The Journal of Surgery最新文献

{"title":"Diagnostic Value of α-Glutathione S-transferase in Acute Mesenteric Ischemia","authors":"A. Elshoura, Hala Ibrahim, S. Hazzaa, Ola El-Shora, G. Moussa","doi":"10.11648/J.JS.20180604.16","DOIUrl":"https://doi.org/10.11648/J.JS.20180604.16","url":null,"abstract":"Background: Acute mesenteric ischemia (AMI) is a life-threatening problem, and the early clinical manifestations of it are non-specific. Despite the advances in laboratory & radiological diagnostic procedures, the mortality rate of AMI is still high. Aim: The purpose of the study to evaluate the ability of α-glutathione S-transferase (α- GST) to predict AMI in patients with abdominal pain. Methods: This prospective study was conducted in Tanta University Hospitals between November 2014 and December 2017. Nighty patients were included after clinical suspicious of AMI. Serum levels of α- GST were measured in the collected stored samples, and other biochemical markers were performed (e.g. LDH, PH, and WBC). AMI was confirmed by CT angiography or laparotomy. Patients without ischemic bowel were considered to be controls. Results: A total of 90 patients in the study, the ischemic group included 52 patients, and the non-ischemic group included 38 patients. Patients with intestinal ischemia had significant higher serum values of D-dimer, LDH and α –GST. Where α –GST diagnosed AMI by accuracy of 84.4%. Conclusion: Measurement of plasma α -GST is a simple, early, easy, and effective procedure making it a useful serum biomarker for early diagnosis of AMI.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"19 1","pages":"107"},"PeriodicalIF":0.0,"publicationDate":"2018-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82541326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postero-Lateral Fusion (PLF) for Degenerative Diseases of the Lumbosacral Spine in Jos Nigeria","authors":"Ode Michael Bundepuun, Taiwo Femi Olu, Onche Icha Inalegwu, Amupitan Idumagbodi, Ode Gloria Nengi","doi":"10.11648/J.JS.20180604.14","DOIUrl":"https://doi.org/10.11648/J.JS.20180604.14","url":null,"abstract":"Degenerative diseases of the spine are a common presentation to the clinician, more so with an increase in the ageing population worldwide. Operative methods of treatment are employed following failure of conservative methods. Spine surgical procedures are expensive, and many different procedures are employed to treat these spinal conditions. Instrumented posterolateral fusion (PLF) is one of the options employed and has a reduced cost owing to the absence of the inter body cage used in inter body fusion techniques. The objective of this study was to assess posterolateral fusions in our center within a developing country with poor health insurance coverage as an effective treatment modality in degenerative lumbosacral spine disease, without the added cost of an interbody fusion cage. This was a retrospective study carried out in Jos, Nigeria covering a two year period from July 2015 to June 2017. Patients with degenerative spine diseases who had been on conservative methods of treatment for more than six months with no significant improvement were recruited for the study. Data was obtained from the case records of the patients the patients were assessed for the indications for the procedure, the number of levels of fusion, duration of surgery and transfusion requirement as well as outcome of procedure using the Numeric pain scale (11 point scale from 0 to 10) and the complications of the procedure. Data was analyzed using the epi info statistical software. 13 patients had Posterolateral fusion (PLF) within this period. The mean age was 61.4years ±10.7. A male female ratio of M:F 1:3.3. 8(61.5%) patients had multiple level disc degeneration and herniation, 2(15.4%) patients each had spinal canal stenosis and facet joint arthritis with instability and 1(7.7%) had degenerative spondylolisthesis. 9(69.2%) patients had 2 level fusion, 2 (15.4%) had 3 level fusion and 2(15.4%) had 1 level fusion. 6(46.2%) had a pain reduction by ≥ 8 points on the numeric pain scale, 6(46.2%) had reduction by 6-7 points and 1(7.7%) had reduction of 3-5 points. 92.6% of the patients had a pain reduction by more than 50%. Mean operative time was 203minutes, and mean transfusion requirement was 2.8 pints of blood. Complications noted were superficial surgical site infection 1 patient and dural tear 1 patient. Postero lateral fusion techniques are a safe and effective treatment modality in treating patients with degenerative lumbosacral spine disease. The non usage of the interbody fusion cage provides a cheaper alternative in posterolateral fusion and every modality to limit surgical site infection should be employed to limit increased cost from this complication.