7th Postoperative Day Research Articles

672 TRANSCATHETER VS SURGICAL TREATMENT FOR PERCEVAL DEGENERATION: TAILORED STRATEGY FROM THE HEART TEAM

Abstract Transcatheter treatment of degenerated aortic bioprostheses is nowadays a well-established option (Valve-in-vale, ViV); however, some patients may pose some specific challenges. Perceval® is a sutureless, stent-mounted, aortic valve bioprosthesis that can be placed with a less invasive surgical technique. Its nitinol self-expandable stent frame is a bulky structure that anchors to the aortic annulus without the need of continuous suture, thus reducing aortic cross-clamp and cardiopulmonary bypass time. Performing transcatheter aortic valve replacement (TAVR) in Perceval® may be associated with increased risk of coronary obstruction, impaired coronary access and increased post-procedural gradients. Here we present the cases of two patients with Perceval® degeneration that have been treated with two different tailored approaches following a dedicated Heart Team evaluation. R.M. is a 74-year-old, very low-weight, woman with a history of diabetes, severe COPD, 3b stage CKD, rheumatoid arthritis and previous carotid surgery. She underwent surgical aortic valve replacement (SAVR) with Perceval® “S” bioprosthesis for severe aortic stenosis in 2016. After five years she was diagnosed with severe symptomatic degeneration of the aortic prosthesis (mean gradient 45 mmHg, NYHA class III). The patient was therefore discussed by the Heart Team and scheduled for percutaneous treatment. A ViV with a self-expandable Medtronic 23 mm Evolut™ R bioprosthesis was successfully performed. Hospital stay was uneventful and the patient was discharged on 6th post-operative day in good clinical conditions and good functional class. S.R. is a 70-year-old active smoker woman with a history of previous hemicolectomy for cancer that underwent SAVR in ministernotomy for severe aortic stenosis with Perceval® “L” in 2015. In 2016 she underwent PCI + DES implantation on OM of LCX for an acute coronary syndrome. In 2022 she was diagnosed with severe symptomatic degeneration of the bioprosthesis (mean gradient 40 mmHg, NYHA class II). The patient was referred to Heart Team discussion and scheduled for surgical reintervention. She underwent successful surgery with implantation of a Medtronic Avalus™ 23 mm bioprosthesis, followed by regular rehabilitation. In the first case the severe comorbidities and frailty made the surgical risk almost prohibitive for reintervention (STS-M 9,23%, STS-MM 23,7%, Euroscore II 6,18%). Moreover, there was very little concern about the risk of impaired coronary access afterwards. The second patient, instead, had an acceptable risk for surgery (STS-M 2,2%, STS-MM 10,6%, Euroscore II 4.45%); there was also a significant concern about the risk of impaired coronary access in case of ViV, since she already had a history of percutaneous coronary revascularization. Furthermore, from a lifetime management point of view it is possible to hypothesize easier future reintervention with a TAVR in SAVR instead of a complex TAVR in TAVR in SAVR. Thus, although ViV was technically feasible in both cases with predictable good short-term outcomes, we decided for opposite treatments by looking at individualized long-term needs. In Conclusion the choice between surgical and transcatheter intervention must be based not only on careful evaluation of clinical, anatomical and procedural characteristics but also on future perspectives, especially in patients with longer life expectancy.

EFFECT OF OCCLUSAL REDUCTION ON POSTOPERATIVE PAIN IN MULTIPLE VISIT ROOT CANAL TREATMENT

The study aimed to assess occlusal reduction's effect on postoperative pain in multiple-visit root canal treatment. This randomized control trial was conducted at the Operative Dentistry & Endodontics Department, Baqai Dental College Karachi, from January 2021 to January 2022. A total of 110 patients fulfilling the inclusion criteria were included in the study. The patient was divided into two groups, Group A, occlusal reduction (OR) and Group B, no occlusal reduction (NOR). In group A, all occlusal contacts on the functional and non-functional cuspsand the marginal ridges were reduced by 1 mm by a diamond bur in a high-speed handpiece and confirmed with articulating paper. No occlusal reduction was performed in group B patients. Patients were recalled after 24 hours and 7 days, and their pain level was recorded on VAS; at the same appointment, the root canal was completed, and the tooth was restored permanently. Pain level on the 7th day was taken as the study's primary endpoint. The meanage of patients was 37.41±10.635, with a minimum age of 19 and a maximum of 59 years old. Female patients were 56% and 44%, male. There were two study groups' OR 50% and NOR 50%. The tooth type included were 40% anterior and 60% posterior. Group A patients had reduced pain levels after 24 hours, with a significant difference of P=0.014 compared to group B patients. After 7 days of treatment, no significant difference was found in postoperative pain between both groups with P=0.533. Thus, it can be concluded from the study that the occlusive reduction may not be effective in reducing pain at the 7th postoperative days of multiple visit root canal treatment. Although a significant difference in pain levels was identified after 24 hours of therapy, patients in the occlusion reduction group reported less discomfort than those in the control group.

