe and effective, with preliminary data demonstrating outcomes equivalent to those previously published.

Utilization of osteopathic manipulation treatment in healing of pressure ulcers

2024-09-07T17:22:21+0530

Pressure ulcers (PUs), caused by prolonged pressure on the skin and tissue, affect millions annually in the US, resulting in significant emotional and financial burdens for patients. The healthcare system bears a substantial cost burden annually, primarily due to stage 3 and 4 ulcers. Through noninvasive techniques, osteopathic manipulative treatment (OMT) targets lymphatic system dysfunction and homeostasis to expedite patient recovery, with documented applications in conditions such as low back pain, pneumonia, and lower extremity wounds by optimizing lymphatic flow. However, the potential of OMT in managing PUs still needs to be thoroughly explored. This pilot study involved lymphatic OMT performed three times a week on patients admitted with community-or healthcare-acquired sacral PUs present for at least one week. Ulcer growth rates were calculated based on volume at baseline and in the third week following the first manipulation. Each patient was provided descriptive comparisons of albumin levels, body mass index (BMI), and demographic data, including age, sex, and race. At week three, following the initiation of treatment, decreased ulcer volume based on growth rate was observed in 75% of patients in our OMT group compared to 25% of patients in our control group. Our OMT pilot study suggests that adding OMT to standard therapy is safe and feasible, and it may accelerate the healing rate of sacral PUs while decreasing the cost burden on the healthcare system.

Comparison of quality of life and sexual function before and after anterior urethral reconstruction surgery

2024-10-24T22:31:03+0530

The study assessed the impact of anterior urethral reconstruction surgery on quality of life and sexual function in 22 male patients with anterior urethral strictures. The mean age was 51 years (range: 25–88), and strictures were localized in the bulbar urethra, penile urethra, or both, with an average stricture length of 4.2 cm. Etiologies included trauma, iatrogenic causes, infections, and idiopathic factors. Surgical techniques included end-to-end urethroplasty, dorsal onlay oral mucosa graft urethroplasty, and combined dorsal graft with ventral augmentation. Significant postoperative improvements were noted in urinary symptoms, with IPSS scores reducing from severe to mild in all patients (p<0.001) and Qmax increasing from a mean of 3.23 ml/s to 19.46 ml/s (p<0.001). Preoperative quality of life, evaluated using EQ-5D and EQ-VAS, showed significant enhancement, with EQ-VAS scores improving from 38.77 to 77.05 (p<0.001). Sexual function, assessed via IIEF-5, remained stable, with no significant postoperative decline (p=0.463), highlighting the preservation of erectile function. USS-PROM evaluations revealed a substantial reduction in symptom severity and improved patient satisfaction. The findings demonstrate that anterior urethral reconstruction effectively restores urinary function and improves quality of life without compromising sexual health, establishing it as a safe and reliable treatment for anterior urethral strictures.

Unusual neck swellings: a case series of a new Pandora’s box

2024-10-17T16:42:23+0530

The neck is an important region in the body containing the greatest number of vital structures traversing it. The variety of structures also means that many varied neck masses may present in this region. We described a series of eight such cases of large and rare neck swellings. These include cystic swellings, benign tumours as well as malignant secondary nodal metastasis. We also describe for the first time a rare case of a large air pocket in the neck. Thus, this series serves to highlight the amazing capability of the neck to throw up a wide range of complex and rare swellings - earning its name as a new Pandora’s box.

An update on incisional hernias

2024-10-26T23:17:07+0530

After abdominal surgery, incisional hernias are a common occurrence that may occur, and the frequency of these hernias may vary considerably depending on a number of different circumstances. This article presents a comprehensive analysis of the characteristics of incisional hernias, including their occurrence, causes, potential complications, and treatment options. Therefore, it is essential for healthcare providers to have a comprehensive understanding of these aspects in order to provide effective treatment and reduce the negative effects of this condition on patients.

A primary umbilical endometrioma in a 38-year-old woman: a case report

2024-09-08T22:52:49+0530

Primary umbilical endometriosis (UE) is a rare case of migration of endometrial tissue to a distant location. However, there are literature gaps surrounding this area of study and may be easily missed when forming differential diagnoses for umbilical masses. We report a case of primary UE in the setting of abdominal pain and umbilical mass. The patient is a 38-year-old female who was admitted for abdominal pain and an umbilical mass. An umbilical mass without evidence of an umbilical hernia was found on computed tomography of the abdomen and pelvis. The differential diagnosis of umbilical hernia was then introduced. Exploration and surgical excision were utilized. Pathologic frozen sections confirmed endometrioma. Both medical and surgical therapies may be used in treating UE. This case highlights the need for awareness of rare endometriosis manifestations and illustrates the diagnostic challenges when assessing for possible causes of umbilical mass. By adequately evaluating for causes such as UE, we can accurately treat it with medical and surgical therapies.

Gastrointestinal granular cell tumour, endometriosis and appendiceal intussusception-a unique report

2024-10-02T17:27:30+0530

Granular cell tumours (GCT) are uncommon, typically benign growths that can appear in various parts of the body, though they most frequently manifest in the oral cavity. The overall frequency of GCT in surgical samples is under 0.05%. Between 5% and 11% of GCT cases are found within the gastrointestinal system, with the oesophagus, colon, and stomach being the most commonly affected sites. This article presents a rare case of appendiceal intussusception caused by an endometriosis nodule, which led to the discovery of a granular cell tumour in the surgical specimen.

Midgut volvulus secondary to congenital malrotation in an adult with Ladd’s band: a case report

2024-09-24T00:22:27+0530

Adult midgut volvulus is a rare surgical disease, with an estimated incidence of less than 0.15%, and more common in Asia and Africa as compared to Europe and the US. It is a developmental anomaly characterized by failure to complete normal fetal rotation of the midgut around the Superior Mesenteric Artery (SMA) inside the peritoneal cavity. Though rare, adult midgut volvulus has the potential for bowel ischemia-related complications, and thus clinicians should have a reasonable index of suspicion to diagnose this. Early computed tomography (CT) scan with diagnostic accuracy of more than 83% would help in early recognition and management of these rare causes of intestinal obstruction. In this study, we reported the case of an adult primary midgut volvulus in a 30-year-old male who presented with features of acute bowel obstruction with a history of similar recurrent episodes and renal transplant. Diagnosis of midgut volvulus was made based on contrast-enhanced CT findings, and Ladd’s procedure was performed.

Diaphragmatic morgagni in adult: a case report

2024-09-30T15:20:43+0530

A 70-year-old male patient with a history of systemic hypertension, gouty arthritis, and possible chronic kidney disease presented with right flank pain, nausea, and decreased appetite. Examinations revealed a right-sided incarcerated diaphragmatic hernia in the anterior region, with protrusion of adipose tissue and loops of small intestine. A laparoscopic surgery was performed, during which the herniated contents were reduced, and a hernia defect approximately 4 cm in size was found and repaired. Post-surgery, he developed complications including pulmonary thromboembolism, intestinal perforation, and fistula, which required reoperation, and progressive clinical deterioration, ultimately leading to death. This case report presents a rare instance of congenital hernia diagnosed through imaging after the onset of nonspecific clinical symptoms. It emphasizes the importance of considering this pathology among differential diagnoses of acute abdomen for prompt diagnosis and appropriate management through surgical intervention.

