Austin journal of surgery最新文献

{"title":"Evaluation of HSG and SIS Diagnostic Value in Comparison to Hysteroscopy to Detect Intrauterine Abnormalities in Infertile Women in Iran","authors":"Nazari L, Boroujeni Pt","doi":"10.26420/austinjsurg.2021.1272","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1272","url":null,"abstract":"Objective: Hysteroscopy is the gold standard in evaluation of uterine cavity. However, being invasive and its possible adverse effects have reduced popularity of hysteroscopy and clinicians have always been looking for a valid alternative for hysteroscopy. In the current study, we aimed to compare diagnostic value of Saline induced Sonography with HSG in diagnosis of intrauterine abnormalities. Material and Method: We performed a retrospective study on 81 infertile women who underwent hysteroscopy, SIS, and HSG at Taleghani infertility center during their IVF treatment course. Polyp, fibroids, adhesion and septate uterus were considered as abnormality. We reported agreement percent, Kappa, sensitivity, specificity, Area Under Curve, Diagnostic Odds Ratio, Positive Predictive Value, and Negative Predictive value for both SIS and HSG. Results: Total agreement between SIS and hysteroscopy was 85.1, while it was 23.4 for HSG. We also observed considerably higher Kappa for SIS (80.1%) than HSG (15.5%). Overall sensitivity and specificity of SIS for diagnosis of all type of anomaly including both uterine abnormalities and Acquired uterine pathologies was 90.1% (95% CI= 80.7, 95.9) and 90.0% (95% CI= 55.5, 99.7). Meanwhile overall sensitivity and specificity of Hysterosalpingography where hysteroscopy was considered as the gold standard was 54.9 (42.7, 66.8) and 50.0 (18.7, 81.3). Conclusion: SIS is more sensitive tools than HSG for diagnosis of intrauterine abnormalities and could be considered one of the best alternative of hysteroscopy. It provides more accurate detail diagnostic information with high sensitivity and specificity.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"51 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91120503","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":"Laparoscopic Distal Splenorenal Anastomosis","authors":"D. Ii, Kotiv Bn, Onnicev Ie, Soldatova Sa, Smorodskiy Av, Shevcov Sv, Apollonov Aa, Bugaev Sa","doi":"10.26420/austinjsurg.2021.1271","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1271","url":null,"abstract":"Introduction: Esophagogastric bleeding is the most formidable complication of the portal hypertension syndrome. At acute bleeding from varicose veins of the esophagus and stomach, mortality reaches 40 to 50% and is accompanied with the high risk of early hemorrhage recurrence in 30-50 % of survivors. Portosystemic shunt surgery provides for radical decompression of the portal vein system and reliably prevent hemorrhage recurrence. Purpose: To assess the possibility and efficacy of the Distal Splenorenal Anastomosis (DSRA) with a minimally invasive laparoscopic approach. Methods: The study included 28 patients with portal hypertension syndrome who underwent laparoscopic DSRA. By the Child-Pugh scale, class A was 42.9%, class B - 57.1%. The indication for surgical decompression of the portal system was the ineffectiveness of repeated sessions of endoscopic ligation with recurrence of varicose veins of the esophagus (21.5%) and/or bleeding from them (46.4%) or the presence of varicose veins of the stomach (32.1%). Results: Mean surgery time was 294±86 minutes. The maximum blood loss was 211±55 ml. The access conversion was performed in 10.7% of cases. In the postoperative period, the patients were in ICU for 1-2 days. The hospital stay and in-patients treatment duration was 9.4±2.5 days. Both in the early and in the long-term follow-up, there were no cases of gastroesophageal bleeding and shunt thrombosis. The portosystemic encephalopathy developed in 12% of cases. The surgical decompression of the portal system was featured by a decrease in the degree of esophagus varication in the long-term period. The maximum follow-up period was 46 months. Conclusion: Minimally invasive laparoscopic DSRA in patients with portal hypertension syndrome is a possible, safe and effective alternative treatment option.