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Results in Journal Journal of Clinical and Investigative Surgery: 117

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Emine Zeynep Tarini, Hasan Ilyas Özardali
Journal of Clinical and Investigative Surgery, Volume 6, pp 43-47; https://doi.org/10.25083/2559.5555/6.1.8

Abstract:
Objective. We aimed to demonstrate whether the immunohistochemical expression of C-erb-B2 and progesterone receptors are valuable in the diagnosis of intraepithelial cervical neoplasia and squamous cell carcinoma. Methods and Results. Our retrospective study, a total of 84 cases diagnosed as squamous cell carcinoma and cervical intraepithelial neoplasia during 2005-2009, at the pathology department of Harran University, was investigated and stained with immunohistochemistry. Progesterone receptor was stained positive in 5 of 21 cervical intraepithelial neoplasia I. As a result of the statistical analysis (SPSS statistic 15.0), a significant correlation was found for positive progesterone receptors. No positive staining was seen in any of the cases with CerbB2 (p>0,05). Conclusions. In this study, it was concluded that positive progesterone receptors can be used to distinguish cases of cervical intraepithelial neoplasia I from other dysplasia and carcinoma, while Cerb-B2 has not been shown to be useful in distinguishing between these lesions.
Hosni Mubarak Khan, Varahasandra Sanjeevaiah Shankare Gowda, Brahmavara Shamburao Ramesh, Dhulipudi Sandeep
Journal of Clinical and Investigative Surgery, Volume 6, pp 30-36; https://doi.org/10.25083/2559.5555/6.1.6

Abstract:
The aim of the present study was to evaluate and compare the efficacy and outcomes of laser hemorrhoidoplasty with that of open surgical hemorrhoidectomy. This prospective observational study consists of 50 subjects in each group. The open surgery group underwent a standardized Milligan-Morgan technique, and the laser group underwent laser hemorrhoidoplasty with a diode laser of 1470 nm (LASOTRONIX), 8.5 watts with a continuous pulse. Postoperative pain was considered as the primary outcome and was evaluated in both groups using the visual analog scale. There was a statistically significant difference between the two groups in VAS score at different follow-up period, with a mean score of 2.3±1.05 and 5.1±1.11 (24 hours) for the laser hemorrhoidoplasty group and open surgery group, respectively (p value < 0.008). There was an improvement in VAS score in the laser hemorrhoidoplasty group compared to the conventional open surgical group in 1, 7, 14, 21, and 30 days follow up.
Oana Denisa Balalau, Ileana Maria Conea, Nicolae Bacalbasa, Anca Silvia Dumitriu, Stana Paunica, Andrei Vasilache, Octavian Gabriel Olaru
Journal of Clinical and Investigative Surgery, Volume 6, pp 6-10; https://doi.org/10.25083/2559.5555/6.1.2

Abstract:
Ovarian cyst is the most common female gynecological pathology and it is characteristic of reproductive age. Its rupture causes the sudden onset of pelvic-abdominal pain, often associated with physical exertion or sexual contact. The differential diagnosis is made with other causes of lower abdominal pain: ectopic pregnancy, adnexal torsion, pelvic inflammatory disease or acute appendicitis. The clinical picture may vary depending on the type of ruptured cyst. Dermoid cyst causes severe symptoms due to chemical peritonitis that occurs in response to extravasation of sebaceous contents in the peritoneal cavity. Surgical treatment is indicated for complicated forms of cystic rupture. Most cases have self-limiting, quantitatively reduced bleeding and spontaneous resorption within a few days. Patients diagnosed with ovarian cyst are recommended for regular ultrasound monitoring to prevent complications such as cystic rupture or adnexal torsion. The identification of any ovarian tumor mass in the woman at menopause requires further investigation to rule out the causes of malignancy.
Navneet Mishra, Kamal Kishore Parmar, Tanweerul Huda
Journal of Clinical and Investigative Surgery, Volume 6, pp 11-16; https://doi.org/10.25083/2559.5555/6.1.3

Abstract:
Introduction. Anal fissures can be defined as a tear or a break in the anoderm. Acute fissures do not exceed a 6 week-duration and can be seen as a simple tear in the anoderm along with edema, whereas chronic fissures are longer than 6 weeks. Aim. To compare the efficacy of the medical and surgical options for the treatment of chronic anal fissures and to recommend the appropriate option in terms of their symptomatic relief, healing of fissures and long-term effectiveness. Materials & Methods. A prospective observational study was conducted for a period of 2 years, that is, from October 2018 to October 2020, including a follow-up period of 2 months. A total of 72 patients with chronic anal fissures were included in the study and randomized into two groups, represented by the medical management group and the surgical management group (Lateral Internal Sphincterotomy (LIS)). Results. In the case of the 36 patients with CAF (chronic anal fissure) who underwent surgical management, all 36 (100%) patients had optimal healing of the fissure at 6 weeks. In the case of the 36 patients with CAF who underwent medical management, only 32 (89%) patients had optimal healing of the fissure at 6 weeks, whereas 4 patients failed to heal even after 2 months. Conclusions. Surgical management is the preferable method for chronic anal fissures in comparison to medical management. But the medical management has a role in acting as a bridge to surgical management in patients who are not fit for surgery or do not perceive surgery as an option at the time.
Bulent Karslioglu
Journal of Clinical and Investigative Surgery, Volume 6, pp 17-21; https://doi.org/10.25083/2559.5555/6.1.4

