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Management of Congenital Cystic Dilation of Common Bile Duct in Dakar (Senegal)
Toure Alpha Oumar,
Seck Mamadou,
Thiam Ousmane,
Sylla Mohamed,
Ka Ibrahima,
Gueye Mohamadou Lamine,
Seye Yacine,
Sarr Ibrahima Sitor,
Cisse Mamadou,
Dieng Madieng
Issue:
Volume 7, Issue 6, December 2019
Pages:
154-157
Received:
8 August 2019
Accepted:
27 September 2019
Published:
10 October 2019
Abstract: Congenital cystic dilatation of common bile duct is a rare condition in Africa and the West. Its discovery is often fortuitous. The diagnosis is based on imagery. Our goal was to report 3 cases followed by a literature review. Three patients were received, most often for pain of the right hypochondrium. There were 2 women and 1 man aged between 16 and 27 years old. The physical examination was normal. The abdominal CT scan allowed us to diagnose a IA Todani cyst in all patients, including one degenerate. Cholecystectomy with resection of the bile duct, followed by hepatico-jejunal anastomosis on anse-en-Y of Roux was performed in 2 patients. The immediate suites were simple. Histology showed inflammation on 2 operative specimen and cholangiocarcinoma on the 3rd. Choledochal DKC is a rare condition, often revealed in adults by complications. Bilio-pancreatic CT is an alternative to cholangio-MRI for its diagnosis with a type I Todani easily recognized. The treatment is surgical with a bad prognosis in case of degeneration.
Abstract: Congenital cystic dilatation of common bile duct is a rare condition in Africa and the West. Its discovery is often fortuitous. The diagnosis is based on imagery. Our goal was to report 3 cases followed by a literature review. Three patients were received, most often for pain of the right hypochondrium. There were 2 women and 1 man aged between 16 ...
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Bilateral Internal Thoracic Artery Bypass Grafting in a High Risk Population - A Four Year Experience with STS Database Derived Clinical Outcomes
John Jeffrey Tyner,
Kate Jensen,
Alexander Conkey Tyner,
Ashley Jaravata
Issue:
Volume 7, Issue 6, December 2019
Pages:
158-162
Received:
14 July 2019
Accepted:
5 October 2019
Published:
24 October 2019
Abstract: The purpose of this retrospective review was to examine the morbidity and mortality associated with the routine use of skeletonized bilateral internal thoracic arteries (BITA) in coronary bypass surgery (CABG). The current rate of BITA use is reported to be 5% in the US. The literature reflects an increased incidence of wound complications, especially in obese, diabetic, and female patients. Our policy has been to use skeletonized BITA in patients regardless of comorbidities. Using the Society of Thoracic Surgery (STS) database, the postoperative markers of prolonged ventilation (PV), length of stay (LOS), wound infection, death, and 30 day readmission were evaluated for all isolated coronary bypass operations (isocab) to allow comparison of bilateral and single internal thoracic artery (ITA) use during this four year period. The incidence of BITA use was 60%. The groups had similar comorbities and postop complications were similar regardless of single or bilateral thoracic artery use. Specifically, there were no wound complications in the BITA group. Adjuncts such as ITA skeletonization, platelet rich plasma, negative pressure wound dressing, and absence of bone wax were utilized in all cases. The added expense is justified to allow the expanded use of BITA.
Abstract: The purpose of this retrospective review was to examine the morbidity and mortality associated with the routine use of skeletonized bilateral internal thoracic arteries (BITA) in coronary bypass surgery (CABG). The current rate of BITA use is reported to be 5% in the US. The literature reflects an increased incidence of wound complications, especia...
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Gastric Cancer After Roux-en-Y Gastric Bypass: A Case Report and a Systematic Review
Lancellotti Francesco,
Coupaye Muriel,
Dior Marie,
Calabrese Daniela
Issue:
Volume 7, Issue 6, December 2019
Pages:
163-167
Received:
29 September 2019
Accepted:
30 October 2019
Published:
6 November 2019
Abstract: Background: Gastric carcinoma in the bypassed stomach after Roux en Y gastric bypass (RYGB) is rare, a few cases have been reported since 1991. The symptomatology associated is non-specific and the monitoring of a bypassed stomach is difficult. Case presentation: We present a case of a 57-year-old woman with an early cancer in the bypassed stomach 1 year after bariatric surgery. Method: PubMed, Web of Science and EMBASE databases were revised. Result: up to date, 17 case reports are founded in literature, among theme 15 revealed gastric carcinoma, 1 GIST and 1 lymphoma. In our study were included 18 patients with gastric carcinoma. The interval between bypass surgery and the diagnosis of cancer ranged from 1 to 22 years. Mean patient age was 53.1 years (range: 38-71 years). The most frequent symptom was vague abdominal pain (50%), while only in one case was asymptomatic. In 7 patients (38,9%) the tumor was unresectable. Conclusion: Gastric carcinoma in the bypassed stomach after RYGB is rare and it is difficult to diagnose, and often disease’s stage is advanced by the time of diagnosis. The associated symptomalogy is non-specific, and so, it’s important to maintain a high clinical suspicion to diagnose it early.