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86976929","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":"Immune Check-Point Inhibitors in Breast Cancer: Current Evidence and Future Directions","authors":"M. Mosteiro, M. Cejuela, S. Pernas","doi":"10.26420/austinjsurg.2021.1270","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1270","url":null,"abstract":"Check-point inhibitors have erupted as a treatment option for numerous kinds of neoplasms. Although there have been some achievements, the evidence supporting their use in breast cancer is scarce. Combinations with chemotherapy seem to provide better outcomes, and triple negative is the subtype most likely to benefit from them. New combination strategies are undergoing research to improve these results. Other approaches to determining biomarkers that identify which populations clearly benefit from these therapies are needed. Here, we review the clinical data of the role of immune check-point inhibitors in early and advanced breast cancer and present emerging strategies.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88680095","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":"Pelvic Congestion Syndrome: Surgical Treatment","authors":"Zekilah, Sallam Em, Mashaal Ab, Ageez Mn, Dessoky Mm, Atta In, Egypt Obstetrics, Egypt Ultrasonography","doi":"10.26420/AUSTINJSURG.2021.1268","DOIUrl":"https://doi.org/10.26420/AUSTINJSURG.2021.1268","url":null,"abstract":"Aims: To evaluate the mid and long term efficacy of surgical interruption of the refluxing ovarian veins as a treatment modality for pelvic congestion syndrome. Study Design: A prospective non comparative interventional study. Place and Duration of Study: This study was conducted between February 2015 and October 2019 in Alexandria Medical Centre and Tanta Main University Hospital. Methodology: The study included a 27 patient’s undergone surgical interruption of refluxing ovarian veins with or without sclerotherapy of vulval, perineal or thigh varices, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up was transvaginal and abdominal venous duplex. Follow up was done considering the change in pelvic venous images and pelvic pain scores in comparison to the pre-operative state. Results: Twenty seven female patients were treated for pelvic congestion syndrome using single session surgical intervention with or without sclerotherapy to pudendal varices. The patients age ranged from 21 to 43 (mean 33.1). All patients presented with chronic continuous pelvic pain. Other associated symptoms as dyspareunia, dysmenorrhea and pudendal varices were found in some cases. Surgical ligation of the ovarian veins were done to all cases, sclerotherapy/ligation of internal iliac varices was done for 6 cases and scerotherapy or surgical interruption of pudendal or thigh varicose veins was done in 21 cases. Technical success was achieved in all patients. Mean pelvic pain score was improved from 7.33 preoperatively to 1.33 and 0.89 in 6 and 12 months of the post-operative recordings. On sonographic basis pelvic reflux disappeared in 26 patients by the end of the follow up. Out of 27 patients treated there were 24 patients satisfied of the procedures at the end of the follow up. Conclusion: Surgical treatment for pelvic congestion syndrome combined with sclerotherapy to the associated varices was found to be effective, safe and affordable modality of treatment.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78401469","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":"Systematic Review and Meta-Analysis of the Impact of Intra-Operative Ultrasound Guidance Breast-Conserving Surgery in Early Breast Cancer","authors":"Tin Smm, Cheema I, Kurup V, Viswanath Yks, Razdan S","doi":"10.26420/AUSTINJSURG.2021.1267","DOIUrl":"https://doi.org/10.26420/AUSTINJSURG.2021.1267","url":null,"abstract":"Systematic review and meta-analysis of the impact of intra-operative ultrasound guided breast-conserving surgery in early breast cancer. Background: Breast Conservation (BCS) is the standard surgical procedure for early breast cancer. It is challenging for surgeons to achieve adequate excision of the lesion with clear margins and acceptable cosmesis. A continuous Intra-Operative Ultrasound (IOUS) is used during BCS in volume precision surgery. We reviewed its effectiveness to obtain clear margins, low excision volume and better cosmetic outcome during BCS. Methods: We searched three bibliographic databases (MEDLINE, CINAHL, Cochrane Library online) for relevant published and unpublished literature from their inception until December 2019. The randomized controlled trials of the impact of IOUS on excision volume, margin status and cosmetic outcome was assessed, and meta-analysis carried out for margin status with narrative summary was done for other results. Results: This study included four articles in the systematic review. A total of 