Pub Date : 2020-12-08DOI: 10.11648/J.JS.20200806.18
Diakite Sandaly, M. Francis, C. Naby, Soumaoro Labile Togba, D. Mamoudou, F. Houssein, F. Naby, C. Mariame, Camara Fode Lansana, Diakité Saikou Yaya, T. Aboubacar, D. Taran
The aim of this work was to eassess the contribution of imaging in the management of non-traumatic abdominal surgical emergencies at the General Surgery Department of the Ignace Deen National Hospital. Material and methods: This was a prospective, descriptive study that included for 6 months all patients admitted and operated for a non-traumatic abdominal surgical emergency and having performed at least one imaging test. Results: During our study period, Non-traumatic abdominal surgical emergencies accounted for 25.27% of admissions. The average age was37.58 years old with a male predominance (65.3%) and a sex ratio of 1.88. The mean consultation time was 66.92h±40.15. PSA was the most performed imaging test (86.44%) followed by abdominal ultrasound (8.47%). The main non-traumatic abdominal surgical emergencies observed were acute generalized peritonitis (45.8%), followed by acute intestinal obstruction (44.1%). The agreement between imaging and operative diagnosis was 93.46% on PSA, 92.86% on abdominal ultrasound and 100% on abdominal CT. Conclusion: Non-traumatic abdominal surgical emergencies are frequent, imaging examinations (ASP, ultrasound) allow a good appreciation of all non-traumatic abdominal emergencies when they are judiciously used. In addition, CT, although essential, remains inaccessible due to its cost, thus limiting its emergency use.
{"title":"Contribution of Imaging to the Management of Surgical Emergencies in the General Surgery Department of the Ignace Deen National Hospital","authors":"Diakite Sandaly, M. Francis, C. Naby, Soumaoro Labile Togba, D. Mamoudou, F. Houssein, F. Naby, C. Mariame, Camara Fode Lansana, Diakité Saikou Yaya, T. Aboubacar, D. Taran","doi":"10.11648/J.JS.20200806.18","DOIUrl":"https://doi.org/10.11648/J.JS.20200806.18","url":null,"abstract":"The aim of this work was to eassess the contribution of imaging in the management of non-traumatic abdominal surgical emergencies at the General Surgery Department of the Ignace Deen National Hospital. Material and methods: This was a prospective, descriptive study that included for 6 months all patients admitted and operated for a non-traumatic abdominal surgical emergency and having performed at least one imaging test. Results: During our study period, Non-traumatic abdominal surgical emergencies accounted for 25.27% of admissions. The average age was37.58 years old with a male predominance (65.3%) and a sex ratio of 1.88. The mean consultation time was 66.92h±40.15. PSA was the most performed imaging test (86.44%) followed by abdominal ultrasound (8.47%). The main non-traumatic abdominal surgical emergencies observed were acute generalized peritonitis (45.8%), followed by acute intestinal obstruction (44.1%). The agreement between imaging and operative diagnosis was 93.46% on PSA, 92.86% on abdominal ultrasound and 100% on abdominal CT. Conclusion: Non-traumatic abdominal surgical emergencies are frequent, imaging examinations (ASP, ultrasound) allow a good appreciation of all non-traumatic abdominal emergencies when they are judiciously used. In addition, CT, although essential, remains inaccessible due to its cost, thus limiting its emergency use.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77213133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-04DOI: 10.11648/J.JS.20200806.17
Xianchang Yu, Xiongdong Zhong
Background: Huangbo, also known as Cortex phellodendri in Latin, is an important drug which has the pharmacological action of clearing heat, drying dampness, purging fire and detoxifying. In recent years, it has been reported that Huangbo also has the activity of treating hemorrhoids. Objective: The aim of this study was to explore the Active Ingredients of Cortex phellodendri in the Treatment of hemorrhoids and Its Mechanism. Study Design: We analyzed Active components and target genes of Cortex phellodendri in the Traditional Chinese Medicine System Pharmacology (TCMSP) database and analysis platform. We then searched the GeneCards database for target genes related to hemorrhoids and the intersection of these genes with the active components of Cortex phellodendri. Target genes related to hemorrhoids were taken as common potential target genes of Cortex phellodendri, which could act on hemorrhoids. Using the R programming language, we drew a Venn map of these common potential target genes. The “component–target gene–disease” network of Cortex phellodendri in the treatment of hemorrhoids was established using Cytoscape software version 3.7.1; the protein–protein interaction (PPI) network was constructed in the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database. With the help of R and Perl languages, we performed gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of potential target genes of Cortex phellodendri in the treatment of hemorrhoids. Results: We extracted a total of 10 active components from Cortex phellodendri, including quercetin and rutaecarpine and so on, as well as 29 potential target genes for hemorrhoids. According to the Degree ranking in Cytoscape3.7.1 software, the top 10 potential target genes were interleukin-6 (IL-6), CCL2, CXCL8, MMP9, vascular endothelial growth factor A (VEGFA), Myc, IL-10, ICAM1, MMP2, and MMP3. Pathway enrichment mainly involved signaling pathways such as advanced glycation end products and receptor for advanced glycation end products (AGE-RAGE) signaling pathway in diabetic complications, hypoxia-inducible factor 1 (HIF-1), IL-17, and Relaxin. Conclusion: Based on network pharmacology, Cortex phellodendri is expected to be mined as a candidate Traditional Chinese Medicine (TCM) for the treatment of hemorrhoids. Its mechanism for treating this disease operates via multiple components and pathways. This study provides the basic theory and the basis for further research.
