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Meteorological factors affecting aneurysmal subarachnoid hemorrhage in the Philippines

Juan Silvestre G. Pascual ; Kathleen Joy O. Khu ; Edroico Mari B. Brillante ; Johnston T. Te Jr ; Bernard Alan B. Racoma ; Katrina Hannah D. Ignacio ; Gerardo D. Legaspi

Philippine Journal of Surgical Specialties.2025;80(1):1-7. doi:https://doi.org/10.61662/PCS_ctut7766

RATIONALE/OBJECTIVE

Aneurysmal subarachnoid hemorrhage (aSAH) may be associated with meteorologic factors in temperate countries. The authors aimed to investigate the relationship between meteorologic factors and aSAH admissions in the Philippines, a tropical country with two seasons: rainy and dry.

METHODS

A census review of aSAH admissions from 2015 to 2019 at a tertiary hospital was performed. Meteorologic data were collected for the same time period, and statistical analysis was performed.

RESULTS

A total of 660 patients were admitted for aSAH, 275 and 385 during the rainy and dry seasons, respectively. August and October had the greatest number of mean admissions (13.2) while February had the least (6.2). There was a moderate positive correlation between aSAH admissions and mean temperature. Negligible to weak negative correlations were seen between aSAH admissions and humidity, barometric pressure and precipitation. However, there was no correlation on regression analysis.

CONCLUSION

There were no significant differences in aSAH admissions between rainy and dry seasons. The authors found an increase in aSAH admissions during months with higher temperatures and HI, and weak to negligible negative correlations between aSAH admissions and humidity, barometric pressure, and precipitation. These findings may inform health care facilities in terms of readiness for aSAH admissions.

Subarachnoid Hemorrhage ; Aneurysm ; Meteorology ; Weather

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Clinicopathologic profile and outcomes of pediatric patients managed with open and laparoscopic cholecystectomy: A two-center experience

Monica Bianca C. Balictar ; Patrick U. Avellano ; Pia Cerise V. Creencia ; Franco Antonio C. Catangui ; Jose Modesto B. Abellera ; Nino P. Isabedra ; Russel Alegarbes ; Dorothy Anne D. Lopez

Philippine Journal of Surgical Specialties.2025;80(1):8-19. doi:https://doi.org/10.61662/PCS_uzzj2749

OBJECTIVE

This seven-year, two-center retrospective cross-sectional study aimed to describe the demographic, clinical characteristics and surgical indications of patients managed with open or laparoscopic cholecystectomy in the pediatric age group, and determine these variables’ associations with patient outcomes.

METHODS

Records of all patients less than 19 years old who underwent laparoscopic or open cholecystectomy at Jose R. Reyes Memorial Medical Center (JRRMMC) and National Children’s Hospital (NCH) from January 2015 to December 2021 were reviewed. The gathered data were organized, described and analyzed using univariate and multivariate statistics.

RESULTS

A total of 32 patients underwent open or laparoscopic cholecystectomy at the two institutions. Majority were female (78.1%). The diagnoses included chronic calculous cholecystitis (62.5%), acute calculous cholecystitis (21.9%), choledocholithiasis (12.5%). One (3.1%) patient had empyema of the gallbladder. The 15 – 18 year age group made up 78.1%, with the rest (21.9%) from the 10 – 14 year age group. By BMI percentile, 62.5% were normal, 15.6% were overweight, and 12.5% were obese. Most patients across all conditions (96.9%) had no known hemolytic disorder. Underweight patients (9.4% of the cohort) had statistically higher lengths of stay [F(3,28) = 3.444, p = .030]. No significant associations were found between the categorical outcomes (discharged well, morbidity, mortality) and patient variables (age group, sex, BMI percentile, presence of co-morbidities, symptoms, indication for surgery, operation done).

CONCLUSION

In pediatric patients undergoing laparoscopic or open cholecystectomy, BMI percentile is inversely related to the length of hospital stay.

