Meckle's diverticulum is the most common embryological anomaly of the small bowel that is rarely seen in adults. It is caused by the incomplete closure of the vitelline or omphalomesenteric duct. ...Those who are symptomatic from Meckle's diverticulum have varied clinical presentations, which raise significant challenges with diagnostic and management options. We report a case of a 47-year-old male who presented to the hospital with clinical signs of appendicitis but was found to have perforated Meckle's diverticulitis with faecoliths on computed tomography imaging and laparoscopy. Furthermore, histopathology revealed an ectopic gastric tissue cell type, which is a rare finding. This was definitively managed surgically with laparoscopic resection of Meckle's diverticulum and appendicectomy.
Adrenocorticotropic (ACTH)-producing neuroendocrine tumours (NETs) are rarely found in the small bowel, and primary mesenteric NETs have only been reported in a few cases globally. We report the case ...of a 68-year-old female with ectopic Cushing's syndrome due to excessive ACTH secretion from small bowel primary lesions and mesenteric metastasis. Initially, only the mesenteric mass was detected on imaging and endoscopy/colonoscopy, and it was only with surgical exploration that the small bowel lesions were found. This highlights the importance of high clinical suspicion and robust investigation when locating NETs. Surgical resection of the affected small bowel and mesentery was the definitive treatment for this patient. Initial hydrocortisone replacement therapy was needed, and subsequent biochemical tests and clinical reviews demonstrated no recurrence.
Approaches to prostate cancer (PCa) diagnosis and treatment have evolved significantly over past decades. There has been an increasing focus on minimizing overdiagnosis and overtreatment of ...clinically insignificant PCa. The objective of this study was to evaluate the changes in the diagnostic approach and initial treatment strategy that has evolved over time in an Australian urological private practice.
Men with newly diagnosed PCa were identified from the private practice electronic and paper medical records from 2005 to 2016 and data was consolidated into six groups of 2-year intervals. Diagnostic strategy was analyzed with particular reference to the use of multiparametric magnetic resonance imaging (mpMRI) scan and 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scans. National Comprehensive Cancer Network risk group stratification was correlated with initial treatment strategy and compared over time.
Chart review identified 839 men who had a mean age of 65.8 years. In 2011–2012, prebiopsy mpMRI scan was introduced. Its uptake correlated with a decrease in numbers of men diagnosed with low risk cancer (r = -0.80, P = 0.04) and an increase in numbers of men diagnosed with high-risk cancer (r = 0.90, P = 0.01). The use of 68Ga-PSMA PET/CT was associated with decreasing use of CT and bone scans performed. Open radical prostatectomy had a declining trend particularly when robotic surgery (robotic assisted radical prostatectomy (RARP)) was introduced. Pelvic lymph node dissections performed progressively decreased. An increased use of luteinizing hormone receptor hormone (LHRH) antagonists was seen in favor of LHRH agonists. Whilst use of high dose rate brachytherapy declined, there was an increased use of low dose rate brachytherapy.
Prebiopsy mpMRI has been associated with an increased proportion of newly diagnosed men having clinically significant PCa. Over time, 68Ga-PSMA PET/CT scans, robotic assisted radical prostatectomy (RARP) and LHRH antagonists have increased in use, whilst CT and bone scans, and pelvic lymph node dissections have decreased.
Acute ischaemia of the glans penis is a rare and serious complication following circumcision. We report the case of a teenage boy with glanular ischaemia shortly after circumcision with dorsal penile ...nerve block. This was successfully treated with total 11 days of topical 2% nitroglycerin ointment, 14 days of oral pentoxifylline 400 mg three times a day and 3 days of epidural (0.2% ropivocaine). There was marked clinical improvement at 4 days with a few patches of cyanosis remaining. Surgical intervention was not required, and the patient was discharged with follow-up review. At 12 days, there was complete resolution of ischaemia and the glans penis appeared normal. We suggest that oral, topical and epidural regimen of vasodilators and anti-sympathomimetic agents can be used in combination for acute ischaemia of the glans penis.
Background/Aims
Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study ...was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1‐year period.
Methods
The following data were collected: age (preschool 0–6 years, school age 7–12 years, and adolescent 13–18 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software.
Results
Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001).
Conclusion
The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0–6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.
Background: Pre-operative anxiety is prevalent and associated with adverse patient outcomes. Many anxiolytic techniques have been utilized in the pre-operative setting, with varying degrees of ...success. The Autonomous Sensory Meridian Response (ASMR) is an increasingly popular method of relaxation used for anxiety reduction in general society. It is a non-invasive, inexpensive intervention with no known adverse effects. It has not been researched in a pre-operative setting. We aimed to investigate the effects of ASMR in the pre-operative patient population.
