Department Of Surgery Research Articles

Evaluation of Thrombomodulin, Heart-Type Fatty-Acid-Binding Protein, Pentraxin-3 and Galectin-3 Levels in Patients with Myocardial Infarction, with and Without ST Segment Elevation

Background: Medical history, ECG findings and cardiac markers are used in the diagnosis of myocardial infarction (MI). Biomarkers used especially for the diagnosis of MI include high-sensitivity troponins (hsTns), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), myoglobin, cardiac myosin-binding protein C and new cardiac biomarkers. This study evaluated the levels of serum thrombomodulin (TM), heart-type fatty-acid-binding protein (H-FABP), pentraxin-3 (PTX-3) and galectin-3 (Gal-3) to determine their utility in distinguishing between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). Methods: This study included a total of 180 patients (90 patients with acute STEMI and 90 patients with NSTEMI) who presented to the Gaziosmanpaşa Training and Research Hospital, Cardiovascular Surgery and Emergency Department, with ischemic chest pain lasting longer than 30 min. Ninety healthy volunteers were included as the control group. Results: Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), TM, H-FABP, PTX-3 and Gal-3 were significantly different across the STEMI, NSTEMI and control groups (p < 0.001). Strong positive correlations were observed between NT-proBNP and TM, H-FABP, PTX-3 and Gal-3 in the STEMI group. ROC analysis demonstrated excellent diagnostic accuracy for these biomarkers in distinguishing STEMI from NSTEMI and control groups. Conclusions: Vascular inflammation plays an important role in the pathophysiology of STEMI and NSTEMI. A comprehensive cardiac biomarker panel enhances diagnostic accuracy and risk stratification, particularly when distinguishing between STEMI and NSTEMI. The biomarkers hs-TnI, CK-MB, NT-proBNP, TM, H-FABP, PTX-3 and Gal-3 offer complementary information when used together as a panel. Further research and validation are essential to establish standardized protocols for their widespread use.

Utilisation of Radiation Oncology Services by Patients with Head and Neck Malignancies in a Nigerian Tertiary Care Hospital: A 5-Year Retrospective Study

Abstract Background: Radiation oncology services are luxuries in resource-challenged settings that should not be underutilised; however, no studies are available on their utilisation. Objectives: To determine the rate and pattern of utilisation of radiation oncology services in a Nigerian teaching hospital. Materials and Methods: All cases of head and neck cancers diagnosed and referred to the Department of Radiation Oncology, of a Nigerian Tertiary Care Hospital, from January 2018 to December 2023 were retrospectively analysed. Data were extracted from the case notes of the patients. Those patients with incomplete information were excluded. Demographic and clinical data were collected. Demographic data included were age, sex, religion, and place of residence, while the clinical data were regional location of cancer, nature of the tumour, origin of tumour, histological type and grade of tumour, and referring department. Both descriptive and inferential statistics were determined. Data were analysed using IBM SPSS Statistics for Windows, version 23.0 software (IBM, Armonk, New York). A value of P < 0.05 was considered significant. Results: A total of 13,690 patients presented for the radiation oncology treatment, of which 1777 patients were treated for head and neck cancer, giving a prevalence of 0.56%. The age 18 range was 20–78 years with a mean age of 49.4 ± 13.7 years. More than half (77%) of the patients were older than 60 years. Two-thirds (74%) of the patients were males. Most (46.8%) of the lesions were on the oral region, which was followed by the nasal region (25%), while the least (6.5%) were observed on the cervical region. More than two-thirds (87%) originated from epithelial cells. In the same vein, the majority (88.3%) were non-odontogenic in origin. More than half (51.9%) were squamous cell carcinomas. Most (51.9%) of the patients were referred from the Department Of Oral and Maxillofacial Surgery. Ethnicity significantly affected the nature of the tumour (P < 0.05), as did the histological types (P < 0.05) of head and neck cancers. Religion was associated with the type of referring departments (P < 0.05). Conclusion: The utilisation of radio-oncological services was high. There was significant distribution of referrals, histological types and types of tumours according to religion and ethnicity.

