Surgical Procedure For Removal Research Articles

Combined Upper Fornix Transconjunctival and Endoscopic Transnasal Approach for Frontoethmoidal Osteoma with Orbital Extension - A Case Report

Abstract Rationale: Intraorbital osteomas are incidentally found and occasionally require surgical treatment. Depending on their localisation, a single technique may not provide a sufficient surgical field. Patient Concerns: We report a 16-year-old male with a left upper medial palpable mass. Diagnosis: Computed tomography revealed a dense bony mass extending from the ethmoid sinus to the superior wall of the frontal sinus, with protrusion into the orbital cavity. Treatment: The combination of upper fornix transconjunctival and endoscopic transnasal approaches was chosen for the surgical removal procedure. Outcomes: The two-pathway approaches resulted in the clear removal of the mass. Post-operative recovery was rapid, although a slight restriction of the inferomedial duction remained at three months. Take-away Lessons: This combination of techniques can provide a wide surgical field for the resection of frontoethmoidal osteomas with orbital extension.

Reliability of CBCT Dataset in Determination of Surgical Approaches of Maxillary Impacted Canine Teeth

Background: One of the most commonly impacted teeth is the maxillary canine, right after the third molar. Many potential difficulties might arise before, during, and after the extraction of impacted maxillary teeth. Performing thorough radiographic exams can be beneficial. The information for a two-dimensional (2D) examination is provided by the periapical and panoramic radiographs (OPG) utilized in conventional dental radiography. Cone beam computed tomography (CBCT) is a novel imaging technology developed in response to the shortcomings of traditional (2D) imaging methods. Everyone will gain from these problems resolved. Objectives: This study aims to evaluate two types of 2D (OPG), and 3D imaging (CBCT) approaches for diagnosing and treating maxillary impacted canines. Furthermore, to determine the best approach selection option for surgical removal procedures utilizing OPG and CBCT, focusing on the sagittal section for increased safety and efficiency. Materials and Methods: This study is a prospective radiographic investigation of 80 patients with CBCT radiographic evaluation. Eighteen cases (22.5%) of men and 62 (77.5%) of women reported. Version 27 of SPSS used to analyze the data. The independent t-test offered information on the reliability of the quantitative variables. We utilized a Chi-square test for the qualitative analysis, and for the quantitative analysis, we used a cross-tabulation to determine the level of agreement. Results: The t-test result, depending on surgical approach time, was 8.4; there is a significant difference between the two radiography prognosis, with p-values of (0.000) at the significant level (0.05). The %ages of agreement between impactions and surgical techniques ranged from 87.5% to 100%. Conclusion: This study shows that the CBCT guide can provide accurate, reliable, and reproducible results in assessing and predicting the kind of impaction and surgical approach in a simple, time-saving manner.

Validation of a Pre-Existing Scoring System for Preoperative Prediction of Difficulty in Laparoscopic Cholecystectomy

Background: One of the most commonly performed surgeries globally is Laparoscopic Cholecystectomy (LC) which is the gold standard surgical procedure for removal of gallbladder. It provides numerous benefits over open cholecystectomy but has also shown higher complication rates. Therefore, a system devised for pre operative assessment of intra operative difficulty level of Laparoscopic Cholecystectomy should be adopted to help with preparedness for complications and ensure an efficient course of surgery. Objective: The aim of this study was to validate a scoring system made by Randhawa Et al to assess intra operative difficulty level of Laparoscopic Cholecystectomy preoperatively. Study Design: This is a non randomized prospective observational study Methodology: This study was conducted in the department of general surgery unit 2 at Dow University Hospital, Karachi, Pakistan on 202 patients. Age, gender, BMI, history of previous hospitalization, examination finding of palpable gallbladder, previous abdominal surgery scars and sonographic findings including wall thickness of gallbladder, pericholecystic collection and impacted stone were considered to score a patient preoperatively. Results: Male gender and presence of pericholecystic fluid collection were found to be statistically significant in predicting intraoperative difficulty in patients undergoing laparoscopic cholecystectomy. Practical implications: Around 7 to 35% of laparoscopic cholecystectomy ends up getting converted into open cholecystectomy. This could be due to various reasons one of which is due to lack of preparedness for intraoperative difficulty in performing the surgery. For this reason, a scoring system that accurately predicts difficulty of surgery could help reducing this rate. Keeping this benefit in mind, a preformed scoring system was tested for its validity in assessing the intraoperative difficulty level of LC preoperatively. Keywords: Laparoscopic cholecystectomy, Scoring system, complications

FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare efcacy and safety of exible and rigid esophagoscopy in esophageal foreign body removal. Methods: It is a prospective study done in E.N.T department in KIMS MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. Results: This prospective cohort study includes 50 patients who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Conclusion: Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for removal of impacted esophageal foreign body.