Methods: This prospective, double-blind trial randomly allocated 50 participants into either a placebo or ASMR group. Pre-operative anxiety was compared before and after viewing specially formatted educational video information in either an ASMR or non-ASMR format with validated anxiety scales-Visual Analogue Scale (VAAS), Amsterdam Pre-operative Anxiety and Information Scale (APAIS) and State-Trait Anxiety Inventory. The physiological characteristics of heart rate and blood pressure were measured as secondary outcomes.
Results: The control group demonstrated a reduction in pre-operative VAAS of 6.6 (p = 0.01) and 1.1 (p = 0.02) on the APAIS. The ASMR group had a reduction of APAIS of 1.9 (p = 0.005) and no change in the VAAS. Changes in State-Trait Anxiety Inventory for state anxiety score were the same in both groups. Increased trait anxiety was correlated with increased post-intervention VAAS and APAIS scores. There was no effect of pre-existing trait anxiety and pre-interventional anxiety on the efficacy of ASMR. Post-intervention, there was a significant decrease in mean systolic blood pressure by 2.7mmHg in ASMR group. In multivariable analysis, ASMR group had a drop of 3.9mmHg in post-intervention systolic blood pressure compared to placebo (p<0.05).
Conclusion: While our findings are inconclusive, potential benefits of ASMR in reducing pre-operative anxiety should be further explored with a larger sample.
Background/Aims
Approximately 20% of patients with maxillofacial trauma are women, but few articles have analysed this. The aim of this multicentric, prospective, epidemiological study was to analyse ...the characteristics of maxillofacial fractures in the female population managed in 14 maxillofacial surgery departments on five continents over a 1‐year period.
Methods
The following data were collected: age (0–18, 19–64, or ≥65 years), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment, and length of hospitalization.
Results
Between 30 September 2019 and 4 October 2020, 562 of 2387 patients hospitalized with maxillofacial trauma were females (24%; M: F ratio, 3.2:1) aged between 1 and 96 years (median age, 37 years). Most fractures occurred in patients aged 20–39 years. The main causes were falls (43% median age, 60.5 years), which were more common in Australian, European and American units (p < .001). They were followed by road traffic accidents (35% median age, 29.5 years). Assaults (15% median age, 31.5 years) were statistically associated with alcohol and/or drug abuse (p < .001). Of all patients, 39% underwent open reduction and internal fixation, 36% did not receive surgical treatment, and 25% underwent closed reduction.
Conclusion
Falls were the main cause of maxillofacial injury in the female population in countries with ageing populations, while road traffic accidents were the main cause in African and some Asian centres, especially in patients ≤65 years. Assaults remain a significant cause of trauma, primarily in patients aged 19–64 years, and they are related to alcohol use.
Background/Aims
The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on ...health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world.
Methods
The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non‐parametric and association tests, as well as linear regression.
Results
Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2–7.2). Statistical analysis showed that women were more involved in fall‐related trauma compared with males (p < .001). It was also shown that road traffic accidents cause more fractures in the lower third (p < .001) and in the middle third‐lower third complex compared with upper third (p < .001).
Conclusions
Maxillofacial fractures in the elderly were more frequent in European and Australian centres and affected men slightly more than women. Falls were the leading cause of fractures, especially among women. The middle third of the face was most often affected, and conservative treatment was the most common choice for the management of such patients.
The World Oral Maxillofacial Trauma (WORMAT) project was performed to analyze the causes and characteristics of maxillofacial fractures managed in 14 maxillofacial surgery divisions over a 1-year ...period.
The following data were collected: age, sex, cause and mechanism of maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score (FISS), associated injury, day of trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software.
Between 30 September 2019 and 4 October 2020, 2,387 patients (1,825 males and 562 females ratio 3.2:1, 47.6% aged 20–39 years mean age 37.2 years, median 33.0 years) were hospitalised. The main cause of maxillofacial fracture was road traffic accidents (RTA), which were statistically associated with male adults as like as assault, sport, and work (p<0,05). Half of the fractures involved the middle third of the face, statistically associated with fall and assault (p<0.05). Trauma in multiple locations was significantly associated with longer hospital stay (p<0.05). The mean length of hospitalization was 3.9 days (95% Confidence Interval 3.7–4.2).
This prospective, multicenter epidemiological study confirmed that young adult males were the ones most commonly affected by maxillofacial fracture. RTAs and assaults are statistically associated with the adult population, while falls are associated with females and older population.
Meckle's diverticulum is the most common embryological anomaly of the small bowel that is rarely seen in adults. It is caused by the incomplete closure of the vitelline or omphalomesenteric duct. ...Those who are symptomatic from Meckle's diverticulum have varied clinical presentations, which raise significant challenges with diagnostic and management options. We report a case of a 47-year-old male who presented to the hospital with clinical signs of appendicitis but was found to have perforated Meckle's diverticulitis with faecoliths on computed tomography imaging and laparoscopy. Furthermore, histopathology revealed an ectopic gastric tissue cell type, which is a rare finding. This was definitively managed surgically with laparoscopic resection of Meckle's diverticulum and appendicectomy.
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