Search results for: surgical drain

Authors: Hsiao-Lin Fang

Abstract:

The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

Procedia PDF Downloads 176

Authors: Shekoufeh Behdad, Amirhossein Yadegari, Leila Ghodrati, Saman Yadegari

Abstract:

Context: Preoperative anxiety is a common psychological reaction experienced by all patients undergoing surgery. It can have negative effects on the patient's well-being and even impact surgical outcomes. Therefore, finding effective interventions to reduce preoperative anxiety is important in improving patient care. Research Aim: The aim of this study is to compare the effects of oral administration of zaleplon (5 mg) and alprazolam (0.5 mg) on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Methodology: This study is a double-blind, randomized clinical trial conducted after receiving approval from the university's ethics committee and obtaining written informed consent from the patients. The night before the surgery, patients were randomly assigned to receive either 0.5 mg of alprazolam or 5 mg of zaleplon orally. Anxiety levels, measured using a 10-cm visual analog scale, and hemodynamic variables (blood pressure and heart rate) were assessed before drug administration and on the morning of the operation after the patient entered the pre-operation room. Findings: The study found that there were no significant differences in mean anxiety levels or hemodynamic variables before and after administration of either drug in both groups (P value > 0.05). This suggests that both 0.5 mg of alprazolam and 5 mg of zaleplon effectively reduce preoperative anxiety in women undergoing abdominal surgery without serious side effects. Theoretical Importance: This study contributes to the understanding of the effectiveness of alprazolam and zaleplon in reducing preoperative anxiety. It adds to the existing literature on pharmacological interventions for anxiety management, specifically in the context of gynecological abdominal surgery. Data Collection: Data for this study were collected through the assessment of anxiety levels using a visual analog scale and measuring hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate. These measurements were taken before drug administration and on the morning of the surgery. Analysis Procedures: Statistical analysis was performed to compare the mean anxiety levels and hemodynamic variables before and after drug administration in the two groups. The significance of the differences was determined using appropriate statistical tests. Questions Addressed: This study aimed to answer the question of whether there are differences in the effects of alprazolam and zaleplon on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Conclusion: The oral administration of both 0.5 mg of alprazolam and 5 mg of zaleplon the night before surgery effectively reduces preoperative anxiety in women undergoing abdominal surgery. These findings have important implications for the management of preoperative anxiety and can contribute to improving the overall surgical experience for patients.

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

Procedia PDF Downloads 80

Authors: Zeynep Busra Velioglu, Deniz Pulat, Beril Demirbakan, Burak Ozcan, Ece Bayrak, Cevat Erisken

Abstract:

Bone tissue has the ability to perform a wide array of functions including providing posture, load-bearing capacity, protection for the internal organs, initiating hematopoiesis, and maintaining the homeostasis of key electrolytes via calcium/phosphate ion storage. The most common cause for bone defects is extensive trauma and subsequent infection. Bone tissue has the self-healing capability without a scar tissue formation for the majority of the injuries. However, some may result with delayed union or fracture non-union. Such cases include reconstruction of large bone defects or cases of compromised regenerative process as a result of avascular necrosis and osteoporosis. Several surgical methods exist to treat bone defects, including Ilizarov method, Masquelete technique, growth factor stimulation, and bone replacement. Unfortunately, these are technically demanding and come with noteworthy disadvantages such as lengthy treatment duration, adverse effects on the patient’s psychology, repeated surgical procedures, and often long hospitalization times. These limitations associated with surgical techniques make bone substitutes an attractive alternative. Here, it was hypothesized that a 3D printed scaffold will mimic trabecular bone in terms of biomechanical properties and that such scaffolds will support cell attachment and survival. To test this hypothesis, this study aimed at fabricating poly(lactic acid), PLA, structures using 3D printing technology for trabecular bone defects, characterizing the scaffolds and comparing with bovine trabecular bone. Capacity of scaffolds on human bone marrow stem cell (hBMSC) attachment and survival was also evaluated. Cubes with a volume of 1 cm³ having pore sizes of 0.50, 1.00 and 1.25 mm were printed. The scaffolds/grafts were characterized in terms of porosity, contact angle, compressive mechanical properties as well cell response. Porosities of the 3D printed scaffolds were calculated based on apparent densities. For contact angles, 50 µl distilled water was dropped over the surface of scaffolds, and contact angles were measured using ‘Image J’ software. Mechanical characterization under compression was performed on scaffolds and native trabecular bone (bovine, 15 months) specimens using a universal testing machine at a rate of 0.5mm/min. hBMSCs were seeded onto the 3D printed scaffolds. After 3 days of incubation with fully supplemented Dulbecco’s modified Eagle’s medium, the cells were fixed using 2% formaldehyde and glutaraldehyde mixture. The specimens were then imaged under scanning electron microscopy. Cell proliferation was determined by using EZQuant dsDNA Quantitation kit. Fluorescence was measured using microplate reader Spectramax M2 at the excitation and emission wavelengths of 485nm and 535nm, respectively. Findings suggested that porosity of scaffolds with pore dimensions of 0.5mm, 1.0mm and 1.25mm were not affected by pore size, while contact angle and compressive modulus decreased with increasing pore size. Biomechanical characterization of trabecular bone yielded higher modulus values as compared to scaffolds with all pore sizes studied. Cells attached and survived in all surfaces, demonstrating higher proliferation on scaffolds with 1.25mm pores as compared with those of 1mm. Collectively, given lower mechanical properties of scaffolds as compared to native bone, and biocompatibility of the scaffolds, the 3D printed PLA scaffolds of this study appear as candidate substitutes for bone repair and regeneration.

Keywords: 3D printing, biomechanics, bone repair, stem cell

Procedia PDF Downloads 172

Authors: Berk Kiliç

Abstract:

In the medical and surgical fields, wound care is a critical and expansive industry. Hydrocolloid wound dressings have been introduced and are widely used due to their effectiveness in promoting healing, managing wound fluids, and protecting against infection. Hydrocolloid wound dressings have been introduced as effective solutions, adherence to wound surfaces and infection prevention. it fabricated different hydrocolloid wound dressings with myrrh resin, garlic and sorrel inorder to enhance healing properties. The physical and mechanical properties were evaluated to confirm which one is most suitable as a hydrocolloid wound dressing. it observations show that mirderm solution showed superior wound healing and fluid control properties compared to other prepared solutions. This indicates that “mirderm” could be a viable alternative to standard gauze and some commercial hydrocolloid dressings that do not contain myrrh.

