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Classification and Clinical Significance of Traumatic Posterior Cranial Fossa Fractures
Issue:
Volume 9, Issue 6, December 2021
Pages:
252-255
Received:
28 September 2021
Accepted:
19 October 2021
Published:
5 November 2021
Abstract: Objective To explore the classification and efficacy of traumatic posterior cranial fossa fractures. Methods 155 cases were diagnosed by CT examination to determine for traumatic posterior fossa fracture involving the wounded and merger, at the same time will find traumatic cerebellopontie angle syndrome, as one of the key content classification, GCS score 3 to 15 points, and according to the clinical symptoms and signs combined with CT examination put forward the new classification, through the selection of parting early surgical and non-surgical treatment. Results 155 cases of posterior cranial fossa fracture and its associated injury were classified into type I-VI, and the therapeutic effect was evaluated according to GOS score after 6 months follow-up. Among the 75 cases, 50 cases were treated with 5 points, 16 cases were treated with 14 points, 5 cases were treated with 3 points, 2 cases were treated with 2 points, 2 cases were treated with 1 point, and the rest 80 cases were treated without operation with 4-5 point. Conclusion The new classification of type I-VI proposed by our group and the selection of ultra-early surgical and non-surgical treatment according to the classification are the key to reduce the mortality and disability rate in this study. Especially, the traumatic cerebellopontine angle syndroma proposed by zhang yan ping that important significance of timely operation.
Abstract: Objective To explore the classification and efficacy of traumatic posterior cranial fossa fractures. Methods 155 cases were diagnosed by CT examination to determine for traumatic posterior fossa fracture involving the wounded and merger, at the same time will find traumatic cerebellopontie angle syndrome, as one of the key content classification, G...
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One-Stage Hybrid Breast Reconstruction with Inflatable Saline Implants: Minimizing the Need for Major Revision Surgery
Anna Zhou,
Peter Deptula,
Pooja Yesantharao,
Irene Ma,
Dung Nguyen
Issue:
Volume 9, Issue 6, December 2021
Pages:
256-263
Received:
3 August 2021
Accepted:
12 August 2021
Published:
10 November 2021
Abstract: Autologous breast reconstruction is an appealing choice for breast cancer undergoing mastectomy. Evaluating for adequate donor tissue volume is a highly subjective process with potentials for miscommunication. It is not uncommon for patients to desire significant augmentation of their autologous breast reconstruction with delayed insertion of an implant. However, flap elevation in the pre-pectoral plane can be treacherous. Our novel technique combines autologous abdominal free flaps with immediate pre-pectoral adjustable saline implants to provide a customizable, single-stage strategy. A retrospective review of patients undergoing breast reconstruction with abdominal free tissue transfer and either immediate placement of adjustable saline implants or delayed placement of implants for augmentation was performed. Patient characteristics, operative details and complications were recorded. Complications, patient satisfaction and ability to achieve goal breast size was compared between the immediate adjustable saline implant group and delayed implant placement group. Twenty-four patients (41 breasts) were identified and met inclusion criteria. Sixteen patients received implants in a delayed manner (28 breasts), while 8 received adjustable saline implants immediately with flap reconstruction (13 breasts). High patient satisfaction with breast size and shape was noted across both cohorts. Nearly all patients across both cohorts believed that it was beneficial to be able to adjust breast volumes post-reconstruction. Immediate saline implant placement was demonstrated to increased odds of patient-reported satisfaction by multivariable analysis. A single-stage hybrid approach breast reconstruction with a pre-pectoral adjustable saline implant and abdominal free flap is feasible. This novel technique reduces the rate of major revision surgery and optimizes patient satisfaction in autologous breast reconstruction.
Abstract: Autologous breast reconstruction is an appealing choice for breast cancer undergoing mastectomy. Evaluating for adequate donor tissue volume is a highly subjective process with potentials for miscommunication. It is not uncommon for patients to desire significant augmentation of their autologous breast reconstruction with delayed insertion of an im...
