Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options

With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular ( < 10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

comparative study between appendicitis inflammatory response score and alvarado score in the diagnosis of acute appendicitis

Background: appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. Despite diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical emergency and is one of the most common causes of acute abdominal pain and one of the most frequent surgical complains in the emergency room

Aim of the Work: the aim of this work was to compare the Appendicitis Inflammatory Response Score to the traditional Alvarado score to determine which is more accurate in the diagnosis of acute appendicitis

Patients and Methods: this descriptive prospective study was carried on 50 patients admitted to the surgical ER of Rashid General Hospital from December 2017 to April 2018 complaining from right lower quadrant pain between the age of 5 years old and 70 years old. All 50 patients had lower quadrant abdominal pain with suspicion of having acute appendicitis, all of them were thoroughly examined and both Alvarado Score and Appendicitis Inflammatory Response Score were applied to all of them, patients with moderate to high probability of having appendicitis [Alvarado Score = 7 or higher, AIR = 8 or higher] underwent open appendectomy and then the resected appendices were sent for histopathology to confirm the diagnosis

Results: the total number of cases with confirmed diagnosis of acute appendicitis by means of post-operative histopathology in our study was 46 out of 50 patients, the AIR score had sensitivity of 95.65% while the Alvarado score had sensitivity of 91.3%

Conclusion: this study demonstrates that the Appendicitis Inflammatory Response Score [AIR] appears to be more accurate than the Alvarado score, easy-to-use and reliable when dealing with a case of right lower quadrant pain with the suspicion of acute appendicitis and can help reduce the negative appendectomy rate

The impact of magnesium sulfate as adjuvant to intrathecal bupivacaine on intra-operative surgeon satisfaction and postoperative analgesia during laparoscopic gynecological surgery: randomized clinical study

BACKGROUND: Surgeon satisfaction and patient analgesia during the procedure of laparoscopic surgery are important issues. The aim of this work was to study if an intrathecal (IT) Bupivacaine combined with Magnesium sulfate may or may not provide good surgeon satisfaction in addition to improvement of intraoperative and postoperative analgesia. METHODS: Sixty female patients were enrolled in this prospective, randomized, double-blind controlled clinical trial study. All patients were operated for gynecological laparoscopic surgery under spinal anesthesia. Patients were divided into two groups (Bupivacaine and Magnesium). Group Bupivacaine (30 patients) received intrathecal Bupivacaine 0.5% only (15 mg), while 30 patients in group Magnesium received intrathecal Bupivacaine (15 mg) in addition to intrathecal Magnesium sulfate (50 mg). The sensory block level, the intensity of motor block, the surgeon satisfaction, the intraoperative visual analog scale (VAS) for pain assessment, the postoperative VAS, and side effects were recorded during the intraoperative period and within the first 24 hours after surgery in the post-anesthesia care unit. RESULTS: Surgeon satisfaction, intraoperative shoulder pain, postoperative pain after 2 h, and perioperative analgesic consumption (ketorolac) were significant better in group Magnesium than in group Bupivacaine. (P < 0.05). The onset of motor and sensory blocks was significant longer in group Magnesium than the other one. The incidence of PONV, pruritus and urinary retention was insignificant statistically between both groups. CONCLUSIONS: Magnesium sulfate if used intrathecally as an adjuvant to Bupivacaine would provide a better surgeon satisfaction and would improve the analgesic effect of spinal anesthesia used for gynecological laparoscopic surgery.

Is LASIK an effective treatment modality for hyperopia or hyperopic astigmatism?

