Laparoscopic Transabdominal Pre-peritoneal Repair of a Bilateral Inguinal Hernia in a Pediatric Female Patient in Pakistan: A Case Report.

Inguinal hernias, although a common occurrence, pose a significant threat to the surgical community on account of their complexity and socioeconomic consequences. Bilateral inguinal hernias, which are a rare subtype of inguinal hernias, in particular, are problematic since there are no existing definitive international guidelines for their repair. It is estimated that between 8% and 30% of inguinal hernia patients have bilateral hernias, but there is still no clarity as to whether a bilateral hernia represents a special type of inguinal hernia or two different hernias in one patient. The transabdominal pre-peritoneal repair (TAPP), totally extra-peritoneal repair (TEP), and Lichtenstein repair techniques are commonly employed depending on the resources and surgical expertise available, but there is a need to conduct large-scale, prospective, randomized-controlled trials to guide the formation of evidence-based guidelines that could be followed globally. Herein, we present the first known case of a bilateral inguinal hernia in a female pediatric patient repaired by the laparoscopic TAPP technique from Pakistan.

Case report: Emergency management of unilateral herniation of bowel and a bilateral defect of the broad ligament in a resource limited setting.

INTRODUCTION: Broad ligament herniation is a rare type of internal hernia, presenting as a diagnostic challenge. An exploratory laparotomy can be performed to definitively diagnose and treat the defect. CASE PRESENTATION: A 36-year-old female, with no known comorbids and no significant past medical and surgical history presented with acute abdominal pain, multiple episodes of vomiting, and absolute constipation. After clinical and radiologic investigations, the diagnosis of an internal herniation of small bowel to the broad ligament was suspected. An emergent exploratory laparotomy was then performed. Intra-operatively it was found that she had a bilateral defect to the broad ligament and a unilateral broad ligament hernia (BLH). Postoperatively she remained vitally stable and was discharged home. CLINICAL DISCUSSION: We report a rare case of a unilateral broad ligament hernia with a bilateral defect. Diagnosis of BLH is associated with diagnostic uncertainty mainly due to its rarity and nonspecific presentation. CONCLUSION: Although broad ligament herniation is rare, it is a significant cause of intestinal obstruction and may result in complications if not attended to timely. Early diagnosis and management is necessary to minimize associated morbidity and mortality that can occur as a consequence of bowel ischemia and necrosis.

Retroperitoneal liposarcoma: Case of a giant tumour inside the abdomen.

Retroperitoneal liposarcomas are rare malignant tumours that often grow rapidly in size and become symptomatic lat e in t he disease course, posing diagnostic a nd therapeutic challenges. Although abdominal imaging can rel iab ly diagnose the tumour, definitive diagnosis is only p ossib le th rough bio psy af ter surgical excision , w hich remains the primary treatment modality for these tumours. Long- term sur v ival is p rimarily determ ined throu gh histologic grade and post-resection tumour margins. We report t he case of a 43-year-o ld male patient, see n at Dr Ruth KM Pfau Hospital Karachi, who under went successful surgical excision for a well-differentiated retroperitoneal liposarcoma an d had no rad io gr aphic evidence o f local recurrence at both 3 and 12-month follow-ups.

Aberrant Arterial Anatomy at the Floor of the Third Ventricle: Video Case Report.

A 65-year-old woman presented with a 2-month progressive history of forgetfulness, headaches, and decline in mobility. Imaging showed a large, enhancing pineal region tumor with triventricular hydrocephalus. She underwent an endoscopic third ventriculostomy and biopsy after appropriate consent was gained. Video 1 demonstrates the endoscopic procedure during which 2 aberrant arteries were identified at the floor of the third ventricle. The endoscopic third ventriculostomy was performed between these 2 arteries with great care to preserve them. The patient improved postoperatively with resolution of the hydrocephalus. Histology showed a metastatic malignant melanoma. To the best of our knowledge, no similar anatomy has been shown in an endoscopic procedure. We speculate that these are perforating arteries from the posterior communicating artery (premamillary artery) or a branch from the first part of the posterior cerebral artery P1 (thalamoperforators). Other options include perforators from the ophthalmic segment of the internal carotid artery, the communicating segment of the internal carotid artery, the superior hypophyseal artery, or a branch of the medial posterior choroidal arteries. We look at each in turn.

