4^th International Conference and Exhibition on Surgery October 05-07, 2015 Crowne Plaza, Dubai, UAE

Amerah Alsalem is a dental intern in Riyadh colleges of dentistry and pharmacy (RCsDP), Kingdom Saudi Arabia. She has completed her Bachelor Of Dental Surgery from Riyadh colleges of dentistry and pharmacy RCsDP., Kingdom Saudi Arabia.

Periodontal plastic surgery is designed to restore the normal function and appearance of the gum, peridontal ligament and the bone that support the teeth, increase their life expectancy and usefulness. By the use of it, we can remove the damaged tissue caused by the periodontal disease and reconstruct. It is considered the terminal way to restore the normal function. We began first with conservative treatment and enhancing the oral hygiene and behavior and some time conservative treatment isn't enough so we did surgery. We detected the predisposing factor and precipitating factor for avoiding what we can avoid and increase the awareness for early detection, seeking the medical advice and early management. Also, we detected different methods of management and when to use each one, time of recovery and post operative advice. In brief, we took about periodontal diseases detection, avoiding, predisposing and precipitating factors and management.

Endoscopic Gastric botox is a procedure that speeds up weight loss by using botox to temporarily relax the muscles of the stomach. Botox will cause gastric motility to slow down making the person feel full more quickly and for longer than usual, reducing the overall amount of food consumption. Our data of 85 patients between December 2013 and March 2015 shows that this procedure is safe and most successful in obese patients with lower body mass index between 28 and 35.

Hibah Saleh Alharbi is a 6th year medical student from Umm al-Qura University at Makkah, Saudi Arabia. She has an interest in health education and increase society awareness about the diseases and how to prevent it. She also has a lot of interest in research work activity field.

Background: Cervical cancer is considered the 4th most common cancer of women worldwide. It is the 10th most common cancer in Saudi women. Due to lack of well-organized screening program in KSA most cases of cervical cancer presented to health care services in late stage of disease.
Aim: To assess the level of knowledge, awareness and attitude about cervical cancer and if the women had undergone screening for cervical cancer or not.
Subjects & Methods: A questionnaire based cross-sectional study was conducted among the women attending the outpatient clinics in 3 health care facilities chosen randomly from all health care facilities in Makah. A sample size of 210 was calculated. Data was analyzed using SPSS Version 20.
Results: Majority of the women have good knowledge about cervical cancer (12.9% [27/210]) taking their knowledge mainly from the internet not from doctors. Only (13.8% [29/210]) are aware about screening. Only 21.4% women had undergone screening while 79.5% have positive attitude towards screening. Although 1.9 % took the vaccine, 90% have positive attitude towards vaccination.
Conclusions: Although majority of women had poor knowledge, but still many had positive attitude towards screening and vaccination. Mass media and health care teams should be used to educate women.

Manojith S S is pursuing Post graduate studies in Department of General Surgeryin Navodaya Medical College, Raichur from Rajiv Gandhi University of Health Science, Bangalore, Karnataka, and presenting this case report under the guidance of Dr. Sridar Venkat Rao who is Professor in Department of General Surgery with more than 12 years of experience in General & Laparoscopic Surgery from Rajiv Gandhi University of Health Science Bangalore, India.

Gastrointestinal stromal tumors (GISTS) are usually solid but cystic degeneration; necrosis and focal hemorrhage have been described in larger tumor leading to central necrotic cavitations. Gastric GISTS can be divided into histologic subgroups including spindle cell and epithelioid variants. The most sensitive mark of GISTS from all sites is cd117 (C-kit). A weak or absent expression of CD117 & Characteristic of gastric GIST’S with epithelioid differentiation in CT Scan, it is after difficult to decide origin of the primary tumor especially in large GISTS. A 53-year old male patient underwent diagnostic laparoscope with retroperitoneal cyst excision (open). The main diagnostic concern was a pancreatic cystic neoplasm. A large 20x20 cm retro gastric lesion was resected and pathology report indicated an unsuspected gastro intestinal stromal tumor (GIST). The report aimed to describe as atypical presentation of GIST.

Gayatri Prakash Tahiliani has worked in the USA for three months in surgical super specialities and prestigious Bombay hospital and Dhirubai Ambani hospital before been practicing as a second year resident in Masters of Surgery at the age of 25 years from MGM Institute of Medical Sciences ,New Bombay ,India .She has published around 5 papers and presentations in reputed journals.

A teratoma is a germ cell tumour derived from pluripotent cells and made up of elements of diff erent types of tissue from one or more of the three germ cell layers. Mature cystic teratomas are rare and account for only about 3 to 12% of the total teratomas. Th ough benign, they can turn malignant. A surgeon should always remember the signifi cance of diagnosing such teratomas and be vigilant to treat the condition promptly. Any delay can cause worsening of the symptoms of the patient and may be fatal. In this poster an attempt has been made to discuss a case report of a patient with such a lesion and was treated for the same with right lateral thoracotomy with mediastinal mass excision with good outcome of the patient.

