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   Table of Contents - Current issue
May-June 2019
Volume 52 | Issue 3
Page Nos. 71-110

Online since Monday, June 17, 2019

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Long-term surgical outcome of median nerve injuries p. 71
Mohammadreza Emamhadi, Hamid Behzadnia, Sasan Andalib
Background: Median nerve integrity is a prerequisite of normal hand function. The median nerve is a frequently injured nerve, and recent evidence indicates that nerve surgery may produce acceptable outcomes. The present study provides a framework of long-term surgical outcomes of median nerve injuries and specifies independent predictors of motor and sensory recovery. Materials and Methods: In the retrospective study, patients with median nerve injuries undergoing the nerve surgery were reviewed. Mechanism of injury, level of injury (arm, elbow/forearm, and wrist), type of injury and lesion, type of surgical repair, and the time interval from injury to surgery were assessed. The long-term follow-up of motor recovery, sensory recovery, and quality of life was done. Results: A total of 106 cases with median nerve injuries undergoing nerve surgery were included in this study. Most injuries were at wrist level with a higher frequency of sharp and not in continuity lesions. There was a significant association between the three outcomes (motor recovery, sensory recovery, and quality of life) and smoking, addiction, type of injury, type of lesion, and type of nerve repair. There was a significant correlation between quality of life and muscle force recovery and between quality of life and sensory recovery. Muscle force recovery was significantly correlated with sensory recovery. Conclusions: The findings of the present study suggest that male and young subjects, lesions in continuity, and injuries treated without grafting may show better surgical outcomes.
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Evaluation of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy Highly accessed article p. 76
Anand C Patel, Vipul D Yagnik
Background: Pancreatic fistula (PF) remains the most common and challenging complication following pancreaticoduodenectomy (PD), with an incidence of 2%–28%. The primary objective of this study was to assess the correlation of fatty infiltration and fibrosis of the pancreas with postoperative pancreatic fistula (POPF). Secondary objectives were to investigate the correlations of POPF with the main pancreatic duct size and subjective intraoperative assessment of pancreatic texture and to determine if diabetes mellitus (DM), body mass index, or increased serum bilirubin correlate with POPF. Materials and Methods: This prospective study was performed at Sudhamayi Hospital, Kochi, India. Forty-six patients were included and divided into either the fatty infiltration group (n = 20) or fibrosis group (n = 17); nine patients had neither fatty nor fibrotic glands. Data were analyzed using analysis of variance and Chi-square test, utilizing SPSS software version 20 (IBM Inc., Armonk, NY, USA). Results: Patients with fatty pancreas had a ten times higher incidence of PF than those with fibrotic pancreas (odds ratio, 10.8; 95% confidence interval [CI], 2.2–52.4; P = 0.003). POPF was 7.9 times higher in patients with a nondilated duct compared to patients with a dilated duct (95% CI, 2.118–29.5; P = 0.003). Preoperative elevated serum bilirubin, body mass index, and DM were not found to be significant risk factors for POPF. Conclusion: We demonstrated that fatty pancreas and small pancreatic duct size (≤3 mm) are risk factors for POPF. Preoperative elevated serum bilirubin, body mass index, and DM were not found to be significant risk factors.
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Enhancing rat full-thickness skin wounds with a mixed aloe/chitosan gel p. 84
Zeinab Janahmadi, Meisam Rezaei Motlagh, Sasan Zaeri
Background: Finding optimal treatment for skin wounds, especially using natural substances, has been of main focus in skin care and cosmetics. Aloe vera has been historically used in wound care, and chitosan, which is obtained from crustaceans, has a variety of biomedical applications. Accordingly, it seems that a mixture of aloe/chitosan may provide added benefits in wound healing. Aims: The aim of the present study was to evaluate the effects of a mixture of aloe/chitosan gel in comparison to each component alone, on the healing of excisional full-thickness wounds in rats. Materials and Methods: Round full-thickness wounds were made on the back of animal necks. Five experimental groups received either no treatment (Group 1) or daily topical treatments with 1% carboxymethyl cellulose (CMC) (Group 2), aloe (Group 3), chitosan (Group 4), or mixed aloe/chitosan gels (Group 5) for 14 days. Wound areas on days 3, 7, and 14 and histopathologic parameters on day 14 were measured for analysis. Results: Means of wound areas showed a significant decreasing pattern in all groups through days 3–14 (P < 0.001). The topical treatment of wounds with aloe/chitosan significantly reduced wound areas compared to nontreated (P = 0.019) or 1% CMC-treated (P = 0.021) wounds. Histopathologic analysis revealed more reepithelialization, fibroblasts, collagen fibers and less polymorphonuclear leukocytes, new vessels, and granulation tissue in wounds treated with aloe/chitosan in comparison to controls (P < 0.05). Conclusions: Aloe/chitosan-treated wounds showed convincing healing profiles affirming the benefits of using natural bioactive substances in wound healing, especially in combination therapy.
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Obstructive tracheal neoplasm: Imaging and therapeutical features of pleomorphic adenoma p. 92
Badreeddine Alami, Saïd Boujraf, Mohamed Smahi, Mounia Serraj, Moulay Youssef Alaoui Lamrani, Meryem Boubbou, Mustapha Maaroufi