Epidermoid cyst in submandibular region: a case report

The epidermoid cyst (EC) is a rare benign tumor that can develop in any region of the human body. About 7% of these cysts are located in head and neck. They are not frequent entities in cranio-facial region and in still more rare in oral cavity 1% statistically. Almost all of them occur in sublingual region, but there are rare case reports of occurrence in other sites. The epidermoid cysts is defined by a lined stratified squamous epithelium supported by an outer layer of collagenous-rich connective tissue. The detachment of keratin from the epithelial lining criates a soft white material rich in cholesterol crystals. This lipid rich content of the cyst may produce a vigorous inflammatory reaction if cyst rupture ocurrs. We report a case of epidermoid cyst (EC) located in submandibular region and the surgical removal procedure. This study was approuved by the Ferraz de Vasconcelos Regional Hospital (IRB) and the patient signed the Informed Consensus Files additionally. Clinical and radiographic examination revealed a movable swelling but hardened on palpation procedure. Histologic analisys of the excisional biopsy confirmed the initial hypotheses that it was an EC lesion. In spite of the EC being a rare benign lesion a differential diagnose is mandatory and it should not be underestimated due to its low but possible neoplasic transformation.

Effect of intra-peritoneal instillation of bupivacaine in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is a minimally invasive surgical procedure for removal of a diseased gall bladder. This technique essentially has replaced the open technique for routine cholecystectomies since the early 1990s. Laparoscopic cholecystectomy has become the gold standard for cholecystectomy in the past decade. Most patients are being discharged on the first or second post-operative day. The aim of the study was to evaluate effect of instillation of intra-peritoneal bupivacaine for pain relief in laparoscopic cholecystectomy. The primary outcome is to evaluate pain scores after this procedure.Methods: It’s an institutional based, observational and randomised control study was conducted in a patients undergoing laparocopic cholecystectomy with gall bladder disease in KPCMCH between 18-70 years of age. The study period was 12 months (from June 2021 to May 2022). 100 patients were included in this study.Results: Our study showed that, less number of patients had right shoulder tip pain (in Numerical rating scale) and requirement of rescue analgesia in case compared to control group.Conclusions: We concluded that instillation of intra-peritoneal bupivacaine reduces pain scores after difficult laparoscopic cholecystectomy.

Multiple magnet ingestion in children: A problem on the rise.

Ingestion of multiple magnets is increasing these last 15 years in children. They have resulted in numerous reports of serious gastrointestinal complications such as bowel obstruction, ischaemia, necrosis, perforation and fistula formation and even led to death. The increasing number of world-wide reports of complications secondary to magnet ingestion and a frequently delayed diagnosis point to a lack of awareness about these risks among medical care-givers in our country and parents in general. We reviewed retrospectively all cases of multiple magnet ingestion that required a gastro-intestinal or surgical procedure for removal from 2009 to 2020. Five children underwent gastroscopy removal and three colonoscopy removal of the magnets. Five patients required surgical (laparotomy or laparoscopy) removal of multiple magnets with intestinal perforations. We propose an updated management algorithm for multiple magnet ingestion to highlight awareness among primary physicians and parents of the presenting circumstances and symptoms as well as the potential complications associated with multiple magnet ingestion.

