Περιεχομενα


Τόμος 24, Τεύχος 1
Ιανουάριος-Μάρτιος 2019


Ερευνητικές εργασίες
1Comparative study of the sensitivity and specificity value between Veterans Affairs Medical Center (vamc) score and Rotterdam score in predicting the occurrence of post laparotomy abdominal wound dehiscence
Alsen Arlan , Hendri Farozah
Πλήρες Κείμενο | Περίληψη
Background: Abdominal wound dehiscence is a serious postoperative complication. The incidence in adults was reported ranging from 0.3 to 3.5% and the chance increase up to 10% in elderly patients. Currently, the mortality rate reported was about 20-45% in the preoperative stage. Webster et al (2003) used the prognostic model of Veterans Affairs Medical Center (VAMC) risk score in the study to elucidate the predictive value for wound dehiscence. On the other hand, Ramshorts et al (2006), introduced model of Rotterdam risk prognostic scores in predicting occurrence of surgical wound dehiscence after laparotomy. In Indonesia, the use of this scoring system in predicting the occurrence of wounds dehiscence post abdominal surgery has not been widely used. Hence, to improvise the quality of surgery in the hospital, it is imperative for best scoring system to be implemented.Aims and Methods: To determine the prognostic value of the VAMC scoring system and Rotterdam Score in predicting the occurrence of post laparotomy abdominal wound dehiscence in patients treated in Dr. Muhammad Hoesin General Hospital (MHGH), Palembang and to determine which scoring system provides a higher prediction accuracy. This study was a descriptive and analytical study to assess the scoring system of VAMC and Rotterdam. The degree of compliance (Kappa values) in predicting laparotomy surgery wound dehiscence was also being assessed.Results: There were 47 patients who underwent laparotomy surgery, either emergency or elective involved in this study. VAMC scores on point > 12 provide prediction with 100% sensitivity and 90.2% specificity. Meanwhile, score of Rotterdam on point > 4.8 portrayed a value of 83.3% sensitivity and 82.9% specificity. The degree of conformity (Kappa value) between the two scoring systems showed that VAMC scoring system is better than the Rotterdam scoring system with the value 0.70.Conclusion: VAMC is a better scoring system in predicting the occurrence of surgical wound dehiscence after laparotomy, but Rotterdam scores is still considerable to be applied because it has a high sensitivity and specificity prediction.
5Quality of life of patients after surgery for post-pneumonic empyema thoracis
Anna Dalipi , Sokratis Tsagkaropoulos , Christos Papakonstantinou , Georgios Tagarakis , Kyriakos Anastasiadis , Christophoros N. Foroulis
Πλήρες Κείμενο | Περίληψη
Objectives: The objective of the study is to investigate how and how long surgery performed for the treatment of post-pneumonic empyema thoracis affects the quality of life (QoL) of patients.Methods: This is a prospective, non-randomized observational study including 42 consecutive, fully employed at the time of surgery, patients (men: 32, mean age: 48.0±12.8 years, variance: 18-65 years) who underwent surgery for empyema thoracis. All the included in the study patients were evaluated before the procedure, the first week after surgery and at 3 and 6 months after surgery by spirometry, pulse oximetry, chest radiography at two levels and assessment of QoL using the SF-36 questionnaire according to the research protocol.Results: Significant improvement of spirometric values was observed during the follow-up time period, especially during the time elapsed between the first week and one month after surgery. Significant, gradual recovery of postoperative chest radiographs was observed throughout the follow-up period. No significant changes were observed in the parameters physical and social role of the SF-36 questionnaire. All the other determinants of the QoL in the SF-32 questionnaire (physical performance, pain, general health, vitality, emotional role, mental health) improved significantly throughout the follow-up time period, while the sickness leave of patients after surgery for empyema was quite long (65.9±21.2 days).Conclusions: Surgery for empyema seriously affects QoL of patients for a long time period and requires long sickness leave for rehabilitation. QoL improves gradually to normal throughout the 1st semester after surgery.
