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2022 ◽  
Vol 226 (1) ◽  
pp. S206-S207
Author(s):  
Braxton Forde ◽  
Mounira Habli ◽  
Sammy Tabbah ◽  
Foong Lim ◽  
Jose Peiro

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenpeng Xu ◽  
Xiucun Li ◽  
Songhua Cao ◽  
Ning Zhang ◽  
Yong Hu

Abstract Background This study aimed to report the outcomes of mimical reconstruction and aesthetic repair of the nail. Methods When the pigmented bands were more than 1/2 the width of the whole nail, mimical reconstruction of the nail was performed, with a lateral toe pulp island flap covering the wound via the subcutaneous channel. If the pigmented bands were 1/4 to 2/5 the width of the entire nail, aesthetic repair of the nail was carried out by split-thickness excision under a microscope. Results The average age of patients at the time of surgery was 14.5 years. Five patients had lesions on their toes, while three had lesions on their fingers. There were no post-operative complications. All toenails of the five patients who had undergone mimical reconstruction exhibited a well-settled flap. The nails of the three patients who underwent aesthetic repair displayed no nail malnutrition or deformity, and all nails had an aesthetic appearance. Conclusions Both mimical reconstruction and aesthetic repair of the nail following resection of subungual melanocytic nevus are reliable and feasible. The “like tissue” repairs of complex nail defects appear to be satisfactory. All patients had excellent aesthetic outcomes. Level of evidence V


2021 ◽  
Vol 15 (11) ◽  
pp. 3333-3336
Author(s):  
Farhan Majeed ◽  
Maham Ashraf ◽  
Mohsin Tahir ◽  
Ahmad Shams ◽  
Mumtaz Hussain

Introduction: Distal radius fracture in pediatric population is the most common sustained injury1. Treatment often is guided by the amount of displacement, with un-displaced fractures requiring only full cast and displaced fractures requiring fixation following reduction with Kirchner Wire (K-wire). Use of a single or double K-wire fixation technique is mostly dependent on the stability of the fracture as well as surgeon preference. Our study aims to evaluate both the Single vs. double K-wire fixation technique for the fixation of Displaced distal radius fracture in children in terms of time of surgery, fracture re-displacement, functional outcome and rate of complications. Materials & Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 54 pediatric patients presenting to the Emergency and outpatient department with trauma to affected wrist with Displaced Fracture of Distal Radius were admitted and divided into two equal groups. Closed Surgical Fixation following manipulation under anesthesia (MUA) with single and double cross K-wires was performed in each group and Full Cast below elbow was applied for 4 to 6 weeks. Mean radial shortening, angulation and displacement was measured on radiograph pre-operatively, immediate post operatively and at the time of removal of k-wires. Functional outcome was measured post k-wire removal follow up in terms of normal, mildly reduced, moderately reduced and severely reduced. Results: A total of 54 patients were included in the study with the mean age of 9.61(6-14) years, mean time of surgery was 17.26±3.75 minutes for single k-wire and 23.22±3.48 minutes for double k-wire fixation which was significant (p ≤ 0.05). Mean Follow-up was 6.70±0.76 weeks for single k-wire and 6.19±0.48 weeks for double k-wire fixation. There was a statistically significant increase in mean dorsal angulation immediate post-operatively and at the time of k-wire removal (p ≤ 0.05). There was no statistical difference in mean dorsal angulation between the two groups at the time of k-wire removal (p= 0.55). Seven (29.12%) patients of single k-wire developed complications including 3 (11.11%) pin site infection, 1 (1.85%) loss of reduction and 2 (7.41%) wire migration. In contrast to single k-wire fixation, 13 (48.15%) patients developed complications in double k-wire fixation including 7 (29.12%) pin site infection, 1 (1.85%) loss of reduction, 2 (7.41%) neuropraxia and 2 (7.41%) wire migration. In the single k-wire group, 22 (81.48%) patients had normal, 5 (18.52%) had mildly reduced and none had moderately reduced outcome. In double k-wire group, 21 (77.78%) had normal, 5 (.52%) had mildly reduced and 1 (3.70%) had moderately reduced outcome. Conclusion: We concluded that although functional outcome is similar in both groups, single k wire fixation is superior to double k-wire fixation technique in terms of reduced time of surgery and less post-operative complications specially the pin site infection. Key words: Displaced, Distal radius Fracture, K-wire fixation


2021 ◽  
Vol 15 (11) ◽  
pp. 3076-3077
Author(s):  
Fauzia Siraj ◽  
Rabbiah Manzoor Malik ◽  
Zafar Iqbal ◽  
Rifat Shamim ◽  
Attya Zaheer ◽  
...  

