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REVIEW ARTICLE
Central venous catheterization: An updated review of historical aspects, indications, techniques, and complications
Rafael Cardoso Pires, Noslen Rodrigues, Jonathan Machado, Ricardo Pedrini Cruz
July-September 2017, 2(3):66-70
DOI:10.4103/ts.ts_10_17  
Central venous catheterization has become an indispensable procedure in various situations in the intensive care unit, emergency room and operation room. There are many applications such as invasive hemodynamic monitoring, parenteral nutrition support, dialysis, chemotherapy, fluid resuscitation and drug administration, though there are some complications associated with catheter placement. There are some articles that discuss the security and advantages of the anatomic landmark technique and ultrasound (US) guidance technique. In this non-systematic review article we searched the current data in Pubmed library.
  10,008 1,240 5
CASE REPORTS
Valentino's syndrome: An unusual presentation of a perforated peptic ulcer
Alessandro Sgro, Mahir Petkar, Angelo Benevento, Francesco Pata
October-December 2017, 2(4):106-108
DOI:10.4103/ts.ts_16_17  
Valentino's syndrome occurs when digestive fluids tend to settle in the right iliac fossa through a perforated gastric or duodenal ulcer, causing peritonitis and clinically mimicking acute appendicitis. Herein, we present the case of a 32-year-old male who was admitted to the emergency department with signs and symptoms suggestive of acute appendicitis. During laparoscopic appendectomy, inspection of the peritoneal cavity revealed an anterior, perforated duodenal ulcer, which was treated with a patch repair. The patient's recovery was uneventful, and a gastrointestinal endoscopy at his 6-week follow-up showed complete healing of the ulcer. This case highlights that Valentino's syndrome should be considered in the differential diagnosis of any patient who has an abdominal examination consistent with acute appendicitis.
  8,091 389 -
REVIEW ARTICLE
Biomaterials and surgical applications: The translational perspective
Brenda Vega-Ruiz, Rodrigo Ramos-Zúñiga, Ivan Segura Duran, Yara Ursiel-Ortega
October-December 2017, 2(4):85-102
DOI:10.4103/ts.ts_17_17  
Basic research provides the results necessary to pursue translational work, where basic and translational approaches used in conjunction can allow for an increased impact in solving public health problems. Biomaterials draws from both approaches and are used today in many surgical specialty areas, such as tissue regeneration and regenerative medicine. These materials can be used as replacements for tissue, as scaffolds for regeneration, as substrates for cell growth, as drug-releasing or bioactive molecule-releasing vehicles, and as several other medical devices. Biopolymers used in regenerative medicine provide a good example of such materials and demonstrate the methodology of a translational approach, where the product begins at the laboratory bench, is applied in preclinical stages, and is finally delivered as a new medical solution back to the patient. The biocompatible, biodegradable, and bioactive properties of some of these polymers have opened different possibilities for their use in the repair and/or regeneration of different tissues, including skin, bone, cartilage, nerves, liver, and muscle. This article serves as a review of the properties of these biopolymers, their use in tissue engineering, and promising alternatives in regenerative medicine.
  7,759 429 3
ORIGINAL ARTICLES
Extracorporeal shock wave lithotripsy in the treatment of pediatric nephrolithiasis: Comparison of the outcome between preschool and schoolgoing children: A single-center study
Nadeem Iqbal, Salman Assad, Aisha Hasan, Muhammad Usman Shabbir, Taimur Hijazi, Saeed Akhter
October-December 2016, 1(4):91-94
DOI:10.4103/2468-5585.197491  
Aim: This study aimed to retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones, between preschool and schoolgoing children. Methods: From January 2007 to March 2015, a total of 103 ESWL-treated children were considered for the study. Stone clearance rate, number of retreatment required, complication rate, and ancillary procedures used were evaluated. Results: Of the 103 patients with age limits of 2-14 years, 36 were <5 years (preschool group) and 67 were ≥5 years (schoolgoing group) of age. The mean age and mean stone size in preschool group was 3.26 ± 1.29 years and 0.97 ± 0.25 cm, respectively, whereas in schoolgoing group, it was 10.31 ± 3.01 years and 14 ± 0.68 cm, respectively. The stone-free rate in preschool and schoolgoing group was 34/36 (94.4%) and 57/67 (85%), respectively, with no statistical difference between the two (P = 0.2076). Post-ESWL complications, including hematuria, mild fever, flank pain, steinstrasse requiring ureteroscopy, and sepsis were seen in both preschool and schoolgoing groups, at varying rates that failed to reach statistical significance among the two (P > 0.05). Mean number of shock waves required for stone clearance was significantly less in preschool group (P = 0.0001). Conclusion: ESWL is equally effective for managing nephrolithiasis in both <5-year or ≥5-year aged children.
