Journal of Clinical and Investigative Surgery
EISSN : 2559-5555
Published by: Digital ProScholar Media (10.25083)
Total articles ≅ 117
Latest articles in this journal
Journal of Clinical and Investigative Surgery, Volume 6, pp 11-16; doi:10.25083/2559.5555/6.1.3
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 17-21; doi:10.25083/2559.5555/6.1.4
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 22-29; doi:10.25083/2559.5555/6.1.5
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 1-5; doi:10.25083/2559.5555/6.1.1
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 58-63; doi:10.25083/2559.5555/6.1.11
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 71-75; doi:10.25083/2559.5555/6.1.14
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 68-70; doi:10.25083/2559.5555/6.1.13
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 43-47; doi:10.25083/2559.5555/6.1.8
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 30-36; doi:10.25083/2559.5555/6.1.6
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.
Journal of Clinical and Investigative Surgery, Volume 6, pp 6-10; doi:10.25083/2559.5555/6.1.2
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.