Intradural extramedullary meningeal melanocytoma: a case report and literature review.

Primary meningeal melanocytomas are extremely rare, benign tumours arising from the leptomeninges. While they are considered to be benign lesions, there is potential for their growth and transformation into malignant melanomas. They are commonly found in the cervical spine, with a decreased incidence in the thoracic and lumbar regions. We present a case report of a 56-year-old man who presented to our unit with a 4-month history of lower limb weakness and a sensory level at T6. Magnetic resonance imaging shows an intradural extramedullary tumour. The patient underwent a thoracic debulking of the lesion with neurophysiological monitoring. Histopathology confirmed the diagnosis of melanocytoma of meningeal origin, with a low mitotic count. Our patient recovered well post-operatively with no complications. Surgical resection is an effective method to manage this tumour; however, adjuvant radiotherapy is advised due to the risk of recurrence and malignant transformation.

Postoperative Magnetic Resonance Imaging (MRI) Scans for the Surgical Resection of Cranial Glial Tumors According to National Institute of Health and Care Excellence (NICE) Guidelines: A Single-Center Experience.

Background Glial tumours are the most common central nervous system (CNS) neoplastic lesions. They occur in 7 per 100,000 individuals in the United Kingdom (UK) and are categorized into astrocytomas, oligodendrogliomas, and glioblastomas in the adult population. The World Health Organization (WHO) has created a classification system in order to better categorise these lesions, placing them in a range from grade I to grade IV. The higher the grade, the poorer the prognosis. The National Institute of Health and Care Excellence (NICE) in the United Kingdom recommends that all surgical resections of glial brain tumours are followed by a postoperative magnetic resonance imaging (MRI) scan within a 72-hour to establish a baseline for further management. Objective We present a retrospective analysis that assessed the compliance rate with NICE guidelines among patients who underwent surgical resection of glial lesions at the Department of Neurosurgery, Queens Hospital Romford, between January 2022 and September 2023. Materials and methods A retrospective analysis was conducted on 136 glial tumour resections that were performed during the period between January 2022 and September 2023. The total time between the end of the operation and the MRI scan was calculated in hours for each procedure. This was analyzed into two groups with respect to compliance with the NICE guidelines, which are within 72 hours and after 72 hours. The non-compliant group was then further investigated regarding the reason for the delay. The cost related to delays was also determined by discussion with the hospital's finance department. Results All of the procedures were followed by a post-operative MRI scan but only 88% were within the timeframe recommended by NICE guidelines. The amount of delay was calculated in hours and the reasons for these delays were identified. We created two categories for delay: requesting delays and radiology department-related delays with an almost equivalent number of delays resulting from each category. This delay has resulted in approximately £19,845 of extra costs for inpatient stays. Conclusion A retrospective analysis at Queens Hospital, Romford, found good compliance with NICE guidelines for post-operative MRI scans in glial lesion resections from January 2022 to September 2023. Eighty-eight per cent of patients received scans within 72 hours, crucial for baseline assessment. A 12% non-compliance rate revealed areas for improvement, causing £19,845 in extra costs due to longer inpatient stays. Expediting scans to 36 hours could save around £30,876 annually and reduce complications like infections and thromboembolism. Proposed strategies include dedicated MRI slots and policy adjustments for MRI requests.

Molecular Pathogenesis of Glioblastoma in Adults and Future Perspectives: A Systematic Review.

Glioblastoma (GBM) is the most common and malignant tumour of the central nervous system. Recent appreciation of the heterogeneity amongst these tumours not only changed the WHO classification approach, but also created the need for developing novel and personalised therapies. This systematic review aims to highlight recent advancements in understanding the molecular pathogenesis of the GBM and discuss related novel treatment targets. A systematic search of the literature in the PubMed library was performed following the PRISMA guidelines for molecular pathogenesis and therapeutic advances. Original and meta-analyses studies from the last ten years were reviewed using pre-determined search terms. The results included articles relevant to GBM development focusing on the aberrancy in cell signaling pathways and intracellular events. Theragnostic targets and vaccination to treat GBM were also explored. The molecular pathophysiology of GBM is complex. Our systematic review suggests targeting therapy at the stemness, p53 mediated pathways and immune modulation. Exciting novel immune therapy involving dendritic cell vaccines, B-cell vaccines and viral vectors may be the future of treating GBM.