Pub Date : 2018-01-01DOI: 10.5455/ACES.20180214092804
F. Sobrón, B. Alonso, J. Argüello
Objective: We report the case of a 14-year-old girl that presented chronic osteomyelitis with extrusion of the proximal phalanx, after a traumatic event three months before, in the rural setting of Djoum, Cameroon. Massive defects of the proximal phalanx of the thumb are uncommon, mostly associated with traumatic amputations or tumors. The aim of this study is to describe our experience in the management of this injury in a low resource center and its mid-term clinical results. Methods: The presence of an active infection and the lack of technological support determined our treatment choice. Extensive debridement, metacarpophalangeal arthrodesis with 2 Kirschner wires and first web space deepening were performed. Rifampicin and trimethoprim-sulfamethoxazole were prescribed empirically for four months. Results: At 6-month-following-up the patient was pain-free. Complete arthrodesis of the distal phalanx and first metacarpal was confirmed in clinical assessment. The thumb was slightly pronated, and it permitted good opposability against second, third and fourth fingers. The sensitivity of the thumb tip kept intact. The overall function was rather good, with a QuickDASH score of 18 at the two-year follow-up visit. She was satisfied with final pinch ability and had returned to her normal activities. Conclusions: We suggest that in a disadvantaged rural environment, metacarpophalangeal arthrodesis associated to first web space deepening may be a reliable treatment for a massive defect of the proximal phalanx of the thumb due to chronic osteomyelitis achieving a satisfactory hand function.
{"title":"Management of thumb chronic osteomyelitis with extrusion of the proximal phalanx in a low-resource setting","authors":"F. Sobrón, B. Alonso, J. Argüello","doi":"10.5455/ACES.20180214092804","DOIUrl":"https://doi.org/10.5455/ACES.20180214092804","url":null,"abstract":"Objective: We report the case of a 14-year-old girl that presented chronic osteomyelitis with extrusion of the proximal phalanx, after a traumatic event three months before, in the rural setting of Djoum, Cameroon. Massive defects of the proximal phalanx of the thumb are uncommon, mostly associated with traumatic amputations or tumors. The aim of this study is to describe our experience in the management of this injury in a low resource center and its mid-term clinical results. Methods: The presence of an active infection and the lack of technological support determined our treatment choice. Extensive debridement, metacarpophalangeal arthrodesis with 2 Kirschner wires and first web space deepening were performed. Rifampicin and trimethoprim-sulfamethoxazole were prescribed empirically for four months. Results: At 6-month-following-up the patient was pain-free. Complete arthrodesis of the distal phalanx and first metacarpal was confirmed in clinical assessment. The thumb was slightly pronated, and it permitted good opposability against second, third and fourth fingers. The sensitivity of the thumb tip kept intact. The overall function was rather good, with a QuickDASH score of 18 at the two-year follow-up visit. She was satisfied with final pinch ability and had returned to her normal activities. Conclusions: We suggest that in a disadvantaged rural environment, metacarpophalangeal arthrodesis associated to first web space deepening may be a reliable treatment for a massive defect of the proximal phalanx of the thumb due to chronic osteomyelitis achieving a satisfactory hand function.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"7 1","pages":"128-132"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766703","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 : 2018-01-01DOI: 10.5455/aces.20180315104111
H. Fayed, D. Allah, Galal AbuElnagah, A. Hasan
Objective: Breast cancer is considered the most common cancer among females. Breast-conserving therapy (BCT) is the preferred treatment option for females presented by early breast cancer. BCT is equivalent to modified radical mastectomy as regarding the overall survival. Intraoperative assessment of the lumpectomy margins is required, the best methods are frozen section (FS) and imprint cytology (IC). Methods: This study was conducted on 40 female patients admitted to the Surgical Oncology Unit, Alexandria Main University Hospital in 2017, who were eligible for BCT. Excised specimens of breast conservation surgery were sent to the pathologist for both IC and FS to assess safety margins. The study compared results of IC for the 259 margins with the results of paraffin section for the same number of margins. Results: Sensitivity of IC was 91.35%, and its specificity was 95%. The overall accuracy rate for this method was 94.21%. The sensitivity of FS was 96.91%, and its specificity was 94%. The overall accuracy rate for this method was 94.59%. Conclusion: Breast conservation therapy must be done in the presence of intraoperative safety margin assessment to improve survival and prevent recurrence. Imprint cytology is a fast and accurate method for intraoperative margin assessment in breast cancer.