  3,559 3,848 1
SHORT COMMUNICATION
Minimally invasive treatment of pilonidal sinus disease using platelet-rich plasma
Ömer Karahan, Barış Sevinç, Gürcan Şimşek, Recep Demirgül
January-March 2016, 1(1):14-17
DOI:10.4103/2468-5585.179563  
Aim: Pilonidal disease is an inflammatory disorder, mainly affecting young adults. Platelet-rich plasma (PRP) is shown to have a positive impact on the wound healing process. Herein, the study aims to define the application of PRP and report early results. Methods: The study data were collected prospectively. PRP was prepared from the patients' own blood samples, transformed into gel form, and applied to the sinus tract under local anesthesia. Furthermore, the healing rate and recurrence rate of the disease were evaluated. Results: There were 50 cases included in the study, with 48 cases were cured at the end of the 1st month. At this stage, with a median follow-up of 15 months, there have been no documented recurrences. Conclusion: Minimally invasive treatment of pilonidal disease with PRP application has promising results. Treatment of pilonidal disease by PRP can be applied in outpatient clinic and provides total cure in a short time. The method is simple, painless, with no hospital stay required, less wound care, shorter time to return daily activity, and the cost is effective. However, long-term outcomes are unknown, and additional follow-up is required.
  5,124 417 6
REVIEW ARTICLE
Medical applications of polyether ether ketone
Yitong Guo, Shenggui Chen, Jing Wang, Bingheng Lu
January-March 2018, 3(1):12-16
DOI:10.4103/ts.ts_3_18  
Polyether ether ketone (PEEK) has been widely used during the past decades in the medical field. Its versatile nature makes PEEK very popular in a variety of medical devices. The purpose of this article is to summarize the medical applications of PEEK in following fields: cranioplasty, dental implants, interbody fusion, joint replacements, soft-tissue repairs, and cardiac surgery. PEEK, as a biocompatible polymer, has been used in fields related to tissue fixation and reconstruction. This is largely due to its superior mechanical characteristics and biocompatibility. The author believes that as collaboration between medical professionals and engineers becomes more standard, PEEK and its composites will become more available and versatile.
  4,865 618 6
ORIGINAL ARTICLES
The reference values for hepatic oxygen consumption and net lactate production, blood gasses, hemogram, major electrolytes, and kidney and liver profiles in anesthetized large white swine model
Mohamed Bekheit, Petru Bucur, Eric Vibert, Christian Andres
October-December 2016, 1(4):95-100
DOI:10.4103/2468-5585.197495  
Aim: Pigs are extensively used as experimental models to study the human physiology and pathophysiological conditions. Knowledge of the normal values of the commonly used parameters is indispensable to the correct interpretation of the test results. This study reports on the normal hemogram, blood gas, major electrolytes, kidney and liver profiles, hepatic oxygen consumption, and net lactate production in a large white pig model. Methods: Twenty-five female large white pigs were included in this study. Blood gas samples were collected from the portal and hepatic veins as well as the carotid artery. Results: The mean hemoglobin level was 97.7 ± 15.8 g/L. white blood cells were 13.5 ± 3.3 10 [3] /mm [3] , and platelet count was 279 ± 104.6 10 [3] /mm [3] . The mean aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, total bilirubin, and direct bilirubin were 83.8 ± 73.9 IU/L, 43.7 ± 5.9 IU/L, 33.6 ± 8.6 IU/L, 296.5 ± 39.7 IU/L, 5.6 ± 3.2 mmol/L, and 1.6 ± 0.73 mmol/L. The mean albumin level was 29 ± 3.9 g/L. The mean ammonia and arterial lactate levels were 49.1 ± 45.67 mmol/L and 1.5 ± 0.46 mmol/L. Kidney profile parameters were comparable to human values. Hepatic oxygen consumption was 17.3 ± 9.7 mL/100 g liver tissue/min and net hepatic lactate production was 0.017 ± 0.03 mmol/L. Conclusion: Knowledge of the normal parameters is mandatory for accurate interpretation of the experimental results that involves large white animals.
