A 17- year- old female high school student, with no remarkable medical history, presented to the emergency department with hematemesis and melena. She reported anorexia, weakness and a mild chronic epigastric pain during the last three months, with unrecorded weight loss. At presentation, the patient was thin. She had no apparent depressive or psychotic symptoms. Her physical examination showed stable vital signs and a pale skin. Her BMI was 18Kg/m² but without clinical signs of nutrient deficiency. Abdominal examination revealed a palpable large, mobile, non-tender and ill-defined solid mass in the epigastric and periumbilical region. The laboratory tests showed hypochromic microcystic anemia with a hemoglobin level of 7.7g/dl and a mean corpuscular volume of 64 fl. Renal and hepatic functions were within the reference range.
{"title":"Upper Gastrointestinal bleeding secondary to an enormous hairball","authors":"A. Hammami, S. Nasr, N. Elleuch","doi":"10.15761/GOS.1000225","DOIUrl":"https://doi.org/10.15761/GOS.1000225","url":null,"abstract":"A 17- year- old female high school student, with no remarkable medical history, presented to the emergency department with hematemesis and melena. She reported anorexia, weakness and a mild chronic epigastric pain during the last three months, with unrecorded weight loss. At presentation, the patient was thin. She had no apparent depressive or psychotic symptoms. Her physical examination showed stable vital signs and a pale skin. Her BMI was 18Kg/m² but without clinical signs of nutrient deficiency. Abdominal examination revealed a palpable large, mobile, non-tender and ill-defined solid mass in the epigastric and periumbilical region. The laboratory tests showed hypochromic microcystic anemia with a hemoglobin level of 7.7g/dl and a mean corpuscular volume of 64 fl. Renal and hepatic functions were within the reference range.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466683","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}
We report the case of a 24-year-old lady presented to our OPD with ulcerated lump in her left breast. She had no history of breast cancer in her first-degree relative. She had a history of painless lump in her left breast for the last 6 months, for which she consulted a homeopathic physician who started her on homeopathic medication. The lump gradually increased in size over the next few months and subsequently ulcerated 1 month back, with slough and intermittent bouts of bloody discharge.
{"title":"Metaplastic carcinoma of the breast – A case study and review of literature","authors":"Manoj Kumar","doi":"10.15761/GOS.1000216","DOIUrl":"https://doi.org/10.15761/GOS.1000216","url":null,"abstract":"We report the case of a 24-year-old lady presented to our OPD with ulcerated lump in her left breast. She had no history of breast cancer in her first-degree relative. She had a history of painless lump in her left breast for the last 6 months, for which she consulted a homeopathic physician who started her on homeopathic medication. The lump gradually increased in size over the next few months and subsequently ulcerated 1 month back, with slough and intermittent bouts of bloody discharge.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466627","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}
Jared Johnson, Michael T. Chung, Jeffrey M. Hotaling, Andrew P. Johnson, A. Fribley
Background: A variety of injuries occur with participation in water sports and can frequently range from minor contusions and lacerations to serious fractures and brain bleeds. Closed head injuries, which have garnered increasing attention in recent years due to potentially long-lasting complications, especially when they occur in the developing brain, also have been noted to occur frequently. Purpose: To estimate the incidence, demographics and injury patterns for patients presenting to the ED with injuries to the head and neck resulting from water sport activities. Study design: Descriptive epidemiology study. Methods : The National Electronic Injury Surveillance System (NEISS) was evaluated for head and neck injuries from water sport activities from 2014 to 2018. The database was queried for “Water skiing, tubing, and surfing.” All age ranges were included. Relevant entries were examined for incidence, patient characteristics, location of injury, and type of injury. Results: There were 689 relevant NEISS entries for head and neck injuries resulting from water sports from 2014-2018. The median age among those injured was 21 years old and the majority were males (64%). The most common water sports that resulted in injury were surfing (37%), inner tube related injuries (32%), followed by injuries resulting from wake board use (14%). The most common injury locations were the head (40%), followed by the face (34%), neck (14%), and ear (8%). Lacerations were the most common type of injury reported (34%), followed by closed head injuries (30%). Other notable type of injuries included facial fractures (5%) and also tympanic membrane perforations (3.7%). There was also a nearly 1% rate of reported intracranial bleeds among those injured. Conclusion: A large number of reported water sport injuries were closed head injuries that occurred in young adults. These types of injuries have been shown to have long-term detrimental effects in the developing brain. This necessitates the need for greater emphasis on head protection during water sports, something that, at this current time, is grossly under-utilized. In addition, patients participating in water sports suffered from a variety of head and neck traumas including facial laceration, fractures, and tympanic membrane perforations. Clinical relevance: This study will also hopefully also assist health care providers when examining and treating patients that present with head and neck injuries related to water sport activities. What is known about the subject: While millions enjoy the thrill of water sports each year, these activities have been noted to pose significant risks for injury. What this study adds to existing knowledge: Given the previously documented risks associated with these activities, this study will provide much needed information to the public on the risks associated with these activities, and also assist medical providers when caring for patients that present with these injuries.
