档案的手术和临床研究 //m.lakotalakes.com/hjsr Heighpubs开放获金博宝app体育取期刊上 en - us 在印度COVID-19爆发对泌尿外科实践的影响 06/18/2021//m.lakotalakes.com/hjsr/ascr-aid1059.php & lt; h2> Abstract< / h2><p>Background: The rapid spread of &ldquo;Coronavirus Disease 2019&rsquo; (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-type 2 (SARS-CoV-2) significantly impacted health care facilities all across the globe. To assess impact on urology practice in our country, we developed a questionnaire based on relevant questions in current scenario for information regarding challenges and changes urologists were facing in their practices.</p> <p>Material and methods: We conducted an online survey to find out the impact of COVID-19 on urology practice in Indian scenario. The questionnaire comprised of total 18 questions, which were relevant to day to day practice.</p> <p>Results: Total 310 urologists across the India participated and consented to being part of the study. The majority admits change in their practice due to the recent COVID-19 outbreak. The majority admitted to attend fixed numbers of patients per day with prior appointment and to keep detailed records. The majority responded in positive that attendees will not be allowed, opted to wear N-95 mask in OPD, opted to take the relevant history, opted for thermal screening, opted for patients to wear a mask before entering OPD room, opted for using the new prescription at new visit and opted to avoid physical examination unless very necessary. The majority wanted to take consent from the patients that they may get infected by COVID-19 in the hospital and agreed on performing COVID-19 testing for every patient posted for surgery. The majority agreed to assign a separate operation theatre to operate patients with positive COVID-19 test and also preferred open surgery over minimal invasive surgery.</p> <p>Conclusion: Our survey revealed that the recent pandemic led to significant impacts on urology practice in our country. The urologists working in different setups are facing different challenges in this difficult condition. They have made certain changes in their practice to safely provide effective care to their patients.</p> 双边瞬态的骨质疏松髋部与单边断裂40岁孕妇 04/02/2021//m.lakotalakes.com/hjsr/ascr-aid1058.php & lt; h2> Summary< / h2><p>Purpose: Some physiological events in women&rsquo;s life such as pregnancy and lactation can be associated to a condition known as Transient Osteoporosis of the Hip (TOH); if not promptly diagnosed it can lead to significant consequences such as femoral neck fracture. In this paper we describe a case of bilateral TOH, focusing on the importance of early treatment and how it influenced the outcome.</p> <p>Methods: A 40 years old post-delivery woman came to our attention for hip pain and a left femoral neck fracture was diagnosed. Magnetic resonance (MRI) showed bilateral edema of the femoral head. She underwent total hip replacement on the left side; toe-touch weight bearing and pharmacological therapy were prescribed for the right hip.</p> <p>Results: MRI at nine months showed complete regression of the femoral head and neck edema; the patient was clinically asymptomatic.</p> <p>Conclusion: If not promptly diagnosed and treated, TOH can potentially evolve in fracture. Many therapeutic strategies have been suggested since now; we believe that avoiding weight bearing on the involved hip as early as possible is the key to recovery.</p> Cholecysto-colonic xanthogranulomatous胆囊炎后瘘:Surgeona€™s噩梦 02/09/2021//m.lakotalakes.com/hjsr/ascr-aid1057.php <p>Xanthogranulomatous cholecystitis is a rare benign inflammatory disease of gallbladder that may be misdiagnosed as carcinoma of the gallbladder intraoperative or in pre-operative imaging. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease.</p> Soliter纤维隔膜的肿瘤患者喉癌症:病例报告 01/13/2021//m.lakotalakes.com/hjsr/ascr-aid1056.php & lt; h2> Summary< / h2>& lt; p>简介:孤独的纤维间充质来源的肿瘤是肿瘤良性和恶性形式。我们旨在提供一个单独纤维开发的肿瘤病人的喉癌和文学起源于隔膜的。你们;/ p>& lt; p>案例报告:一个61岁的男性病人气管造口术的确诊病变似乎几乎10厘米是指我们的诊所。以来大量质量,我们选择执行胸廓切开术在thorachoscopic方法灵活;/ p>& lt; p>讨论:虽然孤独的纤维肿瘤最常见的发生在胸膜但也可能起源于隔膜,和我们的例子中是有价值的,源于膈因为有少于5报告病例为过去的二十年。你们在文学;/ p>& lt; p>结论:即使在复发的情况下,主要的治疗仍然是手术切除。孤独的纤维肿瘤通常发现,因为压缩症状。这是我们选择的主要原因胸廓切开术。你们;/ p> 腹腔镜的方法对急性右髂窝病理学:我们的经验 12/31/2020//m.lakotalakes.com/hjsr/ascr-aid1055.php & lt; h2> Abstract< / h2><p>Laparoscopic approach in emergency theatre is an irreplaceable tool to manage patients with acute surgical pathology. We retrospectively reviewed surgical access records from the Emergency Department for acute right iliac fossa pathology. We considered 51 patients (16 male, 35 female, mean age 23.8 years) access for acute right iliac fossa pathology over the last year. 44 patients underwent laparoscopic approach (86%); 8 patients were treated with an open approach. Outcomes evaluation was based on data comparison from open appendicectomy over 4 year time period.</p> <p>Variables considered for data analyses were: role of laparoscopic surgery for gangrenous /perforated appendicitis, Conversion rate, Laparoscopy appendicectomy for elderly patients.</p> <p>Our study demonstrated that a laparoscopic approach at acute right iliac fossa pathology is feasible, safe and can offer a low incidence of infectious complications, less post-operative pain, rapid recovery, and represent a valid diagnostic tool in doubtful cases, at the expense of longer operating time than OA. We suggest that LA should be the initial choice for all patients with acute right iliac fossa pathology.</p> 急性腹部并发症的膝盖关节镜检查:一个案例报告 12/22/2020//m.lakotalakes.com/hjsr/ascr-aid1054.php & lt; h2> Abstract< / h2><p>A knee arthroscopy in spinal anaesthesia was performed on a 67 years old male patient. During the procedure the patient was hemodynamically stable, until he suddenly turned pale and started complaining of severe pain in lower abdomen with signs of guarding. The procedure was finished as urgently as possible and after releasing the tourniquet we noticed significant difference in volume of the leg, with redness distal to tourniquet. Urgent lab results were essentially unremarkable and the patient was sent for the urgent radiological diagnostics.</p> <p>CD of the left leg described fluid in the soft tissues of the thigh, scrotum, and abdomen; and the unenhanced CT of the abdomen showed free fluid along the entire femoral shaft of the left thigh, extending towards pelvis and abdomen to perihepatic and perisplenic space, and retroperitoneum, with gas bubbles tracking along anterior aspect of the left thigh into the left retroperitoneum.</p> <p>He was admitted to the ICU, and within few hours all symptoms have resolved and his further recovery was without complications.</p> 传统reA IntentA±±mplantatA±无望的牙齿:病例血清±es 10/31/2020//m.lakotalakes.com/hjsr/ascr-aid1053.php & lt; h2> Abstract< / h2><p>Intentional replantation is an alternative for the treatment of advanced periodontal destruction of the anterior teeth. Systemically healthy three female patient was referred to our clinic with functional complaints. Diagnosis were chronic periodontitis and class III mobility was noted at the mandibular incisors with complete periodontal attachment loss. After phase I periodontal treatment periodontally involved teeth were extracted, endodontic treatment accomplished, the teeth were replanted and fixed to its place with fiber reinforced composite splint. At the end of 2 years tooth was in function with alveolar bone gain. Intentional replantation provided long-term maintenance of patient&rsquo;s own teeth.</p> 机器人的作用侧肺非小细胞肺癌 10/06/2020//m.lakotalakes.com/hjsr/ascr-aid1052.php & lt; h2> Abstract< / h2><p>Segmentectomy may be applied to all segments; superior segmentectomies (lower lobe superior segments for both lungs), lingulectomies (two segments forming lingulas of upper left lobe) and basal segmentectomies (segments other than superior segment for both lungs). In lung segment resections; segmentectomy has an equivalent morbidity, recurrence and survival rate compared to lobectomy, in patients with stage I lung cancer, tumors smaller than 2 cm and within the segmental anatomical limits. Segmentectomy also contributes more to preserving lung function and exercise capacity than lobectomy. In tumor resection; especially in patients with advanced age, insufficient performance or insufficient cardiopulmonary reserve, 2 cm in diameter and acceptable segmental margins may be provided.