Gold Standard Method For Treatment Research Articles

Surgical technique for preventing lymphatic complications during robot-assisted radical prostatectomy

Introduction. Radical prostatectomy (RP) stands the gold standard method of treatment for localised prostate cancer. Pelvic lymph node dissection (PLND) is a common surgical procedure that can be used for both diagnostic and therapeutic purposes. Lymphocele is the most common complication after robot-assisted radical prostatectomy (RARP) and PLND.Objective. To develop a surgical technique aimed at reducing the incidence of lymphocele in patients who underwent RARP with TL and to evaluate its efficacy and safety.Materials & methods. The study included 49 patients who underwent RARP and PLND. The patients were divided into 2 groups: group 1 — patients with free peritoneal flap fixed to the pubic bone after RARP and PLND (n = 25) and group 2 — control group «without peritoneal flap fixation» (n = 24). The average follow-up period was 3 months.Results. No significant differences in clinical parameters were observed between the groups in perioperative period. In postoperative period lymphocele was diagnosed in 5 (10.2%) patients: group 1 — 1 (4%) patients, group 2 — 4 (16.7%). There were no significant differences in lymphocele volume between the groups. In group 1 lymphocele had no clinical manifestation. Symptomatic lymphocele was diagnosed in 1 patient (4.2%) from the control group.Conclusion. The surgical technique of a free peritoneal flap fixation to the pubic bone combined with PLND after RARP may reduce the incidence of lymphocele if compared to the standard technique.

Does early granulocyte colony-stimulating factor administration in autologous peripheral blood stem cell transplantation shorten the duration of hospitalization in patients with multiple myeloma?

Aims: Autologous peripheral blood stem cell transplantation (PBSCT), performed with high-dose melphalan support following induction therapy is still the gold standard method of treatment for multipl myeloma (MM)patients suitable for transplantation. It was aimed, with this retrospective study, to investigate the effects of early (1 day after PBSCT) and late (5 days after PBSCT) initiation of granulocyte colony-stimulating factor (G-CSF) support following PBSCT on engraftment time, febrile neutropenia, and length of hospital stay (LOS) in MM patients. Methods: This study included 70 patients with MM, who underwent PBSCT in Erciyes University. Two groups were administered 5µg/kg filgrastim, subcutaneously, either 1 day or 5 days after PBSCT, until neutrophil engraftment was reached. Results: Both neutrophil and platelet engraftment occurred in significantly shorter times in the early G-CSF group compared to late G-CSF group; the median times to neutrophil engraftment were 10 (8-13) and 11 (7-15) days, respectively, and the median times to platelet engraftment were 11 (10- 16) and 13 (11- 21) days (p=0.001). Also, the median LOS was also significantly shorter in the early G-CSF group compared to late G-CSF group; 14 (10-22) vs 16 (11- 33) days, respectively (p=0.016). No significant difference was found between the groups in terms of frequency of febrile neutropenia. Conclusion: The initiation of G-CSF support early, following PBSCT in MM patients, accelerated neutrophil and platelet engraftment and shortened the LOS as compared to the initiation of G-CSF support late, with no significant difference in the frequency of febrile neutropenia.

Ab. No. 15 Efficacy of ADL-Based Dynamic Postural Stability Exercises After Canalith Repositioning Maneuver in Benign Paroxysmal Positional Vertigo Patients

