Squamous cell carcinoma of the foot is rare. A case report of occurrence of metastatic squamous carcinoma of the foot with resemblance to verrucous type in an elderly female is presented. This ...metastatic lesion developed four years after excision of primary squamous cell carcinoma from the left thigh. The patient presented with a painful, exophytic, ulcerated mass on the foot of four months' duration. Fine-needle aspiration and edge biopsy documented this lesion as squamous cell carcinoma.
To study clinical features and treatment of patients diagnosed with fractured penis.
All patients diagnosed with penis fracture from March 2000-March 2007 were retrospectively studied. No invasive ...investigation was used for diagnosis.
Surgical intervention was done in 52 patients while 5 patients were managed conservatively. The constant finding recorded in all cases was that penis fracture occurred in erect penises. Most fractures were observed in the 16-30 years age group (50.88%). Left lateral tear was present in 53.84% cases. One patient had gangrene of penile skin after surgery.
Penis Fracture is not so uncommon as reported. A trauma to erect penis is mandatory for fracture to occur. Surgical intervention is the preferred mode of treatment.
Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue ...infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.
Inflammatory myofibroblastic tumor occurring at intra-abdominal sites in children has rarely been described. In the abdomen, mesentery is a rare location for an inflammatory myofibroblastic tumor.
A ...case report of inflammatory myofibroblastic tumor of mesentery presenting as painless abdominal swelling is presented. Histopathological study of specimen documented the diagnosis. Complete resection of tumor was done with no recurrence seen in follow-up.
Adult intussusception is rare. The author is reporting a case of adult intussusception in a 60-year-old female inside of incisional hernia sac, acting as a lead point. The presentation was subacute ...intestinal obstruction. Ultrasonography was useful adjunct in diagnosis. The site for intussusception was jejunum. Intussusception was seen protruding into hernial sac with adhesions of gut to abdominal wall defect. Resection of involved gut was done.
Intussusception; Hernia sac; Jejunum.
Abstract
Background
Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. ...Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.
Method
A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.
Conclusions
The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.
Intestinal Ascariasis in Children Wani, Imtiaz; Rather, Muddasir; Naikoo, Ghulam ...
World journal of surgery,
20/May , Volume:
34, Issue:
5
Journal Article
Peer reviewed
Background
Ascariasis is a staggering health problem commonly seen in children of endemic areas. In the abdomen, ascaris lumbricoides can cause a myriad of surgical complications. Intestinal ...obstruction by ascaris lumbricoides is commonly seen in children. Most cases are managed conservatively. The purpose was to study the clinical presentation and management of symptomatic intestinal ascariasis in children.
Methods
A 3-year study was performed from April 2006 to April 2009 of pediatric-age patients who had symptomatic intestinal ascariasis. All patients had detailed clinical history, examination, plain X-ray of abdomen, and ultrasonography of abdomen. Peroperative findings were recorded in all patients who had surgical intervention.
Results
This prospective study had 360 patients. Male to female ratio was 1.37:1. 187 patients (52%) presented within 2–4 days of duration of illness. Mean ± standard deviation (SD) age of patients was 6.35 ± 2.25 years. Age group of 4–7 years (80%) was commonest group affected. Abdominal pain was a leading symptom in 357 patients (99%) with the pain in periumbilical area present in 215 patients (60%). In 227 patients (63%) abdominal distension was seen and was the commonest physical finding. Palpable worm masses were seen in 129 patients (36%); 81 patients (63%) had palpable worm masses in the umbilical quadrant. On X-ray of abdomen, visible worm masses were seen in 83 patients (23%). Abdominal sonography showed interloop fluid in 177 patients (49%) and free fluid in the pelvis of 97 patients (27%). The number of patients who were managed conservatively was 281 (78%), and 79 patients (22%) had surgical intervention. In patients who had surgical intervention, 39 patients (49%) had enterotomy and 7 patients (9%) had kneading of worms. Postoperative complications occurred in 33 patients, and an overall mortality of 1% (1 patient) was seen.
Conclusions
Ascaridial intestinal obstruction is common in children in the Kashmir. Abdominal pain is the leading symptom in intestinal ascariasis. Plain X-ray and ultrasonography of the abdomen are used to diagnosis intestinal ascariasis. The majority of the patients can be managed conservatively.
Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact ...on outcome of tSCI patients, we conducted an international survey investigating this topic.
The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia.
There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80-90 mmHg was chosen in almost half of the cases n = 84 (49.1%). A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents n = 100 (58.5%). Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO
) of 80-100 mmHg n = 94 (55%) and an arterial partial pressure of carbon dioxide (PaCO
) of 35-40 mmHg n = 130 (76%) were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm
n = 99 (57.9%) and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control n = 85 (49.7%) in patients needing spinal surgery. MRI n = 160 (93.6%) and spinal surgery n = 158 (92.4%) should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids n = 103 (60.2%), ISP/SCPP monitoring n = 148 (86.5%), and therapeutic hypothermia n = 137 (80%) were not utilized by most respondents.
Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI.
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