Background: Acute pancreatitis (AP) is an inflammatory disorder of the pancreas in along with its complications is one of the most common causes of morbidity and mortality in hospitalized patients. There is a lack of information about the predictive value of Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring in comparison to Ranson score among AP subjects particularly in Tertiary referral hospital in Malaysia Objective: To compare BISAP and Ranson score in predicting the severity of AP (Severe acute pancreatitis (SAP), pancreatitis necrosis (PN) and mortality). Methods: This study was conducted among 154 subjects from Hospital Universiti Sains Malaysia (HUSM) by retrospective method between the period of 2012-2017 to compare the BISAP and Ranson score for predicting the severity of AP. Results: Out of 154 patients, 69 (44.8%) were males and 85 (55.2%) were females. The mean age was 48.2 ± 16.2 years. Of all patients, twenty four patients (15.6%) were classified as severe AP and 6 patients (3.9%) had evidence of pancreatic necrosis on CT scan and 1 (0,6%) mortality. The number of patients with a BISAP score of ≥ 3 was 1 and Ranson score ≥ 3 was 37. There were significant, substantial and positive correlation between Ranson with BISAP in disease severity (p0.05). Conclusion: BISAP can be considered as a simple and accurate tool for predicting the severity of acute pancreatitis.

Εισαγωγή: Η αυξανόμενη συχνότητα επεμβάσεων που περιλαμβάνουν εκτομή του παγκρέατος ή τμήματός του έχουν αναδείξει μία σοβαρή επιπλοκή, το μετεγχειρητικό παγκρεατικό συρίγγιο (ΜΠΣ ή POPF). Με σκοπό την όσο πιο έγκαιρη πρόβλεψη και αντιμετώπιση τους, χρησιμοποιείται η μέθοδος της μέτρησης των επίπεδων της αμυλάσης στο υγρό της παροχέτευσης. Σκοπός: Προσφάτως έχουν προκύψει νέα ερωτήματα σχετικά με την τεχνική αυτή και ανακαλύπτονται νέες προοπτικές που χρήζουν ανάλυσης. Η αναζήτηση στη βιβλιογραφία μελετών σχετικά με την αποτελεσματικότητα της τεχνικής αυτής και η διερεύνηση των νέων εξελίξεων κρίνεται απαραίτητη για την πιθανή υιοθέτησή τους στη χειρουργική πράξη. Υλικό και μέθοδος: Πραγματοποιήθηκε λεπτομερής αναζήτηση στη διεθνή βιβλιογραφία σχετικά με μελέτες που έχουν ως λέξεις κλειδιά: pancreaticoduodenectomy, PD, Whipple, pancreatectomy, pancreatic resection, drain amylase. Αποτελέσματα: Τα αποτελέσματα των σχετικών μελετών εξαρτώνται σε μεγάλο βαθμό από το επιλεγμένο όριο των τιμών cut- off και από το είδος της παγκρεατεκτομής. Για τα επίπεδα της αμυλάσης συνήθως χρησιμοποιείται ως τιμή rule-in τα 350 units/L και ως τιμή rule-out τα 5000 units/L. Οι μελέτες για την χρησιμότητα της CRP στην πρόβλεψη των ΜΠΣ καταλήγουν στην τιμή των 90 mg/dl. Η προκαλσιτονίνη δεν αποδείχθηκε αξιόπιστος δείκτης στην πρόβλεψη ενός ΜΠΣ. Τα επίπεδα λιπάσης του ορού κάτω από το όριο των 300 IU/L και τα επίπεδα λιπάσης στο παροχετευόμενο υγρό άνω των 1000 IU/L αποτελούν έναν δείκτη για την εμφάνιση ΜΠΣ. Μελετήθηκαν επίσης και άλλοι παράγοντες που συμβάλουν στην πρόβλεψη ή στην δημιουργία ενός ΜΠΣ. Συμπεράσματα: Η ανάπτυξη ΜΠΣ αυξάνει σημαντικά τη νοσηρότητα των ασθενών και η μέτρηση δεικτών όπως της αμυλάσης, λιπάσης και CRP φαίνεται ότι βοηθούν τόσο στην πρόβλεψη εμφάνισης των ΜΠΣ, όσο και στην παρακολούθηση της εξέλιξης αυτών.

