Necrotizing Fasciitis of the Thigh as Unusual Colonoscopic Polypectomy Complication: Review of the Literature with Case Presentation

Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms.

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report

Background Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation. Case presentation A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps. Conclusions Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

Gastric GIST: A Rare Cause of Upper GI Bleeding

Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract. This case report highlights the necessity of early surgical intervention in such cases to avoid mortality due to bleeding and to raise the awareness of rare causes of upper gastrointestinal bleed and their management. A 19 year old male presented in the surgery department of Shaheed Suhrawardy medical College Hospital with complaints of recurrent episodes of melena with anorexia and weight loss for 6 months. Apart from anaemia no significant findings were noted on physical examination. Investigations including upper GI endoscopy was not conclusive. So he underwent laparotomy which revealed an exophytic growth along the lesser curvature. Lower partial gastrectomy was done and histopathological and immunohistochemistry report showed evidence of benign low risk GIST. As the tumor was benign with no malignant potential imatinib therapy was not advocated. J Shaheed Suhrawardy Med Coll 2020; 12(2): 119-122

PATIENT AND OBSERVER SCAR ASSESSMENT FOLLOWING BASAL CELL CARCINOMA SURGERY: MULTICENTER QUASI EXPERIMENTAL STUDY

Objective: To assess patient and observer reported scar quality after Basal cell carcinoma surgery of face using the Patient and Observer Scar Assessment Scale (POSAS). Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Department, Tertiary Care Hospitals at Multan and Karachi and Plastic Surgery Department, Tertiary Care Hospital Multan, from Apr to Sep 2020. Methodology: Patients with basal cell carcinoma that full filled inclusion and exclusion criteria were enrolled by consecutive sampling technique at Dermatology and Plastic Surgery Department after informed consent. Surgical excision was followed by reconstruction of defect either by direct closure or by rotation or advancement flap. Surgical scar was assessed independently at 8 weeks by POSAS. Data was analyzed with SPSS-23. Results: A total of 27 patients were enrolled in study. There were 11 (37.9%) males and 16 (59.25%) females between ages of 45-70 years. Basal cell carcinoma was located on cheek in 15 (55.5%), nose in 9 (33.3%), temple 2 (7.4%) and forehead 1 (3.7%) cases. Direct closure was performed in 6 (22.2%), rotation flaps in 10 (40.7%), and advancement flaps in 11 (40.7%) cases. Mean score of observer opinion about surgical scar between different surgical techniques was not statistically significant (p=0.191). How-ever, mean score of patient opinion of scar between different surgical techniques was statistically significant (p=0.032). Conclusion: POSAS is a valid tool for scar evaluation by patient and observer-reported scar qualities after Basal cell carcinoma surgery.

Is the Mandibular Condyle Involved in Medication-Related Osteonecrosis of the Jaw? Audit of a Single Tertiary Referral Center and Literature Review

Background: Medication-related osteonecrosis of the jaw (MRONJ) may manifest as exposed mandible bone. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement. Objective: The aim of this study is to analyze the topographical incidence of MRONJ, comorbidities, demographics data, and clinical characteristics of patients diagnosed with MRONJ between 2014 and 2019 in the Maxillo-Facial Surgery Department University of Campania “Luigi Vanvitelli”, and compare these results with published reports. Methods: Data on 179 patients were collected for the study, including gender, age, underlying malignancy, medical history, and specific lesion location-identifying premaxilla and posterior sectors area involvement for the maxilla and symphysis, body, ramus, and condyle area for the mandible. A literature review was performed in order to compare our results with similar or higher sample sizes and find if any condylar involvement was ever reported. The research was carried out on PubMed database identifying articles from January 2003 to November 2020, where MRONJ site distribution was discussed, and data were examined to scan for condylar localization reports. Results: 30 patients had maxillary MRONJ, 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible. None of the patients reported condylar involvement, neither as a single site nor as an additional localization. Literature review results were coherent to our findings showing no mention of condylar MRONJ. Conclusion: Results do not show reports of condylar involvement in MRONJ. Although the pathophysiology of the disease has not been fully elucidated, two possible explanations were developed: the first one based on the condyle embryogenetic origin; the second one based on the bisphosphonate and anti-resorptive medications effects on the different vascular patterns of the mandible areas.

