bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of survivin immunoexpression in the differentiation of high- and low-grade breast ductal carcinoma in situ
Authors: Chade Milca Cezar , Piato Sebastião , Galvão Maria Antonieta Longo , Aldrighi José Mendes , Negrini Rômulo , Mateus Evandro Falaci , Medeiros Enio Martins
Published: April 2018

ABSTRACT Objective To evaluate the expression of survivin protein in low- and high-grade ductal carcinoma in situ. Methods Breast tissue fragments obtained by incisional biopsy and surgical procedures of 37 women with ductal carcinoma in situ of the breast were subdivided into two groups: Group A, composed of women with low-grade ductal carcinoma in situ, and Group B, women with high-grade ductal carcinoma in situ. Survivin protein expression test was performed by immunohistochemistry, using a monoclonal antibody clone I2C4. The criterion to evaluate survivin immunoexpression was based on the percentage of neoplastic cells that presented brown-gold staining. This criterion was positive when the percentage of stained cells was ≥10%. Results The survivin protein was expressed in 22 out of 24 cases of high-grade ductal carcinoma in situ (78%), whereas, in Group A, of low-grade ductal carcinoma in situ (n=13), it was positive in only 6 cases (21.40%; p=0.004). Conclusion The frequency of expression of survivin was significantly higher in the group of patients with high-grade ductal carcinoma in situ compared to those in the low-grade ductal carcinoma in situ group.
Functional magnetic resonance imaging for clinical evaluation of uterine contractility
Authors: Fornazari Vinicius Adami Vayego , Vayego Stela Adami , Szejnfeld Denis , Szejnfeld Jacob , Goldman Suzan Menasce
Published: April 2018

ABSTRACT Uterine contractility out of the gestational phase, during the menstrual cycle and the habitual functional variations of the organ, this is one of the responsible mechanisms for reproduction and fertility, due to its direct action in the mechanisms conducting the spermatozoa to the ovule and in the decidual implantation. Pathologies such as uterine leiomyoma, endometriosis, adenomyosis, polycystic ovarian syndrome, as well as the use of intrauterine devices and oral contraceptives, may alter a functionality of uterine contractility. Thus, magnetic resonance imaging with ultrafast sequences provides a dynamic evaluation (cine-MRI) and thus the correlation of uterine contractility quality in patients with current infertility or pathologies.
THE “PENDULUM LAW” - HOW TO EXPLAIN THE SPINAL SHAPE? PART I
Authors: NOROTTE GILLES
Published: April 2018

ABSTRACT The author uses the classical parameters that allow studying the sagittal form of the spine, following a vertebral semantics (lordosis, kyphosis, spinopelvic parameters, and sagittal balance). Then he proposes a very different perspective that analyzes the shape of the column, not in the sagittal-coronal plane but in the vertical plane, that is, integrating gravity as a three-dimensional construction axis. Beginning with an analysis of the global body scheme of which the column is part, the muscular synergies are introduced using reference points, defining tension lines, anatomical and functional arches, highlighting the importance of the respiratory function that stabilizes the shape of the thoracolumbar spine. This shows that, whatever the pelvic or frequent anomalies, the biomechanical scheme depends on a single unique law related to gravity: the “pendulum law”. This allows us to define an ideal shaped spine, in comparison to different models, evoking the semantic practical and therapeutic interest of such a perspective.
SACRAL FRACTURE TREATMENT WITH A VARIATION OF THE LUMBOPELVIC FIXATION TECHNIQUE
Authors: ROCHA VINÍCIUS MAGNO DA , GUIMARÃES JOÃO ANTONIO MATHEUS , OLIVAES FILHO ANTÔNIO PAULO DE , CARRASCO FELIPE MOURA , ARAUJO JUNIOR ANTÔNIO EULALIO PEDROSA , AGUIAR DIEGO PINHEIRO , BARCELLOS ANDRÉ LUIZ LOYELO
Published: April 2018

ABSTRACT Spinopelvic instability is an uncommon injury that is caused by high-energy traumas. Surgical treatment is used, in the majority of cases, to restore stability and enable early mobilization. Various stabilization techniques have been used in the treatment of spinopelvic instability, and lumbopelvic fixation (LPF) is currently the technique of choice due to its biomechanical superiority. One of its limitations is the fact that the technique does not directly address the lower sacral segment, permitting a residual kyphotic deformity. This deformity has been attributed to unsatisfactory outcomes, including late development of pelvic floor muscle defects and complications during childbirth. We report a case of a patient with spinopelvic instability due to sacral fracture, which was treated using a variation of the LPF technique, in which rods and screws originally developed for cervicothoracic fixation were adapted to correct sacral deformity in the sagittal plane. The upper sacral segment was reduced indirectly using hip extension and femoral traction manoeuvres, associated with distraction manoeuvres via rods. Bone reduction forceps were used to reduce the kyphotic deviation in the lower sacral fragment, enabling its fixation to the lumbopelvic rod and screws system. There were no complications of infection, suture dehiscence, or breakage of the implants, and at the end of the first year of follow-up, the sacral kyphosis was normal and radiographic consolidation was confirmed. Our technique provides a viable and promising alternative to traditional LPF, making it especially useful in fractures with accentuated deviations of the lower sacral fragment. Level of Evidence: 4.Type of study: Case series
POSTEROLATERAL, POSTERIOR AND MI-TRANSFORAMINAL LUMBAR INTERBODY FUSION: A STUDY OF 212 CASES
Authors: MAIA BRUNO MIGUEL BRÍGIDO , SILVA LUÍS PEDRO DUARTE , SIMÕES ISABEL CRISTINA GOMES COSTA , SIMÕES PEDRO CARVALHAIS , TEIXEIRA LUÍS PEDRO SOUSA FERREIRA
Published: April 2018