Aim: To study the frequency and factors associated with peritoneal involvement among patients operated for acute appendicitis in a tertiary care hospital. Place and duration of study: Department of Surgery, Benazir Bhutto Hospital Rawalpindi Pakistan from 1stJuly 2020 to 30thJune 2021. Methodology: This comparative cross-sectional study 500 patients diagnosed as acute appendicitis and operated by consultant surgeon were included. Peritoneal involvement was defined as signs of inflammation or infection on abdominal lining observed by operating surgeon during the time of surgery. Factors like age, gender, presence of comorbid illnesses and history of previous abdominal surgeries were associated with presence of peritoneal involvement. Results: There were 305 (61%) males while 195 (39%) were females with mean age was 32.331±4.544 years.Four hundred and forty two (88.4%) did not show any peritoneal involvement at the time of surgery while 58 (11.6%) had peritoneal involvement. Chi-square test revealed that history of previous abdominal surgeries and advancing age had statistically significant association with peritoneal involvement among the study participants (p-value<0.05). Conclusion: Peritoneal involvement was found in considerable number of patients operated as acute appendicitis by the treating surgeons. Patients with previous history of abdominal surgeries and advancing age were more at risk of having peritoneal involvement in our study. Keywords: Acuteappendicitis, Peritonitis, Risk factors, Frequency


Author(s):  
Pradeep Kumar Roul ◽  
Aditi Saini ◽  
Srishti Agarwal ◽  
Prashant Kumar Verma ◽  
Anjum Syed

Duplication of the gallbladder is a rare congenital anomaly, which Boyden first illustrated in 1926. No additional risk of cholelithiasis or malignancy with this congenital anomaly was documented. However, this congenital anomaly is associated with more risk for complications during and after laparoscopic cholecystectomy. So, preoperative diagnosis is essential in identifying anatomical abnormalities to avoid biliary injuries at the time of surgery or the performance of an incomplete operation. The removal of an asymptomatic double gallbladder remains controversial. Here, we are reporting a case of the incidentally detected duplex gallbladder in a teenager and review the literature that will enrich the reader’s knowledge regarding this rare congenital anomaly.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 345-345
Author(s):  
Allison P. Wheeler ◽  
Gary Benson ◽  
Hermann Eichler ◽  
Sidsel Marie Tønder ◽  
Katarina Cepo ◽  
...  

