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Rhabdomyolysis after Hand Assisted Laparoscopic Donor Nephrectomy: Calgary’s experience 手辅助腹腔镜供肾切除术后横纹肌溶解:卡尔加里的经验
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43980
R. Rochon, M. Monroy, S. Yilmaz
Background:  Rhabdomyolysis is a post-operative complication resulting from skeletal muscle injury during the surgery.  The true incidence of rhabdomyolysis in laparoscopic living donor nephrectomy is unknown due to a paucity of evidence in the literature. Rhabdomyolysis can have serious short-term and long-term consequences for the living kidney donors. There have been a number of risk factors identified that may increase the risk of rhabdomyolysis. Materials and Methods: Our program has offered a hand assisted laparoscopic donor nephrectomy approach for our donors since 2001.We have performed 209 kidney transplants using this approach.  The institution’s database was searched for postoperative complications. Three donor patients with post-operative rhabdomyolysis were identified. Results: All three patients were young healthy males.  The operative times were all greater than four hours.  Fortunately, all three patients were recognized early and received treatment promptly.  Dialysis was not required and no long-term renal dysfunction occurred. Conclusion:  Rhabdomyolysis is an uncommon post-operative complication following hand assisted laparoscopic living donor nephrectomy.  We have a high index of suspicion for rhabdomyolysis to promptly recognize this rare but potentially serious complication after any operation lasting greater than 4 hours.  Creatinine Kinase levels have been implemented at our centre for all living kidney donors. Journal of Surgical Sciences (2015) Vol. 19 (2) : 44-47
背景:横纹肌溶解是手术中骨骼肌损伤引起的术后并发症。由于文献证据不足,腹腔镜活体肾切除术中横纹肌溶解的真实发生率尚不清楚。横纹肌溶解可对活体肾供者造成严重的短期和长期后果。已经确定了一些可能增加横纹肌溶解风险的危险因素。材料和方法:自2001年以来,我们的项目为供者提供了手辅助腹腔镜供者肾切除术方法。我们已经用这种方法进行了209例肾脏移植手术。在该机构的数据库中搜索术后并发症。3例术后横纹肌溶解供体患者。结果:3例患者均为年轻健康男性。手术时间均大于4小时。幸运的是,这三名患者都被及早发现并及时接受治疗。不需要透析,也没有发生长期肾功能障碍。结论:横纹肌溶解是腹腔镜活体肾切除术后少见的并发症。我们对横纹肌溶解有很高的怀疑指数,以便在任何持续超过4小时的手术后及时识别这种罕见但可能严重的并发症。肌酐激酶水平已在本中心对所有活体肾脏供者进行检测。外科杂志(2015)Vol. 19 (2): 44-47
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引用次数: 0
Microvascular Surgery Training in National Institute of Burn and Plastic Surgery (NIBPS), DMCH 国立烧伤与整形外科研究所(NIBPS)微血管外科培训
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43982
N. Khan, T. Satter
Microvascular surgery is a standard procedure in various surgical specialities. For the beginner the logical approach is to start the training with the materials like latex gloves and silastic tube, moving to animal cadaver and finally living animal. In all respect, the training in this particular speciality is costly and facilities are very limited in Bangladesh. Microsurgical training laboratory in National Institute of Burn and Plastic Surgery in Dhaka medical College Hospital conducting courses on Basic and Advanced microsurgery training since July’ 2013. In this paper we introduce the importance and low cost opportunity of training, so that skill would be mastered first in the lab and then applied in real life. Journal of Surgical Sciences (2015) Vol. 19 (2) : 52-54
