Surgical Medicine Open Access Journal最新文献

{"title":"Pediatric Meningiomas- A Case Report and Review of the Literature","authors":"A. Kelly, T. Tau, Tshilidzi Sidiki","doi":"10.31031/SMOAJ.2018.02.000530","DOIUrl":"https://doi.org/10.31031/SMOAJ.2018.02.000530","url":null,"abstract":"Background: Pediatric meningiomas are relatively rare accounting for only 3% of intracranial neoplasms. As such most of the literature on pediatric meningiomas exists in the form of isolated case reports or as a case series with small patient numbers. Despite this scarcity of literature several important features distinguish pediatric meningiomas from those that occur in adults. These include unique risk factors; a male predominance; larger tumor sizes at presentation; unusual sites of occurrence including intraventricular and parenchymal; higher World Health Organization histological grades; more aggressive clinical behavior and an increased tendency for recurrence. We present a 12-year-old male patient whom presented to our unit with a left fronto-parietal convexity meningioma of an alarming size. Methods: A 12-year-old male patient presented to our unit with an eight-month history of a progressive headache complicated by a two-week history of vomiting. He also complained of progressive weakness of the right side of his body which had worsened to a point that he was no longer independently ambulant. General examination revealed craniomegaly with tortuous scalp veins. Neurological examination revealed a right upper motor neuron facial nerve palsy and a right hemiplegia of 2/5. Radiological investigation revealed an extremely large left fronto-parietal dural based space-occupying lesion which crossed the midline. Due to the adolescent’s progressive neurology he was taken to the operating room for emergency resection of the lesion. Gross total resection was achieved, and histopathological analysis confirmed the lesion to be a fibroblastic meningioma. Result: Post-operatively the patient demonstrated a complete resolution of his hemiplegia and at three weeks post operatively he was already independently ambulant with power 4/5 on the previously hemiplegic side. Conclusion: Despite the notorious features that characterize pediatric meningiomas, as well as an often-intimidating radiological appearance, adherence to standard Neurosurgical operating principles has the best chance of ensuring a successful outcome.","PeriodicalId":283483,"journal":{"name":"Surgical Medicine Open Access Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128718389","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":"Measurement of the True Incidence of Secondary Haemorrhage Post Tonsillectomy","authors":"Luke Holmes, V. Veer","doi":"10.31031/SMOAJ.2018.02.000529","DOIUrl":"https://doi.org/10.31031/SMOAJ.2018.02.000529","url":null,"abstract":"Aim: To determine the ‘true’ secondary haemorrhage rate post-tonsillectomy. Methods: A telephone survey was conducted of 127 consecutive patients who had a tonsillectomy at the Freeman Hospital over a two-month period. Results: 99 patients were contactable. There were 38 post-tonsillectomy bleeds, 23 of which were minor and 15 significant. 23 bleeds went unreported and four of these were significant. 11 percent of bleeds post-cold steel tonsillectomy were significant, compared to 28 percent of bleeds post-diathermy dissection. Conclusion: There is a high incidence of unreported bleeding (61 percent of those that bled) and a third of adults who suffered a significant bleed did not report it. Diathermy had a significantly higher proportion of significant bleeds compared to cold steel. It is recommended if secondary haemorrhage rates are reported in the literature then small studies should contact patients for ‘true’ secondary bleed rates while large studies should use return to theatre and need for transfusion rates. Surg Med Open Acc J Copyright © Vik Veer 2/3 How to cite this article: Luke H, Vik V. Measurement of the True Incidence of Secondary Haemorrhage Post Tonsillectomy. Surg Med Open Acc J. 2(1). SMOAJ.000529.2018. DOI: 10.31031/SMOAJ.2018.02.000529 Volume 2 Issue 1 F. If yes, how were you managed? A bleed of less than one minute was classified as minor, and a bleed greater than one minute as significant. This point was clearly qualified with the patient, as blood actively running for greater than a minute. Multiple presentations were only counted once. Details about each patient’s tonsillectomy operation were also collected from the medical notes. In a few cases the operative procedure wasn’t fully detailed and the individual surgeon’s usual practice was assumed. Results Data was obtained from 99 of the 127 patients who had tonsillectomies in the selected period, which represented 78 percent of the sample. Of these 99, 38 (38 percent) reported a posttonsillectomy bleed (Figure 1). Of the 38 post-tonsillectomy bleeds, 23 (61 percent) went unreported. In total there were 23 minor bleeds and 15 significant bleeds (Figure 2). Figure 1: Post-tonsillectomy bleed rates in 99 patients interviewed. Figure 2: Categorisation of 38 post-tonsillectomy bleeds. Figure 3: Comparison of bleed types in children and adults. Of the 38 people who experienced bleeding, only 15 reported the incident to a health professional, the vast majority of which visited A&E (14 of the 15 reported). Of the 23 people who didn’t report their bleeding, four individuals suffered a significant bleed, the remaining 19 described minor bleeding (Figure 2). Notably, of the four significant unreported bleeds, two heralded a larger episode of bleeding requiring hospital admission. Of the 15 reported bleeds, 11 were significant while four were minor (Figure 3). Of the 11 significant bleeds reported, seven of these were sent home by A&E without consulting ENT as the bleeding had resolv","PeriodicalId":283483,"journal":{"name":"Surgical Medicine Open Access Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132467990","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":"Perforated Appendicitis Preoperatively complicated by Multiple Intra-Abdominal Abscesses","authors":"Juan Velasquez Lopez, T. Zahouani, Franscene E. Oulds","doi":"10.31031/SMOAJ.2018.02.000528","DOIUrl":"https://doi.org/10.31031/SMOAJ.2018.02.000528","url":null,"abstract":"Acute