Abstract Introduction: Concizumab is an anti-tissue factor pathway inhibitor (TFPI) monoclonal antibody in phase 3 clinical development as a once-daily, subcutaneous prophylaxis across all hemophilia subtypes. The phase 2 trials explorer4 (NCT03196284) and explorer5 (NCT03196297) investigated the efficacy and safety of daily subcutaneous concizumab prophylaxis in patients with hemophilia A/B with inhibitors and in patients with severe hemophilia A without inhibitors, respectively. Minor surgeries and diagnostic procedures were permitted during both trials, allowing for the assessment of conducting such procedures during concizumab prophylaxis. Objective: The aim of this analysis was to describe surgeries and diagnostic procedures performed while on concizumab prophylaxis during the main and extension parts of the concizumab phase 2 trials. Methods: Both the explorer4 and explorer5 trials consisted of a main and an extension part, with patients receiving concizumab at an initial maintenance dose of 0.15 mg/kg (with an additional loading dose of 0.5 mg/kg as a first dose in explorer4) in both trials, with the option to dose escalate to 0.20 and 0.25 mg/kg in case of ≥3 spontaneous treated bleeds within the previous 12 weeks. Concomitant treatment with systemic anti-fibrinolytics was not allowed in either trial, while local/topical use was permitted. Minor surgery, defined as an invasive operative procedure in which the skin, mucous membranes, or superficial connective tissue are manipulated, such as skin biopsies, implanting of central venous access devices, or simple dental procedures, were allowed at the investigator's discretion during both trials. Major surgery was not permitted and thus constituted a protocol deviation. Only patients who had been receiving concizumab as part of explorer4 or explorer5 up until, during and immediately after surgery were included in this analysis. Results: Seven of the 25 patients treated with concizumab in explorer4 had a total of 17 surgeries while treated with concizumab during the trial. The patients who underwent surgery were aged between 24 and 45 years old. Five of these patients underwent a single procedure, 1 patient 2 procedures, and 1 patient underwent a total of 10 procedures while in the trial. At the time of surgery, with the exception of 1 patient who was receiving concizumab at 0.20 mg/kg, all patients were on 0.15 mg/kg. Additional perioperative hemostatic treatment was permitted and was given at the investigator's discretion. The majority of procedures involved dental surgery, although a venous catheter removal, hordeolum removal, and laser eye surgery were also performed (Table 1). Out of a total of 6 recorded surgery-related bleeding episodes in patients receiving concizumab in explorer4, 1 was classified as severe, while the remaining 5 as mild or moderate. In explorer5, 13 of the 36 patients treated with concizumab (26-65 years old) underwent a total of 33 surgeries while receiving concizumab prophylaxis. Seven of these patients had more than 1 surgery, ranging between 2 and 8 per person. The majority of patients (8/13) were receiving concizumab at 0.15 mg/kg, 1 patient at 0.20 mg/kg and 2 patients at 0.25 mg/kg at the time of surgery, and 2 patients were on 0.15 mg/kg concizumab for their first surgeries and switched to 0.20 mg/kg for later surgeries. Additional hemostatic treatment was given at the investigator's discretion. Dental procedures constituted most surgeries, and other procedures included vaccinations and cataract surgery, diagnostic procedures such as biopsy, endoscopy and gastroscopy, as well as a hair graft (Table 1). A total of 9 surgery-related bleeds were recorded during explorer5, all of which were classified as mild or moderate. Conclusion: Across both concizumab phase 2 trials, between 28-36% of all patients (7/25 in explorer4 and 13/36 in explorer5) receiving daily concizumab prophylaxis underwent 1 or more surgeries during the overall trial periods of 18 and 22 months, respectively. A wide range of surgeries, including invasive diagnostic procedures, were conducted while the number of surgery-related bleeds was low and classified as mild or moderate, with 1 exception. Prophylactic treatment with concizumab in patients with hemophilia is currently being investigated further in ongoing phase 3 trials. Figure 1 Figure 1. Disclosures Wheeler: Novo Nordisk A/S: Consultancy; Bayer: Consultancy; BioMarin: Consultancy; HEMA Biologics: Consultancy; Spark: Consultancy; Takeda: Consultancy; UniQure: Consultancy. Benson: Novo Nordisk A/S: Consultancy, Speakers Bureau; Takeda: Speakers Bureau; BMS: Speakers Bureau; Sobi: Speakers Bureau. Eichler: Pfizer: Research Funding; Novo Nordisk: Consultancy, Research Funding; BioMarin: Consultancy, Research Funding; Bayer: Consultancy, Research Funding; Takeda: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; CSL Behring: Consultancy, Honoraria; Biotest: Consultancy, Honoraria. Marie Tønder: Novo Nordisk Health Care AG: Current Employment. Cepo: Novo Nordisk A/S: Current Employment. Jimenez Yuste: Novo Nordisk A/S: Consultancy, Research Funding; Bayer: Consultancy; Takeda: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Grifols: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Sobi: Consultancy, Research Funding; CSL Behring: Consultancy; BioMarin: Consultancy. Kavakli: Novo Nordisk A/S: Consultancy, Other: Clinical Trial Support; Takeda: Consultancy, Other: Clinical Trial Support; Roche: Consultancy, Other: Clinical Trial Support. Wong: Astellas Pharma, INc.: Research Funding. Matsushita: Baxalta/Shire/Takeda: Consultancy, Honoraria; Bayer: Consultancy; Novo Nordisk A/S: Consultancy, Honoraria, Other: educational and investigational support ; Chugai: Consultancy, Honoraria, Other: educational and investigational support ; Pfizer: Consultancy; Bioverative/Sanofi: Honoraria; CSL: Honoraria; JB: Honoraria; KMB: Honoraria; Kirin: Honoraria; Nichiyaku: Honoraria; Octapharm: Honoraria; Sysmex: Honoraria.


