Subcutaneous Cellular Tissue Research Articles

Endometrioma de la pared abdominal como diagnóstico diferencial poco frecuente de un tumor de tejidos blandos

Introducción: La endometriosis se caracteriza por la localización de tejido endometrial normal, glándulas y estroma, fuera de la cavidad uterina. Su frecuencia oscila del 3 al 15% de las mujeres en edad fértil. La localización más habitual es la intraabdominal, pero también puede ser extra-pélvica. La endometriosis extra-pélvica es infrecuente y se clasifica, según su localización, en cuatro tipos: gastrointestinal, del tracto urinario, torácica y de “otros sitios”, en forma de nódulos dolorosos en la pared abdominal y en cicatrices de intervenciones quirúrgicas previas, fundamentalmente ginecológicas u obstétricas o como nódulos inguinales o umbilicales. La prevalencia de endometriosis localizada en la cicatriz abdominal después de una cirugía oscila entre 0,1 y 0,4%.
 Objetivo: Describir un caso clínico sobre endometriosis de ubicación infrecuente en la pared abdominal. Material y métodos: Estudio descriptivo, retrospectivo, presentación de caso clínico en el “Hospital Básico IESS Latacunga”, caso que fue tratado en el servicio de Cirugía General del hospital.
 Resultados: : Descripción del caso clínico: paciente femenina de 68 años de edad, con antecedentes clínicos personales de diabetes mellitus tipo 2, no insulino dependiente, siendo controlada con hipoglicemiantes orales; hipertensión arterial diagnosticada hace 30 años en tratamiento; alergias: no refiere; antecedentes quirúrgicos: pelviperitonitis por absceso tubo ovárico izquierdo, hernia umbilical y embarazo ectópico. Enfermedad actual: Paciente refirió que hace aproximadamente 5 meses atrás presenta masa en región umbilical, de crecimiento progresivo, dolorosa al esfuerzo físico, de baja a moderada intensidad sin otra sintomatología acompañante, razón por la cual acudió a médico, quien decidió realizar un eco de partes blandas donde reportó: en región de mesogastrio imagen anecoica de bordes definidos con áreas ecogénicas murales y otras centrales, avasculares al doppler, mide 13.06 x 9.78 x 7.56 cm; por su tamaño no se logra identificar órgano de dependencia. Motivo por el cual acudió al Hospital IESS Latacunga donde es ingresada al Servicio de Cirugía General, se realizó una Tomografía Axial Computarizada simple y contrastada de Abdomen y pelvis, la misma que reportó: en la pared abdominal anterior a nivel de mesogastrio e hipogastrio en la línea media, en el espesor de la porción profunda del tejido celular subcutáneo imagen ovalada hipodensa con densidad de líquido que mide aproximadamente 14 cm de diámetro mayor y tiene un volumen aprox. de 690 ml. Se solicitó marcadores tumorales: antígeno carcino embrionario (CEA): 1.58 ng/ml, CA-125: 9 U/ml, CA19-9: 9.10 U/ml, AFP alfafetoproteina: 0.67 ng/ml. Posterior a presentar el caso a todo el Staff del Servicio de Cirugía General se decide su resección quirúrgica.
 Conclusiones: Considerando que la incidencia de endometriomas de pared abdominal es baja, ante cualquier nódulo de características anómalas en la región inguinal o umbilical, o tumoración sobre cicatriz ginecológica u obstétrica en una mujer de edad fértil, es importante considerar y sospechar la presencia de un endometrioma. Los métodos de imagen y la punción-aspiración con aguja fina pueden ayudar al diagnóstico y su tratamiento definitivo es quirúrgico