ABSTRACT Objective: Degenerative disc disease is a common problem that could require surgical treatment. The aim of this study was to compare clinical outcomes, complications and benefits associated with intersomatic fusions by the MI-TLIF, PLIF and PLF techniques. Methods: A total of 212 patients were retrospectively reviewed. All patients underwent the same pre- and postoperative clinical evaluations using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and SF-36. Follow-ups were performed for at least one year. Inpatient days, complications, blood loss and operative times were equally quantified. Results: Estimated blood loss for MI-TLIF was statistically lower compared to the amount of blood recovered by Cell Saver device on PLIF and PLF groups. Mean surgical time for MI-TLIF were not significantly different compared to PLIF and PLF groups. Inpatient days were significantly lower in the MI-TLIF group, with an average decrease of one day. Four complications were recorded in the PLIF group, 2 in the PLF group, and one in the MI-TLIF group. Analysis of the clinical parameters revealed post-operative improvements at all time points, with the most statistically significant differences occurring at the first six months. Better results were achieved with the MI-TLIF technique. Conclusions: Compared to more invasive techniques, MI-TLIF showed fewer complications, less blood loss and shorter hospitalization times. Longer operative times in this group can be explained by the greater technical complexity and incipient learning curves. Interbody fusion by PLIF, PLF and MI-TLIF provided good clinical outcomes, but faster recovery was obtained with less invasive techniques. Level of evidence: III; Type of study: Retrospective comparative case study.
THORACOLUMBAR EPIDURAL ARACHNOID CYST OF DIFFICULT CLINICAL MANAGEMENT: CASE REPORT
Authors: ARAÚJO JÚNIOR FRANCISCO ALVES DE , BAYER DAFNE LUANA , HASEGAWA HUGO AKIO , SILVA TALITA RIBEIRO DA , ZAMPONI JR. JOHNNI , YOKOO PATRICIA
Published: April 2018

ABSTRACT Introduction: Among the primary lesions occupying the spinal space, only 1% corresponds to the epidural arachnoid cyst (EAC). This condition is usually asymptomatic, and identified accidentally in imaging tests. In symptomatic cases, total surgical resection is recommended. Objective: To describe a case of EAC refractory to clinical treatment. Methods: A 45-year-old woman had lumbar pain for six years and increased pain in the last months, with irradiation to the left lower limb (corresponding to L1). No other alterations found in the physical examination. Magnetic resonance imaging (MRI) of the spine revealed an intravertebral cystic lesion at T12-L1 level, in the left posterolateral position, causing enlargement of the foramen, and suggesting an epidural arachnoid cyst. Results: Due to failure of the initial clinical treatment, the patient underwent left T12-L1 hemilaminectomy, resection of the cyst and correction of dural failure. The patient progressed with effective pain control and MRI confirmed absence of residual lesion. Conclusion: EAC is more common in men (4:1) and may be congenital or acquired. The most common topography is thoracic (65%). Its clinical presentation is low back pain, lower limb pain and paresthesia. MRI is the method of choice for diagnosis and surgical intervention is restricted to cases that are symptomatic or refractory to clinical treatment, and the prognosis tends to be excellent. We conclude that, in addition to being a rare and commonly asymptomatic condition, an adequate therapeutic approach is essential for complete cure, avoiding intense pain and manifestations that bring about a drastic reduction of functional capacity. Level of evidence: IV. Type of study: Case series.
COMPARATIVE ANALYSIS OF TWO CLASSIFICATION SYSTEMS OF THORACOLUMBAR SPINE FRACTURES
Authors: VIEIRA ANDRÉ LUIZ PAGOTTO , SANTOS JULIANO RODRIGUES DOS , HENRIQUES GUILHERME GALITO
Published: April 2018

ABSTRACT Objective: To evaluate the reproducibility and the interobserver coefficient of concordance between the AO/Magerl and AOSpine classifications for thoracolumbar spine fractures. Methods: Retrospective study of radiographic data analysis. Data were collected from 31 radiographic studies of patients with thoracolumbar spine fracture and distributed to a team involving spinal surgeons and residents. The fractures were classified according to the AO/Magerl and AOSpine classifications. Statistical analysis was performed using the Cohen Kappa test to assess the coefficient of concordance. Results: The Kappa value for interobserver concordance of AO/Magerl classification was κ = 0.70 and standard deviation was 0.16. For the AOSpine classification, we observed κ = 0.76, both with significance level α = 0.05 and P<0.001. Conclusions: We conclude that the interobserver concordance of the new AOSpine classification is similar to the AO/Magerl classification. This conclusion reinforces the reproducibility of the new AOSpine classification. Level of evidence: IV,Type of Study: Case series.
DISC REPLACEMENT IN LUMBAR SPINE
Authors: SOUZA EDUARDO SOARES DE , KUSABARA RENÉ , OLIVEIRA FABIO MASTROMAURO DE , NAGASSE YOSHINOBU , YAMAZATO CLÓVIS , MACHADO JUNIOR JOSÉ ANTÔNIO
Published: April 2018