{"title":"An Exploration of the Active Ingredients of Cortex phellodendri in the Treatment of Hemorrhoids and Its Mechanism Based on Network Pharmacology","authors":"Xianchang Yu, Xiongdong Zhong","doi":"10.11648/J.JS.20200806.17","DOIUrl":"https://doi.org/10.11648/J.JS.20200806.17","url":null,"abstract":"Background: Huangbo, also known as Cortex phellodendri in Latin, is an important drug which has the pharmacological action of clearing heat, drying dampness, purging fire and detoxifying. In recent years, it has been reported that Huangbo also has the activity of treating hemorrhoids. Objective: The aim of this study was to explore the Active Ingredients of Cortex phellodendri in the Treatment of hemorrhoids and Its Mechanism. Study Design: We analyzed Active components and target genes of Cortex phellodendri in the Traditional Chinese Medicine System Pharmacology (TCMSP) database and analysis platform. We then searched the GeneCards database for target genes related to hemorrhoids and the intersection of these genes with the active components of Cortex phellodendri. Target genes related to hemorrhoids were taken as common potential target genes of Cortex phellodendri, which could act on hemorrhoids. Using the R programming language, we drew a Venn map of these common potential target genes. The “component–target gene–disease” network of Cortex phellodendri in the treatment of hemorrhoids was established using Cytoscape software version 3.7.1; the protein–protein interaction (PPI) network was constructed in the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database. With the help of R and Perl languages, we performed gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of potential target genes of Cortex phellodendri in the treatment of hemorrhoids. Results: We extracted a total of 10 active components from Cortex phellodendri, including quercetin and rutaecarpine and so on, as well as 29 potential target genes for hemorrhoids. According to the Degree ranking in Cytoscape3.7.1 software, the top 10 potential target genes were interleukin-6 (IL-6), CCL2, CXCL8, MMP9, vascular endothelial growth factor A (VEGFA), Myc, IL-10, ICAM1, MMP2, and MMP3. Pathway enrichment mainly involved signaling pathways such as advanced glycation end products and receptor for advanced glycation end products (AGE-RAGE) signaling pathway in diabetic complications, hypoxia-inducible factor 1 (HIF-1), IL-17, and Relaxin. Conclusion: Based on network pharmacology, Cortex phellodendri is expected to be mined as a candidate Traditional Chinese Medicine (TCM) for the treatment of hemorrhoids. Its mechanism for treating this disease operates via multiple components and pathways. This study provides the basic theory and the basis for further research.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80167968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.11648/J.JS.20200806.16
J. Du, Chen-zhao Lu, Jing Wang
Background: Investigate the risk factors of recurrent vertebral compression fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF). Method: Data of 401 patients with osteoporotic vertebral compression fractures treated by PVP from March 2013 to June 2018 were retrospectively analyzed, and were divided into re-fracture group and nonre-fracture group according to the postoperative recurrence of vertebral compression fractures. The following parameters were observed, including age, gender, bone mineral density (BMD), correction degree of kyphosis, recovery degree of vertebral height, amount of bone cement injected, Pfirrmann classification of adjacent intervertebral disc of hurt vertebral, and bone cement leakage in intervertebral disc. Then, the above parameters were statistically analyzed by univariate and multivariate analysis to explore the risk factors of vertebral recurrent fracture after PVP. Result: Among 401 patients, 34 (34 /401, 8.4%) recurred OVCF after PVP. Statistical analysis showed that the risk of recurrent vertebral fracture increased by 3.732 times (95% CI 1.107-12.581) when Pfirrmann classification of adjacent intervertebral disc was in degeneration grade. The risk of recurrent vertebral fracture was significantly increased by 31.818 times (95% CI 13.384-75.640) when bone cement leakage occurred in intervertebral disc. Conclusion: Pfirrmann classification of adjacent intervertebral disc and bone cement leakage in intervertebral disc are significantly correlated with the recurrence of vertebral fracture after PVP. In PVP operation, avoiding the bone cement leakage in intervertebral disc can significantly reduce the recurrence of vertebral compression fractures.
