Jejunal Gastrointestinal Stromal Tumor and Gallstones.

Gastrointestinal stromal tumors (GISTs) are considered the most common mesenchymal tumors of the digestive system. However, they make up less than 1% of all GI tumors. GISTs arise from the interstitial cells of Cajal and are commonly found in the stomach and small intestine, and rarely in the colon and esophagus. In this case report, we present a 57-year-old male, a known diabetic, who complained of abdominal pain. He was diagnosed with cholelithiasis and a GIST in the jejunum, which was managed laparoscopically without complications. Most of the time, patients with GIST present with vague symptoms, or sometimes, they are asymptomatic. The most common symptoms are abdominal pain, GI bleeding, and an abdominal mass. These symptoms are usually related to the site of tumor growth, tumor size, and tumor rupture or perforation. Regardless of the tumor location, surgical excision is the gold standard for treating GISTs.

Fracture Resistance and Failure Mode of Monolithic Zirconia, Veneered Zirconia, and Metal-Ceramic Full-Coverage Restorations: A Comparative In Vitro Study.

PURPOSE: To evaluate and compare the fracture mode and strength of monolithic zirconia to veneered zirconia and metal-ceramic full-coverage restorations following artificial aging and to test the performance of translucent zirconia in terms of load-bearing capacity. MATERIALS AND METHODS: Two mandibular first molars were prepared and scanned for their respective groups of full-coverage restorations. A total of 75 full-coverage restorations were fabricated and divided into five groups: two groups for monolithic zirconia, two groups for veneered zirconia, and one group for metal-ceramic. Then, 75 light-cured hybrid composite resin dies were fabricated to serve as abutments. Before cementation, all full-coverage restorations were subjected to accelerated aging. After cementation, all full-coverage restorations were subjected to compressive loading until fracture in an electromechanical universal testing machine. A two-way nested ANOVA and Tukey test were used to analyze the results with 95% confidence levels. RESULTS: Monolithic zirconia full-coverage restorations showed the highest mean fracture resistance of 4,201.0 N, followed by metalceramic full-coverage restorations of 3,609.3 N, and veneered zirconia full-coverage restorations showed the lowest mean fracture resistance of 2,524.6 N. The main mode of failure was cohesive bulk fracture for the monolithic zirconia group, cohesive/adhesive failure with infrastructure damage for the veneered zirconia group, and cohesive/adhesive failure without infrastructure damage for the metal-ceramic group. CONCLUSIONS: Monolithic zirconia full-coverage restorations showed superior resistance to fracture compared to metal-ceramic full-coverage restorations and are highly reliable in terms of load-bearing capacity within the posterior regions of the mouth.

Fracture strength of anterior cantilever resin-bonded fixed partial dentures fabricated from high translucency zirconia with different intaglio surface treatments.

PURPOSE: To compare the fracture resistance and failure modes of anterior cantilever resin-bonded fixed partial dentures (RBFPDs) fabricated from high translucency zirconia with different intaglio surface treatments. MATERIALS AND METHODS: Sound-extracted canines (N = 50) were randomly divided into five groups (n = 10) to be restored with high translucency zirconia RBFBDs of different intaglio surface treatments. The RBFPD was designed using exocad software and fabricated using a CAM milling machine. The RBFPDs were treated differently: abrasion with 50 µm alumina particles (Group 1); abrasion with 30 µm silica-coated alumina particles (Group 2); abrasion with silica-coated alumina particles (30 µm) and silane application (Group 3); abrasion with silica-coated alumina particles (30 µm) and 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primer application (Group 4); abrasion with silica-coated alumina particles (30 µm) and silane, and 10-MDP primer application. All RBFPDs were cemented using dual-cured resin cement. The RBFPDs underwent 6000 thermal cycles with distilled water at 5/55°C for 2 min per cycle and then mechanical cyclic loading with 1200,000 cycles of 50 N at a 1.7 Hz frequency at an angle of 135° to the abutment's long axis. Then, RBFPDs were loaded to fracture using a universal testing machine at 1 mm/min. Maximum fracture forces and failure modes were recorded. Fractured specimens and uncemented specimens were examined using a scanning electron microscope. Data was analyzed using ANOVA and Games-Howell post hoc tests at p < 0.05. RESULTS: Mean fracture load results showed a statistically significant difference between the research groups (p < 0.0001) and it ranged from 69.78 to 584 N. Group 4 exhibited the highest fracture load mean (p < 0.0001) which was significantly different from all other groups. Group 2 recorded a significantly higher fracture load mean than Group 3 (p = 0.029). Three modes of failure were observed: prosthesis debonding, prosthesis fracture, and abutment fracture. CONCLUSIONS: Abrasion of zirconia surface with 30 µm silica-coated alumina particles and application of 10-MDP primer yielded the highest mean fracture loads of monolithic high translucency zirconia RBFPD. The mode of fracture of the RBFPDs was influenced by the type of surface treatments.