Introduction: CRP produces short-term effects, not sufficient to reactivate postural control in BPPV. Most studies prescribe balance training which is not well incorporated with ADL activities. Hence, this study aimed to find out the effectiveness of ADL-based dynamic postural stability exercises. Benign paroxysmal positional vertigo is a common peripheral vestibular disorder. Canalith repositioning manoeuvre is considered to be the gold standard method of treatment. Even after CRP 2/3rd of patients has postural instabilities, especially in dynamic conditions such as walking, sitting to standing, and in performing daily activities, which was not given attention in studies and treatment programs. Methods: 100 BPPV patients (50 each in interventional and control group) aged between‹18–60 years, positive for Dix Hallpike test/supine roll test confirmed by an ENT specialist and treated with CRP by random sampling. All patients were evaluated by the Berg balance scale, POMA (gait scale), and Dizziness Handicap Inventory on the third day of CRP. The control group received CRP with conventional balance training whereas the interventional group received ADL-based dynamic postural stability exercises (with more challenging environments involving various sensory inputs with postural strategies) along with CRP for 2 weeks. Data was analyzed using SPSS version 23; the Mann-Whitney U test (between group analysis) and Wilcoxon Signed Rank test (within group analysis) were used. Result: In the interventional group, there was greater improvement in balance in dynamic conditions, functional ability, and reduction in dizziness (p value‹0.05) in ADL activities. Conclusion: ADL-based exercises are beneficial for the improvement of balance, reduction in dizziness, and improving functional activities after CRP in BPPV patients. As this postural instability/residual dizziness has an impact on ADL in BPPV patients even after CRP, if untreated may lead to compensatory strategies that delay functional recovery. Hence, this instability period should be managed with ADL-based dynamic postural stability exercises.

A novel laparoscopic inguinal hernia repair technique: single-port lateral non-abdominal pre-peritoneal approach.

Open and endoscopic techniques have been described for the treatment of inguinal hernia, but the gold standard treatment method is yet to be defined. Recurrence rates after inguinal hernia surgery vary between 10 and 15%, and chronic pain is seen in 10-12% of patients. This study aimed to introduce a new surgical technique called lateral non-abdominal pre-peritoneal repair for inguinal hernia surgery. We recorded the data of patients' age, gender, body mass index (BMI), prior hernia surgery, hernia side, type of hernia, postoperative complications, pain scores according to the numeric pain scale, and analgesic consumption. We performed a nearly 2cm incision from approximately 2cm medial and superior of the anterior superior iliac spine, then separated the peritoneum from the transverse abdominal muscle by blunt dissection, and perform the surgery by a single-port device. Seventeen inguinal hernias were repaired with the new technique in 14 patients. Two of the patients were female. The median age was 59, and the mean BMI was 26.8kg/m2. The median hospital stays and time passed since the surgery was 1day and 72days, respectively. The mean operative time was 64 ± 29min. The median tramadol consumption was 100mg, and the mean paracetamol consumption was 1143mg. The median pain score on POD 1 and current pain score was 4 and 0, respectively. No significant complications occurred intraoperatively. We observed the pain scores were acceptable on POD 1, and excellent in postoperative follow-up. Low pain scores, low analgesic consumption, and the absence of recurrence in a newly developed procedure within the learning curve indicate that satisfactory results can be obtained.

Evaluation of Functional Capacity and Satisfaction of Patients With Lumbosacral Fusion.

Spinal fusion is a surgical procedure that has been successfully conducted for many years. It is applied for various indications, such as degeneration, deformity, instability, spinal stenosis, trauma, tumor, and infection. This study aims to determine the effects of this procedure on daily life and sleep quality by examining postoperative symptoms and refractory complaints of patients who underwent lumbosacral fusion for various indications. The files of the patients who underwent only posterolateral lumbosacral fusion for various indications between June 2021 and July 2022 were reviewed retrospectively. Patients who had had regular clinical follow-ups for at least six months postoperatively were included in the study. Preoperative and postoperative Visual Analog Scale (VAS), Oswestry Disability Index(ODI), and Pittsburgh Sleep Quality Index (PSQI) scores were compared using the Wilcoxon Ordinal Signs test. A p-value of <0.05 was considered statistically significant. Twenty patients were included in the study. The mean age of the patients was 68.2 ± 7.5 (54-79). Three (15%) of the patients were males, and seventeen (85%) were females. Improvement was observed in all three scores, i.e., VAS,ODI, and PSQI assessments. No correlation was found between the number of segments undergoing fusion, body mass index (BMI), and clinical outcomes. Spinal fusion surgery is still viewed as the gold standard treatment method for many indications. Posterolateral fusion provides adequate stabilization in many cases when applied correctly. However, the possibility of persistent or newly developing low back pain in the postoperative period as a result of mechanical reasons should not be forgotten, and patients should be informed about the same. Postoperative expectations should, thus, be shaped accordingly.