Keywords: wound, hydrocolloid, myrrh, garlic, sorrel

Procedia PDF Downloads 25

Authors: M. L. Burnwal, P. Raychowdhury

Abstract:

Earthquake leads to adverse effects on buildings resting on soft soils. Mitigating the response of shallow foundations on soft soil with different methods reduces settlement and provides foundation stability. Few methods such as the rocking foundation (used in Performance-based design), deep foundation, prefabricated drain, grouting, and Vibro-compaction are used to control the pore pressure and enhance the strength of the loose soils. One of the problems with these methods is that the settlement is uncontrollable, leading to differential settlement of the footings, further leading to the collapse of buildings. The present study investigates the utility of geosynthetics as a potential improvement of the subsoil to reduce the earthquake-induced settlement of structures. A steel moment-resisting frame building resting on loose liquefiable dry soil, subjected to Uttarkashi 1991 and Chamba 1995 earthquakes, is used for the soil-structure interaction (SSI) analysis. The continuum model can simultaneously simulate structure, soil, interfaces, and geogrids in the OpenSees framework. Soil is modeled with PressureDependentMultiYield (PDMY) material models with Quad element that provides stress-strain at gauss points and is calibrated to predict the behavior of Ganga sand. The model analyzed with a tied degree of freedom contact reveals that the system responses align with the shake table experimental results. An attempt is made to study the responses of footing structure and geosynthetics with unreinforced and reinforced bases with varying parameters. The result shows that geogrid reinforces shallow foundation effectively reduces the settlement by 60%.

Keywords: settlement, shallow foundation, SSI, continuum FEM

Procedia PDF Downloads 194

Authors: Tarek Aly

Abstract:

The shoulder is the most mobile joint whose stability requires the interaction of both dynamic and static stabilizers. Its wide range of movement predisposes to a high susceptibility to dislocation, accounting for nearly 50% of all dislocations. This trauma typically results in ligament injury (e.g., labral tear, capsular strain) or bony fracture (e.g., loss of glenoid or humeral head bone), which frequently causes recurrent instability. Patients with significant glenoid defects may require Latarjet procedure, which involves transferring the coracoid to the antero-inferior glenoid rim. In spite of outstanding results, 15 to 30% of cases suffer complications. In this article, we discuss the diagnosis of recurrent shoulder instability, the surgical technique and various complications of Latarjet procedure.

Keywords: recurrent, anterior gleno-humeral instability, latarjet, unstable shoulder

Procedia PDF Downloads 84

Authors: Yifan Gao

Abstract:

Owing to the high breakdown field, high saturation drift velocity, 2DEG with high density and mobility and so on, AlGaN/GaN HEMTs have been widely used in high-frequency and high-power applications. To acquire a higher power often means higher breakdown voltage and higher drain current. Surface leakage current is usually the key issue affecting the breakdown voltage and power performance. In this work, we have performed in-situ N₂/NH₃ pretreatment before the passivation to suppress the surface leakage and achieve device performance enhancement. The AlGaN/GaN HEMT used in this work was grown on a 3-in. SiC substrate, whose epitaxial structure consists of a 3.5-nm GaN cap layer, a 25-nm Al₀.₂₅GaN barrier layer, a 1-nm AlN layer, a 400-nm i-GaN layer and a buffer layer. In order to analyze the mechanism for the N-based pretreatment, the details are measured by XPS analysis. It is found that the intensity of Ga-O bonds is decreasing and the intensity of Ga-N bonds is increasing, which means with the supplement of N, the dangling bonds on the surface are indeed reduced with the forming of Ga-N bonds, reducing the surface states. The surface states have a great influence on the leakage current, and improved surface states represent a better off-state of the device. After the N-based pretreatment, the breakdown voltage of the device with Lₛ𝒹=6 μm increased from 93V to 170V, which increased by 82.8%. Moreover, for HEMTs with Lₛ𝒹 of 6-μm, we can obtain a peak output power (Pout) of 12.79W/mm, power added efficiency (PAE) of 49.84% and a linear gain of 20.2 dB at 60V under 3.6GHz. Comparing the result with the reference 6-μm device, Pout is increased by 16.5%. Meanwhile, PAE and the linear gain also have a slight increase. The experimental results indicate that using N₂/NH₃ pretreatment before passivation is an attractive approach to achieving power performance enhancement.

Keywords: AlGaN/GaN HEMT, N-based pretreatment, output power, passivation

Procedia PDF Downloads 317

Authors: Adesola C. Odole, Michael O. Ogunlana, Nse A. Odunaiya, Olufemi O. Oyewole, Chidozie E. Mbada, Ogochukwu K. Onyeso, Ayomikun F. Ayodeji, Opeyemi M. Adegoke, Iyanuoluwa Odole, Comfort T. Sanuade, Moyosooreoluwa E. Odole, Oluwagbohunmi A. Awosoga

Abstract:

Purpose: The Nigerian healthcare industry is bedeviled with infrastructural decay, inadequate funding and staffing, and a dysfunctional healthcare system. This study investigated the influence of health professionals’ well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. Methods: The study was a multicentre cross-sectional survey conducted at four tertiary health institutions in southwest Nigeria. Participants’ demographic information, well-being, quality of work-life, and quality of care were obtained using four standardized questionnaires. Data were summarized using descriptive statistics of frequency (percentage) and mean (standard deviation). Inferential statistics included Chi-square, Pearson’s correlation, and independent samples t-test analyses. Results: Medical practitioners (n=609) and nurses (n=570) constituted 74.6% of all the health professionals, with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants’ well-being = 71.65% (14.65), quality of life = 61.8% (21.31), quality of work-life = 65.73% (10.52) and quality of care = 70.14% (12.77). Participants’ quality of life had a significant negative correlation with the quality of care, while well-being and quality of work-life had a significant positive correlation with the quality of care. Conclusion: We concluded that health professionals’ well-being and quality of work-life are important factors that influence their productivity and, ultimately, the quality of care rendered to patients. The hospital management and policymakers should ensure improved work-related factors to improve the well-being of health professionals. This will enhance the quality of care given to patients and ultimately reduce brain drain and medical tourism.