Ayse Karci has completed her medical education at Ege University, Turkey and was specialized in Anesthesiology in Dokuz Eylul University School of Medicine. She is still working in the same hospital as an Associate Professor. She has worked in the Department of Obstetrics and Labor Unit as Anesthesiologist and was also the Director of School of Anesthesia Technicians for six years. She has 16 publications in reputed journals and 29 Turkish papers in the field of Anesthesia.

Background & Goal of Study: Traditionally evaluation of adequacy of the neuraxial anesthesia depends on the loss of response to the sensations of cold and pinprick which requires patient cooperation. Objective: Assessment of clinical signs of sympathectomy does not appear fast enough to confi rm surgical anesthesia. We hypothesized that increases in the pulse oximeter perfusion index (PI) may provide earlier and clearer objective evidence for sympathectomy compared to traditional responses to sensory stimulation. Materials & Methods: Aft er approval was obtained from the Ethics Committee of University of Dokuz Eylül, Medical School, İzmir, patients at 18–65 years of age who were categorized as American Society of Anesthesiology physical status I-III were included. A spinal block using 0.5% bupivacaine was performed with the patient in the sitting position. No external heating device was used. Th e upper sensory block level was checked 2min aft er the spinal injection by assessing the loss of cold sensation from alcohol swabs. Systolic blood pressure (SAP), heart rate and PI were recorded at 2 min intervals in the fi rst 10 min and then at 5 min intervals. Skin temperature was recorded at the same times. Th e PI value is generated by pulse oximetry placed on the second toe. Results & Discussion: Compared to basal values, sympathectomy caused a signifi cant decrease in SAP and a increase in PI values following spinal anesthesia. Th e increase in skin temperature was signifi cant aft er the 8th minute. Th e increase in the PI value and sensory block level were parallel in 15 minutes following spinal anesthesia and both stayed at a plateau aft erwards. In one patient in whom the spinal block was not successful, PI did not signifi cantly change compared to baseline. Conclusion(s): Give a simple answer to the hypothesis in the light of the new data from your study. You may wish to suggest what needs to be studied next. Th e conclusion must be justified by your data.

Background: Defects larger than one half of the lip cannot be closed primarily; therefore, tissue transfer is necessary. Th e recommended surgical techniques for these defects are Cross lip fl aps which include Abbe-Sabatini and Estlander fl aps. Patients and methods: Ten patients with squamous cell carcinoma at lower lip not reaching angle of mouth excised with safety margin ranging from 0.5 cm to 1 cm in each side and the excision not including angle of mouth. Th e size of the defects in all patients aft er excision of the tumour was ranging from1/2 to 2/3 the size of the lower lip. Reconstruction was done in all patients using Abbe-Sabattini cross lip fl ap and separation of the fl ap was done aft er three weeks. Results: Th e mean age of the patients was 56.5 years (ranging from 47-70 years). Seven patients were males and three patients were females. In all patients the fl aps were survived completely. We evaluate the Abbe-Sabattini cross lip fl ap regarding the functional and aesthetic aspects. Abbe-Sabatini cross lip fl ap had a good functional outcome regarding Oral continence to food, fl uids, and air and Oral mobility and adequate oral access. In seven patients the sensations were gained completely within six months, but in the remaining three patients there were slight hypothesia aft er one year. We found also that Abbe-Sabatini cross lip fl ap had a good aesthetic outcome. Conclusion: Abbe-Sabatini cross lip fl ap is an ideal versatile fl ap to reconstruct the defects of lower lip ranging from 1/2 to 2/3 of the size of the lower lip not including angle of the mouth with very good functional and aesthetic outcome.

Overview: Even today esophagectomy is associated with a morbidity rate of up to 40% and a mortality of 10%. Complications related to the pulmonary system account for the lion´s share of the morbidity and mortality. Such complications Introduction: Th e study‘s objective was to fi nd out if laparoscopic esophageal resection is also associated with such general advantages of minimal invasive surgery. Methods: Retrospective cohort study Between Aug. 2009 – Nov. 20014 n= 69, Tumor location in the lower third of the esophagus (in all patients) Age (years) 62 (41- 74), Female/ Male 16/ 53 39 Squamous Cell Carcinoma, and 30 Adenocarcinoma Results : Operative procedures Laparoscopic blunt n = 32 Laparoscopic – Th oracoscopic n = 24 Laparoscopic open Th oracic n = 13 Intraoperative Problems Abdominal Clip suture rupture during gastric tube construction (n = 2) Th oracic No Lung collaps (n = 3) Cervical Length of Gastric tube (n = 2) Conclusion: Our fi rst experiences demonstrate, that laparoscopic esophagectomy is clearly associated with a low rate of morbidity and mortality. However, for a conclusive assessment, a greater patient collective is needed