  3,661 1,816 -
ORIGINAL ARTICLE
Large decompressive craniectomy combined with vascular reconstruction in patients with severe craniocerebral injury
Xipeng Wang, Feng Ruan, Ping Liu
October-December 2017, 2(4):81-84
DOI:10.4103/2468-5585.221877  
Aim: This study aims to compare the effect of large decompressive craniectomy combined with vascular reconstruction and traditional decompressive craniectomy in the treatment of severe craniocerebral injury. Methods: Forty-eight cases of severe craniocerebral injury were collected from March 2012 to March 2015 in Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology. Patients undergoing large decompressive craniectomy combined with vascular reconstruction or traditional decompressive craniectomy were randomly divided into two groups: the experimental group and the control group. The hemodynamic changes were observed by computed tomography perfusion, and the postoperative Glasgow Outcome Score (GOS) was analyzed. Results: The cerebral blood flow (CBF) and cerebral blood volume (CBV) scores in experimental group were higher than that in the control group at 1 week and 1 month after the operation (P < 0.05). The mean transit time (MTT) and time to peak (TTP) scores in experimental group were lower than that in the control group at 1 week and 1 month after the operation (P < 0.05). The relative CBF and relative CBV values of the control group in 1 week were higher than that in 1 month, while the relative MTT and relative TTP values in 1 week were lower than that in 1 month. The rate of good recovery (including good and residual cases) in experimental group was higher than that in the control group whereas the rate of poor recovery (including severe disability, vegetative state, and death) in experimental group was lower than that in the control group (P < 0.05). Conclusion: The large decompressive craniectomy combined with vascular reconstruction can not only decrease intracranial pressure but also recover the blood supply of the brain. It deserves the clinical promotion.
  3,470 1,292 -
REVIEW ARTICLES
Therapeutic management of postoperative ileus
Lei Zhang, Xiaohui Xu
April-June 2017, 2(2):50-53
DOI:10.4103/ts.ts_40_16  
Postoperative ileus is one of the most common complications in patients after abdominal surgery and is a major determinant of recovery after surgery. It leads to increased postoperative morbidity, prolonged hospital stay, and increased costs. The pathogenesis of postoperative ileus is multifactorial, including pharmacological, neurogenic, and inflammatory mechanisms. In this review, we discuss the current therapeutic strategies for postoperative ileus.
  4,272 437 -
ORIGINAL ARTICLES
Red cell distribution width as a marker of thyroid papillary carcinoma
Baris Sevinc, Omer Karahan, Serden Ay, Nergis Aksoy, Ahmet Okus
April-June 2016, 1(2):41-43
DOI:10.4103/2468-5585.185198  
Aim: The study aims to evaluate the relation between red cell distribution width (RDW) and papillary thyroid carcinoma. RDW is a part of routine complete blood count which shows the heterogeneity of the circulating red cells. Studies showed that RDW increases in inflammatory disorders. Methods: The patients' data from 100 cases with total thyroidectomy were retrospectively evaluated. A total of 50 cases with thyroid papillary carcinoma and 50 cases with benign thyroid nodule were included into the evaluation. Results: The mean RDW value was 14.5 ± 1.7 in papillary carcinoma group and 13.4 ± 0.8 in benign thyroid nodule group. Other hematological parameters of the groups were similar. According to the receiver operating characteristic (ROC) curve, the optimal RDW value for thyroid papillary carcinoma was found to be 12.95% with a sensitivity of 88.00% and specificity of 70.00% (the area under an ROC curve: 0.718, P < 0.001). Conclusion: There is no study in literature evaluating the relation between RDW value and papillary thyroid carcinoma. According to the recent study, an increase in RDW value can be a helping parameter in differentiating papillary carcinoma from benign thyroid nodule.