背景:探讨骨质疏松性椎体压缩性骨折(OVCF)经皮椎体成形术(PVP)后椎体压缩性骨折复发的危险因素。方法:回顾性分析2013年3月至2018年6月采用PVP治疗的401例骨质疏松性椎体压缩性骨折患者资料，根据椎体压缩性骨折术后复发情况分为再骨折组和非再骨折组。观察年龄、性别、骨密度(BMD)、后凸矫正程度、椎体高度恢复程度、骨水泥注射量、损伤椎体相邻椎间盘Pfirrmann分级、椎间盘骨水泥渗漏情况。然后通过单因素和多因素分析对上述参数进行统计分析，探讨PVP术后椎体复发骨折的危险因素。结果:401例患者中有34例(34 /401,8.4%)在PVP术后复发OVCF。统计分析显示，邻近椎间盘Pfirrmann分级为退变级时，椎体骨折复发风险增加3.732倍(95% CI 1.107 ~ 12.581)。椎间盘发生骨水泥渗漏时，椎体骨折复发风险显著增加31.818倍(95% CI 13.384 ~ 75.640)。结论:邻近椎间盘Pfirrmann分型及椎间盘骨水泥渗漏与PVP术后椎体骨折复发有显著相关性。在PVP手术中，避免椎间盘内骨水泥渗漏可显著减少椎体压缩性骨折的复发。
{"title":"Analysis of Risk Factors of Recurrent Vertebral Fractures After Percutaneous Vertebroplasty","authors":"J. Du, Chen-zhao Lu, Jing Wang","doi":"10.11648/J.JS.20200806.16","DOIUrl":"https://doi.org/10.11648/J.JS.20200806.16","url":null,"abstract":"Background: Investigate the risk factors of recurrent vertebral compression fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF). Method: Data of 401 patients with osteoporotic vertebral compression fractures treated by PVP from March 2013 to June 2018 were retrospectively analyzed, and were divided into re-fracture group and nonre-fracture group according to the postoperative recurrence of vertebral compression fractures. The following parameters were observed, including age, gender, bone mineral density (BMD), correction degree of kyphosis, recovery degree of vertebral height, amount of bone cement injected, Pfirrmann classification of adjacent intervertebral disc of hurt vertebral, and bone cement leakage in intervertebral disc. Then, the above parameters were statistically analyzed by univariate and multivariate analysis to explore the risk factors of vertebral recurrent fracture after PVP. Result: Among 401 patients, 34 (34 /401, 8.4%) recurred OVCF after PVP. Statistical analysis showed that the risk of recurrent vertebral fracture increased by 3.732 times (95% CI 1.107-12.581) when Pfirrmann classification of adjacent intervertebral disc was in degeneration grade. The risk of recurrent vertebral fracture was significantly increased by 31.818 times (95% CI 13.384-75.640) when bone cement leakage occurred in intervertebral disc. Conclusion: Pfirrmann classification of adjacent intervertebral disc and bone cement leakage in intervertebral disc are significantly correlated with the recurrence of vertebral fracture after PVP. In PVP operation, avoiding the bone cement leakage in intervertebral disc can significantly reduce the recurrence of vertebral compression fractures.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91436737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-27DOI: 10.11648/J.JS.20200806.15
M.I. Ajaero, S. Nduagu, C. Echieh, Raphael Arinze Onyekwelu
Deep neck space infections (DNSI) are inflammation often with abscess collection within potential fascial spaces in the head and neck region. The incidence of DNSIs is relatively higher in populations of low socioeconomic status This study aimed at analyzing the pattern of presentation and management of DNSIs seen at our facility over 10 years. Data were extracted from patients’ case notes and medical records. A total of 72 patients (47 males and 25 females) were studied with a Male to Female ratio of 1.88:1. The patients’ ages ranged from 4years to 80 years with mean age of 46.2±21.3 years. the commonest presenting complaints were pain (95.8%), dysphagia (81.9%) and odynophagia (70.8%). The mean duration of complaints prior to presentation was 10.9±4.1days. Majority of the DNSIs were of odontogenic origin (56.9%) and diabetes mellitus (26.4%) was the most commonly encountered co-morbid condition. Submandibular and sublingual infections were the most common (40.3%) followed by peritonsillar space infections (23.6%) and retropharyngeal and prevertebral space infections (16.7%). S. aureus (15.3%) was the most commonly isolated organism among the rest with the infection being polymicrobial in 33.3% of the patients. The commonest complications were septicaemia (18.1%), necrotizing fasciitis (12.4%) and mediastinitis (2.8%). In Sub-Saharan Africa, DNSIs can affect all age groups; appear to have more morbidity in people with low socioeconomic class and co-morbidities. They can be managed with a combination of incision and drainage and intravenous antibiotics. Attention to oro-dental hygiene may help reduce the incidence of DNSI as majority are found to be linked with odontogenic and pharyngo-tonsillar conditions.
