Sundus Abbasi, Emma Punni, E. Fakhoury, P. Michael, H. Bui
We present an extremely rare case of combined splenic abscess and B-cell lymphoma in a patient who was initially admitted for congestive heart failure. Due to its non-specific clinical picture, the final diagnosis was challenging. The patient was initially conservatively managed with antibiotics and percutaneous drainage of the abscess and then definitively managed with a splenectomy. This is the first case described with both pathological processes present simultaneously. J Curr Surg. 2016;6(3-4):73-74 doi: https://doi.org/10.14740/jcs304w
我们提出一个极为罕见的病例合并脾脓肿和b细胞淋巴瘤在病人谁最初入院充血性心力衰竭。由于其非特异性临床表现，最终诊断是具有挑战性的。患者最初使用抗生素和经皮脓肿引流术进行保守治疗，然后进行脾脏切除术。这是第一例同时出现两种病理过程的病例。contemporary surgery . 2016;6(3-4):73-74 doi: https://doi.org/10.14740/jcs304w
{"title":"Surgical Management of Coexisting Primary Splenic Abscess and Lymphoma: Case Report and Review of Literature","authors":"Sundus Abbasi, Emma Punni, E. Fakhoury, P. Michael, H. Bui","doi":"10.14740/JCS304W","DOIUrl":"https://doi.org/10.14740/JCS304W","url":null,"abstract":"We present an extremely rare case of combined splenic abscess and B-cell lymphoma in a patient who was initially admitted for congestive heart failure. Due to its non-specific clinical picture, the final diagnosis was challenging. The patient was initially conservatively managed with antibiotics and percutaneous drainage of the abscess and then definitively managed with a splenectomy. This is the first case described with both pathological processes present simultaneously. J Curr Surg. 2016;6(3-4):73-74 doi: https://doi.org/10.14740/jcs304w","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"14 1","pages":"73-74"},"PeriodicalIF":0.0,"publicationDate":"2016-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89548981","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}
Splenic rupture due to trauma is relatively common. However, spontaneous non-traumatic ruptures do occur. Causes include infection, neoplasia and infiltrative process. We present an unique case of a 59-year-old patient who presented with dyspnea and left upper abdominal discomfort following bouts of coughing, and was provisionally diagnosed as pulmonary embolism. CT scan revealed splenic rupture. Only a few case reports are published documenting spontaneous splenic rupture following coughing. The therapy of choice can vary between patients depending on the grade of splenic rupture, hemodynamic instability, availability of endovascular treatment and physician preference. Treatment should be focused on preserving splenic tissue if feasible. Non-traumatic rupture of the spleen must be considered in patients presenting with left-sided upper abdominal pain even without evident history of trauma, since early recognition and treatment can prevent serious morbidity and mortality. J Curr Surg. 2016;6(3-4):81-85 doi: https://doi.org/10.14740/jcs308w
脾破裂是比较常见的外伤。然而，自发的非创伤性破裂也会发生。病因包括感染、瘤变和浸润过程。我们提出一个独特的情况下，59岁的病人谁提出呼吸困难和左上腹部不适后，咳嗽，并被暂时诊断为肺栓塞。CT扫描显示脾破裂。只有少数病例报告被发表，记录了咳嗽后自发性脾破裂。根据脾破裂的程度、血流动力学不稳定、血管内治疗的可用性和医生的偏好，不同的患者选择不同的治疗方法。治疗应尽量保留脾组织。即使没有明显的创伤史，出现左侧上腹部疼痛的患者也必须考虑非外伤性脾破裂，因为早期识别和治疗可以防止严重的发病率和死亡率。contemporary surgery . 2016;6(3-4):81-85 doi: https://doi.org/10.14740/jcs308w
{"title":"Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review","authors":"S. Biswas, L. Richards","doi":"10.14740/JCS308W","DOIUrl":"https://doi.org/10.14740/JCS308W","url":null,"abstract":"Splenic rupture due to trauma is relatively common. However, spontaneous non-traumatic ruptures do occur. Causes include infection, neoplasia and infiltrative process. We present an unique case of a 59-year-old patient who presented with dyspnea and left upper abdominal discomfort following bouts of coughing, and was provisionally diagnosed as pulmonary embolism. CT scan revealed splenic rupture. Only a few case reports are published documenting spontaneous splenic rupture following coughing. The therapy of choice can vary between patients depending on the grade of splenic rupture, hemodynamic instability, availability of endovascular treatment and physician preference. Treatment should be focused on preserving splenic tissue if feasible. Non-traumatic rupture of the spleen must be considered in patients presenting with left-sided upper abdominal pain even without evident history of trauma, since early recognition and treatment can prevent serious morbidity and mortality. J Curr Surg. 2016;6(3-4):81-85 doi: https://doi.org/10.14740/jcs308w","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"1 1","pages":"81-85"},"PeriodicalIF":0.0,"publicationDate":"2016-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79913421","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}