Decoding Chronic Jaw Pain: Key Nature of Temporomandibular Disorders in Slovak Patients

Abstract Background Temporomandibular disorder (TMD) affects the jaw joint and muscles, causing pain, jaw movement issues and symptoms like clicking sounds. More common in women, TMD is linked to factors like stress, bruxism and posture. It often coexists with headaches and neck pain, with causes being a mix of physical and psychological factors. Therefore, we decided to examine Slovak patients with TMD to better understand their specific experiences. Methods Patients with TMD were recruited from the Department of Stomatology and Maxillofacial Surgery at University Hospital in Slovakia from 2017 to 2024, resulting in a sample of 380 patients. Inclusion criteria required adults aged 18–90 with TMD symptoms, such as jaw pain and movement difficulties, diagnosed by a maxillofacial surgeon. Patients completed paper-based questionnaires on background information; TMD characteristics and symptoms; and medical history, psychological factors and prior treatment. Results We confirm that TMD predominantly affects female patients (81.1%) and tends to be a chronic condition, with 58.6% of patients having experienced it for over 6 months. A significant proportion reported moderate to severe pain (42–26.4%) and nearly half (43.7%) experienced constant pain. Movement-triggered pain was common (67.8%), and most patients reported sound phenomena (96.9%) and difficulty opening the mouth (65.6%). Stress played a significant role, with 43.7% of patients experiencing a higher emotional burden and 32.4% reporting stress-related worsening of symptoms. Additionally, 46.3% of patients worked in sedentary environments, potentially contributing to their condition. Conclusion Most Slovak TMD patients experience multidimensional interplay of physical, psychological and social factors.

Histopathologic spectrum and clinical management of pharyngeal and laryngeal sarcomas.

Sarcomas are rare mesenchymal malignancies (<1% of all cancer types), with 5-15% occurring in the head and neck. Common types include osteosarcoma, chondrosarcoma, and rhabdomyosarcoma. They often recur and have poor survival rates. Treatment involves surgery, radiation, and/or chemotherapy, utilizing a multidisciplinary approach. This study aims to overview sarcomas at our hospital and illustrate the interdisciplinary management of pharyngeal and laryngeal cases. This single-center study provides a comprehensive analysis of head and neck sarcomas (HNS) and examines interdisciplinary treatment approaches for pharyngeal and laryngeal sarcomas in patients treated at the Department of Head and Neck Surgery, Technical University of Munich, from 2007 to 2022. The study encompasses data on age, gender, histopathological diagnoses, treatment modalities, follow-up, and outcomes, with an emphasis on histopathological findings and collaborative therapeutic strategies. 27 cases of HNS were identified (2007-2022). Among these, 11 were pharyngeal or laryngeal sarcomas. All pharyngeal sarcomas underwent primary resection with reconstruction based on tumor location and extent. In laryngeal sarcomas, three required laryngectomy, one had a hemilaryngectomy, and one patient opted for primary radiochemotherapy over laryngopharyngectomy. Adjuvant radiotherapy was given in 5 cases, and radiochemotherapy in 3. Diagnoses included a range of soft tissue and bone sarcomas, such as liposarcoma, synovial sarcoma, and osteosarcoma. During the study period, 4 patients survived, 5 patients were noted as deceased, and survival data for 2 patients remain unavailable. Patients exhibited an average survival of 7,6 (± 10,4) years. The survival times within this limited patient population exhibit significant variation. Histologically, a wide spectrum of low and high-grade soft tissue and bone sarcomas were diagnosed including liposarcoma, synovial sarcoma, Ewing, osteo- or chondrosarcoma. HNS are rare and challenging to treat. Surgery is the primary treatment, with postoperative radiotherapy recommended for incomplete resections or high-risk subtypes. Advanced surgical techniques and reconstruction allow for radical resections while preserving function. Incorporating genetic insights and better sarcoma classification can further optimize treatments.

