Using Polidocanol in Treatment of Simple Renal Cyst Abstract The aim of this study was to assess the efficacy of polidocanol in patients with simple renal cysts who were not eligible for surgery due to comorbidities. Twenty-nine patients with Bosniak type 1 or 2 were assessed retrospectively. All of the cysts were exophytic. All of the patients were injected a maximum 20 mL 3% polidocanol as a sclerosing agent following cyst aspiration. Vanishing of symptoms and decrease in size to 10% of the initial size were accepted as complete remission, decrease in size to 10–50% of the initial size was accepted as partial remission, and a return to the initial size of the cyst in a short time or decrease in size > 50% of the initial size was accepted as failure. The results of an average of 14 months’ follow-up are reported. Complete remission was seen in 18 (62%) patients, partial remission was seen in 5 (17.2%) patients, and failure was observed in 6 (20.68%) patients during an average of 14 months’ follow-up. Percutaneous sclerotherapy using polidocanol can be used safely and with low complication rates in the elderly population with comorbidities.

Total Colon “Collapse” in Giant Left-Sided Inguino-Scrotal Hernia: Double-Mesh Plastic Repair Abstract Giant inguino-scrotal hernias are those that extend below the midpoint of the inner thigh when the patient is in the standing position. There are three specific problems with management of these giant inguinal hernias: the “loss of domain” of the bowel, the high risk for recurrence, and the residual exuberant scrotal skin. A fundamental part in the treatment of patients with large hernias is represented by a careful preoperative investigation using MR and, if necessary, CT scan to exclude neoplastic pathology in the context. In this article, we describe the case of an obese patient suffering from Von Recklinghausen syndrome carrying a giant left inguino-scrotal hernia. A wide left inguinotomy partially extended to the scrotum was performed. In the hernia sac, the colon was completely collapsed and floating as it was entirely free from any intra-abdominal anatomic anchoring points. After a radical needful omentectomy, the trasversalis fascia and the internal inguinal ring were reconstructed with a polypropylene mesh placed in the pre-peritoneal-retro muscular space. A second wider polypropylene mesh was positioned above the muscular abdominal plane fixed to the pubic tubercle.

Useful Reconstruction Technique for Fingertip Necrosis Using Modified Louvre Flap: a Case Report Abstract Soft tissue reconstruction surgery for fingertip injuries is challenging, especially in cases with defects in multiple digits, presenting with serious complications. We present a case of circumflex defect due to necrosis in all fingertips that underwent reconstruction surgery by the modified Louvre flap without amputation. A 28-year-old woman, who underwent splenectomy 5 years previously for acquired idiopathic thrombocytopenic purpura and was under vaccination, developed distal fingertip skin and soft tissue defects with necrosis in the peripheral areas of all fingertips, owing to medications used to correct shock while in the ICU. Reconstruction was performed using the modified louvre flap technique. Flaps were designed sequentially for each of the fingers from the fifth finger to the thumb, according to the size and length of the digit. The patient received careful postoperative care involving wound dressings and prophylactic intravenous antibiotics, as well as a vasodilator and an anticoagulant for circulation and vascular augmentation, respectively. There were no signs of complications, such as infection or inflammation. Fingertip reconstruction was successful on all 5 fingers. We were able to successfully reconstruct the fingertip defects in all the circumflexed distal digits using the modified louvre flap technique customized to fit each finger.

Unusual Giant Penile Urethral Calculus Abstract Impacted penile urethral stone is a rare condition. These can form as a result of urethral strictures, meatal stenosis, urethral diverticulum, and migration of stones in the urinary tract. We report the case of an unusually giant penile urethral stone in a 56-year-old gentleman. The patient underwent urethrolithotomy surgery, and a large stone was removed. Stones in the lower urinary passage bladder and urethra can assume giant size without many symptoms. An unusually large penile urethral stone that must have been there for several years with not much symptoms is reported.