</p> <p>Limited long-term results show oncological results of robotic approach similar to open and VATS approaches. Robotic approach facilitates surgery with more intuitive movements, greater flexibility and high definition, three-dimensional vision. However, high cost and lack of touch sense are main disadvantages of robotic surgery. New studies are needed to assess quality of life, morbidity, oncological results and cost effectiveness. However, considering development of technology in our age and fact that many surgical robot brands will be released in the near future, it is predicted that disadvantages of robotic surgery will be minimized in the near future.</p> <p>This article reviews experience of segmentectomy in non-small cell lung cancer and discusses benefits and limitations of robotic segmentectomy.</p> 复发性化脓性肉芽肿由intraosseous船:一个案例报告 09/11/2020//m.lakotalakes.com/hjsr/ascr-aid1051.php & lt; h2> Abstract< / h2>& lt; p>化脓性肉芽肿是一种良性病变局部皮肤和粘膜密切相关的创伤、慢性刺激和激素的变化。治疗方法是手术切除。但可能出现复发。出于这个原因,治疗方法如冷冻疗法、电烙术和激光近年来受到调查。在这种情况下,PG的原因是一个支线船舶。病变切除之前,在两周内复发。一个intraosseous支线船舶是由磁共振成像。这艘船被曝光和烧灼电烙术。;/ p> 电视在先进的非小细胞肺癌胸手术治疗 08/14/2020//m.lakotalakes.com/hjsr/ascr-aid1050.php & lt; h2> Abstract< / h2><p>Non-small cell lung cancer is one of the leading causes of cancer-related mortality worldwide. Despite recent advances in adjuvant treatments, surgical resection is basis of treatment. With the development of minimally invasive surgery in thoracic surgery, surgeons work on minimally invasive surgery for advanced stages of lung cancer, previously considered non-operable at all or previously considered non-operable with minimally invasive surgery approach.</p> <p>Minimally invasive surgical techniques which are routinely used in the surgical treatment of early-stage lung cancer have started to be treated in more complicated and advanced stages of lung cancer. Bilateral anatomic resections, operations after neoadjuvant chemotherapy, bronchial sleeve lobectomies, double sleeve lobectomies, complementary pneumonectomies, and carinal sleeve resections can be performed by minimally invasive methods. The option of video-assisted surgery should be considered with oncological principles at foreground if patients have acceptable lung and cardiac performance conditions with minimal comorbidities.</p> <p>This study reviews VATS experience in patients with advanced-stage lung cancer worldwide and discusses potential benefits and limitations of using VATS technology to perform thoracic surgery procedures.</p> 袖胃切除术后泄漏:内窥镜支架和外科干预 07/24/2020//m.lakotalakes.com/hjsr/ascr-aid1049.php & lt; h2> Abstract< / h2><p><strong>Background:</strong> Laparoscopic sleeve gastrectomy (LSG) is becoming more popular in the treatment of obesity. LSG is safe with a low morbidity. The complications rarely result in morbidity and even mortality. Leaks are the major complication associated with LSG with a reported prevalence between 1.9% and 2.4%.</p> <p><strong>Objective: </strong>To compare surgical intervention and endoscopic stenting for treatment of gastric leakage after sleeve gastrectomy.</p> <p><strong>Patients and method:</strong> Our study included 30 patients presented with post sleeve leaks discovered by routine postoperative imaging or during the follow up period. Patients were recruited from October 6th university hospital during the period from August 2017 to August 2019. Patients were divided to the following groups: 1) Endoscopy group: This included 15 patients with post sleeve leakage undergoing endoscopic stent insertion. 2) Surgery group: which included 15 patients with post sleeve leak age undergoing surgical management. This division was random.</p> <p><strong>Results: </strong>Our study showed that Endoscopic stenting for management of post sleeve gastrectomy leakage is an effective method with lower morbidity and shorter post-operative hospital stay than surgical management. Some patients may be good candidates for early surgical intervention in type 1 leakage if managed early before dissemination of leakage and before tissues become friable. Complications of stents include stent migration (26%), stent related ulcer (13%) and stricture (13%). while the surgical intervention carries more complications (DVT, chest infection, wound infection and stricture) and longer postoperative hospital stay.</p> <p><strong>Conclusion: </strong>endoscopic management of post-sleeve gastrectomy leakage with stenting is recommended because it successfully manages the leaks and avoids invasive procedures with less risk, with shorter hospital stay and early return of function.</p> 预期困难在腹腔镜胆囊切除术 07/24/2020//m.lakotalakes.com/hjsr/ascr-aid1048.php & lt; h2> Abstract< / h2><p><strong>Background:</strong> Laparoscopic cholecystectomy (LC), is one of the most commonly performed surgical procedures worldwide, it is accepted as the gold standard in the treatment of symptomatic gallstones for its minimal invasiveness, less pain and early recovery.</p> <p><strong>Purpose: </strong>To predict the difficulty of laparoscopic cholecystectomy in patients according to the recently published scoring system and select the difficult cases to be done by a senior surgeon.</p> <p><strong>Patients: </strong>This is a prospective cohort study. This study took place Oct 6th University Hospital and Kasr El Aini Hospital, Cairo university; the study involved 120 patients admitted with calcular cholecystitis, arranged for laparoscopic cholecystectomy.</p> <p><strong>Methods: </strong>Laparoscopic cholecystectomy after applying the scoring system.</p> <p><strong>Results: </strong>In our study we found that age, sex and ultrasonographic data were significant predictive factors for assessment preoperatively difficult cases that will be operated upon. We found 14 patients above 50 years who scored to be difficult and very difficult were at outcome difficult, only three patients converted to open surgery over fifty.</p> <p><strong>Conclusion: </strong>We can report that obese patient who were over fifty with history of previous upper abdominal surgery and ultrasonographic picture showed thick walled GB and pericholecystic collection had high risk of conversion. At this study scoring system was used for prediction of difficult laparoscopic cholecystectomy sensitivity was 93.75% and specificity was 52.94% of the scoring system at score 5 for prediction of easy or difficult laparoscopic cholecystectomy.</p> 当在气管laserations保守治疗吗? 07/21/2020//m.lakotalakes.com/hjsr/ascr-aid1047.php & lt; h2> Summary< / h2><p><strong>Introduction:</strong> The tracheobronchial injuries are usually fatal and some of the lucky people can reach emergency services without dying in the place of trauma. They can cause severe symptoms which can be lifetreathing. This type of injuries must been taken carefully and need to decide fast what treatment you going to give.</p> <p><strong>Case report: </strong>We present a 53 years old patient who has been stabbed during a fight and got his trachea ruptured. His complaints shortness of breath and neck swelling. He can be treated conservatively with bronchoscopic and clinical evaluation.<br /> Discussion: Tracheobronchial injuries are life-threatening and the airway must be secured first. They can be treated conservatively in some cases. CT can be useful but fiberoptic bronchoscopy is the key in diagnosis.</p> <p><strong>Conclusion: </strong>Although early treatment of tracheal lacerations is urgent surgery, it is reported that these injuries can be treated with conservative methods under appropriate conditions.</p> 急性坏死性胰腺炎伪装成腰大肌脓肿:两种情况的报告 07/15/2020//m.lakotalakes.com/hjsr/ascr-aid1046.php & lt; h2> Abstract< / h2><p>Acute pancreatitis is commonly diagnosed clinically, with its classical presentation of upper abdominal pain, backed by raised serum levels of enzymes amylase and lipase. However, unusual presentation of this common surgical emergency as a psoas abscess is a rare finding which can lead to missed diagnosis with a fatal outcome.