Keywords: health professionals, quality of care, quality of life, quality of work-life, well-being

Procedia PDF Downloads 83

Authors: Jamal Radaideh

Abstract:

Al-Asfar Lake is located about 14 km east of Al-Ahsa and is one of the most important wetland lakes in the Al Ahsa/Eastern Province of Saudi Arabia. Al-Ahsa is may be the largest oasis in the world, having an area of 20,000 hectares, in addition, it is of the largest and oldest agricultural centers in the region. The surplus farm irrigation water beside additional water supplied by treated wastewater from Al-Hofuf sewage station is collected by a drainage network and discharged into Al-Asfar Lake. The lake has good wetlands, sand dunes as well as large expanses of open and shallow water. Salt tolerant vegetation is present in some of the shallow areas around the lake, and huge stands of Phragmites reeds occur around the lake. The lake presents an important habitat for wildlife and birds, something not expected to find in a large desert. Although high evaporation rates in the range of 3250 mm are common, the water remains in the evaporation lakes during all seasons of the year is used to supply cattle with drinking water and for aquifer recharge. Investigations showed that high concentrations of nitrogen (N), phosphorus (P), biological oxygen demand (BOD), chemical oxygen demand (COD) and salinity discharge to Al Asfar Lake from the D2 drain exist. It is expected that the majority of BOD, COD and N originates from wastewater discharge and leachate from surplus irrigation water which also contribute to the majority of P and salinity. The significant content of nutrients and biological oxygen demand reduces available oxygen in the water. The present project aimed to improve the water quality of the lake using constructed wetland trains which will be built around the lake. Phragmites reeds, which already occur around the lake, will be used.

Keywords: Al Asfar lake, constructed wetland, water quality, water treatment

Procedia PDF Downloads 449

Authors: Ojiegbe Ikenna Nathan

Abstract:

Obesity is a medical condition in which excess body fat has accumulated to the extent that it leads to reduced life expectancy and or increased health problems. Obesity as a worldwide problem is seen clustered in the families and it moves from generation to generation. It causes some disabilities, mortality and morbidity if left unattended to. The predisposing factors to obesity are either genetic or environment in origin. Nevertheless, the main predisposing factor to obesity is the excessive consumption of food rich in low-density lipoprotein (LDL) such as organ meats, saturated fats etc. This low-density lipoprotein causes an increase in adipose tissue and complicates to obesity. There are varieties of obesity which one needs to take appropriate measures to avoid; such as android, gynoid and morbid obesity. Nonetheless, studies have shown that there is hope for the obese individuals, despite the cause, type and degree of their obesity. This is through the use of the different available treatment measures which increase in physical activities, caloric restrictions, drug therapy and surgical intervention.

Keywords: low-density, lipoprotein, culprit, obesity

Procedia PDF Downloads 400

Authors: Davender Kumar, Virender Singh, Rekha Sharma

Abstract:

Correction of skeletal deformities in adult patients with orthodontics is limited. In adult severe cases, the combined approach, orthodontic and orthognathic surgery, is always the treatment of choice, and the results obtained usually ensure a better esthetic, functional, and stable results Orthognathic surgery is the best option for cases when camouflage treatment is questionable and growth modulation is not possible. This case report illustrates the benefit of the team approach in correcting mandible retrusion along with class II skeletal deformity with 100% deep bite. Correction was achieved by anterior repositioning of mandible osteotomy along with orthodontic treatment. The patient's facial appearance was markedly improved along with functional and stable occlusion.

Keywords: camouflage, skeletal, orthognathic, dental

Procedia PDF Downloads 427

Authors: A. Mathieu, B. Aubry, E. Chhim, M. Jobe, M. Arnaud

Abstract:

Present project consists in a study and a development of piezoelectric devices for supplying power to new generation pacemakers. They are miniaturized leadless implants without battery placed directly in right ventricle. Amongst different acceptable energy sources in cardiac environment, we choose the solution of a device based on conversion of the energy produced by pressure variation inside the heart into electrical energy. The proposed energy harvesters can meet the power requirements of pacemakers, and can be a good solution to solve the problem of regular surgical operation. With further development, proposed device should provide enough energy to allow pacemakers autonomy, and could be good candidate for next pacemaker generation.

Keywords: energy harvester, heart, leadless pacemaker, piezoelectric cells, pressure variation

Procedia PDF Downloads 445

Authors: Emily Moore, Dora Amos, Tracy Ellimah, Natasha Parrott

Abstract:

Postoperative haematoma is a well-recognised complication of thyroid surgery with an incidence of 1-5%. Haematoma formation causes progressive airway obstruction, necessitating emergency bedside haematoma evacuation in up to ¼ of patients. ENT UK, BAETS and DAS have developed consensus guidelines to improve perioperative care, recommending that all healthcare staff interacting with patients undergoing thyroid surgery should be trained in managing post-thyroidectomy haematoma. The aim was to assess the effectiveness of a hybrid simulation model in improving clinician’s confidence in dealing with this surgical emergency. A hybrid simulation was designed, consisting of a standardised patient wearing a part-task trainer to mimic a post-thyroidectomy haematoma in a real patient. The part-task trainer was an adapted C-spine collar with layers of silicone representing the skin and strap muscles and thickened jelly representing the haematoma. Both the skin and strap muscle layers had to be opened in order to evacuate the haematoma. Boxes have been implemented into the appropriate post operative areas (recovery and surgical wards), which contain a printed algorithm designed to assist in remembering a sequence of steps for haematoma evacuation using the ‘SCOOP’ method (skin exposure, cut sutures, open skin, open muscles, pack wound) along with all the necessary equipment to open the front of the neck. Small-group teaching sessions were delivered by ENT and anaesthetic trainees to members of the multidisciplinary team normally involved in perioperative patient care, which included ENT surgeons, anaesthetists, recovery nurses, HCAs and ODPs. The DESATS acronym of signs and symptoms to recognise (difficulty swallowing, EWS score, swelling, anxiety, tachycardia, stridor) was highlighted. Then participants took part in the hybrid simulation in order to practice this ‘SCOOP’ method of haematoma evacuation. Participants were surveyed using a Likert scale to assess their level of confidence pre- and post teaching session. 30 clinicians took part. Confidence (agreed/strongly agreed) in recognition of post thyroidectomy haematoma improved from 58.6% to 96.5%. Confidence in management improved from 27.5% to 89.7%. All participants successfully decompressed the haematoma. All participants agreed/strongly agreed, that the sessions were useful for their learning. Multidisciplinary team simulation teaching is effective at significantly improving confidence in both the recognition and management of postoperative haematoma. Hybrid simulation sessions are useful and should be incorporated into training for clinicians.

