Metastatic colorectal cancer at a young age with a pre-existing congenital colorectal motility disorder is a rare but serious presentation.
Objective: This investigation endeavors to scrutinize the most potent evidence for the prevention of Device-Related Pressure Injury (DRPI)
Lymphoepithelial Cyst arising from the submandibular gland is a rare finding. In this article, we propose to highlight the inclusion of LEC in the differential diagnosis of neck swellings.
This review aims to provide an updated overview of neoadjuvant strategies in Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer, with a specific focus on surgical implications.
Introduction: Surgical resection offers the best chance of long-term survival for patients with Pancreatic adenocarcinoma (PDAC).
Background: Talc is a component of oral drugs that acts as a binding and bulking agent and a lubricant for the active ingredients. Talc has been shown to be fibrogenic and can cause the formation of foreign body granulomas in the pulmonary interstitium, leading to talcosis.
Hydatidosis is a zoonotic disease that can affect various parts of the body, primarily the liver, leading to the development of parasitic cystic lesions following the ingestion of food contaminated with animal feces. The disease’s prevalence in Jordan varies based on residency location, educational status, and proximity to herbivorous animals and dogs, which are key hosts. This case study presents a 45-year-old Syrian male patient living in the Al-Zaatary refugee camp in Jordan who works as a b...
Intestinal obstruction can involve small intestines or a large gut. It is an emergency that needs immediate management to avoid serious complications like perforation leading to peritonitis, sepsis, and even death. The most common cause of intestinal obstruction is post operative adhesions, but other common causes are hernias, worm bolus obstruction, volvulus, internal herniation and so on.
Introduction: Rectal cancer treatment is being developed in many different ways, and the surgical one is probably breaking new ground. This is why we talk about sphincter-sparing surgery and the subsequent suggestive rise of diverting ileostomies. However, despite this fact, this approach has a considerable weakness which is usually underestimated.
Neurosurgery is a constantly evolving field with many technological advances occurring over the past decades which have served to broaden our horizons regarding neurosurgical knowledge and capabilities. Of these many advancements, one particular innovation that stands out from the rest is the development of Augmented Reality (AR) and Virtual Reality (VR). While being a relatively new advancement and still in its infancy compared to other technological innovations, it has been demonstrated that ...
Zygomatic implants are reportedly effective in replacing lost teeth and Orofacial soft and hard tissue configuration. The prime goal of this systematic review is to update the survival rate of zygomatic implants. The initial systematic review was carried out in November 2019. In this updated review, articles published between December 2019 and October 2022 were retrieved from PubMed, ISI Web of Science, Cochrane, and Google Scholar databases. The comprehensive electronic search in both systemat...
Zygomatic implants are reported to be viable treatment options to restore defective Orofacial soft and hard tissue configuration. A systematic review, which was conducted in November 2019, identified 29 relevant studies for data analysis. In this review, sinus infection, soft tissue trauma, mucositis, hematoma, and paraesthesia were found to be the leading zygomatic implant-associated complications. This systematic follow-up review was carried out in November 2022 to update the previous study’s...
This study identifies fistulized renal patients likely to develop this type of postoperative complication in order to improve their treatment.
Ocular toxoplasmosis, an infection caused by Toxoplasma gondii, is the most common cause of infectious posterior uveitis in immunocompetent patients. This paper aims to report the case of a woman with retinitis associated with ocular toxoplasmosis and an intravitreal dexamethasone implant.
Objectives: Despite the current prevalence of Electroacupuncture in the world, the information comparing Electroacupuncture to classical acupuncture manipulation techniques is very limited, and the indications for using Electroacupuncture and classical acupuncture manipulation are very limited techniques are absent for practitioners and educators to follow. This study aims to identify how these two acupuncture-related modalities are applied in Australia and the reasons.
Abdominal Cocoon Syndrome or Sclerosing Encapsulating Peritonitis is a rare cause of Intestinal Obstruction. It is characterized by small bowel encapsulation by a fibrous membrane or a cocoon-like sac. We present here such a case. A 59-year-old male presented with acute intestinal obstruction. Though the obstruction settled with conservative management, there was a persistent swelling on one side of the abdomen. CT scan showed matted gut loops corresponding to this swelling.