Human ; Cholecystectomy ; Gallbladder Diseases ; Demography

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Familial adenomatosis polyposis associated papillary thyroid carcinoma- cribriform morular variant: A case report

Jennifer A. Winter ; Michelle C. Payagen ; Mathew B. Bawayan

Philippine Journal of Surgical Specialties.2025;80(1):20-23. doi:https://doi.org/10.61662/PCS_gzoy6812

Familial Adenomatous Polyposis (FAP) is a multi-tumoral syndrome that includes neoplasms in the duodenum, brain, pancreas and thyroid. The Cribriform Morular Variant (CMV) is a rare form of Papillary Thyroid Cancer seen in patients with FAP. Presented here is a 32 year old female who initially presented with an anterior neck mass followed years later by a rectal mass. She was diagnosed with FAP and colorectal adenocarcinoma and underwent total proctocolectomy with end ileostomy. She subsequently underwent a total thyroidectomy which revealed CMV Papillary Thyroid Carcinoma (CMV-PTC). Since FAP can have diverse presentations, a high index of suspicion is needed in order to make an earlier diagnosis to reduce potential morbidity and mortality. Papillary thyroid carcinoma can predate colonic polyposis. Identifying CMV-PTC early on can serve as an opportunity diagnose FAP early.

Human ; Female ; Adult: 25-44 Yrs Old ; Familial Adenomatous Polyposis ; Adenomatous Polyposis Coli ; Thyroid Cancer, Papillary ; Papillary Thyroid Carcinoma

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Metastatic axillary lymphadenopathy from a triple-negative occult breast carcinoma in a male patient: A case report

Lara Veronica Louise G. Montano ; Louis Matthew C. Manlongat ; Francisco Y. Arcellana Jr.

Philippine Journal of Surgical Specialties.2025;80(1):24-28. doi:https://doi.org/10.61662/PCS_fjmc5515

Occult Breast Carcinomas (OBCs) are rare. History and physical examination alone may lead to misdiagnosis hence inappropriate investigative and treatment modalities. Diagnosis is difficult without tissue biopsy and extensive immunohistochemical staining. Presented here is a 74-year-old Filipino male with a 2-month history of axillary mass with erythematous skin, initially assessed as hidradenitis suppurativa failing to resolve with antibiotics. An excision biopsy revealed adenocarcinoma within the lymph nodes. Immunohistochemical stains confirmed a breast primary. Radiologic imaging showed no breast lesions and no distant metastasis. Axillary node dissection done showed metastasis to 5 in 14 nodes harvested, classifying him as OBC Stage IIIA (cT0pN2M0). He completed whole breast radiotherapy and chemotherapy. No tumor recurrence was documented thereafter. Although misdiagnosis is common, OBC is a condition to consider in male patients presenting with axillary lymphadenopathy.

Human ; Male ; Aged: 65-79 Yrs Old ; Lymphadenopathy

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Laparoscopic management of Amyand's hernia in an adult male patient: A case report

Maria Elizabeth D. Dela Cruz ; Louis Matthew C. Manlongat ; Victor Philip Delos Reyes

Philippine Journal of Surgical Specialties.2025;80(1):29-33. doi:https://doi.org/10.61662/PCS_igyd4527

Amyand’s hernia is a hernia where the appendix is within the inguinal hernial sac. It is often diagnosed by chance due its indeterminate clinical presentation. This case reports a 50-year-old Filipino male who presented with direct and rebound tenderness on the lower abdomen in the presence of a right inguinal bulge. CT scan showed an appendix coursing inferiorly into the pelvis, herniating through a 2 cm defect of the anterior abdominal muscle into the right inguinal region along with mesenteric fat. Laparoscopy confirmed acute appendicitis within an inguinal hernia (Amyand’s hernia Type 2). Diagnostic laparoscopy, appendectomy and primary repair of the right inguinal ring were performed. The patient had an unremarkable post-operative course and was discharged after 2 days. He was advised to undergo IPOM to prevent hernia recurrence. Laparoscopic management can be a safe option for cases of Amyand’s hernia.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Appendix ; Appendicitis ; Surgical Mesh

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Combined spinal-epidural vs. epidural anesthesia in abdominal surgery

Martires Clifton J. ; Nuevo Florian

Philippine Journal of Surgical Specialties.1999;11(2):6-13.