A robust localization approach for Percutaneous Nephrolithotomy (PCNL): A single-center retrospective study.

Percutaneous Nephrolithotomy (PCNL) represents the gold standard treatment method for cases with large kidney stones. As a critical step in performing PCNL, the procedure of establishing a safe and accurate nephrostomy tract will dramatically impact the treatment quality of patients with large-sized kidney stones. This work attempts to describe a new and improved process of establishing an accurate nephrostomy tract and clinically evaluate the effectiveness and safeness of this proposed methodology. This work represents a retrospective single-center study carried out between August 2013 and November 2019. The collected samples consist of 937 patients who were operated on using PCNL coupled with our proposed procedure. Briefly, a preoperative B-ultrasonography was firstly performed to decide the puncture point in a simulated surgical position where was marked with ureteral catheter segments (2-3 cm). A computed tomography (CT) scan was followed to correct the anchor points in the simulated surgical position. After this, an accurate puncture operation was performed under the real-time guidance of intraoperative B ultrasound. Examining this study, 851 subjects with renal stones and 86 subjects with ureteropelvic junction stones were included for the PCNL operation project. All samples were grouped with Guy's grading system: grade I, II, III, and IV patients there were 0.00%, 42.69%, 51.01%, and 6.30%, respectively. Among these patients, the average age was 48.49 ± 10.80 years old, with a male to female ratio of around 1.73:1. This study showed that our developed method warrants an accurate and safe PCNL operation that involves the process of establishing the nephrostomy tract. Other advantageous attributes of this new PCNL process include negligible radiation exposure, lesser complications, and low failure rates. More importantly, this new localization approach is particularly attractive for hospitals that are new to the field of adopting PCNL considering its safeness, effectiveness, and learnability.

Erythrocyte-Derived Nanoparticles with Folate Functionalization for Near Infrared Pulsed Laser-Mediated Photo-Chemotherapy of Tumors.

Despite its common side effects and varying degrees of therapeutic success, chemotherapy remains the gold standard method for treatment of cancer. Towards developing a new therapeutic approach, we have engineered nanoparticles derived from erythrocytes that contain indocyanine green as a photo-activated agent that enables near infrared photothermal heating, and doxorubicin hydrochloride (DOX) as a chemotherapeutic drug. We hypothesize that milliseconds pulsed laser irradiation results in rapid heating and photo-triggered release of DOX, providing a dual photo-chemo therapeutic mechanism for tumor destruction. Additionally, the surface of the nanoparticles is functionalized with folate to target the folate receptor-α on tumor cells to further enhance the therapeutic efficacy. Using non-contract infrared radiometry and absorption spectroscopy, we have characterized the photothermal response and photostability of the nanoparticles to pulsed laser irradiation. Our in vitro studies show that these nanoparticles can mediate photo-chemo killing of SKOV3 ovarian cancer cells when activated by pulsed laser irradiation. We further demonstrate that this dual photo-chemo therapeutic approach is effective in reducing the volume of tumor implants in mice and elicits an apoptotic response. This treatment modality presents a promising approach in destruction of small tumor nodules.

Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes.

Background The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT). Methods Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded. Results 98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group. Conclusion Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.

Impact of microscopic intermediate sub inguinal varicocelectomy on varicocele and infertility

