Search results for: surgical menopause

Authors: Krupali Mukeshkumar, Jinesh Shah

Abstract:

Background: Bilateral Sagittal Split Osteotomy (BSSO), used for the correction of mandibular deformities, is a common oral and maxillofacial surgical procedure. Inferior alveolar nerve dysfunction is commonly reported post-operatively by patients as paresthesia or anesthesia. The current literature lacks a consensus on the incidence of inferior alveolar nerve dysfunction as patients are not routinely assessed pre and post-operatively with an objective assessment. The range of incidence varies from 9% to 85% of patients, with some authors arguing that 100% of patients experience nerve dysfunction immediately post-surgery. Systematic reviews have shown a difference between incidence rates at different follow-up periods using objective and subjective methods. Aim: To identify the incidence of inferior alveolar nerve dysfunction following BSSO. Gold standard: Nerve dysfunction incidence rates similar or lower than current literature of 83% day one post-operatively and 18.4% at one year follow up. Setting: A retrospective cross-sectional audit of patients treated between 2017-2019 at the Royal Stoke University Hospital, Maxillofacial and Orthodontic departments. Sample: All patients who underwent a BSSO (with or without le fort one osteotomy) between 2017–2019 were identified from the database. Patients with pre-existing neurosensory disturbance, those who had a genioplasty at the same time and those with no follow-up were excluded. The sample consisted of 121 patients, 37 males and 84 females between the ages of 17-50 years at the time of surgery. Methods: Clinical records of 121 cases were reviewed to assess the age, sex, type of mandibular osteotomy, status of the nerve during the surgical procedure, type of bony split and incidence of nerve dysfunction at follow-up appointments. The surgical procedure was carried out by three Maxillo-facial surgeons and follow-up appointments were carried out in the Orthodontic and Oral and Maxillo-facial departments. Results: 120 patients were treated to correct the mandibular facial deformity and 1 patient was treated for sleep apnoea. Seventeen patients had a mandibular setback and 104 patients had mandibular advancement. 68 patients reported inferior alveolar nerve dysfunction at one week following their surgery. Seventy-six patients had temporary paresthesia present between 2 weeks and 12 months post-surgery. 13 patients had persistent nerve dysfunction at 12 months, of which 1 had a bad bony split during the BSSO. The incidence of nerve dysfunction postoperatively was 6.6% after 1 day, 56.1% at 1 week, 62.8% at 2 weeks, 59.5% between 3-6 weeks, 43.0% between 8-16 weeks and 10.7% at 1 year. Conclusions: The results of this audit show a similar incidence rate to the research gold standard at the one-year follow-up. Future Recommendations: No changes to surgical procedure or technique are indicated, but a need for improved documentation and a standardized approach for assessment of post-operative nerve dysfunction would be beneficial.

Keywords: bilateral sagittal split osteotomy, inferior alveolar nerve, mandible, nerve dysfunction

Procedia PDF Downloads 194

Authors: Yu-Chieh Chen, Kuei-Feng Shen, Chia-Ling Chao

Abstract:

The purpose of this report was to present the nursing experience and case of an unexpected cerebellar hemorrhagic stroke with acute hydrocephalus patient after lumbar spine surgery. The patient had been suffering from an emergent external ventricular drainage and stayed in the Surgical Intensive Care Unit from July 8, 2016, to July 22, 2016. During the period of the case, the data were collected for attendance, evaluation, observation, interview, searching medical record, etc. An integral evaluation of the patient's physiological 'psychological' social and spiritual states was also noted. The author noticed the following major nursing problems including ineffective cerebral perfusion 'physical activity dysfunction' family resource preparation for disability. The author provided nursing care to maintain normal intracranial pressure, along with a well-therapeutic relationship and applied interdisciplinary medical/nursing team to draft an individualized and appropriate nursing plan for them to face the psychosocial impact of the patient disabilities. We also actively participated in the rehabilitation treatments to improve daily activity and confidence. This was deemed necessary to empower them to a more positive attitude in the future.

Keywords: family resourace preparation inability, hemorrhagic sroke, ineffective tissue cerebral perfusion, lumbar spine surgery

Procedia PDF Downloads 91

Authors: Ayat E. Ali, Christeen R. Aziz, Merna A. Helmy, Mohammed M. Malek, Sherif H. El-Gohary

Abstract:

Goal: Purpose of the project was to make a plastic surgery prediction by using pre-operative images for the plastic surgeries’ patients and to show this prediction on a screen to compare between the current case and the appearance after the surgery. Methods: To this aim, we implemented a software which used data from the internet for facial skin diseases, skin burns, pre-and post-images for plastic surgeries then the post- surgical prediction is done by using K-nearest neighbor (KNN). So we designed and fabricated a smart mirror divided into two parts a screen and a reflective mirror so patient's pre- and post-appearance will be showed at the same time. Results: We worked on some skin diseases like vitiligo, skin burns and wrinkles. We classified the three degrees of burns using KNN classifier with accuracy 60%. We also succeeded in segmenting the area of vitiligo. Our future work will include working on more skin diseases, classify them and give a prediction for the look after the surgery. Also we will go deeper into facial deformities and plastic surgeries like nose reshaping and face slim down. Conclusion: Our project will give a prediction relates strongly to the real look after surgery and decrease different diagnoses among doctors. Significance: The mirror may have broad societal appeal as it will make the distance between patient's satisfaction and the medical standards smaller.