Vasospasm is a potentially severe complication of subarachnoid hemorrhage. It can be attributed to neuroinflammation and the robust recruitment of microglia. Emerging evidence has linked this sustained inflammation to the development of delayed cerebral ischemia following subarachnoid hemorrhage. In this focused review, we provide an overview of the historical understanding of vasospasm. We then delve into the role of neuroinflammation and the activation of microglia. These activated microglia ...
Objectives: The study aimed to describe the clinical, microbiological, and therapeutic characteristics of septic arthritis after Anterior Cruciate Ligament Surgery (ACLR).
The Laparoscopic Intraperitoneal Onlay Mesh (IPOM) technique for managing primary inguinal hernia repair has shown conflicting results in previous studies. The main concerns associated with this technique are intestinal adhesion and recurrence of a hernia. However, these concerns need to be balanced with associated advantages, including ease of performance, short operative and anesthesia time, and lower incidence of injuries to the spermatic cord and adjacent structures. Therefore, a retrospect...
Introduction: Proliferating trichilemmal tumor (PTT), also known as hyperplastic hair cyst or hyperplastic hair follicle cyst, is common in women over 60 years of age and mainly presents as a painless scalp mass. Malignant one was very rare.
A 42-year-old male who had a colonoscopy to investigate symptoms of altered bowel habit, low abdominal pain and fatigue. He went on to develop pain 8 hours after his procedure. At the time investigations were all normal, however, due to ongoing pain, two days later a CT scan demonstrated acalculous cholecystitis. He was not known to have gallbladder stones in the past. He had further investigations which did not confirm presence of gall stones. There have previously been 11 case reports of acut...
Fractures of the capitate bone are rare injuries, usually occurring in association with other carpal lesions. This case report aims to bring awareness to the diagnosis of capitate fractures and intracarpal ligament lesions and to provide details of the surgical fixation method and functional outcome.
Introduction: Colorectal cancer (CRC) is one of the major causes of cancer deaths in developed countries. Population-based screening programs in various countries are implemented. CRC Screening Program was implemented in Denmark, aiming at detecting early cancer and precursors of cancer by screening citizens aged 50 years–74 years. Immunohistochemistry is used to detect occult hemoglobin in the feces. Various cut-off levels are used in different countries to guide and choose which patients shou...
Background: The optimal approach for Bethesda III and IV classes is not yet defined, largely because the malignancy rate remains unknown. This study aimed to determine the rate of malignancy and to find any possible association between features of Bethesda categories III and IV patients and the presence of malignancy.
Introduction: Epidermoid cyst is a benign tumor frequently observed throughout the body. It can grow in size and may get infected over a period of time. However, pre-coccygeal epidermoid cysts are rare. Observation: We are reporting a case of a pre-coccygeal epidermoid cyst in a 27-year-old female, which was managed successfully. It was a type 1 tumor that was operated via a posterior parasacral approach.
The objective of this case series study was to evaluate the obstetric, perinatal, and neonatal outcomes of pregnant women who tested positive for the COVID-19 (Coronavirus) infection. All pregnant patients (n = 21) who tested positive for the COVID-19 infection using RT-PCR at the Department of Obstetrics and Gynecology, Royal Commission Medical Center Yanbu, Saudi Arabia from July 14, 2020, to November 14, 2020, were included in the study. Data regarding their demographics, clinical presentati...
Introduction: Abscess can be intra peritoneal, extraperitoneal, retroperitoneal or in the abdominal wall. Abdominal wall abscesses are generally seen in diabetics, immunocomprised or as a sequelae of cutaneous tuberculosis.
Carotid body tumor arise from the paraganglionic cells located at the medial surface of the carotid bifurcation. Bilateral tumors occur in only 5% of these cases. Our case report is about a 29-year-old female resident of high altitude (> 3500 meters above sea levels), she developed bilateral neck swelling and her radiological investigations determined she had bilateral carotid body tumors. The larger tumor (Shamblin III) was successfully excised and the smaller tumor was kept under follow-up.
