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SPONTANEOUS RUPTURE OF DOUBLE J URETERAL STENT 双输尿管支架自发性破裂
Pub Date : 2020-12-26 DOI: 10.33695/JSS.V7I3.396
Abdi El Mostapha, G. Youssef, H. Hagguir, N. Saleh, Dakir Mohamed, Debbagh Adil, A. Rachid
The double J stent is widely used in urological endoscopic surgery with different indications (ureteral stenosis, ureteropelvic junction obstruction, retroperitoneal tumor or fibrosis) and can be a subject to multiple complications including migration, encrustation, stone formation and fragmentation which is a rare complication. We are reporting a rare case of a 42-years-old, followed for cervical cancer since 2018 revealed by an acute obstructive renal failure drained by a left double J ureteral stent (of long duration) and right percutaneous nephrostomy. The patient maintained the double J stent for 2 years. On clinical examination there was a lumbar tenderness on the left side and a hardened vaginal cervix on bimanual vaginal examination. The patient underwent a renovesical ultrasound showing a minimal left ureterohydronephrosis. The uroscanner with reconstruction revealed a fragmented double J stent on the left side.
双J型支架广泛应用于泌尿外科内镜手术中不同适应症(输尿管狭窄、输尿管肾盂连接处梗阻、腹膜后肿瘤或纤维化),可发生移位、结痂、结石形成、碎裂等多种并发症,属罕见并发症。我们报告了一例罕见的42岁患者,自2018年以来一直患有宫颈癌,经左双J输尿管支架(长时间)和右经皮肾造口术引流后出现急性阻塞性肾衰竭。患者维持双J型支架2年。临床检查显示左侧腰椎压痛,双阴道检查显示阴道宫颈硬化。病人接受肾脏超声检查显示轻微左侧输尿管积水。重建尿路扫描仪显示左侧双J型支架碎片化。
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引用次数: 0
3D PRINTING IN PEDIATRIC ORTHOPEDICS – THE NEW GENERATION OF PREOPERATIVE PLANNING IN THE FIELD OF PEDIATRIC ORTHOPEDICS 3d打印应用于小儿骨科——新一代小儿骨科术前规划
Pub Date : 2020-12-26 DOI: 10.33695/JSS.V7I3.390
E. Liciu, Maria Miruna Mihai, Ștefan Carp, L. Popa, C. Vreme, Vlad Costel
The evolution of modern medicine, in its continuous developing process, is highly connected with the progress achieved in the medical branch of technology. Regarding the surgical specialties, the technological progress breakthroughs may determine the appearance of new diagnosis techniques, but also shape innovative treatments, leading to superior therapeutic results. In the surgical treatment as a whole, an essential role is played by the Medical Imagistics. They either offer the much-needed visual support in order to reach an accurate diagnosis, or guide the surgeon in choosing a certain type of intervention. The importance of Imagistics is indisputable. It has also been proven so in intraoperatory guidance and monitoring the patient in post-surgery. In the evolution of medical Imagistics, after the transition to digital imaging, followed by graphic 3D reconstructions based on CT and MRI data, we find ourselves contemporary with a new turning point announcing a technological revolution: the transition from virtual 3D models to tangible 3D replica. Since the beginning, the 3D printing technology has been of great importance to the field of medical research and, once the technique gained popularity, it became a modern tool for many medical specialties, in particular for cranio-maxillofacial surgery, orthopedics, oncology, neurosurgery. The 3D printing technology managed to transgress dated barriers by facilitating the manufacturing of implants or implement new treatments in regenerative medicine. The purpose of this original paper is to present our 3D printing work protocol and general conclusions after 5 years of implementing 3D printing in pediatric orthopedics.  