{"title":"Not so fun in the sun: An analysis of head and neck injury patterns resulting from water sports","authors":"Jared Johnson, Michael T. Chung, Jeffrey M. Hotaling, Andrew P. Johnson, A. Fribley","doi":"10.15761/GOS.1000220","DOIUrl":"https://doi.org/10.15761/GOS.1000220","url":null,"abstract":"Background: A variety of injuries occur with participation in water sports and can frequently range from minor contusions and lacerations to serious fractures and brain bleeds. Closed head injuries, which have garnered increasing attention in recent years due to potentially long-lasting complications, especially when they occur in the developing brain, also have been noted to occur frequently. Purpose: To estimate the incidence, demographics and injury patterns for patients presenting to the ED with injuries to the head and neck resulting from water sport activities. Study design: Descriptive epidemiology study. Methods : The National Electronic Injury Surveillance System (NEISS) was evaluated for head and neck injuries from water sport activities from 2014 to 2018. The database was queried for “Water skiing, tubing, and surfing.” All age ranges were included. Relevant entries were examined for incidence, patient characteristics, location of injury, and type of injury. Results: There were 689 relevant NEISS entries for head and neck injuries resulting from water sports from 2014-2018. The median age among those injured was 21 years old and the majority were males (64%). The most common water sports that resulted in injury were surfing (37%), inner tube related injuries (32%), followed by injuries resulting from wake board use (14%). The most common injury locations were the head (40%), followed by the face (34%), neck (14%), and ear (8%). Lacerations were the most common type of injury reported (34%), followed by closed head injuries (30%). Other notable type of injuries included facial fractures (5%) and also tympanic membrane perforations (3.7%). There was also a nearly 1% rate of reported intracranial bleeds among those injured. Conclusion: A large number of reported water sport injuries were closed head injuries that occurred in young adults. These types of injuries have been shown to have long-term detrimental effects in the developing brain. This necessitates the need for greater emphasis on head protection during water sports, something that, at this current time, is grossly under-utilized. In addition, patients participating in water sports suffered from a variety of head and neck traumas including facial laceration, fractures, and tympanic membrane perforations. Clinical relevance: This study will also hopefully also assist health care providers when examining and treating patients that present with head and neck injuries related to water sport activities. What is known about the subject: While millions enjoy the thrill of water sports each year, these activities have been noted to pose significant risks for injury. What this study adds to existing knowledge: Given the previously documented risks associated with these activities, this study will provide much needed information to the public on the risks associated with these activities, and also assist medical providers when caring for patients that present with these injuries.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466665","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}
M. Crostelli, O. Mazza, M. Mariani, P. Persiani, F. M. Ranaldi, D. Mascello, C. Iorio
Introduction: CL, aged 12 years and 4 months, suffered multiple thoracic spine fractures in an accident as a rider in motorbike competition reporting T7 body fracture with anterior wedging associated with displaced left pedicle fracture at level of vertebral body- pedicle union, pedicle was displaced inside vertebral canal completely obliterating sub arachnoid space. There were associated T5, T6, T8, T9, T10 body wedge fractures. Imaging shown no sign of spinal cord lesion. Clinical exam shown no nervous deficits. Material and Methods: Treatment strategy had two goals, initial T7 fracture stabilization and nervous structures decompression. After initial stabilization with pedicle screws inserted in T5, T6, T8 and T7 vertebras, and only right-side rod mounted, we performed T6 and, partially, T7 left laminotomy: this manoeuvre allowed the direct visualization of left pedicle fragment with facet joint dislocated in the vertebral canal and compressing lateral surface of dural sac. The fragment was accurately isolated from sac surface and removed; no dural lesion showed after fragment removal, the dural sac regained its original dimension. Left rod is inserted, we performed transverse left side T6-T7-T8 arthrodesis and posterior right side T6-T7-T8 arthrodesis. Intra operatory neurophysiologic monitoring is performed during all operation, with continuous normal signal passage. After surgery patient neurologic exam was unchanged. Patient is braced by cast and set up three days after surgery. 30 days after surgery cast is substituted by custom brace that patient wears continuously for 2 months. Nine months after surgery T6-T7-T8 arthrodesis is complete on x-rays exam and instrumentation is removed One year after stabilization patient has regained all his previous life activities, even motorbike competitions, with new motorbike accident and left tibial plate fracture. Discussion: As children motorbike use and competitions are becoming more and more diffuse, motorbike accidents with resulting lesions are more common, including severe spine fractures. The patient of this case report is included in a cohort of 6 cases of thoracic fractures caused by injuries during young riders’ motorbike competitions in patients under 15 years of age. Two of them have been treated by surgery and the other 4 patients have been treated by cast/bracing without surgery.
