The aim of this study is to describe the characteristics, the management and the outcome of a series of patients with no-option critical limb ischemia (CLI) treated with a conservative multidisciplinary combined approach including best wound care, NPWT and dermal substitutes. The primary end was limb salvage and 1-year amputation-free survival. The secondary end was mortality and healing time of lesion. Between January 2016 and January 2021, 76 patients with no options CLI were admitted. In 14 patients, there was a failure in distal revascularization with a persistent CLI after the procedure. In 58 patients, revascularization was not feasible. Despite the persistent CLI, a group of patients of this cohort obtained no progression of CLI, complete wound healing treated with surgical debridement or distal amputation and application of NPWT in association with dermal substitute .Any superimposed infection was treated with antimicrobials. Pain was controlled with analgesics. Overall limb was saved in 72 % of the cases. A 1-year survival was 84%.Use of NPWT, dermal substitutes combined with a conservative foot surgery with an approach with minor amputation in patients with no-option CLI may save patient limb and life
{"title":"‘No-Option Chronic Limb-Threatening Ischaemia: What Can We Do To Save Limb?","authors":"Florio A, Dennis Ms, Sallustro M","doi":"10.47829/cos.2023.9602","DOIUrl":"https://doi.org/10.47829/cos.2023.9602","url":null,"abstract":"The aim of this study is to describe the characteristics, the management and the outcome of a series of patients with no-option critical limb ischemia (CLI) treated with a conservative multidisciplinary combined approach including best wound care, NPWT and dermal substitutes. The primary end was limb salvage and 1-year amputation-free survival. The secondary end was mortality and healing time of lesion. Between January 2016 and January 2021, 76 patients with no options CLI were admitted. In 14 patients, there was a failure in distal revascularization with a persistent CLI after the procedure. In 58 patients, revascularization was not feasible. Despite the persistent CLI, a group of patients of this cohort obtained no progression of CLI, complete wound healing treated with surgical debridement or distal amputation and application of NPWT in association with dermal substitute .Any superimposed infection was treated with antimicrobials. Pain was controlled with analgesics. Overall limb was saved in 72 % of the cases. A 1-year survival was 84%.Use of NPWT, dermal substitutes combined with a conservative foot surgery with an approach with minor amputation in patients with no-option CLI may save patient limb and life","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76631847","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":"Treatment of Multifocal Neuroendocrine Tumor of the Ileum Whit Lymphatic Metastasis (NETG1) And Low Mutational Burden (TMB).Precision Surgery, Case Report and Review Literature","authors":"Losada J, Sarriugarte A, Irizar E, Maestro B, Urizar E, Losada I","doi":"10.47829/cos.2023.9604","DOIUrl":"https://doi.org/10.47829/cos.2023.9604","url":null,"abstract":"SI-NETs: Small Intestinal Neuroendocrine Tumors; TMB: Tumor mutation burden; NET (G1): Grade 1; Mut/Mb: Total number of somatic/acquired mutations per coding area of a tumor genome; mCi: millicurium; TP53: cellular tumor antigen P53 (PTHR11447:SF6); RB1: Retinoblastoma associated protein (PTHR13742:SF17); CDKN1B: Cyclin dependent kinase inhibitor 1B (PTHR10265:SF9); KRAS: GTPase KRAS (PTHR24070:SF388); NRAS: GTPase NRAS (PTHR24070:SF189); MET: Hepatocyte growth factor receptor; HGNC: 7029","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75099177","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}
Khan MS, Hassan SR, Fatima G, Muhammad S, Sherazi B
clinicofsurgery.org 1
clinicofsurgery.org 1
{"title":"Assessment of Asian Pacific Screening Score for Risk Factor Stratification of Colorectal Cancer Patients: A Retrospective Audit from a Tertiary Care Institute, Pakistan","authors":"Khan MS, Hassan SR, Fatima G, Muhammad S, Sherazi B","doi":"10.47829/cos.2023.9601","DOIUrl":"https://doi.org/10.47829/cos.2023.9601","url":null,"abstract":"clinicofsurgery.org 1","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83809522","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}
Staehler M, Graser AK, Marcon J, Götz M, Ziegelmüller B, Rodler S
{"title":"Perioperative Results of Open Renal Surgery in Patients with Dual Antiplatelet Therapy","authors":"Staehler M, Graser AK, Marcon J, Götz M, Ziegelmüller B, Rodler S","doi":"10.47829/cos.2023.9203","DOIUrl":"https://doi.org/10.47829/cos.2023.9203","url":null,"abstract":"","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"183 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72541986","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. B, Chauhan Mn, Nahboo Sz, Wilkinson E, Canelo R