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A Prospective Study on Short-Term Changes in Serum Nutrient Levels After Sleeve Gastrectomy and One Anastomosis Gastric Bypass (OAGB)
Mohamed Fikry,
Hesham Saad Noor,
Waleed Thabet,
Hosam Ghazy,
Sabry Ahmed Mahmoud
Issue:
Volume 9, Issue 6, December 2021
Pages:
264-270
Received:
22 October 2021
Accepted:
12 November 2021
Published:
19 November 2021
Abstract: In Egypt, sleeve gastrectomy and one anastomosis gastric bypass (OAGB) are popular bariatric procedures. The current study was conducted to compare between these two procedures regarding short-term weight loss, comorbidity improvement, vitamin and micronutrient changes. This prospective study included 40 cases who were divided into two equal groups; sleeve gastrectomy and OAGB groups. All cases received the standard perioperative care. Our primary outcome was serum nutrient changes (hemoglobin, iron, calcium, vitamin D, and vitamin B 12), while secondary outcomes included weight loss parameters along with the improvement of obesity related comorbidities. These data were recorded 3, 6, and 12 months after operation, and then compared to the corresponding baseline values. Demographic criteria were comparable between the two groups, apart from diabetes which was more prevalent in the OAGB group. Both groups were followed by a significant and comparable weight loss at the short-term after operation. Both groups were associated with significant improvement in DM and hypertension at 12 months. Most evaluated vitamin and nutrient levels were comparable between the two groups except for hemoglobin, iron and vitamin B 12 levels, which were significantly higher with sleeve gastrectomy at 6- and 12-month follow up. Both sleeve gastrectomy and OAGB are effective bariatric procedures that could achieve satisfactory weight loss and improvement of comorbidities. However, OAGB carries higher risk of iron, hemoglobin and vitamin B 12 deficiency.
Abstract: In Egypt, sleeve gastrectomy and one anastomosis gastric bypass (OAGB) are popular bariatric procedures. The current study was conducted to compare between these two procedures regarding short-term weight loss, comorbidity improvement, vitamin and micronutrient changes. This prospective study included 40 cases who were divided into two equal groups...
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Microbiology of Liver Abscesses and Its Correlation with Hospital Stay
Marcelo Jose Costa,
Nuno Dias Machado,
Joao Pinto-de-Sousa,
Teresa Monica Rocha,
Carlos Soares
Issue:
Volume 9, Issue 6, December 2021
Pages:
271-276
Received:
28 October 2021
Accepted:
23 November 2021
Published:
2 December 2021
Abstract: Pyogenic liver abscess (LA) is a rare disease associated with high morbidity and mortality rates, and prolonged hospital stay. Certain microbiological agents have assumed a predominant role in Asian series, however, few studies have been published in Europe regarding the microbiological agents involved in liver abscesses and their relationship with prognosis and length of hospital stay. The aim of this study was to characterize the main microbiological agents involved in LA in a European hospital, to assess resistance patterns and to relate them to patient prognosis and length of hospital stay. A retrospective analysis was conducted on all LA-diagnosed adult patients, admitted to a northern Portuguese hospital between 2013 and 2018. Clinical, laboratory, imaging, and microbiological data were collected for descriptive and statistical analysis. A total of 63 LA diagnosed patients were admitted to the General Surgery Unit between January 2013 and December 2018. Patients´ mean age at diagnosis was 71.4 years. Abdominal pain and fever were the most common symptoms on admission (73.0 and 61.9%, respectively). Fifty-eight percent of patients were female. Leukocytosis and increased C-reactive protein were the most observed analytical changes. The most frequently isolated microbiological agents were Escherichia coli (36.5%), Streptococcus species (27.8%), Klebsiella pneumoniae (11.4%), and anaerobic agents (10.1%). Of the isolated species, 12.5% proved multi-resistant. A higher LA frequency caused by Klebsiella pneumoniae was identified in relation to other Western series. Klebsiella pneumoniae was associated with a longer hospital stay (25.67 vs 16.50 days, p=0.07) when compared to other agents. There were 4 mortality cases in our series (6.3%). Microbiological agents, namely Klebsiella pneumoniae and multidrug-resistant agents have a predominant role in LA management, negatively affecting prognosis and length of hospital stay. Despite advances in LA treatment, more studies are required to determine the appropriate therapy owing to the absence of internationally defined guidelines. Our results provide important information for the proper management of these patients.
Abstract: Pyogenic liver abscess (LA) is a rare disease associated with high morbidity and mortality rates, and prolonged hospital stay. Certain microbiological agents have assumed a predominant role in Asian series, however, few studies have been published in Europe regarding the microbiological agents involved in liver abscesses and their relationship with...