Keywords: k-nearest neighbor (knn), face detection, vitiligo, bone deformity

Procedia PDF Downloads 128

Authors: C. Kuoh, C. Lucas, T. Lopes, I. Mechie, J. Yoong, W. Yoong

Abstract:

For all surgeons, there is one preventable but still highly occurring complication – wrong site surgeries. They can have potentially catastrophic, irreversible, or even fatal consequences on patients. With the exponential development of microsurgery and the use of advanced technological tools, the consequences of operating on the wrong side, anatomical part, or even person is seen as the most visible and destructive of all surgical errors and perhaps the error that is dreaded by most clinicians as it threatens their licenses and arouses feelings of guilt. Despite the implementation of the WHO surgical safety checklist more than a decade ago, the incidence of wrong-site surgeries remains relatively high, leading to tremendous physical and psychological repercussions for the clinicians involved, as well as a financial burden for the healthcare institution. In this presentation, the authors explore various factors which can lead to wrong site surgery – a combination of environmental and human factors and evaluate their impact amongst patients, practitioners, their families, and the medical industry. Major contributing factors to these “never events” include deviations from checklists, excessive workload, and poor communication. Two real-life cases are discussed, and systems that can be implemented to prevent these errors are highlighted alongside lessons learnt from other industries. The authors suggest that reinforcing speaking-up, implementing medical professional trainings, and higher patient’s involvements can potentially improve safety in surgeries and electrosurgeries.

Keywords: wrong side surgery, never events, checklist, workload, communication

Procedia PDF Downloads 150

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

— Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: diabetic foot, bone biopsy, osteitis, algeria

Procedia PDF Downloads 72

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 55

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic, biopsy, diabetic foot

Procedia PDF Downloads 58

Authors: Suvorov Vasyl, Filipchuk Viktor

Abstract:

Background: If non-surgical treatment of developmental dysplasia of the hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases. The objectives of this study were to assess the results after SPO, evaluate risk factors, and reveal those radiological parameters that may correlate with the results. Mid- and long-term postoperative results after SPO in 17 patients (22 hip joints) were analyzed. Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction, we referred distance "d" and the lateral rotation angle. Results: SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient’s age and higher preoperative AI values (p < 0.05). The risk factor that depends on the surgeon was the amount of AI correction (p < 0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p < 0.05). Conclusion: In older patients with a higher preoperative AI value, the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values).

Keywords: developmental dysplasia of the hip, results, risk factor, pelvic osteotomy, salter osteotomy

Procedia PDF Downloads 97

Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

Abstract:

Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

Procedia PDF Downloads 70

Authors: Suehyun Cho, Darrell Harrington, Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Alex Kiselyov, Michael Shpigelmacher

Abstract:

The Dandy-Walker malformation (DWM) represents a clinical syndrome manifesting as a combination of posterior fossa cyst, hypoplasia of the cerebellar vermis, and obstructive hydrocephalus. Anatomic hallmarks include hypoplasia of the cerebellar vermis, enlargement of the posterior fossa, and cystic dilatation of the fourth ventricle. Current treatments of DWM, including shunting of the cerebral spinal fluid ventricular system and endoscopic third ventriculostomy (ETV), are frequently clinically insufficient, require additional surgical interventions, and carry risks of infections and neurological deficits. Bionaut Labs develops an alternative way to treat Dandy-Walker Malformation (DWM) associated with non-communicating hydrocephalus. We utilize our discreet microsurgical Bionaut™ particles that are controlled externally and remotely to perform safe, accurate, effective fenestration of the Dandy-Walker cyst, specifically in the posterior fossa of the brain, to directly normalize intracranial pressure. Bionaut™ allows for complex non-linear trajectories not feasible by any conventional surgical techniques. The microsurgical particle safely reaches targets in the lower occipital section of the brain. Bionaut™ offers a minimally invasive surgical alternative to highly involved posterior craniotomy or shunts via direct fenestration of the fourth ventricular cyst at the locus defined by the individual anatomy. Our approach offers significant advantages over the current standards of care in patients exhibiting anatomical challenge(s) as a manifestation of DWM, and therefore, is intended to replace conventional therapeutic strategies. Current progress, including platform optimization, Bionaut™ control, and real-time imaging and in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of ovine models, will be discussed.

Keywords: Bionaut™, cerebral spinal fluid, CSF, cyst, Dandy-Walker, fenestration, hydrocephalus, micro-robot

Procedia PDF Downloads 181

Authors: Sujata Chaturvedi, Ishita Pant, Deepak Kumar Jha, Vinod Kumar Singh Gautam, Chandra Bhushan Tripathi

Abstract:

Objective: To describe clinical, histopathological and immunohistochemical profile of glioblastoma in patients and to correlate these findings with patient survival. Material and methods: 30 cases of histopathologically diagnosed glioblastomas were included in this study. These cases were analysed in detail for certain clinical and histopathological parameters. Immunohistochemical staining for p53, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), mouse double minute 2 homolog (MDM2) and Ki67 was done and scores were calculated. Results of these findings were correlated with patient survival. Results: A retrospective analysis of the histopathology records and clinical case files was done in 30 cases of glioblastoma (WHO grade IV). The mean age of presentation was 50.6 years with a male predilection. The most common involved site was the frontal lobe. Amongst the clinical parameters, age of the patient and extent of surgical resection showed a significant correlation with the patient survival. Histopathological parameters showed no significant correlation with the patient survival, while amongst the immunohistochemical parameters expression of MDM2 showed a significant correlation with the patient survival. Conclusion: In this study incorporating clinical, histopathological and basic panel of immunohistochemistry, age of the patient, extent of the surgical resection and expression of MDM2 showed significant correlation with the patient survival.

