Surgery
Bharati Pandya; Vishnu Vardhan P. Reddy; Srujan Dharap; Reyaz Ahmad; Meena Kumari; Ajeet Pratap Maurya
Articles in Press, Accepted Manuscript, Available Online from 07 May 2024
Surgery
maryam kouhestani; Seyed Vahid Hossein; Alimohammad Bananzadeh; ali reza safarpour; khadije gorgi; mohammad masoud andalib
Articles in Press, Accepted Manuscript, Available Online from 05 June 2024
Abstract
Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the restorative procedure of choice for medically refractory ulcerative colitis (UC). In patients who undergo proctocolectomy with IPAA, fecal continence outcomes are an issue. The present study evaluated fecal incontinence ...
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Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the restorative procedure of choice for medically refractory ulcerative colitis (UC). In patients who undergo proctocolectomy with IPAA, fecal continence outcomes are an issue. The present study evaluated fecal incontinence in patients who underwent IPAA for UC.Methods: This was a case series study. We reviewed the clinical records of all patients who had undergone a proctocolectomy with IPAA for UC at the Colorectal Department of Shiraz University of Medical Sciences, Iran, between January 2010 and December 2022. Each patient completed a Cleveland Clinic Florida Fecal Incontinence Scoring System (CCFFIS) questionnaire to evaluate fecal incontinence one year after the closure of the colostomy. Data analysis was conducted utilizing various statistical measures such as mean, count (percentage), chi-square, and one-way ANOVA tests. The entire analysis was performed using SPSS 26 software. P values less than 0.05 were deemed statistically significant.Results: From January 2010 to December 2022, 159 patients who underwent IPAA surgery were included in the study. Of these patients, 108 (67.9%) had no complaint about fecal incontinence (score 0). The median CCFFIS score was 2.19, and there were no significant differences between gender, age, technique, and number of procedures regarding fecal incontinence (P values 0.475,0.125, 0.319, and 0.376, respectively).Conclusion: This study confirmed that total proctocolectomy with IPAA is a complex surgery that could have good functional results if patients are selected carefully and an experienced surgeon performs the procedure.
Surgery
Mirko Barone; Massimo Ippoliti; Felice Mucilli
Volume 9, Issue 2 , July 2023
Abstract
Intra-abdominal infections still represent a challenge for surgeons. The systemic physiopathological effects of infection rapidly progress, leading to sepsis and multiorgan failure, whose prognosis is often dramatic. Mortality risk stratification using scoring systems would unequivocally aid the early ...
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Intra-abdominal infections still represent a challenge for surgeons. The systemic physiopathological effects of infection rapidly progress, leading to sepsis and multiorgan failure, whose prognosis is often dramatic. Mortality risk stratification using scoring systems would unequivocally aid the early identification of patients at risk of disease progression.
Emergency medicine
Garima Sharma; Sanya Vermani; Anjum Syed
Volume 8, Issue 1 , January 2022, , Pages 77-79
Abstract
Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should ...
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Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed.Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air.Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.
Infectious disease
Manas Sharma; Shridhar C. Ghagane; Shubhashree Muralidhar; Shashank Patil; Naina R. Nerli; Rajendra B. Nerli
Volume 6, Issue 2 , July 2020, , Pages 98-101
Abstract
The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to ...
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The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long way in keeping the surgeons and health-care workers safe to perform essential duties.
Emergency medicine
Mirko Barone; Barbara Leone; Giuseppe Cipollone; Felice Mucilli
Volume 6, Issue 1 , January 2020, , Pages 1-2
Abstract
As known, small bowel obstruction is one of the most common emergencies in general surgery carrying a not negligible rate of morbidity and financial expenditures as far as high social impact . Peritoneal adhesions are the leading cause of intestinal obstruction up to 74% of cases. In spite of increasing ...
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As known, small bowel obstruction is one of the most common emergencies in general surgery carrying a not negligible rate of morbidity and financial expenditures as far as high social impact . Peritoneal adhesions are the leading cause of intestinal obstruction up to 74% of cases. In spite of increasing incidence worldwide, current management still presents some “blind corners”, whose aspects still claim debate.
Emergency medicine
Mohit Kumar Arora; Ela Madaan; Rajnand Kumar
Volume 6, Issue 1 , January 2020, , Pages 47-49
Abstract
Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. ...
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Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. These encompass metastasis, osteosarcoma and hemangioendothelioma. The most common complaint in patients of GCT patella is anterior knee pain. Early diagnosis and optimal management are necessary for improving survival rate in these patients.Case Presentation: The authors present a case report of GCT of patella in a 16-year old child. Incisional biopsy was done to confirm the diagnosis. Further radiological examination showed that the tumor involved almost whole of the patella. Hence, surgical management in the form of patellectomy and extensor mechanism repair was done to improve the outcome of the disease. The patient did not have any clinical or radiological symptoms at the end of the final follow up of 22 months.Conclusion: Primary tumor of patella is a rare entity. Benign tumors like GCT present only with anterior knee pain and should be included in the differential diagnosis of anterior knee pain. MRI is useful to determine the extent of involvement of tumor in the patella. Treatment may vary from curettage and bone grafting to total patellectomy with extensor mechanism repair
Surgery
Barbara Leone; Giuseppe Cipollone; Decio Di Nuzzo; Massimo Ippoliti; Mirko Barone; Felice Mucilli
Volume 5, Issue 2 , July 2019, , Pages 35-36
Abstract
Adhesive small bowel obstruction (ASBO) is one of the most frequently encountered disorders in Emergency Surgery Departments worldwide without negligible hospital admission rates and social costs (1,2). Notwithstanding significant improvements in techniques and materials, intra-abdominal adhesions following ...