</p> <p>We present here two such cases of acute necrotising pancreatitis masquerading as psoas abscess, with no classical clinical symptoms and only mildly raised levels of serum amylase and lipase. The region of pancreas involved by necrosis influenced the site of presentation of the psoas abscess. In the first case, acute necrotising pancreatitis involving head and neck of pancreas presented as psoas abscess presenting in the right lumbar region, while the left side collection due to pancreatitis involving body and tail of pancreas manifested as an abscess in left flank.</p> <p>While evaluating the aetiology of a psoas abscess, a differential diagnosis of necrotizing pancreatitis should be kept as a possibility.</p> 非典型腺管增生:因素预测风头癌 07/06/2020//m.lakotalakes.com/hjsr/ascr-aid1045.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>目的:& lt; / strong>经皮芯针吸活组织检查(CNB)被认为是黄金标准技术最初的组织学诊断可疑乳腺癌病变筛查性乳房x光检查,但它是不太可靠的诊断非典型腺管增生(ADH)因重大恶性疾病的诊断率风头后切除活检。本研究的目的是确定因素预测诊断自负的癌患者诊断为ADH核心活检。;/ p>& lt; p> & lt; strong>方法:& lt; / strong>回顾数据库搜索确定连续52 CNB可疑乳腺癌病变显示纯抗利尿激素。入选标准包括无症状妇女筛查性乳房x光检查,随后进行了手术切除。逻辑回归分析评估临床、放射学、组织学因素。;/ p>& lt; p> & lt; strong>结果:& lt; / strong>总共52 ADH CNB是识别患者满足我们的标准。26的52名患者(50%)抢了导管原位癌或浸润性癌,根据手术切除标本的组织学解释。病变大小显示显著预测在单变量逻辑回归分析。 Multivariate logistic regression analysis revealed Asian ethnicity and lesion size as independent predictors of malignancy (p = 0.050 and 0.011, respectively). Conversely, women of Middle Eastern and European origin and lesions &lt; 15 mm on mammography were negative predictors of malignancy.</p> <p><strong>Conclusion: </strong>Lesion size &ge; 15 mm on mammography and Asian ethnicity are independent risk factors for breast carcinoma in asymptomatic patients diagnosed with ADH on CNB.</p> Laparoscopic-Assisted Transumbilical体外切除Meckela€™s憩室10岁男孩,消化道出血的症状 04/20/2020//m.lakotalakes.com/hjsr/ascr-aid1044.php & lt; h2> Abstract< / h2><p>The Meckel&rsquo;s diverticulum (MD) is the most common anomaly of ductus omphaloentericus that surgeon encounters in clinical practice. The accurate incidence is unknown because most patients with the Meckel&rsquo;s diverticulum are asymptomatic. Most studies report an incidence of about 2%. Approximately 4% of patients with the Meckel&rsquo;s diverticulum become symptomatic.</p> <p>A 10 years old boy, was sent from regional hospital. His symptoms started the day before he was hospitalized and represented as gastrointestinal bleeding, lower abdominal pain and four times vomiting, without fever. Ultrasound and X-ray of the abdomen were normal. Blood findings showed: RBC 3,19, hemoglobin 0,95, hematocrit 0,27. During a physical examination abdomen was palpatory soft, with no presence of the pain. Digital rectal examination showed blood. A scintigraphy pathologic scan showed a focal lesion of the right hemi abdomen consistent with the Meckel&rsquo;s diverticulum.Patient was treated byLaparoscopic-Assisted Transumbilical Extracorporeal Resection of the Meckel&rsquo;s Diverticulum.</p> 在慢性胰腺炎横向Pancreato-Jejunostomy: 32例的评价 01/28/2020//m.lakotalakes.com/hjsr/ascr-aid1043.php & lt; h2> Abstract< / h2><p><strong>Background:</strong> Lateral Pancreaticojejunostomy (LPJ) has recognized applications in the management of Chronic Pancreatitis (CP). It is done for patients with severe pain, obstructed and dilated pancreatic duct. Ductal obstruction by stone or stricture causes rise of intraductal pressure and parenchymal ischemia. Surgical decompression of the duct and ductal drainage can achieve best pain relieve and slow the progression of the disease. We want to share our experience of removal of stones and strictures from the pancreatic duct system and drainage of the main pancreatic duct by lateral pancreatojejunostomy (LPJ) for chronic pancreatitis in a teaching institute.</p> <p><strong>Methodology:</strong> We studied 32 cases of chronic pancreatitis operated between January 2010 and January 2017 for a period of 7 years. Patients were selected with ultrasonography, CT scan and or Magnetic Resonance Cholangio Pancreatography (MRCP). Dilatation of the main pancreatic duct by at least 7 mm proximal to the obstruction were recruited for operation. We did Roux-Y lateral pancreato-jejunostomy for patients with obstruction of the pancreatic duct due to intraductal stones or strictures. Additional distal pancreatectomy were done in two cases for stones and/or abscess in the tail area. We did one Frey&rsquo;s operation for stone and fibro-calcification of the head. In all cases ductal drainage was accomplished by LPJ. We studied their post-operative pain control, complications, recurrence and improvement of exocrine and endocrine function of pancreas and mortality during this period. We followed these patients for about 2 years after surgery.</p> <p><strong>Results:</strong> We found 27 out of 32 patients got complete remission of the abdominal pain. Their progression of disease also slowed down. Ultrasonic evidence of chronic pancreatitis have improved or resolved. Ductal diameter have decreased. Two had recurrence of stones in the head and in the parenchyma within a year. 2 patients died during this follow-up period. One died three months after LPJ due to massive gangrene of the small intestine distal to LPJ and jejuno-jejunostomy and subsequent short bowel syndrome. Other one died of complications of diabetes and malabsorbtion. Pain free survival is about 84% and recurrence is 6%. Mortality during this follow up period is 6%.</p> <p><strong>Conclusion:</strong> We found that surgery, if done early, can have good remission of abdominal pain and can slow the progression of chronic pancreatitis and prevent further stone formation in majority of patients. Patient&rsquo;s exocrine and endocrine function improves or remain static. Patient with chronic calcific pancreatitis and diabetes are unlikely to have favorable outcome even after decompressive surgery.</p> 在西班牙开始减肥和代谢手术 12/27/2019//m.lakotalakes.com/hjsr/ascr-aid1042.php <h2>Overview</h2> <p>Bariatric Surgery (BS) from the Greek bari = weight and iatrein = cure) treats obesity and began in Spain in 1973. Its greatest development occurs after the founding of SECO (Spanish Society of Obesity Surgery) in 1997. The purpose of this work is to reflect the changes that have occurred in these 22 years.</p> 急性阑尾炎:西班牙裔和汉堡的迹象 11/20/2019//m.lakotalakes.com/hjsr/ascr-aid1041.php & lt; h2> Abstract< / h2><p><strong>Objective:</strong> To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis.</p> <p><strong>Methods:</strong> This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR).</p> <p><strong>Results:</strong> A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia.</p> <p><strong>Conclusion:</strong> It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.</p> 热胆囊切除术 11/20/2019//m.lakotalakes.com/hjsr/ascr-aid1040.php <h2>Letter to Editor</h2> <p>Acute cholecystitis is a common general surgery disease which may require hospital admission. Delayed or early cholecystectomy is the definitive treatment. Availability of theatre slots may postpone cholecystectomy for weeks. I am writing this letter to explain the importance of early cholecystectomy programme and the necessity of support such programme by hospital managers. I will rationalize the concept of such program and its clinical and economic benefits.</p> 独特的转移性脊髓硬膜外脓肿与肝脓肿后提升胆管炎和大肠杆菌菌血症 11/06/2019//m.lakotalakes.com/hjsr/ascr-aid1039.php & lt; h2> Abstract< / h2><p>Pyogenic liver abscess (PLA) is a life-threatening infection that may develop as a result of an underlying hepatobiliary disease. A possible complication of PLA is metastatic spread, resulting in distant seeding of infection in other organs, and occasionally in the epidural space. Spinal epidural abscess (SEA) is a rare infection with severe potential complications. We describe a 71-year-old patient who presented with ascending cholangitis that was complicated by micro PLA, with a subsequent <em>Escherichia coli</em> bacteremia and metastatic SEA. An emergent surgical intervention with laminotomy and drainage of the epidural collection was performed. The patient was treated with a prolonged antibiotic regimen, with uneventful recovery and no neurologic sequelae. To our knowledge, this is the first reported case of a SEA following <em>E. coli</em> PLA.