Reverse total shoulder arthroplasty with allograft bone block augmentation following proximal humerus sarcoma resection: a novel technique and case report of two patients

2024-10-19T22:32:40+0530

There are several options for endoprosthetic replacement of the proximal humerus following oncologic resections. Reverse total shoulder arthroplasty (RTSA) has gained popularity in recent years for reconstruction, and bone allograft can be used to restore bone stock and improve implant survival. Patient A (67 years female) and patient B (62 years female) with sarcoma of the proximal humerus underwent tumor resection with wide margins and reconstruction with cemented reverse total shoulder arthroplasty. The construct was augmented with allograft bone blocks to decrease burden of osteotomy length and bone defect and improve prosthesis coverage and stability. RTSA with bone block augmentation is functionally stable and effective following massive tumor resection. Controversy still exists on the ideal construction method and more research is needed for assessment of outcomes and appropriate patient selection.

Laparoscopic management of necrotizing granulomatous appendicitis: a diagnostic challenge

2024-10-22T13:40:29+0530

We present a case report of necrotizing granulomatous appendicitis, a rare condition that poses significant diagnostic challenges due to its atypical presentation, often mimicking more common conditions like acute appendicitis or inflammatory bowel disease. A 29-year-old female was admitted with a one-month history of abdominal pain, diarrhea, vomiting, and recent urinary symptoms. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and anemia. A CT scan indicated an inflamed appendix, prompting a laparoscopic appendectomy. Intraoperatively, findings raised the suspicion of inflammatory bowel disease; however, histopathological analysis confirmed necrotizing granulomatous appendicitis. Further microbiological testing excluded bacterial and fungal infections, while the IGRA test was positive for tuberculosis. This case emphasizes the dual role of laparoscopic surgery in both diagnosing and treating necrotizing granulomatous appendicitis. It highlights the importance of considering rare etiologies, such as tuberculosis, especially in patients presenting with atypical symptoms. Early recognition and appropriate management are crucial for improving patient outcomes.

From rare anomaly to clinical reality; managing venous thrombosis in the setting of congenital inferior vena cava agenesis

2024-10-23T01:40:24+0530

A congenital absence of the inferior vena cava (IVC) is a rare anomaly known to be linked with idiopathic deep venous thrombosis (DVT). This anomaly is more commonly observed in individuals with other congenital cardiac anomalies, with an incidence ranging from 0.6% to 2%. Here we are reporting a rare case of missing IVC presented with extensive bilateral lower extremity and iliac veins DVT. The symptoms responded well to therapeutic doses of heparin. In this article, we will review some other cases of IVC agenesis and different management including medical, interventional, and surgical approaches.

Isolated expressive aphasia caused by acute subdural hematoma: case report and literature review

2024-10-25T23:29:05+0530

The occurrence of aphasia as an isolated and dominant clinical feature of acute subdural hematoma (aSDH) has been rarely mentioned in the available literature. Being the most common focal intracranial lesion, subdural hematomas (SDH) pose a clinical challenge, especially when presented with unorthodox clinical features. We report a case of a patient with a traumatic aSDH, presenting with intense frontal headaches and normal neurological examination. On the 3rd postadmission day, he developed expressive dysphasia which progressed to aphasia, with neurological examination findings of an upper motor neuron lesion (UMNL), without hematoma expansion, verified via head CT (computed tomography). The patient underwent decompressive craniotomy and hematoma evacuation. Early speech improvements were noted immediately postoperatively, and at hospital discharge the patient had no evident clinical features of speech disorder and neurological deficits or tests suggesting UMNL. Speech disorders in the setting of an aSDH need to be further investigated and potentially considered as an indication for surgical management, especially in rare instances where they present as an isolated clinical feature and conservative treatment is initially considered.

A rare and fortunate case of unruptured splenic peliosis – case report and literature review

2024-11-13T01:34:45+0530

Splenic peliosis is an extremely rare pathological entity of unclear etiology characterized by the presence of multiple blood-filled cavities. Although numerous associations have been described in the literature, the etiology remains unclear. The present case is about a healthy 40-year-old woman who was referred to our institution due to chronic symptoms of abdominal discomfort and constipation. Despite the abdominal computed tomography (CT) scan and abdominal magnetic resonance imaging (MRI) reported an adrenal mass, reviewing the scans, the radiologist suggested a 17,5 cm, well-vascularized splenic mass. A splenectomy was performed, without any complications. We discuss the current available literature and emphasize the importance of awareness of this diagnosis.

Traumatic rupture of duodenal diverticulum-clinical case in catastrophe setting

2024-09-30T00:31:10+0530

Duodenal diverticula are anatomical outpouchings of the gastrointestinal tract, with a prevalence of up to 27% in individuals over 50 years old. While often asymptomatic, complications such as diverticulitis, obstruction, and perforation can occur. Traumatic rupture of a duodenal diverticulum is extremely rare, with only a few cases documented in the literature. We report the case of a 64-year-old female involved in a major traffic accident with multiple injuries. Initially stable, she later developed abdominal tenderness and hypotension, prompting a CT scan that revealed pneumoperitoneum without significant hemoperitoneum. Surgical exploration revealed a ruptured duodenal diverticulum, which was treated with diverticulectomy and omentoplasty. Blunt abdominal trauma typically affects the liver, spleen, and retroperitoneal organs, while isolated duodenal injuries remain rare. Mechanisms for duodenal rupture, particularly in the context of seatbelt use, include sudden intra-abdominal pressure increases during deceleration. Imaging, particularly CT, plays a crucial role in the early detection of such injuries, although resource limitations during mass casualty events may delay its use. Surgical management remains the definitive treatment, and early intervention is essential in unstable patients. Traumatic rupture of a duodenal diverticulum is an uncommon yet life-threatening event. Early suspicion, timely imaging, and surgical intervention are key to successful outcomes. Continuous reassessment is crucial, as trauma-related injuries may present later in the clinical course.

