RATIONALE/OBJECTIVE

This study aimed to determine the knowledge, attitudes and practices of surgeons and surgical trainees regarding published SSI prevention guidelines. Specifically, the study described knowledge and attitudes towards SSI prevention guidelines among members of surgical training programs, described preoperative, intraoperative, and postoperative practices in SSI prevention and identified the presence of surgical site infection surveillance programs among various institutions.

METHODS

This was a retrospective cross-sectional study that evaluated the knowledge, attitudes, and practices of surgeons and surgical trainees to published SSI prevention guidelines in the Philippines. It utilized existing data from an October 2022 online survey done by the Philippine College of Surgeons distributed to various surgical training institutions in the country.

RESULTS

There were a total of 213 respondents. The different attitudes and knowledge gaps towards present SSI prevention guidelines are described.

CONCLUSION

Despite the existence of local and international guidelines there still appears to be a significant lack of awareness and variability in practice among the different institutions as well as with surgeons of different levels of expertise or training. Varying preoperative, intraoperative and postoperative practices have also been described, including evident deviations from SSI guidelines. Lastly, there is a lack of standardized SSI surveillance programs among institutions and these are not aligned towards improved patient safety and quality improvement.

Human ; Surgical Wound Infection

OBJECTIVE

This study aims to determine the clinical outcome of patients diagnosed with aneurysmal subarachnoid hemorrhage and their association with grading scores.

METHODS

The authors conducted a single-center cross- sectional study involving patients diagnosed with aneurysmal subarachnoid hemorrhage admitted at Vicente Sotto Memorial Medical Center, Cebu City, Philippines from January 2015 to December 2020.

RESULTS

Out of 240 patients diagnosed with ruptured aneurysms, 215 underwent definitive treatment. The average age was 56 years old, predominantly female with a ratio of 2:1. Most patients were classified with admitting Hunt and Hess grading scale of 2-3 and Fisher grading scale of 3. Females had increased incidence of multiple aneurysms (ratio 3:1) compared to male sex. Among patients, 197 underwent clipping while 18 underwent coiling. Clinical Outcome revealed that 84% had good outcome while 16% had poor outcome. The association between Hunt and Hess grading scale and patient outcome was statistically significant (p < 0.001) as well as for Fisher grading scale and patient outcome (p < 0.001). Fisher grading scale and incidence of clinical vasospasm were also significant (p =0.004).

CONCLUSION

Higher scores for Hunt and Hess grading scale and Fisher grading scale were associated with poor outcome. Higher Fisher grading scale was associated with the occurrence of clinical vasospasm among patients with ruptured aneurysm. Female sex also had higher aneurysm incidence with complex and more multiple aneurysms as compared to male sex.

Subarachnoid Hemorrhage

RATIONALE/OBJECTIVE

Hepatic Resection (HR) has emerged as a potentially curative treatment for HCC, particularly in Barcelona Clinic Liver Cancer – B (BCLC-B) patients, even though Transarterial Chemoembolization (TACE) is the standard of care according to the BCLC staging system. This study aimed to investigate the characteristics, survival rates and outcomes of patients who underwent HR for HCC BCLC-B at a single center over a 10-year period.

METHODS

Patients who were diagnosed HCC BCLC-B and had undergone HR from January 2011 to December 2021 were analyzed. Only complete records with long-term follow-up were included in the study. The authors described patient characteristics, calculated overall survival rates, and assessed associations between patient, disease factors, and survival.

RESULTS

Of 344 patients who underwent HR, 20 of them had complete records with long-term follow-up. This cohort had a median age of 57, predominantly male (70%), exhibiting a median alpha-fetoprotein (AFP) level of 230.5 ng/mL and an average of 4 nodules. Lymphovascular invasion was evident in 65%, with 85% displaying negative primary tumor margins. Major hepatectomy was the primary procedure (50%), followed by bisegmentectomy (40%) and trisegmentectomy (10%). The 1, 2 and 3-year survival rates post-hepatic resection (HR) for HCC BCLC-B stood at 65%, 35% and 25% respectively.

CONCLUSION

The study shows that the institution’s treatment approach for BCLC-B HCC patients achieved acceptable 3-year survival rates, and the median overall survival rate observed are comparable with global data. This study highlights hepatic resection as a potential curative option for BCLC-B HCC patients.