Keywords: thyroid surgery, haematoma, teaching, hybrid simulation

Procedia PDF Downloads 96

Authors: Judita Konečná, Dagmar Halo, Martin Matoulek

Abstract:

Background: Personality pathology does not have to be a contraindication nor an obstacle in obesity treatment, or eventually, surgical treatment. Detection of specific maladaptive personality traits can help us understand the manner of behavior leading to obesity as well as to address the treatment better. Objective: Using The Personality Inventory for DSM-5 (PID-5) in combination with clinical interviews with the goal of gaining a psychological evaluation to set the treatment procedure. Data was collected from more than 400 patients to detect differences in constellations of maladaptive personality traits based on BMI, DM2 and gender. Conclusions: Besides the fact that a psychological evaluation can help address the treatment better, analyses showed that it is also useful to detect specific groups of patients. Implications for clinical practice are discussed, as well as recommendations for group education programs based on quantitative research.

Keywords: bariatric surgery, obesity, personality traits, PID-5, treatment

Procedia PDF Downloads 228

Authors: Krishna Prasad Regmi, Jun-Bo Tu, Cheng-Qun Hou, Li-Feng Li

Abstract:

Maxillofacial trauma in a pediatric group of patients is particularly challenging, as these patients have significant differences from adults as far as the facial skeleton is concerned. Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. The etiology and epidemiology of pediatric trauma involving the diacapitular condylar fractures (DFs) have been reported in a large series of patients. Nevertheless, little is known about treatment protocols for DFs in children. Accordingly, the treatment modalities for the management of pediatric fractures also differ. We suggest following the PDA and intracapsular ABC classification of condylar fracture to increase the overall postoperative satisfaction level that bypasses the change of subjective feelings of patients’ from preoperative to the postoperative condition. At the same time, use of 3-D technology and surgical navigation may also increase treatment accuracy.

Keywords: maxillofacial trauma, diacapitular fracture, condylar fracture, PDA classification

Procedia PDF Downloads 271

Authors: Basman Abdul Jabbar

Abstract:

The researchers aimed to improve the importance of the good posture without any divisions & deformities. The importance of research lied in the discovery posture deformities early so easily treated before its transformation into advanced abnormalities difficult to treat and may need surgical intervention. Research problem was noting that some previous studies were based on the discovery of posture deformities, which was dependent on the (self-evaluation) which this type did not have accuracy to discover deformities. The Samples were (500) schoolchildren aged (9-11 years, males) at Baghdad al Karak. They were students at primary schools. The measure included all posture deformities. The researcher used video camera to analyze the posture deformities according to biomechanical variables by Kinovea software for motion analysis. The researcher recommended the need to use accurate scientific methods for early detection of posture deformities in children which contribute to the prevention and reduction of distortions.

Keywords: biomechanics, children, deformities, posture

Procedia PDF Downloads 285

Authors: Karolina Rutkowska, Hubert Pausch, Jolanta Oprzadek, Krzysztof Flisikowski

Abstract:

The placenta is one of the most important organs that plays a crucial role in the fetal growth and development. Placenta dysfunction is one of the primary cause of the intrauterine growth restriction (IUGR). Cattle have the cotyledonary placenta which consists of two anatomical parts: fetal and maternal. In the case of cattle during the first months of pregnancy, it is very easy to separate maternal caruncle from fetal cotyledon tissue, easier in fact than removing an ordinary glove from one's hand. Which in fact make easier to conduct tissue-specific molecular studies. Typically, animal models for the study of IUGR are created using surgical methods and malnutrition of the pregnant mother or in the case of mice by genetic modifications. However, proposed cattle model with MIMT1Del/WT deletion is unique because it was created without any surgical methods what significantly distinguish it from the other animal models. The primary objective of the study was to identify differential expression of selected miRNAs in the placenta from normal and intrauterine growth restricted fetuses. There was examined the expression of miRNA in the fetal and maternal part of the placenta from 24 fetuses (12 samples from the fetal part of the placenta and 12 samples from maternal part of the placenta). In the study, there was done miRNAs sequencing in the placenta of MIMT1Del/WT fetuses and MIMT1WT/WT fetuses. Then, there were selected miRNAs that are involved in fetal growth and development. Analysis of miRNAs expression was conducted on ABI7500 machine. miRNAs expression was analyzed by reverse-transcription polymerase chain reaction (RT-PCR). As the reference gene was used SNORD47. The results were expressed as 2ΔΔCt: ΔΔCt = (Ctij − CtSNORD47j) − (Cti1 − CtSNORD471). Where Ctij and CtSNORD47j are the Ct values for gene i and for SNORD47 in a sample (named j); Cti1 and CtSNORD471 are the Ct values in sample 1. Differences between groups were evaluated with analysis of variance by using One-Way ANOVA. Bonferroni’s tests were used for interpretation of the data. All normalised miRNA expression values are expressed on a value of natural logarithm. The data were expressed as least squares mean with standard errors. Significance was declared when P < 0.05. The study shows that miRNAs expression depends on the part of the placenta where they origin (fetal or maternal) and on the genotype of the animal. miRNAs offer a particularly new approach to study IUGR. Corresponding tissue samples were collected according to the standard veterinary protocols according to the European Union Normative for Care and Use of Experimental Animals. All animal experiments were approved by the Animal Ethics Committee of the State Provincial Office of Southern Finland (ESAVI-2010-08583/YM-23).

Keywords: placenta, intrauterine growth restriction, miRNA, cattle

Procedia PDF Downloads 314

Authors: Wasse Uddin Ahmed Saleh, Nawreenbinte Anwar

Abstract:

A well-written operating note is crucial as a teaching tool for providing patients with high-quality medical care and fending off medico-legal claims. In this review article, some adjustments have been advised to the operative note guidelines by the Royal College of Surgeons (RCS) for different methods of ocular anesthesia and ophthalmic procedures like cataract surgeries, kerato-refractive surgeries, glaucoma surgeries, oculoplastic surgeries, etc. Some modifications of the WHO Surgical Safety Checklist have also been mentioned, including pre-operative responsibilities of the nurses, operative assistants and operating ophthalmologists. It has become essential to assemble globally accepted structured operative note guidelines modified for each ocular surgery.