Background: The Zygoma implant is an alternative to bone grafting to rehabilitate the severely resorbed posterior maxilla. Long-term clinical studies are few, and the primary purpose of this prospective clinical study was to assess the survival rate of zygoma implants used for retention of fixed dental bridges, up to 17 years.
Background & Aims: Transanal Endoscopic Microsurgery (TEM) is a procedure for en-bloc removal of polyps in the rectum. Reported recurrence and complication rates are varying and optimal postoperative surveillance program is still not well-defined. The aim of this study was to evaluate recurrence and complications after polyp removal, in order to evaluate the quality of TEM.
Background: In 1956, there was an attempt to unify a group of diverse patients with symptoms in the shoulder and upper extremity who presented with pain, numbness, tingling, and swelling under the umbrella of Thoracic Outlet Syndrome (TOS). Since that publication, the TOS has been associated with a number of controversies. These have included confusion about the actual pathophysiology of the disease, the appropriate diagnostic tests, and the appropriate therapeutic interventions.
Background: Cardiac Vascular Sentral Kuala Lumpur (CVSKL) is a newly built private hospital, specialising in cardiac, thoracic and vascular cases. Since its establishment in 2017, we have performed over 100 open-heart surgeries and thus it is important to have an analytical report of all the cases to help us improve our patient safety and quality of care.
National Institute of Clinical Excellence recommends continuous monitoring of core body temperature using an insertable temperature probe is part of monitoring in major operations (NICE DG6). There have been many reported complications from using insertable temperature probes when this is not properly used and vigilantly monitored. This includes bleeding from posterior nostrils, entrapment in hiatus hernia surgery and aspiration of sheath in re usable types (Thomas Wass 2010). We report a case ...
Acute cholecystitis in elderly and unfit patients is an increasingly common reason for hospital admission. It is often managed with percutaneous cholecystostomy. A 79-year-old lady who has Heart failure, AF, Diabetes and bed bound was admitted acute cholecystitis. She had abdominal Ultrasound (USG) confirming calculous cholecystitis and she was not fit for a cholecystectomy. There have various reports of creation of Cholecysto-duodenal fistula using covered metal stent to treat acute cholecysti...
Purpose: Late Gadolinium Enhancement (LGE) is widely used method to evaluate the myocardial damages, such as fibrosis. However, the patients with renal insufficiency, asthma and so on have a higher risk for receiving gadolinium administration. We evaluated the utility of non-contrast T1 mapping (native T1) for assessment of myocardial damages in hypertrophic cardiomyopathy (HCM), in comparison with LGE and extracellular volume fraction (ECV).
A 50-year-old woman was admitted to our Hospital for progressive dyspnoea and reduced exercise tolerance. She had primary diagnosis, in childhood, of TGS, VSD and PS for which she underwent surgical anatomical correction that include LV outflow reconstruction by intracardiac prosthetic baffle and RVOT reconstruction with an extra cardiac conduit according to Rastelli procedure. Echocardiography demonstrated left and right ventricular outflow tract obstruction. We performed optimal therapeutic s...
Double Aortic Arch (DAA) with an atretic left arch is a rare congenital anomaly. We report a case of double aortic arch with an atretic left arch and retroesophagealligamentum arteriosum in a 5-year-old boy. He underwent successful surgical correction.
ArterioVenous Fistulas (AVF) can be described as abnormal communication between the artery and vein. In these situations, blood tends to flow from the highest to the lowest pressure vessel, and it can occur in practically the whole body. Traumatic AVF (TAVF) is present in about 4% of vascular traumas among its etiologies. This work aims to evaluate the main clinical characteristics of TAVF. Forty-five articles published in the last five years were selected as free access, using the headings art...
The incidence of Congenital Diaphragmatic Hernia (CDH) ranges from 1.7 to 5.7 per 10,000 live births. There is significant mortality and morbidity despite recent advancements in the management of CDH. The survival of CDH is 60% to 70% in high-volume centers. Antenatal ultrasound helps in diagnosis. The use of MRI is also increasing for the evaluation of CDH. In selected cases, antenatal interventions may be considered. After birth, appropriate management has improved the outcome. Immediate intu...
