Journal of Medical Research and Surgery (ISSN: 2582-9572) is a peer reviewed “open access” which means users can freely access the journal content. Journal aims to publish original research articles from all areas of medical research, surgery, surgical case reports and research in medical field.
Objectives: To determine the inter-observer agreement between resident and consultant radiologist... more Objectives: To determine the inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans. Materials and Methods: This descriptive cross-sectional retrospective study was performed in a tertiary care hospital Karachi from 1st October 2021 to 31st march 2022. Total of 111 number of patients of 18-70 years of age of either gender who underwent emergency Head CT scans were included. Patients who came for follow-up CT scans were excluded. CT findings were interpreted by the radiology resident on duty. Subsequently, these CT images were interpreted by a consultant radiologist, and the decision of both resident and faculty member CT was correlated for inter-observer agreement. Results: The mean age was 47.47 ± 14.20 years. The majority of the patients 46 (41.44%) were between 56 to 70 years of age. Out of these 111 patients, 72 (64.86%) were male and 39 (35.14%) were female with a ratio of 1.9:1. Discrepancy between resident and consultant radiologists in reporting emergency head CT scans is seen in 6 (5.41%) patients. Inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans was found to be 94.59% with a kappa "κ" value of 0.885 which showed a very strong agreement. Conclusion: This study concluded that little discrepancy was found in inter-observer agreement between the radiology residents and the faculty members for interpretation of CT images of Head.
Intracranial hypotension syndrome may occur secondary to Cerebrospinal Fluid Leak (CSFL). Its eti... more Intracranial hypotension syndrome may occur secondary to Cerebrospinal Fluid Leak (CSFL). Its etiology can be iatrogenic, traumatic or spontaneous. The most common cause is related to incidental or intentional punctures during anesthetic approaches. It is a rare complication during lumbar spine surgery. The clinical manifestations of this syndrome are characterized by orthostatic headache as the most frequent symptom, accompanied by a wide variety of manifestations, which frequently result in a disability for daily life activities and a delayed recovery. Diagnosis is made through a detailed medical history, the presence of symptoms and signs, and additional imaging studies. Initial treatment is conservative; however, using a hematic patch is recommended for a significant number of patients as the next step, reserving surgical treatment for cases that are not resolved with these measures. This paper presents the clinical case of a 56-year-old female patient diagnosed with CSF fistula following a surgical procedure, which is treated by applying a blood patch with complete remission of symptoms; similarly, a therapeutic algorithm is proposed for the diagnosis of CSFL.
Cerebellar tonsillar herniation, often associated with Chiari malformation, involves the downward... more Cerebellar tonsillar herniation, often associated with Chiari malformation, involves the downward displacement of the cerebellar tonsils below the foramen magnum. This condition can lead to significant complications due to the limited intracranial space within the rigid skull. Timely diagnosis is crucial given its potentially fatal nature, with brain structural displacement evident on imaging studies. We present a case of a 27-year-old female with continuous headaches and dizziness, diagnosed with tonsillar herniation through MRI revealing 16 mm of tonsillar descent without associated hydrocephalus or syrinx. Tonsillar herniation, characterized by inferior descent of the cerebellar tonsils, may be congenital or acquired, with measurements typically referenced from the McRae line to the displaced tonsil tip. Complications include brainstem compression, obstruction of cerebrospinal fluid flow, syringomyelia, impaired blood flow, and various neurological and psychological symptoms. Management options vary based on symptom severity and may involve observation, medication, or surgical intervention to alleviate compression and improve cerebrospinal fluid flow. Consultation with a neurologist or neurosurgeon is essential for comprehensive evaluation and tailored management plans aiming to relieve pressure on the brainstem and spinal cord in tonsillar herniation cases.
Anorectal Melanoma represents less than 1% of all gastrointestinal tumors. They are infrequent, a... more Anorectal Melanoma represents less than 1% of all gastrointestinal tumors. They are infrequent, aggressive and with little therapeutic consensus. The prognosis is usually reserved, with a five-year survival rate of less than 20%. The anorectal canal is the most common place where melanomas of the gastrointestinal mucosa appear. Thus, although it represents 0.05 to 4.6% of anorectal lesions, this constitutes the third most common location of melanoma, after the skin and eyes. Generally, their diagnosis is confusing and late, as they require a high index of suspicion; The symptoms are non-specific but they mostly present as dark, bleeding and painful masses, sometimes being confused with benign anorectal processes such as hemorrhoids. This occurred in two clinical cases that we presented in women aged 78 and 59 years with a purplish-black anorectal mass, the first case confused with hemorrhoidal thrombosis and the other with bleeding internal hemorrhoids; therefore, being treated as such in primary medical care centers and delaying their diagnosis by an average of 3 months (Figure A, B and E). Both cases with high clinical suspicion of a malignant process were later confirmed in a specialized unit, where they underwent biopsies and imaging studies. The patients underwent surgery, with subsequent chemo-immunotherapy. The first with abdomino-perineal resection (Figure C) plus inguinal lymphadenectomy (Figure E) and the other with local excision (Figure F). Both neo or adjuvant treatment and type of surgery remain controversial today.
Background: In the era of modern transportation there is an increased incidence of compound fract... more Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.
