Cases Of Surgery Research Articles

140 Overall Impact of Varying Plastic Surgery LA Trauma Theatre Availability on Service Delivery in a Medium-Sized Plastic Surgery Department – a Single Centre Multi-Cycle Review

Abstract Aim Access to a dedicated local anaesthetic (LA) trauma facility outside standard theatres is a useful tool in the management of surgical trauma. An efficient cost-effective service should provide a see and treat delivery, wherever possible. We analysed the impact of altering service availability on the time between referral and surgical intervention, the time between surgical review and surgical intervention, and overall hospital services. We used this information to establish a pragmatic benchmark for service delivery. Method Between 2020 and 2023, key data was analysed for 5 separate cycles with differing levels of dedicated LA outpatient trauma theatre availability: 100%, 50%, 40%, 37%, 30%. 100% capacity represented two-sessions per day that ran Monday-Friday. Results Falling below 40% capacity caused a significant increase in the proportion of LA plastic surgery cases being performed in CEPOD or other theatres. 100% and 50% capacity saw similar distribution of theatre location. Once LA theatre capacity falls below 50%, this results in a significant delay between referral and day of surgery and a significant delay between senior review and day of surgery. Conclusions Demonstrates that dedicated LA trauma theatre availability of one half-day session daily can be a reasonable and pragmatic level of service provision for similar departments. Lower availability results in disruption to services, including higher main theatres utilisation, greater hospital bed expenditure, and increasing rates delay/cancellation. Increases towards 100% availability have little significant benefit. While this benchmark is specific to the caseload of the single unit, the analysis methods offer a replicable strategy for similar services.

Initial Experience of Robot-Assisted Surgeries.

To present initial experience with the first 100 cases of robotic-assisted surgery by the Department of General Surgery. Descriptive study. Place and Duration of the Study: Department of Surgery, National Hospital and Medical Centre, Lahore, Pakistan, from May 2022 to August 2023. Demographic and postoperative details of the first 100 patients to undergo robotic-assisted surgery by the Department of General Surgery were reviewed. Prospective data were collected from the hospital information database as well as the CMR database. The data collected in the hospital database included the patients' age, diagnoses, genders, complications during hospital stay as well as 90-day readmission, morbidity, and mortality. Data collected by CMR via Versius robotic surgery console or internal databases included operative minutes using the console. The average age of patients undergoing robotic surgery was 44.26 ± 14.08 years. Cholecystectomy (78%) was the most commonly performed robotic-assisted procedure. Only one patient had blood loss of more than 100ml. There was no postoperative complication, readmission or mortality during the study period. With proper patient selection, robotic-assisted surgery is safe and feasible even in low-middle-income countries (LMICs). Robotic-assisted surgery, Pakistan, Initial experience, Outcomes, Versius.

Secondary Glaucoma after Cataract Surgery Performed in Infancy in Congenital Rubella Syndrome: A Case Control Study

ObjectiveTo compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with non-rubella cataracts and to identify associated risk factors. DesignRetrospective case control study. ParticipantsChildren with CRS who had undergone cataract surgery in infancy and age matched infants who had undergone cataract surgery for infantile cataracts were included. MethodsIncidence of glaucoma and probability of survival was compared among the two groups. Risk factors for the development of glaucoma were assessed. The minimum follow up was 1 year after cataract surgery. ResultsThe study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the non-rubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the two groups (p=0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (p=0.19). Mean follow-up was 5.8 ± 3.7years for CRS group and 6.4± 3.4years for the non-rubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 versus controls 0.8; log rank p-0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (p>0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83, 95% confidence interval 1.44-5.57; p=0.002) in CRS eyes. ConclusionThere was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared to infants who had undergone surgery for infantile cataracts. Since the ten year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow up is recommended especially in eyes with at-risk features.

Significance of signal recognition particle 9 nuclear translocation: Implications for pancreatic cancer prognosis and functionality.

