RATIONALE/OBJECTIVE

Hemifacial spasm (HFS) is painless, paroxysmal, repetitive twitching of the unilateral facial muscle initially starting with the orbicularis oculi progressing to mid and lower facial muscles. This condition can be disabling and affect quality of life. Microvascular decompression (MVD) offers t he m ost permanent treatment and outcomes are measured through cessation of spasm. There are currently no Filipino-translated questionnaires to measure the quality of life (QOL) of patients with HFS. This study translated and validated the HFS-7 questionnaire and used it to assess and compare the preoperative and postoperative QOL of patients with HFS following MVD.

The HFS-7 questionnaire was translated to Tagalog using a “forward–backward” translation method by 2 independent linguists. The translated questionnaire was validated by 4 expert neurosurgeons and were sent to 27 HFS patients to retrospectively assess pre-op and post-op QOL.

Twenty out of 27 HFS patients answered the survey. Majority of HFS patients were middle-aged females. The Criterion Validity Index (CVI) showed a result of 1 which indicates good validity of the translated HFS-7. It has good reliability with Cronbach alpha score of 0.97. T-test comparing the pre-op and post op scores showed that there is a significant improvement in QOL of HFS patients after MVD.

In patients with HFS, MVD offers an improvement of postoperative versus preoperative quality of life measurements. The Tagalog-translated HFS-7 questionnaire is a valid and reliable objective tool in measuring this treatment outcome.

BACKGROUND

Penetrating brain injury (PBI) is a leading cause of combat mortality but local outcome data is limited. The authors examined combat-related PBI cases to describe patient characteristics and identify clinical and radiologic predictors of functional recovery

This is a retrospective cohort study of military personnel aged 18–56 years with combat-related PBI referred to VLGH AFPMC between January 2017 to June 2022. The authors collected demographics data, injury mechanism, pre-hospital and transfer details, admission clinical and radiologic findings, treatments, and follow-up outcomes. The Glasgow Outcome Scale (GOS), dichotomized into unfavorable (GOS 1–3) and favorable (GOS 4–5), was used to assess functional status. Associations were tested with Fisher’s Exact Test.

Thirty-seven patients met inclusion criteria: 31 survivors with follow-up and 6 who died in hospital. All were male; gunshot wounds accounted for 81% of injuries. At a median follow-up of 27 months, among survivors, 74% had a Glasgow Coma Scale (GCS) of 15 and 45% achieved good recovery (GOS 5). Pre-hospital timing measures (evacuation time, interval to surgery, and transfer delays) were not significantly associated with outcome. Favorable outcomes correlated strongly with higher admission GCS (p < 0.001), preserved baseline motor function (p < 0.001), smaller hemorrhage volume (p = 0.01), and injury limited to a single lobe (p < 0.001). Unfavorable outcomes were associated with intracranial infection, post-traumatic seizures, and need for multiple surgeries (all p < 0.001).

Functional recovery after combat-related PBI in this cohort was principally determined by initial neurologic status, injury extent, and subsequent complications The lack of association with pre-hospital timing possibly reflects survivorship bias and incomplete capture of early fatalities.

Omental torsion is a rare cause of acute surgical abdomen from omental twisting leading to distal vascular compromise. Preoperative diagnosis has been a dilemma as clinical features, laboratory and radiographic findings are nonspecific and variable, closely mimicking acute appendicitis. Surgical excision has been suggested to offer rapid symptom relief and postoperative recovery. Presented here is a case of a 59-year-old male with omental torsion who presented with generalized abdominal tenderness and was preoperatively diagnosed as ruptured appendicitis who underwent laparotomy with uneventful post-operative course.

Appendicitis is one of the most commonly encountered general surgery emergencies worldwide and has been extensively studied. However, anatomical variations in the position of the appendix may result in atypical clinical presentations, leading to diagnostic difficulty and delays in management. Reported here is a case of subhepatic appendicitis in a young adult patient who successfully underwent laparoscopic appendectomy. Subhepatic appendicitis is a rare surgical entity that should be considered in patients presenting with right upper quadrant abdominal pain. Contrast-enhanced computed tomography and laparoscopy are valuable tools in the diagnosis and management of this uncommon condition.

Locally advanced low rectal cancers pose a challenge for surgeons as reported local recurrence remain high despite the performance of Total Mesorectal Excision and the provision of neoadjuvant treatment. Extralevator Abdominoperineal Excision offers better oncologic margins with reported decreased recurrence rates when compared to the conventional technique. The improvement in oncologic outcomes, however, comes at the cost of producing larger perineal defects—and with this comes concerns related to coverage. Presented here is a case of a patient with a locally advanced low rectal cancer with gluteal extension where a Vertical Rectus Abdominis Myocutaneous flap was utilized as a means of perineal reconstruction.

This is a case of a 56-year-old Filipina female who presented with a four-month history of a palpable right infraclavicular lymph node that was diagnosed as metastatic melanoma on histopathology and immunohistochemical staining with no apparent primary tumor on physical examination, nasopharyngoscopy, colonoscopy and imaging studies. Patient then underwent modified radical neck dissection, right, with an unremarkable intra-operative and post-operative course. This report aimed to document the clinical profile, laboratory and imaging parameters and treatment of melanoma of unknown primary on a 65-year-old female.

