The intragastric balloon is one of the interventional treatments used to treat obesity. This case report presents a 28-year-old woman undergoing intragastric balloon insertion to treat obesity. Thirty-five days later, she was admitted to the emergency department with acute abdominal pain, nausea, and vomiting. During the physical examination, she had pain on deep palpation in the right lower quadrant. The laboratory showed only high serum amylase levels of 563 IU/L (range 28-100 IU/L). The abdominal ultrasound did not detect gallstones or enlarged intra or extrahepatic ducts. A computed tomography scan was performed, and intragastric balloon and distal pancreatic oedema without mass and peri-pancreatic fluid collection were detected. Intravenous hydration and anti-biotherapy were started. On the second day of hospitalization, the patient's amylase value returned to the normal range (40 IU/L). The patient who tolerated oral intake was discharged on the 3rd day of hospitalization. Diagnosis of pancreatitis is made by a history of intragastric balloon insertion, a pancreatitis-like clinical picture, and biochemical and radiological confirmation of the clinical diagnosis. In such cases, conservative therapy should be applied first; the intragastric balloon should be removed only in patients resistant to treatment or with a long-term intragastric balloon.
Objectives. The aim of this study is to evaluate the early results of patients with and without grafting with the proximal tibia medial biplanar open wedge osteotomy technique used in the surgical treatment of varus gonarthrosis and to compare them with the literature. Materials and Methods. Thirty-six patients with medial gonarthrosis with varus alignment were included in the study. The proximal tibia medial biplanar open wedge osteotomy was performed on thirtysix knees. In eighteen of these patients, a tricortical graft was applied to the osteotomy site from the iliac wing being noted as Group 1. The other patients who did not receive grafts constituted Group 2. All patients were evaluated according to the Ahlbäck classification. Leg length radiographs were taken for all patients, and the osteotomy angle was calculated according to Paley's measurements. Results. Although the mean union-time at the osteotomy site was shorter in the Group 1, it was not statistically significant. No significant difference was observed in terms of HSS scores, and no reduction loss was observed in any patient. The hematoma was seen in three patients in Group 2 and one patient in Group 1. The donor site problems were observed in 10 patients in Group 1. Conclusions. With proximal tibia medial biplanar osteotomy, frontal plane and sagittal plane deformities can be corrected in patients with varus gonarthrosis, and good clinical results can be obtained without using grafts, thus avoiding donor site complications.
Introduction. Colorectal carcinoma has a tendency to increase in recent times worldwide. Even though it is less prevalent in the developing world like India, Kerala has seen a sudden increase in incidence due to changing lifestyle and dietary habits. Objectives. The study aims to describe the epidemiological characteristics of colorectal cancer in adults from the Malabar region, and to find out the relationship between preoperative carcinoembryonic antigen (CEA) values with histological results and TNM staging. Methods. This is a descriptive cross-sectional study conducted at Government Medical College, Kozhikode over a period of 1 year and 6 months starting from July 2020. 168 adult patients aged above 30 years were included in the study. Results. 92 out of 168 patients included in the study (54.8%) were men, colorectal carcinoma being more common in the 50-70 age group. The most common histological variant was well-differentiated adenocarcinoma. 32.7% of the study population had higher CEA levels (>5 ng/ml). Conclusion. While CEA levels in 67.3% of study subjects were within normal limits, the obtained data showed that preoperative CEA levels had a statistically significant relationship only with TNM staging, and not with histological variants.
Introduction. Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal (GI) tract. However, rectal GISTs are rare among these tumors. Case Presentation. A 60-year-old Caucasian woman had surgery for an ovarian mass with carcinomatosis. The patient underwent exploratory laparoscopy, which found a large amount of ascites, epiploic and appendicular carcinomatosis. The Hudson operation was performed to completely and en bloc remove the recto-sigmoid junction, the uterus, and adnexa. The appendix and the carcinomatosis were also removed with no residual tumor. After that, she was sent to the oncology department to start Imatinib therapy. Conclusion. Rectal GIST is a rare entity with varied clinical manifestations and a high risk of recurrence, which may complicate the diagnosis in women with an abdominopelvic tumor mass. Consequently, even if GIST can mimic gynecological tumors, such as ovarian tumor, the surgeon must be aware of this condition and take it into account in establishing the differential diagnosis, especially since surgical treatment is essential in localized rectal GIST.
