5th International Conference and Exhibition on Surgery November 7-8, 2016 Alicante, Spain

Biography:

Dr. Tawfik A Zein finished his Urology training at the University of Maryland in Baltimore, then spent two years in Urologic Oncology fellowship at Roswell Park Cancer Institute before joining State University of New York in Brooklyn to be Associate Professor and Physician-In-Charge of Urologic Oncology at Brookdale Hospital Medical Center.  Dr. Tawfik Zein is currently working at St. Joseph’s Hospital in Buckhannon, West Virginia as a Physician of Urology.

Abstract:

Fifty patients were evaluated in our clinic for symptoms of bladder outlet obstruction and were scheduled for laser ablation of the prostate utilizing the Protouch 1470 laser.

All patients failed medical treatment, five presented with urine retention.  Preoperative evaluation included ultrasound, cystoscopy, flow rate and the BPH scoring system.

Operative time was markedly shorter than the gold standard TURP.  Time of resection ranged from ten minutes to 45 minutes depending on the size of the prostate. The glands ranged in size between 30gms and 120gms.

No intraoperative complications took place and no post-operative bleeding was noted. No post-operative fluid absorption was verified by post-operative blood work and no patient demonstrated an altered mental status while being observed at the hospital. All patients ate on the same day of surgery and were ambulated when spinal anesthesia worn off. Most patients had spinal anesthesia unless contraindicated or refused by the patient.

All patients left the hospital following an overnight stay.  The Foley catheter was removed on the second morning before discharge except in two patients; no manual bladder irrigation was needed. No patient presented to Emergency Department after discharge with bleeding or other complications.

The technology used for these procedures was the Protouch 1470 Diode Laser, which is manufactured by Convergent Laser Technologies located in Alameda, CA. The Protouch operates on the 1470 wavelength. The wattage ranged from 85 to 100, the recommended setting is 90 watts. A setting of 45 watts in Super Pulse mode was found to be optimal for the resection of bladder tumors.

This laser can be used in any operating room that has a standard 110V line. It reduces hospital expenses through decreased intraoperative times and reduced lengths of stay for patients

Biography:

MSc Public Health - Health Services Management stream - LSHTM, UCL, London 2011-2013

MSc Health &Development, IHMT, UNL, Lisbon 2006 - 2009

Senior Consultant Anaesthesiology (2005-2010) Lisbon, Portugal (H. STa Maria)

Specialty Doctor / Locum Specialist (2010-2013) London, UK (2010- 2013)

International Health- Health & Development PhD program (2013- current)

Abstract:

Surgical waiting time remains an important issue regarding access to health care provision. It is considered to be excessive in most OEDC countries (over twelve weeks or ninety days). The development of day surgery has been one of the strategies that proved effective in reducing surgical waiting time. This study aims to establish a correlation between surgical waiting time and the percentage of day-surgery cases, in hospitals with surgical services, in the Portuguese National Health Services. Methodology: An observational was conducted to establish the correlations existing between surgical waiting time and the percentage of day-surgery procedures realized, as well as associations with other variables, through multivariate and correlation analysis. Data was obtained at the Ministry of Health (ACSS).Results: A negative, statistically significant Spearman’s correlation was observed between the percentage of day-surgery cases and the waiting surgical time for elective procedures.

Biography:

Kelsey Hinther has completed her Bachelor of Science in 2013 from University of Saskatchewan. She is currently a Medical student at the University of  Saskatchewan, Canada. She has a profound interest in research and would like to continue with research in her future career.

Abstract:

Laryngeal chondrosarcomas are rare, slow-growing, cartilaginous tumors. Dedifferentiated chondrosarcomas, a rare entity of chondrosarcoma, are more aggressive and associated with a more ominous prognosis. They commonly arise in the hyaline cartilage of the cricoid. Definite diagnosis can be established by incisional biopsy and histopathologic examination. Histopathologic examination reveals a cartilaginous tumor with a malignant spindle cell component. Definitive treatment of dedifferentiated chondrosarcomas of the larynx is total laryngectomy. We present a case of dedifferentiated chondrosarcoma arising in the cricoid cartilage of a male patient, who presented with 3-week history of dyspnea, stridor, dysphonia and intermittent aphonia. As a result, he underwent a total laryngectomy, and received adjuvant radiation therapy.

Biography:

Tuhin Shah has completed his MS in General Surgery from BP Koirala Institute of Health Sciences, Nepal. He is currently a Senior Resident and presented a few papers in the national conference and the scientific sessions held in Nepal.