Clinical implementation of the 3D 4K exoscope (Orbeye™) in reconstructive head and neck surgery

PurposeTo assess the clinical utility of the 3D 4K exoscope for reconstructive head and neck surgery.MethodsThis retrospective study analyzed surgical details and complications with the use of the 3D 4K exoscope for microvascular reconstruction at a high-volume Department of Oral and Maxillofacial Surgery, compared to the use of a 2D microscope. Patients with oral cancer undergoing microvascular reconstruction were categorized into two cohorts based on the intraoperative use of the 3D 4K exoscope (Orbeye™, Olympus, Tokyo, Japan) or a conventional microscope (ZEISS S8 – OPMI Vario, Carl Zeiss AG, Oberkochen, Germany; Leica M680, Leica Mikrosysteme Vertrieb GmbH, Wetzlar, Germany) during a six-month study period, respectively. Outcomes were also compared between two time periods of the exoscope use to assess the learning curve over time.ResultsThe exoscope was applied for microvascular anastomosis in 55 surgical cases (cohort 1), and the conventional microscope was employed in 56 cases (cohort 2). The rates of postoperative complications within 14 days following the use of the exoscope were 14.5% (N = 8), compared to 16.1% (N = 9) in cohort 2. Analysis over time demonstrated a learning curve with the exoscope, reflected in a decrease in postoperative complications within 14 days from 22.7 to 9.1%.ConclusionThe three-dimensional camera system provides excellent and reliable intraoperative visualization in reconstructive head and neck surgery. Transitioning to this new technology did not lead to an increase in intra- or postoperative complications, but the successful implementation requires some experience with the device.

Early Outcomes of Repeat Cardiac Surgery at a Newly Established Cardiac Center in a Developing Country

Objective: The primary objective of this study is to evaluate the early clinical outcomes of repeat cardiac surgery performed at a newly established cardiac center in a developing country. Study Design: This is prospective observational cohort study setting: This study was performed between January 2021 and July 2024 at cardiac surgery department of Peshawar Institute of Cardiology. Methods: A total of 25 consecutive patients aged 18 years or older who had any previous cardiac surgery with and without the use of cardiopulmonary bypass were included. Elective, urgent, emergent, and salvage cases were all there. Patients who had incomplete records were excluded. Our study utilized SPSS (Statistical Program of Social Science) version 20 for analysis of our dataset Results: The average cardiopulmonary bypass (CPB) time was 193.48 minutes (±72.8), while the average duration of aortic clamp time was 136.20 minutes (±73.6). Regarding complications, 16% of patients (n=4) required re-intubation, 12% (n=3) needed re-exploration, 16% (n=4) experienced renal failure, and 4% (n=1) suffered a stroke. Additionally, 16% of patients (n=4) were readmitted, and 4% (n=1) died within 30 days following surgery. Conclusion: This study showed that new cardiac centers are safe for commencing complex cases like repeat cardiac surgeries with comparable results to other established centers.

Impact of enhanced chest CT with three-dimensional reconstruction combined with preoperative olive oil administration on the incidence of postoperative chylothorax: a retrospective study

