Surgery Research Journal (ISSN 2768-0428) is a peer-reviewed, online, open access platform providing a unique forum of discussion and presentation for the surgeons and other researchers with interest into the surgical studies. Journal publishes articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The journal accepts all types of articles such as research, reviews, mini-reviews, case reports, letters to the editor, and commentaries, reports, etc. providing a single forum for discussion. The journal follows strict double blind peer review process to provide unbiased recognition of the work. All the articles will be freely available online immediately after acceptance. Manuscripts could be submitted through our online portal or as directly to the editorial office as attachment to email at publications@scienceexcel.org
The role of surgeons in the medical documentation of torture- UN standards
Rationale: In the article, the authors present the relevance of the frequently neglected UN and World Medical Association standard for the documentation of torture related injuries, the Istanbul protocol. Objectives: We aim at summarising the relevant key aspects of this important standard for surgeons in preserving evidence and fulfilling their ethical obligations as medical doctors. We find the instrument clear and relevant and highlight the need of an interdisciplinary approach in the documentation and prevention of torture. Conclusions: The Istanbul protocol is an important standard that should be known and used in clinical practice whenever confronted with possible or alleged sequels to torture an can also improve the understanding of often underrated forensic procedures and the possible contribution of their field for surgeons and other health professionals, not only for forensic experts.
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Current classification of inguinal hernia: time to correct, update and change?
Repair of an inguinal hernia is a commonly performed surgical procedure. Current classifications are predominantly attributable to Hesselbach, who in the 19th Century described the anatomy of the inguinal region and the relationship of inguinal hernia to the inferior epigastric vessels. However largely due to the dynamic visualization of inguinal anatomy at video-surgery, our better understanding of inguinal anatomy is facilitated; consequently, we believe that the inferior epigastric vessels have a coincidental anatomical relationship and have no significant causal relationship to groin herniation. Furthermore, we believe the current classification, using the terms ‘direct’ and ‘indirect’ are anatomically incorrect. It is our opinion that such classification should be abandoned in favour of a simplified system which reflects our enhanced appreciation of the anatomy.
Influence of minimally invasive laparoscopic surgery experience in minimally invasive robotic surgery dexterity
Background: It is unclear if there is a natural transition from robotic to laparoscopic surgery with transfer of abilities. This study aims to measure the performance and learning of basic robotic tasks in a simulator of individuals with different surgical background. Method: Three groups were tested for robotic dexterity: (a) experts in laparoscopic surgery (n=6), (b) experts in open surgery (n=6), and (c) non-medical subjects (n=4). All individuals were aged between 40 - 50 years. Five repetitions of 4 different simulated tasks were performed: spatial vision, bimanual coordination, hand-foot-eye coordination and motor skill. Results: Experts in laparoscopic surgery performed similar to non-medical individuals and better than experts in open surgery in 3 out of 4 tasks. All groups improved performance with repetition. Conclusions: Experts in laparoscopic surgery performed better than other groups but almost equally to non-medical individuals. Experts in open surgery had worst results. All groups improved performance with repetition.
Variations in anterior segment vasculature of the eye and their implication in strabismus surgery and other surgical procedures
Objective: Anterior segment ischemia (ASI) is a serious complication of strabismus surgery and other ocular procedures. The purpose of this study is to evaluate variation of the long posterior artery (LPCA). These variations may predispose patients to anterior segment ischemia following strabismus surgery, and proper mapping may provide surgical “danger zones” for other invasive ocular procedures. Subjects: A total of 100 preserved cadaveric eyeballs from University of Nebraska Medical Center (UNMC), Creighton University, and Kansas City University (KCU) were utilized for this study. Methods: LPCAs were identified, isolated, and counted prior to removal of the choroid. Two distances were measured from within the orbit: (1) the penetration point of the LPCA through the sclera to the center of the optic nerve and (2) the penetration point of the LPCA through the sclera to the superior border of the corresponding rectus muscle. The data was analyzed to determine the number and location of LPCAs that contribute to the major arterial circle of iris. Independent sample t-tests were used to determine significant differences comparing the number of arteries and penetration points between right and left eyes, medially and laterally located arteries, and sex. Results: Significant differences were found between subjects with one vs two LPCAs, males vs females, and medially vs laterally located arteries in at least one of the two measurements. Thirty-three of 100 eyeballs had only one LPCA (33%). Conclusions: This study demonstrates that a larger percentage of patients may be predisposed to anterior segment ischemia than previously reported. It also provides a surgical “danger zone” that will enable surgeons to avoid damaging the long posterior ciliary artery during invasive choroidal and orbital procedures. This knowledge will facilitate more appropriate management of patients including preoperative screenings, intraoperative isolation of the long posterior ciliary artery, more frequent postoperative monitoring, and accelerated initiation of treatment plans.