11Seasonal Changes of Non-Traumatic Amputations
Ali Sapmaz , Tolga Dinç , UfukUtku Göktuğ , Betül Keskinkılıç , Serdar Gökay Terzioğlu
Πλήρες Κείμενο | Περίληψη
Background: Amputations implemented for non-traumatic reasons, such as diabetics and ischemia, are observed with increasing frequency in the clinical environment. The rates of implementation of these amputations are observed to increase in some seasons. In this study, the aim was to examine the seasonal changes in the number of non-traumatic amputation procedures for small or large joints applied in our clinic, and possible causes that play a role in these changes. Material and Methods: Patients who underwent amputation for non-traumatic ischemic and diabetic foot ulcer were included in the study. Study was designed as retrospective clinic study. All the data were obtained from patients’ files and processed via SPSS. Results: 762 patients were included in the study. 547 (71.8%) of the patients were male and 215 (28.2%) of them were female. 508 of the patients received minor amputation and 254 (33%) received major amputation. According to the seasons: 159 (20.9%) of the patients underwent operation in spring, 232 (30.4%) underwent operation in summer, 187 (24.5%) underwent operation in autumn and 184 (24.1%) underwent operation in winter.Conclusion: In the summer months in comparison to the other season months, an increase is detected in the rate of amputations.
13Surgical site infection after insertion of spinal instrumentation in HIV-positive patients
Shekar Roopan , Shunmugam Govender , Mohammed Rasool
Πλήρες Κείμενο | Περίληψη
Background: Surgical site infection (SSI) following spinal fusion in HIV endemic settings is poorly described. A description of SSI following spinal fusion in HIV endemic areas would likely lead to improvements in HIV-positive patient management in these areas. This was the rationale for our study.Patients and Methods: This was a retrospective case series of 13 adult HIV-positive patients who developed SSI following an index spinal fusion surgery at a South African hospital during 2014. Data related to the index surgery, demographics, HIV-related characteristics, SSI risk factors, microbiological cultures from pus swabs obtained during surgical management of post-spinal fusion SSI, and management-related information were collected from each cases’ medical record. Data were analysed using descriptive statistics.Results: The most important findings were that 1) All cases (13/13, 100.0%) suffered deep incisional SSI; 2) There are differences in particular SSI risk factors between high- and low-prevalence HIV settings; 3) The causative agent could not be identified in the majority (9/13, 69.2%) of SSIs; and 4) Surgical intervention for SSI was performed in all cases (13/13, 100.0%), without further complications.Conclusion: In a setting where HIV is endemic, deep SSI is the most common class of post-spinal fusion SSI in HIV-positive patients. Differences in particular SSI risk factors between high- and low-prevalence HIV settings requires further investigation. Atypical microorganisms are important causative agents of post-spinal fusion SSI in HIV endemic settings. HIV-positive patients can be successfully managed for post-spinal fusion SSI through conventional surgical methods and care.

Ενδιαφέρουσες περιπτώσεις
18Appendicular Abscess with Anterior Abdominal Wall Extension in Elderly
Chan CH , Ziyadi G , Yan YW , Nurul BB
Πλήρες Κείμενο | Περίληψη
Background: Acute appendicitis remains one of the most common disease conditions in general surgery. Appendicitis with abscess formation and extension to anterior abdominal wall is rather rare.Case presentation: We report a case of a 75-year-old gentleman presented with painful right iliac fossa swelling, diarrhoea and reduced oral intake. Clinically abdominal wall abscess was elicited at right iliac fossa. However, abdominal CT demonstrated appendicular abscess with possible extension into the right anterior abdominal wall. He then underwent an emergency appendectomy and drainage of the abdominal wall abscess. Histopathologic report confirmed the diagnosis of appendicitis. Postoperatively, he was kept in ward for 2 weeks due to paralytic ileus and nosocomial pneumonia.Conclusion: Anterior abdominal wall abscess as a result of extension of appendicular abscess is a rare presentation. It needs to be considered in elderly age group in which late presentation always occurs, leads to perforation, abscess formation and subsequently extension into anterior abdominal wall.