{"title":"T7 vertebral burst fracture with left pedicle separated from vertebral body and displaced in vertebral canal without neurologic deficits in a 12 years old motorbike competition rider","authors":"M. Crostelli, O. Mazza, M. Mariani, P. Persiani, F. M. Ranaldi, D. Mascello, C. Iorio","doi":"10.15761/GOS.1000201","DOIUrl":"https://doi.org/10.15761/GOS.1000201","url":null,"abstract":"Introduction: CL, aged 12 years and 4 months, suffered multiple thoracic spine fractures in an accident as a rider in motorbike competition reporting T7 body fracture with anterior wedging associated with displaced left pedicle fracture at level of vertebral body- pedicle union, pedicle was displaced inside vertebral canal completely obliterating sub arachnoid space. There were associated T5, T6, T8, T9, T10 body wedge fractures. Imaging shown no sign of spinal cord lesion. Clinical exam shown no nervous deficits. Material and Methods: Treatment strategy had two goals, initial T7 fracture stabilization and nervous structures decompression. After initial stabilization with pedicle screws inserted in T5, T6, T8 and T7 vertebras, and only right-side rod mounted, we performed T6 and, partially, T7 left laminotomy: this manoeuvre allowed the direct visualization of left pedicle fragment with facet joint dislocated in the vertebral canal and compressing lateral surface of dural sac. The fragment was accurately isolated from sac surface and removed; no dural lesion showed after fragment removal, the dural sac regained its original dimension. Left rod is inserted, we performed transverse left side T6-T7-T8 arthrodesis and posterior right side T6-T7-T8 arthrodesis. Intra operatory neurophysiologic monitoring is performed during all operation, with continuous normal signal passage. After surgery patient neurologic exam was unchanged. Patient is braced by cast and set up three days after surgery. 30 days after surgery cast is substituted by custom brace that patient wears continuously for 2 months. Nine months after surgery T6-T7-T8 arthrodesis is complete on x-rays exam and instrumentation is removed One year after stabilization patient has regained all his previous life activities, even motorbike competitions, with new motorbike accident and left tibial plate fracture. Discussion: As children motorbike use and competitions are becoming more and more diffuse, motorbike accidents with resulting lesions are more common, including severe spine fractures. The patient of this case report is included in a cohort of 6 cases of thoracic fractures caused by injuries during young riders’ motorbike competitions in patients under 15 years of age. Two of them have been treated by surgery and the other 4 patients have been treated by cast/bracing without surgery.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466470","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}
C. Stefanou, S. Stefanou, K. Tepelenis, Thomas Tsiantis, Nikolaos Zikos, S. Koulas
Introduction: The best way of haemodialysis for patients with Chronic Kidney Disease (CKD), is the arteriovenous fistula, but sometimes the difficulties of this method lead to the percutaneous catheterization of the central vein as a temporary or permanent access. Case report: The catheterization of the right subclavian vein in a 73 years old patient with end-stage-renal disease was described in this report. The catheter placed in the wrong position, which passed outside of the superior vena cava and entered into the left pleural cavity causing hemoand pneumothorax. Discussion: The most preferred vascular access for haemodialysis is the internal jugular vein, due to the fact that it is associated with less complications. Malposition of a Subclavian Catheter Venus (SCV) tunnelled occurs in 1,8% to 3,7%. The preferred method is the real time ultrasound guided cannulation. Conclusion: The position of the catheter should be checked regularly and systematically. Malpositioning should be diagnosed as fast as possible and the right management of complications and removal of the catheter are the first priorities.