BACKGROUND: Combined spinal-epidural anesthesia is becoming popular especially in obstetrics and orthopedics, however few studies have been done involving abdominal operations METHODOLOGY: A randomized, blind study was conducted to compare the clinical outcome of combined spinal-epidural anesthesia (CSEA) with epidural anesthesia (EA) in abdominal surgery. CSEA was established using tetracaine 0.5 percent for the spinal component and bupivacaine 0.5 percent for the epidural component, whereas EA was established using bupivacaine 0.5 percent and fentanyl. Sixty patients were enrolled (Group CSEA, n=30; Group EA, n=30) RESULTS: The ease of doing the procedures were similar in both groups. Of the two techniques, CSEA was associated with earlier onset times (p0.05), more intense motor block (100 percent in the CSEA group achieved compete motor block compared to 10 percent in the EA group). Ephedrine use was similar in both groups. Pain scores were similar in both groups. Overall patient satisfactions were higher in the CSEA groups. The incidence of shivering was higher in the EA group (33 percent) compared to CSEA group (17 percent). Pruritus was present only in the EA group (10 percent). Nauses, vomiting, and headache were absent in both groups CONCLUSIONS: CSEA is a useful and safe technique that confers advantages over the EA technique for major abdominal surgery. CSEA has low failure rates, rapidly produces a reliable spinal blockade, provides good operating conditions, and offers high level of patient satisfaction.
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; ANESTHESIA ; ANESTHESIA, EPIDURAL ; ANESTHESIA, SPINAL ; OBSTETRICS, ORTHOPEDICS

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Crystalloid preloading in elective cesarean section under spinal anesthesia

Cruz Ma. Concepcion L. ; Esteban-Habana Ma. Antonia

Philippine Journal of Surgical Specialties.1999;11(2):20-25.

BACKGROUND: The prevention of maternal hypotension by traditional crystalloid preloading prior to spinal anesthesia in obstetric patients undergoing spinal anesthesia has recently been questioned by many. A review of published data with unbiased comparison comparing preloading and no preloading prior to spinal anesthesia was attempted to assess the relative benefits and side-effects in terms of incidence of maternal hypotension, dose of vasopressors given and APGAR scores at one and 5 minutes. METHODS: A medline search of published randomized controlled trials (RCT) from 1966-1997 comparing crystalloid and no crystalloid preloading prior to spinal anesthesia in patients for cesarean section was done. Search for available meta-analysis on preloading, only three met the criteria for analysis. The outcome measures were limited to three due to lack of available data for comparison. RESULTS: Using the Peto Odds Ratio, analysis of the three studies showed no significant difference in the incidence of hypotension between those who were preloaded and those who were not. But a trend towards a lower incidence of hypotension among those who were preloaded was seen. Using the weighted means difference (WMD) to analyze the dose of vasopressors given, there was no significant difference between preloading and no preloading but a trend towards a greater total dose of vasopressors was seen in those not preloaded. There was no significant difference in APGAR scores in the three studies. CONCLUSION: There is no sufficient evidence to support a change in practice to no preloading prior to spinal anesthesia for elective cesarean section based on the results of this meta-analysis. Further studies must be done to increase the validity and precision of results comparing preloading and no preloading.
Human ; Female ; ANESTHESIA, SPINAL ; CESAREAN SECTION ; OBSTETRICS ; HYPOTENSIONS

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A comparison of intubating conditions and duration of activity of cisatracurium and atracurium in Filipinos for surgery at the Philippine General Hospital: A prospective, randomized, double-blind study

Jose Geraldine Raphaela B. ; Evangelista Enrico P. ; Odi Tygran RC ; Tan-Gatue Maria Asuncion ; Villegas Francis L. ; Dela Cruz-Odi Merle F.

Philippine Journal of Surgical Specialties.1999;11(2):26-31.

