У статті подано результати використання мультимодальної програми швидкого одужання у хворих із пахвинними грижами, яким було виконано трансабдомінальну преперитонеальну герніопластику. Метою даної роботи було покращити безпосередні результати оперативного лікування в даного контингенту хворих. Хворим основної групи виконували інтратекальну анестезію з правобічною поверхневою блокадою шийного сплетіння та попереднє знеболювання троакарних ран і гідропрепарування очеревини. У контрольній групі знеболювання проводилося за стандартною методикою ендотрахеального наркозу. Усім пацієнтам, які входили в основну та контрольну групи, при трансабдомінальній преперитонеальній герніопластиці використовували об’ємний поліпропіленовий протез анатомічної форми, що не потребує додаткової фіксації після його імплантації в преперитонеальний простір. З’єднання країв очеревини над сітчастим імплантом здійснювали за допомогою технології електрозварювання біологічних тканин.Суб’єктивна оцінка якості життя та задоволеності результатами лікування виявилася статистично вірогідно кращою в основній групі пацієнтів. Лапароскопічна трансабдомінальна преперитонеальна герніопластика в поєднанні з мультимодальною програмою швидкого відновлення є безпечною лікувальною стратегією, що може стати альтернативою стандартним методикам лікування та реабілітації хворих із пахвинними грижами.

Purpose To focus on the importance of tensor fascia lata or sartorius muscle flaps to improve wound healing and to save exposed groin vascular grafts with minimal complications and to evaluate which is better. Background Treatment of an exposed groin vascular grafts after vascular interventions may be challenging. Saving these grafts saves a patient’s limb. Patients and methods A prospective, randomized clinical trial was conducted on 54 patients suffering from exposed groin vascular grafts to compare postoperative outcomes using tensor fascia lata flap [group A; 28 (51.8%) cases] versus sartorius muscle flap [group B; 26 (48.2%) cases]. Postoperative follow-up was for 6 months. Results No flap loss was recorded in any of the procedure. Minor complications, such as skin graft was lost partially, were seen in group A in five (17.9%) cases at the donor area, but partial loss of skin graft was noticed only in one (3.8%) case in group B (P=0.0022). Small hematoma was noticed in in six (21.4%) cases in group A but only in two (7.6%) cases in group B (P=0.0036). Finally, overall wound healing was noticed in 22 (78.6%) cases in group A and 24 (92.3%) cases in group B (P=0.014). Conclusion Both tensor fascia lata and sartorius muscle flaps for exposed groin vascular grafts are considered a protective weapon to save these exposed grafts and to help to ensure good wound healing. Sartorius muscle flaps are easily rotated from the same incision, are more effective, and are safe, with minimal postoperative complications.

Introduction Chronic groin pain is a significant morbidity following open mesh hernioplasty for inguinal hernia. Although the pain is often mild in nature, different studies have shown that chronic pain, irrespective of severity, can significantly interfere with normal daily activities. Identification and division of the ilioinguinal nerve (IIN) can reduce chronic postoperative inguinal pain as suggested by many authors, yet controversies persist. Patients and methods This prospective study was carried out on 240 patients with primary inguinal hernias categorized into two equal groups. Group A patients underwent prophylactic ilioinguinal neurectomy, whereas nerve preservation was done in group B patients during Lichtenstein tension-free mesh hernioplasty for inguinal hernia in the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (24 months, from January 2017 to December 2018). Follow-up of postoperative groin pain was done on first postoperative day, seventh postoperative day, and after 1, 3, and 6 months using visual analog scale. Results The difference between both groups regarding postoperative pain after 6 months at rest was statistically insignificant. However, after minor exercises like coughing 10 times, walking up three flights of stairs, or cycling for 10 min, there was a statistically significant difference, as no pain occurred in group A patients, whereas 30% of group B patients experienced pain (P 0.05). Conclusion Prophylactic ilioinguinal neurectomy may be beneficial in minimizing inguinal neuralgia after mesh hernioplasty of inguinal hernia.