Abstract: Background: Gastric carcinoma in the bypassed stomach after Roux en Y gastric bypass (RYGB) is rare, a few cases have been reported since 1991. The symptomatology associated is non-specific and the monitoring of a bypassed stomach is difficult. Case presentation: We present a case of a 57-year-old woman with an early cancer in the bypassed stomach ...
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Effect of Intra-Articular Injection of Triamcinolone Acetonide for Wrist, Elbow and Shoulder Pain in Patients with Rheumatoid Arthritis: Retrospective Study
Akihiro Fukui,
Takashi Yoshii,
Hideki Yamada
Issue:
Volume 7, Issue 6, December 2019
Pages:
168-179
Received:
5 October 2019
Accepted:
5 November 2019
Published:
8 November 2019
Abstract: Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 females and 21 men) rheumatoid arthritis patients with wrist, elbow and shoulder pain by analyzing the number of injections, decrease in pain measured on a visual analog scale (VAS), changes in carpal height ratio (CHR), radio carpal distance ratio (RCDR) and radial rotation angle (RRA) on X-ray imaging, and adverse effects in the subcutaneous tissue and extensor tendons. Results: Over the 8-year study period (average 6 yrs.), the mean numbers of intra-articular triamcinolone acetonide injections per patient were 3.7 for 180 wrists in 118 patients, 2.2 for 45elbows in 36 patients, 2.8 for 60 shoulders in 44 patients. Mean improvements in VAS pain scores from baseline were as follows: wrist, from 75 to 11 mm; elbow, from 79 to 17mm; shoulder, from 54 to 11mm. The group that received the injections showed no significant changes in CHR or RCDR, whereas RRA changed significantly decrease (P < 0.05). In the group that did not receive intra-articular injections, no significant changes were observed in CHR, RCDR and RRA over a mean follow-up period of 8 years. No abnormalities were observed in subcutaneous tissue. Conclusions: Overall, >90% of the patients of all disease grades responded to an average of 1–4 intra-articular triamcinolone acetonide injections, which were effective for pain relief in the wrist, elbow and shoulder joints over both the short and long term. Skin atrophy or extensor tendon rupture due to injection did not occur.
Abstract: Background: Many rheumatoid arthritis patients with joint pain refuse the indicated synovectomy, joint arthroplasty, or similar surgical procedures, opting instead to receive intra-articular injections of corticosteroid. Methodology: We evaluated the clinical benefit and safety of intra-articular injections of triamcinolone acetonide in 153 (132 fe...
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Significance of Blood Glucose Control in Severe Nursing Care of ICU
Huang Huifang,
Lu Wanxian,
Shan Miaohang
Issue:
Volume 7, Issue 6, December 2019
Pages:
180-183
Received:
21 September 2019
Accepted:
28 October 2019
Published:
9 November 2019
Abstract: To investigate the effect of intensive blood glucose control in Intensive Care Unit (ICU) nursing and analyze its clinical significance. From August 2018 to August 2019, 94 severe patients treated with ICU in our hospital were divided into two groups according to the random digital table method. 47 cases in the control group received routine nursing, and 47 cases in the observation group were treated with blood glucose control and routine nursing management. The sequential organ failure score (SOFA), acute physiological and chronic health status score (APACHE II), hospitalization time in ICU and total hospitalization time were compared between the two groups. After nursing, the APACHE Ⅱ score and SOFA score of the patients in the observation group were significantly lower than those in the control group (P < 0.05); The total hospitalization time of ICU in the observation group was significantly shorter than that in the control group (P < 0.05). Enhanced glycemic control in ICU intensive nursing can improve the clinical therapeutic effect and shorten the rehabilitation time. In addition, tight glycemic control can also optimize the prognosis and shorten hospital stay time. The intensive blood glucose control is worthy to be popularized in ICU.
Abstract: To investigate the effect of intensive blood glucose control in Intensive Care Unit (ICU) nursing and analyze its clinical significance. From August 2018 to August 2019, 94 severe patients treated with ICU in our hospital were divided into two groups according to the random digital table method. 47 cases in the control group received routine nursin...