Human ; Carcinoma, Hepatocellular ; Survival Rate ; Hepatectomy

Multiple intracranial aneurysms are not uncommon in patients with cerebral aneurysms, however, studies relating to its natural history, symptomatology and management have not been extensively explored especially in the local setting. The case presented is that of a 42-year-old hypertensive female with a three-day history of sudden severe throbbing headache. The patient had three intracranial saccular aneurysms, two on the middle cerebral artery and one on the anterior cerebral artery. The three intracranial aneurysms were clipped through a right pterional approach in one operative procedure. The surgical and postoperative courses were unremarkable. The patient recovered well with no neurologic deficits and was subsequently discharged after three weeks. Single-stage clipping can be performed in the presence of multiple intracranial aneurysms.

Human ; Female ; Adult: 25-44 Yrs Old

Rectal tumor height has been observed to increase after complete mobilization.
OBJECTIVES: 1.) to measure tumor height in resectable rectal cancers before and after complete mobilization, 2.) to describe changes in tumor height measurements at different levels of the rectum, and 3.) to determine the probability of a two centimeter increase in tumor height after mobilization in low rectal cancers.
METHODS: Prospective cross-sectional series including all resectable rectal cancer treated at our hospital from January to December, 2003. Proctoscopy measurements of rectal tumor height after induction of anesthesia were compared to measurements done after complete rectal mobilization. Logistic curve fitting was used to calculate the probability of a two centimeter increase in tumor height for low rectal cancers after complete mobilization.
RESULTS: In the 12-month period, 37 patients with adenocarcinoma of the rectum were seen. Ages of patients ranged from 26 to 86, with mean age of 57.8 years. Thirty-three patients had resectable rectal cancer. Tumor height ranged from zero to 11 cm, with mean height of 5.7 cm. After complete mobilization, tumor height increased in 50 percent of upper rectal cancers, 92 percent of mid-rectal cancers, and 32 percent of low rectal cancers. Logistic curve fitting showed probability of a two-centimeter increase in tumor height was 52 percent at seven centimeters, 40 percent at six centimeters, 28 percent at five centimeters, and 19 percent at four centimeters.
DISCUSSION: The decision to perform APR for low rectal cancers must not be based solely in pre-operative tumor height measurements since pre-operative measurements of rectal tumor height can increase when the rectum is completely mobilized.

Human ; Proctoscopy ; Rectumrectal Neoplasms ; Adenocarcinoma ; Anesthesiology ; Anesthesia ; Probability

The American Joint Committee on Cancer presently recommends obtaining at least seven to 14 lymph nodes in radical colon and rectum resections.
OBJECTIVES: 1.) To determine the number of lymph nodes recovered in our rectal cancer resection specimens, and 2.) to compare the number of our lymph node harvest with current international recommendations.
METHODS: Records of patients who underwent resection for adenocarcinoma of the rectum from 2001 to 2002 were reviewed. From the final pathology report, the number of lymph nodes recovered per specimen was described. This was correlated with the depth of tumor penetration (T) and the intra-operative staging of nodal status (N) by the surgeon.
RESULTS: Forty-seven patients underwent resection for adenocarcinoma of the rectum. Ages of patients ranged from 21 to 74 years, with a mean of 52 years. The lymph nodes recovered from the specimens ranged from zero to 15, with an average of 3.1 nodes per specimen. T4 tumors had the highest average rate of lymph node recovery at four nodes per specimen. In 16 patients, metastasis to regional lymph nodes were identified (16/47 or 34 percent node positive). The range of nodes recovered in node positive patients ranged from one to 15, with an average of six nodes. Thirty-one patients were node negative (31/47 or 66 percent). The average nodes recovered per specimen in this group was 1.8, ranging from zero to 12.
SUMMARY: From our review, almost 90 percent of our reports did not meet the minimum standard of recovering at least seven lymph nodes in rectal cancer resection specimens. In 94 percent of node negative patients, no sound therapeutic plans could be made due to inadequate lymph node harvest.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Rectum ; Lymph Nodes ; Rectal Neoplasms ; Adenocarcinoma ; Colon ; Lymph Node Excision ; Surgeons