Background and aim Relaparoscopic repair of recurrent inguinal hernia carries a lot of challenges. The encountered complex surgical technique is assumed to have greater possibilities of surgical complications with consequent higher recurrence rates. The aim of this study was to evaluate the feasibility, safety, and reliability of laparoscopic approach for recurrent inguinal hernia after previous laparoscopic repair. Patients and methods Records of 33 patients with 34 recurrent inguinal hernias after previous laparoscopic management have been retrospectively revised. The performed procedure for second repair was transabdominal preperitoneal repair for all the cases. Data of perioperative complications, immediate postoperative course, and hernia recurrence were collected and analyzed. Results No intraoperative complications were encountered. Postoperative pain was recorded as moderate. The mean follow-up period ranged from 14 to 40 months with a mean of 24.82±6.9. During the follow-up period, three (9%) cases developed groin seroma and one (3%) case had transient thigh numbness. Of the patients, 85% returned to normal daily activities within 14 days postoperatively. Two patients had rerecurrence of the hernia and they were managed by Lichtenstein repair. Conclusion Relaparoscopic repair of recurrent inguinal hernia is safe and applicable. The procedure should be performed with experienced hands.

Background Despite all advances in the treatment of varicose veins, recurrence rates are still high, and multiple factors have been incriminated. This study aims to evaluate the safety and efficacy of whole-length great saphenous vein ablation, starting flush with the saphenofemoral junction down to the ankle, using a new technique combining laser and chemical ablations. Patients and methods A prospective study was conducted that included patients with varicose veins who presented to the Vascular Surgery Department, Dr. Soliman Fakeeh Hospital, KSA, in the period from May 2016 to February 2018. All patients were treated with endovenous laser ablation of the whole great saphenous vein starting flush at the saphenofemoral junction using radial fiber combining low-level laser energy with truncal injection sclerotherapy for the below-the-knee vein segment with adjusted linear endovenous energy density. Patients were followed up for 18 months. Chronic venous disease quality of life questionnaire-20 (CIVIQ-20) was obtained before treatment and after 6–12 months. Results This study included 125 patients (132 limbs), their mean age was 40.4±11.8 years, male to female ratio was 1 : 2.4, Clinical, Etiological, Anatomical, Pathological (CEAP) classification was 2–6, the presentation was bilateral in seven (5.6%) patients, technical success was achievable in 99.3% of patients, need for extra-truncal treatment at the same time of ablation (laser, injection, or phlebotomy) in 64 (48.5%) patients, postoperative deep vein thrombosis was seen in 0%, saphenous nerve injury was seen in one (0.7%) case, recanalization at 6–12–18 months was seen in two (1.5%) cases, and improvement in CIVIQ-20 from 71.25±9.6 to 32.4±4.6 and 29.7±1.2 was seen at 6 and 12 months, respectively. Conclusion The use of the radial laser fiber allows safe flush thermal ablation of the great saphenous vein, with the anticipated decrease in groin recurrence, combined with thermochemical ablation of the below-the-knee segment has promising result in short-term and mid-term follow-up.

Terminal Groin at Deal Beach, Deal, New Jersey, U.S.A

Aim A randomized controlled study comparing the impact of fixation vs non-fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty on chronic groin pain and quality of life of patients. Patients and methods This study includes 100 patients presented with primary unilateral indirect inguinal hernia treated at Benha University Hospital from June 2016 to August 2018. Patients were randomized to TAPP inguinal hernia repair with fixation of mesh (group A, n=50) and without fixation of mesh (group B, n=50). Parameters assessed included operative duration, time to early ambulation, postoperative pain, and postoperative complications and quality of life. Assessment of pain was done using the visual analog scale at 1 day, 3 months, and 6 months after surgery. Evaluation of quality of life was done using the 36-item short-form health survey 3 months postoperatively. Results The mean operative duration and time to early ambulation in group B (without mesh fixation) were reduced significantly in comparison to group A (with mesh fixation). The visual analog scale score at 1 day, 3 months, and 6 months after surgery for group B was significantly lower than in group A. The physical function (PF), bodily pain (BP), role physical (RP), and general health (GH) in group B were significantly higher than group A while there is no statistically significant difference in vitality (VT), role emotional (RE), social function (SF), and mental health (MH) between group A and group B. Conclusion Mesh fixation and non-fixation in laparoscopic TAPP approach for the repair of inguinal hernia are comparable regarding operative duration, postoperative complications, and time to ambulation while pain scores and quality of life were significantly better in the non-fixation group.