Purpose: Appendicitis is the most commonly presumed diagnosis for the right sided abdominal pain. It can be the fi rst sign of colorectal cancer (CRC) in the patients over the age of 50 years. Vice-versa, appendectomy has been reported as a precursor of colorectal cancer owing to its immune function. Value of colonoscopy, in terms of detection rate and time association, in those patients has not been investigated extensively. Th e purpose of this study was to determine its role and optimal timing in early detection of colorectal cancer. Methodology: Total 318 patients over the age of 50 years who had appendectomy from 2002 to 2014 were included in our study. Detailed data was collected for those patients who were further followed up with colonoscopy. Retrospective analysis of the rate of CRC detection, timing of colonoscopy and histopathology of the tumors was done. Results: Total 63 out of 318 patients underwent colonoscopy aft er appendectomy. Out of 63 eight patients (12.7%) had CRC on colonoscopy. Male to female ratio was 7:1. Timing of colonoscopy ranged from one month to 24 months with median of 17 months. 62% of CRC was right sided. Majority (87.5%) of diagnosed CRC were advanced malignancies. Conclusion: Colonoscopy is a useful tool for early detection of CRC aft er appendectomy in the patients over the age of 50 years. Appendectomy, in this cohort of patients, can be a potential predictor for CRC. Th erefore colonoscopy is recommended to be performed routinely aft er appendectomy within 12 months.

Purpose: Th is study analyzes the cellular and humoral immunologic reactions that occur aft er the in vitro implantation of stainless steel (SS) alloy and titanium (Ti) alloy. Methods: In the study, Wistar albino rats aft er an exploration of the thoraco-lumbar para-vertebral muscle tissue of the subjects, group I underwent a sham surgery and groups II and III were implanted Ti alloy and SS alloy rods respectively. Results: CD4, CD25 (IL-2R) (lymphocyte and CD4 gate), CD4+CD8+ and CD4+CD25+Foxp3+ (Tregs) levels were lower in the SS alloy group compared to the sham and Ti alloy groups. IL-6, IL-17A, TGF-β and TNF-α level in the SS alloy group showed a signifi cant increase on all days in comparison with the sham and Ti alloy groups. IL-4 and IL-10 levels, on the other hand, were lower in the SS alloy group than those in the Ti alloy group; and a signifi cant decrease was observed in the IL-10 level. While there was a reduction in IL-6 and IL-17A levels in the Ti alloy group as opposed to the sham group, no diff erence was observed in TNF-α level. Conclusions: As opposed to SS alloy, Ti alloy suppresses the development of infl ammations by inhibiting pro-infl ammatory response; strengthens the humoral immune system by intensifying the antibody-dependent immune response; triggers the development of immune tolerance by regulating the immune response; and activates the mechanism that prevents immune response-related damage from occurring.

Sandra Lindstedt has been a consultant in cardiothoracic surgery since 2010 and is currently working as a cardiothoracic surgeon at Lund University Hospital in Sweden. Lindstedt completed her PhD (2008) at the age of 34 years at the University of Lund. She has published more than 59 papers in reputed journals and serving as an editorial board member of European Journal of Cardiovascular Medicine. Lindstedt received an honorable research grant from the Swedish government 2011, 2012, 2013, 2014 and 2015 intended for transplantation. In 2015 Lindstedt receive an honorable research grant from Swedish royal physiographic Society for DCD lungtransplantation

The limiting factor for lung transplantation is the availability of donor organs, resulting in deaths on the waiting list. Th e usage of donation aft er cardiac death (DCD) lungs would dramatically increase donor availability. Our study investigated, in a simulated clinical situation in a DCD setting, whether alteplase administration aft er death aff ects donor lung function. Twelve Swedish domestic pigs underwent ventricular fi brillation and were then left untouched for 1 hour aft er declaration of death. Th ey did not receive heparin. Th e animals were randomized into two groups DCD and DCD-A. Th e lungs were then harvested and fl ush-perfused with Perfadex® solution. In the DCD-A group alteplas was added to the Perfadex® solution. Th ereaft er the organs were stored at 8°C for 4 hours. Lung function was evaluated, using ex vivo lung perfusion (EVLP), with blood gases at diff erent oxygen levels, pulmonary vascular resistance (PVR), lung weight, and macroscopic appearance. All lungs meet the criteria for lung transplantation. No diff erence in blood gases, PVR, lung weight, or macroscopic appearance could be detected. It seems as if DCD lungs exposed to 1 hour of warm ischemia before 4 hours of cold storage has satisfying oxygenation capacity, low PVR, normal weight and no signs of thrombosis. According to our study it seems as lungs exposed to 1 hour warm ischemia without heparin and with or without alteplas might be good candidates for transplantation.