Gallbladder agenesis is a rare congenital abnormality of the biliary tract. The diagnosis is usually made during surgery. It has been proven to be very difficult to make a correct preoperative diagnosis of agenesis of the gallbladder in symptomatic patients. The purpose of this presentation is to share our experience about a case of middle-aged lady who presented with symptoms of biliary colic. Ultrasound examination revealed cholelethiasis with contracted gall bladder. On Contrast CT examination Gall bladder could not be visualized. On further imaging as MRCP diagnosis of gallbladder agenesis could be confirmed. This helped in avoiding unnecessary surgery and patient was conservatively treated.

Percutaneous collagen induction (PCI) or needling techniques are increasingly popular in aesthetic practice.  The underlying mechanisms of action rest on producing a pattern of non-ablative and non-confluent puncture wound pattern to the dermis with a resulting regenerative effect on the skin.  The majority of publications in the scar literature focus on the use of PCI in the context of atrophic scars with no currently available summative reports appraising the pertinent evidence relevant to non-atrophic scars

Statement of the Problem: Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. However, synthetic endoprostheses have disadvantages, which include: aseptic inflammation in the surrounding tissues with the formation of a pronounced connective tissue scar; low resistance to the infection; high risk of adhesions between the abdominal organs and the mesh. The aim of study was to create a new method of inguinal hernia repair, not using synthetic mesh.

Methodology & Theoretical Orientation: Our new method of autoplasty of the posterior wall of the inguinal canal based on cutting out the aponeurotic flap from the sheath of rectus abdominis muscle, and moving it on the under spermatic cord, followed by fixing it to the pubic tubercle, inguinal ligament, medial – rectus, internal oblique and transverse muscles of the abdomen (figure 1). In this study, 15 new non-mesh tension-free inguinal hernia repairs were performed. The main outcome measure was recurrence in the early postoperative period (before 30 days).

Findings: Inguinal hernia was indirect in 60% of cases (9 patients), direct in 40% (7 patients). Mean patient age was 47.3 years (range, 18 – 75). Follow-up was completed in all 15 patients (100%) by clinical examination or phone call. Small seroma formation in 1 patient was observed in 5^th day, but not requiring drainage. We have not observed acute infection, hematoma formation or functional or organic changes in the spermatic cord related to the new technique of hernia repair.

Conclusion & Significance: The above-described method ensures the proper strength of the posterior wall of the inguinal canal, preserves the physiological function of it after operation. The use of this technique has a big potential in the inguinal hernia repair, since it can eliminate all complications associated with the use of synthetic material.

A 50-year-old patient with a history of burning in the lower right limb by flame 18 years ago for which he received local treatment. The patient developed a giant Marjolin’s ulcer and consults after total functional impotence of the limb. Clinical examination found ulcerated thickness from the outer side of the right thigh to the deep-seated ipsilateral calf, histological examination revealed a well-differentiated and infiltrating squamous cell carcinoma.

The magnetic resonance imaging showed a dermo-hypodermic thickening of the posterolateral side of the thigh and leg infiltrating the ilio-tibial tract and lateral gastocnemius muscle. After a multidisciplinary discussion, an indication of amputation was retained.

To determine the clinical significance of circulating tumor cells expressing the targeted genes BIRC5 and HER2-neu - markers of minimal residual disease, as markers of the "purity" of the surgical stage of breast cancer treatment,

The study involved 230 patients with verified primary non-metastatic breast cancer (BC) stage I-IIIC at the age of 58.2 ± 9.9 years. All women underwent surgery in the amount of radical mastectomy in Madden (group 1) – 113 (49.1%), oncoplastic radical resection of the breast (group 2) – 49 (21.3%), and 68 (29.6%) women underwent bilateral subcutaneous mastectomy with regional lymph node dissection on the affected side with simultaneous implant reconstruction (group 3). In all patients on the day of surgery, as well as on day 2 after surgery, peripheral blood was examined for the presence of circulating tumor cells (CTCs). To identify the CTCs, the expression of the BIRC5 and HER2-neu genes was studied using real-time PCR.

