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Post Thermal Sciatic Nerve Injury Successfully Repaired with a Sural Nerve Graft: Case Report
Nangole Wanjala Ferdinand,
Ochieng Sephania Raduma
Issue:
Volume 7, Issue 5, October 2019
Pages:
119-122
Received:
28 February 2019
Accepted:
8 July 2019
Published:
6 August 2019
Abstract: Loss of the sciatic nerve may result in paralysis and sensory loss of the leg. Among indications for lower limb amputation is blunt trauma to the nerve that is feared to have no chances of recovery. Injuries of thermal in nature are thought to have an extensive damage far from the site of injury and are thus unlikely to recover. The injured nerve is likely to heal by fibrosis and scarring making it difficult for any axons to go through it. The only hope for such recovery is removal of all injured sections followed by the nerve repair with a nerve graft or nerve transfer. With advances in microsurgery more and more injured nerves that were otherwise considered unsalvageable are now routinely reconstructed with relatively good outcomes. A good proportion of this are nerve injuries of the upper limbs such brachial plexus, median, ulnar and radial nerve injuries. Compared to the upper limb nerve injuries there is little data on the outcomes of lower limb nerve injuries. The tendency towards amputation of the lower limb following blunt trauma to the sciatic nerve is much higher than the upper limb. We present a case of post traumatic thermal sciatic nerve injury that was repaired with a sural nerve graft with good outcomes.
Abstract: Loss of the sciatic nerve may result in paralysis and sensory loss of the leg. Among indications for lower limb amputation is blunt trauma to the nerve that is feared to have no chances of recovery. Injuries of thermal in nature are thought to have an extensive damage far from the site of injury and are thus unlikely to recover. The injured nerve i...
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Mini-incision Hemithyroidectomy—Incision Closure with Subcuticular Suture Versus No Suture of Subcutaneous Tissue and Skin
Sade Rajkumar,
Vaidyula Sudha Spandana,
Mutya Subrahmanyam
Issue:
Volume 7, Issue 5, October 2019
Pages:
123-127
Received:
7 July 2019
Accepted:
6 August 2019
Published:
23 August 2019
Abstract: Minimally invasive thyroid surgery techniques (MIT) have the advantage of reduction of tissue trauma, early hospital discharge, and better neck wound cosmetic appearance, while maintaining the same surgical outcome as traditional thyroidectomy. In addition to MIT, methods of skin closure contribute to the overall aesthetic outcome and patient’s satisfaction. Methods of skin closure depends largely on the surgeon’s choice based upon the need for a rapid, economic, and reproducible technique. The aim of the study is to compare the quality of resulting scar at 6 weeks after mini-incision hemithyroidectomy with subcuticular absorbable sutures or no subcuticular or skin sutures for the closure of the incision. Methods. There are 102 patients undergoing mini-incision hemithyroidectomy. Fifty two patients were randomly assigned to closure with approximation of subcutaneous tissue and skin by bringing the wound edges together by pressing with forceps and the other 50 with subcuticular absorbable suture. Post-operatively patients were assessed for pain and it was observed that pain was less in group treated without skin or subcutaneous sutures. At 6 weeks, the scar was evaluated by the patient after viewing in the mirror and graded as 1-5. Results. Pain during the postoperative period was significantly less in patients without subcutaneous or skin sutures. Assessment of scar appearance by the patients showed a statistically significant difference in favor of no skin or subcutaneous suture (n=48) as compared to subcuticular suture (n=40). Conclusion. Incision closure of mini –incision hemithyroidectomy without subcuticular or skin sutures and only by approximation had less pain postoperatively as compared to subcuticular suture. Scar assessment by patients revealed better satisfaction by this method.
Abstract: Minimally invasive thyroid surgery techniques (MIT) have the advantage of reduction of tissue trauma, early hospital discharge, and better neck wound cosmetic appearance, while maintaining the same surgical outcome as traditional thyroidectomy. In addition to MIT, methods of skin closure contribute to the overall aesthetic outcome and patient’s sat...
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A Useful Technique for Removing a Broken Guide-wire in the Femoral Neck Through the Proximal Femoral Nail Hole During Operation
Wenrui Wu,
Simin Luo,
Tengfeng Zhuang,
Ning Liu,
Zhengang Zha
Issue:
Volume 7, Issue 5, October 2019
Pages:
128-131
Received:
8 July 2019
Accepted:
10 August 2019
Published:
26 August 2019
Abstract: Context: Cannulated instruments are usually used while operating around the hip joint for fractures. For example, femoral neck fracture, intertrochanteric fracture, etc. Perioperative instrument breakage such as kirschner wires and guide pins is not infrequent. The fragment of instruments must be removed in order to avoid injury some important organizations. If the fragment further migrate to the acetabulum can result in serious or fatal complications. Removing a broken guide-wire is difficult and challenging even for experienced surgeons. Case Report: We present a simple and useful method to remove the broken guide-wire in the hip joint just using cannulated reamer to ream over the guide wire under the C-arm image intensifier. At first, confirm the cannulated reamer to sight the broken end of the wire, and passed through the broken guide-wire. Then, further reaming with low speed rotation till the beginning of the reamer encased the broken guide-wire. The reamer was withdrawn a few millimeters, after confirmation of the broken guide-wire dislodgment and firmly engaged within the drill lumen by the C-arm image intensifier. Reverse the guide-wire slightly with the reamer through the Proximal Femoral Nail hole. Conclusions: With this method, the authors were able to remove the broken guide wire easily in a few minutes.
