Journal of Clinical and Investigative Surgery
ISSN / EISSN : 2559-5555 / 2559-5555
Published by: Digital ProScholar Media (10.25083)
Total articles ≅ 154
Latest articles in this journal
Journal of Clinical and Investigative Surgery, Volume 7, pp 113-116; https://doi.org/10.25083/2559.5555/7.1.20
Fibroadenomas are the most common benign tumors of the breast. Since they originate from the fibroglandular breast tissue, they cannot be localized anywhere outside the breast. However, they can be localized in accessory or ectopic breast tissue and cause confusion in terms of clinical differential diagnosis. Small ectopic fibroadenomas placed in normal breast tissue are generally asymptomatic and nonpalpable. In contrast, lesions located in the axillary region are usually palpable, due to their superficial location and skin that is thinner at this level. This case report presents the clinical and imaging findings of a patient with a preliminary diagnosis of lymphadenopathy, with a superficial axillary location of the lesion and who underwent biopsy. In our case, no obvious accessory breast tissue was detected by physical examination or ultrasound of the left armpit. Even though there was axillary accessory breast tissue, it was not at a level that could be detected by ultrasound.
Journal of Clinical and Investigative Surgery, Volume 7, pp 100-103; https://doi.org/10.25083/2559.5555/7.1.17
About 1% of oral cancers are metastases of primary tumors from other parts of the body. The most common primary tumors that metastasize to the oral cavity are placed in the lungs, kidneys, liver and prostate for men, while in women they are placed in the breasts, genital organs, kidneys and colon. The oral cavity is an unusual place for the metastatic spread of primary tumors, especially malignant melanoma, and is usually a sign of the widespread dissemination of the malignancy. When they occur, oral metastases are most often found in the jawbones. Most of the reported soft tissue oral melanoma metastases were localized in the tongue. We report a case of a 50-year-old female patient with a melanoma metastasis in the floor of the oral cavity. The treatment chosen was the transoral excision of the metastatic tumor of the mandibular mucosa and floor of the mouth. We chose this option primarily to relieve the patient's symptoms, so the therapeutic indication was palliative.
Journal of Clinical and Investigative Surgery, Volume 7, pp 51-55; https://doi.org/10.25083/2559.5555/7.1.9
Background. Kidney stone disease possesses a significant health burden not only to the family but also to the society. Sometimes, urethral stones are not expressed by typical manifestations, which can mislead clinicians in making the diagnosis. Materials and Methods. The investigation covers a period of 1 year and 6 months (Oct. 2020-Jan. 2022), carried out after obtaining the written informed consent of 22 symptomatic patients. KUB and pelvis X-ray (with or without perineal ultrasound) were performed after ethical clearance in a single center tertiary care hospital. Results. This study reveals male preponderance with no female patients, mostly in the age groups of 35-50 years (all being symptomatic). 54.54% have retention of urine and 45.45% with features of voiding lower urinary tract symptoms (LUTS); in 20% of cases, additional perineal ultrasound was performed to confirm the diagnosis. It is found that 63.63% of the stones were in the anterior part and 36.36% of the stones are in the posterior part of the urethra, 4.5% of the stones being radiolucent. Two patients were treated by meatotomy and 20 patients were treated by retrograde manipulation and fragmentation of stone by pneumatic lithoclast. Conclusions. In an extremely clinically suspicious case, an effective investigation, such as an X-ray of the pelvis and pelvis and/ or perineal ultrasound, can be used as the best diagnostic tools for urethral stones.
Journal of Clinical and Investigative Surgery, Volume 7, pp 109-112; https://doi.org/10.25083/2559.5555/7.1.19
Appendiceal diverticulitis is a very infrequent cause of pain in the right lower quadrant of the abdominal area. To have good management, it is essential to understand its clinical evolution, whether it is symptomatic or discovered incidentally during an appendectomy or barium enema. So far, few cases of appendiceal diverticulitis in different people have been reported. It is important in this case to avoid misdiagnosis in the form of another disease, especially acute appendicitis and/or possible complications. In this report we present the case of a 45-year-old man who came to the emergency room with symptoms of acute appendicitis. CT scan showed suspicious mass-like tissue in the appendiceal region, while pathological examination showed inflammation with no malignancy. An open appendicectomy was performed in this patient and appendicular diverticulitis was established as the final diagnosis.
