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Background: The COVID-19 pandemic prompted the transition of all teaching and learning of final-year General Surgery students to an online platform. Despite the utility of online methods, challenges exist such as a sense of impersonal learning, and poor student engagement. Student engagement with course content is important for deep learning. An Online Student Engagement Scale (OSE) and a revised Biggs Two-Factor Study Process Questionnaire (R-SPQ-2F) were used to evaluate student engagement and learning approaches respectively. Methods: A cross-sectional study was conducted in 2021 at a South African university. The OSE and R-SPQ-2F online survey tools were administered to all final-year students (n = 325) enrolled in the surgical online module. Quantitative data was collected, and the data was analysed statistically using R-Statistical computing software. Results are presented in the form of descriptive and inferential statistics. The reliability of the tools was evaluated by Cronbach's alpha. Results: The survey response rate was 35.4 % (115/325). Students were engaged at a high level, and the median (IQR) scores of the OSE tool were 71.0 (63.0–78.0). Overall, students adopted a deep approach (DA) to learning, with median (IQR) scores of 34.0 (30.0–39.0) on the R-SPQ-2F tool. There was a moderate positive correlation between the total OSE score and DA (0.53, p

الملخص: أهداف البحث: يحتوي عسل كيلولوت على تريهالولوز ويحتوي على نسبة عالية من مضادات الأكسدة، مثل المواد الفينولية والفلافونويد، والتي يمكن أن تعزز التئام الجروح. تهدف هذه الدراسة إلى تقييم فعالية عسل كيلولوت في التئام جروح مرضى السكري مقارنة بضمادات الجل التقليدية المتوفرة تجاريا (جل انتراسايت من سميث-نيفيو). طريقة البحث: تم إجراء تجربة مراقبة مستقبلية عشوائية وحيدة التعمية على مرضى السكري المؤهلين الذين يعانون من جروح تجويف كاملة السماكة. تم تسجيل التركيبة السكانية للمرضى، وحجم وموقع الجروح، وفحوصات الدم الروتينية الأساسية. تم تضميد الجروح كل يومين إما بعسل كيلولوت لمجموعة التدخل أو الجل للمجموعة الضابطة. تم حساب نسبة تقليل حجم الجرح وتكوين الأنسجة الحبيبية كل ستة أيام لمدة شهر واحد. النتائج: تم اختيار واحد وسبعون مريضا بصورة عشوائية. وبعد 30 يوما من المتابعة، أصبح 62 مشاركا متاحين للتحليل: 30 و32 من مجموعتي المراقبة والعلاج، على التوالي. كان لدى المجموعة الضابطة أنسجة حبيبية أعلى عند خط الأساس وأظهرت المزيد من الجروح في الطرف السفلي والجذع الخلفي. أظهرت كلا المجموعتين زيادة في متوسط ومتوسط النسبة المئوية لظهارة الجرح والأنسجة الحبيبية بمرور الوقت، مع ارتفاع القيم بشكل ملحوظ في كل نقطة زمنية في مجموعة العسل. ومع ذلك، كشفت القياسات المتكررة ''أنوفا'' و ''أنكوفا'' عن عدم وجود تأثير تفاعل كبير بين العلاجات المختلفة والوقت. الاستنتاجات: كشفت هذه التجربة أن عسل كيلولوت كان مشابها للجل التقليدي وفعالا مثله في علاج جروح مرضى السكري من حيث تعزيز تكوين الظهارة وتكوين الأنسجة الحبيبية. Abstract: Purpose: Kelulut honey contains trehalulose and has high antioxidant content, such as phenolic and flavonoid substances, which can promote wound healing. This study evaluated the effectiveness of Kelulut honey in diabetic wound healing compared to a commercially available conventional gel dressing (Intrasite gel). Methods: A prospective, randomized, single-blinded control trial was performed on eligible diabetic patients with full-thickness cavity wounds. Patients’ demographics, size and site of wounds, and baseline routine blood investigations were recorded. The wounds were dressed every other day with Kelulut honey for the intervention group or gel for the control group. The wound size reduction and granulation tissue formation percentage were calculated every 6 days for 1 month. Results: Seventy-one patients were randomized. After 30 days of follow-up, 62 participants were available for analysis: 30 from the control group and 32 from the treatment group. The control group had increased granulation tissue at baseline and more wounds on the lower limb and posterior trunk. Both groups showed an increasing mean and median percentage of wound epithelialization and granulation tissue over time, with significantly higher values at every timepoint in the honey group (p