Iliopsoas hematoma is a rare complication in patients on warfarin and usually presents as lower abdominal, groin or thigh pain. The author presents a case of spontaneous iliopsoas hematoma in an 89-year-old female that was initially suspected to be a hip fracture. A review of 12 case reports on iliopsoas hematoma in patients on warfarin shows that the mean age of reported cases was 72 years. Patients present with lower abdominal, groin, flank or thigh pain (100%), lower extremity weakness and/or difficulty in walking (50%) and loss of or abnormal sensation in the lower extremity (17%). Forty two percent of the hematoma cases were in patients with therapeutic or sub-therapeutic international normalized ratio (INR). Iliopsoas hematoma should be considered in elderly patients on warfarin who present with lower abdominal or groin pain, even in patients with therapeutic or sub-therapeutic INR.

Objective To explore the clinical characteristics of patients with female stress urinary incontinence(SUI) and efficacy of Transobturator Tension-free vaginal tape procedure. Methods We retrospectively analyzed the clinical data of 319 cases who were operated transobturator tension free vaginal tape in Shanghai Changhai Hospital Affiliated of Naval Medical University from Oct.2009 to Jun.2018. Patients age ranged from 39 to 91 years old, with the average age of(59.2±9.7)years old. 145(45.5%) patients aged ≥60 years old. Among them, 155 (48.6%) patients with moderate SUI, 164(51.4%) with severe SUI.96 cases(30.1%) hypertension, 24(7.5%)diabetes, 2(0.6%)had not given birth, 317(99.4%)patients had given birth more than once. 31(9.7%) coexisting pelvic organ prolapse with POP-Q stage 2 and above. Maximum urinary flow rate ranged 5.2-72.6 ml/s. Cystometric capacity ranged 56.7-1 013.6 ml. Average preoperative ICIQ-SF score was 13.9 (range 9-19). Results Operative time of 288 TVT-O procedures ranged 19-60 min, and 31 cases in the surgical management of cystocele with concomitant ranged 50-120 min. A total of 265 patients were evaluable followed up for 12-24 months, Objective cure rate and subjective cure rate were achieved in 95.8%(254 cases) and 93.6%(248 cases) respectively. POP was cured in 96.8% patients.Postoperative complications were 10.6% groin pain, 4.5% urgency, others including urinary tract infection(3.4%), de novo dysuresia(2.6%), dyspareunia(1.1%), and one case of bladder injury, one case sling erosion and one case scar hyperplasia. Conclusions Female stress urinary incontinence were mainly in middle-aged and elderly people who had severely psychological quality of life lasting for several years. TVT-O may achieve a high success or improvement rate and no serious adverse effects. One operation could correct the stress urinary incontinence and simultaneously correct prolapse. Key words: Urinary incontinence, stress; Clinical features; Transobturator tension-free vaginal tape

Malignant penile neoplasms are commonly squamous etiology, with the inguinal nodes being the first echelon of spread. The disease spreads to the pelvic lymph nodes only after metastases to the groin nodes, and this is the most important prognostic factor in penile carcinoma. While treatment of penile carcinoma with proven metastases to the inguinal lymph nodes mandates ilioinguinal lymph node dissection, the treatment of patients with impalpable nodes is more controversial. Overtreatment leads to excessive treatment-related morbidity in these patients, while a wait-and-see policy runs the risk of patients presenting with inguinal and distant metastases, which would have been curable at presentation. Unfortunately, no single imaging modality has been proved to be convincingly superior in the staging, and hence, management of the clinically negative groin has been subject to debate. While some high volume centers have promoted the use of dynamic sentinel lymph node biopsy, others advocate the use of the modified inguinal lymph node template to stage the groin adequately. Newer techniques such as video endoscopic inguinal lymph node dissection have been introduced as an alternative to the original radical inguinal lymphadenectomy to reduce morbidity.

