American Journal of Surgery and Clinical Case Reports最新文献

{"title":"Submucosal Elastosis of the Right Colon-A Case Report with Review of the Literature","authors":"Al Amin, Andrew J Bain, Jingxin Qiu","doi":"10.47829/ajsccr.2021.4204","DOIUrl":"https://doi.org/10.47829/ajsccr.2021.4204","url":null,"abstract":"Submucosal elastosis of the colon is a rarely reported condition that may resemble colonic polyp and amyloid deposition. We report a case of 68-year-old male who underwent screening for colorectal malignant neoplasm. Multiple sessile polyps along with innumerable firm yellow nodules of varying sizes are identified throughout the right colon. Histopathologically, the nodules are characterized by extensive submucosal accumulation of eosinophilic elastic fibers, positive for elastin stain and negative for Congo red stain. The overall findings are consistent with fibroelastoma. The clinical, microscopic, and immunohistochemical characteristics of the current case are reviewed in detail in this report. Other 25 reported cases between 2004-2019 are summarized and their clinical and pathological features are compared with the current case","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84607247","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":"Resuming Business in A COVID Normal Environment","authors":"Akindeju Mk","doi":"10.47829/ajsccr.2021.31303","DOIUrl":"https://doi.org/10.47829/ajsccr.2021.31303","url":null,"abstract":"1. Abstract Although pandemics of its scale and geographical coverage are not unprecedented as widely claimed, coronavirus continues to pose novel and complex challenges to governments, businesses, and individuals. Governments had and continue to have obligations to respond speedily with both health and economic policies to prevent irrevocable damages to their respective economies and sovereignties-some more successful than others. The speed at which governments responded meant there had to be incremental knowledge on the virus, hence public health handling methodologies and policies morphed from form to form in the face of balancing economic realities with health imperatives, inadequate supplies of personal protective equipment and manpower. Amongst all these, MKPro Engineering Pty Ltd (‘MKPro’) identified a critical oversight as of May 2020-official advice had not recognised that aerosol mode of transmission was clearly feasible and was of grave danger. In our modelling, we mathematically established that coronavirus, at published mass of 33.8kDa and 1million cells/mL cluster density, is about 22billion times lighter than air, and can be air-borne, hence able to travel as aerosol particles under suitable conditions for at least several meters before the aerosols become considerably dispersed. Upon establishing the above, MKPro articulated and suggested behavioural and Engineering solutions that can help businesses recover and safely contemplate resumption to business in a COVID-Normal environment. 2. Introduction As SARS-CoV-22 (and COVID-19) pandemic gripped the world, the attention of governments and businesses turned to the widespread damages it was and is still causing to public and private economies. While they battled with stabilising economies and contemplated recoveries, the attention of professionals including doctors, scientists, researchers, public health managers and engineers were focused on the deterministic programming for such recoveries. Those attentions and interests did not always align. Although similar pandemics, by scale, occurred in 1918-1920 (Jarus, 2020; US CDC, 2019; WHO, 2019), COVID19 pandemic was hyped as unprecedented giving rise to governments wielding sweeping Emergency and Public Health powers with elements of public health responses demonstrating most governments may not have adequately learnt from prior comparable pandemics. The attending challenges which include diminished cognition (Marshal, 2021) [14,15], Long-COVID (Marshall, 2021), human behavioural social fatigue (Petherick et al., 2021) [19], deteriorating mental health (Hampshire et al., 2021) [8], shortages of personal protective equipment (Koehler et al., 2020) [13], and non-compliance to public health orders (Nivette et al., 2020) [18] were exacerbated by limited knowledge on coronavirus epidemiology, and in particular on whether coronavirus is communicable via aerosol mode and from saliva (Hu et al, 2020) [9]. With a view to advising necessary gove","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84777419","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":"The Clinical Comparison Between Tokyo Guidelines and A Novel Auxiliary Scoring System in Guiding the Urgent Drainage of Acute Cholangitis","authors":"Guo Y, M. C., W. X, L. L, Wang Q, Xu Z, Li T, Liu F, L. J., Xiu P","doi":"10.47829/ajsccr.2021.3604","DOIUrl":"https://doi.org/10.47829/ajsccr.2021.3604","url":null,"abstract":"","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85761318","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":"Phalloplasty Due to Complete Peno-Scrotal Amputation: A Report Of Surgical Technique","authors":"M. Ozinko, Otobo Of, Otei Oo, Ekpo Rg, I. Isiwele, Ashindoitiang Ja","doi":"10.47829/AJSCCR.2021.2405","DOIUrl":"https://doi.org/10.47829/AJSCCR.2021.2405","url":null,"abstract":"Total penile reconstruction is a challenging procedure considering the anatomy and physiology of the organ.