Signal recognition particles (SRPs) are essential for regulating intracellular protein transport and secretion. Patients with tumors with high SRP9 expression tend to have a poorer overall survival. However, to the best of our knowledge, no reports have described the relationship between SRP9 localization and prognosis in pancreatic cancer. Thus, the present study aimed to investigate this relationship. Immunohistochemical staining for SRP9 using excised specimens from pancreatic cancer surgery cases without preoperative chemotherapy or radiotherapy showed that SRP9 was preferentially expressed in the nucleus of the cancerous regions in some cases, which was hardly detected in other cases, indicating that SRP9 was transported to the nucleus in the former cases. To compare the prognosis of patients with SRP9 nuclear translocation, patients were divided into two groups: Those with a nuclear translocation rate of >50% and those with a nuclear translocation rate of ≤50%. The nuclear translocation rate of >50% group had a significantly better recurrence‑free survival than the nuclear translocation rate of ≤50% group (P=0.037). Subsequent in vitro experiments were conducted; notably, the nuclear translocation rate of SRP9 was reduced under amino acid‑deficient conditions, suggesting that multiple factors are involved in this phenomenon. To further study the function of SRP9 nuclear translocation, in vitro experiments were performed by introducing SRP9 splicing variants (v1 and v2) and their deletion mutants lacking C‑terminal regions into MiaPaCa pancreatic cancer cells. The results demonstrated that both splicing variants showed nuclear translocation regardless of the C‑terminal deletions, suggesting the role of the N‑terminal regions. Given that SRP9 is an RNA‑binding protein, the study of RNA immunoprecipitation revealed that signaling pathways involved in cancer progression and protein translation were downregulated in nuclear‑translocated v1 and v2. Undoubtedly, further studies of the nuclear translocation of SRP9 will open an avenue to optimize the precise evaluation and therapeutic control of pancreatic cancer.

Social determinants of health and disparities in spine surgery: a 10-year analysis of 8,565 cases using ensemble machine learning and multilayer perceptron

BACKGROUND CONTEXTThe influence of SDOH on spine surgery is poorly understood. Historically, researchers commonly focused on the isolated influences of race, insurance status, or income on healthcare outcomes. However, analysis of SDOH is becoming increasingly more nuanced as viewing social factors in aggregate rather than individually may offer more precise estimates of the impact of SDOH on healthcare delivery. PURPOSEThe aim of this study was to evaluate the effects of patient social history on length of stay (LOS) and readmission within 90 days following spine surgery using ensemble machine learning and multilayer perceptron. STUDY DESIGNRetrospective chart review. PATIENT SAMPLE8,565 elective and emergency spine surgery cases performed from 2013 to 2023 using our institution's database of longitudinally collected electronic medical record information. OUTCOMES MEASURESPatient LOS, discharge disposition, and rate of 90-day readmission. METHODSEnsemble machine learning and multilayer perceptron were employed to predict LOS and readmission within 90 days following spine surgery. All other subsequent statistical analysis was performed using SPSS version 28. To further assess correlations among variables, Pearson's correlation tests and multivariate linear regression models were constructed. Independent sample t-tests, paired sample t-tests, one-way analysis of variance (ANOVA) with post-hoc Bonferroni and Tukey corrections, and Pearson's chi-squared test were applied where appropriate for analysis of continuous and categorical variables. RESULTSBlack patients demonstrated a greater LOS compared to white patients, but race and ethnicity were not significantly associated with 90-day readmission rates. Insured patients had a shorter LOS and lower readmission rates compared to non-insured patients, as did privately insured patients compared to publicly insured patients. Patients discharged home had lower LOS and lower readmission rates, compared to patients discharged to other facilities. Marriage decreased both LOS and readmission rates, underweight patients showcased increased LOS and readmission rates, and religion was shown to impact LOS and readmission rates. When utilizing patient social history, lab values, and medical history, machine learning determined the top 5 most-important variables for prediction of LOS —along with their respective feature importances—to be insurance status (0.166), religion (0.100), ICU status (0.093), antibiotic use (0.061), and case status: elective or urgent (0.055). The top 5 most-important variables for prediction of 90-day readmission—along with their respective feature importances—were insurance status (0.177), religion (0.123), discharge location (0.096), emergency case status (0.064), and history of diabetes (0.041). CONCLUSIONSThis study highlights that SDOH is influential in determining patient length of stay, discharge disposition, and likelihood of readmission following spine surgery. Machine learning was utilized to accurately predict LOS and 90-day readmission with patient medical history, lab values, and social history, as well as social history alone.