Purpose: To assess the efficacy, safety and stability of LASIK surgery for treatment of low to moderate degree hyperopia and hyperopic astigmatism

Patients and methods: The study included 34 eyes in 17 patients [7 males, and 10 females] with bilateral low to moderate degree hyperopia or hyperopic astigmatism. Their mean age +/- SD was 26.7 +/- 4.1 years. Range of hyperopia was between +1.75 to +5.50 D, astigmatic errors range was 0.00 to -1.50 D while the spherical equivalent refraction ranged from +1.4 to + 4.8 D. Patients included in this study had a stable refraction for at least one year. All patients underwent bilateral LASIK surgery in the same session in Dr Soliman Faqeeh Hospital [DSFH] and the Eye Subspecialty Center [ESC]using the ALLEGRETTO EYE - Q Excimer Laser machine

Results: UCVA after one year was 20/20 or better in 30 eyes [88.2%], 20/30 or better in 32 eyes [94.1%] and 20/40 or better in 34 eyes [100%], while BCVA was 20/20 or better in 33 eyes [97.1%] and 20/40 or better in 34 eyes [100%]. There was no decrease in UCVA after LASIK surgery. One eye [2.9%] showed 2 lines drop in BCVA after LASIK surgery due to broad wrinkles of the flap. The flap was lifted after one day; trial to flatten the wrinkles showed incomplete resolution. One eye [2.9%] showed diffuse lamellar keratitis [DLK] at one week after LASIK surgery. There was regression in the manifest spherical equivalent refraction one year after LASIK surgery as compared with that at one month, but the difference was statistically insignificant [P=O.46]. The mean score of patient satisfaction was 9.4 at one year postoperatively

Conclusion: LASIK surgery is a safe, predictable, stable and effective for treatment of mild to moderate degree hyperopia and hyperopic astigmatism. No significant regression in UCVA, BCVA or manifest refraction was reported up to 12 months follow up

role of [99m]Tc-Ubiquicidin [UBI] and [99m]Tc-IgG scintigraphies in diagnosis of acute appendicitis: a preliminary result

Appendicitis is one of the most common surgical emergencies. In spite of the relatively high rate of negative appendectomy, as a result of miss diagnosis, uncertainty of diagnosis still continues to challenge physicians. The objective of this prospective study was to investigate the role of [99m]Tc-Ubiquicidin [UBI] scintigraphy in the diagnosis of acute appendicitis and to compare [99m]Tc-UBI scintigraphy with [99m]Tc-IgG scintigraphy. Twelve patients with right lower quadrant pain and suspicious of acute appendicitis were referred to the nuclear medicine imaging center. Radionuclide imaging was performed with [99m]Tc-UBI in 8 and [99m]Tc-IgG in 4 patients. Ultrasonography, Alvarado scoring and histopathological examinations were also performed as additional diagnostic tests. Reports from [99m]Tc-IgG and [99m]Tc-UBI scintigraphies of all patients were negative. This study may conclude that [99m]Tc-IgG scintigraphy and [99m]Tc-UBI scintigraphy in the detection of appendicitis do not have adequate efficacy. However, in order to better evaluate [99m]Tc-IgG and [99m]Tc-UBI scintigraphy, a comprehensive study on a large number of patients with clinical suspicious of acute appendicitis would be more helpful

Experimental evaluation of the performance of HiReSPECT scanner: a high-resolution SPECT system for small animal imaging

In this report, the preliminary results of the experimental evaluation of the Performance of HiReSPECT scanner have been illustrated. In order to assess the capability of the scanner in both planar and tomographic modes, three rats were injected with 99mTc, 99mTc-DMSA, and 99mTc-MDP for thyroid scan, kidney scan and bone scan respectively in order to perform planar imaging. In addition, two rats were injected with 99mTc-MIBI and 99mTc-DMSA to perform cardiac and kidney tomographic imaging, respectively. Tomographic and planar scans of the rat organs showed that radioactive distribution in cardiac, kidney, bone and thyroid images exhibited detailed physiologic information of the imaged organs. Due to high resolution performance of the scanner, thyroid lobes are well depicted and distinguished from each other. Results of the evaluation of the planar and tomographic images indicated that HiReSPECT has appropriate imaging capability as an imaging system in biomedical research

Development of a Five-Day Basic Microsurgery Simulation Training Course: A Cost Analysis

The widespread use of microsurgery in numerous surgical fields has increased the need for basic microsurgical training outside of the operating room. The traditional start of microsurgical training has been in undertaking a 5-day basic microsurgery course. In an era characterised by financial constraints in academic and healthcare institutions as well as increasing emphasis on patient safety, there has been a shift in microsurgery training to simulation environments. This paper reviews the stepwise framework of microsurgical skill acquisition providing a cost analysis of basic microsurgery courses in order to aid planning and dissemination of microsurgical training worldwide.