Keywords: glioblastoma, p53, EGFR, VEGF, MDM2, Ki67

Procedia PDF Downloads 257

Authors: Subramanyam Devarakonda Hanumantharao, Udayendu Prakash Sharma, Mahesh Garg

Abstract:

Introduction: Gomabai Netralaya a reputed eye hospital is located in Neemuch a small city of Madhya Pradesh, India. The hospital is established in 1992 by Late. G.D Agrawal a renowned educationist, freedom fighter and philanthropist. The eye hospital was established to serve all sections of the society in affordable manner. To provide comprehensive eye care services to the rural poor the hospital started organizing outreach camps since 1994. Purpose: To study the cost effectiveness of outreach eye camps for addressing the sustainability issues of the outreach program. Methods: One year statistics of outreach eye camps were collected from Hospital Management Information System software to analyze the productivity of camps. Income and expenses report was collected from outreach department records to analyze per camp expenses and per patient expenses against the income generated. All current year records were analyzed to have accuracy of information and results. Information was collected in two ways: 1)Actual camp performance records and expenses from book of accounts. 2)Cross verification was done through one to one discussion with outreach staff. Results: Total 17534 outpatients were examined through 52 outreach eye camps. Total 6042 (34% of total outpatients) patients were advised with cataracts and 4651 (77% of advice) operations were performed. The average OPD per camp was 337 and per camp 116 patients was advised for cataract surgery and 89 surgeries were performed per camp. Total 18200 US$ incurred on organizing 52 outreach camps in the radius of 100 k.ms. Considering the total outpatients screened through camps the screening cost per patient was 1.00 US$ and considering the surgical output the per surgery expenses was 4.00 US$. The cost recovery of the total expenses was through Government grant of US$ 16.00 per surgery (that includes surgical grant). All logistics cost of camps and patients transportation cost was taken care by local donors. Conclusion: The present study demonstrates that with people’s participation, successful high volume outreach eye camps can be organized. The cost effectiveness of the outreach camps is totally depended on volume of outpatient’s turn-up at camp site and per camp surgical output. The only solution to sustainability of outreach eye camps is sharing of cost with local donors and increasing productivity.

Keywords: camps, outreach, productivity, sustainable

Procedia PDF Downloads 140

Authors: Santosh Sharma Parajuli, Diwas Manandhar

Abstract:

Background: Perioperative pain management plays an integral part in patients undergoing cardiac surgery. We studied the effect of Erector Spinae Plane block on acute postoperative pain reduction and 24 hours opioid consumption in adult cardiac surgical patients. Methods: Twenty-five adult cardiac surgical patients who underwent cardiac surgery with sternotomy in whom ESP catheters were placed preoperatively were kept in group E, and the other 25 patients who had undergone cardiac surgery without ESP catheter and pain management done with conventional opioid injection were placed in group C. Fentanyl was used for pain management. The primary study endpoint was to compare the consumption of fentanyl and to assess the numeric rating scale in the postoperative period in the first 24 hours in both groups. Results: The 24 hours fentanyl consumption was 43.00±51.29 micrograms in the Erector Spinae Plane catheter group and 147.00±60.94 micrograms in the control group postoperatively which was statistically significant (p <0.001). The numeric rating scale was also significantly reduced in the Erector Spinae Plane group compared to the control group in the first 24 hours postoperatively. Conclusion: Erector Spinae Plane block is superior to the conventional opioid injection method for postoperative pain management in CABG patients. Erector Spinae Plane block not only decreases the overall opioid consumption but also the NRS score in these patients.

Keywords: erector, spinae, plane, numerical rating scale

Procedia PDF Downloads 41

Authors: Bang Haeyong

Abstract:

Purpose: The objectives of this study were to determine the prevalence, incidence, and risk factors for postoperative fever after lumbar fusion. Methods: This study was a retrospective chart review of 291 patients who underwent lumbar fusion between March 2015 and February 2016 at the Asan Medical Center. Information was extracted from electronic medical records. Postoperative fever was measured at Tmax > 37.7 ℃ and Tmax > 38.3 ℃. The presence of postoperative fever, blood culture, urinary excretion, and/or chest x-ray were evaluated. Patients were evaluated for infection after lumbar fusion. Results: We found 222 patients (76.3%) had a postoperative temperature of 37.7 ℃, and 162 patients (55.7%) had a postoperative temperature of 38.3 ℃ or higher. The percentage of febrile patients trended down following the mean 1.8days (from the first postoperative day to seventh postoperative day). Infection rate was 9 patients (3.1%), respiratory virus (1.7%), urinary tract infection (0.3%), phlebitis (0.3%), and surgical site infection (1.4%). There was no correlation between Tmax > 37.7℃ or Tmax > 38.3℃, and timing of fever, positive blood or urine cultures, pneumonia, or surgical site infection. Risk factors for increased postoperative fever following surgery were confirmed to be delay of defecation (OR=1.37, p=.046), and shorten of remove drainage (OR=0.66, p=.037). Conclusions: The incidence of fever was 76.3% after lumbar fusion and the drainage time was faster in the case of fever. It was thought that the bleeding was absorbed at the operation site and fever occurred. The prevalence of febrile septicemia was higher in patients with long bowel movements before surgery than after surgery. Clinical symptoms should be considered because postoperative fever cannot be determined by fever alone because fever and infection are not significant.