R. Singal, Mohinder Kumar, Nitin Kaushik, Siddhartha Dhar, Bir Singh
Background: In emergency and elective settings, some surgeons prefer continuous or interrupted closure of abdominal fascia, because in a continuous suturing, cutting out of even a single bite of tissue leads to opening of the entire wound and high risk of burst abdomen, whereas in interrupted method, they found much lower risk of burst abdomen. The aim is to assess the complication rate with the same closure technique between two different sutures. The best suture is one that maintains tensile strength throughout the healing process with good tissue approximation and less wound infection, is well tolerated by patient and is technically simple and expedient. The aim was to compare the non-absorbable sutures (nylon) and delayed absorbable sutures (polydioxanone (PDS)) for abdominal wall closure in cases of peritonitis. We used a different technique to close the abdominal wall fascia and study the postoperative complications. Methods: This was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala from March 2014 to April 2015, a single unit by a single surgeon. A total of 60 patients underwent interrupted closure of abdominal fascia by figure of eight techniques with polyamide (nylon No. 1) suture in group A and polydiaxanone (PDS No. 1) suture in group B. The incidence rates of wound infection, dehiscence, suture sinus formation and incisional hernia were recorded. Patients were followed up for a period of 1 year. Results: Out of the 60 patients, the rates of wound pain, discharge and dehiscence in group A were 30%, 23.3% and 26.7% and in group B were 6.7%, 16.6% and 23.3%. There was 0 burst abdomen in group A compared to one burst abdomen in group B. Suture sinus formation, chronic wound infection and stitch granuloma was one each in group A and was 0 in group B. Incisional hernia was not found in any of the group. We have concluded that condition of the wound depends on the comorbidity of the patient like smoking, malnutrition, and old peritonitis. It also mainly depends on the technique used for closure of the wound and also on the material used. Conclusion: Though wound complications were found more in non-absorbable suture but the rate of wound complications between the two sutures was found insignificant. The purpose of the study is to assess the presence of differences in abdominal wall closure in patients with risk criteria, with the same closure technique between slowly absorbable sutures and non-absorbable sutures. Sutures were placed and tied such that fascial edges were well approximated but not compressed tightly together. J Curr Surg. 2016;6(3-4):65-72 doi: https://doi.org/10.14740/jcs306e
背景:在急诊和择期情况下，一些外科医生倾向于连续或间断缝合腹筋膜，因为在连续缝合中，即使切掉一小口组织也会导致整个伤口裂开，腹部破裂的风险很高，而间断缝合的腹部破裂风险要低得多。目的是评估两种不同缝合线之间相同缝合技术的并发症发生率。最好的缝线是在整个愈合过程中保持抗拉强度，良好的组织近似和较少的伤口感染，患者能很好地耐受，技术上简单易行。目的是比较不可吸收缝合线(尼龙)和延迟吸收缝合线(聚二氧环酮(PDS))在腹膜炎病例中的腹壁闭合效果。我们采用不同的技术关闭腹壁筋膜并研究术后并发症。方法:前瞻性研究于2014年3月至2015年4月在Ambala Mullana MMIMSR外科进行，单个单位，单个外科医生。A组采用聚酰胺(尼龙1号)缝线，b组采用聚二axanone (PDS 1号)缝线，采用8字图间断缝合腹筋膜60例，记录伤口感染、裂开、缝合窦形成及切口疝的发生率。患者随访1年。结果:60例患者中，A组创面疼痛、出血、开裂发生率分别为30%、23.3%和26.7%，B组分别为6.7%、16.6%和23.3%。A组0例腹裂，b组1例腹裂。A组缝线窦形成、慢性创面感染、缝线肉芽肿各1例，b组0例，无切口疝。我们得出结论，伤口的状况取决于患者的合并症，如吸烟、营养不良和陈旧性腹膜炎。这也主要取决于缝合伤口所用的技术和所用的材料。结论:不可吸收缝线虽然创面并发症较多，但两种缝线间创面并发症发生率无明显差异。本研究的目的是评估具有风险标准的患者在使用相同的闭合技术时，缓慢可吸收缝合线和不可吸收缝合线的腹壁闭合是否存在差异。缝合线的放置和绑扎使筋膜边缘很好地接近，但不会紧紧地压在一起。contemporary surgery . 2016;6(3-4):65-72 doi: https://doi.org/10.14740/jcs306e
{"title":"A Comparative Study of Polydioxanone and Nylon for Abdominal Wall Closure With Interrupted Figure of Eight in Peritonitis Cases","authors":"R. Singal, Mohinder Kumar, Nitin Kaushik, Siddhartha Dhar, Bir Singh","doi":"10.14740/JCS306E","DOIUrl":"https://doi.org/10.14740/JCS306E","url":null,"abstract":"Background: In emergency and elective settings, some surgeons prefer continuous or interrupted closure of abdominal fascia, because in a continuous suturing, cutting out of even a single bite of tissue leads to opening of the entire wound and high risk of burst abdomen, whereas in interrupted method, they found much lower risk of burst abdomen. The aim is to assess the complication rate with the same closure technique between two different sutures. The best suture is one that maintains tensile strength throughout the healing process with good tissue approximation and less wound infection, is well tolerated