Research Priorities in Light of Current Trends in Microsurgical Training: Revalidation, Simulation, Cross-Training, and Standardisation

Plastic surgery training worldwide has seen a thorough restructuring over the past decade, with the introduction of formal training curricula and work-based assessment tools. Part of this process has been the introduction of revalidation and a greater use of simulation in training delivery. Simulation is an increasingly important tool for educators because it provides a way to reduce risks to both trainees and patients, whilst facilitating improved technical proficiency. Current microsurgery training interventions are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess the potential benefits of alternative models, particularly cross-training, a model now widely used in non-medical areas with significant benefits. Furthermore, with the proliferation of microsurgery training interventions and therefore diversity in length, cost, content and models used, appropriate standardisation will be an important factor to ensure that courses deliver consistent and effective training that achieves appropriate levels of competency. Key research requirements should be gathered and used in directing further research in these areas to achieve on-going improvement of microsurgery training.

The Rat Model in Microsurgery Education: Classical Exercises and New Horizons

Microsurgery is a precise surgical skill that requires an extensive training period and the supervision of expert instructors. The classical training schemes in microsurgery have started with multiday experimental courses on the rat model. These courses have offered a low threat supervised high fidelity laboratory setting in which students can steadily and rapidly progress. This simulated environment allows students to make and recognise mistakes in microsurgery techniques and thus shifts any related risks of the early training period from the operating room to the lab. To achieve a high level of skill acquisition before beginning clinical practice, students are trained on a comprehensive set of exercises the rat model can uniquely provide, with progressive complexity as competency improves. This paper presents the utility of the classical rat model in three of the earliest microsurgery training centres and the new prospects that this versatile and expansive training model offers.

Radiation exposure from diagnostic nuclear medicine examinations in Golestan province

The aim of present study was to estimate effective dose from most common procedures performed in nuclear medicine departments of Golestan province. Data of nuclear medicine procedures performed in 2 nuclear medicine departments in Golestan province were collected during 4 years. Effective dose, collective effective dose and effective dose per examination were calculated using standard dosimetry tables. Based on the data of this study, results of 10437 nuclear medicine procedures performed during 4 years have lead to 3.97 mSv as average effective dose per examination and 10.37 human-Sv as mean collective effective dose. It was also revealed that Tc-99m was the main source of effective dose [98.3%], bone scan was the most common procedure [25.9%] and cardiac scan [MIBI-rest] has the highest collective effective dose [33.5%] during 4 years. Beside the cardiac scan which was the most common nuclear medicine procedure and the main contributor of effective dose in patients, due to geographical condition of the northeast of Iran, bone scan was the highest performed nuclear medicine examination in the Golestan province

Relative biological effectiveness [RBE] of [131]I radiation relative to [60]Co gamma rays

To assess relative biological effectiveness [RBE] of [131]I radiation relative to [60]Co gamma rays in glioblastoma spheroid cells. In this experimental study, glioblastoma spheroid cells were exposed to [131]I radiation and [60]Co gamma rays. Radiation induced DNA damage was evaluated by alkaline comet assay. Samples of spheroid cells were treated by radiation from [131]I for four different periods of time to find the dose-response equation. Spheroid cells were also exposed by 200 cGy of [60]Co gamma rays as reference radiation to induce DNA damage as endpoint. Resulted RBE of [131]I radiation relative to [60]Co gamma rays in 100 microm giloblastoma spheroid cells was equal to 1.16. The finding of this study suggests that [131]I photons and electrons can be more effective than [60]Co gamma rays to produce DNA damage in glioblastoma spheroid cells

[Complications of non vascularised fibular bone grafts]