Use of Absorbable Suture in Subcutaneous Cell Tissue and Its Impact On The Reduction of Collections in Abdominal Surgical Wounds Experience At The University Hospital ‘’Dr. José Eleuterio González’’
Introduction: Sutures most commonly provide mechanical support for the closed wound during its initial healing. They approximate the wound edges and help maintain wound closure until the healing process provides sufficient force for the wound to withstand stress and strain. Materials and methods: Retrospective, descriptive, comparative and observational study. It was carried out in the general surgery service of the University Hospital ‘’Dr José Eleuterio González’’ where cases of 30 patients who underwent uncontaminated abdominal surgical procedures in the period of time between January 2020 - September 2020 were analyzed. Results: The average hospital stay of all patients was 11 ± 3.1 days. The participants in group A showed a mean of 11.2 ± 3.4 days, while those in group B showed a mean of 10.9 ± 2.9 days without showing a significant difference between both study groups. In group A, 4 (25%) of the patients showed seroma, while 12 (75%) did not, while in group B 4 (28.5%) showed seroma, and 10 (71.5%) did not. Conclusion: The use of subcutaneous cellular tissue closure with absorbable suture did not show any benefit or harm in those patients who underwent it, so there was no decrease in the incidence of seroma, wound dehiscence, or decrease in hospital stay compared to other methods used.
Mesothelial cyst in a young female: Case report and literature review
A systematic review of the latest technologies in Cranial Vault Remodeling and its outcomes for correction of craniosynostosis
Plastic surgeons often come across the dilemma of keeping operative time under check and achieving the "perfect" shape while still compassing the desired functional and aesthetic outcomes on the patient. This leads to a tradeoff between speed and accuracy in the operating room. Craniosynostosis (CS) is a congenital disability that is caused when one or more sutures of an infant's skull fuses too early before the brain is fully formed. This premature fusion of cranial sutures leads to abnormal head skull shape, increased intracranial pressure (ICP), and neurodevelopmental impairment for the child in later stages of life. Total Cranial Vault Remodeling (CVR) is a surgical procedure to treat this condition by reshaping the cranial bones, thus imparting a normative head shape for a child's brain to grow. These surgeries are usually lengthy and require the patient to be under prolonged anesthetic exposure and blood transfusion. Moreover, CVR is highly dependent on the surgeon's experience and lacks repeatability even though each case is specific and may require volatile manipulations that can often last hours. Based on our research question, we deployed the PRISMA protocol, exhausting databases to find relevant literature on this topic. The search strategy yielded a total of 399 research papers and after carefully reviewing each study, 12 papers were included in the systematic review to better understand the current engineering technologies being used effectively to improve the surgical outcomes for the correction of CS. Computer-aided design and manufacturing (CAD/CAM), Virtual Surgery Planning (VSP), threedimensional (3D) printing/CNC milling, resorbable plating system, 3D photogrammetry, 3D simulation, and intraoperative navigation are several technologies that can result in improving surgical outcomes for CVR surgery. Thus, there is a need to develop a workflow for the surgical treatment of CS using the latest technology that can potentially help surgeons achieve predictable and reproducible results in the operating room and be considered a standard across the craniofacial surgical community. A standardized workflow may also result in improving the speed (operative time) by moving part of the surgery to a more controlled pre-surgical planning environment and accuracy (precision) by achieving intricate and precise cuts on the calvarial bone, resulting in fewer errors during the surgery.
Longitudinal vs horizontal capsular incision! Does it alter micro-TESE outcome?
