RATIONALE: The objective of the study was to describe the outcome in a series of patients with delayed primary closure of gastroschisis using a Preformed Spring-Loaded Silo Bag (PSLS).

METHODS: A prospective data collection and chart review were done all gastroschisis patients from May 2011 to April 2013. Eligible gastroschisis patients were applied with silo bag, gradual reduction of abdominal viscera and elective abdominal wall closure. The post- operative  outcomes  investigated  were:  infection  rate,  days  to immediate fascial closure, post-operative ventilatory period, post-operative  NPO  period  to  successful  enteral  feeding,  days  in  the NICU, days of hospital admission, development of post-operative complications, and mortality rate.

RESULTS: Thirty-four  gastroschisis  patients  were  admitted  from May  2011  to  April  2013,  of  whom  25  patients  qualified  for  the study.  Majority  of  the  patients  were  female,  preterm,  delivered vaginally, weighed <2kg admittted within the first 24hrs of life. 84% had prenatal ultrasound, less 50% were diagnosed correctly. 48% of mothers were less than 20 years old. Fascial closure rate was 88% (delayed abdominal closure done within 10 days). 72% were fed within 10 days after delayed abdominal wall closure. 52% were extubated within 24 hours. Average hospital stay was 35 days. Overall outcome: morbidity rate- 48%; home against medical advice (HAMA)-4%; mortality rate - 12%.

CONCLUSIONS: The use of PSLS bags for the delayed primary closure of gastroschisis appears to be a safe and beneficial.

Human ; Female ; Gastroschisis ; Length Of Stay ; Viscera ; Enteral Nutrition ; Mothers ; Abdominal Wall ; Prospective Studies ; Intensive Care Units, Neonatal ; Elective Surgical Procedures ; Morbidity ; Postoperative Period

RATIONALE: Pineal region tumors are rare neoplasms with a reportedly higher incidence in Asian countries; however, local Philippine data is lacking.
METHODS: A retrospective chart review was conducted on all newly diagnosed adult and pediatric patients with pineal region tumors admitted at the Philippine General Hospital between 2011 and 2015. Data  about  demographic  profile,  biochemical  markers,  imaging findings, histopathology, and treatment were collected.
RESULTS: Forty-two patients (36 males, 6 females; Sex Ratio = 6:1) were included in the study, with a mean age of 16.5 years. On imaging, solitary pineal area tumors were seen in 34 (81%) patients, while 8 (19%)  presented  with  synchronous  tumors  in  the  pineal  and suprasellar areas. Hydrocephalus was present in 41 (98%). Tumor marker (serum +/- CSF ?FP and ?hCG) determination was performed in 33(79%)  patients. Thirty-eight (90%) patients underwent surgical intervention for tumor biopsy and/or CSF diversion. Combining the tumor marker levels and histopathology results, there were 20(48%) germ  cell  tumors,  4(9%)  pineal  parenchymal  tumors,  1(2%) meningioma, 1(2%) epidermoid tumor, and 16(38%) tumors with incomplete  diagnosis.  Regarding  adjuvant  treatment,  5  patients underwent chemotherapy, 6 underwent radiotherapy, and 1 patient received both. Follow-up data were available in only 16 patients, with a mean follow-up of 12 months (range: 1-33 months).
CONCLUSION: The demographic profile and histologic subtypes of patients with pineal region tumors in this series were comparable with other series in the literature. However, due to limited resources leading to suboptimal medical care and poor follow-up, a reliable treatment outcome could not be determined

Human ; Male ; Female ; Adult ; Child ; Pinealoma ; Meningioma ; Hospitals, General ; Sex Ratio ; Pineal Gland ; Meningeal Neoplasms ; Hydrocephalus

The analgesic effect of intraperitoneal bupivacaine has been widely studied, but with controversial results.
OBJECTIVE: To determine the efficacy of intraperitoneal bupivacaine on  producing  postoperative  analgesia  in  patients  who  underwent laparoscopic  cholecystectomy.
METHODS: A systematic literature search on the use of intraperitoneal bupivacaine in reducing postoperative pain was done using Medline and Cochrane. The search yielded 6 randomized controlled trials,involving a total of 440 patients. Mean differences in visual analog pain score at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery were pooled using random effects model.
RESULTS: Overall, there was a significant reduction of pain score in the bupivacaine group with VAS score of -0.55 cm (95% CI, -0.80 to -0.31). Subgroup analysis at 0, 2, 4, 6, 8, and 12 hours post-surgery showed statistically significant mean differences in the VAS score of  -1.59 cm (95% CI, -2.31 to -0.86), -0.60 cm (95% CI, -1.02 to -0.17), -0.80 cm  (95% CI, -1.34 to -0.26),  -0.85 cm  (95% CI, -1.46 to -0.24), -0.64 cm  (95% CI, -1.12 to -0.16), and -0.38 cm  (95% CI,-0.68  to  -0.08),  respectively,  in  favor  of  the  bupivacaine  group.However,  at  24  hours  post-surgery,  there  was  no  statistically significant mean difference in the VAS score of -0.09 cm (95% CI,-0.49 to 0.31).
CONCLUSION: Intraperitoneal bupivacaine instillation among patients undergoing laparoscopic cholecystectomy is effective in providing postoperative analgesia specifically in the first 12 hours post-op.