Varicocele is primarily tortuous dilation of the internal spermatic vein [ISV] and pampiniform plexus in the scrotum. It’s the most common correctable cause of infertility. It has a higher prevalence in primary and secondary infertility in men. In this article, we reviewed the advantages and disadvantages of microscopic intermediate sub inguinal [MISV] varicocelectomies over conventional surgical methods. Although various mechanisms are postulated for pathogenesis, increased venous reflux is accepted as the predominant cause. Varicocelectomy is done to ligate the veins and reduce venous reflux without affecting the arteries, vas deferens and lymphatics. Open, laparoscopic and microscopic varicocelectomies are the different surgical approaches of varicocele. Embolization is another treatment option. MISV is a relatively novel technique and considered superior to the conventional treatment approaches because of increased spontaneous pregnancy rates, reduced recurrence, increased seminal parameters and fewer postoperative complications, as evidenced by many studies. Microscopic visualization and usage of micro-doppler in surgery gives more safe and easy handling of the operative field. Absolute indications for varicocelectomy are documented infertility, clinically palpable varicocele abnormal seminal parameters and potentially treatable female infertility or normal fertility. Persistent pain, discrepancies in the testicular volume of more than 20% and hypogonadism are considered as relative indications for varicocelectomies. MISV should be regarded as the gold standard treatment method for varicocele.

Use of thyroid hormones in hypothyroid and euthyroid patients: A THESIS questionnaire survey of Hungarian physicians

Hypothyroidism has a high prevalence in the adult population. Levothyroxine (LT4) supplementation is considered to be the gold-standard treatment method. In Hungary, LT4 tablets and soft gel capsules are the available formulations. Similarly to the international trends, hypothyroidism is earlier recognised, leading to early LT4 supplementation. Up till now, there has been no survey on the treatment of hypothyroidism among Hungarian endocrinologists. THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) had been conducted to assess treatment preferences among European endocrinologists. Here we report the results on the use of thyroid hormones in hypothyroid patients and euthyroid individuals in Hungary. An e-mail invitation to participate, containing the link to the online survey was sent to members of the Hungarian Society for Endocrinology and Metabolism. There were 165 responses with full demographics which were included in the analysis. By the majority (99.4%) of them, LT4 was the first treatment of choice. LT4 + LT3 combination was considered an option in patients with persistent symptoms despite biochemical euthyroidism while on LT4 (36,1%). In euthyroid individuals, 60.3% of the respondents would consider starting LT4 in euthyroid infertile women with high antibody levels, which is hardly supported by evidence. In the presence of comorbidities and interfering medications which may hinder LT4 absorption, 66.4% of Hungarian endocrinologist anticipate significant improvement after switching from tablets to soft gel capsules. The treatment of choice for hypothyroidism is LT4 in Hungary. Combination therapy with LT4 + LT3 was considered for patients with persistent symptoms. In the presence of diseases and interfering medications affecting bioavailability, a high number of Hungarian endocrinologists prefer the new LT4 formulation. The administration of LT4 in euthyroid conditions awaits explanation and calls for intensive discussions at local conferences and courses. Orv Hetil. 2022; 163(12): 463-472.

Comparative Study of Arthroscopic Anterior Cruciate Ligament Reconstruction by Quadrupled Semitendinosus-Gracilis and Tripled Semitendinosus Auto Graft

Background: The anterior cruciate ligament (ACL) is the most frequently disrupted ligament of the knee. Arthroscopic ACL reconstruction is one of the most common orthopaedic procedures now-a-days and has become the gold standard method of treatment in complete ACL tear. Though the choice of graft for ACL reconstruction and the methods of its fixation are matters of debate, hamstring tendon is considered as the favorable graft. Common options for the choice of graft are quadrupled semitendinosus-gracilis and tripled semitendinosus auto graft. Aim of our study is to compare the outcome of arthroscopic ACL reconstruction by quadrupled semitendinosus-gracilis and tripled semitendinosus auto graft.Material &amp; Methods:In this prospective interventional study purposive sampling was done. Sixty patients with complete ACL tear were included in this study from May 2017 to August 2019 at NITOR, strictly considering the inclusion and exclusion criteria. Thirty of them treated with quadrupled semitendinosus-gracilis (group 1) and thirty with tripled semitendinosus (group 2) auto graft. Evaluation by Lysholm knee score was done before and after surgery. Final outcome was evaluated at 24th week post-operatively.Results:Preoperative Lysholm Knee Score was almost similar in group 1 (63.2±2.1) and in group 2 (63.1±2.5). This difference was not statistically significant (p=0.582). Postoperative Lysholm Knee Score at 24th week was slightly higher in group 1 (95.0±2.0) in comparison to group 2 (94.4±3.2). This difference was also not statistically significant (p=0.361). But excellent functional outcome was more in group 1 (80.0%) in comparison to group 2 (73.3%) whereas no poor or fair outcome was reported in group 1 but fair outcome was reported in 6.7% of patients in group 2. Overall complication rate was 6.67% with no significant intergroup difference.Conclusions:Quadrupled semitendinosus-gracilis auto graft has yielded more excellent results than tripled semitendinosus graft. But as this difference was not significant, it can be said that, both the procedure can be performed for arthroscopic reconstruction of ACL.