A Synopsize Report of the Various Perspectives of Urolithiasis and its Ethno-Medical Future

Kidney stone formation or urolithiasis is a complex process that results from a series of physicochemical events, including supersaturation, nucleation, growth, aggregation, and retention in the kidney. Urolithiasis affects about 10% of people in the Western world in their 70s. Epidemiological data show that calcium oxalate is the major mineral in most kidney stones.
 To date, great progress has been achieved in identifying metabolic risk factors that predispose to this complex condition, the most prominent of which is hypercalcemia. The unique genetic and epigenetic elements concerned in urolithiasis have remained largely unknown, thanks in part to the candidate gene and linkage techniques that have been available to date, which are inherently low in terms of their decision-making power and ability to assess modest outcomes in complicated traits.
 However, when combined with studies of rare Mendeliantypes of urolithiasis linked to various metabolic danger factors, those methodologies have shown organic pathways that appear to underpin the improvement of stones in the urinary system. Furthermore, despite substantial improvements in research into the biochemical and physical signs of kidney stones, therapeutic therapy medications are in short supply. Phytotherapy may be effective as an alternative or adjunctive therapy in the treatment of urolithiasis, according to data from in vitro, in vivo, and clinical investigations. This article discusses the various varieties of stones, as well as their characteristics.
 The varieties of stones, their composition, clinical evaluation, various surgical procedures for removal, treatment downsides, and several herbal medicine details giving therapeutic effects are all included in this review.
 Keywords: Urolithiasis, Epidemiological data, Diagnosis, Herbal drugs, Ethno medicines.

P 93 How does the vestibular function change after selective amygdalahipoocampectomy by stereotactic Laser-Thermoablation?

Objectives: The medial temporal lobe, centered in hippocampus, is known to receive vestibular input for processing spatial information. Patients with medial temporal lobe epilepsy (TLE) perform significantly worse on tests assessing clinical balance, path integration and rotational memory abilities. It is unknown whether a novel laser surgical procedure for removal of epileptic loci in the medial temporal lobe leads to improvement in these abilities. The goal of this study was to compare deficits related to clinical balance, path integration and rotational memory pre- and post-surgery in patients with medial (TLE). Methods: Five patients with medial TLE (41.4±17.0 years, 2 females) underwent a test battery that assessed vestibular-MTL functions both pre- and post-surgery: clinical balancing, path integration (triangle completion test) and rotational memory. All tests tests took place within one month before and after surgery. Results: Compared with pre-surgery assessment, the TLE-patients did not perform significantly better on any of the tests post-surgery. However, the effect sizes on each of the tests were large to very large in favor of the post-surgery assessment. Conclusion: Although the results were not significant, the obtained effect sizes indicate a potential benefit of the novel laser surgical procedure in TLE-patients‘ clinical balancing, path integration and rotational memory abilities. To confirm these findings, further studies on larger cohorts of patients are necessary.

Nerve-sparing Robot-assisted Retroperitoneal Lymph Node Dissection: The Monoblock Technique

BackgroundRetroperitoneal lymph node dissection (RPLND) is a treatment option for men with stage 1 or 2 testis cancer and the standard of care for men with postchemotherapy retroperitoneal residual disease. Given the morbidity of RPLND, four important surgical modifications have been proposed: minimally invasive access, nerve-sparing resection, template resection, and en-bloc resection. ObjectiveTo describe the surgical steps and perioperative outcomes of robotic nerve-sparing unilateral template RPLND with en-bloc resection (roboRPLND-NS+). Design, setting, and participantsFrom 2017 to 2019, five patients with suspicion of retroperitoneal metastatic testicular cancer on abdominopelvic computed tomography underwent roboRPLND-NS+ at a single referral center. All surgeries were carried out by a single surgeon who has performed more than 500 extended and more than 50 super-extended robot-assisted lymph node dissections. Surgical procedureA lateral transperitoneal robotic approach with a da Vinci Xi Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in six-arm configuration was used. The sympathetic chains, postganglionic sympathetic fibers, and hypogastric plexus were preserved as much as possible to ensure a nerve-sparing procedure. The template borders consisted of the renal vein cranially, the ureter laterally, the interaortocaval space medially, the common iliac artery caudally, and the psoas muscle dorsally for the right and left modified RPLND templates. Lymph nodes and the surrounding fatty tissue were progressively resected from the common iliac vessels and the abdominal aorta using the split-and-roll technique, and all of the template tissue was resected as a single specimen. Intraoperative and postoperative complications were recorded. MeasurementsLymph node yield and perioperative and postoperative oncological and functional outcomes were measured. Results and limitationsThe median patient age was 38 yr (interquartile range [IQR] 32–41) and the median operative time was 274 min (IQR 238–280). Node metastases were pathologically confirmed in three patients. The median number of lymph nodes removed was 19 (IQR 18–21), and the median number of positive lymph nodes was 2 (IQR 1–3). No patient experienced intraoperative or postoperative complications. The postoperative hospital stay was either 3 or 4 d. Maintenance of antegrade ejaculation was achieved in all patients. After median follow-up of 15 mo (IQR 14–30), all patients were alive and no recurrence was observed. Limitations include the low number of patients and the single surgeon experience. ConclusionsRoboRPLND-NS+ is a safe and feasible technique that allows removal of a high number of lymph nodes with good functional outcomes. Short-term survival outcomes were excellent, with no recurrences or deaths recorded. Patient summaryWe describe a feasible and safe robot-assisted surgical procedure for removal of lymph nodes in patients with testicular cancer. Our technique has potential to decrease the medical problems arising as side effects of the surgery while achieving good cancer control.

