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Happy Thanksgiving Day

Warm greetings from Crimson Publishers...! Hope this season is filled with Lots of happiness and joy, wealth, and prosperity. May your home be filled with love on this wonderful occasion of Thanksgiving! 

Happy Thanksgiving to you and your family.

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Spontaneous Gall Bladder Perforation: A rare clinical entity, a diagnostic and surgical challenge

Introduction

Gallbladder perforation requiring an emergent treatment is usually a complication of cholecystitis [1]. Acute cholecystitis develops in up to 2% of patients affected by asymptomatic cholelithiasis. Gallbladder perforation occurs in 2 to 11% of acute cholecystitis cases. Due to the high mortality that can be caused by a delay in the correct diagnosis and following adequate surgical treatment, gallbladder perforation represents a special diagnostic and surgical challenge [2].

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Postoperative Complications in Thyroidectomy Performed at Hospital Escuela Universitario and Hospital General San Felipe, Tegucigalpa MDC in 2018

Abstract

Introduction:

Specific complications of thyroid surgery include injury to the recurrent laryngeal nerve and the parathyroid glands, without being exempt from other complications such as infection of the surgical site, bleeding, surgical wound dehiscence, and others.

Methods:

The present study is retrospective observational and aims to analyze the condition of thyroid surgery in the country, specifically in state hospitals in Tegucigalpa, its rate of complications and its relationship with associated factors before the procedure.

Result:

A total of 92 patients undergoing thyroid surgery were studied at the Hospital Escuela and Hospital General San Felipe by reviewing the clinical record. The preoperative status, comorbidities and the surgical procedure performed were recorded and were related to the main complications mentioned above.

Conclusion:

A global rate of complications related to laryngeal nerve injury of 15% and late hypocalcemia of 7% was found, which are higher than the incidences reported in international series, however these vary from 0% of recurrent laryngeal nerve injury in thyroidectomies subtotal up to 22% in radical dissections in patients with neo proliferative processes.

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Non Tuberculous Mycobacterium as a Causative Factor in Port Site Wound Infection - A Case Report

Abstract

Over the two decades there has been an increase in Non Tuberculous Mycobacterium (NTM) organisms in post laparoscopic port site skin and soft tissue infections. Presenting a patient who underwent eight successive surgical explorations of multiple skin and soft tissue sinuses and for aggressive necrosectomy and debridement of multiple sinuses caused by NTM organisms which ended up in abdominoplasty and meshplasty 2 months after the infection had been completely controlled. She finally had complete relief from the infection and had 6 months follow up from the last meshplasty surgery. The presentation and treatment of NTM skin and soft tissue infection are briefly outlined.

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Urgent Myocardial Revascularization after Previous Surgery for Gunshot Wounds to the Heart and Lungs

Abstract

Due to the full-scale invasion of the Russian Federation in Ukraine, many patients with injuries of various nature and severity appeared. Damage to the heart and blood vessels is the biggest threat to human life. Patients with injuries of this nature have been treating in Amosov National Institute of Cardiovascular Surgery since the first day of the war. One of them was young man with elevation of the ST segment after surgery for gunshot wounds to the heart and lungs. After non-invasive research methods, coronary angiography was performed followed by an attempt of endovascular revascularization. Due to the impossibility of complete blood-flow restoration and dye extravasation patient was directed to urgent surgical treatment [1].

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Skin Grafts in Plastic Surgery: Review Article

Abstract

Skin grafts within plastic surgery are highly performed and constantly updated procedures, being the second most performed procedure worldwide in this specialty and, in turn, the one with the greatest comorbidities associated with poor management. The skin is the largest organ of the human body, which is why different plastic surgery techniques have been developed. This bibliographic review provides a historical, histological, morphofunctional and procedural overview of grafts. Which have great importance within the surgical unit.

