Prevalence of DFU among diabetic patients and its management

: To study the prevalence of DFU among diabetic patients and the management of DFU among diabetic patients.: Prospective observational study. : The study was conducted in inpatients with diabetes of all departments and inpatients with diabetic foot ulcer (DFU) of surgical department of age 20 to 80 of both genders with sample size 150 were included from September 2019 to march 2020. The prevalence of DFU among diabetic patients was 16%. Among them more diabetic cases were seen in age group of 50-59 and DFU in 40-49 and More diabetic cases are observed in male compared to female. DFU observed equally and the most common causative organism for DFU was staphylococcus aureus followed by proteus species, klebsiella and pseudomonas aeruginosa and more cases of DFU were noticed in diabetic patients with duration of 6-10 years. As the main cause of DFU is infection the primary treatment is anti microbial therapy and the most prescribed class of antibiotics is cephalosporins followed by nitroimidazoles, penicillins, oxazolidinones, lincosamides etc. surgical procedures like debridement, amputation and sometimes both were done in 9,14,1 patients respectively. : Our study revealed the information regarding the prevalence of DFU among diabetic patients is due to lack of knowledge and uncontrolled diabetes may develop poor circulation which leads to wound that may heal slowly which leads to DFU.

Embolism to the main limb arteries in patients with atrial fibrillation

Introduction. Acute limb ischemia due to embolism in patients with atrial fibrillation remains poorly studied. Objective – to study the clinical significance and role of atrial fibrillation (AF) in the development of embolism to the bifurcation of the aorta and the main arteries of the limbs. Materials and methods. Treatment results of 1816 patients with acute ischemia of the extremities due to embolism treated at a specialized vascular surgical department for the past 30 years were analyzed. 1611 (88.7 %) of them had AF. The distribution into studied groups was according to the period time factor. Group 1 (n = 744) consisted of patients admitted in the period from 1991 to 2000; in group 2 (n = 568) – admitted in the period from 2001 to 2010, in group 3 (n = 299) – from 2011 to 2020. Methods included clinical examination, electrocardiography, Doppler-ultrasound, echocardiography. Results. The role of rheumatic heart disease as a cause of AF has decreased over the past decades by almost 10 times (from 19.5 % in group 1 to 2.0 % in group 3). Currently, the main background diseases for the development of AF are arterial hypertension and various forms of coronary artery disease. Embolism in patients with AF may develop in the arteries of all vascular areas of the systemic circulation, but in the practice of a vascular surgeon more often in the main arteries of minor caliber – the brachial (24.5 %) and popliteal (13.0 %). Multiple embolisms to various vascular areas were found in 2.8 % of patients. Urgent surgical revascularization of the limb by open embolectomy was performed in 1481 (91.9 %) patients that allowed 1348 (83.7 %) to be discharged with limb-sparing. Conclusion. In patients with acute limb ischemia of embologenic ethiology, comorbid AF has 88.7 % of them. Urgent embolectomy allows 83.7 % of patients to be discharged without limb amputation. Hospital mortality in the period 1991–2000 was 15.6 %, the last decade has been reduced to 7.4 %.

EFFICACY OF NEGATIVE PRESSURE WOUND THERAPY IN EARLY DIABETIC FOOT ULCER MANAGEMENT IN COMPARISON WITH ADVANCED MOIST WOUND THERAPY

Objective: To compare negative pressure wound therapy with advanced moist wound therapy in managing early diabetic foot ulcer. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical Department, Combined Military Hospital Rawalpindi, from Jul 2016 to Jun 2018. Methodology: A total of 100 patients of diabetic foot ulcer were randomly allocated into two equal groups for the treatment with negative pressure wound therapy (NPWT) and advanced moist wound therapy (AMWT). Ulcers were reassessed after 4 weeks for presence of granulation tissue covering entire ulcer base and reduction of 3 cm in largest diameter of ulcer. Results: Mean age of the study participants was 57.08 ± 9.99 years. 33 patients had Wagner grade-I ulcer, while remaining had Wagner grade-II ulcer. Mean ulcer size at presentation was 6.46 ± 1.71 cm. Both study groups were comparable in terms of mean age (p=0.968), wound size at presentation (p=1.000), age (p=0.695), gender (p=1.000) and Wagner ulcer grade (p=0.288). Mean ulcer size was found smaller with negative pressure wound therapy (3.46cm, p=0.061) at follow-up visits. Reduction in ulcer size ≥3cm was achieved frequently with negative pressure wound therapy technique (72.0% vs. 38.0%; p>0.01). Mean healing time was 4.11 ± 1.65 weeks which was lower with negative pressure wound therapy (3.66 weeks vs. 4.56 weeks; p>0.05). Treatment efficacy (healing in ≤4 weeks and ≥3cm reduction in ulcer) was significantly higher with negative pressurewound therapy (72.0% vs. 38.0%; p<0.01) as well. Conclusion: This study demonstrates superiority of negative pressure wound therapy over advanced moist...............

