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  • ISSN: 2379-0911
    Early Online
    Volume 7, Issue 1
    Review Article
    E. Scott Sills* and Samuel H. Wood
    Prompt diagnosis of tubal ectopic pregnancy (EP) is now usually possible before rupture and catastrophic hemorrhage, yet if unrecognized, EP remains an obstetrical emergency with high maternal mortality. Long considered unsalvageable, the EP itself is incidentally terminated during treatment to save the life of the mother. Of note, the embryo ploidy error rate in EP is thought to be comparable to intrauterine gestations. As operative experience with EP has increased, rare cases have been documented where scattered trophectoderm foci occasionally escape and successfully migrate to secondary extrauterine sites following surgical removal of the primary lesion. From this sequence, the following insights are possible: 1) that trophectoderm developed well beyond the stage for in vitro culture retain the capacity to tolerate mechanical, thermal, and/or hypoxic stress of standard EP surgery, and 2) that the ectopic so dislodged is sufficiently tenacious for attachment to atypical surfaces never physiologically matched to support pregnancy (e.g., omentum, peritoneum, ovarian epithelium, etc). In this report, these features are exploited to outline an experimental surgical and laboratory protocol to facilitate ectopic-to-eutopic (E2E) pregnancy transposition. At least three relevant issues push against the limits of present technology: 1) Optimal atraumatic removal of the ectopic implant site is unsettled; 2) Once the gestational sac is exteriorized, temporary in vitro culture support will be needed with microsurgical modification to maximize subsequent graft uptake in the awaiting maternal endometrium; 3) The best method and equipment for fresh transfer of a relatively large, complex embryo is undefined. Recent progress in reviving tissue for heterologous heart transplant—even after confirmed cardiac death of the donor—suggests that estimating success with ectopic recovery, processing, and reimplantation could depend on factors besides embryo cardiac potential and gestational sac status. Parallel advances in layered tissue allografting, in utero microsurgery, and wound healing along with in vitro perfluorocarbon-based embryo oxygen support; endometrial preparation and embryo transfer techniques borrowed from IVF promote consideration for how selected EPs may be relocated to the womb. The E2E procedure thus explores the shared terrain of tissue harvest/resuscitation, organ transplant, vascular engraftment and advanced reproductive technology domains. Rescue will not be possible for every EP case, and extensive investigational work in animal models will be required to establish inclusion criteria before the concept is ready for clinical use.
    Case Report
    Pablo Weber Alvarez*, Alejandro Weber Sanchez, Carlos Ricardo Rueda Alvarado, Maria Josefina Marín y Dorado
    Congenital deformities that cause limb overgrowth in childhood have multiple genetic and environmental etiologies. One of them is the Klippel-Trenauney-Weber syndrome (SKT), a rare condition characterized by blood vessel, soft tissue and bones abnormalities, which may affect structures like fingers toes or the hole limb, and may worsen preexisting deformities such as clubfoot. We present the case of a 9-year-old patient with SKT and congenital cubfoot.
    Short Communication
    Rhys George*, Richard John Lyon, and Philip Ng Cheng Hin
    Background: Acute appendicitis is the most common abdominal surgical emergency, yet its diagnosis remains difficult with high negative appendicectomy rates (NAR) reported throughout the United Kingdom (UK). High NARs are associated with increased risk of morbidity. Recently guidelines have suggested the use of preoperative imaging modalities to reduce this; however these are not routinely followed in the UK. Our aim was to assess the effects of preoperative imaging on the NAR.
    Methods: Retrospective cohort study of all appendicectomies at a London District General Hospital over a one-year period. Examining histological data taken from tissue intraoperatively and examining reports of imaging conducted prior to operation.
    Results: The total NAR was calculated at 25.54%. Females had a higher NAR. (35.82% Vs 15.97%) (p<0.05). No significant difference in the NAR was seen between patients who underwent preoperative imaging and those who did not (21.53% Vs 26.12% (p=0.8908)).
    Conclusion: The use of preoperative imaging in our centre does not alter the NAR. The high rate of inconclusive ultrasound reports could contribute to this. UK guidelines for the secondary care management of suspected appendicitis are needed to reduce the NAR; careful consideration for the use of preoperative imaging should be used whilst conducting these guidelines.
    Fatih Can Karaca*
    Background and aim: The tissue undergoes wound healing processes following the surgery, with various cell populations serving during different processes. The aim of the current study was to analyze the cell populations present in the drainage fluid collected from the patients who underwent laparoscopic sleeve gastrectomy (SG) and analyze cell subsets using a flow cytometry-based approach.
    Materials and methods: The study subjects were patients who operated for laparoscopic SG, with a BMI of =35 kg/m2 and without any known comorbidities that might lead to intra- and postoperative complications. Draining fluid from the plastic chamber was collected in a 200 mL sterile plastic container for two days during the postoperative period. The monoclonal antibodies were utilized for the determination of cell sub-populations in the flow cytometry.