{"title":"Malpositioned right subcalvian tunnelled catheter and complications of the left pleural cavity","authors":"C. Stefanou, S. Stefanou, K. Tepelenis, Thomas Tsiantis, Nikolaos Zikos, S. Koulas","doi":"10.15761/gos.1000206","DOIUrl":"https://doi.org/10.15761/gos.1000206","url":null,"abstract":"Introduction: The best way of haemodialysis for patients with Chronic Kidney Disease (CKD), is the arteriovenous fistula, but sometimes the difficulties of this method lead to the percutaneous catheterization of the central vein as a temporary or permanent access. Case report: The catheterization of the right subclavian vein in a 73 years old patient with end-stage-renal disease was described in this report. The catheter placed in the wrong position, which passed outside of the superior vena cava and entered into the left pleural cavity causing hemoand pneumothorax. Discussion: The most preferred vascular access for haemodialysis is the internal jugular vein, due to the fact that it is associated with less complications. Malposition of a Subclavian Catheter Venus (SCV) tunnelled occurs in 1,8% to 3,7%. The preferred method is the real time ultrasound guided cannulation. Conclusion: The position of the catheter should be checked regularly and systematically. Malpositioning should be diagnosed as fast as possible and the right management of complications and removal of the catheter are the first priorities.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466930","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}
{"title":"Perspectives of neurosurgery for psychiatric disorders","authors":"Marcelo B de Sousa, Paulo SB de Abreu","doi":"10.15761/gos.1000205","DOIUrl":"https://doi.org/10.15761/gos.1000205","url":null,"abstract":"","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466857","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}
V. Master, S. Leung, T. Page, A. Blacker, Simon T Williams, A. Chakravarti, G. Oades, Gurminder S. Mann, C. Sundaram, A. Breda, C. Hernández, Erin E. Creedon, M. Schwiers, David W. Singleton, Jason R. Waggoner, E. Fegelman
Objective: The purpose of this study was to determine if use of a powered vascular stapler (PVS) during laparoscopic nephrectomy or nephroureterectomy procedures would yield an equivalent rate of additional hemostatic interventions to Standard of Care (SOC) staplers. Methods: A prospective, randomized, multicentre, controlled study was conducted comparing the use of PVS to SOC in laparoscopic nephrectomy or nephroureterectomy. The primary performance endpoint was the incidence of additional intraoperative haemostatic interventions, and the primary safety endpoint was the frequency of postoperative bleeding-related interventions. Equivalence was denoted by a 95% confidence interval for the difference in intervention rates between PVC and SOC with a limitation of 3%. Results: There were 136 subjects in the SOC group and 130 subjects in the PVS group who completed the study. The rates of intraoperative haemostatic interventions were 13.6% and 18.4% for SOC and PVS groups, respectively, (p=0.107). The upper bound of the difference in intervention rates exceeded the 3% criterion for equivalence. Postoperative bleeding that required intervention was experienced in two subjects (1.4%) in the SOC group and one (0.8%) in PVS. There were four adverse events rated as serious for SOC and none for PVS. Estimated blood loss was similar between the two groups. Conclusions: The PVS performed safely and effectively in nephrectomy and exhibited a rate of haemostatic intervention that was not statistically different than the SOC.
{"title":"Evaluation of a novel powered vascular stapler in laparoscopic nephrectomy","authors":"V. Master, S. Leung, T. Page, A. Blacker, Simon T Williams, A. Chakravarti, G. Oades, Gurminder S. Mann, C. Sundaram, A. Breda, C. Hernández, Erin E. Creedon, M. Schwiers, David W. Singleton, Jason R. Waggoner, E. Fegelman","doi":"10.15761/gos.1000211","DOIUrl":"https://doi.org/10.15761/gos.1000211","url":null,"abstract":"Objective: The purpose of this study was to determine if use of a powered vascular stapler (PVS) during laparoscopic nephrectomy or nephroureterectomy procedures would yield an equivalent rate of additional hemostatic interventions to Standard of Care (SOC) staplers. Methods: A prospective, randomized, multicentre, controlled study was conducted comparing the use of PVS to SOC in laparoscopic nephrectomy or nephroureterectomy. The primary performance endpoint was the incidence of additional intraoperative haemostatic interventions, and the primary safety endpoint was the frequency of postoperative bleeding-related interventions. Equivalence was denoted by a 95% confidence interval for the difference in intervention rates between