Abstract:
Objective. Distal humerus fractures constitute of approximately 2% of all fractures and 30% of elbow fractures. Olecranon osteotomy provides excellent exposure of distal humerus and articular surface. In this study, we aimed to compare transverse osteotomy with gigli saw and classical chevron osteotomy techniques in terms of osteotomy duration and clinical results. Materials and Methods. 40 elbows of 40 patients with Type B intraarticular distal humerus fractures according to AO classification were included in our study. Patients were divided into 2 groups as transverse or chevron osteotomy groups. Patients were evaluated in terms of intraoperative osteotomy time, postoperative time to union, range of motion in the elbow joint and Quick Dash scores at 6th, 12th and 24th months. Results. The mean age of the patients was 45.6 years (19-62). 40% of the patients (8 patients) in the Chevron group had more than 2 mm stepping at articular surface, while this rate was 10% (2 patients) in the gigli saw group. Union was obtained in all patients for both techniques. There was no significant difference between the mean QuickDASH scores and range of motion of the elbow joints except flexion in both groups. Range of motion of flexion was statistically better in the gigli saw group (p<0.05). Conclusions. Transverse osteotomy technique significantly reduces osteotomy and fixation time and will not cause problems in fracture union. It may be preferred because it is simpler and faster to apply than chevron osteotomy and because intra-articular stepping is less common.
Samican Özmen, Sefa Kurt, Orkun Ilgen, Funda Barlik Obuz, Ali Riza Sisman, Meral Koyuncuoglu
Journal of Clinical and Investigative Surgery, Volume 6, pp 22-29; https://doi.org/10.25083/2559.5555/6.1.5

Abstract:
Objective. Endometrial cancer is one of the most common malignancies in the world. There is no effective screening method used for predicting the clinical stage of the disease in the preoperative period and to plan the surgical procedure. The aim of this study is to compare the serum levels of CA-125 and HE-4 with MRI, to evaluate their ability to predict the depth of myometrial invasion in patients diagnosed with endometrial cancer, and to compare the specificity between these two tests. Materials and Methods. This prospective study was conducted at Dokuz Eylul University Faculty of Medicine, Department of Obstetrics and Gynecology, between February 2019 and February 2020. A total of 47 cases were included in the study. The cases were evaluated with MRI preoperatively to determine the extent of the disease. Preoperative serum CA-125 and HE4 levels were measured by ELISA method and compared, and the superiority of the tests to each other in determining the depth of myometrial invasion was evaluated. Results. In patients with endometrioid cancer, preoperative CA-125 and HE-4 levels were found to be higher if the myometrial invasion is >50% and lymphovascular space invasion is positive, and the difference was statistically significant. A cut-off of 7,05 U/ml for CA-125 could detect the deeper myometrial invasion with a sensitivity of 83% and a specificity of 52%, respectively. A cut-off of 94,25 pmol/L for HE-4 could detect deeper myometrial invasion with a sensitivity of 75% and a specificity of 56%, respectively. The sensitivity of MRI in determining the depth of myometrial invasion was 87,1%, and the specificity was 86,7%. Conclusions. MRI, HE-4 and CA-125 were found to be valuable tests in predicting the extent of the disease and planning the surgical treatment. All three methods successfully predicted the myometrial invasion depth of the disease. The success rates of the tests in predicting the depth of myometrial invasion were MRI, HE-4 and CA-125, respectively. HE-4 and CA-125 could not reach the sensitivity and specificity of MRI in determining the depth of myometrial invasion at any cut-off value. However, it was proved in this study that they can play important roles as simpler and more cost-effective tests in determining the extent of the disease, able to contribute to surgical planning during preoperative evaluation.
Anca Daniela Stanescu, Mihai George Loghin, Liana Ples, Daniela Gabriela Balan, Ioana Paunica, Oana Denisa Balalau
Journal of Clinical and Investigative Surgery, Volume 6, pp 1-5; https://doi.org/10.25083/2559.5555/6.1.1