Aims and objectives: The primary aim of our analysis was to do a systemic review and updated meta-analysis of literature published in the last 10 years and look for the association of neoadjuvant chemoradiation and risk of subsequent clinically significant pancreatic fistula. Methods: EMBASE, MEDLINE, and the Cochrane Database were searched for Studies comparing outcomes in patients receiving neoadjuvant chemoradiotherapy first with those patients who received surgery first in case of pancreatic cancer. A systemic review and Metanalysis were done according to MOOSE and PRISMA guidelines. Heterogeneity was measured using Q tests and I2, and p 0.10 was determined as significant. Results: Twenty-six studies including 17021 patients finally included in the analysis. 339 patients out of a total of 3386 developed clinically significant pancreatic fistula in the neoadjuvant first group. 2342 patients out of 13335 patients developed clinically significant pancreatic fistula in the surgery first group. Neoadjuvant treatment significantly reduced the risk of subsequent clinically significant pancreatic fistula. (p= 0.0001). The number of patients with soft pancreas was significantly higher in the surgery first group. (p 0.0001). Pancreatic duct diameter mentioned in only two studies but there was no significant difference between both groups. [p=1]. Blood loss was significantly more in the surgery first group. [ p 0.0001]. There was no difference in pancreaticoduodenectomy, or distal pancreatectomy performed between both groups. (p=0.82). There was no difference in the number of borderline resectable pancreatic tumors between both groups. (p= 0.34). There was no difference in overall grade 3/grade 4 complications rate between both groups. (p= 0.39). Conclusion: Neoadjuvant treatments may be responsible for the lower rates of clinically significant pancreatic fistula after subsequent surgery.

Aim of study: The aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker to predict post- operative infectious complications after pancreatic surgeries. Material and Methods: Systemic literature search was performed using MEDLINE, EMBASE and to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) as a predictor for detecting infectious complications on postoperative days (POD) 3 and 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters for POD 3 and 5 were derived. Geometric means were calculated for PCT cut offs. The work has been reported in line with PRISMA guidelines. Results: 6 studies included day 3 PCT analysis, 2 studies included both day 3 and day 5 analysis. Total data of 471 patients were derived. 161 patients developed infectious complications. Pooled sensitivity, specificity, pooled area under curve, diagnostic odds ratio (DOR), positive and negative like hood ratio of day 3 PCT were 74%,79%,0.8453, 11.03,3.17 and 0.31 respectively. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative like hood ratio of day 5 PCT were 83%,70%,12.91,2.91 and 0.25 respectively. Geometric means for PCT cut off for day 3 and 5 were 0.80 and 0.43. Conclusion: Postoperative procalcitonin particularly day 3 procalcitonin levels predict post-operative infectious complications following pancreatic surgeries.

Background, Aims: Laparoscopic One-anastomosis gastric bypass (LOAGB) has proved to be safe and effective, with short learning curve and low morbidity rate. The aim of this study was to evaluate the short term results of LOAGB regarding safety and efficacy. Methods: Forty morbidly obese patients (27 female, 13 male) were included in this prospective study and were subjected to LOAGB. Follow up was done at 1, 3, 6, 12 and 24 months postoperative. Results: Mean patients’ age was 38.5± 9.45 years. Mean patients’ BMI was 53.59 ± 6.25 kg/m2. All procedures were completed laparoscopically, mean operative time was 94.125 ± 33.20 min (range, 65–230 min). The mean length of hospital stay was 2.025±1.32 day. Mean percentage of excess weight loss achieved was 21.03 ±3.32 %, 38.02±5.15 %, 58.095±5.83%, 70.98 ±7.29%, and 78.64 ±10.3% at 1, 3, 6, 12 and 24 month respectively. Most of co-morbidities were improved or resoluted within the first postoperative year. There was no perioperative mortality whereas total morbidity occurred in 9 patients (22.5%). Conclusion: LOAGB is feasible, safe with short hospital stay and accepted morbidity rate. Short term outcomes concerning promotion of weight loss and remission/improvement of obesity associated comorbidities are promising.

Background: In recent years, the African continent has seen a rapid rise in obesity prevalence as well as associated co- morbidities. However bariatric surgery remains little known and practiced. This study aimed to determine the profile of patients with indications for bariatric surgery in a cohort of Cameroonian obese patients and evaluate their acceptability to this surgery. Material and Methods: We conducted a cross sectional study at the National Obesity Centre of Yaoundé (Cameroon). Patients aged 18 years or older, received for management of overweight/obesity from June 2019 to December 2019 with indication of bariatric surgery according to the Europeans guidelines for obesity management in adults, were included. Results: We recorded 56 patients. They were mostly women (91.1%) aged 40 to 50 years with a mean BMI of 42.4 kg/m2, of a higher level of education (44.6%) but unemployed (37.5%), from the West region of the country (Bamiléké ethnic group, 44.1%), with at least one comorbidity linked to obesity. Only 20 patients (35.7%) had ever heard of bariatric surgery. After discussions on all aspects of bariatric surgery, 35 (62.5%) patients agreed to be included in this therapeutic project. None of the factors studied was statistically associated with a risk of refusal of bariatric surgery. Conclusion: Bariatric surgery is most often indicated in unemployed and morbidly obese female patients in Cameroon. The acceptability of bariatric surgery is good; therefore, establishment of a dedicated unit for this purpose is needed.