PVC and SOC with a limitation of 3%. Results: There were 136 subjects in the SOC group and 130 subjects in the PVS group who completed the study. The rates of intraoperative haemostatic interventions were 13.6% and 18.4% for SOC and PVS groups, respectively, (p=0.107). The upper bound of the difference in intervention rates exceeded the 3% criterion for equivalence. Postoperative bleeding that required intervention was experienced in two subjects (1.4%) in the SOC group and one (0.8%) in PVS. There were four adverse events rated as serious for SOC and none for PVS. Estimated blood loss was similar between the two groups. Conclusions: The PVS performed safely and effectively in nephrectomy and exhibited a rate of haemostatic intervention that was not statistically different than the SOC.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466995","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}
S. Mazzei, A. Sindoni, F. Fama’, Giampietro Bertasi, Nimfa Jeraldine Buizon, M. Shafei
The use of human Acellular Dermal Matrices (hADMs) has been described in patients requiring treatment after skin burns, wounds with bone exposure, complex trauma wounds and breast surgery. We report a clinical case using hADM to close an open wound of the right foot caused by the penetration of part of a shell into the skin followed by necrotizing fasciitis, after multiple unsuccessful treatments using Negative Pressure Wound Therapy, porcine acellular dermal substitutes and a split-thickness skin graft. hADM appeared to be an appropriate adjunct for wound healing process in our patient with chronic open wound failing to heal. Introduction Skin and soft-tissue infections (SSTIs) include a variety of pathological conditions which involve the skin and underlying subcutaneous tissues, fascia or muscles, that may also cause necrotizing infections [1,2]. In 1998, the US Food and Drug administration (FDA) classified SSTIs in two main categories: uncomplicated and complicated. Uncomplicated SSTIs are represented by superficial infections as furuncles, abscesses, cellulitis and/or impetigo requiring antibiotic or surgical procedures, whereas complicated SSTIs are represented by deep soft tissue infections such as necrotizing infections, infected ulcers, infected burn and major abscess requiring surgical intervention with drainage and debridement [3,4]. The use of human Acellular Dermal Matrices (hADMs) has been reported mainly after skin burns or cosmetic and reconstructive procedures [5]. These applications can be performed successfully since hADMs have the ability to incorporate into host tissue and allow cellular and vascular ingrowths, without eliciting any biologic inflammatory response and avoiding infection [6,7]. We reported a clinical case using hADM to close an open wound of the right foot caused by necrotizing fasciitis after multiple treatment failures. Case presentation On July 2018, a 48-year-old non-smoker and non-diabetic healthy man had small open wounds of the right leg and plantar foot as a consequence of the penetration of part of a shell into the skin. After 12 hours, he experienced high fever caused by an infection involving locally the skin and subcutaneous tissues up to the muscular fascia (Figure 1). The patient was admitted to the intensive care unit for *Correspondence to: Giampietro Bertasi, Via Molino 43, San Pietro in Cariano, Italy, Tel: +393456001037; E-mail: bertasi.g@sis.it
人类脱细胞真皮基质(hADMs)在皮肤烧伤、骨暴露伤口、复杂创伤伤口和乳房手术后需要治疗的患者中使用。我们报告了一个临床病例，在使用负压伤口疗法、猪脱细胞真皮替代品和分厚皮肤移植多次失败后，使用hADM来关闭右脚的开放性伤口，该伤口是由部分贝壳穿透皮肤引起的坏死性筋膜炎引起的。在我们的慢性开放性伤口不能愈合的患者中，hADM似乎是一个合适的辅助伤口愈合过程。皮肤和软组织感染(SSTIs)包括多种病理情况，涉及皮肤及其下皮下组织、筋膜或肌肉，也可能引起坏死性感染[1,2]。1998年，美国食品和药物管理局(FDA)将ssti分为两大类:简单和复杂。不复杂的ssti以疖、脓肿、蜂窝组织炎和/或脓疱疮等浅表感染为代表，需要抗生素或手术治疗，而复杂的ssti以深部软组织感染为代表，如坏死性感染、感染性溃疡、感染性烧伤和大脓肿，需要手术干预，进行引流和清创[3,4]。据报道，人类脱细胞真皮基质(hadm)的使用主要是在皮肤烧伤或美容和重建手术后。这些应用可以成功进行，因为hadm能够融入宿主组织，允许细胞和血管向内生长，而不会引起任何生物炎症反应，避免感染[6,7]。我们报告了一个临床病例，在多次治疗失败后，使用hADM关闭右脚坏死性筋膜炎引起的开放性伤口。2018年7月，一名48岁的非吸烟者和非糖尿病健康男性，由于部分贝壳渗透到皮肤中，右腿和足底有小的开放性伤口。12小时后，患者出现由局部皮肤和皮下组织直至肌筋膜感染引起的高烧(图1)。患者因以下原因被送入重症监护室:Giampietro Bertasi, Via Molino 43, San Pietro in Cariano, Italy, Tel: +393456001037;电子邮件:bertasi.g@sis.it