Paediatric and congenital heart disease (PCHD) is common but remains forgotten on the global health agenda. Congenital heart disease is the most frequent major congenital anomaly, affecting approximately 1 in every 100 live births. In high-income countries, most children now live into adulthood, whereas in low- and middle-income countries, over 90% of patients do not get the care they need. Rheumatic heart disease is the most common acquired cardiovascular disease in children and adolescents. While almost completely eradicated in high-income countries, over 30-40 million people live with rheumatic heart disease in low- and middle-income countries. Challenges exist in the care for PCHD and, increasingly, adult congenital heart disease (ACHD) worldwide. In this review, we summarize the current status of PCHD and ACHD care through the health systems lens of workforce, infrastructure, financing, service delivery, information management and technology, and governance. We further highlight gaps in knowledge and opportunities moving forward to improve access to care for all those living with PCHD or ACHD worldwide. Résumé: Les cardiopathies pédiatriques et congénitales (CPC) sont fréquentes, mais demeurent dans l’angle mort des politiques de santé mondiale. La cardiopathie est l’anomalie congénitale majeure la plus fréquente; elle touche environ 1 naissance vivante sur 100. Dans les pays à revenus élevés, la plupart de ces enfants atteignent désormais l’âge adulte, tandis que dans ceux à revenus faibles ou moyens, plus de 90 % des patients n’obtiennent pas les soins dont ils ont besoin. La cardiopathie rhumatismale est la maladie cardiovasculaire acquise la plus fréquente chez les enfants et les adolescents. Alors qu’elle est pratiquement éradiquée dans les pays à revenus élevés, plus de 30 à 40 millions de personnes en sont atteintes dans les pays à revenus faibles et moyens. À l’échelle mondiale, il existe de nombreux obstacles aux soins des CPC et, de plus en plus, des cardiopathies congénitales chez l’adulte (CCA). Notre article de synthèse présente un résumé de l’état actuel des soins des CPC et des CCA en abordant plusieurs aspects des systèmes de santé : ressources humaines, infrastructures, financement, services offerts, gestion des renseignements, technologies de l’information et gouvernance. Nous mettons également en lumière des lacunes dans les connaissances et des avenues d’amélioration de l’accès aux soins pour les personnes atteintes de CPC et de CCA partout dans le monde.

Purpose: To investigate the impact of smoking on clinical outcomes after repair of supraspinatus tendon in patients who had an intact repair found on postoperative magnetic resonance imaging. Methods: Patients who received primary complete repair of supraspinatus tendon tear between 2014 and 2020 were retrospectively identified. Patients were excluded if a postoperative magnetic resonance imaging scan was not available or if the follow-up was less than 2 years. Visual analog score (VAS), American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion were assessed at the 2-year follow-up. The percentage of patients acquiring minimal clinically important difference (MCID) was reported. Results: One hundred primary supraspinatus tendon repairs were included. The healing rate was 77% in smokers and 90% in nonsmokers. Smoking was the independent predictor of a poorer 2-year VAS (P < .001) and ASES (P < .001) scores. Significant improvement in clinical outcomes was observed between preoperation and the 2-year follow-up, regardless of the integrity of the repair or smoking status (P < .001). When the repaired tendon was intact, nonsmokers had a greater chance of achieving MCID in 2-year VAS and ASES scores than smokers. Ninety-nine percent of nonsmokers, compared with 82% of smokers, achieved MCID in VAS at the 2-year follow-up (P = .023). The corresponding figures for ASES were 98% and 71%, respectively (P = .004). Conclusions: In this study, smoking was associated with poorer clinical outcomes, including a greater 2-year VAS pain score and a lower 2-year ASES score, when compared with nonsmokers, even in cases in which there was no full-thickness retear of the repaired supraspinatus tendon. Level of Evidence: Level III, retrospective cohort study.