A Prospective Study on Return of Protective Tactile Sensations in Split-Thickness Skin Grafts Abstract In the long evolution of world surgery, split-thickness skin grafting has distinguished itself as an age-old clinical tool utilised for soft tissue coverage. However, the scanty endorsement of return of protective tactile sensations in these split-thickness skin grafts seems mired between therapeutic subservience and clinical necessity. The objective of this study was to evaluate recovery of tactile protective sensations in split-thickness skin grafts. A total of 100 patients were recruited for the study. Prospective analysis of demographics, pre- and post-operative variables was done to evaluate the return of tactile sensations by two-point discrimination and cotton touch. Males represented 69% of the patients with a mean age of 49.04 (± 16.34) years. Early recovery of two-point discrimination at the periphery of the split-thickness skin graft was observed in 1 week in 23.9% and cotton touch in 61.4% of patients. Over a follow-up period of 1 year, 60% patients had recovery of two-point discrimination and 92.8% for cotton touch. The return of sensation at the centre of the graft was delayed and at 1-year follow-up, 67% developed tactile sensations. The rate of change of two-point discrimination with respect to time was significant (F = 5.74, P = 0.018). Delayed recovery of sensations was observed in patients who developed graft bed oedema or had a scarred graft bed. The encouraging early return of tactile sensation furnishes the split-thickness skin graft with a protective capability against shear, often offered as a reason for graft loss in contemporary wisdom. The findings of a delayed return in a scarred and oedematous graft bed can be expressed as clinical underpinnings and these observations should expand the myriad uses a split thickness skin graft can be put to in soft tissue coverage.

Surgical Management of Breast Cancer in Turkey: a 30-Year Single-Center Retrospective Study of 2531 Patients Abstract Mastectomy and lumpectomy are well-established surgical methods for the surgical treatment of breast cancer. The comparison of these methods within the 30-year period in terms of clinicopathological characteristics, recurrence, and survival patterns is required in order to provide aid in clinical decision-making. A total of 2531 women who underwent mastectomy or lumpectomy between 1982 and 2012 for primary invasive breast tumors were compared. Starting from 2003, similar variables for patients with primary invasive breast tumors who underwent sentinel node biopsy (SNB) were presented. Mastectomy was performed in 1870 patients and lumpectomy in 661. The median follow-up was 38 months for all patients. The ratio of mastectomy was lower for the patients who underwent SNB. There was no significant difference in breast cancer-related survival or disease-free survival between lumpectomy and mastectomy even after adjusting for the clinicopathological variables. Lumpectomy and mastectomy demonstrate similar survival rates for patients with invasive breast carcinoma. Tumor grade, stage, hormone receptor status, lymphovascular invasion, and distant recurrence have an impact on breast cancer-related survival.

Anorectal Function Recovery Curve of the Patients with Different Tumor Locations After Sphincter-Saving Resection for Low Rectal Cancer Abstract The detailed process of anorectal function recovery of the patients after sphincter-saving resection is unclear. We aimed to achieve detailed anorectal function recovery data of the patients after sphincter-saving resection and explore the relationship between the two frequently used anorectal function evaluation methods. A total of 72 eligible cases who underwent the sphincter-saving resection were divided into 3 groups according to the distal tumor margin distance from the anal verge. “L” replaced the distance; group 1: L ≤ 4 cm, group 2: 4 cm < L ≤ 6 cm, group 3: below the peritoneal reflection L > 6 cm. The anorectal function recovery outcomes of the 3 groups before and after the operation were compared. According to Wexner scores, the patients could achieve a satisfactory anorectal function at 3 months after surgery in group 2 and group 3. The patients required 4–5 months after surgery to achieve a satisfactory anorectal function in group 1. According to the ARM, in group 1 to group 3, the time at which the patients’ ARP and MSP after surgery started to show no significant decreases (p > 0.05) compared with preoperative levels were 12 months, 6 months, and 3 months after surgery, respectively. By combining the two methods, although the patients’ ARM indexes did not reach preoperative level (p < 0.05) at 6 months, 9 months, and 3 months in group 1 and group 2, respectively, their Wexner score showed a satisfactory anorectal condition. To all patients, when their ARP and MSP were basically returned to preoperative levels (p > 0.05), their average Wexner score was ≤ 4 or so. According to different rectal tumor locations, we had drawn the different anorectal function recovery curves with time, which could provide a reference for many treatments, such as the time of ileostomy closure. And we found the two anorectal function evaluation methods were not completely identical.