Background: Despite numerous discussions about the using of self-expanding metal stents (SEMS) compared to surgical treatment as an initial step in the management of patients with malignant colorectal obstruction, our study showed that the establishment of SEMS in obstruction caused by malignant colorectal tumors is a safe treatment option with an acceptable risk profile. Aim of the study - evaluate the immediate results of the establishment of SEMS in patients with obstruction of the colon and rectum by malignant neoplasms. Materials and methods. The presented research based on a retrospective analysis of cases using of SEMS in patients with malignant colorectal obstructions. All patients with colorectal obstruction were subjected to either preoperative decompression of the colon with the prospect of one-stage surgery, or palliative treatment for inoperable cancer. All datas were collected and investigated by analysis of case histories. Results: SEMS were used in 18 patients. 66.67% of the patients were subsequently radically operated, while the remaining 33.33% of SEMS was established as palliative care. Perforation occurred in 1 patient, Migration of stents was not observed. The influence of age, sex, time between the onset of symptoms and the introduction of SEMS, time between the establishment of SEMS and the duration of surgery, length of stenosis, localization of stenosis, albumin level on the development of complications - perforation, migration and reocclusion of the stent were analyzed. At the same time, no significant influence of any of the above factors on the development of complications was found. Conclusion: Establishment of SEMS in patients with colorectal obstruction by malignant neoplasms is an acceptable method of intervention for symptomatic, palliative treatment of this cancer, as well as a promising option of the preparatory stage before radical surgery with a proven safety and efficacy profile.

Background: Colorectal cancer is the fourth most common cancer in South Africa. Rectal cancer poses its own unique challenges. Objectives: The aim of this study was to document our experience with management of rectal cancer and to assess the long-term outcome of treatment. Methods: This was a retrospective analysis of prospectively collected data carried out at the Durban Colorectal Unit. Data on all patients with rectal cancer was extracted from the ongoing colorectal cancer database. Study outcomes were staging, surgical resection and recurrence. Results: A total of 1210 patients had rectal cancer (rectosigmoid 313, rectum proper 897). Mean age was 57.95 (+ 14.45) years. There were 645 (53.31%) males (M:F ratio 1.2:1). Six hundred and twenty-six patients (51.73%) underwent resection (rectosigmoid 139, rectum 487) of whom 272 had abdominoperineal resection (APR) (43.45%). Patients have been followed up for a median of 19.33 months (IQR 22). Overall resection rate was 51.99%; 44.4 % among rectosigmoid tumours and 54.29% among rectal tumours. Stage IV disease predominated in both rectosigmoid and rectal tumours at 31.6% and 26% respectively. Open surgery predominated in our study with 86.33% of patients with rectosigmoid tumours and 68% of patients with rectal tumours undergoing open surgery respectively. Conclusions: The age at presentation of our patients was lower than international literature. A high proportion of patients presented with stage IV disease. There was a slight male preponderance. The resection rate was just over 50 % of which APR contributed to less than 50%. Open surgery predominated in our study.

Background: Intestinal stoma is a major part of general and colorectal surgeries. It usually has negative drawbacks on patients’ quality of life at the beginning, especially if accompanied with stoma complications. Proper stoma care is provided by specialized Enterstomal nurses, who are non-existent in our hospital. We assessed the knowledge of non-Enterstomal nurses about stoma care in a tertiary care center, King Abdulaziz University Hospital Methods: Data were collected using a paper-based questionnaire and distributed to nurses from different departments. They were recruited using convenience sampling with a face to face interaction. First eight questions were regarding participants' demographics, then 12 assessed basic knowledge surrounding ostomies and last 6 questions related to problems that nurses may face with ostomy patients. Results: One hundred and twenty-two nurses answered the survey with a response rate of 100%. The clear majority indicated that they knew what a stoma is 98.36% (N=119) and 87.7% (N=107) had prior experience managing stoma patients. The majority were working in either the medical (35%) or surgical department (42%). With regards to knowledge assessment, the lowest- scoring question received 25.41% correct answers and the highest-scoring question received 95.90% correct answers. Conclusion: Our study has shown an inadequate level of knowledge regarding stomas among nurses at a tertiary care hospital. This indicates the significant need for a specialized ET nurse in order to provide patients with optimal care and follow up. Increased training and education regarding stomas and the problems ostomy patients face is also recommended.