</p> 腹前壁脓肿:一个不寻常的结肠癌的癌 10/18/2019//m.lakotalakes.com/hjsr/ascr-aid1038.php & lt; h2> Abstract< / h2><p><strong>Background:</strong> Colorectal cancer progresses without any symptoms early on, or those clinical symptoms are very discrete and so are undetected for long periods of time. The case reported is an unusual presentation of colorectal cancer.</p> <p><strong>Case Report:</strong> A 60 year old man presented with right sided abdominal swelling. On examination, a well-defined, firm, tender swelling was noted. Computed tomography confirmed the presence of a mass arising from the right colon with infiltration of the right lateral abdominal wall and adjacent collection. An exploratory laparotomy with drainage of the subcutaneous abscess, resection of ascending colon, and ileotransverse colon anastomosis was performed.</p> <p><strong>Conclusion:</strong> A differential diagnosis of carcinoma colon should be considered when an elderly patient presents with abdominal wall abscess accompanied by altered bowel habits or per rectal bleeding, even if there are no other significant clinical symptoms and a thorough investigative work up is required to confirm the diagnosis, to avoid untimely delay in treatment, and reduce mortality.</p> 结果腹腔镜再发的质量为症状性精索静脉曲张结扎技术 09/06/2019//m.lakotalakes.com/hjsr/ascr-aid1037.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>精索静脉曲张治疗是一个有争议的问题。没有一个方法是采用最好的治疗选择。睾丸从睾丸动脉得到血液供应,睾提肌的动脉和动脉血管的顺从。所以腹部睾丸动脉结扎不会引起睾丸缺血。这是已经在很多研究中得到验证。古典Palomo再发也包括开放的睾丸血管结扎腹膜后腔。集体睾丸静脉和动脉结扎在技术上是容易和快速腹腔镜再发(LV)。缺少一些静脉的机会也更少。从今以后复发也更少。 Recurrence and post-operative complications are high when only testicular vein is ligated by laparoscopy in the retroperitoneum. We wanted to see the outcome of laparoscopic varicocelectomy by mass ligation technique.</p> <p><strong>Methods:</strong> 56 patients of symptomatic varicoceles were included in the study from the outpatient services. Symptomatic varicoceles of grade 2 to grade 3 were operated from January 2012 till January 2019 over a period of 7(seven) years in Jahurul Islam Medical college Hospital. The patients were selected for dull pain and ugly veins not for infertility. All were operated by laparoscopy with en-mass ligation of testicular vein and artery in the retroperitoneum. They were followed up for a period of six months after surgery. We collected all the data in a retrospective manner.</p> <p><strong>Results: </strong>The average operation time was 27&plusmn;3 minutes. Average post-operative hospital stay was 32&plusmn;7 hours. There were no technical failures requiring conversion to open varicocelectomy. There was no incidence of hydrocele formation nor testicular atrophy. One patient of bilateral varicocele had 50% reduction of his varicocele. We considered this a recurrence. All other patient had complete reduction of varicocele. One patient developed hemo-peritoneum due to dislodgement of hemo-clip, which required laparotomy. He did not require any further surgery for his varicocele.</p> <p><strong>Conclusion: </strong>Laparoscopic varicocelectomy with mass ligation technique is safe, effective, less time consuming and easy to perform. Recurrence and post-operative complications are minimum. Plastic hemo-lock should be used rather than titanium heom-clip for ligation of testicular vessels. There is no incidence of testicular atrophy or any adverse effect on testis.</p> 非常大的肝血管瘤:准的安全管理 09/06/2019//m.lakotalakes.com/hjsr/ascr-aid1036.php & lt; h2> Abstract< / h2><p>Hemangiomas are known as congenital vascular malformations that can affect almost any organ or tissue, with the liver being the most common intra-abdominal organ to be involved. It is well known that hemangiomas are the most common benign tumours of the liver, and develop in about 4-20% of people, mainly young adult females. Recently, due to the dramatic rise in the use of imaging studies for different purposes, a parallel increase in the incidence of these tumours has been noticed. Most liver hemangiomas are small (less than 4cm in diameter), asymptomatic and found incidentally during abdominal operation for other indication or on radiologic studies. Giant liver hemangioma is defined as hemangioma with a diameter of more than 5cm. This unique and uncommon type of haemangioma usually poses therapeutic challenges for the treating physician, especially hepatic surgeons, due to the unclear natural history, and due to the risk of life threatening complications is yet to be established. While it is already proved by several studies that conservative management of giant hepatic hemangioma is safe, it is not known whether observation of the extremely large hepatic hemangioma (tumours larger than 10cm) is safe as well.</p> <p>The aim of this article is to review the English literature to find out if conservative management of the extremely giant liver hemangioma is safe and can be recommended.</p> 颈动脉疾病:AngioCT特性 08/26/2019//m.lakotalakes.com/hjsr/ascr-aid1035.php & lt; h2> Abstract< / h2>& lt; p>本文的目的是强调AngioCT颈动脉解剖的特点/壁画血肿。图像显示内部颈动脉狭窄偏心腔包围月牙形hypodense壁增厚,明显提高血管壁。颈动脉血肿是一种hypodense壁增厚,导致动脉壁的扩张,压缩腔和释放形成血栓的因素的内膜的损伤。内膜和媒体之间的血肿引起血管扩张直径和一个狭窄的古怪的腔。外围超密度是由于对比增强血管滋养管的外膜层。医生应该熟悉imagiologic颈动脉疾病的特点,由于不同的治疗方案。;/ p> 指甲下的外生骨疣:儿科方面 07/26/2019//m.lakotalakes.com/hjsr/ascr-aid1034.php & lt; h2> Introduction< / h2>& lt; p>指甲下的外生骨疣(苏)是一种良性的指骨的肿瘤osteocartilaginous自然[1]。苏在儿童和年轻成人最常见的诊断;大多数这些病变位于大脚趾,尽管他们可能发生在其他脚趾(尽管很少)。我们报告中描述五观察苏年轻10岁以下儿童的特性并讨论在儿科人口。你们;病理/ p> ROGAVF研究2019 -糖化血红蛋白的关系(血糖控制)在AV瘘管的结果:一个前瞻性研究 07/22/2019//m.lakotalakes.com/hjsr/ascr-aid1033.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>目的:& lt; / strong>这项研究的主要目的是比较结果基于糖尿病控制对病人进行组建一个新的上肢动静脉瘘(AVF)。研究设计和方法:前瞻性队列研究,我们获得的基线糖化血红蛋白在65例接受AV瘘管形成。在我们的诊所随访6周后创建评估瘘成熟。你们;/ p>& lt; p> & lt; strong>结果:& lt; / strong>多个使用逻辑回归分析糖化血红蛋白之间的关系状态和成熟的AVF控制在6周后可能的混杂因素如年龄、性别、高血压和dyslipidaemia的存在。那些糖化血红蛋白小于6.5的22倍可能成熟在6周动静脉与糖化血红蛋白相比6.5或更多(优势比= 22.65,p, lt;0.005)。;/ p>& lt; p> & lt; strong>结论:& lt; / strong>糖尿病控制良好,反映的糖化血红蛋白小于6.5,与一个非常高的可能性在6周后创建灵活AVF成熟度;/ p> 特发性术后胆管系统扩张;潜在病因和管理 07/22/2019//m.lakotalakes.com/hjsr/ascr-aid1032.php & lt; h2> Summary< / h2><p>What is called &ldquo;idiopathic biliary duct system dilatation&rdquo; or better to name it &ldquo;un-explained biliary dilatation&rdquo; is mostly following surgical procedures related to upper gastrointestinal and hepato-bilio-pancreatic systems. Having such situation, adaptive physiology of the biliary duct system has to be considered and rational has to be explained. The vast multimodal progress in techniques of investigations that has been applied on studying the hepato-bilio-pancreatic system has been utilized to clear the clinical ambiguity of biliary duct system dilatation for no logic reason but missing the correlation between both fields; the technical and the clinical ones. This clinical review is trying to fill this gap and introduce a comprehensive discussion of the subject.&nbsp;&nbsp; Mechanical, biochemical and immune causes constitute a wide diversity of etiology related to biliary system dilatation that in some situations is really difficult to verify clinically. On the least, even we could not verify the etiology we need to identify that reaching a closed road is different than postulating suspicions that never exist. This review is a trial collecting all subject-related data that might be related to etiology mechanisms and utilize to find a correlation rationale. At some point verification of such correlation is really a far target that might be even impossible clinically with availing technical tools and hope in the future could be achieved.</p> 讲座:€œFirst援助的人口伤口在事故中,Natastrophes、自然灾害、恐怖attacksa€人道主义和技术大学 07/19/2019//m.lakotalakes.com/hjsr/ascr-aid1031.php <h2>Study questions</h2> <ol> <li>The concept of wounds.</li> <li>Classification of wounds.</li> <li>Signs of wounds.</li> <li>Factors affecting the course of the wound process.</li> <li>Phases of the wound process.</li> <li>Types of wound healing.</li> <li>Features of wounds in children.</li> <li>First (first emergency) help.</li> <li>Complications of wounds.</li> <li>Specific bite wounds. Notion Treatment. Complications.</li> <li>Snake bites. First aid.</li> <li>Arthropod bites. First aid.