Iatrogenic Laryngeal Lipoma: Rare Complication after Fat Injection Due to Increased Vocal Fold

Centrifuged autologous fat injection is a safe, feasible and effective phonosurgical technique for the treatment of chordal paralysis and its use dates back to 1991. This procedure allows to correct glottic incompetence by medialization of one or both vocal cords. Expecting fat resorption, which occurs postoperatively, the surgeon injects at least 30-40% more fat than needed to achieve glottic closure. The procedure is minimally invasive, with minimal morbidity and complications. In this article, we present a rare case of iatrogenic lipoma secondary to excessive lipoinjection due to the increase of the vocal cords, causing severe dysphonia.

Indication for management of oropharyngocutaneous fistulas after head and neck reconstruction using a “stick-shaped platysma flap” technique

Oropharyngocutaneous fistula is an unfavorable complication that may occur after head and neck reconstruction. The authors used a “stick-shaped platysma flap” technique to close these narrow and deep intractable fistulas. It is a highly efficient and straightforward method to close intractable fistulas with minimal morbidity.

Thorax Gunshot and Sharp Cutting Tool Injuries: For 5 Months Nyala Experiences

Background: The two most common causes of penetrating thoracic trauma are firearm injuries and injuries by sharpened cutting tool. Penetrating thoracic injuries are risk factors for high mortality and morbidity, so they need to be diagnosed correctly and timely in order to perform an effective intervention. In this study, patients with penetrating thoracic trauma were treated through surgical intervention accompanying minimal morbidity–mortality compared to literature, even though they were admitted relatively late. Methods: In this retrospective study, 29 gunshot and stab wounds penetrating thoracic trauma patients were admitted to the emergency department of Nyala Sudan Turkey Education and Research Hospital between April and September 2018. Results: Of the 29 patients, 7 (24.13%) were gunshot injuries and 22 (75.86%) were injured with a sharp cutting tool. While 13 of the cases (44.82%) were admitted on the day the incident took place, 5 of them (17.24%) were post-traumatic first day of the admission, 9 of them (31.03%) were post-traumatic day 2, whereas 1 of them (3.44%) was post-traumatic the third day of admission. Finally, 14 patients (48.28%) were followed-up conservatively without tube thoracostomy, while 15 patients (51.72%) underwent tube thoracostomy in follow-up. No patient was operated for penetrant trauma. Mortality was not seen. Conclusion: Patients with penetrating thoracic trauma were treated by surgical interventions accompanying minimal morbidity–mortality even though they were admitted relatively late to healthcare facilities. Key words: penetrating thoracic injuries, sharp cutting tool, gunshot

The mini osteoplastic flap for eroded anterior table: case report

<p class="abstract">Trans-nasal Endoscopic access to the frontal sinus is in vogue now a days with advancements imaging modalities and availability of angled instrumentation. The external osteoplastic flap approach to the frontal sinus is still applicable in failed endoscopic procedures, laterally placed pathologies or eroded anterior or posterior tables. We discuss an intriguing patient with chronic dull ache over the forehead being treated with a mini osteoplastic flap technique. There is no single approach that has been able to fulfil the criteria for the modality of choice in terms of excellent results, no recurrence or residual disease, minimal morbidity, short hospital stays, uneventful long-term postoperative course, and good cosmesis in cases of extensive disease involvement. The main objective of this study was to study the outcome of external frontal sinus osteoplastic flap approach in terms of intraoperative disease clearance for extensive frontal sinus lesions beyond the scope of endoscopic excision. </p>

Experience of Mini PCNL in Horseshoe Kidneys

Objective: The objective of this article is to share our experience of Mini PCNL in horseshoe kidneys. Methods: We performed Mini PCNL in 05 patients with Horse shoe kidneys in theurology centre of CMH Dhaka. Per cutaneous puncture was made with patient in proneposition. Their ages ranged between 35-52 years with a mean age of 42.3 years. PCNLaccess tract was made in upper pole of the kidney in 03(60%) while 01(20%) throughmiddle calyx, and 01(20%) had direct pelvic access. The stone size was 2.3-2.75cm withmultiple calculi in two kidneys. Results: Complete Stone clearance was achieved in all 05 cases .Mean hospital stay was3.8 days (range 3-5 days).All cases were followed up at 4 weeks and after 3 months. Nosignificant Complications were seen except one patient who developed transient postoperativepyrexia which subsided with antipyretics. None of our patients developedpost PCNL bleeding or wound infection. Conclusion: Mini PCNL in horse shoe kidneys are not too difficult than normal kidneysand does not carry significant risk than reported for normal kidneys. This effectivemodality resulted in almost100% stone clearance with minimal morbidity. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.82-86

Epigastric Hernias in Children: A Personal Series and Systematic Review of the Literature