微血管手术是各种外科专业的标准手术。对于初学者来说,合乎逻辑的方法是用乳胶手套和橡胶管等材料开始训练,转移到动物尸体,最后是活体动物。在所有方面,这一特殊专业的培训费用昂贵,孟加拉国的设施非常有限。2013年7月起在达卡医学院附属医院国立烧伤整形外科研究所显微外科培训实验室开展基础和高级显微外科培训课程。在本文中,我们介绍了培训的重要性和低成本的机会,以便在实验室中掌握技能,然后在现实生活中应用。外科杂志(2015)Vol. 19 (2): 52-54
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引用次数: 0
Metastatic Melanoma in the Breast with unknown Primary 原发不明的乳腺转移性黑色素瘤
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43989
T. K. Paul, Mosammat Mira Pervin
Secondary in the breast is a very rare condition but may occur usually from contralateral breast and from others like lymphoma, melanoma, ovarian tumors, and pulmonary malignancies and  malignancies of the gastrointestinal and genitourinary tract. Among the primary diseases, melanoma is notorious and unpredictable in its metastatic potentiality and organ of dissemination. There are few reported cases with metastatic melanoma in the breast. We report a case of metastatic deposits in the breasts of a 45year-old lady who presented with bilateral breast lumps with axillary lymphadenopathy having no primary site of melanoma. Journal of Surgical Sciences (2015) Vol. 19 (2) : 72-74
继发性乳腺肿瘤是一种非常罕见的疾病,但通常发生在对侧乳腺,以及其他如淋巴瘤、黑色素瘤、卵巢肿瘤、肺部恶性肿瘤、胃肠道和泌尿生殖系统恶性肿瘤。在原发疾病中,黑色素瘤在其转移潜能和传播器官方面是臭名昭著和不可预测的。有报道的病例转移性黑色素瘤在乳房。我们报告一例转移性沉积在乳房45岁的女士谁提出了双侧乳房肿块腋窝淋巴结病没有原发部位的黑色素瘤。外科杂志(2015)Vol. 19 (2): 72-74
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引用次数: 0
Laparoscopic Cholecystectomy- A Safe treatment option for Gangrenous Cholecystitis 48 and Empyema Gallbladder in experienced hands 腹腔镜胆囊切除术-经验丰富的人对坏疽性胆囊炎和胆囊脓肿的安全治疗选择
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43981
S. K. Mondal, Sharmistha Roy
Background: Laparoscopic cholecystectomy has become the gold standard of treatment for gall stone disease and in acute cholecystitis. But controversy persists regarding laparoscopic approach to gangrenous gallbladder and empyema gallbladder due to the risk of life threatening complications. We share our experience in a tertiary care multidisciplinary diabetic hospital where we encounter significant number of patients with empyema Gallbladder and gangrenous gallbladder because most of our patients are diabetic and hence immunocompromised. Purpose of this study was to evaluate the safety of laparoscopic procedure for the treatment of empyema of gallbladder and gangrenous gallbladder in an experienced hand. Methods & Materials: Between January 2013 and January 2015 we performed 1191 cases of laparoscopic cholecystectomy. Empyema gallbladder and gangrenous gallbladder were found per operatively in 345 and 53 cases respectively.All were managed by laparoscopic procedure except two cases, where conversion to open cholecystectomy was needed. Result: The mean operating time was 72 minutes(45-100 minutes) in empyema gallbladder. In gangrenous cholecystitismean operating time was 80 minutes(60-100 minutes). Total number of patients (including empyema gallbladder 345 and gangrenous cholecystitis 53) were 398. Among them 52 patients (13%) had excessive bleeding(>100ml) from calot’s triangle or gallbladder bed in liver. Spillage of stones occurred in 28 patients (7%). 