2021 ◽  
Vol 8 ◽  
Author(s):  
Kendall Taney ◽  
Mark M. Smith ◽  
Nathan P. Cummings ◽  
Alicia J. Lozano

The objective of this retrospective pilot study was to describe potential risk factors for failure of hard palate mucoperiosteal flaps (HPF) transposed for closure of oronasal communication. Dogs (n = 28) with acquired oronasal communication defects were included in the study population. Functional success of an HPF was determined by visual inspection at the last examination and lack of clinical signs. Risk factors for HPF failure including age, sex, body weight, presence of neoplasia at the time of surgery, presence of neoplasia after surgery due to incomplete or narrow margins, use of CO2 laser, previous surgeries in the same location, HPF blood supply, size of the HPF as a percentage of the total area of the hard palate mucoperiosteum, and distance traveled by the apex of the HPF were evaluated using descriptive statistics and unadjusted logistic regression modeling. Seven out of 28 (25%) hard palate flap procedures resulted in persistent oronasal communication and were considered failures. Body weight (Median: 17 vs. 25 kg, OR = 0.94, 80% CI = 0.90, 0.99), presence of neoplasia at the time of surgery (86 vs. 57%, OR = 4.50, 80% CI = 1.01, 20.06), HPF area (Median: 0.49 vs. 0.41, OR = 84.40, 80% CI = 1.66, 4,298) and apex travel distance (Median: 2.06 vs. 0.67, OR = 5.15, 80% CI = 2.14, 12.38) were associated with flap failure. Within this sample, the presence of neoplasia at the time of initial surgery, increasing the area of the HPF, and distance traveled by the HPF apex were associated with a greater odds of HPF failure. Further studies with larger sample sizes are needed to confirm repeatability of these results. HPFs remain a viable surgical option for closure of oronasal communication. Careful surgical planning, strict adherence to surgical principles, and awareness of anatomical limitations can increase the likelihood of success.


2021 ◽  
Author(s):  
Wenpeng Xu ◽  
Xiucun Li ◽  
Songhua Cao ◽  
Ning Zhang ◽  
Yong Hu

Abstract Background: The purpose of this study is to report the outcomes of mimical reconstruction and aesthetic repair of the nail.Methods: When the width of the pigmented bands was more than 1/2 of the whole nail width, the mimical reconstruction of the nail, the lateral toe pulp island flap covered the wound via the subcutaneous channel, was performed. If the width of the pigmented bands ranged from 1/4 to 2/5 of the entire nail, the aesthetic repair of the nail, the split-thickness excision under microscope, would be carried out.Results: The average age at the time of surgery was 14.5 years. The lesions were located at the toes in 5 patients and fingers in 3 patients. No complications occurred postoperatively. In 5 patients with the mimical reconstruction of the nail, all of toenail showed well-settled flap. In three patients with the aesthetic repair of the nail, there was no nail malnutrition or deformity, and all nails have an aesthetic appearance.Conclusions: Mimical reconstruction and aesthetic repair of the nail following resection of subungual melanocytic nevus is reliable and feasible. It seems to be satisfactory that “like tissue” repairs the complex nail defects. All patients obtain an excellent aesthetic outcome.Level of Evidence: V


2021 ◽  
Vol 10 (21) ◽  
pp. 4846
Author(s):  
Kyla D. Joubert ◽  
Olugbenga T. Okusanya ◽  
Summer Mazur ◽  
John P. Ryan ◽  
Chigozirim N. Ekeke ◽  
...  

Background: Pleural metastasis in lung cancer found at diagnosis has a poor prognosis, with 5–11 months’ survival. We hypothesized that prognosis might be different for patients who have had curative-intent surgery and subsequent pleural recurrence and that survival might differ based on the location of the first metastasis (distant versus pleural). This may clarify if pleural recurrence is a local event or due to systemic disease. Methods: A database of 5089 patients who underwent curative-intent surgery for lung cancer was queried, and 85 patients were found who had biopsy-proven pleural metastasis during surveillance. We examined survival based on pattern of metastasis (pleural first versus distant first/simultaneously). Results: Median survival was 34 months (range: 1–171) from the time of surgery and 13 months (range: 0–153) from the time of recurrence. The shortest median survival after recurrence was in patients with adenocarcinoma and pleural metastasis as the first site (6 months). For patients with pleural metastasis as the first site, those with adenocarcinoma had a significantly shorter post-recurrence survival when compared with squamous cell carcinoma (6 vs. 12 months; HR = 0.34) and a significantly shorter survival from the time of surgery when compared with distant metastases first/simultaneously (25 vs. 52 months; HR = 0.49). Conclusions: Patients who undergo curative-intent surgery for lung adenocarcinoma that have pleural recurrence as the first site have poor survival. This may indicate that pleural recurrence after lung surgery is not likely due to a localized event but rather indicates systemic disease; however, this would require further study.


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