Laparoscopic resection of an intra-abdominal esophageal duplication cyst in the ileum: a case report.

Esophageal duplication cyst (EDC) is a type of gastrointestinal duplication cyst that involves congenital malformations of the gastrointestinal tract. EDCs are frequently found in the mediastinum and thoracoabdominal region, but rarely occur in the abdominal cavity. However, intra-abdominal EDCs are frequently found in the upper abdomen near the abdominal esophagus. Here, we report, for the first time, a case of intra-abdominal EDC that occurred in the ileum. A 14-year-old female patient presented to our hospital with complaints of epigastric pain and vomiting. Abdominal computed tomography (CT) revealed a cystic tumor in the pelvis, suspected of ovarian origin. She was admitted to our gynecology department and underwent emergency surgery. The laparoscopic examination revealed that both ovaries were intact and that a primary tumor had developed from the ileal mesentery. Since the patient's condition was not urgent at the time of the gynecological surgery, the procedure was completed by only performing exploratory laparotomy; the patient was admitted to our department after the surgery. Pelvic magnetic resonance imaging performed on the next day revealed a cystic mass measuring 90 × 65mm with a smooth margin and homogeneous signal intensity, arising posterior to the uterus. The mass was suspected as an intestinal duplication cyst. On another day, after the examinations were completed, we resected the portion of the small intestine containing the tumor by laparoscopy. The patient had a successful postoperative course and was discharged on the 5th postoperative day. Histological examination showed that the cyst was lined by stratified squamous epithelium, contained esophageal glands, and had a two-layer muscularis propria. Therefore, a diagnosis of intra-abdominal EDC was performed. An intra-abdominal EDC cyst is relatively rare; this is the first case reported at the distal ileum.

The Effect of Ascorbic Acid Supplementation on the Time of Healing of Rats Submitted to Neurosurgical Procedures

Abstract Introduction Vitamin C is an essential nutrient for both humans and rats and has been noted for its beneficial properties, among them, healing. Objective To verify the effect of oral and subcutaneous vitamin C supplementation on the healing time of surgical wounds of rats skulls. Statistical Methodology Thirty male Wistar rats were divided into 3 groups: 10 from the control group (GI), 10 from the group treated with oral vitamin C (GII), and 10 from the group treated with subcutaneous vitamin C (GIII). Vitamin C was administered to GI and GIII animals from the 3rd to the 7th postoperative day, totaling 10 days of administration at a dose of 100 mg/kg/day. On the 4th day of the study, the rats were submitted to a surgical procedure consisting of a 2-cm incision of the skin of the animals' heads and suturing with single stitches. After a determined period, the rats were killed and submitted to the collection of material for study by the picrosirius red technique for the evaluation of collagen types I and III, the degree of hematoxylin and eosin healing, and the rate of contraction of the wound on subsequent days. The results were described in averages, medians, minimum and maximum values, and standard deviations. For the comparison of the three groups, the analysis of variance with one factor (one-way ANOVA) or Kruskal-Wallis non-parametric test was used. The normality of the variables was evaluated by the Shapiro-Wilk test. Values of p < 0.05 indicated statistical significance. The data were analyzed using the IBM SPSS Statistics for Windows, v.20.0. software. (IBM Corp., Armonk, NY, USA). Results The amount of collagen type III was higher in the groups that received vitamin C, however, without significant difference (n = 0.292). In relation to the rate of contraction of the surgical wound, it was higher in the groups treated with vitamin C, with a significant difference between groups I and II (p = 0.001), and between groups I and III (p < 0.001). No significant difference was found between the groups that were treated with vitamin C (p = 0.227). Conclusion Healing was more effective in the groups treated with vitamin C than in the group that did not receive vitamin supplementation. There was no significant difference in healing between the groups receiving oral or subcutaneous vitamin C.

Enterovesical Fistula Presenting with Gross Hematuria and Fecaluria after Pelvic Radiation Therapy and Transurethral Resection of Bladder Tumor: A Case Report and Literature Review