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Morbidity and Mortality of Acute Mechanical Intestinal Obstruction in the General Surgery Department of the Ignace Deen National Hospital in Conakry
Mamadou Sakoba Barry,
Soriba Naby Camara,
Hamidou Sylla,
Aboubacar Toure,
Aïssatou Taran Diallo
Issue:
Volume 9, Issue 6, December 2021
Pages:
277-281
Received:
7 November 2021
Accepted:
25 November 2021
Published:
24 December 2021
Abstract: The aim of this study is to assess the morbidity and mortality factors associated with acute mechanical intestinal obstruction. Acute mechanical bowel obstruction is one of the most common pathologies in emergency digestive surgery. The objective of this study was to assess mortality from acute mechanical intestinal obstruction. Materials and methods: This was a descriptive and analytical typical observational study from April 1 to September 30, 2020 in the General Surgery Department of the Ignace Deen National Hospital, Conakry University Hospital. Results: Acute mechanical bowel obstructions accounted for 18% of digestive surgical emergencies. The average age was 43.94 years old. The sex ratio was 2.26 in favor of men. The 40-59 age group was the most represented with 41.9%. The most common aetiologies were bridles 40.32% followed by pelvic colon volvulus 27.42%. The site of the obstacle was on the small bowel in 69% and on the colon in 31% of cases. Bowel resection followed by end-to-end anastomosis was performed in 53.22% of cases and flange resection in 40.32% of cases. Mortality was 23%, statistically correlated with ASA≥II score, site of occlusion, bowel resection, surgical site infection and stercoral fistula. Conclusion: Acute mechanical intestinal obstruction was frequent. Their etiologies were multiple. The care recorded a significant mortality. Improving the prognosis of acute mechanical intestinal obstruction depends on early and adequate management.
Abstract: The aim of this study is to assess the morbidity and mortality factors associated with acute mechanical intestinal obstruction. Acute mechanical bowel obstruction is one of the most common pathologies in emergency digestive surgery. The objective of this study was to assess mortality from acute mechanical intestinal obstruction. Materials and metho...
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Treatment of a Patient with Ossification of Ligamentum Flavum of Cervical Spine and Literature Review
Issue:
Volume 9, Issue 6, December 2021
Pages:
282-286
Received:
1 November 2021
Accepted:
6 December 2021
Published:
31 December 2021
Abstract: Background: The ossification of ligamentum flavum occurs frequently in the thoracic vertebra, and the incidence of ossification of cervical ligamentum flavum is relatively low. It is easy to cause misdiagnosis and mistreatment due to lack of understanding in clinical practice. Object: To understand the diagnosis and treatment of cervical ossification of ligamentum flavum through the treatment of one case. Material: A 65-year-old female patient was hospitalized due to "lumbar discomfort with numbness of both lower limbs for 1 year, and aggravation with numbness and weakness of both upper limbs for the last 3 months". Physical examination showed cervical flexion, extension and lateral flexion activities were limited, post extension limitations were obvious, limb muscle strength was grade 4, right knee tendon reflex was active, and bilateral Hoffman sign and right Babinski sign were positive. Cervical JOA score was 8 points. Magnetic resonance imaging of cervical spine showed that there were pressure objects protruding to the spinal canal between C3/4, C5/6, and C6/7 laminae. Sagittal MRI showed segmental or focal nodular space occupying and protruding into the spinal canal from the rear of the spinal canal. Cross sectional MRI showed nodular or "M" shaped occupying space. T1 weighted image was equal signal, and T2 weighted image showed low signal shadow, suggesting high-density ossification and severe spinal cord compression. The effective sagittal diameter was less than 8mm. Method: Hemilaminectomy was performed for a single segmental OLF of C3/4, and a total laminectomy was performed for bilateral and multi-segmental OLF of C5/6, 6/7. According to the range of intraoperative decompression, C5 and 6 posterior lateral mass screws and C7 pedicle screws were fixed. Result: After the operation, the patient indicated that his upper limbs were relaxed, the umbilical horizontal band disappeared, and the muscle strength of his limbs was stronger than that before the operation. She could move freely on the ground, and her holding was more flexible and powerful than before. The postoperative JOA score was 12 points. The postoperative pathological result was fibrous connective tissue and ossification. The follow-up JOA score was increased to 15 points 8 months after operation, and the improvement rate was 78%. The patient could completely take care of herself, and the treatment was satisfactory. Conclusion: Surgical resection of cervical olf and canal decompression is an effective method for the treatment of Cervical OLF and can achieve good clinical results.
Abstract: Background: The ossification of ligamentum flavum occurs frequently in the thoracic vertebra, and the incidence of ossification of cervical ligamentum flavum is relatively low. It is easy to cause misdiagnosis and mistreatment due to lack of understanding in clinical practice. Object: To understand the diagnosis and treatment of cervical ossificati...
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