Comparative Study of Postoperative Complications after Rubber Band Ligation (RBL) and RBL Combined with Sclerotherapy in Treatment of Second- and Third-Degree Internal Hemorrhoids Abstract Hemorrhoid is a very common disease in surgical departments. Internal hemorrhoids of second degree or above often require surgical treatment due to the persistent bleeding and prolapse symptoms. Rubber band ligation (RBL) is the most common procedure available for hemorrhoids because of its safety, efficacy, and effectiveness. The study evaluates comparative results of postoperative complications after RBL and RBL combined with sclerotherapy. It included 300 patients having second- or third-degree internal hemorrhoids who attended the colorectal surgical department in Beilun People’s Hospital of Ningbo, China, over a period of 1 year from July 2015 to June 2016. These 300 patients were selected randomly and divided into two groups, with 150 for RBL group and 150 for RBL combined with sclerotherapy group. All the patients were asked to return to an out-patient clinic for follow-up at 1 day, 3 days, 7 days, 14 days, 2 months, and 6 months and through a telephone call every 6 months for 2 years. The data of all the patients including gender, age, postoperative pain, postoperative bleeding, the days of rubber band slippage, and postoperative recurrence were recorded. The statistical analysis of the study was done using SPSS statistical package in which we used descriptive statistics and chi-square test for the final evaluation. There was no significant difference between the two groups in postoperative pain. However, RBL combined with sclerotherapy achieves better results than RBL, less postoperative bleeding, less unexpected rubber band slippage, and less postoperative recurrence.

Curative Efficacy of Fosfomycin Tromethamine Versus Ciprofloxacin in the Initial Therapy of Uncomplicated UTI—a Prospective Open-Label Randomised Controlled Clinical Study Abstract The precise current role of fosfomycin in the management of uncomplicated UTI (uUTI) is not well defined in the published English literature (PubMed(™)). We aim to compare the overall curative efficacy, safety, and outcome of fosfomycin tromethamine vis-a-vis Ciprofloxacin therapy in the initial management of uncomplicated UTI in a select group of patients. After obtaining prior institutional ethical clearance and written informed consent, 120 consenting patients with uUTI were selected as per protocol (based on symptoms of uUTI, positive urine culture sensitivity (c/s), urine routine/microscopy (r/m) or positive urine leukocyte esterase dipstick (LED) test) and enrolled in this study. They were randomized by computer draw of lots, into two groups of 60 each, randomised to receive initial empirical therapy with either fosfomycin (F-intervention arm) or Ciprofloxacin (C-comparator arm), pending the urine culture report. Patients were followed up with urine culture analysis and other parameters. The primary outcome measures were clinical/bacteriological response/resolution of UTI documented by negative urine culture (sent on day 3), absence of pyuria, and negative urine LED on 3rd day. Urine c/s was sent at day 0, but treatment was started (based on randomization) for those with urine r/m positive and positive LED test, pending the result of c/s. If the urine c/s turned out to be negative, the patient was excluded from the study. For the patients who satisfied the inclusion criteria, urine c/s was again sent on day 3, based on which report, bacteriological cure was defined. Secondary outcomes included bacteriological spectrum, antimicrobial sensitivity pattern, incidence of UTI caused by extended spectrum beta-lactamase (ESBL) producing strains of Escherichia coli, possible risk factors for UTI, side effects, ADRs, and ADEs of the drugs. E. coli and Klebsiella were the commonest cause of UTI while ESBL uropathogens were detected in 14/120 (11.67% 11 and 3 in F/C groups, respectively) patients. The sensitivity of uropathogens to F and C was 86 and 50% respectively while the overall clinical curative efficacy (CCE) of same was 83 and 43% respectively. In the subset of 14 patients with UTI due to ESBL, the CCE of F and C was 91 and 67% respectively. Side effects (minor and self-limiting) were significantly more common with the F group (p < 0.001), with diarrhoea being the commonest. Hospitalization was the commonest risk factor for UTI (27%) though the association of risk factors with UTI was not significantly different (p = 0.609). Fosfomycin was safe and significantly more efficacious in treating uncomplicated UTI (p < 0.001) versus ciprofloxacin. The overall incidence of UTI due to ESBL strains was 12% in which the CCE of fosfomycin was significantly higher (p = 0.023).

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