Pub Date : 2018-11-13DOI: 10.26420/austinjsurg.2018.1153
Minliang Chen
Neurofibromas are benign peripheral nerve sheath tumors. Solitary neurofibromas may be quite large. They are radio resistant and have poor sensitivity to chemotherapeutic drugs. Surgical resection, the remaining option, can be difficult due to the infiltrating nature of the tumor and the risk of massive hemorrhage. We report a patient with a massive (>80 kg) neurofibroma who was successfully managed with preoperative embolization of feeder arteries followed by surgical resection.
{"title":"A Case Report of the Resection of Giant Trunk Neurofibroma","authors":"Minliang Chen","doi":"10.26420/austinjsurg.2018.1153","DOIUrl":"https://doi.org/10.26420/austinjsurg.2018.1153","url":null,"abstract":"Neurofibromas are benign peripheral nerve sheath tumors. Solitary neurofibromas may be quite large. They are radio resistant and have poor sensitivity to chemotherapeutic drugs. Surgical resection, the remaining option, can be difficult due to the infiltrating nature of the tumor and the risk of massive hemorrhage. We report a patient with a massive (>80 kg) neurofibroma who was successfully managed with preoperative embolization of feeder arteries followed by surgical resection.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78722585","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}
Pub Date : 2018-10-23DOI: 10.26420/austinjsurg.2018.1150
K. Ch
A 77-year-old woman with aggravating chest pain for a month visited our outpatient clinic. Nearly occluded left anterior descending coronary artery and right lower lobe nodule suggesting lung cancer were identified in coronary angiogram and computed tomogram, respectively. To minimize postoperative complication, simultaneous robot-assisted minimally invasive coronary artery bypass grafting (CABG) and video-assisted thoracoscopic surgery (VATS) of right lower lobectomy were performed. Postoperative course was uneventful except transient atrial fibrillation. The patient was discharged on the 8 th postoperative day. Simultaneous minimally invasive CABG and VATS lobectomy instead of median sternotomy and thoracotomy approach could be a safer treatment option for concurrent coronary artery disease and lung cancer in high-risk patients.
{"title":"Simultaneous Minimally Invasive Surgery in a Patient with Lung Cancer and Coronary Artery Disease","authors":"K. Ch","doi":"10.26420/austinjsurg.2018.1150","DOIUrl":"https://doi.org/10.26420/austinjsurg.2018.1150","url":null,"abstract":"A 77-year-old woman with aggravating chest pain for a month visited our outpatient clinic. Nearly occluded left anterior descending coronary artery and right lower lobe nodule suggesting lung cancer were identified in coronary angiogram and computed tomogram, respectively. To minimize postoperative complication, simultaneous robot-assisted minimally invasive coronary artery bypass grafting (CABG) and video-assisted thoracoscopic surgery (VATS) of right lower lobectomy were performed. Postoperative course was uneventful except transient atrial fibrillation. The patient was discharged on the 8 th postoperative day. Simultaneous minimally invasive CABG and VATS lobectomy instead of median sternotomy and thoracotomy approach could be a safer treatment option for concurrent coronary artery disease and lung cancer in high-risk patients.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84154894","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}
Pub Date : 2018-09-19DOI: 10.26420/austinjsurg.2018.1148
K. Toda
Fibromyalgia (FM) and related syndrome (FMRS) often causes severe pain on any part of the body. This causes some kinds of problems. First, depending on the location of the pain, FMRS may be misdiagnosed with other diseases. In case that spinal surgery is performed, we should confirm that the cause of the symptoms is abnormality of the spine. Second, if patients with FMRS suffer from other painful diseases such as appendicitis, it is very difficult to find early other painful diseases. Surgeons have to make a final decision on the surgery. Third, surgeons often have to treat out patients. Treatment for spinal pain such as neck pain and low back pain without knowledge of FMRS is the same as talking about the American War of Independence without knowledge of George Washington. Forth, FM may be risk factor of complex regional pain syndrome. In case that patient with risk factor of complex regional pain syndrome undergo surgery, sufficient pain control is necessary.
{"title":"Surgeons, Especially Orthopedic Surgeons Should Know Fibromyalgia and Incomplete Form of Fibromyalgia","authors":"K. Toda","doi":"10.26420/austinjsurg.2018.1148","DOIUrl":"https://doi.org/10.26420/austinjsurg.2018.1148","url":null,"abstract":"Fibromyalgia (FM) and related syndrome (FMRS) often causes severe pain on any part of the body. This causes some kinds of problems. First, depending on the location of the pain, FMRS may be misdiagnosed with other diseases. In case that spinal surgery is performed, we should confirm that the cause of the symptoms is abnormality of the spine. Second, if patients with FMRS suffer from other painful diseases such as appendicitis, it is very difficult to find early other painful diseases. Surgeons have to make a final decision on the surgery. Third, surgeons often have to treat out patients. Treatment for spinal pain such as neck pain and low back pain without knowledge of FMRS is the same as talking about the American War of Independence without knowledge of George Washington. Forth, FM may be risk factor of complex regional pain syndrome. In case that patient with risk factor of complex regional pain syndrome undergo surgery, sufficient pain control is necessary.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90196805","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}
Pub Date : 2018-08-07DOI: 10.26420/austinjsurg.2018.1147
P. Weledji, J. Tambe
The main consequences of abdominal trauma are haemorrhage and sepsis. Early deaths following abdominal trauma are usually attributable to haemorrhage. Sepsis is the most common cause in deaths occurring more than 48 hours after injury. Thus the first priority for the surgeon performing a laparotomy for abdominal trauma is haemorrhage control and prevention of spilling of visceral contents from visceral injuries is the second priority. In selected patients definitive repair is delayed until after a period of intensive resuscitation following damage-control surgery. The diagnosis or exclusion of hollow viscus injuries can be problematic. Excluding the general principles of trauma laparotomy and definitive intraabdominal procedures, the article discussed the clinical assessment and decisionmaking which would ensure that injuries are not missed during laparotomy and thus decrease mortality.