Abstract:
The most common benign pelvic tumor in young women is uterine leiomyoma. It is often asymptomatic, but can cause symptoms such as pelvic-abdominal pain, vaginal bleeding, urinary and intestinal transit disorders. If there is a suspicion of malignancy, it is necessary to perform fractional uterine curettage to establish the histopathological diagnosis. The surgical treatment of uterine leiomyoma includes several procedures: myomectomy, subtotal or total hysterectomy. The procedure will be chosen depending on the patient's particularities: BMI, uterine size, leiomyoma location, surgical history or other associated pathologies. Laparoscopic hysterectomy has a 45-minute shorter duration of intervention than vaginal hysterectomy, and the conversion rate to the open procedure is lower. Laparoscopically treated cases have fewer postoperative complications compared to other surgical procedures and have a shorter hospitalization and recovery time. The recurrence rate of uterine leiomyoma is similar for both laparoscopic and open abdominal approach, and the frequency of long-term complications such as adhesion syndrome or pelvic pain is higher after the latter.
Ahmet Keskin, Bulent Karslioglu
Journal of Clinical and Investigative Surgery, Volume 6, pp 58-63; https://doi.org/10.25083/2559.5555/6.1.11

Abstract:
Introduction. The Covid-19 outbreak has changed orthopedic practices more than expected. We are going through a period in which conservative treatment will become prominent when deciding on fractures with indistinct surgical margins in guidelines. Considering global tendency for surgical interventions in the pre-pandemic period, we tried to find out the answer to the following question: will conservative treatment be the shining star in the post pandemic period? Materials and Methods. 262 patients who were with “gray zone fractures-injuries” like extraarticular distal radius fracture, proximal humerus fracture and Weber type B ankle fracture was treated conservatively during March and August, 2020. Open or pathological fracture, fractures with vascular or neurological injury and fractures involving the articular joint were excluded. Results. 59 patients with proximal humerus fracture followed with arm-sling. Mean ASES scores at 6th was 48.3 and 69.9 12th week. 91 patients with Weber B-type ankle fracture were followed up with below-knee plaster for 6 weeks. American Orthopedic Foot & Ankle Score was 48 in the 6th week and 75 in the 12th week. 90 patients with distal radius fracture were followed up with plaster. Malunion was detected at 5 patients. Mean Quick Dash score at 6th weeks was 52.3 and 29.5 at 12th weeks. Mean wrist flexion was 450, wrist extension was 350, forearm supination 600 and forearm pronation was 700 at final control. Conclusions. The conservative treatment experiences we have gained from pandemic periods probably will change our treatment algorithm.
Osama Bani Hani, Omar Halalsheh, Yazeed Mohammad, Anas Bani Yaseen, Ruba Khasawneh, Nour Al–Sheikh, Mais Al-Khalili, Mohannad Mahmoud Alomari
Journal of Clinical and Investigative Surgery, Volume 6, pp 71-75; https://doi.org/10.25083/2559.5555/6.1.14

Abstract:
Herein we present a case of crossed renal ectopia with an unusual type of fusion, discovered incidentally in a 11-year-old girl presented with recurrent urinary tract infections. Both kidneys were located on the right side of the body fused in their upper poles only, forming an inverted U shape. After reviewing the published data on this topic, we found that most of the described anomalies were within the six well-known types of fusion anomalies. This child had an unusual clinical presentation of severe hydronephrosis of the orthotopic kidney. A unique surgical technique to correct the pathology to be able to preserve the residual mass of that kidney was performed.
Helvacioglu Caglar, Boukari Bako Bibata, Serdar Karakuzu, Ali Emre Cetinkol, Nursen Atasoy
Journal of Clinical and Investigative Surgery, Volume 6, pp 68-70; https://doi.org/10.25083/2559.5555/6.1.13

Abstract:
Perimortem cesarean is rare and one of the worst possible scenarios in obstetrics. Multidisciplinary approach and speed are extremely important. Pelvic packing in massive postpartum hemorrhages is a method which obstetricians do not commonly use. The patient who had cardiac arrest during travail was successfully managed with a peripartum hysterectomy and two different types of pelvic packing after perimortem cesarean. The mother and baby were healthily discharged. Fetal and maternal survival after perimortem cesarean is quite low. The most important factor determining survival is speed. Pelvic packing is effective in postpartum unstoppable bleeding.
Prashanth A T, Nishanth Lakshmikantha, Krish Lakshman
Journal of Clinical and Investigative Surgery, Volume 6, pp 37-42; https://doi.org/10.25083/2559.5555/6.1.7

