Wilms tumor is very rare in adults. Even more infrequent is an adult Wilms tumor with an extensioninto the central nervous system.Reported here is a case of an adult Wilms tumor in a 38-year-old female. She was referred to theJRRMMC with a 2 month history of intermittent hematuria associated with a rapidly enlargingabdominal mass and right-sided facial asymmetry. Abdominal computed tomography revealed a largemass inthe rightkidney. CranialMRI showedmultiple brainmetastases. Thepatient underwentrightradicalnephrectomy.Pathologicalanalysisdemonstratednephroblastoma.Thepatientwasdischargedunremarkable and underwent adjuvant chemotherapy. After 2 months, the patient succumbed to thedisease.Adult Wilms tumor presents almost similarly with renal cell carcinoma and there is no definitivediagnostictesttoconfirmitpre-operatively.Eventhoughit’sararetumor,itshouldalwaysbeincludedin the differential diagnosis for any renal tumor.

OBJECTIVE: Specimen retrieval bags were used to remove cysts and masses in minimally invasiveurologic surgeries for more than 3 decades. This study aims to describe the steps in making a home-made specimen retrieval bag named JuRoLap and its safety and resiliency. MATERIALS AND METHODS: The bag’s name was taken from the initials of the institution combined withthe department's short-name (uro) and laparoscopy (Lap). The bag is composed of a non-toxicpolyvinyl chloride (PVC) urine bag custom fitted according to the expected specimen size. The sideswere sealed using an impulse sealer leaving one side open. The bag ways rolled and introducedintracorporeally via the 12mm port. It was opened followed by specimen placement using standardlaparoscopic instruments. Purse-string suture at the one-side opening was tightened and extractedthrough the umbilical port extending the incision as necessary. RESULTS: JuRoLap was used in 33 cases removing various organs such as adrenals, kidney, ureter,bladder and prostate. It was easily prepared, safe, resilient and economical costing approximatelyUSD 0.68. It was essential to routinely check its durability by doing a leak test prior to sterilization.Proper rolling, transparent plastic component of the bag and the use of two laparoscopic graspersprovided ease in bag deployment and specimen entrapment. It was also observed that smaller incisionon extraction site as compared to the specimen size was needed due to the resiliency of the bag.Despite the required learning curve in organ entrapment and extraction, there were no complicationsand specimen leakage noted. CONCLUSION JuRoLap specimen retrieval bag is organ size specific, safe, resilient and low cost specimenretrieval bag innovation.
Laparoscopy

BACKGROUND: A reliable and socially validated definition of recovery in schizophrenia is essential to decrease stigma associated with the illness. This study aimed to define recovery in schizophrenia in the Philippine context, determine its specific elements, and describe methods of assessment in clinical practice. METHODS: We invited a group of purposively selected Filipino psychiatrists to participate in six simultaneous roundtable discussions to gather their opinions and perspectives on recovery in schizophrenia. Transcripts of the discussions were then subjected to framework analysis. RESULTS AND CONCLUSION Most Filipino psychiatrists were of the considered opinion that recovery in schizophrenia is possible, and their vision of a recovered patient resembles a combination of psychological and medical models. The mini-FROGS tool was deemed generally applicable in the Philippine setting except for self-esteem and sense of independence primarily because it is difficult to evaluate. The SWN was received with mixed reactions among the psychiatrists. Spirituality as an element of recovery and the family-oriented culture of the Filipinos were emphasized as important considerations in assessing patients. Other suggestions were given to tailor-fit these tools to the Philippine context.
Schizophrenia ; Philippines

Objective: The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults. Purpose: This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others. Action Statements The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.
Mandibular Fractures ; Jaw Fractures ; Classification ; History ; Diagnosis ; Diagnostic Imaging ; Therapeutics ; Diet Therapy ; Drug Therapy ; Rehabilitation ; General Surgery