by patient and is technically simple and expedient. The aim was to compare the non-absorbable sutures (nylon) and delayed absorbable sutures (polydioxanone (PDS)) for abdominal wall closure in cases of peritonitis. We used a different technique to close the abdominal wall fascia and study the postoperative complications. Methods: This was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala from March 2014 to April 2015, a single unit by a single surgeon. A total of 60 patients underwent interrupted closure of abdominal fascia by figure of eight techniques with polyamide (nylon No. 1) suture in group A and polydiaxanone (PDS No. 1) suture in group B. The incidence rates of wound infection, dehiscence, suture sinus formation and incisional hernia were recorded. Patients were followed up for a period of 1 year. Results: Out of the 60 patients, the rates of wound pain, discharge and dehiscence in group A were 30%, 23.3% and 26.7% and in group B were 6.7%, 16.6% and 23.3%. There was 0 burst abdomen in group A compared to one burst abdomen in group B. Suture sinus formation, chronic wound infection and stitch granuloma was one each in group A and was 0 in group B. Incisional hernia was not found in any of the group. We have concluded that condition of the wound depends on the comorbidity of the patient like smoking, malnutrition, and old peritonitis. It also mainly depends on the technique used for closure of the wound and also on the material used. Conclusion: Though wound complications were found more in non-absorbable suture but the rate of wound complications between the two sutures was found insignificant. The purpose of the study is to assess the presence of differences in abdominal wall closure in patients with risk criteria, with the same closure technique between slowly absorbable sutures and non-absorbable sutures. Sutures were placed and tied such that fascial edges were well approximated but not compressed tightly together. J Curr Surg. 2016;6(3-4):65-72 doi: https://doi.org/10.14740/jcs306e","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"15 1","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2016-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80017098","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}
Reparative giant cell granuloma is a rare benign tumor. Mandible is the most common site. The case is reported for its rarity in maxilla and difficulty in differentiating it from other giant cell lesions. Differentiation is only based on the clinical test and histopathological examination. Midfacial degloving approach popularized by Caisson et al and Conley in 1974 is best suited for bilateral facial lesions. This approach gives a wide exposure with no facial scar or deformity. The advantages of the degloving technique in exposure of the midface, maxilla, mandible, nasal cavities, and paranasal sinuses, have led to its increasing importance in the otorhinolaryngology. J Curr Surg. 2016;6(3-4):78-80 doi: https://doi.org/10.14740/jcs304e
摘要修复性巨细胞肉芽肿是一种罕见的良性肿瘤。下颌骨是最常见的部位。该病例在上颌骨罕见，且难以与其他巨细胞病变鉴别。鉴别仅基于临床检查和组织病理学检查。Caisson等和Conley于1974年推广的面中去手套入路最适合双侧面部病变。这种方法暴露面广，没有面部疤痕或畸形。脱手套技术在暴露中脸、上颌骨、下颌骨、鼻腔和鼻窦方面的优势，使其在耳鼻喉科的重要性日益增加。contemporary surgery . 2016;6(3-4):78-80 doi: https://doi.org/10.14740/jcs304e
{"title":"Midfacial Degloving Approach for Bilateral Giant Cell Reparative Granuloma","authors":"G. Ahluwalia, K. Morwani","doi":"10.14740/JCS304E","DOIUrl":"https://doi.org/10.14740/JCS304E","url":null,"abstract":"Reparative giant cell granuloma is a rare benign tumor. Mandible is the most common site. The case is reported for its rarity in maxilla and difficulty in differentiating it from other giant cell lesions. Differentiation is only based on the clinical test and histopathological examination. Midfacial degloving approach popularized by Caisson et al and Conley in 1974 is best suited for bilateral facial lesions. This approach gives a wide exposure with no facial scar or deformity. The advantages of the degloving technique in exposure of the midface, maxilla, mandible, nasal cavities, and paranasal sinuses, have led to its increasing importance in the otorhinolaryngology. J Curr Surg. 2016;6(3-4):78-80 doi: https://doi.org/10.14740/jcs304e","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"7 1","pages":"78-80"},"PeriodicalIF":0.0,"publicationDate":"2016-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81973641","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}
Asmita A. Mehta, A. Gupta, Aziz Kallikunnel Sayed Mohamed