SUN-029 Diabetes Mellitus Associated with Klinefelter Syndrome

Background: It has not been clarified why diabetes mellitus develops in patients with Klinefelter’s syndrome. However the association between both diseases is frequent. Clinical Case: A 31-years-old man with type 2 diabetes diagnosed 2 months ago who received metformin for treatment. He presented to the hospital with dysuria, polyuria, polydipsia, weight loss, hyporexia, vomiting and drowsiness. On examination: BP: 110/60 mmHg, HR: 108 lp, FR: 24 rp, T °: 37 ° C, BMI: 31.4 kg / m2, oral mucosa dry, bilateral gynecomastia, subcutaneous cellular tissue of gynecoid distribution. His body hair was thin. His penis was small and both testicles were prepubertal. Laboratory: Glucose: 410 mg / dl; HbA1c 15.2%; creatinine: 1.01 mg / dl; arterial gases: pH 7.14 pCO2: 20, HCO3: 6.6, AG: 29. Normal electrolytes. Ketonuria: 3+. We concluded: diabetic ketoacidosis. In addition, FSH 61.18 μU / ml (RR: 1.5-12.5); LH: 28.47 μU / ml (RR: 0.7-8.6); Total testosterone: 0.41 ng / ml (RR: 2.8-8), compatible with hypergonadotropic hypogonadism. Therefore a karyotype is requested in peripheral blood, resulting in 47, XXY in 20 metaphases analyzed. Klinefelter’s syndrome was diagnosed from his physical characteristics, hormonal findings and his chromosomal aberration. He received testosterone undecanoate every 4 weeks, NPH insulin 12 IU / 8UI plus metformin 850 mg every 12 hours. Three months later: baseline glucose 89 mg / dl and HbA1C of 9.5%. Conclusion: We present the case of a young male with diabetic ketoacidosis and hypogonadism, secondary to Klinefelter syndrome. Klinefelter syndrome is associated with Diabetes mellitus with a RR that varies from 1.64 to 7.06 according to current literature. In addition, we highlight the importance of the medical history and physical examination for an adequate diagnosis of rare conditions such as Klinefelter Syndrome. Reference: 1. Kanakis GA, Nieschlag E. Klinefelter syndrome: more than hypogonadism. Metabolism. Septembere 2018;86:135-44.

Reactions of Subcutaneous Cellular Tissue in Response to the Implantation of a Polypropylene Endoprosthesis Modified with a Polycaprolactone Solution by Electrospinning

Objective: to study the morphological features of subcutaneous tissue in response to the implantation of a polypropylene mesh endoprosthesis (PSE) modified with a polycaprolactone solution by the method of electrospinning. Material and methods. The object of the study was modified polypropylene mesh endoprostheses implanted in experimental animals. The animals were removed from the experiment on the 3rd, 7th, 60th day of the experiment. Subcutaneous fatty tissue along with the implanted material and regional lymph nodes were fixed in a 10 % solution of neutral formalin, followed by histological posting according to the standard technique and filled with paraffin. Histological sections 3-4 μm thick were stained with hematoxylin and eosin. The morphological assessment of reactions to the implantation of the materials was carried out by means of the calculation of the cellular elements of inflammatory and connective tissue origin along the periphery of the implants (neutrophilic leukocytes, phagocytic neutrophilic leukocytes, degenerating neutrophilic leukocytes, eosinophilic leukocytes, lymphocytes, plasmacytes, histiocytes, macrophages, fibrocytes, fibroblasts, multinucleated giant cells).Results. The study of the cellular composition has showed a statistically significant increase in the content of fibrocytes (p = 0.002) and fibroblasts (p < 0.001) on the 7th day of observation around the modified PSE. On the 60th day, the number of neutrophilic leukocytes at the periphery of the modified PSE was lower than that of the control sample (p = 0.004). The enhancement of the fibroplastic properties of the samples modified with polycaprolactone by electrospinning was characterized by a less pronounced inflammatory reaction of the peripheral tissues.Conclusion. The obtained data are indicative of the fact that the modification of PSE with polycaprolactone reduces the reactive properties of endoprostheses and make it possible to recommend to introduce this method of PSE modification in clinical practice.

The Cutaneous Branch of the Deep Palmar Artery and Blood Supply to the Proximal Hypothenar Skin: An Anatomic Research Oriented to Flap Design.