BACKGROUND: In the Philippines, mammography is frequently requested in the evaluation of patients with breast cancer concern.
OBJECTIVES: The general objective was to take a look at the practice of requesting for a mammography in a health care institution and its outcome in terms of cancer detection in patients with non- palpable breast masses.
METHODS: A retrospective review of past records from 1994 to 2001 was accomplished.
RESULTS: A total of 7,323 mammog-raphies. 192 (3 percent) were done in the 20-29 age group; 966 (13 percent) in 30-39 age group; 2708 (37 percent) in 40-49 age group, 2410 (33 percent) in 50-59 age group and the remaining 1047 (14 percent) in those older than 60 years old. The top three physicians requesting for mammography were obstetrician-gynecologists, 2337 (32 percent); general surgeons, 1348 (18 percent) and internists and family medicine specialists, 806 (10 percent). Normal findings were reported in 4449 (61 percent); benign in 2721 (37 percent), suspicious for cancer without a clinically palpable mass in 99 (1.35 percent) and suspicious for cancer with a palpable breast mass in 52 patients (0.74 percent). A total of 50 patients underwent needle localization biopsy of which 35 had fibrocystic changes (70 percent), 10 had cancer (20 percent) and 5 with indefinite results.
CONCLUSION: The overall cancer detection yield for mammography in those without a palpable breast mass, 7271 (7323-52) persons, was extrapolated to be 0.28 percent (20/7271). The authors deemed the information obtained in this study would be useful to the public, health care administrators and health care providers in reviewing the indication and cost-effectiveness of mammography.

Human ; Male ; Female ; Middle Aged ; Adult ; Family Practice ; Public Health ; Specialization ; Mammography ; Breast ; Breast Neoplasms ; Surgeons ; Biopsy

INTRODUCTION: Palpable breast tissue is so prevalent in studies of men and boys that some authors suggest differentiating it from clinically important gynecomastia. Understanding male breast problems present a great challenge to many physicians especially when there is no specific guidelines developed for men.

OBJECTIVES: This study aims to determine the demographic and clinical profile of male patients with breast problems consulting at Vicente Sotto Memorial Medical Center.

METHODOLOGY: This study is a review of 77 male patients seen at the breast center of Vicente Sotto Memorial Medical Center from April 1, 2001 to March 31, 2004. The clinical profile included the age, geographic origin, chief complaint, family history of breast cancer, clinical breast examination findings, attributes of the clinically palpable breast mass like number, size, consistency, laterality, location, associated breast pain and pain score, clinical diagnosis and final histopathologic report.

RESULTS: Within this time period, there were 2,669 consultations seen at the breast clinic. A total of 77 male patients, comprising 2.9 percent were seen at the clinic. The mean age of occurrence was 36.2 years old. The frequency distribution of breast problem is highest between the ages of 20 to 29 years old at 40.3 percent. In all of the 69 patients (89.61 percent) with clinically palpable mass, 66 patients (95.65 percent) only had a solitary mass while 3 patients (4.35 percent) had two masses. Forty-three (59.7 percent) of the masses were less than 2 centimeters in diameter. Only 1 (1.4 percent) of the 72 masses was fixed to the chest wall which turned out to be a soft tissue sarcoma while the rest (98.6 percent) were freely movable. Based on the final histopathologic results, gynecomastia was the most common diagnosis among patients subjected to fine needle aspiration biopsy and excisional biopsy.

CONCLUSION: Male breast problems are common in the third decade of life and among patients living the urban area like Metro Cebu. Male patients sought consultation due to problems of unilateral firm breast mass less than 2 centimeters in diameter located in the nipple-areola complex. The most common clinical diagnosis is that of gynecomastia which is supported by the final histopathologic result of the same condition.

Human ; Male ; Mastodynia ; Nipples ; Gynecomastia ; Thoracic Wall ; Breast Diseases ; Breast Neoplasms ; Sarcoma

This is a case of a Filipino patient with necrotic soft tissue sarcoma (fibrosarcoma) on the thigh that developed tetanus. This case report intends to instill awareness that tetanus can occur in tumors and not just in traumatic wounds. Literature search was made obtaining no local reports and foreign literature showed that though uncommon, tetanus could occur in tumors, especially in those that developed necrosis. Recommended preventive measures include early treatment of the tumor before necrosis sets in and if necrosis has occurred,early treatment, usually by surgical extirpation and anti-tetanus prophylaxis.

Human ; Female ; Adult ; Tetanus ; Thigh ; Sarcoma ; Fibrosarcoma

Sentinel lymph node biopsy has not gained popularity in the Philippines, perhaps the reason being the unavailability of resources. The use of methylene blue may change this situation.
OBJECTIVE: The authors intend to demonstrate that methylene blue may be used as an alternative dye in sentinel lymph node biopsy for breast cancer with satisfactory results.
METHODS: Twenty patients diagnosed with breast cancer underwent sentinel lymph node biopsy after injection with methylene blue dye, followed by complete axillary dissection. Histologic evaluation of the nodes was done using H&E stain.
RESULTS: The identification rate was 95%, with no false negatives.
CONCLUSION: Sentinel lymph node biopsy using methylene blue can be done with satisfactory results.

Human ; Sentinel Lymph Node Biopsy ; Methylene Blue ; Philippines ; Lymph Node Excision ; Breast Neoplasms ; Coloring Agents