Non Vascularized fibular Bone Grafts are considered one of the most method used in limp sparing surgery. This study aims to knowledgement the early and later complications of the Non Vascularized fibular grafts in bone reconstruction following bone tumor resection. The retrospective study was performed at 40 patients with malignant and benign tumors, the study lasted from January 2007 to January 2011. During this period 40 surgical operation were performed. This study depends on the arshef of bone Tumors unit- Albairouni hsspital. from early complication one superfacial infection [2.5%], two cases of peroneal nerve paralysis [5%] two cases of alternation of the gait [5%], one case of valgus deformity [2.5%]. The later complication include 8 cases of stress fracture [20%], 6 cases of late union [15%] 6 cases of bone absorbtion [15%] and 4 cases non union of bone graft [15%]. The number of malignant bone tumors were 24 [60%] and the benign bone tumors were 16 [40]. The non vascularized fibula graft is a good choice and available after ablation bone tumor in the defects below 6 cm and acceptable in the clefects which measure from 7-10cm but this choice not good in the defects that increase than 10cm

Accuracy of oral exfoliative cytology in Sudanese patients undergoing oral biopsy

Introduction: Early detection of a premalignant or malignant oral lesions promises to improve the survival and the morbidity of patients suffering from these conditions. Oral exfoliative cytology (OEC) is a non-invasive method that is well accepted by the patient, and is therefore, suitable for screening at-risk population for early diagnosis of oral cancer. Objective: The purpose of this study is to investigate the value of OEC in the detection of oral premalignant and malignant lesions. Material and methods: In this hospital-based case-control study, cytological scrapes from buccal mucosa were obtained from 100 individuals, of whom 50 were patients with oral lesions ascertained as "cases" and 50 were clinically healthy volunteers ascertained as "controls". All patients with oral lesions were also subjected to oral biopsy and histological examination. Results: Out of 50 cases studied, histopathology showed the presence of: Oral squamous cell carcinoma OSCC (n = 28), leukoplakia (n = 8), dysplasia (n = 3), and benign normal lesions (n = 11). In cytology, a specificity of 100%, sensitivity of 93% and accuracy of 92% were obtained for OSCC. Leukoplakia gave a specificity of 100%, a sensitivity of 87.5%, and an accuracy of 95%. Conclusion: Despite the small number of cases in this study, OEC is a useful method for detecting oral premalignant and malignant lesions. OEC can detect a number of pathological conditions that require management.

Splenic vein thrombosis: a rare complication of celiac disease

The principal cause of splenic vein thrombosis [SVT] is pancreatic disease. Isolated splenic vein thrombosis [ISVT] is a very rare complication of celiac disease. Only few cases are reported worldwide. Affected patients develop left-sided portal hypertension often complicated by splenomegaly and isolated gastric varices. The condition is usually asymptomatic, but patients may complain of non-specific abdominal pain. Gastric variceal bleeding in this context is uncommon but should it occur, it could be life threatening and splenectomy would be the treatment of choice. The role of anticoagulation is controversial and the risk of further thrombotic events must be balanced against that of variceal bleed. We report a case of a patient with celiac disease [CD] who presented with a new onset non-specific abdominalpain, who was found to have ISVT complicated by portal hypertension, splenomegaly and non-bleeding isolated gastric varices. He was successfully managed with anticoagulation

Use of various kinds of fibular grafts as substitutes after bone tumors resetion in Albairouni university hospital

Background: To present the experience of Al- Bairouni university hospital in Damascus in using vascularized and non vascularized fibula grafts after bore tumor's Resection.· Subjects and Methods: The Study was performed at 26 patients with malignant and benign tumor, the study lasted from january 2007 to may 2009. During this period 28 surgical operation were performed: 26 primar operation by vsing fibrla in reconstruction of bone defects after ablation of bone tumors and 2 secondary operation after comblication [fracture]. · Results: A free fibrla vascularized grafts was implanted with micro vascvlar arastomosis in two cases and seren cases with pedicle. In 19 nonvasculanzed fibrle was implanted. The healing was good in 9 cases and late im 14 cases. Five paatient died and fracture occurred in two cases. Absorption of the graft occurred in 6 cases. · Conclusion: The vascularizcd fibrla graft is considered a good choice in reconstruction of bone defects with active good stability and repid recovery to return of the frnction within several monthes and also avoids nonvascu larized grafts complications and amputation. · Keywords: Vascvlarized fibvla graft [free, pedicle, non vascvlarized].- Tumors [malignant, benign]