Aims: To investigate the outcome of Cholecystostomy drains in the management of Acute Cholecystitis at Cumberland Infirmary. To develop a Cholecystostomy Pathway for patient selection, management and post procedure management. Method: A retrospective study of all patients with Cholecystostomy drains over the last 3 years at Cumberland Infirmary. 58 Inpatients at Cumberland Infirmary and West Cumberland Hospital who had cholecystostomy drains inserted for Acute Cholecystitis from January 2019 to January 2022 were included in the study. The patient list was collected from the Information Department at Cumberland Infirmary, with the Cholecystostomy code J 24.1 used in the search. Results: CRP ranged from 10-450 (mean 200) pre-insertion and on 5th post-procedure day, 37(63.79%) patients had a CRP of less than 50. Similar trends have been observed with the WBC counts. Follow-up investigations post drain insertion varied between CT abdomen, ultrasound abdomen and tubogram. The overall morality in the study group was 8(13.79%). Non of the mortalities were Cholecystostomy related. Reported over all complications were 2 (3.44%) which were sub-phrenic abscess and Cholo-Cutaneous fistula. Conclusion: We conclude that Insertion of a Cholecystostomy drain is a useful and safe procedure for the management of Severe Cholecystitis, especially in critically ill patients, with good early and late outcomes, and a low mortality rate. It can be used as a temporary management option with plan for Interval Laparoscopic Cholecystectomy, or can be the Definitive Management, especially in those patients with High Operative Risk
{"title":"Role of Cholecystostomy Drain in Severe Acute Cholecystitis in Critically Ill Patients","authors":"M. B, Chauhan Mn, Nahboo Sz, Wilkinson E, Canelo R","doi":"10.47829/cos.2023.8701","DOIUrl":"https://doi.org/10.47829/cos.2023.8701","url":null,"abstract":"Aims: To investigate the outcome of Cholecystostomy drains in the management of Acute Cholecystitis at Cumberland Infirmary. To develop a Cholecystostomy Pathway for patient selection, management and post procedure management. Method: A retrospective study of all patients with Cholecystostomy drains over the last 3 years at Cumberland Infirmary. 58 Inpatients at Cumberland Infirmary and West Cumberland Hospital who had cholecystostomy drains inserted for Acute Cholecystitis from January 2019 to January 2022 were included in the study. The patient list was collected from the Information Department at Cumberland Infirmary, with the Cholecystostomy code J 24.1 used in the search. Results: CRP ranged from 10-450 (mean 200) pre-insertion and on 5th post-procedure day, 37(63.79%) patients had a CRP of less than 50. Similar trends have been observed with the WBC counts. Follow-up investigations post drain insertion varied between CT abdomen, ultrasound abdomen and tubogram. The overall morality in the study group was 8(13.79%). Non of the mortalities were Cholecystostomy related. Reported over all complications were 2 (3.44%) which were sub-phrenic abscess and Cholo-Cutaneous fistula. Conclusion: We conclude that Insertion of a Cholecystostomy drain is a useful and safe procedure for the management of Severe Cholecystitis, especially in critically ill patients, with good early and late outcomes, and a low mortality rate. It can be used as a temporary management option with plan for Interval Laparoscopic Cholecystectomy, or can be the Definitive Management, especially in those patients with High Operative Risk","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81541175","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":"STARR Single Stapler? yes, we can. Starrone: Stapled Trans-Anal Rectal Resection with only one High-Volume Device. Review of 155 Personal Cases from 2009 to 2021","authors":"Nando Gallese","doi":"10.47829/cos.2021.61401","DOIUrl":"https://doi.org/10.47829/cos.2021.61401","url":null,"abstract":"","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80869331","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. B, N. I., Eifell R, Cusso M, Barakat T, Babikir S, Taran D, M. C., Ojimba T, Naqvi S
Introduction: Venous-thromboembolism is common vascular disease affecting lower limbs composed of DVT (2/3 of VTE) and PE (1/3 of VTE). The goal of management of DVT is to prevent PE, recurrence or PTS .Anticoagulation was the cornerstone of DVT management to prevent PE or recurrent DVT. Aim: To review our experience and assess efficacy of EKOS® thrombolysis in management of ilio-femoral DVT at Cumberland infirmary focusing on clinical outcome and any post procedure complications. Results: 22 patients had thrombolysis for illiofemoral DVT over 7years in Cumberland infirmary (Females 16 Males 5). Median age 20-89 years. Total number of treatment Sessions; 1 session: 18.18% (n=4), 2 Session: 54.54% (n=12), 3 sessions: 22.73% (n=5), 4 sessions: 04.55% (n=1). Success rate more than 80%: 90.91.7 % (n=20). Further procedures needed, Stents placement %77.27 (n=17), angioplasty 36.36% (n=8). Outcome; Improvement of symptoms in 90.91% % (n=20) leg ulcer healed in 9.52% (n=2). Post procedure complications: Leg swelling 28.6% (n=6) all are short terms resolved within six weeks and just one long standing leg swelling. Post procedure leg pain is in 19.04% (n=4). Ongoing issues were in 9.52% (n=2) and were persistent leg ulcer and PTS in each. One patient had recurrence. No patient had PE/ intracranial bleeding. Conclusion: EKOS is effective in treating acute ilio-femoral DVT with patency at 80% and more at the cessation of treatment, as well as prevention of DVT related long term complication (recurrence-PE and PTS) in comparison of conventional CDT or anticoagulation alone.