Objectives. To study proportion of malignancy in patients with solitary thyroid nodule who had underwent hemi/total thyroidectomy. Methodology. Study design: Cross sectional study. Study setting: Patients in the Out-patient and In-patient Department of General Surgery, Government Medical College, Thiruvananthapuram. Sample size: 150 patients Study Procedure: Data was collected using a structured proforma. An informed consent written in the local language was read out to the study subjects and signature was obtained. All the questions in the proforma were read to the study subjects and responses recorded. Investigation reports and previous medical reports were used for filling relevant parts of the proforma. Analysis. Data collected was entered in excel sheets and analyzed using SPSS software. Results. 150 patients were operated for clinically detected STN. 16 (10.67%) were malignant. Papillary thyroid cancer was the most common type (93.75%). Mean age of patients with malignancy (n = 58) was 39.94 ± 14.83 years. Out of them 12 were females and 4 were male patients (F: M = 3: 1). 134 STNs were benign (23 males and 111 females). Malignant STN was reported in 14.81% males and 9.76% females. No significant correlation between tumour size and the risk of malignancy (P = 0.338). Altered thyroid function status is not a predictive factor for malignancy (P=0.801). FNAC (P=0.002) and USG (P=<0.001) were predictive of malignancy. Complications were more associated with total thyroidectomy (53.57%). Most frequent complication was transient hypocalcemia (15.4%). Hospital stay were more in patients who had underwent total thyroidectomy (P=<0.001). Conclusions. STN has high malignant potential compared to MNG. Preoperative evaluation with thorough history, physical examination, USG and FNAC could diagnose STN as benign or malignant. Strong predictors of malignancy include male gender, micro calcification and cervical lymphadenopathy. Complications are more associated with Total thyroidectomy. Hypocalcemia was the most common complication following thyroid surgery.
Trichoblastic carcinoma is a sporadic malignant tumor. It usually arises in the scalp, trunk, and extremities. However, its occurrence in the base of the penis is highly uncommon. To our knowledge, there were no similar cases reported in the literature. Case Presentation. A 65-year-old Tunisian man with no significant medical history consulted our department with a 10 cm ulcerative lesion on the base of the penis. The lesion biopsy was concordant with the diagnosis of basal cell carcinoma. The patient underwent a wide local excision. The tissue defect was reconstructed by an anterolateral pedicled flap of the thigh. The final histopathology report was concordant with the diagnosis of a trichoblastic carcinoma. Conclusion. There is no treatment consensus due to the few reported cases of trichoblastic carcinoma in the literature. Surgical excision with free margins remains the cornerstone of the treatment.
Objective. This study investigated the relationship between fear of childbirth (FOC) and mode of delivery and proposed a cut-off value of FOC for an unselected Turkish pregnant population. Materials and Methods. This cross-sectional study was conducted between March 2019 and February 2020 at Kirsehir Ahi Evran University Obstetrics and Gynecology Polyclinic. The Wijma Delivery Expectancy (WDEQ-A) Scale and General Information Form were used for data collection. Results. Social-media effect, concern for disorder in baby, education level, and fear of vaginal bleeding were significant risk factors for the study groups. A new cut-off value of FOC was proposed based on the distribution of FOC scores as 69 (fourth quartile) for an unselected Turkish pregnant population. Conclusions. Training programs regarding delivery and pregnancy processes were recommended to be organized to reduce FOC. Moreover, the newly proposed cut-off value of FOC was recommended to be utilized in clinics.