Keywords: ocular surgeries, operation notes, cataract surgery, kerato-refractive surgery, Oculoplastic surgeries, guidelines

Procedia PDF Downloads 135

Authors: Mateusz Bilski, Jakub Klas, Emilia Kowalczyk, Sylwia Koziej, Katarzyna Kulszo, Ludmiła Grzybowska- Szatkowska

Abstract:

Background: Liver metastases are a common complication of primary solid tumors and sig-nificantly reduce patient survival. In the era of increasing diagnosis of oligometastatic disease and oligoprogression, methods of local treatment of metastases, i.e. MDT, are becoming more important. Implementation of such treatment can be considered for liver metastases, which are a common complication of primary solid tumors and significantly reduce patient survival. To date, the mainstay of treatment for oligometastatic disease has been surgical resection, but not all patients qualify for the procedure. As an alternative to surgical resection, radiotherapy techniques have become available, including stereotactic body radiation therapy (SBRT) or high-dose interstitial brachytherapy (iBT). iBT is an invasive method that emits very high doses of radiation from the inside of the tumor to the outside. This technique provides better tumor coverage than SBRT while having little impact on surrounding healthy tissue and elim-inates some concerns involving respiratory motion. Methods: We conducted a systematic re-view of the scientific literature on the use of brachytherapy in the treatment of liver metasta-ses from 2018 - 2023 using PubMed and ResearchGate browsers according to PRISMA rules. Results: From 111 articles, 18 publications containing information on 729 patients with liver metastases were selected. iBT has been shown to provide high rates of tumor control. Among 14 patients with 54 unresectable RCC liver metastases, after iBT LTC was 92.6% during a median follow-up of 10.2 months, PFS was 3.4 months. In analysis of 167 patients after treatment with a single fractional dose of 15-25 Gy with brachytherapy at 6- and 12-month follow-up, LRFS rates of 88,4-88.7% and 70.7 - 71,5%, PFS of 78.1 and 53.8%, and OS of 92.3 - 96.7% and 76,3% - 79.6%, respectively, were achieved. No serious complications were observed in all patients. Distant intrahepatic progression occurred later in patients with unre-sectable liver metastases after brachytherapy (PFS: 19.80 months) than in HCC patients (PFS: 13.50 months). A significant difference in LRFS between CRC patients (84.1% vs. 50.6%) and other histologies (92.4% vs. 92.4%) was noted, suggesting a higher treatment dose is necessary for CRC patients. The average target dose for metastatic colorectal cancer was 40 - 60 Gy (compared to 100 - 250 Gy for HCC). To better assess sensitivity to therapy and pre-dict side effects, it has been suggested that humoral mediators be evaluated. It was also shown that baseline levels of TNF-α, MCP-1 and VEGF, as well as NGF and CX3CL corre-lated with both tumor volume and radiation-induced liver damage, one of the most serious complications of iBT, indicating their potential role as biomarkers of therapy outcome. Con-clusions: The use of brachytherapy methods in the treatment of liver metastases of various cancers appears to be an interesting and relatively safe therapeutic method alternative to sur-gery. An important challenge remains the selection of an appropriate brachytherapy method and radiation dose for the corresponding initial tumor type from which the metastasis origi-nated.

Keywords: liver metastases, brachytherapy, CT-HDRBT, iBT

Procedia PDF Downloads 114

Authors: Rozelle Labuschagne, Ronel Roos

Abstract:

Individuals often experience a reduction in physical function, quality of life and basic activities of daily living after surgery. This is exponentially true for high-risk patients, especially the elderly and frail individuals. Not much is known about the physical function, physical activity preferences and factors associated with the six-minute walk test of elderly individuals who would undergo elective abdominal surgery in South Africa. Such information is important to design effective prehabilitation physiotherapy programs prior to elective surgery. The purpose of the study was to describe the demographic profile and physical function of elderly patients who would undergo elective surgery and to determine factors associated with their six-minute walk test distance findings. A cross-sectional descriptive study in elderly patients older than 60 years of age who would undergo elective abdominal surgery were consecutively sampled at a private hospital in Pretoria, South Africa. Participants’ demographics were collected and physical function assessed with the Functional Comorbidity Index (FCI), DeMorton Mobility Index (DEMMI), Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) and six-minute walk test (6MWT). Descriptive and inferential statistics were used for data analysis with IBM SPSS 25. A p-value ≤ 0.05 were deemed statistically significant. The pilot study consisted of 12 participants (female (n=11, 91.7%), male (n=1, 8.3%) with a mean age of 65.8 (±4.5) years, body mass index of 28 (±4.2) kg.m2 with one (8.3%) participant being a current smoker and four (33.3%) participants having a smoking history. Nine (75%) participants lived independently at home and three (25%) had caregivers. Participants reported walking (n=6, 50%), stretching exercises (n=1, 8.3%), household chores & gardening (n=2, 16.7%), biking/swimming/running (n=1, 8.3%) as physical activity preferences. Physical function findings of the sample were: mean FCI score 3 (±1.1), DEMMI score 81.1 (±14.9), IADL 95 (±17.3), 6MWT 435.50 (IQR 364.75-458.50) with percentage 6MWT distance achieved 81.8% (IQR 64.4%-87.5%). A strong negative correlation was observed between 6MWT distance walked and FCI (r = -0.729, p=0.007). The majority of study participants reported incorporating some form of physical activity into their daily life as form of exercise. Most participants did not achieve their predicted 6MWT distance indicating less than optimal levels of physical function capacity. The number of comorbidities as determined by the FCI was associated with the distance that participants could walk with the 6MWT. The results of this pilot study could be used to indicate which elderly individuals would benefit most from a pre-surgical rehabilitation program. The main goal of such a program would be to improve physical function capacity as measured by the 6MWT. Surgeons could refer patients based on age and number of comorbidities, as determined by the FCI, to potentially improve surgical outcomes.