Liposarcoma is a malignant mesenchymal neoplasm composed of adipose tissue with varying degrees of atypia. While generally indolent, some tumors have the potential to grow enormously particularly if located in the retroperitoneum. We report a 49-year-old female generally asymptomatic except for a 1-year history of gradual abdominal enlargement. Contrast-Enhanced Computed Tomography (CT) of the abdomen showed a large retroperitoneal mass with characteristic features consistent with liposarcoma. On laparotomy, the mass was encapsulated with good plane of dissection, great vessels were preserved, however the right kidney and suprarenal gland were undetachable from the primary tumor hence was removed en bloc with the liposarcoma. The post-operative course was uneventful with excellent outcome after 6 months of follow-up. Final histopathologic diagnosis revealed low-grade, dedifferentiated liposarcoma, which has favorable prognosis following radical surgery.

Laparoscopic cholecystectomy has become the standard of care in the management of gallstone disease with a slightly increased risk for bile duct injury. It is therefore essential that a standard grading system can be utilized and thus predict whether cholecystectomy can be completed laparoscopically or warrants the need for bailout procedure to prevent biliary injury. This study includes all patients who underwent laparoscopic cholecystectomy in Capitol University Medical Center and Maria Reyna Xavier University Hospital from March 2021 to January 2022. Total of 220 patients underwent laparoscopic cholecystectomy but only 173 patients were included due to incomplete data. Age, BMI, sex and G10 scoring were collected. This scoring system focuses on four components: the gallbladder’s operative appearance, whether distended or contracted, ease of access including limited access due to adhesions from prior surgery, the presence of sepsis in the peritoneal cavity, either biliary peritonitis or purulent fluid, and/or a cholecystoenteric fistula, and the degree of gallbladder adhesions. Descriptive statistics and univariate analysis were used to determine the need for bailout procedure in laparoscopic cholecystectomy. It was found that each year increase in age raises the odds of doing bailout surgery by 8.2% (OR: 1.0823, p = 0.009), while higher G10 scores nearly triple the odds (OR: 2.9227, p < 0.0001). The G10 scoring system is a practical scoring system with easy to remember assessment variables. G10 score of greater than 3 with increasing age shown to have increased chance of employing bailout procedure.

This study aimed to determine the clinicopathologic predictors of hormone receptor [Estrogen Receptor (ER)/ Progesterone Receptor (PR)] and Her-2/Neu status of patients with breast cancer. The was an analytical, cross-sectional study with a three-year review of breast cancer patients in the three hospitals of Cordillera Consortium. Multinomial logistic regression analysis was used to determine the association of the clinicopathologic variables such as age, sex, time interval to diagnosis, cancer stage, site, focality and laterality of primary tumor, clinical lymph node status, distant metastasis, recurrence, cancer type, histologic grade, tumor size (T stage), lymphovascular invasion and pathologic nodal stage (N stage) with the hormone receptor and HER-2 status. A total of 143 patients were included in this study. The results showed that laterality (p 0.0154), histologic grade (p 0.0004), and tumor size (T stage) (p 0.049) are associated with the molecular subtypes. Luminal A, luminal B and basal-like subtypes were mostly located on the left while Her-2 enriched was mostly right-sided. All well differentiated tumors were luminal A. Luminal A and Luminal B were mostly moderately differentiated. While Her-2 enriched and basal-like were mostly poorly-differentiated type. Only Her2-enriched had T0 or complete disappearance of tumor (Complete Pathologic Response) among those given with neoadjuvant chemotherapy. In this cohort, there was no recorded tumor of ≤2cm under the basal-like. The clinicohistopathologic features of breast cancer such as laterality, histologic grade, and tumor size can be used as an adjunct to predict the molecular biology of invasive breast carcinoma patients.

OBJECTIVE

To evaluate the reliability and validity of the Filipino version of the Vascular Access Quality of Life (VASQoL) measure.

The Vascular Access Quality of Life (VASQoL) measure was translated to the Filipino language and, subsequently back translated to the English version by professors from the university. This translated questionnaire was face validated by a vascular surgeon, both adept in using both Filipino and English language. Pre-test was done on 10 subjects to assess cross cultural applicability of the questionnaire. Reliability was tested on 24 patients who were all diagnosed with Stage V Chronic Kidney Disease (CKD).

A total of 24 patients were recruited in the study with a mean age of 50.6, ranging from 15 to 77 years old. Slightly higher population of female versus male participants. For both test and retest, the internal consistency of the VASQoL was unacceptable with Cronbach’s alpha of 0.5209. Test-retest reliability showed almost perfect agreement except for one item (Q7) with substantial agreement.

The evaluation of the Filipino version of the VASQoL measure has revealed shortcomings in terms of reliability, suggesting that it may not be a dependable tool for assessing the experiences of patients with CKD undergoing hemodialysis (HD) in the Filipino population.