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The Unicorn Syndrom: Case of a Giant Skull Invasive Metastasis of a Pulmonary Cancer
Maxime Rivollier,
Benoit Marlier,
Jean-Charles Kleiber,
Stanislas Loniewski,
Claude-Fabien Litre,
Fabien Rivollier
Issue:
Volume 9, Issue 2, April 2021
Pages:
49-52
Received:
16 February 2021
Accepted:
5 March 2021
Published:
12 March 2021
Abstract: Background: Tumors of cranial vault are quite uncommon but represent a major diagnostic and therapeutic issue. Skull involvements are rarely primitive tumors. Mostly, cranial vault tumors are metastases of lung, breast, thyroid, kidney and prostate cancers. These lesions often grow quickly and sometimes become infected, which raises the issue of how to manage them. Patient: We operated a patient of 64 years old for a large, painful and sweating tumor of the frontal cranial vault with subcutaneous, meningeal and cerebral parenchyma dissemination. The lesion grew rapidly following a frontal shock within 3 months. Initially, according to history, we thought of an infected abscess. However, thanks to MRI, the possibility of a tumor is quickly suggested. We choose to operate quickly in order to obtain a histological tissue which permits to orient the additional medical treatment. This also allows us to perform a plasty at the same time. Histological analysis assets a metastasis of a pulmonary adenocarcinoma undiagnosed at this time. Therefore, we were able to refer the patient to oncology for the rest of medical exams and treatment. The aesthetic result is satisfactory too. Conclusion: We report this case to explain our care. We also submit this article to emphasize that careful skin examination can provide valuable clues to guide the diagnosis.
Abstract: Background: Tumors of cranial vault are quite uncommon but represent a major diagnostic and therapeutic issue. Skull involvements are rarely primitive tumors. Mostly, cranial vault tumors are metastases of lung, breast, thyroid, kidney and prostate cancers. These lesions often grow quickly and sometimes become infected, which raises the issue of ho...
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Standardized Postoperative Recovery Reduces in-Hospital Stay After Minimally Invasive Esophagectomy
Anna Katrine Nyman Rasmussen,
Michael Hareskov Larsen,
Alan Patrick Ainsworth
Issue:
Volume 9, Issue 2, April 2021
Pages:
53-57
Received:
20 February 2021
Accepted:
4 March 2021
Published:
12 March 2021
Abstract: Background: This study aims to examine if a standardized enhanced recovery program (ERP) could reduce the length of stay (LOS) after minimally invasive esophagectomy (MIO) compared to the earlier applied recovery program without increasing the risk of postoperative complications and readmissions. Methods: Retrospective study of patients with esophageal and gastroesophageal junction cancer who have had an uncomplicated postoperative stay following MIO. Patients had followed two different postoperative recovery programs according to their year of surgery (2016 versus 2018). Results: 48 patients in 2016 and 42 patients in 2018 were included. Patients were comparable on demographic factors. The median LOS was reduced from 9 days in 2016 to 8 days in 2018 (p<0.001). In 2018, 27 patients (64.3%) fulfilled the aim of discharge to their own home on day 8 after surgery. There was no significant difference (p>0.05) between the two groups in the risk of complications (Clavien-Dindo degree 0-2). Two patients in 2016 (4.2%) and two patients in 2018 (4.8%) were readmitted within 7 days after discharge (not significant). There was no in-hospital mortality or 30-day mortality in either of the two groups. Conclusion: The introduction of an ERP at our institution reduced the median postoperative stay after MIO by one day without increasing the risk of complications and readmittance. Further reduction might be obtained if oral feeding is allowed earlier.
Abstract: Background: This study aims to examine if a standardized enhanced recovery program (ERP) could reduce the length of stay (LOS) after minimally invasive esophagectomy (MIO) compared to the earlier applied recovery program without increasing the risk of postoperative complications and readmissions. Methods: Retrospective study of patients with esopha...