Primary tumor of the trachea is rare. Although most tumors in adults are malignant, various benign tumors might occur. However, pleomorphic adenoma of the trachea is extremely rare. So far, few cases have been reported in medical literature. We report a case of a 38-year-old man with 6 months history of dyspnea and wheezing; the asthma was the initial diagnosis formulated by his family doctor. However, the symptoms were not improved by asthma treatment. The patient was admitted to the emergency department for respiratory distress, and underwent nasal continuous positive airway pressure. Immediately, after an urgent chest computed tomography (CT) was done and revealed an obstructive tumor of the distal trachea which was homogeneous with a smooth and regular surface suggesting its benignity. The patient was operated urgently, the histological examination of the surgical specimen revealed pleomorphic adenoma. We present this case to inform colleagues that pleomorphic adenoma must be considered in the differential diagnosis of tracheal tumors, especially if we have an appearance on CT suggesting the benignity. Surgery is the treatment of choice of this tumor with the lowest recurrence probability.
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Using donor ascending aorta for venous reconstruction in a situs inversus heart transplantation p. 96
Jenn-Yeu Song, Yi-Ting Tsai, Ta-Chung Shen, Chien-Sung Tsai
A 66-year-old female was a case of situs inversus that developed heart failure. Heart transplantation was performed with the modified method. While we harvested the donor's heart, we left an extra-aortic conduit in the ascending aorta. Donor's superior vena cava (SVC) and inferior vena cava were also retained for available anastomoses to the systemic venous return of the recipient. The donor's right atrium (RA) and lower half of the recipient's RA were connected using a 4-cm long conduit (from the retained aortic segment). The donor's SVC was anastomosed to the upper half of the recipient's RA. We placed a titanium vascular ring around the donor's SVC between the aorta and pulmonary artery (PA). In the present case, we preserved the extra-aortic conduit for reconstruction of the venous return system. The allogeneic aortic conduit had the advantage that it could avoid external compression and may have prevented thrombosis in anastomoses between the vena cava and atrium. A titanium ring could maintain the donor's SVC that passed through the aorta and PA. Future efforts should be directed to follow the patency of the venous pathway.
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Multiple massive intratumoral hemorrhages of metastatic brain melanoma after ventriculoperitoneal shunt p. 99
Tsung-Hsi Yang, Jung-Tung Liu, Fook-How Chan
A 50-year-old male presented with sudden-onset headache, diplopia, and unsteadiness due to a posterior fossa hemorrhagic melanoma causing hydrocephalus. Computed tomography of the brain showed a 2.3 cm × 2.0 cm hemorrhagic tumor in the cerebellar vermis and a concomitant fourth ventricular hemorrhage. He underwent removal of the tumor and then ventriculoperitoneal shunt insertion for hydrocephalus. Because of his widespread disease, the patient died 2 weeks later from multiple massive intratumoral hemorrhages. To avoid this unfortunate consequence, we discuss the mechanism and suggest methods for treatment improvement. The variable we could control carefully was the opening pressure of the shunt and the flow of cerebrospinal fluid drainage. Setting a higher opening pressure and changing the pressure more slowly should be considered. To achieve this goal, the use of a programmable valve and anti-siphon system should strongly be recommended in these high-risk populations with extremely high bleeding tendency.
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Long-term survival of a patient with advanced hepatoid type adenocarcinoma of stomach and liver metastasis p. 103
Chao-Chien Hung, Tsung-Jung Liang, Huai-Pao Lee, I-Shu Chen
Hepatoid adenocarcinoma is a rare variant of gastric cancer, and exhibits most of the characteristics of alpha-fetoprotein-secreting cancer; it has been reported to have poor outcomes irrespective of the treatment used. Here, we report a case wherein a relatively favorable outcome was obtained following surgical treatment of metastatic hepatoid adenocarcinoma originated in the stomach, and discuss the treatment of the disease. Metastatic gastric cancer is considered a systemic disease; however, even with a worse prognosis of the hepatic variant type, we achieved long term survival following surgical resection of primary and metastatic tumor. This experience highlights the importance of using aggressive surgical treatments for potentially resectable metastatic gastric cancer, irrespective of the tumor variant.
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Gastric cancer and intrahepatic cholangiocarcinoma: Gastrectomy followed by left hepatectomy to achieve R0 resection p. 107
Alex Emmanuel Elobu, Ashok Thorat, Vianney Kweyamba, Rakesh Rai
Gastric cancer is the fifth most common cancer and the third leading cause of cancer deaths globally. Its incidence is highest in Asia and lowest in Africa. In 1.1%–4.7% of all gastric cancer cases, at least one other primary tumor may be found. We present the case of a 55-year-old male from West Asia who underwent proximal gastrectomy for Stage IIB gastric adenocarcinoma. One year into postoperative surveillance, routine abdominal imaging revealed a liver tumor. A left hepatectomy was performed, histology of which revealed cholangiocarcinoma. Cholangiocarcinoma though rare may occur following a diagnosis of gastric cancer, thus the strong need for routine abdominal imaging during surveillance of these patients. Any suspicious lesions discovered during follow-up need to be vigilantly evaluated so that patients are offered appropriate and timely treatment.
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Corrigendum: Chronic periodontal disease correlated with sezual function in young males p. 110

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