appendicitis is the most common surgical emergency in the pediatric population [1]. Complications are seen in 30 to 40% of cases, and include perforated, gangrenous, intra-abdominal abscess and peritonitis [1]. The rate of perforated appendicitis is higher in children compared to adults and varies from 30% to 74% [2]. We report a case of perforated appendicitis preoperatively complicated by multiple intra-abdominal abscesses.","PeriodicalId":283483,"journal":{"name":"Surgical Medicine Open Access Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126126460","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":"Common Etiology of Foreign Body Ingestion","authors":"A. Qureshi, J. Cunningham, Sobia Naz","doi":"10.31031/SMOAJ.2018.01.000525","DOIUrl":"https://doi.org/10.31031/SMOAJ.2018.01.000525","url":null,"abstract":"The aim of this study was to look at the demography, sites of insertion, most common causes of foreign body ingestion and the procedures used for retrieval of these foreign bodies (FB). We also looked at length of stay and common a mental health diagnosis for patients admitted with FB ingestion. Material & Method: This was a retrospective analysis of four years data from January 2014 to January 2018 at Northampton general Hospital. The data was collected using the hospital electronic record system. All patients admitted under surgical subspecialties and gastroenterology was included. Children with a genital FB were excluded from the study. The number of admissions for each patient was recorded. Patients were divided into accidental and mental health illness (MHI) groups. Result: A total of 146 patients were admitted with FB diagnosis. 57% (84) were in the accidental group and 43% (63) were in the MHI group. In the accidental group 70% (54) were under the age of 16 years, the most common cause was inorganic FB and the most common site was an ENT. While in adults most common site in accidental FB was oesophagus and the food bolus was the commonest cause. In the MHI group 63 patients had 257 admissions episodes. The mean age was 25±21 years. Female sex and younger age i.e early adulthood were at a higher risk for FB ingestion. Abdominal x-ray was the most common investigation. Mean length of stay was 3±2 days. Endoscopic retrieval was successful in 85% of patients. Most common mental health diagnosis was deliberate self harm (DSH) 40%. Conclusion: Younger age group, female sex and patients with history of DSH are at a higher risk of FB ingestion and recurrent presentation. Early recognition of high risk patients and prompt psychiatric help can minimise the recurrent presentation of these patients. Minimally invasive techniques like endoscopic retrieval of FB should be first choice.","PeriodicalId":283483,"journal":{"name":"Surgical Medicine Open Access Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125165138","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":"Internal Iliac Artery Aneurysm Repair with Iliac Branch Endoprothesis","authors":"J. Ngai, G. Lazaraviciute, Y. Chan, Kristen Kehoe, Sophie MacDonald, Angharad Jones, E. Munro, Alisdair Wilson, Athanasios Pantos, B. Renwick","doi":"10.31031/SMOAJ.2018.02.000527","DOIUrl":"https://doi.org/10.31031/SMOAJ.2018.02.000527","url":null,"abstract":"Isolated internal iliac artery aneurysm is a rare condition with limited evidence in the literature to support management strategy. Repair has traditionally been associated with significant morbidity. However advances in endovascular technique offer the potential for new treatment options. We report our experience of using an","PeriodicalId":283483,"journal":{"name":"Surgical Medicine Open Access Journal","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123024064","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":"Vertebroplasty: Review of the Procedure in Relation to Patients with Fracture of Osteoporotic Origin","authors":"I. Arrotegui","doi":"10.31031/SMOAJ.2018.01.000524","DOIUrl":"https://doi.org/10.31031/SMOAJ.2018.01.000524","url":null,"abstract":"Vertebroplasty was initially described by Gallibert and cols. in 1987 to treat symptomatic hemangiomas of the vertebral body. Percutaneous vertebroplasty (PV) is a minimally invasive technique used to reinforce pathological vertebral bodies. It is indicated in symptomatic hemangiomas, vertebral fractures due to osteoporosis and vertebral involvement due to metastasis or multiple myeloma with bone destruction and risk of spinal and/or root involvement. The efficacy of VP is based on its analgesic effect, in addition to preventing vertebral fractures and, in the event of a vertebral fracture already existing, the VP prevents its progression. The technique involves the injection of methyl-methacrylate cement (M-M) into the pathological vertebra, in a semiliquid or pasty state so that in a very short time it polymerizes to a solid state, giving a good support to the vertebral body","PeriodicalId":283483,"journal":{"name":"Surgical Medicine Open Access Journal","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122270931","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":"Challenges in Managing Metaplastic Breast Cancer-Referencing an Indexed Case and a Ten-Year Experience in a Developing Country","authors":"J. Bisnath, N. Sookar, Jameel Ali","doi":"10.31031/SMOAJ.2018.01.000523","DOIUrl":"https://doi.org/10.31031/SMOAJ.2018.01.000523","url":null,"abstract":"Breast cancer is the leading cause of cancer related deaths in Caribbean women [1]. Metaplastic breast cancer is a rare subtype. The tumours consist of both epithelial and mesenchymal components and are fast growing with advanced disease at presentation [2]. Diagnosis via traditional means can be difficult due to mixed tumour makeup and most cases are recognised postoperatively. Axillary nodal involvement is uncommon and most spread is hematogenous. Most tumours are triple negative and show poor response to systemic therapy. Surgery and radiotherapy have been shown to be of benefit, however this disease still carries a high risk of locoregional recurrence and poor prognosis.","PeriodicalId":283483,"journal":{"name":"Surgical Medicine Open Access Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126440138","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}