Today more than ever, functional and aesthetic changes during the growth, which have been proven ... more Today more than ever, functional and aesthetic changes during the growth, which have been proven to influence the patient's quality of life for better, remain an essential reason for conducting orthodontic treatment. Understanding the psychological characteristics and motivations of each patient is fundamental and a part of empathy. But these factors must be controlled because they can affect patient’s satisfaction and cooperation. Therefore, there is a need for clinicians to improve the patient experience of treatment delivery and increase the potential for a successful treatment outcome. The aim of the present study is to present a classification of motivation for orthodontic treatment. In fact, the classification proposal is based on more than 10 years of own research on orthodontic treatment motivation and awareness.
Introduction: The inadequate closure of the urachus, an embryological remnant that connects the b... more Introduction: The inadequate closure of the urachus, an embryological remnant that connects the bladder to the umbilicus, results in the rare congenital defect known as the vesicourachal diverticulum. Even though it is frequently asymptomatic, it might show up as lower abdomen discomfort, hematuria, frequent urination, and recurrent urinary tract infections. Case Report: The patient in this case study, a 38-year-old male with hematuria and right renal discomfort, had a tiny vesicourachal diverticulum discovered by accident during a CT scan. Discussion: Vesicourachal diverticulum is one of the congenital urachal remnant abnormalities, representing a result of the failure of the urachus to close at the urinary bladder, forming an out-pouching of variable length from the anterosuperior aspect of the urinary bladder, which does not communicate with the umbilicus as seen in our case. The location and size of the diverticulum might affect how symptoms appear, and in severe situations, surgery such as diverticulectomy or urachal residual resection may be necessary. For prompt and appropriate care, it is essential to comprehend the clinical presentation, diagnostic techniques, and available treatments. Conclusion: Though often benign, knowledge of the vesicourachal diverticulum helps prevent additional imaging and trials.
Acute abdomen in pregnancy is one of the biggest diagnostic and therapeutic challenges today. Des... more Acute abdomen in pregnancy is one of the biggest diagnostic and therapeutic challenges today. Despite advances in medical technology, the preoperative diagnosis of acute abdominal conditions is still inaccurate. Torsion of the adnexa, which refers to complete or partial rotation of the adnexa, resulting in obstruction of venous and lymphatic reflux in the ovary, is a common gynecological emergency. Torn adnexa affect both the ovary and the fallopian tube, and rarely affect only one of them. Adnexal torsion occurs more frequently in the first and early second trimester than in the third trimester. It is difficult to diagnose in advanced pregnancy because of nonspecific symptoms and signs of acute abdomen as well as ultrasound limitations due to uterine enlargement complicate diagnosis. Late diagnosis and delayed surgical treatment result in ovarian loss and fetal endangerment. It is important to thoroughly evaluate the adnexa at the 1st ultrasound examination in pregnancy and to monitor the observed formations.
Introduction: Osteochondroma are benign bone tumours that often affect the metaphysical region of... more Introduction: Osteochondroma are benign bone tumours that often affect the metaphysical region of long bones; the scapula is rarely affected. Owing to its bulk effect, scapular osteochondroma may frequently present with symptoms. These tumours typically damage the skeleton's developing ends and stop becoming larger once the skeleton reaches maturity.Suspicion of a cancer should be raised by any increase in size Case Report: A female patient, age 25, complained of a hard lump on her shoulder posteriorly on further imaging it was confirmed as an osteochondroma of scapula Discussion: Osteochondromas must exhibit continuity with the underlying parent bone cortex and medullary canal. They are made up of cortical and medullary bone with an overlaying hyaline cartilage cap. They have a very minimal potential for malignancy and are often asymptomatic. Conclusion: The cases of osteochondromas in the scapula are relatively rare, it is crucial to remain vigilant and consider the possibility of malignancy if there are concerning changes in symptoms or size.
Introduction: Meningiomas, tumors originating from the meninges covering the brain, are typically... more Introduction: Meningiomas, tumors originating from the meninges covering the brain, are typically considered benign. They primarily develop from arachnoid cap cells within the meninges and can manifest as primary orbital meningiomas (affecting structures like the optic nerve sheath) or secondary orbital meningiomas that extend from intracranial origins, such as the sphenoid wing and rarely from frontal lobe as in our case. Case Presentation: This report documents a very rare case where a meningioma emerged in the subfrontal lobe of the brain and subsequently spread to the orbit. The presence of such malignant variants in the orbit poses unique diagnostic challenges due to their potential to compress critical adjacent brain structures. Impact on Orbital Structures: The extension of these tumors into the orbit can have significant consequences, affecting structures like the cavernous sinus, superior orbital fissure, intraorbital contents, and the optic nerve. This further complicates their surgical management, given their proximity to essential neurological systems. Conclusion: This case study underscores the atypical growth pattern of malignant meningioma and highlights the complexities associated with identifying and treating meningioma with orbital extensions. The propensity of these tumors to impact vital brain structures necessitates a comprehensive approach to their diagnosis and management.
Background: A unique fracture pattern involving subtrochanteric fracture associated with ipsilate... more Background: A unique fracture pattern involving subtrochanteric fracture associated with ipsilateral posterior dislocation of hip in a young adult male eventually having a functional hip at six year follow up following aggressive management is described. Case presentation: We present a case of a 40 year old male labourer from Central India who was admitted in our hospital within hours of a road accident he sustained in Feb 2012. Early reduction and osteosynthesis, supervised physiotherapy, and routine follow-up all contributed to the patient having an acceptable functioning hip at the six-year follow-up. Conclusion: The result at six year follow up showed complete union of fracture without any radiological signs of avascular necrosis of the femoral head which highlights the importance of team work in the management of the complex injury.
