Introduction: Aim of this meta-analysis was to compare short term outcomes of laparoscopic and open gastrectomy for gastric cancer. Material and methods: EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for randomized control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30 days morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2gastrectomies, lymphnode retrieval, operative time, distal gastrectomy, wound complications, and intraabdominal complications Systemic review and Metanalysis were done according to MOOSE and PRISMA guidelines. Results: Morbidity was significantly low in laparoscopic group(P=0.003). There was no significant difference between mortality between the two groups. (P=0.75). There less wound complications in laparoscopic group, no difference intra-abdominal complications in both the groups. Blood loss was significantly lesser in laparoscopic group. (p 0.001). Hospital stay was similar in laparoscopic group. (P=0.30). Operative time was significantly higher in laparoscopic group. ( P 0.001). Laparoscopic group patients had a smaller number of lymph node retrieval compared to laparoscopic group. (p = 0.002). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies. (p= 0.64) Conclusions: Laparoscopic gastrectomies were associated with better short-term outcomes.

The aim of this retrospective study is to analyze the causes of bile leaks after laparoscopic cholecystectomy and the possible options for their management. Material and methods: Between January 2011 and December 2020, 1196 patients underwent laparoscopic cholecystectomy in our department. Postoperative bile leaks occurred in 15 patients. The amount of bile discharge, associated complications, need for interventional management, morbidity and mortality were evaluated. Results: All but one patients were diagnosed during the first 24 postoperative hours. In 4 patients with a low output from the drain, bile leak was resolved spontaneously. Among the 11 patients with major bile leakage and signs of biliary peritonitis, 6 underwent a laparotomy. In 2 cases, a dislodgement of a clip and an orifice near the clip in the cystic-hepatic junction was identified. In one case the lesion was dealt with by suturing the injury over a T-tube and drainage of the underlying biloma and in the other one with ligature of the cystic stump. One case of leakage from the cystic duct stump was managed with ligation of the stump. Finally, in the remaining 3 cases the leakage was coming from an accessory bile duct in the liver bed. The accessory duct was ligated and the liver bed sutured. Five patients with mild symptoms underwent endoscopic retrograde cholangiopancreatography (ERCP) which revealed leakage from the cystic duct in 4 cases and from a laceration of the common bile duct cystic in the remaining one. All cases were successfully managed in a tertiary center with ERCP – sphincterotomy and insertion of a stent into the bile duct. Complications due to the management of bile leaks included one deep vein thrombosis and two acute pancreatitis. Conclusions: Management of bile leaks after laparoscopic cholecystectomy depends on the output of bile, their cause and presence of associated complications. ERCP is the option of choice for both diagnosis and treatment of bile leaks complicating minor bile duct injuries, while conventional surgery is indicated in cases of major bile duct injury, severe biliary peritonitis or failed ERCP.

Aims/objective: The aim of this study is to compare vertical midline wound closure with far-near technique using nylon and interrupted –X technique using polyglactin 910. Methods: This was a Multi-center prospective descriptive follow up study conducted by the department of Surgery from January 2017 to December 2019. Eighty cases were divided into two different groups and studied. Most of the patients (55% in group 1 and 42.5% in group 2) were within the age range of 21-40 years. The most common indication of surgery was gastrointestinal perforation followed obstruction and malignancy. The laparotomy wound closure with far near techniques using nylon was better than interrupted technique using polyglactin 910. Discussion: Far near suturing technique with nylon was associated with less number of wound infections, dehiscence and burst abdomen resulting in reduced hospital stay and morbidity.