</li> </ol> <p>Wounds are called traumatic violation of the integrity of the skin or mucous membranes with possible damage to the deeper tissues.</p> 急性胃肠出血;不会太老了,是由于Meckela€™s憩室——病例报告和文献综述 06/03/2019//m.lakotalakes.com/hjsr/ascr-aid1030.php & lt; h2> Abstract< / h2><p>Gastrointestinal (GI) bleeding is a very common medical problem encountered in the acute care setting, and is a major cause of admission to hospitals with about 300,000 patients admitted annually. Obscure GI bleeding, defined as persistent or recurrent bleeding following initial negative upper and lower endoscopy, represents approximately 5% of all GI hemorrhages. The small bowel is the most common source for obscure GI bleeding. Variable lesions of the small bowel can cause obscure GI bleeding, with tumors, Crohn&rsquo;s disease and Meckel&rsquo;s diverticulum being more common in young age group. Meckel&rsquo;s diverticulum, the most common GI congenital malformation, is usually asymptomatic and incidentally found. It can present with GI bleeding, seen more in pediatric patients, and rarely in adult patients. Herein, we present a 45 years old female patient, presenting with massive obscure GI bleeding due to Meckel&rsquo;s diveticulum.</p> 女人成功的病例报告:性药吗? 05/07/2019//m.lakotalakes.com/hjsr/ascr-aid1029.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>简介:& lt; / strong>腹部疝是一种病理条件导致的异常突出的腹部脏器。特别是,腹内疝(IH)代表大约-0.9%至0.2的情况下与帕拉-十二指肠闭孔疝疝,而只有0.07%的占疝。;/ p>& lt; p> & lt; strong>方法:& lt; / strong>我们报道的病例报告,79岁的妇女被我们医院肺内科部门失败和几天后腹痛转移到我们的手术部门。;/ p>& lt; p> & lt; strong>结论:& lt; / strong>闭孔疝是罕见类型的疝和更频繁的在多胎妊娠史的老年妇女,慢性咳嗽,习惯性便秘。在我们的病人,详细的体格检查和MRI术前影像学研究,诱导成功诊断。;/ p> 迷你胃旁路手术后胆汁返流性胃炎:胆红素水平的影响 02/19/2019//m.lakotalakes.com/hjsr/ascr-aid1028.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong> Minigastric旁路是全球流行作为一个有效的减肥手术并发症比RYGB少。有提高胆汁回流及其对胃黏膜的影响的担忧。在这项研究中,我们试图找到之间的联系存在胆汁MGB后的胃和胃炎的发病率。;/ p>& lt; p> & lt; strong>方法:& lt; / strong>这夏姆斯大学进行了前瞻性研究在医院从2017年1月到2018年5月包括40例。所有患者接受MGB 12个月随访,UGI MGB内镜进行了9个月后对所有的病人,在多个切片和胃管获得了胆红素水平。你们;/ p>& lt; p> & lt; strong>结果:& lt; / strong>在操作平均年龄是32年(18,mdash; 60),术前体重指数44.31 kg / m2。平均手术时间为95(和plusmn;18分钟),意思是% EWL 81.2%在12个月。完成分辨率8患者发生高血压的糖尿病2型(80%)和11例(84.2%)。 Level of bilirubin in gastric aspirate was elevated in 8 patients (20%) all of them had different levels pouch gastritis confirmed by histopathological examination.</p> <p><strong>Conclusion: </strong>Biliary reflux reached about 20% after MGB, the severity of biliary gastritis is related to the elevation of bilirubin level in the gastric aspirates, this results need to be confirmed by further studies on the MGB.</p> 风险定义在腹腔镜与开放的胆囊切除术 02/07/2019//m.lakotalakes.com/hjsr/ascr-aid1027.php & lt; h2> Abstract< / h2><p>Nothing without risk. As cholecystectomy is one of the most common procedures, any minor risk will be a mass volume. This study was to define the magnitude of that risk. In the study were 1486 patients between Feb. 2009 and April. 2018. Open in 292 (19.6%), 1194 (80.4%) laparoscopically, 1086 [91%] completed so and 108 (9%) converted. There were 18 (1.2%) with bile duct injury. 1 (0.3%) in the open group and 17 (1.4%) in the laparoscopic group. 9 diagnosed during surgery, 4 with jaundice, 2 early and 2 late, 5 with leak. Statistically the operative injury is insignificance in the 2 groups (P&lt;0.3). The jaundice was significantly high in the laparoscopic group of patients (P&lt;0.045). Also the bile leak (P&lt;0.028). The same for morbidity (P&lt;0.01. The revers was for mortality (P&lt;0.04).</p> <p><strong>Conclusion:</strong> The incidence of CBD injury in the literature is less than the actual rate. Laparoscopic interventions have a higher rate of injury and the proximal ducts are at higher risk.</p> 鳞状细胞癌上开发被忽视、虐待和延迟诊断慢性下肢静脉溃疡 02/04/2019//m.lakotalakes.com/hjsr/ascr-aid1026.php & lt; h2> Abstract< / h2><p>Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC) with particularly aggressive behaviour. We present a case of a 71-year-old female patient with a relevant personal history of multiple SCC and basal cell carcinoma (BCC) excision and chronic venous insufficiency showing for about three years a ulcerated lesion located on the anteromedial distal third of the left leg non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology revealed a G2 SCC in all biopsy samples. After the staging, a left inguino-femoral lymphadenectomy and the excision were done. The treatment of bone exposure with a soleus muscle flap in the upper half of the defect and skin graft for all the defect and a specific oncologic treatment were proposed as possible curative solutions. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.</p> 反式腹部Pre-Peritoneal (TAPP)网格腹股沟疝修补术与外固定(Abdelhamid技术),结果评估 01/24/2019//m.lakotalakes.com/hjsr/ascr-aid1025.php & lt; h2> Abstract< / h2><p><strong>Purpose:</strong> To compare the outcomes of Abdelhamid technique in treatment of inguinal hernia to conventional TAPP with mesh stapling, Prolene hernia system (PHS) and Lichtenstein repair.</p> <p><strong>Background: </strong>the mesh is applied and fixed externally aiding in decreasing port size and cost. There is controversy concerning the necessity of securing the mesh during laparoscopic TAPP repair.</p> <p><strong>Patients:</strong> The study was carried out at the faculty of medicine &ndash; Beni Suef University, Egypt from September 2008 to April 2018. 672 patients with unilateral inguinal hernia participated in the study. 432 were treated using Abdelhamid Technique, 382 of which were unilateral primary inguinal hernia and 50 were unilateral recurrent. 50 patients were treated using Prolene Hernia System (PHS). 50 patients with recurrent hernias were treated using Lichtenstein repair and 140 patients went TAPP with mesh stapling.</p> <p><strong>Results:</strong> Abdelhamid technique showed more cost effectiveness than stapling (1800$ vs 3000$) , pronounced less recurrence rate in comparison with Liechtenstein and PHS (2% vs 4%) , same LOS compared to other techniques and mean operative time of 76 minutes which is longer than stapling (60 mins), Liechtenstein (65 mins) and PHS (55 mins).</p> <p><strong>Conclusion:</strong> Abdelhamid technique was a more lengthy operation costing more than open surgery but less than mesh stapling. The recurrence rate is considerably reduced with shorter recovery period. The technique is done with smaller port size that leads to cost reduction.</p> 原发性胆总管闭包的安全 01/22/2019//m.lakotalakes.com/hjsr/ascr-aid1024.php & lt; h2> Abstract< / h2><p>Primary closure of the common bile duct following exploration has been safely and effectively performed, as advocated by Halsted, provided no evidence of pancreatitis, cholangitis, or ampullary obstruction exists. This study was to gain back confidence to primary closure in selected cases. This study was conducted at Beniswaif University Hospital. Between July 2008 to May. 2014. Using this precedent, the operative management and post-operative course of 19 patients undergoing common bile duct (CBD) exploration for choledocholithiasis were studied, twelve had primary closure of the common bile duct following choledochotomy and exploration, and seven had T-tube placement.</p> <p>Patients were selected for T-tube if there were pancreatitis, cholangitis, undue trauma, ampullary obstruction. Two patients in that study had bile leak, one in each group. Intravenous fluids were less in primary suture (P&lt;0.001). The long of stay were significantly less in primary suture (P&lt;0.001). The outcome of this study greatly support the safety of primary common bile duct closure in selected cases.</p> Iarogenic胆管损伤:维修的可行性 01/14/2019//m.lakotalakes.com/hjsr/ascr-aid1023.php & lt; h2> Abstract< / h2><p><strong>Purpose: </strong>To compare the outcomes of Abdelhamid technique in treatment of inguinal hernia to conventional TAPP with mesh stapling, Prolene hernia system (PHS) and Lichtenstein repair.<br /> Background: the mesh is applied and fixed externally aiding in decreasing port size and cost. There is controversy concerning the necessity of securing the mesh during laparoscopic TAPP repair.</p> <p><strong>Patients:</strong> The study was carried out at the faculty of medicine &ndash; Beni Suef University, Egypt from September 2008 to April 2018. 