  4,286 365 -
A preliminary study on forced expiratory volume in 1 s/forced vital capacity to predict prognosis of patients with lung cancer
Yechi Li, Jingqi Tian
July-September 2017, 2(3):57-61
DOI:10.4103/ts.ts_37_16  
Aim: The purpose of the study is to verify if there is statistic difference of lung function before surgery based on differences in clinical characteristics (sex, age, degree of differentiation, size of tumor, tumor node metastasis (TNM), methods of surgeries, pleural metastasis, and lymph gland metastasis). Another purpose is to test if forced expiratory volume in 1 s/forced vital capacity obstruction (FEV1/FVC) is a risk factor of the prognosis of lung cancer. Methods: This retrospective study used t-test or analysis of variance to explore whether dramatic difference of lung function (FVC, FEV1, maximal voluntary ventilation [MVV], and FEV1/FVC) existed based on differences in clinical characteristics. The study used the Kaplan–Meier method to verify if FEV1/FVC could be a risk factor to predict the prognosis of lung cancer patients after surgeries. Results: The statistical results indicated that statistical difference of FVC existed between different age groups. In patients of different ages and sexes, there was statistically different MVV. Results of FEV1/FVC showed that FEV1/FVC varied dramatically in patients of different pleural metastasis conditions or TNM. Analysis of prognosis proved that in patients with a different differentiation degree, size of tumor, metastasis conditions of lymph gland, and TNM stage, a statistically different prognosis was found. As for groups of normal and abnormal FEV1/FVC, no apparently different prognosis was observed. Analysis of lung cancer patients of stage I indicated that the 5-year survival was dramatically different between patients of normal and abnormal FEV1/FVC. Conclusion: In lung cancer patients of stage I, FEV1/FVC was one of the risk factors of prognosis.
  4,194 311 -
REVIEW ARTICLES
Advances in multi-therapies for the treatment of Ewing's sarcoma
Lei Zhang, Xing Zhou, Xiaozhou Liu, Chengjun Li, Sujia Wu
January-March 2017, 2(1):14-18
DOI:10.4103/ts.ts_32_16  
Ewing's sarcoma (ES) is a type of bone and soft tissue tumor that is highly invasive and primarily occurs in children and adolescents. In recent years, with the combination chemotherapy, surgery, and radiotherapy, prognosis, and quality of life have significantly improved. The overall survival (OS) rate is 65%–75%. However, metastasis and recurrence after surgical resection are still the main determinants of mortality. The OS rate in these patients is <30%. Exploring the pathogenesis of ES and looking for effective targeted therapies are the primary focus of many research teams. A global effort to improve the clinical efficacy of chemotherapy while reducing the toxic side effects, has led to further advances. We summarize the current multidisciplinary treatment advances in ES, with an emphasis on molecular targeted therapy and immunotherapy.
  4,019 409 1
REVIEW ARTICLE
Modeling neurodegenerative diseases by human pluripotent stem cell-induced brain organoid
Feng Tian, Jin Hao, Longyu Hu, Xu Luo, Rui Sun
April-June 2018, 3(2):42-47
DOI:10.4103/ts.ts_4_18  
Neurodegenerative disease (ND) contains a range of conditions which are primarily characterized by progressive neuronal dysfunction and loss. ND is particularly difficult to cure, due to the vulnerability of the nervous system. Currently, few genes and pathways are found to be related to ND. However, no solitary mechanism appears to be primary in neurodegeneration, and these pathogenic mechanisms likely act synergistically through complex interactions to promote neurodegeneration. Moreover, the existing treatment is mainly focusing on alleviating the symptoms of the disease. Furthermore, recent studies reveal considerable overlaps of symptomatology and genetic risks across the disease subtypes by detailed studies at cellular, molecular and genetic level. To better understand the etiology and pathogenesis of ND, study of the abnormalities at patient level is most ideal. However, direct access to the brain tissues from healthy individuals and patients is very limited. Therefore, an alternative experimental model is required to study the mechanism of ND. The most commonly used models are animal models, including Caenorhabditis elegans, Drosophila, zebrafish, and genetically modified mice. However, animal models also have their limitations including partial recapitulation of the disease features and difficulties in modifying disease genes. The recent development in three-dimensional (3D) brain organoids might provide a better experimental model to study ND, because 3D brain organoid system carries great potential to expand the range of both physiological and pathological features that can be found during the development of disease, enabling higher order investigation of mechanism and functionality.