ABSTRACT With the increase in the elderly population worldwide, the prevalence of degenerative diseases tends to grow, especially degenerative disc disease (DDD) in the lumbar spine. It is important to seek excellence treatments to ensure a better quality of life for patients. In this sense, the total disc replacement and the use of prostheses in the lumbar spine have been pointed out as alternative and promising treatments when compared to the standard treatment. The aim of this study is to show the results of total replacement of the intervertebral disc, through a review of the literature. The electronic search was performed in the PubMed databases, with the keywords “Total Disk Replacement”, “Low Back Pain”, and “Arthroplasty” in articles published as of 2012. We selected 16 articles. Level of Evidence: II. Type of study: Systematic reviewb of Level II studies or Level I studies with inconsistent results.
ALIF WITH AUTO-LOCKING CAGE WITHOUT SUPPLEMENTATION - TOMOGRAPHIC ANALYSIS OF INTERBODY BONE FUSION
Authors: MARCHI LUIS , NOGUEIRA-NETO JOES , AMARAL RODRIGO , FAULHABER NICHOLAI , COUTINHO ETEVALDO , OLIVEIRA LEONARDO , POKORNY GABRIEL , JENSEN RUBENS , PIMENTA LUIZ
Published: April 2018

ABSTRACT Objective: The objective of this work is to study the fusion rate and complications of the mini-ALIF with an auto-locking device at the L5-S1 level. Methods: Retrospective and radiological study. The inclusion criteria were mini-ALIF in L5-S1 with auto-locking cage, DDD and/or low grade spondylolisthesis. The exclusion criteria were posterior/anterior supplementation; lack of 12-month follow-up images, and previous surgery at L5-S1 level. The primary endpoint was fusion assessed in CT images and/or lateral lumbar flexion/extension radiographs. The secondary endpoint was the revision surgery due to device movement/migration or pseudoarthrosis. Lumbar TCs and radiographs were analyzed during 12 months of follow-up. Fusion was defined according to Bridwell/Lenke classification. Results: Sixty-one cases were included in this study. Complete or ongoing fusion was found in 57 cases (93%). Forty-two of the 61 levels (65%) were completely fused after 12 months. Fifteen levels (28%) had evident bone growth, two levels (3%) showed lysis lines around the implant, and two levels (3%) presented lysis lines and depression. Reoperation for pedicular screw supplementation was necessary in two cases (3%), one with vertebral sliding progression (12 months), and one with symptomatic micro-movement (six months). No implant has undergone migration or expulsion of the disc space. Conclusions: Mini-ALIF in L5-S1 level using an auto-blocking interbody implant construction in cases of low segmental instability results in good interbody fusion index and low failure rate, even without the need for further supplementation, but should not be applied indiscriminately. Evidence Level: IV. Type of study: Case series.
Spatial and temporal dynamics of functional groups of phytoplankton in a tropical shallow lake
Authors: Silva Núbia da , Santos João Paulo de Oliveira , Oliveira Danielle Lima de , Silva Joseilson dos Santos , Silva Kelly Dayane Pereira da , Dantas Ênio Wocyli , Barbosa Luciana Gomes
Published: April 2018

Abstract Aim To evaluate the structure and dynamics of functional phytoplankton groups (FGs) over a macrophyte cover gradient and their relations with environmental variable in small, shallow clear-water lake. Methods Physical, chemical and phytoplankton analyses were made between August 2014 and June 2015 at three points on the Santa Lucia lake (Paraiba, Brazil). Tukey and Wilcoxon tests were applied to the data followed by CCA and Anova. Results The submerged macrophyte cover and phytoplankton biomass presented high spatial and temporal uniformity. The increase in rainfall induced small variations in functional groups, promoting increase the N group and reduction of the SN. Conclusion The homogeneity in the composition and structure functional groups along macrophyte cover confirm the tendency that in small and shallow lakes communities of limnetic and shoreline zones tend to be similar.
Revisión teórica sobre el perfil cognitivo del perfeccionismo desadaptativo.
Authors: Chemisquy Sonia
Published: April 2018

El perfeccionismo puede ser entendido como la tendencia a establecer estándares de desempeño elevados y hasta irracionales, a realizar una autoevaluación estricta y rígida, y a medir el valor personal en relación a los logros y/o fracasos. El modelo cognitivo propone la descripción de perfiles cognitivos en los que se incluyen algunos componentes principales como los esquemas, las creencias, las distorsiones cognitivas, los pensamientos automáticos y el afrontamiento. En este trabajo se procuró describir el perfil cognitivo de los perfeccionistas desadaptativos para lo que se realizó una revisión no sistemática de la bibliografía buscando evidencias empíricas de los componentes de ese perfil. Se hallaron evidencias sobre la presencia de esquemas principalmente referidos al dominio de desconexión/rechazo, creencias acerca de la necesidad perfección y la auto-valoración contingente, un sesgo interpretativo de perfección y otros como la atención selectiva y el pensamiento dicotómico, diversos pensamientos automáticos de tipo perfeccionista que se suelen asociar a pensamientos negativos más generales y que perseveran en forma de rumiaciones y autocrítica; y un estilo de afrontamiento enfocado en la emoción que no logra neutralizar las situaciones estresantes. Los lectores encontrar en este artículo información accesible y actualizada útil para identificar objetivos preventivos o de tratamiento.
The association of early postoperative lactate levels with morbidity after elective major abdominal surgery
Authors: Veličković Jelena , Palibrk Ivan , Miličić Biljana , Veličković Dejan , Jovanović Bojan , Rakić Goran , Petrović Milorad , Bumbaširević Vesna
Published: April 2018