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Umbilical Cord True Knot and Overcoiling: A Dangerous Association

Abstract

The association of true knot and overcoiling of cord is a rare and risky condition during pregnancy. Most knots are loose with no clinical significance, but when becoming tight, they may damage fetal circulation and give a sudden Intrauterine Death (IUD). Coils number/cm identifies Umbilical Coiling Index (UCI). Hypercoiled cords is defined when UCI exceeds 0.3 coils/cm. We report one case of a double rare congenital anomaly occurred at Catania S. Marco’s University-Hospital. A 37 years old, para 1: a previous Caesarean Section (CS), gravida 2, was admitted to hospital and an unexplained intrauterine fetal demise at 37th week of gestation was diagnosed. Following CS, a female stillborn of 2,300 grams with large areas maceration signs was extracted. A combination of true knot and spiralization of umbilical cord was observed and identified finally, as death trigger following fetal hyper mobility. Since the movements of the child and the onset of both knot and coiling cord with mechanical ischemic alterations, do not depend on the correct management but often on fortuity, this event is unpredictable, and no fault can be attributed to the medical team.

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Easter Wishes-Crimson Publishers

Happy Easter!

Wishing you and your family the happiest and blessed Easter of all. God bless you now and always.

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Complicated Congenital Diaphragmatic Bochdalek Hernia in Adult-Crimson Publishers

Complicated Congenital Diaphragmatic Bochdalek Hernia in Adult by Allan Fernando DM in Surgical Medicine Open Access Journal-Crimson Publishers : Crimson Publishers- Journal of Surgical Medicine

Diaphragmatic hernia is an extremely rare entity in adults, it is defined as the transposition of abdominal organs to the thoracic cage, through defects of the phrenic muscle. They can be classified as congenital or acquired. The incidence is reported to be 0.17%, with most hernias occurring on the left side. In Honduras there are few cases reported in pediatrics and one case reported in adults. 53-year-old male patient, farmer, from Tegucigalpa, Honduras. Who attended the Surgery Emergency at the Hospital Escuela Universitario? With a single history of chronic alcoholism, she presented stopping of evacuation of 10 days of evolution which channeled gases, accompanied by abdominal distention in turn, abdominal pain of 1 week of colic-like evolution, in the left iliac fossa irradiated to the flank and right hypochondrium, progressive insidious onset, of mild to moderate intensity, sometimes it did not remit with analgesics, accompanied by dyspnea from small to medium efforts and paroxysmal episodes of cough, without cyanosis. Abdomen: globose at the expense of adipose tissue, distended, on auscultation with abolished bowel sounds, tympanic percussion, with pain on superficial and deep palpation with involuntary muscular resistance. The chest radiograph showed the presence of intestinal and stomach loops in the left hemithorax. Abdominal radiographs show hydroaerous levels, with an image of a pile of coins, with dilated loops of the large intestine. After laparotomy, the patient presented a satisfactory evolution, with subsequent hospital discharge.

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Is H. Pylori the New Risk Factor for GB Cancer? -Crimson Publishers

Is H. Pylori the New Risk Factor for GB Cancer? by Shilpi B in Surgical Medicine Open Access Journal-Crimson Publishers : Crimson Publishers- Journal of Surgical Medicine

Abstract

To find out the various clinicopathological presentations of gall stone disease with special relation to H. pylori infections of Gall Bladder. Institution based observational study in a tertiary care center. A total of 50 patients were selected who were admitted with the diagnosis of cholelithiasis and planned for cholecystectomy. Gallbladder specimen was then sent for routine H&E stain and additional Giemsa stain. Patients were grouped under two categories based on result of Giemsa stain. Out of which 10% showed the presence of H. pylori in the GB wall specimen. The presence of H. pylori in gall bladder wall was mostly seen in patients depicting chronic cholecystitis features on histopathological examination. Chronic cholecystitis is one of the most common risk factors for development of GBC. And inflammation being an important predisposing factor for development of cancer, could help us establish a relationship between GB cancer and H. pylori. Thus, in areas of high prevalence of GBC, like the gang belt H. pylori should further be evaluated as an etiological agent for the development of gall bladder cancer.