<p>本案例為一名75歲女性表現為肉眼可見的血尿兩天，過去病史有10年前子宮頸癌第四期接受過骨盆腔放射治療、高血壓及第2型糖尿病。病人到本院急診就醫後住院接受進一步檢查，住院後第2天膀胱鏡發現出血性膀胱炎，住院後第4天接受經尿道膀胱腫瘤切除術，病理報告顯示為膀胱急慢性發炎併出血。病人於手術後第四天出院。病人於手術後第10天出現下腹痛、肉眼可見的血尿及糞尿，安排腹部電腦斷層及腸胃道鋇劑攝影均顯示迴腸膀胱廔管。後續安排住院接受剖腹探查、廔管及迴腸切除術及膀胱修補術。病理報告顯示為迴腸憩室和潰瘍伴有急性和慢性發炎。病人於術後第7天併發膀胱出血及膀胱滲漏，經膀胱鏡清血塊及腹腔引流後，於術後第36天出院。本文討論腸道膀胱廔管的病態生理學、危險因子、常見症狀、診斷及治療、手術併發症處理等。此案例提醒基層醫師若病人有肉眼可見的血尿合併骨盆腔放射線治療的病史應鑑別診斷腸道膀胱廔管，需儘早安排腸胃道鋇劑攝影或腹部電腦斷層，以免延誤診斷時機。</p> <p> </p><p>The patient was a 75-year-old woman who presented with gross hematuria for two days. Her medical history included cervical cancer, stage IV treated with pelvic radiation therapy (RT) 10 years ago, hypertension, and type 2 diabetes mellitus. The patient visited the emergency department of our hospital on May 29, 2016, and was hospitalized for further evaluation. Cystoscopy on the 2nd day after admission revealed hemorrhagic cystitis. Transurethral resection of bladder tumor (TURBT) was performed on the 4th day after admission. The pathology report revealed acute and chronic bladder inflammation and bleeding. The patient was discharged on the 8th day after admission. However, the patient developed lower abdominal pain, gross hematuria, and fecaluria on the 10th postoperative day. Abdominal computed tomography (CT) and gastrointestinal tract (GI) series were performed, all of which showed an ileum-vesical fistula. Exploratory laparotomy, resection of the fistula and ileum, and bladder repair, were performed on June 17, 2016, fifteen days after her first operation. The surgeries were successful and uneventful. Pathological examination revealed a diverticulum and ulcer with transmural mixed acute and chronic inflammation. Unfortunately, the patient developed intraperitoneal bladder perforation on the 7th postoperative day. After adequate abdominal drainage and cystoscopy-assisted blood clot evacuation, she was discharged from the hospital on the 36th postoperative day. This article discusses the pathophysiology of enterovesical fistula, risk factors, common symptoms, diagnosis and treatment, and the management of surgical complications. Clinicians should keep this clinical scenario in mind if the patient has gross hematuria combined with a history of pelvic RT. This combination of symptoms and history should suggest a differential diagnosis of enterovesical fistula and arrangement of GI series or abdominal CT should be performed as soon as possible to avoid delaying the diagnosis.</p> <p> </p>

Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique.

The present study aimed to assess clinical results, in terms of postoperative pain, functional recovery and recurrence rates of FESSA (Full Endoscopic Suprapubic Subcutaneous Access) technique compared to endoscopic anterior rectus sheaths plication and mesh, in male patients with midline ventral or incisional hernias and severe rectus diastasis (SRD) associated. Secondary aims were to identify intra- and postoperative complications associated with each technique. Male patients with midline ventral or incisional hernia and severe rectus diastasis were included in a prospectively maintained databased and retrospectively analyzed from January 2017 to December 2020. From January 2017 to January 2019, male patients underwent to anterior rectus sheaths plication (ARSP) (Control group). From January 2019 to December 2020, male patients underwent to FESSA technique (FT) (Case group). 53 patients were finally included. 28 patients (52%) underwent to FT and 25 patients (48%) to ARSP. Regarding intraoperative complications, no significant differences were identified between the groups. Hospital stay was significantly improved in FT group when compared to ARSP group. No significant differences in terms of postoperative seroma or hematomas, were shown. FT group showed significantly less pain on 1st, 7th and 30th postoperative days than ARSP group. Functional recovery was significantly improved in FT group compared to ARSP group on the 30th day and no differences were observed on the 180th day after surgery. The mean follow-up was 17.3 ± 2.6months in FT group and 24 ± 3months in ARSP group. During the follow-up, 1(3%) and 9 (36%) diastasis recurrences were identified respectively, with significant differences in favor of FT group. In males with SRD and symptomatic midlines hernias, ARSP with onlay mesh placement shows high diastasis recurrence rate in mid-term follow-up. We propose FESSA technique in those patients, which decreases the excessive midline tension, improving the postoperative pain, functional recovery and recurrence rate, without increasing postoperative complications.

Anterior segment optical coherence tomography for the detection and management of early keratoplasty complications

