BACKGROUND: Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme's and Altemeier's) used in the treatment of rectal prolapse. METHODS: A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis. RESULTS: Ten studies with 605 patients were selected; 286 underwent Altemeier's procedure (standalone), 39 had Altemeier's with plasty (perineoplasty or levatoroplasty), and 280 had Delorme's. Recurrence rate [OR: 0.66; 95% CI [0.44-0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00-0.09], P = 0.03] was significantly higher in the Altemeier's group. However, sub group analysis of Altemeier's with plasty failed to show significant differences in these outcomes compared with the Delorme's procedure. Length of hospital stay was significantly more following an Altemeier's operation compared with Delorme's [MD: 3.05, 95% CI [0.95 - 5.51], P = 0.004]. No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches. CONCLUSIONS: A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier's approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.
Digestive System Surgical Procedures , Rectal Prolapse , Humans , Rectal Prolapse/surgery , Constriction, Pathologic , Neoplasm Recurrence, Local , Digestive System Surgical Procedures/methods , Blood Loss, Surgical , Recurrence , Treatment Outcome
Heart transplantation (HTx) stands as a life-saving intervention for patients with end-stage heart disease, but the field is fraught with numerous challenges that span from the scarcity of donor organs to long-term complications arising from immunosuppressive therapies. This comprehensive review article offers an in-depth exploration of the multifaceted aspects of HTx. The review covers groundbreaking advancements in xenotransplantation, enabled by cutting-edge genetic engineering techniques, and the promising role of stem cell therapies, particularly porcine mesenchymal stem cells, in cardiac regeneration. It also delves into the evolution and limitations of immunosuppressive therapies and the revolutionary potential of artificial intelligence (AI) and machine learning (ML) in enhancing donor-recipient matching and predicting patient outcomes. Economic considerations, especially in the context of rising healthcare costs, are examined to assess the sustainability of these advancements. The article further discusses the significant improvements in patient outcomes over the years, while highlighting persisting challenges, such as graft failure, rejection, and infection. It underscores the importance of experience and specialized training, evidenced by the presence of an institutional learning curve. The review concludes by advocating for a multifaceted, collaborative approach involving clinicians, researchers, and policymakers to overcome existing challenges. Through coordinated efforts that consider medical, ethical, and economic factors, the field of HTx is poised for further evolution, offering renewed hope for improved patient care and outcomes.
Testicular trauma can be classified aetiologically as blunt or penetrative. Bicycles and motorbikes are considered high risk for road traffic accidents accounting for 9-17% % of all blunt trauma. We present a case of assessment and management of isolated blunt testicular trauma in a tertiary care hospital. A 36-year-old gentleman presented to the accident and emergency department with testicular pain after a road traffic accident while riding a motorcycle. On arrival, he was fully conscious and denied any other injuries. On examination, he had bruising and gross swelling of the right hemiscrotum. Ultrasound of the scrotum revealed testicular rupture and emergency exploration was undertaken which confirmed the diagnosis. Testis was non-salvageable therefore orchidectomy was done. The patient had unremarkable post-operative recovery. A majority of testicular ruptures are secondary to blunt trauma mainly caused by sport-related injuries and road traffic accidents. Ultrasonography remains a non-invasive modality to investigate testicular injuries with a sensitivity of 100%. When not available in an emergency setting, scrotal exploration should be undertaken for both diagnostic and therapeutic purposes. Surgical repair done within 72 hours yields a 90% salvage rate after which the salvage rate is reduced significantly. Tumor markers should be checked in patients managed conservatively. Early assessment and diagnosis are crucial in the management of acute testicular rupture. Early intervention can salvage injured testes and an orchidectomy can be avoided.
This article provides an in-depth review of the current state of management for diabetes, hypertension, and cardiovascular disease, focusing on advancements from genomics to robotics. It explores the role of genomic markers in personalized medicine, offering tailored treatment options for these chronic conditions. The article also examines the efficacy of various pharmacological and surgical interventions, including bariatric surgery for diabetes and device-based treatments for hypertension. A comparative analysis is presented to evaluate the cost-effectiveness and patient outcomes between medical and surgical approaches. The review concludes that while personalized medicine and minimally invasive surgical techniques show promise, more high-quality comparative research is needed. The ultimate goal is to integrate these emerging technologies within a framework of evidence-based medicine to improve patient outcomes and health equity.