Breast cancer is the most common cancer diagnosed during pregnancy and has a complex line of management. Delayed first birth is a risk factor for breast cancer, thus the incidence has increased in recent years due to women delaying childbearing to a later age. Breast cancer can be safely diagnosed, staged, and treated during pregnancy with good outcomes for both the mother and fetus. However, some modifications need to be considered according to the gestational age and the stage of breast cancer. We reported five cases of pregnancy-associated breast cancer (PABC) managed in our facility highlighting various management modes and their outcome.

Aim: This study’s primary objective is to evaluate the oncological outcome of oncoplastic breast surgery (OBS) for resection of breast cancers located in the upper breast quadrants. The secondary purpose is to evaluate the aesthetic outcome and patients’ satisfaction. Methodology: Oncoplastic breast excision with or without contralateral breast reduction to obtain proper symmetry was performed on 105 patients with breast cancer up to stage 3a including those received neoadjuvant chemotherapy. Patients evaluated according to their stage. Short term surgical outcomes including hospital stay, complications, cosmoses, patient satisfaction and recurrence were assessed. Results: A total of 105 patients were included in the study. The four oncoplastic techniques used in this study were batwing mastopexy (n=24), donut mastopexy (n=15), Cosmetic lateral Quadrantectomy (n=42), and inferior pedicle mammoplasty (n=24). Most patients healed uneventfully within 15 days. Overall complication rate was 20%. Natural breast shape was achieved with good cosmesis in 62%, and high patient satisfaction in 80% of cases. We did not encounter neither reoperation nor early recurrence within the 18 months follow up duration. Conclusion: Our study shows that oncoplastic surgery for breast cancers in the upper quadrants can achieve equivalent oncologicaloutcome with advantageous cosmoses and better patient satisfaction

Purposes Pit-picking (PP) is a minimally invasive technique that is gaining popularity for the treatment of sacrococcygeal pilonidal sinus disease. However, no data exist regarding cases with concomitant pilonidal abscess. The purpose of this study was to evaluate the outcome of PP on patients with acute pilonidal sinus disease and abscess. Methods From 2013 to 2018 forty-one patients with acutely inflamed pilonidal sinus were primarily treated by PP. Patients with pilonidal abscess greater than 2 cm in diameter, were excluded from the study. Demographic data, operating times, morbidity and recurrence rate were recorded prospectively. Results Postoperative complications occurred in 2.4% of the cases (n = 1). The median operating time was 8 minutes (Range: 3 - 15). The median duration of the follow-up period was 15 months (Range: 2 - 48). Seventeen patients (41.5%) had a recurrent disease at the site of primary operation. The presence of a single midline pit was associated with a higher rate of recurrence [Recurrence rate in patients with multiple pits vs. single pit: 17.6% (n=3) vs. 58.3% (n=14), p=0.01. Conclusion PP does not seem to be appropriate for all patients with acute pilonidal abscess. Cases with a more limited disease where multiple midline pits can be intraoperatively identified, constitute a distinct subgroup that appears to benefit from this procedure.

Background: About half of the population has hemorrhoids by the age of fifty years. Hemorrhoidectomy is considered the gold standard, and Milligan-Morgan hemorrhoidectomy is the most widely used technique worldwide. This study aimed to compare two techniques of open hemorrhoidectomy, clamp and diathermy hemorrhoidectomy and Milligan-Morgan hemorrhoidectomy. Patients and methods: Eighty-four patients with 3rd or 4th-degree hemorrhoids were randomly subdivided into two groups; group (I) was managed by clamp and diathermy hemorrhoidectomy, the hemorrhoid was excised over an artery clamp using spray diathermy with no dissection, and group (II) was managed by Milligan-Morgan hemorrhoidectomy. Results: The patients were subdivided into two groups, 42 patients in each group. The operative time was shorter in group (I) than in group (II), p-value < 0.05%. Intraoperative blood loss was significantly less in group (I), 3.0 ml versus 6.57±1.78 ml in group (II), p<0.05%. The time for complete wound healing was shorter in group (I), 16.59± 2.379 days vs 24.54± 3.255 days in group (II), p<0.05%. Regarding incontinence, there was no statistically significant difference of Wexner score for incontinence form preoperative to 3 months postoperatively in each group, p-value= 0.323 and 0.160 in group (I) and group (II) respectively. Conclusion: Clamp and diathermy technique is an effective method in the treatment of 3rd and 4th-degree hemorrhoids with rapid healing if compared to Milligan-Morgan hemorrhoidectomy