    Results: The patient population consisted of 8 male and 8 female patients with a mean age of 38.6±14.2 years. The neutrophils were the predominant cell type in the postoperative period. The percentage of the monocytes and lymphocytes significantly decreased on postoperative day 2 (p<0.01 and p<0.05, respectively). T lymphocytes were the predominant lymphocyte population in the drain fluid samples during the postoperative period.
    Conclusion: There is a strong presence of neutrophils on the surgery site, and the monocyte concentration significantly decreased on the postoperative second day. We suggest that the transformation of monocytes to the tissue macrophages during the wound healing process affected the monocyte ratio. T lymphocytes were the predominant population in the among the lymphocytes during the postoperative period.
    Mohammed Abdullah Alawad Abdullah*, Mugtaba Elsheikh Ibrahim, Reem Mohammed Hassan, and Nesreen Khidir
    Desmoid tumors are benign neoplasms that can often arise from the abdominal wall. We report the case of an abdominal wall desmoid tumor in a female patient with a history of one cesarean section. Surgical resection of the mass was done with wide excision and safe margins. Histopathology confirmed the diagnosis of desmoid tumor.
    Case Report
    Mohammed Abdullah Alawad Abdullah* and Nesreen Khidir
    Trichobezoar occurs in patients with psychological irresistible urge to pull and ingest hair from different parts of the body. Extension of trichobezoar to the duodenum and small bowel is called Rapunzel Syndrome. An18-year-old patient presented with mild abdominal symptoms and no clinical signs of peritonitis. Radiological investigations revealed huge pneumoperitoneum on CT scan but no free intraperitoneal fluid. Hybrid laparoscopic excision and closure were done. The case was complicated by dumping syndrome and leak. Re-operated with primary re-suturing of the leak. In conclusion, Rapunzel Syndrome can present with massive pneumoperitoneum only. Dumping syndrome can complicate the surgical treatment of Rapunzel Syndrome. Our patient had complications of wound infection, leakage and burst abdomen. Psychiatrist’s involvement is mandatory.
    Olga Haakman, George A. Vilos, Angelos G. Vilos, Tina Liang, Nancy G. Chan, and Basim Abu-Rafea*
    Struma ovarii is a rare, monodermal variant of mature ovarian teratoma predominately composed of mature thyroid tissue. It is usually diagnosed on histopathology following removal of an adnexal mass. Co-occurrence of endometriosis and Struma ovarii has been described in two case reports with no cases described of this entity co-existing with endometrioma in the same ovary in the absence of a dermoid cyst. A 47-year-old patient presented with a history of Stage IV endometriosis. Following laparoscopic oophoro-cystectomy, on histopathology assessment, Struma ovarii was diagnosed within an endometrioma. The patient had a normal TSH and CA-125. She recovered well post operatively and is seeking further fertility treatments using donor oocytes. This case presents the unique finding of Struma ovarii co-existing with endometrioma in the same ovary.
    Research Article
    Thamer A. Hamdan*, Nazar Haddad, and Ahmad A. Akbar
    Background: Preoperative nutritional status reflects a patient’s ability to successfully undergo physically demanding surgical procedures, resist infections and heal of surgical incisions. Serum albumin, transferrin and total lymphocyte count are all nutritional biomarkers that are used to assess overall nutritional status. Malnutrition is frequently not identified during preoperative preparation of individuals who will undergo spine surgery.
    Patients and methods: The prospective study which was conducted in the department of orthopedic surgery from March 2018–September 2019. A total of 48 patients that presented to the orthopedic department in Basra Teaching Hospital and Ibn-Albaitar private hospital had spinal lumbar surgery .The patients were investigated in form of total lymphocyte count, serum albumin, and serum transferrin preoperatively and at postoperative days 3, and 16th. The results and post-operative complications were recorded, and compared with pre-operative results.
    Results: The patients was divided into two groups : Group(A) whom developed complications labeled as symptomatic patients were 5 (10.5%), 2 patients with spinal infection (discitis), 1 patient with delay wound healing, 1 patient with seroma formation and 1 patient with surgical site infection and group (B) labeled as asymptomatic whom not developed complications. From the total patients (48), preoperative investigations showed 8(16.6%) had low S. Albumin, 7 (14.5%) had low S. Transferrin, and 3 (6.2%) had low total lymphocyte count. In the symptomatic patients (n=5) 4 (80%) had low S. Albumin, 2 (40%) had low S.Transferrin and 1 (20%) had low total lymphocyte count.
    Conclusions: Hypoalbuminemia is a risk factor for postoperative surgical site infection and wound healing problems.
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