The positive effects of preoperative chlorhexidine rinse to reduce postoperative pneumonia after kidney transplantation surgery

BackgroundPostoperative pneumonia is one of the most observed hospital-acquired infections and increases the postoperative mortality rate. Further, it drives the healthcare systems under a severe financial burden. Preventing postoperative pneumonia is an incredibly challenging issue for clinicians. Since immunosuppression therapy, the patients who had kidney transplants are more vulnerable to postoperative infections. There is no data in the scientific literature focusing on the effects of preoperative oral care with chlorhexidine antiseptic solutions on postoperative pneumonia in kidney transplantation surgery cases. In the present research, we studied this topic. MethodsA prospective, randomized clinical trial was conducted at our institution between August 2020 and August 2022. Group A: Received 0.12 % chlorhexidine oral rinse preoperatively; Group B: Not received 0.12 % chlorhexidine oral rinse preoperatively. We analyzed the differences between the two trial groups using a chi-square or t-test. The Mann-Whitney U test was used for the categorical data. ResultsNine patients (17.6 %) were diagnosed with postoperative pneumonia in Group A and fourteen (25.9 %) in Group B (p < 0.05). Hospitalization time of Group B was prolonged (p < 0.05). In multivariate analysis, significant risk factors associated with postoperative pneumonia were advanced age, diabetes mellitus, smoking, delayed graft function and not gargling with 0.12 % chlorhexidine (p < 0.05). ConclusionsTo reduce postoperative pneumonia risk in patients undergoing kidney transplantation surgery, an oral health protocol including 0.12 % chlorhexidine mouth rinse seems beneficial.

Hydrocele among Patients undergoing Surgery in the Department of Surgery in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Hydrocele, an accumulation of serous fluid within the remnant of the processus vaginalis, is a common cause of painless scrotal enlargement. While prevalent, few studies have been conducted to assess the extent and risk factors of hydrocele in Nepal. This study aimed to assess the prevalence and associated factors of hydrocele among patients undergoing the surgery department at a tertiary care center in Nepal. This descriptive cross-sectional study was conducted at a tertiary care center. Data were retrospectively collected from medical records over one year (2021 July to 2022 June), including all patients undergoing surgery in the general surgery department. Ethical Approval was received from the Institutional Review Committee of the same institute (Reference number: 820/2080/81) Cases of hydrocele surgery were identified, and relevant data were extracted using a structured proforma. Descriptive analyses were performed using Microsoft Excel 2016. Out of 1812 surgeries, 95 (9.72%) were hydrocele surgeries. Of these, 94 (98.95%) were non-communicating hydroceles, 79 (83.16%) were unilateral, and 90 (94.74%) showed positive transillumination tests. The mean age of patients was 50.84 ± 17.02 years, with the highest number of cases in the 46-55 age group (20%). Postoperative complications occurred in 19 (20%) patients, with seroma and surgical site infection being the most common (31.58% each). Hydrocele surgeries comprised a significant portion (5.24%) of surgical cases at the tertiary care center, with the majority being non-communicating and unilateral types.

Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011-2020).

To evaluate the prognostic utility of baseline frailty, measured by the Risk Analysis Index (RAI), for prediction of postoperative mortality among patients with spinal malignancy (SM) undergoing resection. SM surgery cases were queried from the American College of Surgeons - National Surgical Quality Improvement Program database (2011-2020). The relationship between preoperative RAI frailty score and increasing rate of primary endpoint (mortality or discharge to hospice within 30 days, "mortality/hospice") were assessed. Discriminatory accuracy was assessed by computation of C-statistics (with 95% confidence interval [CI]) in receiver operating characteristic (ROC) curve analysis. A total of 2,235 cases were stratified by RAI score: 0-20, 22.7%; 21-30, 11.9%; 31-40, 54.7%; and ≥ 41, 10.7%. The rate of mortality/hospice was 6.5%, which increased linearly with increasing RAI score (p < 0.001). RAI was also associated with increasing rates of major complication, extended length of stay, and nonhome discharge (all p < 0.05). The RAI demonstrated acceptable discriminatory accuracy for prediction of primary endpoint (C-statistic, 0.717; 95% CI, 0.697-0.735). In pairwise ROC comparison, RAI demonstrated superiority versus modified frailty index-5 and chronological age (p < 0.001). Preoperative frailty, as measured by RAI, is a robust predictor of mortality/ hospice after SM surgery. The frailty score may be applied in clinical settings using a user-friendly calculator, deployed here: https://nsgyfrailtyoutcomeslab.shinyapps.io/spinalMalignancyRAI/.