Background: Acute appendicitis is classified as complicated and uncomplicated appendicitis in emergency department. This condition can affect the treatment strategy. In this study, we aimed to assess the efficiency of the Albumin C-reactive protein ratio (ACR) in predicting whether appendicitis is complicated in patients diagnosed with acute appendicitis in the emergency department. Materials and Methods: Patients in the 18-60 age group who applied to the General Surgery department between March 2019 and December 2020, were diagnosed with appendicitis, were operated, and pathologically diagnosed with appendicitis, and had albumin and CRP values were included in the study. Demographic data, complete blood counts, biochemical parameters, CRP, pathology results, and examination findings of the patients were recorded. The patients were separated into two groups as uncomplicated and complicated appendicitis. The presence of any difference between ACR and other parameters between the two groups was compared. Results: A total of 210 patients were included in the study. Of the patients, 124 (59%) were male and 86 (41%) were female. 143 of the patients (68.1%) had uncomplicated appendicitis (Group 1), and 67 (31.9%) of them had complicated appendicitis (Group 2). In the analysis between groups 1 and 2, statistical significance was found between the groups in terms of white blood cell count, monocyte, neutrophil, CRP, and ACR (p<0.05). There was a strong statistical significance between CRP, monocyte and basophil parameters and the presence of complication (p<0.01). Conclusion: ACR is a useful score to predict complicated / uncomplicated differentiation of acute appendicitis cases.

Background: Helicobacter pylori infection affects almost half of the population and remains clinically significant in chronic gastritis and gastric malignancy. However, its prevalence is found to be low in Pahang, Malaysia population where the practice of single antral biopsy during endoscopy has been advocated. Our aim for this research is to determine the role of multiple gastric biopsy sites during endoscopy (OGDS) to increase the detection of Helicobacter pylori infection. The recommended 5 biopsy sites in the Updated Sydney System in which includes antrum, incisura angularis and body of stomach. Methodology: This is a cross sectional study of 141 patients with clinical diagnosis of gastritis or dyspepsia who underwent OGDS in 2 tertiary hospital in Pahang, Malaysia from January 2016 to December 2016. Five biopsy sites have been obtained and tested with CLO test and send for histology. The positive result for Helicobacter pylori infection by CLO test and/ or histology together with sociodemographic data, endoscopic diagnosis and histology characteristics were recorded and analyzed using IBM SPSS Statistic version 23. Results: Total of 17 patients were diagnosed with Helicobacter pylori infection, making the prevalence of the infection to 12%. No significant difference seen in most of the parameters identified. However, we found out that single antral biopsy can missed the infection rate up to 35%. Conclusion: Multiple biopsy sites during endoscopy can increase detection of Helicobacter pylori infection.

Background: Malnutrition in surgical patients predisposes them to higher risk of morbidity. Nutritional assessment of such patients can play a vital role in predicting post-operative complications. Aim: The aim of this study was to determine the association between nutritional biomarkers and occurrence of postoperative complications Methods: The study was conducted as a prospective observational study. The BMI, mid-upper arm circumference (MUAC), albumin, proteins, urea and creatinine was obtained from patients undergoing surgery. Complications during their hospital stay was noted. Risk assessment was done by univariate and multivariate analysis. A receiver operating character (ROC) curve was plotted for all biomarkers, taking p value <0.05 as significant. The sample size was calculated as 175, using sensitivity as 0.89, absolute precision as 10% and an expected prevalence of 20%. Results: Out of all 175 patients that underwent surgery and those that underwent major surgery, 49.71% and 76.19% of patients had postoperative complications respectively, with a male predominance. BMI and MUAC were found to be significantly associated with the incidence of complications (relative risks of 2.62 and 1.82). 94.37% of patients with hypoalbuminemia were found to have postoperative complications with a relative risk of 2.47. All patients with hypoproteinemia were found to have postoperative complications. Albumin and total protein showed significant association on multivariate analysis but were not associated with the severity of complications. Conclusion: Albumin, proteins, a combination of albumin and proteins can be used as a measure to predict post-operative complications in patients. However, they cannot predict the severity of these complications.

