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Evaluation of a Monofile, Ultra-Long Absorbable Suture with High Elasticity for Abdominal Wall Closure Under Daily Clinical Routine MULTIMAC a Prospective Observational Study
Petra Baumann,
Florin Savulescu,
Alexander Ferko,
Cestmir Neoral,
Moritz Nicolas Wente
Issue:
Volume 7, Issue 1, February 2019
Pages:
1-7
Received:
29 October 2018
Accepted:
20 January 2019
Published:
19 February 2019
Abstract: Recent meta-analyses have shown that the application of a monofile, late-absorbable suture using a continuous suture technique with a suture-to-wound length ratio of at least 4:1 is the method of choice for the closure of midline laparotomies. Monomax, a new ultra-long term absorbable, high elastic monofilament suture, was approved in 2009 and its safety and efficacy were proven in a selected patient population under controlled conditions for elective midline abdominal wall closure (ISSAAC Study). The present multi-centric, international, prospective observational study is aimed at evaluating the performance of Monomax suture for transverse and midline abdominal wall closure in daily clinical practice even in high risk patients. A total of 200 patients undergoing a primary elective laparotomy using either a midline or transverse incision were examined regarding the frequency of short-term complications (e.g. reoperation due to burst abdomen, wound infection, wound healing disorders), until discharge and 1 month after surgery. Postoperative length of hospital stay was also reported. Frequency of reoperation due to burst abdomen was 2.5% and a wound infection rate of 3.5% was reported up to day of discharge. Seven patients developed a wound healing disorder (3.5%). Average length of postoperative hospital stay was 10.3 days. Our results indicate that the ultra-long term absorbable, elastic monofilament suture is safe and efficient for transverse and midline abdominal wall closure performed under daily clinical routine even in high risk patients.
Abstract: Recent meta-analyses have shown that the application of a monofile, late-absorbable suture using a continuous suture technique with a suture-to-wound length ratio of at least 4:1 is the method of choice for the closure of midline laparotomies. Monomax, a new ultra-long term absorbable, high elastic monofilament suture, was approved in 2009 and its ...
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Jejunal Diverticulosis Is a Rather Difficult Diagnosis: Report of a Case and Review of the Literature
Georgios Delimpaltadakis,
Kalliopi Strataki,
Konstantinos Spiridakis,
Theodoros Papadakis,
Eleni Kaloeidi,
Eleni Tsagkataki
Issue:
Volume 7, Issue 1, February 2019
Pages:
8-13
Received:
9 January 2019
Accepted:
1 March 2019
Published:
21 March 2019
Abstract: Jejunal diverticulosis is most commonly an incidental intraoperative finding, while rarely can be a clinical diagnosis as demonstrated in our case and on published articles in the literature. Besides the rarity of the disease, a second factor that incommodes the preoperative diagnosis is the vague symptomatology. The case of a 72-year-old male patient is described, who was complaining for mild intensity abdominal pain, with no other specific symptoms. A leucocytosis of 12.500/mm3 was revealed, with all other laboratory tests being within normal limits. CT scan showed bubbles of free air in abdominal cavity and the decision for surgical exploration was taken. In the operating room multiple large diverticula were found along the jejunum without obvious perforation. A resection of 105 cm of jejunum was performed. Patient’s postoperative recovery was uneventful and two years later he does not complain of any abdominal symptoms. Postoperatively an expert radiologist was asked to read and explain the preoperative CT scan. Radiologist’s diagnosis was that the patient had either multiple jejunal diverticula or trapped free air in peritoneal cavity. Consequently, the preoperative diagnosis is feasible with a prompt cooperation between surgeon and radiologist and a better interpretation of CT scan findings from the radiologist.
Abstract: Jejunal diverticulosis is most commonly an incidental intraoperative finding, while rarely can be a clinical diagnosis as demonstrated in our case and on published articles in the literature. Besides the rarity of the disease, a second factor that incommodes the preoperative diagnosis is the vague symptomatology. The case of a 72-year-old male pati...
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Treatment of Bowen’s Disease with Ingenol Mebutate: A Retrospective Study
Montserrat Salleras,
Mònica Quintana,
Jorge Arandes,
Ignasi Figueras
Issue:
Volume 7, Issue 1, February 2019
Pages:
14-18
Received:
25 January 2019
Accepted:
15 March 2019
Published:
12 April 2019
Abstract: Management of BD is widely variable and there is little evidence for the most appropriate treatment. Our aim was to evaluate the effectiveness of ingenol mebutate (IM) gel in the treatment of patients with Bowen’s disease (BD). We performed a retrospective analysis of 24 cases of biopsy-confirmed BD treated with IM. Data retrieved from the patients’ file included age, sex, anatomic sites, clinical images of lesions, histopathological data of skin biopsies, local skin reactions, clinical and histological response to treatment, alternative treatments tried and follow-up. The majority of patients were females (18/24, 75%), with an average age of 79.5 years (range 53-90 years). Four of the 24 patients were lost to follow-up. The average duration of follow-up was 10.4 months (range 0.5-44 months). After treatment with IM, 41.7% of patients showed complete clinical resolution. Retreatment with IM of six non-responder patients led to three more cases of successful healing. Therefore, 54.2% of patients with BD lesions achieved complete resolution after treatment with one or two cycles of IM. Local skin reactions were mostly mild or moderate, and only 12.5% were regarded as severe. The results indicate that topical IM gel may be considered as a safe and beneficial non-invasive treatment option for BD, especially in patients who are poor candidates for surgery and anatomical sites that are unsuitable for other treatments. The acceptable safety profile, short treating course and easy self-application of IM gel may improve patient compliance.