Predictors of osteoradionecrosis following irradiated tooth extraction

BackgroundTooth extraction post radiotherapy is one of the most important risk factors of osteoradionecrosis of the jawbones. The objective of this study was to determine the predictors of osteoradionecrosis (ORN) which were associated with a dental extraction post radiotherapy.MethodsA retrospective analysis of medical records and dental panoramic tomogram (DPT) of patients with a history of head and neck radiotherapy who underwent dental extraction between August 2005 to October 2019 was conducted.ResultsSeventy-three patients fulfilled the inclusion criteria. 16 (21.9%) had ORN post dental extraction and 389 teeth were extracted. 33 sockets (8.5%) developed ORN. Univariate analyses showed significant associations with ORN for the following factors: tooth type, tooth pathology, surgical procedure, primary closure, target volume, total dose, timing of extraction post radiotherapy, bony changes at extraction site and visibility of lower and upper cortical line of mandibular canal. Using multivariate analysis, the odds of developing an ORN from a surgical procedure was 6.50 (CI 1.37–30.91, p = 0.02). Dental extraction of more than 5 years after radiotherapy and invisible upper cortical line of mandibular canal on the DPT have the odds of 0.06 (CI 0.01–0.25, p < 0.001) and 9.47 (CI 1.61–55.88, p = 0.01), respectively.ConclusionExtraction more than 5 years after radiotherapy, surgical removal procedure and invisible upper cortical line of mandibular canal on the DPT were the predictors of ORN.

Postpartum retained products of conception: Is it possible to avoid postpartum curettage?

Removal of retained products of conception (RPOC) by suction curettage or hysteroscopy may be required in the postpartum period, possibly causing intrauterine adhesions. We investigated whether rates of suction curettage, hysteroscopy, and postoperative intrauterine adhesions have changed over time. Parturients considered at risk for RPOC were followed in a specialized postpartum clinic with sequential ultrasound scans. We compared the rates of women requiring surgical procedures for RPOC removal and rates of postoperative intrauterine adhesions between two 2-year periods: 2011-2012 ("early period") and 2016-2017 ("late period"). The overall rates of women requiring a surgical procedure for removal of RPOC did not differ between the early and late periods (38/762 [5.0%] vs 41/732 [5.6%], respectively, P=0.595). However, removal of RPOC by suction curettage decreased significantly over time whereas removal by hysteroscopy increased (P=0.022). Intrauterine adhesions were diagnosed in 7 of 38 women (18.4%) who underwent a surgical procedure for RPOC removal in the early period, but none of the patients operated on in the late period developed intrauterine adhesions (P=0.004). Removal of RPOC in postpartum women may be completed by hysteroscopy in most cases, significantly reducing the need for postpartum curettage and the rates of postoperative intrauterine adhesions.

Limited Vitrectomy versus Complete Vitrectomy for Epiretinal Membranes: A Comparative Multicenter Trial.

Purpose To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications. Methods In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups. Results We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p=0.49). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group (p=0.22). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences (p=0.18). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group (p < 0.001). Conclusion A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications.