Background: COVID-19 pandemic affected the operation of surgical services in Malaysia. Anxiety levels have been on the rise and could have possibly affected various health care providers. This study aims to determine whether an association is present between the amendments made to surgical practice and surgeon’s anxiety level during this pandemic. Methods and Material: This study was conducted using a web-based anonymous survey via snowball sampling technique for 11 days. A total of 77 respondents from 22 different institutions participated in this study. Result: It was found that 70.1% surgeons experienced postponement of prior planned surgery during MCO period, while 26.3% surgeons had only some planned surgery being postponed and 2.6% stated MCO had not affected planned surgeries. Despite the uncertainties, the data showed that the majority (61.0%) of the surgeons had good control of anxiety, while 29.9% of the surgeons were mildly anxious, and 5.2% of the surgeons had moderate anxiety level. Only 3.9% of the respondents were at a severe stage of anxiety. A Chi-square test was conducted to determine the relationship between the postponement of elective surgery and the surgeon’s level of anxiety, resulting in a statistically significant association between these two factors. Conclusion: It was concluded from the results that surgeons were significantly affected by the changes introduced to surgical practice during the pandemic.

Η κατακόρυφη αύξηση του επιπολασμού της νόσου Covid-19 στην Ευρώπη δοκιμάζει την ικανότητα ανταπόκρισης των ευρωπαϊκών συστημάτων υγείας σε μια σειρά πρωτόφαντων και άμεσων, ως προς την ικανοποίησή τους, αναγκών με στόχο την προστασία της δημόσιας υγείας. Σκοπός: Η βραχεία βιβλιογραφική ανασκόπηση των οικονομικών επιπτώσεων της πανδημίας στα ευρωπαϊκά συστήματα υγείας και ο εντοπισμός μέτρων και αποφάσεων για τον μετριασμό του κόστους. Μέθοδος: Βραχεία ανασκόπηση σε έντυπη και ηλεκτρονική βιβλιογραφία από τις ηλεκτρονικές βάσεις δεδομένων Scopus και Pub-Med. Αποτελέσματα: Κυβερνητικές αποφάσεις και διακρατικοί μηχανισμοί, οι οποίοι τέθηκαν σε εφαρμογή με σκοπό την ενίσχυση της ανθεκτικότητας και τη χρηματοδότηση των ευρωπαϊκών συστημάτων υγείας αλλά και τον έλεγχο του κόστους της πανδημίας. Συμπεράσματα: Η απόκριση των ευρωπαϊκών συστημάτων υγείας στις ανάγκες που δημιουργεί η πανδημία εξαρτάται από την ικανότητά τους να προβλέπουν και να προσαρμόζονται αλλά και να προχωρούν σε αλλαγές που θα επιτρέψουν την συνέχεια των λειτουργειών τους και την επανάκαμψή τους στον ελάχιστο δυνατό χρόνο.

Background: Biopsy and histopathological examination (HPE) remain the mainstay for thyroid disorder diagnosis, but are invasive and may require thyroidectomy, leading to surgical comorbidities. A less invasive addition would be fine needle aspiration cytology (FNAC), which is a simple, rapid, safe and cost-effective outpatient diagnostic tool, that aids in differentiating benign lesions, thereby reducing unnecessary thyroid surgery. However, due to its limitations, corroboration of FNAC with HPE is required. Objective: To evaluate the sensitivity and specificity of FNAC in the diagnosis of thyroid swelling. Methods: Seventy-five patients, irrespective of age, reporting with a neck (thyroid) swelling, were recruited into the study. They were subjected to a detailed history and complete physical, systemic and local examination. Relevant laboratory investigations as well as FNAC and HPE of the lesions were performed. The results were compiled and analyzed using statistical software R version 3.6.3. Results: Majority patients were females (74.67%) and, most commonly complaining of swelling (100%), with 93.33% having benign lesions. The most prevalent clinical diagnosis was solitary thyroid nodule (54.67%) and FNAC diagnosis was goiter (85.33%), followed by thyroiditis (8%). Papillary carcinoma was more common (4%) than anaplastic carcinoma (2.67%). The carcinomas showed female preponderance and were diagnosed in 5 (6.67%) patients by FNAC, but 10 (13.33%) patients using HPE. Taking HPE as the gold standard, sensitivity and specificity of FNAC were found to be 100% and 50%, respectively, for classifying benign lesions. Cohen’s Kappa showed that there was 63.4% agreement between FNAC diagnosis and HPE diagnosis, which was substantial. Conclusion: FNAC procedure has excellent sensitivity and acceptable specificity to be used as a preoperative diagnostic modality in the management of thyroid lesions, thus reducing the number of surgeries.