Background: The distal half of the hypothenar eminence (HE) skin vascularization has been extensively investigated. Different flaps have been described based on these arteries. Similarly, the vascularization of the proximal half of HE has also been investigated, although to a lesser extent. The aim of this paper is to determine, in a cadaver sample, the anatomy of the hypothenar cutaneous branches in their proximal half. Methods: In all, 20 adult, red-colored-latex-injected hands were studied. Dissections were performed with a 4X to 10X magnification. Cutaneous branches in the proximal half of the HE were found. Their variants were studied, and they were classified into different types according to their relationships. Results: A cutaneous branch of the deep palmar artery (CBDPA) was identified. It was located in the subcutaneous cellular tissue thickness in the proximal half of the HE. Moreover, it presented 3 anatomical variants, classified according to its relationships with the superficial ulnar nerve branch (SUN). Type 1 variant: the CBDPA and the PDA ran in front of the SUN (60% of cases). Type 2: the CBDPA and the DPA ran behind the SUN (30% of cases). Type 3: the CBDPA ran in front of the SUN while the DPA ran behind it (10% of cases). Conclusion: There is a CBDPA which is the HE proximal half main cutaneous branch. Although it presented several variants, its existence is constant, making it possible to use it as pedicle for proximal hypothenar flaps.

Robotic adenomastectomy: follow-up of operated cases

Introduction: For the past few years, Nipple-Sparing Mastectomy (NSM) has been a tendency, and robotic breast surgery has become a reality. Until August, 2019, three robotic adenomastectmy procedures were carried out in Hospital Erasto Gaertner. The objective of this article is to demonstrate our results and publicize the knowledge in robotic surgery. Methods: Surgical Technique. The Da Vinci Surgical System Si® (Intuitive Surgical, Sunnyvale, CA) was used to perform the NSM surgeries. The 3 cm long incision was initiated in the axillary region, and the subcutaneous cellular tissue was resected to an area of 5 cm in diameter, to the portal. One mg/ml of adrenaline diluted in physiological serum 0.9% was infiltered in the subdermal breast tissue. Tunneling is executed with Metzenbaum scissors in the subdermal region. The device is coupled (GelPOINT Advanced Access Platformtm), and gas pressure of 8 mmHg is activated. The ProGrasp Forceps, the monopolar curved scissors and the 30º video camera are allocated in the robotic arms. The upper quadrants are superficially dissected, and then the lower quadrants, the retro-mammillary region and, finally, the breast muscle tissue. The expander is allocated between the chests with the open technique. Result: The duration of the mammary gland extirpation was 5 hours in the first unilateral adenomastectomy surgery, and 1 hour and 45 minutes in the last for the same type of surgery. In total, the first surgery took 6 hours and 20 minutes, which reduced to 3 hours in the last. In two surgeries we observed skin burns caused by electrocautery. These were solved in weeks, however, without the need for surgical intervention. We did not observe complications such as seroma, hematoma, loss of prosthesis, major pain, infection or subcutaneous emphysema due to carbon dioxide. Discussion: Complication rates are low, as shown by Lai et al. (2019), who analyzed a case series and showed transient nipple ischemia (10.3%) as the highest rate of complication; however, without nipple necrosis or loss of prosthesis. In the cases operated in Hospital Erasto Gaertner, the aesthetic results were very well evaluated both by the patients and the plastic surgery and mastology staff. Minor complications were solved in weeks, which maintained an excellent final outcome. The learning curve of the robotic technique was extremely fast, with considerable reduction in surgical time. Conclusion: We believe that innovative robotic surgery can contribute with the advancement of breast surgery around the world.

Combination of ozone and mesenchimal cells to repair the intervertebral disc [abstract

INTRODUCTION: Ozone is the best available therapeutic resource for disc herniation, but once the pain is resolved, the intervertebral disc is left with a scar as well as volume reduction, and therefore to osteoarthritis. This situation affects all the anatomical structures that are part of the intervertebral space. This is why Degenerative Disc Disease (DDD) is currently considered a disease that affects not only the intervertebral disc but also the end plates and vertebral bodies. Several years ago we began studying therapeutics for DDD. It is our challenge, to prove that the intervertebral space regains its original integrity and homeostasis.
 In 2010 we developed an experimental model of regeneration of the intervertebral disc with mice, and the research protocol. Today, after overcoming some legal issues in Argentina, we begun the regeneration of the intervertebral disc in humans.
 
 PURPOSE: In this paper we present the firsts patients treated with ozone therapy and pre-differentiated cartilage cells, from February 2016 to the present.
 