Abstract:

A 35 year female presented to our hospital with recurrent pain in right lower abdomen for four months which had increased in intensity in the last 24 hrs. She used to have on and off passage of altered blood in stool during previous attacks of pain but absent on this presentation. She had undergone open  appendectomy four and half months back at another center. Her last pain episode was one month ago and was diagnosed as ileocolic intussusception and was managed conservatively at another center without an adverse outcome. On clinical examination, the patient was afebrile and her vital signs were otherwise normal. Physical examination revealed a tender mass in right iliac fossa of 3X2 cm2 without evidence of guarding, rebound tenderness, or other peritoneal signs. Routine laboratory studies were remarkable for a WBC count of 10,000/ mm3 with 88% neutrophils. Urinalysis was negative. An ultrasound of the abdomen and pelvis was performed which showed invagination of one bowel loop into another bowel loop with characteristic target sign which suggested the preoperative diagnosis of ileocolic intussusception. Exploratory laparotomy with a lower midline incision was done under general anesthesia. The operative findings were adhered inflamed omentum forming a lump over the ileocecal junction with inflamed surrounding mesentery and acutely inflamed stump of appendix (~2 cm). Rest of the bowel was normal. Completion appendectomy was done and the post-operative period was uneventful. The patient was discharged on postoperative day four and is asymptomatic till date. Her histopathological report showed acutely inflamed appendix.

Biography:

Professor and senior ENT-consultant and Director of research and development at Sahlgrenska University Hospital and Sahlgrenska Academy at Department of
Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, SwedenResearch in Clinical and translational research applied to risk organs and intervention for complications following Head and Neck Cancer treatment. Medical licence issued by the Government Sweden 1987, senior ENT-consultant 2002. Also credits in Quality improvement from Chalmers University of technology Gothenburg parttime-2009-2011, and Pedagogical credits at the Pedagogical Development and Interactive Learning (PIL) University of Gothenburg part-time 2012-2015.

Abstract:

Aim: Aim of this study is to investigate the long-term effects of structured trismus intervention in patients with head and neck cancer (HNC) and trismus in terms of trismus related symptoms and health related quality of life (HRQL) and mouth opening.
Material&Methods:Patients with HNC to receive radiotherapy±chemotherapy (n=50) were included in this prospective study along with a matched control group. The intervention group received a 10 weeks structured exercise with a jaw mobilizing device. Patients were assessed before and after trismus exercise intervention and at a two-year follow-up. Primary endpoint was maximum inter-incisal opening (MIO) and secondary endpoints included trismus-related symptoms and HRQL assessed with patient-reported outcome (PRO)-instruments European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the related HNC-specific module the EORTC Head & Neck Questionnaire (EORTC QLQ-H&N35) and Gothenburg Trismus Questionnaire (GTQ).
Results: At the two-year follow-up, the intervention group had a higher MIO compared to the control group (40.5 mm and 34.3 mm, respectively), which was statistically significant. The intervention group also reported less jaw-related problems according to the GTQ and higher functioning as measured by EORTC QLQ-C30 and QLQ-H&N35 compared to the control group.

Conclusion: A positive persistent effect of exercise intervention for trismus in HNC patients was found with regard to trismusrelated symptoms, MIO and HRQL. Exercise intervention is important in long-term treatment of radiation-induced trismus in HNC patients. The trismus-specific questionnaire, GTQ, is a valuable tool for observing and evaluating trismus over time.

Biography:

Weon Yong Lee has completed his MD and PhD from Seoul National University, College of Medicine, South Korea. He is a Chief in Cardiothoracic Department, Hallym University Sacred Heart Hospital.

Abstract:

Aim: Off-pump coronary artery bypass (OPCAB) has been a reasonable alternative to conventional CABG. Nevertheless, it carries significant risk factors related to conversion from off-pump to on-pump surgery. Therefore, this study evaluated the effects of left  ventricular (LV) function and dimension on the success rates of OPCAB.
Methods: From 2008 to 2012, 100 OPCAB were performed. Of these, 84 (84%) patients underwent OPCBA without events (OPCAB group) and 16 (16%) cases were converted to C-CABG (conversion group). The causes of conversion were hemodynamic instability in 12, difficulty of anastomosis in three and ventricular arrhythmia in one patient. The present study evaluated risk factors such as LV ejection fraction, wall thickness, dimension and mitral insufficiency for conversion to on-pump surgery between two groups.
Results: The preoperative demographics and operative characteristics were not statistically different between two groups. There were no independent risk factors for conversion to on-pump CABG related with LV function and dimension (p=.154 for LV ejection fraction, p=.287 for LV diastolic dimension and =.739 for LV wall thickness). The mitral regurgitation did not raise the conversion rate (p=1.0).
Conclusions: The deteriorated LV function, increased LV dimension and wall thickness including valvular insufficiency has been regarded as increasing the rate of conversion during OPCAB. The present study demonstrated that LV parameters including LV wall thickness, dimension, function and valvar insufficiency did not increase the conversion rate of OPCAB.