Keywords: H. pylori; Cholelithiasis; Gall bladder cancer (GBC); Cholecystitis

Introduction

India is a high incidence area for GBC. GBC is one of the three leading cancers among women of North and North-east India. The incidence has been steadily rising in India among women as well as men. India accounts for 10% of the global burden of GBC. In India, the incidence of GBC is 10 times higher in north India compared to the southern Indian states [8.9/100,000 population (Delhi) VS. 0.8/100,000 population (Chennai)] [1]. Gallbladder Cancer (GBC) arises from the epithelial lining of the Gall Bladder (GB) and the cystic duct (Figure 1). It is the most common biliary tract malignancy worldwide and manifests as either diffuse thickening of the GB wall or as a GB mass arising from the fundus, neck or body of the GB [2]. Helicobacter species has been associated with increased risk of GBC. H. pylori was first described in the gallbladder mucosa in patients with gallstones 1996, and a relationship between H. pylori and gallstone formation was reported [3]. All studies from India have shown a definite but small risk of H. pylori in the causation of GBC. It is hypothesized that a relationship like that of H. pylori and gastric carcinoma exists in the gall bladder (Figure 2). According to this, H. pylori is a causative agent of gallbladder cancer by causing chronic cholecystitis due to gall stones and later developing dysplasia, metaplasia and carcinoma. A history suggestive of chronic cholecystitis is present in approximately 50 % of the GBC patients. Recently, inflammation was distinguished as a hallmark of cancer. Increasing proof demonstrated that a large number of tumors originate from sites of chronic inflammation, which supports the perspective that chronic inflammation can incline to cancer [4]. Chronic inflammation plays a serious role in evoking cancer development in the gallbladder.

Aims and Objective

To study the presence of H. pylori in cholecystectomy specimen of patients of gall stone disease and its co-relationship with histopathological changes.

Material and Methods

A total of 50 patients who presented to surgery department with diagnosis of gall stone disease from the month of April 2020 to October 2020 were included in the study. The study was started after approval from the ethical committee of the medical college (Table 1). These patients were selected randomly between the age group of 18-60 years, with informed written consent and a proforma was created and filled by every patient. Patient taken treatment for H.pylori eradication in the past 6 months were excluded from the study. Patient underwent cholecystectomy, Gall bladder specimens was sent for histopathological examination in 10% buffered formaldehyde solution. Gross tissue processing and routine H&E staining of the sections was done as per standard lab protocol (Table 2). Additional sections were taken and subjected to Giemsa staining. The results were studied and compared according to the HPE findings. Based on HPE report, patients will be divided into two categories H. Pylori positive and negative group. Further the two groups shall be compared based on the histopathological findings as follows: A. Inflammation B. Hyperplasia C. Pyloric and intestinal metaplasia D. Dysplasia E. Cancerous changes.

Result

Among the 50 patients included in the study, 20% (10) were male and 80% (40) were females. Out of which 93% were symptomatic for gall stone disease and all of them were diagnosed for cholelithiasis based on USG findings (Table 3). The histopathological report depicted chronic inflammation/ cholecystitis in 90% (45) of the patients. 20% (10) patients showed acute and acute on chronic inflammation. Presence of inflammation of depicted in 48/50 patients, accounting for 96% patients .74% (37/50) patients showed metaplasia in GB wall on HPE. Hyperplasia was seen in 10% of the cases. Cancerous changes were evident in 4% (02) of evaluated cases. 10% patients showed presence of H. pylori with Giemsa staining in GB wall. Out of the 10%, every patient had chronic cholecystitis appearance on HPE.

