American Research Journal of Medicine and Surgery

Abdullah S. Al-Darwish, MD1*, Abdullah Z. Alsaif, MD1, Sami AlHawassi, MD1, Hisham AlKhalidi, MD, PhD2,3, Youssuf AlSuhaibani, MD1, Nahar A. AlSelaim, MD, MPH1,4,5, Abdulrahman Al-Balla, MD1

Introduction: Appendiceal Mucocele is a rare medical condition, sometimes it is discovered incidentally but occasionally it could mimic acute appendicitis. Laparoscopic resection of appendiceal mucocele recently has been reported, but the safety and efficacy are still controversial.Presentation of Cases: We will present four cases of laparoscopic resection of appediceal mucocele. The First, second, and fourth cases were treated by laparoscopic appendectomy only; While the third case was treated by laparoscopic right hemicolectomy.Discussion: We elected to do our cases using a Laparoscopic approach. Laparoscopic resection is achievable with expert surgeons, despite the risk of malignancy, but necessary precautions should be taken. The four cases’ final histopathology reports showed the same result: Low-Grade Appendiceal Mucinous Neoplasm (LAMN) .Conclusion: A Laparoscopic resection of appendiceal mucocele can be done by expert surgeons if the necessary precautions were taken to prevent spillage.

Rickert C., Ploetz M., Kalisch T., Gosheger G., Klingebiel S.

Purpose: Quality of scientific society`s activity is reflected in the publication rate (PR) for congress presentations. The aim of this study was to evaluate the publication rates of the annual AGA congress, as the largest professional society for arthroscopy in Europe, and to compare it to other orthopedic conferences.Methods: 604 abstracts of podium and poster presentations presented from 2010 to 2013 were included. Using a PubMed search for corresponding articles in peer-reviewed journals for a follow-up (FU) period for each congress of 5 years was examined. Evaluation of abstracts and publications regarding hypothesis, method, number of cases, and outcome was made. Subgroup analysis of the publication data was performed according to the investigated body region and study type.Results: The FU period of 5 years showed a publication rate of 49.7% with a mean publication period of 24.97 months (SD 16.74) and an average impact factor of 2.68 (SD 1.17). 60.5% of publications were in first-rate, 29.6% in second-rate, and 10.0% in third-rate journals. The following three journals had the most publications: Knee Surgery, Sports Traumatology, Arthroscopy (29.5%), Archives of Orthopaedic and Trauma Surgery (11.3%), and The American Journal of Sports Medicine (9.9%).Conclusion: The overall publication rate (49.6%) was in the middle range of rates reported for other orthopedic conferences (25-71%). The high level of the journals in which they were published testified to the quality of the studies reported at the AGA meeting.

Mohamed B. M. Kotb, Mostafa T. Ahmed, Ibrahim A. Ibrahim. Abd-Elradi Abd-Elsalam Farghaly

Background: Thyroidectomy is one of the most surgical interventions in endocrine surgery. When the operation is performed in the respective surgical centers, the operation is safe with low morbidity and 0% mortality.Patients and Methods: The study was a quasi-experimental study carried out at Assiut University Hospital. One hundred patients with benign and malignant goiter disorders underwent primary (not recurrent) total thyroidectomy. The patients were assigned into two groups: group 1 (interventional group) included 50 cases operated upon with methylene blue spraying technique and group 2 (control group) 50 cases established with the conventional technique. Methylene blue was sprayed over the thyroid lobe and perilober area. Parathyroides and recurrent laryngeal nerves were identified and evaluated.Results: Recurrent laryngeal nerve was not stained and remained white in all cases while all other tissues were stained blue. Three minutes later, the parathyroid glands washed out the blue stain and regained their original yellow color. Thyroid gland wash-out time was ∼15 min.Conclusion: Methylene blue spraying is a new technique that allows identification of both parathyroid glands and recurrent laryngeal nerves. This technique is safe, effective, and technically feasible.

Tricia Sandrine Lewis1, Yong Dong Feng2*, Fa Yong Hu2, Ling Wei Jia2

Introduction: In recent years, the incidence of esophageal junction cancer (EGJ) has increased. The management of Siewert type II remains undecided while total gastrectomy with distal esophagectomy is mostly recommended for type III. Data is still lacking from studies assessing proximal and total gastrectomy approaches without thoracotomy as the surgical management of these types of cancer.Methods: Data was retrospectively collected on histopathological characteristics, short-term complications, hemoglobin, total protein, albumin and weight changes. 18 patients with type II, 15 patient type III underwent proximal gastrectomy-Double tract reconstruction (PG-DTR) and 17 patients and 10 patients with type II and III respectively, underwent total gastrectomy-Roux-en y (TG-RY). Patients were followed up every 3 months for one year. The Spitzer-index was used to assess quality of life (QOL) at months 3,6 and 12.Results: There was no statistical significance for operation time, length of hospital stay, blood loss, and change in weight at 6 months after surgery. Changes in hemoglobin, total protein and albumin also failed to show statistical significance (P=0.517, P=0.885 & P=0.8237, respectively). Recurrence was seen in 18.5% and 21.2% of TG and PG group respectively.QOL was significantly better in PG-DTR (P=0.017).Conclusions: This study failed to show any difference for intraoperative and short-term complications between the two procedures. PG-DTR might provide better QOL for patients with types II/III cancer. In addition to D2, Siewert II/III tumors of larger sizes may require extended lymphadenectomy. This study needs further verification with larger cohort, additional parameters, and extended follow up periods.