Background. Breast cancer is the most common malignancy and the leading cause of cancer death among women worldwide. This study was conducted to establish early diagnosis and therapy, thus improving prognosis and overall survival rate. Objectives. To assess the levels of proliferation index marker Ki67 and hormone receptor status in patients with breast carcinoma and to correlate Ki67 with ER, PR, Her2neu status, as well as to correlate Ki67 and hormone receptor status with onco-pathological parameters. Materials and Methods. 392 patients diagnosed with breast carcinoma over a period of four years were included in the study. Data regarding patient’s identification, history, clinical finding, investigations and histopathological report were recorded in a specific proforma. Result. Breast cancer was seen to affect people in the older age group, and invasive ductal carcinoma of nonspecific type was the most common type. Most patients had unifocal tumor with grade 2 disease. Stage II disease was most common stage among the patients studied and Luminal B subtype was the predominant type of molecular subtype. Most of the patients were Ki67 positive, i.e., Ki67 >14%. The correlation of Ki67 with estrogen receptor, progesterone receptor, tumor size, mitotic count, lymph node ratio, lymphovascular invasion and extra-nodal extension was found to be statistically significant. Conclusions. There exists a statistically significant, positive correlation between breast cancers, its onco-pathological parameters, proliferation index marker Ki67 and hormone receptor status. Therefore, the judicious use of these tests (Ki67 is an old marker of proliferation but not routinely used) will help in the early appropriate treatment of patients and contribute to the assessment of treatment response and prognosis.
Background. Fine-needle aspiration cytology (FNAC) is the basic investigation that can be performed even in small centers, with low costs, without major complications and with good patient compliance. The broad spectrum of diseases can be classified into inflammatory conditions, malignancies or lymphoma, which allows the planning of the treatment strategy or further investigation that is necessary for diagnosis. Materials and Methods. A prospective study was performed on 100 individuals with enlarged cervical lymph nodes who underwent FNAC and surgery, from 2017 to 2019. The histopathological reports of the patients were correlated with the preoperative cytological reports. Results. Of the studied cases, reactive lymphadenopathy was the most common - 43%, followed by tuberculous lymphadenopathy - 21%, granulomatous lymphadenopathy - 16%, and malignancy - 16%. Among malignancy, the most common is the secondary from squamous cell carcinoma – 11 cases (68.75%) followed by metastasis from thyroid carcinoma – 4 cases (25%) and metastasis from adenocarcinoma – 1 case (6.25%). By the age of 40, the most common malignancy is metastasis from thyroid carcinoma, while over 40, the secondary tumor from squamous cell carcinoma is the most common. Sensitivity, specificity and accuracy of FNAC are high in carcinomatous (93.75%, 100%, 99%), lymphomatous (75%, 98.96%, 98%) and tuberculous lymphadenopathy (95.24%, 96.20%, 96%). Conclusions. FNAC is a simple and safe test, with a good accuracy of diagnosis and low complications, being therefore an effective diagnostic tool.
Objectives. This study aimed to demonstrate the simultaneous correction of all deformities with the Spider Frame computer-assisted external fixation system, to determine the characteristics of the application technique, and to evaluate its effectiveness, complications and results. Materials and Methods. The evaluation was performed on 22 patients treated with a spider frame between 2012 and 2014. The lengthening amount, union status and bone angles were evaluated radiologically on the pre and postoperative orthoroentgenograms. In the preoperative evaluation, the Paley difficulty scale was used; the postoperative bone and functional results were evaluated according to the Paley criteria. The external fixator index and distraction index were evaluated. Results. The mean score of the Paley difficulty scale applied preoperatively, was 4.5 (range, 1-10). The mean duration of the fixator was 199 days (range, 104-300 days). The mean external fixator index was 105.3 day/cm (range, 38-300 day/cm). The mean distraction index was 11.4 day/cm (range, 7-22 day/cm). According to the Paley criteria, excellent and good results were obtained in 75% and moderate results in 25% of cases involving the femur. In the tibia cases, excellent and good functional results were obtained in 83.3% and excellent and good bone results in 91.6% patients. Conclusion. In cases of deformity, acute fracture and nonunion, the computer-assisted external fixator system (spider frame® ) without any modification provides single-stage correction by allowing postoperative intervention to the deformity. It is a new generation external fixator system which has shown successful functional results, and can therefore be considered for use.