Robot‐assisted radical cystectomy for bladder cancer after low anterior resection: A case report

AbstractRadical cystectomy after low anterior resection is rare, and no cases of robotic surgery have been reported. Cystectomy in patients who have undergone a previous pelvic surgery, whether open or endoscopic, requires caution to avoid damaging other organs due to anatomical changes caused by adhesions in a limited space. Additionally, the curative nature of the treatment must be maintained. We describe a 69‐year‐old man with a history of open low anterior resection for rectal cancer who underwent robot‐assisted radical cystectomy with extracorporeal ileal conduit construction. Although this procedure is challenging, it was performed safely with the collaboration of colorectal surgeons. The patient was discharged without perioperative complications and remained recurrence‐free for 5 years.

Evaluating the clinical application and effect of acupuncture therapy in anal function rehabilitation after low-tension rectal cancer surgery

BACKGROUND According to the indexes of serum and anal function, acupuncture therapy was applied to patients with low rectal cancer in order to avoid the occurrence of anal incontinence and reduce complications. AIM To explore the clinical application and evaluate the effect of acupuncture therapy for anal function rehabilitation after low-tension rectal cancer surgery. METHODS From the anorectal surgery cases, we selected 120 patients who underwent colorectal cancer surgery between January 2020 and December 2022 and randomly divided them into a control group (n = 60), observation group (n = 60), and control group after surgery for lifestyle intervention (including smoking cessation and exercise), dietary factor adjustment, anal movement, and oral loperamide treatment. The serum levels of motilin, 5-hydroxytryptamine, and vasoactive intestinal peptide (VIP), Wexner score for anal incontinence, and incidence of complications were compared between groups. RESULTS After treatment, the VIP and 5-hydroxytryptamine levels in the observation group were lower than those in the control group (P &lt; 0.05). The motilin level was higher than that in the control group (P &lt; 0.05). Postoperative anal incontinence was better in the observation group than in the control group (P &lt; 0.05). The incidence of complications in the observation group was 6.67%, which was significantly lower than that in the control group (21.67%; P &lt; 0.05). CONCLUSION Acupuncture therapy has a positive effect on the rehabilitation of anal function after low-tension rectal cancer surgery; it can effectively help to improve the serum indices of patients, avoid the occurrence of anal incontinence, and reduce the incidence of complications. Popularizing and applying it will be valuable.

Clinical Evaluation of Primary Suturing of Normal-Diameter Common Bile Ducts After Microincision of Cystic Duct Confluence for Stone Removal.

In patients with gallstones complicated by common bile duct (CBD) stones, both normal and dilated common bile ducts have been reported. The goal of this study was to investigate the efficacy and safety of primary suturing after microincision of the cystic duct confluence in treating these patients. Between July 2018 and December 2021, 104 patients were admitted to the Department of General Surgery at Guannan County People's Hospital with gallstone complications, and their records were reviewed retrospectively. The patients were divided into 2 groups: normal CBD group (n=70, CBD diameter: 6.0 to 8.0mm) and dilated CBD group (n=34, CBD diameter: >8.0mm). In these 104 patients, there were 75 cases of CBD stones with acute cholangitis, 12 cases of CBD stones without cholangitis, and 17 cases of mild biliary pancreatitis with CBD stones (including 2 cases of biliary pancreatitis with cholangitis). Among all patients, there were 37 cases with jaundice, 67 cases without jaundice, and 5 cases of emergency surgery. All patients underwent microincision of the cystic duct confluence followed by primary suturing. Both groups were compared on a variety of general and perioperative indicators. All patients underwent laparoscopy combined with choledochoscopy; there were no cases of biliary tract injury or conversion to laparotomy. There was no statistically significant difference in operation duration ( P =0.286), blood loss ( P =0.06), length of stay ( P =0.821), and time to drainage tube removal ( P =0.096) between the 2 groups. Microincision of the cystic duct confluence, followed by a primary suture, is a safe and effective treatment for CBD stones in patients with a normal CBD diameter, as determined by preoperative imaging.