Biochemically silent normotensive colossal pheochromocytoma

2024-10-16T23:49:21+0530

A case presentation about rare giant pheochromocytoma of about a 50 year old female patient came to our out-patient department of general surgery with epigastric and right flank discomfort for past 1 day, abdominal distension and constipation for past 6 months. Patient’s blood pressure was normal without any postural variations and with no features of androgenic excess. All routine investigations were normal. Biochemical profile of urinary [VMA, metanephrine and normetanephrine], serum [cortisol, metanephrine, normetanephrine], serum aldosterone and plasma renin activity are measured normal. Contrast enhanced CT abdomen done suggestive of large well defined heterogeneously enhancing soft tissue lesion of size 21×22×28 cm noted involving abdominal cavity more on right side arising from right lumbar region was identified. Patient underwent exploratory laparotomy and identified that mass was arising from right adrenal gland and right kidney which was difficult to be dissected from the mass, for which right nephrectomy was also done along with mass removal of size 28×28×20 cm and weight of 4200 gm. Postoperative period was uneventful. Histopathological examination showed gross feature of single large encapsulated globular structure with right kidney attached to it. Mass was encapsulated with total size of 24×25×14 cm, greyish in colour and soft to firm in consistency. On cut section focal areas of greyish yellow friable tissue with few small cystic areas, large hemorrhagic area and focal greyish white areas was seen. Microscopic feature of these tumor cells was arranged in well defined nests (zellballen) bound by highly vascularized stroma. Cells were polygonal shaped with finely granular amphophilic cytoplasam, round to oval nuclei with salt and pepper chromatin and at places prominent nucleoli were seen. Special staining with PAS done and it was negative.

Laparoscopic management of colo-colonic intussusception, an uncommon cause of acute intestinal obstruction in adult: a case report

2024-09-11T18:00:32+0530

Colo-colonic intussusception is an uncommon cause of acute intestinal obstruction in adults. Traditionally open surgical methods were chosen as the primary form of treatment; however, few recent reports of successful treatment have been achieved with laparoscopic approach. We report a 44-year-old lady, who presented to accident and emergency department of our hospital with features of acute intestinal obstruction for two days. Ultrasonography and Contrast-enhanced computed tomography (CECT) of abdomen revealed colo-colonic intussusception. After resuscitation and optimization, patient underwent diagnostic laparoscopy which confirmed colo-colonic intussusception involving splenic flexure and proximal descending colon. Laparoscopic classical left hemicolectomy with stapled side to side colo-colonic anastomosis was done. Post-operative course was uneventful. Histopathology report confirmed presence of intraluminal hyper plastic polyp as lead point.

A rare case report on solitary pigmented neurofibroma over scalp region

2024-09-16T22:46:54+0530

Neurofibromas are benign proliferations that are made up of all nerve elements, and arise as fleshy and nontender, sessile or pedunculated masses on the skin. Pigmented (or melanocytic) neurofibroma constitutes only 1% of cases and is considered a rare variant of neurofibroma containing melanin-producing cells. Our patient has solitary pigmented neurofibroma over scalp region which is very rare and only few cases were reported. Here we present a case of 25 year old female patient who had brown colored swelling since birth over left temporo-parietal region which gradually increased in size with age. Patient had no any other swelling or pigmentation over any other regions of body. Patient underwent excision for the same with skin grafting. Her recovery was uneventful.

A case of a colo-colic intussusception secondary to adenocarcinoma of the sigmoid colon

2024-09-17T11:51:41+0530

When a more proximal section of the bowel (intussusceptum) invaginates into the more distal bowel (intussuscipiens), it results in intussusception. Changes in intestinal peristalsis at the intraluminal lesion, which serves as a lead point for the intussusceptum, is assumed to be the mechanism. Adult cases of intestinal intussusception are uncommon; they make up about 1% of all bowel obstructions. We describe a case of a colo-colic intussusception caused by an adenocarcinoma of the sigmoid colon. The most frequent urgent condition in children is intussusception, although it is extremely uncommon in adults. It is challenging to make the diagnosis based only on the history and physical exam results. Since a malignant pathology typically serves as a lead point in adulthood, as opposed to childhood, treatment of this pathology still raises questions. Accurately identifying and comprehending relevant symptoms, signs, and imaging results is crucial for an adult intussusception's early diagnosis and proper treatment. It's not always obvious how to treat adult intussusception appropriately. Regarding the reduction prior to resection in sigmoido rectal intussusception cases, there is disagreement. A useful diagnostic marker of colorectal intussusception in bowel-within-bowel configuration cases is the target-like sign on CT images, which shows the bowel's layers duplicated to form concentric rings. Quick and precise diagnosis will be facilitated by a high index of suspicion combined with radiological investigation. A high degree of suspicion of a malignant etiology is important in cases of adult intussusception.

Symptomatic left diaphragmatic eventration in a 64-year-old male: a case report and review of management

2024-09-27T17:18:44+0530

Eventration of diaphragm, particularly in adults, are rare and often underdiagnosed, especially when symptomatic. This report presents a case of a 64-year-old male with a symptomatic left sided significant Eventration of Diaphragm, characterized by two months of left upper abdominal pain and exertional dyspnea. The patient's history included an open cholecystectomy performed three to four years prior. Radiological investigations revealed significant eventration of abdominal contents into the left thorax with a contralateral mediastinal shift. The patient underwent surgical intervention through a left subcostal incision extending 2 cm to the right of midline, where the herniated contents were reduced, and the diaphragm was plicated. Post-operative management was successful, with the patient being discharged on the fifth postoperative day. This case emphasizes the importance of timely diagnosis and surgical management of diaphragmatic hernias in symptomatic adults.

A case of sigmoid colon carcinoma presenting as pyrexia of unknown origin

2024-09-29T18:04:52+0530

Pyrexia of unknown origin (PUO) is a diagnostic challenge with a variety of causative factors, one of which is malignancy. This report throws light on sigmoid colon carcinoma, one of the lesser understood causes of pyrexia of unknown origin, where unremitting fever was the presenting symptom. Exclusion of common infectious causes of fever with thorough diagnostic work up lead to a diagnosis of adenocarcinoma of sigmoid colon. Fever subsided completely in the postoperative course.

Ileosigmoid knotting: a rare and life threatening case of acute bowel obstruction

2024-10-02T19:42:36+0530

Ileosigmoid knotting is a rare cause of acute intestinal obstruction, and is also known as compound volvulus or double volvulus. It occurs due to wrapping of the ileum or sigmoid colon around the base of the other, causing bowel obstruction. The bowel obstruction rapidly progresses to gangrene of the ileum as well as the sigmoid colon, generalized peritonitis and septic shock. It is a potentially lethal condition with high morbidity and mortality rates. The incidence of ileosigmoid knotting is rare and usually seen in areas where there is a high incidence of the sigmoid volvulus with male preponderance. The primary risk factor for ileosigmoid knotting is a long small bowel mesentery with a freely mobile small bowel and a redundant sigmoid colon on a narrow mesentery. We present the case of a 79-year-old male patient who presented with an acute abdomen at our emergency with signs of peritonism. Emergent surgical exploration was done given acute intestinal obstruction and peritonitis. Intra-operatively, ileosigmoid knotting was present with gangrenous ileum and sigmoid colon. Resection of gangrenous bowel was performed with end ileostomy and Hartmann's procedure for descending colon in view of haemodynamic instability.

