Recent Articles

Pneumoperitoneum is mainly caused by viscus perforation, in most cases by ulcer. However, it may be caused by non-surgical causes in 10 % of the cases, such as patients on respiratory support, renal dialysis, paracentesis, and anaerobic bacterial infections. In addition, there are some sporadic causes of pneumoperitoneum; one of them is wisdom tooth extraction, which is described in our case. In the literature review, there were many documented cases of subcutaneous emphysema, pneumothorax, and pneumomediastinum caused by wisdom tooth extraction. However, there was only one case that represented pneumoperitoneum after that procedure. In this case report, We are reporting a case of a 50-year-old male patient who presented one-week status post wisdom tooth extraction, with significant subcutaneous emphysema involving the face, neck, and upper chest; further workup and assessment showed that the patient has considerable pneumoperitoneum, pneumomediastinum, mild pneumothorax bilaterally, and extensive subcutaneous emphysema on computerized tomography. The patient was managed conservatively, with no need for any surgical intervention, and he was discharged home in a good general condition.

Calcium polystyrene sulfonate (CPS), also known as Kalimate, is a cationexchange resin (CER), commonly used to treat hyperkalemia. A case of a patient with chronic kidney disease (CKD) who underwent right hemicolectomy for colonic perforation due to intestinal necrosis secondary to oral CPS administration is presented. The histopathological findings confirmed the colonic ischemia and perforation and showed a luminal deposition of crystals with a fish scale pattern, compatible with CER (Kalimate). This report aims to present and discuss this unusual case considering the most updated scientific evidence.

Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia is associated with high morbidity and mortality. Early identification of a source of infection is critical for appropriate management. MRSA infection can affect any organ system, however infection of the biliary tract is a rare phenomenon. We report on a 67-year-old male who presented with atypical cholecystitis, intra-hepatic collections and MRSA bacteraemia. The patient was managed on a long course of antibiotics following cholecystectomy and surgical drainage of the collections. Our case highlights the importance of considering biliary sepsis as a potential source for MRSA bacteraemia, in order to expedite source control and prevent intra-hepatic abscess formation.

Introduction: Intrahepatic cholangiocarcinoma (ICC) is rare and often diagnosed in an advanced stage. Neoadjuvant therapy is not established and data on its value are in palliative intention. In the case of a recurrence patients often are offered systemic chemotherapy as the only treatment option. We report on a patient with advanced intrahepatic cholangiocarcinoma who underwent multimodal treatment leading to a long-term survival. Case report: A 61-year-old woman presented with an advanced intrahepatic cholangiocarcinoma of the right liver lobe without evidence of metastatic spread. She had already completed two cycles of chemotherapy of Cisplatin and Gemcitabine resulting in stable disease. An extended hemihepatectomy of the right lobe including segments I, IVa and partially IVb was performed. The TNM status (8th edition) was pT2b (3), pN0 (0/6), M0, V1, G2 and R0. Ten months later recurrence was diagnosed and treated with microwave ablation. Recurrence occurred again and the patient underwent repeated resection 22 months after primary resection. After detection of repeated recurrence once more, repeated resection was performed 46 months after initial resection. The patient is still alive and tumor-free 7 years after primary resection. Conclusion: Multimodal treatment including preoperative chemotherapy, complete resection and repeated resection of recurrence as well as microwave ablation led to long-term survival in a case of advanced intrahepatic cholangiocarcinoma. Close follow-ups were crucial to offer the best treatment options.

Background: There is great impact of implementing evidence based screening programs on improving public health outcomes. When applied properly it will lead to prevent disease, reduce disability and cut mortality. 1st step in conducting such programs is awareness about current situation regarding knowledge and willingness of the targeted population for such programs. Objectives: To estimate level of knowledge about breast cancer, colorectal cancer and osteoporosis and assess willingness to participate in screening programs among resident of king Fahad airbase in Taif city. Methods: This is a cross-sectional study that was conducted among King Fahad Air base residents using an online survey to investigate the awareness of the residents of air base about the detection of some diseases. The study included all age groups and both genders, the study continued for 2 weeks. The survey investigated demographics of participants, their awareness about breast cancer, colon and rectum cancers, and osteoporosis regarding the prevalence, family history, and other questions associated with level of knowledge of such diseases. Results: The present study included 121 participants; most dominant age group represented 41.32% with an age range of 35-44 years old. Females were more dominant than males with 65.29%. Regarding family history, there were 6.61%, 5.83%, and 42.15% reported having a family history of breast cancer, colon and rectum cancers, and osteoporosis. Regarding the prevalence of breast cancer, there were 59.17% moderate in prevalence. Regarding colon and rectum cancers, there were 58.68% moderate in prevalence. There were 70.83% reported that osteoporosis is prevalent. Regarding the appropriate age for early detection of the diseases, there were 38.02% reported 30 years and more for the detection of breast cancer, 52.07%, 42.15% when symptoms appear regarding colorectal cancers and osteoporosis respectively. Regarding the symptoms related to colon and rectum cancers, there were 44.63% reported abdominal pain, 49.59% reported…