{"title":"A faster technique for intraoperative assessment of resection margins in breast cancer","authors":"H. Fayed, D. Allah, Galal AbuElnagah, A. Hasan","doi":"10.5455/aces.20180315104111","DOIUrl":"https://doi.org/10.5455/aces.20180315104111","url":null,"abstract":"Objective: Breast cancer is considered the most common cancer among females. Breast-conserving therapy (BCT) is the preferred treatment option for females presented by early breast cancer. BCT is equivalent to modified radical mastectomy as regarding the overall survival. Intraoperative assessment of the lumpectomy margins is required, the best methods are frozen section (FS) and imprint cytology (IC). Methods: This study was conducted on 40 female patients admitted to the Surgical Oncology Unit, Alexandria Main University Hospital in 2017, who were eligible for BCT. Excised specimens of breast conservation surgery were sent to the pathologist for both IC and FS to assess safety margins. The study compared results of IC for the 259 margins with the results of paraffin section for the same number of margins. Results: Sensitivity of IC was 91.35%, and its specificity was 95%. The overall accuracy rate for this method was 94.21%. The sensitivity of FS was 96.91%, and its specificity was 94%. The overall accuracy rate for this method was 94.59%. Conclusion: Breast conservation therapy must be done in the presence of intraoperative safety margin assessment to improve survival and prevent recurrence. Imprint cytology is a fast and accurate method for intraoperative margin assessment in breast cancer.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"69 1","pages":"159-165"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766922","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 : 2018-01-01DOI: 10.5455/ACES.20170503081251
Chaitsi Jani, Pukur I. Thekdi, Vijay Thakore
Objective: Intermittent claudication is one of the symptoms of painful Peripheral Arterial Disease (PAD) in which walk ing was conventionally used treatment, though forcing patients with PAD to walk with increasing pain is challenging. The purpose of the study was to compare the effect of upper body strength training exercise vs. treadmill walking on intermittent claudication through which an alternative, effective and pain free protocol could be implemented in the clinical settings. Methods: In this study fifty four patients were enrolled in two groups through convenience sampling. Data were collected for 18 patients in Group A (upper body strength training) and 16 in group B (treadmill walking) for analysis. Independent t test was used for inter group comparison and ANOVA for intra group comparison of Ankle Brachial Index (ABI), Pain Free Walking Distance (PFWD), Maximum Walking Distance (MWD), Heart Rate (HR) and Walking Impairment Questionnaire (WIQ) (p< 0.05). Results: Comparison of both groups for PFWD, HR and WIQ were shown significant difference during post and follow up values while no apparent changes were noted in MWD and ABI. p values for pre-post and pre-follow up phases for all outcome measures except ABI were <0.05 indicated statistical significance. Conclusions: Upper body strength training and treadmill walking both forms of exercise appears to be an effective for improving PFWD, HR and WIQ in intermittent claudication. However, upper body strength training is the primary choice in patients unable to complete treadmill walking training.