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Direct Neck Lift in Massive Weight Loss Patients – Classification and Treatment Algorithm
Ulrich Eugen Ziegler,
Ruth Schaefer,
Adrien Daigeler,
Philip Helge Zeplin
Issue:
Volume 9, Issue 2, April 2021
Pages:
58-62
Received:
2 March 2021
Accepted:
13 March 2021
Published:
22 March 2021
Abstract: The neck is an often-neglected part of body lift procedures after massive weight loss. The objective of this study was to classify massive weight loss patients undergoing direct neck lift procedures and provide a standardized treatment algorithm. A retrospective review of all neck lift procedures performed between January of 2012 and December of 2019 was conducted. Patients were classified as follows: Grade I, no skin excess with remaining preplatysmal fat and no platysmal laxity; Grade IIa, moderate submental skin excess with subplatysmal fat deposits and platysmal laxity; Grade IIb, moderate anterior neck skin excess with no fat deposits and platysmal laxity; Grade III, considerable anterior skin excess with no or limited fat deposits and platysmal laxity and bands. Grade I patients had Liposuction, Grade IIa patients Submental Neck Lift with anterior fat excision and central platysmaplasty, Grade IIb Submental Neck Lift with central platysmaplasty, and Grade III patients Median Z-Plasty with fat excision (if needed) and central platysmal resection and tightening. Thirty-one patients were included for analysis. One underwent liposuction, twenty-five a Submental Neck Lift and five a Median Z-Plasty. Concomitant surgery was carried out in all cases. A recurrent skin laxity occurred in 2 (11.8%) patients, so in local anesthesia an operative revision was required. A standardized algorithmic approach for neck lift in massive weight loss patients may optimize the result without increasing the complication rate. Direct neck lift procedures prove to be reliable techniques with rare complication rates that can be performed together with other postbariatric procedures.
Abstract: The neck is an often-neglected part of body lift procedures after massive weight loss. The objective of this study was to classify massive weight loss patients undergoing direct neck lift procedures and provide a standardized treatment algorithm. A retrospective review of all neck lift procedures performed between January of 2012 and December of 20...
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Prospective, Observational Study to Assess a New Quick Absorbable Monofilament Suture for Skin Closure in Adults
Petra Baumann,
Frank Gumpinger
Issue:
Volume 9, Issue 2, April 2021
Pages:
63-68
Received:
28 January 2021
Accepted:
23 February 2021
Published:
26 March 2021
Abstract: This is the first prospective, single centre study assessing the clinical outcome of a new quick, absorbable, monofilament suture for skin closure in adults after general surgical interventions. In total 50 patients were included in the study to apply Monosyn Quick suture to skin closure. Suture handling was evaluated by the surgeons using a 5-point Likert scale. The Visual-Analogue-Scale (VAS) was used to rate wound healing, pain and satisfaction. Adverse events were reported up to the day of discharge. The new suture material was judged good to excellent regarding its handling properties. Patients stayed in hospital for an average of 5.46 days. Wound healing assessment by the physician was excellent [mean (range) 94.94 (50.00 – 100.00)]. Low pain level was reported by the patients (mean (SD) 23.21±18.96; [range 0.00 – 95.00]) and persisted in mean for 2.56 days [range 0.00 - 7.00 days]. High satisfaction with the skin closure was reported by patients at discharge (mean (SD) 94.25±7.89 [range 70.00 – 100.00]). No wound healing-related adverse events were observed. Our results showed, that the new quick, absorbable, monofilament suture is appropriate for dermal wound approximation in general surgery and represents a good alternative option to other suture materials which are in common use to close the skin.
Abstract: This is the first prospective, single centre study assessing the clinical outcome of a new quick, absorbable, monofilament suture for skin closure in adults after general surgical interventions. In total 50 patients were included in the study to apply Monosyn Quick suture to skin closure. Suture handling was evaluated by the surgeons using a 5-poin...