{"title":"A Review of Deep Neck Space Infections: Perspective from a Sub-Saharan African Center","authors":"M.I. Ajaero, S. Nduagu, C. Echieh, Raphael Arinze Onyekwelu","doi":"10.11648/J.JS.20200806.15","DOIUrl":"https://doi.org/10.11648/J.JS.20200806.15","url":null,"abstract":"Deep neck space infections (DNSI) are inflammation often with abscess collection within potential fascial spaces in the head and neck region. The incidence of DNSIs is relatively higher in populations of low socioeconomic status This study aimed at analyzing the pattern of presentation and management of DNSIs seen at our facility over 10 years. Data were extracted from patients’ case notes and medical records. A total of 72 patients (47 males and 25 females) were studied with a Male to Female ratio of 1.88:1. The patients’ ages ranged from 4years to 80 years with mean age of 46.2±21.3 years. the commonest presenting complaints were pain (95.8%), dysphagia (81.9%) and odynophagia (70.8%). The mean duration of complaints prior to presentation was 10.9±4.1days. Majority of the DNSIs were of odontogenic origin (56.9%) and diabetes mellitus (26.4%) was the most commonly encountered co-morbid condition. Submandibular and sublingual infections were the most common (40.3%) followed by peritonsillar space infections (23.6%) and retropharyngeal and prevertebral space infections (16.7%). S. aureus (15.3%) was the most commonly isolated organism among the rest with the infection being polymicrobial in 33.3% of the patients. The commonest complications were septicaemia (18.1%), necrotizing fasciitis (12.4%) and mediastinitis (2.8%). In Sub-Saharan Africa, DNSIs can affect all age groups; appear to have more morbidity in people with low socioeconomic class and co-morbidities. They can be managed with a combination of incision and drainage and intravenous antibiotics. Attention to oro-dental hygiene may help reduce the incidence of DNSI as majority are found to be linked with odontogenic and pharyngo-tonsillar conditions.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83333638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-11DOI: 10.11648/J.JS.20200806.14
A. Bolt, S. Govilkar, C. Dover, J. Blackwell, S. Hay
Introduction: This study represents an analysis of data collected prospectively over a seven-year period to our trauma unit, to identify the epidemiological background behind the admissions of patients with acute elbow problems and to highlight the impact of these admissions on our trauma service. Method: Nearly 16,000 patients were included in our database. The admissions were initially categorized into A) fractures/dislocations or B) soft tissue trauma. The fractures/dislocations were then further classified by radiographic anatomical location, with data also collected on length of stay and operative management. In total 509 admissions were included in this study; 193 were paediatric cases and 316 were adults. This included 428 admissions with fractures/dislocations and 81 cases of soft tissue trauma. Conclusion: In conclusion, this data allows us to identify relative frequency of acute elbow conditions, including the incidence of common fracture patterns. These figures help to facilitate resource planning, such as expertise amongst personnel or the acquisition of equipment, including radial head replacement, elbow arthroplasty, and periarticular locking plates.