Keywords: abdominal surgery, elderly, physical function, six-minute walk test

Procedia PDF Downloads 197

Authors: Dewan Hasin Mahtab, Farzana Sadia

Abstract:

At present, wastewater treatment has become essential to maintain a constant supply of safe water as well as to protect the environment. Due to overpopulation and overconsumption, the water quality from various surface water sources is degrading every day. Being one of the megacities in the world, Dhaka City, is going through rapid industrialization and urbanization. The effluents from these industries and factories are mostly discharged directly into the rivers without any treatment. As such, the quality of water of Buriganga is being afflicted with a noisome problem of pollution. The water of the Buriganga River has become detrimental to humans, animals, and the environment. It has become crucial to conserve the environment so that we can save both ourselves and the environment. The first step towards it should be analyzing the wastewater to decide the further steps of the treatment process. Increased population and increased consumption both contribute to water pollution. Mohammadpur is a developing area of Dhaka City, and Kamrangirchar is one of the largest slum areas in Dhaka City. The total study area is 6.13 sq. Km of Dhaka city with a population of 4,73,310 people. Of them, 86.47% had their own latrine, 47% were directly connected to the drain, 55% had septic tanks, and 70.09% of them cleaned their septic tank once a year. The pH, Dissolved Oxygen, Chemical Oxygen Demand, Biochemical Oxygen Demand, Total Dissolved Solid, Total Suspended and total coliforms of wastewater from two samples of both Mohammadpur and Kamrangirchar was analyzed. The DO level from the water bodies of Kamrangirchar was found very low, making the water bodies inhabitable for aquatic plants and animals. The BOD and COD level was extremely high from samples collected from Mohammadpur. The total coliforms count was found too high during the wet season, making it a potential health concern in the wet season in these two areas.

Keywords: Dhaka, environmental conservation rule, sanitation, wastewater

Procedia PDF Downloads 130

Authors: Piotr Tylec, Alicja Dudek, Grzegorz Torbicz, Magdalena Mizera, Natalia Gajewska, Michael Su, Tanawat Vongsurbchart, Tomasz Stefura, Magdalena Pisarska, Mateusz Rubinkiewicz, Piotr Malczak, Piotr Major, Michal Pedziwiatr

Abstract:

Introduction: Quality of life after bariatric surgery is an important factor when evaluating the final result of the treatment. Considering the vast surgical options, we tried to globally compare available methods in terms of quality of following the surgery. The aim of the study is to compare the quality of life a year after bariatric intervention using network meta-analysis methods. Material and Methods: We performed a systematic review according to PRISMA guidelines with Bayesian network meta-analysis. Inclusion criteria were: studies comparing at least two methods of weight loss treatment of which at least one is surgical, assessment of the quality of life one year after surgery by validated questionnaires. Primary outcomes were quality of life one year after bariatric procedure. The following aspects of quality of life were analyzed: physical, emotional, general health, vitality, role physical, social, mental, and bodily pain. All questionnaires were standardized and pooled to a single scale. Lifestyle intervention was considered as a referenced point. Results: An initial reference search yielded 5636 articles. 18 studies were evaluated. In comparison of total score of quality of life, we observed that laparoscopic sleeve gastrectomy (LSG) (median (M): 3.606, Credible Interval 97.5% (CrI): 1.039; 6.191), laparoscopic Roux en-Y gastric by-pass (LRYGB) (M: 4.973, CrI: 2.627; 7.317) and open Roux en-Y gastric by-pass (RYGB) (M: 9.735, CrI: 6.708; 12.760) had better results than other bariatric intervention in relation to lifestyle interventions. In the analysis of the physical aspects of quality of life, we notice better results in LSG (M: 3.348, CrI: 0.548; 6.147) and in LRYGB procedure (M: 5.070, CrI: 2.896; 7.208) than control intervention, and worst results in open RYGB (M: -9.212, CrI: -11.610; -6.844). Analyzing emotional aspects, we found better results than control intervention in LSG, in LRYGB, in open RYGB, and laparoscopic gastric plication. In general health better results were in LSG (M: 9.144, CrI: 4.704; 13.470), in LRYGB (M: 6.451, CrI: 10.240; 13.830) and in single-anastomosis gastric by-pass (M: 8.671, CrI: 1.986; 15.310), and worst results in open RYGB (M: -4.048, CrI: -7.984; -0.305). In social and vital aspects of quality of life, better results were observed in LSG and LRYGB than control intervention. We did not find any differences between bariatric interventions in physical role, mental and bodily aspects of quality of life. Conclusion: The network meta-analysis revealed that better quality of life in total score one year after bariatric interventions were after LSG, LRYGB, open RYGB. In physical and general health aspects worst quality of life was in open RYGB procedure. Other interventions did not significantly affect the quality of life after a year compared to dietary intervention.

Keywords: bariatric surgery, network meta-analysis, quality of life, one year follow-up

Procedia PDF Downloads 159

Authors: Faidon Kyriakou, William Dempster, David Nash

Abstract:

Abdominal Aortic Aneurysm (AAA) is a major life-threatening pathology for which modern approaches reduce the need for open surgery through the use of stenting. The success of stenting though is sometimes jeopardized by the final position of the stent graft inside the human artery which may result in migration, endoleaks or blood flow occlusion. Herein, a finite element (FE) model of the commercial medical device AnacondaTM (Vascutek, Terumo) has been developed and validated in order to create a numerical tool able to provide useful clinical insight before the surgical procedure takes place. The AnacondaTM device consists of a series of NiTi rings sewn onto woven polyester fabric, a structure that despite its column stiffness is flexible enough to be used in very tortuous geometries. For the purposes of this study, a FE model of the device was built in Abaqus® (version 6.13-2) with the combination of beam, shell and surface elements; the choice of these building blocks was made to keep the computational cost to a minimum. The validation of the numerical model was performed by comparing the deployed position of a full stent graft device inside a constructed AAA with a duplicate set-up in Abaqus®. Specifically, an AAA geometry was built in CAD software and included regions of both high and low tortuosity. Subsequently, the CAD model was 3D printed into a transparent aneurysm, and a stent was deployed in the lab following the steps of the clinical procedure. Images on the frontal and sagittal planes of the experiment allowed the comparison with the results of the numerical model. By overlapping the experimental and computational images, the mean and maximum distances between the rings of the two models were measured in the longitudinal, and the transverse direction and, a 5mm upper bound was set as a limit commonly used by clinicians when working with simulations. The two models showed very good agreement of their spatial positioning, especially in the less tortuous regions. As a result, and despite the inherent uncertainties of a surgical procedure, the FE model allows confidence that the final position of the stent graft, when deployed in vivo, can also be predicted with significant accuracy. Moreover, the numerical model run in just a few hours, an encouraging result for applications in the clinical routine. In conclusion, the efficient modelling of a complicated structure which combines thin scaffolding and fabric has been demonstrated to be feasible. Furthermore, the prediction capabilities of the location of each stent ring, as well as the global shape of the graft, has been shown. This can allow surgeons to better plan their procedures and medical device manufacturers to optimize their designs. The current model can further be used as a starting point for patient specific CFD analysis.