\u0000A lot of penile reconstructions have been done in the past and many options have been considered, yet there\u0000are still problems associated with either function or aesthesis. Many options that were used are still leaving\u0000some dissatisfactory. The authors decided to use the anteromedial thigh flap for penile reconstruction which\u0000is not a common choice for total phalloplasty. The anteromedial thigh flap is a veritable tool in scrotoplasty.\u0000Thus, we present the use of double anteromedial thigh flaps for the reconstruction of the penis.\u0000","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87752758","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":"Resection of a Giant Hepatocellular Adenoma Causing Refractory Hypertension, Stroke, Hyperkalemia, Malnutrition and Mesenteric Ischemia","authors":"S. Kulkarni, Tayler J. James, R. Selby, M. Stapfer","doi":"10.47496/nl.ajscr.2020.01.05","DOIUrl":"https://doi.org/10.47496/nl.ajscr.2020.01.05","url":null,"abstract":"Hepatocellular adenoma is a rare, benign liver neoplasm. Hepatocellular adenomas carry a risk of malignant\u0000transformation and spontaneous bleeding, and giant hepatic adenomas can cause additional morbidity by\u0000compressing important adjacent structures. Surgical resection is recommended for large adenomas and is\u0000curative. We report a case of a 31-year old Hispanic male with a giant 35cm hepatocellular adenoma causing\u0000right lung compression/collapse, pulmonary hypertension, mesenteric ischemia, refractory hypertension,\u0000and cerebrovascular accident (CVA) due to renal vein compression. Exploratory laparotomy, median\u0000sternotomy, left lobectomy, cholecystectomy and hepatico-jejunostomy were performed. The giant\u0000adenoma was successfully removed with the resolution of all associated medical problems and a full\u0000recovery. Massive liver lesions can be resected safely with adequate exposure and may require median\u0000sternotomy. Multiple medical problems due to compression can be completely reversed with resection of\u0000these benign but giant lesions. Enucleation of giant adenomas is an acceptable form of treatment for lesions\u0000causing multiple symptoms due to compression and leads to a cure in most cases.","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83158515","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":"Perineal Endometriosis: What to Do in These Cases - Analysis of 13 Patients","authors":"E. Vargas, I. M. Amaral, S. Lopez, M. Paz, Daniel Chiantera, Jenils Coacuto, B. Eliana, M. Pérez","doi":"10.47496/nl.ajscr.2020.01.03","DOIUrl":"https://doi.org/10.47496/nl.ajscr.2020.01.03","url":null,"abstract":"Objective: To analyse the clinical features of perineal endometriosis (PEM), its treatment and outcome.\u0000Methods: Prospective, single-centre study with 13 patients with PEM who were treated between 2011-2018\u0000at Domingo Luciani Hospital and mean followed up for 58.4 months. Results: Mean age was 32,2 years.\u0000All cases had a history of vaginal delivery with an episiotomy. All complained of perineal pain related to\u0000the menstrual cycle; the perineal mass progressively increased in size and was tender during menstrual\u0000periods. Mean VAS was 7. 69,2% with rectal bleeding. The mean size of the lesion was 3.42 cm. CA125\u0000levels were measured in all patients, 3 (23,1%) with abnormal range; all patients were subjected to\u0000transvaginal, endoanal ultrasonography (EUS) and FNAB before surgery. Anal sphincter (AS) involvement\u0000was demonstrated by EUS in 46.2% (6). Mean EUS pre-treatment volume 18.98 ml. First, these 6 patients\u0000received hormonal therapy based on GnRH and evaluated response. Mean EUS post-treatment volume\u000010.21 ml p < 0.05. Complete local excision was performed on all cases. Mean CCFIS preoperative was 2.46\u0000and postoperative 3.01 p=0.01. No major complications or recurrences were noted. Conclusion: PEM\u0000presents with typical clinical features when it involves the AS, it could benefit from first a hormonal therapy\u0000before surgery. EUS is a useful preoperative tool to decide what we should do. The main idea at the time of\u0000surgery is performed a complete local excision with non-touch AS, and in cases where these aren’t possible,\u0000a sphincteroplasty is mandatory with good continence results, minor complications and no recurrences.","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89832460","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":"Non Traumatic Rupture of Splenic Metastases as the First Presentation of Clinically Occult Disseminated Primary Lung Cancer","authors":"Tharmaradinam S, Brits N, Kanthan R","doi":"10.47829/ajsccr.2020.2402","DOIUrl":"https://doi.org/10.47829/ajsccr.2020.2402","url":null,"abstract":"Key Learning Points • Though ruptured aortic aneurysm is one of the commonest causes of sudden hypovolemic shock in an adult male, an urgent abdominal CT angiography is recommended for confirmation of diagnosis as it may occasionally reveal an intact aorta with other unexpected causative factors such as an unsuspected splenic rupture. • Non traumatic splenic rupture is rare and is usually associated with a ‘pathological’ spleen with underlying infectious or neo plastic lesions which are usually primary hemopoietic in nature with secondary metastases being relatively uncommon. • Metastases to the spleen from visceral organs is extremely infrequent (<5%) with breast, lung, pancreas, ovary, melanoma and choriocarcinoma often being attributed as their primary source. • Though lung cancer is a commonly diagnosed cancer in Canada with many being diagnosed at an advanced stage, non-traumatic rupture of splenic metastases is an extremely rare first time clinical presentation of primary occult disseminated lung cancer. 