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Comparison of Management of AVN of Femoral Head by Decompression with TFL Muscle Pedicle Bone Graft and Fibular Graft
Krishna Priya Das,
Nakul Kumar Datta,
Mohamad Quamruzaman Parvez,
Mamunur Rashid,
Habibur Rahman,
Reza Hassan,
Mriganka Bhattachyara,
Jahidul H Khan,
Zahidul Islam,
Rumpa Mani Chowdhury
Issue:
Volume 9, Issue 1, February 2021
Pages:
1-9
Received:
29 November 2020
Accepted:
10 December 2020
Published:
15 January 2021
Abstract: Background: Avascular necrosis (AVN) of the femoral head usually occurs in the active age of life, and is an increasingly common cause of musculoskeletal disability. Objective: we envisage to evaluate and compare the clinic oradiological outcomes between TFL muscle pedicle bone graft and no vascularized fibular grafting after core decompression prior to hip joint involvement of AVN femoral head provides painless and mobile life. Method: January 2013 to December 2019, total 64 hips (44 patients) in the age group of 18–48 years (mean 30.36±4.64 years) were included in this prospective study. Ficat and Arlet staging system was used, Stage I (n=10 hips), Stage II (n=44 hips) and stage III (n=10) of AVN of femoral head, were included after clinical and radiological evaluation, where 32 hips (half of all stage-I, II and III) were treated with fibular graft (Group 1) and rest 32 hips were treated with TFL muscle pedicle bone graft (Group 2) after decompression of femoral head. Preoperative Harris Hip Score (HHS), visual analog score (VAS), plain radiographs, and magnetic resonance imaging (MRI) were compared with serial postoperative HHS, VAS, plain radiographs at regular interval. The average follow up was 56 months. Result: Out of 44 patients, male was 28 (63.64%) and female was 16 (36.36%). Failure of surgery was defined as progression of the disease, which was n=1,10% (1/5, 20% in group 1, 0% in group-2) in stage I, n=12/44, 27.27% (7/22, 31.82% in group-1 and 5/22, 22.73% in group-2) in stage II and n=5/10, 50% (2/5, 40% in group 1 and 3/5, 60% in group 2) in stage III disease. Median values of HHS at the end of the follow up in Group I was 80 and 76 in Group 2, compared to the preoperative HHS of 56 and 52 respectively. Overall satisfactory result was 71.88%, p value was <0.01, that is significant. In group 1 satisfactory result was 22/32 (68.75%) but 24/32 (75%) in group 2, no statistical significant difference (>0.05) between two groups. Even in early stage III disease, only 50% was effective. Conclusion: Core decompression with bone graft is effective in preserving the sphericity of the femoral head and to delay the progression in the early stages of the AVN of femoral head, (Stage I and II), fibular graft gives early stability but long term results are similar in both group.
Abstract: Background: Avascular necrosis (AVN) of the femoral head usually occurs in the active age of life, and is an increasingly common cause of musculoskeletal disability. Objective: we envisage to evaluate and compare the clinic oradiological outcomes between TFL muscle pedicle bone graft and no vascularized fibular grafting after core decompression pri...
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Pre-operative Imaging Avoids Unnecessary Surgery for Suspected Acute Appendicitis
Gavin Nair,
James Virgin,
Tim Kenyon-Smith,
Bev Thomas,
Karolina Juszczyk,
Hidde Kroon,
Paul Hollington
Issue:
Volume 9, Issue 1, February 2021
Pages:
10-15
Received:
15 December 2020
Accepted:
28 December 2020
Published:
22 January 2021
Abstract: Background: The decision to perform an appendicectomy is traditionally based on clinical findings. This approach, however, results in high rates of negative (non-inflamed) appendicectomies with procedure morbidity associated. Therefore, some consider a negative appendicectomy to be a complication since surgical morbidity could have been avoided. The aim of this study was to evaluate the effect of preoperative imaging on the negative appendicectomy rate in case of suspected appendicitis. Methods: The prospectively collected database for all patients who had undergone acute surgery for a suspected appendicectomy, with or without preoperative imaging, was analysed over a 5-year period. Patient and treatment characteristics, histopathology and postoperative outcomes were recorded and analyzed. Results: A total of 2,070 patients were included, 848 (41%) with preoperative imaging (CT, ultrasound or MRI) and 1,222 (59%) without. Imaged patients were older and suffered from more comorbities. The negative appendicectomy rate was 19.2% (n=235) for the non-imaged patients, and 12.4% (n=105) for imaged patients (p<0.0001). When preoperative imaging was performed, a CT-scan was most accurate to diagnose appendicitis correctly compared to ultrasound (93.6 vs. 30.2%, p<0.0001). Median hospital stay was 3.2 days in the imaged group compared to 2.1 days in the non-imaged group (p=0.171). Conclusion: Preoperative imaging significantly reduces the negative appendicectomy rate. In this time of modern imaging modalities readily available, it is recommended to perform preoperative imaging in case of suspected acute appendicitis to avoid unnecessary surgery and associated morbidity.