The minimally invasive Nuss procedure is currently the preferred surgical approach for treatment ... more The minimally invasive Nuss procedure is currently the preferred surgical approach for treatment of pectus excavatum. During this procedure, a retrosternal bar is inserted which instantly corrects the deformity. The bar typically remains in place for 2 to 3 years, during which time the chest is considered to have adopted its new shape. Removal of the bar is generally considered to be a nondemanding procedure. Notwithstanding, it is associated with rare but potentially life-threatening complications.
Traumatic brain injuries affect an estimated 69 million individuals worldwide each year. Direct h... more Traumatic brain injuries affect an estimated 69 million individuals worldwide each year. Direct head trauma can lead to traumatic brain bleeds, which carry life-threatening consequences if not promptly addressed. While the current body of research suggests utilizing antithrombotic therapy for treatment, the optimal duration of such treatment remains a subject of debate in neurosurgery. This paper critically examines recommendations for the ideal timing of antiplatelet and anticoagulant therapy in conditions such as subarachnoid hemorrhage, subdural hematoma, skull fractures, cerebral contusions, and diffuse axonal injury. Additionally, it explores the role of these medications in the context of prosthetic valves and stents and assesses their impact on bleeding time and platelet aggregation. The review underscores potential directions for future research in this area, emphasizing the limitations inherent in the current body of literature. While reinitiating appropriate AAT after an interval of cessation to mitigate the risks of ICH is the standard of care in the context of bleeds in TBI, clinicians differ on the timeline and modality of treatment. Various studies demonstrate that reinitiating AAT decreases the long-term risks of thrombotic events and ischemic stroke, but this benefit must be balanced with the risk of developing ICH if AAT is reinitiated too quickly. The timeline for AAT resumption should be based on interdisciplinary risk stratification that takes into consideration patient risk factors and comorbidities that may predispose them to the thromboembolic complications of prolonged AAT cessation.
Renal Cell Carcinoma (RCC) is the most lethal malignancy of urinary tract. Invasion of right lobe... more Renal Cell Carcinoma (RCC) is the most lethal malignancy of urinary tract. Invasion of right lobe of liver by RCC is rare and possess a treatment challenge. Simultaneous nephrectomy with right hepatectomy has been proposed as a part of multi-modality treatment approach. We herein discuss a patient who underwent simultaneous nephrectomy with right hepatectomy along with single peritoneal metastasectomy for a huge RCC of right kidney and infiltrating the right lobe of liver. A 30-year old female was diagnosed with a right renal tumor invading into the right hepatic lobe. Post multidisciplinary tumor board meeting she was planned for surgical intervention. Intra-operatively a single peritoneal nodule was present which came positive for malignancy on frozen section. Considering young age, good performance status and oligometastatic disease definitive procedure in the form of combined right nephrectomy and right hepatectomy was performed. She was discharged from the hospital on 6th post-operative day with an uneventful post-operative course. This type of RCC has been rarely reported and the combined nephrectomy and right hepatectomy is safe and feasible for this type of huge RCC invading right hepatic lobe.
Surgeons may now conduct complex surgeries with more precision, accuracy, and safety thanks to im... more Surgeons may now conduct complex surgeries with more precision, accuracy, and safety thanks to image-guided navigation. This article analyzes how image-guided navigation devices have changed surgical operations. Surgeons now approach procedures differently thanks to the integration of imaging modalities like Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and ultrasound with surgical navigation systems. Surgeons can confidently navigate complex anatomical features and plan surgical paths using these technologies' real-time, three-dimensional anatomy visualization. Image-guided navigation has advanced with Augmented Reality (AR) and Virtual Reality (VR). Augmented Reality (AR) devices improve spatial awareness and reduce errors by superimposing patient-specific anatomical data onto the surgeon's field of view. VR allows surgeons to perform complex surgeries in a virtual environment, increasing their skills and aiding preoperative planning. Another innovation is machine learning and Artificial Intelligence (AI) algorithms in image-guided navigation systems. These algorithms evaluate massive volumes of patient data, including medical pictures, surgery plans, and results, to help surgeons make predictions and judgments. Data-driven algorithms in AI-driven navigation systems optimize surgical operations, accuracy, and patient outcomes. Miniaturized and wireless tracking systems provide less invasive image-guided navigation. Electromagnetic and optical monitoring devices allow surgeons to track surgical tools inside the patient's body, providing real-time feedback and instruction. Image-guided navigation is being used in laparoscopic, endoscopic, and robotic-assisted surgeries. Image-guided navigation still faces challenges. The incorporation of diverse imaging modalities, system accuracy, and smooth compatibility with surgical instruments are ongoing research and development. To promote widespread adoption of these technologies, cost-effectiveness, training, and regulations must be addressed. Image-guided navigation has improved surgical visualization, navigation, and decision-making. Augmented reality, virtual reality, machine learning, and tiny tracking have improved surgery and patient outcomes. Image-guided navigation could become common surgery with continued study and improvement in this sector.