Abstract:
Background. Laparoscopic surgery has gained popularity in the last few decades replacing open standard techniques in several procedures. While its use and scope expand, a standardized method of training and assessment in laparoscopic skills is lacking. Aim. To assess the effect of virtual reality (VR) training on laparoscopic surgical skills. Materials and Methods. It is a prospective, controlled study conducted at Sagar Hospital’s skill lab and Shanthi Hospital and Research Centre (SHRC). We included 27 post graduates in general surgery. They were divided into two groups. One group underwent training in VR Simulator for one week, 30 minutes each day. The second group received no training. Their proficiency while mobilizing the Gallbladder from its liver bed was assessed using a validated scale by a single blinded observer. Results. The statistical analysis was done using a non-parametric test (Mann-Whitney U test). Residents who underwent training in VR simulator got better scores in Overall rating and also in individual parameters when compared with the control group (P = <0.05). Conclusions. Laparoscopic surgical skills can be increased by using proficiency-based VR simulator training and it can be transferred to actual operations. VR simulators are a valid tool for laparoscopic surgical skills training.
Ibrahim Kale, Çağlar Helvacıoğlu, Tuğba Erel Muğurtay
Journal of Clinical and Investigative Surgery, Volume 6, pp 48-52; https://doi.org/10.25083/2559.5555/6.1.9

Abstract:
Objective. Investigation of the relationship between the first trimester complete blood count parameters and miscarriage. Materials and Methods. The study group consisted of 39 patients who admitted to the hospital with the diagnosis of abortus imminens between January 2016 and December 2019, and whose pregnancy ended as miscarriage before the 20th week. The control group consisted of 200 randomly selected healthy pregnant women, with follow-up and delivery in our hospital. Patient information was obtained retrospectively from the hospital records. Results. Age and BMI of both groups were similar. There was no significant difference between the two groups in terms of basophil, neutrophil, eosinophil, lymphocyte, monocyte, platelets, RBC, hemoglobin, hematocrit, MCV, MCH, MCHC, RDW, MPV, Pct and PDW, while leukocyte and neutrophil counts was statistically significantly higher in the miscarriage group (p=0,002, p=0,001, respectively). NLR was statistically higher in the miscarriage group (p=0,005), PLR was also higher in the miscarriage group, but this did not reach statistical significance (p=0,056). Both groups were similar in terms of MLR. Conclusions. High NLR levels obtained from the hemogram results in the first trimester seems to be associated with miscarriage. NLR can be an easy, cheap and useful tool for predicting pregnancy prognosis in patients with abortus imminens.
R. Naveena Ms
Journal of Clinical and Investigative Surgery, Volume 6, pp 53-57; https://doi.org/10.25083/2559.5555/6.1.10

Abstract:
Objective. The objective of this study was to evaluate the clinical spectrum of obstructive jaundice in inflammation, stone disease, and malignancy. Methods. A descriptive observational study was done among 50 patients with the diagnosis of obstructive jaundice during the period 2012 to 2013. A detailed history and clinical examinations and radiological confirmation were done. Results. Among the participants, 74% participants had jaundice, 58% with vomiting as presenting complaints. Among benign cases, 60% were choledocholithiasis, 25% were common bile duct stricture, and 15% were choledochal cyst. Among malignant cases, 26.67% were periampullary carcinoma, 23.33% had carcinoma of the pancreas head, and 13.33% had D2 duodenal carcinoma. Conclusions. The etiology of obstructive jaundice was malignancy in the elderly male population. The most common presenting features were yellowish discoloration of skin and mucosa followed by vomiting and abdominal pain.
Deniz Esin Tekcan Sanli, Duzgun Yildirim
Journal of Clinical and Investigative Surgery, Volume 6, pp 64-67; https://doi.org/10.25083/2559.5555/6.1.12

Abstract:
Breast cancer is the most common cancer in women. Patients usually present with a rapidly progressed painless mass in the breast. The first pathological entity to be considered is breast cancer in case of newly developed painless mass, so that radiological and pathological evaluations must be performed. However, some systemic disorders; benign conditions like rheumatological diseases, and also systemic malignancies such as lymphoma, can mimic breast cancer by involving the breast. It is necessary to distinguish between such diseases through a correct diagnosis, because they have very different treatments and prognoses. We present a case diagnosed as bilateral primary breast lymphoma with a palpable mass in a single breast, its clinical and radiological characteristics. This case report suggests that systemic diseases should be considered in the differential diagnosis of breast diseases and breast masses, especially when there is bilaterally involvement, as discussed in this article.
, Krish Lakshman
Journal of Clinical and Investigative Surgery, Volume 5, pp 116-118; https://doi.org/10.25083/2559.5555/5.2/116.118

Abstract:
Adrenal cysts are generally rare clinical entity, but due to advances in imaging diagnostic methods, detection incidental cases are increasing. Therefore, discussions about the therapeutic management of these cases are more numerous, due to the growing number of cases. We present a case of a 29-year-old woman who has had complaints of headaches and right low back pain in the last week. She had a history of high blood pressure in the past 6 months. Clinical examination was essentially normal. Routine blood investigations including a workup for pheochromocytoma was normal. CT abdomen and pelvis showed 8x8x8cm cyst in the right adrenal gland. We decided to perform a laparoscopic excision of the adrenal cyst and successfully excised the adrenal cyst, fully saving the adrenal gland. Laparoscopic excision of the adrenal cyst seems to be the best recommended treatment option for these pathologies. The probability of recurrence after surgical excision is low.
Irina Doinița Oașă, , Cristian Balalau, Razvan V. Scaunasu, Felicia Manole, Maria Domuta, Alina Lavinia Antoaneta Oancea
Journal of Clinical and Investigative Surgery, Volume 5, pp 73-75; https://doi.org/10.25083/2559.5555/5.2/73.75