{"title":"A 7-year Prospective Epidemiological Study of Acute Elbow Admissions to a Trauma Unit","authors":"A. Bolt, S. Govilkar, C. Dover, J. Blackwell, S. Hay","doi":"10.11648/J.JS.20200806.14","DOIUrl":"https://doi.org/10.11648/J.JS.20200806.14","url":null,"abstract":"Introduction: This study represents an analysis of data collected prospectively over a seven-year period to our trauma unit, to identify the epidemiological background behind the admissions of patients with acute elbow problems and to highlight the impact of these admissions on our trauma service. Method: Nearly 16,000 patients were included in our database. The admissions were initially categorized into A) fractures/dislocations or B) soft tissue trauma. The fractures/dislocations were then further classified by radiographic anatomical location, with data also collected on length of stay and operative management. In total 509 admissions were included in this study; 193 were paediatric cases and 316 were adults. This included 428 admissions with fractures/dislocations and 81 cases of soft tissue trauma. Conclusion: In conclusion, this data allows us to identify relative frequency of acute elbow conditions, including the incidence of common fracture patterns. These figures help to facilitate resource planning, such as expertise amongst personnel or the acquisition of equipment, including radial head replacement, elbow arthroplasty, and periarticular locking plates.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91461395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-09DOI: 10.11648/J.JS.20200806.13
N. K. Gaspar, A. Gaspar
Introduction-Insulin exerts metabolic and growth-stimulating actions both through its own receptors and the receptors of its homologous factors (IGFs), although with different degrees of affinity. The A receptor of insulin acts more intensely on the cell membrane, with a metabolic response, whereas the B receptor is quickly internalized, stimulates cell growth, can be directed to the treatment of wounds difficult to heal. Objective-we proposes to evaluate the potential of insulin as an inducing agent in the regeneration of wounds that are difficult to heal as a therapeutic option. Methodology-Simultaneous intra and perilesional injections of 0.01ml of the solution containing 5UI of NPH single-component insulin diluted in 1 ml of lidocaine into various planes and wound sites. Clinical, glycemic and photographic evaluations of the patients were performed. Results-The cicatricial response occured in all patients and observed since the first applications. Withouth glycemic changes. Comments - The responses obtained can be attributed to both the stimulation of insulin receptors and that of their counterparts. Conclusions-The method was effective and without adverse effects. Different intervals between applications did not change the results. The availability of insulin and safety for its use indicate the method as a therapeutic option in difficult to heal wounds.
{"title":"Difficult to Heal Wounds Intralesional Insulin Therapy Trial","authors":"N. K. Gaspar, A. Gaspar","doi":"10.11648/J.JS.20200806.13","DOIUrl":"https://doi.org/10.11648/J.JS.20200806.13","url":null,"abstract":"Introduction-Insulin exerts metabolic and growth-stimulating actions both through its own receptors and the receptors of its homologous factors (IGFs), although with different degrees of affinity. The A receptor of insulin acts more intensely on the cell membrane, with a metabolic response, whereas the B receptor is quickly internalized, stimulates cell growth, can be directed to the treatment of wounds difficult to heal. Objective-we proposes to evaluate the potential of insulin as an inducing agent in the regeneration of wounds that are difficult to heal as a therapeutic option. Methodology-Simultaneous intra and perilesional injections of 0.01ml of the solution containing 5UI of NPH single-component insulin diluted in 1 ml of lidocaine into various planes and wound sites. Clinical, glycemic and photographic evaluations of the patients were performed. Results-The cicatricial response occured in all patients and observed since the first applications. Withouth glycemic changes. Comments - The responses obtained can be attributed to both the stimulation of insulin receptors and that of their counterparts. Conclusions-The method was effective and without adverse effects. Different intervals between applications did not change the results. The availability of insulin and safety for its use indicate the method as a therapeutic option in difficult to heal wounds.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88189423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-04DOI: 10.11648/J.JS.20200805.14
Maheshwaran Sivarajah, J. Gates
Fistulae forming between the alimentary tract and kidney after trauma are an anomaly. In contrast to general vesico-alimentary communication, a colonephric fistula almost invariably results secondary to an initial pathological process in the kidney. A primary infectious cause has by far been the most common renal pathology implicated in its formation. The diagnosis of this condition is suggested by pneumaturia but almost entirely based on radiological examination. Even though conservative strategies have been attempted, surgical resection is the treatment of choice and should be pursued if all else fails. We report a case of a subacute presentation of a colonephric fistula following blunt trauma with a documented injury to the kidney associated with a possible concomitant injury to the large bowel. However, the inciting event could also have been a primary occult colon injury overlying the renal injury, eventually culminating in a fistula between the two organs resulting in pneumaturia and signs of sepsis. A review of the literature on colonephric fistulae and their appropriate management strategies are reported and briefly discussed. It is important to be familiar with its clinical symptoms so that the diagnosis can be suspected, and adequate investigative and therapeutic approaches can be implemented.