Introduction. Surgical site infection (SSI) is one of the most important causes of morbidity and mortality in postoperative patients, but it is preventable in some cases. Our aim is to study the prevalence of surgical site infections and to determine the risk factors that influence the rate of SSI in a tertiary care hospital. Materials and Methods. This is an observational study conducted in the department of general surgery, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, from July 2021 to June 2022. Results. The present study includes 59 men and 34 women. Out of 93 patients, most patients were in the age group of 40-50 years. In our study, there was a 3.722-fold higher probability of developing SSI in patients with comorbidities. Emergency surgery also has a 7.187 times higher risk of developing SSI than elective surgery. The prevalence in this study of SSI was 8.60%; of 8 patients, only 1 developed SSI on deep incision. Conclusion. The following conclusions/ recommendations emerged from this study: reducing the duration of surgical procedures by adopting appropriate techniques and early resumption of patient mobilization. Judicious use of drains is also recommended, paying more attention in emergency operations and/or with a high risk of contamination.
Background. This is a clinicopathological study comparing lymph node involvement in breast carcinomas before and during the COVID-19 period. During the pandemic, access to healthcare was limited, which led to a delay in the diagnosis and treatment of malignant tumors, which often presented in advanced stages, with lymph node metastases. Methods. A retrospective study was performed on 40 patients with carcinomas treated by surgical excision of the tumor combined with lymph node resection. Histopathological examination of lymph nodes was performed to detect malignant metastases, and the mean lymph node positivity rate was calculated. Odds ratio was used to measure the association between pre covid era and covid era (p value < 0.05 being considered statistically significant). Results. Lymph node metastasis was observed in 10 patients in 2019 (50%) and in 16 patients in 2021 (80%). The average node positivity rate was significantly higher in 2021 (39.4%) than in 2019 (21.1%). Conclusion. During the Covid-19 pandemic, there was a considerable delay in presenting patients for symptoms of malignancy. This led to a delay in the diagnosis of malignancies, which were treated in advanced stages, frequently with metastases in the regional lymph nodes. Patient awareness should be improved to ensure early presentation and reporting of symptoms. Surgeons must be more vigilant and fully explore the dissection field to ensure that all involved lymph nodes are resected, thus avoiding recurrence and improving the patient's overall prognosis.
Aim. ALGAN Hemostatic Agent (AHA) is obtained with a standard mixture of 6 different herbs. It is a polysaccharide based hemostatic agent. The purpose of this study is to determine the clinical efficacy and reliability of AHA as a local hemostatic agent in lumbar disc herniation operations. Materials and Methods. In the study, the hemostatic efficacy of the product was observed on 28 volunteers underwent lumbar disc herniation surgery. In the treatment and control groups (14 patients each), operation times, bleeding stop times, pre- and postoperative hematocrit values (amount of blood loss), duration of hospital stay, and need for cautery use were compared. Traditional methods (cautery, ligation, etc.), which are used as a hemostatic in the operation, were always ready to be used effectively. The AHA application took 120 seconds. Results. While there was no difference between the groups in terms of preoperative hemoglobin and hematocrit values, postoperative hemoglobin and hematocrit values were statistically significant (p=0.033, 0.043). The amount of cautery use decreased significantly in the treatment group and the result was found to be statistically significant (p=.0.001). There was no significant difference in blood transfusion and mean operation times. Conclusions. AHA has been shown to be both effective in controlling bleeding and safe, so it can be used as an auxiliary product in capillary bleeding control in lumbar disc operations.