207 patients with IOUS and 192 patients with Palpation Guided (PGS) BCS was studied in this review. The standardised mean difference of excision volume for 2 trials was -0.31 (-0.62, -0.00) and -0.50 (-0.85, -0.16) with p-value of 0.048 and 0.004. There was no significant volume difference in the remaining two studies. The positive margin rate reduced significantly with IOUS guidance with the pooled OR was 0.19 (95% CI: 0.09, 0.41) with no heterogeneity among studies (p=0.72, I2= 0%). The overall cosmetic outcome favoured satisfaction in both ultrasound-guided and palpation guided BCS groups without significant difference. Conclusion: This study suggests that the use of IOUS provides a statistically significant, less positive margin without a considerable difference in excisional volume. Overall, satisfaction exceeds dissatisfaction with ultrasound-guided Breast-conserving surgery. However, there is insufficient evidence to support the better cosmetic outcome in the IOUS group.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85361687","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":"Surgical Management of a Caustic Ingestion in a Gastric Bypass Patient: A Case Report","authors":"Van Boxstael E, Terwagne N, Deswysen Y","doi":"10.26420/AUSTINJSURG.2021.1266","DOIUrl":"https://doi.org/10.26420/AUSTINJSURG.2021.1266","url":null,"abstract":"Introduction: Bariatric surgery is recognized as the most effective treatment for obesity. Increased rate of psychological disorders has been noted after surgery. However, no case of caustic ingestion after bariatric surgery and its surgical management has been reported in the literature. Presentation of Case: A 48-year-old woman, who underwent a Rouxen- Y gastric bypass 9 years ago, ingested caustic substances as a suicide attempt, causing necrosis of the entire alimentary limb without severe lesion of esophageal tract or gastric pouch. During exploratory laparotomy, resection of the alimentary limb and gastrostomy in the neogastric pouch were performed. Three months later, the patient presented to the emergency room with a dislodged gastrostomy tube. Exploratory laparotomy was performed with restoration of anatomical continuity via gastro-gastric anastomosis. Discussion: Bariatric surgery is correlated to a higher postoperative risk of psychological disorders until suicide attempt. This case is the first description of caustic ingestion after Roux-en-Y gastric bypass and its surgical management. It underlines the importance for bariatric teams to consider psychological aspect of surgical patients pre- and postoperatively.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75283297","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":"Results of a German Wide Survey by NOGGO and AGE towards Current Surgical Approach in Early Stage Cervical Cancer after the LACC Trial- NOGGO MONITOR 11","authors":"R. Armbrust, F. Chen, R. Richter, Muallem Mz, J. Sehouli, A. Mustea, B. Holthaus","doi":"10.26420/AUSTINJSURG.2021.1264","DOIUrl":"https://doi.org/10.26420/AUSTINJSURG.2021.1264","url":null,"abstract":"Purpose: Minimally Invasive Surgery (MIS) has become the standard approach in Early Stage Cervical Cancer (ECC). However, the recently published “LACC” trial and even others could show inferior PFS and OS of MIS compared to open radical hysterectomy. The results led to a widespread debate about the best surgical approach in ECC. The present survey aimed to get first insights after publication. Methods: NOGGO and AGE conducted a nationwide digital survey among 186 Gynecological Cancer Centers. Descriptive statistics and t-tests were performed using SPSS. Results: A majority of the centers were of high expertise and/or experience in treatment of ECC and were highly aware of the LACC trial results. Trial quality and scientific value were rated as very good/good. However, still 40% would not change the standard of care to open surgery. Centers with higher volume and participating in clinical trials were more likely to change. Conclusion: This survey represents some first insights after the surprising results of recently published trials towards the surgical approach of ECC. There still seems to be a high need of future trials and possible explanations for the unexpected worse outcomes in the MIS group.