Ukraine is a young independent country in central Europe.  For a long time this country has occupied by Russian Imperia and USSR. That’s why medicine in Ukraine has a lot of problem now. First of all these problems are related with emergency medicine and trauma. Cherkasy emergency hospital works 24-hours a day and 365-days a year and of course has a lot of patients with abdominal and thoracic injuries. Without modern equipment or laboratory, we always find a way to do our best.  Now reform in medical is going but not all doctors and administrations want changing. Only fresh mind and international studying can help to be like better in medicine.

 

Carcinoma breast continues to be a major cause of mortality and morbidity worldwide, including India. Incidence of breast cancer has particularly risen in young females in 3^rd and 4^th decade. In large, aggressive cancers, neoadjuvant chemotherapy can reduce tumour bulk and breast-conserving surgeries may be done, albeit with a significant risk of recurrence. With a novel neoadjuvant regimen, it may be possible to downsize tumour to achieve cosmetically better results and allow conservative surgery with a better prognosis.

 

Statement of the Problem: Surgical site infections (SSIs) are infections of the incision, organ or space that occur in the 30 days following surgery. 5% of patients undergoing surgery develop SSIs. They are associated with significant morbidity and mortality.  SSIs pose a heavy financial burden, prolong inpatient stay, and negatively impact quality on life. Numerous factors such as obesity, ASA score, operation duration and contaminated/dirty wounds are associated with SSIs. Attention therefore to pre, intra, and post-operative risk factors are essential in reducing their incidence.  The purpose of this audit is to identify the incidence of SSIs occurring in general, vascular colorectal and breast surgery over a 1 year period (1st Jan – 31st Dec) and to identify techniques that may reduce occurrence. Methodology: Retrospective data were collected on surgical patients that developed SSIs in 2018.  Independent predictors of SSIs were evaluated including type of operation performed and use of intra/post-operative antibiotics. Consequences of SSIs were then reviewed involving wound swab utilisation, antibiotic duration, use of further imaging, subsequent surgical intervention and prolongation of hospital stay. Findings: 3996 operations were performed. 58 SSJs were identified (incidence of 0.015%). 79% received intraoperative antibiotics. 51% of patients had wound swabs taken. 11 patients had antibiotics prescribed according to sensitives. 30 readmissions, 12 further operations and 27 additional scans were identified. 143 extra bed days were calculated. 402 days of antibiotics were prescribed. Conclusion and Significance: The consequences of SSIs are multifactorial. More focussed antibiotic prescribing is needed according to wound swab results and sensitivities. The duration/ indication for antibiotics and inclusion of SSIs on discharge summaries require improved documentation. Follow up of patients discharged is recommended to identify SSIs treated in the community, a potential source of bias in this study. 

Small losses of nose substances secondary to a tumor of the nose at the tip and the nostril are difficult to reconstruct. The bilobed flap of Zitelli is the best indication in these cases.

We will present the case of a 60-year-old man with an infiltrating basal cell carcinoma, poorly limited to 6mm in diameter, straddling the tip of the nose, the right nostril and the right paramedian face.The tumor is removed with 3mm lateral safety margins, the reconstruction of the loss of substance is made with Zitelli's improved bilobed flap allowing coverage of the loss of substance without anatomic and aesthetic modification of the subunits of the nose .

Nasal reconstruction must respect morphological, functional and aesthetic imperatives. Unit repairs offer the advantage of repairing loss of substance with skin of the same quality, matched in texture and color, and they reconstruct aesthetic subunits of the nose while maintaining scars within the unit. . The bilobed flap is a double transposition flap whose overall rotation is 90 °, with a rotation of each lobe of the order of 45 °. It must be dissected sub-muscular to ensure its viability. It is intended for losses of substance less than 20mm in size, paramedianes, low columellar tip or that can border the nostril margin.