Giant Soft Tissue Sarcoma of Scalp with Skull and Cerebral Invasion

Scalp soft tissue sarcomas (STS) are very rare accounting for less than 0.1% of all malignancies. We report a rare clinical image of advanced stage soft tissue sarcoma of the scalp. A 65 year woman had presented to the surgical department with complaints of a rapidly growing swelling over the scalp for three months. On examination there was huge 20 x 20 cm swelling over the scalp in the left temporoparietal region with variegated consistency. Computed tomography of head revealed a large soft tissue mass with necrosis invading the bone and underlying brain parenchyma. Histopathological finding from core needle biopsy revealed pleomorphic sarcoma. STS are highly malignant tumors which should be diagnosed and treated using multimodality approach. Recurrences are common even after complete resection and prognosis is poor.

Gaucher's disease

The article presents a rare clinical case of Gaucher's disease, a hereditary disease that belongs to lysosomal accumulation diseases. A 36-year-old patient was admitted to the clinic with complaints of pain in the left half of the abdomen, pain in the chest, cough with yellow sputum, difficulty breathing due to pain, general weakness. The mental underdevelopment, hepatosplenomegaly, anemia, thrombocytopenia, and the threat of rupture of the spleen were revealed in the process of collecting anamnesis and examination. The patient was transferred to the surgical department, and a splenectomy was performed. Histological examination of the spleen and genetic examination confirmed the diagnosis of Gaucher's disease.

Microvascular myocutaneous and cutaneous free flap reconstruction in patients with terminal esophagostomy after complicated oncological esophagus resection

Summary Background Persisting anastomotic leakage after oncological esophagectomy is a severe problem associated with high mortality and morbidity. Unfortunately, treatment options with promising results are scarce, especially when conventional operative and endoscopic methods have failed. Due to limitation of oral intake and the need for artificial nutrition, quality of life (QOL) is reduced. Microvascular myocutaneous and cutaneous free flap (MFF) reconstruction could be a promising alternative. Methods This retrospective case series presents 7 patients treated between March 2017 and November 2020 at our surgical department, with persisting postoperative anastomotic leakage without further feasible treatment options. All patients received anastomotic MFF reconstruction; used flaps and important intraoperative factors like microvascular anastomosis were evaluated. Complications and patient contentment was assessed. Results The included 7 male patients had median age of 65.15 years (range: 48–75). MFF function was adequate in 6/7 patients, one flap necrosis was encountered. Whereas 5 patients initially had good results, surgical revision was performed in 1 patient to ensure graft function. Postoperative complications appeared in 6/7 patients. Mean duration of inpatient care was 63 days (range: 24–156). At the time of evaluation, 1 patient has died of his malignant disease. No more additional nutrition was needed in 3/6 patients with adequate graft function. Most patients reported improved QOL after MFF. Conclusion MFF free flap can be an alternative treatment option for patients with terminal esophagostomy after complicated oncological esophagus resection without further treatment options. The renewed ability of oral food intake results in a significant improvement of QOL.