{"title":"A comparative study of upper body strength training exercise vs. treadmill walking on patients with intermittent claudication","authors":"Chaitsi Jani, Pukur I. Thekdi, Vijay Thakore","doi":"10.5455/ACES.20170503081251","DOIUrl":"https://doi.org/10.5455/ACES.20170503081251","url":null,"abstract":"Objective: Intermittent claudication is one of the symptoms of painful Peripheral Arterial Disease (PAD) in which walk ing was conventionally used treatment, though forcing patients with PAD to walk with increasing pain is challenging. The purpose of the study was to compare the effect of upper body strength training exercise vs. treadmill walking on intermittent claudication through which an alternative, effective and pain free protocol could be implemented in the clinical settings. Methods: In this study fifty four patients were enrolled in two groups through convenience sampling. Data were collected for 18 patients in Group A (upper body strength training) and 16 in group B (treadmill walking) for analysis. Independent t test was used for inter group comparison and ANOVA for intra group comparison of Ankle Brachial Index (ABI), Pain Free Walking Distance (PFWD), Maximum Walking Distance (MWD), Heart Rate (HR) and Walking Impairment Questionnaire (WIQ) (p< 0.05). Results: Comparison of both groups for PFWD, HR and WIQ were shown significant difference during post and follow up values while no apparent changes were noted in MWD and ABI. p values for pre-post and pre-follow up phases for all outcome measures except ABI were <0.05 indicated statistical significance. Conclusions: Upper body strength training and treadmill walking both forms of exercise appears to be an effective for improving PFWD, HR and WIQ in intermittent claudication. However, upper body strength training is the primary choice in patients unable to complete treadmill walking training.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"7 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766111","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 : 2018-01-01DOI: 10.5455/aces.20170227101620
C. Çokluk
Aims: The modeling of the surgical steps with creating a suitable laboratory models is critically important issue in the successful gaining of microneurosurgical practice. In this experimental study, a laboratory-training model was created for microneurosurgical drilling of delicate and thin cranial base bones using walnut shell in the repetitive repeating of experimental microsurgical training technique. Materials and Methods: All steps of this study were performed under the operating microscope. Twenty-five walnut shells were used for this experimental feasibility study. The difficulty and suitability of the model were evaluated in terms of the usability in the training of microneurosurgical microdrilling. Difficulty of the procedure was divided into three degrees (very easy, easy, and difficult). The objective criterion for the evaluation of the difficulty of the procedure was the protection of the interior organic material during the procedure. The suitability of the procedure was also evaluated within three groups, bad, good, and perfect. Results: In three (12%) walnut shells, the microdrilling was evaluated as difficult. The microdrilling procedures of the twelve (48%) walnut shells were evaluated as easy procedure. Microdrilling procedure of the remaining ten (40%) of the walnut shells was evaluated as very easy. The suitability of the model was evaluated as bad in two (8%) of the walnut shells. The suitability was found as good in 17 (68%) of the walnut shells. In microdrilling of the remaining six (24%) of the walnut shells, the suitability of the model was evaluated as perfect. Conclusion: Microsurgical drilling of the walnut shells without any interior organic injury is accepted as the indication of the successful surgical microdrilling process. Consolidation of the surgical practice in a laboratory setting, grasping, and using of microsurgical instruments can be repeated several times in this model. We believe that this model will contribute to the practical training of microneurosurgery.
{"title":"Using walnut shell in the microdrilling training model","authors":"C. Çokluk","doi":"10.5455/aces.20170227101620","DOIUrl":"https://doi.org/10.5455/aces.20170227101620","url":null,"abstract":"Aims: The modeling of the surgical steps with creating a suitable laboratory models is critically important issue in the successful gaining of microneurosurgical practice. In this experimental study, a laboratory-training model was created for microneurosurgical drilling of delicate and thin cranial base bones using walnut shell in the repetitive repeating of experimental microsurgical training technique. Materials and Methods: All steps of this study were performed under the operating microscope. Twenty-five walnut shells were used for this experimental feasibility study. The difficulty and suitability of the model were evaluated in terms of the usability in the training of microneurosurgical microdrilling. Difficulty of the procedure was divided into three degrees (very easy, easy, and difficult). The objective criterion for the evaluation of the difficulty of the procedure was the protection of the interior organic material during the procedure. The suitability of the procedure was also evaluated within three groups, bad, good, and perfect. Results: In three (12%) walnut shells, the microdrilling was evaluated as difficult. The microdrilling procedures of the twelve (48%) walnut shells were evaluated as easy procedure. Microdrilling procedure of the remaining ten (40%) of the walnut shells was evaluated as very easy. The suitability of the model was evaluated as bad in two (8%) of the walnut shells. The suitability was found as good in 17 (68%) of the walnut shells. In microdrilling of the remaining six (24%) of the walnut shells, the suitability of the model was evaluated as perfect. Conclusion: Microsurgical drilling of the walnut shells without any interior organic injury is accepted as the indication of the successful surgical microdrilling process. Consolidation of the surgical practice in a laboratory setting, grasping, and using of microsurgical instruments can be repeated several times in this model. We believe that this model will contribute to the practical training of microneurosurgery.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"6 1","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766396","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 : 2018-01-01DOI: 10.5455/aces.20170919114215