We propose modifying the outside-in technique by adopting a posterolateral (PL) portal as the working portal to introduce the anterior cruciate ligament reconstruction (ACLR) aiming guide while keeping the anteromedial portal as the viewing portal, the “PL-portal outside-in technique.” This modification facilitates the preparation of an anatomical femoral tunnel, even when preserving a “big” ACL remnant or in small joint scenarios, such as pediatric ACLR. There is a minimal learning curve in adopting this technique because a standard 30° arthroscope is used, and the viewing portal is anterior.

Hip prosthetic joint infection management is complex and expensive, especially in severe bone loss. Reducing the price of interval prosthesis when performing staged revision could minimize costs without compromising outcomes. We present 2 similar techniques developed independently that use an antibiotic-coated cephalomedullary nail with a total hip arthroplasty bearing (head and cemented acetabular component) attached to it as an interval proximal femoral replacement prosthesis. Using this technique, the femoral implant cost was reduced up to 10-fold. All patients have recovered well with resolution of infection and functional recovery similar to patients undergoing proximal femoral replacement. In one case, the lag screw (femoral neck) fractured at 5 months prompting the second-stage revision. This complication should be considered when deciding the timing of second-stage revisions in these cases.

For patients with “no-option” chronic limb-threatening ischemia, a final attempt can be made for limb salvage in the form of percutaneous deep vein arterialization (pDVA). In the present study, we describe five cases of pDVA using a BeBack crossing catheter (Bentley InnoMed GmbH; previously, the GoBack crossing catheter; Upstream Peripheral Technologies). From November 2021 to July 2022, five patients underwent pDVA using the BeBack crossing catheter. The demographic data, procedural details, and patient outcomes were recorded. Successful vascular crossing was achieved in all five cases using the BeBack device. No surgical complications were encountered. The limb salvage rate was 60%, and the wound closure rate was 40%. No mortalities occurred during the follow-up period. The findings from the present study demonstrate that the use of the BeBack crossing catheter for pDVA is safe and feasible.

Background: The study aimed to calculate the predictive value of admission laboratory values in patients with perforated peptic ulcers. Methods: A retrospective, cohort analytical, observational study was performed, including patients with surgically confirmed perforated peptic ulcers over a 5-year period. Demographic data and admission laboratory values were collected from hospital electronic databases. Outcomes measured were in-hospital mortality, intensive care unit (ICU) admission and length of stay. The significance of categorical variables was calculated by chi-square and Fisher's exact test. Logistic regression analysis was performed to determine univariately statistically significant variables. Results: In total, 188 patients met the inclusion criteria. The median age was 46 (range 15–87) years with a male predominance of 71.3 % (n = 134). The median length of hospital stay was 7 (range 1–94) days and 31.4 % (n = 59) of patients were admitted to the ICU. Post-operative in-hospital mortality was 25.0 % (n = 47). Predicting the categorical outcome of in-hospital mortality, abnormal haemoglobin, platelet count, urea, creatinine and potassium levels were all found to be statistically significant in the univariate analysis. Age (odds ratio [OR] 1.03), haemoglobin (OR 4.36) and creatinine (OR 7.76) levels were significant in the multivariate analysis. Conclusions: Mortality rate among patients with perforated peptic ulcer disease is still substantial. Admission laboratory values showed statistical significance as outcome indicators and were valuable to assist in predicting the prognosis. An abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission. Key message: Initial laboratory findings of patients admitted for perforated peptic ulcer showed that an abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission.