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Treatment of Diabetic Foot Ulcer with Tibial Transverse Transport Combined with Antibiotic Bone Cement, a Case Report
Huankai Chen,
Wu Ji Li,
Mok Tsz Ngai,
Simin Luo
Issue:
Volume 9, Issue 2, April 2021
Pages:
69-73
Received:
25 February 2021
Accepted:
15 March 2021
Published:
26 March 2021
Abstract: Diabetic foot is one of the most difficult complications of diabetes and the main cause of non-traumatic amputation, accounting for 85% of all non-traumatic amputations. [1-2], We report a case of diabetic foot ulcer treated with transverse tibial transport combined with bone cement implantation. The ulcer healed and the effect was good. Case presentation: A 65-year-old man has been diagnosed with Type 2 diabetes for more than 20 years, combined with Type 2 diabetic neurological complications and type 2 diabetic eye complications. Two years ago, his right thumb was removed due to foot ulcers. 20 days ago, The second toe of the right foot was removed due to an ulcer. When he entered our hospital for treatment, the back of the right foot and the sole of the foot had large ruptures. After thorough debridement and transverse tibial transport combined with bone cement placement, the wound healed well. Conclusion: In the treatment of diabetic foot ulcers, it is very important to restore the blood supply of the affected limb. Tibial transverse transport promotes the reconstruction of anastomotic branches below the knee joint, and the induced membrane technology can improve local blood supply. The combination of the two can provide an economical and effective way for the treatment of diabetic foot, which is worthy of our continued exploration.
Abstract: Diabetic foot is one of the most difficult complications of diabetes and the main cause of non-traumatic amputation, accounting for 85% of all non-traumatic amputations. [1-2], We report a case of diabetic foot ulcer treated with transverse tibial transport combined with bone cement implantation. The ulcer healed and the effect was good. Case prese...
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COVID-19 Associated Spontaneous Bowel Perforation
Mohammed Alkatary,
Hamda Al Zarooni,
Salem Al Harthi
Issue:
Volume 9, Issue 2, April 2021
Pages:
74-77
Received:
7 March 2021
Accepted:
19 March 2021
Published:
30 March 2021
Abstract: The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection (COVID-19) in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients’ demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.
Abstract: The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection (COVID-19) in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between Ma...
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Management of Humeral Shaft Fracture by Antegrade Interlocking Intramedullary Nail
Md. Tariqul Islam,
Md. Nazibullah,
Anam Ahmed Ripon,
Md. Atiqur Rahman Khan,
AKM Shaharul Islam
Issue:
Volume 9, Issue 2, April 2021
Pages:
78-81
Received:
16 January 2021
Accepted:
11 March 2021
Published:
1 April 2021
Abstract: Background: The humeral shaft fracture is relatively common fracture among the younger and older age groups of people followed by direct or indirect violence. Humeral shaft fractures account for approximately 3% of all fractures. We have very few data regarding issue. Aim of the study: The aim of this study was to collect information regarding the procedure and outcomes of antegrade interlocking intramedullary nail in treating humeral shaft fracture. Material and methods: This study was carried out during the period from January 2017 to January 2020 at TMSS Medical College and RCH Bogura & Natore Trauma Center and Hospital, Natore, Bangladesh. Total 15 patients were selected where 10 were male and 5 were female. The study was approved by the ethical committees of mentioned both the institution. Proper written consents were taken from all the participants before starting the main intervention. All data were collected analyzed and disseminated by MS Office program. Results: Postoperative infection were found in 2 patients (13.33%) and shoulder pain in 1 case (6.67%). In this study, excellent and good result were accepted as Satisfactory while fair and poor results were regarded as being unsatisfactory. Among them 5 (33.33%) cases were excellent, 7 (46.67%) cases good, 2 (13.33%) cases fair and 1 (6.66%) cases poor. In this study, overall satisfactory result was found in 12 (80%) cases and unsatisfactory in 3 (20%) cases. Conclusion: The antegraded interlocking intramedullary nail is an effective and technically demanding method for the treatment of humeral shaft fracture.