Discussion

The true prevalence and relationship of different species of Helicobacter in the pathogenesis of these diseases is not known. There is currently insufficient evidence regarding the route whereby H. pylori settles in the gallbladder. It may reach the gallbladder via an ascending route from the duodenum or via the portal circulation system [5]. Researchers continue to discover new associations between H. pylori and idiopathic diseases, as well as potential benefits of H. pylori infection. Zhou 14 found H. pylori in 20% of chronic cholecystitis cases, and also emphasized that gallbladder metaplasia and pre-malignant lesions such as adenomyomatosis were more frequent in patients positive for gallbladder H. pylori [6]. In another study, Hassan [7] 19 reported that H. pylori infection aggravated potentially precancerous mucosal lesions. Helaly [8] in their study also showed the presence of H. pylori in almost 40.9% of samples in patients with chronic calcular cholecystitis. They also found a significant association between gastric and gall bladder H. pylori positivity. The source for gall bladder infection may be gastric colonization with H. pylori. They suggested that H. pylori may act as a lithogenic component, especially in presence of pure pigmented gallstones. Bansal, they concluded that there was a high prevalence of H. pylori infection in the gallbladder in northern Indian patients undergoing cholecystectomy for benign gallbladder disease which was detected only by PCR. Mishra [9] H. pylori may be endemic to the Varanasi region and may not play a significant role in the etiopathogenesis of gallbladder cancer in that region. They concluded that H. pylori colonizes areas of gastric metaplasia in gallbladder producing histological changes like those in gastric mucus. A recent study has shown that H. pylori can damage human gallbladder epithelial cells in vitro and could be the key factor that leads to clinical Cholecystitis. Histological changes, considered preneoplastic, were demonstrated in the mucosa of gallbladder, limited to mice infected with Helicobacter spp such as, intestinal metaplasia, hyperplasia, dysplasia in addition to eosinophilic inflammation and hyalinosis. Higher prevalence of cholesterol stones in the North Indian population and presence of heavy metals in the water and soil of the Indo Gangetic plains have been postulated as the reason for the same.

Conclusion

H. pylori was found in 10% of the patients included in this study. GBC being asymptomatic, is usually diagnosed in later stages. Therefore, any risk factor that could be evaluated earlier could be an added asset for the early diagnosis of GBC. It raises chances of potential prevention of this disease by eradication of H. pylori through medical therapy. Also, clinicians treating patients with gastric H. pylori infection need to be aware that associated gall bladder disease may need attention at the same time.

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Happy Thanksgiving Day-Crimson Publishers

Hope this season is filled with Lots of happiness and joy, wealth and prosperity. May your home be filled with love on this wonderful occasion of Thanksgiving!

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Primary Torsion of Omentum-Case Report_Crimson Publishers

Primary Torsion of Omentum-Case Report by Momcilo S in Surgical Medicine Open Access Journal

The purpose of the study is to report a case of spontaneous, primary torsion of omentum. The analyses showed the signs of inflammation, and the main symptom was vomiting. Physical examination: high tenderness and guarding in the ileocecal region. It was decided to operate on the patient immediately since the pain was severe and it was treated as an urgent case of appendicitis. The study aims to present that the typical clinical presentation of appendicitis can have other causes, for example, the torsion of omentum. The torqued part was gangrenous, and it was resected. In the last 40 years, this has been the first registered case in our hospital. Having done the MEDLINE literature review, we are proposing a more elaborate classification of the torsion of omentum.

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Diagnostic and Therapeutic Characterization in Patients with Colorectal Cancer, Hospital Escuela, 2016-2019_Crimson Publishers

Diagnostic and Therapeutic Characterization in Patients with Colorectal Cancer, Hospital Escuela, 2016-2019 by Allan Fernando DM in Surgical Medicine Open Access Journal

Colorectal cancer is defined as the uncontrolled growth of cells in the colon and/or rectum. Objective: Characterize the diagnosis and therapy performed in patients with colorectal cancer, Hospital Escuela, 2016-2019.

Methodology: A quantitative, descriptive, cross-sectional, retrospective study, with a universe of 92 files with a sample of 75 files and one of ours Non- Probabilistic, collecting data at the Hospital Escuela, generating an emptying with Epi Info and Excel, as well as analyzing the data by Average frequencies and percentages, including complete records of elderly people with a confirmed diagnosis of colorectal cancer and excluding those who have been used for legal proceedings, was approved by the Ethics Committee of the UIC-FCM-UNAH.