Keywords: lumbar surgery, fever, postoperative, risk factor

Procedia PDF Downloads 220

Authors: M. Krishna

Abstract:

The study was intended to identify if scalp cooling therapy is effective on preventing chemotherapy-induced hair loss among cancer patients. Critical literature of non-randomized controlled trials was used to investigate whether scalp cooling therapy is effective on preventing chemotherapy-induced alopecia. The review identified that scalp cooling therapy is effective on preventing chemotherapy-induced alopecia. Most of the patients receiving chemotherapy experience alopecia. It is also perceived as the worst effect of chemotherapy. This may be severe and lead the patients to withdraw the chemo treatment. The image disturbance caused by alopecia will make the patient depressed and will lead to declined immunity. With the knowledge on effectiveness of scalp cooling therapy on preventing chemotherapy-induced alopecia, patient undergoing chemotherapy will not be hesitant to undergo the treatment. Patients are recommended to go through scalp cooling therapy every chemo cycle and the proper therapy duration is 30 minutes before, during chemo. The suggested duration of the scalp cooling therapy is 45-90 minutes for an effective and positive outcome. This finding is excluding other factors of alopecia such as menopause, therapeutic drugs, poor hair density, liver function problems, and drug regimes.

Keywords: alopecia, cancer, chemotherapy, scalp cooling therapy

Procedia PDF Downloads 177

Authors: Alimohamad Asghari, Ahmad Daneshi, Mohammad Farhadi, Arash Bayat, Mohammad Ajalloueyan, Marjan Mirsalehi, Mohsen Rajati, Seyed Basir Hashemi, Nader Saki, Ali Omidvari

Abstract:

Evidence suggests that Cochlear Implantation (CI) is a beneficial approach for auditory and speech skills improvement in children with severe to profound hearing loss. However, it remains controversial if implantation in children <12 months is safe and effective compared to older children. The present study aimed to determine whether children's ages affect surgical complications and auditory and speech development. The current multicenter study enrolled 86 children who underwent CI surgery at <12 months of age (group A) and 362 children who underwent implantation between 12 and 24 months of age (group B). The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were determined pre-impanation, and "one-year" and "two-year" post-implantation. Four complications (overall rate: 4.65%; three minor) occurred in group A and 12 complications (overall rate: 4.41%; nine minor) occurred in group B. We found no statistically significant difference in the complication rates between the groups (p>0.05). The mean SIR and CAP scores improved over time following CI activation in both groups. However, we did not find significant differences in CAP and SIR scores between the groups across different time points. Cochlear implantation is a safe and efficient procedure in children younger than 12 months, providing substantial auditory and speech benefits comparable to children undergoing implantation at 12 to 24 months of age. Furthermore, surgical complications in younger children are similar to those of children undergoing the CI at an older age.

Keywords: cochlear implant, Infant, complications, outcome

Procedia PDF Downloads 72

Authors: Ghada E. Esheba, Ghufran Kheshaifaty, Kholoud Al-Harbi, Wafa'a Al-Harbi, Ala'a Al-Orabi, Moayad Turkistani

Abstract:

Krukenberg tumor is a rare metastatic ovarian carcinoma that usually occurs in female between 30 - 40 year old and rarely seen after menopause. Stomach is the most common primary site. Histopathological features of krukenberg tumors appear as diffuse stromal proliferation, mucus-production, and numerous signet-cells and these tumors spread mostly by lymphatic route. Treatment and prognostic factors are not well established. This study describes a 34 year old female with a unilateral ovarian mass discovered accidentally during cesarean section delivery and it was misdiagnosed as luteoma of pregnancy, but histopathological examination showed a diffuse infiltration of the ovary and omentum by signet ring cells. These findings were not correlated with luteoma of pregnancy or any other types of primary ovarian tumors like surface epithelial tumor, sex cord stromal tumor or germ cell tumor. However, after the analysis of immunohistochemical results (negative CK7, positive CK20 and CDX-2), the finding was the diagnostic of metastatic krukenberg tumor. Two weeks later, the patient was evaluated and a large gastric tumor was found in her stomach and she underwent gastrectomy.

Keywords: CK7, CK20, CDX-2, Krukenburg tumor, metastatic ovarian tumor

Procedia PDF Downloads 281

Authors: Kamal Tolani, Sandeep Kumar, Rohit Luthra, Ankit Dadhania, Krishnaprasad K., Ram Gupta, Deepa Joshi

Abstract:

