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   Table of Contents - Current issue
July-August 2022
Volume 55 | Issue 4
Page Nos. 129-162

Online since Monday, August 1, 2022

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A combination of diosmin, hesperidin, and ruscogenin: Clinical effects in symptomatic hemorrhoidal disease p. 129
Lucia Romano, Andrea Nervini, Simone Stia, Mario Schietroma, Antonio Giuliani
Background: Phlebotonics are made of plant extracts and synthetic compounds. Although their mechanism of action is not completely clear, they are associated with an increase in venous tone and decreased capillary permeability. The aim of this paper was to assess the efficacy of Diosmin 500mg, Esperidine 90mg, Ruscogenin 100mg in improving symptoms of patients with hemorrhoidal disease. Materials and Methods: This was an observational trial performed at the Department of Universitary General Surgery of L'Aquila from March 2021 to September 2021. Symptoms have been evaluated using scoring system proposed by Giordano et al. Patients have been clinically evaluated by the same surgeon at the time of diagnosis and at the 30th day of treatment. Results: Seventy-one patients were included in the study. In Group A (study group) we reported a decrease in symptomatologic score of 50% with a 30-days follow-up, while we reported a decrease of 27% in Group B (control group). Among patients in Group A, 67% of those with grade IV hemorrhoidal disease have been re-stadiated to grade III after 30 days of treatment. Conclusion: Flavonoids mixture could be a safe and effective mean for conservative management of hemorrhoidal disease. The doses seemed to be satisfactory and the proposed duration of treatment can be considered adequate.
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Outcomes of laparoscopic appendectomy during the level 3 alert of the coronavirus disease 2019 pandemic in Taiwan: Experience in a referral center p. 134
Hui-Ju Tsou, Shou-Sen Huang, Chung-Hsin Tsai, Shih-Ping Cheng, Tun-Pang Chu
Background: Emerging studies have reported an increased proportion of complicated cases of acute appendicitis and increased prehospital delay during the coronavirus disease 2019 (COVID-19) pandemic. We wondered whether there was a difference in the perioperative outcomes of laparoscopic appendectomy during the 69-day level 3 alert in our community. Materials and Methods: Adult patients who underwent laparoscopic appendectomy for acute appendicitis between May 19 and July 26, during the years of 2019, 2020, and 2021 at our institution, were included. Patient demographics, clinical presentation, interval from emergency department (ED) arrival to operation, operation duration, hospital stay, and postoperative complications were analyzed using SPSS Statistics. The Kruskal–Wallis and Pearson Chi-square tests were used for the analysis of numerical and nominal variables, respectively. Results: A total of 94, 102, and 63 cases were included during the corresponding periods in 2019, 2020, and 2021, respectively. Patient age, sex, symptom duration at presentation, percentage of leukocytosis, bacteremia, complicated appendicitis, and white blood cell count showed no group differences. The interval between ED arrival and surgery was not significantly different (P = 0.753). There were no significant differences in the operation duration (P = 0.094), estimated blood loss (P = 0.273), or proportion of drain insertion (P = 0.626). The length of hospital stay (P = 0.681), incidence of postoperative complications (P = 0.894), and postoperative complications according to the Clavien–Dindo classification (P = 0.241) were not significantly different among the groups. Conclusion: Adult patients undergoing laparoscopic appendectomy at our institution during the level 3 alert of the COVID-19 pandemic had no statistically significant differences in perioperative outcomes, including operation time, estimated blood loss, hospital stay, and complication rates.
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Can sensory protection improve the functional outcome in delay repaired rat brachial plexus injury? p. 140
Tommy Nai-Jen Chang, Wei-Chuan Hsieh, Jo-Chun Hsiao, Bassem W Daniel, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu
Background: Reconstruction of brachial plexus injuries (BPIs) at a delayed time point may prolong the denervation of target muscles and jeopardize the outcome. Sensory protection has been hailed as a promising technique that may help preserve muscle mass and restore functional outcome. We utilize the rat brachial plexus model to investigate the difference between early and delay repair, and evaluate if sensory protection of distal nerves can assist in delayed repair. Materials and Methods: Forty-eight Lewis rats were randomly assigned to four groups (n = 12 in each group, including one positive control group). All the rats were transected at the upper, middle, and lower trunk levels with a 2-cm gap. Group I underwent immediate reconstruction from the upper trunk to the median; Group II underwent the same reconstruction but at 4 months after the initial transection; Group III was same as Group II and additional sensory protection to the median nerve via a nerve graft from the lower trunk. The final outcome was studied and analyzed 16 weeks postoperatively. Results: Group I (immediate repair) showed the best functional results in muscle contraction force, muscle action potential, and muscle weight, in addition to higher axon counts. Groups II and III (delayed repair) both showed inferior results to Group I, and sensory protection did not show any significant improvements in outcome. Conclusion: Delayed repair still shows inferior outcomes to acute repair in BPIs. There is no sufficient evidence to support the use of sensory protection in delayed repair.