Endocervical polyp represents as a benign, exophytic lesion constituted of variable admixture of ... more Endocervical polyp represents as a benign, exophytic lesion constituted of variable admixture of proliferating endocervical glandular epithelium and metaplastic squamous epithelium permeated with a fibro-vascular core. The commonly encountered endocervical polyp is frequently accompanied by chronic inflammation, erosion of superficial epithelial surface and reactive alterations of layering epithelium.
Background: In gummy smile subjects with short clinical crown periodontal surgeries are the class... more Background: In gummy smile subjects with short clinical crown periodontal surgeries are the classic essential aesthetic approach. However, in gummy smile caused by vertical maxillary excess Le Fort I osteotomy, but patient refuse to go for Le Fort I osteotomy, then orthodontic treatment alone doesn't restore the complete esthetic. Currently mini screw with orthodontic treatment is the best choice. Objective of Case Report: To determine the outcome of gummy smile managing with orthodontic treatment and mini screw. Methodology: A 35-year-old female patient with skeletal class II malocclusion, convex profile, and noticeable gummy smile. The case was treated with first premolar extraction and mini screw for intrusion and retraction. Followed by plastic periodontal surgery to increase crown length and accumulated gingival overgrowth. Conclusions: The case was completed with class I malocclusion with restoring acceptable gum visibility.
Background: During growth modification, the mandible plays a crucial role in functional orthopaed... more Background: During growth modification, the mandible plays a crucial role in functional orthopaedic treatment. To maximize the efficacy and efficiency of functional appliance therapy, one must know when to initiate treatment. To accurately determine when to initiate functional appliance therapy, the contemporary maturity indicators utilised are subjective with poor reproducibility and validity. Quantitative cervical vertebral maturity indicators are quantitative with good reproducibility. Objective: To determine the correlation between quantitative cervical vertebral maturation and mandibular dimensional changes in 8-18-year-old growing children. Material and Method: In this prospective cross-sectional analytical study, 164 samples were employed with an age range of 8-18 years. Samples were divided into four groups as per the quantitative cervical vertebral maturity indicator. Pubertal staging was analysed utilising the Li Chang, et al. method on a lateral cephalometric radiograph, and mandibular dimensions were measured as the total mandibular length of a condylon-gnathion line, the height of the mandibular ramus from the condylon-gonion intersection line, and the length of the mandibular body from the gonion intersection-gnathion line. Statistical Analysis: The data obtained was analyzed using Statistical Package for the Social Sciences (SPSS) software; descriptive statistics, student t test and bivariant analysis were applied. Results: The mean total mandibular length was seen at its maximum in periods of high acceleration velocity. Intergroup analysis shows significant differences between the groups, and there is a strong correlation between maturational stage and mandibular dimensional change. Conclusions: During functional orthopaedic treatment planning, the mandible can be utilised as a skeletal maturity indicator.
An inguinal hernia is a bulge or protrusion that is seen or felt in the groin area or the scrotum... more An inguinal hernia is a bulge or protrusion that is seen or felt in the groin area or the scrotum (for boys). Inguinal hernias occur in boys more frequently than in girls. Infants who are born prematurely are at an increased risk of having an inguinal hernia. Incarceration of hernia is a major problem in neonates, it causes significant pain and the content of this hernia is the intestine. If not diagnosed early it causes a cut in the blood supply and the infant became very sick. Treatment of inguinal hernia is surgical under general anesthesia, but if an inguinal hernia is present in preterm the surgical will be done before discharge. Bilateral inguinal hernia in females must be investigated very carefully, maybe ovaries are present in inguinal hernia.
Background: Esophageal achalasia is an esophageal motility disorder of unknown etiology that resu... more Background: Esophageal achalasia is an esophageal motility disorder of unknown etiology that results in impaired lower esophageal sphincter relaxation and loss of esophageal peristalsis. The aim of our study was to show our experience in the management of esophageal achalasia in a case treated by laparotomy in our service. Case Report: 21-year-old patient, student, admitted to our department for progressive dysphagia to solids accompanied by regurgitation, epigastric pain, nocturnal cough and weight loss, evolving for 5 years. ATCD of pulmonary tuberculosis. The physical examination noted a deterioration in general condition, stage (I) of the WHO; there was hypo coloration of the integuments and conjunctivae, TA=120/80mmHg, Pulse=70/min. The abdomen was symmetrical with presence of sluggish skin folds, supple and painless without a palpable mass, the digital rectal examination did not present any particularity. The thorax was symmetrical with a FR=20 c/mn. The biology showed a normo chrome and normocytic anemia of 8 g/l Group O+. The esogastroduodenal transit was in favor of an amputation (tight stenosis) extended on the cardia with megaesophagus upstream. We performed a cardiomyotomy according to Heller associated with a hemivalve according to Toupet. We performed a followed by preesophageal and subhepatic drainage. The postoperative course was simple, marked by a resumption of food on D6 postoperatively. The control test carried out with gastrographine 10 days after the surgical intervention noted a regression of the signs with passage of the product of contrast in the small intestine. The patient seen again 6 months after the operation showed no particularities. Conclusion: Achalasia is a chronic esophageal motility disorder characterized by the inability of the lower esophageal sphincter to relax. Heller cardiomyotomy by laparotomy associated with Toupet-type fundoplication retains its place in its management in our exercise context.