Background: Thoracostomy tubes are a mainstay of treatment for removing fluid or air from the pleural space. Placement of a chest tube is, however, an invasive procedure with potential morbidity. In an effort to reduce these complications, the use of percutaneous pigtail catheters in place of traditional large-bore tubes for thoracostomy and pleural drainage has been described. The aim of the study was to determine the role of pigtail catheters in adult population for drainage of pleural effusion. Methods: It was an observational study. All consecutive patients with pleural effusion requiring drainage were subjected to either tube thoracostomy or pig tail drainage. A standardized questionnaire was prepared for retrieving data. Outcomes of interest were time to drain and total duration of hospital stay. Results: A total of 92 patients (71 men and 21 women; age range, 17 - 86 years; mean age, 54 ± 15 years) were enrolled into the study. Thirty-five patients were treated with traditional chest tubes, whereas 57 patients were treated with pigtail catheters. There were no significant differences in either drainage days or hospitalization days between the chest tube group and pigtail catheter group (9.81 ± 6 vs. 9 ± 5.6 and 13.8 ± 6 vs. 13 ± 5.7, respectively). Conclusions: The pigtail catheter offers reliable treatment of effusions and is a safe and less invasive alternative to tube thoracostomy. There was no significant difference in time to drain and duration of hospital stay in both the groups. J Curr Surg. 2016;6(2):52-56 doi: http://dx.doi.org/10.14740/jcs300e
背景:胸腔造瘘管是清除胸腔积液或空气的主要治疗方法。然而，放置胸管是一种具有潜在发病率的侵入性手术。为了减少这些并发症，经皮细尾导管取代传统的大口径导管用于开胸术和胸腔引流。本研究的目的是确定猪尾导管在成人胸腔积液引流中的作用。方法:观察性研究。所有需要引流胸腔积液的连续患者均接受管式开胸术或猪尾引流。为检索数据准备了一份标准化问卷。关注的结局是引流时间和总住院时间。结果:共92例患者，其中男性71例，女性21例;年龄范围:17 - 86岁;平均年龄(54±15岁)。35例患者采用传统胸管治疗，57例患者采用细尾导管治疗。胸管组与尾纤管组在引流天数和住院天数上均无显著差异(分别为9.81±6∶9±5.6、13.8±6∶13±5.7)。结论:猪尾导管治疗积液可靠，是一种安全、微创的胸腔插管替代方法。两组患者引流时间和住院时间差异无统计学意义。contemporary surgery . 2016;6(2):52-56 doi: http://dx.doi.org/10.14740/jcs300e
{"title":"The Pigtail Catheter for Pleural Drainage: A Less Invasive Alternative to Tube Thoracostomy","authors":"Asmita A. Mehta, A. Gupta, Aziz Kallikunnel Sayed Mohamed","doi":"10.14740/JCS300E","DOIUrl":"https://doi.org/10.14740/JCS300E","url":null,"abstract":"Background: Thoracostomy tubes are a mainstay of treatment for removing fluid or air from the pleural space. Placement of a chest tube is, however, an invasive procedure with potential morbidity. In an effort to reduce these complications, the use of percutaneous pigtail catheters in place of traditional large-bore tubes for thoracostomy and pleural drainage has been described. The aim of the study was to determine the role of pigtail catheters in adult population for drainage of pleural effusion. Methods: It was an observational study. All consecutive patients with pleural effusion requiring drainage were subjected to either tube thoracostomy or pig tail drainage. A standardized questionnaire was prepared for retrieving data. Outcomes of interest were time to drain and total duration of hospital stay. Results: A total of 92 patients (71 men and 21 women; age range, 17 - 86 years; mean age, 54 ± 15 years) were enrolled into the study. Thirty-five patients were treated with traditional chest tubes, whereas 57 patients were treated with pigtail catheters. There were no significant differences in either drainage days or hospitalization days between the chest tube group and pigtail catheter group (9.81 ± 6 vs. 9 ± 5.6 and 13.8 ± 6 vs. 13 ± 5.7, respectively). Conclusions: The pigtail catheter offers reliable treatment of effusions and is a safe and less invasive alternative to tube thoracostomy. There was no significant difference in time to drain and duration of hospital stay in both the groups. J Curr Surg. 2016;6(2):52-56 doi: http://dx.doi.org/10.14740/jcs300e","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"46 1","pages":"52-56"},"PeriodicalIF":0.0,"publicationDate":"2016-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77853170","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}
J. Kilkenny, Douglas C. Brown, Avril Gunning, M. Reis, E. Macaskill
