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   2021| March-April  | Volume 54 | Issue 2  
    Online since March 20, 2021

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Duplications of the alimentary tract in infants and children
Rupesh Keshri, Ramjee Prasad, Digamber Chaubey, Zaheer Hasan, Vijayendra Kumar, Vinit Kumar Thakur, Ramdhani Yadav, Rakesh Kumar, Asjad Karim Bakhtiyar, Sandip Kumar Rahul
March-April 2021, 54(2):39-44
Background: Duplications of the alimentary tract are known for their embryonic, anatomical, clinical, and pathologic variations. Summarizing the features of these lesions would reveal these characteristics and guide appropriate management. The objectives of this study are to describe the clinical features and characteristics of all cases of duplication of alimentary tract managed at a tertiary center. Materials and Methods: A retrospective study on all cases of duplications of the alimentary tract managed at a tertiary center from July 2015 to June 2020 (5 years) was conducted after approval from the Institutional Ethics Committee. Data regarding history, demographic details, symptoms, clinical features and investigation results, and intraoperative and histopathologic findings were collected from the hospital records and analyzed. Results: Twenty-eight cases of duplication were managed during this period. They had different locations (esophageal-5 [cervical-2 and thoracic-3], gastric-1, jejunal-3, ileal – 11, cecal-3, appendicular-2, colorectal-1, rectal-1, and posterior anal canal-1) and site-specific symptoms but definite histopathology with evidence of adjacent gastrointestinal tissue on microscopic examination. Unique cases included cervical esophageal duplication, bleeding ileal duplication (ID) with heterotopic mucosa, ID with bezoar, jejunal duplication with malrotation, appendicular duplication with type 2 pouch colon and anorectal malformation, rectal duplication, and posterior anal duplication. Case-specific management ensured minimal complication without any mortality. Conclusion: Variable location and site-specific symptoms necessitate individualized case-specific management of duplication anomalies. Histopathology confirms both native and heterotopic gastrointestinal tissues and is indispensable for the diagnosis.
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Predictors of mortality in necrotizing fasciitis
Mahendra Kumar, Mohan Lal
March-April 2021, 54(2):52-60
Background: Necrotizing fasciitis (NF) is a rapidly progressing life threatening necrosis of the fascia and subcutaneous tissue. This study was done to assess the clinical presentation, laboratory investigations, microbiological characteristics, and major predictors of mortality associated with NF. Material and Methods: A prospective study was conducted from March 2013 to February 2014. NF patients were categorized into two groups based on their in hospital outcome. Demographic data, clinical features, comorbidities, site of infection with microbiology and laboratory results, and surgical intervention for patients were compared and analyzed. SPSS 26.0 statistics software was used for statistical analysis. Results: The mean age was 48.6 ± 16.78 years. Fever (P = 0.0177), tachycardia (P = 0.0155), and septic shock (P = 0.0046) were significantly high in nonsurvivors. Diabetes was the most common comorbidity. Renal impairment (P = 0.0229) was significantly high in the nonsurvivor group. The most common site was lower limb/thigh NF. Abdomen/groin NF (P = 0.0158) was significantly high in nonsurvivors. Nonsurvivors had significantly low hemoglobin (P = 0.0027) and serum sodium (P = 0.0023) and had significantly high leukocyte count (P = 0.00001), serum creatinine (P = 0.0000), serum glucose (P = 0.00003), and LRINEC score (P = 0.00002). Polybacterial infections (P = 0.021) were significantly high in nonsurvivors. The frequency of debridement more than 2 (P = 0.0469) and debridement within 24 h of admission (0.0013) were significantly high in survivors. Hospital stay (P = 0.0272) was significantly high in nonsurvivors. Multivariate logistic regression analysis did not show any independent factors associated with mortality Conclusion: Identification of predictors of mortality can improve the management and outcome of NF.
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Fractionated stereotactic radiosurgery in treating the complex intracranial arteriovenous malformations
Peng-Wei Hsu
March-April 2021, 54(2):45-51
Background: The aim of this study was to examine the efficacy and safety of treating large or eloquently located intracranial arteriovenous malformations (AVMs) with fractionated stereotactic radiosurgery (FSRS). Materials and Methods: Eighteen patients with AVM treated with FSRS between March 2006 and August 2018 were retrospectively evaluated. The nidus obliteration, volume reduction, rate of rebleeding, newly onset neurological deficit, and signal change in magnetic resonance imaging (MRI) were evaluated. Results: With a median follow-up of 88 months (range: 24–154), 6 of the 18 lesions (33.3%) had a complete obliteration. All obliteration occurred in patients received the total treatment dose of 21 Gy (6 of 9 patients, 66.7%). The median time to complete obliteration was 38 months (range: 12–53). The mean volume reduction after FSRS in the 25 Gy group was 30.2% ± 20.9% and that in the 21 Gy group was 87.7% ± 24.2%. During the follow-up period, 4 of 18 (22.2%) lesions revealed T2 signal change in the MRI. No FSRS-related complication was noted clinically or radiologically. Conclusion: According to the present results, FSRS could be an effective and safe treatment alternative for complicated AVMs. Delayed toxicity after treatment is not noticed in the current study, but long-term follow-up is required. A higher dose in total and each fraction is likely needed when treating larger lesions.