Lactate levels are widely used as an indicator of outcome in critically ill patients. We investigated the prognostic value of postoperative lactate levels for postoperative complications (POCs), mortality and length of hospital stay after elective major abdominal surgery. A total of 195 patients were prospectively evaluated. Lactate levels were assessed on admission to the intensive care unit (ICU) [L0], at 4 hours (L4), 12 hours (L12), and 24 hours (L24) after the operation. Demographic and perioperative clinical data were collected. Patients were monitored for complications until discharge or death. Receiver operating characteristic (ROC) curves were used to determine the predictive value of lactate levels for postoperative outcomes. The best cut-off lactate values were calculated to differentiate between patients with and without complications, and outcomes in patients with lactate levels above and below the cut-off thresholds were compared. Univariate and multivariate analyses were used to identify variables associated with POCs and mortality. Seventy-six patients developed 184 complications (18 deaths), while 119 had no complications. Serum lactate levels were higher in patients with complications at all time points compared to those without complications (p < 0.001). L12 had the highest predictive value for complications (AUROC12 = 0.787; 95% CI: 0.719–0.854; p < 0.001) and mortality (AUROC12 = 0.872; 95% CI: 0.794–0.950; p < 0.001). The best L12 cut-off value for complications and mortality was 1.35 mmol/l and 1.85 mmol/l, respectively. Multivariate analysis revealed that L12 ≥ 1.35 mmol/l was an independent predictor of postoperative morbidity (OR 2.58; 95% CI 1.27–5.24, p = 0.001). L24 was predictive of POCs after major abdominal surgery. L12 had the best power to discriminate between patients with and without POCs and was associated with a longer hospital stay.
The Evolving Framework of Determinants of Foreign Direct Investment: A Review of Literature
Authors: Bhasin Rahul , Murthy K V Bhanu
Published: April 2018

The last two decades have witnessed intense competition among countries, particularly developing economies, to attract foreign direct investment (FDI). This is because FDI fills the gap between desired investment and domestic private investment and helps them to acquire new technology and managerial skills. This paper attempts to understand the evolution of FDI theory along with changes in the significance of determinants of FDI over a period of time. An analysis of the extant literature shows that factors such as market size and per capita incomes have remained important determinants of FDI decisions both traditionally as well as in contemporary times. However, some factors such as resources, trade openness and FDI openness have now become secondary factors influencing FDI. Other factors which were earlier secondary but have now gained prominence as FDI determinants are infrastructure; institutional factors such as corruption and political stability; and tax related variables. The above review provides us insights into the changing aspects of FDI decision-making and can provide useful inputs to policy makers regarding the areas which need focus for creating a congenial climate for FDI
MYPG liquid medium v1
Authors: Bonatto Diego
Published: April 2018

Malt extract - yeast extract - peptone - glucose rich medium for yeast growth and maintenance.
Luria-Bertani (LB) liquid medium v2
Authors: Bonatto Diego
Published: April 2018

Rich medium comonly used for Escherichia coli growth and maintenance.
Protocol to accompany paper entitled "Alternative splicing of helicase-like transcription factor (Hltf): Intron retention-dependent activation of immune tolerance at the feto-maternal interface" v1
Authors: G Kaur , RA Helmer , LA Smith , R Martinez-Zaguilan , JM Dufour , BS Chilton
Published: April 2018

Helicase-like transcription factor is regulated by alternative mRNA splicing. Global deletion of Hltf causes perinatal lethality, i.e. 75% die of hypoglycemia <24 hours postpartum. In heart, the full-length Hltf isoform is a transcriptional regulator of Hif-1α that regulates transport systems. Thus, we tested the hypothesis that Hltf deletion in placenta either caused or exacerbated neonatal hypoglycemia via Hif-1α regulation of nutrient transporters. RNA-seq data analyses of the placentome identified significant changes in transcript expression and splicing. The iPathwayGuide tool was used for gene ontology (GO) analysis of biological processes, molecular functions and cellular components. The Elim pruning algorithm identified hierarchical relationships. The methylome was evaluated by Methyl-MiniSeq Epiquest analysis. GO analysis with DAVID identified gene enrichment within biological processes. Protein expression was visualized with immunohistochemistry. Although two Hltf mRNA isoforms are quantifiable in most murine tissues, only the truncated Hltf isoform is expressed in placenta. iPathwayGuide analysis identified targets − 157 genes of 11,538 total genes with measured expression – of the encoded Hltf protein. Hltf deletion altered transcription of trophoblast lineage-specific genes, and increased transcription of the Cxcr7 (p=0.004) gene whose protein product is a co-receptor for human and simian immunodeficiency viruses. Concomitant increased Cxcr7 protein was identified with immune labeling. Hltf gene deletion had no effect on transcription or site-specific methylation patters of Hif-1α, the major glucose transporters, or System A amino acid transporters. There was no measureable evidence of uteroplacental dysfunction or fetal compromise. iPathGuide analysis revealed Hltf suppresses cytolysis (10/21 genes; p-value 1.900e-12; p-value correction: Elim pruning; GO:019835) including the perforin-granzyme pathway in uterine natural killer cells. Our findings 1) identify a functional link between alternative splicing of Hltf and immunosuppression at the feto-maternal interface, and 2) underscore the importance of differential splicing analysis to identify functional diversity in the transcription factor under investigation.
Functional dyspepsia and chronic gastritis
Authors: Uspenskiy Yury P. , Baryshnikova Natalia V.
Published: April 2018