BackgroundChylothorax is a rare but potentially life-threatening complication after esophageal cancer resection. This study aims to investigate the impact of a strategy combining preoperative three-dimensional (3D) reconstruction of contrast-enhanced chest CT with olive oil ingestion on the incidence of chylothorax following esophageal cancer resection.MethodsWe retrospectively analyzed the clinical data of 357 patients who underwent esophageal cancer resection in the Department of Thoracic Surgery at Gansu Provincial People’s Hospital from January 2019 to June 2024. Among them, 179 patients who underwent preoperative 3D reconstruction of contrast-enhanced chest CT combined with oral olive oil administration were assigned to the 3D reconstruction group, while 158 patients who did not receive these interventions served as the control group. The primary outcome measures included the incidence of chylous leakage and related perioperative outcomes.ResultsAll patients in both groups underwent surgeries successfully without any perioperative deaths. Compared to the control group, the 3D reconstruction group exhibited a significant decrease in the incidence of postoperative chylothorax (0% versus 8.2%, P < 0.001). The visualization rate of the thoracic duct during surgery was higher in the 3D reconstruction group compared to the control group (93.85% vs. 48.73%). Furthermore, patients in the 3D reconstruction group had less intraoperative bleeding (P = 0.003), shorter postoperative hospital stays (P = 0.003), and reduced chest drainage in the first three postoperative days (P < 0.001).ConclusionThis study reveals that preoperative three-dimensional reconstruction of chest using enhanced CT allows for the anticipation of thoracic duct anatomy. Additionally, the combination of preoperative oral olive oil administration significantly enhances the intraoperative visualization of the thoracic duct. This integrated strategy effectively reduces the incidence of postoperative chylothorax, demonstrating promising clinical application prospects.

Postoperative Outcomes of Modified Carnoy’s Solution versus 5-Fluorouracil for Chemical Cauterisation following Enucleation and Peripheral Ostectomy in Patients with Odontogenic Keratocyst: A Research Protocol

Introduction: An Odontogenic Keratocyst (OKC) is always a topic of debate due to its distinct biological behaviour to recur after surgical procedure. Also, it has an odyssey cyst-tumourcyst from 1956 to 2005 to 2017. For this reason, number of treatment modalities was cited in the literature. Modified Carnoy’s Solution (MCS) is commonly used due to its effectiveness, while 5FU, an antimetabolite used in cancer treatment, presents a newer approach. Need of the study: The varying Recurrence Rate (RR) and postoperative complications associated with different treatment modalities for OKC. While MCS is a commonly used adjuvant therapy due to its effectiveness, and bone resection minimises recurrence but leads to severe functional and aesthetic issues, there is limited data comparing the efficacy of MCS to newer agents like 5-Fluorouracil (5FU) in reducing recurrence. Evaluating the effectiveness of 5FU, a promising chemotherapeutic agent, could potentially offer a less invasive and equally effective treatment option for reducing recurrence and improving patient outcomes in OKC management. Aim: To compare and evaluate the postoperative outcomes, specifically the RR, of MCS vs 5FU used for chemical cauterisation following enucleation and peripheral ostectomy in patients with OKC. Materials and Methods: An experimental in-vivo study will be conducted in the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (M), Wardha, Maharashtra, India, from April 2023 to March 2024. The approach involves categorising 12 histologically proven cases of OKC into two groups according to distinct adjunct techniques used (six patients in each group). Group A includes subjects treated with MCS. Group B includes subjects with 5FU. Postoperative outcomes will be evaluated and compared among the groups. The data will be analysed and compared using Student's t-test and Mann-Whitney U test. It will be used at a 5% level of significance (p-value ≤0.05).

Clinical study on low-energy semiconductor laser treatment in the promotion of wound healing after maxillofacial fracture surgery.