{"title":"Perspectives on the Management of Abdominal Trauma","authors":"P. Weledji, J. Tambe","doi":"10.26420/austinjsurg.2018.1147","DOIUrl":"https://doi.org/10.26420/austinjsurg.2018.1147","url":null,"abstract":"The main consequences of abdominal trauma are haemorrhage and sepsis. Early deaths following abdominal trauma are usually attributable to haemorrhage. Sepsis is the most common cause in deaths occurring more than 48 hours after injury. Thus the first priority for the surgeon performing a laparotomy for abdominal trauma is haemorrhage control and prevention of spilling of visceral contents from visceral injuries is the second priority. In selected patients definitive repair is delayed until after a period of intensive resuscitation following damage-control surgery. The diagnosis or exclusion of hollow viscus injuries can be problematic. Excluding the general principles of trauma laparotomy and definitive intraabdominal procedures, the article discussed the clinical assessment and decisionmaking which would ensure that injuries are not missed during laparotomy and thus decrease mortality.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"582 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77015559","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}
Pub Date : 2018-07-30DOI: 10.26420/austinjsurg.2018.1145
G. Sc
With an increase in hospital-based employment of plastic surgery graduates, understanding how hospitals evaluate physician performance is essential, as data could have important career implications. At our hospital (Loma Linda University Medical Center), the software program The CRIMSON Initiative is used to provide data related to physician performance. Upon review of this data, our Plastic Surgery department had a 30 days readmission rate that was higher than the hospital average. We were interested to see how accurate this number actually was, and so we closely examined the 30 days readmission rates for our department for an entire year. Using the CRIMSON Initiative software, two separate major searches were used (by “Attending Physician” and by “Performing Physician”). Searching either way revealed a 30 days readmission rate that was higher for our department than the hospital average. However, after manually sorting through each patient chart, there were cases that were not readmissions due to the patient’s plastic surgery. Once these cases were excluded from the original calculations, it brought our department’s readmission rate down to slightly lower than the hospital average for each search. This discrepancy highlights the margin of error of such automated physician performance programs, and brings to light pitfalls that physicians should be aware of concerning similar programs at their own institutions. As plastic surgery residency graduates are increasingly employed by hospitals, it would behoove them to be cognizant of this issue, and to be empowered to question the data being used to assess their performance.
{"title":"An Assessment of Artificial Intelligence Software Measurement of Physician Performance: Not Quite Ready for Prime Time","authors":"G. Sc","doi":"10.26420/austinjsurg.2018.1145","DOIUrl":"https://doi.org/10.26420/austinjsurg.2018.1145","url":null,"abstract":"With an increase in hospital-based employment of plastic surgery graduates, understanding how hospitals evaluate physician performance is essential, as data could have important career implications. At our hospital (Loma Linda University Medical Center), the software program The CRIMSON Initiative is used to provide data related to physician performance. Upon review of this data, our Plastic Surgery department had a 30 days readmission rate that was higher than the hospital average. We were interested to see how accurate this number actually was, and so we closely examined the 30 days readmission rates for our department for an entire year. Using the CRIMSON Initiative software, two separate major searches were used (by “Attending Physician” and by “Performing Physician”). Searching either way revealed a 30 days readmission rate that was higher for our department than the hospital average. However, after manually sorting through each patient chart, there were cases that were not readmissions due to the patient’s plastic surgery. Once these cases were excluded from the original calculations, it brought our department’s readmission rate down to slightly lower than the hospital average for each search. This discrepancy highlights the margin of error of such automated physician performance programs, and brings to light pitfalls that physicians should be aware of concerning similar programs at their own institutions. As plastic surgery residency graduates are increasingly employed by hospitals, it would behoove them to be cognizant of this issue, and to be empowered to question the data being used to assess their performance.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"322 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79708295","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}
Pub Date : 2018-07-30DOI: 10.26420/austinjsurg.2018.1146
H. Elkaoui
A 67-year-old man with a history of hypertension, presented with a 3-month history of fatigue, intermittent fever and abdominal pain over the left upper quadrant. Abdominal examination revealed a splenomegaly (4cm from costal arch), without any regional lymphadenopathy. The hemogram was normal and blood biochemistry did not show abnormalities. Abdominal sonography showed multiple hypoechoic splenic nodules. Abdominal CT revealed multiple hypodense splenic tumors, likely perisplenic lymphadenopathy, around the pancreatic tail and splenic hilum, involving the splenic vein (Figure 1). The patient underwent splenectomy, and perisplenic and peripancreatic lymphnode dissection (Figure 2). Pathology revealed malignant splenic marginal zone B-cell lymphoma (SMZL). After 6 cycles of R-CHOP*, the patient went into complete remission. SMZL is an indolent B cell malignancy, presents as an incidental finding or with symptoms of splenic enlargement [1,2]. Diagnosis is based on lymphocyte morphology, immunophenotype and marrow and /or splenic histology [2]. Therapeutic options include splenectomy and alkylating agents. The median survival is 10-13 years [3].