 MATERIALS AND METHODS: Patients with DDD who meet the inclusion and exclusion criteria. Subcutaneous cellular tissue and blood were extracted, which were processed according to the corresponding technique to obtain pre-differentiated cartilage cells. After 21 days, the cells were implanted back to the patient in the operating room under neuroleptoanesthesia and radioscopic control. During these days an oxidative preconditioning with ozone was realized to modulate the microenvironment.
 
 RESULTS: Patients showed significant improvement in their pain and RMN images by comparing VAS scales before and after treatment.
 
 DISCUSSION: The combination of pre-differentiated cartilage cells with ozone therapy is an effective, novel and minimally invasive treatment for DDD. We must increase the number of cases in order to strengthen our results.

Successful outcome of kleibsella necrotising fasciitis in an immunocompromised child with conservative measures

Necrotizing soft tissue infections (NSTIs), are rare, very rapidly progressing disease of superficial fascia and subcutaneous cellular tissue. They are considered as secondary infections as they develop from an initial break down of skin integrity due to trauma or surgery. There is significant local tissue destruction causing grave morbidity and long-term sequelae. NSTIs are rare in children and the predisposing factors are skin damage due to trauma, diabetes, malnutrition and immunosuppression. Broad spectrum antibiotics, wide surgical debridement and supportive care are the standard treatment options. Diagnostic delays are common as the initial signs and symptoms mimics cellulitis or abscess. The diagnostic challenges in immunocompromised host are due to the facts that : i) infections are caused by diverse organisms that are usually not considered pathogens in healthy hosts; ii) infections of soft tissue might be a part of a bigger systemic infection; iii) immune deficiency masks the clinical signs. We report a case of successful outcome with nonsurgical management of necrotizing fasciitis in a boy with newly diagnosed Acute lymphoblastic anemia. He developed Klebsiella Necrotizing Fasciitis (NF) in the first week of induction therapy and his wound healed without surgical debridement or reconstructive measures, due to the high index of suspicion, early diagnosis and adequate intervention.

The general and primarily diagnosed morbidity of diseases of skin and subcutaneous cellular tissue in the Stavropol kraii

Atopic dermatitis and contact dermatitis are most common in all age groups of the population. In this regard, the study of the epidemiological situation of these nosological forms is highly relevant. The aim of the study was to study the indicators of general and primary morbidity in diseases of the skin and subcutaneous tissue and their structure. Material and methods. The data of official statistics on the general and primary incidence of diseases of the skin and subcutaneous tissue in the Stavropol Territory for the period from 2010 to 2017 have been studied. Results. Analysis of the incidence of diseases of the skin and subcutaneous tissue taken into account in official statistics showed an increase in the overall incidence of diseases of the skin and subcutaneous tissue by 21.5%, including contact dermatitis, other dermatitis, psoriasis and psoriatic arthritis. The overall incidence of lupus erythematosus and localized scleroderma has decreased. The highest rates of newly detected incidence of contact and atopic dermatitis were noted. Contact and atopic dermatitis prevailed in the structure of both the general and newly diagnosed diseases of the skin and subcutaneous tissue. Conclusion Despite the decrease in newly detected incidence, during the analyzed period there was an increase in the overall incidence of diseases of the skin and subcutaneous tissue. In the structure of both the general and newly detected incidence of diseases of the skin and subcutaneous tissue, the main part is occupied by contact and atopic dermatitis.

Implantation of the collagen membrane with adsorbed multipotent stem cells in experiment

Objective. To follow-up the processes, taking place with autologous multipotent mesenchymal stem cells (ММSC) of the bone marrow origin after their implantation into the organism on surface of the collagen material in experiment.
 Маterials and methods. The changes in subcutaneous adipose cellular tissue in rats after implantation of the collagen membrane with passively adsorbed on the MMSC on the surface with transfected gene GFP and additionally stained cellular membranes with Vybrant® CM-Dil were studied up, using the light microscopy methods and a luminescence.
 Results. While application of a luminescence in a one week after implantation of the collagen material with the MMSC adsorbed in a neighborhood with the implant there were revealed typical very small vessels owing a one-layer membrane, which have fluoresced intensely while a rodamine filter was installed. On the second week on periphery of the collagen material and in neighborhood to the implant on background of a rodamine filter application only small inclusions inside macrophages were shining with a red color. Subsequently step by step the quantity of such shining objects have reduced down to solitary ones, presenting very rarely, as well as their fluorescence intensity.
 Conclusion. The main cause for the tissue vascularization enhancement around the implanted collagen with the MMSC adsorbed on the surface is their differentiation into cellular elements of vascular membranes. Starting from the second week all the MMSC undergo destruction and are phagocytized by macrophages, also in this term the structures from these MMSC disappear as a result of their differentiation, including the vessels.