BACKGROUND: Cisatracurium , an R-cis, R-cis isomer of atracurium, is a benzoquinolinium non-depolarizing muscle relaxant with intermediate duration of action that has the advantage of minimal histamine release compared to the parent compound atracurium. Similar studies have described cisatracurium to have cardiovascular stability up to 7 times the ED95 dose. However, few have been conclusive owing to concomitant use of agents that can cause potential histamine release and hemodynamic effects. This study was specifically designed to minimize these variables. The promise of the clinical advantages of the use of cisatracurium merits investigation against its parent compound atracurium in the Filipino population especially in terms of hemodynamic stability when utilized intraoperatively. The study was conducted to evaluate the onset of action, conditions for intubation, duration of neuromuscular block and side effects of cisatracurium compared to atracurium among Filipino surgical patients METHODOLOGY: A prospective, randomized, double-blind study was performed in eighty one (81) healthy patients of ASA Physical Status 1 and 2 undergoing elective surgical procedures treated with either 0.15 mg/kg cisatracurium (3 x ED 95) n=39 or 0.5 mg/kg atracurium (3 x ED 95) n=42 administered over 5 seconds intravenous bolus under adequate anesthesia, before surgical stimulation. We compared the time course of the neuromuscular block and determined whether the muscle relaxants caused cutaneous and systemic evidence of histamine release. Induction of general anesthesia commenced with the use of propofol-fentanyl in oxygen. Stabilization of the Neuromuscular junction was achieved prior to the administration of the muscle relaxants with the use of tetanic stimulation of 50 Hz; for 5 seconds followed by single twitch stimuli for 2 minutes. Neuromuscular transmission was assessed by recording the mechanical twitch response to train-of-four nerve stimulations every 10 seconds. Cutaneous manifestations, blood pressures and heart rates were recorded periodically. RESULTS: Time to 95 percent block were 77.09-155.99 seconds with cisatracurium. and 64.60 - 128.21 seconds with atracurium. The administration of either muscle relaxant resulted in complete neuromuscular block in all patients providing good to excellent intubating conditions. The time to spontaneous recovery (T4:T1 ratio 80 percent) were noted to be within the range of 63.48 - 103.48 minutes for cisatracurium whereas those treated with atracurium recovered within the range of 74.76 - 92.64 minutes and none necessitated reversal from the muscle relaxants. One patient from the cisatracurium group and two from the atracurium group were noted to have cutaneous flush. CONCLUSION: When given a dose of 3 x ED 95, except for onset, cisatracurium group did not differ significantly from the atracurium group with regard to onset, duration, intubating conditions, and hemodynamic stability.
Human ; Middle Aged ; Adult ; Young Adult ; Adolescent ; INTUBATION ; HEMODYNAMIC ; ANESTHESIA ; CISATRACURIUM ; ATRACURIUM ; HISTAMINE ; MUSCLE RELAXANTS, CENTRAL

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The effect of oral clonidine premedication on the duration of hyperbaric tetracaine spinal anesthesia

Partahusniutojo Pangkuwidjaja

Philippine Journal of Surgical Specialties.1999;11(2):32-39.

BACKGROUND: In anesthesia, clonidine has been proven to be clinically useful in producing sedation, anxiolysis, and decreasing the requirement for both general and regional anesthetics. Studies have shown that oral clonidine is able to prolong the duration of spinal anesthesia when bupivacaine or isobaric tetracaine is used. This study was conducted to determine the effects of oral clonidine premedication on the duration of hyperbaric tetracaine spinal anesthesia. METHODS: Forty-six patients for lower extremity and perineal surgery under hyperbaric tetracaine spinal anesthesia were randomly grouped into two: group I - control and group II - clonidine. The clonidine group received 150 mcg oral clonidine premedication 1 hour prior to the spinal anesthesia. Sensory level was measured using the pinprick method. The onset, maximal sensory block, duration and the hemodynamic variables were determined and compared between the two groups. RESULTS: No significant differences were noted as to onset and the maximal level of sensory blockade. The mean duration of sensory analgesia was significantly prolonged in the clonidine group (298.33 min) as compared to the control group (176.73 min). Hemodynamic variables were significantly decreased in the clonidine group. CONCLUSION: This study demonstrated that 150 mcg oral clonidine given 1 hour prior to tetracaine spinal anesthesia significantly prolonged the duration of the blockade.
Human ; ANESTHESIA, SPINAL ; HEMODYNAMICS ; CLONIDINE ; BUPIVACAINE

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Autologous normovolemic hemodilution: An acceptable alternative blood transfusion technique in a Jehovahs Witness patient for thoracotomy

Ortillo Jojie Marie F.

Philippine Journal of Surgical Specialties.1999;11(2):52-55.

A case of a Jehovah's Witness patient was presented who underwent thoracotomy and decortication of the right lung with great potential for blood loss but refused homologous blood transfusion. Acute Normovolemic Hemodilution is the only autologous transfusion technique that is acceptable to the patient satisfying the objections of a archetypal Jehovah's Witness belief regarding blood transfusion. The wide margin of safety with regards to conservation of red blood cells in ANH was seen in this case thus, providing its efficiency and acceptability.
Human ; Female ; Aged ; TRANSFUSION, BLOOD ; ANESTHESIA ; INTUBATION ; OROTRACHEAL ; THORACOTOMY

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