  3,952 445 2
ORIGINAL ARTICLES
Health-related quality of life among postischemic stroke patients
Salman Mansoor, Maimoona Siddiqui, Salman Assad, Sehrish Javed, Nadia Mehboob, Anam Abrar, Nabeel Muzaffar Syed, Memoona Nasir, Qamar Zaman, Hamza Hassan Khan, Ahmed Shah Bukhari
July-September 2016, 1(3):63-68
DOI:10.4103/2468-5585.191483  
Aim: This study aims to assess the effects of health-related quality of life (HRQOL) in postischemic stroke patients. Methods: The cross-sectional survey included 100 patients who presented at neurology outpatient clinic of Shifa International Hospital of Pakistan for follow-up 6 months after stroke. The Short Form Health Survey (SF-36) was used to assess HRQOL. Stroke severity was determined by the National Institute of Health Stroke Scale. The modified Rankin scale (mRS) was used to assess functional status and outcome. Results: Totally 100 patients including 63% males and 37% females with a mean age of 60.18 ΁ 13.1 years participated in this study. Among 41 (41%) patients with mRS ≥3, there were 22 (54%) males and 19 (46%) females as compared to 59 (59%) patients with mRS R3 including 41 (70%) males and 18 (31%) females. There were 57% of patients presented with right-sided weakness, 37% with left-sided weakness, 3% exhibited speech difficulty, and 1% presented with visual problems. Nonhypertensive patients scored better in physical role domain as compared to hypertensive patients (P = 0.004) on SF-36. Better social functioning was observed in those who had ischemic heart disease as compared to those without disease (P < 0.001). Higher physical component scores were seen among dyslipidemics as compared to nondyslipidemic patients (P = 0.052). Conclusion: This study provides insight into the relation between several health domains and major diseases in poststroke patients. This information is very important for physicians to rehabilitate poststroke patients presenting with comorbidities.
  3,605 689 -
CASE REPORTS
Differentiation of esophageal duplication cysts from esophageal bronchogenic cysts: A case report and literature review
Jun Yang, Tao Zhou, Jiaqiang Fu, Yimei Zhang
January-March 2018, 3(1):20-22
DOI:10.4103/ts.ts_1_18  
Esophageal bronchogenic cysts located in inferior esophagus are rare. Here, we report on the case of a 12-year-old female patient who presented at our institution with dyspepsia and abdominal distention for 2 years with no other symptoms. Physical examination of abdomen and chest was negative, and laboratory tests did not show any abnormal results. However, computed tomography imaging showed a mass of about 8 cm × 8 cm × 4 cm in the lower esophagus compressing the stomach. The preoperative diagnosis was determined to be an inferior esophageal duplication cyst. A transabdominal excision of the cyst was performed 5 days after hospital admission. Pathology revealed an esophageal bronchogenic cyst. The case report and literature shows that differences exist between esophageal duplication cysts and esophageal bronchogenic cysts.
  3,898 293 1
Laparoscopic cholecystostomy in treatment of obstructive jaundice
Zijah Rifatbegovic, Amra Mestric, Zlatan Mehmedovic
January-March 2016, 1(1):21-23
DOI:10.4103/2468-5585.179561  
Cholecystostomy is considered to be a treatment option when conservative treatment of acute cholecystitis failed in elderly and critically ill patients. The aim of this paper is to present a cholecystostomy in the treatment of obstructive jaundice before the definitive operation for the underlying cause of jaundice. The patient in poor general condition with the obstructive jaundice was diagnosed to have a pancreatic head tumor. He had undergone the laparoscopic cholecystostomy. After improvement of the general condition and lower total bilirubin level, the patient had undergone to definitive procedure. It is shown that laparoscopic cholecystostomy can be a successful way for adequate bile drainage in a patient with poor general condition before the definitive treatment of obstructive jaundice.
  3,748 329 -
REVIEW ARTICLE
Advances in artificial nucleus pulposus material
Fei Yang, Jianning Zhao, Haidong Xu
July-September 2016, 1(3):83-87
DOI:10.4103/2468-5585.191503  
Degenerative disc disease is very common in clinical practice, and 40% of low back pain is caused by lumbar disc degeneration. Clinical surgery can relieve symptoms in short term, but cannot achieve the purpose of cure. In discectomy surgery, to maintain a sufficient height of disc, the artificial nucleus pulposus materials such as silicone rubber, stainless steel, and hydrogel material are used to fill the defect of nucleus pulposus. With the continuous development of tissue engineering and materials science, it is possible to use stem cells or multipotent cells to cure disc disease or reverse the degenerative process and reshape the physiological function of the intervertebral disc. Now, the problem that still has to be faced in tissue engineering is how to find an extracellular scaffold which has similar structure and function of the nucleus pulposus to provide a suitable environment for the growth and physiological activity of seed cells. The article reviews the history of the development of artificial nucleus material and the current research situation.