This study aims to evaluate the clinical effect of low-energy semiconductor laser treatment on the promotion of wound healing after maxillofacial fracture surgery. A prospective randomized controlled study was conducted. Patients with maxillofacial fractures who were hospitalized in the Department of Trauma and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, from August 2021 to June 2023 were selected as the study subjects and randomly divided into experimental and control groups. The experimental group was treated with a low-energy semiconductor laser once a day for six consecutive days after daily routine dressing change on the first day after surgery. The control group only underwent routine dressing change treatment and did not receive low-energy semiconductor laser treatment. Wound healing times, wound healing conditions, modified Stony Brook scar evaluation scale (mSBSES) scores, pain indices, and wound infection rates were compared between the two groups. A total of 211 patients were included in this study. A total of 104 and 107 cases comprised the experimental and control groups, respectively. A total of 128 males and 83 females were included. After low-energy semiconductor laser treatment, the facial skin wound healing time of the experimental group was found to be significantly shorter than that of the control group (P<0.05). Moreover, the wound grade A healing rate of the experimental group was higher than that of the control group on the seventh day after surgery (P<0.05). Among postoperative facial skin wound evaluation indices, the mSBSES scores of the experimental group at all observation points were higher than those of the control group (P<0.05), and the scores of the experimental group were higher than those of the control group in terms of wound width reduction, height reduction, color lightening, and incision line loss (P<0.05). In postoperative wound pain evaluation, the pain index of the experimental group after low-energy semiconductor laser treatment was significantly lower than that of the control group (P<0.05). No significant difference in wound infection rates was found between the two groups (P>0.05). For facial skin wounds in maxillofacial fracture surgery, low-energy semiconductor laser treatment can effectively promote wound healing, improve wound healing quality, fade scars, and relieve wound pain.

Readiness for hospital discharge among patients requiring home nutrition support: a cross-sectional study.

This study aimed to investigate readiness for hospital discharge of patients requiring home nutrition support and explore the factors that influence this readiness. This cross-sectional survey included 220 patients discharged from the general surgery department of a tertiary-care teaching hospital in China with home nutrition support. Readiness for Hospital Discharge Scale and Quality of Discharge Teaching Scale scores were calculated and general, disease- and therapy-related information were collected. Univariate, correlation, and multiple linear regression analyses were performed. The mean standardized total Readiness for Hospital Discharge Scale score was 7.33±1.65, with the subscales expected support, personal status, perceived coping ability, and knowledge scoring 7.40±1.78, 7.35±1.66, 7.30±1.73, and 7.26±1.74, respectively. The mean standardized Quality of Discharge Teaching Scale score was 7.48±1.59. The Quality of Discharge Teaching Scale score, length of hospital stay, expected length of home nutrition support, first-time use of home nutrition support, Nutrition Risk Screening 2002 score, and diagnosis were all identified as influencing factors of readiness for discharge (adjusted R2=0.564, F=14.5, p<0.001). Patients requiring home nutrition support were only moderately ready for discharge. Enhancing the quality of education on patient discharge could significantly improve readiness for discharge, in which patients who have been admitted for longer periods require more attention. They are expected to utilize home nutrition support in the long-term, are at risk of malnutrition, are using home nutrition support for the first time, or have a digestive system malignancy.

RESISTANCE INDEX AS A PROGNOSTIC FACTOR FOR PATENCY IN DISTAL LOWER LIMB ARTERIAL REVASCULARIZATION

Critical limb ischemia (CLI) of the lower limbs (LLs) is a severe condition caused by peripheral arterial obstructive disease (PAOD). Surgical planning for CLI requires the study of limb circulation, and the vascular resistance index (RI) measured by Doppler ultrasound (US) has been used to aid in surgical decision-making. The objective is to correlate the RI of recipient arteries with the patency of LL revascularization surgeries in patients with CLI. Prospective cohort study conducted from July 2021 to March 2023. The RI of the recipient arteries was evaluated preoperatively by US in 58 patients with CLI who underwent infrainguinal open or endovascular revascularizations, hospitalized in the Vascular Surgery Department of the Hospital das Clínicas of Empresa Brasileira de Serviços Hospitalares/Universidade Federal de Pernambuco. After 30days of surgery, all patients were evaluated for the presence of pulses in the revascularized limb and the ankle brachial index (ABI) was measured in all cases. Statistical analysis was conducted with a 95% confidence level, and the Student's t-test was used to compare 2 independent samples. Clinical evaluation and ABI assessment of revascularization patency after 30days revealed that infragenicular revascularizations that occluded had an average RI of 0.72 (SD±0.16), while patent revascularizations had a mean RI of 0.69 (SD±0.17) without statistical significance (P=0.658). Despite the lack of statistical significance, the study observed that a lower preoperative RI of the distal recipient artery was associated with greater patency of the revascularization surgery after 30days.