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An Affordable Way to Treat Frozen Shoulder_Crimson Publishers

An Affordable Way to Treat Frozen Shoulder by Majid MM in Surgical Medicine Open Access Journal

Frozen shoulder, or adhesive capsulitis, a condition characterized by pain and stiffness in the shoulder. And over time, moving the shoulder becomes difficult and extremely painful. It commonly affects people between 40 and 60 of age and occurs in women more often than men. People with diabetes are more likely to develop frozen shoulder. Physical therapy, with a focus on shoulder flexibility, is the primary treatment recommendation for frozen shoulder. In an attempt to find an accessible and effective way to treat the frozen shoulder, a sample of 13 volunteers with the frozen shoulder was selected and asked to follow the following method, which involves exposing the affected shoulder to a stream of hot water (Maximum tolerable water temperature ≈40 °C) for a continuous 5-7 minutes, with a rotating movement of the shoulder. Eight of the thirteen patients had symptoms that disappeared permanently and no longer felt pain or stiffness, and their normal ability to move the shoulder joint returned to its previous state before the disease. In the other five patients, the symptoms improved significantly, with some symptoms remaining and some limited movement. This may be related to not reaching the required time and temperature. Which may require repeated trying one or more times to reach the desired recovery.

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For the Right Hemiliver Graft May Need Tissue Expander After Living Donor Liver Transplantation

For the Right Hemiliver Graft May Need Tissue Expander After Living Donor Liver Transplantation by Batsaikhan B in Surgical Medicine Open Access Journal

Introduction: Hepatic venous outflow is an important for the graft survival in living donor liver transplantation. Hepatic venous outflow obstruction generates liver failure, which may influenced due to graft malposition, which unsized upper part of abdomen between donor and recipient. The number of Liver Transplantation (LT) increases last few years, which is related with populating the high surgical technology in developing country like in Mongolia. The main reason of LT is a hepatitis B virus-related liver cirrhosis in Mongolia. Liver transplantation had started since 2011 under the supporting of Professor Sung Gyu Lee from hepato-biliary surgery and liver transplantation of ASAN Medical Center. Veno-Occlusive Disease (VOD), Budd-Chiari Syndrome (BCS), and Congestive Hepatopathy (CH), all of which results in hepatic venous outflow obstruction. The early Hepatic Venous Outflow Obstruction (HVOO) is a rare, however that could raise a serious complication as a graft failure and eventual lose. We report a case of early HVOO, which may result of size mismatch of abdominal cavity. The size mismatch of abdominal cavity may produce kinking syndrome after transplantation of right lobe, which reveals the HVOO without anastomosis complication. Methods: A 38-year-old male patient with liver cirrhosis due to HBV, HDV, HCC in S8 of the liver (CTP-B, MELD-18). On the first postoperative day the patient developed impairment of the liver function. Doppler ultrasound (US) showed the different speed of RHV preanastomosis and postanastomosis field. This was diagnosed acute liver failure due to veno-oclusive disease, after that started intensive therapy

https://crimsonpublishers.com/smoaj/pdf/SMOAJ.000584.pdf

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Approaches to the Management of Elective Patients in General Surgery During Covid-19 Pandemic_ Crimson Publishers

Approaches to the Management of Elective Patients in General Surgery During Covid-19 Pandemic by Aktokmakyan TV in Surgical Medicine Open Access Journal

Abstract Objective: Recently published papers have defined the clinical characteristics and overall outcomes of COVID-19 patients with the influence on the healthcare system. Especially, general surgeons are uniquely affected due to the broad range of procedures they perform, many of which are conducted routinely in the outpatient setting. This report aims to represent the clinical presentation and outcomes of elective surgical patients during the COVID-19 epidemic. Methods: We designed a retrospective study of elective surgeries from 13 March to 13 May 2020 in Bagcilar Training and Research Hospital, a pandemic hospital in this period.

https://crimsonpublishers.com/smoaj/pdf/SMOAJ.000583.pdf

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Management of Extramedullary Hematopoiesis: Why is a Hematologist’s Opinion Important_Crimson Publishers

Management of Extramedullary Hematopoiesis: Why is a Hematologist’s Opinion Important by Ankita Sen in Surgical Medicine Open Access Journal

Extramedullary Hematopoiesis (EMH) is a compensatory mechanism in response to ineffective hematopoiesis or stress erythropoiesis, in sites other than the bone marrow. The EMH often presents as pseudotumors and may be confused with other benign or malignant tumors. The cause of EMH often is an underlying hematopoietic disorder, and it may be adequately treated by treating the underlying cause. This will avoid unnecessary surgical interventions. Hence, knowledge of this entity is of utmost importance, and careful history, clinical examination and necessary investigations must be carried out before deciding the course of therapy.

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