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"23 1","pages":"97"},"PeriodicalIF":0.0,"publicationDate":"2018-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81392895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Scrotal Flaps: A Novel Ideain the Management of Massive Scrotal Lymphoedema","authors":"N. Ferdinand, B. Peter","doi":"10.11648/J.JS.20180604.13","DOIUrl":"https://doi.org/10.11648/J.JS.20180604.13","url":null,"abstract":"Massive Scrotal lymphoedema is a debilitating condition that could result in both psychological and physical trauma to the patient. Irrespective of the cause of this condition, surgery remains the cornerstone in its management. A variety of surgical procedures have been described with varied degree of success. A total of eight patients with massive scrotal lymphoedema of ages between 15 and 60 years were managed by the authors. The mean excision of the scrotal tissue was 5.7 kilogrammes. All patients had post excision defect reconstructed with bilateral scrotal flaps. No skin grafts were utilized in any patient. They all healed well without any complications and were able to resume to their normal functions within nine weeks. No recurrence was noted at two years of follow up. Bilateral scrotal flap is an effective method of managing massive scrotally mphoedema. It allows for massive removal of scrotal tissue and primary repair of the defect using scrotal tissue that allows for early return to work and sexual activities. The complications are minimal and there is high patient satisfaction.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"57 1","pages":"92"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72960986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon Dioxide Assisted Subcision in the Treatment of Adherent Localized Scars","authors":"Georgia Lee Sk","doi":"10.11648/J.JS.20180603.15","DOIUrl":"https://doi.org/10.11648/J.JS.20180603.15","url":null,"abstract":"Modified subcision assisted with Carbon Dioxide insufflation is described in 2 patients; one with post acne scar and another with adhesion following liposuction. Both subjects have satisfactory results after 3 fortnightly sessions. The Carbon Dioxide flow controlled by the flow rate and procedurist’s maneuvering adjusted to the size and positon of the scars help to separate the underlying fibrotic bands allowing the reach beyond the length of the subcising device; in this case being a 30G ½ needle. The results and recovery is being compared with traditional subcision and possible benefits of Carbon Dioxide assisted subcision are discussed.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"116 1","pages":"78"},"PeriodicalIF":0.0,"publicationDate":"2018-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77271289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ischemic/Septic Diabetic Hand: Review of Literature and a Case Report","authors":"C. Alessandro, L. Domenico, L. Luisa, Romano Giovanni, L. Guido, C. Michela","doi":"10.11648/J.JS.20180604.11","DOIUrl":"https://doi.org/10.11648/J.JS.20180604.11","url":null,"abstract":"The term “diabetic hand” was born to describe the complications of the diabetes mellitus on the hand resulting in a rigid hand with a poor mobility. The traumatic wounds with soft tissue involvement increase the risk of infection. Staphylococcus aureus methicillin-resistant (MRSA) is the most common bacterium isolated in the hand infections. The case report of a type 2 diabetic patient, dialysed with chronic obstructive peripheral artery disease and Monckeberg sclerosis of the vessels of the hands, ischemic necrosis of the right hand fingers is reported by the authors. In the diabetic patient the hands can be infected in the same way that feet could be infected too. Several amputation interventions have been performed with the intent of saving part of the hand. The diabetic hand syndrome (DHS) is an important pathology that requires strong antibiotics and surgery to avoid severe disability as rigidity, contracture and amputation. Apparently, in the last years good results are reported using antibiotic, surgical and hyperbaric treatment. In conclusion it would be wrong to ignore or underestimate this disease and any doctor should practice a scrupulous visit of the hands in the diabetic patient.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"13 1","pages":"82"},"PeriodicalIF":0.0,"publicationDate":"2018-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87683501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helmet Wearing and Traumatic Brain Injuries Among Motorcyclists in Cotonou","authors":"Iréti Fiacre Tidjani, S. P. Chigblo, V. Houannou, Thierry Alihonou, E. Lawson, Penance Agbélélé, S. Madougou, A. H. Akué","doi":"10.11648/j.js.20180603.14","DOIUrl":"https://doi.org/10.11648/j.js.20180603.14","url":null,"abstract":"Background: traumatic brain injury is a real health problem, especially in low-income countries. The aim of this study was to assess the impact of helmet wearing on primary injuries in motorcycle trauma. Methods: this was a cross-sectional study from 1 st January to 31 st December 2013. It covered all motorcycle users, admitted in emergency at Cotonou National Teaching Hospital, with a traumatic brain injury. Epidemiological variables and primary lesions were identified. Statistical analysis was