Abstract: Background: The decision to perform an appendicectomy is traditionally based on clinical findings. This approach, however, results in high rates of negative (non-inflamed) appendicectomies with procedure morbidity associated. Therefore, some consider a negative appendicectomy to be a complication since surgical morbidity could have been avoided. Th...
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The Treatment of Becker’s Nevus by Combination Therapy: Dr. Hoon Hur’s Golden Parameter Therapy and Dr. HOON Hur’s Optimal Melanocytic Suicide-1 Parameter Therapy
Hoon Hur,
Jie Hoon Kim,
Duck Taik Shim,
Suk Jin Choi,
Pyoung Su Kim,
Yu Ri Kim
Issue:
Volume 9, Issue 1, February 2021
Pages:
16-21
Received:
30 December 2020
Accepted:
19 January 2021
Published:
25 January 2021
Abstract: Becker’s nevus, a cutaneous hamartoma, usually occurs as a large, unilateral, hyperpigmented and hypertrichotic patch on the shoulder or upper trunk, which can be present in childhood or adolescence. Becker’s nevus can be treated with traditional laser therapy using various types of lasers including a 532nm potassium titanyl phosphate (KTP) laser, 694nm ruby laser and 755nm alexandrite laser. However, this may cause harmful side effects such as scarring, mottled hypopigmentation, post-inflammatory hyperpigmentation (PIH), purpurae, and crusts. As a result, no standard for the treatment of Becker’s nevus using lasers has been established. Therefore, this study was implemented to investigate the safety and efficacy of treating Becker’s nevus using Dr. Hoon Hur’s Golden Parameter Therapy (GPT) followed by Dr. Hoon Hur’s Optimal Melanocytic Suicide-1 Parameter Therapy (OMS-1 PT) which uses a high fluence 1064nm Q-switched Nd: YAG laser (QSNL). Forty-two Koreans suffering from Becker’s nevus participated in the study and received treatment on a weekly basis for 75-100 sessions using the QSNL according to Dr. Hoon Hur’s GPT then followed by Dr. Hoon Hur’s OMS-1 PT. The parameters for this study were a spot size of 7 mm, a fluence of 2.2 J/cm2 and a pulse rate of 10 Hz using a sliding-stacking technique for a single pass over the Becker’s nevus, followed by Dr. Hoon Hur’s OMS-1 PT using a sliding technique for 5 passes with the QSNL over the Becker’s nevus. Upon completion of the last treatment, all 42 patients with Becker’s nevus were cured, having no side effects, and entirely removing the pigmented lesions. None of the 42 patients reported any recurrences after their follow-ups 6-15 months after the final treatment. As a result of this study, we propose therapy to safely and effectively treat Becker’s nevus using a fusion of Dr. Hoon Hur’s GPT and Dr. Hoon Hur’s OMS-1 PT with a high fluence 1064nm QSNL to avoid any recurrences or harmful side effects.
Abstract: Becker’s nevus, a cutaneous hamartoma, usually occurs as a large, unilateral, hyperpigmented and hypertrichotic patch on the shoulder or upper trunk, which can be present in childhood or adolescence. Becker’s nevus can be treated with traditional laser therapy using various types of lasers including a 532nm potassium titanyl phosphate (KTP) laser, ...
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Post-arthroscopy Tuberculosis of the Knee Joint: An Analysis of Incidence, Presentation, Diagnosis and Treatment Outcome
Wakil Ahmed,
Zinat Rehana Shipu,
Md. Fazlul Haque Qasem,
Md. Abu Awal Shameem,
Shah Muhammad Aman Ullah
Issue:
Volume 9, Issue 1, February 2021
Pages:
22-26
Received:
15 December 2020
Accepted:
4 January 2021
Published:
30 January 2021
Abstract: Introduction: Tuberculosis of the knee joint is not very much common. It is the third highest affected site after spine and hip in osteoarticular tuberculosis. Diagnosis of TB knee is difficult because the clinical features are not typical. Ligaments reconstruction, meniscus surgery and many other procedures can successfully be done by arthroscopy in knee joint. Aim of the study: The aim of this study was to evaluate the incidence, clinical and laboratory findings and assess the treatment outcome of post arthroscopy MTB infections of the knee joint. Methods: This cross-sectional study was conducted in Ibn Sina Knee Centre, Dhaka and Northern International Medical College Hospital, Dhaka, Bangladesh during the period from February 2015 to January 2020. Purposive sampling technique used in the selection of the study patients. Somehow we selected 7 patients for the study with unusual presentations of night cries after arthroscopic procedures. Statistical data were analysed by MS-Excel 2016. Result: We describe 7 cases of isolated MTB infection after arthroscopic procedures in immuno-competent patients as study people for our inquiry. Almost all the study patients 6 (85.71%) treated by anti- TB drugs and 1 (14.29%) treated with MDR-TB drug. Almost all patients 6 (85.71%) had gain excellent results and 1 (14.29%) had good results. So we found a satisfactory result in the post arthroscopy tuberculosis of the knee joint with this treatment. Conclusion: We found Mycobacterium Tuberculosis (MTB) infection as a complication after arthroscopic procedures like anterior cruciate ligament (ACL) reconstruction and or meniscus surgery of the knee joint.