Abstract:
Deep neck space infections are of great risk for patients considering even death in certain cases. Collection of purulent secretions that can accumulate in a particular region of the neck is due to the anatomy of the deep neck fascia, muscles of the neck and compartments for blood vessels and organs in the neck region. Deep neck spaces communicate with each other and in some patients with morbidities like diabetes or other form of immuno-suppression extension can be great. Ludwig's angina is a form of abscess of the floor of the mouth with origin in teeth located on the mandible. Like any other abscess medical and surgical therapy are ways of treatment, but incision and drainage are mandatory. However, surgical management of such a complication might include other type of surgery as tracheostomy, blood vessels ligation, resection of necrotic tissue or even reconstruction.
, Choaib Essadouni, Adil Mchachi, Leila Benhmidoune, Abderrahim Chakib, Rayad Rachid, Mohamed Elbelhadji, Chu Ibn Rochd, HASSAN II University of Casablanca, Morocco
Journal of Clinical and Investigative Surgery, Volume 5, pp 100-103; https://doi.org/10.25083/2559.5555/5.2/100.103

Abstract:
Topical anesthesia during phacoemulsification cataract surgery has become the best choice for ophthalmologists, which broadens the indications for surgery, and eliminates the risk of peribulbar injections. The aim of our study is to assess the advantages and disadvantages, the efficacy and the tolerance of this protocol. Prospective study extending from January 2018 to December 2019, including 116 patients operated for cataracts under topical anesthesia (group 1), and 179 patients under peribulbar anesthesia (group 2). All patients were operated by phacoemulsification. The patients evaluated their pain on a visual analog scale graduated from 1 to 10. The two groups were comparable in age, gender and history of high blood pressure. All patients received premedication before surgery (Atarax). It was the first eye operated for cataracts in 79 patients in group 1 and 75 patients in group 2. The two groups did not differ significantly in systolic blood pressure rate (p= 0,36), pain score (p=0.54), duration of surgery (p=0.52), anaesthesia-related intraoperative difficulties (p=0.17), or intraoperative surgical complication rate (p=0.49) or blood oxygen saturation (p=0.74). However, in the peribulbar groups, better patient and surgeon satisfaction scores were obtained (P < .005).
Narindra Njarasoa Mihaja Razafimanjato, Tsiry Dama Ntsoa Ravelomihary, Mampionona Ranaivomanana, Guillaume Odilon Tsiambanizafy, Hanitrala Jean Louis Rakotovao, Francis Allen Hunald
Journal of Clinical and Investigative Surgery, Volume 5, pp 104-108; https://doi.org/10.25083/2559.5555/5.2/104.108

Abstract:
Alveolar rhabdomyosarcomas (ARMS) are rare entities that occur predominantly on the extremities and represent 20% of rhabdomyosarcomas. Other common locations include the peri-rectal and perineal regions, head and neck, and genitourinary system. To our knowledge, this presentation is the first case of alveolar rhabdomyosarcoma of the chest wall reported in the literature. Here, we describe a case of a 64-year-old man with alveolar rhabdomyosarcomas who underwent a chest wall resection. The defect was reconstructed with polypropylene mesh and latissimus dorsi muscle. Our patient did not show recurrence ten months after complete resection. The present paper describes our surgical approach to a case of primary alveolar rhabdomyosarcoma of the chest wall in an adult. The authors discuss the principal judgment criteria for successful surgical resection and prognosis, highlighting the relevance of chest wall reconstruction and their complementary aspects in the multimodal management of this rare entity.
, Octavian-Gabriel Olaru, Adrian V. Dumitru, Ioana Păunică, Anca Daniela Stănescu, Bucharest Natl Inst Diabet Nutr And Metab Dis. Prof Nc Paulescu
Journal of Clinical and Investigative Surgery, Volume 5, pp 66-72; https://doi.org/10.25083/2559.5555/5.2/66.72