  3,673 383 -
CASE REPORTS
Thrombectomy and angioplasty as treatment for acute superior vena cava syndrome
Paulo Eduardo Ocke Reis, Leonardo Roever, Marcelo Rotolo Nascimento, Pietro de Almeida Sandri
October-December 2016, 1(4):112-114
DOI:10.4103/2468-5585.197497  
Superior vena cava syndrome (SVCS), a disease caused by obstruction of the venous blood influx, because of benign etiology, from the upper body into the right atrium, is becoming more frequent, with growing use of central catheters. The present study is a case report of such acute SVCS managed successfully with an endovascular approach. A 53-year-old male patient, who had received a central venous catheter into the right jugular vein for chemotherapy, revealed an extensive thrombus formation in the veins and was diagnosed of grade 2 SVCS. He was subjected to local thrombolysis therapy followed by mechanical thrombectomy with adjunctive catheter-guided aspiration and a stent being placed through balloon angioplasty. The patient revealed a complete relief of symptoms, excellent signs of clinical improvement, and no signs of recurrence till date, 6 months posttherapy. This case supports the feasibility, safety, and efficacy of endovascular thrombectomy and angioplasty to treat SVCS.
  3,666 358 -
REVIEW ARTICLES
The cross-contaminated cell lines of adenoid cystic carcinoma: A crucial concern
Nan-Nan Liu, Sen-Lin Zhang, Wei Chen
January-March 2017, 2(1):10-13
DOI:10.4103/2468-5585.200513  
Adenoid cystic carcinoma (ACC) is a common type of salivary gland cancer, characterized by slow growth but high incidence of distant metastasis. Distant metastasis occurs in 25%–50% of ACC patients and more commonly in lungs. However, the molecular mechanism underlying the aggressive growth of ACC remains obscure. Human tumor cell lines are extremely useful in studying cancer biology, under both in vitro and in vivo condition. Unfortunately, the tumor cell lines are susceptible to cross-contamination, by other cell lines, during routine culture. Recent studies have proved that most of the ACC cell lines, established for preclinical research, are either cross-contaminated or nonhuman cells. Here, we review the literature assessing the identity of ACC cell lines, dated up to September 1, 2016, using PubMed, EMBASE, and the China National Knowledge Infrastructure databases with the following keywords: “adenoid cystic carcinoma,” “cell line,” and “characterization” or “contamination.” According to the results, only salivary adenoid cystic carcinoma (SACC)-83/SACC-lung metastasis, the HPV-transformed ACC-112 and the two newly established moderately differentiated adenocarcinoma-ACC-01 and LACC-1 cell lines are authentic ACC cell lines. These results suggest that, in the future, it is crucial to authenticate the ACC cell lines before research.
  3,640 351 1
ORIGINAL ARTICLES
A modified uncut roux-en-y anastomosis in laparoscopic-assisted distal gastrectomy: Balance of the cost and minimally invasion
Shun Zhang, Tao Du, Dongyi Yan, Xiaohua Jiang, Chun Song
January-March 2018, 3(1):1-5
DOI:10.4103/ts.ts_20_17  
Aim: The aim of the study was to evaluate the cost of minimally invasive surgery using a modified uncut Roux-en-Y anastomosis technique in laparoscopic distal radical gastrectomy patients with gastric cancer. Methods: Clinical and cost data were reviewed on the perioperative outcomes of 15 gastric cancer patients who received laparoscopic distal radical gastrectomy using uncut Roux-en-Y anastomosis from January 2016 to December 2016 in the Department of Gastrointestinal Surgery, Shanghai East Hospital. Results: The mean operation time was 175 ± 30 min. Mean hospitalization expense was 9829 USD and mean linear stapler expense was 2940 USD. Laparoscopic distal radical gastrectomy with uncut Roux-en-Y anastomosis was successfully carried out in all the patients. There were no serious complications and no death in this series. Conclusion: Modified uncut Roux-en-Y anastomosis in laparoscopic distal radical gastrectomy may be a good way to balance the cost and minimally invasive surgery.