AbstractPurpose: This study aimed to assess the contribution of anterior segment optical coherence tomography (AS‐OCT) in the detection of early postoperative complications following penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in order to guide their management.Methods: A single‐center, prospective study, designed to evaluate the postoperative results of 42 eyes who had PK (39 eyes) and DALK (3 eyes) for various diagnoses. Complications occurring between the first and 7th day after surgery were recorded. AS‐OCT was performed to assess central corneal thickness (CCT), Descemet's membrane (DM) position, graft‐host junctions (GHJ), and iridocorneal angle (ICA) opening.Results: Early postoperative complications were detected in 4 eyes (9.5%). Among them, 2 eyes (patients 1 and 2) had PK for corneal perforation, and 2 eyes (patients 3 and 4) had DALK for keratoconus. Patient 1 had an early graft ectasia. Corneal thinning was first detected on the 6th postoperative day by CCT measurement on AS‐OCT. He underwent a second PK with a favourable outcome. Patient 2 had persistent corneal edema on the 4th postoperative day. AS‐OCT revealed graft steps at the GHJ. After surgical revision, the graft became clear and the GHJ were well‐apposed on AS‐OCT. Patient 3 had important graft edema (CCT 1005 μm) secondary to DM detachment diagnosed on the first postoperative day with AS‐OCT. She was treated with an intracameral air injection leading to the reattachment of DM and regression of the edema. Patient 4 had on the first postoperative day a pupillary block successfully managed with a peripheral iridotomy leading to the reopening of the ICA seen on AS‐OCT.Conclusions: AS‐OCT is a non‐contact and reproducible imaging tool that proved to be useful to identify early postoperative complications after keratoplasty and to guide their management. It allows for a quantitative and objective assessment of the anterior segment behind a usually non‐transparent corneal graft.

Efficacy and safety of a hypertonic nasal wash solution containing sea algae extracts in patients that underwent surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction.

The objective of this study was to evaluate efficacy and safety of a Hypertonic Seawater Solution (2.3% NaCl) containing brown and blue-green Algae (HSS-A) in comparison to Isotonic Saline Solution (ISS) regarding the improvement of nasal breathing in patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction. A total of 101 individuals were enrolled in the study (HSS-A: 57; ISS: 44). Nasal breathing was evaluated using a Peak Nasal Inspiratory Flow (PNIF) measurement device at four timepoints: prior to surgical intervention (up to 30 days pre-surgery) and at the 2nd, 10th and 20th postoperative days. On the 20th postoperative day, patients also answered a Nasal Surgical Questionnaire (NSQ) evaluating breathing ability and overall satisfaction from the use of both nasal sprays. No significant differences were observed in PNIF measurements between groups at different points. On the 20th postoperative day, NSQ analysis showed that ISS-treated patients had more frequently moderate nasal bleeding compared to the HSS-A group (85.7% vs. 14.3%, p=0.038). No other statistically significant differences were observed between groups. When NSQ parameters were evaluated in a binary mode, a trend for reduced crusting scores was seen in the HSS-A group (15.9% vs. 35.5% in ISS, p=0.053). No safety concerns were reported throughout the study. In patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction, PNIF values did not differ significantly in patients receiving HSS-A and ISS solutions. Nasal bleeding was more frequent in ISS patients versus HSS-A. Overall, both solutions provided symptomatic relief and use satisfaction in the absence of side effects.

Uterine didelphys: A Case report of successful term pregnancies in each endometrial cavity

Background: Uterine didelphys is a rare congenital anomaly that may increase the risk of pregnancy loss and adverse perinatal outcome. There is limited knowledge of specific increased risk related to uterine didelphys. Uterine didelphys occurs in approximately 1 in 3000 women and accounts for 8 -10% of all mullerian duct anomalies (MDAs). Aim: To present this rare congenital clinical condition and offer management modality experience from the Rivers State University Teaching Hospital (RSUTH). Case report: Mrs. MC was a 33 year old booked G3 Para 1+ 1 (alive), previous caesarean section, who presented for antenatal care. Her index pregnancy was complicated by premature uterine contractions and ante – partum haemorrhage at 29 weeks and 30 weeks gestation respectively which were managed successfully. Obstetric ultrasound scan revealed a second uterine cavity with separate endometrial plate in keeping with uterine didelphys. She subsequently had an elective repeat caesarean section at 38 weeks gestation for transverse lie and uterine anomaly. Findings were a gravid left uterus and an empty right uterus with a lower segment scar. The left uterus contained a live male neonate in transverse lie with a birth weight of 3.5 kg and good Apgar scores. The baby was successfully managed for neonatal Jaundice. The mother developed postpartum haemorrhage which was successfully managed. The mother and baby were discharged on the 5th and 12th post-operative day respectively in good clinical state. The mother was given appointment to the family planning clinic. Conclusion: We presented a patient with a rare congenital clinical condition – uterine didelphys who conceived spontaneously. She had a previous successful pregnancy on the right uterus followed by a spontaneous miscarriage and successfully carried the index pregnancy on the left uterus to term and was delivered by an elective repeat caesarean section with good fetal and maternal outcome.