Phantom sensation in genital gender-affirming surgery: a narrative review.

To review findings related to phantom genital sensation, emphasizing phantom sensation in the transgender and gender diverse (TGD) population. We discuss prevalence, presentation and potential implications for sensory outcomes in genital gender-affirming surgery. There is a high prevalence of phantom genital sensations in the TGD population. The prevalence varies by body part, approaching 50% in the most frequently reported transgender phantom - the phantom penis. Unlike genital phantoms that occur after trauma or surgery which are often painful, transgender phantoms are typically neutral and often erogenous in experience. Phantom sensation in the TGD population can be an affirming experience and important part of sexual well being and embodiment. Recent studies have begun to characterize the prevalence and presentations of phantom genital sensations in TGD people, informing our evolving understanding of the sensory experiences of the transgender and gender diverse population. Targeting integration of these centrally-mediated phantom genital sensations with the peripherally generated sensation from genital stimulation may represent one potential avenue to improve sensation and embodiment following genital gender-affirming surgical procedures. Additionally, emerging techniques in modern peripheral nerve surgery targeting phantom pain may offer potential treatment options for painful phantom sensation seen after cases of genital surgery or trauma.

Robotic-Assisted Endovascular Treatment for Transplant Renal Artery Stenosis: A Feasibility Study.

To describe a single-center experience with robotic-assisted endovascular treatment for transplant renal artery stenosis. This is a single-center, retrospective, feasibility study of 4 consecutive cases of robotic-assisted endovascular surgery for transplant renal artery stenosis from October 2021 to August 2022. All lesions were identified, and stenting was performed with no complications. Conversion to manual control was not necessary. The mean fluoroscopy time was 25.25min (range 12-60.9). A control Doppler ultrasound was routinely performed, demonstrating no residual lesions in all cases. There was no reintervention during the follow-up period. The operator learning curve was felt to be acceptable. Robotic-assisted endovascular treatment is a feasible technique for transplant renal artery stenosis.

Model-based individual life-spanning documentation in visceral surgery: a proof of concept.

Surgical documentation has many implications. However, its primary function is to transfer information about surgical procedures to other medical professionals. Thereby, written reports describing procedures in detail are the current standard, impeding comprehensive understanding of patient-individual life-spanning surgical course, especially if surgeries are performed at a timely distance and in diverse facilities. Therefore, we developed a novel model-based approach for documentation of visceral surgeries, denoted as 'Surgical Documentation Markup-Modeling' (SDM-M). For scientific evaluation, we developed a web-based prototype software allowing for creating hierarchical anatomical models that can be modified by individual surgery-related markup information. Thus, a patient's cumulated 'surgical load' can be displayed on a timeline deploying interactive anatomical 3D models. To evaluate the possible impact on daily clinical routine, we performed an evaluation study with 24 surgeons and advanced medical students, elaborating on simulated complex surgical cases, once with classic written reports and once with our prototypical SDM-M software. Leveraging SDM-M in an experimental environment reduced the time needed for elaborating simulated complex surgical cases from 354 ± 85s with the classic approach to 277 ± 128s. (p = 0.00109) The perceived task load measured by the Raw NASA-TLX was reduced significantly (p = 0.00003) with decreased mental (p = 0.00004) and physical (p = 0.01403) demand. Also, time demand (p = 0.00041), performance (p = 0.00161), effort (p = 0.00024), and frustration (p = 0.00031) were improved significantly. Model-based approaches for life-spanning surgical documentation could improve the daily clinical elaboration and understanding of complex cases in visceral surgery. Besides reduced workload and time sparing, even a more structured assessment of individual surgical cases could foster improved planning of further surgeries, information transfer, and even scientific evaluation, considering the cumulative 'surgical load.' Life-spanning model-based documentation of visceral surgical cases could significantly improve surgery and workload.

Treatment of lumbar disc herniation with robot combined with unilateral biportal endoscopic technology: A case report

BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion (UBE-LIF), utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment, and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement. The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies, and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients, and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference. CASE SUMMARY A 44-year-old patient presented to our hospital. Combining various clinical data, we diagnosed the patient with lumbar disc herniation with radiculopathy, lumbar spondylolisthesis, and lumbar spinal stenosis. We developed a surgical plan of "UBE decompression + UBE-LIF + orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation". The results were satisfactory. CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results. Therefore, the technique is worthy of clinical promotion.