Mucocele of the Appendix: A Case Report and Review of Literature.

An appendiceal mucocele is a rare disease characterized by the dilation of the appendix lumen with mucus accumulation. Although this disease is often found incidentally during appendectomy, it is crucial to differentiate it from acute appendicitis preoperatively to select adequate surgical management. We present a case of a 31-year-old male, medically free, with right-sided abdominal pain associated with nausea and vomiting. He was diagnosed with appendiceal mucocele and underwent laparoscopic appendectomy. The absence of a distinct clinical presentation and biochemical parameters necessitates a comprehensive and collaborative diagnostic approach for mucocele of the appendix. Achieving an accurate diagnosis prior to surgery is imperative to ensure the appropriate surgical technique is chosen, thereby minimizing the risk of serious intraoperative and postoperative complications such as pseudomyxoma peritonei.

Successful Conservative Management of Spontaneous Greater Omental Artery Aneurysm: A Case Report.

Omental hemorrhage is the result of a rupture of the omental vessels. Many causes have been identified to cause omental hemorrhage, which includes trauma, aneurysms, vasculitis, and neoplasms. Spontaneous omental hemorrhage is rare, and usually, patients present with a vague clinical manifestation. In this article, we present the case of a 62-year-old male patient who presented to the emergency department complaining of severe epigastric pain. He was diagnosed by enhanced computed tomography as having a great omental aneurysm and admitted to the surgical ward. The patient was treated conservatively with no apparent complications. Physicians should be made aware of the possibility of great omental bleeding even if none of the mentioned risk factors have been recognized to prevent the life-threatening complications that would follow this condition.

Fracture resistance and failure mode of monolithic zirconia, veneered zirconia, and metal-ceramic full-coverage restorations: A comparative in vitro study.

PURPOSE: To evaluate and compare the fracture mode and strength of monolithic zirconia to veneered zirconia and metal-ceramic full-coverage restorations following artificial aging. The main concern was to test the performance of translucent zirconia in terms of load-bearing capacity. MATERIALS AND METHODS: Two mandibular first molars were prepared and scanned for their respective groups of full-coverage restorations. 75 full-coverage restorations were fabricated and divided into five groups: two groups for monolithic zirconia, two groups for veneered zirconia, and one group for metal-ceramic. 75 light-cured hybrid composite resin dies were fabricated to serve as abutments. Before cementation, all full-coverage restorations were subjected to accelerated aging. After cementation, all full-coverage restorations were subjected to compressive loading until fracture in an electromechanical universal testing machine. A two-way nested analysis of variance and Tukey test were used to analyze the results with 95% confidence levels. RESULTS: Monolithic zirconia full-coverage restorations showed the highest mean fracture resistance of 4,201 N, followed by metal-ceramic full-coverage restorations of 3,609.3 N, and the veneered zirconia full-coverage restorations showed the lowest of 2,524.6 N. The main mode of failure was cohesive bulk fracture for the monolithic zirconia group, cohesive/adhesive failure along with infrastructure damage for the veneered zirconia group and cohesive/adhesive failure without infrastructure damage for the metal-ceramic group. CONCLUSIONS: Monolithic zirconia full-coverage restorations showed superior resistance to fracture in comparison to metal-ceramic full-coverage restorations and are highly reliable in terms of load-bearing capacity within the posterior regions of the mouth.

Successful Management of a Young Patient Suffering From Pyoderma Gangrenosum Following Gastric Bypass Surgery: A Case Report.

Pyoderma gangrenosum (PG) is a pathogenetically ill-defined neutrophilic dermatosis frequently characterized by severely painful ulcerations with no identifiable infective pathogens. There are no diagnostic criteria for PG, nor specific gold standard management, which may complicate the process of dealing with patients suffering from this disease. Here, we report a case of a 27-year-old male patient, with a history of gastric bypass surgery three years ago, who presented with a left leg non-healing ulcer diagnosed as a PG by the clinical presentation and biopsy of the ulcer. He was managed by the administration of systemic immunomodulators, a surgical debridement procedure, and the application of a vacuum. The patient was discharged with vitamin B complex and vitamin D supplements as well as zinc sulfate and folic acid. Also, multiple doses of Infliximab intravenously and vitamin B 12 intramuscularly result in a satisfactory healing process of the ulcer. Since PG is a diagnosis of exclusion, clinicians must be aware of the need for highly specific history-taking, previous surgical history, laboratory investigations, and histopathological workup in order to reach the diagnosis.