Xanthogranulomatous cholecystitis infiltrating anterior abdominal wall: a rare case report

2024-10-03T07:51:28+0530

Xanthogranulomatous cholecystitis (XGC) is a benign chronic inflammatory disease of the gallbladder often presenting as features of chronic cholecystitis. The disease closely mimics gallbladder carcinoma (GBC) and distinguishing XGC from gallbladder cancer preoperatively is very challenging. Biochemical or radiological investigations cannot differentiate XGC from GBC and they share overlapping symptoms. Reporting here is a 31 year old female patient who presented with features of failed attempt of cholecystectomy due to suspected carcinoma gallbladder at an outside hospital. Even CECT abdomen showed gallbladder mass with hepatic and anterior abdominal wall infiltration. Intraoperatively, there was a mass in the gallbladder with large calculi and extending into the adjacent liver, anterior abdominal wall and part of hepatic flexure of colon. Radical cholecystectomy with en block excision of anterior abdominal wall and part of hepatic flexure of colon was done. Frozen section and final histopathological reports confirmed the diagnosis of XGC.

A case report of perforated gall bladder in an adolescent female: a diagnostic dilemma successfully managed by laparoscopy

2024-10-04T13:08:31+0530

Gall bladder perforations are rare and usually seen in elderly age group having comorbidities like diabetes and are associated with severe morbidity and mortality. Gall bladder perforation is much rarer in younger patients and thus leads to diagnostic dilemma. These cases generally require exploratory laparotomy and are associated with high incidences of SSI. With advent of minimal invasive procedure laparoscopic cholecystectomy is an option for management with prompt and accurate diagnosis. We present a case of 19-year-old female with anaemia having severe pain in abdomen and fever at presentation. She was diagnosed as gall bladder perforation on ultrasound which was confirmed by CECT Abdomen. Patient was managed by laparoscopic subtotal cholecystectomy with uneventful post-operative period. Gall bladder perforations are rarely seen in young adults posing diagnostic dilemma. Delay in diagnosis can lead to increased morbidity and mortality. In patients of cholecystitis with non-resolving fever and peritonitis generalised or localised should raise a high suspicion of perforation and should be promptly diagnosed with CECT Abdomen. Although conventionally exploratory laparotomy is done for gall bladder perforation with peritonitis, diagnostic laparoscopy with cholecystectomy is a feasible option in selected patients. In young adults with non-resolving acute abdomen with calculous cholecystitis high degree of suspicion of Gall Bladder perforation should be kept. Laparoscopic cholecystectomy is a feasible option with minimal morbidity and higher cosmesis in young adults.

Isolated advanced chest wall recurrence with a rectified reconstruction

2024-10-05T14:59:45+0530

In developed nations, breast cancer stands as the primary cause of cancer-related death among females. Local recurrence is often considered an initial sign of treatment ineffectiveness, occurring on the chest wall, axilla, or ipsilateral breast post Breast-Conserving Surgery (BCS). Local recurrence is observed in approximately 30% of patients with locally advanced breast cancer. A 58-year-old postmenopausal woman, who is a known case of triple negative breast cancer presented to us with an ulcerative lesion over left chest wall. In the past, she underwent neoadjuvant chemotherapy followed by left MRM and received adjuvant chemotherapy for left breast carcinoma. The staging of her previous disease is yT2N1aM0. Now presenting as locally advanced recurrent infiltrating lesion in the anterior wall of pericardium with sternal erosion of size 7.7×9.7×15 cms. Isolated chest wall recurrences of breast cancer can be surgically treated with chest wall resection, sternal resection, and reconstruction, providing a good quality of life and disease-free survival. Titanium mesh, gaining recent popularity as a reliable and promising bone replacement, was utilized in this case.

Laparoscopic cholecystectomy in an unsuspected left sided gallbladder: a rare case report with review of literature

2024-10-06T18:31:36+0530

Left sided gallbladder (LSG) is a very rare clinical entity and most are diagnosed at operation. The patients usually present with features of biliary colic or pain in the right upper abdomen similar to normally positioned gallbladder. Ultrasonography is not a good diagnostic modality for diagnosing LSG and CT scan is better for the pre-operative diagnosis of the condition. Laparoscopic cholecystectomy can be done in patients with LSG and antegrade or fundus first technique is usually advocated.

Cervical cystic lymphangioma in an adult: a rare entity

2024-10-09T19:09:35+0530

Lymphangiomas are benign malformations of the lymphatic system, commonly arising from sequestered lymphatic vessels. While typically found in infancy or childhood, their occurrence in adults is rare. This case details a 44-year-old female with a progressively enlarging, painless neck mass. Imaging revealed a cystic lesion near major neck vessels. Fine-needle aspiration cytology initially suggested lymphocele, while ultrasonography and computed tomography angiography provided differential diagnoses, including lymphangioma. Surgical excision of the mass and histopathological examination confirmed the diagnosis of cavernous lymphangioma. Although benign, lymphangiomas can cause complications through invasion of surrounding structures, leading to mass effects or secondary infections. Definitive management is surgical excision, but thorough imaging and differential diagnosis are critical to ruling out other potential conditions, especially given the rarity of lymphangiomas in adulthood.

Optimizing surgical outcomes in recurrent plunging ranula: a case report

2024-10-11T17:59:21+0530

A plunging ranula is the extravasation of saliva from the sublingual gland due to trauma or ductal obstruction. The saliva tracks through fascial planes into the submandibular space. While typically originating from the sublingual gland, it rarely involves the submandibular gland. Two types are recognized: simple oral ranula and plunging ranula. Various treatment approaches exist, particularly for preventing recurrence in the plunging type. This case report presents the clinical and radiological findings along with our surgical management of a recurrent plunging ranula using a combined intraoral and extraoral approach with dual salivary gland excision utilising intraoperative ultrasonography to ensure complete excision and prevent recurrence. We present the case of a 16-year-old female with recurrent plunging ranula following incomplete excision of a sublingual ranula in the past. Initially asymptomatic after the first surgery, the patient later developed swelling in the mouth floor and neck. The recurrence was managed using a combined intraoral and extraoral approach for complete excision of the sublingual and submandibular glands, along with the cervical extension of the ranula, guided by intraoperative ultrasonography. Postoperatively, the patient showed no signs of recurrence during follow-up, with complete resolution of symptoms. The combined approach ensured thorough removal of mucus-secreting glands and cystic components, preventing recurrence. The optimal treatment for a plunging ranula involves excision of the lesion and the involved gland. Intraoperative ultrasonography aids in ensuring complete excision of all cystic components, reducing recurrence risk.

Molecular heterogeneity of clinically diverse cases of follicular thyroid carcinoma in next-generation sequencing: case report

2024-10-18T12:25:42+0530

Thyroid cancer is the most common endocrine malignancy worldwide, with rising incidence. Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer, accounting for 10% of thyroid cancer cases. FTC encompasses three different subtypes, with divergent clinical behavior. The encapsulated angioinvasive and minimally invasive subtypes have favorable outcomes. Whereas, the widely invasive subtype is associated with higher rates of hematogenous spread, refractoriness to radioactive iodine therapy and higher mortality rates. A better understanding of tumor biology can pave the way for targeted treatment strategies, optimizing the therapeutic outcome. To date, the molecular landscape of FTC is less well-characterized and poorly understood. Moreover, the clinical significance of the molecular characteristics of FTC remains elusive. Hence, we investigated genomic and transcriptomic profile of FTC using Next-Generation Sequencing in two patients with diverse clinical courses. This case report uncovered the molecular signatures, potentially unique to each patient, which may have clinical implications for risk stratification and personalized treatment strategies.