Abstract: Management of BD is widely variable and there is little evidence for the most appropriate treatment. Our aim was to evaluate the effectiveness of ingenol mebutate (IM) gel in the treatment of patients with Bowen’s disease (BD). We performed a retrospective analysis of 24 cases of biopsy-confirmed BD treated with IM. Data retrieved from the patients...
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Incidence of Pedestrian Traffic Injury in Sao Paulo Brazil
Washington Gomes de Araujo,
Rodrigo Tadashi Martines,
Tamiris Pontel de Oliveira,
Priscila Souza Schinzari,
Jane de Eston Armond
Issue:
Volume 7, Issue 1, February 2019
Pages:
19-23
Received:
17 February 2019
Accepted:
26 March 2019
Published:
18 April 2019
Abstract: Pedestrian traffic injuries represent an important cause of mortality, and although the occurrence rates are lower than collisions between vehicles, the lethality is much higher due to the vulnerability of the pedestrians. This study characterized the victims of traffic accidents as to gender, age group, period of occurrence, association with alcohol and drug use, place of accidents, diagnosis of attendance, evolution of victims and types of vehicles involved, in order to assist public managers in intervening in such scenario. It is a cross-sectional, quantitative, descriptive and retrospective epidemiological study of 2719 pedestrians injured in traffic accident records, during 2017 in Sao Paulo, Brazil. Men were involved in 61.9% of the traffic accidents and the most affected age group was between 20 and 24 years (12.4%). The highest incidence was in the afternoon (12.2%), in the South region (4.5%) and 46.3% associated with cars. The lower limb traumas were the most frequent (32.3%) and 76.5% of the victims followed to hospital discharge. This study revealed the importance of the epidemiological analyses of traffic accidents. It is an important tool to guide governments to promote public and drivers education to respect the traffic regulations. And besides, it can be used to manage the assistance of the pedestrian victims of traffic accidents by the maintaining of the pre-hospital and hospital care teams in strategic locations to minimize the time between the accident and the victim’s care by the public Brazilian National Health System (Sistema Único de Saúde - SUS).
Abstract: Pedestrian traffic injuries represent an important cause of mortality, and although the occurrence rates are lower than collisions between vehicles, the lethality is much higher due to the vulnerability of the pedestrians. This study characterized the victims of traffic accidents as to gender, age group, period of occurrence, association with alcoh...
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Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report
Xiang Li,
Frankie Leung,
Christian Fang,
Tak Man Wong
Issue:
Volume 7, Issue 1, February 2019
Pages:
24-27
Received:
17 February 2019
Accepted:
2 April 2019
Published:
22 April 2019
Abstract: Double dislocation of carpometacarpal and metacarpo-phalangeal joints of thumb is also called ‘floating thumb metacarpal’. This rare injury usually presents with combined joints dislocation and collateral ligaments rupture, which may be predisposing to joint instability after closed reduction. We report a case of traumatic and chronic dislocation of carpometacarpal and metacarpo-phalangeal joints of left thumb in a 63-year-old housewife. Failure of non-operative treatment was found up to 1 month after injury due to missed follow-up. Closed reduction was tried but failed because of joints stiffness. Open reduction and K-wire fixation were performed and radial collateral ligaments were repaired. Patient restored good functional outcome with no evidence of arthritis or subluxation at 1 year. Open reduction and fixation show good result in our case with delayed surgical intervention. The management of a floating thumb could be non-operative by close reduction and cast immobilization. However, closed monitoring and regular follow-up are critical after non-operative treatment to avoid potential risk of post-operative complications.
Abstract: Double dislocation of carpometacarpal and metacarpo-phalangeal joints of thumb is also called ‘floating thumb metacarpal’. This rare injury usually presents with combined joints dislocation and collateral ligaments rupture, which may be predisposing to joint instability after closed reduction. We report a case of traumatic and chronic dislocation o...
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Retroperitoneal Mass-Lesion with Calcificaction; Cystic Lymphangioma; Case Report
Arash Moradi,
Abbas Hajian,
Abdoulhosein Davoodabadi,
Hosein Sadeghi
Issue:
Volume 7, Issue 1, February 2019
Pages:
28-30
Received:
26 February 2019
Accepted:
2 April 2019
Published:
22 April 2019
Abstract: Lymphangioma in retroperitoneum is a rare mass-like lesion which presented histopatholigically with single or multi-cystic type and/or cavernous type; and clinically is often asymptomatic. Imaging studies was not enough to conclude exact diagnosis due to wide distribution of differential diagnosis resulted from different organ origination of tumor including of pancreas, liver, gastrointestinal and urologic system. This report described a 36 years old women complaining of 8 months vague abdominal pain underwent surgery in order to trans-abdominal total resection of a cystic mass-like tumor just located between abdominal aorta and inferior vena cava. Pathologic studies revealed benign multi-cystic lymphangioma with calcified foci. Symptoms completely removed after surgery and in follow-up period.
Abstract: Lymphangioma in retroperitoneum is a rare mass-like lesion which presented histopatholigically with single or multi-cystic type and/or cavernous type; and clinically is often asymptomatic. Imaging studies was not enough to conclude exact diagnosis due to wide distribution of differential diagnosis resulted from different organ origination of tumor ...
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