Objective To investigate the therapeutic effect of varicocele treated with high ligation of the inguinal or retroperitoneal varicocele and microsurgical ligatures vein ligation. Methods A retrospective analysis of 90 patients with varicocele treated in our hospital from August 2015 to March 2018 was conducted. The patients were divided into three groups according to the different surgical methods. They were group A (surgical methods: High inguinal varicocele ligation), group B (surgical method: high retroperitoneal varicocele ligation) and group C (surgical method: microsurgical ligatures vein ligation), 30 cases in each group. The operative time, blood loss, postoperative day temperature, length of hospital stay, sperm quality, postoperative complications, and recurrence of the three groups were compared. Results The operation time of group C was significantly longer than that of group A and B, and the difference was statistically significant(P 0.05). One year after operation, the sperm quality indicators of the three groups were significantly higher than before surgery, and the difference was statistically significant (P<0.05). At the same time, the quality of each index in group C was significantly higher than that of group A and B(P<0.05). The group C of the 2 h incision pain was significantly better in group A and group B(P<0.05). The incidence of postoperative complications in group C was significantly lower than that in group A (40%) and group B (33.3%) (P<0.05). The difference in disease recurrence between the three groups was not statistically significant(P<0.05). Conclusions Microsurgical ligatures vein ligation for the treatment of varicocele compared to the inguinal or retroperitoneal varicocele ligation, its effect on improving sperm quality is better, the incidence of complications is low, the safety is higher , is worthy of further promotion of surgical methods. Key words: Varicocele; Groin; Peritoneum; Ligation; Spermatozoa

Background Hernia is a common problem of the modern world with an incidence ranging from 5 to 7%. Of all groin hernias, around 75% are inguinal hernias. Recently with the advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work. Aim of the work To compare between self-fixating mesh and fixation of non-self-fixating mesh with absorbable tacks in laparoscopic inguinal hernia repair transabdominal preperitoneal approach as regards intraoperative time, complications, postoperative pain, return to normal activity, and incidence of recurrence. Patients and methods Our study is a randomized, prospective study. It was conducted in El Demerdash, Ain Shams University Hospital on 30 patients with inguinal hernia who were operated upon between September 2018 and December 2018 with a minimal follow-up of 3 months. Statistical analysis used Data were collected, revised, coded, and entered to the Statistical Package for the Social Sciences (IBM SPSS), version 23. The quantitative data were presented as mean, SDs, and ranges when their distribution was found parametric. Also qualitative variables were presented as number and percentages Results Our study demonstrates that laparoscopic inguinal hernia repair using the transabdominal preperitoneal technique with implantation of a new Parietex ProGrip laparoscopic self-fixation mesh is a fast, effective, and reliable method in experienced hands, which combines the advantages of laparoscopic approach with simple and practical implantation of self-fixation mesh, which, according to our results, reduces the occurrence of chronic pain and the recurrence rate. Conclusion After this comparative study, both the use of self-gripping mesh and fixation of mesh by absorbable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications, and chronic pain coinciding with all the available literature.