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89445231","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":"Initial Experience with Biodegradable Pancreatic Stents in the Prevention of Postoperative Pancreatic Fistula after Cephalic Pancreaticoduodenectomy","authors":"F. SánchezBueno, Hepatobiliopancreatic Surgery, G. Pj, D. Ferreras, B. Gómez, J. EgeaValenzuela, F. AlbercadelasParras","doi":"10.26420/AUSTINJSURG.2021.1263","DOIUrl":"https://doi.org/10.26420/AUSTINJSURG.2021.1263","url":null,"abstract":"Background: Postoperative Pancreatic Fistula (POPF) remains the most important morbidity after pancreaticoduodenectomy. There is no consensual technique for pancreatic reconstruction and many surgeons use a transanastomotic drain. Currently, the stents used are not degradable and they can cause obstruction, stricture and pancreatitis. The use of biodegradable stents that disappear a few months after the intervention could have a role in the prevention of pancreaticojejunostomy complications. The aim of the study was to evaluate technical success of implantation and safety of newly available biodegradable stents in 16 patients undergoing cephalic duodenopancreatectomy. Materials and Methods: A single-center prospective non-randomized study was conducted with patients undergoing PD. A total of 16 patients were included. A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (Archimedes) was placed from the pancreatic duct to the jejunum. Results: One of the patients developed POPF, which was successfully treated with interventional radiology drainage and somatostatin analogues. Completed degradation occurred after 3 months in all cases. There was no mortality at 30 days after PD. Conclusion: Based on our experience, the use of resorbable internal pancreatic prostheses could be a valid alternative to prevent POPF after a pancreaticoduodenectomy, also avoiding the main complications related to the use of non-absorbable prostheses.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79997355","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":"Is Sub-Commissural Annuloplasty a Safe Adjunct to Sutureless Perceval-S Aortic Valve Implantation?","authors":"A. Roumy, M. Verdugo, Gunga Mz, M. Kirsch, P. Monney, Rancati","doi":"10.26420/AUSTINJSURG.2021.1262","DOIUrl":"https://doi.org/10.26420/AUSTINJSURG.2021.1262","url":null,"abstract":"Background: Sutureless bioprosthesis aortic valves simplify surgery for aortic valve replacement (AVR) but some unexpected anatomical features of the recipients aortic annulus might preclude anchoring and lead to a paravalvular leak. Sub-Commissural Annuloplasty (SCAP) has been sporadically proposed to secure implantation under these circumstances. This study evaluated whether SCAP affects early postoperative outcomes and follow-up after sutureless Perceval-S implantation. Methods: We included all elective patients who underwent AVR (isolated or combined with coronary bypass) with the Perceval-S valve from March 2016 to August 2019. SCAP was performed each time the surgeon deemed it useful to improve anchoring. Results: One hundred and three patients were included. The mean age was 73.9±7.2 years and 36 (35%) were women. SCAP was performed in 34 (33%) patients, significantly more frequently in patients with large aortic annulus or bicuspid aortic valve. Perceval-S implantation was successful in 100 (97%) patients. Thirty-day mortality was 2% (n=2), of which one was related to the procedure. There was no significant difference in the incidence of postoperative conduction disorders between patients with and without SCAP (respectively, 3 [9%] vs 7 [10%], p=1.0). At one-year follow-up, no more than trivial paravalvular leak was noted in both groups, and peak and mean gradients were similar in patients with SCAP than in those without (19.1±8.3 vs 17.9±7.1 mmHg, p=0.53 and 10.7±5.0 vs 10.0±3.9 mmHg, p=0.59, respectively). Conclusions: SCAP is a safe, simple and reproducible technique that might facilitate Perceval-S aortic valve implantation in specific situations.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80840273","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":"Ectopic Adrenocortical Tissue Attached to the Inguinal Sac in an Adult","authors":"M. Yurdacan, Turgut Bc, O. Akıncı, Uner Mb, S. Ergun","doi":"10.26420/AUSTINJSURG.2021.1261","DOIUrl":"https://doi.org/10.26420/AUSTINJSURG.2021.1261","url":null,"abstract":"Inguinal localization of ectopic adrenal tissue is a rare condition in literature. We report an unusual case of a 28-year-old male patient with ectopic adrenocortical tissue, which was noticed coincidentally as a orangeyellowish nodule during surgery of inguinal hernia and resected for patological examination.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84792745","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}