672 patients with unilateral inguinal hernia participated in the study. 432 were treated using Abdelhamid Technique, 382 of which were unilateral primary inguinal hernia and 50 were unilateral recurrent. 50 patients were treated using Prolene Hernia System (PHS). 50 patients with recurrent hernias were treated using Lichtenstein repair and 140 patients went TAPP with mesh stapling.</p> <p><strong>Results: </strong>Abdelhamid technique showed more cost effectiveness than stapling (1800$ vs 3000$) , pronounced less recurrence rate in comparison with Liechtenstein and PHS (2% vs 4%) , same LOS compared to other techniques and mean operative time of 76 minutes which is longer than stapling (60 mins), Liechtenstein (65 mins) and PHS (55 mins).</p> <p><strong>Conclusion: </strong>Abdelhamid technique was a more lengthy operation costing more than open surgery but less than mesh stapling. The recurrence rate is considerably reduced with shorter recovery period. The technique is done with smaller port size that leads to cost reduction.</p> 一个€œIliosacral bridginga€——一个新的替代微创固定不稳定骨盆环骨折 11/20/2018//m.lakotalakes.com/hjsr/ascr-aid1022.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>简介:& lt; / strong>两前部和后部骨盆环骨折是常见的损伤多发伤和老年人超越那些简单的低强度的创伤。虽然传统x射线主要显示损伤的腹侧方面,计算机断层扫描通常发现额外的骶骨骨折。大量的这些骨折AO B-injuries,主要压缩骨折在一个先进的年龄。此外,骨盆骨折的流行引起的骨质疏松症,而不是后来的一个明显的创伤是增加,这样一个损害动员的损伤常与疼痛。标准骶髂螺钉固定通常以放松,因此失败的骨缝术尤其是老年患者的骨质疏松性骨。;/ p>& lt; p> & lt; strong>方法:& lt; / strong>一个新的替代外科微创技术,,,宝贝,iliosacral bridging&”,,稳定骶骨骨折内固定的S1椎弓根受伤到髂骨的影响。的组合与标准单一骶髂螺钉内固定在受伤方面允许立即完全负重自由动员和痛苦。一系列病例8例。;/ p>& lt; p> & lt; strong>结果:& lt; / strong>临床和放射学分析类似于pelvic-outcome-score提出,2例显示一个优秀的和两个病人一个好的结果。 The other 4 patients achieved sufficient results.</p> <p><strong>Conclusions: </strong>The &ldquo;iliosacral bridging&rdquo; we have introduced in the present study provides evidence of an expected increased stability of the pelvis after B-injuries.</p> 急诊腹腔镜左路结肠切除原发性吻合:可行性和安全性 11/20/2018//m.lakotalakes.com/hjsr/ascr-aid1021.php & lt; h2> Abstract< / h2><p>Patients undergoing laparoscopic surgery had a lower incidence of major complications, such as anastomotic leak, intra-abdominal bleeding, abscess, and evisceration. Controversies about the operative management of left colonic emergencies are decreasing. Nowadays there is worldwide shifting towards primary resection, on table lavage and primary anastomosis. The aim of this study is to record the safety of laparoscopic primary anastomosis in left-sided colonic emergencies.</p> <p><strong>Patients: </strong>The study was carried out at Beni-Suef University Hospital, in the period between January 2016 and July 2017. Twenty-six patients were included in this study, twelve with left colon cancer, twelve with left colonic complicated diverticulitis and two cases with sigmoid volvulus. Patients presented clinically with either obstruction or perforation. All patients were subjected to laparoscopic resection, on table lavage and primary anastomosis.</p> <p><strong>Method: </strong>Decompression was done prior to starting the intervention, followed by resection and on table lavage then colorectal anastomosis using the circular stapler. The study was approved by the ethical committee in the faculty.</p> <p><strong>Results: </strong>Mean operative time: 185 min (160- 245).</p> <p>LOS: 12 (10- 18).</p> <p><strong>Leak: </strong>one in obstruction group and two in perforation group.</p> <p>Redo one in perforation group.</p> <p><strong>Conclusion: </strong>Emergency laparoscopic left-sided colonic resection and primary anastomosis can be performed with low morbidity, however with caution if there was free perforation with peritonitis.</p> 阑尾放线菌病 10/17/2018//m.lakotalakes.com/hjsr/ascr-aid1020.php <h2>Case Report</h2> <p>A 40 year old woman presented to the emergency department with acute on chronic abdominal pain in her right iliac fossa. On history her pain had been present for over 6 months and had previously been investigated with ultrasound, CT and a diagnostic laparoscopy several months prior to presentation. Her pain had acutely worsened over the preceding two weeks. This was associated with two days of diarrhoea but nil other systemic symptoms. Her medical history was significant for immunosuppression with tacrolimus, azathioprine and prednisone post renal transplant for IgA nephropathy [1].</p> 腹内的睾丸肿瘤——病例报告 10/17/2018//m.lakotalakes.com/hjsr/ascr-aid1019.php 一个35岁的男人在面对小腹肿胀2个月。他被发现有未降到阴囊的睾丸。超声波扫描显示一个坚实的浮动盆腔质量。他的胸部x光片和睾丸癌的肿瘤标记被正常。开腹探查术显示左腹腔睾丸肿瘤。腹腔左睾丸切除术。病人做了一个平淡无奇的复苏。组织学显示不成熟的精原细胞瘤。质量在小腹cryptorchidic睾丸强烈指向在腹部睾丸恶性肿瘤的诊断。为了防止这种并发症之前所有未降到阴囊的睾丸被睾丸固定术在post-adolescent生活2年或睾丸切除术。 But some cases remain unnoticed, which leads to this kind of presentation. So, we decided to present this rare and interesting case of intra-abdominal testicular tumour. 腹腔镜胆囊切除术:初学者所面临的挑战我们的视角 08/23/2018//m.lakotalakes.com/hjsr/ascr-aid1018.php & lt; h2> Abstract< / h2><p><strong>Background: </strong>Laparoscopic cholecystectomy is gold standard and most widely performed surgery for gallstone disease all over the world. Surgeons entering into the field of laparoscopic surgery for the first time faces challenges that are different from those with experienced hands. We in this study tried to enumerate the various such challenges and also recommend few steps to counter them.</p> <p><strong>Aims &amp; Objectives: </strong>To study the challenges faced by new surgeons in laparoscopic cholecystectomy and recommendations to reduce them.</p> <p><strong>Material &amp; Methods: </strong>This study was carried out in a medical college in the department of General and Minimal Access surgery. In this retrospective study, ten general surgeons working as senior residents in in this medical college over a period of 3 years having never performed laparoscopic surgery in past were included.</p> <p><strong>Results: </strong>A total of 50 cases, five operated by each surgeon with minimal assistance by senior surgeon in few cases. Operative time varied from 90 to 120 minutes. The various technical challenges faced by the new surgeon were in the Creation of Pneumoperitoneum, Creation of second port (epigastric port 10mm), Gallbladder Retraction and Dissection at calot&rsquo;s triangle, Dissection at gallbladder bed and Removal of the gallbladder from epigastric port.it has been observed that following various simple steps will abate these technical difficulties for these beginners while doing laparoscopic cholecystectomy.</p> <p><strong>Conclusion: </strong>Laparoscopic cholecystectomy is the most commonly performed minimal access surgical procedure nowadays and almost all the new surgeons enter the world of laparoscopic surgery via this surgery. Knowing and following the above recommendations will help them abate the technical challenges generally faced during the initial phase in the laparoscopic field.</p> Gossypiboma由于保留手术海绵腹部子宫切除术后,并发肠迁移和小肠阻塞——病例报告 08/14/2018//m.lakotalakes.com/hjsr/ascr-aid1017.php gossypiboma是一个大规模的棉花材料从任何来源,在手术后体腔。这增强了发病率,治疗费用和潜在的病人死亡率的法医学的问题。我们报告一例32岁女士提出的投诉中心1月腹痛和呕吐,发烧了20天,non-passage胀气及粪便的5天。她经历了4个月前在行经腹全子宫。在临床检查,怀疑小肠梗阻的粘合剂。在摄影评估,gossypiboma提出有可能迁移到小肠。剖腹手术发现成群的存在肠循环,材料等解剖有撕裂和显示纱布肠内腔。诊断与肠道gossypiboma迁移的保留手术海绵是确定的。gossypiboma的可能性,特别是在先前操作的情况下,必须牢记,必须采取措施来防止这样的事件。 减肥手术前Esophagogastroduodenoscopy的至关重要的作用 06/20/2018//m.lakotalakes.com/hjsr/ascr-aid1016.php & lt; h2>亲爱的Editor< / h2>& lt; p>我们读有兴趣的病例报告题为,宝贝,Dieulafoy&,年代病变相关的大规模在单吻合胃分流术中消化道出血需要总胃切除术:案例Repor& # 39; t发表在手术和临床研究档案b Ashraf伊玛目et al . [1]。我们感谢作者这样一个复杂的管理案例,分享他们的经验,但我们有一些conIlict管理,和我们想添加一些评论关于还在减肥手术的重要性。;/ p> 阴囊积水与专利突起鞘突的孩子无关 05/02/2018//m.lakotalakes.com/hjsr/ascr-aid1015.php & lt; h2> Abstract< / h2><p><strong>Background: </strong>After the closure of patent processus vaginalis (PPV) in boys with indirect inguinal hernia (IIH) or hydrocele, large scrotal hydroceles can occur on rare occasions despite the complete occlusion of internal inguinal ring (IIR). We present some cases that may help to explain the cause of this rare occurrence.</p> <p><strong>Materials: </strong>During last 14 years, six boys exhibited non-communicating large scrotal hydroceles (2 right, 1 left, 3 bilateral) among 352 children who underwent laparoscopic repair for hydroceles. Ages ranged from 7 months to 15 years with a median of 12 years. Five of them had a history of repair for hydrocele or IIH prior to the definitive surgery and one boy underwent an initial operation.