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Treatment results of teratologic arthrogryposis in a case of Freeman-Sheldon syndrome: A 25-year follow-up
Tsung-Mu Wu, Lin-Shaw Chin
March-April 2021, 54(2):66-69
Freeman-Sheldon syndrome (FSS) is a very rare genetic disorder, also called “whistling-face syndrome.” Patients with this condition have distinctive facial appearance of small mouth and pursed lips, and skeletal malformations such as talipes equinovarus, hip dysplasia, camptodactyly, and scoliosis. The reports for the arthrogryposis of such cases by management are rare. A 2-year-old girl with FSS presented with hypertelorism, increased philtrum length, small nose and nostrils, and pursed lips, with skeletal deformities including (1) bilateral windmill vane hands, (2) bilateral rigid talipes equinovarus, and (3) bilateral high riding hip dislocation. To provide the patient with a pair of plantigrade feet for future standing, we performed a bilateral clubfoot soft tissue release and total talectomy with tibiocalcaneal fusion. For the bilateral high riding hip dislocation, we chose the nonoperative treatment by rehabilitation, given that the pelvis was relatively stable and in a leveled position. At the 25-year follow-up, she walked independently with mild waddling gait without support, on a stable, plantigrade foot. From the outcome, performing radical soft-tissue release with talectomy to obtain a plantigrade foot and conservative treatment for the bilateral hip dislocation to ensure a leveled pelvis may be a proper option for such cases.
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A comparative study evaluating the efficacy of 2.0-mm mini locking plate and 2.0-mm three-dimensional locking miniplates in mandibular angle fractures
Deepika Subramaniyan, R Sathyanarayanan, V Suresh, Monica Subramaniyan, Venugopalan , Thamizhp Pozhil Guna
March-April 2021, 54(2):61-65
Background: Three-dimensional (3D) mini locking plates not only provide stability due to their unique double-lead thread structure but also cause minimal interference with the underlying vasculature. However, there are not much data available regarding the application of 3D miniplates as a treatment modality for mandibular angle fracture. Therefore, this study was designed to gauge and compare the efficacy of 2.0-mm mini locking plates and 2.0-mm 3D locking miniplates in mandibular angle fractures. Materials and Methods: This comparative randomized study involved 34 mandibular angle fracture patients with randomly categorization into Group 1 (managed using 2.0-mm conventional mini locking plate) and Group 2 (managed using 3D miniplates). The parameters evaluated were occlusal stability, displacement of fracture, signs of inflammation as well as any hardware failure postoperatively. Analysis done was Chi-square test. Results: The mean duration of operation was significantly less in Group 2 (P < 0.05). Normal healing was noted to be more in Group 2 than in Group 1, with no hardware failure observed in any of the groups. Postoperative occlusal stability was observed to be more satisfactory during the 3rd week of follow-up in Group 2 patients, which was statistically insignificant (P = 0.2). Conclusion: 3D miniplates have emerged as a feasible treatment option in cases of mandibular angle fractures. This study reveals comparable results depicting the effectiveness of 3D titanium miniplates to standard titanium miniplates. However, further interventions are needed to arrive at more conclusive outcomes.
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Non-dysraphism intradural cervical lipoma
Zhao-Quan Liu, Cheng-Ta Hsieh, Jui-Ming Sun, Chih-Ta Huang
March-April 2021, 54(2):70-74
Intradural spinal lipomas not associated with spinal dysraphism account are rare entity. The pure cervical intradural lipomas are rarer and only eleven cases have been reported in the literature. The median age at diagnosis was 35 (8m-52y) years old and the ratio of men to female was 1.4:1. The possible risk factor included weight increase or rapid metabolic change. Only one case had recurrent condition during follow-up period. Here, we reported a 32-year-old male who presented with posterior neck pain and radiating numbness from neck to bilateral upper extremities. The radiograph of cervical spine showed a widening spinal canal diameter. Further study confirmed a pure cervical intradural intramedullary lipoma without spinal dysraphism. For preventing the neurologic deficit, early diagnosis and adequately surgical decompression were needed. Subtotal removal with cavitational ultrasonic surgical aspirator has been widely use as it minimizes any traction on already compromised neural tissues.
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Pyuria in Fournier's gangrene: A curious presentation
Kaminder Bir Kaur, Deepak Kumar, Vishal Mangal, Shailendra Pratap Singh
March-April 2021, 54(2):75-76
  154 23 -
Surgery-related COVID-19: A note
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
March-April 2021, 54(2):77-77
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