Micro-TESE (testicular sperm extraction), a procedure performed for treatment of non-obstructive azoospermia (NOA), a leading infertility issue among males globally accounting for about 7% of male population. Azoospermia is absence of sperms in ejaculate upon semen analysis, 2% of global population has encountered. A lot is discussed upon sperm retrieval success in both variants of MicroTESE, which are transverse or horizontal and longitudinal or vertical approach, established studies have identified about 45% to 65% of success retrieving spermatozoa. The objective being identification of success of both the variants of procedure separately and also of post-operative complications to both approaches for micro-TESE. A cohort study, for which data, secondary (retrospective), was obtained from King Abdulaziz Medical City (KAMC), Riyadh. The time frame for data covered January 2016 to November 2018; 87 patients underwent micro-TESE, as in logbook available in “Best Care System at KAMC. Data obtained was analyzed using SPSS Software, 87 of these patients who underwent micro-TESE procedure, 45 were done with the transverse approach and 42 with longitudinal approach, accounting for 51.7% and 48.3%, respectively. Upon post-operative evaluation, in transverse approach, sperm were retrieved in 25.29% and for longitudinal approach retrieval was about 19.54%. The success rate was 48.9% out of 45 procedures in transverse approach and 40.5% out of 42 procedures in vertical/ longitudinal approach. The most common reported post-operative complication in transverse type was atrophy 20% and pain 13.3% on other hand common complications recorded for vertical type, atrophy was about 17.2% and pain in 12.6% of patients. Not much of statistical significance was observed between the transverse and longitudinal approach in either of the outcomes whether it is success rate or post-operative complications. Both approaches are influenced by the factors of surgeon expertise and certain other factors that include pre- and post-operative hormonal therapy, baseline hormonal status and intracytoplasmic sperm injection (ICSI)..
9 years - experiences with VenaSeal® vein glue Longest time follow - up study conducted on 3240 truncal saphenous veins in 1658 cases
The paper is about 9 years - experiences in treatment of truncal varicose veins with the vein glue VenaSeal®: 108 months - follow up of 1658 cases and 3240 truncal varicose veins. Over 21 years, about from 1999/2000 years by now, varicosis has been increasingly treated endovenously by catheter technology. At the start, the rather inconvenient VNUS® Closure plus - procedure and the more convenient linear laser procedure were used, and these were followed in 2007 by the bipolar RFITT® catheter, the VNUS® Closure Fast system and the radial laser. These endovenous treatment techniques were followed by the Clarivein System and the VenaSeal® System in 2011/2012. Thus, in the course of the last few years, plenty of experience has been gathered with endoluminal therapy, quality criteria have been defined and standards for the different techniques have been developed. The presented actual paper sheds light on the advantages and disadvantages of the vein glue VenaSeal® and presents the 108 months results of a single - center praxis study with prospective design. We will report our long time experiences and results of a prospective comparative study of VenaSeal® - Closure in the treatment of 3240 saphenous veins.
Revealing obstructive acute pyelonephritis of horseshoe kidneys, about 2 cases
The horseshoe kidney is a malformation of the upper urinary tract where the kidneys have a U-shape. This is most often the result of the fusion of the lower poles of both kidneys on the median plane. This congenital malformation can remain asymptomatic in 30% of cases and diagnosed incidentally during a radiological examination. The horseshoe kidney may increase the risk for occurrence of pyelonephritis or renal lithiases which may be accompanied by urinary tract dilation or vesicoureteral reflux (VUR). We reported two clinical cases consulting for a picture of obstructive pyelonephritic revealing horseshoe kidneys.
Rare Cholestatic Form of Stauffer Syndrome
A 57-year-old man with inexplicable fevers and deranged liver function tests was found to have new renal cell carcinoma on imaging without metastasis. Following surgical resection of the tumour, his fevers immediately disappeared. Stauffer syndrome describes fever associated with renal cell carcinoma and may have accompanying deranged liver biochemistry. Antibiotics should not be automatically prescribed in clinically stable patients who have negative septic and hepatic screens. Instead, a wide differential net should be cast, including for renal cell carcinoma as a potential diagnosis..