现代医学在不断发展的过程中,其演变与医学技术分支的进步密切相关。对于外科专科而言,技术进步的突破不仅决定了新的诊断技术的出现,而且还塑造了创新的治疗方法,从而取得了更好的治疗效果。在整个外科治疗中,医学影像起着至关重要的作用。他们要么提供急需的视觉支持,以达到准确的诊断,要么指导外科医生选择某种类型的干预。意象学的重要性是无可争辩的。在术中指导和术后监护中也得到了证实。在医学影像学的发展过程中,经过向数字成像的过渡,随后是基于CT和MRI数据的图形3D重建,我们发现自己处于一个新的转折点,宣布了一场技术革命:从虚拟3D模型到有形3D复制品的过渡。从一开始,3D打印技术就对医学研究领域具有重要意义,一旦该技术得到普及,它就成为许多医学专业的现代工具,特别是颅颌面外科、骨科、肿瘤学、神经外科。3D打印技术通过促进植入物的制造或在再生医学中实施新的治疗方法,成功地突破了过时的障碍。这篇原创论文的目的是介绍我们在儿童骨科实施3D打印5年后的工作方案和总体结论。
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引用次数: 0
EARLY OUTCOME OF PANCREATICODUODENECTOMY IN SEPTUAGENARIANS AND OCTOGENARIANS IN NEPAL 尼泊尔七八十岁老人胰十二指肠切除术的早期预后
Pub Date : 2020-12-26 DOI: 10.33695/JSS.V7I3.392
R. Ghimire, D. Maharjan, P. Thapa
Elderly population is growing because of increasing life expectancy. Decision-making for major surgery like pancreaticoduodenectomy in this group is challenging. Therefore, we evaluated the feasibility of this procedure by comparing perioperative outcomes in Septuagenarians and Octogenarians patients. From August 2017 to December 2019, 18 consecutive patients who underwent pancreaticoduodenectomy were enrolled. These patients were divided into two groups (group1 – septuagenarians and group 2 – octogenarians). A comparative study between two groups was done regarding perioperative outcome and early complications. 18 patients were enrolled, 10 patients (55.6%) were septuagenarians (70-80 years) and 8 (44.4%) patients were Octogenarians (>80 years). There was no significant difference in the rate of surgical and medical complications between the two groups. Furthermore, there were no significant differences in risk factors, blood loss and operating time between the groups. Overall mortality in the study is 5.5%. Pancreaticoduodenectomy is feasible treatment option in septuagenarians and octogenarians with the help of multidisciplinary approach. Age alone should not be considered as decision maker for pancreaticoduodenectomy.
由于预期寿命的延长,老年人口正在增加。大手术如胰十二指肠切除术的决策是具有挑战性的。因此,我们通过比较70岁和80岁患者的围手术期结果来评估该手术的可行性。从2017年8月到2019年12月,连续入组了18例接受胰十二指肠切除术的患者。这些患者分为两组(组1 - 70岁老人和组2 - 80岁老人)。比较两组围手术期预后及早期并发症。入组患者18例,70岁(70 ~ 80岁)10例(55.6%),80岁(>80岁)8例(44.4%)。两组手术并发症和内科并发症发生率无显著差异。两组在危险因素、出血量、手术时间等方面均无显著差异。该研究的总死亡率为5.5%。胰十二指肠切除术在多学科联合治疗下,是七八十岁老人的可行治疗选择。年龄不能单独作为胰十二指肠切除术的决定因素。
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引用次数: 0
LARYNGEAL SYNOVIAL SARCOMA – A CASE REPORT 喉滑膜肉瘤1例报告
Pub Date : 2020-12-26 DOI: 10.33695/JSS.V7I3.395
A. N. Vlăescu, E. Ioniță, Andreea Nicoleta Vlăescu, F. Anghelina, I. Ioniță, C. Mogoantă, M. Ciolofan
Laryngeal synovial sarcoma is an extremely rare mesenchymal tumor. During the past four decades, literature findings revealed under 40 cases with this localization. We are bringing forward the case of a 70-year-old male patient who was referred to the ENT Clinic as a respiratory emergency – a tumor obstructing the laryngeal glottis, for which an emergency tracheotomy was initially performed, followed by a CT scan and a biopsy under general anesthesia through suspension videolaringoscopy. The histopathological report was suggestive of a biphasic synovial sarcoma. A multidisciplinary team set the surgical indication for total laryngectomy followed by chemo-radiotherapy. Long-term follow-up is mandatory for recurrence prevention. Patient has checked in for follow-up every 3 months over the past 2 years, with no macroscopic signs of tumoral relapse.