Abstract:
Screening testing for infectious diseases with vertical transmission, from mother to foetus, decreases the prevalence of foetal malformations. The most common infections with teratogenic potential are found in the TORCH test (Toxoplasma, Other infections, Rubella, Cytomegalovirus, Herpes simplex virus). Early identification of these pathogens results in better neonatal outcomes. Most foetuses with congenital toxoplasmosis are asymptomatic or have no apparent birth defect, while the primary infection of pregnancy with varicella-zoster virus (VZV) can lead to congenital foetal abnormalities with devastating consequences. Treponema pallidum can easily infect the placenta, with transplacental transmission to the foetus that can occur from about 9-10 weeks of gestation. Also, hepatitis B and C are the most common causes of chronic viral hepatitis in children and adults. In the case of HIV-positive pregnant women, the early association of ART, together with the choice of birth by scheduled caesarean section and the complete lack of breastfeeding determine expected neonatal results, the risk of vertical transmission decreasing up to 1-2%. Primary rubella infection during pregnancy can significantly affect foetal development, as does Herpes simplex virus (HSV) infection, but if it occurs as close as possible to birth, the disease may be self-limiting with mild forms. No teratogenic agent should be described qualitatively, as a teratogenic exposure includes not only the agent but also the dose and time of pregnancy when the exposure will occur. Screening tests are recommended to be performed both preconceptionally and during pregnancy.
Sinan Göçer, Mehmet Karaçalilar, , Cemalettin Aydin
Journal of Clinical and Investigative Surgery, Volume 5, pp 96-99; https://doi.org/10.25083/2559.5555/5.2/96.99

Abstract:
Objective. Demonstration of the advantages of using the natural Y shaped form of saphenous vein graft, which is the most preferred coronary bypass graft after internal thoracic artery (ITA). Methods. 32 patients with coronary artery disease who underwent coronary bypass grafting (CABG) with 3 or more distal anastomoses between January 2014 and January 2018 were included in the study. The natural Y saphenous vein grafts were used in these operations beside of LİMA-LAD anastomosis. Patients have been evaluated in terms of early and short-term survival, early cardiac events, the need for reoperation, and the need for percutaneous transluminal coronary angioplasty (PTCA). All patients were followed up directly by outpatient examination or telephone consultation. Results. New cardiac events, reoperation and death were not seen in the early postoperative period. Coronary angiography performed in 3 patients due to angina in the second and third years revealed that all anastomoses of y-saphenous grafts were open. No mortality was observed in the patients who were followed remotely. The duration of operation and the duration of cardiopulmonary bypass resulted in a reduction in the number of proximal anastomoses and the time by about 10 to 15 minutes. The incision in the saphenous leg was about 10 cm shorter for each anastomosis. Conclusion. The natural shaped Y saphenous vein can be used safely in multi vessel coronary artery disease (CAD) patients for reducing the surgical trauma.
Orhan Uzun, Aziz Serkan Senger, Selçuk Gülmez, Sinan Ömeroğlu, Cem Batuhan Ofluoğlu, Ayhan Öz, Erdal Polat, Mustafa Duman
Journal of Clinical and Investigative Surgery, Volume 5, pp 76-82; https://doi.org/10.25083/2559.5555/5.2/76.82

Abstract:
Purpose. This study investigates the prognostic significance of tumor size and its effect on survival among patients undergoing gastrectomy and D2 lymph node dissection due to gastric cancer. Materials and Methods. The clinicopathological characteristics of 320 patients who were operated due to gastric cancer between November 2006 and September 2019 were assessed retrospectively, of which 271 were included in the present study. A receiver-operating characteristic curve (ROC) analysis was carried out to identify the tumor size cut-off value. Patients were divided into small-size and large-size tumor groups. Clinicopathological characteristics were assessed using Chi-square and Mann-Whitney U tests, while survival was assessed with a Kaplan-Meier log-rank test. Results. The cut-off gastric cancer tumor size value was calculated as 4.75 cm. A statistical difference was noted in the tumor depth of wall invasion (p
Ghazi Laamiri, , Nouha Ben Ammar, Slim Zribi, Mongi Mighri, Mahdi Bouassida, Hassen Touinsi
Journal of Clinical and Investigative Surgery, Volume 5, pp 109-112; https://doi.org/10.25083/2559.5555/5.2/109.112

Abstract:
Introduction. Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency. Generally, it is associated with significant maternal and fetal mortality. The diagnosis is difficult, often delaying the therapeutic management. It is reported an exceptional association of acute intestinal obstruction due to a band adhesion that is put into tension as the uterus enlarges. Case Report. A 35 years old Caucasian pregnant woman with a past medical history of appendectomy was examined and found with abdominal pain, severe vomiting, and bowel obstruction. The patient underwent surgery. Per operatively, the obstruction was caused by an adhesion put into tension by the enlargement of the uterus. The postoperative course was uneventful and the patient was discharged on day 2. Conclusions. The etiological diagnosis of acute intestinal obstruction during pregnancy is difficult. Surgery is the cornerstone of the treatment and the management varies depending on the intraoperative findings and the condition of the patient.
Gurushantappa Yalagachin, Nishanth Lakshmikantha, Sanjay B. Mashal
Journal of Clinical and Investigative Surgery, Volume 5, pp 91-95; https://doi.org/10.25083/2559.5555/5.2/91.95