Surgical Procedures for Biliary Stricture in Chronic Pancreatitis
Background: Biliary stricture (BS) in chronic pancreatitis (CP) is observed in up to 21% of patients with CP. However, there are no clearly established criteria when the one should operate in case of the CBD dilatation without increased liver enzymes. Attention is now paid to endoscopic interventions, the disadvantage of which is the need for repeated procedures, as well as less effectiveness in the treatment of pain in CP, while the operation can be aimed at various manifestations of CP. Early surgery - up to 3 years from onset of symptoms of CP showed improved results in terms of pain and exocrine function, but it is unknown whether it is of value in prevention of BS. Goal. To determine the optimal timing of surgery to prevent biliary stricture in CP, the optimal type of intervention in the bile ducts, the optimal combination of surgery on the bile ducts and pancreas and to establish indications for the latter. Materials and methods: Retrospective analysis of case histories of patients who were operated due to chronic pancreatitis from 2001 to 2020. Diagnostic criteria of BS were mechanical jaundice and/or dilatation of CBD ≥10 mm. BS was confirmed by intraoperative cholangiography (IOCG). Choledochoduodenostomy (CDS), hepatic and choledochoenterostomy (GEA / HEA), transduodenal papillosphincterotomy (TDPST), duodenum-preserving resections of the pancreatic head (DPRPH) were performed. The effectiveness of operations assessed by the absence of cholangitis / mechanical jaundice during observation. Statistical analysis was performed using IBM SPSS Version27. Pearson's χ², Fisher's exact criterion, was used to analyze categorical data. The level of statistical significance is set at p <0,05 . Results: No recurrence of BS achieved in 85.7% of patients. Recurrence of BS (cholangitis / jaundice) was observed in 8 patients (14.3%). Signs of recurrence were found: in the group of TDPST in 33.3%, in 16.7% of patients with CDS, in 9.7% of patients with DPRPH. For the latter, resection decompression was supplemented in these patients by fenestration of the choledochus into the resection cavity. BS was observed in 18.8% of patients with symptoms lasting up to 3 years and in 33.8% - more than 3 years. Conclusions: Surgery up to 3 years from the onset of symptoms of CP prevents the occurrence of BS. Dilatation of the choledochus ≥10 mm in a patient with CP indicates the presence of BS. In the case of an inflammatory mass or pseudocyst in the head of the pancreas as a cause of BS, it may be sufficient to eliminate it via DPRPH, in particular Frey's procedures. If external decompression of the CBD was not sufficient, the best operation is choledochoenteroanastomosis (GEA / HEA). In the absence of inflammatory mass in the head, it is also advisable to combine pancreatojejunostomy with GEA / HEA.
Pericapsular Nerve Group Block for Surgeries Involving The Hip
Exstrophy Bladder or Ectopia Vesica : ‘An Inside Out Affair’ A Surgical Update With Review of Current Literature
The word 'exstrophy,' first described by Chaussier in 1780 is derived from the Greek ekstriphein and refers to 'turn inside out'; an uncommon congenital anomaly. It has a male to female ratio of 2:1. These are congenital defects of unknown origin characterised by an abnormal development of multiple systems such as the musculoskeletal system resulting lower abdominal wall muscles separation, the skeletal system resulting in vertebral and spinal cord defects along with a diastasis of the pubic bones leading to the protrusion of hollow organs the bladder & occasionally the intestine that is exposed outside the body. The surgical challenges therefore include the reconstruction of the abdominal wall, the restoration of the bladder to its anatomical position with the aim of having a competent bladder storage system along with a cosmetically acceptable external genital with a good functional sexual outcome. .