Background: Post-operative analgesia remains a clinical challenge, with central and peripheral sensitization playing a pivotal role in treatment-related complications and impaired quality of life. Centrally acting opioids offer poor risk benefit profile with increased intensity of gastrointestinal or central side effects and slow onset of clinical analgesia. The objective of this study was to assess the clinical feasibility of induction and maintenance therapy with Tapentadol Nasal Spray (NS) in moderate to severe acute post-operative pain. Methods: Phase III, randomized, active-controlled, non-inferiority clinical trial involving 294 cases who had undergone surgical procedures under general anesthesia or regional anesthesia. Post-surgery patients were randomized to receive either Tapentadol NS 45 mg or Tramadol 100mg IV as a bolus and subsequent 50 mg or 100 mg dose over 2-3 minutes. The frequency of administration of NS was at every 4-6 hours. At the end of 24 hrs, patients in the tramadol group who had a pain intensity score of ≥4 were switched to oral tramadol immediate release 100mg capsule until the pain intensity score reduced to <4. All patients who had achieved pain intensity ≤ 4 were shifted to a lower dose of either Tapentadol NS 22.5 mg or oral Tramadol immediate release 50mg capsule. The statistical analysis plan was envisaged as a non-inferiority trial involving comparison with Tramadol for Pain intensity difference at 60 minutes (PID60min), Sum of Pain intensity difference at 60 minutes (SPID60min), and Physician Global Assessment at 24 hrs (PGA24 hrs). Results: The per-protocol analyses involved 255 hospitalized cases undergoing surgical procedures. The median age of patients was 38.0 years. For the primary efficacy variables, Tapentadol NS was non-inferior to Inj/Oral Tramadol in relief of moderate to severe post-operative pain. On the basis of SPID60min, no clinically significant difference was observed between Tapentadol NS and Tramadol IV (1.73±2.24 vs. 1.64± 1.92, -0.09 [95% CI, -0.43, 0.60]). In the co-primary endpoint PGA24hrs, Tapentadol NS was non–inferior to Tramadol IV (2.12 ± 0.707 vs. 2.02 ±0.704, - 0.11[95% CI, -0.07, 0.28). However, on further assessment at 48hr, 72 hrs, and 120hrs, clinically superior pain relief was observed with the Tapentadol NS formulation that was statistically significant (p <0.05) at each of the time intervals. Secondary efficacy measures, including the onset of clinical analgesia and TOTPAR, showed non-inferiority to Tramadol. The safety profile and need for rescue medication were also similar in both the groups during the treatment period. The most common concomitant medications were anti-bacterial (98.3%). Conclusion: Tapentadol NS is a clinically feasible option for improved compliance as induction and maintenance therapy while offering a sustained and persistent patient response that is clinically meaningful in post-surgical settings.

Keywords: tapentadol nasal spray, acute pain, tramadol, post-operative pain

Procedia PDF Downloads 207

Authors: Hatice Kahyaoglu Sut, Serap Unsar, Seda Kurt

Abstract:

The aim of this study is to investigate sexual quality of life in women with gynecological cancer. This cross-sectional study was conducted on 37 women with gynecological cancer and 39 control women (in menopausal term) at the Gynecooncology and Menopause Clinics of Trakya University Medical Faculty between January and July 2015. Women who had sexual active and willing to participate in the study filled an information form inquiring socio-demographic characteristics and Sexual Quality of Life Questionnaire-Female (SQLQ-F). Data were analyzed by Mann-Whitney-U test and Kruskal-Wallis test. The average age of the women was 52.7 ± 7.6 (51.2 ± 8.7 in women with gynecological cancer, 54.3 ± 6.0 in controls). The SQOL-F scores in women with gynecologic cancer (60.8 ± 22.4) was lower than controls (63.5 ± 20.7), however, there was no statistically significant difference (p = 0.759). Women with gynecological cancer who had vaginal dryness and pain during sexual intercourse (45.7 ± 21.3) were lower SQOL-F total score than control group (66.0 ± 21.7) (p = 0.014). The SQOL-F scores in women who took chemotherapy treatment (55.7 ± 17.8) were lower than in women who had not chemotherapy treatment (86.8 ± 16.6) (p = 0.005). In conclusion, taking chemotherapy treatment and occurring vaginal dryness and pain complaints during sexual intercourse in women with gynecological cancer reduces sexual quality of life. Therefore, sexual quality of life in women with gynecological cancer should be evaluated, and they should be supported in order to improve their sexual quality of life.

Keywords: gynecological cancer, quality of life, sexuality, women

Procedia PDF Downloads 311

Authors: Ae Ra Han, Taek Hoo Lee, Sun Zoo Kim, Hwa Young Lee

Abstract:

Introduction: Ovarian endometrioma is one of the important causes of poor ovarian reserve and up to half of them have recurred. However, the treatment for recurrence prevention has limited efficiency and repeated surgical management makes worsen the ovarian reserve. To find better management for recurrence prevention, we investigated risk factors and biomarkers for the recurrence of ovarian endometrioma. Methods: The medical records of women with the history of surgical dissection for ovarian endometrioma were collected. After exclusion of the cases with concurrent hysterectomy, been menopaused during follow-up, incomplete medical record, and loss of follow-up, a total of 134 women were enrolled. Immunohistochemical staining for progesterone receptor isoform B (PR-B) and nuclear factor kappa B (NFκB) was done with the fixed tissue blocks of their endometriomas which were collected at the time of surgery. Results: Severity of dysmenorrhea and co-existence of adenomyosis had significant correlation with recurrence of endometrioma. Increased PR-B (P = .041) and decreased NFκB (P = .036) immunoreactivity were found in recurrent group. Serum CA-125 level at the time of recurrence was higher than the highest level of CA-125 during follow-up in unrecurred group (55.6 vs. 21.3 U/mL, P = .014). Conclusion: We found that the severity of dysmenorrhea and coexistence of adenomyosis are risk factors for recurrence of ovarian endometrioma, and serial follow-up of CA-125 is effective to detect and prevent the recurrence. However, to determine the possibility of immunoreactivity of PR-B and NFκB as biomarkers for ovarian endometrioma, further studies of various races and large numbers with prospective design are needed.