Erişkin Üreteropelvik Bileşke Darlığı Hastalarında Piyeloplastinin Başarısı: Retrospektif Klinik Çalışma

Objective: Ureteropelvic junction obstruction (UPJO) is a disease often diagnosed in childhood, but it can rarely be detected in adults. Dismembered pyeloplasty is the gold standard treatment method. In this study, we evaluated the success of pyeloplasty in adult patients with UPJO. Material and Methods: We retrospectively reviewed the data of the adult patients who underwent pyeloplasty between January 2012 and July 2021. Preoperative and postoperative differential renal function (DRF), the time required for the clearance of half of the radioisotope from the renal pelvis (T1/2), presence of symptoms, degree of hydronephrosis, anteroposterior (AP) diameter of the renal pelvis, and parenchymal thickness were compared. Results: A total of 30 patients with a mean age of 32.43±7.18 were included in the study. No statistically significant difference was detected between preoperative and postoperative mean DRF (37.6±12.08 and 38±11.35, respectively) (p=0.775). In 19 (63.33%) patients DRF remained unchanged. In 7 (23.33%) patients DRF was improved, and in 4 (13.34%) patients DRF deteriorated. The mean AP diameter and grade of hydronephrosis were significantly improved after pyeloplasty. The ratio of patients with a T1/2>20 minutes significantly decreased from 83.33% to 26.67% (p=0.001). Before the operation 26 (86.67%) patients were symptomatic. After the operation only 8 (26.67%) patients were symptomatic. This change was statistically significant (p=0.001). Conclusion: There were significant improvements in T1/2, AP diameter of the renal pelvis, and the degree of hydronephrosis. Renal function was preserved after the surgery. Also, pyeloplasty was effective in pain relief and should be recommended to adults with UPJO.

Operative versus non operative treatment for displaced intra articular fracture of calcaneus: A prospective study 58 patients

Background: Calcaneus fractures are the most common tarsal bone fractures, and displaced intra articular fractures account for 60% to &75% of all calcaneal fractures. Fractures of the calcaneus remain among the most challenging for the orthopedic surgeon to manage effectively as these injuries are more destructing and devastating. The management dilemma is still going on regarding conservative or operative treatment for such fractures as there is no clear evidence to delineate the gold standard treatment method, which is superior in every aspect. Material and Method: We have done a prospective study of 58 patients (2 had bilateral fracture) with displaced intra-articular calcaneus fracture after applying strict inclusion and exclusion criteria. We have randomly allocated patients into operative (A, n-30) and non-operative groups (B, n-30). We compared the clinical, functional and radiological outcomes of both groups. Results: The mean age in the operative group is 34.7 years and in the non-operative group is 36.03 years. The average follow-up is 12.4 months and the average time of union was 10.1 weeks in the operative group, while in a non-operative group it is 11.03 month and 10.6 weeks, respectively. The mean AOFAS score at the final follow up of the operative group is 84.2 and in the other group it is 79.4. Total of 8(39%) patients undergoing operative management have an excellent result, 15(50%) have good results,3(10%) have fair and 4(1%) have poor results as compared to the other group 4 (13%), 9 (30%), 8(27%), 9(30%) respectively. Conclusion: Operative management has a better radiological, clinical and functional score in comparison with conservatively managed patients of displaced intra articular calcaneal fracture. However, operative management is also associated with an increased number of surgery-related complications like long hospital stay, cost effectiveness, local wound healing problems, superficial and deep infection, implant related problems as compared to another group.