Comparative analysis of antibiotic prophylaxis guidelines in cardiac surgery: a survey in Czechia and Slovakia.

Surgical site infections (SSIs) in cardiac surgery significantly impact patient outcomes. This study examines cardiac antimicrobial prophylaxis guidelines in Czech and Slovak hospitals, crucial for reducing SSI incidence. An electronic survey was conducted across cardiac surgery departments in both countries, focusing on surgical antibiotic prophylaxis (SAP) protocols, antibiotic choices, dosages, timing and postoperative infection rates. Responses were collected over three months, ensuring a comprehensive overview. Most surveyed hospitals (79%) implement SAP, but guidelines exhibit notable variability. Cefazolin dominates as the primary prophylactic choice, with varying dosing regimens. Challenges include timing inconsistencies and prolonged prophylaxis durations, particularly in implant-related procedures. Regular guideline revisions are reported in 18% of hospitals within the last year, emphasizing the need for updated practices. This study shows the importance of standardizing SAP practices, aligning them with evolving evidence, and implementing regular guideline revisions. The observed variations highlight opportunities for enhanced SSI prevention strategies in cardiac surgery, ultimately contributing to improved patient outcomes.

IMPACT OF ACTIVITIES OF NIGERIA CUSTOMS SERVICE ON BORDER SECURITY IN RIVERS STATE

The problem of porous borders and its effects on the activities of Nigeria Customs Service (NCS) have continued to impact on the level of border security in Rivers State. Purpose of this study is to examine the impact of activities of Nigeria Customs Service on border security in Nigeria. The target population, in this study is 2,620, while the sample size was 400 which was gotten through the use of Rakesh sample size formula. The target population covered staff in Port Harcourt 1 Area Command of NCS, Rivers State; Port Harcourt II Command of NCS, Onne, Department of Border Management in Nigeria Immigration Service (NIS), Onne; National Drugs Law Enforcement Agency (NDLEA), Rivers State Command; and Department of Operations in Nigeria Police Force, Onne, who are designed to respond to questions and statements in the questionnaire and interview guide relating to the role of NCS in border security in Rivers State. The target population also covered registered agents at Onne, and dock workers in Port Harcourt II Command. Data were collected from 5-Point Likert Questionnaire, in-depth interview and secondary sources. Data collected from 5-Point Likert questionnaire were analysed using simple percentages and absolute frequencies. While data from in-depth interview were presented textually, manually-transcribed and analysed using narrative-analytical method. Data from secondary sources were analysed using relational-content analysis. Findings showed, among other things, that more the improvement in the activities of Nigeria Customs Service, better the state of border security in Rivers State. Among other things, constant monitoring and evaluation of the activities of the NCS to ensure that they largely conform to their operational standards is recommended.

Management of side effects following hyaluronic acid filler injections

With the increase of esthetic procedures using hyaluronic acid injections, the risk of complications also increases. Due to their complexity, interdisciplinary treatment is often necessary. In recent months, three cases have been treated on an interdisciplinary basis at Leipzig University Medical Center. This motivated us to develop ajoint recommendation for action in co-operation with the departments of dermatology, plastic surgery, oral and maxillofacial surgery, ENT (ear, nose and throat), ophthalmology, and neurology.