The morbidity of diseases of skin and subcutaneous cellular tissue in population of the Republic of Bashkortostan

The diseases of skin and subcutaneous tissue are an actual medical and social problem. The purpose of study was to analyze dynamics of incidence and prevalence of diseases of skin and subcutaneous tissue in population of the Republic of Bashkortostan in 2008-2017. The average rates of incidence and prevalence of these diseases in the Republic of Bashkortostan were significantly higher than relevant data in the Russian Federation and Volga federal district. In the Republic of Bashkortostan the study established increase in incidence rate of atopic dermatitis (primary morbidity increased up to 18.6%, total morbidity increased up to 20.2%) and psoriasis (total morbidity increased up to 3%). The low level of dispensary observation of patients with dermatitis in the medical organizations of the Republic of Bashkortostan was established. In 2017 full coverage with dispensary observation was established in case of children aged 0-14 years with discoid lupus erythematosus. The low level of dispensary observation of children with atopic dermatitis (42%) and adults with psoriasis (30.6%) was established. The study demonstrated necessity of further studying of total and primary morbidity of diseases of skin and subcutaneous tissue and also indices of dispensary observation of patients according nosologies and age groups, identification of corresponding risk factors, development and implementation of measures improving medical care at all stages of its rendering.

Abdominal Wall Transplantation in Organ Transplantation: Our Experience

Abdominal wall transplantation has been consolidated as an alternative to primary abdominal wall closure in intestinal and multiple organ transplant recipients. Given that it is feasible to obtain the visceral graft and the abdominal wall graft from the same donor, abdominal wall transplantation could offer satisfactory outcomes and be easily coordinated. Non-vascularized fascia is one of the alternatives for abdominal wall closure in transplantation. We report two cases of non-vascularized fascia transplantation in intestinal and multivisceral transplants, respectively. Both donors were young (23 and 18 years old). Both recipients had endured multiple previous surgeries, and no surgical alternatives for primary wall repair could be offered. In both cases, a complete abdominal wall flap was retrieved from the donor, however, due to the characteristics of the recipient's abdominal wall defect, only non-vascularized fascia was used after removing skin and subcutaneous cellular tissue from the graft. Abdominal wall transplantation is an option to consider for abdominal wall closure in patients with multiple previous surgeries and no alternatives for primary wall repair.

Utilidad del trasplante de la pared abdominal en el trasplante de órganos. Nuestra experiencia inicial

Abdominal wall transplantation has been consolidated as an alternative to primary abdominal wall closure in intestinal and multiple organ transplant recipients. Given that it is feasible to obtain the visceral graft and the abdominal wall graft from the same donor, abdominal wall transplantation could offer satisfactory outcomes and be easily coordinated. Non-vascularized fascia is one of the alternatives for abdominal wall closure in transplantation. We report two cases of non-vascularized fascia transplantation in intestinal and multivisceral transplants, respectively. Both donors were young (23 and 18 years old). Both recipients had endured multiple previous surgeries, and no surgical alternatives for primary wall repair could be offered. In both cases, a complete abdominal wall flap was retrieved from the donor, however, due to the characteristics of the recipient's abdominal wall defect, only non-vascularized fascia was used after removing skin and subcutaneous cellular tissue from the graft. Abdominal wall transplantation is an option to consider for abdominal wall closure in patients with multiple previous surgeries and no alternatives for primary wall repair.