A 10-year retrospective study on primary and recurrent hidradenitis suppurativa

2024-09-23T21:02:43+0530

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by follicular occlusion and apocrine gland inflammation. It is often misdiagnosis and delays, resulting in poor quality of life in some cases and severe consequences and poor patient outcomes. Limited literature compares presentation and treatment outcomes of recurrent HS, any information may aid clinicians in prompt diagnosis and treatment to alleviate the various challenges patients face and the complications from disease progression.

Methods: A 10-year (2012-2022) retrospective chart review of the Epic Medisys database that analyzed patients admitted to flushing hospital center with a diagnosis of HS as a primary or secondary diagnosis at our community teaching hospital in Flushing, New York.

Results: In our patient sample, HS was most commonly diagnosed in African-American and female patients under the age of 30 years. Common comorbidities included obesity. Antibiotics had the highest cure rate overall, and surgical interventions were more effective for recurrent disease.

Conclusions: From our study we concluded that most patients were African American and female presenting younger than 30 years with axillary lesions most commonly characterized as nodules and abscesses. Antibiotics had the highest cure rate for both groups; with surgical intervention more effective from recurrent disease.

Do we need group and save for trans-urethral resection of bladder tumour and trans-urethral resection of the prostate procedures?

2024-11-12T17:59:15+0530

Background: Trans-urethral resection of the prostate (TURP) and trans-urethral resection of bladder tumour (TURBT) are urological procedures essential for treating benign prostatic hyperplasia (BPH) and non-muscle invasive bladder cancer, respectively, these procedures may result in post-operative bleeding. In our hospital, pre-operative blood group and save is a routine to enhance patient safety. This study aims to evaluate transfusion rates and the potential cost benefits of limiting routine blood group and save.

Methods: We conducted a retrospective audit of patients undergoing TURP and TURBT between October 2018 and October 2020. Data was collected using theatre system records and blood bank information regarding transfusions.

Results: Out of 233 patients (average age 74), 141 underwent TURBT, 89 underwent TURP, and 3 underwent both simultaneously. Historical group and save were found in 214 (91.84%) patients, and 162 (69.5%) had same-day group and save. Only 2 patients (0.85%) necessitated transfusions.

Conclusions: The necessity for blood transfusion after TURP and TURBT is low, indicating that routine pre-operative group and save may not be essential for all patients. Tailoring this practice to high-risk individuals may reduce costs and relieve workloads. Enhanced surgical techniques and tools are likely contributors to these improved outcomes.

Location of venous reflux in our duplex test of patients with primary chronic venous insufficiency and comparison with that of the literature

2024-10-02T17:37:33+0530

Background: Chronic venous insufficiency (CVI) significantly impacts patients’ quality of life and poses economic burdens on healthcare systems. Accurate assessment of venous reflux is crucial for effective management. This study aimed to identify the sites of deep, superficial, and perforator venous reflux, including junctional incompetencies between superficial and deep veins in patients with primary CVI.

Methods: A prospective observational study was conducted from July 1, 2022 to June 30, 2024, utilizing non-invasive Duplex ultrasonography on patients in our clinical practice. Data were collected without patient identification, and informed consent was obtained prior to procedures. Reflux was defined as venous flow reversal lasting over 0.5 seconds.

Results: A total of 50 limbs from patients aged 20 to 77 years (mean age 43) were examined, with a male-to-female ratio of 52:48. Reflux was detected in the external iliac (41 limbs), common femoral (39 limbs), superficial femoral (21 limbs), popliteal (26 limbs), posterior tibial (7 limbs) and perforator veins (21 limbs). Sapheno-femoral junction incompetency was observed in 28 cases, with 6 cases indicating early-stage reflux. Dilatation of the great saphenous vein was noted in 33 cases, while 14 cases exhibited short saphenous vein dilatation.

Conclusions: The detection of venous reflux reveals significant insights for diagnosing and managing CVI. This study highlights areas for improvement in Duplex examination techniques, advocating for enhanced training for healthcare professionals to elevate diagnostic standards, ultimately benefiting patient outcomes and reducing societal burdens associated with CVI.

Outcome of combined surgery with compression therapy for management of venous leg ulcer

2024-10-02T00:31:50+0530

Background: Venous leg ulcers (VLUs) are late indicators of chronic venous insufficiency (CVI) and venous hypertension. Compression therapy (CT) with multilayer bandage is the first line of treatment modality of ulcer management. But CT has a slow ulcer healing rate and high chance of recurrence. The present study was conducted to identify the outcome of combined surgery with compression therapy to manage VLU.

Methods: In this prospective study, 60 patients were included who presented to the department of cardiovascular surgery of Dhaka Medical College and Hospital between January 2021 to December 2023. The patients were divided into two groups. Group A included the patients who underwent surgery combined with compression therapy while Group B patients received only compression therapy (CT). Ulcer healing time, recurrence rate and Venous Clinical Scoring System (VCSS) were analysed to determine the outcome.

Results: There was no significant difference in the demographic variables between two groups. 30 limb ulcers healed in the combined treatment group with a median healing time of 1.6 months (95% CI, 1.42–1.82), while 24 limb ulcers healed in the CT alone group with a median healing time of 2.15 months (95% CI, 1.92–2.45). The ulcer healing time was shorter in the combined treatment group than in the CT alone group (HR for ulcer healing 1.98, 95% CI, 1.474–2.309, p<0.05). Recurrence rate was higher in CT group (16.66% vs 53.33%). Besides VCSS was lower in Combined group that CT group after 1month, 6 month and 12 month of follow-up which was statistically significant. (p<0.05)

Conclusions: The present study has demonstrated combined treatments can shorten the ulcer healing time and reduce the ulcer recurrence rate compared with CT alone for treating VLU. Further randomized large scale multicenter study is recommended to provide a better management to the patients.

Demographic and clinical profile of patients with acute biliary pancreatitis: an experience in Patan academy of health sciences

2024-10-21T21:04:23+0530

Background: Acute pancreatitis is one of the most common causes of acute abdomen encountered in emergency department with wide range of severity from mild self-limiting disease to severe and rapidly progressive illness leading to multi organ failure and even death. Gall stones are leading cause of acute pancreatitis. This study has been carried out to find out demographic pattern and clinical profile of patients with acute biliary pancreatitis.

Methods: This is a prospective cross-sectional study carried out in the department of surgery in Patan academy of health sciences (PAHS) in the time period between May 1, 2021 and April 30, 2022. The process of data collection was started after obtaining ethical approval from institutional review committee (IRC) of PAHS, and written informed consent was obtained from patients. Total sampling was done and 66 patients were enrolled into the study, who were diagnosed as acute biliary pancreatitis. Data was analyzed with SPSS ver 25 and Microsoft excel 2016.