Effect of bariatric surgery, physical activity, and weight regain on the prevalence of metabolic risk factors
Aim: To analyze the effect of bariatric surgery, physical activity and weight regain on the prevalence of metabolic risk factors. Method: Observational study with retrospective data collection. The study had the participation of 84 individuals submitted to bariatric gastric bypass surgery with follow-up of more than five years. Data collection was carried out in the form of a telephone interview to which data from the patients' clinical process were added. An evolutionary analysis was performed regarding associated health data and comortities, namely metabolic risk factors (diabetes, dyslipidemia and mean blood pressure) at baseline (before surgery), one year and 5 years after surgery. Results: We observed a relative improvement in the values of metabolic risk factors one year after surgery, which was maintained at five years after surgery with statistically significant values (p <0.007). This result may translate a positive effect of surgical intervention. In addition, the evolution of the prevalence of metabolic risk factors after surgical intervention is not influenced by weight regain or physical activity. Discussion: All the comortities present a decrease with significance to the 1st and 5th year, related to the surgery itself, regardless of weight regain and the practice of physical activity, which confirms the efficacy of surgery as the most effective factor in the treatment of the comortities. Conclusions: We did not obtain a relationship between metabolic syndrome and physical activity, or weight regain, which shows how effective surgery is in combating the comorbidity.
Classification and Management of High-Risk Pregnancies and the Influence of Antenatal and Nutritional Interventions on Pregnancy and Delivery Outcomes in 1097 Pregnant Women on the MICHD program in Lagos State, Nigeria
This study was carried out to monitor 1097 women on the MICHD project. This was an independent monitoring and evaluation study on indigent women in Lagos State. The study was to evaluate the impact of antenatal visits and nutritional interventions on the Mother, Infants and Child and their pregnancy journey; while accessing the impact of the interventions on the High risk pregnancies and their outcome. The cohorts were divided into 2 major groups. The MICHD Plus group with 502 pregnant women (they attended weekly antenatal incentivized by weekly food Packs and Iron supplements for 12 weeks) and the MICHD control group with 595 pregnant (they attend regular antenatal for the same duration without the intervention). The antenatal visits reports were electronically automated and data of all pregnant women on the project collected and transcribed into a Gerocare MICHD application. Statistical analysis of antenatal variable and essential elements of a focused approach to Antenatal Care especially for the high-risk women were analyzed. Stability check reports of the antenatal visits monitored on the application at week 1, week 16 and week 20 showed the percentage of stable women at 56%, 71% and 93% respectively. Report shows that the MICHD cohorts’ attendance records estimates that 85% of the women attended antenatal between 4 - 13 times during the research period. The Highrisk pregnancies were identified and classified; there were 21 women below age 17, 13 had Hepatitis B, 36 had High Blood Pressure, 191 were Obese, 189 had Overweight BMI, 23 had Underweight BMI, and 14 women were above the age of 40. A total of 437 women were identified as High Risk and 610 women were No Risk. 78.3% of the 437 women had vaginal deliveries with no complications, while 87.7% of the no risk had vaginal deliveries. This shows that the interventions were able to improve pregnancy outcomes in 381 High risk women. Of the MICHD Plus intervention group 51% were high risk at takeoff but at delivery 84.2% of the women delivered with no complication and vaginally. An even higher percentage compared to the MICHD control that had less high risk women at takeoff. The results shows that focused approach to antenatal care and enhanced nutrition can improve pregnancy outcomes and reduce the chances of Caesarian surgery in high-risk pregnancies.
Robotic Versus Laparoscopic Right Hemicolectomy For Cancer
Background: Laparoscopic right colectomy is regarded technically difficult especially with intracorporeal anastomosis, and in obese patients. Robotic surgery may offer a solution to these limitations. Our aim is to evaluate the results of robotic right hemicolectomy for cancer compared to traditional laparoscopy. Methods: Retrospective study including all patients who underwent elective laparoscopic or robotic right hemicolectomy for cancer from January 2009 till August 2011.We analyzed the preoperative, operative and pathological criteria, postoperative outcomes and follow up. Results: We had 48 patients (M: F of 1.3:1), 34 laparoscopic, 14 robotic comparable as regards ASA grade BMI and co-morbid conditions. The site of lesions were; cecum=18, ascending colon=24, hepatic flexure=7 (one patient had 2 synchronous tumors). There were no statistically significant differences in the total operative time or amount of blood loss or hospital stay between both groups. No open conversion in the robotic group compared to 2 in the laparoscopic group. There was a statistically significant difference in the number of lymph nodes retrieved; 21.1±10 in the robotic group compared to 16.4±4.8 in the laparoscopic group (P value=0.0320). In the laparoscopic group we performed extracorporeal mechanical anastomosis in 24 cases (70%) and in the robotic group intracorporeal manual anastomosis in 9(64%). In the laparoscopic group there were 3 anastomosis related complications: 2 bleedings and one major leak, none in the robotic group. We had a single mortality in the laparoscopic group from advanced disease. Short term follow up revealed no relapses in neither groups. Conclusion: Robotic hemicolectomy for right colon cancer appears as a safe and effective technique with less anastomosis related complications and better patient outcome with comparable oncological results.