Pediatric Floating Elbow Caused by a Novel Mechanism: A Case Report.

A pediatric floating elbow is a rare condition in which there is a humeral supracondylar fracture with an ipsilateral fracture of one or both bones of the forearm. We report a case caused by an unusual mechanism of a semi-automatic washing machine. This injury, on its own, involves the risk of compartment syndrome, however, this particular child came late. We present our approach to this challenging injury along with the controversial management in the literature.

Successful Conservative Management of Traumatic Pancreatic Duct Injury: A Case Report.

Patients with blunt abdominal trauma are at high risk of getting pancreatic injury, with high morbidity and mortality rates. The decision to manage the patient operatively depends highly on the condition of the main pancreatic duct (MPD). Conservative management of traumatic MPD injuries is rarely reported in the literature. In this article, we present the case of a 19-year-old male patient, medically free, admitted to the hospital following blunt abdominal trauma. He was hemodynamically stable and computed tomography showed MPD injury with no evidence of active bleeding or bile leakage. So, the decision to manage him conservatively was taken. Our aim in this report is to highlight the fact that the operative management of traumatic MPD injuries, which carries dangerous post-operative complications, could be avoided.

Partial Extraction Therapy with Early Implant Placement in the Esthetic Zone: A Clinical Case Report.

Immediate replacement of teeth designated for extraction is an appealing treatment rationale for both the patient and the operator. However, it has been associated with a greater risk of facial recession and compromised soft-tissue esthetics. Partial extraction therapy (PET) or synonymously socket shield technique (SST) or root membrane technique (RMT) has been proposed to conserve the facial alveolar contour and soft-tissue esthetics. In this article, a special case is described where a root membrane was used to prevent the modeling of the facial aspect of the extraction socket. Partial extraction was performed allowing the socket with the facial root membrane in situ to partially heal for 8 weeks before implant placement. Successful integration and restoration were achieved with very minimal hard- and soft-tissue changes, accentuating satisfactory esthetic results as dictated by objective esthetic assessment. PET with early implant placement may be considered a viable treatment option for selected cases.

Risk Assessment of Varicose Veins Among Teachers in Al-Ahsa, Saudi Arabia.

Background Varicose veins (VV) are abnormally swollen, tortuous, and prominent veins caused by insufficient venous valves leading to venous congestion and elevated venous pressure. Prolonged standing at work has been proposed to be an important risk factor for varicose veins. Teachers are prone to have varicose veins due to prolonged standing. The aim of this study was to assess the risk of varicose veins among teachers in Al-Asha, Saudi Arabia. Method This was a cross-sectional study conducted among teachers of primary, secondary, and high schools in Al-Ahsa, of both genders, between April 2022 and June 2022. The participants were interviewed and examined for the presence of signs and symptoms of the disease. Finally, the collected data were analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 26.0 for Windows) software. Result Out of 399 participating teachers with a mean age of 43.2 ± 12.9 years, 216 (54.1%) were males and the remainder were female. The commonest symptom was pain in the legs, which was exacerbated by work (43.1%). Most of the participants were working for more than 16 years (43.6%) and standing for less than six hours per day (72.7%). The most pointed sign was spider legs-shaped veins (23.8%). However, the least collective sign was paleness in the ulcer area after healing (1.8%). A total of 140 teachers had a family history of varicose veins, 74 of them (18.5%) were diagnosed with varicose veins previously. We summarize our result as female teachers who have a family history of VV have more risk to develop the disease. Conclusion The prevalence of varicose veins was high among teachers in Al-Ahsa, Saudi Arabia. According to our study, teachers have a significant chance of developing the condition since their working style contributes to its progression. Further actions need to be made in order to increase awareness and prevent its complications.

Solid Ectopic Cervical Thymus: A Case Report.