Results: Out of total 66 patients in the study 25 (37.9%) were male and 41 (62.1%) were female with male: female ratio of 1:1.64. Mean age was 48.42±16.62 years. ranging from 16-88 years. Epigastric abdominal pain was predominant presenting symptoms accounting for 57 (86.4%) cases. Pleural effusion was most common complication seen in 17 (25.8%) cases. Mortality occurs in 2 (3%) cases, both of cases had severe pancreatitis. Only 21 (31.8%) patients underwent cholecystectomy among which 13 (19.7%) interval and 8 (12.1%) index cholecystectomy.

Conclusions: Female gender with age group of 40-60 years. predominates acute biliary pancreatitis. Though most of the cases are mild and have benign course, severe cases and patients with advanced age are associated with high mortality. Acceptance of index cholecystectomy is very low.

Prevalence, risk factors, and management of ascites in the western sub-divisional hospitals of Fiji: a multi-center retrospective study

2024-10-03T03:25:06+0530

Background: Ascites, a condition characterized by fluid accumulation in the abdominal cavity, is a common complication of chronic liver disease and other serious health conditions. In resource-limited settings such as Fiji, managing ascites presents unique challenges. This study investigates the prevalence, associated risk factors, and current management approaches for ascites in the Western Sub-Divisional Hospitals of Fiji, focusing on population demographics and healthcare practices.

Methods: This retrospective study analyzed patient records from January 2021 to December 2023 across five hospitals—Sigatoka, Nadi, Ba, Tavua and Rakiraki. Data on demographics, medical history, lifestyle factors and treatment practices were collected. The study adhered to ethical standards, with approval from the Fiji National Research.

Results: Ascites primarily affected individuals over the age of 50, with a higher prevalence among men and individuals of Indian descent. Key risk factors included alcohol abuse, chronic liver disease, and metabolic syndrome. Management typically involved sodium restriction, diuretics and in limited cases, Transjugular Intrahepatic Portosystemic Shunt (TIPSS) due to accessibility constraints.

Conclusions: The findings highlight a need for culturally responsive healthcare strategies, improved screening, and multidisciplinary treatment protocols to manage and prevent ascites effectively in this population. Enhanced public health initiatives and clinical guidelines could significantly impact patient outcomes in Fiji.

Role of tranexamic acid as an adjunctive for chronic sub dural hematoma for early resolution and reduced recurrence rate: a prospective case-control study

2024-10-22T14:23:54+0530

Background: Literature shows the effective use of tranexamic acid to reduce CSDH either as a primary treatment or as an adjunctive treatment. However, literature lacks conclusive evidence on the use of tranexamic acid for CSDH. There are not many Indian studies also on this subject. This study was aimed at finding the effectiveness of tranexamic acid in reducing the recurrence rate following surgery and early resolution.

Methods: From May 2023 to May 2024, single centric case control study was done in a tertiary care center (Government Mohan Kumaramangalam medical college hospital, Salem) in Southern India. All patients with chronic subdural hematoma with Markwalder grading 2-4 and grade 1 with midline shift more than 1 cm were included in the study. Patients with severe cardio-cerebrovascular disease, patients with allergy to tranexamic acid and patients not willing to participate were excluded from the study. Tranexamic acid was given at a dose of 500 mg twice a day for 10 days. Patients were allocated into two groups: group A: where tranexamic acid was used, group B: where tranexamic acid was not used.

Results: The mean duration of hospital stay was lesser in tranexamic acid group (p<0.005). The mean SDH thickness was lesser at 4^th and 8^th week in tranexamic acid group (p<0.005). Recurrence rate was lesser in tranexamic acid group at three months (p>0.05).

Conclusions: This study of patients with CSDH showed that the adjunctive use of TXA after burr-hole drainage is effective in achieving resolution of CSDH through faster hematoma reduction. TXA may have a favorable effect in reducing recurrence and can be administered safely in selected patients.

A 10-year retrospective study of 43 female patients presenting with idiopathic granulomatous mastitis

2024-10-08T21:26:00+0530

Background: Idiopathic Granulomatous Mastitis (IGM) is a rare inflammatory breast condition affecting middle aged women. IGM typically presents as a unilateral, painful and challenging-to-treat breast mass, with a high recurrence rate. Common treatments include corticosteroids and antibiotics, with surgical excision reserved for resistant cases. However, the absence of a standardized treatment protocol leads to variability in management across different settings and providers.

Methods: We present a case series of 43 patients diagnosed with IGM at a community hospital in New York, aiming to facilitate early recognition and treatment of this rare condition. This study identifies risk factors and reviews best practices in imaging and treatment, emphasizing the importance of considering IGM in the differential diagnosis, particularly in cases of recurrent disease.

Results: The sample comprised 43 patients with an average age of 34.65 years, 31 (72%) of whom were Hispanic. The most commonly reported symptoms were pain, mass, erythema, and swelling. In all cases, IGM was confirmed by histopathological examination. Treatment modalities included incision and drainage (I and D), corticosteroids, antibiotics, methotrexate and surgical intervention.

Conclusions: IGM is a rare condition often mistaken for breast cellulitis, abscess or carcinoma. Maintaining a high index of suspicion is crucial, particularly in Hispanic women who may be at increased risk. Histopathological diagnosis is essential to prevent unnecessary surgical interventions and antibiotic use, thereby reducing recurrence rates. Early initiation of corticosteroids or alternatives like methotrexate can optimize patient outcomes and reduce healthcare costs.

Association between KRAS, NRAS, and BRAF mutations and tumor localization in colorectal cancer patients in BSMMU

2024-10-10T00:46:44+0530

Background: Colorectal cancer (CRC) is a common malignancy with significant genetic heterogeneity. Mutations in proto-oncogenes such as KRAS, NRAS, and BRAF play a pivotal role in CRC development, impacting prognosis and treatment. This study aims to correlate mutations in these genes with tumor localization in both primary and metastatic CRC in the Bangabandhu Sheikh Mujib medical university (BSMMU) cohort.

Methods: This prospective cross-sectional study was conducted between July 2023 and June 2024 at BSMMU. A total of 30 CRC patients, confirmed via histopathology, were included. Purposive sampling was used to select patients. Tumor tissue samples were collected and analyzed for KRAS, NRAS, and BRAF mutations using DNA isolation, PCR amplification, and sequencing techniques.

Results: Among the 30 patients, the majority were male (66.7%) with a mean age of 50.4 years. KRAS mutations were found in 5 patients (16.7%), while no mutations in NRAS or BRAF were detected. Rectal cancer was the most frequent tumor location (36.7%), followed by hepatic and splenic flexure (16.7% each). No significant correlation was observed between KRAS mutations and tumor localization.

Conclusions: There was no statistically significant correlation between KRAS, NRAS, and BRAF mutations and tumor localization in the BSMMU CRC patient cohort. The study highlights the need for larger sample sizes to better understand the genetic landscape of CRC in Bangladesh. Small sample size may limit the ability to detect significant associations. Further large-scale studies could offer more conclusive insights.