J. Aguirre, Hanna Ruiz-Niño, M. M. Medina, J. Caballero, J. Pereira
Giant inguinoscrotal hernias are rare surgical entities, generally seen in developing countries, and pose a challenge to surgeons trying to repair this hernial defect. Therefore, to facilitate the surgical procedure, a progressive pneumoperitoneum technique before surgery has been proposed. Here we describe the case of a 43-year-old male patient who presented to the outpatient surgery office with a giant inguinoscrotal hernia, which had been growing for 11 years and was not associated with any discomfort other than a difficulty in walking. During hospitalization, preoperative progressive pneumoperitoneum generation technique was performed, and intra-abdominal pressure levels were monitored for seven days. Surgical right inguinal hernia repair was performed using the Stoppa technique, exposing a large defect on the posterior wall of the right inguinal canal where the greater omentum bulged out. There was also evidence of small intestine loops and right colon lodged in the scrotum. The hernia sac was reduced and cut with relative ease; the defect was repaired using a mesh implant covering the full area of the Fruchaud’s myopectineal orifice defect in the preperitoneal space, closing the cavity layer by layer until reaching the skin. The patient had a postoperative period with no complications and was discharged on the fifth day.
{"title":"Case report: Preoperative progressive pneumoperitoneum in giant inguinoscrotal hernia -","authors":"J. Aguirre, Hanna Ruiz-Niño, M. M. Medina, J. Caballero, J. Pereira","doi":"10.5455/aces.20170919114215","DOIUrl":"https://doi.org/10.5455/aces.20170919114215","url":null,"abstract":"Giant inguinoscrotal hernias are rare surgical entities, generally seen in developing countries, and pose a challenge to surgeons trying to repair this hernial defect. Therefore, to facilitate the surgical procedure, a progressive pneumoperitoneum technique before surgery has been proposed. Here we describe the case of a 43-year-old male patient who presented to the outpatient surgery office with a giant inguinoscrotal hernia, which had been growing for 11 years and was not associated with any discomfort other than a difficulty in walking. During hospitalization, preoperative progressive pneumoperitoneum generation technique was performed, and intra-abdominal pressure levels were monitored for seven days. Surgical right inguinal hernia repair was performed using the Stoppa technique, exposing a large defect on the posterior wall of the right inguinal canal where the greater omentum bulged out. There was also evidence of small intestine loops and right colon lodged in the scrotum. The hernia sac was reduced and cut with relative ease; the defect was repaired using a mesh implant covering the full area of the Fruchaud’s myopectineal orifice defect in the preperitoneal space, closing the cavity layer by layer until reaching the skin. The patient had a postoperative period with no complications and was discharged on the fifth day.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"7 1","pages":"84-88"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766426","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 : 2018-01-01DOI: 10.5455/aces.20170921120541
I. López-Torres, J. Calvo-Haro, L. Mediavilla-Santos, Ruben PerezMaanes, M. Cuervo-Dehesa, J. Vaquero
Background: The number of publications reporting the appearance of post-radiation secondary tumors has increased in parallel with the development of radiotherapy. However, little information is available about the presence of sarcomas associated with prostate radiotherapy. Objective: To review cases of pelvic sarcoma associated with prostate radiotherapy in a tertiary hospital. Methods: Following the criteria established by Cahan, 11 pelvic sarcoma patients with a history of radiotherapy treatment of prostatic adenocarcinoma between the years 2006 to 2016 were identified. A descriptive study was designed to review the characteristics of patients, tumors, therapy administered, and its effect on the outcome of the cancer. Results: The average age of patients upon diagnosis was 72.27 years (60-79), with an average latency time of 6.27 years (4-9 years) between radiotherapy and diagnosis of sarcoma. The mean radiotherapy dose was 74Gy (70-78). The most common location of the sarcoma was regions II-III of the pelvic girdle (72%), followed by the pelvic cavity. The main histological type was undifferentiated pleomorphic sarcoma (54%); two patients presented metastases at the time of diagnosis. In total, 81.8% of patients were treated surgically with curative intent, and of these, seven received adjuvant chemotherapy. Mean follow-up was 14 months, with a two-year survival rate of 18.2%. Conclusion: Given the poor prognosis of post-radiation pelvic sarcomas, efforts must be made to establish protocols for early diagnosis and to develop aggressive, standardized treatment guidelines.