The thymus gland is a lymphoid organ normally located in the superior anterior mediastinum. It can rarely present abnormally in other sites along the thymopharyngeal canal and it might cause difficulties in breathing and/or feeding. We present a case report of an ectopic cervical thymus of a 10-month-old male infant who was presented to the hospital with a swelling on the left side of his neck for nine months. Investigations raised suspicion about four differential diagnoses and a total surgical excision for histopathological confirmation was deemed mandatory. It is of great importance to consider ectopic cervical thymus in the differential diagnosis of pediatric neck masses to avoid unnecessary procedures and prevent possible complications.

Gastric Perforation as a Complication of COVID-19 Infection: A Case Report.

Pulmonary symptoms are the primary manifestation of the COVID-19 disease, which originated in Wuhan in China in December 2019. However, it is now established to show widespread extrapulmonary manifestations, including gastrointestinal involvement. Abdominal pain, diarrhea, nausea, and vomiting are considered the most common gastrointestinal symptoms. Gastric perforation in association with COVID-19 is rarely reported in the literature. Here, we report a case of a 71-year-old male COVID-19-infected patient, medically free, who presented to the emergency department complaining of severe abdominal pain for a one-week duration. He was diagnosed with a case of perforated viscus and septic shock. The patient was shifted to the operating room for exploratory laparotomy. We aim in this report to highlight this fatal complication of COVID-19 infection in order to improve patients' outcomes.

The Side Effects of COVID-19 Vaccines and Its Association With ABO Blood Type Among the General Surgeons in Saudi Arabia.

Introduction The benefits of vaccination outweigh its risks as it protects approximately two to three million individuals from infectious diseases annually. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, new vaccines have been developed. However, it is crucial to follow and recognize the side effects of COVID-19 vaccines. Previous studies have shown a relationship between ABO blood groups and coronavirus. Some vaccination side effects, such as muscle pain at the injection site and fatigue, may impair an individual's ability to perform tasks that require fine motor skills, such as those performed by a general surgeon. Therefore, this study aimed to identify the association between ABO blood groups and the side effects of COVID-19 vaccines among general surgeons in Saudi Arabia. Method A cross-sectional online survey-based study regarding the side effects following COVID-19 vaccination was conducted among Saudi and non-Saudi general surgeons working in public and private hospitals in Saudi Arabia who had received one or two doses of mRNA-based COVID-19 vaccines. Results A total of 612 surgeons responded. Approximately, 74.7% of the respondents reported side effects after receiving vaccines. Tiredness was the most commonly reported side effect of the vaccine, followed by severe local pain at the site of injection. Approximately, 16.2% of the participants started showing side effects 12 hours after receiving the vaccine. There was a significant relationship between the type of vaccine administered and the appearance of side effects (p = 0.004). The rate of appearance of side effects was higher in participants who received the Pfizer vaccine. However, there was no significant relationship between the appearance of side effects and age, gender, blood group, number of doses, and past history of COVID-19 infection (p > 0.05). Of the total participants, 256 (41.8%) stated that the side effects of the vaccine affected their work performance. Moreover, there was no significant difference in side effects, symptoms appearing after vaccination, the onset of symptoms, and duration of symptoms between the participants who received one dose and those who received two doses of the vaccine. In addition, there was no significant relationship between the severity of side effects and age, past history of COVID-19 infection, number of doses, and blood type (p > 0.05). However, there was a significant relationship between the severity of side effects and gender and type of vaccine (p = 0.000 and 0.004, respectively). A high percentage of females and those who received the AstraZeneca vaccine stated that their side effects affected their work performance. Conclusion Three-quarters of the participants reported side effects after the COVID-19 vaccination, which affected the work performance of 41% of participating general surgeons. There was no significant relationship between the appearance of symptoms and age, gender, blood group, number of doses, and past history of COVID-19 infection. However, there was a significant relationship between the severity of side effects and gender and type of vaccination. Future large-scale studies are recommended to further evaluate the implication of ABO blood type on COVID-19.

Giant Breast Lipoma: A Case Report.

Lipomas are slow-growing, benign mesenchymal masses. Most lipomas are small, weighing only a few grams; however, if their size becomes exceptionally large, they are called giant lipomas. Giant lipoma of the breast is infrequently observed due to the rarity of size and location, with very few case reports available in the literature. Here, we report the case of a 48-year-old female patient who presented with a painless, huge lump in her right breast. The patient underwent surgical removal of the mass with a histologic examination confirming the diagnosis of a giant breast lipoma.

Analysis of the effect magnitude of different parameters on smile attractiveness.