Young-Min Kim, MD

Sarcopenia is commonly defined as a decrease in muscle mass accompanied by low muscle strength, and is known to increase the risk of frailty, falls and disability. According to the European guidelines for sarcopenia revised in 2018, if sarcopenia is clinically suspected, the muscle strength should be checked to determine whether it is probable sarcopenia before diagnosing sarcopenia. Recent studies have shown that depression is associated with sarcopenia. To explore further, this study investigated the association of probable sarcopenia with depressive symptom severity. This Cross-sectional study was conducted using data from the Korean National Health and Nutrition Examination Survey (2014, 2016). In the KNHNE survey, 2062 participants aged 65+ who completed both the PHQ-test and the grip strength test were selected. PHQ-9 was categorized into 4 groups according to the score, and low grip strength was defined as less than 26 kg for men and 18 kg for women according to AWGS criteria. Age, BMI, waist circumference, smoking status, comorbidities and diets were assessed as covariates. When adjusted all the covariates, Age ([OR]=1.175; [CI]=1.123-1.229), history of stroke ([OR]=2.467; [CI]=1.094-5.564), carbohydrate intake ([OR]=1.004; [CI]=1.000-1.009) was significantly associated with probable sarcopenia in male group. Whereas, in female group, age ([OR]=1.130; [CI]=1.090-1.171), lipid intake ([OR]=0.962; [CI]=0.929-0.997) was significantly associated with probable sarcopenia. Moreover, as the PHQ-9 score increased, the odds ratio for probable sarcopenia increased in female group (mild ([OR]1.477; [CI]1.007-2.167), moderate ([OR]2.421; [CI]1.292-4.537), moderately severe ~ severe ([OR]3.095; [CI]1.441-6.646)). The risk of probable sarcopenia increases with the depressive symptom severity in Korean elderly women.

Dr. Shantanu Vyas1, Dr. Girish Chauhan2

Choledochal cysts in adults are often detected during the investigation of nonspecific symptoms. Choledochal cysts are uncommon and of unknown cause, with an incidence of 0.1% even among adults referred for endoscopic retrograde cholangiopancre atography (ERCP) investigation 2. There is a higher incidence in females 3, 4. The presentation is often vague and nonspecific, impending prompt diagnosis. However, the diagnosis is facilitated by modern imaging techniques. While some aspects of optimal management have been resolved, others remain controversial. Here in we report our experience concentrating particularly on current issues in management of the disease.MRCP is the best imaging modality for diagnosis and characterization of these cysts. Complete excision and hepaticojejunostomy is the management of choice. Two drain (Subhiepatic and pelvis) should be put at time of surgery.

Salami T.A.T1, Akinkugbe A.O2

Dermatitis as an inflammatory skin disorder is characterized by erythema and scaling of the cutaneous surface of the body. The pattern of occurrence differs across the ages and varies in different parts of the body.The records of all patients with a diagnosis of dermatitis presenting to the dermatologic clinic of Irrua Specialist Teaching Hospital, Irrua Edo State Nigeria over a ten years period between April 2005 and April 2015 were reviewed and analyzed retrospectively and subjected to simple statistical analysis.One thousand six hundred and twenty patients (1620) with various types of dermatitis were seen during this period representing 22% of all dermatologic presentations. Among the different types of dermatitis encountered, atopic dermatitis accounted for the highest prevalence at 28.1% occurring equally in the young and the old, followed by contact dermatitis occurring in 18.2% of the patients (mainly in young adults). Those with the lowest prevalence were stasis dermatitis (2.4%) and asteatotic eczema (3.6%) both occurring majorly in the elderly. Seborrhoiec dermatitis (8%) and onchodermatitis (5%) were the major infective dermatitis found.The spread of dermatitis in a tropical dermatology practice from this study varies greatly among different age groups and several factors such as inherent immunity and various environmental conditions from activities of daily living are responsible for these and the knowledge of this variation may help to exclude other lesions such as psoriasis and drug eruptions which can present with a similar clinical picture.

Dr. med. Jacek Karski1, Prof. Tomasz Karski2, Dr. Katarzyna Karska3, Dr. med. Jarosław Pyrc4

Abstract: Deformations of the feet of children and feet pain syndromes of adults are very common, more likely among women. In children and youth we can observe: 1/ valgus or plano – valgus feet deformity, 2/ congenital or neurological deformations of feet, 3/ Köhler’s disease among girls wearing improper shoes. Among adults can appear: 1/ insufficiency and pain of frontal part of feet connected with limited toes flexion, 2/ valgus deformity of the big toes (hallux valgus), 3/ “insufficiency and pain syndrome of ankle joint” – till now not been described. The pain is due to the instability of this joint. In our study, we describe this special type of foot insufficiency – “instability of ankle joint” and pain syndrome as a result of “permanent distortion of ankle joint” – left leg by drivers and right leg by passengers in countries with “right traffic rules”.