Prevalence of causative bacteria on cell phones of patients with chronic suppurative otitis media: a descriptive cross-sectional study

2024-10-07T02:05:24+0530

Background: The aim of this study is to identify the prevalence of causative bacteria on the cell phones of patients with chronic suppurative otitis media (CSOM).

Methods: Fifty clinic patients were randomly selected according to the eligibility criteria. Ear swab samples and swabs from the ear-piece area of their cell phones were collected for laboratory investigation. Additionally, 20 controls were recruited for comparison.

Results: Among the 50 subjects, 60% were Females, and the highest prevalence was observed in the 36-45 age group. Ear swab cultures showed bacterial growth in 32 samples (64%), with Pseudomonas spp. (24%) being the most prevalent, followed by coagulase-negative Staphylococcus spp. (14%) and Staphylococcus aureus (14%). Only 11 out of 50 phone swabs (22%) showed bacterial growth, predominantly coagulase-negative Staphylococcus spp. (18%). In three cases, the same non-pathogenic bacteria (coagulase-negative Staphylococcus spp.) were found in both ear and phone samples. Among the controls, 55% were female, and the highest prevalence was in the 26-35 age group. Four ear swab samples (20%) from the controls grew coagulase-negative Staphylococcus spp., but phone samples showed inconsistent laboratory results due to technical issues.

Conclusions: Based on the findings, there is no significant prevalence of CSOM causative bacteria on the cell phones of patients. However, limitations, including sample size and the inability to establish a causal relationship, should be considered. Larger studies exploring multiple environmental reservoirs may better clarify potential transmission routes for CSOM pathogens.

Association of serum procalcitonin level with acute respiratory distress syndrome in patients following cardiopulmonary bypass

2024-09-29T11:15:02+0530

Background: Acute respiratory distress syndrome is a potentially life-threatening complication after cardiac surgery. Systemic inflammatory response is activated during cardiopulmonary bypass time which may cause acute respiratory distress syndrome and serum procalcitonin level also increases during systemic inflammatory response. This study aimed to see the association of serum procalcitonin level with acute respiratory distress syndrome in patients following cardiopulmonary bypass.

Methods: This was a prospective observational study conducted in the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh during the period from September, 2020 to August, 2022. In our study, we included 140 patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were divided into two groups- group A included 70 patients with serum procalcitonin levels <7 ng/ml and group B included 70 patients with serum procalcitonin levels>7 ng/ml.

Results: The mean (±SD) age of the patients was 43.20 (±13.18) years and 46.61 (±13.75) years in group A and group B respectively. In group A, 41.4% of patients were male and 58.6% were female; in group B, 52.9% were male and 47.1% were female. On 1st postoperative day, in group, A serum procalcitonin levels were 1.36(±0.97) ng/ml and in group B serum procalcitonin levels were 27.09(±26.11) ng/ml (p<0.001). The incidence of ARDS was significantly higher in group B than in group A (35.7% versus 8.5%, p= 0.002).

Conclusion: This study concluded that there was an association of serum procalcitonin level with acute respiratory distress syndrome in patients following cardiopulmonary bypass.

Our experience at Bangabandhu Sheikh Mujib Medical University on laparoscopic assisted surgery for rectal cancer

2024-10-10T00:31:38+0530

Background: Rectal cancer is a leading cause of mortality worldwide, with laparoscopic surgery emerging as a viable alternative to open surgery due to its benefits in postoperative recovery, pain management and survival rates. Despite its advantages, laparoscopic colorectal resection faces scrutiny over oncologic safety and technical demands, limiting its widespread adoption.

Methods: This retrospective descriptive study analyzed 60 patients with colorectal adenocarcinoma treated at the Department of Colorectal Surgery, BSMMU, from January 2018 to December 2018. Inclusion criteria encompassed clinically diagnosed colorectal cancer with histological confirmation. Data on demographics, tumor characteristics, surgical details and postoperative outcomes were collected and analyzed with SPSS software.

Results: Among the 60 patients, 32 were male, with a mean age of 52 years. Tumors within 5 cm of the anal verge necessitated abdominoperineal resections (n=44), while anterior resections were performed for the remaining (n=16). All patients achieved adequate proximal margins (>5 cm) and most (90%) had distal margins >2 cm. The average operative time ranged from 190 to 270 minutes, with no intraoperative complications and a postoperative stay of 3-5 days. Patients reported less postoperative pain and faster recovery.

Conclusions: Laparoscopic colorectal surgery demonstrated similar oncologic outcomes to open surgery but involved a longer operative time and required advanced surgical skills. The benefits included reduced blood loss, lower postoperative pain and a shorter hospital stay, although costs were higher. A need for expert surgeons in selected patients is emphasized for optimal outcomes. Laparoscopic resection for rectal cancer aligns with oncologic principles and offers a safe, effective approach, yielding improved recovery metrics compared to traditional surgery. Further analysis on cost-effectiveness, especially for lower socioeconomic populations, is warranted to enhance accessibility.

Role of repeat neuroimaging in complicated mild traumatic brain injury: a single centre study

2024-10-22T15:00:43+0530

Background: Patients with mild traumatic brain injury (TBI) and positive initial CT brain findings undergo routine repeat CT brain for follow-up usually after 48 hours as a Standard of care. Use of repeat routine neuro imaging is controversial in mild TBI. We hypothesized that in patients with mild TB I repeat neuro imaging of the brain would not alter the outcome or patient’s care. Aims and objectives were to evaluate the role of repeat CT brain in patients with complicated mild TBI (c-mild TBI) who were determined non-surgical medical line of management at the time of admission.

Methods: It is a hospital based prospective observational single centre study. Clinical and demographic data including age, gender, admission and discharge GCS and timing of the first and second CT brain of the patients included in the study were recorded on pre-designed and pre-tested proforma. department of neurosurgery, government Mohan Kumaramangalam medical college hospital, Salem-01, Tamil Nadu, India.

Results: Out of 552 patients, our study found that 46 (8.33%) patients had neurological deterioration in the form of drop in GCS, change in pupillary size, increased focal deficit, seizures or raised ICP symptoms, 94 (17.02%) patients had radiological progression in the form of increase in size of hematoma or edema and out of which only 21 (3.8%) patients underwent surgical intervention following second CT and all the patients who underwent surgical intervention had clinical neurological deterioration.

Conclusions: For patients with c-mild TBI a repeat CT brain should be obtained only in patients who have neurological worsening and serial neurological examination and observation after the injury is recommended. With this approach, patients who need delayed neurosurgical intervention can be identified while unnecessary imaging procedures can be avoided.

Study of below knee amputation in patients with diabetic foot ulcer in a tertiary care centre in India

2024-11-03T10:37:19+0530

Background: This study aims to evaluate the predictive factors affecting the clinical outcome of below knee amputation performed in diabetic foot patients who had developed foot ulcers.

Methods: This is a retrospective study of 25 random patients who underwent below-knee amputation for diabetic foot ulcers. These patients were admitted in the Department of Surgery, Shri MP Shah Medical College, Jamnagar, between November 2017 and October 2019.