摘要喉滑膜肉瘤是一种极为罕见的间充质肿瘤。在过去的四十年中,文献发现有这种定位的病例不到40例。我们提出一个70岁的男性病人,他被转诊到耳鼻喉科作为呼吸急症——一个肿瘤阻塞喉声门,最初进行了紧急气管切开术,随后进行了CT扫描,并在全身麻醉下通过悬吊式视屏镜检进行了活检。组织病理学报告提示为双期滑膜肉瘤。一个多学科团队确定了全喉切除术后化疗的手术指征。长期随访是预防复发的必要措施。患者2年内每3个月随访一次,无肿瘤复发的宏观征象。
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引用次数: 0
The efficacy of serial physical examination in management of penetrating abdominal trauma to avoid negative laparotomy in selected cases 连续体格检查在治疗穿透性腹部创伤中避免阴性剖腹手术的效果
Pub Date : 2020-03-22 DOI: 10.3329/jss.v21i2.43901
Md Aminul Lslam, M. Bhuiyan, Razibul Haque, Kazi Majharul Islam, M. Masum, Md. Azizur Rahman
Background: Patients with Penetrating Abdominal Injury (PAI) are at risk of harboring life-threatening injuries. Many patients are in need of emergency operative intervention. However, there are some patients who can be safely managed non-operatively. Every patient with an abdominal penetrating trauma should have a thorough clinical examination. Repeating the clinical examination at regular intervals is the cornerstone of selective management, as symptoms and signs that were initially absent may appear later. Objective: To see the efficacy of serial physical examination in patients with penetrating abdominal injury thus avoiding non-therapeutic laparotomy in the overall management of patients. Methods: Convenient and purposive 60 PAI patients admitted in casualty block of Dhaka Medical College & Hospital were selected for selective non operative management (SNOM). On admission the abdominal wound was inspected and neither digital nor direct probing of the wound was attempted. Patients selected for admission had an intravenous line established, a thoracic and abdominal X-ray taken and urine and blood samples were taken. If necessary, a nasogastric tube was inserted. Asymptomatic haemodynamically stable patients were admitted for clinical observation in a single unit during which period the patient was examined by a senior surgeon for clinical re-assessment. Patients were discharged when feeding was normal and if there were clear signs of improvement. Results: Over a 6 month period 60 consecutive patients with penetrating abdominal wound were reviewed. In total 52 patients (86.67%) were managed with clinical re-assessment and discharged without laparotomy. Eight patients (13.33%) underwent laparotomy after observation. Small bowel, liver, mesenteric vessels were most frequently affected. Non-therapeutic laparotomy rate was 0%. After laparotomy the morbidity rates were 62.5% (p = 0.92). One local wound infection occurred without prior laparotomy. Average hospital stay after observation was 2.8 days, after laparotomy 9.8 days. Delayed laparotomy did not increase morbidity or hospitalization. Conclusion: Our experience with penetrating abdominal trauma supports the concept of selective conservatism based on repeated physical examination. In a well-established trauma center this has proven to be highly effective with remarkably low rates of non-therapeutic laparotomies and absence of missed diagnosis of visceral injuries. Journal of Surgical Sciences (2017) Vol. 21 (2): 76-79
背景:穿透性腹部损伤(PAI)患者存在危及生命的损伤风险。许多患者需要紧急手术干预。然而,也有一些患者可以安全地进行非手术治疗。每一个腹部穿透性创伤的病人都应该进行彻底的临床检查。定期重复临床检查是选择性治疗的基础,因为最初没有的症状和体征可能会在以后出现。目的:探讨连续体格检查对穿透性腹部损伤患者的治疗效果,避免非治疗性剖腹手术。方法:选择方便、有针对性的达卡医学院附属医院急诊区收治的60例PAI患者进行选择性非手术治疗。入院时检查了腹部伤口,没有尝试用手指或直接探查伤口。选择入院的患者建立静脉注射线,拍摄胸部和腹部x光片,并采集尿液和血液样本。必要时,插入鼻胃管。无症状血流动力学稳定的患者在一个单独的单元接受临床观察,在此期间由一名高级外科医生对患者进行检查以进行临床重新评估。当进食正常且有明显改善迹象时,患者出院。结果:在6个月的时间里,我们回顾了60例连续的腹部穿透伤患者。52例患者(86.67%)经临床再评估出院,未开腹手术。观察后行开腹手术8例(13.33%)。小肠、肝脏、肠系膜血管最常受影响。非治疗性剖腹手术率为0%。剖腹手术后发病率为62.5% (p = 0.92)。1例局部伤口感染未开腹手术。观察后平均住院时间2.8天,开腹后平均住院时间9.8天。延迟剖腹手术不会增加发病率或住院率。结论:我们对穿透性腹部创伤的经验支持基于反复体检的选择性保守的概念。在一个完善的创伤中心,这种方法被证明是非常有效的,非治疗性剖腹手术的发生率非常低,并且没有内脏损伤的漏诊。外科杂志(2017)Vol. 21 (2): 76-79