Strongyloides colitis, a rare but important mimic of Crohn’s disease, resulting in coma and multi-organ failure: a case report

BackgroundStrongyloides colitis is a severe form of strongyloidiasis that carries a high mortality rate if untreated. There is an overlapping clinical presentation between Strongyloides colitis and Crohn’s disease. Here, we present a case of a patient who was diagnosed with Crohn’s disease and was treated with immunosuppressant therapy which resulted in a poor outcome.Case presentationA middle-aged, native African male presented with diarrhea, abdominal pain, and weight loss. Colonoscopy showed some patchy inflammation in the caecum, which on biopsy was suggestive of Crohn’s disease. He had a short course of steroids before being admitted to an emergency with abdominal pain, diarrhea, malnutrition, and severe weight loss. Initial conservative treatment failed, and he became acutely unwell and septic with peritonitis. Laparotomy was carried out, which showed mild inflammation in the terminal ileum, which was not resected. Postoperatively, the patient became comatose and went into multi-organ dysfunction. He failed to progress, and a further laparotomy and subtotal colectomy were performed on the 12th postoperative day. His multi-organ failure progressed, and he succumbed to death 4 days later.DiscussionStrongyloides stercoralis is a parasite causing an enteric infection in animals and humans. Strongyloidiasis in immunocompetent individuals is usually an indolent disease. However, in immunocompromised individuals, it can cause hyperinfective syndrome. Patients with strongyloid colitis should undergo colonoscopy and biopsy where acute inflammation with eosinophilic infiltrates indicates parasitic infiltration of the colonic wall. Surgery is generally not indicated, and any surgical intervention with misdiagnosis of a flare-up of IBD can be very detrimental to the patient.ConclusionStrongyloid colitis can very harmfully mimic Crohn’s colitis, and the use of steroids and immunosuppressants can disseminate parasitic infection. Hyperinfection syndrome can lead to sepsis, organ dysfunction, and comma. Disseminated infection carries a high mortality.

Does a tonsillectomy indicated according to the German S2k guideline affect short-term quality of life in adults?

Tonsillectomy (TE) for recurrent tonsillitis (RT) is one of the most common surgical interventions. Since 2015, the indication criteria for TE have become much stricter (German S2k guideline). Patient-reported outcome measures (PROMs) of short-term quality of life (QoL) after TE have not yet been investigated. To clarify if stringent indication for TE will better identify patients worthy of surgery and patients' QoL. We prospectively studied the Tonsillectomy Outcome Inventory 14 (TOI-14) responses of 38 RT-patients recruited according to the S2k guideline in 2020 and compared their TOI-14 scores with those of a historical RT cohort from 2006 to 2008 and with a healthy middle-European cohort. New RT patients were assessed before, 2, 4, and 14days and 6months after TE. TOI-14 was measured as total and as disease-specific score. From pre- to 6-month postoperative, patients' QoL was significantly different, measured by TOI-14 (49.92 vs. 6.35; p < 0.001) and disease-specific score (60.35 vs. 9.9; p < 0.001). Preoperative disease-specific score was not different from that of the 2nd and 4th postoperative days but from the 14th postoperative day (60.35 vs. 29.26; p < 0.001). The historical cohort had significantly less RT complaints than the new cohort beforehand, but more dissatisfaction in QoL after TE. New TE patients had worse QoL pre- (49.92 vs. 11.78; p < 0.001) but more QoL postoperatively (6.34 vs. 11.78; p = 0.004) than healthy individuals. Our results show that the tightening of the indication criteria for TE was justified and that TE patients significantly benefit from this surgery from day 14.

TRANSMISSIBLE VENEREAL TUMOR SURGERY AND CHEMOTHERAPY IN A FEMALE LOCAL DOG WITH A HISTORY OF MACROCYTIC-HYPOCHROMIC ANEMIA

Canine transmissible venereal tumor (CTVT) is a malignant tumor of the genital organs that is transmitted to dogs through implantation of tumor cells in the mucous membranes during mating, licking, biting, fighting, or various forms of direct contact. The case animal is a 1.5 years old female local dog with a body weight of 10.45 kg with a complaint of a lump in the vaginal area for the last 2 months and blood dripping from her vagina. Based on anamnesis, physical examination, and supporting examinations including hematological examination, it was found that the case dog had hypochromic macrocytic anemia, on cytology examination found the presence of intranuclear and intracytoplasmic CTVT vacuoles, and histopathological examination revealed homogeneous lymphoblasts and lymphocytes, mitotic cells, and connective tissue stroma, so the case dog was diagnosed with Canine Transmissible Venereal Tumor. Treatment for CTVT is done through surgery and chemotherapy. Preoperatively given atropine sulfate premedication at a dose of 0.02 mg/kg BW subcutaneously, and anesthetized using a combination of ketamine-xylazine at a dose of 2 mg/kg BW and 12 mg/kg BW intravenously, respectively. Surgery is performed by excision of the tumor mass in the vaginal area. Postoperatively, cefotaxime at a dose of 25 mg/kg BW was administered intravenously twice a day and the analgesic tolfenamic acid at a dose of 4 mg/kg BW was administered intramuscularly once a day. Followed on the second day by administering the drug orally, namely the antibiotic cefixime at a dose of 5 mg/kg BW given twice a day for five days, meloxicam at a dose of 0.1 mg/kg BW given once a day for five days. Sangobion capsules are given once a day for five days. Dogs were given chemotherapy drug vincristin sulfate at a dose of 0.025 mg/kg BW intravenously on the 4th and 11th postoperative days. On the fourth postoperative day, the vulva did not experience swelling, the dog was actively playing, normal urination, eating and drinking well, no disturbances occurred, so the case dog was declared to have developed well after surgery.