performed with Chi 2 and Fischer’s tests; a p-value ≤ 0.05 was considered statistically significant. Results: we collected 310 patients (57.9% of traumatic brain injury), 11 of whom wore a helmet. They were predominantly male (male to female ratio =7.6), with a mean age of 33.2 ± 10.9 years. Craftsmen (24.4%) were the most affected. The head trauma was often opened (172 cases / 299) in patients without helmet compared with 4 cases / 11 in patients with helmet (p = 0.001). Similarly, primary lesions were often more severe in patients without helmet, with a large number of primary lesions requiring surgery. Conclusion: helmet wearing significantly reduces the risk of serious primary injuries in motorcyclists in our context. Strict enforcement of mandatory helmet use should reduce the incidence of disabling injuries in our country.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"34 1","pages":"73"},"PeriodicalIF":0.0,"publicationDate":"2018-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72646593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compression Therapy in the Management of Cellulitis: A Comparative Study","authors":"K. Joseph, N. Wanjala, K. Stanley","doi":"10.11648/J.JS.20180603.13","DOIUrl":"https://doi.org/10.11648/J.JS.20180603.13","url":null,"abstract":"Cellulitis is a common condition causing significant morbidity. Conventional treatment has been mainly by the use of antibiotics, limb elevation and analgesics. There is no consensus on the role of compression therapy in the management of cellulitis. This study was a comparative study of patients who presented with cellulitis at Kenyatta National Hospital. The study was set to determine the effect of compression therapy as an adjunct in the treatment of limb lower limb cellulitis The study period was between May 2014 and May2015 Patients were randomly assigned into two groups through a computer generated program. Group A patients were managed with antibiotics, limbelevation, analgesia and elasticcompression therapy.. Group Bpatients were managed with elevation, antibiotics and analgesia. The antibiotic used was amoxyclavulinic acid while the analgesic was paracetamol and diclofenac. The parameters assessed wereoedema resolution, pain, tenderness and length of hospital stay. A total of eighty patients withcellulitis were recruited inbothgroupswith each arm having 40 patients. Group A patients who were managed with compression therapy had greater reduction in pain, tenderness and oedema as compared togroup B patients. The length of hospital stay was 10.2 days in group Aand 13.4 days in groupB. Elasticcompression therapy as demonstrated in this study is beneficial inthe management of cellulitis. It results in faster resolution of cellulitis with reduction in the length of hospital stay and with no increase in complications.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"65 1","pages":"68"},"PeriodicalIF":0.0,"publicationDate":"2018-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87801158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Effects of Bariatric Surgery on Health-Related Quality of Life: A Systematic Review","authors":"R. Alvares, M. Diniz, Ana Luisa Bagno de Almeida, Matheus Nagib Lemos Paulo, A. Beleigoli","doi":"10.11648/j.js.20180603.12","DOIUrl":"https://doi.org/10.11648/j.js.20180603.12","url":null,"abstract":"Introduction: Obese patients who seek bariatric surgery (BS) have great impairment in health-related quality of life (HRQoL). Along with weight loss, BS leads to improvement in HRQoL in the short-term. However, physical, psychological and social issues that ensue after BS might impact on HRQoL in the long-term. The aim was to systematically review the literature in order to explore the impact of bariatric surgery on HRQoL of severely obese patients in the long-term. Methods: Electronic databases were searched (Pubmed/Medline, Lilacs, IBECS, Cochrane Library, SciELO) to retrieve studies of adults with BMI≥35kg/m² which assessed HRQoL five or more years after BS. Hand search of references of previous reviews was also performed. GRADE was used to assess the quality of the evidence. Results: Of the 1226 articles retrieved, nine longitudinal studies were selected. A total of 4031 patients were followed-up. Female sex was predominant in all studies. Only one study did not find improvement in HRQoL after BS. Improvement of physical aspects of HRQoL was more commonly reported than mental aspects. The quality of the evidence retrieved was rated as low mainly due to the lack of adjustment for prognostic factors that might have led to counfounding in the assessment of HRQoL and under-report of follow-up rates. Differences in the instruments to assess HRQoL and in the composition of control groups among the studies did not allow to perform meta-analysis. Conclusion: BS was associated with improvement in HRQoL in the long-term, particularly in physical aspects. The low quality of the studies selected points out to the need of controlled trials to better assess the long-term effects of BS on HRQoL.