Objectives: To determine the inter-observer agreement between resident and consultant radiologist... more Objectives: To determine the inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans. Materials and Methods: This descriptive cross-sectional retrospective study was performed in a tertiary care hospital Karachi from 1st October 2021 to 31st march 2022. Total of 111 number of patients of 18-70 years of age of either gender who underwent emergency Head CT scans were included. Patients who came for follow-up CT scans were excluded. CT findings were interpreted by the radiology resident on duty. Subsequently, these CT images were interpreted by a consultant radiologist, and the decision of both resident and faculty member CT was correlated for inter-observer agreement. Results: The mean age was 47.47 ± 14.20 years. The majority of the patients 46 (41.44%) were between 56 to 70 years of age. Out of these 111 patients, 72 (64.86%) were male and 39 (35.14%) were female with a ratio of 1.9:1. Discrepancy between resident and consultant radiologists in reporting emergency head CT scans is seen in 6 (5.41%) patients. Inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans was found to be 94.59% with a kappa "κ" value of 0.885 which showed a very strong agreement. Conclusion: This study concluded that little discrepancy was found in inter-observer agreement between the radiology residents and the faculty members for interpretation of CT images of Head.
Intracranial hypotension syndrome may occur secondary to Cerebrospinal Fluid Leak (CSFL). Its eti... more Intracranial hypotension syndrome may occur secondary to Cerebrospinal Fluid Leak (CSFL). Its etiology can be iatrogenic, traumatic or spontaneous. The most common cause is related to incidental or intentional punctures during anesthetic approaches. It is a rare complication during lumbar spine surgery. The clinical manifestations of this syndrome are characterized by orthostatic headache as the most frequent symptom, accompanied by a wide variety of manifestations, which frequently result in a disability for daily life activities and a delayed recovery. Diagnosis is made through a detailed medical history, the presence of symptoms and signs, and additional imaging studies. Initial treatment is conservative; however, using a hematic patch is recommended for a significant number of patients as the next step, reserving surgical treatment for cases that are not resolved with these measures. This paper presents the clinical case of a 56-year-old female patient diagnosed with CSF fistula following a surgical procedure, which is treated by applying a blood patch with complete remission of symptoms; similarly, a therapeutic algorithm is proposed for the diagnosis of CSFL.
Cerebellar tonsillar herniation, often associated with Chiari malformation, involves the downward... more Cerebellar tonsillar herniation, often associated with Chiari malformation, involves the downward displacement of the cerebellar tonsils below the foramen magnum. This condition can lead to significant complications due to the limited intracranial space within the rigid skull. Timely diagnosis is crucial given its potentially fatal nature, with brain structural displacement evident on imaging studies. We present a case of a 27-year-old female with continuous headaches and dizziness, diagnosed with tonsillar herniation through MRI revealing 16 mm of tonsillar descent without associated hydrocephalus or syrinx. Tonsillar herniation, characterized by inferior descent of the cerebellar tonsils, may be congenital or acquired, with measurements typically referenced from the McRae line to the displaced tonsil tip. Complications include brainstem compression, obstruction of cerebrospinal fluid flow, syringomyelia, impaired blood flow, and various neurological and psychological symptoms. Management options vary based on symptom severity and may involve observation, medication, or surgical intervention to alleviate compression and improve cerebrospinal fluid flow. Consultation with a neurologist or neurosurgeon is essential for comprehensive evaluation and tailored management plans aiming to relieve pressure on the brainstem and spinal cord in tonsillar herniation cases.
Anorectal Melanoma represents less than 1% of all gastrointestinal tumors. They are infrequent, a... more Anorectal Melanoma represents less than 1% of all gastrointestinal tumors. They are infrequent, aggressive and with little therapeutic consensus. The prognosis is usually reserved, with a five-year survival rate of less than 20%. The anorectal canal is the most common place where melanomas of the gastrointestinal mucosa appear. Thus, although it represents 0.05 to 4.6% of anorectal lesions, this constitutes the third most common location of melanoma, after the skin and eyes. Generally, their diagnosis is confusing and late, as they require a high index of suspicion; The symptoms are non-specific but they mostly present as dark, bleeding and painful masses, sometimes being confused with benign anorectal processes such as hemorrhoids. This occurred in two clinical cases that we presented in women aged 78 and 59 years with a purplish-black anorectal mass, the first case confused with hemorrhoidal thrombosis and the other with bleeding internal hemorrhoids; therefore, being treated as such in primary medical care centers and delaying their diagnosis by an average of 3 months (Figure A, B and E). Both cases with high clinical suspicion of a malignant process were later confirmed in a specialized unit, where they underwent biopsies and imaging studies. The patients underwent surgery, with subsequent chemo-immunotherapy. The first with abdomino-perineal resection (Figure C) plus inguinal lymphadenectomy (Figure E) and the other with local excision (Figure F). Both neo or adjuvant treatment and type of surgery remain controversial today.
Background: In the era of modern transportation there is an increased incidence of compound fract... more Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.