Abstract: Context: Cannulated instruments are usually used while operating around the hip joint for fractures. For example, femoral neck fracture, intertrochanteric fracture, etc. Perioperative instrument breakage such as kirschner wires and guide pins is not infrequent. The fragment of instruments must be removed in order to avoid injury some important orga...
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Laparoscopic Assisted Percutaneous Microwave Ablation for Hepatocellular Carcinoma Close to Large Hepatic Vessels
Mohamed Mogahed,
Bahaa El Wakeel,
Ashraf El Kholy,
Wessam Moustafa Abdellatif,
Ashraf Anas Zytoon,
Mohamed Manaa,
Nashwa Said Ghanem
Issue:
Volume 7, Issue 5, October 2019
Pages:
132-137
Received:
13 May 2019
Accepted:
25 June 2019
Published:
29 August 2019
Abstract: Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. It was believed that ablation for tumors close to large vessels should be avoided for the concern of major complications. Microwave ablation (MWA) seemed to be a better choice than radiofrequency ablation (RFA) in treating HCC close to large vessels (≥ 3 mm), for its advantages of a lower susceptibility to heat-sink effects (blood-vessel-mediated cooling), as well as the ability to achieve larger tumor volumes in shorter time. The aim of this study is to evaluate safety and efficacy of MWA for HCC close to large vessels. Methods: 32 patients with 52 HCC lesions were included, all patients have a lesion close to large vessel. 14 patients had single lesion, 16 had two lesions and 2 had three lesions. All patients are Child-Pugh A or B within Milan Criteria and class A disease Barcelona Clinic Liver Cancer (BCLC). Results: This study was conducted on 32 HCC patients 24 males and 8 females with median age 63 years. 32 HCC lesions were close to large vessel while 20 lesions were not close to large vessel. Laparoscopic assisted percutaneous MWA was decided as the treatment of choice for all patients. two patients (6%) had major complications (one patient had right portal vein thrombosis and the other patient had intra-hepatic hematoma), 3 patients (9%) had minor complications in the form of skin burn. Local tumor progression (LTP) occurred in 2 lesions (3.8% of lesions). Conclusion: laparoscopic assisted percutaneous MWA proved to be a safe and effective as a management for HCC close to large vessels.
Abstract: Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. It was believed that ablation for tumors close to large vessels should be avoided for the concern of major complications. Microwave ablation (MWA) seemed to be a better choice than radiofrequency ablation (RFA) in treating HCC close to large vessels (≥ 3 mm), fo...
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Neonatal Intestinal Obstruction: A 5 Year Experience in a Tertiary Hospital in Enugu, Nigeria
Chukwubuike Kevin Emeka,
Odetunde Oluwatoyin Arinola,
Ekwochi Uchenna,
Iheji Chukwunonso Chigozie,
Eze Thaddeus Chikaodili
Issue:
Volume 7, Issue 5, October 2019
Pages:
138-142
Received:
31 July 2019
Accepted:
18 August 2019
Published:
2 September 2019
Abstract: Background: Neonatal intestinal obstruction is one of the most common surgical emergencies in a newborn requiring the services of a pediatric surgeon. This study reports the etiology, sex incidence, age of presentation, management and outcome of neonatal intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of neonates who presented, at Enugu State University Teaching Hospital, with intestinal obstruction over a 5-year period. Result: Thirty five neonates were recruited into the study. There were 24 (68.6%) males and 11 (31.4%) females. Five patients (14.3%) were delivered before term (preterm) while thirty patients (85.7%) were delivered at term. Most of the patients (54.3%) presented after 72 hours from onset of symptoms. Abdominal distension was the most common symptomatology recorded in our patients. Necrotizing enterocolitis was the most common etiology in our patients accounting for 17 neonates (48.6%). This was followed by anorectal malformation 5 (14.3%), obstructed hernia 4 (11.4%), intestinal atresia 4 (11.4%), Hirschsprung’s disease 3 (8.6%), meconium plug 2 (5.7%). Colostomy formation was the most common surgical procedure performed. Twenty percent of our patients developed post-operative complication and mortality was 22.9%. Conclusion: Necrotizing enterocolitis is the most common cause of neonatal intestinal obstruction in the current study. With the mortality of 22.9%, the outcome in our patients is still poor and requires some improvements.
