Current Issue : April - June Volume : 2020 Issue Number : 2 Articles : 7 Articles
Background: Hypocalcemia is a derangement in serum calcium level due to a vast spectrum of disorders, but the\nmost common cause is surgery, usually thyroid gland surgery. Symptoms of hypocalcemia can be due to increased\nneuromuscular excitation resulting in tetany, paresthesia or seizure. It can also be because of deposition of calcium\nin soft tissues producing reduced vision /cataract or calcification of basal ganglia. Cataract is the most common\nocular symptom of hypocalcemia.\nCase report: A twenty-six years old Ethiopian female patient presented with painless reduction of vision of both\neyes. Five years prior to the reduction of vision she was diagnosed to have hypocalcemia. The serum calcium level\nwas very low (3 mg/dl) due to damage to the parathyroid gland during total thyroidectomy for toxic goiter. She\nhas been on supplemental calcium gluconate twice daily. She had typical bilateral symmetrical posterior sub\ncapsular cataract with punctate iridescent opacities in the anterior and posterior cortex of the lens. Systemic\nexamination revealed horizontal surgical scar on the anterior neck and positive Chvostek sign....
A 52-year-old lady was seen in the breast clinic after an 8mmlesion was found in her left breast on screening mammogram. Clinical\nexamination was normal. The left breast mammogram showed an 8mm rounded density posteriorly in the inner half of breast and\nultrasound also showed a 7 mm, well-defined ovoid echogenic lesion (R3, U3). Biopsy confirmed the lesion was fibro-fatty tissue\ncontaining a diffuse infiltrate of lymphoid cells macroscopically (B3/4)--- findings in line with a diagnosis of a myofibroblastoma.\nA myofibroblastoma is a rare benign mesenchymal tumour comprising of spindle cells. Most breast myofibroblastomas\ndescribed in the literature have been excised by wide local excision. In this patientâ??s case, a vacuum-assisted technique was\ndiscussed and suggested at the multidisciplinary meeting. It was excised using ultrasound-guided Vacora® breast biopsy system.\nThe lesion was completely excised with the encore biopsy measuring 24 *17mm. This is the first documented case of such a\ntechnique for the excision of a breast myofibroblastoma. There still is uncertainty about breast myofibroblastomas, their\naetiology, associations, and how they are best investigated. Regarding management, vacuum-assisted technique, being less\ninvasive and cheaper than local excisions, is adequate for small lesions....
Background: Coverage of post-traumatic or post-oncosurgical nasal defects\nis a very challenging procedure. Small nasal defects may be covered by skin\ngrafts or small local flaps while larger nasal defects require more complex\nflap coverage techniques as using tissue expanders, prefabricated flaps or\nfree flaps. The forehead flap has been used for centuries and remains a\nworkhorse flap for reconstruction of large and complex nasal defects. Aim:\nevaluate the feasibility and versatility of forehead flap for resurfacing nasal\ndefects. Materials and Methods: 12 patients underwent coverage of nasal\ndefects after trauma or tumor excision using forehead flaps. All flaps needed\na second stage for flap separation 3 weeks after the time of operation. The\nsize of the harvested flap, the harvesting time, results of transferred flaps, patient\nsatisfaction and flap-related complications were analyzed. Results: 12\npatients (10 males and 2 females) underwent reconstruction of different nasal\ndefects using 12 forehead flaps. The overall complications occurred in 2\npatients. The remaining 10 patients showed no complications and passed an\nuneventful follow-up period. 7 Patients were very satisfied, 4 were satisfied\nand only one patient was not satisfied as she was 23 years old young female\nand was subjected to human bite. Follow-up periods ranged from 6 to 12\nmonths. Conclusion: Nasal defects can successfully be managed with the\nforehead flap. Probably, the flap provides the best result due to the good\nmatching of the skin in terms of color, texture, and thickness. Also, despite\nthe increasing use of free flaps, the forehead flap is still a valid and safe option\nfor nasal defects coverage that allows good aesthetics and functional\noutcomes....