Introduction: The aim of this systematic review and meta-analysis is to compare the outcomes of single-incision laparoscopic surgery (SILS) versus multi-port laparoscopy for ileocolic resection in patients with Crohn's disease (CD). Patients and Methods: A systematic search of multiple electronic databases was conducted. The peri- and post-operative outcomes were evaluated between Crohn's patients undergoing SILS versus multi-port laparoscopy for ileocolic resection. The primary outcomes included operative time, anastomotic leak rate, post-operative wound infections and length of hospital stay. Analysed secondary outcomes were conversion rates, ileus occurrence, intra-abdominal abscess formation, return to theatre and re-admissions. Revman 5.3 was used to perform the statistical analysis. Results: Five observational studies with 521 patients (SILS: 211; multi-port: 310) were included in the data synthesis. Patients undergoing SILS had a reduced total operative time compared to multi-port laparoscopy (mean difference [MD]: -16.14, 95% confidence interval: [CI] -27.23 - 5.05, P = 0.004). Post-operative hospital stay was also found to be significantly less in the SILS group (MD: -0.57, 95% CI: -0.73--0.42, P < 0.0001). No significant difference was seen in the anastomotic leak rate (MD: -16.14, 95% CI: 0.18-1.71, P = 0.004) or post-operative wound infections (odds ratio: 0.78, 95% CI: 0.24 - 2.47, P = 0.67) between the two groups. Moreover, all the measured secondary outcomes were comparable. Conclusion: SILS seems to be a feasible alternative to multi-port laparoscopic surgery for ileocolic resection in patients with CD. Improved outcomes in terms of total operative time and length of hospital stay were observed in patients undergoing SILS surgery. Adopting this procedure into routine clinical practice constitutes the next step in the development of minimally invasive surgery.
Introduction Irisin, a newly discovered myokine, has been reported for its role in coronary artery disease (CAD), which is a major cause of mortality worldwide. Atherosclerosis is the primary cause of CAD. Irisin has been reported to reduce atherosclerosis by improving endothelial function and inhibiting inflammation via iNOS/NF-κB pathways. We sought to investigate the relationship between serum irisin levels and the severity of CAD that is confirmed with coronary angiography. Methods A comparative cross-sectional study was designed between the Chemical Pathology and Cardiology departments at KEMU/Mayo Hospital in Lahore, Pakistan. Patients were divided into group A with mild CAD (<50% stenosis) and group B with moderate-severe CAD (>50% stenosis). Serum was collected from venous blood, and irisin levels were analyzed by ELISA. Inclusion criteria: patients with stable CAD. Exclusion criteria: History of coronary artery bypass grafting (CABG), acute coronary syndrome (ACS), active or chronic infection, hepatic or renal dysfunction. Results The mean + SD age (years) of patients in group B (57.0±9.5) was significantly higher than group A (50.0±13.7). Irisin levels (µg/ml) were significantly higher in group A (15.3±4.6) than in group B (9.3±2.4). Irisin levels were significantly negatively correlated with the severity of CAD (% stenosis). Conclusion Serum irisin levels are low in patients with moderate to severe CAD, and they are negatively correlated with the severity of CAD (% stenosis).