EP31 Setting fire to sleeping giants: multiple autoimmune inflammatory diseases set off by chronic viral infection

Case report - IntroductionAutoimmune diseases are a group of disorders where the body produces an immune response against its own tissue constituents. The understanding of the immune mechanisms underlying autoimmunity has significantly deepened and broadened recently.The viral infection is a well-known trigger of autoimmunity and chronic hepatitis is known to cause various auto-immune diseases; organ-specific or systemic.Self-reactivity is part of the normal regeneration and healing. Auto-reactive T&B cells are kept dormant by the concerted action of a variety of mechanisms.Hepatitis C can disrupt this by molecular mimicry, by providing adjuvant and even by directly affecting B cell function.Case report - Case descriptionWe report a case of a 77 yr old Caucasian lady from South Africa who presented to Addenbrooke's hospital complaining of general decline, multiple constitutional symptoms, and low-grade fever for nearly 6 weeks. She did not have any infective symptoms. She had a past medical history of Type 1 DM, Hypothyroidism, Sjögren’s syndrome Osteoporosis and chronic hepatitis C infection which was treated 4 years ago. Family history was not significant, and she was a non-smoker.She was found to be thin with a BMI of 18, pyrexical with a temperature 37-38'c; otherwise, examination findings were unremarkable.Initial investigations revealed high inflammatory markers with an ESR of 99 and CRP of 120. WCC was within the normal range as were her renal and liver function tests. She was thoroughly investigated for Pyrexia of Unknown Origin. Her septic screen including Echocardiogram was negative. There was no detectable serum Para-protein and tumour markers were negative. Her CT scan of the chest abdomen and pelvis, MRI scan of the spine and PET scan were reported to be normal. The Serum Pro-calcitonin was low.Rheumatology team was enlisted at this point. On further assessment, the patient mentioned of having an ongoing mild generalised headache - described as a 'fullness in the head' and mild generalised scalp tenderness. She also had an aching pain in her legs. There was no history of visual symptoms, jaw, or tongue pain. On examination, she had generalised scalp tenderness which was worse over the left temporal artery.She had a temporal artery biopsy which showed typical features of GCA (disruption of IEL and giant cell) Following which she was commenced on steroids to which she had a remarkable response. After a month she was commenced on Tocilizumab with quick wean off steroids in view of her elevated risk for fractures.Case report - DiscussionThis lady believes to have contracted Hepatitis C in the early 80s during a surgical procedure for removal retained products of conception following an incomplete miscarriage in South Africa.She was found to be positive for hepatitis C in the early 90s when she tried to donate blood in the UK. She had genotype 1 hep C. on diagnosis her fibro scan was normal and live biopsy showed mild fibrosis. After regular surveillance during the following years, she was treated with AbbVie 3D regime and ribavirin in 2016 and she was declared to be clear in 2017 (Hepatitis C was undetectable).This lady received a diagnosis of Sjögren’s syndrome in the early 2000s which was based on the fact that she had Sicca symptoms, Positive ANA of 9.2, positive anti-La and anti-Ro, Rheumatoid factor of 13 and lymphocytic clusters in lip biopsy. There are many studies linking Hepatitis C and Sjögren’s syndrome. Sicca symptoms are common in hepatitis C, as chronic sialadenitis is a well-known extrahepatic manifestation. A recent meta-analysis showed a strong association between Hepatitis C infection and Sjögren’s syndrome (OR3.31).This lady was diagnosed with hypothyroidism in the early 90s. Thyroid autoantibodies were not checked then. Thyroid autoimmunity is quite common in Hepatitis C positive patients. Higher prevalence of anti-TPO (21%) and anti-thyroglobulin antibodies (17%) has been demonstrated in Hepatitis C positive population even before they develop hypothyroidism.She was diagnosed with Type 1 Diabetes mellitus in 1997 at the age of 55 after she presented with Diabetic ketoacidosis. She was strongly positive for Anti-GAD antibody (>2000). Again, pancreatic autoimmunity is highly prevalent in non-diabetic Hepatitis C population (1.4% vs 0.4%). There are several case reports of patients who developed type 1 DM after acute hepatitis C infection. Case report - Key learning pointsAs chronic infections are known to trigger autoimmune diseases, it is advisable to screen for them in patients with multiple or atypical autoimmune diseases. Treating the infection itself will lead to complete remission of these autoimmune conditions.

