Lietuvos chirurgija
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Giant Gallstones – a Systematic Review
Get PDFGiant gallstones are rare occurrences and measure 5 cm in any one dimension. They present unique set of features and complications. Due to their rarity, we conducted this systematic review to investigate the profile of patients with giant gallstones applying seven variables. For this study, we used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After an initial search of 111 peer reviewed articles from reliable sources, we included 29 articles for this study enrolling 30 patients with mean age of 66.7 years. Majority (97%) were symptomatic, reporting with cholecysto-enteric fistula/gallstone ileus (33%), acute cholecystitis (30%) and chronic dyspepsia (24%). The management options adopted included open cholecystectomy (48%), laparoscopic cholecystectomy (33%), endoscopic lithotripsy (6%) and conservative management (6%)
Airway Management in Pan Facial Fracture: An Outcome Analysis of Elective Tracheostomy and Submental Endotracheal Intubation
Get PDFBackground and Aims. Pan facial fractures are complex and often requiring complex airway management. Elective tracheostomy (ET) and submental endotracheal intubation (SEI) are the two major techniques for airway management. The aim of this article is to compare the management outcome between these techniques. Methods. This study was done in a tertiary care hospital from Jan 2019 to Dec 2019. Data were retrieved for all patients from hospital admission-discharge reports, operation room records, follow-up notes, and clinical photograph records which was recorded prospectively after ethical clearance. Total 38 patients were included in the study after the exclusion criteria into two groups: submental endotracheal intubation (SEI) and elective tracheostomy (ET). Demographic data, intraoperative time (IOT), length of hospital stay (LOHS), postoperative pain score at three and seven days, and Vancouver Scar Score (VSS) at 4 and 12 weeks was compared between the two groups. Results. SEI consisted of 23 patients (60%) while ET had 15 (40%) patients. The mean age was 32.77±8.24 years in the SEI and 29.36±7.32 years in the ET. The IOT in SEI was 15.36±1.53 min and 24.60±1.40 min in the ET which was statistically significant (p = 0.00001). The LOHS was 11±3.87 days in SEI and 25.2±3.88 days in ET (p = 0.0001). The mean VSS at 4 and 12 weeks for SEI were moderate and mild respectively and for the ET was moderate and mild respectively. Both were statistically significant with a p = 0.003 and p = 0.006. Conclusion. Submental intubation is a safe airway management technique in pan facial fracture. It provides the surgeon with an excellent operative field for achieving the proper dental occlusion. Both short- and long-term outcomes are better compared to the alternative airway method of elective tracheostomy
Mikrochirurgijos pradininkai: prisilietimas prie istorijos
Get PDFEvery hand and microsurgeon worldwide is more or less familiar with the names of those who are mentioned in this article: Harry Buncke, Harold E. Kleinert, Robert Acland, Hanno Millesi and Algimantas Otonas Narakas. Who ever new or were familliar with them experienced feeling as it was “the royal touch” for those who had a scropulosis in the middle ages: the touch was healing and left the unforgettable memories – they were toutched by a queen or a king. Every contact with the giants of microsurgery left noteworthy memories of their lavish lessons and cordial advises. The author had a very close professional contacts with all of them and is eager to share some of the highlights spent with them in operating rooms, writing articles and discussing subjects during the scietific meatings.Dar nė šimtmečio netrunkanti mikrochirurgijos istorija gyva daugelio mikrochirurgų atmintyje. Beveik kiekvienas mikrochirurgas žino šios chirurgijos šakos pradininkus: Harry Buncke’ą, Haroldą E. Kleinertą, Robertą Aclandą, Hanno Millesį ir mūsų tautietį Algimantą Otoną Naraką. Šio straipsnio autoriui dirbti su minėtais mikrochirurgais ir juos pažinti buvo lyg karaliaus prisilietimas. Kadaise karaliaus prisilietimu buvo gydoma skrofuliozė: ligonis, susitikęs su karaliumi ar karaliene, ne tik įgydavo viltį pasveikti, bet ir gaudavo auksinį pakabuką – neišdildomą atsiminimą. Straipsnyje dalijamasi prisiminimais apie minėtus mikrochirurgijos grandus. Prisimenama, kaip jie nuoširdžiai ir dosniai dalijosi žiniomis, pamokomis ir patarimais
Giant Splenic Artery Aneurysm – An Analysis of the Recent Literature