Lymph node Yield in Apical Tissue During Triangle Operation While Doing Whipples Operation: An Observational Study

Introduction: The "TRIANGLE operation" involves the en-bloc removal of the tumor and the entire "mesopancreas" from the triangle-shaped space bounded by the superior mesenteric artery, coeliac trunk, and portal vein. This study assessed lymph node yield in apical tissue during the triangle operation.Methods: An observational cross-section study was conducted for two years at the Department of Gastrointestinal and General Surgery at a tertiary care center of Nepal. from 15th March 2022 to 15th March 2024. The operative procedure included pancreaticoduodenectomy or Whipple’s operation. Total sampling was done. Postoperative outcome and lymph node yeild of the surgeries were studied. Ethical approval was taken from the Institutional Review Committee (Reference No-1102202204).Results: A total of 56 patients underwent pancreaticoduodenectomy along with a triangle operation. The mean age of the patients was 56.38±14.79 years. Male: Female ratio was 1.2:1. Mean preoperative BMI was 24.41±4.72. The mean total lymph node yield was 20.95±8.57. Nineteen patients had a positive lymph node yield in the triangle tissue. The mean triangle lymph node yield was 10.59±4.92, and the mean positive lymph node was 2.58 ±1.64. Among 56 patients, nine patients had both apical margin and the rest of the triangle tissue margin positive. Ten patients had negative apical tissue margins, but the rest of the triangle tissue was positive, whereas, in thirty-seven patients, both the apical tissue and the rest of the triangle circumferential resection margin tissue were negative.Conclusions: This study emphasizes the importance of the inclusion of apical tissue dissection at the confluence of SMA and coeliac trunk to achieve R0 resection. However, a long-term follow is awaited.

Comparative Study on Conventional Radiography versus Cone Beam Computed Tomography for the Diagnosis of Mandibular Fracture

Background: The facial skeleton is a complex structure composed of five paired bones and four unpaired bones, with mandible fractures being among the most common injuries encountered in trauma centers. Panoramic imaging, also known as pan tomography (OPG), is a technique that provides a single, wide-view image of the facial structures. Methods: The study was a descriptive cross-sectional study which was carried out from 16 August 2016 to 16 May 2017 in the Department of Oral and Maxillofacial Surgery, Dental Wing, Combined Military Hospital, Dhaka and Dhaka Dental College and Hospital. A total 40 patients having mandibular fracture were included in this study and were evaluated radiologically by both conventional radiography (orthopantomography) and cone beam computed tomography (CBCT). Results: Among the 40 cases the mean age for the male patient with mandibular fracture were 25.16 ± 2.7 and for the female patient it was 29.80 ± 5.0. Most cases were male than female, RTA was found the most common cause of fracture mandible. Most of the cases were associated with other body part injury excluding head injury. Most commonly fractured anatomic region of mandible was found angle 18 (45%) followed by body 16(40%). CBCT detected more fracture sites than Orthopantomograph. Conclusion: CBCT was found more accurate than orthopantomography (OPG) in detecting fracture sites. Thus CBCT helped in early and proper management of fracture reduction and rehabilitation of the patients. J Bangladesh Coll Phys Surg 2025; 43: 32-38

Enhanced patient recovery with early extensive surgical deb-ridement in Fournier's Gangrene: evaluation of perioperative outcomes in a multicentric experience.

Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement. We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered. 28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days. Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.

Family centered care in pediatric cardiac surgery departments: Nurses’ perceptions

Background: Family-centered care (FCC) in pediatric healthcare settings holds significant implications for hospitalized children and their family, as well as for healthcare providers, particularly nurses. This study aims to explore the perceptions of Pediatric Nurses (PN) working in Pediatric Cardiac Surgery departments regarding FCC. Materials and Methods: A cross-sectional study was conducted between November 2021 and July 2022 at two pediatric hospitals and a Cardiac Surgery Center in Athens, Greece. The Family Centered Care Questionnaire–Revised (FCCQ-R) was utilised to assess nurses' perceptions of FCC. This questionnaire consists of 45 items divided in 9 subcategories accessing the current nursing practice and the perceived necessity of FCC. Data analysis was performed using SPSS-28, with a significance level set at α=0.05. Results: 62 nurses were recruited. Most nurses were female (93.5%), with 41.9% aged between 31 and 40 years. Mean scores for the necessity scale and current scale were 25.93 (±5.26) and 17.85 (±4.25), respectively, with Cronbach's alpha coefficients of 0.942 and 0.937, respectively. Predictors of the current scale score included age group 51–60 years (β=4.62, p=0.010) and necessity scale score (β=0.26, p=0.016), whilst predictors of the necessity scale score included years of experience (β=-7.31, p&lt;0.001) and daily scale score (β=0.35, p=0.019). Conclusions: Nurses acknowledge the importance of FCC dimensions but may encounter challenges in consistently applying them in their work. Further strategies may be required to bridge this gap and enhance the integration of FCC principles into pediatric nursing practice.

