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The Ischemic/Septic Diabetic Hand: Review of Literature and a Case Report
Crisci Alessandro,
Lombardi Domenico,
Lombardi Luisa,
Romano Giovanni,
Lombardi Guido,
Crisci Michela
Issue:
Volume 6, Issue 4, August 2018
Pages:
82-87
Received:
1 May 2018
Accepted:
17 May 2018
Published:
12 June 2018
Abstract: The term “diabetic hand” was born to describe the complications of the diabetes mellitus on the hand resulting in a rigid hand with a poor mobility. The traumatic wounds with soft tissue involvement increase the risk of infection. Staphylococcus aureus methicillin-resistant (MRSA) is the most common bacterium isolated in the hand infections. The case report of a type 2 diabetic patient, dialysed with chronic obstructive peripheral artery disease and Monckeberg sclerosis of the vessels of the hands, ischemic necrosis of the right hand fingers is reported by the authors. In the diabetic patient the hands can be infected in the same way that feet could be infected too. Several amputation interventions have been performed with the intent of saving part of the hand. The diabetic hand syndrome (DHS) is an important pathology that requires strong antibiotics and surgery to avoid severe disability as rigidity, contracture and amputation. Apparently, in the last years good results are reported using antibiotic, surgical and hyperbaric treatment. In conclusion it would be wrong to ignore or underestimate this disease and any doctor should practice a scrupulous visit of the hands in the diabetic patient.
Abstract: The term “diabetic hand” was born to describe the complications of the diabetes mellitus on the hand resulting in a rigid hand with a poor mobility. The traumatic wounds with soft tissue involvement increase the risk of infection. Staphylococcus aureus methicillin-resistant (MRSA) is the most common bacterium isolated in the hand infections. The ca...
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The Importance of Diagnosis and Treatment of May-Thurner and Pelvic Congestion Syndromes Before Complications, in Patients with Thrombophilia
Diego Victor Nascimento,
Gabrielle Maria de Oliveira Kraychete da Silveira,
Helena Chaves de Queiroga,
Lidie Anne Diniz Viégas,
Sérgio Ricardo Ferreira Vieira,
Francisco Chavier Vieira Bandeira,
Paulo Roberto da Silva Lima
Issue:
Volume 6, Issue 4, August 2018
Pages:
88-91
Received:
1 May 2018
Accepted:
28 May 2018
Published:
14 June 2018
Abstract: May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein. In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) [3]. It is also known as Cockett Syndrome, iliac vein compression syndrome and iliocaval compression syndrome [3]. Because of the stress arising from the pulsation of the artery, the intima layer of the vein undergoes a hypertrophy with consequent development of Deep Vein Thrombosis (DVT) [1, 3]. Because it prevents drainage to the inferior vena cava, MTS is related to the appearance of pelvic varices characterized by dilatation and reflux, venous stasis of the pelvic organs, having as main manifestation chronic pelvic pain (CPP) without inflammatory signs, although the CPP does not is a well-defined diagnostic criterion [5, 6]. In substitution for open surgery, appeared more effective methods such as endovascular surgery [7]. The patient in this case authorized the authors to describe her clinical case. We performed a search on the PubMed and Bireme databases. A white woman was complaining of pain in her lower extremities (LE), apart from feeling of heaviness and tiredness in her Right Lower Extremity (RLE), ankle edema, legs and pelvic varices. At physical examination, the patient had the presence (according to the CEAP classification) of C1, 3 varicose veins in the RLE and C1, 2, 3 varicose veins in the Left Lower Extremity (LLE). She was submitted to varied clinical treatment, and the investigation of the causes of the symptoms, including thrombophilia. She was not responding well to the treatment and the endovascular treatment of Cockett's syndrome was performed. Due to the non-release of the embolization of the ovarian veins by the patient's health plan there was a delaying for the right treatment of the patient, because she has ovarian varicose veins. The endovascular treatment of the May-Thurner and Pelvic Congestion Syndrome is safe and has excellent primary patency in the medium to long term.
Abstract: May-Thurner syndrome (MTS), initially observed in 1851 by Virchow as an anatomical variation of the left common iliac vein. In 1965, Cockett and Thomas supplemented the work of May and Thurner correlating with the observed symptoms. The syndrome is characterized by an anatomical anomaly that results in compression of the left common iliac vein (LCI...