Epigastric hernias are relatively uncommon in children, and there is a paucity of literature on their incidence, presenting features, natural history, and surgical outcomes. A systematic review was conducted according to PRISMA guidelines. Articles describing the incidence, outcome, and interventions for pediatric epigastric hernias, both open and laparoscopic, were analyzed. Eight relevant articles published between 1975 and 2019 were included in the analysis. Of 81 children, 58% were females, 35% were symptomatic and 8% were multiple. All hernias contained preperitoneal fat only and were repaired using standard open surgery or laparoscopic techniques. No recurrences were recorded. In a personal series of 37 hernias in 36 children of median age 4 years, there were no recurrences; however, this series included two children with a recurrent or persistent epigastric hernia after surgery by others. Epigastric hernias in children are relatively uncommon. They typically contain only preperitoneal fat but more than a third are symptomatic. Standard open repair can be undertaken with minimal morbidity. Laparoscopic repair takes longer and provides a marginal cosmetic benefit.

Penile Reconstruction: Current Thoughts, Techniques, and Outcomes

Phalloplasty has matured considerably over the last decades in reconstructive options and technical refinements, thanks to increasing recognition of gender dysphoria. The primary goals of performing a phalloplasty are to facilitate sexual penetration, protective sensation, orgasm, standing micturition, and natural aesthetic, ideally in few stages and with minimal morbidity. Radial forearm free flap, anterolateral flap, and metoidioplasty are the most common options, each with a unique profile of complications, aesthetic, and functional outcomes. Choices for reconstruction must be tailored to the individual patient’s goals and available tissue characteristics.

Total Injectable Anesthesia of Dogs and Cats for Remote Location Veterinary Sterilization Clinic

Background : Sterilization clinics often occur in remote places where anesthesia machines and compressed oxygen are unavailable. This study describes the use of total injectable anesthesia in dogs and cats presented for sterilization in a remote location. Results: A total of 100 animals were sterilized; 26 female cats (CF), 22 male cats (CM), 28 female dogs (DF), and 24 male dogs (DM). CF were anesthetized with dexmedetomidine (20 mcg/kg), ketamine (8 mg/kg) and hydromorphone (0.1 mg/kg) IM. CM were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. Insufficient anesthesia in cats was treated with alfaxalone (1mg/kg) IM. All cats were administered meloxicam at 0.3mg/kg SQ. DF were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (7-10 mg/kg) and hydromorphone (0.1 mg/kg) IM. DM were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. All dogs had IV catheter and endotracheal tube placed. If SpO 2 <90<91%, dogs had assisted ventilation via Ambu bag. Insufficient anesthesia in dogs was treated with alfaxalone (1 mg/kg) IV. All dogs were administered meloxicam at 0.2 mg/kg SQ. Following surgery, atipamezole (0.05-0.1mg/kg) IM was administered to any patient that did not have voluntary movement. All patients survived and were discharged. Less than 25% of cats and male dogs required supplemental anesthesia. Fifty seven percent of female dogs required supplemental anesthesia. More than 89% of patients (in any group) required atipamezole administration. One cat recovered with agitation and hyperthermia (41.1C/ 106F). Some dogs required ventilatory assistance to remain normoxemic while anesthetized. Conclusion: Total injectable anesthesia can be accomplished for remote location sterilization clinics with minimal morbidity.

Total Injectable Anesthesia of Dogs and Cats for Remote Island Veterinary Sterilization Clinic

Background: Sterilization clinics may occur in remote places where anesthesia machines and compressed oxygen are unavailable. This study evaluated the efficacy of total injectable anesthesia in dogs and cats presented for sterilization on Isabela Island, Galápagos, Ecuador. Results: A total of 100 animals were sterilized; 26 female cats (FC), 22 male cats (MC), 28 female dogs (FD), and 24 male dogs (MD). FC were anesthetized with dexmedetomidine (20 mcg/kg), ketamine (8 mg/kg) and hydromorphone (0.1 mg/kg) IM. MC were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. Inadequate anesthesia in cats was treated with alfaxalone (1mg/kg) IM. All cats were administered meloxicam at 0.3mg/kg SQ. FD were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (7-10 mg/kg) and hydromorphone (0.1 mg/kg) IM. MD were anesthetized with dexmedetomidine (15mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. All dogs had IV catheter and endotracheal tube placed. If SpO2<90%, dogs had assisted ventilation via Ambu bag. Inadequate anesthesia in dogs was treated with alfaxalone (1mg/kg) IV. All dogs were administered meloxicam at 0.2 mg/kg SQ. Following surgery, atipamezole (0.05-0.1mg/kg) IM was administered to any patient that did not have voluntary movement. All patients survived and were discharged. Less than 25% of cats and male dogs required supplemental anesthesia. Fifty seven percent of female dogs required supplemental anesthesia. More than 89% of patients (in any group) required atipamezole administration. One cat recovered with agitation and hyperthermia (41.1C/ 106F). Some dogs required ventilatory assistance to remain normoxemic while anesthetized. Conclusion: Total injectable anesthesia can be accomplished for remote location sterilization clinics with minimal morbidity.