Biography:

Ronald Bogdasarian has earned his MD degree from The Commonwealth Medical College in Scranton, PA, USA where he became a Member of the prestigious Alpha Omega Alpha Honor Society. He is currently a Resident Physician in the Rutgers New Jersey Medical School, Division of Plastic Surgery. He has published several peer reviewed articles and book chapters and presented multiple posters on various medical and surgical topics.

Abstract:

In this poster I will present our recent experience with giant facial neurofibromas (GFNs). In case-1, a 29 year old man presented with GFN on the left face with severe facial deformity. We performed two staged excision and left facial reconstruction including the upper eyelid. In case-2, a 38 year old male exhibited an enormous, 30×25cm, left GFN. The patient was seeking surgical treatment for many years but unsuccessfully. We discuss in depth the surgical preparation for this case. Drawing upon a recent comprehensive literature review, we will include our new GFN Classification System and preoperative management algorithm.

Biography:

M Tayyar Kalcioglu has completed his graduation from Hacettepe University and worked as a ENT Resident at Inonu University, Department of Otorhinolaryngology, Turkey. He became an Associate Professor and Professor at Inonu University, Turkey. He has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

Aim: MESNA (sodium -2- mercaptoethanesulfonate ) has widespread use in medicine due to its antioxidant and mucolytic effects. In recent years, it has been used also in otologic surgery. Taking advantage of breaking the disulfide bonds, it is used to dissect easily epithelial problems such as cholesteatoma and atelectasis. In particular, the possibility of cholesteatoma and facial nerve canal
dehiscence make chemicals used during ear surgery to suggest potential negative effects on nerves. In this study, the effects of MESNA on the facial nerve were examined histologically and electrophysiologically.
Materials & Methods: In this study, 20 Wistar albino rats were used and were divided into four groups. Group A was identified as control group and group B was identified as sham. The animals in group C was administered in 20% MESNA solution after facial nerve was found, and in group D, 50% solution was administered to the animals. EMG measurements were performed in the preoperative and postoperative fourth weeks. Then, animals were euthanized; facial nerve samples were taken for histopathologic examination.
Results: When the EMG parameters were compared within and between each group, preoperative and postoperative results were not statistically significant. Histopathological examination showed that MESNA did not cause any inflammation, granulation tissue and a foreign body reaction.
Conclusion: As far as we know, there has been no study showing the effect of MESNA on facial nerve functions. In this study, the effects of MESNA after application directly to the facial nerve were examined electrophysiologically and histologically and it was determined that MESNA did not cause any toxic effects. As a result, it has been concluded that MESNA can be used safely in the middle ear by ear surgeons.

Biography:

Ho Jin Son has completed his PhD from Kyungpook National University and Postdoctoral studies from Catholic University of Daegu, South Korea. He holds the Fellowship at Asan Medical Center.

Abstract:

Postoperative surgical site infection (SSI) is a major complication of head and neck surgery, leading to major cause of nosocomial infection and increased medical expenses. The purpose of this study was to examine the risk factors of SSI in patients undergoing major head and neck cancer (HNC) surgery. This study prospectively involved 368 consecutive patients who underwent major
oncological surgery for head and neck cancer between September 2010 and December 2015 in our tertiary referral center. The SSIs within 30 days were classified as incision, space or leakage/fistula. Circulating hematological and nutritional parameters were regularly measured before and after surgery. Univariate and multivariate analyses were used to find the significant perioperative risk factors for SSIs. Of these 368 patients, 105 (28.4%) had SSIs: 46 (12.4%), incisional; 6 (1.6%), space; and 53 (14.3%), leakage/fistula.
Multiple preoperative and perioperative were significantly associated with the development of SSIs. Multivariate analyses showed that preoperative radiotherapy, BMI and hypoalbuminemia were the independent factors predictive of SSIs. Patients with low serum albumin levels (<3.3 g/L) at preoperative and postoperative two days were increasing risk of SSIs compare to their counter parts. Several patient and laboratory factors can predict the risk of SSI development after major oncological HNC surgery. Our study also shows the nutritional status of patients affect the SSI risk. Based on our findings, future clinical trials might be required to minimize the risk.