6:1 Suture or Wound length ratio with the short stitch technique – a reality check on practicability and short term outcome
Aim: To analyze laparotomy closure of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. Method: Prospective, single centre, non randomised, controlled cohort study on short stitches with a longterm resorbable, elastic suture (material: poly-4-hydroxybutyrate) aiming at a 6:1 suture to wound (SL/WL) length ratio in midline and transverse, primary & secondary laparotomies for elective & emergency surgery. Results: We included 351 patients (♂: 208; ♀: 143), midline (n=194), transverse (n=103) and a combined midline/transverse L-shaped (n=54) incisions. There was no stitch performance quality difference between elective (n=296) and emergency (n=55) operations, while results in the first 150 patients showed a significantly reduced SL/WL-ratio to the following 200 suture closures (SL/WLratio: 5.64±2.5 vs 6.1±2.3, p<0.001). Average SL/WL-ratio in general was better for midline than transverse incision sutures (6.62±2.5 vs 4.3±1.51, p<0.001). SL/WL-ratio varied among the 6 surgeons participating, although results steadily improved and eventually approximated each other. Conclusions: We could show that a 6:1 SL/WL-ratio with a 2-0 single, ultra-long term, absorbent, elastic suture material can be significantly performed better in midline than transverse incisions. Transverse incisions should preferably be closed in 2 layers in order to achieve a sufficient SL/WL-ratio equivalent to the median incision. While on an individual level, results varied between surgeons, quality will improve and eventually approximate.
L’hermitte–Duclos Disease In An Infant: A Case Report With Review of Literature
Jacques Jean Lhermitte a French neurologist and P. Duclos in 1920 first described a growth in the cerebellum gangliocytoma, as a rare hamartomata’s lesion due to abnormal development of the cerebellum. Since then it has been called by many names Lhermitte-Duclos disease, dysplastic gangliocytoma of the cerebellum, benign hypertrophy of the cerebellar cortex, granular cell hypertrophy and Purkinjeoma. It is a characteristic radiological feature and there has been reported in over 200 cases worldwide in adolescents [1] and old people but a handful of cases are detected and reported in infants. We report a 6 month old male child whose parents reported a history of irritability and typical lion facies with normal mile stones and radiological features of L’hermitte–Duclos disease.
Out-Patient Neurosurgery Telemedicine Clinics: A Model to Provide Healthcare And Prevent Cross-Infection
Objectives: To determine patient’s and health worker’s views of telemedicine on prevention of cross infection and delivery of health care in our centre. Methods: A prospective cross-sectional study conducted at our neurosurgery centre. Sample size was calculated, questionnaire designed and administered to consecutive patients or healthcare workers. Data was analysed using SPSS, IBM version 20.0. Results: We found 161 patients. 79.5% were males with a male to female ratio of 3.8:1. The mean age of the patients was 32±12 years. Majority of patients, 68.9% (111/161) lack awareness of virtual consultation. Most patients, 76.4% (123/161) showed interest in having virtual consultation to prevent COVID-19 infection. Most patients opined that, virtual consultation can be done in any day and at any time. There is statistically significant association between age (11-30year), male gender and short distance to the hospital (1-200KM), to interest in virtual consultation (p< 0.05). Patients living close to hospital have five times likelihood of accepting virtual consultation than those coming from far distance (odds ratio-5.7, CI-1.5-21.23, p-0.002). 84.6% of the health workers have prior knowledge of virtual consultation as a means of preventing COVID-19 infection. All age group, gender and non-emergency cases should be offered virtual consultation as suggested by the 100% of health workers. Conclusion: This single centre study shows paucity of knowledge of virtual consultation in our patients, though interested. In contrast, most health workers know about virtual consultation as a way;.
