外科ジャーナル

Introduction: Free vascularized fibular bone grafts have become the most commonly used free vascularized bone grafts used to treat large post-traumatic defects caused by high-energy trauma, as well as large post-traumatic nonunions.

Material and methods: We present two high energy trauma cases: a traumatic amputation of the forearm – 22C3 open Gustilo-Anderson type IIIC (case 1) with a 10 cm residual radial shaft defect and a paragliding accident resulting in a 43C3 open Gustilo-Anderson type IIIB (case 2) with a residual tibial shaft defect of 8 cm. The residual defect was treated in both cases with an osteoseptocutaneous free vascularized fibular bone graft. The follow-up was performed at 3 weeks, 3 months, 6 months, 1 year and 3 years. The bone graft showed radiological signs of integration at 3 months in both cases. The three-year follow-up revealed good clinical and excellent radiological results in case 1 and excellent clinical and radiological results in case 2.

Conclusions: Free vascularized fibula grafting provides an attractive reconstructive option for orthopedic surgery. Free fibular grafting has been proven to be an ideal choice in the management of large segmental bone defects as well as in situations of biological failure of bone healing.

Endoscopic placement of stents tends to become a routine for the treatment of various esophageal diseases, since it is a trustworthy and non-invasive technique. However there can be complications, which are divided into immediate and delayed. In this article we report a rare case of an 80-year-old man with acute abdomen, caused by obstruction of the terminal ileum due to the migration of an esophageal stent. Enterectomy was performed with end-to-end anastomosis of the small and large intestine. Postoperative period was uneventful.

Reconstruction of zygomatico-orbital complex remains as one of the troublesome and topical problems at steady posttraumatic deformations and fresh traumas of the mentioned region. The case of post gunshot zygomatico-orbital complex defect reconstruction with titanium mesh and autologous bone graft in combination with platelet rich plasma (PRP) is presented.

Aim: The purpose of the study is to verify the hypothesis that there is a correlation between the degrees of myorelaxation obtained by neuromuscular blockage during general anesthesia with changes in IAP values.

Material and methods: The present study was carried out in surgery department, during September 2016 - October 2016. The plot consisted of 9 patients who undergone surgeries in the extra-abdominal area: 2 total thyroidectomies, 3 subtotal thyroidectomies, 3 simple mastectomy and one axilo-femoral bypass.

Results: By comparing the results obtained in the nine cases, it was observed a statistically insignificant increase of intraabdominal pressure at train of four ratio values of 0, 1 or 2, intraabdominal pressure instead showed statistically significant variations in train of four ratio values of 3 or 4, observed especially at the reversal of anesthesia and patient waking up.

Conclusions: Train of four ratio is an accurate indicator of the degree of neuromuscular blockage. Train of four ratio values of 0-2 changed statistically insignificant the intra-abdominal pressure. Increase train of four ratio over 3 led to sudden increases in intra-abdominal pressure.

Background: Early diagnosis is an important factor for successful outcome in breast cancer. Current existing prognostic and predictive tool like ER, PR and HER2 status have main utility to guide whether a patient should or should not receive adjuvant endocrine or targeted therapy and situation has become more complex after the discovery of genomic tests like oncotype Dx etc. So the need to enhance the understanding of the disease process and treatment response, a hunt for suitable tumor marker is still on.

Sample collection: 5-7 ml fasting peripheral venous blood was withdrawn from newly diagnosed breast cancer patients. The subjects were properly matched in terms of age, sex, dietary habits and other parameters. The blood was centrifuged and resultant supernatant serum was put into the 3 ml ependorf tube and the specimen was immediately snap frozen in liquid nitrogen and was transferred to the HRMAS lab where it was stored at -80ºC.

HRMAS experiment: The collected samples (Malignant 32, Benign 32 and Healthy Control 28) were thawed and subjected to 800 MHz HRMAS spectrometer. The serum samples were recorded in native form using TSP as an internal standard and a coaxial insert. The spectra were acquired using 1D single pulse and Carr-Purcell-Meiboom-Gill (CPMG) pulse sequence with water suppress [PRESET- 90 degree- (δ-180°-δ)n-Aq] with a echo time of 40 ms. The HRMAS findings were correlated with the standard histopathological report.

Results: The 3D scattered PCA score plot of serum (explaining 83% of the total variance showed distinct group separation among the healthy, fibroadenoma and malignant tumor samples. The PLS-DA model generated considering all the three groups showed a predictive ability of 78% which proves that the model was robust enough for group differentiation. The X-loading plot (PC-1 which explained 69% of total variance) of the cases, exhibited positive loadings of lactate, succinate and alanine in serum. When compared with healthy controls, while glucose was found to be down-regulated in almost all the fibroadenoma and malignant cases. Thus, glucose along with lactate appeared to be the major confounders between the two groups viz. healthy and tumor groups.

Conclusion: All malignant tumors showed up regulation of lactic acid, acetate and choline containing compounds while down regulation of glucose and lipids. The study did provided evidence for the clinical use of these identified metabolites. However, future studies involving large sample size using sequential samples should be carried out.

Objective: Facet tropism is defined as asymmetry in both the facet joint angles of the lumbar and lumbosacral regions. In the present study, the authors attempt to determine lumbar facet angles and incidence of facet tropism in adults. Materials and Methods: 54 patients (30-50 years) admitted to the hospital due to spinal trauma with normal imaging and examination were included and evaluated in the lumbar levels of L2-L3, L3-L4, L4-L5 and L5-S1 using CT scan.

Results: The mean degree of right and left L2-L3 facet angle was 29.51° (sd 3.03°) and 31.22° (sd 4.44°), respectively and the mean degree of right and left L3-L4 was 33.57° (sd 6.29°) and 34.71° (sd 7.68°), respectively. The mean measurement of right and left L4-L5 facet angle was 37.02° (sd 7.37°) and 39.48° (sd 7.78°), respectively. Finally, the mean degree of right and left L5-S1 facet angle was 44.51° (sd 6.98°) and 46.34 ° (sd 8.10°), respectively.

Conclusion: Low-degree facet tropism is common in lumbar region and the most involved levels are L4-L5 and L5-S1.

The surgical team always tries to provide consistently low incidence of major complications for patient undergoing any operation. Recognizing patients at high risk of developing a complication will contribute substantially to quality of operation and of cost reduction in surgery. In operating room, surgical apgar score (SAS) has helped surgeons for objective assessment of the operative course for postoperative prognostication instead of their "gut- feeling". Here we prospectively evaluated postoperative complications according to SAS. This was a hospital based, single centre longitudinal prospective observational study from October 2014 to March 2015 including 66 patients. There was significant association between type of risk group according to SAS and occurrence of complication (P<0.001). Again, patient more prone to develop major complications including mortality in 30 day follow up had low mean SAS. Mean ASA was found to be inversely proportional to SAS. Increase in SAS was proved to be associated with good prognosis (P<0.0001). Thus, it was proven that SAS was significant predictor of outcome in terms of postoperative major complications including mortality in 30-day post emergency surgeries under general anaesthesia.

Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance in the bariatric community as a definitive weight loss procedure as compare to laparoscopic Roux- en – Y gastric bypass (LRYGB). In a similar effort, a study was conducted in Security Forces Hospital Program - Dammam, Kingdom of Saudi Arabia on 55 patients who were morbidly obese. On the basis of characteristics and needs of each individual two procedures were practiced. During the course of study these patients were subjected to laparoscopic Roux- en – Y gastric bypass (LRYGB) and Laparoscopic sleeve gastrectomy (LSG).