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Adhesive small bowel obstruction (ASBO) is one of the most frequently encountered disorders in Emergency Surgery Departments worldwide without negligible hospital admission rates and social costs (1,2). Notwithstanding significant improvements in techniques and materials, intra-abdominal adhesions following abdominal surgery still represent a major unsolved and debated issue harbouring challenges regarding diagnosis, pathogenesis, management and revention. In this setting, the cornerstone lies on a proper nosological classification with a subsequent diagnostic dilemma in distinguishing ASBO from other causes of obstruction and in an early identification of emergency surgery cases. conflicting results raise more questions.
Surgery
Nasser Malekpour Alamdari; Samad Shams Vahdati; Barmak Gholizadeh; Shima Nayebian
Volume 5, Issue 1 , January 2019, , Pages 19-22
Abstract
Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter ...
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Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter (permicath) may be inserted blindly or by fluoroscopic guidance. This study aimed to compare the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter.Methods: This prospective randomized clinical trial was undertaken in the emergency department of Modarres hospital in Tehran, Iran during 2014 and 2015. Patients who needed catheter due to renal failure entered the study. Patients who needed emergency dialysis and those who could not wait for permicath were excluded. Patients were randomly assigned into 2 groups, under fluoroscopic guidance and blindly catheter insertion. Data were collected using a questionnaire and a checklist related to function (after 24 hours and 1 month), a need to exchange the catheter and the early adverse effects such as pneumothorax, hemothorax, and vascular injury.Results: A total of 101 patients were enrolled in this trial. Early dysfunction (blind group = 5), a need for catheter exchange (blind group = 2), pneumothorax (blind group = 2), vascular injury (blind group = 1) were recorded but the difference between the two groups was not statistically significant (P > 0.05).Conclusion: We did not observe a significant difference between the placement of permicath by fluoroscopic or blind method. However, more studies with larger groups are recommended.
Cardiology
Mustafa Bolatkale; Çağdaş Can; Ahmet Çağdaş Acara; Mustafa Topuz
Volume 3, Issue 2 , July 2017, , Pages 40-41
Abstract
In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside cardiac ...
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In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside cardiac ultrasonography. But these two methods are not always sufficient to explain the underlying another pathologies such as pancreatitis and acute cholecystitis which can mimick acute cardiac events. Patients who are followed up with a preliminary diagnosis of acute coronary syndrome in the emergency department, might have underlying biliary or pancreatic pathologies, or even more, these might be the sole reason of the clinical picture. So bedside abdomen ultrasonography and liver enzymes may be requested in all patients with suspected cardiac pathology with a normal cardiac ultrasonography when a patient presented with acute chest or abdominal pain. Physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations. So the diagnostic tests for gallbladder pathology could be added to cardiac ultrasonography.
Emergency Medical Services
Mirko Barone; Marco Prioletta; Giuseppe Cipollone; Decio Di Nuzzo; Pierpaolo Camplese; Felice Mucilli
Volume 3, Issue 2 , July 2017, , Pages 53-58
Abstract
Objective: Cardiac tamponade is a life-threatening clinical entity that requires an emergency treatment. Cardiac tamponade can be caused both by benign and malignant diseases. A variety of methods have been described for the treatment of these cases from needle-guided pericardiocentesis, balloon-based ...
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Objective: Cardiac tamponade is a life-threatening clinical entity that requires an emergency treatment. Cardiac tamponade can be caused both by benign and malignant diseases. A variety of methods have been described for the treatment of these cases from needle-guided pericardiocentesis, balloon-based techniques to surgical pericardiotomy. The Authors report their experience in surgical management of cardiac tamponade and an exhaustive review of literature. Methods: This study involved 61 patients (37 males and 24 females) with an average age of 61.80 ± 16.32 years. All patients underwent emergency surgery due to the presence of cardiac tamponade. Results: Cardiac tamponade was caused by a benign disease in 57.40% of patients. In cancer patients group, lung cancer, breast cancer and malignant pleural mesothelioma were the most common neoplasms (17-27, 87%). The average preoperative size of pericardial effusion at M-2D echocardiography was 30.15 ± 5.87 mm. Postoperative complications were observed in 11 patients (18%). The reoperation rate was 3.3% (2 patients) due to relapsed cardiac tamponade. 30-day mortality rate was 3.3%. Overall cumulative survival was 29.9 ± 20.1 months. Twenty-nine patients (47.5%) died during the follow up period. By dividing the population into two groups, group B (benign) and group M (malignant), there was a statistically significant difference (P < 0.001) in terms of survival. Conclusion: In conclusions, anterior minithoracotomy for surgical treatment of cardiac tamponade has to be held into account in patients both with benign diseases and malignancies.