{"title":"Post-radiation pelvic sarcomas after radiotherapy treatment of prostate adenocarcinoma -","authors":"I. López-Torres, J. Calvo-Haro, L. Mediavilla-Santos, Ruben PerezMaanes, M. Cuervo-Dehesa, J. Vaquero","doi":"10.5455/aces.20170921120541","DOIUrl":"https://doi.org/10.5455/aces.20170921120541","url":null,"abstract":"Background: The number of publications reporting the appearance of post-radiation secondary tumors has increased in parallel with the development of radiotherapy. However, little information is available about the presence of sarcomas associated with prostate radiotherapy. Objective: To review cases of pelvic sarcoma associated with prostate radiotherapy in a tertiary hospital. Methods: Following the criteria established by Cahan, 11 pelvic sarcoma patients with a history of radiotherapy treatment of prostatic adenocarcinoma between the years 2006 to 2016 were identified. A descriptive study was designed to review the characteristics of patients, tumors, therapy administered, and its effect on the outcome of the cancer. Results: The average age of patients upon diagnosis was 72.27 years (60-79), with an average latency time of 6.27 years (4-9 years) between radiotherapy and diagnosis of sarcoma. The mean radiotherapy dose was 74Gy (70-78). The most common location of the sarcoma was regions II-III of the pelvic girdle (72%), followed by the pelvic cavity. The main histological type was undifferentiated pleomorphic sarcoma (54%); two patients presented metastases at the time of diagnosis. In total, 81.8% of patients were treated surgically with curative intent, and of these, seven received adjuvant chemotherapy. Mean follow-up was 14 months, with a two-year survival rate of 18.2%. Conclusion: Given the poor prognosis of post-radiation pelvic sarcomas, efforts must be made to establish protocols for early diagnosis and to develop aggressive, standardized treatment guidelines.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"7 1","pages":"94-99"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766444","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 : 2018-01-01DOI: 10.5455/ACES.20170816073935
C. Mesina, T. Dumitrescu, C. Obleagă, D. Ciobanu
Objective: The aim of this study was to evaluate the characteristics of colonic ischemia and to highlight predictive factors for ischemic colitis gangrenous type Methods: We performed a retrospective study of 20 patients with ischemic colitis, whose diagnosis was confirmed in the anatomo-pathological examination during 2010-2015. Patients with ischemic colitis were divided into two groups: severe ischemic colitis with transmural colonic ischemia and/or multi-organ failure (irreversible type – gangrenous colitis) and moderate ischemic colitis without multi-organ failure (reversible type). Results: Irreversible ischemic colitis (gangrenous ischemic type) was found in five patients. All patients with ischemic colitis gangrenous type underwent colectomy with primary anastomosis in two cases and total colectomy with ileostomy in three cases. Two patients died postoperatively (these were patients with pancolitis) because of multi-organ failure. Conclusion: The analysis of this cases indicated four factors predictive of severe ischemic colitis (gangrenous type): abdominal tenderness, absence of hematochezia, absence of diarrhea, and hypoalbuminemia. Total colectomy with ileos tomy was the prefered surgical option.