Background/Aims: Fungal endophthalmitis is an infection related with many serious complications. For its treatment; systemic and intravitreal injections of antimycotics are used. Although their hepatotoxicity after systemic use is known, there are no histological studies of their hepatic effect after intravitreal injection. Materials and Methods: Three groups of three New Zealand White Rabbits were intravitreally injected with micafungin (Group M) or voriconazole (Group V) or Balanced Salt Solution (Control Group). Ten (10) days after the injection, hepatic samples were taken, and specimens were then prepared for observation under optical microscope and immunohistochemical staining using Ki- 67 and CD68. Results: Eosin-hematoxylin staining revealed focal periportal inflammatory infiltration, sinusoidal dilatation and congestion in both groups, whereas vacuolization of hepatocytes as well as an impression of distinct nodularity were visible in Group V. In the same group some lobules, the central and portal veins were dilated and congested. Staining for Ki-67 as well as CD68 markers were found negative (-) in all samples of the Control Group. Ki-67 was found moderate in Group V and was absent in Group M. On the other hand, CD68 was found mild in Group V and moderate in Group M. Conclusion: The results and conclusions extracted by the current study are consistent with a permanent damage of the hepatic tissue. Our in vivo study showed that a single therapeutic dose of intravitreal voriconazole or micafungin can cause histologic alterations and positive immunological markers.

Aim of the study: The present study was undertaken to examine the inhibitory effect of vitamin C on 4-nitroquinolone-1-oxide (4NQO)-induced carcinogenesis of the tongue mucosa in male rats. Material and Methods: Thirty-six Wistar-Futh male rats were randomly divided into three equal groups: one control (A) and two experimental (B) and (C).The solution of 4NQO was applied on the dorsal tongue surface of each rat, thrice per week for a period of 15 to 26 weeks. In group A 4NQO was exclusively applied. In group B, vitamin C was injected intraperitoneally three times a week, the same time with 4NQO. In group C, the simultaneous administration of 4-NQO and vitamin C ceased after 15 weeks and then was administered only vitamin C. In this experimental study we present the gradual ultrastructural changes in the tongue mucosa observed in all the groups periodically at weeks 17, 19, 21, 23, 25 and 26. Results: Noticeable was the delay but not hindering of neoplastic changes in groups B and C, in comparison to group A, while in group C a clear tendency for repair of the ultrastructural changes was observed as vitamin C administration continued after 4NQO has ceased. Conclusion: These results support the chemoprotective effect of vitamin C against chemically induced oral carcinogenesis.

Introduction. Endoscopic retrograde cholangiopancreatography (ERCP) has replaced surgery as the first modality in the management of choledocholithiasis. However, one major problem that needs to be considerd is extraction of stone larger than the orifice of the access point. The aims of this study are to investigate the percentage of endoscopic clearance of large bile duct stone, and its associated factors. Methods. This is a retrospective observational study involving patients with 1.5cm bile duct stones or larger, from January 2013 until December 2017. All bile duct stones of 1.5cm or larger are included in this study. The associated factors that may influence the endoscopic clearance of large bile duct stones are investigated. Result. Endoscopic clearance of large bile duct stone is 28.9% (33 out of 114 cases). The rate of incomplete or failed clearance by endoscopic means is 71.1% (81 out of 114 cases).The significant factors for complete endoscopic clearance are the location of stones (p value = 0.01823), size of stones (p value = 0.001) and type of stones (p value 0.001). Conclusion. In conclusion, the successful rate of endoscopic clearance of large bile duct stone is 28.9%. This is comparable with other studies in the literature.

Introduction: Colorectal anastomosis using circular stapler has a lot of advantages. However, some technical problems may be encountered during the use of the device such as firing system disorders, incomplete anastomosis and formation of stapler defects. In this study, our clinical experience in ‘the missing doughnut’ problem will be evaluated with the literature. Methods: The patients who were operated with colorectal tumor between 2012-2017 was entered the study. In which we have researched and evaluated the operation reports. Case series: We detected a missing doughnut in 7 cases. The condition of the anastomosis was checked by intra-abdominal palpation, endoscopy, and “air leak test”. We did not detect any leakage with the air test. Conclusion: Missing doughnuts is a condition that disturbs the surgeon, makes them think that the anastomosis is insufficient and insecure at first and evokes the idea that the anastomosis should be remade. However, a condition like this in difficult areas may jeopardize the safety of the anastomosis and cause the patient to have a permanent colostomy. In such conditions, at first one must be calm, test the strength and leak of the anastomosis line and then decide what to do.