Journal of Clinical and Investigative Surgery, Volume 7, pp 93-99; https://doi.org/10.25083/2559.5555/7.1.16
Introduction. Internal fixation is the current treatment approach for displaced clavicle fractures, which ensures firm immobilization and pain relief, thus preventing complications such as non-union, shortening and deformity. Aims. The aim of the study is to investigate the union rates with plate osteosynthesis, in order to be able to compare the clinical results obtained by several treatment modalities, in terms of movements, pain relief, return to normal activities and work. Materials and Methods. This is a prospective study on 30 patients with middle third clavicle fractures treated with plate osteosynthesis between December 2018 and October 2020, at Santiram Medical College and General Hospital, Nandyal. The study included patients older than 18 years. Results. The road accident was the most common cause of this fracture in our study, 70% being males and 63% with a right-sided injury. All patients were operated on within one week of the injury. Robinson Type-2B1 was the most commonly observed in our study and was approximately 53%. Twenty patients (66%) were treated with a Recon plate, nine patients (30%) were treated with an anatomical locking compression plate, one patient (3%) was treated with 1/3 tubular plate. All patients were immobilized in an arm sling, allowing a passive range of movements for 2-3 weeks. The duration of hospitalization was six to seven days, while the duration of the union varied from 8-14 weeks. Evaluation of functional outcome was based on Constant-Murley score, showing excellent results in 20 patients. Conclusions. In displaced midshaft clavicle fractures, open reduction with internal fixation has led to good union rates with excellent functional outcomes.
Journal of Clinical and Investigative Surgery, Volume 7, pp 43-50; https://doi.org/10.25083/2559.5555/7.1.8
Objectives. The aim of the study is to investigate the outcome of primary wound closure versus non-wound closure after fistulectomy in terms of postoperative pain and wound healing time. Materials and Methods. A prospective comparative randomized study was performed on patients admitted to the General Surgery Department of our Institute (Dec.1, 2019-Nov.31, 2021), with a diagnosis of low anal fistula and undergoing fistulectomy. 54 patients were included in the study and were assigned alternately and equally in group A (fistulectomy with laying open of wound) and group B (fistulectomy with primary closure), with 27 patients in each group. On day 1 postoperatively, the pain score was assessed by analog visual scale. Patients were followed for 6 weeks, and healing was assessed by visual examination of epithelialization at each follow-up visit. Results. In our study, the average healing time in group A was 20.77 days and in group B 14.07 days (the average healing time in group B is significantly longer than in group A, with P value of <0.00001). In our study, the average pain score among the participants in group A is 4, and among the participants in group B it is 2,148, with the value P <0.00001, which is statistically significant. Conclusion. Primary closure fistulectomy is a better method for treating low anal fistula due to the fact that it causes less pain, accelerated healing compared to wound opening fistulectomy. However, further studies are needed to compare other methods of treating low anal fistula.
Journal of Clinical and Investigative Surgery, Volume 7, pp 71-75; https://doi.org/10.25083/2559.5555/7.1.13
Objectives. Following the SARS-CoV-2 pandemic, all health care professionals were forced to change their methods of managing patients who come to the hospital for different diseases. The purpose of our study is to report the experience of this period, regarding: the study of demography in the presentation of facial and maxillary facial fractures, as well as the description of precautions taken and changes in management methods during the treatment of these cases. Materials and Methods. The study was performed in a tertiary care hospital, as a descriptive study on 30 consecutive patients with faciomaxillary trauma admitted to our hospital since the onset of the Covid-19 lockdown. The demographic data and the management protocol of the patient with facial fractures were noted and interpreted. Results. We found that several men suffered maxillofacial injuries as a result of RTA, despite the lockdown. Middle face fractures were the most common that required surgery. Sixteen patients underwent surgery in view of malocclusion and complex facial lacerations. Intra operative important steps were taken to reduce aerosol generation in the form of quick intubation, lower power settings of bipolar cautery and drill, islet application and use of self-drilling screws thereby reducing OT time as well. Post op. minimal malocclusion was seen in 5 (30%) patients who had undergone arch bar application and in 2 (12%) patient who had undergone islet application. Conclusions. Understanding patient demography is crucial for redistribution of hospital resources especially during a pandemic. Adaptable and flexible guidelines are required at every stage to ensure adequate patient treatment as well as limit any cross infection. Proper fixation of all fractures as per universal recommendations should be preferred always.