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引用次数: 0
Socity News 社会新闻
Pub Date : 2020-03-22 DOI: 10.3329/jss.v22i1.44034
Professor Salma Sultana
Abstract not available Journal of Surgical Sciences (2018) Vol. 22 (1) : 73-74
外科杂志(2018)Vol. 22 (1): 73-74
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引用次数: 0
Moral and Ethical Issues in Surgical Practice 外科实践中的道德和伦理问题
Pub Date : 2020-03-22 DOI: 10.3329/jss.v21i2.43896
Maref Majid
Abstract not available Journal of Surgical Sciences (2017) Vol. 21 (2) : 59-60
外科科学杂志(2017)Vol. 21 (2): 59-60
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引用次数: 0
c-Kit negative Gastro Intestinal Stromal Tumour with Subcutaneous tissue and Lymph Node 115 Metastasis c-Kit阴性胃肠道间质瘤伴皮下组织和淋巴结115转移
Pub Date : 2020-03-22 DOI: 10.3329/jss.v21i2.43921
M. Matubber, S. Billah, S. Paul, Jahirul Lslam, Roksana Afroj
We report a rare case of c-kit negative gastrointestinal stromal tumor with metastasis in left cervical lymph nodes and subcutaneous tissue. The patient presented to us with recurrent neck swelling, perforation of gas containing hollow viscous and multiple subcutaneous swellings. After confirmation of diagnosis we transferred the patient to medical oncologist. Patient expired two months after starting chemotherapy. Journal of Surgical Sciences (2017) Vol. 21 (2): 115-117
我们报告一例罕见的c-kit阴性胃肠道间质瘤,并在左侧颈部淋巴结和皮下组织转移。病人向我们提出复发性颈部肿胀,含中空粘性气体穿孔和多发皮下肿胀。确诊后,我们将患者转至内科肿瘤科。病人在开始化疗两个月后死亡。外科杂志(2017)Vol. 21 (2): 115-117
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引用次数: 0
A Comparative Study between Patients with Mechanical Bowel Preparation and Patients with No Bowel Preparation in Elective Colo-rectal Surgery 择期结肠直肠手术中机械肠道准备与非肠道准备的比较研究
Pub Date : 2020-03-22 DOI: 10.3329/jss.v21i2.43919
Molla Sharfuddin Ahmed, Md Ibrahim Siddique
Background: Modern surgical techniques and improved preoperative care has reduced both morbidity and mortality of colorectal surgery but the role of mechanical bowel preparation is recently disputed. Primary colonic anastomosis without mechanical bowel preparation is still considered unsafe. Objective: One of the objectives of this study was to evaluate pre-operative mechanical bowel preparation in preventing anastomotic and wound dehiscence in elective colon and rectal surgery. Methods: Fifty patients who were included in this study were randomly divided into two groups (group A & Group B). Group A was the preparatory group and Group B was the non-preparatory group. In preparatory group oral poly ethylene glycol was used for mechanical bowel preparation and in non-preparatory group no bowel preparation done. All patients were operated on by qualified surgeons and followed up for outcome and collected data were analyzed. Results: 80% of the Patients in Group A had adverse effects of bowel preparation like nausea, vomiting, blotting, loose motion and precaution had to be taken for them. All the patients of both groups were given per-operative antibiotics whereas 24 patients of Group A and 23 patients of Group B were given transfusion. 15(60%) patients of Group A had developed post-operative surgical infectious complications. The majority number of patients of Group A had been suffered from surgical site infection (10, 40%) followed by Anastomotic Leak, Intra-abdominal abscess and Peritonitis whereas in Group B 10(40%) patients developed surgical complications. Conclusion: Mechanical bowel preparation before elective colon and rectal surgery is not so effective in preventing complications and without any mechanical preparation of the bowel colorectal surgery can be done safely. Journal of Surgical Sciences (2017) Vol. 21 (2): 105-109