Nursing role toward patients undergoing abdominal laparoscopic surgery; A suggested training program

Teaching programs for nursing staff constitutes an important part. These programs are urgently designed to assist staff nurses in developing and enhancing their skills needed to provide high standards of care to their patients. In the present study, the researcher tried to investigate and identify needs for developing and implementing a training program designed towards improving the knowledge and performance of nurses working in the surgical departments of Assiut University Hospital. The study aimed to assess the role of nurses in caring for patient's undergoing Abdominal Laparoscopic Surgery and to suggest a training program for nurses caring for patients undergoing Abdominal Laparoscopic Surgery in the surgical department. The assessment needs for developing program was determined by test questionnaire sheet and observation checklist. The study included all male and female nurses [N=63] working in the general surgical departments. They were most of them holders of the diploma of nursing and very small number holders bachelor of nursing. The program was evaluated applying the same tools used in the assessment phase, then immediately after the program implementation. The main results obtained were as follows. The nurses' knowledge and performance related to caring of patients undergoing Abdominal Laparoscopic Surgery in surgical department was quite poor. The educational program showed improvement in nurses knowledge and performance regarding the nursing care of patients undergoing Abdominal Laparoscopic Surgery The results of comparison between the pre-test and post-test showed statistically significant differences. The present study concluded that nurses in general surgical department have unsatisfactory level of knowledge and performance. Attending training or orientation programs about caring for patients undergoing Abdominal Laparoscopic Surgery is absolutely lacking for nurses serving in the general surgical department. During their nursing practice, they usually lose their knowledge and skills related to caring patients after coming form PACU as they are not well trained and are not assigned for such activity. Moreover, they lack background knowledge and any experience as regards pre and post operative caring of patient undergoing Abdominal Laparoscopic Surgery in spite of its crucial importance for managing patients in the general surgical department. However, they can gain the necessary knowledge and technical skills that will enable them to perform better after the exposure to a well planned and organized training program. The present study recommended that educational department should be established within Assiut University Hospital to prepare and improve the nursing staff level of knowledge and performance

Cardiac arrhythmias and silent myocardial ischemia in chronic renal failure patients on hemodialysis

Cardiovascular diseases are the most common cause of death in patients with End Stage Renal Disease [ESRD] on renal replacement therapy. Cardiac arrhythmias are frequent cardiovascular complication during dialysis session. ST segment depression on ambulatory ECG without patient awareness is a marker of what has been termed "silent ischemia". It has been suggested that in patient with ESRD transient ST segment depressions are associated with increased cardiovascular mortality. The objective of this study is to evaluate and to detect the effect of hemodialysis on cardiac rhythm in ESRD patients on regular hemodialysis by using Holler's monitor [24 hours. ambulatory electrocardiogram] and also to detect prevalence of silent myocardial ischemia among these patients. This study was conducted in the Dialysis Unit, Sohag University Hospital, Sohag Faculty of Medicine. It included 40 adult patients [29 males and 11 females] with ESRD on regular hemodialysis. Their ages ranged from 18-50 years with a mean age of [35 +/- 2.36] years. Results of this study showed that there is runs of ventricular and supraventricular arrhythmia in dialysis patients and the occurrence of this arrhythmia in the form of insignificant ventricular runs which occurred in 2 [5%] out of 40 patients studied. However there is a significant prevalence of total ventricular arrhythmia which occurred in 80% of the patients. There is significant occurrence of supraveniricular arrhythmia which occurred in 62.5%, 42.5% and 40% [predialysis, during dialysis and postdialysis respectively]. Ventricular tachycardia was not seen, and supraventricular was observed in 5 patients [12.5%]. The total number of these arrhythmias [both ventricular and supraventricular] were improved by hemodialysis. The present study showed that there is a high incidence of myocardial ischemic episodes in relation to hemodialysis. 29 [72.5%] out of 40 patients showed ischemic episodes of whether 24 [83%] patients showed asymptomatic ischemic episodes. The study also showed that most ischemic episodes whether painful or silent were recorded during hemodialysis session [72.8%]. Dialysis per se is not arrhythmogenic. The isolated ventricular and atrial arrhythmias occurred in patients with ESRD cluster before next hemodialysis sitting are assumed to be due to disturbances of both serum phosphorus and serum potassium levels. On the other hand myocardial ischemic episodes frequently occurred during hemodialysis