{"title":"Ischemic colitis problems of diagnosis and treatment","authors":"C. Mesina, T. Dumitrescu, C. Obleagă, D. Ciobanu","doi":"10.5455/ACES.20170816073935","DOIUrl":"https://doi.org/10.5455/ACES.20170816073935","url":null,"abstract":"Objective: The aim of this study was to evaluate the characteristics of colonic ischemia and to highlight predictive factors for ischemic colitis gangrenous type Methods: We performed a retrospective study of 20 patients with ischemic colitis, whose diagnosis was confirmed in the anatomo-pathological examination during 2010-2015. Patients with ischemic colitis were divided into two groups: severe ischemic colitis with transmural colonic ischemia and/or multi-organ failure (irreversible type – gangrenous colitis) and moderate ischemic colitis without multi-organ failure (reversible type). Results: Irreversible ischemic colitis (gangrenous ischemic type) was found in five patients. All patients with ischemic colitis gangrenous type underwent colectomy with primary anastomosis in two cases and total colectomy with ileostomy in three cases. Two patients died postoperatively (these were patients with pancolitis) because of multi-organ failure. Conclusion: The analysis of this cases indicated four factors predictive of severe ischemic colitis (gangrenous type): abdominal tenderness, absence of hematochezia, absence of diarrhea, and hypoalbuminemia. Total colectomy with ileos tomy was the prefered surgical option.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"7 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766734","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 : 2018-01-01DOI: 10.5455/ACES.20171128090019
S. Nitecki, Liad Yosef, M. Tozzi, R. Shofti
Objective: Despite significant advances in the understanding of vein graft remodeling during the post-implantation, vein graft disease is still a major limitation of surgical revascularization. The study objective was to evaluate the performance of a new cobalt chrome external support device designed to mitigate vein graft remodeling and development of intimal hyperplasia. Methods: Bilateral carotid interposition of reversed saphenous vein graft segments was performed in seven adult sheep. Following completion of the first anastomosis, randomization was performed to allocate the experimental and control grafts in each animal. Post-procedure, Doppler US was used to assess grafts lumen diameter at T0 and then 3-5 and 12-14 weeks after surgery. At 12-14 weeks, all sheep underwent angiography to assess grafts patency and lumen uniformity (coefficient of variance - CV) after which they were sacrificed, and all grafts were harvested for microscopic histological analysis. Results: Baseline (T0) internal diameter was not significantly different between the supported and unsupported grafts. At twelve to fourteen weeks, the internal diameter of supported grafts remained unchanged and was significantly lower compared to the non-supported grafts (6.6mm±0.4mm vs. 12.8mm±4.0mm respectively, p= 0.0001). Percentage coefficient of variance (%CV) was 4.6%±4.3 in the supported grafts as opposed to average CV% of 14.7%±6.5 in the non-stented group (p=0.011). Neointimal area was significantly lower in the stented compared to the non-stented group (1.4 mm2±3.3mm2 versus 9.6mm2±9.7mm2 respectively, p=0.009). Conclusions: External support of vein grafts using a braided cobalt chrome external stent reduces early vein graft remodeling and mitigates the development of neointimal hyperplasia.