Artículo traducido] Cauterización de la matriz con nitrato de plata para el tratamiento de las uñas encarnadas en los dedos de los pies en niños: estudio piloto

BackgroundAlthough partial onychectomy with chemical matricectomy has been described asthe treatment of choice, there is sparse evidence in the literature regarding the use of silvernitrate for matricectomy. Our aim is to describe the effectiveness of silver nitrate for matrixcauterization after partial onychectomy. MethodsA prospective observational study was performed on patients with ingrown toenailsstage 2–3 who underwent partial onychectomy with silver nitrate chemical matricectomy during 2018–2019 in our institution. All patients were evaluated in the outpatient clinic on the 7th and 30th post-operative day and a telephone evaluation was performed every 6 months afterthe surgical procedure to date. ResultsOne hundred and twenty-three patients, who underwent 231 partial onychectomies with silver nitrate chemical matricectomy were included, with a median follow-up of 21 months (interquartile range, 12–29). The procedure had an effectiveness of 95.3%, with only 11 recur-rences (4.7%) reported so far on follow-up. Postoperative infections were observed in 4 patients (1.7%). Adverse effects, such as pain and postoperative drainage, were irrelevant in mostpatients. ConclusionsSilver nitrate matricectomy after partial onychectomy is an effective and safealternative for the treatment of ingrown toenail in children, with scarce postoperative morbidityand low recurrence rate.

Thoracic aortic pseudoaneurysm mimicking recurrence of lung cancer

A man in his late 70’s visited to a hospital with one day history of fever and cough. Eight years before, he underwent a left upper lobectomy due to stage IB lung cancer. He had taken follow-up Computed Tomography (CT) exams annually and no abnormality was detected 9 months earlier (Figure 1A and B). Laboratory data showed elevated C-reactive protein, 9.7 mg/dL and D-dimer, 2.5 μg/mL with normal white blood cell counts. A chest CT on a visit showed a mediastinal mass near the resected site of left upper lobe (Figure 1C and D) with slight ground- glass opacity around it. Local recurrence of lung cancer with mild pneumonia was suspected, then an oral antibiotic was administered. His fever was alleviated and contrast-enhanced CT was performed one week later for detailed examination, which revealed a ruptured pseudoaneurysm of thoracic aorta (Figure 2A and B). Semi-urgent total arch replacement was completely achieved although it was tough due to severe adhesion of surrounding tissue. He was discharged without any complications on the 30th postoperative day.

Primary versus secondary closure of stoma reversal skin wound: Randomized controlled trial.

To compare the efficacy of primary versus secondary closure of stoma reversal skin wound in terms of wound infection. The study was conducted at Surgical B Unit of Ayub Teaching Hospital, Abbottabad, Pakistan, from January 1 to December 31, 2020, and comprised adult patients of either gender undergoing stoma reversal. The patients were randomised into primary closure group A and secondary closure group B. Surgical procedure was similar in both the groups except the skin closure technique. In group A, skin was closed with interrupted polypropylene sutures, while in group B, wound was dressed with saline-soaked gauze daily using aseptic technique and was allowed to heal by secondary intention or delayed primary closure later on. Postoperatively, the wound was assessed for infection till 30th postoperative day or complete wound healing. Data was analysed using SPSS 16. Of the 50 patients, 35(70%) were males and 15(30%) were females. The overall mean age was 28±1.65years. There were 25(50%) patients in each of the two groups. There were 19(76%) males and 6(24%) females in group A with a mean age of 32±2.8years. There were 16(64%) males and 9(36%) females in group B with a mean age of 23±3.5years. Overall, 10(20%) patients had wound-site infections; 9(36%) in group A versus 1(4%) in group B (p=0.005). Frequency of wound infection with respect to gender, type of stoma and length of hospital stay was not significant (p>0.05). Secondary skin closure was found to be associated with significantly reduced wound infection rate after stoma reversal. https://clinicaltrials.gov/ct2/show/NCT04785404.