Biography:

Jun Seok Lee has completed his MD from Kyung Hee University, Postdoctoral studies from Kyung Hee University School of Medicine and completed his Resident course. He is presently an Instructor in Department of  Otorhinolaryngology, Head and Neck Surgery in Kyung Hee University Hospital and his specialization is in Head and Neck Surgery. He has published 6 papers in SCI (E) journals and has been serving as Board Member of Korean Society of Otorhinolaryngology-Head and Neck Surgery.

Abstract:

To evaluate the association between the parameters of 24-hour multichannel intraluminal impedance (MII)-pH monitoring and the symptoms or quality of life (QoL) in laryngopharyngeal reflux (LPR) patients, the authors conducted this study prospectively. 45 LPR patients were selected from subjects who underwent 24-hour MII-pH monitoring and were diagnosed with LPR from September 2014 to May 2015 in a tertiary teaching hospital. Reflux Symptom Index (RSI), Health Related Quality of Life (HRQoL), Short Form 12 (SF-12) Survey questionnaires were surveyed. Spearman correlation was used to analyze the association between the symptoms or QoL and 24-hr MII-pH monitoring. As a result, most parameters in 24-hr MII-pH monitoring showed weak or no correlation with RSI, HRQoL, and SF-12. Only number of nonacid reflux events that reached the larynx and pharynx (LPR-nonacid) and number of total reflux events that reached the larynx and pharynx (LPR-total) parameters showed strong correlation with heartburn in RSI (R=0.520, p<0.001, R=0.478, p=0.001, respectively). Multiple regression analysis showed that there was only one significant regression coefficient between LPR-nonacid and voice/hoarseness portion of HRQoL (b=1.719, p=0.022). In conclusion, most parameters of 24-hour MII-pH monitoring did not reflect subjective symptoms or QoL in patients with LPR in this study.

Biography:

Ho Joong Kim has completed his MD from Kyung Hee University, Postdoctoral studies from Kyung Hee University School of Medicine and completed his Resident course. Currently, he is an Instructor in Department of Otorhinolaryngology-Head and Neck Surgery at Kyung Hee University Hospital. He has published 6 papers in SCI (E) journals and has been serving as Board Member of Korean Society of Otorhinolaryngology-Head and Neck Surgery.

Abstract:

Aim: Comparison of acyclovir and famciclovir in the treatment of Bell’s palsy is uncertain. Therefore, aim of this study was to evaluate which antiviral agent provided better recovery outcomes in patients with Bell’s palsy.
Methods: The study cohort consisted of patients with facial palsy who visited the outpatient clinic between January 2006 and January 2014. Patients were treated with prednisolone plus either acyclovir (n=457) or famciclovir (n=245). Patient outcomes were measured using the House-Brackmann scale according to initial severity of disease and underlying disease.
Result: The overall recovery rate tended to be higher in the famciclovir than in the acyclovir group. The rate of recovery in patients with initially severe facial palsy (grades V and VI) was significantly higher in the famciclovir than in the acyclovir group (p=0.01), whereas the rates of recovery in patients with initially moderate palsy (grade III–IV) were similar in the two groups.
Conclusion: The overall recovery rates in patients without hypertension or diabetes mellitus were higher in the famciclovir than in the acyclovir group, but the difference was not statistically significant. Treatment with steroid plus famciclovir was more effective than treatment with steroid plus acyclovir in patients with severe facial palsy. Famciclovir may be the antiviral agent of choice in the treatment of patients with severe facial palsy

Biography:

Manuela Stoicescu is a Consultant Internal Medicine Doctor and has completed her PhD in Internal Medicine. Currently, she is an Assistant Professor of Medical Disciplines Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania, Internal Medicine Hospital and Office. She is a Member of Romanian Society of Internal Medicine and Romanian Society of Cardiology, Chemistry and Biochemistry.