Abstract: Background: The humeral shaft fracture is relatively common fracture among the younger and older age groups of people followed by direct or indirect violence. Humeral shaft fractures account for approximately 3% of all fractures. We have very few data regarding issue. Aim of the study: The aim of this study was to collect information regarding the ...
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Proximal Extra-articular Tibial Fractures Associated with Soft-tissue Impairment in Geriatric Patients: Definitive Treatment by Hybrid External Fixation
Yoann Durand,
Franziska Kocher,
Moritz Tannast,
Daniel Petek
Issue:
Volume 9, Issue 2, April 2021
Pages:
82-85
Received:
5 March 2021
Accepted:
29 March 2021
Published:
7 April 2021
Abstract: Fractures in the elderly population are a major increasing issue for any healthcare institution, associated with the growing life expectancy. Proximal tibial fractures affect the metaphyseal bone with or without articular extension, in 5 to 11% of all tibia fracture. Treatment options such as plate fixation, intramedullary nailing or even primary total knee arthroplasty are accepted valuable options. However, specific age-related risk factors such as osteoporosis, arthritis, multiple comorbidities and soft-tissue impairment shall also be taken in consideration as they may lead to severe complications if not fully understood. Therefore, a hybrid tibio-tibial external fixator may be considered as a valid surgical option for primary and definitive treatment care of these fractures especially if associated with soft-tissue damage. We report a retrospective observational analysis of three cases of closed extra-articular proximal tibia fractures associated with soft-tissue impairment in a geriatric population and treated with a hybrid external fixator (TenXor, Stryker). The fractures were classified according to the AO, as metaphyseal fractures (AO 41A2.1, 41A3.3). The post-operative protocol was standardized, with immediate full weight bearing. Complete consolidation of the fractures was obtained at 6 months. There were no pin tract infection and removal of the material has been done at 6 months. No cut-out of the proximal tibial wires was observed. The primary and definitive care of proximal tibial fractures by a hybrid external fixator appears to be a valuable surgical option in geriatric patients especially when associated with poor soft tissue coverage. The major advantage of this technique, acknowledging the longer bone consolidation process, is to avoid additional insult to the soft tissues. This surgical option gathers further treatment perspectives in the elderly population especially in cases of soft tissue limitations.
Abstract: Fractures in the elderly population are a major increasing issue for any healthcare institution, associated with the growing life expectancy. Proximal tibial fractures affect the metaphyseal bone with or without articular extension, in 5 to 11% of all tibia fracture. Treatment options such as plate fixation, intramedullary nailing or even primary t...
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Removal of Foreign Body Aided with Various Navigation Modalities: A Case Report and Literature Review
Peng Li,
Hongyu Guan,
Jing Song,
Dahong Huang
Issue:
Volume 9, Issue 2, April 2021
Pages:
86-92
Received:
17 February 2021
Accepted:
9 March 2021
Published:
13 April 2021
Abstract: Background: Computerized surgical navigation (CSN) has many potential applications in foreign body (FB) removal. Case report: While playing, a 14-year-old girl was accidentally shot in the facial area with a shotgun. Removal of the superficial shots and of the left eyeball was performed at a local hospital. She was transferred to the West China Hospital of Stomatology (Sichuan, China) on the third day after the accident due to difficulties in removing the remaining shots. Except for left eye vision loss, there was no abnormal physical or laboratory test. Spiral computed tomography (CT) scan of the head was performed and data were imported into the iplan software of the VectorVision2 navigation system. A dynamic reference frame was fixed to the skull and another to the forceps. Eight shots were successfully removed. One shot could not be removed because of significant shifting. At 1 month, the incisions were successfully healed and there were no symptoms or signs. Conclusion: The case presented here and the relevant literature about CSN indicates that CSN is a valuable modality for the removal of FBs, not only in the craniomaxillofacial area, but anywhere in the body.