HSD34 Analysis of Changes in the Number of Cases of Gynecological Surgeries for Benign Indications in Hungary

HSD34 Analysis of Changes in the Number of Cases of Gynecological Surgeries for Benign Indications in Hungary

A successful complete resection for multidrug-resistant giant gastrointestinal stromal tumor invading the transverse colon with multiple liver metastases in a young female: a case report

BackgroundGastrointestinal stromal tumors (GISTs) are rare in young people and are often detected after becoming symptomatic or at an advanced stage. Herein, we report a case of complete reduction surgery for a substantially large malignant gastric GIST with multiple liver metastases in a young woman who successfully resulted in R0 surgery.Case presentationAn 18-year-old woman presented to our hospital with anorexia and vomiting, and was diagnosed with a 17 cm gastric GIST with transverse colon invasion and multiple liver metastases. Due to being considered unresectable, tyrosine and multi-kinase inhibitor therapy were administered up to the fourth line yielding no response. After careful discussion at a multidisciplinary team conference, pancreatoduodenectomy or distal gastrectomy, transverse colectomy, and resection of the liver metastases were planned. Consequently, distal gastrectomy, transverse colectomy, resection of the liver metastases, and incidental peritoneal metastases were performed. Although the primary goal of the surgery was to reduce the volume of the tumor as much as possible, the results revealed that the complete removal of all detectable tumors was achieved. No recurrence was observed after surgery for 27 months with long-term adjuvant imatinib therapy.ConclusionsEven for highly advanced GISTs, aggressive surgery followed by adjuvant drug therapy may prolong survival in young patients.

Double entrapment neuropathy of the ulnar nerve at the elbow and the wrist : double crush syndrome?

BackgroundDouble crush syndrome refers to a nerve in the proximal region being compressed, affecting its proximal segment. Instances of this syndrome involving ulnar and cubital canals during ulnar neuropathy are rare. Diagnosis solely through clinical examination is challenging. Although electromyography (EMG) and nerve conduction studies (NCS) can confirm neuropathy, they do not incorporate inching tests at the wrist, hindering diagnosis confirmation. We recently encountered eight cases of suspected double compression of ulnar nerve, reporting these cases along with a literature review.MethodsThe study included 5 males and 2 females, averaging 45.6 years old. Among them, 4 had trauma history, and preoperative McGowan stages varied. Ulnar neuropathy was confirmed in 7 cases at both cubital and ulnar canal locations. Surgery was performed for 4 cases, while conservative treatment continued for 3 cases.ResultsIn 4 cases with wrist involvement, 2 showed ulnar nerve compression by a fibrous band, and 1 had nodular hyperplasia. Another case displayed ulnar nerve swelling with muscle covering. Among the 4 surgery cases, 2 improved from preoperative McGowan stage IIB to postoperative stage 0, with significant improvement in subjective satisfaction. The remaining 2 cases improved from stage IIB to IIA, respectively, with moderate improvement in subjective satisfaction. In the 3 cases receiving conservative treatment, satisfaction was significant in 1 case and moderate in 2 cases. Overall, there was improvement in hand function across all 7 cases.ConclusionTypical outpatient examinations make it difficult to clearly differentiate the two sites, and EMG tests may not confirm diagnosis. Therefore, if a surgeon lacks suspicion of this condition, diagnosis becomes even more challenging. In cases with less than expected postoperative improvement in clinical symptoms of cubital tunnel syndrome, consideration of double crush syndrome is warranted. Additional tests and detailed EMG tests, including inching tests at the wrist, may be necessary. We aim to raise awareness double crush syndrome with ulnar nerve, reporting a total of 7 cases to support this concept.

Comparison of carprofen and firocoxib as analgesic for post-operative pain management in clinical cases of canine orthopaedic surgery

Comparison of carprofen and firocoxib as analgesic for post-operative pain management in clinical cases of canine orthopaedic surgery

Surgical site infections in elective and emergency general surgery cases in a tertiary public hospital of South India: a retrospective study

Surgical site infections in elective and emergency general surgery cases in a tertiary public hospital of South India: a retrospective study