Background: The combination of SH/CMC/SA are proven to be effective in reducing post-operative adhesion. This study aimed to evaluate the effectiveness of the SH/CMC/SA in reducing peristomal adhesion by assessing the operative time of the ileostomy closure and rate of intraoperative bowel perforation. Methods: Historical control trial, involving patients who underwent closure of loop ileostomy before June 2018 without SH/CMC/SA and with SH/CMC/SA after June 2018.At ileostomy closure, the operative time and intraoperative bowel perforation were analysed. Other than that, we also compared the rate of post-operative complications such as surgical site infection, anastomotic leak and intestinal obstruction in both groups. Results: A total of 45 patients were recruited. There are no significant differences in the demographic data and most of the clinical characteristics except for the duration of waiting time the closure between the intervention and control group (median, 146 versus 300 days, p= 0.002). The intervention group shows shorter operative time (median, 145 versus 105 min, p = 0.049) with no significant difference of intraoperative bowel perforation compared to the control group. The subgroup descriptive analysis performed in between both groups shows median operative time is shorter in both type regardless the type of anastomosis or operating surgeon.The rate of the postoperative complications (surgical site infection (SSI), anastomotic leak, or intestinal obstruction) between the two groups are comparable. Conclusion: Even though there are no strong statistically significant results achieved, there is a reduction of the total operating time observed in the intervention group regardless of the type of anastomosis. The perioperative complication and rate of intraoperative bowel injury were also comparable.

Aim: Acute appendicitis is the most common disease that requires emergency surgery.In some cases, diagnosis is difficult due to non-specific or atypical examination findings.The aim of this study was to evaluate the predictive value of RDW in the diagnosis of patients undergoing appendectomy for acute appendicitis. Materials and Methods: The study included patients who underwent appendectomy for acute appendicitis in the general surgery clinic between January 2019 and March 2020. According to the histopathology results, the cases were evaluated in 2 groups as no inflammation observed (Group I) and inflammation observed (Group 2).The groups were compared in terms of WBC, neutrophil count and RDW. Results: Group 1 comprised 67 (12.6%) patients and Group 2, 466 (87.4%) patients. A statistically significant difference was determined between Group 1 and Group 2 in terms of WBC and neutrophil count. There was no statistically significant difference between the groups in respect of RDW. When the cut-off value for WBC was taken as 13.80, sensitivity was 57.08% and specificity 56.72%.When the cut-off value for the neutrophil count was taken as 10.44, sensitivity was 58.4% and specificity 58.2%. Conclusion: Despite the low sensitivity and specificity of WBC and neutrophil count in the diagnosis of acute appendicitis, they are hematological markers that can be used with clinical findings.However, it is thought that RDW is not a hematological marker that can be used in the diagnosis of acute appendicitis.

Background. The most common complication of surgical management for intussusception is anastomosis leakage. Warm normal saline application, especially on the bowel with a doubtful viability, is thought to cause vasodilation and subsequently reduce the resected bowel requirement. This research compared the effect of topical warm normal saline and papaverine on collagen grading and incidence of anastomosis leakage of the intussusception model in rats. Methods. Ileo-ileal intussusception was created on 21 Sprague-Dawley rats. Groups included control group, normal saline group, and papaverine group. Intussusceptions were then reduced and given topical warm normal saline or papaverine according to each group. Afterward, each bowel was resected, and an end-to-end anastomosis was created. After five days, laparotomy was performed to assess anastomosis leakages. Moreover, a collagen grading assessment was performed on the anastomosis. Results. The papaverine group had the highest collagen grade and no anastomosis leakage. There was no significant association between treatments and the incidence of anastomosis leakage (p=0.174), but treatments were significantly associated with collagen grade (p=0.014). Collagen grade was significantly associated with anastomosis leakage (p=0.01). Conclusion. Findings suggested that the topical application of papaverine is associated with an increase in collagen grading and higher collagen grade is associated with a decrease of anastomosis leakage.