Human ; Bupivacaine ; Cholecystectomy, Laparoscopic ; Pain, Postoperative ; Cholecystectomy ; Laparoscopy ; Analgesia ; Analgesics

Pancreaticoduodenectomy (Whipple's) procedure is indicated for complex  pancreatic  injuries,  with  immediate  reconstruction  for stable  patients  and  delayed  reconstruction  for  unstable  patients. This study aimed to review the authors' experience with trauma-related  Whipple's  procedure  at  the  East  Avenue  Medical  Center (EAMC).
METHODS: This study reviews cases where Whipple's procedure was performed from 2011 to 2015 at EAMC.  Data collected included age, gender, mechanism of injury, presentation, patient Injury Severity Score (ISS), time interval between injury to presentation, associated injury, surgical procedure, time and type of surgical reconstruction after resection complications and 30-day mortality.
RESULTS: During the 5 year period, 4 patients underwent Whipple's. All patients were male, mean age of 33.25 (range 29-48). Penetrating gunshot trauma was the predominant mechanism of injury (75% of cases) whereas peritonitis was the most common presentation (75% of cases). Mean ISS score is 29.5 (range 25-37).  Among them, 2 underwent  initial  resection  with  delayed  reconstruction  and  the other 2 underwent immediate reconstruction. Pancreaticojejunostomy was done for all pancreatic reconstruction. Cholecystojejunostomy (75%) and Choledochojejunostomy (25%) for biliary enteric conduit. Complications included pancreatic leak (50%), sepsis (25%) and pneumonia  (25%).  Overall,  30-day  mortality  rate  was  25%.Pancreatic leak was noted on all patients without stent placed on the pancreatic anastomosis.
CONCLUSION: Use of stents in pancreatic anastomosis in Whipple's for trauma may lessen the pancreatic leak rates, further studies are needed to prove this.  Cholecystojejunostomy can be an option for biliary enteric continuity, but further studies are needed to identify long tem patency rates.

Human ; Male ; Adult ; Pancreaticojejunostomy ; Pancreaticoduodenectomy ; Choledochostomy ; Pancreas ; Pancreatectomy ; Pancreatic Diseases ; Anastomosis, Surgical ; Peritonitis ; Sepsis

This  is  a  case  of  a  47  year-old  female  presenting  with  typical Cushingoid appearance and CSF rhinorrhea. MRI revealed a 4.4 cm x 2.9 cm x 4.5 cm enhancing intranasal mass with evidence of erosion of the left cribriform extending to the left anterior cranial fossa. Dexamethasone suppression  test  yielded  elevated  cortisol  level. Endoscopic nasal biopsy done showed a round cell tumor positive for  ACTH,  synaptophysin,  chromogranin  A,  and  S-100.  Patient subsequently  underwent  endoscopic  endonasal  excision  of  left intranasal mass with creation of pericranial flap for repair of CSF leak.  This  report  is  presented  to  discuss  a  rare  case  of  ACTH secreting esthesioneurblastoma including its diagnostic challenges and surgical options for repair of anterior cranial fossa defect to address CSF leak particularly by means of a vascularized pericranial flap.

Human ; Female ; Middle Aged ; Cerebrospinal Fluid Rhinorrhea ; Cranial Fossa, Anterior ; Synaptophysin ; Chromogranin A ; Hydrocortisone ; Nose ; Endoscopy ; Surgical Flaps ; Dexamethasone ; Adrenocorticotropic Hormone

This is an unusual case of a 55 year old male with appendicitis caused by the incarceration of the appendix in an area of tissue reaction from a prosthetic mesh used for open inguinal hernia repair which migrated transanatomically from the right inguinal area into the right lower peritoneal cavity. Isolated appendicitis caused by such phenomenon has never been reported in current literature.

Human ; Male ; Middle Aged ; Appendix ; Appendicitis ; Hernia, Inguinal ; Peritoneal Cavity

It is the practice in most health care institutions in our country to have patients for elective surgery evaluated pre-operatively by Internists and Anesthesiologists. Practitioners don’t seem to agree on how this is to be carried out. Each institution has its own protocol and even individual physicians have their own preference, which they have learned either during their training or from experience. Physicians usually request for preoperative tests for patients undergoing elective surgery in order to minimize risk, and to serve as a baseline to detect subsequent changes. Several authors agree to this as the goal of pre-operative evaluation. This is being done to identify risk factors and to screen broadly for undiagnosed disease. Undiagnosed clinical conditions are correlated with the risk of complications during the perioperative period. This then allows the physician to identify patients with increased risk of morbidity and mortality, and to help them design preoperative strategies that can reduce these risks. These tests can be helpful to stratify risk and guide postoperative management; however, most of them are obtained because of protocol rather than medical necessity. Majority of surgeries performed are non-cardiac in nature. Mortality rates for these procedures can be as high as 4% depending on the patient’s risk and type of surgery. Cardiovascular complications account for half of all morbidities and mortalities in the perioperative period for patients undergoing non-cardiac surgery.
Human ; Male ; Female ; Adult ; Elective Surgical Procedures ; Preoperative Care ; Surgeons ; Universities

OBJECTIVE: Nearly 20% of patients with critical limb ischemia will not be suitable for arterial bypass due to distal small vessel occlusion, and venous arterialization of the distal venous bed might be a valuable surgical option. This study demonstrates the in-vivo microcirculatory effects of this type of intervention.