</p> <p><strong>Results: </strong>In all the patients, laparoscopic inspection at the definitive surgery revealed completely closed IIRs. One infant with primary hydroceles was found to have large hydroceles bulging into the peritoneal cavity. All the patients were treated with subtotal removal of the sac without any recurrence. Marked thickness of the sack walls with abundant lymph vessels was characteristic histopathological findings.</p> <p><strong>Conclusions: </strong>The complete occlusion of the PPV does not always prevent the recurrence of hydrocele through alternative pathogenesis. The pathological findings of resected specimens suggested a disturbance in lymph flow in the testicular system. The subtotal removal of the sac is the treatment of choice. Diagnostic laparoscopy prior to a direct cut-down approach to the neck of the seminal cord is advisable to identify non-communicating hydroceles to avoid further impairment of lymph drainage around the IIR.</p> 幽门螺杆菌的作用导致重复再感染在慢性前列腺炎口腔 01/10/2018//m.lakotalakes.com/hjsr/ascr-aid1014.php & lt; h2> Abstract< / h2><p><strong>Introduction: </strong>The refractoriness in treatment of chronic prostatitis (CP) could be due to repeated infection. This reinfection could be caused by Helicobacter Pylori present in human saliva.</p> <p><strong>Methods: </strong>The oral cavities seem to be the important reservoirs for the reinfection. The transmission from these reservoirs could be stopped by avoiding contact between male urethera and saliva.</p> <p><strong>Results: </strong>Three patients suffering from refractory symptoms of CP were advised to avoid contact between their urethera and saliva and were prescribed antibiotics. All patients had complete response.</p> <p><strong>Conclusions: </strong>The oral cavity serve as reservoir of microorganisms (H.Pylori) which infects patient&rsquo;s urethera repeatedly in patients of CP.</p> 210年腹腔镜的安全性和有效性管理患者的侵蚀胃带可调 11/21/2017//m.lakotalakes.com/hjsr/ascr-aid1013.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>背景:& lt; / strong>乐队侵蚀(是)被定义为部分或完整的运动向胃腔,也被称为迁移,胃合并和胃包容。这个减肥手术的并发症包括失败的报告是无效的,因此需要切除腹腔镜可调式胃带(LAGB),通常通过腹腔镜手术。;/ p>& lt; p>本研究的目的是描述的临床表现、诊断方法、手术、术后进化的整体治疗。材料和方法:我们捕捉到患者的数据是自2010年1月至2017年10月。数据库包括病人护理,年龄,性别,体重指数带位置之前,多余的体重的比例,数量的设备调整、临床数据和外科手术进行决议。你们;/ p>& lt; p> & lt; strong>结果:& lt; / strong> 379 LAGB并发症诊断在我们的机构;210是诊断和治疗,患者的平均年龄是39岁;从19岁到66岁,性行为是178名女性和32岁的男性。诊断内窥镜在210名患者(100%)。 The surgical procedure to solve the problem was: to remove the LAGB, the fistulous orifice was closed and patch of omentum. The hospital stay was 3-5 days. The motility was zero. Complications were minor in 3% of the 210 patients (fever, atelectasis, wound infection). One patient was re-operated for evolving to residual abscess.</p> <p><strong>Conclusions: </strong>The BE is a serious failure in bariatric surgery. The resolution in this group of patients was to remove the band, direct closure of the fistulous orifice with patch of omentum. The surgical technique that was performed in this complication is safe, effective and easily reproducible.</p> 为众多患者HIV-HCV肝移植的新时代:一个案例报告 11/14/2017//m.lakotalakes.com/hjsr/ascr-aid1012.php & lt; h2> Abstract< / h2>& lt; p>艾滋病病毒感染者的发病率和死亡率已经改善了过去几十年随着抗逆转录病毒疗法相结合。因此,其他并发症,如慢性肾脏和慢性肝脏疾病出现的艾滋病人口。相当比例的终末期肝脏疾病(ESLD)艾滋病人口是由于丙型肝炎合并感染和复活,和越来越需要实体器官移植病人中出现了。另一方面,一些研究在肝移植的患者合并感染人类免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)在患者和移植物存活率都令人沮丧的结果。因此,HIV-HCV合并感染被认为是肝移植的一个相对禁忌症。值得庆幸的是,新的药物治疗丙肝病毒被发现,代理直接在丙肝病毒复制和他们已经改变了整个临床过程的HCV / HIV感染肝移植受者。我们的案例说明了新组合的长期疗效和安全性Sofosbuvir / Ledipasvir HCV / HIV感染的肝移植受者。;/ p> 三十天术后并发症袖胃切除术后,胃旁路手术和迷你胃旁路手术/一个吻合胃旁路手术。分析意大利社会的减肥手术和新陈代谢紊乱(S.I.C.OB) 7年时间的数据库 10/24/2017//m.lakotalakes.com/hjsr/ascr-aid1011.php & lt; h2> Abstract< / h2><p><strong>Background: </strong>To date, the scientific community has mainly focused on outcomes of obesity surgery such as weight loss and resolution of associated complications. Adverse post-operative events and reoperation rates have been poorly reported even if they are a marker of surgical safety and therefore of great importance in guiding patients and surgeons in the choice of the more suitable operation.</p> <p><strong>Methods: </strong>This retrospective multicenter observational study is based on the data extracted from the Italian Society of Bariatric Surgery and Metabolic Disorders (S.I.C.OB.) database, which covers almost all the bariatric operations performed in Italy. We analysed the 30 days post-operative complications occurring, in the period from 2009 to 2015, after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) and Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) qualitatively, quantitatively and on the basis of the Clavien-Dindo classification of surgical complications. Complications following surgeries were tested using the 95% confidence interval. Statistical analysis was performed with Statistical Analysis System (SAS).</p> <p><strong>Results: </strong>In the 2009-2015 time frame, a total of 31,624 operations were performed of which 6,864 RYGB, 10,833 SG and 992 MGB/OAGB. The complication rate was 4.39 %, 4.04 % and 3.83% respectively. The most frequent complications were hemoperitoneum (0.9%) and perforation, fistula and dehiscence (1%) which were higher in SG when compared with RYGB (with a statistical significance) and when compared with MGB/OAGB (without a statistical significance). When dividing the complications by the different grades of the Clavien-Dindo classification, the only significant difference encountered, from a statistical standpoint, was between MGB/OAGB and SG. MGB/OAGB was associated with a lower grade I Clavien-Dindo complication rate (1.31% versus 2.34%).</p> <p><strong>Conclusions: </strong>This study supports a safe profile of obesity surgey in Italy, along with positive bariatric outcomes. The rate of 30 days post-operative complications is progressively lower after MGB/OAGB (3.83%), SG (4.04%) and RYGB (4.39%) respectively. In particular, MGB/OAGB records statistically less low-grade Clavien-Dindo complications compared to SG and RYGB.</p> 70年后纽伦堡代码的注释 10/20/2017//m.lakotalakes.com/hjsr/ascr-aid1010.php & lt; h2> Comments< / h2>& lt; p>纽伦堡代码在人类实验的故事被一个70岁的进化历史的联系,旨在为科学家提供一个警告消息的nonprovisional灾难造成的不道德的人类实验。它站在第一线发挥了保护作用[1]。;/ p> 腹腔镜肿瘤局部nephrectomydoes简介影响力点有效的性能? 10/10/2017//m.lakotalakes.com/hjsr/ascr-aid1009.php <强>简介:< /强>腹腔镜方法是新兴作为质量管理的标准治疗方法适合部分切除。腹腔镜部分切除是一项具有挑战性的手术,其成功的性能取决于各种因素。我们的目标是评估肿瘤的影响在腹腔镜部分切除手术的性能特点。<强>方法:< /强>进行腹腔镜部分切除的病人在我们的机构参与了这个研究。肿瘤轮廓是由一位放射科医师评估从横截面成像(ct或磁共振成像)。肿瘤characerestics定义通过评估肿瘤大小、肿瘤位置和肾的分数。最重要的性能是评价热缺血时间、失血、操作时间和任何重大手术并发症。统计推断是画。<强>结果:< /强> 37病人腹腔镜部分切除2010年1月至2012年6月被纳入本研究。意味着肿瘤尺寸是3.81厘米。 21 tumors involved left kidney and 16 involved right kidney. 12 were located in upper pole, 8 were located in midpole and 17 were located in lower pole. The average RENAL score was 6.56. The mean warm ischemia time, blood loss and operation duration was 26.29 minutes (min), 256.76 millilitres (ml) and 208.11 min respectively. Statistically significant correlation was appreciated between tumor location (polar location, side, anterior/ posterior location) and RENAL score and operative parameters (warm ischemia time and operation duration). Tumor size did not have any correlation with the operative parameters. Conclusion: The operative performance of laparoscopic partial nephrectomy is significantly influenced by the tumor location and RENAL score. Dieulafoya€™s病变相关的大规模在单吻合胃分流术中消化道出血需要总胃切除术:病例报告 09/15/2017//m.lakotalakes.com/hjsr/ascr-aid1008.php & lt; h2> Abstract< / h2><p><strong>Introduction: </strong>Immediate postoperative gastrointestinal bleeding following bariatric bypass surgery is a major complication, and usually results from staple line hemorrhage or conventional gastro-esophageal causes. Dieulafoy`s lesion is a rare cause of gastrointestinal bleeding and is usually managed by endoscopic means. Herein we present a case of massive intraoperative bleeding resulting from gastric Dieulafoy`s lesion single anastomosis gastric bypass surgery necessitating resection of the gastric pouch. This is the first description of this complication, and the difference of such a lesion from the sporadic ones is discussed.