1 patient had common bile duct injury (.25%). Gallbladder retrieval was difficult in 71 patients (18%). In the post operative period 21 patient (5%) developed minor port infection in the umbilical port. 9 patients (2%) developed chest infection, and 1 patient (.25%) developed MI. 356 patients (89%) were discharged within 72 hours of surgery. Conclusions: Innovative technique, appropriate instruments, knowledge about the possible risks and way to manage them, with expertise in intracorporeal suturing and knotting are an essential pre requisites to attempt these cases. Operating time is more but post operative recovery is prompt. Hospital stay is significantly less than open cholecystectomy. Laparoscopic cholecystectomy is a safe procedure in cases of Empyema and gangrenous gallbladder, provided the surgeon is experienced enough and has a low threshold to convert to open cholecystectomy at anypoint of time. Journal of Surgical Sciences (2015) Vol. 19 (2) : 48-51
背景:腹腔镜胆囊切除术已成为治疗胆结石疾病和急性胆囊炎的金标准。但由于危及生命的并发症风险,腹腔镜下坏疽性胆囊和胆囊脓肿的手术方法仍存在争议。我们分享我们在一家三级护理的多学科糖尿病医院的经验,在那里我们遇到了大量的胆囊脓肿和坏疽性胆囊患者,因为我们的大多数患者是糖尿病患者,因此免疫功能低下。本研究的目的是评估腹腔镜手术治疗胆囊脓肿和坏疽性胆囊的安全性。方法与材料:2013年1月至2015年1月共行腹腔镜胆囊切除术1191例。术中发现胆囊脓肿345例,坏疽53例。除2例需要转开腹胆囊切除术外,所有病例均行腹腔镜手术。结果:胆囊脓胸平均手术时间72分钟(45 ~ 100分钟)。坏疽性胆囊炎平均手术时间80分钟(60 ~ 100分钟)。其中胆囊脓肿345例,坏疽性胆囊炎53例,共398例。其中52例(13%)出现肝内卡洛三角或胆囊床出血(>100ml)。28例(7%)发生结石溢出。胆总管损伤1例(0.25%)。71例(18%)患者胆囊取出困难。术后21例(5%)出现脐口轻微感染。9例(2%)患者发生胸部感染,1例(0.25%)患者发生心肌梗死,356例(89%)患者在手术72小时内出院。结论:创新的技术,合适的器械,对可能的风险和管理方法的了解,以及体内缝合和打结的专业知识是尝试这些病例的必要先决条件。手术时间较长,但术后恢复迅速。住院时间明显少于开腹胆囊切除术。腹腔镜胆囊切除术是一种安全的手术,在脓胸和坏疽胆囊的情况下,只要外科医生有足够的经验,并且在任何时候都有较低的阈值来转换为开放胆囊切除术。外科杂志(2015)Vol. 19 (2): 48-51
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引用次数: 0
Breast Cancer in Bangladesh 孟加拉国的乳腺癌
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43979
P. Akhtar
Abstract not available Journal of Surgical Sciences (2015) Vol. 19 (2) : 42-43
外科杂志(2015)Vol. 19 (2): 42-43
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引用次数: 0
Treatment of Chronic Anal Fissure 慢性肛裂的治疗
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.43987
A. Tarique, Manjurul Alam
Chronic anal fissure is a non healing ulcer in the anoderm appearing as a painful tear below the dentate line. There are debates about the efficacy of different treatment options for chronic anal fissure. This review aims to evaluate existing and newer treatment modalities. Aspects of chronic anal fissure aetiology and pathogenesis are also reviewed. Glyceryl trinitrate (GTN) ointment, Diltiazem ointment can be used as first line and Botulinum toxin (BTX) injection as second line pharmacological treatment. The effects of these chemicals are not permanent with higher fissure recurrence rates. Lateral internal sphincterotomy is the operative treatment of choice for fissures with high anal tone. Flap anoplasty should be done for fissures with normal anal tone especially in female patients. Both surgical procedures can be used as primary treatment option. The newer treatment options like gonyautoxin, controlled balloon anal dilatation, closed anal spand fissurotomy need more research. Perineal support device can be used as an adjunct to other treatment modalities. Journal of Surgical Sciences (2015) Vol. 19 (2) : 67-71