THE VITRO STUDY EFFECT OF GINGER EXTRACTS ON FUNGAL ISOLATED FROM A SUPPURATIVE OTITIS MEDIA AND EXTERNA

Background: Otitis media is a group of complex inflammatory disorders affecting the middle ear, which can be acute or chronic. Otitis externa is an inflammation on the skin of the external auditory canal usually associated with secondary bacterial and/or fungal infection of macerated skin and subcutaneous cellular tissue. Objective: To investigate the effect of ginger extracts on fungal isolates from patients suffering from otitis. Methods: Two hundred patients suffering from suppurative otitis media and externa who attended to ENT Department, Al-Imamein Al-Kadhimein Medical City enrolled in this study from November 2016 to the end of April 2017, included patients all age groups with discharging ear. All specimens were transported to the laboratory for processing and investigations at the same day. The powder of ginger rhizomes soaked with the solvent and left in a shaking water bath at 40 °C for 24 hours, and then filtered using Whatmann's filter paper No.1 for clear extract. Each extract was concentrated using a rotary evaporator with vacuum to get the final crude extract\; after the procedure of ginger extract was done, this extract was taken and tested for bacterial and fungal isolates from patients with otitis. Results: Results revealed that acute otitis media consisted of about 96 (48%), while chronic suppurative otitis media about 75 (37.5%). Otitis externa was less common infection among the other types of otitis 29(14.50%). The most fungal isolates were Candida parapsilosis. In addition, there is a significant effect of (chloroform, methanol, and aqueous) extract of ginger on pathogenic fungi. Conclusion: Ginger extracts have been showed evident zones of inhibition effect on pathogenic fungi by chloroform more than ethanol, with less effect by aqueous extract. Keywords: Otitis externa, otitis media, ginger extract Citation: Al-Attraqchi AAF, Sahib HB, Al-Hasseni JMK, Mohammed MM. The vitro study effect of ginger extracts on fungal isolated from a suppurative otitis media and externa. Iraqi JMS. 2019; 17(1): 4-11. doi: 10.22578/IJMS.17.1.2

Preaponeurotic endoscopic repair (REPA) of diastasis recti associated or not to midline hernias

Diastasis recti is a common pathology during pregnancy and puerperium, usually associated with midline hernias, with aesthetic and symptomatic problems. This approach allows us to restore the alba line, without entering the abdominal cavity. Between April 2014 and July 2017, 50 patients underwent surgery, 94% female (mean age 38). Ultrasonography confirmed diagnosis. Recti diastasis was associated with midline defects in 100%. The preaponeurotic endoscopic repair is done with suprapubic approach and in both iliac fossae. A preaponeurotic new cavity was created with dissection of the subcutaneous cellular tissue and then recti plication with barbed suture was performed. The wall is reinforced with polypropylene mesh. Drainage is left systematically. Diastasis recti < 50mm (55.5%) was diagnosed, from 51 to 80mm (29.6%), and > 81mm (14.9%). Recti plication with bearded suture was performed. It was associated with external oblique release in 32% of patients, being unilateral (87.5%). Light/intermediate (90%) and heavy (10%) polypropylene meshes were placed, being fixed with absorbable (62%) and non-absorbable material (38%). Navel was reinserted using internal or external sutures. The average surgical time is 83min. There are no intraoperative complications, but PO seroma finding 12%. The average hospital stay was 1.3days, with pain level 3/10 according to AVS. The patients returned to their usual activities after 16.5 days. No complications or recurrences were observed by clinical and sonographic control at 18months in 74% of patients. The patients were followed up at 39 months. Patient satisfaction was reported as 96%. Diastasis recti is a common pathology with aesthetic and symptomatic problems. Endoscopic surgery allowed us to resolve the parietal defect with plication of recti and placement of preaponeurotic reinforcement prosthesis, increasing the safety of the repair, without entering the abdominal cavity, with a short hospitalization and no complications or recurrence in 3years.

Mucinosis nodular de la mama

Nodular mucinosis of the breast is a rare entity of uncertain histogenesis and with benign behavior. It usually presents as an asymptomatic tumor around the nipple or areola and located in the dermis or subcutaneous cellular tissue. We present a case of typical nodular mucinosis. Histologically it is defined as being composed of irregular lakes of mucin negative with PAS but positive with colloidal iron and alcian blue. Mucin is accompanied by fibrous stroma with a scarce component of fusiform cells. Some authors suggest a possible myofibroblastic origin. However, molecular studies of nodular mucinosis have not been performed. The differential diagnosis must be made mainly with benign and malignant mammary lesions of mucinous stroma. In the literature, 13 cases of nodular mucinosis are described.