Proceeding to hospital immediately stroke occurs is important for early intervention that would minimize the consequences of stroke. But most stroke patients in developing countries prefer herbal centers than hospital. Reasons for this attitude have not been established. Two well-trained assistants were used to interview 117 stroke survivors who attended Bebe Herbal Center (BHC), in Nigeria for at least two visits. The survivors self-reported their experiences in hospitals visited and at BHC. Data obtained were analyzed using Independent t-test, Pearson’s chi-squared test, on SPSS package version 23. Significant value was set at p

Collision tumors are a rare group of tumoral pathologies characterized by their composition, which is based by the presence of two or more tumor types affecting the same anatomical site and separated by distinct tumor borders. These tumors may be a combination of either malignant or benign tumors [1]. Collision tumors are classified as independently coexisting neoplasms which have different genetic, behavioral, and histological features separated by a distinct demarcated border but coexist within the same organ [2]. These tumors tend to have distant immunohistochemical and morphological differences which aid in diagnosis, but can lead to confounding imaging findings, which in times, make diagnosis more challenging. According to literature this tumor tends to grow simultaneously or following each other in sequence of less than 2 months apart [3]. Accurate classification and diagnosis of these tumors is important for proper treatment options, as well as better patient outcomes. Here will be discussed a case of a rare form of collision tumor, compose of a primary lung adenocarcinoma with a mucosa-associated lymphoid tissue (MALT) lymphoma.

Introduction: The use of cardiac implantable electronic devices (CIED) is increasing, and implanted patients require more often interventional procedures such as external defibrillation (ED) and electrical cardioversion (ECV). The creation of periprocedural care algorithms for patients with CIED is complex: the different programming capabilities of currently manufactured devices, confusion regarding the differences between pacemakers (PM) and implanted cardiac defibrillator (ICD), the use of old devices in some patients and lastly the continuous evolution in CIED technology with the introduction of leadless PM and subcutaneous implanted cardioverter defibrillators (S-ICD). Procedural advisories have been developed by professional societies, but the recommendations of these societies differ regarding to ED and ECV use. Methods: We performed a systematic database search of studies published between January 2000 and October 2021 assessing ED and ECV by the selection process (PRISMA) and identified 5 prospective eligible articles. Two meta-analyses assessed the proportion of patients with complications and the proportion of patients with no clinicallly relevant parameter modifications, respectively. Results: The final population for the meta-analysis included 2077 patients. The meta-analysis showed a weighted random pooled effect size of 0.55% (95% CI = 0.04% − 1.06 %) for complications, and of 22.4% (95% CI = 2.03% – 42.7%) for no clinically relevant modification parameters. Conclusions: Our review indicates that few dysfunctions are detectable in patients with chest implanted CIED treated with ECV or ED. When an impanted patient undergoes ECV or ED procedures, caution is needed including CIED interrogation before and after the procedure.

Introduction: Tibial plateau fractures form a wide spectrum of injuries accounting for 1.2% of all fractures and a prevalence of 10 cases per 100,000 inhabitants. Methodology: A prospective consecutive multicentre study from May 2018 to May 2021 was carried out in Yaounde. All consenting cases of tibial plateau fracture underwent surgical treatment while patients with pathologic fractures, previous knee osteoarthritis, medically unfit for surgery, and discharging against medical advice were excluded. Data was analysed with SPSS 26.0 and the level of significance set at p

The Kocher-Langenbeck (K-L) approach is the ‘workhorse’ of surgery for acetabular fractures needing posterior fixation. It is indicated for most of these fractures for proper surgical technique and optimal outcome. We therefore evaluated the outcome of surgically treated acetabular fractures through the K-L approach in our setting with limited resources. 57 patients were operated by the K-L approach during the 3-year study period. The most common indications of this approach were: posterior wall (38.6%) and transverse + posterior wall fractures (36.8%). Based on Matta’s criteria of fracture reduction, 81 % were judged anatomic, 16% imperfect and 3 % poor. A surgery waiting time of 8 to 14 days after injury, significantly favoured anatomic fracture reduction. The MAP score was excellent in 72 % and unacceptable in 10.6 %. Factors associated with poor outcomes were poor fracture reduction and the development of early post-operative complications. Iatrogenic sciatic nerve palsy (ISNP) was the most significant post-operative complication (19.3%). The levering of Hohmann retractors in the sciatic notches was the major risk factor for developing ISNP, compared to the use of sciatic nerve retractors. Other early and late complications included surgical site infections (12.3%) and heterotopic ossification (8.8 %), respectively. The overall outcome following surgery by the K-L approach is satisfactory. However, there is need to ameliorate the technique, especially at the level of instrumentation, to limit post-operative complications.