Mean age-at-onset of leprosy in libya

The mean age-at-onset of leprosy was investigated restrospectively in 154 Libyan [133 males, 21 females]. The overall mean age-at-onset was 32.91 +/- 14.69 year and no significant difference was noted between males and females [33.64 +/- 14.82 vs 27.32 +/- 13.79 years, P = 0.063]. Majority of the patients [106/154, 68.8%] had age-at-onset between >10-40 years. The peak incidence of 33.08% [44/133] in males and 38.09% [8/21] in females were in the age range of >20-40 years. The lowest age-at-onset was 7 years in a male patient with Neuritic Leprosy [NL], while the highest age-at-onset was 84 years in also a male patient but with Lepromatous Leprosy [LL]. According to the type of leprosy, no significant differences were observed between males and females for mean age-at-onset in LL, Borderline Lepromatous [BL] and Borderline Borderline [BB] [P>0.05], while it was significant in Borderline Tuberculoid [BT] [P<.05] and NL [P<0.01]. Comparison of our results with similar data reported from other countries indicated that age-at-onset of leprosy differ significantly from region to region of the world

Nature of hearing impairment in children of upper Egypt

In this retrospective study, a total of 12670 children, during the last ten years, from 1990 to 1999 inclusive, were examined in the ENT Department and Audiology Unit, Assiut University Hospital in Upper Egypt. The examination included, full history taking, full ENT examination and audiological evaluation [pure tone audiometry and speech audiometry when needed free field audiometry, auditory brain system response [ABR] and immittancemetry testing]. The incidence of conductive hearing loss [CHL] and mixed hearing loss were 58.8 percent of total hearing impaired children, where 22.7 percent are mixed hearing loss [12 percent of them were in need for hearing aid], sensorineural hearing loss [SNHL] was met within 41.2 percent of total hearing loss. The post febrile hearing loss was encountered as 38.5 percent and hereditary hearing loss was in 22.9 percent of total SNHL. Chronic suppurative otitis media [CSOM] accounted for 44.8 percent and middle ear effusion [MEE,] was found in 54.5 percent of total CHL. Hearing impairment in children is a significant problem in Upper Egypt. Hereditary and post febrile hearing impairment are the most common causes. Consanguineous marriage is an important factor in SNHL in children. CSOM and MEE are the most common features in CHL in children of Upper Egypt. Both factors could be prevented with certain measures which would reduce the magnitude of the problem

Incisäo e curetagem da doença pilonidal sacrococcigea / Incision and curettage technique in the pilonidal afection of the sacrococcigeum region

Os autores analisam retrospectivamente os resultados de 174 casos de doença pilonidal sacrococcígea operados pela técnica de incisäo e curetagem, tanto na fase aguda como crônica da doença, em período compreendido entre 1972 e 1989. Concluem que a técnica é simples e apresenta morbidade mínima, podendo ser usada tanto na fase aguda como crônica da doença. O tempo de internaçäo é mínimo, näo necessitando de antibióticos, e o uso de analgésicos no pós-operatório é mínimo. A cicatrizaçäo se processa sem anormalidades, permitindo o retorno às atividades laborativas a partir da 1ª semana; o índice global de recidivas foi de 10,2%