Critical Care
Haleh Mousavi; Samad Shams Vahdati; Roshan Fahimi
Volume 3, Issue 2 , July 2017, , Pages 66-67
Abstract
Invagination is a kind of intestine disease in children and it is occurred between 2 upto 14 years old. This is a report of 17 months infant with intussusception due to trauma. The patient had admitted to emergency department because of motor vehicle accident and because of abdominal pain, abdominal ...
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Invagination is a kind of intestine disease in children and it is occurred between 2 upto 14 years old. This is a report of 17 months infant with intussusception due to trauma. The patient had admitted to emergency department because of motor vehicle accident and because of abdominal pain, abdominal computed tomography (CT) scan was done.
Critical Care
Akbar Fadaei Haghi; Rouya Shokri; Samad Shams Vahdati; Farid Eftekhar Milani; Shahrad Tajoddini
Volume 3, Issue 1 , January 2017, , Pages 30-31
Abstract
We report a 54-year-old woman with the history of end-stage renal disease (ESRD) who was admitted to our hospital because of volume overload. Due to long-term use of peripheral veins and arteriovenous fistula (AVF) failure, central venous catheterization was the only choice for hemodialysis. She developed ...
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We report a 54-year-old woman with the history of end-stage renal disease (ESRD) who was admitted to our hospital because of volume overload. Due to long-term use of peripheral veins and arteriovenous fistula (AVF) failure, central venous catheterization was the only choice for hemodialysis. She developed right upper extremiti’s pain and paresis during hemodialysis. A posteroanterior chest x-ray showed the catheter tip was accidently pushed from right internal jugular vein into right subclavian vein during hemodialysis by the dialysis center nurse. Therefore, we believe that the physician should be aware of any changes in the catheter size after insertion. And a chest x-ray should ensure the catheter’s correct position in any patient who develops complications.
Emergency medicine
Rouzbeh Rajaei Ghafouri; Saeed Shahbazi; Changiz Gholipour; Samad Shams Vahdati; Manouchehr khoshbaten; Amir Ghaffarzad; Respina Jalilian
Volume 2, Issue 2 , July 2016, , Pages 46-49
Abstract
Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, ...
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Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, but in general, such studies will not establish the diagnosis.Methods: In a prospective, non-interventional study, from October 2012 to October 2013, we investigated 70 patients with probable diagnosis of AMI. Blood samples were taken from patients and analyzed for complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), urea, creatinine (Cr), sodium (Na), potassium (K), D-dimer, lactate, amylase, PH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3). Finally the results were compared with AMI diagnosis confirmed by computed tomography (CT) angiography.Results: Seventy patients with acute severe abdominal pain were studied. Thirty-nine patients (55.7%) were male and 31 patients (44.3%) were female. The average age was 68.01 ± 14.67 (±SD). Based on CT-angiography results, 27 (38.6%) patients had AMI and 43 (61.4%) patients did not have AMI. Chi-squire test showed P values of 0.606 and 0.986 for relations between sex and risk factors with AMI correspondingly. One-sample Kolmogorov-Smirnov revealed white blood cell (WBC), hemoglobin (Hb), platelets (Plt), urea, Cr, Na, K, PCO2 and HCO3 as normally distributed parameters (P > 0.05). Moreover PT, PTT, INR, D-dimer, lactate, amylase, and PH were non-normally distributed (P < 0.05).Conclusion: We found a significant relation between increased serum lactate level and definitive AMI diagnosis. We recommend rising serum lactate as a finding in AMI.
Critical Care
Maryam Ziaee; Amirhossein Mirafzal
Volume 2, Issue 2 , July 2016, , Pages 50-54
Abstract
Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients ...
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Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients under 16 years of age with trauma presenting to an academic level ІІ trauma center, we obtained venous BD values initially and followed the patients for in-hospital mortality. Initial vital signs were measured and injury severity score (ISS), randomized trauma score (RTS), and pediatric trauma score (PTS) were calculated. Results: A total of 102 patients were included, with 48 patients diagnosed with TBI. Nine patients (8.8%) died during admission, of which 6 were diagnosed with TBI. Based on the univariate analysis, BD was associated with mortality in the whole group (P = 0.01), but not in the TBI subgroup (P = 0.08). In multivariable analysis, RTS was the only variable independently associated with mortality (P = 0.001, odds ratio [OR] = 0.197). Linear regression model showed that BD was predictive of ISS, RTS, and PTS. Receiver operating characteristics (ROC) curve showed a cutoff point of -7 mmol/L for BD, below which there is a 12 fold increased risk for mortality. Conclusion: BD is a useful parameter in mortality prediction in pediatric trauma like in adult age group, but this predictive role in TBI patients is not supported by our results.