{"title":"Inhibition of vein graft remodeling and neo-intimal formation using a cobalt chrome external support","authors":"S. Nitecki, Liad Yosef, M. Tozzi, R. Shofti","doi":"10.5455/ACES.20171128090019","DOIUrl":"https://doi.org/10.5455/ACES.20171128090019","url":null,"abstract":"Objective: Despite significant advances in the understanding of vein graft remodeling during the post-implantation, vein graft disease is still a major limitation of surgical revascularization. The study objective was to evaluate the performance of a new cobalt chrome external support device designed to mitigate vein graft remodeling and development of intimal hyperplasia. Methods: Bilateral carotid interposition of reversed saphenous vein graft segments was performed in seven adult sheep. Following completion of the first anastomosis, randomization was performed to allocate the experimental and control grafts in each animal. Post-procedure, Doppler US was used to assess grafts lumen diameter at T0 and then 3-5 and 12-14 weeks after surgery. At 12-14 weeks, all sheep underwent angiography to assess grafts patency and lumen uniformity (coefficient of variance - CV) after which they were sacrificed, and all grafts were harvested for microscopic histological analysis. Results: Baseline (T0) internal diameter was not significantly different between the supported and unsupported grafts. At twelve to fourteen weeks, the internal diameter of supported grafts remained unchanged and was significantly lower compared to the non-supported grafts (6.6mm±0.4mm vs. 12.8mm±4.0mm respectively, p= 0.0001). Percentage coefficient of variance (%CV) was 4.6%±4.3 in the supported grafts as opposed to average CV% of 14.7%±6.5 in the non-stented group (p=0.011). Neointimal area was significantly lower in the stented compared to the non-stented group (1.4 mm2±3.3mm2 versus 9.6mm2±9.7mm2 respectively, p=0.009). Conclusions: External support of vein grafts using a braided cobalt chrome external stent reduces early vein graft remodeling and mitigates the development of neointimal hyperplasia.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"7 1","pages":"108-115"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766580","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 : 2018-01-01DOI: 10.5455/ACES.20171001101706
Kshitij Manerikar, C. Patil, S. Bhatia, Gurjit Singh, H. Gawade
Introduction: Lower limb veins are most prone to having venous disorders – and varicose veins are the biggest issue. Varicose veins can be grouped into Primary or Secondary Varicose veins. Secondary Varicose veins are associated with acquired factors causing stasis and hypercoagulable state. This study addresses the various associated risk factors for secondary varicose veins such as age, sex, Body Mass Index (BMI), pregnancy, prolonged standing, tobacco use, and deep vein thrombosis history and family history of secondary varicose veins. Methods: A prospective non-randomized study of fifty patients was carried out between August 2015 and July 2016. Demographic details of all patients were recorded. Detail history and examination of both lower limbs were performed. Descriptive statistics were calculated by measuring means, standard deviation (SD), and proportions with 95% confidence interval. Results: Tobacco chewing in any form was the most common associated risk factor of secondary varicose vein in our study of 50 patients and it was observed in 46% of patients. We found that varicose veins were more common in males and it was especially predominant in the over fifty years of age. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m2. Past history of varicose veins and treatment for same was not associated significantly with varicose veins prevalence. More than two numbers of pregnancies were found in 26% females with varicose veins. Conclusion: We found that prolong standing, smoking (> 10 cigarettes/day), more than two pregnancies, and family history of deep venous thrombosis were some of the major associated risk factors for varicose veins. We couldn’t establish any strong association between previous history of deep venous thrombosis and varicose vein surgery with respect to recurrence of it. Among modifiable risk factors, tobacco chewing and smoking should be abandoned to decrease the inci dence of varicose veins.
{"title":"A study of etiology of secondary varicose veins","authors":"Kshitij Manerikar, C. Patil, S. Bhatia, Gurjit Singh, H. Gawade","doi":"10.5455/ACES.20171001101706","DOIUrl":"https://doi.org/10.5455/ACES.20171001101706","url":null,"abstract":"Introduction: Lower limb veins are most prone to having venous disorders – and varicose veins are the biggest issue. Varicose veins can be grouped into Primary or Secondary Varicose veins. Secondary Varicose veins are associated with acquired factors causing stasis and hypercoagulable state. This study addresses the various associated risk factors for secondary varicose veins such as age, sex, Body Mass Index (BMI), pregnancy, prolonged standing, tobacco use, and deep vein thrombosis history and family history of secondary varicose veins. Methods: A prospective non-randomized study of fifty patients was carried out between August 2015 and July 2016. Demographic details of all patients were recorded. Detail history and examination of both lower limbs were performed. Descriptive statistics were calculated by measuring means, standard deviation (SD), and proportions with 95% confidence interval. Results: Tobacco chewing in any form was the most common associated risk factor of secondary varicose vein in our study of 50 patients and it was observed in 46% of patients. We found that varicose veins were more common in males and it was especially predominant in the over fifty years of age. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m2. Past history of varicose veins and treatment for same was not associated significantly with varicose veins prevalence. More than two numbers of pregnancies were found in 26% females with varicose veins. Conclusion: We found that prolong standing, smoking (> 10 cigarettes/day), more than two pregnancies, and family history of deep venous thrombosis were some of the major associated risk factors for varicose veins. We couldn’t establish any strong association between previous history of deep venous thrombosis and varicose vein surgery with respect to recurrence of it. Among modifiable risk factors, tobacco chewing and smoking should be abandoned to decrease the inci dence of varicose veins.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"1 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766495","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 : 2018-01-01DOI: 10.5455/ACES.20171226121513
A. Abdelkader
Breast cancer is the commonest cancer among females and considered as one of the leading causes of cancer deaths. Modified radical mastectomy (MRM) is the commonest procedure to be done for treatment of breast cancer in developing countries due to late diagnosis, and lack of screening programs. The aim of this study is to assess the importance of dead space closure technique after modified radical mastectomy as regards to; incidence of postoperative seroma, frequency of aspiration, and patient complications. Methods and patients: This study was conducted on 40 female patients admitted to the Surgical Oncology Unit, Alexandria Main University Hospital, and were indicated to MRM during a period from April 2014 to December 2015. The patients were randomly divided into two equal groups; group A (20 patients had MRM with the closure of dead space by suturing the skin flaps to the underlying muscles (quilting), and group B (20 patients had MRM with the closure of wound by the conventional method without closure of dead space. Results: Group (A) showed a significant reduction over the control group as regards to the daily drain output in the initial three postoperative days, the total amount of drained fluid and the drainage period (p=0.009, <0.001, <0.001 respectively), clinically significant seroma was observed in 22 of all patients. Group (A) showed a significant reduction in both rate and duration of seroma formation following drain removal compared to the control group. In cases of patients that develop se roma; the mean number of aspirations and the mean fluid volume aspirated were also decreased significantly in the group (A) compared to the control group. Conclusion: It was found that closure of dead space significantly reduces the total amount of drained fluid leading to early drain removal, total volume of seroma aspirated, and post-operative wound complications had been decreased.
{"title":"Closure of dead space after modified radical mastectomy: Does it reduce the incidence of seroma?","authors":"A. Abdelkader","doi":"10.5455/ACES.20171226121513","DOIUrl":"https://doi.org/10.5455/ACES.20171226121513","url":null,"abstract":"Breast cancer is the commonest cancer among females and considered as one of the leading causes of cancer deaths. Modified radical mastectomy (MRM) is the commonest procedure to be done for treatment of breast cancer in developing countries due to late diagnosis, and lack of screening programs. The aim of this study is to assess the importance of dead space closure technique after modified radical mastectomy as regards to; incidence of postoperative seroma, frequency of aspiration, and patient complications. Methods and patients: This study was conducted on 40 female patients admitted to the Surgical Oncology Unit, Alexandria Main University Hospital, and were indicated to MRM during a period from April 2014 to December 2015. The patients were randomly divided into two equal groups; group A (20 patients had MRM with the closure of dead space by suturing the skin flaps to the underlying muscles (quilting), and group B (20 patients had MRM with the closure of wound by the conventional method without closure of dead space. Results: Group (A) showed a significant reduction over the control group as regards to the daily drain output in the initial three postoperative days, the total amount of drained fluid and the drainage period (p=0.009, <0.001, <0.001 respectively), clinically significant seroma was observed in 22 of all patients. Group (A) showed a significant reduction in both rate and duration of seroma formation following drain removal compared to the control group. In cases of patients that develop se roma; the mean number of aspirations and the mean fluid volume aspirated were also decreased significantly in the group (A) compared to the control group. Conclusion: It was found that closure of dead space significantly reduces the total amount of drained fluid leading to early drain removal, total volume of seroma aspirated, and post-operative wound complications had been decreased.","PeriodicalId":30641,"journal":{"name":"Archives of Clinical and Experimental Surgery","volume":"1 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70766639","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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