Keywords: endometriosis, recurrence, biomarker, risk factor

Procedia PDF Downloads 522

Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

Abstract:

Background: The breast unit local guideline recommends that 12 cores should be used in a stereotactic-guided biopsy to diagnose DCIS. Twelve cores are regarded to provide good diagnostic value without removing more breast tissue than necessary. This study aimed to determine compliance with guidelines and investigated how the number of cores impacted upon the re-excision rate and size discrepancies. Methods: This single-centre retrospective cohort study of 72 consecutive breast screened patients with <15mm DCIS on radiological report underwent stereotactic-guided core biopsy and subsequent surgical excision. Clinical, radiological, and histological data were collected over 5 years, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Results: Forty-six (63.9%) patients had <12 cores taken, and 26 (36.1%) patients had ≥12 cores taken. Only six (8.3%) patients had 12 cores taken in their stereotactic biopsy. Incomplete surgical excision was seen in 17 patients overall (23.6%), and of these patients, twelve (70.6%) had fewer than 12 cores taken (p=0.55 for the difference between groups). Mammogram and biopsy underestimated the size of the DCIS in this subgroup by a median of 15mm (range: 6-135mm). Re-excision was required in 9 patients (12.5%), and five patients (6.9%) were found to have invasive ductal carcinoma on excision (80% had <12 cores, p=0.43). Discussion: There is poor compliance with the breast unit local guidelines and higher rates of re-excision in patients who did not have ≥12 cores taken. Taking ≥12 cores resulted in fewer missed invasive cancers lower incomplete excision and re-excision rates.

Keywords: stereotactic core biopsy, DCIS, breast screening, Re-excision rates, core biopsy

Procedia PDF Downloads 92

Authors: Assia Haif, Djelloul Achouri, Zineddine Soualili

Abstract:

Introduction: Laparoscopic treatment of liver echinococcosis cyst has become popular. In parallel, the diagnostic approach of cystic liver lesions is based on the number of lesions and their distribution. The etiologies of cystic masses in children are different, and the role of imaging in their characterization and pre-therapeutic evaluation is essential. The main differential diagnoses of hepatic hydatid cysts can be discovered intraoperatively by minimally invasive surgery. Methods: The clinical data contained seven patients with hepatic cystic who underwent laparoscopic surgery in the Department of Pediatric Surgery, SETIF, Algeria, from 2015 to 2022. Results: Of reported seven patients, five are male, and the remaining two are female. Abdominal pain was the most frequent clinical signs. Biological parameters were within normal limits, Abdominal ultrasound, practiced in all cases, completed by abdominal computed tomography (CT), showed a hydatid cystic. For all patients, surgical procedures were performed under laparoscopy. Total cystectomy in four patients, fenestration or subtotal cystectomy in three patients, respectively. A histopathological feature confirmed the nature of the cysts. During the follow-up period, there was no recurrence. Conclusions: Laparoscopic liver surgery is a safe and effective approach, it is an alternative to conventional surgery and a reproducible method. Laparoscopic surgery approach should follow the same principals with those of open surgery. This surgical technique can rectify the diagnosis of hydatid cyst, the histopathological examination confirms the nature of the cystic lesion.

Keywords: children, cyst, echinococcosis, laparoscopic, liver

Procedia PDF Downloads 104

Authors: Soyeon Kang, Youn-Jee Chung, Jung Namkung

Abstract:

Objective: This retrospective study investigated the association between uric acid level and bone mineral density (BMD) in the postmenopausal period. Methods: The study included 328 menopausal women (mean age, 57.3 ± 6.5 years; mean serum uric acid level, 4.6 ± 1.0 mg/dL). Patients were divided into three groups by tertile of serum uric acid level. Patients who used hormone treatment (HT), bisphosphonates, or lipid-lowering agents were included. Results: Blood urea nitrogen, serum creatinine, and serum triglyceride levels were significantly higher in the upper uric acid tertiles. No significant difference was found in the mean uric acid levels between medication users and non-users. Distinct HT regimens showed different mean serum uric acid levels. In a cross-sectional analysis, higher serum uric acid levels showed a tendency toward increased BMD in the spine and femoral neck. Longitudinal analysis of 186 women who underwent follow-up examination at a mean interval of 14.6 months revealed a trend toward a smaller reduction in femoral neck BMD in women in the upper serum uric acid tertiles. Conclusion: A positive correlation exists between serum uric acid levels and BMD in menopausal women.

Keywords: menopause, antioxidant, uric acid, bone mineral density

Procedia PDF Downloads 97

Authors: Kwei Huan Liw, Sashi B. Darshan

Abstract:

Background: Double eyelid surgery has become one of the most sought-after aesthetic procedures among Asians. Many surgeons perform surgical blepharoplasty and various other methods of non-incisional blepharoplasty. Face-Q is a validated method of measuring patient satisfaction for facial aesthetic procedures. Here we have analyzed the overall eye satisfaction score, the upper eyelid appraisal score and the adverse effect on eyes score Methods: 274 patients (548 eyes), aged between 18 to 40 years old, were recruited from 2015-2018. Each patient underwent a non-incisional double-eyelid blepharoplasty using a single-knotted continuous buried suture. 3 – 5 stab incisions were made depending on the upper eyelid size. A needle loaded with 7-0 nylon is passed from the lateral most wound through the dermis and the conjunctiva in an alternate fashion into the remaining stab wounds. The suture is then tunneled back laterally in the deeper dermis and knotted securely with the suture end. The knot is then buried within the orbicularis oculi muscle. Each patient was required to fill the Face-Q questionnaire before the procedure and 2 weeks post procedure. The results are described based on the percentage of the maximum achievable score. Patients were reviewed after 12 to 18 months to assess the long-term outcome. Results: The overall eye satisfaction score demonstrated a high level of post-operative satisfaction (97.85%), compared to 27.32% pre-operatively. The appraisal of upper eyelid scores showed drastic improvement in perception post-operatively (95.31%) compared to 21.44% pre-operatively. Adverse effect on eyes score showed a very low post-operative complication rate (0.4%) The long-term follow-up showed 6 cases that had developed asymmetrical folds. Only 1 patient agreed for revision surgery. The other 5 patients were still satisfied with the outcome and were not keen for revision surgery. None of the cases had loosening of knots. Conclusion: Modified single-knot continuous buried suture technique is a simple and non-invasive method to create aesthetically pleasing non-surgical double-eyelids, which has long-term effects. Proper patient selection is crucial and good surgical technique is required to achieve a desirable outcome.