Anton Chekhov’s Sakhalin Island: An Ongoing Commentary

A study of the currently existing translations of Anton Chekhovs Sakhalin Island (From Travel Notes) (Luba and Michael Terpak - 1967, Brian Reeve - 1993) shows that the reason for some errors in translated texts is not always due to the negligence of translators, which is so clearly noticeable in the first translation, but rather in the incomprehensibi- lity for foreigners of some realia in the original text. Reference to two available Сommentaries on Sakhalin Island, by M.L. Semanova (1985) and M.S. Vysokov (2010), as well as to the works of other Chekhov scholars, did not give the sought-after explanations of certain vague excerpts from the book. Those obscure excerpts are also poorly understood by the Russian readership. In particular, we are talking about Chekhovs mention of the use of a naval rope in the surgical department (Chapter VII) and the perception of the status of a class feldscher/paramedic (Chapter XII). The author of the article offers her own commentary on difficult-to-understand passages and thus fills the gap that has arisen. Conclusions are drawn about the need to continue to provide Chekhovs Sakhalin Island with commentaries and notes. Such commentary should serve two purposes. Its linguistic and cultural character should help to clarify the realias not only for representatives of a foreign linguistic culture - in order to prevent gross errors in translations, but also for the present-day Russian reader, separated from the time when A.P. Chekhovs book was written by almost one hundred and thirty years.

Nodular Fasciitis of the breast – An uncommon benign reactive proliferative lesion

Nodular fasciitis is rarely reported in breast. It is benign reactive proliferative lesion of fibroblast. A 65 year old female presented to surgical department for left breast mass since 2 months duration, rapidly enlarging without any regional lymphadenopathy. Mammography showed hyperdensity masses with irregular margin. On FNAC reported as benign spindle cell lesion. Left sided two breast masses measuring 4 x 3.3 x 2.5cm and 2.0 x 1.6 x 0.5cm were excised and on histopathology reported as Nodular Fasciitis of left breast. We are presenting this extremely rare case of nodular fasciitis of breast for its clinical, radiological and histopathological findings.

Frequency of Malignancies in Surgical Subjects and Subjects with Mass in Breast in the Surgical Department of Pumhsw Nawabshah Pakistan

Objective: To conclude frequency for malignancies in subjects with mass in breast at the PUMHSW Nawabshah department of surgery Wards. Design of Study: This is an Observational research. Duration & Location of Study: Current research was carried out in surgery at Nawabshah People's Medical College Hospital (SBA) from November 20, 2018 to November 20, 2020. Methodology: This research comprised of 200 subjects. A comprehensive history was taken from total subjects with special consideration for breast nodules & axillary lymph nodes & recorded proforma to evaluate the affected area was specifically inspected. A systematic review was also conducted to identify comorbidities. Total subjects received baseline & specific tests, especially radiological & histopathological reports. The selection criterion was that total female subjects over the age of 15 associated with mass in breast were included in this research. Exclusion criteria were subjects with breast abscesses & those who were diagnosed & treated for breast cancer with recurrent lesions. Results: the range of age started from 15-65 years, 39+4.11 years was mean age. lesion of Benign nature on biopsy were were Fibroadenoma 22%, intraductal papilloma 9%, Phylloid Tumor Benign 6% & lactating adenoma 5%. Neoplastic nature was observed on biopsy invasive ductal carcinoma 19%, Invasive lobular carcinoma 11% & malignant phylloides tumor 9%. Conclusion: Study determined that frequency of breast malignancy in breast lumps was 58%.

Desarda’s Repair Vs Lichtenstein Repair in Indirect Inguinal Hernia -Preferred technique

Aim: To compare the outcome of Desarda`s technique with that of Lichtenstein mesh hernioplasty in terms of chronic pain, recurrence and infection. Methods: A prospective comparative study with randomized controlled trial was conducted at Lahore General Hospital in Surgical Department to appraise the outcome of Desarda Hernioplasty in comparison with Lichtenstein Hernioplasty technique to evaluate recurrence, wound infection and chronic groin pain. The Desarda repair is used to treat inguinal hernia without the use of mesh. Results: Total sixty (n=60) patients were included in the study by dividing into two groups Group A and B with mean age 40.5 and 39.5 years for Desarda vs Lichtenstein groups correspondingly. Insignificant statistical difference was noted in both groups regarding wound infection but considerable statistical advantage was noted regarding recurrence and Chronic groin pain for Group A patients in comparison to Group B. Conclusion: We concluded that Desarda repair is emerging technique and cost effective with lesser pain, infection and recurrence than other techniques. Keywords: Desarda`s repair, Lichtenstein repair, wound infection, chronic groin pain and recurrence