Background. Although several scoring systems are available for the diagnosis of acute appendicitis, there is no one specific for the diagnosis of gangrenous or perforated appendicitis. This study aims to evaluate the sensitivity and specificity of serum total bilirubin in gangrene or perforated appendicitis. Materials and Methods. A prospective study was conducted on 55 patients undergoing emergency appendectomy, in whom total serum bilirubin was determined for statistical analysis. Results. In our study, out of 55 patients with a perforated or non-perforated appendix, the mean total serum total bilirubin was 2.34 and 1.27, respectively. The cut-off value of serum total bilirubin in this study was calculated using the ROC curve and found to be 1.75. Hyperbilirubinemia is 92.7% sensitive and 96.4% specific in perforation or gangrene of acute appendicitis. The positive predictive value was 96.2% and the negative predictive value was 93%. Conclusions. Patients with acute appendicitis and increased bilirubin levels have a higher chance of gangrene or perforation than those with normal bilirubin levels. Estimation of total serum bilirubin is available in most centers at minimal cost, and can therefore be used in conjunction with clinical and laboratory investigations for the diagnosis of gangrenous or perforated appendicitis.
Castleman disease (CD) is a rare B-cell lymphoproliferative disorder of unknown etiology characterized by benign lymphoid follicular hyperplasia and capillary proliferation. CD can be divided histologically into four different variants: hyaline-vascular (HV), plasma-cell (PC), mixed and plasmablastic types. The unicentric CD (UCD) is localized lymphadenopathy while multicentric CD (MCD) is a systemic disorder involving cytokine-induced polyclonal lymphoproliferation and systemic inflammation due to overexpression of interleukine-6, and can be idiopathic or associated with HIV/HHV-8 infection. Surgical removal is the gold standard for patients with unicentric CD, while multicentric CD requires systemic therapy. In our presentation we wanted to show that even multicentric type of CD can be treated surgically only and that this surgical approach can be therapeutic and not mutilating at the same time. As in every rare disease, the recording of cases in rare disease registries is essential. Accumulation of the cases enables the evaluation of treatments and may provide a solid base for guidelines update.
Objectives. Septic arthritis is a medical emergency with a mortality rate of approximately 10%, the knee being the most commonly affected joint (about 50% of cases). The systemic inflammatory response caused by septic arthritis may be affected by the severity of the infection or the success of surgical joint debridement. Materials and Methods. This article was a retrospective study on patients admitted to our hospital (between 2013 and 2020) with septic arthritis of the knee. Patients were diagnosed based on history, examination, blood test results, and knee aspirate fluid. The patient's response to antibiotic therapy was monitored in the outpatient setting using serological markers. Results. Of the 48 patients included in the study, 26 were male, and 22 were female. Based on the ROC analysis, the optimal cutoff value of preoperative NLR was 8.33. The AUC was 0.782 for postoperative NLR level (95% CI,0,626–0.938; p:0.009) and 0.922 for postoperative CAR level (95% CI,0.844–0.999; p <0.001). Postoperative NLR and CAR cutoff values are 15.4 and 115, respectively. Conclusions. Preoperative NLR elevation in septic arthritis may be associated with recurrent surgical debridement postoperatively. In addition, postoperative NLR and CAR values can predict debridement rates in patients after septic arthritis surgery.
Bilateral femoral and inguinal hernias are a rare co-occurrence related to abdominal wall pathology, and can lead to various complications such as incarceration, strangulation and high postoperative recurrence. This article presents a patient who complained of bilateral pain and pseudotumoral formations of the inguinal areas, being diagnosed during surgical intervention with bilateral femoral hernias in association with bilateral (direct and indirect) inguinal hernias. Generally, the laparoscopic method is reported to have several advantages, such as less postoperative pain, fewer postoperative infections, and rapid return to daily activities. In the presented case, the surgical team performed an open/Lichtenstein operation, due to the patient's age, shorter operating time, lower likelihood of recurrence and postoperative complications, as well as low cost. Considering the significant morbidity/mortality rates of multiple and complicated hernias, it is necessary that an accurate diagnosis and appropriate treatment be instituted as early as possible.