Diseases of upper parts of digestive tract are extremely widespread pathology and have not only the medical, but also social importance since often occur at young working-age people. It is actual to separate the items: functional dyspepsia (FD) and a dyspepsia associated with Helicobacter pylori because it is important for optimization of patient’s treatment. The review of modern foreign and Russian references about treatment of dyspeptic patients depending on existence or absence of an infection of Helicobacter pylori is presented in article (recommendation of V Maastricht consensus, Kyoto consensus, Russian gastroenterological association, Science society of Russian gastroenterologists). At diagnosis of a functional dyspepsia, it is recommended to be guided by the Roman criteria of the IV revision. In with document not only importance of an exception of organic pathology of digestive tract as the reasons of a secondary dyspepsia, but also need of inspection for the purpose of verification of Helicobacter pylori for an exception of an etiological role of a microorganism in development of a dyspepsia is emphasized. Allocation of two clinical options of a functional dyspepsia is also proved from the point of view of approaches to therapy of this disease. Algorithms of treatment of patients with various options of a dyspepsia are presented in article. These algorithms include different schemes of eradication therapy in case of dyspepsia associated with Helicobacter pylori and prokinetics/acid suppressors in case of functional dyspepsia.
Foreign experience in organizing regular pig-gyback service
Authors: Skorchenko Mikhail Yu.
Published: April 2018

The economic crisis being overcome by the Russian economy, on the one hand, combined with the inevitable globalisation processes, on the other hand, brings to the forefront the economic efficiency of technical processes associated with environmental safety and the possibility of introduction into the world system. One example of effective use of innovative technologies in the interaction of transport systems in the world is the piggyback transportation.
Aim: The author has conducted the analysis of international experience of the organisation of the piggyback transportation in order to identify technological solutions suitable for efficient use in the Russian market of intermodal transportation.
Methods: To assess the efficiency of different technological systems, the author uses comparative analysis methods, inductive reasoning, system approach method. The author has also synthesised the world experience in the organisation of the piggyback transportation.
Result: The results of the analysis have revealed that the current economic situation in Russia allows the evaluation of innovative transport systems in the first place in terms of the possibility of rapid return, which draws attention to the most economical technologies. In this regard, the use of the rolling highway and Lift-on – Lift-off (Lo-Lo) piggyback systems seems to be the most rational at this stage.
Conclusion: Since 1990s Russia has made a number of attempts to organise regular piggyback service on certain routes. However, due to the lack of demand for this type of services in the Russian market at the moment, investing in the development of piggyback technology involves high risks. The experience of other countries shows that regardless of the chosen technology, stimulating the demand for innovative "green technologies" is not possible without the participation of governmental bodies. At the same time, the creation of the necessary methodological framework for the organisation of piggyback transportation in Russia is possible by virtue studying the multifaceted world practice of piggyback technology operation in the world.
Hyperreactio luteinalis: benign disorder masquerading as an ovarian malignancy
Authors: P. Kaur P. , . Ashima , R. Isaacs , S. Goyal
Published: April 2018

Hyperreactio luteinalis (HL) refers to pregnancy related moderate to marked enlargement of the ovaries due to multiple benign theca lutein cysts. It is caused due to elevated Human chorionic gonadotropins leading to maternal complications such as preeclampsia and preterm delivery may result. We report case of a 24 years old lady, G3P1A1L1 with spontaneous twin pregnancy at 13 weeks + 4 days gestation presented with chief complaint of lower abdominal pain on exertion for 5 days. Ultrasonography (USG) showed a large left ovarian mass in Pouch of Douglas pushing uterus up and extending into the left side of midline upto costal cartilage. It showed multiple thick septations with vascularity pointing towards malignancy. CA-125 was elevated to 193U/ml. Laparotomy was undertaken. Intraoperatively, bilateral huge, congested, bosselated, multicystic ovarian masses were present which replaced normal ovaries and appeared malignant. Bilateral oophorectomy was done. Specimens received for histopathological examination comprised of two large multilobulated, dark brown, ovarian masses with intact glistening capsule. Serial sections through both the masses showed thin walled, multiloculated cysts with smooth inner lining, filled with thin clear to hemorrhagic fluid. On microscopic examination diagnosis of Hyperreactio luteinalis, bilateral ovarian masses were made. HL can be misinterpreted on USG or laparotomy as ovarian malignancy resulting in unnecessary surgical intervention.
Is there is a role for laparoscopy for treatment of appendicular mass?
Authors: Mohammed Asem F. , Shaheen Mahmoud A. , Eldesouky Mahmoud S.
Published: April 2018