21Rare Presentation of Bilateral Phylloides Tumor In A Prepubertal Girl
GH Loo , Latiff JA
Πλήρες Κείμενο | Περίληψη
Phylloides tumors are rare fibroepithelial tumors, accounting for less than 1% of all breast tumors. Phyllodes tumor in children and adolescent is even more unusual. The median age of occurrence of this disease is usually 40-50years old, although the youngest reported case is in a 6-year old girl. With that in mind, we would like to report a case of bilateral borderline phyllodes tumor in a pre-menarcheal 12-year-old girl, including its preoperative diagnostic difficulties, and subsequent management. A right mastectomy and a wide local excision of the left breast lesion was subsequently performed. As phyllodes tumor occurring in children and adolescent are rare occurrences, a high clinical index of suspicion is essential, with the treatment regime individualized, adopting a more conservative breast-conserving surgery. This should be then followed up with a reconstructive surgery later if required, and a close serial triple assessment.
24Rare case of Advanced Squamous Cell Carcinoma of the Thyroid Masquerading as Miliary Tuberculosis
Nasir RA , Jagwani A , Safian NM
Πλήρες Κείμενο | Περίληψη
Background: Primary squamous cell carcinoma (SCC) of thyroid is an extremely rare malignancy and has been reported to have a very poor prognosis. It makes up less than 1% of all thyroid malignancies and has been reported fatal within a short period of months. The median age is 5th till 7th decade but can be has been reported in various ages. Death in these patients are because of extensive secondary deposits to lungs or direct invasion onto the trachea. While making a diagnosis, the probability of the tumor arising from neighboring structures (esophagus, larynx) or metastatic disease from a primary growth somewhere else (lungs) must be pondered before settling for a diagnosis of primary SCC of thyroid. We report a case of an aggressive primary SCC of thyroid who came at a late stage who succumbed before a chance of treatment before discovering it was not a case of miliary Tuberculosis.
27An Unusual Cause of Temporomandibular Joint Dislocation due to Bonfils Intubation Technique
Nazimi AJ , Joanna OSM.
Πλήρες Κείμενο | Περίληψη
Background: We report an unusual cause of temporomandibular joint (TMJ) dislocation due to Bonfils rigid fiberoptic endoscopic intubation in two patients with anticipated difficult airway who underwent surgery under general anesthesia. To the best of authors knowledge this complication is scarcely reported within the literature. Case Presentation: In the first illustrated case, the diagnosis of the dislocation was delayed as the patient was ventilated postoperatively. It was only diagnosed 40 hours later following extubation when patient complained of pain and inability to close his mouth. In contrast, there was an immediate diagnosis on clinical ground in the second case as patient was immediately extubated and transferred to the ward. Reduction was subsequently performed successfully in both patients. Conclusion: When Bonfils intubation rigid fiberoptic endoscope is used, clinicians should always immediately examine patients postoperatively to rule out the possibility of TMJ dislocation due to excessive jaw thrust involved. Emphasis should also be given for patients with a known history of TMJ disorder. Early recognition and appropriate management would reduce the incidence and its associated complications.