Abstract:

Aim: The most important objective of this clinical case presentation was to find the real cause of a patient who came in the emergency department for a clinical picture of a left renal colic.
Material & Methods: I present the clinical case of a 42 year old man,  prisoner-convict who came in the emergency department together with a policeman who supervised him with sudden onset of left lumbar pain irradiate into the left flank and left iliac fosse (on the way of left ureter), pollakiuria, dysuria and macroscopic hematuria. At the objective examination: BP=130/80 mmHg, HR rhythmic=78 bates/min, normal vesicular sound, Giordano sign positive on left side, costovertebral and costo-muscle points sensible on left side, superior and middle ureteral points sensible. For this reasons the doctor from penitentiary sent the patient in emergency with the diagnosis: left renal colic, left kidney stone. The results of blood tests were in normal range, except the level of Hb=10 g/ dl, Ht=42%, red blood cells =3.7 million cells/mcL. The abdominal ultrasound image showed all the organs normal, both kidneys normal as well but unexpected a free fluid collection around the spleen in small quantity but the capsule of the spleen apparent intact and without free liquid collection in the Douglas cavity. An abdominal CT was performed and relieved the same image with fluid collection around the spleen and all the organs normal. The patient was referred to the surgery department with suspicion of possible spleen fine fissure unobservable at echo and CT scan, because of the free fluid collection around the spleen, indifferent that the patient didn’t recognize any trauma. After abdominal laparotomy, spleen was normal with intact capsule without any fissure and fresh blood around the spleen, but this came from a big hematoma localized in the posterior wall of the left kidney and migrates around the spleen and was solved with good evolution of the patient.
Results & Discussions: The clinical case is surprising and particular because in the first instance, the symptoms and signs suggest a left renal colic and the normal image of the kidney at abdominal ultrasound and CT scan not confer us safe that everything is normal, because it isn’t possible to see the posterior wall of the kidney. Because the free fluid appears around the spleen, suggest in the first instance a possible fissure of the spleen, but in reality the fluid was migrated from big posterior hematoma of the left kidney, impossible to be detected. The diagnosis was really difficult, the convict and the policemen as well, didn’t recognize trauma, but the reality was that the convict was hit-creamed without any ecchymosed on the skin. Conclusion: Indifferent if a convict patient didn’t recognize trauma, in this context of couple: policemen-convict, we must suspect a possible undeclared trauma.

Biography:

Dr. Himidan obtained an MBBS from King Abdul Aziz University and finished a year of internship there in 1990. Subsequently, she completed a general surgery residency program at the University of Toronto followed by a year of Paediatric Critical Care at The Hospital for Sick Children. She completed her Paediatric General Surgery training at Baylor College of Medicine and Texas Children’s Hospital. 

Prior to moving back to Toronto, Dr. Himidan spent three years as a full-time paediatric surgeon in Regina, Saskatchewan and as a clinical assistant professor at the University of Saskatchewan. Her clinical practice includes the care of children with neonatal and paediatric surgery diseases with a special interest in congenital anomalies, minimally invasive procedures and inflammatory bowel disease.

Abstract:

In the modern era, the role of pediatric surgeons has changed from one that has a tremendous impact on individual patients or a moderate influence within small communities served to a leading role in technology development, global health care and sustainability of health care.

This presentation will discuss this expanding role pediatric surgeon. It will illustrate how pediatric surgeons made the transition from being mere clinicians into this evolving identity, capacity and capability of the future surgeon.

Biography:

Guosheng Wu is a professor of the Gastrointestinal Surgery at the Xijing Hospital, Xi’an, China. I received my M.D. from the Fourth Military University and Ph.D. from the Karolinska Institute, Sweden. After ten-year training as a clinical transplant fellow both at the Miami Transplant Institute and the University of Pittsburgh Medical Center, I returned to Xi’an, Where I accepted a tenure position at the Xijing Hospital. In addition to routine GI surgery, I am especially focusing of clinical intestinal transplantation, intestinal auto-transplantation, and complicated Whipple’s procedure.

Abstract:

Abdominal tumors involving the root of the superior mesenteric and/or celiac arteries were deemed unresectable with conventional surgical techniques. We report a series of patients undergoing temporary removal of a healthy segmental intestine followed by radical tumor resection and autotransplantation of the excised intestine in our center and evaluate surgical indications, technical feasibility and clinical outcomes after this procedure. From March 2011 to June 2016, intestinal autotransplantation was performed in ten patients (9 males, 1 female; average age 52 years old). A primary diagnosis includes mesenteric desmoid tumor in 3, pancreatic pseudopapillary tumor in 2, pancreatic ductal carcinoma in 2, pancreatic neuroendocrine tumor in 2, and retroperitoneal ganglioneuroma in 1. All cases had a previous surgical history of a failed attempt to remove the tumors in outside institutions. One patient died secondary to ischemic acute pancreatitis 30 days after the procedure. The remaining nine patients survived with no evidence of tumor recurrence currently at an average of 18 months (range, 2-49 months) follow-up. Of those, one patient lost the intestinal autograft due to thrombosis of the superior mesenteric artery two days after surgery and has been thereafter dependent on total parenteral nutrition. The other 8 patients had a well-functioning autograft with no requirements for parenteral nutritional support or any intravenous fluid hydration since hospital discharge. Intestinal auto-transplantation is suitable for locally invasive mesenteric tumors with major vascular involvement and is associated with good outcomes for selective patients. The procedure is technically challenging and should be performed in a center experienced in intestinal transplantation.