Risk Factors For Treatment-Induced Hearing Impairment: Perspective From A Resource-Poor African Setting
Background - Treatment-induced hearing impairment can result from prolonged administration of potentially ototoxic medications often in the pharmacotherapeutic management of chronic illnesses such as drug-resistant tuberculosis. Whereas drug ototoxicity may be idiosyncratic, it is imperative to be aware of its potential risk factors while treating patients. We aimed in our study to identify risks factors for hearing impairment in patients treated for drug-resistant pulmonary tuberculosis at our Centre. Patients and methods – This study was a 24-month prospective study of drug-resistant tuberculosis patients treated at the pulmonology unit of Federal Medical Centre, Owerri, Nigeria. Each patient had pure tone audiometry before commencement of treatment (baseline) and after three months of treatment for comparison. Clinical data was obtained using pre-tested examiner-administered questionnaire. Data collected was analyzed with SPSS version 25.0 and statistical significance set at p < 0.05. Results - Thirty-eight (38) participants completed the study with a male-to-female (M:F) ratio of 1.53:1. The modal age group was 41-50 years and median duration of presenting complaints 9.9 weeks. HIV seroprevalence was 18.4% among the study participants. The baseline prevalence of hearing impairment was 73.7% but increased to 89.5% after three months of treatment with a cumulative incidence of 15.8% which was statistically significant (p < 0.001). The identified risk factors for hearing impairment were age (>50 years), family history of hearing impairment, kanamycin administration and BMI <18.5kg/m2 . Conclusion – Kanamycin was associated with more severe hearing impairment than capreomycin. Advancing age, family history of hearing impairment and BMI < 18.5kg/m2 were risk factors for development of hearing impairment in patients treated for drug-resistant tuberculosis in our setting.
Infectious Complications After A Liver Transplant
Liver transplantation is a life-extending procedure for patients with end-stage liver disease (ESLD), post-transplant infections continue to be a leading cause of morbidity and mortality. Infection risk varies over time, with issues most commonly related to transplant surgery and nosocomial infections in the early post-transplant period. Because of the increased burden of immunosuppression, opportunistic infections become more common between 1 and 12 months post-transplant. As immunosuppression is reduced after 12 months, the risk of opportunistic infections decreases. Recipients are still vulnerable to community-acquired infections, and recurrent cholangitis may become an issue in those with chronic allograft dysfunction or recurrent cholestatic liver disease. This article will go over a strategy for dealing with infectious complications in the early, intermediate, and late stages following liver transplantation, with a focus on the most common infections as well as those of emerging concern.
Mirror Therapy for Total Knee Arthroplasty: A Pilot Study
Background: One in five patients experience persistent pain and disability after total knee arthroplasty (TKA), often driven by increased sensitization of the nervous system and pain. Pain and a sensitized nervous system are major barriers to postoperative rehabilitation impeding improved movement, and function. Objective: To determine if mirror therapy following TKA yields any positive shifts in self-reported pain, active range of motion (ROM) and nerve sensitivity (pressure pain thresholds - PPT). Design: Case series with pre- and immediate post-intervention measurements. Methods: A convenience sample of patients who just underwent TKA was recruited for the study. Prior to mirror therapy, self-reported pain, active knee flexion ROM and PPTs were measured. In hook lying, a mirror was placed between the legs, separating the surgical and non-surgical legs. Patients performed 3 sets of 10 supine heel slides with the non-surgical leg while watching the leg in the mirror, mimicking active knee flexion of the surgical leg. Results: Eighteen patients (9 female), with a mean age of 65.94 years and mean time since TKA of 7.83 days participated in the study. Immediately following mirror therapy, mean active knee flexion improved by 3.84 degrees (p = 0.001), with 10 patients exceeding minimal detectable change. Self-reported pain (p = 0.08), PPT of the surgical knee (p = 0.95), PPT of the non-surgical knee (p = 0.21) and PPT of the upper trapezius (p = 0.23) failed to show any significant improvement after mirror therapy. Conclusion: The results of this study show that mirror therapy immediately following TKA may have some benefit in improving ROM, but not pain or sensitivity of the nervous system. This is the first study exploring the immediate effects of mirror therapy in postoperative TKA.