Background: The surgical intervention for acute appendicitis presenting with appendicular mass is not well established. The aim of this study was to evaluate the benefits of early laparoscopy and laparoscopic appendectomy (LA) in the treatment of appendicular mass.Methods: During a 1-year period, 48 patients underwent LA for suspected appendicitis (n = 39), generalized peritonitis (n = 1), and an appendicular mass (n = 8).Results: All appendectomies were attempted and done laparoscopically except in one case (appendicular abscess), converted to an open approach. None of appendicular mass patients developed complications. There were no deaths. There was no significant difference between appendicular mass forming patients and non-mass-forming patients who underwent LA for an early appendicular mass as regard to the operative time (median [interquartile range]: 50 [36–60] vs 45 [25–50] min, p = 0.085) and postoperative hospital stay (median [interquartile range]: 2 [1–2] vs [1–2] days, p = 0.1).  Conclusions: Early LA for appendicular mass patients is feasible, safe, and avoids misdiagnoses and the need for hospital readmission.
Low endogenous testosterone level is associated with high-risk prostate-specific antigen level in men with prostate cancer disease
Authors: Amadi Collins , Odum Ehimen P. , Aleme Benjamin M.
Published: April 2018

Background: Low serum testosterone levels is hypothesized to predict adverse outcomes in prostate cancer patients. This study was structured to investigate this hypothesis using high-risk serum prostate-specific antigen as a marker of adverse outcome of the disease.Methods: This was a retrospective analysis of serum total testosterone (TT) and total prostate-specific antigen (PSA) records of prostate cancer patients in a tertiary hospital in Nigeria. Records of age, serum TT, and serum PSA test results from 1st January 2008 to 31st December 2017 were acquired from laboratory and medical records and analyzed with SPSS software version 20.   Results: The records of 450 men with prostate cancer were recruited for the study. The majority (56.7%) of the study cohorts were between 70 to 79 years of age. Hypogonadism was observed in 34.7% of the study cohort. The hypogonadal patients had higher PSA values compared to the eugonadal patients (p<0.001). Lower testosterone values were observed in patients with high-risk PSA levels (p<0.001). Strong significant negative correlations were observed between total PSA and endogenous testosterone within the overall study cohort (r= -0.792; p< 0.001), the hypogonadal group (r= -0.615; p < 0.001), and among the high-risk PSA group (r= -0.632; p< 0.001).     Conclusions: The findings of this study suggest low, rather than high, endogenous testosterone in prostate cancer disease is associated with high-risk PSA levels which implies adverse outcome in prostate cancer patients. However, further studies are warranted to confirm this association.
Blunt Chest Injury: epidemiological profile and determinant of mortality
Authors: Okonta Kelechi E. , Ocheli Emmanuel O.
Published: April 2018

Background: The identification of the epidemiological profile and the determinants of mortality for blunt chest injuries (BCI) ensures the proper documentation of susceptible patients, and the implementation of strategies for prompt and improved patients’ care.Methods: This is a prospective study for a 4-year period at two tertiary hospitals in Nigeria. The inclusion criteria were patients who had BCI, did chest radiograph and admitted for treatment. The statistical software for analysis was SPSS version 22 and using Pearson’s X2 and spearman’s X2 for correlation of mortality with the Injury Severity Score (ISS), Glasgow Coma Scale(GCS) and Hemi-thorax affected. The p-value was significant at <0.001.Results: I One-hundred and twenty-six (52.3%) of 241 patients had BCI, the average age was 40.4years with a range of 0.8-79years.There were 104 (82.5%) male with a ratio of 4.7:1. Most patients 86(68.3%) were between 19-59 years of age, 85 (67.5%)were unskilled workers and 57 (45%) had no formal education. Most 66.7% of the injuries occurred in the first half of the year with a peak (16.3%) in March. Mondays and Fridays,and, morning hours were the peak periods. BCI was by motor vehicular accidents 94 (74.6%), falls 28 (22.2%), and other causes 4 ((3.2%). The associated injuries were extremities 25(19.8%,), cranio-spinal injuries 17(13.5%) and blunt abdominal injuries13 (10.3%). Eleven (8.7%) patients died within one-month of admission. The determinants of mortality were high ISS (p<0.001), severe head injury (p<0.001) and bilateral chest injury (p<0.001).Conclusions: The contribution of falls to BCI is on the increase with BCI occurring at periods of increased activities like Mondays, Fridays and morning hours.The determinants of mortality were high  ISS ,severe head injury and bilateral chest injury.
Comparative study between open and laparoscopic lymphadenectomy (pelvic and para-aortic) in gynecological malignancies
Authors: Yassin Hytham R. , ALShakhs Soliman , Hamed Mohammed , Karam Adel , Mouneer Mohammed
Published: April 2018