30A Rare Case of Breast Malignant Phyllodes Tumor With Metastases to the Oropharynx and Larynx
Kutubudin AFM , Hamal MH , Kumar L
Πλήρες Κείμενο | Περίληψη
Oropharynx or laryngeal metastasis is very rare. Metastasis of a phyllodes tumor to the oropharynxis an extremely rare condition with important clinical implications. We herein report a rare case of malignant breast phyllodes tumor with oropharyngeal/laryngeal metastasis. A 68 years old Malaysian woman received surgery (right mastectomy) for malignantphyllodes tumorin March 2016 and subsequently completed 35# of radiotherapy in August 2016. Eleven months after the initial surgery, local recurrence of malignant phyllodes tumorand distant metastases to chest wall and lymph nodes were detected and within 1month, she presented again with acute stridor and impending airway obstruction. Airway was secured surgically,and laryngoscopy biopsy revealed an oropharyngeal and laryngeal metastasis from the malignant phyllodes tumor. She was diagnosed of having malignant phyllodes tumorof the right breast with oropharyngeal and laryngeal metastasis. Currently, she already completed 3 cycles of palliative chemotherapy.A patient with a malignant phyllodes tumor of the breast with oropharyngeal and laryngeal metastasis is reported here, along with a discussion of the relevant literature of this very rare pattern of metastasis
34Atypical Presentation of Central Venous Occlusion (CVO) Disease
R. Rosnelifaizur , I. Aizat Sabri , I. Azim , H. Hanafiah
Πλήρες Κείμενο | Περίληψη
Chylothorax is an accumulation of lymph (containing a great amount of lymphocytes, triglycerides, and chylomicrons) in the pleura due to the blockage of thoracic duct drainage. The etiology may be from either traumatic or non-traumatic causes (sarcoidosis, neoplasm, chest irradiation, SVO etc), however there also have been reported as idiopathic forms. Direct trauma and malignancy are the most common causes of the chylothorax in adult with reported incidence of 50% and 30% respectively. However, the central vein thrombosis as a cause of chylothorax is uncommon and only a few cases has been reported in literature. It was mainly related with central venous catheterization. We reported a case of end stage renal failure (ESRF) patient with a previous history of central venous cannulation before and presented with persistent unilateral chylothorax.
36A rare tumor of the fatty tissue in the axilla; hibernoma
Sertkaya M , Emre A , Baykara M , Bahar AY , Kale İT
Πλήρες Κείμενο | Περίληψη
Background: Hibernomas are rare benign tumors of brown adipose tissue. They usually grow slowly without pain and cause symptoms due to the compression of adjacent tissues.Case Report: We want to share a case of a 31-year-old female patient who was diagnosed with hibernoma of the left axilla. The patient presented with a complaint of swelling in the left axilla. Ultrasonography revealed a heterogeneous mass of 49x42 mm in size surrounding the axillary vessels. Firstly, a biopsy was performed considering breast-induced malignancies. Preoperative computed tomography and magnetic resonance imaging were performed to clarify the relationship with the surrounding structures. The tumor tissue was successfully removed completely. The tumor showed growth at the time of the first application until the time of surgery, and when it was removed, it reached a size of 100 mm. Pathology revealed a tumor with S-100 positive staining and other features of hibernoma. Conclusion: Treatment of hibernomas is surgical excision and no recurrence, metastasis or malignant transformation has been reported. Hibernomas should not be confused with other soft tissue tumors.

Εικόνες στη χειρουργική
39Malignant Melanoma of the Anal Verge
Eleanor Felsy Philip , R Pravin Ramudaram , Rosdi Pon , Adrian Gerard
Πλήρες Κείμενο

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40Laparoscopic complementary radical resection for a T2b gallbladder adenocarcinoma after laparoscopic cholecystectomy
Petras P. , Bratko Α. , Zacharioudakis G. , Arapoglou S. , Lagopoulos V. , Gkoutziotis I. , Kamparoudis A.
Πλήρες Κείμενο | video



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42Early Resectional Debridement for Blunt Liver Injury: Still a Treatment Option?
Tan JH , Yuzaidi M , Tan HCL , Rizal IA
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45Transcervical submandibular approach for parapharyngeal tumour excision: a technique for complete safe tumour removal
Sanjeevan N , Irfan M , Jawaad AA , Baharudin A
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49Mediastinal goiter : when to do sternotomy
M.Rohaizak , AR Nor Faezan , O Suraya , AS Shahrun Niza
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52A Case of Warty Carcinoma of the Penis
LY Lim , P Singam , FH Imran
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