Objective To explore the clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting. Methods The retrospective descriptive study was conducted. The clinical data of one 66-year-old male patient who underwent Da Vinci robot-assisted iliofemoral vein bypass grafting in the First Affiliated Hospital of Army Military Medical University in March 2019 were collected. The patient was failed to recanalize iliofemoral vein stent thrombosis by endovascular measures and underwent Da Vinci robot-assisted iliofemoral vein bypass grafting after balloon occlusion preset in the common iliac vein. Observation indicators: (1) intra- and post-operative situations; (2) follow-up and survival situations. Follow-up using outpatient examination was performed to detect the patient′s postoperative survival and swelling reduction of affected extremity up to April 2019. Results (1) Intra- and post-operative situations: the patient underwent Da Vinci robot-assisted iliofemoral vein bypass grafting successfully. The operation time of balloon occlusion preset by digital subtraction angiography was 35 minutes. The operation time of Da Vinci robot-assisted iliofemoral vein bypass grafting was 502 minutes (50 minutes of exposure time of femoral vein, 80 minutes of exposure time of iliac vein, 40 minutes of great saphenous vein harvesting time, 70 minutes of end to side anastomosis between autogenous great saphenous vein and femoral vein, 10 minutes of subcutaneous tunnel construction, 90 minutes of end to side anastomosis between autogenous great saphenous vein and iliac vein, 60 minutes of suturing except vessel closure, 102 minutes of preparation time, check and washing time). The volume of intraoperative blood loss was 500 mL and no intraoperative complications occurred. The autogenous great saphenous vein graft was well filled and no bleeding was found at both proximal and distal anastomoses after iliofemoral vein bypass grafting. There were 4 abdominal Trocar holes including 2 of 1.2 cm and 2 of 0.8 cm. The incisional length of right groin and left great saphenous vein harvesting region was 5.0 cm and 15.0 cm, respectively. At the discharge time, the patient had swelling subsided partially at right lower extremity and skin tesion reduced significantly compared with the admission. The perimeters at 15 cm above right knee joint and left knee joint were 53.5 cm and 48.0 cm. The maximum perimeters of right calf and left calf were 41.0 cm and 38.0 cm. No postoperative complications occurred. Duration of hospital stay after surgery was 3 days. (2) Follow-up and survival situations: the patient was followed up for 1 month, with good survival. The patient had swelling subsided of affected extremity. The perimeters at 15 cm above right and left knee joint were 52.0 cm and 48.0 cm. The maximum perimeters of right calf and left calf were 40.0 cm and 38.0 cm. Conclusion The Da Vinci robot-assisted iliofemoral vein bypass grafting is safe and feasible, with good short-term outcomes. Key words: Vein thrombus; Da Vinci robotic surgical system; Vein; Bypass grafting; Minimally invasive surgery

Background Inguinal hernia repair is one of the most common elective general surgical procedures, and laparoscopic inguinal hernia repair has become very popular procedure, accounting for 15–20% of hernia operations worldwide. Aim of the work This study was conducted to compare mesh fixation versus nonfixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Patients and methods This study is a prospective randomized comparative study that was carried out in the Gastrointestinal and Laparoscopic Surgery Department of Tanta University Hospitals for a year on 40 patients with inguinal hernia who underwent TEP inguinal hernia repair. They were randomized into two equal groups (20 cases): group A: with mesh fixation and group B: without mesh fixation. Results All patients of both groups were males. Group A had a longer operative time than group B (P=0.018). There was no significant difference in postoperative pain in both groups (P=0.6). One (5%) patient in each group had an accidental peritoneal tear. No cases needed conversion. Drain was inserted in one (5%) patient in each group (P=1). No cases had seroma or hematoma formation or chronic groin pain in both groups. One (5% each) patient in each group had scrotal edema, and postoperative surgical emphysema was present in two (10%) patients in each group. No cases of postoperative wound infection or mesh infection were seen in both groups. There was a recurrence in one patient in group B (after 1 week postoperative). The mean hospital stay is statistically insignificant in between both groups. The mean total cost is much higher in group A than group B (P Conclusion On comparing mesh fixation or nonfixation in laparoscopic TEP repair for inguinal hernia, we recommend the technique without mesh fixation as there were no differences in the complications, hospital stay, or recurrence, but longer operative time and higher cost were seen in mesh fixation technique.