Abstract:
Introduction. Various studies have reported conflicting results regarding the relationship between breast and thyroid diseases. The exact pathogenesis behind this association is not clear. The aim of this study was to determine the prevalence of thyroid disease in patients presenting with breast diseases and to examine whether thyroid screening is required in patients with breast diseases. Methodology. All patients attending the department of General Surgery in our institution with breast diseases during the period from December 2015 to September 2017 were enrolled for the study. A thorough clinical examination which included an examination of the neck was done. Thyroid profile and ultrasonography neck were performed in all patients and the pathology in all radiologically diagnosed cases of nodular goiter was confirmed by cytology. Results. We had 128 patients with breast diseases enrolled in the study of which 62 (48%) patients had malignant breast disease and 66 (52%) patients had benign breast disease. None of the patients in our study had a palpable thyroid nodule or a diffuse goiter. Of the 61 patients having malignant breast diseases, 26 (42.6%) patients had a radiologically detected thyroid disease and among the 64 patients with benign breast diseases, 10 (15.6%) had radiologically detected thyroid diseases. Conclusions. In our study the prevalence of nodular goiter was higher in patients with malignant breast diseases than patients with benign breast diseases. However, this prevalence or clinical relevance is not significant enough to warrant screening for thyroid disease in patients with breast diseases.
Heeya Shah, Rima Shah, Hiren Sanghani,
Journal of Clinical and Investigative Surgery, Volume 5, pp 83-90; https://doi.org/10.25083/2559.5555/5.2/83.90

Abstract:
Aim. To evaluate the health-related quality of life (HRQOL) in DFU patients and its association with different surgical parameters in a tertiary care teaching hospital. Methodology. A total of 70 DFU patients from surgery department were enrolled and their demographic details, surgical examination and treatment related parameter were recorded. HRQOL was evaluated using Cardiff Wound Impact Questionnaire. Association of different surgical parameters as predictors of HRQOL was statistically evaluated. Results. Mean age of the study patients was 53.92 ± 9.27 with male preponderance and male: female ratio of 1.5:1. All the patients in the study suffered from type 2 diabetes and mean duration of the diabetes was 8.0±1.4 year. Mean BMI of the study patients was 23.36 ±1.4. All patients of DFU showed deteriorated HRQOL with mean score of 42.2±15.13 in social domain, 17.12±7.43 in wellbeing, 75.33±27.06 in physical domain and total score of 146.56±45.46. Increasing age, female gender, increased BMI, alcohol addiction found to be significantly associated with the deteriorated quality of life with respect to all four major domains which include Social life (P
, Mustafa Farasat, Halil Ibrahim Tanriverdi
Journal of Clinical and Investigative Surgery, Volume 5, pp 113-115; https://doi.org/10.25083/2559.5555/5.2/113.115

Abstract:
Imperforate hymen is a rare congenital abnormality. It often presents with abdominal mass associated with pain. Differential diagnosis includes abdominal malignancies. A thirteen years-old female was referred to our center with abdominal distention and pain with the presumptive diagnosis of abdominal malignancy. Serum levels of tumor markers were extremely high. Abdominal CT scan without contrast revealed an extremely large, cystic mass (hematocolpos) with thickened walls. Gynecologic examination revealed imperforated hymen. A midline vertical hymenal incision was performed. This case is unique in terms of high suspicion of malignancy in light of physical examination, CT scan characteristics and high levels of tumor markers. It emphasizes that gynecologic examination should be a part of routine physical examination in adolescent females presenting with abdominal mass.
Eduardo García-Cruz, Hospital Plató De Barcelona Unitat D´urologia, Javier Romero Otero, Pilar Altés Ineva, Luís Miguel Marco Pérez, Llorenç Pinsach Elías, Antonio Alcaraz Asensio
Journal of Clinical and Investigative Surgery, Volume 5, pp 18-23; https://doi.org/10.25083/2559.5555/5.1/18.23

Oana-Denisa Bălălău, Nicolae Bacalbașa, Octavian Gabriel Olaru, Liana Pleș, Daniela Anca Stănescu
Journal of Clinical and Investigative Surgery, Volume 5, pp 13-17; https://doi.org/10.25083/2559.5555/5.1/13.17

Caglar Helvacioglu, Didem Can Trabulus, Elif Asli Sarioglu Yardimci, Hasan Turan
Journal of Clinical and Investigative Surgery, Volume 5, pp 56-58; https://doi.org/10.25083/2559.5555/5.1/56.58

Cristina N. Marina, Daniela Elena Gheoca Mutu, Laura Raducu, Razvan V. Scaunasu, Cristian R. Jecan
Journal of Clinical and Investigative Surgery, Volume 5, pp 51-55; https://doi.org/10.25083/2559.5555/5.1/51.55