ODONTOMA Not Otherwise Specified (NOS)

Twenty-year-old female leucoderm patient V.G.P. sought the dental office reporting discomfort during chewing in the left retromolar region. During the anamnesis and extraoral clinical examination, no changes were observed. In the intraoral examination during palpation, the patient reported mild discomfort in the region referred to above. The conventional periapical radiographic examination revealed a radiolucent area with well-delimited radiopaque halo circular shape in the distal region of the tooth 38 adhered in the coronary portion with radiopaque image suggestive of a tooth in formation. In view of this finding, a panoramic radiograph was requested to evaluate the area. During the surgical procedure for removal of the included tooth and the intraosseous lesion, a puncture was performed, which had a negative result. Material was sent for histopathologic examination. The diagnostic hypotheses were ameloblastic fibro-odontoma, odontoma. Histopathologic diagnosis was of odontoma SOE. Twenty-year-old female leucoderm patient V.G.P. sought the dental office reporting discomfort during chewing in the left retromolar region. During the anamnesis and extraoral clinical examination, no changes were observed. In the intraoral examination during palpation, the patient reported mild discomfort in the region referred to above. The conventional periapical radiographic examination revealed a radiolucent area with well-delimited radiopaque halo circular shape in the distal region of the tooth 38 adhered in the coronary portion with radiopaque image suggestive of a tooth in formation. In view of this finding, a panoramic radiograph was requested to evaluate the area. During the surgical procedure for removal of the included tooth and the intraosseous lesion, a puncture was performed, which had a negative result. Material was sent for histopathologic examination. The diagnostic hypotheses were ameloblastic fibro-odontoma, odontoma. Histopathologic diagnosis was of odontoma SOE.

Factors associated with subsequent surgical procedures after intramedullary nailing for tibial shaft fractures

IntroductionThe reported rate of subsequent surgery after intramedullary nailing (IMN) of tibial shaft fractures (TSFs) is as high as 21%. However, most studies have not included the removal of symptomatic implant in these rates. The purpose of this study was to evaluate the subsequent surgery rate after IMN of TSFs, including the removal of symptomatic implants. Secondly, this study aimed to assess what factors are associated with subsequent surgery (1) to promote fracture and wound healing and (2) for the removal of symptomatic implants.MethodsOne-hundred and ninety-one patients treated with IMN for TSFs were retrospectively included. The rate of subsequent surgery was determined. Bi- and multivariable analysis was used to identify variables associated with subsequent surgery.ResultsApproximately half of patients (46%) underwent at least one subsequent surgical procedure. Forty-eight (25%) underwent a subsequent surgical procedure to promote fracture or wound healing. Age (P < 0.01), multi-trauma (P < 0.01), open fracture (P < 0.001) and index surgery during weekdays (P < 0.05) were associated with these procedures. Thirty-nine patients (20%) underwent a subsequent surgical procedure for removal of symptomatic implants. There was a significantly lower rate of implant removal in ASA II (11%) and ASA III–IV (14%) patients compared to ASA I patients (29%) (P < 0.05).ConclusionsPatients treated with IMN for TSFs should be consented that about one-in-two patients will undergo an additional surgical procedure. Half of these procedures are required to promote wound or fracture healing; the other half are for symptomatic implant removal.Level of evidenceTherapeutic level-IV.

Development of a surgical procedure for removal of a placentome from a pregnant ewe during gestation

BackgroundIn recent decades, there has been a growing interest in the impact of insults during pregnancy on postnatal health and disease. It is known that changes in placental development can impact fetal growth and subsequent susceptibility to adult onset diseases; however, a method to collect sufficient placental tissues for both histological and gene expression analyses during gestation without compromising the pregnancy has not been described. The ewe is an established biomedical model for the study of fetal development. Due to its cotyledonary placental type, the sheep has potential for surgical removal of materno-fetal exchange tissues, i.e., placentomes. A novel surgical procedure was developed in well-fed control ewes to excise a single placentome at mid-gestation.ResultsA follow-up study was performed in a cohort of nutrient-restricted ewes to investigate rapid placental changes in response to undernutrition. The surgery averaged 19 min, and there were no viability differences between control and sham ewes. Nutrient restricted fetuses were smaller than controls (4.7 ± 0.1 kg vs. 5.6 ± 0.2 kg; P < 0.05), with greater dam weight loss (− 32.4 ± 1.3 kg vs. 14.2 ± 2.2 kg; P < 0.01), and smaller placentomes at necropsy (5.7 ± 0.3 g vs. 7.2 ± 0.9 g; P < 0.05). Weight of sampled placentomes and placentome numbers did not differ.ConclusionsWith this technique, gestational studies in the sheep model will provide insight into the onset and complexity of changes in gene expression in placentomes resulting from undernutrition (as described in our study), overnutrition, alcohol or substance abuse, and environmental or disease factors of relevance and concern regarding the reproductive health and developmental origins of health and disease in humans and in animals.