Today more than ever, functional and aesthetic changes during the growth, which have been proven ... more Today more than ever, functional and aesthetic changes during the growth, which have been proven to influence the patient's quality of life for better, remain an essential reason for conducting orthodontic treatment. Understanding the psychological characteristics and motivations of each patient is fundamental and a part of empathy. But these factors must be controlled because they can affect patient’s satisfaction and cooperation. Therefore, there is a need for clinicians to improve the patient experience of treatment delivery and increase the potential for a successful treatment outcome. The aim of the present study is to present a classification of motivation for orthodontic treatment. In fact, the classification proposal is based on more than 10 years of own research on orthodontic treatment motivation and awareness.
Introduction: The inadequate closure of the urachus, an embryological remnant that connects the b... more Introduction: The inadequate closure of the urachus, an embryological remnant that connects the bladder to the umbilicus, results in the rare congenital defect known as the vesicourachal diverticulum. Even though it is frequently asymptomatic, it might show up as lower abdomen discomfort, hematuria, frequent urination, and recurrent urinary tract infections. Case Report: The patient in this case study, a 38-year-old male with hematuria and right renal discomfort, had a tiny vesicourachal diverticulum discovered by accident during a CT scan. Discussion: Vesicourachal diverticulum is one of the congenital urachal remnant abnormalities, representing a result of the failure of the urachus to close at the urinary bladder, forming an out-pouching of variable length from the anterosuperior aspect of the urinary bladder, which does not communicate with the umbilicus as seen in our case. The location and size of the diverticulum might affect how symptoms appear, and in severe situations, surgery such as diverticulectomy or urachal residual resection may be necessary. For prompt and appropriate care, it is essential to comprehend the clinical presentation, diagnostic techniques, and available treatments. Conclusion: Though often benign, knowledge of the vesicourachal diverticulum helps prevent additional imaging and trials.
Acute abdomen in pregnancy is one of the biggest diagnostic and therapeutic challenges today. Des... more Acute abdomen in pregnancy is one of the biggest diagnostic and therapeutic challenges today. Despite advances in medical technology, the preoperative diagnosis of acute abdominal conditions is still inaccurate. Torsion of the adnexa, which refers to complete or partial rotation of the adnexa, resulting in obstruction of venous and lymphatic reflux in the ovary, is a common gynecological emergency. Torn adnexa affect both the ovary and the fallopian tube, and rarely affect only one of them. Adnexal torsion occurs more frequently in the first and early second trimester than in the third trimester. It is difficult to diagnose in advanced pregnancy because of nonspecific symptoms and signs of acute abdomen as well as ultrasound limitations due to uterine enlargement complicate diagnosis. Late diagnosis and delayed surgical treatment result in ovarian loss and fetal endangerment. It is important to thoroughly evaluate the adnexa at the 1st ultrasound examination in pregnancy and to monitor the observed formations.
Introduction: Osteochondroma are benign bone tumours that often affect the metaphysical region of... more Introduction: Osteochondroma are benign bone tumours that often affect the metaphysical region of long bones; the scapula is rarely affected. Owing to its bulk effect, scapular osteochondroma may frequently present with symptoms. These tumours typically damage the skeleton's developing ends and stop becoming larger once the skeleton reaches maturity.Suspicion of a cancer should be raised by any increase in size Case Report: A female patient, age 25, complained of a hard lump on her shoulder posteriorly on further imaging it was confirmed as an osteochondroma of scapula Discussion: Osteochondromas must exhibit continuity with the underlying parent bone cortex and medullary canal. They are made up of cortical and medullary bone with an overlaying hyaline cartilage cap. They have a very minimal potential for malignancy and are often asymptomatic. Conclusion: The cases of osteochondromas in the scapula are relatively rare, it is crucial to remain vigilant and consider the possibility of malignancy if there are concerning changes in symptoms or size.
Introduction: Meningiomas, tumors originating from the meninges covering the brain, are typically... more Introduction: Meningiomas, tumors originating from the meninges covering the brain, are typically considered benign. They primarily develop from arachnoid cap cells within the meninges and can manifest as primary orbital meningiomas (affecting structures like the optic nerve sheath) or secondary orbital meningiomas that extend from intracranial origins, such as the sphenoid wing and rarely from frontal lobe as in our case. Case Presentation: This report documents a very rare case where a meningioma emerged in the subfrontal lobe of the brain and subsequently spread to the orbit. The presence of such malignant variants in the orbit poses unique diagnostic challenges due to their potential to compress critical adjacent brain structures. Impact on Orbital Structures: The extension of these tumors into the orbit can have significant consequences, affecting structures like the cavernous sinus, superior orbital fissure, intraorbital contents, and the optic nerve. This further complicates their surgical management, given their proximity to essential neurological systems. Conclusion: This case study underscores the atypical growth pattern of malignant meningioma and highlights the complexities associated with identifying and treating meningioma with orbital extensions. The propensity of these tumors to impact vital brain structures necessitates a comprehensive approach to their diagnosis and management.
Background: A unique fracture pattern involving subtrochanteric fracture associated with ipsilate... more Background: A unique fracture pattern involving subtrochanteric fracture associated with ipsilateral posterior dislocation of hip in a young adult male eventually having a functional hip at six year follow up following aggressive management is described. Case presentation: We present a case of a 40 year old male labourer from Central India who was admitted in our hospital within hours of a road accident he sustained in Feb 2012. Early reduction and osteosynthesis, supervised physiotherapy, and routine follow-up all contributed to the patient having an acceptable functioning hip at the six-year follow-up. Conclusion: The result at six year follow up showed complete union of fracture without any radiological signs of avascular necrosis of the femoral head which highlights the importance of team work in the management of the complex injury.