Background: Objective of present study was to compare the results of lymphaenectomy (pelvic and para-aortic) between laparoscopy and laparotomy in gynecological malignancies.Methods: Authors analyze the results of 30 patients suffering from gynecological malignancies (Enometrial, Ovarian and cervical) submitted to surgery as apart of treatment. Patients were classified in Two Groups Group (1) included15 patients were submitted to open radical surgery and group (2) included 15 patients Were submitted to laparoscopic radical surgery between May 2016 and October 2017.Results: In present comparative study, there was significant difference regarding intra operative blood loss, operative time and post operative hospital stay (P<0.001) and there was no significant difference regarding intra-operative complications, post-operative complications, total number of lymph node harvested, number of positive lymphnodes (P>0.05).Conclusions: Laparoscopic lymphadenectomy is a technically feasible and safe procedure. Authors recommend further study in large number of patients with longer duration and follow up period for assessment of oncological out-come.
Audit of Surgical management and outcome of colorectal cancer at B.P.KI.H.S., Eastern Hospital of Nepal: an institutional review
Authors: Sah Suresh Prasad , Gupta Rakesh Kumar , Karkee Rikesh Jung , Gupta Mukesh Kumar , Paudel Poonam
Published: April 2018

Background: Colorectal cancers (CRCs) are the third most commonly diagnosed cancer in human and major public health problems worldwide. The number of people afflicted with cancer is increasing in the country, and if the trend continues, cancer could soon be among Nepal’s main killer diseases. The purpose of this study was to know the management and outcome of colorectal surgery for colorectal cancer at our centre.Methods: The study was conducted in the Department of Surgery, B.P.K.I.H.S. Dharan, after ethical approval from institutional ethical review board. All patients of colorectal cancer who were operated in our hospital, between 15th June 2012-15th June 2017 (5 years) were included in this study. Each patient’s medical record was reviewed retrospectively. Data on the patients presenting complaints, disease status, radiological findings, treatments provided, co morbidities, operative details, postoperative mortality and morbidity, histological results, outcomes and follow up was retrieved from the available case record files and was recorded in predesigned performa. Only histopathological confirmed cases were included in the study.Results: Total of 109 patients of colorectal carcinoma was registered in our hospital in last five years but only 69 patients underwent curative colorectal surgery at our centre. Out of 69 patients, 41(59.42%) were male and 28(40.58%) were females. The range of the age was 22 to 86; the median age at the diagnosis was 56.5 years. Out of 69 patients, 19 patients underwent right sided hemicolectomy, 12 patients underwent left sided hemicolectomy, 29 patients underwent anterior resection (high/low) and 9 patients underwent abdominoperineal resection. About 95.42% cases were adenocarcinoma on histology. The overall morbidity and mortality were 21.52% and 8.45% respectively.Conclusions: Colorectal cancer is common cancer and there is increasing trend. We believes that until and unless a population-based cancer registry is created and maintained, it will be difficult to project the exact number of people living with colorectal cancer and the necessary measures to be taken.
Primary reconstruction of depressed skull fracture
Authors: Khan Arshad , Shrivastava Nishant , Pal S. S.
Published: April 2018

Background: Depressed fracture poses a specific challenge to neurosurgeon. Aim of our study is to analyze benefits of primary reconstruction of depressed skull fracture and to compare various methods of fracture reconstruction with that of titanium miniplates The concept of primary reconstruction was to close the defect and preserve the anatomical barrier, to avoid later crainoplasty and to prevent further complications like CSF leak, pneumocephalus, brain fungus and meningitis etc. The second reason for rigid fixation was to achieve good cosmetic results.Methods: This is observational study carried out in Department of General Surgery, Hamidia hospital Bhopal on 36 patients over period of 18 months from January, 2016 to July, 2017.Results: : Depressed skull fracture is more prevalent in second and third decade of life with male to female ratio of 5:1 . Most of the patients (72%) presented with open fracture skull and majority of them (89%) presented with underlying brain injury. Out of total 36 patients of depressed fracture skull, 18 patients (50%) underwent fixation with titanium miniplate and rest underwent fixation with nylon suture, Poly-L-Lactide and primary elevation of depressed skull fracture. The correction of deformity was more than 90% compared to contralateral side and better cosmetic results were obtained on patients treated with titanium mini-plates. Post operative infection rate was nil in patient treated with titanium mini-plates compared to 8.2% of total infection rates in patients treated with other methods.Conclusions: The concept of primary reconstruction of depressed skull fracture to achieve better cosmetic results and minimum post operative complications. Cosmetic results that were obtained with titanium mini-plates were excellent with nil post operative infection rates and complete neurological recovery. Hence titanium mini-plates are cost effective and better than any other methods.
Varicose vein surgery stripping method compared to radio frequency ablation
Authors: Potula Vigna Sai
Published: April 2018

Background: This randomised study was conducted to evaluate clinical, patient based outcomes after RFA and conventional surgery in a selected population.Methods: This study was conducted in the Meenakshi Medical College Hospital and Research Institute, Enathur, Kanchipuram, Tamil Nadu, India.Results: In present study, it was reported that 150 patients in total were assessed in the study, out of which, 110 were randomised, 100 underwent the intervention as a daily procedure. 50 patients underwent RFA and 50 patients had conventional surgery. In group R, males were 15, females were 35; in group C, males were 17 and females were 33. In CEAP classification, in C2 class, there were 40 in group R, 39 in group C; in C3 class, there were 8 in group R, 6 in group C; in C4-6 class, 2 were in group R and 5 were in group C. The highest total clinical severity score was 1 i.e. 30 in group R and  32 in group C. Highest venous disability score was in 1 i.e. 46 in group R, 42 in group C. Main outcomes after RFA and conventional surgery for great saphenous varicose veins. Theatre time was 80 mins in group R, 52 mins in group C, procedure time was 74 mins in group R, 46 mins in group C, pain in first week (VAS score) was 1.5 in group R, 3.5 in group C, duration of analgesia was 3 days in group R, 11 days in group C, in 4 days group R patients returned to normal activity, in 13 days group C patients returned to normal activity. Numbness/reduced sensation was followed up after 1 week and 6 week, in group R, 8 patients and in group C, 16 patients have shown numbness/reduced sensation after 1 week; 6 patients in group R and 14 patients in group C have shown numbness/reduced sensation after 6 weeks.Conclusions: This study concluded that compared to conventional surgery, RFA took longer time to perform but it gave better and significantly early outcome in patients with varicose veins.
Tumescent versus non-tumescent technique in skin graft healing: a cross-sectional study
Authors: Koujalagi Ramesh , Uppin V. M. , Pawar Rajesh , Patil Vaibhav Avinash
Published: April 2018