A Rare Case of Abdominal Aortic Aneurysm with Ureteral Compression

Abstract Introduction: In this report, we present a rare case of aortic aneurysm with associated left ureter obstruction and consequent hydronephrosis. Case presentation: A 62-year-old man was admitted for epigastric and periumbilical pain, extended in the spine, and anuria. As for associated diseases, he presented arterial hypertension stage II/III, chronic ischemic cardiomyopathy, acidosis, hyperpotassemia, spondylosis with radiculopathy, acute renal failure, renal lithiasis, and eating difficulties. After performing a CT scan, the patient was diagnosed with giant abdominal infrarenal aortic aneurysm with ureter compression, and retroperitoneal rupture with common and internal iliac arteries occlusion. We performed a xifo-pubian laparotomy with endoaneurysmorrhaphy and aortoiliac bilateral bypass using silver Dacron vascular prosthesis (16 × 8 mm in diameter). Douglas drainage was necessary, ending with laparoraphy. The patient presented a favorable postoperative evolution. Conclusion: Open surgery remains the gold standard method of treatment for large aortic aneurysms, given the inability of endovascular procedures to solve problems caused by compression.

The Investigation of Endomyocardial Biopsy Results, Plasma pro-BNP Levels and Non-invasive Parameters for Diagnosing of Acute Rejection in Patients Who Undergo Cardiac Transplantation

Aim: Heart failure is a disease with high mortality and morbidity, reducing the patient's quality of life. Each year 10% of heart failure patients progress to end-stage heart failure. Cardiac transplantation is the gold standard treatment method in these patients, however acute rejection is the most important factor affecting the success of this treatment. In this study, it was aimed to evaluate endomyocardial biopsy results, serum pro-BNP and non-invasive parameters in patients with acute rejection following cardiac transplantation.Patients and Methods: Twenty patients who underwent cardiac transplantation in our center were included in the study. The patients were divided into two groups, namely acute rejection (n: 10) and without rejection (n: 10). Echocardiography, electrocardiography (ECG), endomyocardial biopsy results, serum reactive proteins (CRP), sedimentation rate and serum pro-BNP levels, were evaluated among the patients and compared between the groups.Results: Endomyocardial biopsies obtained from patients with acute rejection revealed grade 1 rejection in 6 (60%) patients, grade 2 in 3 (30%) patients and grade 3 rejection in 1 (10%) patients. CRP and sedimentation rate were found to be similar between the groups (p&amp;gt; 0.05). High pro-BNP levels were found in patients with rejection (4843.20 ± 6690.10 pg / ml) when compared to the control group (496.30± 216.20 pg / ml) (p: 0.001). In addition, higher pro-BNP levels were detected with progressing of rejection grade (p: 0.03). The highest pro-BNP level was found in a patient with Grade-3 rejection (15211 pg / ml, p: 0.000).Conclusion: Our results show that serum pro-BNP levels are associated with acute rejection. In addition, higher pro-BNP levels were found to be associated with advanced rejection levels.

Port Site Infiltration and Intraperitoneal Instillation of Bupivacaine for Post Operative Analgesia in Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy has become the gold standard treatment method for symptomatic gallstone diseases. However pain is the only complaint that delays the discharge. This study aimed to evaluate the efficacy of bupivacaine infiltration into port site and instillation into peritoneal cavity to reduce pain following laparoscopic cholecystectomy. One hundred patients underwent elective laparoscopic cholecystectomy enrolled in this study. Patients were divided into experimental group (Group A) and control group (Group B) of 50 patients each. Following removal of gallbladder, patients of experimental group received 20 ml of 0.5% bupivacaine in gallbladder bed and 20 ml of 0.5% bupivacaine was infiltrated into 4 port sites. Control group received no treatment. The evaluation of postoperative pain was done at 4, 8, 12 and 24 hours postoperatively by using Visual Analogue Scale and the dose of NSAID was also recorded. Mean VAS score at 4, 8 and 12 hours postoperatively in experimental group was less than that of the control group (p&lt;0.05). VAS score at 24 hours postoperatively did not differ between two study groups (p&gt;0.05). The mean total NSAID doses used during first 24 hours postoperatively was less in the experimental group than control group (p&lt;0.05). The localization of pain during first 24 hours postoperatively was 62% incisional, 29% intra abdominal and shoulder tip pain 9%. Port site infiltration and intraperitoneal instillation of bupivacaine following laparoscopic cholecystectomy reduce pain following laparoscopic cholecystectomy and this simple, inexpensive and effective method should be practiced to minimize early postoperative pain for all elective laparoscopic cholecystectomy. Faridpur Med. Coll. J. Jul 2019;14(2): 58-61