Background: Survival has significantly improved in women diagnosed with breast cancer, and as a result, it has become increasingly important to assess the psychological outcomes from the patient’s perspective. Interpreting the outcome based on the opinion of the operating surgeons may not reflect the opinions of the patient. The aim of this study was to assess clinician and patient reported outcomes of breast surgery at routine follow-up. Methods: Consecutive patients previously treated for breast cancer attending routine follow-up breast clinic over a period of 5 weeks were invited to participate. Patients were first seen by a clinician for review (four breast surgeons and one clinical nurse specialist), and cosmetic outcome was assessed using the Harris Harvard scale. Patient reported outcomes were measured using the Hopwood body image scale 10-item questionnaire. Results: Of 105 patients, complete data were available for 84 patients. All patients were female with a median age of 65 years (range 32 - 83 years). Wide local excisions accounted for 54% of all surgeries (n = 45), mastectomies 26% (n = 22) and mastectomy with reconstruction 20% (n = 17). Patients’ scores ranged from 0 to 30 with a median score of 1; 9% of patients had a score of > 10. Clinician rating was “excellent” for 37%, 34% as “very good”, 22% as “good” and 5.9% as “poor”. There was a weak correlation of patient scores to clinician score (Spearman rho: 0.219; 95% CI: 0.005 - 0.414; P = 0.045). Conclusions: With standard breast surgery, the majority of patients seen at follow-up clinics were satisfied with their cosmetic outcome, with the most favorable outcomes in patients who had undergone breast conservation, with mastectomy and reconstruction yielding the poorest results. Patient reported outcomes are not reflected in the clinician assessment of cosmesis. J Curr Surg. 2016;6(2):46-51 doi: http://dx.doi.org/10.14740/jcs303w
{"title":"Assessing Outcomes After Breast Surgery: Patient and Clinician Reported Outcomes","authors":"J. Kilkenny, Douglas C. Brown, Avril Gunning, M. Reis, E. Macaskill","doi":"10.14740/JCS.303W","DOIUrl":"https://doi.org/10.14740/JCS.303W","url":null,"abstract":"Background: Survival has significantly improved in women diagnosed with breast cancer, and as a result, it has become increasingly important to assess the psychological outcomes from the patient’s perspective. Interpreting the outcome based on the opinion of the operating surgeons may not reflect the opinions of the patient. The aim of this study was to assess clinician and patient reported outcomes of breast surgery at routine follow-up. Methods: Consecutive patients previously treated for breast cancer attending routine follow-up breast clinic over a period of 5 weeks were invited to participate. Patients were first seen by a clinician for review (four breast surgeons and one clinical nurse specialist), and cosmetic outcome was assessed using the Harris Harvard scale. Patient reported outcomes were measured using the Hopwood body image scale 10-item questionnaire. Results: Of 105 patients, complete data were available for 84 patients. All patients were female with a median age of 65 years (range 32 - 83 years). Wide local excisions accounted for 54% of all surgeries (n = 45), mastectomies 26% (n = 22) and mastectomy with reconstruction 20% (n = 17). Patients’ scores ranged from 0 to 30 with a median score of 1; 9% of patients had a score of > 10. Clinician rating was “excellent” for 37%, 34% as “very good”, 22% as “good” and 5.9% as “poor”. There was a weak correlation of patient scores to clinician score (Spearman rho: 0.219; 95% CI: 0.005 - 0.414; P = 0.045). Conclusions: With standard breast surgery, the majority of patients seen at follow-up clinics were satisfied with their cosmetic outcome, with the most favorable outcomes in patients who had undergone breast conservation, with mastectomy and reconstruction yielding the poorest results. Patient reported outcomes are not reflected in the clinician assessment of cosmesis. J Curr Surg. 2016;6(2):46-51 doi: http://dx.doi.org/10.14740/jcs303w","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"26 1","pages":"46-51"},"PeriodicalIF":0.0,"publicationDate":"2016-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83062247","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}
Abdulwahhab Al Jubab, I. Jafarli, Tariq Al Tokhais