Results: The patient’s age ranged from 30 to 80 years, with a mean age of 62.92 years. 60% were between the ages of 51 and 70. Of the total, 14 were male and 11 were female, suggesting that males due to generally more active lifestyles, may be at higher risk for foot injuries leading to diabetic ulcers. 64% were from a lower socio-economic background. All 25 patients had previous admissions, 12 had a history of previous amputation, while 13 treated conservatively. Most patients presented with infected or non-healing ulcers, cellulitis and/or gangrene. Primary healing occurred in 13 patients, 7 required refashioning for healing, 3 required transfemoral amputation and 2 patients unfortunately passed away. The mean duration of hospital stay was 49.82±28.07 days.

Conclusions: Lack of awareness, poor glycaemic control and duration of diabetes where the main factors causing diabetic foot problems. For patients with infected feet, difficulty with mobility and prolonged immobilization were common issues. Timely below-knee amputation helped restore movement and improved the ability to use prosthetic limbs, allowing for greater mobility and independence.

Evaluation and management of pressure ulcers in plastic surgery department at tertiary care center in India

2024-09-29T21:09:48+0530

Background: A pressure ulcer also known as decubitus ulcers, bedsores, or pressure sores is a localized injury to the skin and/ or underlying tissue usually over a bony prominence, as a result of unrelieved pressure or pressure in combination with shear. When extrinsic pressure exceeds the capillary pressure of 32 mmHg than vessel occluded and blood flow stops. When pressure not relieved for 5 minute every 2 hour, then necrosis and ulceration will result.

Methods: Retrospective study of 74 patients with pressure injury admitted in SMS hospital Jaipur during 3 year duration from September 2019 to August 2022 requiring plastic surgery intervention. Patient specific factor, wound characteristics and flap outcomes analysed in study.

Results: Patients with early-stage pressure injury (stage I and II) and advance stage (stage III and IV) with deteriorating or terminal co-morbidities, managed with conservative treatment in form of dressing with pressure management. Patients with advance stage pressure injury (stage III and IV) managed with active operative intervention in form of debridement and flap cover surgery.

Conclusions: Prevention of pressure ulcer development is mainstay in management of both development and recurrence of pressure ulcer.

A comparative study between early and conventional intestinal stoma closure in a tertiary care institute

2024-10-19T20:39:42+0530

Background: Little is known about ideal time for stoma closure. Therefore, the aim of this study is to compare early versus conventional stoma closure following bowel surgery in terms of quality of life (QoL), length of hospital stay (LoH), and postoperative complications.

Methods: This randomized controlled trial was conducted at a medical college affiliated teaching hospital from May 2023 to June 2024. The 116 patients undergoing bowel surgery with temporary stoma creation were randomized into early closure (3 weeks post-surgery) and conventional closure (8-12 weeks post-surgery) groups. Primary outcome was anastomotic leak rate. Secondary outcomes included other postoperative complications, LoH, and QoL assessed using the EORTC QLQ-C30 questionnaire.

Results: There was no significant difference in anastomotic leak rates between early (6.9%) and conventional (12.1%) closure groups. Overall complication rates were similar (56.9% early vs 50% conventional). LoH did not differ significantly between groups. QoL scores were significantly higher in the early closure group, with 100% of patients achieving considerable improvement (EORTC score 26-36) compared to 79.3% in the conventional group (p<0.05).

Conclusions: Early stoma closure is safe and feasible in appropriately selected patients, with no increased risk of anastomotic leak or other complications. It significantly improves QoL compared to conventional closure timing, without prolonging hospital stay. These findings suggest that early stoma closure may be a beneficial option for suitable patients following bowel surgery.

The impact of Hashimoto’s thyroiditis on the diagnostic utility of P63 and CK19 immunohistochemistry markers in predicting thyroid cancer

2024-10-21T20:44:32+0530

Background: The incidence of thyroid cancer (TC) and Hashimoto’s thyroiditis (HT) is increasing worldwide. Coexisting HT adds to diagnostic confusion in establishing TC on histopathological examination (HPE). Studies have shown the promising role of immunohistochemistry markers in predicting cancer, but the impact of coexisting HT is unclear. This prospective study determined the impact of HT on the diagnostic utility of p63 and CK19 in predicting thyroid cancer.

Methods: Out of 103 patients undergoing total thyroidectomy for benign or malignant thyroid nodules, 31 patients (mean age=39.7 years, Male:Female=4:27) with elevated thyroid autoantibodies were studied. HPE of formalin-fixed paraffin-embedded tissue from surgical specimens confirmed the final diagnosis. Sections 2-4μ were stained for immunohistochemistry using the standard avidin-biotin complex method with antibodies against P63 and CK19. Expression in 10% or more of neoplastic cells qualified as positive while expression in less than 10% was considered negative. Receiver Operating Characteristic (ROC) assessed the diagnostic accuracy.

Results: Histopathology comprised 58.1% benign and 41.9% malignant lesions. CK19 exhibited membranous expression in 87.1%, while p63 exhibited focal nuclear expression in 35.5% of cases. In ROC analysis predicting TC for entire cohort, the area under curve (AUC) of P63 was 0.6 and CK19 was 0.532. In subgroup with HT, the AUC of p63 was 0.8. Each P>0.05.

Conclusions: P63 expression had better predictability for thyroid cancer with co-existent Hashimoto’s thyroiditis but was not statistically significant. Whereas, CK19 was non-specific and unreliable. Histomorphological features on HPE are the gold standard for diagnostic decisions.

A comparative study of modified Bassini's repair and lichtenstein repair for indirect inguinal hernia in young age population

2024-10-22T23:56:46+0530

Background: Inguinal hernia surgery has significant world-wide diversity in management. European Hernia Society guidelines 2020, for management of groin hernias recommends the use of open non-mesh repair in specific patients or types (e.g. young males with lateral hernia)as an acceptable alternative to a Lichtenstein technique. The present study deals with the comparison of intra operative, postoperative course and clinical outcome of modified bassinis repair (non mesh) and Lichtenstein repair [mesh repair] for indirect inguinal hernia in young age population.

Methods: Observational analytical prospective cohort study, conducted in General Surgery, Peoples hospital, Bhopal from November 2022 to February 2024. Patient of indirect inguinal hernia in the age (16-35 years) group and operated by either Modified Bassinis (Group A, n=34) or lichtenstein hernia repair (Group B, n=48). The above study arms group were studied and compared.

Results: Mean duration of surgery among Group A patients was 62.65 minutes and 57.19 minutes in Group B. Seropurulent discharge among 2.9% patients in Group A and 4.2% in Group B and superficial SSI among 2.9% patients in Group A and 4.2% in Group B was reported. Chronic post-operative pain VAS score was assessed at end of 2nd week, end of 1 month and end of 3 months with statistically no significant among two groups.

Conclusions: Our study did not demonstrate any significant difference of one repair method over the other. However, an Individualized approach for cases with a customized strategy is recommended for surgical management of hernia.