{"title":"Use of human acellular dermal matrix for wound healing in a patient with necrotizing fasciitis, after failure of autologous dermal / epidermal skin graft: A case report","authors":"S. Mazzei, A. Sindoni, F. Fama’, Giampietro Bertasi, Nimfa Jeraldine Buizon, M. Shafei","doi":"10.15761/gos.1000209","DOIUrl":"https://doi.org/10.15761/gos.1000209","url":null,"abstract":"The use of human Acellular Dermal Matrices (hADMs) has been described in patients requiring treatment after skin burns, wounds with bone exposure, complex trauma wounds and breast surgery. We report a clinical case using hADM to close an open wound of the right foot caused by the penetration of part of a shell into the skin followed by necrotizing fasciitis, after multiple unsuccessful treatments using Negative Pressure Wound Therapy, porcine acellular dermal substitutes and a split-thickness skin graft. hADM appeared to be an appropriate adjunct for wound healing process in our patient with chronic open wound failing to heal. Introduction Skin and soft-tissue infections (SSTIs) include a variety of pathological conditions which involve the skin and underlying subcutaneous tissues, fascia or muscles, that may also cause necrotizing infections [1,2]. In 1998, the US Food and Drug administration (FDA) classified SSTIs in two main categories: uncomplicated and complicated. Uncomplicated SSTIs are represented by superficial infections as furuncles, abscesses, cellulitis and/or impetigo requiring antibiotic or surgical procedures, whereas complicated SSTIs are represented by deep soft tissue infections such as necrotizing infections, infected ulcers, infected burn and major abscess requiring surgical intervention with drainage and debridement [3,4]. The use of human Acellular Dermal Matrices (hADMs) has been reported mainly after skin burns or cosmetic and reconstructive procedures [5]. These applications can be performed successfully since hADMs have the ability to incorporate into host tissue and allow cellular and vascular ingrowths, without eliciting any biologic inflammatory response and avoiding infection [6,7]. We reported a clinical case using hADM to close an open wound of the right foot caused by necrotizing fasciitis after multiple treatment failures. Case presentation On July 2018, a 48-year-old non-smoker and non-diabetic healthy man had small open wounds of the right leg and plantar foot as a consequence of the penetration of part of a shell into the skin. After 12 hours, he experienced high fever caused by an infection involving locally the skin and subcutaneous tissues up to the muscular fascia (Figure 1). The patient was admitted to the intensive care unit for *Correspondence to: Giampietro Bertasi, Via Molino 43, San Pietro in Cariano, Italy, Tel: +393456001037; E-mail: bertasi.g@sis.it","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466802","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}
Azam Jan, N. I. Awan, A. Mohammad, Syed Ma Shah, Somaiyya Rehman, M. Tariq, Tahir Iqbal, J. Rehman
Objective: We wanted to compare the outcome and cost of open and thoracoscopic (VATS) pneumonectomy. Introduction: The primary objective of this study was to compare the in-hospital mortality and morbidity of patients who underwent pneumonectomy either by thoracoscopy or thoracotomy approaches. We also wanted to determine risk factors for in-hospital mortality (death during hospital admission) and/or morbidity after pneumonectomy. Methodology: The Healthcare Cost and Utilization Project (HCUP), sponsored by The Agency for Healthcare Research and Quality’s (AHRQ), includes the largest collection of longitudinal hospital care data in the United States. The data in the HCUP databases primarily include data from non-federal community hospitals. HCUP creates the National In-patient Sample (NIS) to help conduct national and regional analysis of in-patient care. NIS was the primary database used for this research purpose. The NIS is derived from the State In-patient Databases (SID) and approximates a 20% sample of discharges from all HCUP community hospitals in the U.S. The NIS is the largest publicly available all-payer inpatient health care database in the United States, yielding national estimates of hospital inpatient stays. Unweighted, it contains data from more than 7 million hospital stays each year. Weighted, it estimates more than 35 million hospitalizations nationally. Results: We enrolled a total of 37,037 patients. Since 2001, the number of pneumonectomies have decreased from 3,518 to 1920 in 2013.The in-hospital mortality was 8.67 % in 2001 which is down to 4.43% in 2013. Mean charge increased from 48,412 $ in 2001 to 121069 $ in 2013. Also, there is no change in routine discharges, use of nursing home, rehabilitation institutions, home health care over the years 2008 to 2012. Mean length of hospital stay was 9.2 days. Total deaths in our study were 2959 patients. Conclusions: Thoracoscopic pneumonectomies decrease cost and are discharged to home more frequently as compared to open pneumonectomies. Abbreviations: AHRQ: The Agency for Healthcare Research and Quality’s; HCUP: The Healthcare Cost and Utilization Project; SID: State Inpatient Databases; NIS: National Inpatient Sample (NIS); ICD9-CM: International Classification of Diseases, Clinical Modification (ICD-9-CM); VATS: Video associated thoracoscopic surgery.
