International Journal of Surgery Open最新文献

Introduction

Virginal breast hypertrophy VBH with the sobriquet “gigantomastia” is an uncommon condition with sporadic presentation usually in adolescence.

Case presentation

In this retrospective study, eight patients (three case summaries presented, while the clinicopathologic features of all the patients are presented in Table 1) were managed.

Discussion

The age range in this retrospective cohort study is 13–34 years and the series consists predominantly of teenagers, a third had bilateral disease, and the symptoms triad of mastalgia, cosmetic concerns, and psychosocial/esteem issues were present in all the patients. With a third consenting to surgical intervention.

We present what to our knowledge must be in the global literature, one of the few largest accruals of cases of gigantomastia, the VBH, seen over time in our surgical oncology practice.

Conclusion

VBH should be appraised along with other BBD to exclude malignancies and provide prompt and appropriate care whilst limiting complications. A multidisciplinary approach is particularly important and incorporating care for perceived low self-esteem cannot be over-emphasized.

Introduction

Cholelithiasis is a rare abdominal condition in children. The cause of pediatric cholelithiasis is unclear, and the most commonly occurring type is pigment stones due to hemolytic diseases and other causes such as medications, hepatobiliary tract anomalies, and genetic problems. Asymptomatic patients require monitoring, whereas symptomatic patients require surgical removal of the gall bladder (cholecystectomy), which can be performed using open or laparoscopic techniques. Here, we present two cases of cholelithiasis (symptomatic and asymptomatic) with neglect of proper medical management until a definite diagnosis and surgical treatment.

Case presentation

A 13-year-old and an 11-year-old child were presented with the diagnosis of cholelithiasis to our pediatric surgery department. The earlier patient suffered from jaundice in early childhood and was treated with the traditional method (non-surgical home remedy using an onion). Later, he was diagnosed with multiple gallbladder stones. The later patient was asymptomatic until his hospitalization at the age of 11 years, when he was diagnosed with a single gallbladder stone (epigastric pain after heavy meals as a chief complaint). Both patients were symptomatic, so we decided to plan them for definite treatment. The patients underwent cholecystectomy with no complications and were discharged from the hospital in satisfactory condition.

Clinical discussion

However, cholelithiasis is uncommon in children, but recent reports indicate increased detection of the disease. In developed nations, an increase in childhood obesity has risen the rate of gallstone cases in the pediatric population. Typically, pediatric cholelithiasis is asymptomatic, but symptomatic children may present with biliary colic as the sudden onset of recurrent epigastric or right upper quadrant (RUQ) pain radiating to the back or right shoulder. In young children, the episodes are accompanied by nausea, vomiting, and fever. Many times, the pain develops without precipitating factors, and fat intolerance is an inconsistent feature. The management of cholelithiasis requires a concise work-up regarding its cause in children.

Conclusion

Cholelithiasis has different underlying causative factors. In otherwise healthy children, surgical treatment is only warranted in symptomatic cases.

The text explores the negative aspects of dieting. Dieting has been more common in recent years as more people strive to adhere to strict food plans in an effort to achieve their desired body weight and form. Unfortunately, this strategy may have unforeseen repercussions that could have a negative impact on one's health. Insufficient calorie intake, for instance, might deprive the body of vital nutrients, resulting in malnutrition and a weakened immune system. Similar to too-restricted diets, irregular periods and even infertility can result from a disruption in the hormonal balance. Furthermore, dieting can lead to psychological distress, which in turn promotes disordered eating behaviors such as binge eating, purging, and other eating disorders. These disorders have the potential to have a long-term negative impact on physical and mental health, and in some situations, they may even be fatal. It's important to exercise caution and knowledge when it comes to various diet regimens that are advertised on social media and online.

Introduction

Combined posterolateral corner (PLC) - anterior cruciate ligament (ACL) tears account for 10% of complex knee injuries. In an ACL-PLC injured knee, an untreated PLC injury causes a significant increase in force on the ACL graft and may be a leading cause of graft failure.