The impact of skin grafts on the management of deep burns: Approaches and results in the treatment of third-degree burns

Deep burns are serious and complex injuries, leading to complete destruction of the skin and subjacent tissues, with risks of major complications. Treatment requires a multidisciplinary approach, with skin grafting playing a key role in restoring skin integrity and promoting healing. The aim of this study is to demonstrate the efficiency of skin grafting in the treatment of deep burns, and its impact on improving the management of burn patients. A retrospective study of 50 patients admitted for the management of deep burns, hospitalized in the plastic, reconstructive and burns surgery department of CHU Tanger-Tetouan-Al Hoceima, over a 12-month period. Patients were divided into two groups: 15 patients treated with skin grafting (30%) and 35 patients treated with directed wound healing (70%). The average age of the patients was 29 years. Men accounted for 60% of patients, with a predominance also in the graft group. Patient comorbidities included arterial hypertension (14%), psychiatric disorders (10%), diabetes (8%) and epilepsy (6%). In terms of burns, 56% were thermal by flame, 32% by liquid contact and 12% electrical burns. Burns mainly affected the upper limbs (60%) and trunk (46%). Concerning the burn extent, 62% of patients had a BSI ≥ 20%. Skin grafts were mainly performed after 21 days, with a majority of thin skin grafts (87%). Graft uptake was optimal in the majority of cases, and we observed a minimal rate of post-operative complications consisting of partial graft lysis and one case of infection. Finally, major complications were more frequent in the directed healing group, including retractile bridles (14%) and hypertrophic scars (20%), whereas grafted patients mainly presented dysesthesia (8%) and hypertrophic scars (6%). Skin grafting has an important role to play in restoring skin integrity and preventing complications, improving healing and having a significant functional and aesthetic impact.

Clinical Presentation of Carcinoma of Stomach and Its Relationship to the Treatment Outcomes

Background: Carcinoma of the stomach remains a significant cause of cancer-related mortality worldwide, often presenting with non-specific symptoms such as epigastric pain, weight loss, nausea, and anemia. The clinical presentation frequently correlates with the disease stage at diagnosis, influencing treatment outcomes. This study aimed to evaluate the clinical presentation of gastric carcinoma and its relationship to treatment outcomes. Methods: This was a prospective observational study that was conducted in the Department of Surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh from January 2007 to January 2009. A total of 50 patients with carcinoma of the stomach were selected irrespective of age and gender purposively. Data were analyzed using MS Office tools. Results: Significant clinical features included anemia (80%), epigastric tenderness (70%), and palpable lumps (60%). Gastroduodenoscopy detected 74% antral lesions with 95.6% sensitivity. Patients with vague abdominal symptoms presented at advanced stages, while general symptoms correlated with early stages. Curative resections achieved recurrence-free survival in 52% at 24 months. Palliative procedures were common (50%), and non-compliance (16%) negatively impacted outcomes. Adjuvant chemotherapy improved survival for 80% of cases. Conclusion: Anemia, epigastric tenderness, and lumps are key features of stomach cancer. Advanced stages show vague symptoms; early stages show general symptoms. Gastroduodenoscopy aids diagnosis. Early detection, regular follow-ups, and routine gastroduodenoscopy improve outcomes and survival rates.