Spontaneous insufficiency fracture of the knee is a potentially devastating yet poorly understood disease entity that can lead to secondary osteoarthritis. Most cases involve the medial femoral condyle, and the lateral femoral condyle is rarely affected. The optimal treatment for spontaneous insufficiency fracture of the lateral femoral condyle remains undetermined, and there are no previous dedicated reports on treatment outcome with unicompartmental knee arthroplasty. A middle-aged lady presented with subacute left knee pain and a locked knee. Subsequent imaging studies revealed a spontaneous insufficiency fracture of the lateral femoral condyle. In view of the isolated compartment involvement, unicompartmental knee arthroplasty was performed with satisfactory outcome. At 1 year postoperatively, the patient had complete resolution of knee pain and was able to resume working.

A 55-year-old healthy lady underwent left side PCNL for a 1.5cm upper ureteric stone. The surgery was straightforward, and the stone was removed by pneumatic lithotripsy. We diagnosed bowel perforation while we were withdrawing the scope at the end of the procedure. Subsequently, she underwent exploratory laparotomy and jejunal perforation was identified, which was repaired primarily. To our knowledge, there were few similar case scenarios in the English literature, therefore we are sharing our experience on diagnosis and management of bowel perforation during PCNLs.

Background: Primary cardiac tumors are quite rare and mostly benign in nature. Most of the benign heart tumors are myxomas. These might present with a wide range of symptoms from being completely asymptomatic to having life-threatening complications like stroke, heart failure, or even sudden death. This study summarizes our 6-year clinical experience with surgical resection of cardiac tumors at Chittagong Medical College and Hospital, Chattogram, Bangladesh. Methods: Twenty patients who underwent surgical excision of primary intracardiac myxoma between February 2014 and February 2020 were included in the study. Seventeen (85%) of them were female and 3 (15%) were male. Mean age was 43.4 ± 14.1 years. The tumors were located in the left atrium in 19 patients and in 1 patient it was in the right atrium. The most common attachment site was the interatrial septum. Most of the patients presented with dyspnea. Preoperative diagnosis was established using transthoracic echocardiography with colour Doppler. Surgery for all patients was via median sternotomy. Results: All 20 patients survived the surgery. Mean tumor dimension was 4.6 ± 3.5 cm in the longest diameter. Solid tumors were detected in 13 patients (65%) whereas papillary myxomas were found in 7 patients (35%). On follow-up of these 20 patients, there was no perioperative death. One patient presented with recurrence 28 months after the surgery. Conclusions: Although cardiac myxomas carry the risk of serious systemic and cardiac symptoms, prompt surgical excision gives excellent outcome. Résumé: Introduction: Les tumeurs cardiaques primitives sont assez rares et pour la plupart bénignes par nature. La plupart des tumeurs cardiaques bénignes sont des myxomes, qui pourraient se manifester sous diverses formes allant de l’absence complète de symptômes à des complications mettant la vie en danger telles que les accidents vasculaires cérébraux, l’insuffisance cardiaque, voire la mort subite. La présente étude résume les six années d’expérience clinique en résection chirurgicale de tumeurs cardiaques au Chittagong Medical College and Hospital, Chattogram, Bangladesh. Méthodes: Vingt patients qui avaient subi une excision chirurgicale d’un myxome intracardiaque primitif entre février 2014 et février 2020 ont fait partie de l’étude. Dix-sept (85 %) étaient des femmes, et trois (15 %), des hommes. L’âge moyen était de 43,4 ± 14,1 ans. Dix-neuf patients avaient une tumeur située dans l’atrium gauche, et un patient avait une tumeur située dans l’atrium droit. Le site de fixation le plus fréquent était le septum interauriculaire. La plupart des patients accusaient une dyspnée. Le diagnostic préopératoire était établi par échocardiographie Doppler couleur transthoracique. Tous les patients opérés ont subi une sternotomie médiane. Résultats: Les 20 patients ont survécu à l’intervention chirurgicale. La dimension moyenne de la tumeur était de 4,6 ± 3,5 cm dans le plus grand diamètre. Treize (65 %) patients avaient des tumeurs solides, et sept (35 %) patients, des myxomes papillaires. Aucun décès périopératoire n’a été observé durant le suivi de ces 20 patients. Un patient a eu une récidive 28 mois après l’intervention chirurgicale. Conclusions: Bien que les myxomes cardiaques comportent un risque de symptômes systémiques et cardiaques sérieux, l’excision chirurgicale rapide apporte d’excellents résultats.