The minimally invasive Nuss procedure is currently the preferred surgical approach for treatment ... more The minimally invasive Nuss procedure is currently the preferred surgical approach for treatment of pectus excavatum. During this procedure, a retrosternal bar is inserted which instantly corrects the deformity. The bar typically remains in place for 2 to 3 years, during which time the chest is considered to have adopted its new shape. Removal of the bar is generally considered to be a nondemanding procedure. Notwithstanding, it is associated with rare but potentially life-threatening complications.
Traumatic brain injuries affect an estimated 69 million individuals worldwide each year. Direct h... more Traumatic brain injuries affect an estimated 69 million individuals worldwide each year. Direct head trauma can lead to traumatic brain bleeds, which carry life-threatening consequences if not promptly addressed. While the current body of research suggests utilizing antithrombotic therapy for treatment, the optimal duration of such treatment remains a subject of debate in neurosurgery. This paper critically examines recommendations for the ideal timing of antiplatelet and anticoagulant therapy in conditions such as subarachnoid hemorrhage, subdural hematoma, skull fractures, cerebral contusions, and diffuse axonal injury. Additionally, it explores the role of these medications in the context of prosthetic valves and stents and assesses their impact on bleeding time and platelet aggregation. The review underscores potential directions for future research in this area, emphasizing the limitations inherent in the current body of literature. While reinitiating appropriate AAT after an interval of cessation to mitigate the risks of ICH is the standard of care in the context of bleeds in TBI, clinicians differ on the timeline and modality of treatment. Various studies demonstrate that reinitiating AAT decreases the long-term risks of thrombotic events and ischemic stroke, but this benefit must be balanced with the risk of developing ICH if AAT is reinitiated too quickly. The timeline for AAT resumption should be based on interdisciplinary risk stratification that takes into consideration patient risk factors and comorbidities that may predispose them to the thromboembolic complications of prolonged AAT cessation.
Renal Cell Carcinoma (RCC) is the most lethal malignancy of urinary tract. Invasion of right lobe... more Renal Cell Carcinoma (RCC) is the most lethal malignancy of urinary tract. Invasion of right lobe of liver by RCC is rare and possess a treatment challenge. Simultaneous nephrectomy with right hepatectomy has been proposed as a part of multi-modality treatment approach. We herein discuss a patient who underwent simultaneous nephrectomy with right hepatectomy along with single peritoneal metastasectomy for a huge RCC of right kidney and infiltrating the right lobe of liver. A 30-year old female was diagnosed with a right renal tumor invading into the right hepatic lobe. Post multidisciplinary tumor board meeting she was planned for surgical intervention. Intra-operatively a single peritoneal nodule was present which came positive for malignancy on frozen section. Considering young age, good performance status and oligometastatic disease definitive procedure in the form of combined right nephrectomy and right hepatectomy was performed. She was discharged from the hospital on 6th post-operative day with an uneventful post-operative course. This type of RCC has been rarely reported and the combined nephrectomy and right hepatectomy is safe and feasible for this type of huge RCC invading right hepatic lobe.
Surgeons may now conduct complex surgeries with more precision, accuracy, and safety thanks to im... more Surgeons may now conduct complex surgeries with more precision, accuracy, and safety thanks to image-guided navigation. This article analyzes how image-guided navigation devices have changed surgical operations. Surgeons now approach procedures differently thanks to the integration of imaging modalities like Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and ultrasound with surgical navigation systems. Surgeons can confidently navigate complex anatomical features and plan surgical paths using these technologies' real-time, three-dimensional anatomy visualization. Image-guided navigation has advanced with Augmented Reality (AR) and Virtual Reality (VR). Augmented Reality (AR) devices improve spatial awareness and reduce errors by superimposing patient-specific anatomical data onto the surgeon's field of view. VR allows surgeons to perform complex surgeries in a virtual environment, increasing their skills and aiding preoperative planning. Another innovation is machine learning and Artificial Intelligence (AI) algorithms in image-guided navigation systems. These algorithms evaluate massive volumes of patient data, including medical pictures, surgery plans, and results, to help surgeons make predictions and judgments. Data-driven algorithms in AI-driven navigation systems optimize surgical operations, accuracy, and patient outcomes. Miniaturized and wireless tracking systems provide less invasive image-guided navigation. Electromagnetic and optical monitoring devices allow surgeons to track surgical tools inside the patient's body, providing real-time feedback and instruction. Image-guided navigation is being used in laparoscopic, endoscopic, and robotic-assisted surgeries. Image-guided navigation still faces challenges. The incorporation of diverse imaging modalities, system accuracy, and smooth compatibility with surgical instruments are ongoing research and development. To promote widespread adoption of these technologies, cost-effectiveness, training, and regulations must be addressed. Image-guided navigation has improved surgical visualization, navigation, and decision-making. Augmented reality, virtual reality, machine learning, and tiny tracking have improved surgery and patient outcomes. Image-guided navigation could become common surgery with continued study and improvement in this sector.