{"title":"“Bubbles in My Urine” – A Presentation After Blunt Trauma","authors":"Maheshwaran Sivarajah, J. Gates","doi":"10.11648/J.JS.20200805.14","DOIUrl":"https://doi.org/10.11648/J.JS.20200805.14","url":null,"abstract":"Fistulae forming between the alimentary tract and kidney after trauma are an anomaly. In contrast to general vesico-alimentary communication, a colonephric fistula almost invariably results secondary to an initial pathological process in the kidney. A primary infectious cause has by far been the most common renal pathology implicated in its formation. The diagnosis of this condition is suggested by pneumaturia but almost entirely based on radiological examination. Even though conservative strategies have been attempted, surgical resection is the treatment of choice and should be pursued if all else fails. We report a case of a subacute presentation of a colonephric fistula following blunt trauma with a documented injury to the kidney associated with a possible concomitant injury to the large bowel. However, the inciting event could also have been a primary occult colon injury overlying the renal injury, eventually culminating in a fistula between the two organs resulting in pneumaturia and signs of sepsis. A review of the literature on colonephric fistulae and their appropriate management strategies are reported and briefly discussed. It is important to be familiar with its clinical symptoms so that the diagnosis can be suspected, and adequate investigative and therapeutic approaches can be implemented.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86058959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-04DOI: 10.11648/J.JS.20200805.12
M. Schmitz, S. Rogmans, S. Kasparek, N. Mustafi
Dressings applied to primarily closed surgical incisions should be appropriate interactive dressing [13] and demonstrate an ability to protect the wound from contaminants and trauma, manage exudate, and avoid excessive pressure to the incision line. Additionally, they should be flexible, well fixed to the skin on application, skin protective (e.g. reduce the risk of blistering or irritation, not excessively adhesive) and waterproof [14]. Film dressings were one of the first modern wound-dressing products. They are extremely flexible, transparent and adhesive. During the removal of the dressing skin stress occurs. An essential role are shearing and friction forces between skin and wound dressing playing. This problem includes missing elasticity, flexibility and too strong adhesion. A non-interventional, non-placebo-controlled, national pilot study was done to prove a new shearing force reducing technique and dressing. The used post-op dressing consists of a thin film backing with a switchable polyurethane adhesive and non-adhering absorption pad. Before removal the adhesion is reduced by illuminating the dressing with the UV-A lamp. 52 patients at a mean age of 55.79 years (SD±16.22) with a total of 52 wounds were included in the study, all of them finalized the 1-week study period. At baseline, pain was measured with a mean of 3.52 (SD±1.26), during the study period pain decreased to a mean of 2.10 (SD±0.97) (VAS 0=no pain, 10=excruciating pain). Significance was calculated as 0,000 (paired t-test). At each dressing change, pain level after dressing change was rated lower compared to the pain level before dressing change. Overall, pain level decreased over the study period. The removal of the dressing after illumination with the UV-A lamp was rated in mean with 1.79 (2. Visit) and 1.86 (3. Visit) on the 6–point-scale (1=very good – 6=insufficient). Significance was calculated as 0,000 for visit 3 (one sample t-test [test value=3,0]). Reactions on the wound edge/wound surroundings have not been reported. In contrast, a reduction of maceration and redness of the wound edge/wound surrounding was observed. The results confirm that the adhesive ensures a safe and effective occlusion/fixation of the dressing and that the strong adhesion enables dressing to function according to specification. There was no deterioration of the wound situation or an infection in any of the cases. The switchable function of the adhesive allows the adhesion of the post-op dressing to the skin to be reduced when illuminated by the supplied UV-A lamp. The results of the present study show that the reduced adhesion upon illumination enables easy and comfortable removal of the dressing.