Prevalence of surgical site infection among bile spillage and non-spillage patients undergoing laparoscopic cholecystectomy: A cross-sectional study

Introduction: Laparoscopic cholecystectomy, a common procedure is not without complications, and bile spillage can cause surgical site infection (SSI). There is no local evidence in our hospital setting.&#x0D; Objective: The objective of this study was to find the prevalence of surgical site infection among bile spillage and non-spillage patients following laparoscopic cholecystectomy at BMCTH&#x0D; Methodology: A hospital-based cross-sectional study was conducted from 25 February 2021 to 25 August 2021 at the surgery department of BMCTH. We enrolled 120 patients through the total enumeration technique who underwent laparoscopic cholecystectomy. We enrolled all the eligible study participants who were more than 18 years excluding patients having age &gt;75 years, acute calculous cholecystitis, evidence of cholangitis and/or obstructive jaundice, previous biliary tract surgery, or previous Endoscopic retrograde cholangiopancreatography, evidence of uncontrolled diabetes mellitus and patients taking immunosuppressive drugs and immunosuppressed conditions like HIV/AIDS. The surgical site infection was assessed on the 7th postoperative day.&#x0D; Results: Among 120 patients undergoing laparoscopic cholecystectomy, the majority were female 92(76.7%) and 40-50 years age group 65(54.2%). Bile spillage was found in 27(22.5%) and non-spillage in 93(77.5%). The prevalence of surgical site infection (SSI) was found to be 7.5% which was more in the bile spillage group 25.9% than the non-spillage group 2.2%. The odds of having SSI among the spillage group was 15.9 times more than the non-spillage group and was statistically significant (p &lt;0.05). The pus culture of SSI found the predominant organism as Staphylococcus aureus 6(66.7%) followed by Escherichia coli 3(33.3%). The common indications of laparoscopic cholecystectomy were symptomatic cholelithiasis 95(79.1%) followed by chronic calculus cholecystitis 15(12.5%), gall bladder polyp 8(6.7%) and gall stone pancreatitis 2(1.7%).&#x0D; Conclusion: More than two and almost one out of ten had bile spillage and surgical site infection (SSI) respectively. A significantly higher number of SSI among the spillage group should be a concern of surgeons. We need to be extra careful with the spillage group for surgical site infection.

An enigmatic tale of the missed and migrated tail

We, report a case of missing and migrated intrauterine device presenting as vague abdominal pain. The patient had symptoms of vaginal discharge and menstrual disturbances as polymenorrhagia and leukorrhea. She was evaluated for a suspected malignancy of the ovaries. During evaluation on pelvic CT scan, the missing and migrated Intrauterine Contraceptive Device (IUCD) was located in the small bowel and tumor markers were normal. We treated her with antibiotics for presumptive diagnosis of pelvic inflammatory disease and then posted her for the evaluation of the missing IUCD and the tubo-ovarian masses by endoscopy. The missed IUCD was seen embedded in the terminal ileum with intraperitoneal adhesions and the tubo-ovarian masses. The IUCD was removed endoscopically enterotomy of ileum which was sutured. The patient recovered well and was discharged on the 6th post-operative day.

Profile of Perioperative Coagulation in Major Liver Resection for Cancer: A Prospective Observational Study

Background: The liver plays a key role in the complex and dynamic process of blood coagulation. Consequently, after liver resection the equilibrium between procoagulant and anticoagulant activity is often deranged. Major hepatectomies have been associated with excessive intraoperative blood loss, hemodynamic instability, massive fluid shifts, and coagulopathy. Alterations of the coagulation profile are always present post-operatively even in case of normal pre-operative coagulation function. Cumulative evidence supports the superiority of global coagulation analysis compared with conventional coagulation for clinical decision-making. Aim: The purpose of this study was to assess the perioperative coagulation status of patients undergoing major hepatectomies for primary or metastatic hepatic malignancy. Conventional coagulation tests, plasma levels of coagulation factors, and TGA measurements were used for longitudinal documentation of the coagulation activity. Methods: Patients included in the study were referred for major liver resection which was defined as a resection of three or more liver segments, and were followed up to the 10th post-operative day by serial measurements of conventional coagulation tests, plasma levels of coagulation factors, and thrombin generation assay parameters. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were determined by STA Neoplastin R, and STA-Cephascreen, Fibrinogen by STA-Liquid Fib, D-dimer STA Liatest D-DI Plus, all from Diagnostica Stago, France. Coagulation factor activity for FII, FV, FVII, FVIII, FIX, FX, was measured by clotting assay using coagulation factor deficient plasma, vWFAg , and vWFAc by vWFAg and Innovance vWFAc, from Siemens Healthcare Diagnostics, Germany. Thrombin generation (TG) was assessed in samples of PPP with the TF 5 pM PPP-Reagent on Calibrated Automated Thrombogram (Stago, France). Results: Changes over time for FII, FV, FVII and FX were statistically significant (p <0.05). Factor VIII level was above normal values at baseline. A steady rise was observed for fibrinogen, FVIII, and vWF antigen throughout the study period, but only vWF antigen exhibited statistically significant changes over time. Levels of coagulation inhibitors, AT, PC and PS, decreased significantly during the first postoperative day and then increased reaching baseline values by POD5 for protein C and S, but AT, remained low by POD10. INR increased after surgery, reaching a peak on the first post-operative day and decreasing toward baseline levels from then on (p <0.001). The aPTT remained within normal range throughout the study period (Table 1). TG conducted at baseline, on POD1, POD5, and POD10 showed elevated of Lag time and time to peak at baseline, whereas the rest thrombin generation parameters were within reference range. ETP decreased significantly over time, reaching lower values by POD5 and sustaining those low values by POD10. Peak height fluctuated in a similar manner, but changes over time did not bear any statistical significance. Lag-time, which was prolonged at baseline, exhibited a steady rise throughout the study period, bearing borderline statistical significance (Table 2) . A statistically significant positive correlation was detected between AT and time to Peak (ttPeak) at baseline, however any other significant difference between coagulation factors, natural coagulation inhibitors, and TGA parameters was observed. Conclusion: This study shows that patients with hepatic malignancy have systematic endothelial activation and hyper-coagulability as indicated by increased FVIII levels and lag time prolongation in thrombin generation. These patients are in a hyper-coagulable state in the early post-operative period, as shown by increased vWF, FVIII, D-dimer, fibrinogen and decreased levels of natural coagulation inhibitors AT, PC, and PS. Measurements of INR, PT, aPTT are not useful in this setting and could be misleading. Global coagulation analysis may be more appropriate for clinical guidance. To the best of our knowledge this is the first report in literature documenting the pre-existing coagulation disturbances in patients with hepatic carcinoma and their impact on the coagulation status after major hepatectomy. However, the clinical implications of our findings deserve further investigation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Efficacy of Silver Coated Foley’s Catheter in Comparison with Latex Foley’s Catheter for Prevention of Antimicrobial Resistance and Catheter Associated Urinary Tract Infections in Obstructive Urolithiasis of Male Buffalo Calves

