Indian Journal of Surgery最新文献

Abstract

Nevus sebaceous of Jadassohn (NSJ) is an infrequent congenital epidermal cutaneous lesion that usually appears on the scalp and face. NSJ may have sex hormones-related growth, so removal in the prepubertal stage is indicated. A female newborn with no prenatal history presented with an excrescent lesion in the parietal region of the scalp at birth, measuring approximately 1 × 1 cm. She also had a nuchal capillary malformation and a small lumbar congenital hemangioma (CH). The lesion was clinically and ultrasonographically diagnosed as a CH and evolutionary surveillance was indicated. At 3 years of age, the lesion maintained a proportional size with a cerebriform, non-vascular appearance. Complete surgical excision was performed. Histopathology established the diagnosis of NSJ. In the presence of a scalp lesion present from birth, the diagnosis of NSJ should be considered. Ultrasound studies may create diagnostic confusion since the findings may be similar to those of a CH. NSJ located on the scalp may be difficult to diagnose on inspection alone.

Neuralink has successfully implanted its brain-computer interface in a human. The procedure marks a significant milestone in the history of neurosciences. The telepathy unit is roughly coin-sized, though much thicker, and fits inside a hole bored in a patient’s calvarium. It carries a processor that oversees the communications with the brain and the outside world. It communicates and charges wirelessly. The goal of the study is to assess the functionality of its wireless brain-computer interface for those with movement impairments or paralysis of all four limbs to control devices with their thoughts. If successfully pursued the technology has potential where an active brain can perform function by bypassing a diseased body or treat cases of certain brain diseases like motor neuron disease, amyotrophic lateral sclerosis, spinal cord injuries, Parkinson’s disease, epilepsy, depression, blindness, deafness, and chronic pain. An extended use could be a neural interface to amplify inherent human abilities like memory and concentration. Brain implant research has raised many questions, including whether (and where) humanity should draw the line in our integration with technology. There are issues of privacy, patient safety, and discrimination.

We present a rare instance of an elderly male self-amputating his penis due to acute urinary retention from benign prostatic hyperplasia. While cases of genital self-amputation are documented globally, there is scarcity of such reports in Indian literature, with most resembling “Classical Klingsor” syndrome seen in psychiatric cases. Our case stands out as the first reported instance linked to a common cause prevalent in elderly males. Surgeons should be vigilant about this possibility and promptly address isolated elderly patients to mitigate such occurrences.

Popliteal artery entrapment syndrome (PAES), a rare vascular developmental anomaly, occurs due to abnormal relationship between popliteal artery and the myofascial structures in the popliteal fossa. It is classically found in young, athletic, and non-smoking male. Patient may be asymptomatic or may present with claudication or rest pain. The signs and symptoms are related to either stenosis, occlusion, aneurysmal dilatation of popliteal artery or due to distal embolization. PAES is classified into six types (type I–VI) depending on relationship between popliteal artery and medial head of gastrocnemius around popliteal fossa. Diagnosis remains challenging as symptoms mimic other vascular conditions like peripheral arterial occlusive disease (PAOD), thromboangiitis obliterans (TAO), adventitial cystic disease (ACD), fibro-muscular dysplasia (FMD), small- and medium-vessel vasculitis etc. CT angiogram and MRI are the investigations of choice and surgery is considered as the mainstay of treatment. Surgery is highly rewarding and recurrence is very rare. We hereby report a case of PAES, which was mis-diagnosed and mis-treated as early onset peripheral vascular disease over a period of three years. PAES with popliteal artery occlusion was suspected clinically, confirmed on imaging and treated successfully by popliteal artery (P1-P3) reverse saphenous vein graft (RSVG) with favorable outcome.

Asia is having rapid economic growth, advancements in healthcare infrastructure and a burgeoning cadre of skilled researchers. Our bibliometric analysis is aimed at discovering the evolving trends in surgical publications across Asian nations. We accessed the SCOPUS data from the SCImago Journal & Country Rank website for analysis of quantitative (number of publications) and qualitative (citations, self-citations, citations per publications and h-index) publication metrics. The bibliometric profile of surgical publications from the Top 10 Global Nations in 2022 shows the primacy of the United States of America, followed by China, Japan, the United Kingdom and India. China and India have made large strides recently and improved their rankings. Among 31 Asian countries, China stands at the top of the ranking with the highest publications in 2022, followed by Japan and India; however, Singapore leads in citations per document and Japan in h-index. Our bibliometric study provides an analysis of the current state and trajectory of surgical research in Asian countries.