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A Prospective Study: Is Routine Pre-operative Urinalysis Mandatory in Ambulatory Operations in Children
Roland Iheanyichuwu Osuoji,
Titilola Awodesu
Issue:
Volume 7, Issue 6, December 2019
Pages:
184-187
Received:
23 October 2019
Accepted:
14 November 2019
Published:
25 November 2019
Abstract: There are controversies regarding pre-operative routine investigations in ambulatory operations in the paediatric age group. Routinely, patients’ packed cell volume (PCV), and genotype were the investigations done for children before surgery, but somewhere along the line, the anaesthesiologists now demand for pre-operative routine urinalysis in children going for ambulatory operations to help detect occult urinary tract diseases. The aim and objectives was to find out the benefits of doing routine preoperative urinalysis and whether it was really necessary in children undergoing ambulatory operations in Lagos, Nigeria”? It was a one year prospective study, carried out from the 1st of September, 2018 to the 31st of August, 2019 in the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Eighty four children, between the ages of 0 - 12 years, slated for ambulatory operations were mandated to do routine pre-operative urinalysis, routine packed cell volume estimation, and genotype studies. All the children were operated under general anaesthesia. Eighty four children were recruited, comprising of 72 (85.7%) males and 12 (14.3%) females with a male: female ratio of 6:1. The patients’ age ranged from 0 to 12 years with a mean age of 5 ± 3 STD. An average, minimum and maximum weights of 18.9kg, 5.0kg, and 44.0kg respectively were recorded, while the average PCV was 34.4%, with a minimum of 26.9% and maximum of 48.0%. The results of urinalysis were normal in 82.1% and abnormal in about 17.9% participants. In the abnormal group, (proteinuria trace = 7, leucocytes = 4, nitrites = 2, proteins + nitrites = 1, and urobilirubin = 1). All study subjects underwent the procedures successfully with no record of cancellation of any procedure as a result of an abnormal urine finding. We conclude that routine pre-operative urinalysis should be done on all our paediatric ambulatory surgery patients with a view to detecting any abnormalities that may require a follow-up.
Abstract: There are controversies regarding pre-operative routine investigations in ambulatory operations in the paediatric age group. Routinely, patients’ packed cell volume (PCV), and genotype were the investigations done for children before surgery, but somewhere along the line, the anaesthesiologists now demand for pre-operative routine urinalysis in chi...
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Comparison of Two Predictive Scores for the Development of Incisional Hernia
Edgard Efren Lozada Hernández,
Miguel Agustín González Gonzalez,
José Francisco Molina Rodríguez,
Enrique Obregón Moreno,
Aldo Edyair Jiménez Herevia,
Martin Cano Rosas
Issue:
Volume 7, Issue 6, December 2019
Pages:
188-193
Received:
19 November 2019
Accepted:
29 November 2019
Published:
10 December 2019
Abstract: Introduction: Incisional Hernia (IH) is a frequent complication of abdominal surgery, with an incidence of 10-23%, which can increase to 38% in specific risk groups. So far there is no ideal method to identify patients at high risk of developing IH, this variety in the criteria of inclusion of patients in different studies makes is very complicate to compare the results. The aim of this study is comparing the two predictive scores of incisional hernias (Hernia project Vs Van Ramshorst) with higher diagnostic performance and determine which is better to predict IH. Methods: An analytical, observational study was conducted between June and December 2018, in patients of both sexes, who were 18 years or older, undergoing midline laparotomy, regardless of their background diagnosis either urgently or scheduled between 2007 to 2016. The two different classifications, the Hernia Project score and Van Ramshorst score, were applied to each of the patients. With the identification of patients with hernia, two groups, healthy and ill, were performed and Bayesian statistics were made with it and to identify which scale best predicts the presence of this complication. Results: The records of 1085 patients undergoing midline laparotomy were reviewed. 296 patients were ruled out because their follow-up was not complete. Both tests were compared to determine the best diagnostic performance using the ROC curve and the area under the curve, finding that the Hernia Project Score has a larger area 0.724 compared to a 0.663 of Van Ramshorst. Discussion: In our patient cohort, the Hernia Project score has a greater predictive capacity, with an area under the best curve (0.72 vs. 0.66) however both They have a poor sensitivity and this is the main measure of the predictive capacity of any diagnostic test, so with these results, we can affirm that the Project hernia scale has a greater diagnostic capacity than the Van Ramshorst scale but still its diagnostic capacity is limited. Conclusions: Both scores have low sensitivity. We can affirm that the Hernia Project score has a greater diagnostic capacity than the Van Ramshorst score, but both have a limited diagnostic capacity.
Abstract: Introduction: Incisional Hernia (IH) is a frequent complication of abdominal surgery, with an incidence of 10-23%, which can increase to 38% in specific risk groups. So far there is no ideal method to identify patients at high risk of developing IH, this variety in the criteria of inclusion of patients in different studies makes is very complicate ...
