Thuchchai Pipitpanpipit’s Post

***News on DynaMesh®-CICAT visible*** Based on their findings, Rodicio Miravalles et al. concluded that the prophylactic use of onlay PVDF mesh in midline laparotomy in high-risk patients is safe and effective in the short-term, regardless of the type of surgery or degree of contamination. Read more below: In their prospective multi-centre observational cohort study, Rodicio Miravalles et al. from Spain investigate the use of DynaMesh®-CICAT visible for onlay mesh reinforcement of midline laparotomy closure in a high-risk cohort (risk factors > 1) for the development of incisional hernia. The analysis focused on the short-term results. A total of 185 patients were included. 30.3% of the cases were emergencies, 68.6% of the operations were clean-contaminated, 10.7% contaminated, and 11.8% dirty. Postoperative surgical complications included 19.5% ileus, 13.5% surgical site infections (5.9% superficial, 3.2% deep, 4.3% organ/space), 10.8% anastomotic dehiscence, 10.3% seromas, 7% haematomas, 2.7% evisceration and 2.1% mesh exposure; the complications were expected based on the cohort/type of surgery performed. 8.1% (15/185) of patients underwent reoperations: one due to a subcutaneous haematoma, six had access to the abdominal cavity through the mesh without causing any problems, four had their mesh changed (3 contamination, 1 evisceration with a different mesh from that used in the study) and four had their mesh removed due to bad prognosis. A total six (3.2%) patients died during the first 6 weeks postoperatively: three due to septic shock, one due to Clostridium infection, one due to massive ischaemia, and one patient of advanced age with multiple complications and evisceration. After 3 months, 95.5% (171/179) of the surviving patients were followed up. The incidence of incisional hernia was 1.8%, 2.3% of cases had a seroma, 1.8% had a wound infection and in 1.2% the mesh was exposed. The mean pain score measured with VAS (range 0-10) was 0.2 ± 0.6. According to multivariate logistic regression, the requirement for stoma creation during surgery was the only statistically significant risk factor for superficial wound infection (OR 1.2; p = 0.03) and age the only risk factor for evisceration (OR 1.2; p = 0.03). Based on their findings, the authors concluded that the prophylactic use of onlay PVDF mesh in midline laparotomy in high-risk patients is safe and effective in the short-term, regardless of the type of surgery or degree of contamination.   Note on the contraindication: The device must not be used if there is an acute or chronic infection in the implantation area. For more: https://lnkd.in/ezPuCx-X #DynaMeshNews #CICAT #hernia #PVDF #MRIvisible

VATS , Restrictive Lung Disease and ILD 1) VATS ( Video assisted Thoracoscopic surgery) Decortication 2)It is minimally invasive surgical procedure to treat , Recurrent Pl Effusions, Empyema and Pleural thickening or Fibrosis. 3) It involves removal of fibrous tissue and peel ( decortication) that has developed around the lung and can restrict lung Expansion. Indications : 1) Pl Effusion Reccurent 2) Empyema 3) Pl thickening/ Fibrosis 4) lung Abscess 5) Chronic lung infections that develops fibrous tissue around lung. Restrictive Lung Disease 1)Hallmark of Restrictive lung disease is reduced lung volumes ( TLC, VC, FVC), FEV1 and FEV1/FVC may be normal or slighly reduced. 2) Examples are : A) Pulmunary Fibrosis B) Sarcoidosis/ ILDs C) Chest wall deformaties ( Scoliosis), (OHS)Obesity Hypoventilation Syndrome D ) Secondary causes of restriction such as Pl eff, Empyema, Pleural thickening. Presentation: SOB , Cough, Reduced exercise tolerance. Diagnostic tests: 1) PFTs 2) Diffusion Capacities ( DLCOs) 3 CXR, for Pl effusion to valuate causes of secondary restriction and primary ones 4) HRCT chest: helps in diagnosing of underlying disease by indication lung paranchyma , inflamation and fibrosis of interstitium 5) Exercise tolerance test 6) Bronchoscopy ILD: Diverse group of lung disease characterized by Inflammation and Fibrosis of lung interstitium surrounding air sacs 1) IPF ( most common/ most severe) 2) NSIP( uniformly distributed 3) COP/ BOOP ( inflammation and fibrosis of small airways . 4) HP( immune mediated lung interstitium disease due to repeated exposure to enviromental antigen such as mold , bird droppings, chemicals A) Bird fashiers lung B) Farmers lung 5) CTD-ILD( autoimmune mediated connective tissue disorders. A) Systemic Sclerosis B) Rheumatoid Arthritis C) SLE D Sojrens Syndrome 6) Sarcoidosis( Sytemic Inflammation characterized by formation of granulomas) 7) Drug Induced ILD ( chemotherapy ,antibiotics, anti inflammatory) 8) Occupational Lung Disease ( Pneumoconiosis) 9 ) LAM