Targeted Optical Imaging of the Glucagonlike Peptide 1 Receptor Using Exendin-4-IRDye 800CW.

The treatment of choice for insulinomas and focal lesions in congenital hyperinsulinism (CHI) is surgery. However, intraoperative detection can be challenging. This challenge could be overcome with intraoperative fluorescence imaging, which provides real-time lesion detection with a high spatial resolution. Here, a novel method for targeted near-infrared (NIR) fluorescence imaging of glucagonlike peptide 1 receptor (GLP-1R)–positive lesions, using the GLP-1 agonist exendin-4 labeled with IRDye 800CW, was examined in vitro and in vivo. Methods: A competitive binding assay was performed using Chinese hamster lung (CHL) cells transfected with GLP-1R. Tracer biodistribution was determined in BALB/c nude mice bearing subcutaneous CHL-GLP-1R xenografts. In vivo NIR fluorescence imaging of CHL-GLP-1R xenografts was performed. Localization of the tracer in the pancreatic islets of BALB/c nude mice was examined using fluorescence microscopy. Laparoscopic imaging was performed to detect the fluorescent signal of the tracer in the pancreas of mini pigs. Results: Exendin-4-IRDye 800CW binds GLP-1R with a half-maximal inhibitory concentration of 3.96 nM. The tracer accumulates in CHL-GLP-1R xenografts. Subcutaneous CHL-GLP-1R xenografts were visualized using in vivo NIR fluorescence imaging. The tracer accumulates specifically in the pancreatic islets of mice, and a clear fluorescent signal was detected in the pancreas of mini pigs. Conclusion: These data provide the first in vivo evidence of the feasibility of targeted fluorescence imaging of GLP-1R–positive lesions. Intraoperative lesion delineation using exendin-4-IRDye 800CW could benefit open as well as laparoscopic surgical procedures for removal of insulinomas and focal lesions in CHI.

Thoracomelia in sheep: a case report

In this case report, the occurrence of thoracomelia in a female sheep is reported. Thoracomelia is acongenital malformation that can affect several animal species and is characterized by the presence ofa supernumerary limb in the thoracic region. Scientific studies regarding the etiology of changes of thisnature are limited in veterinary medicine, especially concerning sheep. So far, there is no consensusregarding if the origin of this congenital malformation is genetic or environmental. Here, we provide thehistorical and photographic record of thoracomelia in a female sheep, and relate the malformation to anenvironmental cause: physical aggression suffered during embryonic development. The sheep underwenta surgical procedure for removal of the accessory limb and subsequently remained in the breeding line,giving birth to healthy descendants without thoracomelia.

Antibiotics Used After Impaction Removal in A Private Dental College

To evaluate antibiotic usage after the surgical removal of impacted teeth in saveetha dental college. In this study around 785 patient's data was collected from patient’s dental records who reported with impaction, between june 2019 to march 2020, Saveetha Dental College and Hospital, Chennai. The values obtained were tabulated and documented. The data were then entered into SPSS software for statistical analysis. The association between study variables was calculated using the chi-square test. Among the selected data, amoxicillin( and amoxicillin with metronidazole were mostly prescribed after impaction removal in saveetha dental college. The incidence of amoxicillin among the total population was found to be 57.4%. Whereas, Amoxicillin with metronidazole was 17.3% and amoxicillin with clavulanic acid was 14.1%. Percentage of males and females among the population were 57.4% and 42.5% respectively. Percentage of impaction removal in third molars , 38 (45.7%) and 48 (38.6%) were reported to have maximum percentage for surgical removal procedure for impaction. Correlations between the antibiotics and gender were determined, which showed p value to be .001(p