Journal of Clinical and Investigative Surgery, Volume 7, pp 20-24; https://doi.org/10.25083/2559.5555/7.1.4
Background. Thoracic empyema is an inflammatory condition of the pleura that can cause many complications and can even threaten people's lives. So, choosing the right treatment method from all available methods can improve the prognosis, reduce costs and post-treatment complications, thus improving the health of patients after the disease. Video-assisted thoracoscopic surgery (VATS) and open thoracotomy are the most commonly used surgical methods. In this study, these two surgical methods have been investigated, in terms of duration of hospitalization, postoperative pain level and the possibility of air leakage (as postoperative complications). Methodology. Patients with thoracic empyema stage II referred (between 2011 and 2020) to the Poursina and Razi Hospital Medical Center, Rasht, Iran were included in a retrospective cohort study. SPSS software and other statistical tests such as the Shapiro-Wilk test, Mann-Whitney non-parametric test, and Chi-square test were used for statistical analysis, and a P-value of less than 0.05 was considered an acceptable value. Results. The investigation on different qualitative and quantitative factors and complications after surgery showed that patients who underwent a VATS procedure had a shorter hospital stay (5.09±1.67 vs. 7.61±2.03), had a lower pain level (4.81±2.22 vs. 8.24±2.39), and the possibility of air leakage as a postoperative complication (41% vs. 56%) was lower than in the case patients who have undergone open thoracotomy. Conclusions. It can be concluded that choosing the VATS method instead of the open thoracotomy can reduce postoperative complications (such as length of hospital stay, pain level and possibility of air leakage) and can reduce the costs of treatment and the degree of health system use, especially during Covid-19 pandemic.
Journal of Clinical and Investigative Surgery, Volume 7, pp 13-19; https://doi.org/10.25083/2559.5555/7.1.3
Introduction. Ventral hernias are the second most common hernia; Onlay and Sublay operating techniques are procedures commonly performed in such cases. There is no consensus on the superiority of these procedures. The aim of this study was to compare the results of both procedures in order to identify the recommended technique between the two options. Materials and Methods. A total of 106 patients with epigastric, umbilical, paraumbilical, incisional hernias were studied. These patients were grouped into group A (onlay) and Group B (sublay). The outcomes of the two techniques were compared with respect to operative time, pain, hospital stay, seroma, infection, recurrence and patient satisfaction. Results. The mean operative time was 81.30 minutes in group A, and 85.85minutes in group B. Twenty-two (42.5%) patients in group A and seven (12.96%) patients in group B developed seroma. Nine (17.3%) patients in group A, 3 (5.55%) patients in group B developed post-operative infection. 30 (57.69%) patients in group A and 47(87.3%) patients in group B reported moderate pain, whereas three (5.76 %) and seven (12.96%) patients in group A and group B were reported severe pain in immediate post-operative period. At 48 hours, 20 (38.46%) and 24 (44.44%) of patients in group A and B were reported moderate pain, whereas 32 (61.53%) and 30 (55.55%) patients in group A and B reported mild pain. The mean hospital stay was 10.11 days in group A and 6.22 in group B. Three (5.76 %) patients of group A has recurrence, none of the patients in sublay group has developed recurrence. Thirty-nine (72.22%) patients of sublay group expressed their satisfaction but only 20(38.46%) patients in onlay group expressed their satisfaction. Conclusion. With reference to all the study parameters except one, the sub lay technique of mesh placement appears to be better. The exception is pain in the immediate postoperative period.
Journal of Clinical and Investigative Surgery, Volume 7, pp 62-66; https://doi.org/10.25083/2559.5555/7.1.11
Background. One of the most common causes of acute surgical abdomen is acute appendicitis. The aim of this study was to compare the accuracy of C-reactive protein (CRP) and the total leukocyte count (TLC) with the postoperative histopathological examination in the diagnosis of acute appendicitis. Methods. It is a prospective observational study over a period of 18 months, on patients who underwent emergency appendectomy. Purposive sampling method and Chi square test were used for the study to find significant association between the variables. Results. The mean age of the participants was 24.06 ± 8.61 years (74.7% men and 25.3% women). All cases had abdominal pain, and 86.7% anorexia, 57.3% migraine, 49.3% vomiting, 38.7% fever. In the case of the normal appendix, TLC was positive in 31% of cases; in cases with inflamed appendix 65% of cases were positive for TLC, while in cases with gangrenous and/or perforated appendix all cases were positive for TLC. CRP had a sensitivity of 88.7%, 69.23% specificity, 93.22% PPV and 56.25% NPV for diagnosis. When both TLC and CRP were used, they have a high sensitivity (90.32%) compared to single use and reported to histopathological findings, and a high PPV value (93.33%). Conclusions. The combined sensitivity and specificity values of TLC and CRP were higher in the diagnosis of acute appendicitis, thus reducing the number of negative appendicectomies and the need for a CT scan, which is generally expensive and associated with the risk of radiation.