Keywords: AAA, efficiency, finite element analysis, stent deployment

Procedia PDF Downloads 191

Authors: Maryam Jaberi, Siavosh Shayan, Mojtaba Yamani

Abstract:

Habble-Rud River basin (HR), up to 100 km length, one of the largest watersheds which drain into deserts to the north of Central Iran (Dasht-e Kavir). This stream is oblique with the NE-SW trending, flow in the southern range of central Alborz Mountains and the northern border of Central Iran. The end of the ~17 km suddenly change direction and with the southern trending to have a morphology which meanders passes through the Alborz Mountain ridge and flows into the Garmsar plain where it forms one of the largest alluvial fans in Iran, i.e. the vast Garmsar alluvial fan with an area of 476 km2. This study was carried out through morphometric analyses, longitudinal river profiles, and study of geomorpholic evidence such as fluvial terraces, gypsum-salt domes, seismic data, and satellite images. This study aimed to investigate the changes in the pattern of rivers in the southern part of the HR river basin. The southern part of HR river basin located at the southern foothills of the Central Alborz is characterized the thrust faults (Sorkheh-Kalut and Garmsar faults), folds,diapirs and arid climate. The activity of more than 10 salt domes that belong to the Oligocene-Miocene period has considerably influenced the pattern of streams in this region. Dissolution of these domes has not only reduced the quality of water and soil resources, but also has led to the formation of badlands and gullies.Our results indicated that the pattern of rivers in the southern part of HR river basin was influenced by discharge of the HR river in Quaternary, geological structure, subsidence of Central Iran and vertical uplift of Alborz mountain. These agents caused the formation meanders in the southern part of the HR River and evaluation of the seasonal rivers like Shoor-Darre and Garmabsar.

Keywords: geomorphologic evaluation, rivers pattern, Habble-Rud River basin, seasonal rivers

Procedia PDF Downloads 501

Authors: Samson Mil'shtein, Dhawal Asthana, Benjamin Sullivan

Abstract:

The wide energy gap of GaN is the major parameter justifying the design and fabrication of high-power electronic components made of this material. However, the existence of a piezo-electrics in nature sheet charge at the AlGaN/GaN interface complicates the control of carrier injection into the intrinsic channel of GaN HEMTs (High Electron Mobility Transistors). As a result, most of the transistors created as R&D prototypes and all of the designs used for mass production are D-mode devices which introduce challenges in the design of integrated circuits. This research presents the design and modeling of an E-mode GaN HEMT with a very low turn-on voltage. The proposed device includes two critical elements allowing the transistor to achieve zero conductance across the channel when Vg = 0V. This is accomplished through the inclusion of an extremely thin, 2.5nm intrinsic Ga₀.₇₄Al₀.₂₆N spacer layer. The added spacer layer does not create piezoelectric strain but rather elastically follows the variations of the crystal structure of the adjacent GaN channel. The second important factor is the design of a gate metal with a high work function. The use of a metal gate with a work function (Ni in this research) greater than 5.3eV positioned on top of n-type doped (Nd=10¹⁷cm⁻³) Ga₀.₇₄Al₀.₂₆N creates the necessary built-in potential, which controls the injection of electrons into the intrinsic channel as the gate voltage is increased. The 5µm long transistor with a 0.18µm long gate and a channel width of 30µm operate at Vd=10V. At Vg =1V, the device reaches the maximum drain current of 0.6mA, which indicates a high current density. The presented device is operational at frequencies greater than 10GHz and exhibits a stable transconductance over the full range of operational gate voltages.

Keywords: compound semiconductors, device modeling, enhancement mode HEMT, gallium nitride

Procedia PDF Downloads 260

Authors: Geeta Gahlawat, Ashok Kumar Srivastava

Abstract:

In the present study, a simple drain and fill protocol strategy of repeated batch was adopted for enhancement in polyhydroxyalkanoates (PHAs) production using alcaligenes latus DSM 1124. Repeated batch strategy helped in increasing the longevity of otherwise decaying culture in the bioreactor by supplementing fresh substrates during each cycle of repeated-batch. The main advantages of repeated batch are its ease of operation, enhancement of culture stability towards contamination, minimization of pre-culture effects and maintenance of organism at high growth rates. The cultivation of A. latus was carried out in 7 L bioreactor containing 4 L optimized nutrient medium and a comparison with the batch mode fermentation was done to evaluate the performance of repeated batch in terms of PHAs accumulation and productivity. The statistically optimized medium recipe consisted of: 25 g/L Sucrose, 2.8 g/L (NH4)2SO4, 3.25 g/L KH2PO4, 3.25 g/L Na2HPO4, 0.2 g/L MgSO4, 1.5 mL/L trace element solution. In this strategy, 20% (v/v) of the culture broth was removed from the reactor and supplemented with an equal volume of fresh medium when sucrose concentration inside the reactor decreased below 8 g/L. The fermenter was operated for three repeated batch cycles and fresh nutrient feeding was done at 27 h, 48 h, and 60 h. Repeated batch operation resulted in a total biomass of 27.89 g/L and PHAs concentration 20.55 g/L at the end of 69 h which was a marked improvement as compared to batch cultivation (8.71 g/L biomass and 6.24 g/L PHAs). This strategy demonstrated 3.3 fold and 1.8 fold increase in PHAs concentration and volumetric productivity, respectively as compared to batch cultivation. Repeated batch cultivation strategy had also the benefit of avoiding non-productive time period required for cleaning, refilling and sterilization of bioreactor, thereby increasing the overall volumetric productivity and making the entire process cost-effective too.