Background The aim of this study to assess the result of catheter directed thrombolysis (CDT) in acute thrombotic lower limb ischemia with special emphasis on the technique and challenges. Methods It is a prospective study that was held in vascular surgery department, Cairo University from March 2016 to March 2018. Twenty four patients with ALI were recruited with infra-inguinal acute native arterial occlusions less than 14 days. Inclusions criteria were age is less than 75 years, ALI categories I, IIa Rutherford classification. Exclusion criteria were; acute embolic ischemia, ALI category IIb or III Rutherford classification, occluded bypass graft, contraindication of thrombolytic therapy and Patients older than 75 years. Result Twenty four consecutive patients (19 males and 5 females) were included in the study with mean Age 63.5 years. Out of 24 CDTs performed, 20 patients (83.3%) required additional procedures, 15 percutaneous intervention (12 balloon dilatations and 6 stentings for superficial femoral artery (SFA), and 3 cases of aspiration thrombectomy) and 3 open procedures (3 cases of popliteal thromboemolectomy) and 2 hybrid cases of CFA thromboendarterectomy and angioplasty for femeropoliteal segment). Five bleeding complications were reported in the study group with 4 clinically non- major bleeding complications, all were managed conservatively. Major bleeding from groin required surgical intervention in only one case. A total of 4 (16.6%) major amputations were done during the follow-up period, the amputation-free survival was 87.5%, 83.3%, and 83.3 at one, three, and six months post-procedurally. No mortalities in the study patients during 6 months of follow up. Conclusion Thrombolytic therapy remains an effective and valuable option for treatment of ALI. About 25% of patients still required an open procedure post thrombolytic therapy. So; proper patients selection is needed to detect patient who will benefit from primary surgery rather than thrombolysis.

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND) and standard pelvic lymph node dissection (sPLND) in open radical cystectomy. Methods We retrospectively analyzed the clinical data of 139 patients with bladder cancer cases in our hospital from January 2007 to January 2017, who underwent open radical cystectomy and pelvic lymph node dissection performed by the same group of surgeons. There were 117 males and 22 females, aged from 20 to 84 years old, with an average of (64.6±11.7) years, 91 patients were underwent ePLND group and 48 patients were underwent sPLND group. The preoperative anemia-free patients was compared between the ePLND group and the sPLND group [24 (50.0%)] vs. 58 (54.9%), respectively], the patients with anemia were [24 (50.0%) vs. 41 (45.1%)]. The range of ePLND is: sway to the common iliac artery and the lower aortic (unreaching the inferior mesenteric artery); the lateral boundary to the reproductive femoral nerve; the distal end of the iliac artery at the groin level, the posterior border to the iliac vessels and closure, which contains the anterior tibial lymph nodes between the two sides. The range of sPLND is below the level of the common iliac artery bifurcation, and the rest of the range is the same as ePLND. The average operative time, average intraoperative blood loss, intraoperative blood transfusion, intraoperative and postoperative complications, postoperative eating time, postoperative activity time, postoperative exhaust time, postoperative hospital stay, mean gastric tube indwelling time, average pelvic drainage tube indwelling time, lymph nodes positive rate, lymph node density, and cancer-free survival were evaluated. Results All 139 patients underwent surgery successfully. The average operative time in the ePLND group and the sPLND group were [(351.2±79.5) min vs.(342.5±69.3) min], average intraoperative blood loss [(314.6±120.6) ml vs.(298.3±126.3) ml], intraoperative blood transfusion [(702.9±645.7) ml vs.(936.9±818.1) ml], no intraoperative complications, postoperative complications [29 cases (31.9%)vs.18 cases (37.5%)], postoperative eating time [(5.4±1.9)d vs.(4.8±2.1)d], postoperative activity time[(2.1±0.9)d vs.(1.9±0.8)d], postoperative exhaust time [(3.8±0.9)d vs.(3.6±1.0)d], postoperative hospital stay [(14.9±7.8) d vs.(15.5 ± 6.9) d], average gastric tube indwelling time [(4.8 ± 2.6) d vs.(4.53± 1.9) d], average pelvic drainage tube indwelling time [( 11.1±4.9)d vs.(10.9±4.9)d], the difference was not statistically significant (P>0.05). A total of 2 359 lymph nodes were dissected from the two groups. The number of lymph nodes dissected in each of the ePLND group and the sPLND group was [(20.3±3.8) vs. (10.6±3.1), P<0.01], and the average number of positive lymph nodes was [(0.6±1.3) vs.(0.3±1.0), P=0.034], the ratio of lymph node positive patients was [33 (36.3%) vs. 9 (18.8%), P=0.026], and the lymph node density was [7.9% (146/1848) vs. 4.1% (21/511)], the difference was statistically significant (P<0.05). In regard to prognosis, the disease-free survival rate (DFS) of ePLND group was 94.5%, 91.0%, 84.4%, 81.1%, 75.3% at 1, 2, 3, 4 and 5 years follow-up respectively. The other group was 70.5%, 63.5%, 57.8%, 51.4%, 41.1% respectively. DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups. The difference between the two groups was statistically significant (P<0.001). Conclusions In open radical cystectomy, ePLND and sPLND have similar surgical safety, but expanded lymph node dissection can improve disease-free survival in patients and improve the prognosis by increasing the detection range of positive lymph nodes. Key words: Bladder cancer; Radical cystectomy; Lymph node dissection; Cancer-free survival; Prognosis