慢性肛裂是一种无法愈合的肛肠溃疡,在齿状线以下表现为疼痛的撕裂。关于慢性肛裂不同治疗方案的疗效存在争议。本综述旨在评价现有的和较新的治疗方式。对慢性肛裂的病因和发病机制也进行了综述。三硝酸甘油(GTN)软膏、地尔硫卓软膏可作为一线药物治疗,肉毒杆菌毒素(BTX)注射液可作为二线药物治疗。这些化学物质的影响不是永久性的,裂隙复发率较高。外侧内括约肌切开术是高肛张力裂隙的首选手术治疗方法。对于肛门张力正常的裂隙,尤其是女性患者,应行皮瓣肛管成形术。这两种手术都可以作为主要的治疗选择。较新的治疗方案,如性腺毒素,控制球囊肛管扩张,闭合性肛管裂开需要更多的研究。会阴支撑装置可作为其他治疗方式的辅助。外科杂志(2015)Vol. 19 (2): 67-71
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引用次数: 0
Gastrointestinal stromal tumor of rectum 直肠胃肠道间质瘤
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.44006
R. Rahman, S. H. Sheikh, I. J. Lima, Most Bilkis Fatema, A. Alam, G. Salahuddin, Rashidul Islam, K. N. Naznin, T. A. Khan, Mosammat Mira Pervin, A. Taher
Although gastrointestinal stromal tumors (GISTs) frequently occur in the gastrointestinal tract, they are relatively rare in the rectum. Biopsy of the lesion and immunohistochemistry (IHC) confirm the diagnosis. Complete surgical resection is the principal curative procedure. In combination with surgery, immunotherapy with Imatinib shows cure in intermediate risk and improvement in high risk rectal GIST. We report a case of a 45-yearold female who  presented with constipation and generalized weakness, ultimately diagnosed to have rectal GIST. Journal of Surgical Sciences (2015) Vol. 19 (2) : 85-88
虽然胃肠道间质瘤(gist)经常发生在胃肠道,但在直肠中相对罕见。病变活检和免疫组化(IHC)证实了诊断。完全手术切除是主要的治疗方法。结合手术,免疫治疗伊马替尼可治愈中度风险和改善高危直肠GIST。我们报告一例45岁的女性谁提出便秘和全身无力,最终诊断为直肠GIST。外科杂志(2015)Vol. 19 (2): 85-88
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引用次数: 0
Laparoscopic Cholecystectomy in A Case of Symptomatic Cholelithiasis with Situs Inversus Totalis 症状性胆石症伴完全性倒位的腹腔镜胆囊切除术1例
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.44005
S. S. Haque, Syed Al Fesuny, Belaluddin, S. Kabir, Meer Ishrat Jahan
Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world now a days.  Chronic cholecystitis in a patient with situs inversus totalis may pose diagnostic and therapeutic challenges specially while laparoscopic cholecystectomy is to be carried out. We discuss one such case and make an outline how the diagnosis was made and the pitfalls encountered during surgery and how they were overcome. Journal of Surgical Sciences (2015) Vol. 19 (2) : 82-84
腹腔镜胆囊切除术是当今世界上最常见的外科手术之一。慢性胆囊炎患者的完全性倒位可能会给诊断和治疗带来挑战,特别是在进行腹腔镜胆囊切除术时。我们将讨论一个这样的病例,并概述如何做出诊断,在手术中遇到的陷阱以及如何克服它们。外科杂志(2015)Vol. 19 (2): 82-84
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引用次数: 0
Eosinophilic Ureteritis: Report of A Rare Case 嗜酸性输尿管炎1例报告
Pub Date : 2019-11-13 DOI: 10.3329/jss.v19i2.44004
H. Asad, Towhid Belal, K. Islam, P. Saha