背景:现代手术技术和术前护理的改善降低了结直肠手术的发病率和死亡率,但机械肠道准备的作用最近受到争议。没有机械肠道准备的原发性结肠吻合仍然被认为是不安全的。目的:本研究的目的之一是评估术前机械肠准备在预防择期结肠和直肠手术吻合口和伤口裂开中的作用。方法:将50例患者随机分为A组和B组,A组为预备组,B组为非预备组。预备组采用口服聚乙二醇进行机械肠道准备,非预备组不进行肠道准备。所有患者均由合格的外科医生进行手术,随访结果并对收集的数据进行分析。结果:A组80%的患者出现恶心、呕吐、血块、运动松散等肠准备不良反应,需采取预防措施。两组患者术前均给予抗生素治疗,其中A组24例,B组23例输血。A组15例(60%)出现术后感染并发症。A组以手术部位感染为主(10.40%),其次为吻合口漏、腹内脓肿和腹膜炎,B组有10例(40%)出现手术并发症。结论:择期结肠直肠手术前机械准备对预防并发症效果不佳,无需机械准备即可安全进行结肠直肠手术。外科杂志(2017)Vol. 21 (2): 105-109
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引用次数: 0
Comparison between aspiration and incision and drainage of breast abscess 乳腺脓肿抽吸与切开引流的比较
Pub Date : 2020-03-22 DOI: 10.3329/jss.v22i1.44008
Fardhus, A. Sharfuzzaman, Nayeem Dewan, Dipak Chandra Kirttania, A. Hasan, Joy Zakharia Rab
Background: Breast abscess is defined as an acute inflammatory lump which yields pus on incision/aspiration. The frequency of occurrence is highly related to pregnancy and caused due to nipple cracking by a child during breast feeding and bacterial colonization due to improper nursing technique and incomplete emptying of the breast. Objective: The present study compares the outcome and effectiveness of traditional treatment incision and drainage against needle aspiration in the treatment of breast abscess. Methods: This is a comparative study carried out in department of general surgery, SherE- Bangla Medical College Hospital, Barisal between January 2014 and December 2014. 50 female patients of age between 20-40 years and diagnosed breast abscess with abscess size of 5'7 cm in diameter on ultrasonography were included in the study after taking written consent form. Of these 25 had undergone aspiration of the breast abscess (group A) and 25 had undergone incision and drainage (group B). Results: The mean age of the female patients in group A was 23.42 years and in Group B was 23.31. 91% of the cases were lactating. S. aureus was the common organism isolated in both lactating and non-lactating cases, encountered in 27 patients (54%). Out of that were in the aspirated group 17patients (56.67%). 10 patients were in the incised group (33.33%). The mean healing time and cosmetic outcome was significantly (p =0.001) very good in patients treated with needle aspiration compared to incision and drainage. There was no recurrence of breast abscess observed in needle aspiration group during the study. There was 3.3% recurrence rate observed in the incision and drainage group. Conclusion: Breast abscess in patients with diameter of 5'7 cm can be treated with needle aspiration successfully and with a good cosmetic outcome. Journal of Surgical Sciences (2018) Vol. 22 (1): 11-15
背景:乳腺脓肿被定义为一种急性炎性肿块,在切口/抽吸处产生脓。发生频率与妊娠高度相关,是由于婴儿在母乳喂养时乳头破裂,以及由于护理技术不当和乳房排空不完全导致细菌定植所致。目的:比较传统的切开引流与针吸治疗乳腺脓肿的疗效。方法:对2014年1月至2014年12月在巴里萨尔SherE- Bangla医学院附属医院普外科进行对比研究。选取50例年龄在20-40岁之间,超声检查诊断为乳腺脓肿,脓肿直径为5′7 cm的女性患者,经书面同意后纳入研究。其中25例行乳腺脓肿抽吸术(A组),25例行切口引流术(B组)。结果:A组女性平均年龄23.42岁,B组女性平均年龄23.31岁。91%的病例处于哺乳期。金黄色葡萄球菌是哺乳期和非哺乳期患者中常见的分离菌,27例(54%)。其中抽吸组17例(56.67%)。切开组10例(33.33%)。与切口引流相比,针吸治疗的平均愈合时间和美容效果显著(p =0.001)。研究期间针吸组乳腺脓肿无复发。切口引流组复发率为3.3%。结论:乳腺脓肿直径为5 ~ 7cm的患者可采用针吸治疗,美容效果良好。外科杂志(2018)Vol. 22 (1): 11-15
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引用次数: 1
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Journal of Surgical Sciences
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