Introduction Acute cholangitis is defined as bacterial infection of the biliary tract. We performed this study to identify the indication for urgent Endoscopic Retrograde Cholangio Pancreatography (ERCP) in acute cholangitis patients, based on the new prognostic scoring system. Method This was a prospective cross sectional study analysis of 112 patients who was admitted with the diagnosis of acute cholangitis from January 2015 till May 2015. The patient was scored using the proposed new scoring system and base on the score they were divided into urgent-ERCP group and elective-ERCP group. The factors included are the presence of systemic inflammatory response syndrome (SIRS), low serum albumin level(20mg/dl), a low platelet count(1000,000/ul) , serum C reactive protein (CRP) and International normalized ratio(INR) of more than 1.5. These parameters were used to prognosticate and identify which patients required an urgent ERCP upon admission. Results From 112 patients there were 39 patients who requires an urgent ERCP within 24 hours of admission. The receiver operator characteristics (ROC) curve of the proposed new scoring system showed a good test performance for predicting the need for an urgent ERCP and the areas under concentration curves (AUCs) was 0.96. Conclusion We found that this new proposed scoring system which base on Tokyo guideline and inclusive of CRP score good screening tool to identify the indication for urgent ERCP in patient diagnosed with moderate acute cholangitis.

Background: Liver is one of the most frequently injured organs in abdominal trauma. However, there are still many controversies in its management. Purpose: We aimed to evaluate the clinical presentation and management of the patients with liver trauma. Methods: This is a retrospective study on patients with liver trauma admitted between 2012 and 2020. Demographic data, vital signs, type of trauma, laboratory findings, imaging findings, grading according to AAST scoring, surgical techniques, morbidity and mortality were evaluated. Results: Of the 100 patients included in the study, 77 (77%) were male and 23 (23%) were female. 51 (51%) of these patients were treated non-operatively and 49 (49%) were treated operatively. While 3.9% of non-operatively managed patients became excitus, 8.1% of operative patients became excitus. Conclusion: As a result; currently, the most effective factor in the decision-making process concerning the management of liver trauma is the patients hemodynamic status. Although non-operative management is getting widespread in blunt traumas, operative treatment is still more preferred in penetrating traumas. In order to spread non-operative management in liver traumas, in addition to conventional equipment, hybrid operating rooms that allow angiographic and endovascular interventions

Objectives: Wide local excision (WLE) is a better alternative to mastectomy as it preserves the desired cosmetic outcome without compromising the patient survival rate. Margin involvement is the main pitfall for WLE. It leads to reoperation which technically can be more challenging and potentially causes emotional stress to the patient. This study evaluates intraoperative frozen section (FS) in determining the margin status during WLE with the intention to avoid the need for second operation. Method: All breast cancer patients who underwent wide local excision were included in the study. In our institution, intraoperative FS for WLE was started in 2015. This cohort of patients was compared with earlier patients whom WLE were performed without FS. Patients demographic, tumour characteristics, margin status and number of reoperations were analysed. Results: A total of 20 patients aged 43 to 71 years (mean 56 years) were included in this study. Frozen sections were performed on the last eight of the patients. Six patients (30%) had at least one positive margin involvement. Three patients who had no FS were scheduled for reoperation after 2 weeks. Another three patients had FS and cavity shaving in the same operation. Total margins evaluated for FS were 39. Out of these, 6 (15.4%) were positive for malignancy. One (2.6%) was falsely reported as positive for malignancy. Overall sensitivity and specificity of FS in this study were 100% and 96.9%, respectively. Conclusion: FS is a reliable tool in determining adequate margin during WLE. Nevertheless, positive margin at FS should be taken cautiously, especially when it involves decision to convert the surgery to mastectomy. In that case, it could be wise to wait for paraffin section to confirm the margin status.