Background: Although Enhanced Recovery after Surgery (ERAS®) programs has been proven beneficial in many fields of surgery yet they are not widely practiced in developing countries as compared to developed countries.
Importance: The global COVID-19 pandemic has severely stressed the system supplying Personal Protective Equipment (PPE) to healthcare professionals. Healthcare professionals have become fearful of not meeting standards established to protect patients and team members. Critical shortages, especially in N95 masks, have resulted in leaders struggling with local, state, and federal agencies and vendors to secure adequate supplies.
Background: Breast cancer is the most common malignancy in women. The caecum is an extremely rare site of metastasis in breast cancer, and only five cases have been reported in literature. To date, there have not been reviews on the reported cases. This study aims to conduct a review on the reported cases of the caecal metastases in breast cancer as well as a case experienced in our local facility.
Objectives: With Cone-Beam Computed Tomography (CBCT) established in daily dental practice, there is an urgent need to raise awareness of the radiation risk it poses and to encourage training in its safe use. This study aimed to evaluate the effective doses of all possible field of view modes and varying recording settings of two-/ three-dimensional (2D/3D) hybrid machines.
Introduction: Enterovesical Fistula (EVF) is a rare condition in abnormal communication between the intestine and bladder. Colonic diverticulosis is the most common cause of EVF, accounting for 50% to 70% of cases. The primary goal of treatment for EVF is resection of the diseased bowel; however, there is still no consensus on Bladder Fistula (BF) management. This study aimed to describe the clinical characteristics, practice pattern, and surgical outcomes of EVF due to colonic diverticulitis ...
87-year-old female presented with slow-healing ulcers and a colovaginal fistula. The patient’s past medical history included having multiple coronary stents and a failed coronary bypass in 2018 resulting in residual angina (Aspirin, Nicorandil, Furosemide, Isosorbide mononitrate), Type 2 Diabetes Mellitus (Insulin, Linagliptin and Metformin), Hypercholesteremia (Pravastatin), Hypertension (Sotalol), Chronic kidney kisease ktage 3b, and Atrial fibrillation (Apixaban).
Background: Primary Non-Hodgkin’s Lymphoma (NHL) of the spine is an uncommon presentation of extra nodal lymphoma. Chemotherapy, radiotherapy, and biological therapy are standard treatment protocols for patients with NHL. In patients with neurologic compression due to primary NHL of spine, the role of surgical decompression still remains unclear. We retrospectively evaluate the improvement of neurological function and the survival rate following decompressive surgery of 17 NHL patients involvin...
The American Association of Medical Colleges projects a shortage of between 19,800 and 29,000 physicians in the surgical specialties by 2030. General surgery projects the greatest shortfall among surgical specialties, in part because of high rates of graduating residents pursuing fellowships. International medical graduates, many of whom trained in the US, have become a major part of the physician workforce in other specialties, but represent a small part of general surgeons in practice and tra...
Background: Treatment options of symptomatic High-Grade Spondylolisthesis (HGS) are surgery. But surgical treatment of HGS is often difficult and related techniques are still debated. Objectives: To assess the outcome of adult HGS by partial reduction, instrumentation and circumferential fusion in a single institution.
This is a case report of 68-year-old lady presented with several months of intermittent epigastric pain and bloating without any relationship to meals. An abdominal computed tomography detected an intussusception at the terminal ileum without proximal obstruction. Subsequent colonoscopy revealed a large caecal tumour with microscopy suggesting diffuse large B-cell lymphoma. The ideal management of solid tumour lymphoma of the bowel is contentious depending on whether the patient is seen by an o...
Objective: To analyze the frequency, risk factors and management of ectopic pregnancy. Design: Cross-sectional study. Place and Duration of study: The Department of Obstetrics and Gynecology, Royal Commission Medical Center, Yanbu, Saudi Arabia from January 01, 2015 to December 31, 2019.
A 94-year-old female presented to her family General Practitioner with what appeared to be a large right thigh infected seroma or haematoma. She reported having a painful right thigh lump for 8 weeks with no history of trauma and had also taken antibiotics which did not improve her symptoms. On examination, there was a tender, fluctuant and bruised area approximately 10 by 8 cm in size. Ultrasound confirmed the presence of a large hypoechoic mass in the right groin with well defined margins and...