Pseudoaneurysm of the iliac arteries are rarely reported in the literature. Failure to identify the pathology may delay the necessary treatment, and potentially lead to high mortality. We report a case of ruptured mycotic iliac artery aneurysm in a 46-year-old man with newly diagnosed diabetes mellitus. Initial CT appearance mimicked psoas abscess. However, further CT showed features more suggestive of a psoas haematoma with heterogeneous hyperdensities within the lesion. A ruptured mycotic iliac artery aneurysm was diagnosed. Patient was urgently referred to the vascular team for endovascular stenting. Blood-stained purulent material was noted in the left psoas muscle intra-operatively. It was drained and sent for culture, which later yielded Salmonella Enteritidis sensitive to cefotaxime. We present this case to highlight the importance of reviewing any pre-contrast intramuscular hyperdensities which may suggest acute blood content, and raise suspicion of adjacent vascular pathologies.

Objectives: To improve our understanding of patients’ perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences. Design: Qualitative research with semi-structured interviews. Setting: General community. Participants: Individuals who received (N=10) and who did not receive (N=15) prehabilitation before LSS surgery were recruited at the 6-month postoperative follow-up (8 females; average age: 67.7±6.7 years) by purposive sampling. Additionally, 1 participant invited her daughter to accompany her in an interview. Interventions: Not applicable. Main Outcome Measures: Concerns and experiences of patients with LSS regarding prehabilitation and recovery after spine surgery. Results: Thematic analysis was conducted to identify 4 themes inductively: (1) sources of information about LSS surgery; (2) factors affecting the surgical decision-making; (3) attitudes toward prehabilitation; and (4) postoperative recovery. All participants desired to have more preoperative education to inform their surgical decision-making. There were mixed opinions regarding the perceived benefits of prehabilitation because some individuals hesitated to participate in prehabilitation because of their symptoms, or the cost or time of traveling. Many participants expected some or even complete relief of LSS-related symptoms after surgery. However, not all participants experienced the expected postoperative improvements. Some participants only experienced temporary symptomatic relief, while others experienced new postoperative symptoms. Patients generally found that postoperative exercises taught by physiotherapists were useful although their compliance decreased over time. Conclusions: Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.

Lobular capillary hemangiomas (LCHs) are a common form of benign vascular tumors originating from the skin and subcutaneous tissues. We have described the case of a 47-year-old man who had presented with a 1-month history of a tender swelling to the right temporal region. Biopsy was performed to rule out temporal arteritis and demonstrated a subset of LCH, now formally known as intravascular LCH. We have described the occurrence of a rare subtype of LCH arising from the intravascular wall of the temporal artery. To the best of our knowledge, this is the only reported case of an intravascular LCH in the Caribbean.

Hip fusion takedown to total hip replacement is a challenging operation. Neck osteotomy and acetabular component placement are technically demanding and often require fluoroscopic guidance. Robotic arm–assisted total hip arthroplasty enhances accuracy of preoperative planning and provides navigated guidance for neck osteotomy and haptic guidance on acetabular reaming and cup implantation. Fluoroscopic guidance is replaced by real-time navigation and on-screen data. This article describes how robotic arm assistance can simplify this complex operation.

Angiosarcomas represent highly-aggressive malignant lesions of the endothelial cells of blood vessels, affecting mostly the elderly population, and usually located in the scalp or face. As cutaneous angiosarcomas often metastasize to the lung, they can manifest in various forms. We report a case of a 77-year-old male who presented after a posttraumatic blunt scalp lump that was initially diagnosed as infected subgaleal hematoma. This was later found to be an angiosarcoma. Further workup revealed that the tumor was invading the dura, with a rare pattern of mixed concomitant cystic and solid lung metastasis with ground-glass infiltrates. The patient underwent soft tissue reconstruction with split-thickness skin graft for the scalp lesion and palliative chemotherapy. We are discussing the common manifestations of scalp angiosarcomas and their potential pulmonary metastatic patterns. Also, a review of the differential diagnoses that may mimic cutaneous scalp angiosarcoma will be demonstrated.