Objectives. Pathologies of the long head of the biceps have been viewed as a source of anterior shoulder pain and disability. Thus, we performed a histopathological and immunohistochemical examination of the biceps tendon with regard to the neuronal structure, the number of mechano[1]receptors and immunohistochemical types, to investigate the relationship of these factors with pain. Materials and Methods. This is a single-center prospective comparative study, on 11 patients divided into Group A (n=5) and Group B (n=6). Patients who underwent arthroplasty due to Neer type[1]4 proximal humeral fractures were selected as the control group (Group A). Group B consisted of patients with chronic anterior shoulder pain who underwent subpectoral biceps tenodesis during arthroscopic rotator cuff repair. The long head of biceps tenodesis was performed in all patients. Results. Hyalinization in the tendon was observed in 2 patients of group B. Chondroid degeneration was found in one patient with hyalinization. Inflammation, calcification, or matrix formation were not detected in any patients. Normal nerve fibers were observed around the tendon in 9 patients with S-100 immunohistochemical staining. In 1 patient, weak staining was observed in the nerve sheath with EMA immunohistochemical stain. No tactile body was detected. Conclusions. We did not observe any histo[1]pathological findings that could be considered the cause of pain in the two groups. Biomolecular and biomechanical studies, in addition to microscopic studies, are needed to explain why the biceps is a potential source of pain.
Introduction. Papilloma is more common among neoplastic lesions, and vocal cord polyps are more common among nonneoplastic lesions. The objective of this study is to investigate the epidemiological factors, clinical features, etiopathogenesis and management methods of benign lesions of the larynx. Materials and Methods. It is a prospective study on 40 benign lesions of the larynx, in a tertiary referral medical period of 18 months (from March 2018 to October 2019). Detailed history and ENT examination as well as relevant investigations were performed. Results. Vocal cords were involved in 92.5% of cases, and both supraglottis in 7.5% of cases. Vocal cord polyp lesions were more common than papilloma lesions. Preoperative conservative voice therapy was recommended, and 70% of cases showed improvement. Coblation assisted laryngeal surgery and excision was performed in 1 case, while 11 cases were treated by microlaryngeal surgery. Voice rest and voice therapy was given to all post operative cases. Follow-up ranged from 2 to 18 months, and improvements were seen in 8 cases that were treated by surgery. All cases that underwent conservative treatment improved symptomatically. Conclusions. The most likely causes of treatment failure are due to ongoing predisposing factors such as voice abuse, smoking and alcohol consumption, lack of commitment to voice therapy and non-compliance with recommendations by patients.
Background. In this study, it was aimed to evaluate the treatment results of distal radius intra-articular comminuted fractures treated with closed reduction and external fixation. Material and Methods. This study included 46 patients who underwent closed reduction and external fixation with the diagnosis of distal radius intra-articular comminuted fracture. According to the AO classification, 21 patients had type C1, and 25 patients had type C2 fractures. Patients were evaluated with the radiological criteria developed by Lindstrom and the clinical scoring system developed by Gartland and Werley. Results. Mean union time was 7 weeks (6-8 weeks). All patients were followed for 12 months. As a result of Lindstrom radiological-anatomical evaluation 10 (21,73%) patients were evaluated as moderate, 16 (34.7%) patients as good, and 20(43.4%) patients as excellent. When these 46 cases were evaluated according to the modified Gartland and Werley functional evaluation scheme, a satisfactory result (excellent and good) was obtained in 42 cases (91.3%), and unsatisfactory (moderate and poor) results were obtained in a total of 4 (8.7%) cases. Conclusion. The closed reduction and external fixator application is a treatment method that can be preferred in the treatment of unstable radius distal intra-articular comminuted fractures in the right indication and in the right patients, under appropriate conditions.