We describe two new species of Pristimantis from southwestern Colombia. The first new species inhabits the humid Pacific slopes of the Cordillera Occidental, Valle del Cauca; it is most similar to three allopatric Ecuadorian species—P. eugeniae (Lynch and Duellman 1997), P. nyctophylax (Lynch 1976), and P. subsigillatus (Boulenger 1902). It is distinguished, however, by having subarticular tubercles beneath the joint between distal phalanges, basal webbing on outer edge of toe IV, papilla at the tip of snout, and uniform cream-brown coloration on the anterior surfaces of thighs and in the groin. The second new species inhabits the high mountains of the Cordillera Central, Cauca, and it is most similar to P. boulengeri (Lynch 1981) and two Peruvian species—P. deyiLehr et al. 2013 and P. schultei (Duellman 1990). However, it differs by having subarticular tubercles beneath the joint between distal phalanges, dorsal skin with low warts, papilla at the tip of snout, and by lacking tympanic membranes, dentigerous processes of the vomer, and vocal slits.

Objectives: The objective of this study was to evaluate and describe the current practice of surgical repair of inguinal herniotomy among pediatric surgeons working in Saudi Arabia. Materials and Methods: Between May and June 2018, a questionnaire of 15 multiple choices was sent to all pediatric surgery consultants working in pediatric surgery units across the kingdom of Saudi Arabia. The responses to the questionnaire were analyzed and categorized as shown in the results section. Results: A total of 215 questionnaires were sent, over half of the practitioners fill the questionnaire 56.3% (121). With fair distribution, among type of hospitals were 33% in children hospital, 33% in tertiary hospital, 7% in private hospital, and 8% in general or academic hospitals. Regarding the diagnosis, almost all the surgeons depend on the mother history of a swelling in the groin that comes and goes. The majority (97%) of surgeon will do a standard open herniotomy for male infants, and only 2% will do laparoscopic hernia repair. For ex-premature infants with an inguinal hernia and already discharged from the neonatal intensive care unit, 35% will repair the hernia at presentation regardless of the age, 27% will do it after 50 weeks of postmenstrual age, 18% will do it after 60 weeks of postmenstrual age, 12% will do it after 2 months or above 5 kg weight, and only 8% will do it on urgent basis. Conclusions: The majority of pediatric surgeons depend on a clinical diagnosis of inguinal hernia. Although the timing of surgical repair is still controversial, the majority of pediatric surgeons will repair inguinal hernia as soon as possible. Still, there is no consensus on when or if contralateral inguinal exploration is necessary.