THE EFFECT OF GINGER EXTRACTS ON BACTERIAL ISOLATES FROM PATIENTS WITH SUPPURATIVE OTITIS MEDIA AND EXTERNA: IN VITRO STUDY

Background: Otitis media is a group of complex inflammatory disorders affecting the middle ear, which can be acute or chronic. Otitis externa is an inflammation on the skin of the external auditory canal usually associated with secondary bacterial and/or fungal infection of macerated skin and subcutaneous cellular tissue. Objective: To determine the effect of ginger extracts on bacterial isolates from patients suffering from otitis. Methods: Two hundred patients suffering from suppurative otitis media and externa, who were attending to ENT Department, Al-Imamein Al-Kadhimein Medical City. The powder of ginger rhizomes was soaked with the solvent left in a shaking water bath at 40 °C for 24 hours and then filtered using Whatman No.1 filter paper. Each extract was concentrated using a rotary evaporator with vacuum to get the final crude extract after the procedure of ginger extract was done. The activity of this extract was tested against bacterial isolates from patients with otitis. Results: The results of this study revealed that otitis externa was less common infection than the other types of otitis 29 (14.5%), while acute otitis media comprised 96 (48.0%), and chronic suppurative otitis media consisted of 75 (37.5%). The most common bacterial isolates that caused otitis were Pseudomonas spp. followed by Staphylococcus spp. The results showed that, there are different effects among (chloroform, methanol, and aqueous) extracts of ginger against pathogenic bacteria. Conclusion: Generally, ginger extracts had a good effect on isolated bacteria. Chloroform extract was the most effective one, followed by methanol extract, while aqueous extract showed the least activity in this regard. Keywords: Otitis externa, otitis media, ginger extraction Citation: Mohammed MM, Al-Attraqchi AAF, Al-Hasseni JMK, Sahib HB. The effect of ginger extracts on bacterial isolates from patients with suppurative otitis media and externa: in vitro study. Iraqi JMS. 2018; 16(2): 216-222. doi: 10.22578/IJMS.16.2.14

Treatment of Large Incisional Hernias in Sandwich Technique - A Review of the Literature.

IntroductionIn a systematic review of the surgical treatment of large incisional hernia sublay repair, the sandwich technique and aponeuroplasty with intraperitoneal mesh displayed the best results. In this systematic review only the sandwich technique, which used the hernia sac as an extension of the posterior and anterior rectus sheath and placement of a non-absorbable mesh in the sublay position, was included. Other modifications of the sandwich technique are published in the literature and were also analyzed in this literature review.MethodsA systematic search of the available literature was performed in November 2017 using Medline, PubMed, and the Cochrane Library using the terms “sandwich technique”, “double prosthetic repair”, “double mesh intraperitoneal repair”, and “component separation technique with double mesh”. This review is based on 24 relevant publications. Unfortunately, the evidence of the available studies is not very high since only prospective and retrospective case series have been published. There are no comparative studies at all. Therefore, the findings of the published case series must be viewed in a critical light.ResultsThe published studies report a remarkably low recurrence rate of 0-13% with a follow-up of 1–7 years. One limitation that must be mentioned here is that in around half of the studies the method of follow-up was not specified and in the remaining cases this was based on clinical examination by the surgical team. This puts into perspective the reported results, which appear to be too favorable given the complex nature of the hernias involved.The major disadvantage of the sandwich technique is a very high rate of wound complications of up to 68%, mainly induced by creation of large skin and subcutaneous cellular tissue flaps.ConclusionIt is difficult to evaluate the significance of the various modifications of the “sandwich technique” based on the available literature since it includes only case series and no comparative studies. The techniques used are associated with very high wound complication rates but with only relatively low recurrence rates despite the complexity of the cases involved. This must be verified in studies with a well-designed methodology.