Abstract: Introduction: Tuberculosis of the knee joint is not very much common. It is the third highest affected site after spine and hip in osteoarticular tuberculosis. Diagnosis of TB knee is difficult because the clinical features are not typical. Ligaments reconstruction, meniscus surgery and many other procedures can successfully be done by arthroscopy ...
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Gastrointestinal Trichobezoard Revealed by Intussusception at the University Hospital of Conakry
Camara Fode Lansana,
Balde Abdoulaye Korse,
Camara Soriba Naby,
Balde Habiboulaye,
Diakite Saikou Yaya,
Balde Oumar Taibata,
Toure Ibrahima,
Balde Thierno Mamadou,
Diallo Amadou Dioulde,
Camara Alpha Kabine,
Doumbouya Bourlaye,
Toure Aboubacar,
Diallo Aissatou Taran,
Diallo Biro
Issue:
Volume 9, Issue 1, February 2021
Pages:
27-30
Received:
21 December 2020
Accepted:
11 January 2021
Published:
2 February 2021
Abstract: The aim of this is to make our contribution to the study of Gastrointestinal trichobezoard Introduction: The digestive bezoar is a conglomerate of indigestible substances trapped in the gastrointestinal tract. Aim: The aim was to report an exceptional case of a gastrointestinal trichobezoard revealed by acute intestinal obstruction by ileo-ileal intussusception and to discuss it with data from the literature. Methodology This was a 7-year-old girl who was referred to us from the Nutritional Institute at Donka National Hospital. She presented paroxysmal abdominal pain, vomiting, anorexia and physical asthenia without notion of gas stoppage, evolving for four months. On examination, the patient was in poor general condition with sunken eyeballs. The abdomen was the site of an epigastric mass, mobile and painful. The digital rectal examination noted an emptiness of the rectal bulb. The biological assessment revealed hyperleukocytosis (11.8giga/l); normochromium-normocytic anemia (10g/l). Abdominal ultrasound showed prominent images of distended loops, with material stasis, forming a mass syndrome consistent with a reducible and unstable invagination coil. The diagnosis of acute intussusception was ultrasound. Surgery confirmed intussusception, which was secondary to the entrapment of a trichobezoar in the gastrointestinal lumen. Intestinal disinvagination and extraction of trichobezoar by gastrotomy was the indication. Results the operative consequences were simple. Conclusion: Trichobezoar is a rare condition and the preoperative diagnosis difficult when the notion of trichophagia has not been mentioned. Its treatment is surgical, its prevention requires regular monitoring and psychiatric care.
Abstract: The aim of this is to make our contribution to the study of Gastrointestinal trichobezoard Introduction: The digestive bezoar is a conglomerate of indigestible substances trapped in the gastrointestinal tract. Aim: The aim was to report an exceptional case of a gastrointestinal trichobezoard revealed by acute intestinal obstruction by ileo-ileal in...
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A Review of Capacitive Return Electrodes in Electrosurgery
Paul Richard Borgmeier,
Crystal Diane Ricketts,
Jeffrey Warren Clymer,
Gaurav Gangoli,
Giovanni Antonio Tommaselli
Issue:
Volume 9, Issue 1, February 2021
Pages:
31-35
Received:
19 January 2021
Accepted:
29 January 2021
Published:
9 February 2021
Abstract: Background: Monopolar electrosurgery, one of the most widely used techniques in surgery, requires two electrodes: a working electrode and a return electrode. Commonly, adhesive or “sticky” pads that attach directly to the patient are used as return electrodes. Acting as electrolytic conductors, adhesive pads are highly effective, but require some effort to apply and remove, and if improperly placed or partially detached may lead to high electrical current density and the potential for pad site burns. Alternatively, a capacitive return electrode, such as the Mega Soft pad, may be used that works on the same principle as a two-plate capacitor. Objective: This article details the technology underlying capacitive electrodes, reviews the scientific literature to-date, and provides recommendations on how to best use the Mega Soft pad. Results: No direct contact is required between the pad and patient, and the return electrode is designed so that current density is limited regardless of pad placement, reducing the risk of pad site burn. Although the technology is now mature, having been in the field for over 20 years, best practices for optimal performance from capacitive return electrodes are still not widespread, and misunderstandings persist regarding use of capacitive electrodes with contact monitoring systems and implantable electronic devices. Conclusion: With proper training, capacitive return electrodes may be substituted for conventional adhesive pads with the benefits of easier application and reduced risk of pad site burns.