Abstract: Background: Neonatal intestinal obstruction is one of the most common surgical emergencies in a newborn requiring the services of a pediatric surgeon. This study reports the etiology, sex incidence, age of presentation, management and outcome of neonatal intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Met...
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A 5-Year Review of the Presentation and Management of Urolithiasis in a Nigerian Teaching Hospital
Olufunmilade Omisanjo,
Muftau Bioku,
Omolara Williams,
Olufemi Akinola,
Fatai Balogun,
Stephen Ikuerowo
Issue:
Volume 7, Issue 5, October 2019
Pages:
143-147
Received:
23 May 2019
Accepted:
26 August 2019
Published:
16 September 2019
Abstract: Introduction: Urolithiasis has afflicted humans since centuries dating back to 4000BC, with the disease prevalence differing in various parts of the world. Contrary to earlier studies that depicted urinary stone disease as rare in Nigeria, recent reports have shown an increasing incidence. We aim to document the pattern and management of urinary tract calculi seen at the Lagos State University Teaching Hospital, Ikeja, Nigeria. Patients and Methods: We retrospectively reviewed the cases of urolithiasis managed at Lagos State University Teaching Hospital, Ikeja, Nigeria between January 2012 and December 2016. Variables analyzed were patients’ age, gender, presenting symptoms, investigations and modalities of treatment. Results: The clinical records of a total of seventy-six patients treated for urinary stone disease within the 5-year study period were available for review. The ages of the patients ranged from 2 years to 84 years with a mean age of 49.13 ± 16.27 years. The male to female ratio was 1.8:1. While the urinary bladder was the commonest site of the stone amongst our patients (n=37, 48.7%), 4 (5.3%) were found at multiple sites. All the patients had abdominal ultrasound and 57.9% had, in addition, a computerized tomography (CT) urography. Majority, (53.9%) were treated by open surgery. There was no statistically significant impact of gender on disease presentation (P=0.167) or treatment (P=0.8381). However the patients who had surgical treatment were significantly older than those who were treated conservatively (P=0.033). Conclusion: Urolithiasis in our region has become more common, mimicking the increasing prevalence reported in the West. Most of the cases of urinary tract stones are still successfully managed by open surgery and thus open stone surgery should be considered as a valid alternative to endourologic management techniques in resource poor regions lacking endoscopic facilities.
Abstract: Introduction: Urolithiasis has afflicted humans since centuries dating back to 4000BC, with the disease prevalence differing in various parts of the world. Contrary to earlier studies that depicted urinary stone disease as rare in Nigeria, recent reports have shown an increasing incidence. We aim to document the pattern and management of urinary tr...
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Effects of Zinc on Non-alcoholic Fatty Liver Disease After Pancreatoduodenectomy
Atsushi Miyosh,
Hiroki Koga,
Satomi Nakamura,
Hiroaki Nakamura,
Kohei Yamada,
Hiroshi Kubo,
Masatsugu Hiraki,
Osamu Ikeda,
Toshiya Tanaka,
Kenji Kitahara,
Seiji Sato,
Hirokazu Noshiro
Issue:
Volume 7, Issue 5, October 2019
Pages:
148-153
Received:
17 August 2019
Accepted:
12 September 2019
Published:
26 September 2019
Abstract: Background: The etiology, treatment and prevention of Nonalcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD) remain largely unknown. We aimed to elucidate the risk factors for NAFLD after PD and investigate the nutritional effects of zinc medication. Methods: We retrospectively examined 109 patients who underwent PD between 2013 and 2017. We diagnosed the postoperative NAFLD using CT attenuation at six months later. We identified the risk factors for postoperative NAFLD among perioperative factors and analyzed the nutritional effect of zinc medication at six months after surgery. Results: We diagnosed 27 patients with NAFLD after PD. A univariate analysis showed that pancreas cancer (p = 0.029), operative time (p = 0.008), blood loss (p = 0.034), postoperative diarrhea (p < 0.001) and zinc medication (p < 0.001) were associated with postoperative NAFLD. A multivariate analysis demonstrated that zinc medication was the most important factor for the prevention of NAFLD after PD. All patients who received zinc also took pancreatic enzyme simultaneously and showed a significantly lower rate of body weight loss than in patients without zinc at six months after PD (p = 0.041). These patients showed a significantly higher total cholesterol level (p = 0.006) and higher serum zinc level (p<0.001). Furthermore, significantly fewer cases of postoperative NAFLD were noted among the patients who received zinc than among those who did not receive it (5.7% vs 33.8%: p = 0.001). Conclusion: These results suggest that zinc administration might improve the postoperative nutritional status and prevent NAFLD after PD.
Abstract: Background: The etiology, treatment and prevention of Nonalcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD) remain largely unknown. We aimed to elucidate the risk factors for NAFLD after PD and investigate the nutritional effects of zinc medication. Methods: We retrospectively examined 109 patients who underwent PD between 2013 ...
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