THE CLINICAL PHARMACOKINETIC PARALLELS OF PERI-OPERATIONAL ANTIBIOTICS PREVENTION IN ABDOMINAL SURGERY

The purpose of study is to evaluate features of pharmacokinetics and efficiency of cefoperazone as a mean of peri-operational antibiotic prevention under surgical treatment of ventral hernia. Material and methods. The results of herniotomy and meshed endoprosthesis replacement were analyzed in 459 patients who, 20 minutes before the operation, received intravenous bolus injection of 1 g of cefoperazone with purpose of preventing wound infection. The pharmacokinetics of medication was analyzed according developed technique of capillary electrophoresis using device KAPEL-105M («Lumex», St. Petersburg). The analysis was applied to blood, urine and tissues of wound (skin, subcutaneous cellular tissue, aponeurosis, muscle, peritoneum) taken after 20, 40 and 60 minutes after injection of cefoperazone. The results. The first stage of study established that content of cefoperazone in subcutaneous fat is as much as possible approximated to its concentration in blood and it is 2-3 times higher in peritoneum. At the 60th minute a higher level of cefoperazone is observed in all tissues except subcutaneous cellular tissue though it is most stable there. At that, wound complications are established in 9 (1.95%) patients, including 2 (0,44%) patients шт the form of seroma. Discussion. In case of intravenous injection cefoperazone is distributed in tissues in the way that up to 60th minute of study, a significant decreasing of medication level (p

Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns.

We studied the lymphatic drainage of the upper limb and mammary region directing to the axilla to investigate whether independent pathways can be observed or whether anastomoses and shared drainage occur between them. This analysis aimed to assess the safety of axillary reverse mapping (ARM) in breast cancer treatment and to understand the development of lymphedema after sentinel lymph node biopsy (SLNB) alone. Seven unfixed stillborn fetuses were injected with a modified Gerota mass in the peri-areolar area, palm and dorsum of the hands, formalin fixed, and then submerged in 10% hydrogen peroxide solution. Microsurgical dissection was then performed on the subcutaneous cellular tissue of the upper limb, axillary region, and anterior thorax to expose the lymphatic vessels and lymph nodes. The dye injected into the upper limb reached either the lateral axillary group, known to be exclusively responsible for upper limb drainage, or the anterior group, which is typically related to breast drainage. There was great proximity among the pathways and lymph nodes. Communicating lymphatic vessels among these groups of lymph nodes were also found in all studied cases. Lymphedema remains a challenging morbidity in breast cancer treatment. ARM and SLNB aim to avoid unnecessary damage to the lymphatic drainage of the upper limb. However, our anatomical study suggests that ARM may have potential oncological risks because preserved lymph nodes may harbor malignant cells due their proximity, overlapping drainage pathways, and connecting lymph vessels among lymph nodes.

Efecto de la lipohipertrofia en el control metabólico de pacientes con diabetes mellitus tipo 2

La lipodistrofia (lipohipertrofia, lipoatrofia) es una complicación dada por la técnica inadecuada de inyección subcutánea de insulina. Se presenta el caso de una paciente de 46 años con diabetes mellitus tipo 2 descontrolada, en tratamiento con insulina glargina 45UI/día, sin control glucométrico y con múltiples ajustes y hospitalizaciones. Al ingreso, el automonitoreo muestra glucometrías basales y posprandiales fuera de metas, glucemia basal de 299 mg/dL y HbA1c de 11%. Al interrogatorio, se evidencian fallas en la técnica de aplicación de insulina, en particular falta de rotación del sitio de aplicación. En el examen físico se encuentra lipohipertrofia dada por panículo adiposo infraumbilical prominente bilateral e induración del tejido celular subcutáneo; en ecografía se visualiza infiltración grasa de rectos anteriores. Se da instrucción a la paciente sobre la correcta técnica de aplicación de insulina con rotación diaria del sitio de aplicación, descanso de zonas con lipohipertrofia y guía para automonitoreo.El automonitoreo en los 10 primeros días mostró mejoría de glucometrías basales hasta 116 mg/dL y valor limítrofe de 75 mg/dL, comparados con promedio de glucometría basal previa de 242 mg/dL con la misma insulina y dosis. Se hizo seguimiento estrecho para definir dosis requerida de insulina y vigilar posible hipoglucemia, con mejoría en la HbA1c de 9.2% y 8.8% a los 4 y 11 meses, respectivamente.