Introduction Appendicitis is a common surgical condition that can be difficult to diagnose due to its varied clinical presentations. Surgical removal of the inflamed appendix is often necessary, and the appendix is sent for histopathological assessment to confirm the diagnosis. However, in some cases, the analysis may return a negative result for acute inflammation, known as a negative appendicectomy (NA). The definition of NA varies among experts. While negative appendicectomies are not ideal, they are accepted by surgeons to reduce the rate of perforated appendicitis, which can have severe consequences for patients. A study was conducted to investigate the rates of negative appendicectomies and their impact at a local district general hospital in Cavan, Republic of Ireland. Methods The study was conducted retrospectively from January 2014 to December 2019 on patients who were admitted with suspected appendicitis and underwent appendicectomy for appendicitis, regardless of age and sex. The researchers excluded patients who underwent elective, interval, and incidental appendicectomies. Data were collected on patient demographics, duration of symptoms prior to presentation, the intraoperative appearance of the appendix, and the histology results of the appendix specimens. Descriptive statistics and the Chi-squared test were used for data analysis with the help of IBM Statistical Package for the Social Sciences (SPSS) Version 26. Results The study retrospectively reviewed 876 patients who underwent an appendicectomy for suspected appendicitis between January 2014 and December 2019. The age distribution of patients was non-uniform, with 72% presenting before the third decade. The overall perforated appendicitis rate was 7.08%, and the overall negative appendicectomy (NA) rate was 21.3%. A subset analysis showed a statistically significant lower NA rate in females than in males. The NA rate decreased significantly over time and has been sustained since 2014 at around 10%, which is consistent with other published studies. The majority of the histology findings were uncomplicated appendicitis. Discussion This article discusses the challenges of diagnosing appendicitis and the need to reduce unnecessary surgeries. Laparoscopic appendectomy is the standard treatment, with an average cost of £2222.53 per patient in the UK. However, patients with negative appendicectomies (NA) have longer hospital stays and higher morbidity than uncomplicated cases, making it crucial to reduce unnecessary surgeries. The clinical diagnosis of appendicitis is not always straightforward, and the rate of perforated appendicitis increases with a longer duration of symptoms, particularly pain. The selective use of imaging in suspected appendicitis could reduce NA rates, but a statistical difference has not been proven. Scoring systems like the Alvarado score have limitations and cannot be relied upon alone. Retrospective studies have limitations, and biases and confounding variables must be considered. Conclusion The study found that a thorough investigation of patients, particularly with preoperative imaging, can decrease the rate of unnecessary appendectomies without increasing the rate of perforation. This could save costs and reduce harm to patients.
Introduction: Easy accessibility, high sensitivity and specificity of CT scans have markedly increased its usage in developed countries. Its importance is undeniably considered integral for the diagnosis of various pathologies. However, sometimes this costly resource is wasted when used unnecessary. This paper is an audit on CT scans performed to look for surgical pathologies between July 2018 and April 2019 recapitulating the numbers of CT scan's abnormal and normal findings. Methodology: Anonymized record of all the patients seen by the surgical team in the emergency department was reviewed. Retrospective data of every patient who had the CT scan was taken through Mckesson Radiology software of an Irish Hospital. Analysis was done using SPSS. Findings of 102 CT scans was broken down in to three different groups depending at which departmental level CT was performed, namely:Emergency department, Inpatient and Outpatient. Results: 102 CT Scans were performed of which 51 (50%) patients out of all the three groups had unremarkable. Conclusions: Adequate history, proper clinical examination and strong clinical knowledge may bring down the number of unnecessary CT scans.
BACKGROUND: Primary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue neoplasm which originates from the mesenchyme and has a characteristic smooth muscle differentiation. Usually, it presents as a painless, firm, slow-growing unilateral scrotal mass. Investigations include imaging, tumor markers, and histopathology. CASE PRESENTATION: A 65-year-old gentleman known diabetic and beta-thalassemic trait was referred to the Urology OPD at Letterkenny University Hospital. His presenting complaint was a left groin lump that appeared 1 year ago and was growing larger in size gradually. According to the patient, his lump was slightly painful (localized) initially that later became painless. He did not report any testicular trauma/infection or UTI. There was no significant history of malignancies running through his family. Clinical examination revealed a soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well-circumscribed, mobile, firm to cystic irreducible left inguinoscrotal mass and appeared to be attached to the spermatic cord. Cough impulse was indiscernible. Ultrasound left groin showed 1.8 cm transverse x 1.4 cm AP x 1.9 cm sagittal) well-circumscribed ovoid nodular subcutaneous lesion present in the upper left inguinal area just lateral to the left pubic tubercle that appeared solid with heterogeneous internal echotexture and no internal calcification. Some internal vascularity is demonstrated with color Doppler assessment. CONCLUSION: Because of its rareness, LMS represents a management conundrum. There is no standard protocol for treatment. We present a case and discuss the available evidence from the literature to date to help identify LMS of the spermatic cord that is highly unusual.
Genital Neoplasms, Male , Leiomyosarcoma , Soft Tissue Neoplasms , Spermatic Cord , Aged , Genital Neoplasms, Male/diagnosis , Genital Neoplasms, Male/pathology , Genital Neoplasms, Male/surgery , Humans , Leiomyosarcoma/pathology , Leiomyosarcoma/surgery , Male , Soft Tissue Neoplasms/pathology , Spermatic Cord/pathology , Spermatic Cord/surgery , Ultrasonography