Keywords: alcaligenes, biodegradation, polyhydroxyalkanoates, repeated batch

Procedia PDF Downloads 369

Authors: M.Rüştü Karaman, İsmail İşeri, Kadir Saltalı, A.Reşit Brohi, Ayhan Horuz, Mümin Dizman

Abstract:

Considerable relations has recently been given to the environmental hazardous caused by agricultural chemicals such as excess fertilizers. In this study, a neural network approach was investigated in the prediction of potential nitrate pollution across different land-use patterns by using a feedforward multilayered computer model of artificial neural network (ANN) with proper training. Periodical concentrations of some anions, especially nitrate (NO3-), and cations were also detected in drainage waters collected from the drain pipes placed in irrigated tomato field, unirrigated wheat field, fallow and pasture lands. The soil samples were collected from the irrigated tomato field and unirrigated wheat field on a grid system with 20 m x 20 m intervals. Site specific nitrate concentrations in the soil samples were measured for ANN based simulation of nitrate leaching potential from the land profiles. In the application of ANN model, a multi layered feedforward was evaluated, and data sets regarding with training, validation and testing containing the measured soil nitrate values were estimated based on spatial variability. As a result of the testing values, while the optimal structures of 2-15-1 was obtained (R2= 0.96, P < 0.01) for unirrigated field, the optimal structures of 2-10-1 was obtained (R2= 0.96, P < 0.01) for irrigated field. The results showed that the ANN model could be successfully used in prediction of the potential leaching levels of nitrate, based on different land use patterns. However, for the most suitable results, the model should be calibrated by training according to different NN structures depending on site specific soil parameters and varied agricultural managements.

Keywords: artificial intelligence, ANN, drainage water, nitrate pollution

Procedia PDF Downloads 310

Authors: R. Trad Khodja, A. Guessmi, R. Ghoul, A. Mahtout, S. A. Benbouali, M. A. Boulahlib

Abstract:

Cranioplasty is a surgical act that aims to restore cranial bone losses in order to protect the brain from external aggressions and to improve the patient's aesthetic appearance. This objective can be achieved by taking advantage of the current technological development in computer science and biomechanics. The objective of this paper is to present an approach for the realization of high-precision biocompatible cranial implants using new 3D printing technologies at the lowest cost. The proposed method is to reproduce the missing part of the skull by referring to its healthy contralateral part. Once the model is validated by the neurosurgeons, a mold is 3D printed for the production of a biocompatible implant in Poly-Methyl-Methacrylate (PMMA) acrylic cement. Using this procedure, ten patients underwent this procedure with excellent aesthetic results.

Keywords: cranioplasty, cranial defect, PMMA, 3d printing, custom made implants

Procedia PDF Downloads 56

Authors: Bernard Olumide Ewuoso, Asma Gharaibeh

Abstract:

Rationale: Placental mesenchymal dysplasia (PMD) resembles molar pregnancy quite a bit. Although there have been documented live births of healthy babies, obtaining an objective diagnosis is crucial to assisting the mother in making an educated decision on what option of management she would like to explore. Prenatal invasive testing is recommended to help obtain an objective diagnosis in cases of abnormal placenta. We present a 23-year-old who, at 14 weeks, had ultrasonographic findings suggestive of placental mesenchymal dysplasia. She was offered prenatal invasive testing but declined and opted for surgical management, with a diagnosis of PMD confirmed on histopathology. There will be occasions such as this when prenatal invasive testing is declined. In these situations, careful consideration can be given to color Doppler and MRI, especially if the patient decides to keep pregnancy.

Keywords: placental mesenchymal dysplasisa, molar pregnancy, prenatal invasive testing, Color doppler, MRI

Procedia PDF Downloads 23

Authors: Paul Feyi Waboso

Abstract:

This case report presents a 57-year-old female patient with a history of colon cancer, colostomy, and immunocompromise, who presented with an unusual bilateral vulval abscess, more prominent on the left side. Due to the atypical presentation, an MRI was performed, revealing a pelvic collection and a fistulous connection between the pelvis and vulva. This finding prompted an urgent surgical intervention. This case highlights the diagnostic and therapeutic challenges of managing complex abscesses and fistulas in immunocompromised patients. Introduction: Vulval abscesses in immunocompromised individuals can present with atypical features and may be associated with complex pathologies. Patients with a history of cancer, colostomy, and immunocompromise are particularly prone to infections and may present with unusual manifestations. This report discusses a case of a large bilateral vulval abscess with an underlying pelvic fistula, emphasizing the importance of advanced imaging in cases with atypical presentations. Case Presentation: A 57-year-old female with a known history of colon cancer, treated with colostomy, presented with severe pain and swelling in the vulval area. Physical examination revealed bilateral vulval swelling, with the abscess on the left side appearing larger and more pronounced than on the right. Given her immunocompromised status and the unusual nature of the presentation, we requested an MRI of the pelvis, suspecting an underlying pathology beyond a typical abscess. Investigations: MRI imaging revealed a significant pelvic collection and identified a fistulous tract between the pelvis and the vulva. This confirmed that the vulval abscess was connected to a deeper pelvic infection, necessitating urgent intervention. Management: After consultation with the multidisciplinary team (MDT), it was agreed that the patient required surgical intervention, having had 48 hours of antibiotics. The patient underwent evacuation of the left-sided vulval abscess under spinal anesthesia. During surgery, the pelvic collection was drained of 200 ml of pus. Outcome and Follow-Up: Postoperative recovery was closely monitored due to the patient’s immunocompromised state. Follow-up imaging and clinical evaluation showed improvement in symptoms, with gradual resolution of infection. The patient was scheduled for regular follow-up visits to monitor for recurrence or further complications. Discussion: Bilateral vulval abscesses are uncommon and, in an immunocompromised patient, warrant thorough investigation to rule out deeper infectious or fistulous connections. This case underscores the utility of MRI in identifying complex fistulous tracts and highlights the importance of a multidisciplinary approach in managing such high-risk patients. Conclusion: This case illustrates a rare presentation of bilateral vulval abscess with an associated pelvic fistula.

Keywords: vulval abscess, MDT team, colon cancer with pelvic fistula, vulval skin condition

Procedia PDF Downloads 18