Mior Faiq Mior Abu Tahrin, Muhammad Izzuddin Hamzan, Ahmad Rizal Hamid
Journal of Clinical and Investigative Surgery, Volume 5, pp 59-62; https://doi.org/10.25083/2559.5555/5.1/59.62

Hüseyin Sina Coskun, Mirac Baris Usta, Ferhat Say, Abdurrahman Murat Yildirim
Journal of Clinical and Investigative Surgery, Volume 5, pp 24-28; https://doi.org/10.25083/2559.5555/5.1/24.28

Bogdan Popescu, Irina Doinița Oașă, Serban Vifor Gabriel Bertesteanu, Cristian Balalau, Felicia Manole, Maria Domuta, Alina Lavinia Antoaneta Oancea
Journal of Clinical and Investigative Surgery, Volume 5, pp 9-12; https://doi.org/10.25083/2559.5555/5.1/9.12

Sarah Sghaier, Montassar Ghalleb, Hanen Bouaziz, Molka Chemlali, Monia Hechiche, Maher Slimane, Khaled Rahal
Journal of Clinical and Investigative Surgery, Volume 5, pp 1-8; https://doi.org/10.25083/2559.5555/5.1/1.8

Bogdan Popescu, Irina Doinița Oașă, Serban Vifor Gabriel Bertesteanu, Cristian Balalau, Razvan Scaunasu, Felicia Manole, Maria Domuta, Alina Lavinia Antoaneta Oancea
Journal of Clinical and Investigative Surgery, Volume 5, pp 34-38; https://doi.org/10.25083/2559.5555/5.1/34.38

Bogdan Popescu, Irina Doinița Oașă, Cristian Bălălău, Răzvan Scăunașu, Felicia Manole, Maria Domuța, Alina Lavinia Antoaneta Oancea
Journal of Clinical and Investigative Surgery, Volume 5, pp 63-65; https://doi.org/10.25083/2559.5555/5.2/63.65

Abstract:
Patients benefit from the use of telescopes and flexible fiber optics when are examined by the ENT specialist. It is not mandatory in all situations but in most cases, some form of optical endoscopic examination of the nasal cavities, pharynx or larynx is needed. There is some reluctance to use this kind of method in patients in COVID 19 era since this is a maneuver that can generate aerosols and thus increase the chance of transmitting SARS-Cov-2 virus. There are several precautions that can be considered and we offer an insight on how fibroscopic examination can be performed with smaller risk for the physician. The question that we address is whether it is safe or not to perform this procedure and in what conditions.
Marinela Chioveanu, Oana-Denisa Bălălău, Romina-Marina Sima, Liana Pleș, Cristian Bălălău, Anca-Daniela Stănescu
Journal of Clinical and Investigative Surgery, Volume 4, pp 66-71; https://doi.org/10.25083/2559.5555/4.2/66.71

Bogdan Popescu, Irina Doinița Oașă, Claudiu Curcă, Elena Arjoca, Denisa Mitran, Roxana Androne, Șerban Berteșteanu, , Alina Oancea
Journal of Clinical and Investigative Surgery, Volume 4, pp 72-76; https://doi.org/10.25083/2559.5555/4.2/72.76

Oana-Denisa Bălălău, Adina-Teodora Corbu, Cristian Bălălău, Romina-Marina Sima, Liana Pleș, Anca-Daniela Stănescu
Journal of Clinical and Investigative Surgery, Volume 4, pp 77-80; https://doi.org/10.25083/2559.5555/4.2/77.80

Cristina N. Marina, Razvan Danciu, , Razvan Scaunasu, Cristian Jecan, Petre Florescu
Journal of Clinical and Investigative Surgery, Volume 4, pp 96-100; https://doi.org/10.25083/2559.5555/4.2/96.100

, Răzvan Scăunașu, Mirela Moarcăs, Mihai Cristian Dumitrașcu
Journal of Clinical and Investigative Surgery, Volume 4, pp 108-113; https://doi.org/10.25083/2559.5555/4.2/108.113

, The surgical oncology department, Hanen Bouaziz, Sarah Sghaier, Maher Slimane, Hatem Bouzaiene, Jamel Ben Hassouna, Tarek Ben Dhiab, Monia Hechiche, Riadh Chargui, et al.
Journal of Clinical and Investigative Surgery, Volume 4, pp 58-65; https://doi.org/10.25083/2559.5555/4.2/58.65

Bogdan Popescu, Roxana Ionescu, Irina Doinița Oașă, Serban Vifor Gabriel Bertesteanu, Cristian Balalau, , Mircea Denis Lupușoru
Journal of Clinical and Investigative Surgery, Volume 4, pp 27-31; https://doi.org/10.25083/2559.5555/4.1/27.31

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