Background: Many of the complications related to bone block augmentation for recurrent shoulder instability are related to metal screw fixation. Alternative fixation techniques using suspensory fixation have been described with good results, although they require an additional posterior incision to manage the button. It was postulated that the use of an all-suture anchor would remove the requirement for a posterior incision, whilst providing equivalent union rates. Thus, the aim of this study was to evaluate the radiological outcome of a technique using all-suture anchor fixation of iliac crest autograft. Methods: Eleven patients (mean age 28 years, 10 males, 1 female) underwent open anterior shoulder stabilization using an autologous iliac crest bone graft that was fixed with all-suture anchors and supplemented by 2-hole tibial plate. Union of the graft was evaluated 6 months postoperatively using computed tomography. Results: There were no intraoperative complications and none of the participants needed further surgery. All patients reported a stable shoulder at 6 months follow-up. The grafts united in 10 out of the 11 patients. Conclusion: An all-suture anchor construct is a viable alternative to metal screw fixation for iliac crest bone grafting in shoulder instability with critical bone loss, and unlike suspensory techniques does not require a second posterior incision.

Retroperitoneal liposarcomas are rare mesenchymal tumors which carry a poor prognosis because of their late presentation. When symptoms do occur, they are usually nonspecific and related to mass effect or invasion of local structures. Rarely, retroperitoneal liposarcomas can clinically and biochemically mimic phaeochromocytomas. We discuss one such case of a 56-year-old Afro-Trinidadian female who presented to her primary care physician with a 3-month history of weakness, intermittent sweating, difficulty sleeping and elevated blood pressure. After a 2 week trial of an oral antihypertensive regime her blood pressure was still elevated and she complained of new right sided abdominal pain. A subsequent Computed Tomography scan of her abdomen revealed an enhancing, heterogeneous right suprarenal mass suspicious for pheochromocytoma. Urinary catecholamines were also elevated and an MRI of her abdomen supported the diagnosis of pheochromocytoma although intralesionsal fat was noted, an uncommon feature of pheochromocytomas. She was booked for laparoscopic adrenalectomy. Histological analysis of the resected specimen confirmed a dedifferentiated retroperitoneal liposarcoma. While the imaging features of phaeochromocytomas and retroperitoneal liposarcomas can be similar, the presence of intralesional fat on CT and MRI should favour the diagnosis of a retroperitoneal liposarcoma, albeit the clinical and biochemical picture.

Objective: To compare the outcome of suture mediated vascular closure device Perclose Proglide (PP) with manual compression (MC) following transfemoral access for coronary interventions (CI). Methods: It is a retrospective, observational, single centre study from January 2018 to September 2019. Consecutive patients undergoing interventions through transfemoral access were divided into PP and MC groups. Those with less than 3 months follow up were excluded. Two groups were compared for baseline characteristics and various complications at 24 h and at 30 days. Results: Out of 1743 patients studied, PP group included 1343 and MC group, 400 patients. Both groups were comparable in baseline characteristics, sheath size and use of antiplatelets and anticoagulation. PP group had significantly less minor bleeding (P = .01, CI 0.34–4.03) and hematoma (P = .0007, CI 0.95–5.10) at 24 h. At 30 days, minor bleeding (P

Severely calcified lesions continue to plague endovascular interventions by negatively affecting the acute and long-term results. A new technique was developed to allow balloon crossing or to treat persistent recoil. In the direct extravascular calcium interruption arterial procedure technique, an artery forceps is percutaneously introduced to modify the plaque after conventional techniques have failed. In this initial experience, the direct extravascular calcium interruption arterial procedure technique was successful as a bailout option in patients in whom balloon crossing was impossible or recoil was untreatable even with high-pressure balloons.