Keywords: blepharoplasty, double-eyelid, face-Q, non-incisional

Procedia PDF Downloads 94

Authors: S. Alireza Mirghasemi, Javad Parvizi, Narges R. Gabaran, Shervin Rashidinia, Mahdi M. Bijanabadi, Dariush G. Savadkoohi

Abstract:

Background: The anterior cruciate ligament is one of the most frequent ligament to be disrupted. Surgical reconstruction of the anterior cruciate ligament is a common practice to treat the disability or chronic instability of the knee. Several factors associated with success or failure of the ACL reconstruction including preoperative laxity of the knee, selection of the graft material, surgical technique, graft tension, and postoperative rehabilitation. We aimed to examine the biomechanical properties of any graft type and initial graft tensioning during ACL reconstruction using 3-dimensional computational finite element simulation. Methods: In this paper, 3-dimensional model of the knee was constructed to investigate the effect of graft tensioning on the knee joint biomechanics. Four different grafts were compared: 1) Bone-patellar tendon-bone graft (BPTB) 2) Hamstring tendon 3) BPTB and a band of gracilis4) Hamstring and a band of gracilis. The initial graft tension was set as “0, 20, 40, or 60N”. The anterior loading was set to 134 N. Findings: The resulting stress pattern and deflection in any of these models were compared to that of the intact knee. The obtained results showed that the combination of a band of gracilis with the former graft (BPTB or Hamstring) increases the structural stiffness of the knee. Conclusion: Required pretension during surgery decreases significantly by adding a band of gracilis to the proper graft.

Keywords: ACL reconstruction, deflection, finite element simulation, stress pattern

Procedia PDF Downloads 269

Authors: Kusmayadi Ita Nursita, Sundoro Ali

Abstract:

Cleft lip and palate are one of the most common congenital abnormalities in the face. It could happen to anyone, but mostly affect Asian population including Indonesia. Factors that influence the occurrence of cleft lip and palate vary from genetic to environmental factors. Children with cleft lip and palate will often have various problems such as airway disorders, eating disorders, speech and language developmental disorders, hearing disorders and psycho-social disorders, one of which is caused by appearance disorders. During his life, the child will experience multidisciplinary surgery and non-surgical treatment and can be accompanied by a psychological and financial burden on himself and his family. In Indonesia, there are no detailed scientific data on the prevalence and characteristic of cleft lip and palate patients. It was mainly caused by the absence of a national level organization, differences in geographical location, and the absence of national guidelines. This study aimed to describe the characteristic and prevalence of cleft lip and palate patients in Bandung Cleft Lip and Palate Center from 1 January 2016 to 31 December 2017. A total of 560 patients were included in the study. The highest percentage of cases are left unilateral cleft lip and palate with higher number of female patient and labioplasty as the most often surgical procedure to be conducted in Bandung Cleft Lip and Palate Center. In order to improve quality of life in patients with cleft lip and palate, early recognition and early treatment based on actual comprehensive data should be conducted. The data from Bandung Cleft Lip and Palate Center as one of the largest center of cleft lip and palate in West Java Indonesia hopefully could provide a big step of further comprehensive data collection in Indonesia and for the better overall management of cleft lip and palate in the future.

Keywords: cleft lip, cleft palate, characteristic, prevalence

Procedia PDF Downloads 111

Authors: Sana Ilyas

Abstract:

Parry-Romberg syndrome is a rare condition clinically defined by slowly progressive atrophy of the skin and soft tissues. This usually effects one side of the face, although a few cases have been documented of bilateral presentation. It is more prevalent in females and usually affects the left side of the face. The syndrome can also be accompanied by neurological abnormalities. It usually occurs in the first two decades of life with a variable rate of progression. The aetiology is unknown, and the disease eventually stabilises. The treatment options usually involve surgical management. The least invasive of these options is the management of facial asymmetry, associated with Parry Romberg syndrome, through the use of tissue fillers. This paper will review the existing literature on the management of Parry Romberg syndrome with tissue filler. Aim: The aim of the study is to explore the current published literature for the management of Parry Romberg syndrome with fillers. It is to assess the development that has been made in this method of management, its benefits and limitations, and its effectiveness for the management of Parry Romberg syndrome. Methodology: There was a thorough assessment of the current literature published on this topic. PubMed database was used for search of the published literature on this method of the management. Papers were analysed and compared with one another to assess the success and limitation of the management of Parry Romberg with dermal fillers Results and Conclusion: Case reports of the use of tissue fillers discuss the varying degrees of success with the treatment. However, this procedure has it’s limitation, which are discussed in the paper in detail. However, it is still the least invasive of all the surgical options for the management of Parry Romberg Syndrome, and therefore, it is important to explore this option with patients, as they may be more comfortable with pursuingtreatment that is less invasive and can still improve their facial asymmetry