METHODS: Using intravital video microscopy, the authors studied the distal skeletal microcirculatory characteristics following venous arterialization of critical hindlimb ischemia in the rat. 25 Wistar rats underwent proximal ligation of the femoral arteries followed by venous arterialization carried out by anastomosing the saphenous vein to the femoral artery using microsurgery techniques. Microcirculatory hemodynamic conditions of the soleus muscle were observed under normal, ischemic, and arterialized conditions. Fluorescein-labeled red cells were used to measure red cell velocities (Vrbc) at the capillaries, and acridine orange injections used to stain endothelial cell nuclei to measure microcirculatory diameters, and leukocyte nuclei to measure leukocyte adhesion. Laser Doppler Perfusion (LDP) units at the distal limb were measured continuously throughout the procedure.

RESULTS: Proximal femoral arterial ligation resulted in drastic reductions in LDP and Vrbc. Following distal venous arterialization, LDP returned to an average of 41% of baseline. Vrbc returned to near baseline values in 70% of the capillaries. Flow at the capillary and venular system showed frequent reversals and great variations in velocities. Venules and venu-venular anastomoses diameters increased by 50%. There was immediate macromolecular tracer leakage and leukocyte activation was significantly increased in both ischemic and arterialized groups (15 cells vs 156 and 178 cells respectively).

CONCLUSION: Venous arterialization may provide an improvement in microcirculatory velocities but is accompanied by microcirculatory injury and dysfunction in the acute phase. These results suggest that mechanisms besides microcirculatory hemodynamics play a role in the overall picture of clinical effectivity of the procedure

Animal ; Male ; Rats, Wistar ; Saphenous Vein ; Acridine Orange ; Venules ; Ischemia ; Femoral Vein ; Leukocytes ; Hemodynamics ; Muscle, Skeletal ; Hindlimb ; Endothelial Cells

OBJECTIVE: Intimal hyperplasia (IH) remains one of the major obstacles to long term vein graft patency. IL-1B has been demonstrated to be one of the first inflammatory cytokines expressed in the rat vein graft model of IH and may be an important initiator of the sequence of events leading to the development of IH. This study was designed to establish the role of IL-1B by demonstrating the outcome of inhibiting its effects by the use of neutralizing antibodies on the development of IH in this model.

METHODS: Rat epigastric vein to femoral artery interposition grafts were treated with neutralizing antibody to IL-1B suspended in pluronic gel and harvested at the end of one week and two weeks. The amount of intimal hyperplasia was measured at the anastomotic and midgraft regions.

RESULTS: The amount of IH was less at the anastomotic and midgraft regions of the treated grafts at the end of one week (p<0.05), but did not differ significantly with the untreated group at the end of two weeks.

CONCLUSION: Neutralizing antibody to IL-1B delivered locally retarded but did not prevent the occurrence of IH in vein grafts. The initiation of the cascade of events in the development of IH is affected in a major way , but not singularly by IL-1B

Animal ; Male ; Rats ; Hyperplasia ; Antibodies, Neutralizing ; Cytokines ; Poloxamer ; Femoral Artery ; Veins ; Tunica Intima ; Interleukin-1beta ; Transplants

OBJECTIVE: As there is a dearth of information on phyllodes tumors of the breast in the Philippines yet this ultimately impacts on the management and survival of Filipino patients, the authors reviewed their surgical cases of phyllodes tumors, focusing in this report, for the first time in Philippine literature, on the real risk of distant metastasis from the more common benign variety of phyllodes tumors. They therefore aim to identify case/s and do a review of literature on distant metastasis from benign phyllodes tumors.

METHODS: A review of records of all surgical cases of phyllodes tumor managed at PGH from 2005 - 2014 was done. Data from patients who on follow up were found to have distant metastasis were gathered and further reviewed. A literature search on metastatic phyllodes tumor and its implications was likewise done to complete this study.

RESULTS: A total of 200 patients with phyllodes tumor surgically managed within the study period were reviewed and followed up. One hundred sixty one out of 200 (80.5%) patients were histologically classified as benign. Twelve patients out of 200 (6.0%) developed distant metastasis on follow up, 1 (0.62% of 161 benign phyllodes tumors) of whom had benign phyllodes tumor.

CONCLUSIONS: The authors show that distant metastasis from benign phyllodes tumor can occur here in the Philippines. Therefore, the subtype of phyllodes tumor alone, especially in benign lesions, does not absolutely predict biological behavior and risk of recurrence. A better understanding of the true nature of metastasis in these tumors is highly anticipated.

Human ; Male ; Female ; Phyllodes Tumor ; Breast ; Risk ; Neoplasm Recurrence, Local ; Breast Neoplasms