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  • ISSN: 2379-0911
    Volume 4, Issue 3
    Short Communication
    Liapakis IE*, Christopoulos A, Tzouganakis AC, and Paschalis EI
    Parry-Romberg syndrome is a degenerative disease characterized by progressive hemifacial atrophy of the skin, muscle and bones of the forehead, eyes, mouth, nasolabial crease and the upper/lower maxilla. It causes skin hyperpigmentation and trigeminal neuralgia. The syndrome has higher prevalence in women between the ages of 5-15 and it stabilizes within 2-10years. It results in significant facial deformity, which affects the patient's self esteem and social appearance.
    Aim of the study: We present a case of Parry-Romberg syndrome with facial deformity that was treated with lipofilling and bleaching of the skin using a modified "Kligman's formula" cream. Materials and Methods: A 21years old female with left hemifacial atrophy was diagnosed with Parry-Romberg syndrome at age of 15, which has been stable for the last 2years. The patient was treated with lipofiling of 20cc of fat in the left forehead, nose, nasolabial crease, cheek, and mental region. Treatment of skin hyperpigmentation performed for 1 month every night (to eliminate the erythema), using a modified "Kligman's formula" cream with added 5% ascorbic acid and applied gradually to the skin: the 1st week applied 1hour before sleep, the 2d week 2hours before sleep, the 3d week 3hours before sleep and the 4th week all the night long. The day after and every day after the treatment, a hydration/sun care cream (with SPF over 30) applied to the skin in order to eliminate the irritation/dehydration of the skin.
    Results: The appearance of the hemifacial atrophy and skin hyperpigmentation was significantly improved using lipofiling and the bleaching cream. We followed the patient 6 months after the procedure, since there is no evidence that more time is needed to evaluate the stability of the results. No complications occured during and after the procedure.
    Conclusion: Facial deformities derived from Parry-Romberg syndrome can be successfully treated with fat transfer and bleaching of the skin. More studies are required to demonstrate the efficacy of this procedure.
    Mini Review
    Daisuke Kanamori* and Jyoji Yoshizawa
    Since laparoscopic percutaneous extra peritoneal closure (LPEC) was introduced as a treatment for pediatric inguinal hernia in 2000, the procedure has been the most common surgical technique for repairing pediatric inguinal hernia in Japan. Research date shows that LPEC and conventional open repair have equivalent rates of recurrence and of postoperative complications. In addition, if contra lateral patent processes vaginalis (CPPV) is confirmed, prophylactic contra lateral LPEC is useful for preventing metachronous contra lateral hernia (MCH). Recently, reduced-port surgery has been adopted throughout the laparoscopic surgery field. Two improved LPEC techniques, known as single-incision laparoscopic percutaneous extra peritoneal closure (SILPEC) and percutaneous internal ring surgery, are not significantly different from LPEC in operating time, intra operative complications or recurrence. Finally, the learning curve for surgical residents to perform the LPEC technique safely without supervision is more than 30 cases. Thus LPEC is an acceptable alternative to conventional open repair.
    Case Series
    Victor Valenti*, Carlota Tuero, Patricia Ahechu, Javier A. Cienfuegos1, Rafael Moncada, Manuel F. Landecho, Maria Teresa Chiquito, Gema Frühbeck, and Fernando Rotellar
    Background: Routine preoperative upper gastrointestinal endoscopy (UGE) for bariatric surgery is still controversial. The optimal assessment for upper gastrointestinal tract in bariatric patients is not well defined although the prevalence of clinically relevant lesions found on the UGI is described in some observational studies.
    Methods: The present study highlights the clinical usefulness of preoperative UGE based on two real cases taking place in our practice.
    Results: Preoperative routine UGE prior to laparoscopic revisional surgery and gastric bypass surgery, showed adenocarcinoma in asymptomatic patients changing the initial surgical bariatric approach to an Oncological surgery.
    Conclusions: Preoperative routine UGE for bariatric surgery has a high diagnostic significance and low cost in relation to its effectiveness. Since, findings with this conventional exploration allow changes in the therapeutic strategy and also provide an adjustable treatment to every patient, preoperative routine UGE should be recommended.
    Case Report
    Marta Afonso Nogueira*, Luisa Moura Branco, Ana Galrinho, Alvaro Laranjeira, Jose Alberto Oliveira, Ana Agapito, Jose Fragata, and Rui Cruz Ferreira
    The etiology of ascending aortic aneurysms includes genetic, degenerative, inflammatory and infectious causes. We present a case of a 49 year-old male patient without any known cardiovascular risk factors, who presented mainly with fatigue of increasing severity. The physical examination revealed a grade IV decrescendo, blowing aortic diastolic murmur, as well as an Austin Flint murmur and water hammer peripheral pulses. Imaging methods (echocardiography and computed tomography angiography) showed a large (8.6 cm) ascending aortic aneurysm with corresponding severe aortic insufficiency. In this context, he underwent surgical implantation of an aortic tube graft and mechanical prosthesis in aortic position, with good final result. Surprisingly, the histopathological diagnosis of the surgical specimen was compatible with atherosclerosis.
    Research Article
    Michinobu Ohno, Masao Endo*, Masayoshi Mori, Hirofumi Tomita, Fumiko Yoshida, Toshihiko Watanabe, and Miwako Nakano
    Purpose: High ligation of the patent processus vaginalis (PPV) as basis of the treatment of indirect inguinal hernia in pediatric patients is not applied to adults. Instead, the popular options are the laparoscopic transabdominal preperitoneal (TAPP) approach or totally extra peritoneal (TEP) approach. We developed a unique technique to achieve laparoscopic completely extra peritoneal closure (LPCEC) of the PPV and have applied it to adolescent and adult patients on patient’s demand. The purpose of this paper is to introduce our initial experience with LPCEC in adolescents and adults and evaluate their outcomes.
    Material and methods: This report includes 20 patients over 15 years of age with indirect inguinal hernia consecutively experienced since 2004. The medical records of these patients were analyzed in terms of intra operative findings of the internal inguinal ring (IIR), rates of contralateral patent processus vaginalis (cPPV), operation time, complications, postoperative recurrence rates, and rates of metachronous contralateral inguinal hernia (MCIH).
    Results: There were 13 males and 7 females; 11 with right unilateral, seven with left unilateral and two with bilateral hernias. Ages ranged from 15 years to 67 years with an average of 23.4 years. Three males had an episode of open herniorrhaphy on the contralateral side during childhood. One male patient had a direct hernia on the contralateral groin. The two oldest patients were associated with omental incarceration. One male presented with bowel loop incarceration. The procedures were completed successfully without complications in all of the patients. The mean operation time was 45 minutes for unilateral and 53 minutes for bilateral hernia, respectively. No recurrence and MCIH has been noted. No patients reported postoperative chronic groin pain.
    Conclusions: The advantages of our LPCEC include technical ease, short operation time, minimal invasion, preservation of reproductive systems, rapid return to daily activities and low recurrence rate. The LPCEC is a feasible alternative to the TAPP and TEP for the repair of inguinal hernia in adolescents and adults, when the diagnostic laparoscopy via umbilical port defines the inguinal hernia as indirect.
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