{"title":"Ekos Thrombolysis for The Management of Ilio-Femoral Dvt at Cumberland Infirmary","authors":"M. B, N. I., Eifell R, Cusso M, Barakat T, Babikir S, Taran D, M. C., Ojimba T, Naqvi S","doi":"10.47829/cos.2022.8503","DOIUrl":"https://doi.org/10.47829/cos.2022.8503","url":null,"abstract":"Introduction: Venous-thromboembolism is common vascular disease affecting lower limbs composed of DVT (2/3 of VTE) and PE (1/3 of VTE). The goal of management of DVT is to prevent PE, recurrence or PTS .Anticoagulation was the cornerstone of DVT management to prevent PE or recurrent DVT. Aim: To review our experience and assess efficacy of EKOS® thrombolysis in management of ilio-femoral DVT at Cumberland infirmary focusing on clinical outcome and any post procedure complications. Results: 22 patients had thrombolysis for illiofemoral DVT over 7years in Cumberland infirmary (Females 16 Males 5). Median age 20-89 years. Total number of treatment Sessions; 1 session: 18.18% (n=4), 2 Session: 54.54% (n=12), 3 sessions: 22.73% (n=5), 4 sessions: 04.55% (n=1). Success rate more than 80%: 90.91.7 % (n=20). Further procedures needed, Stents placement %77.27 (n=17), angioplasty 36.36% (n=8). Outcome; Improvement of symptoms in 90.91% % (n=20) leg ulcer healed in 9.52% (n=2). Post procedure complications: Leg swelling 28.6% (n=6) all are short terms resolved within six weeks and just one long standing leg swelling. Post procedure leg pain is in 19.04% (n=4). Ongoing issues were in 9.52% (n=2) and were persistent leg ulcer and PTS in each. One patient had recurrence. No patient had PE/ intracranial bleeding. Conclusion: EKOS is effective in treating acute ilio-femoral DVT with patency at 80% and more at the cessation of treatment, as well as prevention of DVT related long term complication (recurrence-PE and PTS) in comparison of conventional CDT or anticoagulation alone.","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88945955","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}
Alsharji M, Aljabri M, Elgohary H, Alhashmi M, Almuadi A
Ventriculo-peritoneal shunt is the procedure of choice for hydrocephalus. Various complications of ventriculoperitoneal shunts were reported. Abdominal complications involving the distal tip of the catheter make the majority of the complications. In this case report we present a case of incisional hernia occurring in a patient who underwent fixation of ventriculoperitoneal shunt followed by revision of the shunt after a while
{"title":"Incisional Hernia Occurring after Ventriculoperitoneal Shunt Fixation","authors":"Alsharji M, Aljabri M, Elgohary H, Alhashmi M, Almuadi A","doi":"10.47829/cos.2022.8601","DOIUrl":"https://doi.org/10.47829/cos.2022.8601","url":null,"abstract":"Ventriculo-peritoneal shunt is the procedure of choice for hydrocephalus. Various complications of ventriculoperitoneal shunts were reported. Abdominal complications involving the distal tip of the catheter make the majority of the complications. In this case report we present a case of incisional hernia occurring in a patient who underwent fixation of ventriculoperitoneal shunt followed by revision of the shunt after a while","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83188898","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":"A Case of Superior Mesenteric Artery Occlusion without causing Non-Cirrhotic Portal Hypertension","authors":"Ekladious A, L. L","doi":"10.47829/cos.2022.71001","DOIUrl":"https://doi.org/10.47829/cos.2022.71001","url":null,"abstract":"","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"144 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77958624","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":"Robotic Ileal Interposition Surgery with Duodenal Exclusion and Sleeve Gastrectomy For Diabetes: The First Case Report and 1-Year Follow-Up","authors":"Branco Filho AJ, C. Mrr, Brioschi Ml, Lavalle Acr","doi":"10.47829/cos.2021.8502","DOIUrl":"https://doi.org/10.47829/cos.2021.8502","url":null,"abstract":"","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88880107","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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