  3,604 268 1
CASE REPORTS
Intestinal obstruction and abdominal compartment syndrome secondary to colitis cystica profunda: Case report and review of the literature
Luis Angel Medina Andrade, Juan Carlos Mendez Chavez, Jaime Abdel Diaz Ramos, Javier Olivares Rivera, Humberto Hidalgo Ibarra, Alicia Itzel Hickman Alvarez, Eduardo Vidrio Duarte, Adriana Paz Mendoza, Juan Jose Rodriguez Carrillo, Carlos Eduardo Rodriguez Rodriguez, Eligio Angeles Margarita, Arsenio Torres Delgado
April-June 2016, 1(2):51-53
DOI:10.4103/2468-5585.185202  
Colitis cystica profunda is a rare pathology with approximately 200 cases reported in the literature. This entity is characterized by a slow, asymptomatic evolution and when finally recognized, confusion with a malignant tumor with subsequent application of unnecessary therapies or surgical resections is frequent. We present the case of a 41-year-old male with 7-day evolution ultimately presenting to the emergency room with abdominal pain. At physical examination, he was dehydrated with severe abdominal pain, tachycardia and tachypnea, abdominal distention, without bowel sounds, "wood abdomen" with clearly acute abdomen signs, and anuria for 48 h. The patient required mechanical ventilation secondary to abdominal restriction with severe metabolic acidosis. The situation of hemoglobin (14.5 mg/dL), hematocrit (38), leukocytes (18,500/mm [3] with 89% neutrophils), platelets (257,000), creatinine (2.1 mg/dL), glucose (230 mg/dL), and normal clotting times were included in the laboratory reports. The diagnosis was intestinal obstruction, abdominal compartment syndrome, and septic and hypovolemic shock. At exploratory laparotomy, we found a sigmoidal tumor totally occluding the lumen with severe dilatation of the proximal colon and haustral tearing with ischemia. Totally, 2 m of ileum showed necrotic patches secondary to compartment syndrome and compression to the abdominal wall. A total colectomy and resection of 2 m of ileum with ileostomy and Hartmann's procedure were completed. The pathology examination reported colitis cystica profunda without atypia. After 3 weeks and stoma remodelation, the patient was discharged. This benign lesion could be treated with less aggressive procedures. With the correct pathological diagnosis, a better treatment with excellent prognosis could have resulted.
  3,523 333 -
ORIGINAL ARTICLES
Visual analog scale and beck depression inventory assessing the clinical correlation of backache with depression
Muhammad Nadeem, Salman Mansoor, Shoab Saadat, Nadia Mehboob, Hamza Hassan Khan, Salman Assad, Bazeela Saeed, Anam Saleem, Anam Zehra, Ahmed Shah Bukhari
April-June 2018, 3(2):38-41
DOI:10.4103/ts.ts_6_18  
Aim: Patients with chronic pain mostly suffer from additional psychiatric condition especially depression. The aim of this study is to determine a relation between depression and backache. Methods: We conducted a study between January 2015 and November 2015 at a tertiary care hospital in Islamabad, Pakistan. The study included 165 adult patients (≥20 years) with backache and were interviewed at the neurosurgery clinic. Visual analog scale (VAS) and Beck depression inventory (BDI) scores were analyzed. Results: According to VAS, 11.5% patients had mild, 67.2% patients had moderate, and 21.8% patients had severe backache. A striking difference in the frequency of depression was observed between the genders, 67.8% in females compared to 32.2% in males. BDI scores showed 12.1% normal, 13.9% mild, 3% borderline, 26% moderate, 24.8% severe, and 19.3% extreme depression. A statistically significant correlation was observed between severity of backache and depression (P < 0.003). Conclusion: A high number of patients suffering from backache also demonstrated mild to extreme depression. We recommend screening for depression among these patients to achieve a better treatment outcome.
  3,593 230 -
Nissen fundoplication in severely ill infants: A STROBE compliant study
John Yoon, Sathyaprasad Burjonrappa
January-March 2016, 1(1):1-4
DOI:10.4103/2468-5585.179564  
Aim: Anti-reflux surgery is offered to those who fail medical management for gastroesophageal reflux disease (GERD) in the pediatric population. A handful of studies show that those with neurologic impairment have benefited from these procedures; however, there are a few studies that document the indications and outcomes for infants < 6 months of age. Methods: A retrospective analysis of children < 6 months of age who underwent a Nissen fundoplication (NF) at St. Joseph's Regional Medical Center from December 2006 to June 2013 was performed. The following factors, such as surgical indications, comorbidities, hospital course data, weight gain, length of stay, and complications, were analyzed. Results: A total of 23 patients with the average age of 95.8 days were studied in this analysis. Presurgery, the average weight of these patients was 9.88 percentile (interquartile range: 5.85). A total of 65.2% patients were considered having failure to thrive (FTT) as they were under the 10th percentile and 78% patients had anatomic or genetic abnormalities. Nearly 47.8% patients underwent upper gastrointestinal studies that were positive for reflux. All patients had a concomitant gastrostomy tube (G-tube) placed during the NF. Diet was advanced on the average postoperative day of 2, and the patients tolerated the highest diet by the postoperative day of 6. Most patients saw a decrease in medications after the procedure. Moreover, 7 patients had complications related to the G-tube, with the main complication reported as leakage around the tube. There were two mortalities, both unrelated to the operation. Conclusion: Infants undergoing NF under the age of 6 months typically present with multiple comorbidities. NF in this population will not only lead to weight gain but also decrease in overall need for GERD-related medications. Early recognition of the failure of nasojejunal feeds will facilitate NF before significant FTT is present.