OBJECTIVE: To evaluate the effect magnitude of different parameters on smile attractiveness. MATERIALS AND METHODS: A reference and 13 images were produced by manipulating 13 parameters. Image rating was performed with a 4-point Likert scale from least attractive (1) to most attractive (4). Image raters included laypeople, dental students, dentists, and dental specialists. Friedman and Wilcoxon image were used for estimate of effect size. Parameters were classified into small (0.10- < 0.30), medium (0.30- < 0.5), or large (≥0.50). RESULTS: A total of 1040 people participated with good consistency (α = 0.861), and moderate reliability (0.64-0.7). The reference image had the highest rank (laypeople:11.79, dental background: 12.55). For effect size; gingival margin level (-0.11, -0.01), teeth width proportion (-0.09, -0.10), inverted smile arch (-0.09, -0.21), commissure line cant (-0.15, -0.17) and low smile (-0.24, -0.23) had small effect size; occlusal plane cant (-0.36, -0.49), midline cant (-0.36, -0.48), and midline shift (-0.37, -0.49) had medium effect size; diastema (-0.55, -0.54) and color (-0.56, -0.56) had large effect size for the laypeople and dental groups. High smile (-0.42, -0.51), incisor edge symmetry (-0.46, -0.54) had medium effect size in laypeople group and large effect size in the dental group. Width to length tooth proportion (-0.26, -0.39) had small effect size in the laypeople group and medium effect size in the dental group. CONCLUSIONS: Smile parameters had different effect magnitude on smile attractiveness and were classified into small, medium, or large parameters. Neither laypeople nor professionals have a collective judgment on what constitutes a beautiful smile. CLINICAL SIGNIFICANCE: This study investigated the effect magnitudes of 13 smile parameters and presented a small, medium, and large smile parameters classification. It should provide the clinician with an insight into the expected effect each parameter has on the smile.

Optical properties of CAD-CAM monolithic systems compared: three multi-layered zirconia and one lithium disilicate system.

OBJECTIVE: this in vitro investigation aims to evaluate and compare optical properties of three types of esthetic CAD-CAM monolithic multi-layered zirconia materials with a control (conventional lithium disilicate, IPS e. max CAD). METHODS: Four monolithic CAD-CAM ceramic materials were investigated: Ceramill Zolid® FX Multilayer (ZF), IPS e. max® ZirCAD MT Multi (ZM), Katana® STML (KS) and one lithium disilicate glass-ceramics as a control (IPS e. max® CAD LT; LC). A total of 72 (15 × 15 × 1 mm) samples were CAD CAM fabricated and sintered based on sample-size power calculations, and each material comprised 18 samples. The translucency and opalescence parameters with the contrast ratio were evaluated with a dental spectrophotometer over the backgrounds of black and white. The data were analyzed by ANOVA, then Bonferroni post hoc comparison test was made between groups. The statistical significance was set at p < 0.05. RESULTS: Zirconia materials revealed lower optical properties than the lithium disilicate control LC (P < 0.05). TP values ranged from 14.174 to 20.439. No differences were detected between the zirconia products in terms of TP and CR (P = 1.000). OP values ranged from 5.068 to 10.097. The lowest OP values were found statistically significant for ZF followed by KS and ZM (P = 1.000). LC had the highest TP and OP values, as well as the lowest CR (p < 0.05). CONCLUSIONS: The optical properties of monolithic zirconia systems tested here are still lower than those of lithium disilicate glass-ceramics. The only difference observed between the monolithic CAD CAM zirconia materials, was for the low opalescence parameter for the ZF. CLINICAL SIGNIFICANCE: Multi-layered monolithic zirconia systems have better esthetics by shade layers resembling natural tooth color gradients. CAD-CAM technology allowed for in-office milling and shaping of restorations using these systems. This study reports on their optical properties affecting human vision/perception of natural tooth shade to conclude about their use in the esthetic zones.

Appendiceal Adhesion to the Gallbladder Detected During Laparoscopic Cholecystectomy: A Case Report.

Acute cholecystitis is a very common acute abdominal disease that mostly indicates abdominal surgery. Appendiceal adhesion to the gallbladder is a very rare condition detected during laparoscopic surgery. A 54-year-old female patient, with a known case of diabetes and hypertension, presented with right upper quadrant abdominal pain of four months' duration. The pain was increasing in severity and associated with fatty meals. She was diagnosed with acute cholecystitis and was sent to the operating room for laparoscopic cholecystectomy. Appendiceal adhesion to the gallbladder was found, and laparoscopic cholecystectomy and laparoscopic appendectomy were performed. Adhesion of the appendix to the gallbladder should be considered by general surgeons.