Background: This study aimed to propose a novel surgical reconstruction technique for complex high-location bile\nduct injury (CHBDI).\nMethods: There were eight patients with CHBDI underwent the novel hepaticojejunostomy between Feb 2015 and\nFeb 2017. Seven patients underwent a primary operation and found CHBDI postoperatively in the inferior hospitals\nreferred to our center. And four of them had received hepaticojejunostomy, but the results were not satisfying. One\npatient (No.8) with radiographically diagnosed hilar cholangiocarcinoma came to our center for surgical treatment and\nunderwent the novel hepaticojejunostomy technique because CHBDI was found in operation. Perioperative and\nfollow-up data of these patients were retrospectively reviewed.\nResults: The mean age was 47.6 ± 10.7 years, and there was four female. The mean range of time between the injury\nand the repair operation in our center was 6.3 ± 4.8 months. All repair operations using the novel hepaticojejunostomy\ntechnique in our center were successfully performed. No postoperative complications, including biliary fistula,\nrestenosis, peritonitis, and postoperative cholangitis was observed. Besides, no evidence of biliary stenosis or biliary\ncomplications happened during the follow-up (median 28months).\nConclusions: The novel hepaticojejunostomy is a reliable and convenient technique for surgical repair of multiple\nbiliary ductal openings like CHBDI....
Background Data: Atlanto-occipital dislocation is a rare and fatal condition.\nPain, limitation of movements, and weakness, were the main complaints of\npatients with upper cervical lesions. Internal fixation and fusion was indicated\nin all patients of Atlanto occipital dislocation with deficits. CT scan is\nthe imaging modality of choice for evaluation. Objective: To evaluate the efficacy\nand safety of rod and screw fixation in cranio-cervical instability. Study\nDesign: Retrospective study reviewed all patient treated by rod and screw fixation,\nthey were 12 patient operated for atlanto-occipital instability from April\n2013 to April 2016 in Alazher University Hospital Damietta. Pre and postoperative\ndata collection and analysis of the outcome were completed based\non the Frankel classification and grading. Patients and Methods: We operated\n12 patients, 10 with traumatic and 2 with pathologically diagnosed Atlanto\noccipital instability. From April 2013 to April 2016. All patients presented\nwith neck pain, limitation of neck movement, and neurological deficits.\nThe patients were investigated by standard plain X ray to the cervical\nspine, CT scan and MRI of the cervical spine pre-operatively, and they operated\nthorough posterior Cranio-cervical fixation. These patients followed\npost-operatively clinically for improving neural functions and radiologically\nfor alignment, stability, fusion and efficacy of hard ware fixation. Results:\nThe mean age of the studied cases was 42.1 years, trauma was the cause of instability\nin 10 patients, and 2 patients one with rheumatoid arthritis and one\nwith neoplastic lesion. The mean follows up period is 14.7 months. We used\nscrew rod system in posterior craniocervical fixation with iliac bone graft\nwithout operative or post-operative complications. All our patients were improved\nneurologically post-operatively and no hardware failure during the\nfollow up period. Conclusion: Craniocervical instability was rare condition,\nwith miss diagnosis and may be fatal condition. Posterior occipitocervical\nfixation when indicated can be done by various techniques. The screw rod\nsystem was the most upgraded used technique with immediate rigid fixation.\nSurgery in this area was possible with confident results....
5 million central venous access lines are placed every year in the United States, and it is a common surgical bedside procedure. We\npresent a case of a central venous catheter placement with port for chemotherapy use, during which a duplication of a superior vena\ncava was discovered on CTA chest after fluoroscopy could not confirm placement of the guidewire. Due to its potential clinical\nimplications, superior vena cava duplication must be recognized when it occurs....
Background: Ectopic mediastinal parathyroid tumor (EMPT) is a rare cause of primary hyperparathyroidism (PHPT);\nit is difficult to resect using the cervical approach. We describe a case of using video-assisted thoracic surgery\n(VATS) for EMPT resection.\nCase presentation: A 67-year-old woman with a history of postoperative thyroid cancer had no symptoms. She\nwas diagnosed with PHPT and underwent thyroid cancer surgery. She had serum calcium and intact parathyroid\nhormone (PTH) levels of 11.1 mg/dL and 206 pg/mL, respectively. Chest computed tomography showed a 10-mm\nnodule in the anterior mediastinum. Technetium-99m methoxyisobutyl isonitrile scintigraphy showed an abnormal\nuptake lesion in the anterior mediastinum. She was diagnosed with PHPT caused by EMPT and underwent VATS.\nThe pathological examination confirmed parathyroid adenoma. Her serum calcium and intact PTH levels were\nnormal from 15 min after tumor resection. She has had no recurrence of EMPT.\nConclusions: The VATS approach was effective for the resection of EMPT....
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