Introduction: Rectourethral Fistulas (RUF) after Radical Prostatectomy (RP) are an uncommon but serious complication, and there is no consensus on their management. In this study, we report the results of a standardized management procedure for RUF after RP.
Objectives: The aim of this study is to present single surgeon’s experience in the early surgical repair of Congenital Completely Buried Penis (CCBP) in a series of 103 boys and review of literature. Methods: This is a retrospective study of management of patients of CCBP at the median age of 28 months between May, 2012 and March, 2019. All the children were followed up for 6 months.
Background: This paper shows originality for the treatment of acute spinal cord injuries by the absorption of fibrinogen by the omentum. This paper also shows that the statement by Ramon y Cajal that the reason spinal cords don’t heal is that the scar that routinely occurs at the point of spinal cord injury must be removed in order for axons to progress into the distal spinal cord.
Background: Surgical Ambulatory Emergency Care (AEC) provides better patient flow, improves patient experience, and reduces hospital admissions. This study aims to assess the functionality pattern of an AEC for acute surgical patients in a tertiary care hospital.
Wound healing is a complex process with steps of haemostasis, the inflammatory and proliferative phases, remodelling. The difficulties in the edge of the wound can be detrimental to healing and may cause a delay in wound healing. Sucralfate has been used in gastric and duodenal ulcers. Studies have shown a beneficial effect on skin lesions, dermatitis, and burns. In this article, we share our experience of using sucralfate in the case of a non healing ulcer.
COVID-19 was first described in Wuhan-China and soon after delaring a pandemic according to WHO. In Brazil, it truly became a health problem, with more than 2 million cases. Clinically, the disease manifests as pneumonia, but abdominal surgeons have been called since the beginning to face acute abdominal syndromes associated with this disease. The most were related to mesenteric lymphadenitis and managed without surgery. But as the disease worsened a more critical presentation presented are rel...
Non healing wound is a common problem encountered by plastic surgeon. There various causes due to which the wound becomes non healing and fails to heal. However there is no well-established method that can accelerate the wound healing rate. Prolotherapy is a method of injecting some irritant locally into the wound and is claimed to hasten the healing time. This article highlights the role of prolotherapy in management of amputation stump.
COVID-19 pandemic is a testing time for every branch of medicine which opened up a new challenge of protecting themselves meantime treating the sick without compromise. For example, treating burns patients, who are very vulnerable for COVID-19 infection. One of the most important step in minimizing the spread of COVID-19 infection is by maintaining social distancing. Now Telemedicine is being revisited as a tool in implementing social distancing, thus providing a safer healthcare.
The pressure ulcer also called bed sore or decubitus ulcer is one of the complications seen in bedridden patients. Management of these ulcers is often challenging. But there is no well-established method that accelerates the wound healing rate. In this article we would highlight the role of laser therapy in wound bed preparation in the case of a pressure ulcer.
Telemedicine plays an important role in imparting healthcare facilities worldwide in special situations like the COVID-19 Crisis. Use of technology in healthcare has come a long way. Special cameras for surveillance and interaction have been used in fields of industries, offices, home based and national security systems etc. Here we describe our experience regarding the use of Pan-Tilt camera in Tele-interaction for imparting healthcare services during the time of corona pandemic.
Background: Prognostic scoring systems such as TNM [1] and NPI (Nottingham prognostic index) [2] use maximal tumour diameter for staging. Breast cancer is three-dimensional therefore tumour volume and weight could be more accurate biological predictors. Nodal spread may also be different for tumors occupying a greater or lesser proportion of the breast. This study aims to measure breast cancer weights as a proportion of the mastectomy specimen weight and to compare node positivity rates in high...
Pressure ulcer or pressure sore is one of the complications seen in bedridden patients. Management of these ulcers is often challenging. But there is no well-established method that accelerates the wound healing rate. Prolotherapy is a technique that involves injecting some irritant locally in the wound that is claimed to hasten the healing. This article highlights the role of prolotherapy in wound bed preparation.