Objective: The purpose of this study is to evaluate the short-term results of Trendelenburg operation with stripping of GSV with minimally invasivesubfascial endoscopic perforator surgery (SEPS) in the management of varicose veins. This combined approach is known as hybrid technique. Methods: This is a single centreprospective studyconductedfrom 1 November 2018 to 31 March 2020.All Patients of ≥ 18 years with varicosity of Great saphenous vein (GSV) with saphenofemoral junction (SFJ) incompetence with multiple perforators in the legdocumented by colour doppler studywere included. This study included 30 patients with chronic venous insufficiency (CVI), who underwent hybrid technique (saphenofemoral flush ligation with stripping with minimally invasive SEPS) as part of themanagement of their CVI. Results: The mean number of incompetent perforators identified intraoperatively (3.77±0.62) was more than perforator identified preoperatively (3.23±0.67) on Doppler study. The mean pain score at 24 hours after surgery as per the visual analogue scale (VAS) was 4.67. The mean duration to return to normal daily activities was 2.43 days. Surgical site infection (SSI) was seen in only two patients (6.67%). Two patients(6.7%) had persistence of incompetent perforator veins ateight weeks postoperatively, as demonstrated by Doppler USG.Out of 6 patients with venous ulcer, five patients (83.3%) had complete healing of the ulcer at 8 weeks postoperatively while one patient (16.6%) had partial healing of the ulcer at eight weeks postoperatively.No improvement in skin changes was observed in the majority of these patients at eight weeks postoperatively. Conclusions: Hybrid technique (Trendelenburg operation with stripping of GSV with SEPS) has been found to be effective in the management of primary varicose veins in terms of reduced hospital stay, better yield of perforators, better ulcer healing, minimal post-operative pain, and less post-operative recurrence.

Background: Enhanced recovery after surgery (ERAS) programs aim to improve postoperative outcomes.. This metaanalysis aims to evaluate the impact of ERAS programmes on outcomes following liver surgeries. Methods: EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for studies comparing outcomes in patients undergoing liver surgery utilizing ERAS principles with those patients receiving conventional care. The primary outcome was occurrence of 30 day morbidity and mortality. Secondary outcomes included length of stay , functional recovery ,readmission rates,time to pass flatus,blood loss and hospital costs. Results: Ten articles were included in the metaanalysis. 30 days morbidity and mortality was significantly less in ERAS group.Hospital stay, time to pass flatus, time to complete recovery and hospital costs were also significantly reduced due to ERAS protocols. Blood loss and readmission rates were also significantly less in ERAS group. Conclusions: The adoption of ERAS protocols significantly reduced morbidity, mortality hospital stay, readmission rates, time to recovery, hospital costs, time to pass flatus, blood loss and readmission rates

Regardless of the type of surgical intervention to remove LH, massive blood loss remains the "Achilles heel". Therefore, the preventive imposition of a tourniquet on the hepatoduodenal ligament (PM) should be performed in all patients without exception, but without tightening.

Background: Traumatic brain injury is currently the leading cause of post traumatic mortality [1]. At our center, the emergency department (ED) responses to trauma varies between activating Trauma Team Activation (TTA) involving a trauma surgeon, and a non-trauma team response (NTT) led by an ED physician. This study aims to evaluate the TTA system in reducing the time to CT brain in a severe head injury patient. Method: A retrospective review of severe traumatic head injuries identified from Hospital Tengku Ampuan Rahimah (HTAR), Klang with Glasgow Coma Scale (GCS) ≤8 and underwent a CT brain at the hospital. Data was analyzed using SPSS. Results: There were a total of 216 severe head injury cases in 2017; 151 TTA, 65 NTT, predominantly male patients of median age 29 years old; and median GCS scoring of 3 (lowest) in both groups. Compared between TTA and NTT, there was significant 57 minutes faster in time to CT brain, (median 113 versus 170 minutes (P =0.005),. In terms of outcome, TTA scored similar outcome, (median Glasgow Outcome Score 5 – low disability IQR 4 , P=0.407) but shorter hospital stays (median 8 days, IQR 17 versus 9 days, IQR 1798, P=0.404), Conclusion: Trauma Team Activation in a suspected severe traumatic head injury reduces time to CT brain compared to non- trauma team response.