</p> <p><strong>Discussion: </strong>Gastric bypass saurgery is an effective procedure for morbid obesity. The approach we have adopted for massive upper GI hemorrhage in the immediate postoperative period should be distinguished from delayed bleeding after gastric bypass. In these latter cases, marginal ulceration is more common than bleeding from the remnant gastric pouch. It is also likely that bleeding from a Dieulafoy`s lesion following gastric bypass surgery represents a different disease compared to other Dieulafoy&#39;s cases.</p> <p><strong>Conclusion: </strong>This is the first description of an intraoperative Dieulafoy&#39;s lesion bleeding during the conduct of a single anastomosis gastric bypass procedure which required gastric pouch resection. Such a lesion differs from sporadic Dieulafoy`s cases, and must be considered in every case of intraoperative bleeding during gastric bypass.</p> 心脏手术发展的革命头:心脏手术进化 08/28/2017//m.lakotalakes.com/hjsr/ascr-aid1007.php <h2>Letter to Editor</h2> <p>From the First case of primitive cardiac surgery (CS), treatment of stab wound of the heart (Dr. Daniel Hale Williams, 1893), to recent surgical procedures and device implantations for end-stage heart failure (HF), the CS has grown and emerged in the public health more and more [1].</p> <p>The heart valve disease had interested immediately since the non-cardiopulmonary era because of the multitude of rheumatic patients and congenital valve disease. In the 1952, Hufnagel implanted the first valve in descending aorta and it was the sign of the first step of the CS evolution. New prosthesis and heart valve techniques were tested between 1970 and 2000 with optimal results in patients&rsquo; quality of life and survival, at the same time of CPB evolution.</p> 手术和新的药理战略在某些动脉粥样硬化慢性和急性病 08/18/2017//m.lakotalakes.com/hjsr/ascr-aid1006.php & lt; h2> Introduction< / h2><p>In actual pharmacological therapy we can see that some drugs can be added to other medical instruments to improve their activity: in example we can see medicated stent for some coronary disease, or hormonal medical devices used in pregnancy prevention, but other example are known today. In example Carmustine wafer is delivered by delivery systems in some brain cancer and radioactive seed implants in prostatic cancer. Ocular intra vitreal implants for some macular degenerations (MABS or cortisones) other implants delivery systems drugs, naltrexone implant for opiate dependence. Other strategies imply carrier use to deliver the drugs in the site of action: In example MABS linked to radioactive isotopes in some relapse of severe Hodgkin disease but many other example we can see in therapy used today. So we can think that other chronic conditions can be treated using a combination of drugs with other instrument to improve the clinical outcomes. This to make possible that the ERLICH MUGIC BULLETS can act in the right site reducing the side effect. In example today we can see various medical interventional radiological strategy to treat in coronary and hearth disease with medicate stents positioning or to local use of contrast agents or other valvle surgery procedures with global good clinical results.</p> 使用Orthodeoxia脉搏血氧仪的检测Hepatopulmonary综合症 08/04/2017//m.lakotalakes.com/hjsr/ascr-aid1005.php & lt; h2> Abstract< / h2><p>Chronic Hepatic deficiency due to the ingestion of alcohol remains as one of the main causes of morbidity and mortality in our country. From it a variety of complications arise, one of them is the Hepatopulmonary Syndrome, which usually goes unnoticed and undiagnosed; this syndrome is distinguished by the presence of hypoxemia and pulmonary vasodilation. The gold standard to establish a diagnostic is contrast-enhanced Echocardiogram. No pathognomonic sign is known for this syndrome, which leads the present elaboration to evaluate the use of orthodeoxia by pulse oximetry as a screening test in the detection of Hepatopulmonary Syndrome cases.</p> 尿淀粉酶在急性胰腺炎的临床意义 06/27/2017//m.lakotalakes.com/hjsr/ascr-aid1004.php & lt; h2> Abstract< / h2><p>Acute pancreatitis forms a major bulk of our inpatient admission due to gall stone disease. Diagnosis of acute pancreatitis remains a challenge even now. Serum amylase remains the most commonly used biochemical marker for its diagnosis but its sensitivity can be reduced by late presentation, hyper-triglyceridemia and chronic alcoholism. We conducted a study to determine the levels of serum and urinary amylase in patients with acute pancreatitis and compared their sensitivity and correlation with CT findings vis-&agrave;-vis the severity of the disease. The study was taken as a post graduate research model in the Post graduate Department of General and Minimal Access Surgery, Govt. Medical College Srinagar, J&amp;K, India 2014-2016 and submitted for the award of masters in General Surgery. A total number of 150 patients were enrolled in the studies which were admitted in our unit as acute pancreatitis. 73 (48.7%) belonged to the age group of 30-44 years, 15(10%) patients aged &gt;60 years with 86 (57.3%) males and 64 (42.7%) females. We had 81 (54%) patients with biliary tract diseases, followed by 21 (14%) patients with worm induced, 20 (13.3%) had hyperlipidaemia and only 4 (2.7%) patients had post ERCP etiology. Tenderness in epigastrium was the presenting sign in 111 (74%), followed by chest signs in 25 (16.7%) patients, diffuse tenderness in 19 (12.7%), icterus in 11 (7.3%), low grade fever in 9 (6%) patients, shock in 5 (3.3%). Diabetes mellitus as a comorbidity was observed in 48 (32%) patients followed by hypothyroidism 37 (24.7%) patients. Hypertension was seen in 31 (20.7%) patients, COPD in 19 (12.7%) patients and obesity in 13 (8.7%) patients. Twenty two (14.7%) needed ICU admission; while as 128 (85.3%) were managed in the general ward. All the enrolled patients in our study were managed conservatively. Out of a total of 150 patients, 148 (98.7%) survived while as only 2 (1.3%) of our patients expired. At the time of admission in the hospital, 120 (80%) patients had serum amylase level of &gt;450 U/L, 19 (12.7%) patients had 150-450 U/L levels while as 11 (7.3%) patients had &lt;150 U/L serum amylase levels. CT has been shown to yield an early overall detection rate of 90% with close to 100% sensitivity after 4 days for pancreatic gland necrosis. The correlation of urinary amylase with the CECT Severity Scoring in a patient of acute pancreatitis is still ambiguous.</p> 肠梗阻复杂大型Morgagni疝 03/27/2017//m.lakotalakes.com/hjsr/ascr-aid1003.php & lt; h2> Abstract< / h2>& lt; p> Morgagni疝代表2 - 4%的先天性膈疝。只有三分之一的症状,由于疝在胸腔腹腔脏器,导致呼吸和消化问题,其中一些严重的,如肠梗阻。急性演讲,内容是罕见的监禁;只有7例中描述文学。;/ p>& lt; p>我们呈现的膈疝,结肠癌和继发性缺血的阻塞,需要紧急手术在两个阶段:第一个手术来控制损害,以开放部分结肠切除术,然后手术修补疝和执行重建肠道运输,通过适当的术后复发。你们的进化,也没有证据;/ p>& lt; p>治疗Morgagni膈疝手术。还在无症状的情况下,由于监禁的危险,最合适的方式进入腹部,无论是通过剖腹手术或腹腔镜检查,减少内容的疝囊,缺陷的修复,以及相关技术的执行在椎间盘髓内脏,是发生在我们的例子中灵活;/ p>& lt; p>一个复杂的先天性疝是一种罕见的病理,并没有处理经验。急性演讲需要综合治疗疝气的腹部症状和修复缺陷。 The carrying over of surgical techniques for damage control into non-traumatic surgery in the face of serious hemodynamic instability is a widespread, accepted practice with the benefits of reducing mortality in critical patients and at times allowing the avoidance of ostomies.</p> Bouveret综合症在一位上了年纪的女性 01/03/2017//m.lakotalakes.com/hjsr/ascr-aid1002.php & lt; h2> Abstract< / h2>& lt; p> & lt; strong>简介:& lt; / strong>胆石性肠梗阻的胃出口梗阻二级称为Bouveret综合症。在此我们提出一个有影响的一位老妇人的胆石在十二指肠和讨论its&,管理。;/ p>& lt; p> & lt; strong>病人描述:& lt; / strong>一个96岁的老妇人被我们部门由于胃出口梗阻。最初的胃镜检查发现胃牛黄。试图对其提取失败了。她接受了剖腹手术cholecystoduodenal瘘和一个大的影响石头被发现。十二指肠瘘的分离,包括关闭,胆囊切除术和删除的阻碍进行了胆石。额外的石头被发现和检索在胆总管(CBD)探索。 Surgery was finalized by duodenoplasty, closure and T-tube drainage of the CBD. Post-operative course was prolonged and uneventful.</p> <p><strong>Discussion and Conclusions: </strong>Bouveret syndrome is a rare cause of gastric outlet obstructions. In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum.</p> 腹腔镜肾上腺切除术;一个简短的总结与回顾文献 01/02/2017//m.lakotalakes.com/hjsr/ascr-aid1001.php & lt; h2> Abstract< / h2><p>We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.</p>