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"60 1","pages":"61"},"PeriodicalIF":0.0,"publicationDate":"2018-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82849435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unroofing of Left Coronary Artery in a Patient with Aortic Valve Replacement","authors":"S. Shahabuddin, O. Sami, Jamal Kabeer Khanv, S. Sami","doi":"10.11648/j.js.20180603.11","DOIUrl":"https://doi.org/10.11648/j.js.20180603.11","url":null,"abstract":"During aortic valve replacement, coronary artery obstruction is a rare but fatal complication. It may require revision of the surgical procedure including re-implantation of the valve or additional coronary revascularization. It is more common in the presence of abnormality of coronary artery like malposition or abnormal course. We report a case of 32 years old gentleman undergoing aortic valve replacement for severe aortic stenosis, having an abnormally placed left main coronary artery ostium. The risk of coronary ostial compression on seating the prosthetic valve was evident. A left main coronary artery unroofing was performed to translocate the ostium to avoid the obstruction. The patient recovered well intra and postoperatively and is doing well at nine months follow up.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"24 1","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2018-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82048754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of Upper Abdominal Pain that Predict Symptoms Relief after Cholecystectomy in Patients with Uncomplicated Gallstones Disease","authors":"W. M. Soliman, M. Hablus, Khaled M. Zaghloul, Loai Mohamed Elahawal, A. A. Alattar","doi":"10.7438/1584-9341-14-1-5","DOIUrl":"https://doi.org/10.7438/1584-9341-14-1-5","url":null,"abstract":"Introduction: Gallbladder disease is common and results in high health care costs. Indeed, estimates of the lifetime risk of gallstone formation are as high as 10% to 20% of the general population. The natural history of symptomatic gallstone disease is such that approximately 70% of patients will continue to have episodic symptoms or experience a complication of gallstones within 2 years of initial diagnosis. Adding to this potential confusion is the occurrence of abdominal pain thought to resemble gallbladder pain but without gallstones present. Laparoscopic cholecystectomy remains the gold standard for treatment of symptomatic cholelithiasis. However, persistent symptoms after cholecystectomy occur in 10 to 33% of patients. Although a variety of clinical characteristics have been evaluated as preoperative factors associated with outcome after cholecystectomy, preoperative symptoms are generally used as a reference point for diagnosis and determination of need of cholecystectomy. Characterizing and identifying symptoms that predict relief from upper abdominal pain after cholecystectomy could better guide physicians to recommend cholecystectomy so as to reduce morbidity, mortality and cost and minimize unnecessary surgery. \u0000Aim: The objective of this study is to identify symptoms predicting complete relief of upper abdominal pain (UAP) after cholecystectomy to help better selection of patients who might benefit from surgery. \u0000Subjects and methods: This study is a prospective analysis involving 950 adult patients undergoing cholecystectomy for symptomatic cholelithiasis. The study included 721 females (75.89%) and 229 males (24.11%). The patients were asked to complete a previously-validated biliary symptoms questionnaire (BSQ) before operation and 3 months postoperatively as well. At the end of the last questionnaire, each patient was required to define whether (as overall) his symptoms were relieved or not. Our patients were divided into two groups according to pain relief after surgery; Group (I) included patients who had pain relief after surgery (713 patients-75.05%) and group (2) included patients who did not have pain relief after surgery (237 patients-24.95%). \u0000Results: Our study shows that the likelihood of having pain relief is greater in patients who have UAP onset one year or less preoperatively, UAP of short duration, UAP occurring most frequently in the evening or at night time and whose pain awakens them by night, patients who do not have lower abdominal pain, patients who have normal bowel habit pattern, patients who have infrequent nausea attacks, patients who do not often have excessive gas bloat or burps and patients who do not suffer concomitant GERD or IBS. \u0000Conclusion: Laparoscopic cholecystectomy is an effective management option for symptomatic cholelithiasis, with a cure rate of 75.05% in our study. Better rates of pain relief can be achieved by better selection of patients, as sub analysis of symptoms showed better cure ","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":"299 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2018-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79656370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}