Background: Chronic wound is when there is no complete healing after 6 weeks or poor response to a treatment change. Although any wound has the potential to become chronic, medical conditions commonly associated with chronic/non-healing wounds are diabetes mellitus, chronic venous congestion, arterial insufficiency and pressure sores. We are compared efficacy of collagenase (enzymatic debridement) and hydrogel dressing (autolytic debridement in management of chronic wounds at a tertiary health centre. Material and Methods: This prospective, comparative study, with in-patients more than 18 years admitted in Shri B.M Patil Medical College and Hospital, Vijayapura, Karnataka, India. Patients were randomised by lottery method, Group A-20 patients treated with collagenase dressings & Group B-20 patients treated with hydrogel dressings. Results: Total 40 patients were taken for the study. Age & gender distribution (Table 1) statistically not significant. Most patients were from 41-70 years age group, male to female ratio was approximately 2:1 in both groups. It was noted that complete responder, partial responder, non-complete responder & non-responder patients in group A were 65%, 20%, 10% & 5%. While in group B complete responder, partial responder, non-complete responder & non-responder patients were 50%, 15%, 25% & 10%. Difference between complete responder (completely healed) & non-complete responder (less than 50% reduction from the baseline area) was statistically significant in group A & group B Conclusion: Both hydrogel & collagenase are good options in management of chronic wounds. Experience was better with collagenase, larger studies are required for future guidelines.

Objective: Head and neck squamous cell carcinoma (HNSCC) has been reasonably linked to smoking and / or alcohol consumption. The purpose of our study was to investigate the possible correlation of HPV infection with papillary, precancerous and cancerous laryngeal lesions. Methods: Biopsy material was obtained from larynx of patients with papillary, precancerous or cancerous laryngeal diseases. The study included 55 patients, 53 men and 2 women. HPV-DNA microarray technique has been used. Results: Of the 55 patients, 23 HPV positive (41.8%), 27 HPV negative (49.1%) and 5 cases with no results were detected. From the subgroup of 23 HPV positive patients, 7 HR (30.4%) and 16 LR (69.6%) were found. The most common subtypes are HPV 11 (20%), HPV 85 (20%), HPV 31 (14.3%) and HPV 89 (14.3%). We should note the absence of HPV 16 in all patients. Furthermore, patients with HPV positive result are on average younger (23 patients, mean age 58.83 and Std. Deviation: 13.859) than patients who had HPV negative result (27 patients, mean age 67.3 and Std. Deviation: 7.917) (p = 0.014). Conclusions: In this prospective clinical analysis, a ‘weak’ correlation of HPV with the occurrence of pre-cancerous and cancerous laryngeal lesions was revealed in patients from northwestern Greece.

Background: Superior mesenteric artery syndrome occurs when the duodenum is compressed between the abdominal aorta and the superior mesenteric artery, and often requires surgical intervention. The underlying mechanism is a reduction in the aortomesenteric angle, and a subsequently reduced aortomesenteric distance. Literature from outside the African continent has identified several characteristics which determine aortomesenteric angle, however these might not be entirely applicable to African populations. We aimed to determine characteristics associated with aortomesenteric angle/distance in a South African population. Methods: We conducted a prospective cross-sectional study involving 124 adult patients who had abdominal computed tomography (CT) scans at a South African tertiary hospital between 1 January 2020 and 30 June 2020. We obtained demographic and comorbid disease characteristics from the patient’s medical records. Sagittal and axial CT scans were used to determine aortomesenteric angle (in degrees) and distance (in mm). We analysed the data using descriptive and bivariate statistics. Results: The median aortomesenteric angle for our study sample was 47.0 (Interquartile range: 36.5-61.8) degrees, and the median aortomesenteric distance was 11.6 (Interquartile range: 9.9-15.3) mm. We found that aortomesenteric angles were significantly larger in patients with cancer (p=0.045) and obese patients (p=0.007). We also found that aortomesenteric distance was significantly longer in patients aged >65 years old (p<0.001) and obese patients (p=0.010). Conclusion: In our South African population, the possibility of superior mesenteric artery should be ruled out in cancer patients, those >65 years of age, and in the obese individual.

Background: Reconstruction of multiple facial lesions detected simultaneously pose more difficulties. Taking into the account on the importance of facial aesthetic subunits and possible requirement of future reconstructions, available options should be explored carefully. Case presentation: This report presents a case of multiple facial skin squamous cell carcinoma in a patient with lower eyelid ectropion from previous cheek advancement flap and underlying psoriasis. Lower eyelid was reconstructed with bipedicled Tripier flap from the upper lid. An analysis of the surgical options, reconstructions and the results observed during follow-up were discussed. Conclusion: Achieving surgical clearance with minimal tissue defect is the main goal in any oncologic resection. Skin laxity and local tissue quality should be considered in all reconstructions. In lower eyelid reconstruction, establish horizontal rather than vertical tension.