Sigmoid Colon Endometriosis Case Report: A Rare Large Bowel Entity
Endometriosis refers to the extrauterine presentation of ectopic functional uterine tissue. It is a common gynaecological condition in reproductive females. Its clinical presentation involves irregular menstrual cycles, pelvic pain, and infertility. However, it is highly unusual for Endometriosis to present as a large bowel mass with symptoms of obstruction. Here, we present a 41-year-old female with symptoms of chronic constipation and abdominal discomfort due to an endometrial colonic mass.
Infero-Auricular Folded Flap for The Reconstruction of a Full-Thickness Defect of The Earlobe
Basal cell carcinoma is the most common type of malignant cutaneous tumor. Chronic exposure to sunlight is the main factor in its etiology. The main treatment goals in the management of BCC are total removal of the lesion, preservation of healthy tissue, preservation of function and obtaining aesthetically acceptable results. Posteroauricular/preauricular advancement flaps, biloble flaps, helical rim advancement flaps and revolving door flaps are among the flaps used in ear reconstruction. In this study, we present a case of the reconstruction of a full-thickness ear lobe defect with a postro-inferiorly based flap. The patient did not develop any recurrence within the 3 years follow-up period. .
False Aneurysm With Contained Rupture Of The Right Primitive Iliac Artery: A Case Operated On At The Festoc Center In Bamako
An iliac artery aneurysm is defined as a localized and permanent dilatation of the artery with a diameter greater than 1.5 cm. We report the case of a 32-year-old patient who had been admitted to the André Festoc center for one month of evolving lumbar pain, and in whom the morphological work-up revealed an aneurysm of the right common iliac artery. The aneurysm was cured by flattening and interposition of a PTFE prosthesis. Post-operative management was straightforward. Initially, Bechet's disease was suspected in view of the genital ulcerations, but the ophthalmological examination was normal. Syphilitic origin was therefore considered, as syphilis serology can be negative in the primary phase.
Distinguishing Between Population and Target Population: A Mini Review
First Tirone David’s Intervention In Mali : About A Case At The Festoc Centre In Bamako
Surgery to replace the aortic root with a valved tube, whether mechanical or biological, remains the most widely used technique for correcting diseases affecting this segment of the aorta. Although mechanical valves are usually used, they expose patients to the risk of thromboembolic complications associated with anticoagulation. We report the case of the first Tirone David operation performed at the Festoc centre in Bamako. The patient was 60 years old and had been referred for dilatation of the ascending aorta in the context of stage 3 dyspnoea. Physical examination revealed a Musset's sign and a diastolic murmur of intensity 3/6 at the aortic focus. Ultrasound revealed severe aortic insufficiency associated with dilation of the ascending aorta, with the aortic annulus measured at 23.5 mm, the sinus at 50 mm and the sino-tubular junction at 61 mm. Thoracic angioscan showed a saccular aneurysm of the initial segment of the ascending aorta. Coronary angiography was normal. The operation performed was an ascending aorta replacement with preservation of the aortic valve and re-implantation of the coronary arteries. Following the operation, a haemorrhagic syndrome with pre-buffering occurred, prompting repeat surgery 24 hours after the initial operation. The outcome was favourable and the drains were removed 48 hours later.
Nissen-Sleeve For Bariatric Patients With Hiatus Hernia and/or GERD: Case Report
Primary Angiosarcoma of The Breast : A Case Report of a Rare Presentation
Primary angiosarcoma of the breast is a rare entity, accounting for less than 0.1% of breast malignancies, with potential life-threatening outcomes. Diagnosis of angiosarcoma can be difficult due to its variable and unpredictable clinical, radiological, and pathological presentation. Primary angiosarcoma occurs predominantly in younger populations with no previous risk factors; in contrast, secondary angiosarcoma occurs predominantly in the elderly with a previous of radiation exposure. We describe the case of a 50-year-old female presenting with a large, advanced breast tumour diagnosed as primary angiosarcoma..