Renal arteriovenous fistula is classified into idiopathic, acquired and congenital. Endovascular therapy has become the gold standard compared to surgery. We present the embolization procedure of a renal fistula postbiopsy in a 57-year-old female patient through the use of St. Jude Medical Amplatzer vascular Plug IV. Although numerous embolizing agents are available, plug type IV has numerous advantages in terms of procedure times, speed of embolization and precision of the occlusion, but with a relative increase in costs.

Background: Phyllodes tumour is a rare breast neoplasm having three histological types i. e benign, borderline and malignant. Surgical excision is the mainstay of treatment, but quantification of adequate margin required during excision is still a matter of debate. Role of adjuvant radiotherapy also remains controversial. Aims: Study of prognostic factors in patients with phyllodes tumour of breast and their effect on survival. Setting and design: A retrospective analysis. Material and methods: From the year 2016 to 2019 we included 54 patients in this study and assessment of clinical and histopathological features, requirement of adjuvant radiotherapy and their effect on DFS (disease free survival) and OS (overall survival) was done. Log-rank test was used for univariate analysis and multivariate analysis was done by using Cox propotion hazard ratio method. Statistical analysis: Descriptive statistics was used for calculating proportion and median value. Survival analysis was done by using Kaplan Meier method. P value of

Nephroblastoma is the second most common intraabdominal cancer of childhood and the fifth most common pediatric malignancy. Most of the cases occur in children less than 5 years of age with a peak incidence at 2–3 years of age. The survival rate is more than 90%. The primary sites for nephroblastoma metastases are the lungs and less common hepatic metastases. Metastasis to the bladder is extremely rare in younger patients, especially in children and adolescents. Surgery for recurrent nephroblastoma can be challenging and a multidisciplinary team should be developed to reduce complications and improve the survival rate. We reported a successful transurethral resection of huge recurrent nephroblastoma in the bladder, which is an extremely rare site of recurrence in an 11-year-old boy after applying “gentle and unforceful” urethral dilatation. A complete resection may maintain a high rate of cure and relieve upper tract obstruction.

Lateral lumbar interbody fusion (LLIF) is an interbody fusion technique which approaches the spine via the transpsoas route. Although such an approach eliminates many of the known complications associated with traditional fusion, it does not allow for the harvesting of local bone. Therefore, alternative strategies must be employed in order to ensure high rates of successful arthrodesis. One such strategy is to increase the volume of bone graft material (BGM) within the cage, thereby improving the environment for osteogenesis and subsequent fusion. In this study, we tested the hypothesis that the use of a novel bone graft delivery system would lead to significantly higher volumes of intra-cage BGM, compared to traditional cage filling methodology. The senior author performed a LLIF on a cadaveric spine in a traditional manner, which included hand-packing the cages with BGM and then inserting them into prepared disc spaces. A CT scan was performed and all BGM cage volumes were calculated. Next, attempts were made to inject additional quantities of BGM into the in situ cages, via the delivery system. A second CT was performed and new cage volumes of BGM were calculated. Results demonstrated significantly higher cage volumes of BGM after the use of the bone graft delivery system (p = 0.014), compared to those volumes achieved with standard cage packing methodology. This first-of-its-kind study suggests the use of a novel bone graft delivery system will significantly increase cage volumes of BGM which potentially may lead to increase rates of arthrodesis and improved clinical outcomes. Keywords: Lateral lumbar interbody fusion, InFill® V2 Lateral Interbody Fusion Device, Local bone alternatives, Bone graft material volume, Bone graft material, Cadaveric pilot study