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Bilateral Scrotal Flaps: A Novel Ideain the Management of Massive Scrotal Lymphoedema
Nangole Wanjala Ferdinand,
Biribwa Kansiime Peter
Issue:
Volume 6, Issue 4, August 2018
Pages:
92-96
Received:
7 May 2018
Accepted:
29 May 2018
Published:
16 July 2018
Abstract: Massive Scrotal lymphoedema is a debilitating condition that could result in both psychological and physical trauma to the patient. Irrespective of the cause of this condition, surgery remains the cornerstone in its management. A variety of surgical procedures have been described with varied degree of success. A total of eight patients with massive scrotal lymphoedema of ages between 15 and 60 years were managed by the authors. The mean excision of the scrotal tissue was 5.7 kilogrammes. All patients had post excision defect reconstructed with bilateral scrotal flaps. No skin grafts were utilized in any patient. They all healed well without any complications and were able to resume to their normal functions within nine weeks. No recurrence was noted at two years of follow up. Bilateral scrotal flap is an effective method of managing massive scrotally mphoedema. It allows for massive removal of scrotal tissue and primary repair of the defect using scrotal tissue that allows for early return to work and sexual activities. The complications are minimal and there is high patient satisfaction.
Abstract: Massive Scrotal lymphoedema is a debilitating condition that could result in both psychological and physical trauma to the patient. Irrespective of the cause of this condition, surgery remains the cornerstone in its management. A variety of surgical procedures have been described with varied degree of success. A total of eight patients with massive...
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Postero-Lateral Fusion (PLF) for Degenerative Diseases of the Lumbosacral Spine in Jos Nigeria
Ode Michael Bundepuun,
Taiwo Femi Olu,
Onche Icha Inalegwu,
Amupitan Idumagbodi,
Ode Gloria Nengi
Issue:
Volume 6, Issue 4, August 2018
Pages:
97-100
Received:
7 June 2018
Accepted:
27 June 2018
Published:
21 July 2018
Abstract: Degenerative diseases of the spine are a common presentation to the clinician, more so with an increase in the ageing population worldwide. Operative methods of treatment are employed following failure of conservative methods. Spine surgical procedures are expensive, and many different procedures are employed to treat these spinal conditions. Instrumented posterolateral fusion (PLF) is one of the options employed and has a reduced cost owing to the absence of the inter body cage used in inter body fusion techniques. The objective of this study was to assess posterolateral fusions in our center within a developing country with poor health insurance coverage as an effective treatment modality in degenerative lumbosacral spine disease, without the added cost of an interbody fusion cage. This was a retrospective study carried out in Jos, Nigeria covering a two year period from July 2015 to June 2017. Patients with degenerative spine diseases who had been on conservative methods of treatment for more than six months with no significant improvement were recruited for the study. Data was obtained from the case records of the patients the patients were assessed for the indications for the procedure, the number of levels of fusion, duration of surgery and transfusion requirement as well as outcome of procedure using the Numeric pain scale (11 point scale from 0 to 10) and the complications of the procedure. Data was analyzed using the epi info statistical software. 13 patients had Posterolateral fusion (PLF) within this period. The mean age was 61.4years ±10.7. A male female ratio of M:F 1:3.3. 8(61.5%) patients had multiple level disc degeneration and herniation, 2(15.4%) patients each had spinal canal stenosis and facet joint arthritis with instability and 1(7.7%) had degenerative spondylolisthesis. 9(69.2%) patients had 2 level fusion, 2 (15.4%) had 3 level fusion and 2(15.4%) had 1 level fusion. 6(46.2%) had a pain reduction by ≥ 8 points on the numeric pain scale, 6(46.2%) had reduction by 6-7 points and 1(7.7%) had reduction of 3-5 points. 92.6% of the patients had a pain reduction by more than 50%. Mean operative time was 203minutes, and mean transfusion requirement was 2.8 pints of blood. Complications noted were superficial surgical site infection 1 patient and dural tear 1 patient. Postero lateral fusion techniques are a safe and effective treatment modality in treating patients with degenerative lumbosacral spine disease. The non usage of the interbody fusion cage provides a cheaper alternative in posterolateral fusion and every modality to limit surgical site infection should be employed to limit increased cost from this complication.
Abstract: Degenerative diseases of the spine are a common presentation to the clinician, more so with an increase in the ageing population worldwide. Operative methods of treatment are employed following failure of conservative methods. Spine surgical procedures are expensive, and many different procedures are employed to treat these spinal conditions. Instr...