A recent contribution from our Hepatobiliary Division in Tampa “Robotic Biliary Stricturoplasty and Roux-en-Y Hepaticojejunostomy After Hepatic Artery Infusion Pump Injury.” Biliary sclerosis is a known complication of Hepatic Artery Infusion Pump FUDR treatment. This treatment option for an isolated stricture provides a solution for patients who are otherwise in the pathway and serious need/consideration of needing Liver Transplantation to survive. Case selection is Key and expertise in complex biliary surgery is crucial. https://lnkd.in/eKt3QcK2 #adventhealth #MSKCC #HAIP #sages #ssat #ahpba #ihpba #biliarysurgery #colorectalcancer #americancollegeofsurgeons #sso #surgicaloncology #livertransplantation #Hepatobiliary

📃Scientific paper: Coexistence of TSH-secreting adenoma and primary hypothyroidism: a case report and review of literature Abstract: Background Thyrotropin-secreting adenoma (TSHoma) is the least common type of pituitary adenoma, these patients often present with symptoms of hyperthyroidism. When TSHoma patients combined with autoimmune hypothyroidism, it is critically difficult to diagnose for the specific confusion in the results of thyroid function test. Case presentation One middle-aged male patient was presented with a sellar tumor on cranial MRI for headache symptoms. After hospitalization, a significant increase in thyrotropin (TSH) was revealed by the endocrine tests, while free thyronine (FT3) and free thyroxine (FT4) decreased, and the diffuse destruction of thyroid gland was revealed by thyroid ultrasound. Based on the endocrine test results, the patient was diagnosed as autoimmune hypothyroidism. After the multidisciplinary discussion, the pituitary adenoma was removed by endoscopic transnasal surgery, until the tumor was completely excised, for which TSHoma was revealed by postoperative pathology. A significant decrease of TSH was revealed by the postoperative thyroid function tests, the treatment for autoimmune hypothyroidism was conducted. After 20 months of follow-up, the thyroid function of patient had been improved significantly. Conclusion When the thyroid function test results of patients with TSHoma are difficult to interpret, the possibility of combined primary thyroid disease should be considered. TSHoma combined with autoimmune hypothyroidism is rare, which is difficult t... Continued on ES/IODE ➡️ https://etcse.fr/Kk8M ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Coexistence of TSH-secreting adenoma and primary hypothyroidism: a case report and review of literature Abstract: Background Thyrotropin-secreting adenoma (TSHoma) is the least common type of pituitary adenoma, these patients often present with symptoms of hyperthyroidism. When TSHoma patients combined with autoimmune hypothyroidism, it is critically difficult to diagnose for the specific confusion in the results of thyroid function test. Case presentation One middle-aged male patient was presented with a sellar tumor on cranial MRI for headache symptoms. After hospitalization, a significant increase in thyrotropin (TSH) was revealed by the endocrine tests, while free thyronine (FT3) and free thyroxine (FT4) decreased, and the diffuse destruction of thyroid gland was revealed by thyroid ultrasound. Based on the endocrine test results, the patient was diagnosed as autoimmune hypothyroidism. After the multidisciplinary discussion, the pituitary adenoma was removed by endoscopic transnasal surgery, until the tumor was completely excised, for which TSHoma was revealed by postoperative pathology. A significant decrease of TSH was revealed by the postoperative thyroid function tests, the treatment for autoimmune hypothyroidism was conducted. After 20 months of follow-up, the thyroid function of patient had been improved significantly. Conclusion When the thyroid function test results of patients with TSHoma are difficult to interpret, the possibility of combined primary thyroid disease should be considered. TSHoma combined with autoimmune hypothyroidism is rare, which is difficult t... Continued on ES/IODE ➡️ https://etcse.fr/Kk8M ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Case report: surgical management of symptomatic pretracheal thyroid gland in a patient with dual ectopic thyroid Abstract: Background Dual ectopic thyroid, a very rare condition, is defined as the simultaneous presence of ectopic thyroid tissue in two abnormal locations. Here, we report the surgical management of a patient with dual ectopic thyroid. Case presentation The patient was a 12-year-old boy with right para-midline swelling for 2 months. On physical examination of the upper anterior neck, there was a 4 cm × 3 cm mass that was soft, mobile, smooth, and painless. Blood examination showed euthyroidism. Neck ultrasonography showed a well-circumscribed multilocular cyst. We followed up by observation only because the patient had no local symptoms or malignancy. After 2 years, the mass gradually enlarged, so we performed surgery to improve cosmetic outcomes. Preoperative neck CT revealed both a high-density solid mass at the base of the tongue and a central low-density region surrounded by a high-density area at the pretracheal region below the hyoid. The infrahyoid mass was surgically removed, and the sublingual mass was left intact. Pathological findings showed the growth of multiple-size follicles, leading to a diagnosis of adenomatous goiter. Postoperative ^123−I scintigraphy showed radioactive iodine uptake in the sublingual lesion, but none in the normal thyroid bed despite the extirpation of thyroid tissue. Postoperative thyroid hormone replacement was started for subclinical hypothyroidism. One year postoperatively, the patient became euthyroid. Conclusion Surgical exci... Continued on ES/IODE ➡️ https://etcse.fr/rOe6 ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Coexistence of TSH-secreting adenoma and primary hypothyroidism: a case report and review of literature Abstract: Background Thyrotropin-secreting adenoma (TSHoma) is the least common type of pituitary adenoma, these patients often present with symptoms of hyperthyroidism. When TSHoma patients combined with autoimmune hypothyroidism, it is critically difficult to diagnose for the specific confusion in the results of thyroid function test. Case presentation One middle-aged male patient was presented with a sellar tumor on cranial MRI for headache symptoms. After hospitalization, a significant increase in thyrotropin (TSH) was revealed by the endocrine tests, while free thyronine (FT3) and free thyroxine (FT4) decreased, and the diffuse destruction of thyroid gland was revealed by thyroid ultrasound. Based on the endocrine test results, the patient was diagnosed as autoimmune hypothyroidism. After the multidisciplinary discussion, the pituitary adenoma was removed by endoscopic transnasal surgery, until the tumor was completely excised, for which TSHoma was revealed by postoperative pathology. A significant decrease of TSH was revealed by the postoperative thyroid function tests, the treatment for autoimmune hypothyroidism was conducted. After 20 months of follow-up, the thyroid function of patient had been improved significantly. Conclusion When the thyroid function test results of patients with TSHoma are difficult to interpret, the possibility of combined primary thyroid disease should be considered. TSHoma combined with autoimmune hypothyroidism is rare, which is difficult t... Continued on ES/IODE ➡️ https://etcse.fr/Kk8M ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