Idit Melnik MD1, Oleg Dukhno MD1, Ornit Cohen M.MED Sc2, Dimitry Goldstein MD1 Moris Batumsky1,Boris Yoffe MD FACS1

Purpose: single incision laparoscopic technique is an emerging modality. The purpose of our study was to compare the intraoperative and short-term postoperative outcomes of single incision laparoscopic colectomy (SILC) versus multi-incision laparoscopic colectomy (MILC) and to explore whether, for any of the different types of colectomies, SILC is the recommended approach.Methods: We retrospectively reviewed the charts of all patients who underwent laparoscopic colectomies between October 2010 and December 2012. The cohort was divided into two groups, SILC and MILC, which were compared in terms of their intra-operative and early postoperative outcomes. Each group was then sub-divided according to the type of procedure, each of which was compared separately between SILC and MILC. The intra-operative parameters were total operative time, surgical margin involvement and the number of lymph nodes extracted. The postoperative parameters included length of hospital stay, 30-day readmission, maximum pain score, morbidity, and mortality.Results: Seventy-five patients underwent laparoscopic colectomies (SILC-21/ MILC-54). Between the two groups, patient characteristics were not statistically different. A comparison of the groups’ intraoperative and postoperative results showed no statistically significant differences. There were no deaths in either group. Analyses of each procedure separately showed that when performing RH there was a trend (p = 0.08) of better oncological results with a higher mean number of lymph nodes extracted (23.5 ± 3.16 vs. 17.19 ± 6.93). In addition, LOS decreased (5.91 ± 3.59 vs. 6.48 ± 1.76, respectively), which was statistically significant (p = 0.05).Conclusions: Single incision approach for bowel resections is feasible and safe. Given our findings, we believe that SILC technique is an effective alternative to MILC when performing RH with the statistically significant benefits of lower LOS and better oncological results. However, the efficiency of the technique in LH or AR is still questionable and needs further evaluation.

Background and Aims: Cirrhosis of liver is one of the commonest cause of ill health among general population particularly in chronic alcoholics in developing countries like India. Cirrhosis patients show increased incidence of hyperglycemia; to study impaired glucose tolerance in patient with cirrhosis & to predict prognosis of patients with Liver Cirrhosis.50 Patients of liver cirrhosis of either sex and age were included in the study. All patient were subjected to oral glucose tolerance test and the findings were correlated with the severity of the disease.Results: 16% patients belonged to child’s grade A, 50% belonged to grade B & 34% patients belonged to Child’s grade C. 56% of patients showed impaired glucose tolerance. No patient showed diabetic response to glucose tolerance test. 15 (88%) patients belonging to Child’s grade C showed impaired glucose tolerance. While there were 12 (48%) patients in Child’s grade B who showed impaired glucose tolerance. Only 1 (12.5%) patient in Child’s grade A had glucose intolerance.Conclusion: The incidence of impaired glucose tolerance was significantly high among patients with cirrhosis of liver. This high incidence of glucose intolerance was not related to the age, sex and etiology but was related with the severity of disease.Cirrhosis of liver is one of the commonest cause of ill health among general population particularly in chronic alcoholics in developing countries like India. Since it is a slowly progressive silent disease it is usually overlooked by the patient themselves unless they develop some complication. In India there has been a rise in case of post necrotic cirrhosis following hepatitis B infection.Cirrhosis a generic term, includes all forms of chronic diffuse liver disease characterized by significant loss of liver cells, collapse and diffuse septal fibrosis of liver associated with regenerative parenchymal nodules and disturbed intrahepatic circulation. Cirrhosis results from prolonged and widespread but patchy hepatocellular necrosis which may have many cause (Oxford Textbook of Medicine 3rd edition, pg. 2085).1Cirrhosis of liver causes significant derangement of carbohydrate metabolism. Narayan (1906) first time, established impairment of carbohydrate metabolism scientifically in liver disease including cirrhosis of liver. Impaired glucose tolerance is related to severity of liver disease and there is no evidence that DM predispose to cirrhosis. O Riggio et al. (1982).2 Glucose intolerance in cirrhosis is caused by simultaneous occurrence of insulin resistance in muscles and inadequate secretion of insulin by beta-cell of pancreas to overcome the insulin resistance (Petrides et al, 1994).3Cirrhosis patients show increased incidence of hyperglycemia associated with increased insulin level. Hyperglycemia is explained by reduced absorption of glucose by muscles and decreased glycogen storage in liver and muscles. This leads to increased insulin level in serum and increased insulin resistance [Sleisenger & Fordtrans GI and liver ds. 6th Edi. Vol 2. Page 1067].4Fasting blood glucose is usually normal in cirrhotics but most are insulin resistant and are intolerant to an oral glucose load, and have post prandial hyperglycemia (Oxford Textbook of Medicine, 3rd edition, Pg. 2088).1In this study oral glucose tolerance test was done in patients of cirrhosis to demonstrate glucose intolerance and its correlation with the severity of cirrhosis.