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Outcomes of Management of Anal and Perianal Suppuration at Niamey National Hospital, Niger
Rachid Sani,
Harissou Adamou,
Lassey Didier James,
Ibrahim Amadou Magagi,
Younssa Hama,
Adama Saidou,
Kadi Idé,
Illa Hamidine,
Hadjara Dady,
Maman Sani Chaibou
Issue:
Volume 6, Issue 4, August 2018
Pages:
101-106
Received:
9 July 2018
Accepted:
19 July 2018
Published:
14 August 2018
Abstract: Bakground: Anal and perianal sepsis is common anorectal disorders found in surgical practice. This study aims to report epidemiological aspects and outcomes of management of anal and perianal suppuration. Methods: This was a retrospective study from January 2011 to June 2016 at Niamey National Hospital. Patients operated on for anal and perianal suppuration of non-specific anorectal origin were included. Results: During the study period, we collected 141 cases of anal and perianal suppurations. The average age of our patients was 42±8.8 years. The sex ratio was 3.27 in favor of men. The origin of the patients was urban in 73.8% of the cases. The history of diabetes mellitus was found in 14.2% (n=20). Anal fistulas and anal abscesses (n=115) were simple in 46% (n=53) and complex in 54% (n=62). A fistulectomy with the placement of an elastic seton was performed for 41.13% of cases (n=58) and fistulotomy in 29.78%. The evolution of 6 months was marked by a recurrence in 10.63% (n = 15), the anal incontinence of gas at 9.21% (n=13). Deaths (n=4) were recorded in patients with Fournier’s gangrene. Uncomplicated therapeutic success was 80.13% (n=113). Conclusion: The surgical treatment of anal fistula (the main cause of anal and perianal suppuration) aims to eradicate the suppuration and to preserve the anal continence. The fistulotomy done in the context of the management of a simple fistula gives a better outcome. Incontinence-related complications and relapses must impose thoroughness and patience in the surgical treatment of complex fistulas.
Abstract: Bakground: Anal and perianal sepsis is common anorectal disorders found in surgical practice. This study aims to report epidemiological aspects and outcomes of management of anal and perianal suppuration. Methods: This was a retrospective study from January 2011 to June 2016 at Niamey National Hospital. Patients operated on for anal and perianal su...
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Diagnostic Value of α-Glutathione S-transferase in Acute Mesenteric Ischemia
Ahmed Abdel Fattah Elshoura,
Hala Desouky Ibrahim,
Sahar Mohey Hazzaa,
Ola Abdel Fattah Elshora,
Gamal Ibrahim Moussa
Issue:
Volume 6, Issue 4, August 2018
Pages:
107-111
Received:
10 July 2018
Accepted:
20 July 2018
Published:
14 August 2018
Abstract: Background: Acute mesenteric ischemia (AMI) is a life-threatening problem, and the early clinical manifestations of it are non-specific. Despite the advances in laboratory & radiological diagnostic procedures, the mortality rate of AMI is still high. Aim: The purpose of the study to evaluate the ability of α-glutathione S-transferase (α- GST) to predict AMI in patients with abdominal pain. Methods: This prospective study was conducted in Tanta University Hospitals between November 2014 and December 2017. Nighty patients were included after clinical suspicious of AMI. Serum levels of α- GST were measured in the collected stored samples, and other biochemical markers were performed (e.g. LDH, PH, and WBC). AMI was confirmed by CT angiography or laparotomy. Patients without ischemic bowel were considered to be controls. Results: A total of 90 patients in the study, the ischemic group included 52 patients, and the non-ischemic group included 38 patients. Patients with intestinal ischemia had significant higher serum values of D-dimer, LDH and α –GST. Where α –GST diagnosed AMI by accuracy of 84.4%. Conclusion: Measurement of plasma α -GST is a simple, early, easy, and effective procedure making it a useful serum biomarker for early diagnosis of AMI.
Abstract: Background: Acute mesenteric ischemia (AMI) is a life-threatening problem, and the early clinical manifestations of it are non-specific. Despite the advances in laboratory & radiological diagnostic procedures, the mortality rate of AMI is still high. Aim: The purpose of the study to evaluate the ability of α-glutathione S-transferase (α- GST) to pr...
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