Get PDFObjective. This article was composed to review the profile of giant splenic artery aneurysm as reported in the recent literature. Methodology. A systematic literature search was conducted through electronic databases and scientific networking sites, including PubMed, Scopus, and Google Scholar, using the key words and terms “giant splenic artery aneurysm”, “large splenic artery aneurysm”, and “huge splenic artery aneurysm”. Only literature in English was considered for inclusion in this study, and the time frame was fixed between 2014 and 2024. Results. 16 cases, including 9 (56.25%) females and 7 (43.75%) males, ranging in age from 35 to 84 years (mean 60.4±13.4 years). Years were included in the review. The size of aneurysm varied from 10 cm to 30.68 cm (mean 12.54±5.32 cm). Upper abdominal pain was the commonest presentation, along with shock and palpable lumps. The majority of the cases (n = 11; 68.7%) were managed by laparotomy, and an endovascular approach was adopted in 4 (25%) cases. Conclusion. Giant splenic artery aneurysm (GSAA) is a rare but potentially life-threatening condition. Physicians need to be aware of this condition so that a diagnosis is made promptly. There is no role of conservative management, and all giant aneurysms need appropriate treatment after detection. Open surgical aneurysmectomy is the mainstay of management
Amyand’s Hernia in Adults – an Analysis of Recent Literature
Get PDFAmyand’s hernia is a rare disorder characterized by the presence of the vermiform appendix within an inguinal hernia. It is predominantly found in the pediatric age group, and its occurrence in adulthood is rare. Hence, a systematic analysis of twenty-six case reports of Amyand’s hernia published in the peer-reviewed literature in the year 2023 is presented with emphasis on variables including age of the patient, gender, clinical presentation, side of the inguinal hernia, imaging modalities used for evaluation, achievement of preoperative diagnosis or otherwise, classification, appendix management, hernia management, surgical approach, and outcomes
Bedside Teaching in Undergraduate Surgical Education: A Pilot Study of Students’ Perspective
Get PDFBackground. Bedside teaching is an important tool in medical education. In recent years, studies have shown that this tool has witnessed gradual deterioration due to various reasons. Hence this pilot study was conducted to assess the students’ perspective about this tool and suggest remedies for the deficiencies. Methodology. An anonymous questionnaire was designed and students were requested to register the response offline. Data was analysed and inferences made. Results. Various deficiencies were highlighted by the students that require correction and improvement. Unavailability of suitable patients is a significant barrier. Communication skills and understanding of infection control protocols had got improved in 84% and 94% students respectively. Half of the students were fully satisfied or satisfied with the overall conduct of the bedside teaching and the other half were either partially satisfied or dissatisfied. Conclusion. There is a need to improve bedside teaching in Undergraduate Surgery course. Simulation sessions need to be devised and enhanced. Faculty development sessions to train the teachers are required
Iatrogenic Tracheal Rupture after Endotracheal Intubation: A Case Report
Get PDFIatrogenic tracheal rupture is very rare condition and has a lot off causes (intubation, tracheostomy, bronchoscopy, esophagectomy), but orotracheal intubation is the most common. Diagnosis is based on the occurrence of symptoms that are not specific but highly suggestive: subcutaneous emphysema, respiratory insufficiency, pneumothorax, and hemoptysis. The appearance of subcutaneous emphysema as a first sign plays a main role for early diagnosis and rapid appropriate treatment. Diagnostic confirmation is possible by chest X-ray, thoracic computed tomography and bronchoscopy which confirmed the size and site of the lesion. Treatment can be conservative, in patients with small ruptures, less than 2 cm, and surgical in the majority of ruptures over 2 cm in length.
Our case report presents an iatrogenic post-intubation tracheal rupture treated conservatively. Our patient was a 71-year-old woman, admitted in our hospital with fracture of right humerus for elective surgery. Her medical history was only arterial hypertension. She underwent general anesthesia, intubated with flexible ET tube, positioned in beach-chair position after introduction, and no complication occurred during surgery. 18 hours after surgery, after severe coughing, she suddenly developed subcutaneous emphysema of the facial, neck and upper anterior chest. Tracheal rupture was confirmed with a thoracic computed tomography and tracheobronchial fiber endoscopy. It showed a posterior tracheal transmural rupture 1 cm long, located 4 cm above the carina, covered with small tissue that opened in inspirium. Conservative treatment with antibiotic cover was performed, and the patient was discharged home in good condition, fourteen days after the initial injury