Gastroparesis is a common motor disorder of the upper gastrointestinal tract. Surgical management presents a challenge, particularly in regions lacking proprietary data or experience with surgical approaches to this condition. This study aimed to compare surgical outcomes of patients undergoing gastric bypass vs. pyloroplasty for refractory gastroparesis, for the first time in Colombia. A longitudinal study was conducted on 16 patients with refractory gastroparesis undergoing pyloroplasty or laparoscopic gastric bypass at a tertiary referral center in Colombia between January 2018 and December 2020. Ten (62.5%) patients underwent gastric bypass, and 93.8% were women. Surgical time was significantly shorter with pyloroplasty (p = 0.001), as well as time to symptom resolution (50% vs. 30% within the first 24 h, and 100% vs. 70% at 15 days). The preoperative and postoperative mean body mass index (BMI) was 29.7 (21.3—33.4) and 23.1 (20.9—25.4), respectively. Both groups were similar in all analyzed characteristics except for a higher BMI in the gastric bypass group (p = 0.01). Gastric bypass resulted in a reduction of approximately 20% of the baseline BMI value, compared to 5% with pyloroplasty. This study found that both techniques were feasible and safe for surgical treatment of refractory gastroparesis. Gastric bypass may be preferred for obese patients due to greater weight loss, which could impact additional outcomes.

Dr. Lalit Mohan Banerjee had the distinction of being the first Professor of Surgery in India. He was also one of the founders of the Association of Surgeons of India and served as the third President of the Association of Surgeons of India during 1941–42. He was the first medical professional awardee of MS Surgery degree from the University of Calcutta and one of the earliest surgeons to receive the Padma Bhushan award from the Government of India. He was also nominated as the personal surgeon of the President of India. He had the opportunity to perform surgery on the Nobel laureate Rabindranath Tagore and the famous Bengali novelist Sarat Chandra Chatterjee.

Kienbock’s disease refers is avascular necrosis of lunate bone also called lunato malacia. It is a rare disease with a prevalence of about 0.0066% Golay [1]. The disease was first described by Austrian radiologist Kienbock in 1910 Wagner and Chung [2]. The disorder usually limits wrist movements may cause pain-swelling in the wrist and is rarely seen in both wrists. It most commonly affects men between the ages of 20 to 40 years [3, 4]. The aetiology of the disease is not very clear but main factors which can be attributed are:- trauma, uneven bones in forearm, irregular lunate bone, underlying medical condition like lupus, sickle cell anaemia and cerebral palsy.

Breast conservation surgery is the standard of care for patients with early breast cancer. Although most surgeons perform oncoplasty for closure of defect, there is no randomised evidence for its favour as compared to simple closure of breast defect. We compared the cosmetic outcomes of patients treated by oncoplasty versus simple closure with 1-cm vs. 2-cm margin of excision. One hundred and four patients with breast cancer were randomised to four groups: excision with 1-cm margin with simple closure or excision with 2-cm margin with simple closure; excision with 1-cm margin and oncoplasty; and excision with 2-cm margin oncoplasty. Fifty-two patients underwent oncoplasty and 52 patients had simple closure of breast defect. There was no significant difference in the cosmetic outcomes in patients undergoing oncoplasty compared to simple closure. Excision with 2-cm margin compared to 1 cm did not worsen the cosmetic outcome. The margin positivity and re-excision rates were higher with 1-cm margin and oncoplastic closure group (p-value 0.018). There was no significant difference in complications between oncoplasty compared to simple closure, and 1-cm vs. 2-cm margin of excision. Simple closure demonstrated similar cosmesis as compared to oncoplasty.

Median arcuate ligament syndrome (MALS) and superior mesenteric artery syndrome (SMAS) are well known abdominal vascular compression syndrome, but coexistence of these is rarely described in literature. We report a patient presenting with chronic abdominal pain, occasional emesis and weight loss and was diagnosed as having coexistent MALS and SMAS. The patient underwent release of celiac artery compression with posterior gastrojejunostomy with good outcome. Coexistent MALS and SMAS is a rare entity.