O litoral de Fortaleza/CE apresenta desde o século XIX importantes alterações na linha de costa, principalmente devido a obras portuárias e de estruturas mitigatórias de erosão. A pesquisa teve como objetivo analisar a evolução batimétrica do litoral norte de Fortaleza desde o início de operação do porto do Mucuripe em 1945. A área de estudo foi delimitada pelo espigão do Titanzinho e o emissário submarino, porém foi enfatizado o entorno portuário. Foi realizada a construção de modelos digitais batimétricos a partir das cartas náuticas da Diretoria de Hidrografia e Navegação – DHN entre 1945 e 2014. Evidenciou-se devido às constantes intervenções antrópicas a presença de dois setores: um adjacente a ponta do Mucuripe, com o substrato diretamente modificado por atividades de gerenciamento portuário e um segundo setor, que seria o restante da área submersa até o emissário submarino. O primeiro setor é marcado pela criação de áreas eminentemente deposicionais devido ao molhe do Titã (efeito sombra hidrodinâmica), Titanzinho (barramento da deriva litorânea) e pelo Píer (devido ao efeito sombra do Titã e do avanço da bacia de evolução). Verifica-se que o sotamar do Titã e entornos do Píer foram sucessivamente dragados desde a década de 1950, além da criação do canal de acesso do porto na década de 1970. O segundo setor é marcado pela presença dominante de feições arenosas, destaca-se um banco longitudinal subparalelo a linha de costa de cerca de 2 Km². Esta feição apresentou grandes variações espaço-temporais desde a instalação das estruturas portuárias, no entanto a sua gênese estaria relacionada a duas possíveis origens: efeito morfodinâmico do promontório do Mucuripe no redirecionamento dos processos (pretéritos e atuais) e/ou como uma antiga barreira costeira, que posteriormente foi afogada devido à elevação do nível relativo do mar no Quaternário Superior. Destacam-se quatro complexos rochosos – o Recife do Meireles, o Recife Grande, a Pedra do Justin, e o Recife da Velha. No fim do setor dois (praia da Leste), tem a presença do emissário submarino com cerca de 3 km de comprimento e uma área de descarte de sedimentos dragados. Este setor se apresenta parcialmente modificado pelas estruturas portuárias, onde as principais alterações ocorrem nas proximidades da linha de costa (espigões e enrocamentos). Verifica-se que a morfologia do litoral submarino de Fortaleza apresenta grandes modificações (aprofundamento do leito, criação de altos sedimentares) nas proximidades do Porto do Mucuripe e na linha de costa, devido às estruturas rígidas de proteção e operação portuária.

Objective To explore the method and clinical value of sentinel lymph node biopsy for penile carcinoma guided by multispectral separate-merge guided surgery device(MGS). Methods The clinical data of 7 patients with sentinel lymph node biopsy of penile cancer guided by MGS from April 2017 to April 2018 were analyzed retrospectively at First Hospital of Shanxi Medical University. They were 62-78 years old, with an average age of 65 years. All of carcinoma was located in the glans or coronal sulcus, which diameter was 1.0-3.5 cm, with an average of 2.5 cm. Three cases of inguinal lymph nodes could be non-palpable and the others palpable. All patients were injected 0.25 ml (2.5 mg/ml) of indocyanine green solution with 1 ml syringe at 12, 4, 6 and 9 points in the proximal normal skin of penile tumors. Immediately, the imaging probe was aligned with the injection point to observe the dynamic changes of fluorescence image on MGS display. Results There were 14 sides of groin in 7 patients, except for 1 side without images, other 13 sides developed well. The images displayed by MGS include visible image, fluorescent image and merged image, and the merged image was green pseudo color. According to the dynamic changes of the image, it could be divided into five parts: injection point, penile body, pubic symphysis, inguinal region and sentinel lymph node. In 13 well-developed sides, fluorescence gradually disappeared in other parts about 15 minutes after injection, and the location of sentinel lymph nodes was determined in vitro by gradually consolidating and fixing the fluorescence images in the inguinal region. The lymph node-like tissue with strong fluorescence intensity was observed immediately after the skin incision. There was a clear boundary between the lymph node-like tissue and the surrounding tissue. Along this boundary, lymph nodes were separated, ligated, excised. No lymph nodes were found on the undetected side. Postoperative pathology confirmed that lymph nodes were located by fluorescence imaging in vitro and traced by fluorescence imaging in vivo, the coincidence rate was 100%. There were residual fluorescent tissues on three sides and lymphatic vessels were removed. Conclusions MGS-assisted intraoperative fluorescence imaging could improve the doctor's visual depth so that physicians can real-time, dynamic, accurate in vitro location and in vivo tracking of sentinel lymph nodes of penile cancer. Key words: Penile carcinoma; Sentinel lymph node biopsy; Fluorescence image; Indocyanine green; Image guided