{"title":"Comparison of outcome and cost in open and thoracoscopic pneumonectomy: A 13 years multicentre study","authors":"Azam Jan, N. I. Awan, A. Mohammad, Syed Ma Shah, Somaiyya Rehman, M. Tariq, Tahir Iqbal, J. Rehman","doi":"10.15761/gos.1000203","DOIUrl":"https://doi.org/10.15761/gos.1000203","url":null,"abstract":"Objective: We wanted to compare the outcome and cost of open and thoracoscopic (VATS) pneumonectomy. Introduction: The primary objective of this study was to compare the in-hospital mortality and morbidity of patients who underwent pneumonectomy either by thoracoscopy or thoracotomy approaches. We also wanted to determine risk factors for in-hospital mortality (death during hospital admission) and/or morbidity after pneumonectomy. Methodology: The Healthcare Cost and Utilization Project (HCUP), sponsored by The Agency for Healthcare Research and Quality’s (AHRQ), includes the largest collection of longitudinal hospital care data in the United States. The data in the HCUP databases primarily include data from non-federal community hospitals. HCUP creates the National In-patient Sample (NIS) to help conduct national and regional analysis of in-patient care. NIS was the primary database used for this research purpose. The NIS is derived from the State In-patient Databases (SID) and approximates a 20% sample of discharges from all HCUP community hospitals in the U.S. The NIS is the largest publicly available all-payer inpatient health care database in the United States, yielding national estimates of hospital inpatient stays. Unweighted, it contains data from more than 7 million hospital stays each year. Weighted, it estimates more than 35 million hospitalizations nationally. Results: We enrolled a total of 37,037 patients. Since 2001, the number of pneumonectomies have decreased from 3,518 to 1920 in 2013.The in-hospital mortality was 8.67 % in 2001 which is down to 4.43% in 2013. Mean charge increased from 48,412 $ in 2001 to 121069 $ in 2013. Also, there is no change in routine discharges, use of nursing home, rehabilitation institutions, home health care over the years 2008 to 2012. Mean length of hospital stay was 9.2 days. Total deaths in our study were 2959 patients. Conclusions: Thoracoscopic pneumonectomies decrease cost and are discharged to home more frequently as compared to open pneumonectomies. Abbreviations: AHRQ: The Agency for Healthcare Research and Quality’s; HCUP: The Healthcare Cost and Utilization Project; SID: State Inpatient Databases; NIS: National Inpatient Sample (NIS); ICD9-CM: International Classification of Diseases, Clinical Modification (ICD-9-CM); VATS: Video associated thoracoscopic surgery.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466147","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}
B. ALShareef, W. Yaseen, W Jawa, Y Barnawi, H Alqtham, W. Bukhari, W. Alshehri, O Alqumaili
Introduction: Breast cancer (BC) is the most frequent malignancy of women and second leading cause of cancer related death worldwide. In Saudi Arabia, is the ninth cause of death. Few studies have been conducted to address BC awareness in KSA in general and to our knowledge, this is the first to be conducted in Makkah region. Aim: To assess the level of awareness knowledge, attitude of Saudi female teachers towards BC in primary, intermediate and secondary schools in Makkah region. Method and materials: The study proposal was approved by the Research Ethical Committee in faculty of medicine, Umm Al-Qura University. A self-administered questionnaire on BC was designed and tested. Questionnaire consisted of 23 items covered four domains (awareness about the aetiology, knowledge about BC risk factors, symptoms, knowledge about diagnosis and treatment & attitude toward screening). A sample of 400 female school teachers working in primary, intermediate and secondary schools was selected by multistage random sampling. Forty schools in Makkah were selected randomly, and a convenient sample of 10 teachers from each school was randomly selected as well. Proper permission was obtained from the authorities. The collected data statistically analyzed using SPSS version 21. Results: The results showed significant knowledge & attitude about BC among the female teachers differed significantly by their age and marital status. Those aged 46-55 (F = 8.5, p > 0.00) and those who are married (F = 2.7, p > 0.04) had more knowledge about BC than others. The majority of respondents had limited level of knowledge and understanding of BC symptoms. However, it also showed that the teachers are very enthusiastic to learn about BC, and its prevention. Most participants reported that they did not perform any breast exam before (40/%). Conclusions and recommendation: This study indicated that Saudi female teachers’ level of knowledge of BC is inadequate. This might be an obstacle to screening program. Public-awareness interventions are needed in order to overcome an ever-increasing burden of this disease among Saudi females and introducing and develop an effective health education program in female schools in KSA is recommended.