Non-operative Management of Benign Colorectal Anastomotic Stenosis in Patients Undergoing Elective Surgery for Non-Metastatic Primary Rectal Cancer

Introduction: Benign anastomosis stenosis may develop in postoperative or long term period due to many reasons such as anastomosis leakage and anastomosis ischemia after colorectal surgery. While surgical treatment was commonly used in benign anastomosis stenosis in the past, surgery has left its place to more minimally invasive methods such as endoscopic treatments. There is no gold standard treatment method in the management of benign anastomosis strictures in the literature. In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer. Material and Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively. Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used. Discussion and Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented. Keywords: Rectal Neoplasms, Stenosis, Laparoscopy, Anastomostic stenosis

Management of chronic anal fissures: a narrative review

Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.

Prospective study of management of long bone fracture by intra-medullary elastic nailing in children

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The treatment of long bone fractures in children from 6 to 14 years is a challenging scenario. Titanium elastic nail (TEN) fixation was originally meant as a gold standard treatment method for femoral fractures, but was gradually applied to other long bone fractures in children, because it represents a middle path between conservative and surgical modality.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In the present study paediatric patients in the age group of 6 to 14 year with long bone fractures to be treated with TEN in the Department of Orthopaedics were admitted to MGM Hospital (Kamothe) were selected. A total of 30 patients consenting to undergo this study were subjected for treatment after screening using the inclusion and exclusion criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of the patients was 9.67±2.68 years. There was male preponderance (63.3%). In our study, RTA was observed to be the main cause of fracture (80%) whereas 20% fractures were due to fall. In our study, 50% patients had fracture of radius ulna followed by fracture of tibia 23.3%, femur (23.3%), and humerus (3.3%). The mean time to union was 5.30±1.06 weeks.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; TEN seems to be simple, biocompatible, more physiological, reliable and effective method of treatment of all long bone shaft fractures in 6 to 14 years old children. It is a rapid, safe and simple procedure with advantages of short operative time, minimal blood loss, shorter hospital stays early union, allowing early mobilization and early return to function with minimal complications.&lt;/p&gt;

Anterior intra-pelvic approach and corona mortis vascular anastomoses: A clinical anatomical study shows high frequency

Background/Aim. Corona mortis vascular anastomoses (CMVA) must be located during surgical gold standard treatment method for displaced acetabular fractures. This study aimed to answer the following questions: What is the clinical frequency observed of CMVA? What is the composition of CMVA: arterial, venous or a combination? Methods. A retrospective review was made of 31 patients (24 males, 7 females; mean age 43.5 years) who underwent surgery for acetabular fractures between 2011 and 2015. The anterior intra-pelvic (AIP) approach was applied to all patients. By examination of the intraoperative CMVA compositions, the frequency of CMVA was determined together with identification of venous or arterial formation and distance from the pubic symphysis. Results. CMVA was observed during dissection in 29 (94%) patients and was ligated. In 14 (45%) patients, CMVA was recorded as venous, in 7 (23%) patients as arterial and in 8 (26%) patients as both. The mean distance of CMVA from the pubic symphysis was 35.9 mm (range 21.6?48.7 mm). Conclusion. The results showed very high CMVA frequency in the AIP approach, higher than previously reported in the English literature. Orthopedic surgeons should be aware about CMVA while doing this approach in surgical treatment of acetabular fractures.