1. Abstract In Canada, lung cancer is one of the most commonly diagnosed cancers and is the leading cause of cancer related death. Unfortunately, more than half of all lung cancers present at an advanced stage and are often metastatic at diagnosis. The common sites of metastases include the brain, bone, liver, adrenals, opposite lung and distant lymph nodes. The spleen, a hemopoietic organ is an extremely uncommon site of metastases. In the setting of lung cancer, splenic metastases occurs in the context of disseminated disease, or uncommonly presents as a solitary metastases that is often detected on radiological image surveillance. Most of these scenarios occur in the background of known lung cancer disease. In this case report, we share a case of non-traumatic rupture of splenic metastases whose clinical presentation mimicked a ruptured abdominal aneurysm. The presentation of non-traumatic rupture of the splenic metastases arising from an occult disseminated primary lung cancer as the first clinical encounter is extremely rare and to our knowledge has not been previously reported. Increased clinical awareness of this extremely uncommon clinical presentation of an underlying common disease is important as rapid diagnosis can significantly reduce major morbidity and mortality. 2. Case Presentation A 63-year-old male presented to the community hospital with a one hour history of sudden onset of central abdominal pain, nausea, vomiting and diarrhea accompanied by shortness of breath. On examination, his abdomen was mildly distended with signs of peritonism. His past medical history included a remote repair of an inguinal hernia and was otherwise unremarkable. While being transferred to a larger referral center for further workup and investigations, he unfortunately went into cardiac arrest requiring cardiopulmonary resuscitation. He was intubated on arrival at the emergency department as he was hemodynamically unstable and in acute hypovolem","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"314 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88604233","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":"Hellp Syndrome","authors":"Solomons Hd","doi":"10.47829/ajsccr.2021.3201","DOIUrl":"https://doi.org/10.47829/ajsccr.2021.3201","url":null,"abstract":"1.Introduction This is a life threatening disorder thought to be a variant of pre-eclampsia. The two conditions occur during the later stages of pregnancy or after childbirth. 2. Hellp means: Haemolytic Anaemia Elevated Liver Enzymes and Low Platelet Count. 3. Methods Hellp is associated with gestational hypertension and in patients who have pre-eclampsia elevated blood pressure and proteinuria. It is thought to be a malignant clonal stem cell disorder! The patients get headaches, blurred vision, malaise, nausea and vomiting abdominal pain and paraesthesias. Generalized oedema may occur. The liver capsule may rupture with a resultant haematoma. Seizures and coma lead to full blown eclampsia. DIC (Disseminated Intravascular Coagulation) is seen in 20% of cases 84 % of cases go into renal failure. Patients with Hellp may be misdiagnosed increasing the risk of liver failure and morbidity [1]. 4. Results In a patient with Hellp syndrome blood tests should include; full blood count, liver enzymes; urea and electrolytes and creatinine and prothrombin index /international normalized ratio, partial thromboplastin time and fibrin degradation products Lactate dehydrogenase is a marker of haemolysis and albuminuria may be present. D-Dimers are a useful test in the disorder. The platelet count may be low, e.g. < 50000. The coagulation system is thought to be the problem. Fibrin crosslinks the vessels. A microangiopathic haemolytic anaemia results and erythrocytes are destroyed. Thrombocytopaenia results and hepatic ischaemia leads to periportal necrosis. 5. Conclusion The DIC (Disseminated Intravascular Coagulopathy) leads to paradoxical haemorrhage. Seizures should be treated as for eclampsia and fresh frozen plasma, steroids and anti-hypertensives must be given. Fluids (preferably Ringer’s lactate) should be given at the required rate Hepatic haemorrhage must be treated by embolization. The incidence of Hellp is 0.2-0,6% i.e.10 to 20% of pregnancies. With treatment maternal mortality is 1%. Complications include renal failure, subcapsular hepatic haematoma and retinal detachment. Hellp syndrome was discovered in 1982 by Dr. Louis Weinstein [2].","PeriodicalId":7649,"journal":{"name":"American Journal of Surgery and Clinical Case Reports","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76218870","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}