The study design of this paper is a systematic review of literature published in the recent 10 years. Esophageal perforations in children have long been a topic of debate. The management protocols are chiefly governed by symptom severity, perforation site, time elapsed since perforation and cause of perforation. Esophageal perforations in pediatric group of patients can be iatrogenic or traumatic. The aim to conduct the study was to assess the benefits and timely management of surgical versus non-surgical treatment for pediatric patients with traumatic esophageal perforation. The two research questions below were determined. We systematically reviewed retrospective serial studies assessing the medical treatment compared to the surgical interventions for the traumatic esophageal perforation in children. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects, as well as foreign literature with English translations. No randomized controlled trial studies had been conducted in children with esophageal perforation. Information on patients’ age, comorbidities, methods of treatment, and effects on mortality, morbidity were extracted. Three independent reviewers selected the articles for analysis after screening the titles, abstracts, and full texts, then extracted data and graded the quality of each paper according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Specific clinical questions were as follows. 1) In patients with early diagnosis of esophageal perforation, what are the indications for treatment (surgery versus conservative management) and its impact on prognosis? 2) In patients with delayed diagnosis, what are the indications for treatment (surgery versus conservative management) and its impact on mortality and morbidity rate? A total of 66 abstracts were identified using various keywords. Nine retrospective articles (level III) were eligible for inclusion, involving a total of 77 cases of esophageal perforation in pediatric patients. Non-operative management is recommended for perforations diagnosed within 24 - 48 hours in a stable patient with contained leakage, but hemodynamically unstable patients with a contained perforation, ongoing leakage and early diagnosed have a higher chance of successful primary repair, whereas delayed ones require conservative treatment. J Curr Surg. 2016;6(2):41-45 doi: http://dx.doi.org/10.14740/jcs296w
本文的研究设计是对近10年发表的文献进行系统综述。儿童食管穿孔长期以来一直是一个争论的话题。治疗方案主要由症状严重程度、穿孔部位、穿孔时间和穿孔原因决定。小儿食道穿孔可能是医源性或外伤性的。开展这项研究的目的是评估手术与非手术治疗小儿外伤性食管穿孔的益处和及时管理。确定了下面两个研究问题。我们系统地回顾了回顾性系列研究，评估了儿童外伤性食管穿孔的药物治疗与手术治疗的比较。我们检索了MEDLINE、EMBASE、Cochrane中央对照试验注册库和Cochrane疗效评价摘要数据库，以及有英文翻译的外国文献。没有对食管穿孔儿童进行随机对照试验研究。提取了患者的年龄、合并症、治疗方法以及对死亡率和发病率的影响等信息。三名独立审稿人在筛选标题、摘要和全文后选择文章进行分析，然后提取数据，并根据分级推荐、评估、发展和评估(GRADE)标准对每篇论文的质量进行评分。具体临床问题如下。1)早期诊断为食管穿孔的患者，治疗指征是什么(手术还是保守治疗)及其对预后的影响?2)延迟诊断患者的治疗指征是什么(手术还是保守治疗)及其对死亡率和发病率的影响?使用不同的关键词共识别了66篇摘要。9篇回顾性文章(III级)符合纳入条件，共涉及77例儿科食管穿孔患者。对于在24 - 48小时内诊断出穿孔并伴有隐匿性渗漏的稳定患者，建议非手术治疗，但血液动力学不稳定且隐匿性穿孔、持续渗漏和早期诊断的患者有更高的成功修复机会，而延迟的患者则需要保守治疗。contemporary surgery . 2016;6(2):41-45 doi: http://dx.doi.org/10.14740/jcs296w
{"title":"Surgical Versus Non-Surgical Treatment for Traumatic Esophageal Perforation in Children: A Systematic Review","authors":"Abdulwahhab Al Jubab, I. Jafarli, Tariq Al Tokhais","doi":"10.14740/JCS296W","DOIUrl":"https://doi.org/10.14740/JCS296W","url":null,"abstract":"The study design of this paper is a systematic review of literature published in the recent 10 years. Esophageal perforations in children have long been a topic of debate. The management protocols are chiefly governed by symptom severity, perforation site, time elapsed since perforation and cause of perforation. Esophageal perforations in pediatric group of patients can be iatrogenic or traumatic. The aim to conduct the study was to assess the benefits and timely management of surgical versus non-surgical treatment for pediatric patients with traumatic esophageal perforation. The two research questions below were determined. We systematically reviewed retrospective serial studies assessing the medical treatment compared to the surgical interventions for the traumatic esophageal perforation in children. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects, as well as foreign literature with English translations. No randomized controlled trial studies had been conducted in children with esophageal perforation. Information on patients’ age, comorbidities, methods of treatment, and effects on mortality, morbidity were extracted. Three independent reviewers selected the articles for analysis after screening the titles, abstracts, and full texts, then extracted data and graded the quality of each paper according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Specific clinical questions were as follows. 1) In patients with early diagnosis of esophageal perforation, what are the indications for treatment (surgery versus conservative management) and its impact on prognosis? 