Introduction: Acute colonic pseudo- obstruction or Ogilvie’s syndrome is a rare clinical entity that is characterized by acute, massive and non-toxic large bowel dilatation without the presence of mechanical bowel obstruction or volvulus. The typical pattern of this syndrome consists of elderly patients with many comorbidities and recent history of surgical (most commonly orthopedic or gynecological) operation. In the majority of patients, the management of Ogilvie’s syndrome is conservative. Decompressive colonoscopy and neostigmine administration are specialized conservative treatment options. Objective: The presentation of a rare and massive colon dilatation in a patient with Ogilvie’s syndrome that was successfully managed surgically. Case presentation: An 82-year-old woman was referred to the emergency department of our hospital from a rehabilitation center, because of gradually worsening abdominal distention, diffuse abdominal pain and absence of stool and flatus. The clinical, laboratory and radiological workup led to the diagnosis of Ogilvie’s syndrome and the patient was immediately posed in conservative treatment (resuscitation, hydration, decompressive colonoscopy). Despite the above measures, the clinical condition of the patient remained unchanged and the CT scan revealed a persistent massive colon dilatation, leading to the decision of emergent surgical operation. A Hartmann’s sigmoidectomy was performed with the fashioning of an end colostomy. The postoperative course of the patient was uneventful and with gradual return of normal bowel function. Conclusion: Ogilvie’s syndrome is rare but may appear in elderly patients with multiple comorbidities. In the majority of patients, the conservative methods of treatment are successful. However, the possibility of ischemia or bowel rupture must be kept in mind and demand high clinical suspicion, in order to proceed to surgery in the appropriate time.

Introduction: Failure of the normal embryologic descent of the thyroid gland usually results in midline ectopias. The presence of ectopic thyroid tissue in the lateral regions of the neck is rare. “Parasitic” thyroid nodules are anatomically separate from the thyroid gland and have no relation to lymph nodes. In such cases, exclusion of metastatic thyroid carcinoma may be necessary. Case Report: A 61-year-old woman, with a free individual history, came to the Outpatient Clinics with swelling of the left cervical region, despite the thyroid cartilage of the larynx, from two months. A complete clinical and imaging examination with ultrasound and MRI, followed by ultrasound-guided fine needle aspiration (FNA). FNA was non-diagnostic due to thin cell puncture. Surgical removal followed, under local anesthesia and histological examination revealed the presence of a parasitic nodule. Thyroid scintigraphy, with complementary whole-body imaging and thyroid function was normal. The patient is under observation. Conclusion: The presence of ectopic thyroid tissue should be included in the differential diagnosis of patients with non-lymph node-associated lateral edema, after the possibility of metastatic thyroid cancer is ruled out.

Ascariasis is a common intestinal parasitic infestation. Biliary tract is the commonest extraintestinal manifestation of ascaris lumbricoides. Hepatobiliary ascariasis can present as acute cholecystitis, acute pancreatitis, biliary colic, liver abscess, acute cholangitis or recurrent pyogenic cholangitis. Diagnosis includes the use of hepatobiliary ultrasound and/or MRCP. Majority of cases responds to conservative management. Persistent symptoms may need endoscopic treatment.

Even though liver and lung are the usual targets for distant metastasis from colorectal carcinoma, metastasis can occur also in other distant sites. We report herein an unusual case of colorectal metastasis two years after primary colonic resection. A 49- year-old man had undergone a two stage right hemicolectomy and a transverse colon resection during a six month period for initially misdiagnosed synchronous colorectal tumors. Two years later he was found to have two uncommon metastases on follow up imaging. One into the left lower retroperitoneal space and another in the spleen. As these lesions were well localized, they were surgically resected and the patient received adjuvant chemotherapy. At one year follow up patient did not present any signs of recurrence. Although the current available data is too small to draw any definite conclusion regarding the nature of spread and treatment for such metastases from a colorectal primary tumour, surgical excision seems to be preferable, when possible, promising the best term survival.

Intussusception is telescoping of a proximal segment of the gastrointestinal tract (intussusceptum) into the distal segment (intussuscipiens)1. Adult intussusception is a rare condition. It accounts for 5% of all intussusceptions and only 1 % of bowel obstruction cases2. 90% of adult intussusceptions are secondary to underlying pathological process in which most of the lead point are due to tumor, while only 10% of pediatric intussceptions have identifiable lead point3,4. Diagnosis of adult intussusception is challenging as patients might presented with non specific symptoms that can be acute, intermittent or chronic. En-bloc resection without reduction whenever possible is believed to be the treatment of choice for adult intussusceptions as many cases of the adult intussusceptions are secondary to maglinancy7. We are presenting a case of adult ileocolic intussusceptions secondary to caecum adenocarcinoma.