{"title":"Pilot-Study Lumina Switchable Post-Op Dressing & Postsurgical Wounds: A Non-interventional, Non-placebo-controlled, National Pilot Study","authors":"M. Schmitz, S. Rogmans, S. Kasparek, N. Mustafi","doi":"10.11648/J.JS.20200805.12","DOIUrl":"https://doi.org/10.11648/J.JS.20200805.12","url":null,"abstract":"Dressings applied to primarily closed surgical incisions should be appropriate interactive dressing [13] and demonstrate an ability to protect the wound from contaminants and trauma, manage exudate, and avoid excessive pressure to the incision line. Additionally, they should be flexible, well fixed to the skin on application, skin protective (e.g. reduce the risk of blistering or irritation, not excessively adhesive) and waterproof [14]. Film dressings were one of the first modern wound-dressing products. They are extremely flexible, transparent and adhesive. During the removal of the dressing skin stress occurs. An essential role are shearing and friction forces between skin and wound dressing playing. This problem includes missing elasticity, flexibility and too strong adhesion. A non-interventional, non-placebo-controlled, national pilot study was done to prove a new shearing force reducing technique and dressing. The used post-op dressing consists of a thin film backing with a switchable polyurethane adhesive and non-adhering absorption pad. Before removal the adhesion is reduced by illuminating the dressing with the UV-A lamp. 52 patients at a mean age of 55.79 years (SD±16.22) with a total of 52 wounds were included in the study, all of them finalized the 1-week study period. At baseline, pain was measured with a mean of 3.52 (SD±1.26), during the study period pain decreased to a mean of 2.10 (SD±0.97) (VAS 0=no pain, 10=excruciating pain). Significance was calculated as 0,000 (paired t-test). At each dressing change, pain level after dressing change was rated lower compared to the pain level before dressing change. Overall, pain level decreased over the study period. The removal of the dressing after illumination with the UV-A lamp was rated in mean with 1.79 (2. Visit) and 1.86 (3. Visit) on the 6–point-scale (1=very good – 6=insufficient). Significance was calculated as 0,000 for visit 3 (one sample t-test [test value=3,0]). Reactions on the wound edge/wound surroundings have not been reported. In contrast, a reduction of maceration and redness of the wound edge/wound surrounding was observed. The results confirm that the adhesive ensures a safe and effective occlusion/fixation of the dressing and that the strong adhesion enables dressing to function according to specification. There was no deterioration of the wound situation or an infection in any of the cases. The switchable function of the adhesive allows the adhesion of the post-op dressing to the skin to be reduced when illuminated by the supplied UV-A lamp. The results of the present study show that the reduced adhesion upon illumination enables easy and comfortable removal of the dressing.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73011361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-04DOI: 10.11648/J.JS.20200805.13
Omar Atef Elekiabi, E. Oraby, M. Zaitoun, Abdelwahab Saleh Almoregy
Background: Surgical intervention is mostly needed in many cases of undescended testis to improve fertility; it is still unsure which approach is better than the other in management of undescended testicle in infants; classic inguinal approach or scrotal single incision approach. Aim of the current study was to compare between classic inguinal approach and scrotal single incision approach to perform orchiopexy for management of un-descended testis in infants and to clarify which is better; inguinal orchidopexy or scrotal orchidopexy. Patients and methods: we included forty male patients with undescended testis who were divided into two groups; group A included twenty patients and they were surgically managed with single trans-scrotal orchiopexy and group B included twenty patients and they were surgically managed with classic inguinal approach by two incisions (inguinal and scrotal). We assessed operative time and complications as wound infection, recurrence and testicular atrophy. Results: Operative time in group A was shorter than the operative time of group B which was managed by the inguinal approach (p=0.004). Immediate post-operative complications as; skin site infection, hematoma and edema, in group A were slightly more than the complications in group B (p=0.002). group A showed no recurrence or testicular atrophy after six months while group B showed 2 cases of recurrence and one case of testicular atrophy (p=0.005). At three months after surgery, cosmetic results and patients satisfaction of the incision scar was higher in group A than group B (p<0.001). Conclusions: performing orchiopexy through single scrotal incision approach is better than the approach of inguinal incision regarding operative time, rabid healing time, parents’ satisfaction, fewer long-term complications, less incidence of testicular atrophy and recurrence.