Παρουσιάζεται περίπτωση ανεύρεσης τριών εστιών έκτοπου ηπατικού ιστού στο τοίχωμα της χοληδόχου κύστης κατά τη διενέργεια προγραμματισμένης λαπαροσκοπικής χολοκυστεκτομής για χολολιθίαση. Πρόκειται για την περίπτωση γυναίκας 54 ετών, που εισήχθη λόγω χολολιθίασης, για προγραμματισμένη λαπαροσκοπική χολοκυστεκτομή. Κατά τη διάρκεια της επέμβασης ήταν εμφανείς οι τρεις εστίες έκτοπου ιστού, που η όψη και το χρώμα παρέπεμπαν σε ηπατικό ιστό. Η βιοψία έδειξε ότι επρόκειτο πράγματι για τρεις εστίες έκτοπου ηπατικού ιστού στον ορογόνο της πρόσθιας επιφάνειας της χοληδόχου κύστης. Στη βιβλιογραφία αναφέρεται ύπαρξη έκτοπου ιστού από πολλά άλλα όργανα, στο τοίχωμα της χοληδόχου κύστης, όπως ηπατικού, γαστρικού, παγκρεατικού, ακόμα και θυρεοειδικού και επινεφριδικού. Η ανεύρεση όμως τριών εστιών έκτοπου ηπατικού ιστού, όπως στην περίπτωσή μας, αποτελεί μια σπάνια οντότητα, πιθανά και μοναδική.

Pleomorphic liposarcoma is a rare type of liposarcoma, accounting for between 5% and 10% of lipomatous tumours. It is an aggressive type of liposarcoma with poor prognosis, high rates of recurrence and metastasis. It can affect both young and elderly people and presents most commonly in the extremities and retroperitoneally. At the time of writing, gluteal pleomorphic liposarcoma is a rare entity with little documentation available in the literature. We present the case of a 22-year-old lady who presented with a painless left buttock mass which had been gradually getting larger over the 8 months prior. She underwent wide local resection of the mass and subsequent histopathological examination revealed the mass to be a gluteal pleomorphic sarcoma. Following recurrence of the disease on imaging, she underwent a second-wide local excision of pleomorphic liposarcoma. Post-operatively she was well with no complications and was discharged with oncology follow- up for early radiotherapy. This case report was used as a basis to further elaborate on the presentation, prognosis and multi-faceted management of gluteal pleomorphic liposarcoma. Management of this condition is most likely to involve surgical resection as the mainstay of treatment, with the use of chemotherapy and / or radiotherapy for select cases, frequently relating to high-grade tumours with metastatic spread – which is often the case for pleomorphic liposarcoma.

Breast cancer is the most common malignancy in women. In the era of de-escalating surgery, adjuvant radiotherapy is becoming a standard care. Radiotherapy induced angiosarcoma (RIAS) of the breast is one of the complications from radiotherapy with aggressive behavior and poor prognosis. A61 year old lady with stage II invasive ductal carcinoma of the right breast was treated with mastectomy and axillary dissection, followed by adjuvant chemotherapy and radiotherapy. Twenty-three years after the initial diagnosis, she developed multiple red papules and red purplish mass on the right chest wall. She had wide local excision and the histopathology confirmed radiation-induced angiosarcoma. Although RIAS of the breast can be potentially life- threatening, studies have shown that the overall risk of angiosarcoma following radiation therapy does not outweigh the benefits of radiation therapy in the treatment of primary breast cancer. The literature review of this rare condition is discussed.

We would like to report case of young lady with underlying depression presenting with a giant gastric trichobezoar which require a mini-laparotomy for extrication. A 17-year-old lady recently diagnosed with depression was referred to our hospital with colicky abdominal pain associated with an epigastric mass. She was diagnosed to have giant gastric trichobezoar from CT scan. She underwent a mini-laparotomy and extrication of the gastric trichobezoar after failed endoscopic removal. Though rare, the diagnosis of trichobezoar should be considered in young females presenting with abdominal pain and mass especially in those with psychiatric disorders. Imaging combined with endoscopic evaluation remains the mainstay of diagnosis. Most importantly, a psychiatric consult and evaluation is important in preventing a recurrence of this condition.