Aim: To investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. Methodology: Retrospective study of 7053 patients who underwent surgery for colonic diverticulitis. Patients with right-sided diverticulitis, no anastomosis, or missing data were excluded, giving 4441 patients in the final analysis. Path analyses were used. Results: AL/PA occurred in 4.6%, and SAS in 1.8%. AL/PA was associated with an ↑ risk of SAS (OR = 3.41), as was a diverting stoma for ≥100 days (OR = 2.77). Central vessel ligation proximal to the IMA was associated with a ↓ risk of SAS (OR = 0.41). Diverting stoma, whether kept for <100 days (OR = 3.08) or ≥100 days (OR = 12.95), was associated with an ↑ risk of AL/PA. No significant association was found between radiological or surgical management of AL/PA and SAS. Conclusion: AL/PA is associated with ↑ risk of SAS. The management of AL/PA does not influence the occurrence of anastomotic stenosis. Diverting stoma is associated with ↑ risk of both AL/PA and SAS, especially if left for ≥100 days. Limitations: 1. Retrospective methodology - limits ability to investigate causality 2. Definition of SAS - retrospective and limited by symptomatic characteristic 3. Survival analysis - lacking, only occurrence recorded, not the date 4. Elective surgery - many patients underwent it contrary to new guidelines, introducing possible bias 5. Anastomosis details - type, height, and extent of resection not collected, potential risk factors for AL/PA or SAS 6. Stapled anastomosis recommendations - adherence not verified by study design 7. SAS management - data on consequences and management not collected https://lnkd.in/gEvukTZa

📃Scientific paper: Impact of modified bladder neck suspension on early recovery of continence after robot-assisted radical prostatectomy (RARP) Abstract: The incontinence after RARP significantly decreases the quality of life in prostate cancer patients. A number of techniques have been introduced for the recovery of continence after RARP. Although, the mechanism of the continence recovery is still unclear. We aimed to evaluate the early recovery of continence after RARP by inducing early anterior adhesion and reducing the hypermobility of the urethra through the modified bladder neck suspension (BNS) procedure. From March 2018 to February 2020, a total of 227 consecutive patients who underwent RARP (by single surgeon) were included. Patients were divided into two groups based on operation procedure (Standard procedure vs BNS procedure). Demographics, perioperative variables, and pathologic outcome were analyzed. We assessed recovery of continence at 1, 3, 6 and 9 months after surgery. Postoperative recovery of continence defined as the use of no pad during 24 h. Multivariable logistic regression analyses were performed to evaluate independent predictors of the early recovery of continence at 1 month. We performed RARP with standard procedure (n = 106) or BNS procedure (n = 121). There was no statistical difference in perioperative variables between the two groups except anastomosis time (21.6 ± 12.9 vs 17.0 ± 7.6, p  = 0.003). The pad free continence rate were 80.2% (standard group) and 91.3% (BNS group) at 9 month after RARP ( p  = 0.037). However, early continence rate (1mo) were significantly higher in the BN... Continued on ES/IODE ➡️ https://etcse.fr/VMqBj ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

A Real life journey of a patient with a rare presentation of a #neuroendocrine neoplasm managed with Dr.Prasad K. Wagle sir. Highlights the importance of having experienced teams for #cancertreatment for good outcomes and a need for long term follow up in #cancer cases. Key features to learn - Pre-op scan reading with the expert radiologists Dr. Manoj Deshmukh sir and kaustubh lokhande , excellent images by the radiology team to map the tumors - Intraoperative sonography a must - Adherance to the ten commandments of safe liver surgery - https://lnkd.in/dmTP3q_i - Experienced anesthesia team for such complex cases and post-op support system in place All these together help in achieving good outcomes for the patients. https://lnkd.in/dRy9R8pk To get epaper daily on your whatsapp click here: https://lnkd.in/drnzeKeV