乳腺癌(BC)是女性最常见的恶性肿瘤，也是全球癌症相关死亡的第二大原因。在沙特阿拉伯，它是第九大死因。很少有研究是针对沙特阿拉伯的BC意识进行的，据我们所知，这是首次在麦加地区进行的研究。目的:评估沙特阿拉伯麦加地区小学、初中和中学女教师对BC的认知、知识水平和态度。方法和材料:本研究方案经Umm Al-Qura大学医学院研究伦理委员会批准。设计并测试了一份自我管理的BC问卷。问卷共23项，涵盖4个领域(对病因的认识、对BC危险因素的认识、症状、对诊断和治疗的认识及对筛查的态度)。采用多阶段随机抽样的方法，选取400名中小学女教师为研究对象。在麦加随机抽取了40所学校，并从每所学校随机抽取了10名教师作为样本。得到了当局的适当许可。收集的数据使用SPSS 21版进行统计分析。结果:不同年龄和婚姻状况的女教师对BC的认知和态度存在显著差异。46 ~ 55岁组(F = 8.5, p > 0.00)和已婚组(F = 2.7, p > 0.04)对BC的了解程度高于其他组。大多数应答者对BC症状的认识和理解水平有限。然而，这也表明了老师们对BC及其预防的热情。大多数参与者报告说他们以前没有做过任何乳房检查(40%)。结论与建议:本研究表明沙特女教师BC知识水平不足。这可能是筛选程序的一个障碍。需要采取提高公众意识的干预措施，以克服沙特女性日益增加的这一疾病负担，并建议在沙特阿拉伯的女子学校引入和制定有效的卫生教育方案。
{"title":"Breast cancer awareness among female school teachers in Makkah region, Saudi Arabia. A cross-sectional study","authors":"B. ALShareef, W. Yaseen, W Jawa, Y Barnawi, H Alqtham, W. Bukhari, W. Alshehri, O Alqumaili","doi":"10.15761/gos.1000199","DOIUrl":"https://doi.org/10.15761/gos.1000199","url":null,"abstract":"Introduction: Breast cancer (BC) is the most frequent malignancy of women and second leading cause of cancer related death worldwide. In Saudi Arabia, is the ninth cause of death. Few studies have been conducted to address BC awareness in KSA in general and to our knowledge, this is the first to be conducted in Makkah region. Aim: To assess the level of awareness knowledge, attitude of Saudi female teachers towards BC in primary, intermediate and secondary schools in Makkah region. Method and materials: The study proposal was approved by the Research Ethical Committee in faculty of medicine, Umm Al-Qura University. A self-administered questionnaire on BC was designed and tested. Questionnaire consisted of 23 items covered four domains (awareness about the aetiology, knowledge about BC risk factors, symptoms, knowledge about diagnosis and treatment & attitude toward screening). A sample of 400 female school teachers working in primary, intermediate and secondary schools was selected by multistage random sampling. Forty schools in Makkah were selected randomly, and a convenient sample of 10 teachers from each school was randomly selected as well. Proper permission was obtained from the authorities. The collected data statistically analyzed using SPSS version 21. Results: The results showed significant knowledge & attitude about BC among the female teachers differed significantly by their age and marital status. Those aged 46-55 (F = 8.5, p > 0.00) and those who are married (F = 2.7, p > 0.04) had more knowledge about BC than others. The majority of respondents had limited level of knowledge and understanding of BC symptoms. However, it also showed that the teachers are very enthusiastic to learn about BC, and its prevention. Most participants reported that they did not perform any breast exam before (40/%). Conclusions and recommendation: This study indicated that Saudi female teachers’ level of knowledge of BC is inadequate. This might be an obstacle to screening program. Public-awareness interventions are needed in order to overcome an ever-increasing burden of this disease among Saudi females and introducing and develop an effective health education program in female schools in KSA is recommended.","PeriodicalId":73175,"journal":{"name":"Global surgery (London)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67466344","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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