During evaluation for left loin to groin pain, a 14- year-old boy was found to have left mid ureteric stricture with proximal hydro-ureteronephrosis on imaging. Pus cells were present in his urine with a raised serum creatinine level. There was peripheral eosinophilia and biopsy near the stricture revealed eosinophilic ureteritis. The patient was evaluated to find out the possible causes of eosinophilia. Here we report a case of eosinophilic ureteritis for its rarity. Journal of Surgical Sciences (2015) Vol. 19 (2) : 80-81 
在评估左腰至腹股沟疼痛时,一名14岁男孩在影像学上被发现有左输尿管中部狭窄并近端输尿管积水。尿中有脓细胞,血清肌酐水平升高。周围有嗜酸性粒细胞增多,狭窄附近活检显示嗜酸性粒细胞性输尿管炎。对患者进行评估以找出嗜酸性粒细胞增多的可能原因。我们在此报告一例罕见的嗜酸性输尿管炎。外科杂志(2015)Vol. 19 (2): 80-81
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引用次数: 0
Idiopathic Granulomatous Mastitis: In Search of a Therapeutic Template 特发性肉芽肿性乳腺炎:寻找治疗模板
Pub Date : 2019-11-07 DOI: 10.3329/jss.v20i2.43815
S. Khan, A. Ali
Background: Granulomatous mastitis also known as granulomatous inflammatory lesionsof the breast can be divided into idiopathic granulomatous mastitis and granulomatousmastitis occurring as a rare secondary complication of a great variety of other conditions.Treatment is radically different for idiopathic granulomatous mastitis and other granulomatouslesions of the breast, the precise diagnosis is therefore very important. Objectives: The purpose of this study was to find the clinicopathological features ofidiopathic granulomatous mastitis, as well as the authors' experience with surgicaltreatment of these patients. Methods and Materials: A hospital based retrospective study done with twenty diagnosedpatients of idiopathic granulomatous mastitis enrolled from department of surgery, Ad-dinwomen's.medical college hospital, Dhaka in the period between July 2012- July 2015. Results: Mean age of presentation was 38.1 years. All patients had a history of childbirthand breastfeeding. Sixteen (80%) patients were premenopausal. The main clinical featurewas a mass in the breast in all patients and clinical findings suggesting an infection accompaniedthe mass in seven patients (35%). Surgery was the definitive procedure in allpatients. Wide local excision done in all patients. None of the patients received steroids.Median follow-up time was 12 months. During follow-up, two patients (10%) presented withrecurrence. All patients with recurrence had a mass in their breasts on the same side ofprevious disease. Conclusion: Increased recognition of this disease will improve its understanding andmanagement. Long-term follow-up is necessary. Journal of Surgical Sciences (2016) Vol. 20 (2) :51-54
背景:乳腺肉芽肿性乳房炎也称为肉芽肿性炎性病变,可分为特发性肉芽肿性乳房炎和肉芽肿性乳房炎,是一种罕见的继发性并发症,发生于多种其他疾病。特发性肉芽肿性乳腺炎与乳腺其他肉芽肿性病变的治疗方法截然不同,因此准确的诊断非常重要。目的:本研究的目的是发现原发性肉芽肿性乳腺炎的临床病理特征,以及作者对这些患者的手术治疗经验。方法和材料:对20例诊断为特发性肉芽肿性乳腺炎的患者进行回顾性研究。2012年7月至2015年7月期间,达卡医学院医院。结果:平均发病年龄为38.1岁。所有患者均有分娩和母乳喂养史。16例(80%)患者处于绝经前。所有患者的主要临床特征为乳房肿块,7例(35%)患者临床表现提示肿块伴感染。手术是所有患者的最终治疗方法。所有患者均行大面积局部切除。所有患者均未接受类固醇治疗。中位随访时间为12个月。随访期间,2例(10%)出现复发。所有复发的患者在既往疾病的同侧乳房上都有肿块。结论:提高对本病的认识有助于提高对本病的认识和治疗。长期随访是必要的。外科杂志(2016)Vol. 20 (2):51-54
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引用次数: 0
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Journal of Surgical Sciences
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