Background: Effectiveness and safety of pharmaceuticals is the prime concern of every osteoarthritis (OA) treatment. Chronic administration of NSAIDs, especially in case of geriatrics, through oral route tend to compromise the patient's safety, whereas topical treatments are not found to be effective owing their poor ability to deliver drug molecules.Thus, the present study deals with a randomized, double-blind, controlled trial conducted on patients with knee osteoarthritis (OA) for comparing the performance of a novel topical gel (liposomal gel) of diclofenac with a placebo and a marketed gel. Methods: The patients were treated and evaluated for 6 weeks as per the Western Ontario McMaster Universities (WOMAC) Index for OA. Patients were also observed for any adverse events. All the results were analyzed statistically using Kruskal-Wallis test, followed by Student's t-test at p ≤ 0.05. Results: Patients treated with liposomal gel showed statistically significantly improvements in treatment in comparison to the other tested formulations. All the treatments were found to be well tolerated with no report of adverse event. The results unequivocally demonstrated the superiority of the diclofenac liposomal gel, in the relieving the symptoms of OA of the knee, in comparison to placebo and marketed gel. Conclusion: From above results it was revealed that the drug in liposome have higher therapeutic potential. Thus, this can be a safe and effective option for the management of chronic OA especially for geriatric patients.

Denervation of muscle usually leads to muscle atrophy with fatty replacement but, uncommonly, also results in muscle hypertrophy or pseudohypertrophy with fatty replacement. We report the ultrasonographic and magnetic resonance imaging (MRI) findings of a patient with diffuse fatty infiltration of calf muscles as a result of denervation pseudohypertrophy. The elevated fasting glucose, neurogenic electromyographic changes, and muscle atrophy with adipose tissue infiltration are consistent with diabetic neuropathy as the cause of denervation pseudohypertrophy. Lumbosacral radiculopathy and plexopathy were excluded by MRI. The imaging features reported in the literature are reviewed. The important differential diagnosis of infiltrating lipoma and denervation hypertrophy, as well as other causes of monomelic hypertrophy or swelling, is discussed. This case report demonstrates the importance of MRI, with clinical, biochemical, electrophysiological, and histologic correlation in the diagnosis of denervation pseudohypertrophy. Correct diagnosis of denervation pseudohypertrophy has an important role in guiding further investigations and treatment of the disease and the underlying cause.

Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletal anomaly seen in children. It is a condition in which the affected sternocleidomastoid muscle becomes a fibrosed cord with associated shortening of the muscle. This leads to an ipsilateral side tilt of the neck and contralateral rotation of the face and chin to the other side. Apart from surgery various other treatment modalities are used to treat this condition. We present two siblings of Sudanese nationality with manifestation of Congenital Muscular Torticollis, a male child and female child at the age of 12 and 10 years respectively. Both had CMT of the right sternomastoid muscle. Both were delivered normally. They did not undergo any form of physiotherapy or surgical procedure since birth. Because of this neglected circumstances, the facial asymmetry and deformity were severe. Both the siblings were operated in our hospital with satisfactory result on follow up. Management for CMT starts during the early infancy and physiotherapy is the main treatment for this condition. But some of these CMT children may need surgical intervention to prevent further deterioration of cranial deformity and facial asymmetry. If these children are neglected and present later in life, they will have severe facial deformity with its associated sequelae. These patients are usually managed by other specialities worldwide. But awareness of these conditions is required among paediatric surgeons, as some of these children may be referred to them for treatment. In our case report we have also described various other modalities of treatment for this condition.

A 62-year-old man presented to our department with abdominal pain and diarrhea for 3 weeks on a background of previous branched endovascular repair for a thoracoabdominal aneurysm. A triple-phase computed tomography scan of his abdomen and pelvis showed a large aortocaval fistula caused by a type III endoleak from a dislodged superior mesenteric artery stent. He was successfully treated with a BeGraft (Bentley Innomed, Hechingen, Germany) by using an endovascular technique.

إن عدم تكون الزائدة الدودية منذ الولادة خلقيا أو عدم وجودها هو نادر للغاية. تعرض هذه الحالة مريضا ذكرا عمره ٢٥ عاما ظهرت عليه أعراض وعلامات التهاب الزائدة الدودية الحاد. تعذر العثور على الزائدة الدودية على الرغم من عملية الاستكشاف الجراحي الواسع. ولم تظهر فحوص مابعد الجراحة شيئا غير طبيعي، وتم تشخيص المريض كحالة آلام في البطن غير محددة وعدم تخلق الزائدة الدودية.