  3,418 378 -
CASE REPORT
Horner's syndrome: A rare complication of thyroid cancer surgery
Sonmez Ocak, Huseyin Alakus, Mehmet Esat Duymus, Mustafa Kaya, Kursat Karadayi, Elif Colak
July-September 2016, 1(3):88-89
DOI:10.4103/2468-5585.191505  
Horner's syndrome (HS) is a disorder of oculosympathetic pathway. Signs of this syndrome are ipsilateral ptosis, pupillary miosis, and anhidrosis. Cerebrovascular diseases, malignant tumors and iatrogenic injuries after neck and thoracic surgical procedures are the most common reasons. It is a rare complication of thyroid cancer surgery. In this case report, a patient with HS after total thyroidectomy and central neck dissection due to medullary thyroid carcinoma with multiple endocrine neoplasia type 2A had presented.
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ORIGINAL ARTICLES
Ambulatory open cholecystectomy and multimodal analgesia as the critical step: An observational study
Luis Angel Medina Andrade, Lizette Blanco Aguilar, Eduardo Vidrio Duarte, Adriana Paz Mendoza, Juan José Rodriguez Carrillo, Carlos Eduardo Rodriguez Rodriguez, Stephanie Serrano Collazos, Jessica Gonzalez Noriega, Uriel Maldonado Aparicio, Israel Gonzalez Gonzalez, Silva Gonzalez Misael
July-September 2016, 1(3):75-78
DOI:10.4103/2468-5585.191496  
Aim: Cholecystectomy is the most frequent, nonurgent surgery in the surgical services around the world. The access to laparoscopic cholecystectomy is neither always available in health services nor indicated in every patient. For this reason, the open approach is still frequently utilized. The objective of this study is to confirm the safety and feasibility of an ambulatory open cholecystectomy. Methods: From August 2015 to December 2015, patients aged 18-60 years underwent open cholecystectomy in a rural hospital in Chiapas of Mexico were included in this operational study. A multimodal analgesia protocol was employed including presurgical nonsteroidal anti-inflammatories (NSAIs), interpleural blockade before surgery, skin infiltration with local anesthetic, and the use of NSAIs and avoidance of opioids in the postoperative period. The visual analog scale (VAS) was evaluated at 4 and 8 h after surgery. Feeding began 4 h after surgery and walking after feeding. Discharge criteria included feeding tolerance and VAS < 3 points at 8 h after surgery. Patients returned next day for evaluation. Pathologic background, surgical findings and outcomes, VAS score, and length of hospital stay were registered and analyzed. Results: A total of 90 patients with 78 females (86.7%) were included in the study. Moreover, 48 patients (53.3%) presented acutely (first episode of cholecystitis). Complicated cholecystitis was presented in 6 cases (6.7%). Surgical complications included hypovolemic shock in 2 patients (2.2%), and postsurgical complications were present in 10 patients (11.1%). At 4 h after surgery, a VAS < 2 was seen in 44 patients (48%), VAS = 3 in 42 patients (46.7%), and VAS > 6 in 4 patients (4.4%). A total of 62 patients (68.9%) were completely ambulatory in < 12 h after open cholecystectomy and were discharged at that time. A total of 81 (90%) patients were discharged by 48 h after surgery. Conclusion: Ambulatory cholecystectomy is a safe and feasible surgical approach in the era of enhanced recovery programs. Multimodal analgesia is the key factor to achieve early walking, intestinal movements, and early feeding, allowing discharge after an uncomplicated.
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