{"title":"Surgical Management of Undescended Testis in Infants, Single Scrotal Incision Orchiopexy Versus Traditional Inguinal Approach: A Comparative Study","authors":"Omar Atef Elekiabi, E. Oraby, M. Zaitoun, Abdelwahab Saleh Almoregy","doi":"10.11648/J.JS.20200805.13","DOIUrl":"https://doi.org/10.11648/J.JS.20200805.13","url":null,"abstract":"Background: Surgical intervention is mostly needed in many cases of undescended testis to improve fertility; it is still unsure which approach is better than the other in management of undescended testicle in infants; classic inguinal approach or scrotal single incision approach. Aim of the current study was to compare between classic inguinal approach and scrotal single incision approach to perform orchiopexy for management of un-descended testis in infants and to clarify which is better; inguinal orchidopexy or scrotal orchidopexy. Patients and methods: we included forty male patients with undescended testis who were divided into two groups; group A included twenty patients and they were surgically managed with single trans-scrotal orchiopexy and group B included twenty patients and they were surgically managed with classic inguinal approach by two incisions (inguinal and scrotal). We assessed operative time and complications as wound infection, recurrence and testicular atrophy. Results: Operative time in group A was shorter than the operative time of group B which was managed by the inguinal approach (p=0.004). Immediate post-operative complications as; skin site infection, hematoma and edema, in group A were slightly more than the complications in group B (p=0.002). group A showed no recurrence or testicular atrophy after six months while group B showed 2 cases of recurrence and one case of testicular atrophy (p=0.005). At three months after surgery, cosmetic results and patients satisfaction of the incision scar was higher in group A than group B (p<0.001). Conclusions: performing orchiopexy through single scrotal incision approach is better than the approach of inguinal incision regarding operative time, rabid healing time, parents’ satisfaction, fewer long-term complications, less incidence of testicular atrophy and recurrence.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87714283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.11648/J.JS.20200805.11
Kadhaya David Muballe, Sewani Constance Rusike, B. Longo-Mbenza, J. Iputo
Traumatic brain injury is a global health problem, it is a major cause of devastating neurological sequelae and significant mortality. The underlying physiological events in traumatic brain injury are responsible for the poor clinical outcomes seen in patients. Inflammatory and oxidative stress changes in traumatic brain injury result in the release of inflammatory biomarkers, a reduction in the endogenous anti-oxidants and dysfunction of the blood brain barrier. An understanding of the natural history of oxidative stress and inflammatory changes in traumatic brain injury can help design appropriate management protocols to reduce mortality and morbidity in these patients. Aim of the study: The aim of this study was to identify potential biomarkers that are predictive of fatality in patients with moderate to severe traumatic brain injury. Methods: This was a prospective study of patients with moderate to severe traumatic brain injury managed at the Nelson Mandela Academic Hospital during the period March 2014 - March 2016. Following admission and management, the patient demographics (sex, age) and admission Glasgow Coma Score were recorded. Oxidative stress and inflammatory biomarkers in blood and cerebrospinal fluid where sampled on day 1 to 7. On day 14 only blood was sampled for the same biomarkers. The primary outcome was the Glasgow Outcome score assessed on day 90. Due to its simplicity the Glasgow Outcome scale was used to assess clinical outcomes at day 90. Because of difficulty in regular follow up due to the vastness of our region, difficult terrain and long travel distances a 3 month follow up period was used to avoid default. Results: Of the 64-patient’s, fatality was noted in 12.5% of them. There was a significant association between fatality and the; ages of the patients, anti-oxidant levels, proinflammatory biomarkers and admission Glasgow Coma Score. Conclusion: The admission Glasgow Coma Score, low anti-oxidant levels and elevated serum interleukin-1β levels were associated with fatal outcomes.
{"title":"Clinical and Biochemical Predictors of Fatality in Traumatic Brain Injury","authors":"Kadhaya David Muballe, Sewani Constance Rusike, B. Longo-Mbenza, J. Iputo","doi":"10.11648/J.JS.20200805.11","DOIUrl":"https://doi.org/10.11648/J.JS.20200805.11","url":null,"abstract":"Traumatic brain injury is a global health problem, it is a major cause of devastating neurological sequelae and significant mortality. The underlying physiological events in traumatic brain injury are responsible for the poor clinical outcomes seen in patients. Inflammatory and oxidative stress changes in traumatic brain injury result in the release of inflammatory biomarkers, a reduction in the endogenous anti-oxidants and dysfunction of the blood brain barrier. An understanding of the natural history of oxidative stress and inflammatory changes in traumatic brain injury can help design appropriate management protocols to reduce mortality and morbidity in these patients. Aim of the study: The aim of this study was to identify potential biomarkers that are predictive of fatality in patients with moderate to severe traumatic brain injury. Methods: This was a prospective study of patients with moderate to severe traumatic brain injury managed at the Nelson Mandela Academic Hospital during the period March 2014 - March 2016. Following admission and management, the patient demographics (sex, age) and admission Glasgow Coma Score were recorded. Oxidative stress and inflammatory biomarkers in blood and cerebrospinal fluid where sampled on day 1 to 7. On day 14 only blood was sampled for the same biomarkers. The primary outcome was the Glasgow Outcome score assessed on day 90. Due to its simplicity the Glasgow Outcome scale was used to assess clinical outcomes at day 90. Because of difficulty in regular follow up due to the vastness of our region, difficult terrain and long travel distances a 3 month follow up period was used to avoid default. Results: Of the 64-patient’s, fatality was noted in 12.5% of them. There was a significant association between fatality and the; ages of the patients, anti-oxidant levels, proinflammatory biomarkers and admission Glasgow Coma Score. Conclusion: The admission Glasgow Coma Score, low anti-oxidant levels and elevated serum interleukin-1β levels were associated with fatal outcomes.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86769159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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