Abstract: Background: Monopolar electrosurgery, one of the most widely used techniques in surgery, requires two electrodes: a working electrode and a return electrode. Commonly, adhesive or “sticky” pads that attach directly to the patient are used as return electrodes. Acting as electrolytic conductors, adhesive pads are highly effective, but require some e...
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Closed Incision Negative Pressure Therapy for Management of Incision Wounds in the Groin After Revision Vascular Surgery: A Randomized Controlled Trial
Sebastian Paul Pleger,
Liesa Fuhrmann,
Mouiad Al Tattan,
Alexander Kunold,
Meshal Elzien,
Andreas Böning,
Ahmed Koshty
Issue:
Volume 9, Issue 1, February 2021
Pages:
36-44
Received:
29 January 2021
Accepted:
6 February 2021
Published:
27 February 2021
Abstract: Wound healing complications (WHCs) in the groin after vascular surgeries are a serious problem for patients and surgeons in various surgical disciplines. The incidence of WHCs of up to 44% after incisions in the groin is often responsible for prolonged hospital stay and high treatment costs. An effective reduction of WHCs for various wound types after using closed incision negative pressure therapy (ciNPT) has been documented in many case reports and clinical studies. As the majority of studies have addressed the effect of ciNPT on primary groin incision wounds, concerning groin incision wounds after revision vascular surgery are extremely scarce. The aim of this prospective, randomized clinical study was to investigate the effectiveness of ciNPT compared with conventional therapy on groin incisions after revision vascular surgery. We analyzed the cases of a total of 94 patients with 100 groin incisions. Patients were randomized and treated with either PREVENA™ (n=47 groins) or a conventional adhesive dressing (n=53 groins; control group). PREVENA™ was applied intraoperatively and was removed on day 5, 6 or 7 postoperatively. Wound evaluation was carried out on the 5th to 7th and 30th postoperative day. Compared with the control group, the ciNPT group showed a reduction in the overall incidence of WHCs assessed 30 days postoperatively (p<0.0005). With regard to prevention of revision surgeries, the ciNPT had no significant impact (p=0.056). Subgroup analysis revealed a significant effect of ciNPT for almost all wound healing risk factors. Based on our results, ciNPT provides a promising therapeutic option to reduce the frequency of postoperative WHCs and the need for revision surgeries in the groin after revision vascular surgery in patients with wound healing risk factors.
Abstract: Wound healing complications (WHCs) in the groin after vascular surgeries are a serious problem for patients and surgeons in various surgical disciplines. The incidence of WHCs of up to 44% after incisions in the groin is often responsible for prolonged hospital stay and high treatment costs. An effective reduction of WHCs for various wound types af...
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Endovesical Metastasis of a Colic Adenocarcinoma: A Case Report
Mohamed Bouziane,
Omar Mouni,
Wafaa Kaikani,
Meriem Kassimi,
Redouane Rabii,
Abderrahmane Albouzidi
Issue:
Volume 9, Issue 1, February 2021
Pages:
45-48
Received:
29 January 2021
Accepted:
9 February 2021
Published:
27 February 2021
Abstract: Background: Bladder infiltration by neighbourhood tumors is a common situation and can be found in prostate, colo-rectum and genital tumours in women. The main mechanism is a direct invasion of the bladder by the tumor. Intraluminal bladder metastases from distant primary tumors remain exceptional. Patient: We report the case of a 56-year-old patient without any particular medical history initially admitted for an occlusion caused by a transverse colic tumor. The patient did not have clinically haematuria and the initial scan did not show a location or abnormality in the bladder. Initial surgical exploration did not find peritoneal or bladder abnormalities. The patient's evolution will be marked by the appearance of bladder thickening at a distance from the primary tumor and peritoneal carcinosis. The immunohistochemical study in addition to the anatomopathological examination resulted in positive marking of the chorion tubes by anti CDX2 and anti CK 20 and positive marking of surface vesical epithelium by anti P63, anti GATTA3 and anti CK7 which confirmed the colorectal origin of endo-vesical metastasis. Conclusion: We will try through this case report and a review of literature to shed light on this unusual situation and it is important to keep in mind the possibility of remote metastatic location at the bladder of another primary tumor.
Abstract: Background: Bladder infiltration by neighbourhood tumors is a common situation and can be found in prostate, colo-rectum and genital tumours in women. The main mechanism is a direct invasion of the bladder by the tumor. Intraluminal bladder metastases from distant primary tumors remain exceptional. Patient: We report the case of a 56-year-old patie...
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