Background: Foley’s catheters are widely used for treating obstructive urolithiasis and are often associated with high rate of urinary tract infections. The urinary catheters act as a platform for colonization and biofilm formation by pathogens, leads to increasing the risk of catheter associated bacterial infections. Methods: The present study was aimed to address the antimicrobial activity and biofilm inhibition effect of silver Foley’s catheter in male buffalo calves suffering from obstructive urolithiasis. The study was conducted on twelve male buffalo calves suffering from obstructive urolithiasis, randomly divided into two groups irrespective of their age viz., group I (latex Foley’s catheter treatment) and group II (silver hydrogel coated Foley’s catheter treatment). Cultural examination and antibiotic sensitivity of cultured bacteria from the urine passed through fixed urinary catheter was performed at 0th, 7th, 14th and 28th postoperative days in both the groups. Result: There was significant reduction in growth of bacteria like Streptococcus, Staphylococcus and E. coli bacterial colony formation on blood agar and MacConkey lactose agar, respectively in silver catheter group as compare to latex catheter group from day 0 to day 28th. The zone of inhibition was more pronounced for both antibiotics viz., Cefotaxime and Ceftriaxone (upto 24 mm) in urine samples collected from silver hydrogel coated Foley’s catheter as compared to latex Foley’s catheter indicating its biofilm inhibition effect on bacteria. Silver-hydrogel Foley’s Catheter are more cost-effective as compare to latex Foley’s catheter.

Delayed oral feeding reduces pharyngocutaneous fistula formation after open surgical treatment of primary hypopharyngeal cancer: A case-control study.

Pharyngocutaneous fistula (PCF) formation following open surgical treatment of hypopharyngeal cancer (HPC) is a common and troublesome complication. To date, the postoperative protocol of restarting oral intake is not clear, and vast discrepancies exist in the literature and among institutions. This study aimed to explore the impact of a postoperative protocol of restarting oral intake on PCF formation after open surgical treatment of primary HPC, and its impact on overall survival (OS) and swallowing function based on the functional outcome swallowing scale (FOSS). This was a prospective observational study of 42 patients who received open surgical treatment for primary HPC at Beijing Friendship Hospital between April 2019 and August 2021. This cohort included two groups: patients who restarted oral intake on the 10th postoperative day (Group 1), and those who started on the 20th (Group 2). The Chi-square test and Fisher's exact chi-squared test were used for comparing qualitative data among the groups. Group 1 (n = 27) and Group 2 (n = 15) were comparable in clinical characteristics. PCF occurred in 7 (25.9%) patients in Group 1, while none occurred in Group 2 (P = 0.038). The 2-year OS of all 42 patients was 75.6%; 65.8% and 93.3% for Groups 1 and 2, respectively (P = 0.07). The swallowing function was satisfactory (FOSS Grades 0-III) for 19 (70.4%) patients in Group 1 and 15 (100%) patients in Group 2 (P = 0.035). Laryngeal preservation was achieved in 25 (59.5%) patients, while decannulation was successful in 22 (88.0%) patients. Delayed oral feeding significantly reduces PCF after open surgical treatment of primary HPC, and improves the swallowing function outcome without jeopardizing the OS.