Endocervical polyp represents as a benign, exophytic lesion constituted of variable admixture of ... more Endocervical polyp represents as a benign, exophytic lesion constituted of variable admixture of proliferating endocervical glandular epithelium and metaplastic squamous epithelium permeated with a fibro-vascular core. The commonly encountered endocervical polyp is frequently accompanied by chronic inflammation, erosion of superficial epithelial surface and reactive alterations of layering epithelium.
Background: In gummy smile subjects with short clinical crown periodontal surgeries are the class... more Background: In gummy smile subjects with short clinical crown periodontal surgeries are the classic essential aesthetic approach. However, in gummy smile caused by vertical maxillary excess Le Fort I osteotomy, but patient refuse to go for Le Fort I osteotomy, then orthodontic treatment alone doesn't restore the complete esthetic. Currently mini screw with orthodontic treatment is the best choice. Objective of Case Report: To determine the outcome of gummy smile managing with orthodontic treatment and mini screw. Methodology: A 35-year-old female patient with skeletal class II malocclusion, convex profile, and noticeable gummy smile. The case was treated with first premolar extraction and mini screw for intrusion and retraction. Followed by plastic periodontal surgery to increase crown length and accumulated gingival overgrowth. Conclusions: The case was completed with class I malocclusion with restoring acceptable gum visibility.
Background: During growth modification, the mandible plays a crucial role in functional orthopaed... more Background: During growth modification, the mandible plays a crucial role in functional orthopaedic treatment. To maximize the efficacy and efficiency of functional appliance therapy, one must know when to initiate treatment. To accurately determine when to initiate functional appliance therapy, the contemporary maturity indicators utilised are subjective with poor reproducibility and validity. Quantitative cervical vertebral maturity indicators are quantitative with good reproducibility. Objective: To determine the correlation between quantitative cervical vertebral maturation and mandibular dimensional changes in 8-18-year-old growing children. Material and Method: In this prospective cross-sectional analytical study, 164 samples were employed with an age range of 8-18 years. Samples were divided into four groups as per the quantitative cervical vertebral maturity indicator. Pubertal staging was analysed utilising the Li Chang, et al. method on a lateral cephalometric radiograph, and mandibular dimensions were measured as the total mandibular length of a condylon-gnathion line, the height of the mandibular ramus from the condylon-gonion intersection line, and the length of the mandibular body from the gonion intersection-gnathion line. Statistical Analysis: The data obtained was analyzed using Statistical Package for the Social Sciences (SPSS) software; descriptive statistics, student t test and bivariant analysis were applied. Results: The mean total mandibular length was seen at its maximum in periods of high acceleration velocity. Intergroup analysis shows significant differences between the groups, and there is a strong correlation between maturational stage and mandibular dimensional change. Conclusions: During functional orthopaedic treatment planning, the mandible can be utilised as a skeletal maturity indicator.
An inguinal hernia is a bulge or protrusion that is seen or felt in the groin area or the scrotum... more An inguinal hernia is a bulge or protrusion that is seen or felt in the groin area or the scrotum (for boys). Inguinal hernias occur in boys more frequently than in girls. Infants who are born prematurely are at an increased risk of having an inguinal hernia. Incarceration of hernia is a major problem in neonates, it causes significant pain and the content of this hernia is the intestine. If not diagnosed early it causes a cut in the blood supply and the infant became very sick. Treatment of inguinal hernia is surgical under general anesthesia, but if an inguinal hernia is present in preterm the surgical will be done before discharge. Bilateral inguinal hernia in females must be investigated very carefully, maybe ovaries are present in inguinal hernia.
Background: Esophageal achalasia is an esophageal motility disorder of unknown etiology that resu... more Background: Esophageal achalasia is an esophageal motility disorder of unknown etiology that results in impaired lower esophageal sphincter relaxation and loss of esophageal peristalsis. The aim of our study was to show our experience in the management of esophageal achalasia in a case treated by laparotomy in our service. Case Report: 21-year-old patient, student, admitted to our department for progressive dysphagia to solids accompanied by regurgitation, epigastric pain, nocturnal cough and weight loss, evolving for 5 years. ATCD of pulmonary tuberculosis. The physical examination noted a deterioration in general condition, stage (I) of the WHO; there was hypo coloration of the integuments and conjunctivae, TA=120/80mmHg, Pulse=70/min. The abdomen was symmetrical with presence of sluggish skin folds, supple and painless without a palpable mass, the digital rectal examination did not present any particularity. The thorax was symmetrical with a FR=20 c/mn. The biology showed a normo chrome and normocytic anemia of 8 g/l Group O+. The esogastroduodenal transit was in favor of an amputation (tight stenosis) extended on the cardia with megaesophagus upstream. We performed a cardiomyotomy according to Heller associated with a hemivalve according to Toupet. We performed a followed by preesophageal and subhepatic drainage. The postoperative course was simple, marked by a resumption of food on D6 postoperatively. The control test carried out with gastrographine 10 days after the surgical intervention noted a regression of the signs with passage of the product of contrast in the small intestine. The patient seen again 6 months after the operation showed no particularities. Conclusion: Achalasia is a chronic esophageal motility disorder characterized by the inability of the lower esophageal sphincter to relax. Heller cardiomyotomy by laparotomy associated with Toupet-type fundoplication retains its place in its management in our exercise context.
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Published Papers by Journal of Medical Research and Surgery Indexing