2) In patients with delayed diagnosis, what are the indications for treatment (surgery versus conservative management) and its impact on mortality and morbidity rate? A total of 66 abstracts were identified using various keywords. Nine retrospective articles (level III) were eligible for inclusion, involving a total of 77 cases of esophageal perforation in pediatric patients. Non-operative management is recommended for perforations diagnosed within 24 - 48 hours in a stable patient with contained leakage, but hemodynamically unstable patients with a contained perforation, ongoing leakage and early diagnosed have a higher chance of successful primary repair, whereas delayed ones require conservative treatment. J Curr Surg. 2016;6(2):41-45 doi: http://dx.doi.org/10.14740/jcs296w","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"3 1","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2016-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86960400","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}
Modified fronto-temporo-zygomatic approach is a relatively direct and less time-consuming approach to infratemporal fossa and orbital apex. This approach has a smaller learning curve and sutures are hidden in hairs, hence beneficial to both the patient and the surgeon. J Curr Surg. 2016;6(2):60-64 doi: http://dx.doi.org/10.14740/jcs298e
改良额颞颧入路是一种相对直接、省时的颞下窝及眶尖入路。这种方法的学习曲线较小，缝合线隐藏在头发中，因此对患者和外科医生都有益。contemporary surgery . 2016;6(2):60-64 doi: http://dx.doi.org/10.14740/jcs298e
{"title":"Fronto-Temporo-Zygomatic Approach for Orbital Apex and Infratemporal Fossa","authors":"K. Morwani, G. Ahluwalia","doi":"10.14740/JCS298E","DOIUrl":"https://doi.org/10.14740/JCS298E","url":null,"abstract":"Modified fronto-temporo-zygomatic approach is a relatively direct and less time-consuming approach to infratemporal fossa and orbital apex. This approach has a smaller learning curve and sutures are hidden in hairs, hence beneficial to both the patient and the surgeon. J Curr Surg. 2016;6(2):60-64 doi: http://dx.doi.org/10.14740/jcs298e","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"4291 1","pages":"60-64"},"PeriodicalIF":0.0,"publicationDate":"2016-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74990505","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}
Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous neoplasm with low to intermediate grade malignancy. While it rarely metastasizes, it is characterized by aggressive local infiltration and high recurrence. The etiology of DFSP remains unknown, but current research has shown that DFSP has specific histologic, immunohistochemical, and cytogenetic findings. We report a unique case of a 29-year-old female who presented with a dry, shallow ulcerated right posterior shoulder mass diagnosed as DFSP, and describe our surgical management. J Curr Surg. 2016;6(2):57-59 doi: http://dx.doi.org/10.14740/jcs302w
摘要隆突性皮肤纤维肉瘤(DFSP)是一种少见的低至中度恶性肿瘤。虽然它很少转移，但其特点是侵袭性局部浸润和高复发率。DFSP的病因尚不清楚，但目前的研究表明，DFSP具有特异性的组织学、免疫组织化学和细胞遗传学发现。我们报告一个独特的案例，一个29岁的女性谁提出了一个干，浅溃疡右后肩肿块诊断为DFSP，并描述我们的手术处理。contemporary surgery . 2016;6(2):57-59 doi: http://dx.doi.org/10.14740/jcs302w
{"title":"Dermatofibrosarcoma Protuberans: A Case Report and Review of Surgical Management","authors":"S. Trinh, P. Hanna, K. Petersen, Osama A Elsawy","doi":"10.14740/JCS302W","DOIUrl":"https://doi.org/10.14740/JCS302W","url":null,"abstract":"Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous neoplasm with low to intermediate grade malignancy. While it rarely metastasizes, it is characterized by aggressive local infiltration and high recurrence. The etiology of DFSP remains unknown, but current research has shown that DFSP has specific histologic, immunohistochemical, and cytogenetic findings. We report a unique case of a 29-year-old female who presented with a dry, shallow ulcerated right posterior shoulder mass diagnosed as DFSP, and describe our surgical management. J Curr Surg. 2016;6(2):57-59 doi: http://dx.doi.org/10.14740/jcs302w","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"7 4","pages":"57-59"},"PeriodicalIF":0.0,"publicationDate":"2016-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72604087","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}
T. Ribeiro, Ricardo Issler Unfried, Luiz Giulian Brito, K. Stein, João Alberto Larangeira, O. Monticielo