Keywords: dermal fillers, facial asymmetry, parry romberg syndrome, tissue fillers

Procedia PDF Downloads 61

Authors: Titap Yazicioglu

Abstract:

Purpose: To determine the etiological factors responsible for the eye removal surgery and to evaluate our surgical results. Material and Methods: Medical records of 226 patients, who underwent eye removal surgery, were analyzed retrospectively. Demographic information, clinical history, surgical procedure, and histopathological data were all collected. Evisceration surgery was performed under general anesthesia in all patients except tumor cases and one patient with rhino-orbital mucormycosis. The patients were followed for an average of 16.46±10.78 months and checked for the possible complications, cosmesis, and functional results.Results: 144 men, and 82 women,with a mean age of 41.78±22.6 years, were underwent enucleation (n=15) or evisceration (n=211) due to traumatic (n=169) and non-traumatic (n=57) causes. In the traumatic group, 79.8% of 169 patients were injured by penetrating and 14.2% by blunt trauma.3.6% of the patients were injured in a traffic accident, and 2.4% of them were injured by explosives. In the non-traumatic group, 40% of 25 patients had post-traumatic endophthalmitis, 32% had endophthalmitis due to corneal ulceration and melting, and 24% had endophthalmitis after cataract surgery. One patient had panophthalmitis due to rhino-orbital mucormycosis. Another cause in the non-traumatic group was glaucoma, of which 92.3% had neovascular glaucoma, and 8.7% had congenital glaucoma. Of the 14 patients who were enucleated for tumor, 35.7% had retinoblastoma, 14.3% had medulloepithelioma, 42.9% had uveal melanoma, and 7.1% had metastatic tumor from paranasal sinuses.The most common complaint in the follow-up period was discharging, seen in all prosthesis-wearing patients. 13.3% of the patients had itching due to ocular prosthesis. 4.4% of the patients were complaining about deep superior sulcus. 4.4% had pyogenic granuloma, and 17.8% had implant exposure. Conclusion: Etiological factors should be carefully evaluated, and precautions should be taken in order to reduce the devastating effect of the physical loss of the eye.

Keywords: enucleation, evisceration, ocular injury, etiology, frequency

Procedia PDF Downloads 70

Authors: Lingyu Ding, Hongxia Hua, Hanfei Zhu, Jinling Lu, Qin Xu

Abstract:

Background: Postoperative pain is a prevalent problem leading to many adverse outcomes in surgical patients. Virtual reality (VR) is an emerging non-pharmacological method of postoperative pain relief, but the effects of it are not clear. This review aimed to explore the effects of VR on relieving postoperative pain. Methods: We searched PubMed, Embase, Web of Science, and other databases from inception to November 2019 to get the eligible studies. Meta-analyses were conducted to compare VR and usual care for relieving postoperative pain. Subgroup analyses and sensitivity analyses were performed to explain the heterogeneity. Results: Overall, 8 randomized control trials (RCTs) enrolling 723 participants were included. Our results demonstrated that the patients receiving the VR intervention had lower postoperative pain scores than those receiving the usual care. One subgroup analysis revealed that VR could relieve postoperative pain both in minor surgery and major surgery. Another subgroup analysis demonstrated a significant reduction in postoperative pain among patients receiving VR during the intraoperative and the postoperative periods. However, there was no significant postoperative pain relief when receiving VR during the preoperative period. Additionally, significant improvements in postoperative satisfaction were reported in two studies. However, another two studies included found that VR could not affect physiological parameters related to pain. Conclusion: Applying VR can relieve postoperative pain effectively. The type of surgery and timing of using VR are the main sources of heterogeneity. More rigorous studies about the relationship between VR and postoperative pain relief will be needed.

Keywords: meta-analysis, postoperative pain, systematic review, virtual reality

Procedia PDF Downloads 103

Authors: Shih-cheng Li, Ming-Yi Chung, Mei-Lien Chen

Abstract:

Background: Plasticizers, such as phthalates and adipates, were substances added to a material that provided flexibility and durability to plastics such as polyvinyl chloride (PVC). Phthalates were generally recognized as an endocrine disrupter due to their estrogenic and anti-androgenic activities. Phthalates had the capacity to bind to estrogen receptors, and hence they might prolong menstrual cycles and increase the proportion of premature menopause. Recently, adipates such as di-2-ethylhexyl adipate (DEHA) and di-isononyl adipate (DiNA) had replaced phthalates and were now used for food packaging. Methods: MCF-7 cell lines were treated with di-2-ethylhexyl phthalate (DEHP), di- 2-ethylhexyl adipate (DEHA), or di-isononyl adipate (DiNA) (10-6 , 10-5 , and 10-4 mol/l), using 17β-estradiol (10-8 mol/l) as a positive control. After incubations of 24, 48, 72, and 96 hours, the cells were tested using the alamarBlue assay. Results: The alamarBlue assay revealed that cell proliferation significantly increased after treatments of DEHP and DEHA for 24 hours at a concentration of 10-6, 10-5, and 10-4 mol/l. After more than 48 hours, cell proliferations in DEHP at 10-6, 10-5, and 10-4 mol/l significantly decreased compared to the control group. Conclusions: The present study demonstrates that adipates, as well as phthalates, were capable of inducing cell proliferation. We further used MDA-MB-231 cell lines to confirm that the proliferation effect was generated through binding to estrogen receptors.

Keywords: MCF-7, phthalate, adipate, endocrine disrupter

Procedia PDF Downloads 270