{"title":"Unusual Cause of Splenomagaly","authors":"H. Elkaoui","doi":"10.26420/austinjsurg.2018.1146","DOIUrl":"https://doi.org/10.26420/austinjsurg.2018.1146","url":null,"abstract":"A 67-year-old man with a history of hypertension, presented with a 3-month history of fatigue, intermittent fever and abdominal pain over the left upper quadrant. Abdominal examination revealed a splenomegaly (4cm from costal arch), without any regional lymphadenopathy. The hemogram was normal and blood biochemistry did not show abnormalities. Abdominal sonography showed multiple hypoechoic splenic nodules. Abdominal CT revealed multiple hypodense splenic tumors, likely perisplenic lymphadenopathy, around the pancreatic tail and splenic hilum, involving the splenic vein (Figure 1). The patient underwent splenectomy, and perisplenic and peripancreatic lymphnode dissection (Figure 2). Pathology revealed malignant splenic marginal zone B-cell lymphoma (SMZL). After 6 cycles of R-CHOP*, the patient went into complete remission. SMZL is an indolent B cell malignancy, presents as an incidental finding or with symptoms of splenic enlargement [1,2]. Diagnosis is based on lymphocyte morphology, immunophenotype and marrow and /or splenic histology [2]. Therapeutic options include splenectomy and alkylating agents. The median survival is 10-13 years [3].","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80081164","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}
Pub Date : 2018-05-29DOI: 10.26717/BJSTR.2018.05.0001134
Ł. Krakowczyk, K. Dowgierd, Maciej Borowiec, D. Smyczek, D. Walczak, A. Maciejewski
Central Giant Cell Granuloma (CGCG) accounts for 1–7% of all benign lesions of the head and neck. It often arises in the maxilla followed by mandible and affects children and young adults. Free flap surgery in the pediatric population has gained widespread acceptance regarding its technical utility and reliability. One-stage reconstruction combining osseous free flaps with virtual surgical planning are becoming the standard for mandibular defects. The aim of this study was the present the case with fibula free flap with virtual surgical planning for reconstruction after resection of multiple central giant cell granuloma of the mandible and to assess the feasibility and safety of this technique.
{"title":"Multifocal Central Giant Cell Granuloma of the Mandible in 9-Year-Old Boy with one Stage Surgery using Fibula Free Flaps with Virtual Surgical Planning","authors":"Ł. Krakowczyk, K. Dowgierd, Maciej Borowiec, D. Smyczek, D. Walczak, A. Maciejewski","doi":"10.26717/BJSTR.2018.05.0001134","DOIUrl":"https://doi.org/10.26717/BJSTR.2018.05.0001134","url":null,"abstract":"Central Giant Cell Granuloma (CGCG) accounts for 1–7% of all benign lesions of the head and neck. It often arises in the maxilla followed by mandible and affects children and young adults. Free flap surgery in the pediatric population has gained widespread acceptance regarding its technical utility and reliability. One-stage reconstruction combining osseous free flaps with virtual surgical planning are becoming the standard for mandibular defects. The aim of this study was the present the case with fibula free flap with virtual surgical planning for reconstruction after resection of multiple central giant cell granuloma of the mandible and to assess the feasibility and safety of this technique.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"40 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91504883","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 describe the case of a 57 year old man with a solitary kidney after undergoing resection of a Wilm's tumor as a child and a recent left partial colectomy who presents with an incidentally found clinical T1b renal mass. The patient underwent tumor enucleation and had no change in his renal function twelve days after surgery as compared to his preoperative baseline, highlighting the additional nephron-sparing associated with tumor enucleation as compared to partial nephrectomy that includes a gross margin of normal parenchyma.
{"title":"Tumor Enucleation of Renal Cell Carcinoma in a Solitary Kidney.","authors":"N J Farber, I Faiena, J S Parihar, E A Singer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We describe the case of a 57 year old man with a solitary kidney after undergoing resection of a Wilm's tumor as a child and a recent left partial colectomy who presents with an incidentally found clinical T1b renal mass. The patient underwent tumor enucleation and had no change in his renal function twelve days after surgery as compared to his preoperative baseline, highlighting the additional nephron-sparing associated with tumor enucleation as compared to partial nephrectomy that includes a gross margin of normal parenchyma.</p>","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568747/pdf/nihms-696256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34080170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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