Background: Hip fracture is a devastating injury in elderly and the vast majorities are usually treated surgically. However, this treatment can also be non-operative, principally for patients classified at ASA III-IV. Several risk factors are associated with 1-year mortality for operated patients but a small number of studies provide the risk factors for non-operated patients. The aim of this study was to investigate the influence of hospitalization time and other risk factors on non-operated patients. Methods: A prospective observational cohort study from April 2005 to April 2012 was conducted on 286 patients aged 65 years or more with hip fracture classified at ASA III-IV for 1 year to investigate the influence of hospitalization time and the 1-year mortality risk factors. Survival time was analyzed by Kaplan-Meier curves and Cox’s regression models were used to evaluate risk factors to all subjects, operated and non-operated subjects. Results: The mortality was 73.5% for non-operated subjects. Final Cox’s regression for all subjects demonstrated that for patients that do not undergo surgery, mortality increased by six times. To operated patients, for each day of hospitalization, 1-year survival decreased 12.6 days, and ASA IV increased the mortality rate three times. To non-operated subjects, hospitalization time was a protective factor; for each day of hospitalization, 1-year survival increased 10.44 days. Conclusion: When conservative treatment is chosen for a complicated elderly, extended hospitalization should be considered. Hospitalization time has proved to be a protective factor in these cases and discharge with improved survival rates with good clinical status should be advocated. However, surgery should always be employed even for patients with poor clinical conditions. J Curr Surg. 2016;6(1):21-29 doi: http://dx.doi.org/10.14740/jcs296e
背景:髋部骨折是老年人的一种破坏性损伤，绝大多数通常采用手术治疗。然而，这种治疗也可以是非手术治疗，主要针对ASA III-IV级的患者。一些危险因素与手术患者的1年死亡率有关，但少数研究提供了未手术患者的危险因素。本研究旨在探讨住院时间及其他危险因素对非手术患者的影响。方法:于2005年4月至2012年4月对286例65岁及以上ASA III-IV级髋部骨折患者进行为期1年的前瞻性观察队列研究，探讨住院时间及1年死亡危险因素的影响。采用Kaplan-Meier曲线分析生存时间，采用Cox回归模型评价所有受试者、手术组和未手术组的危险因素。结果:非手术组死亡率为73.5%。所有受试者的最终Cox回归表明，不接受手术的患者死亡率增加了6倍。手术患者每住院1天，1年生存期减少12.6天，ASA IV使死亡率增加3倍。对于未手术的患者，住院时间是保护因素;每住院1天，1年生存期增加10.44天。结论:老年复杂患者在选择保守治疗时，应考虑延长住院时间。在这些病例中，住院时间已被证明是一个保护因素，应提倡在临床状况良好的情况下提高生存率出院。然而，即使对临床条件较差的患者，也应始终采用手术治疗。contemporary surgery . 2016;6(1):21-29 doi: http://dx.doi.org/10.14740/jcs296e
{"title":"Length of Hospitalization: A Protective Factor in a Prospective Observational Cohort Study in Brazilian ASA III and IV Hip Fracture Elderly Patients","authors":"T. Ribeiro, Ricardo Issler Unfried, Luiz Giulian Brito, K. Stein, João Alberto Larangeira, O. Monticielo","doi":"10.14740/JCS296E","DOIUrl":"https://doi.org/10.14740/JCS296E","url":null,"abstract":"Background: Hip fracture is a devastating injury in elderly and the vast majorities are usually treated surgically. However, this treatment can also be non-operative, principally for patients classified at ASA III-IV. Several risk factors are associated with 1-year mortality for operated patients but a small number of studies provide the risk factors for non-operated patients. The aim of this study was to investigate the influence of hospitalization time and other risk factors on non-operated patients. Methods: A prospective observational cohort study from April 2005 to April 2012 was conducted on 286 patients aged 65 years or more with hip fracture classified at ASA III-IV for 1 year to investigate the influence of hospitalization time and the 1-year mortality risk factors. Survival time was analyzed by Kaplan-Meier curves and Cox’s regression models were used to evaluate risk factors to all subjects, operated and non-operated subjects. Results: The mortality was 73.5% for non-operated subjects. Final Cox’s regression for all subjects demonstrated that for patients that do not undergo surgery, mortality increased by six times. To operated patients, for each day of hospitalization, 1-year survival decreased 12.6 days, and ASA IV increased the mortality rate three times. To non-operated subjects, hospitalization time was a protective factor; for each day of hospitalization, 1-year survival increased 10.44 days. Conclusion: When conservative treatment is chosen for a complicated elderly, extended hospitalization should be considered. Hospitalization time has proved to be a protective factor in these cases and discharge with improved survival rates with good clinical status should be advocated. However, surgery should always be employed even for patients with poor clinical conditions. J Curr Surg. 2016;6(1):21-29 doi: http://dx.doi.org/10.14740/jcs296e","PeriodicalId":93115,"journal":{"name":"Journal of current surgery","volume":"4 1","pages":"21-29"},"PeriodicalIF":0.0,"publicationDate":"2016-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89737731","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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