Wunderlich syndrome is a rare fatal condition characterized by spontaneous atraumatic renal hemorrhage that confined to peri- renal and sub capsular space. It may present as an acute or insidious onset. Female has more predilection for the syndrome compared to males. Diagnosis is usually incidental. A constellation of symptoms known as Lenk’s triad described by the German physician Carl Reinhold August Wunderlich in diagnosing the condition that are acute flank pain, flank mass and hypovolemic shock. Etiologies related to the syndrome can be broadly classified into neoplastic and non-neoplastic. Commonest benign neoplastic cause of Wunderlich syndrome is renal angiomyolipoma while malignant causes such as renal cell carcinoma (RCC) and liposarcoma. Non neoplastic causes such as vasculitis, aneurysm, arteriovenous malformation and cystic rupture. Wunderlich syndrome has a high mortality rate associated with the rupture of the hematoma. Early accurate diagnosis is crucial in patient’s intervention and management. Multimodality treatment is available in Wunderlich syndrome such as highly specific embolization, surgeries as well as conservative. Treatments are tailored according to the hematoma size, availability specialty services and patient’s hemodynamic status.

Situs inversus totalis is not uncommon entity, approximately 1 in over 5000 births. In situs inversus totalis, laparoscopic cholecystectomy poses many technical difficulties. We report a case of lady with situs inversus totalis and cholelithiasis presented with ascending cholangitis secondary to choledocholithiasis. She first underwent endoscopic retrograde cholangiopancreaticography (ERCP) and then laparoscopic cholecystectomy. We describe the technical aspects of the laparoscopic cholecystectomy in situs inversus totalis. The monitor was set up to the left of the patient while surgeon standing on the right of the patient. Ports insertion sites were mirror-image of conventional laparoscopic cholecystectomy. Despite technically unfamiliar, the procedure was completed within 2 hours and the patient recovered well post-operatively. Laparoscopic cholecystectomy in situs inversus totalis is a safe procedure albeit more challenging due to reversed anatomy.

Background: Inflammatory Myofibroblastic Tumour (IMT) of the colon is a rare mesenchymal tumour, and like its counterpart in other sites of the body it possesses intermediate biological behaviours. Diagnosis is achieved only after final histological assessment. Case presentation: We describe a case of a 60-year-old male who presented to our casualty with a two weeks history of right lumbar pain without any evidence of peritonitis. He had loss of appetite and lethargy during these two weeks. Contrast-enhanced CT images of the abdomen showed ruptured appendicitis with thickening of the caecal wall. Intra- operatively, we found a perforation at the appendiceal body without faecal contamination. However, the caecum was thickened and a right hemicolectomy was performed. The final histological diagnosis was IMT of the caecum. Conclusion: We reviewed the literature for approach management of colorectal IMT.

Three elderly ladies presented with clinical suspicion of breast cancer. Lumpectomy was performed in all 3 cases and histopathological examination came back as lymphocytic mastopathy. Only one of them had a classical long history of diabetes to suggest diabetic mastopathy. The other two cases was non-diabetic and not associated with autoimmune disease. Clinicopathologic and imaging revisited. The disease posed a diagnostic challenges and management dilemma.

Cervical rib is an anomaly rib which arises from the 7th cervical vertebrae. It is sometimes called the ‘neck ribs ‘or extra ribs which is seen congenitally. These extra ribs usually present in about 1% of human population and most of the time is asymptomatic. However some cases seen in which people with cervical rib present with Thoracic Outlet Syndrome (TOS).It refers to the compression of the subclavian vessels and the brachial plexus in the region of the superior aperture of the chest by the cervical rib. The symptoms varies from neuronal or vascular or the combination of both. Symptoms can be mild as paraesthesia of the affected limb to intrinsic muscle atrophy. There are no objective test for detecting TOS other than symptomatic approach. Surgical resection of the extra ribs has shown vast benefits for those suffering from the TOS when other modalities of treatment fails. There are multiple approach for the cervical rib resection available nowadays but there’s no ‘Gold Standard’ approach described. In this case report we would like to report a successful cervical rib resection through the Supraclavicular Approach.

Impalement injury in pediatric age group is a rare presentation but potentially lethal. Limited clinical experience and standard management protocol are the challenges faced by clinicians in managing impalement injuries. We present a case report of a nine-year-old boy who sustained impalement injury to the flank at construction site. A metallic rod impaled the left flank and intra-abdominal injury was suspected. The child underwent Computed Tomography and subsequently he was posted for exploratory laparotomy and the metallic rod was removed under direct vision. The entry wound debrided and dressed and subsequently the patient discharged home well. A judicious pre hospital care and timely referral to tertiary center are the initial crucial steps in managing impalement injury. A successful pediatric impalement injury management require a multidisciplinary team approach and regular post trauma follow up.