Background: Patients with chronic portal venous obstruction can develop portal cavernoma and obstruction in the biliary system, which is termed as portal biliopathy. Symptomatic portal biliopathy requires intervention. It is a complex problem and therapeutic strategy has not been optimized. Materials and methods: Retrospectively, details of 23 patients who were admitted between June 2015 and November 2018 with symptomatic portal biliopathy were analysed. Endoscopic stenting was the preferred i...
Objectives: Congenital Lung Malformations (CLM) are rare and vary in their clinical presentations depending on the extent of lung involvement. Congenital Cystic Adenomatoid Malformation (CCAM), Congenital Lobar Emphysema (CLE) and Bronchogenic Cyst (BC) are all congenital lung malformations that present in imaging studies as abnormal air, fluid or fluid filled cysts. Neonates with CLM can present with respiratory distress at birth or may remain asymptomatic for a long period and are diagnosed i...
A limitation on the efficiency of procurement and utility of donated organs is the simultaneous coordination and communication among Organ Procurement Organizations (OPO) and transplant support teams. This applies to each organ which may be utilized for any given donor. Results of this study, currently “In Production” in the journal Progress in Transplantation, showed an improvement in communication and coordination using a real time effective, HIPAA compliant tool among procurement and transpl...
Introduction: There is no consensus data regarding closure or non-closure of peritoneum in laparotomy and this topic remains a controversy among surgeons. Material and method: In this prospective interventional study 124 patients undergoing laparotomy with midline incision have been assessed from March 2019 till September 2019 in Imam Hossein Medical Center. Sixty-two of these patients had peritoneal closure with continuous absorbable suture, while 62 other assigned to the non-closure group.
Bouveret’s syndrome is a rare form of gallstone ileus caused by the passage and impaction of a large gallstone through a cholecystoduodenal fistula into the duodenum, resulting in gastric outlet obstruction. It is a rare form of gall stone ileus (1-3% of cases of gall stone ileus; gall stone ileus itself is extremely rare occurring in only 0.3-0.5% of patient with cholelithiasis) and causes significant morbidity and mortality1. It is common in elderly female patients with multiple comorbidities...
Background: Laparoscopic Cholecystectomy (LC) is the ‘gold standard’ operation for cholelithiasis, but still carries significant morbidity and occasional mortality. Patient and methods: A retrospective analysis of 834 LC over a period of 4 years in a single surgical unit in a tertiary care medical college was performed and various factors affecting conversion and complications reviewed.
Post burn contractures of the hand are very common. The most important aspect of release of these contractures is to provide a functional hand. There are various methods of release of these contractures depending on if they are on the dorsal or volar aspect of the hand. We have used distraction assisted management of post burn contracture of the little finger.
Osteoid osteoma is a benign tumour in adolescents and young adults. The clinical manifestations are generally typical nocturnal pain that prevents sleep and that is alleviated with aspirin. When the typical clinical and radiological features are present, diagnosis may arrive in connection with an unusual location. The lesion is removed arthroscopically, and histopathologic findings confirm the preoperative diagnosis of osteoid osteoma. Here, we document a brief review of literature. In this rev...
Burnout is a psychological state of mind which arises from distress and disfavor with a work-related course of life. Burnout has been linked in recent years to life in the medical world, during schooling, training, and subsequent professional practice. In fact, burnout has become an in-word for any topic of medical exasperation today. For those of us older folks in medicine, the question seems to be “did we face burnout at some earlier time and not perceive it?”. And so the definition seems to ...
We performed thermal images of the brain during tumor surgery. Temperature increases corresponded temporally and spatially to directed movements. Good correlation with conventional methods of intraoperative brain mapping also was obtained. Focal temperature decreases provided accurate localization of underlying tumors. Thus, thermal imaging represents potentially valuable input for neuronavigation system.
Introduction and objective: To report the hydrodynamic of a porous orifice (G) tube as replacement for the wrong Starling’s law. Material and methods: Hydrodynamics of the G tube, based on capillary ultra-structure, were studied. The effect of changing G tube orifice diameter, proximal pressure and distal pressure on the side pressure and chamber (C) pressure were evaluated. The physiological proof that the capillary works as G tube not Poiseuille’s tube is provided.
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