Case presentation

A 26-year-old male patient with combined ACL and PLC injury. He was concurrently reconstructed in both ACL and PLC. We used 2 semitendinosus (1 in each knee) and 1 glacilis tendon (in the injured knee). The ACL was reconstructed by one 4-stranded simitendinosus with an all-inside technique and TightRope fixation. The PLC reconstruction utilized one femoral tunnel at the isometric point, graft fixation at the femoral tunnel by TightRope, and at the tibial tunnel by absorbable screw. After a follow-up of 9 months, Cincinnati's score was 70/100 and the IKDC score was B type.

Discussion

The main advantage is that surgeons do not have to care about tendon length and graft diameter compared to the previous method.

Conclusion

Concomitantly combined ACL and PLC reconstruction has good results in remaining knee functions and decreasing ACL reconstruction failure. However, femoral tunnel creation needs to be careful to avoid femoral tunnel intersections.

Background

Post-operative haemorrhage can lead to significant complications and even mortality. These utilise scarce healthcare resources and increase hospital costs, as well as negatively impacting on patient's quality of life. Haemostats that exhibit additional adhesive properties can reduce the rate of bleeding complications. Standard gelatin sponges have been used safely in surgery for over 75 years but have almost no adhesive properties. This article reports the performance of a novel adhesive gelatin patch in human surgery for the first time.

Methods

A CE-marked gelatin foam patch (TenaTac®, Selentus Science, UK) has been created through a physical modification of the sponge surface, avoiding the need for the addition of blood-derived components or additional chemicals to stimulate adhesion. Real-world, post-approval clinical evaluations of the device were undertaken, and a structured data form was utilised to collect information on the device's performance during these procedures.

Results

In total, 63 evaluations were undertaken by 40 surgeons in 13 countries, covering 29 different surgical procedures. When assessing the adherence of TenaTac, 83 % (48/58) of the surgeons assessed the adhesion as very good or excellent. Both “haemostatic effect” and “time to haemostasis” achieved median scores of 4/5 (IQR 4–5), which equated to “very good” on the questionnaire. When surgeons were asked to compare their experience with TenaTac against their usual haemostat, 91.7 % (55/60) rated it as good, very good or excellent. When surgeons were asked if they would recommend the use of TenaTac, 96.5 % (55/57) of the surgeons responded positively to this question.

Conclusion

Real world evaluation of the novel adhesive patch, TenaTac, has confirmed that it exhibits very good adhesive and haemostatic qualities and could be considered for use by a wide variety of surgical specialities.

Introduction and clinical importance

Teratomas are neoplasms originating from pluripotent cells, rising from more than one or all three embryonic germinal layers. The nomenclature “Teratoma” is derived from the Greek word “teras” which translates to the word “monster”. One of the rarest locations is the adrenal gland, with adrenal teratomas representing only 0.13 % of all adrenal tumors.

Case presentation

A 36-year-old female, morbidly obese, was found to have a right adrenal mass after she presented to our surgical outpatient clinic with a complaint of abdominal pain. The mass was found on an abdominal computed tomography (CT) scan, which revealed a large retroperitoneal lesion measuring 29 × 15 × 22 cm and displacing the IVC, pancreas, duodenum, right kidney, and ascending colon. The differential diagnosis based on the patient's workup was adrenal teratoma, myolipoma, angiolipoma, and liposarcoma. The patient underwent an uneventful open right adrenalectomy. The final histopathology confirmed the diagnosis of a mature right adrenal cystic teratoma weighing 4 kg. The last follow-up was 3 years postoperatively with no evidence of recurrence on CT scan.

Clinical discussion

A thorough discussion of the clinical presentations of the reported cases in the literature including the first reported case in the English literature. Furthermore, the use of the different modalities of diagnosis e.g., Ultrasonography, CT scan, and MRI. Also, the mainstay modality of treatment and the debate of minimal invasive laparoscopic adrenalectomy vs open adrenalectomy. Finally, the discussion of the period of following up the patient after successful operation and the removal of the tumor were presented.

Conclusion

Adrenal teratoma is extremely uncommon entity, with a great percentage of patient presenting with a non-specific presentation or are asymptomatic. Initial diagnosis might be made radiologically. However, a confirmatory diagnosis is based on the histopathological examination. The workup must rule out other possible differential diagnoses, like metastastis or functional tumors. Finally, surgical resection is the mainstay treatment of adrenal teratoma with an excellent survival rate.