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Comparative study of oxytocin versus tranexamic acid and ethamsylate in preventing primary postpartum hemorrhage in women undergoing lower-segment cesarean section p. 147
Sanjeev Singh, Rachna Mishra, Arti Singh, Pavagada Shaifulla
Background: Worldwide, 21% of deliveries are by elective cesarean sections (C/S) as a procedure to reduce maternal and neonatal mortality and morbidity. Blood loss during C/Ss is more than vaginal delivery. Therefore, reducing blood loss during the C/Ss is essential and challenging for anesthesiologists and obstetricians. This study aimed to assess the efficacy of intravenous oxytocin versus tranexamic acid + ethamsylate (TXA + Eth) in reducing blood loss in pregnant women at high risk of primary PPH undergoing elective lower-segment cesarean section. Materials and Methods: A single-center, prospective, randomized, and double-blind study was started after obtaining institutional ethical approval. The study involved women undergoing elective C/Ss at full-term pregnancy at high risk for primary postpartum hemorrhage (PPH) at the SAMSRI between September 2021 and March 2022. The study participants received an infusion of either oxytocin 10 International Unit or TXA 1 g + Eth 250 mg before the skin incision. The primary outcome was the blood loss calculation, alongside hemoglobin and hematocrit before and after the surgery. The secondary outcome was the percentage of participants who progressed into primary PPH and required blood transfusion. Results: Analyses included 132 women in each group, and results showed that TXA + Eth significantly reduced bleeding during and after cesarean section in pregnant women at high risk for PPH. In oxytocin and TXA + Eth groups, postoperative blood loss was (613.7 ± 123.7 and 406.2 ± 116.5) ml, respectively, P < 0.001. The duration of surgery in oxytocin and TXA + Eth groups were (48.5 ± 9.3) and (44.3 ± 9.8) minutes, respectively (P = 0.287). The blood transfusion requirement in the oxytocin and TXA + Eth groups were 10.69% and 0.75%, respectively (P = 0.023). The PPH in the oxytocin and TXA + Eth groups were 2.30% and 0%, respectively (p < 0.017). Pre- and postoperative hemoglobin and hematocrit values at 24 h after cesarean section in the oxytocin (10.78 and 8.29) and (32.23 + 25.10) and TXA + Eth groups were (11.07 and 10.02) and (33.20 and 30.73), respectively (P < 0.001). Conclusion: The use of TXA and Eth is safe and more effective than oxytocin in minimizing blood loss, and the demand for blood transfusion after cesarean section.
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Merendino procedure as an alternative to total gastrectomy in the treatment of gastrointestinal stromal tumors of the gastroesophageal junction: A case series p. 154
Nakhieeran Nallasamy, Theiyallen Ambikapathi, Wei Keat Ooi, Firdaus Hayati
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the alimentary canal and are postulated to have originated from the interstitial cells of Cajal. We present three patients with an age range from 43 to 63 years old diagnosed with GIST of the gastroesophageal junction (GEJ). All patients were noted to have submucosal lesions through gastroscopy, in which the largest was 5 cm × 7 cm in size. All of them underwent emergent surgery due to various reasons, and the Merendino procedure was performed as the surgery of choice. All of them recovered well and were discharged on days 10–12. The histopathological examination demonstrated a GIST. Merendino procedure can improve patients' digestive functions and nutritional status, leading to a better quality of life after surgery with a reduction in postoperative complications. This case series demonstrated proximal gastrectomy with Merendino procedure reconstruction as a safe, efficient, and feasible approach in treating gastric GISTs at the GEJ.
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Cerebral venous sinus thrombosis-associated hemorrhage in vaccine-induced immune thrombotic thrombocytopenia: Catastrophic outcome if delayed diagnosis and treatment p. 158
Chee-Tat Lam, Kuan-Yu Lin, Ming-Chien Kao, Ming-Cheng Tsai
The authors reported the clinical course of a 58-year-old female suffering from cerebral venous sinus thrombosis associated with hemorrhage after the ChAdOx1 nCov-19 vaccination. Emergent decompressive craniectomy was performed, and aggressive blood transfusion was given. Nevertheless, progressive intracerebral hemorrhage and thrombocytopenia developed. A delayed diagnosis was made on a rare complication of vaccine-induced immune thrombotic thrombocytopenia (VITT) with a positive result of anti-platelet factor 4 antibodies (PF4 Ab). The patient died 4 days postoperative due to brainstem failure.
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Comment on “onlay and sublay (retrorectus) mesh repair for incisional hernia” p. 161
Pathum Sookaromdee, Viroj Wiwanitkit
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Author's reply: Comparative analysis of onlay and sublay (retrorectus) mesh repair for incisional hernia (width ≤10 cm) of abdominal wall: A single-center experience p. 162
Manoj Kumar, Manoj Kumar, Ashesh Kumar Jha, Abhishek Arora, PP Sreepriya, BS Niroop, Md Ashraf Ali
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