Background: Skin grafting, especially burn surgery, is associated with great blood loss. Tumescent technique is the subdermal injection of fluid containing a vasoconstrictor prior to burn wound surgery to reduce blood loss. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. Although adrenaline is widely used, its local and systemic effects vary from patient to patient. The object of the present study was to observe the efficacy of tumescent technique, using adrenaline, versus non-tumescent technique in the healing of split thickness skin graft donor day 10.Methods: Two treatment groups of patients, tumescent (group A, n = 45) and non-tumescent technique (group B, n = 45), who fulfilled the inclusion criteria were randomly assigned. Tumescent technique involved administration of 1 mg (1:1000) adrenaline in 500 mL of saline. No prior administration of agent was performed in non-tumescent technique. Split-thickness skin grafting was carried out followed by regular inspection of the donor site. Healing rate was recorded at the postoperative day 10 by performing wound tracing technique and evaluated by performing unpaired t-test. P <0.05 was considered as statistically significant. Results: The mean age of patients was 29.98±12.6 years in group A and 45.36±10.23 years in group B. Age distribution was concentrated between 18 and 38 years. On postoperative day 10, complete epithelialization was observed in 15.56 % and 6.66% of patients in group A and B, respectively. Compared to the patients in group B, patients who underwent tumescent technique (group A) had higher healing rate (>80%, p=0.0134). Evidence of infection in the donor site was absent in both the groups.Conclusions: Tumescent technique by using adrenaline is more effective than non-tumescent technique in the healing of donor site and can be implemented preoperatively in split-thickness skin grafting.
Effect of varicocelectomy on seminogram in patients with clinical varicocele
Authors: Chhabra Tulit , Dalal Satish , Prakash Sant , Nara Nityasha , Bhatia Chisel , Beniwal Jagat Pal
Published: April 2018

Background: Despite various studies published in the recent years, efficacy of varicocelectomy and its influence on semen parameters, particularly sperm count, motility and morphology has not yet been determined. Conflicting results obtained in different studies, accounts for sparked interest in varicocele management and its effects on seminal parameters. Therefore, present study was designed in an attempt to evaluate the effect of varicocelectomy on the semen parameters by analyzing reports that included men with varicoceles who had both preoperative and postoperative semen examination done.Methods: The present prospective study enrolled fifty patients. Varicocele was graded by Dubin grading system by palpation in standing and during Valsalva maneuver under adequate exposure and illumination. Macro and microscopic assessment of semen samples was carried out according to WHO guidelines. The surgical approach used for varicocelectomy was inguinal (Modified Ivanissevich procedure).Results: Significant improvement in semen parameters viz sperm counts/ml, sperm counts/ejaculate and sperm motility were observed after varicocelectomy. We noted no effect of patient’s age on the degree of improvement in semen parameters post operatively. Preoperatively, men with Grade III varicoceles had lower sperm counts and sperm motility, but significant improvement was observed post-operatively compared to men with Grades I and II varicoceles.Conclusions: Our study supports the fact that, varicocele exerts a deleterious effect upon sperm motility, concentration and repair of varicocele leads to improvement in these seminal parameters. The repair of larger varicocele seems to be a predictor for better post-repair semen parameters. Varicocele is a treatable cause of male infertility (primary and secondary), so patients undergoing varicocelectomy should have a pre-operative and post-operative semen examination done routinely.
The experimental study on the tubularized incised plate (tip) urethroplasty in children on the central India
Authors: Mane Shobhita K. , Kumar Santosh
Published: April 2018

Background: The main objective of the present study is assessment of the tubularized incised plate (TIP) urethroplasty. The present study was done in experimental research design.Methods: We had started Tubularized incised plate urethroplasty as developed by Warren Snodgrass in all boys having coronal sub-coronal, distal, mid, and proximal hypospadias where urethral plate is intact.Results: Out of 37 patients 17 patients developed fistulas at different sites, 10 patients had coronal fistula, 2 distal penile and one mid-shaft fistula. 2 patients who had fistula closure with urethroplasty for distal urethra by TIP developed reopening of fistula. 7 patients had thinning of stream out of which 3 patients developed immediate post-operative. It was managed by meatal dilatation. 4 patients complained thinning of stream after l0 days to one month. All patients were advised meatal dilatation. Stream improved later on in 6 patients. In 7 patients fistulas also closed spontaneously.Conclusions: It is also found and concluded that the total number of the complication rate between primary and re-operative in TIP method is very low; it means TIP method is very useful and effective.