Abstract: Background: Computerized surgical navigation (CSN) has many potential applications in foreign body (FB) removal. Case report: While playing, a 14-year-old girl was accidentally shot in the facial area with a shotgun. Removal of the superficial shots and of the left eyeball was performed at a local hospital. She was transferred to the West China Hos...
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The Effects of Patients BMI on Lumbo Pelvic Parameters in Patients with Chronic Low Back Pain in Jos North Central Nigeria
Michael Bundepuun Ode,
Okpatuma Tony,
Taiwo Femi Olu,
Amupitan Idumagbodi,
Ode Gloria Nengi,
Yilleng Shem Bulus,
Onche Icha Inalegwu
Issue:
Volume 9, Issue 2, April 2021
Pages:
93-97
Received:
18 March 2021
Accepted:
30 March 2021
Published:
13 April 2021
Abstract: Introduction. The pelvic posture is defined by measurable radiologic parameters which are related to the lumbar and sacral spine. These parameters include, pelvic tilt (PT), lumbar Lordosis (LL), Sacral slope (SS), Pelvic incidence (PI) and the Lumbosacral angle (LSA) The lumbopelvic parameters in the lower back have been noticed to be altered in patients presenting with low back pain. Increased BMI has been found to be a contributing factor in the onset and course of low back pain. Increased weight especially around the trunk affects the dynamics of posturing to maintain sagittal balance. We set out to determine the extent BMI influenced the lumbopelvic parameters in patients presenting with chronic nonspecific low back pain. Methods. This was a prospective cross sectional study. There were three BMI groups; normal weight (BMI19-24.9), overweight (BMI 25-29.9) and obese (BMI>30). All subjects had standing lateral radiographs of the spine. The pelvic parameters; PI, LL PT, SS and LSA, were measured. The mean values and standard deviations of the parameters in each group was determined. Analysis of variance was used to determine differences in means The relationships between all parameters were assessed using Spearman’s coefficients and statistically significant correlation coefficients were determined. The level of significance was set at P<0.05Results. A hundred and forty patients participated in the study. Their ages ranged from 18 to 65years. M:F 1:1.1. 31 (22.1%) of them were of normal weight, 55 (39.3%) of them were overweight, and 54 (38.6%) were obese. None was underweight. The sacral slope was; 34.29±6.29 in the normal weight group, 36.20±5.97 in those overweight and 37.81±5.98 in the obese. (P=0.036). Pelvic incidence was: 51.19±6.35 in the normal weight group, 52.55±7.37 in those overweight and 54.43±9.23 in the obese (P=0.176). Lumbar lordosis was; 40.48±8.16 in the normal weight group, 40.35±8.06 in those overweight and 43.17±10.92 in the obese (P=0.032). The pelvic tilt was; 16.84±5.33 in the normal weight group, 16.29±3.54 in those overweight and 16.61±5.20 in the obese. (P=0.862). The Lumbosacral Angle was 12.74±3.14 in the normal weight group, 13.45±3.79 in those overweight and 12.98±3.55 in the obese. (P=0.634) Conclusion. Increasing BMI had a statistically significant effect on increased lumbar lordosis and sacral slope in patients with chronic low back pain. Pelvic Incidence showed an increase with increasing BMI but was not statistically significant. Pelvic tilt and lumbosacral angle did not show any relationship with BMI.
Abstract: Introduction. The pelvic posture is defined by measurable radiologic parameters which are related to the lumbar and sacral spine. These parameters include, pelvic tilt (PT), lumbar Lordosis (LL), Sacral slope (SS), Pelvic incidence (PI) and the Lumbosacral angle (LSA) The lumbopelvic parameters in the lower back have been noticed to be altered in p...
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