The Covid-19 pandemic has introduced an array of organ-specific and systemic phenotypes- some previously observed in viral infections, including severe acute respiratory syndrome (SARS) and others that appear to be unique to SARS-coronavirus (CoV)-2. The coronavirus disease affects mainly the respiratory system, other organs may be involved, usually due to coagulation disturbances that lead to a high rate of thrombotic complication. We describe a case of a 59-year-old male, with Sars Cov-2 who infection developed an acute superior mesenteric venous thrombosis (MVT) with acute intestinal obstruction. The patient came to our observation with an acute abdomen condition for which urgent surgery with intestinal resection and subsequent second look was necessary. Bowel viability was favoured by direct infusion of heparin in superior mesenteric vein. This is a rare presentation of Covid19 associated superior mesenteric vein (SMV) thrombosis resulting in ischaemic bowel

Utilization of intravascular surgical items is increasing in trend in view of its importance in clinical practice, particularly in fluid monitoring and administrating of medications. In view of high demand and usage of these items, procedure -related complications also increasing such as catheter fragmentation, embolization and retained items. It is important to be vigilant in handling and performing any surgical procedure and identifying ‘high-risk’ patients for proper catheter-related care. Intravascular retained surgical items can be managed either surgically or non-surgically. We reported a case of a sound mind elderly woman who self-cut central venous catheter.

ΣΚΟΠΟΣ της έρευνας είναι να καταγράψει τον βαθμό ικανοποίησης του μόνιμου νοσηλευτικού προσωπικού του Τμήματος Επειγόντων Περιστατικών (Τ.Ε.Π)του Γενικού Νοσοκομείου Θεσσαλονίκης «Γ.Γεννηματάς» από τα χαρακτηριστικά της εσωτερικής ποιότητας των υπηρεσιών. ΥΛΙΚΟ-ΜΕΘΟΔΟΣ: Για την έρευνα χρησιμοποιήθηκε η ποσοτική μέθοδος με το ερωτηματολόγιο διερεύνησης των πέντε διαστάσεων της εσωτερικής ποιότητας βασισμένο στη κλίμακα SERVQUAL Στην έρευνα συμμετείχαν πενήντα (50) εργαζόμενοι του νοσοκομείου. Η ανάλυση των δεδομένων διεξήχθη με το SPSS 21. ΑΠΟΤΕΛΕΣΜΑΤΑ: Διαπιστώθηκε πως η ανταπόκριση, η ασφάλεια, η αξιοπιστία και η ενσυναίσθηση που χαρακτηρίζουν τον προϊστάμενο βαθμολογήθηκαν σε υψηλότερο βαθμό από τη λειτουργικότητα των χώρων, τον εξοπλισμό και την καλαισθησία των εγκαταστάσεων του Τμήματος. Από τις συσχετίσεις που διερευνήθηκαν διαπιστώθηκε ότιυπάρχει στατιστικά σημαντική συσχέτιση μεταξύ όλων αυτών των διαστάσεων, με εξαίρεση τη σχέση μεταξύ της εν συναίσθησης και των απτών στοιχείων. Επιπρόσθετα, δε βρέθηκε πως υπάρχει επίδραση των δημογραφικών στοιχείων των νοσηλευτών (φύλο, ηλικία, οικογενειακή κατάσταση, επίπεδο σπουδών, έτη προϋπηρεσίας) στις απόψεις που εξέφρασαν οι ερωτηθέντες. ΣΥΜΠΕΡΑΣΜΑΤΑ: Από την έρευνα προκύπτει η αναγκαιότητα λειτουργικής αναβάθμισης των χώρων του Τ.Ε.Π, αλλά και ύπαρξη εταιρικής κουλτούρας ποιότητας στο τμήμαπου περιλαμβάνει όλες τις πτυχές της διαδικασίας παροχής υπηρεσιών.