Comparative study of use of 32-F, multi-perforated tube drainage of subcutaneous plane versus no drainage, in laparotomy

Background: We are concerned about the wound management and wound healing amongst post-operative patients, as wound complications increase the morbidity of patients post-surgery. Most common wound complications post-surgery are wound seromas, hematomas and surgical site infections (SSIs). SSIs lead to increased hospital stay and increased morbidity alongside increasing unnecessary patient suffering and a decreased quality of life. The underlying principle for the use of subcutaneous drains is based on the belief that removal of serum or debris and eradication of dead space in subcutaneous plane will bring down the rate of infection and wound complications.Methods: A randomized control study was conducted at the General Surgery Department at SGT Medical College, Gurgoan, Haryana. In total, 60 patients were selected (after taking informed written consent) among those admitted to the Surgery Department for laparotomy procedure. Patients were divided randomly into two groups i.e., group-A (study group) and group-B (control group). In group-A patients, subcutaneous wounds were closed over a drain (32-F multi-perforated drain), while in group-B patients no drain was used. Intra-operative and post-operative findings were recorded and analysed to draw study conclusions.Results: SSIs were observed significantly higher among patients without subcutaneous drain (group-B). Patients of group-B had significantly higher incidence of seroma and pus as compared to group-A patients. Experience of pain was reported higher among the patients without subcutaneous drain (group-B).Conclusions: Subcutaneous drains play an important role in reducing the incidence of SSIs, wound complications, wound pain; thereby lead to better healing of the surgical wound.

Terapi Oksigen Hiperbarik Meningkatkan Kualitas Hidup Pasien Glioblastoma Multiforme Stadium Akhir Dinilai Berdasarkan Neurologic Assessment Neuro Oncology Score

Patients with end-stage glioblastoma multiforme (GBM) that cannot be operated or treated with chemotheraphy and radiotheraphy have increased clinical complaints, thus affecting the patients’ quality of lifes (QoL). Hyperbaric oxygen therapy (HBOT) could alters hypoxic condition in tumor tissue with a different cascade from wound healing process. This study was aimed to assess whether the QoL of end-stage GBM patients could improve with the administration of HBOT assessed by decreased clinical complaints based on NANO score. The study was carried out at the Surgery Department of Prof. Dr. R. D. Kandou Hospital Manado, using pre and posttrial design. Each sample was assessed for the NANO score before HBOT, after one time, three times, five times, and 10 times of HBOT. The results showed that there was a change in the NANO score before and after 10 times of HBOT. The decrease in the NANO score occurred more quickly after the therapy. In the last two measurements, the NANO score according to the RVC model decreased from one to two units. The decreased NANO score occurred quite regularly with variations in the score that changed from time to time. In conclusion, HBOT can improve the QoL of patients with end-stage GBM and reduce the NANO score which is an assessment of clinical complaints of the patients.Keywords: glioblastoma multiforme; hyperbaric oxygen therapy; NANO score Abstrak: Penderita glioblastoma multiforme (GBM) stadium akhir yang tidak dapat dilakukan operasi, kemoterapi dan radioterapi memiliki keluhan klinis yang semakin meningkat sehingga memengaruhi kualitas hidup. Terapi oksigen hiperbarik (TOHB) dapat mengubah kondisi hipoksia pada jaringan tumor dengan kaskade yang berbeda dari proses penyembuhan luka. Penelitian ini bertujuan untuk menilai apakah kualitas hidup pasien GBM stadium akhir dapat membaik dengan pemberian TOHB, dinilai dengan menurunnya keluhan klinis berdasarkan NANO score. Penelitian dilakukan di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado, dengan menggunakan pre and posttrial design. Pada setiap sampel dilakukan penilaian NANO score sebelum TOHB, setelah satu kali, tiga kali, lima kali, dan 10 kali TOHB. Hasil penelitian mendapatkan adanya perubahan NANO score sebelum TOHB dan setelah 10 kali TOHB. Penurunan NANO score berlangsung lebih cepat pasca terapi tersebut. Dalam dua pengukuran terakhir, NANO score menurut model RVC turun dari satu hingga dua satuan. Pada grafik, hasil penurunan NANO score terjadi cukup beraturan dengan variasi score yang berubah dari waktu ke waktu. Simpulan penelitian ini ialah TOHB dapat meningkatkan kualitas hidup penderita GBM stadium akhir dan menurunkan NANO score yang menjadi penilainan keluhan klinis penderita.Kata kunci: glioblastoma multiforme; terapi oksigen hiperbarik; NANO score