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Laparoscopic Sleeve Gastrectomy: An Effective Surgical Procedure for Control of Obesity: A Prospective Cohort Study
Shailesh Kumar,
Tayod Kumar Choudhary,
Md Shazid Akbal
Issue:
Volume 7, Issue 6, December 2019
Pages:
194-197
Received:
15 September 2019
Accepted:
4 October 2019
Published:
13 December 2019
Abstract: Obesity has come up in a big way resulting into constellation of metabolic abnormalities affecting mainly the productive age group resulting into loss of productivity of an individual as well as their nation. The conservative methods of treating obesity have been proved transient and unsatisfactory. Laparoscopic Sleeve Gastrectomy (LSG) results in long-term success in most of the morbidly obese patients. In the study conducted in the department of Surgery at ABVIMS & DR. RML Hospital, New Delhi on morbidly obese patients between November 2017 to March 2019, LSG resulted in significant weight reduction as well as control of the BMI. The effect of LSG in controlling weight as well as Body Mass Index (BMI) is more in the patients of BMI with <40 BMI as compared to patients of BMI>40.
Abstract: Obesity has come up in a big way resulting into constellation of metabolic abnormalities affecting mainly the productive age group resulting into loss of productivity of an individual as well as their nation. The conservative methods of treating obesity have been proved transient and unsatisfactory. Laparoscopic Sleeve Gastrectomy (LSG) results in ...
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Transsphenoidal Endoscopic Approach in Treatment of Spontaneous Nasal CSF-leak
Sergei Karpishchenko,
Vladislav Cherebillo,
Olga Vereshchagina,
Nikita Puzakov,
Olga Stancheva
Issue:
Volume 7, Issue 6, December 2019
Pages:
198-201
Received:
13 November 2019
Accepted:
11 December 2019
Published:
23 December 2019
Abstract: Spontaneous nasal liquorrhea is a pathological condition associated with defects between the nasal cavity and the intracranial structures, which results in CSF leak from the nasal cavity. Diagnostic criteria include: anamnesis, examination of the nasal fluid, endoscopic examination of the nasal cavity, and CT - and MRI - cisternography. Conservative therapy is applicable to small fistulas. In the case of the inefficiency of this method, surgical method is then applied to the defect closure. Purpose of the study: To evaluate the effectiveness of endoscopic endonasal approach in the CSF leak treatment. Materials and methods: For the period from 2008 to 2018 at the Pavlov First Saint Petersburg State Medical University, at the clinic of neurosurgery of the Kirov Medical Institute and the Medical Research Center Almazov, 38 patients with spontaneous nasal liquorrhea were treated. All patients underwent plastic surgery of the CSF fistula by endoscopic endonasal approach. Results: In 4 cases, there was a large defect requiring secondary surgical intervention 1-2 weeks after the initial operation. Conclusions: The use of auto tissues (muscle or fat) is the method of choice for repeated surgical plastics of the cerebrospinal fluid fistula or in the case of a large size defect.
Abstract: Spontaneous nasal liquorrhea is a pathological condition associated with defects between the nasal cavity and the intracranial structures, which results in CSF leak from the nasal cavity. Diagnostic criteria include: anamnesis, examination of the nasal fluid, endoscopic examination of the nasal cavity, and CT - and MRI - cisternography. Conservativ...
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Sacro-coccygeal Teratoma in a Child of 6 Months: A Case Report
Mfouou Azoo Frederic,
Engbang Ndamba Jean Paul,
Essola Basile,
Chichom-Mefire Alain,
Ngowe Ngowe Marcelin
Issue:
Volume 7, Issue 6, December 2019
Pages:
202-206
Received:
15 November 2019
Accepted:
20 December 2019
Published:
31 December 2019
Abstract: Sacro-coccygeal teratoma (SCT) is a type of tumor which mostly occurs in newborn babies. The vast majority of this type of tumor is benign. That pathology can be diagnosed antenatally or at birth. Teratomas, especially those diagnosed in the neonatal period, occur most frequently in the sacrococcygeal region. Clinically in many cases, we can observe a large swelling (mass) in the sacrococcygeal region. In some cases, there are signs of compression following by the displacement of the rectum and pelvic organs. Alphafetoprotein is the main biological test used. In association morphologically by echography, CT-scan, MRI and others, the tumor is classified. The classification used is the topographical one of TSCs, which was proposed by Altman to the American Academy of Pediatric Surgery. The mainstay of therapy is the complete surgical removal. We present a case of a newborn (6 months), female, with teratoma sacro-coccygeal. At birth the baby was noticed to have large swelling (mass), without any sign of compression of others organs. Clinical and paraclinical signs permitted us to conclude of a SCT type II of Altman’s classification. A surgery was performed with a sacral approach. Histologically, tumors were classified into good (mature) category.
Abstract: Sacro-coccygeal teratoma (SCT) is a type of tumor which mostly occurs in newborn babies. The vast majority of this type of tumor is benign. That pathology can be diagnosed antenatally or at birth. Teratomas, especially those diagnosed in the neonatal period, occur most frequently in the sacrococcygeal region. Clinically in many cases, we can observ...
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