Biography:

Assoc. Prof. Dr. Dida Kazakova has completed her PhD from University of Cologne – Germany. She is a fellow of the European Glaucoma Society. She is elected Associated Professor in Ophthalmology in the Medical Faculty of the Sofia University. She is Professor of Ophthalmology in the Medical Faculty of the Sofia University. She has several specializations in the field of glaucoma in Moscow, London, Lausanne, Basel, Leipzig, Cologne, etc. She has published more than 50 papers in the field of glaucoma.
                                      

Abstract:

Glaucoma has traditionally been classified as an ophthalmic disease associated with increased intraocular pressure and, accordingly, has been treated with antihypertensive drugs. However, retinal ganglion cells often continue to degenerate even when the pressure is reduced to normal level. Glaucoma a progressive optic neuropathy, is phenomenologically defined as a disease characterized by the loss of retinal ganglions cells and their axons, and tissue remodeling involving both the optic nerve head and the retina. In 1968, Cairns described the first successful trabeculectomy technique. Several techniques of the non-penetration filtering surgery based on sinusotomy published by Krasnov in 1968 have been described. Deep Sclerectomy is a operation with the patients with uncontrolled IOP (intraocular pressure) in open angle glaucoma. Postoperative IOP decreased significantly in the most of the patients. Some eyes had an  postoperative increase of IOP and additional procedures were performed, such a goniopuncture with Nd:Yag laser, or postoperative subconjunctival injections of mitomycin C. Non-penetration glaucoma surgery is the best treatment for open-angle glaucoma.NPGS targets the presumed site of pathology, namely the trabecular meshwork. Conventional glaucoma surgery in cases with high myopia carries a hiqh risk of complications because of the abnormal globe dimensions. Choroidal detachments and consequent shallow anteriors occur in 15% of trabeculectomies.NPGS appears to offer glaucoma patients a suffer outcome because of the gradual intraoperative IOP reduction. There are two areas of interest in the study of mechanisms involved in the efficiency and safety of non-penetrating surgeries: aqueous humor flow through the trabeculo-Descement's membrane; the created trabeculo-Descemet's window, allowing a progressive drop in IOP while at the same time offering enough resistance to prevent the immediate postoperatve complications. After aqueous humor passage through the trabeculo-Descemet's membrane, four mechanisms of aqueous resorption may occur: 1. a subconjunctival filtering bleb; 2. an intrascleral bleb with probable new aqueous drainage veins; 3. a suprachoroidal passage with hypotetical increased uveoscleral outfl

Biography:

Ashaolu James Olumide is a Senior Lecturer and the Current Head of the Department of Anatomy, University of Medical Sciences in Nigeria. He has published about 31 articles in the area of Clincal Anatomy and Gravitational Biology. He has lectured the subject of Anatomy for about ten years in different Medical Institutions in Nigeria including Nnamdi Azikiwe University, Bowen University and the University of Medical Sciences. He is an Editor and Reviewer to many International Journals and is a National Postgraduate Award winner  in Anatomy in Nigeria. He discovered the triradiate collateral ligament of knee, the four-headed gastrocnemius muscle and the rediscovered the cystoduodenal ligament.

Abstract:

The knee is the most complex joint in the human body. It is constituted by bones such as the femur, tibia, fibula and patella which are held together as a component by ligaments while the  knee movement is created by the surrounding muscles. There is paucity of information regarding the morphological variation of knee ligaments and muscles in African subjects while surgical and radiological assessments have relied on informations derieved from caucasian specimens and it was usually expected that the world human population has almost similar anatomical arrangement. The knowlegde of  ligamentous and muscular variations around the knee in Africans is important in clinical diagnosis and surgical interventions, not only to African surgeons but also to the international surgical community, considering how medical tourism has created global patient flow. The anterolateral ligament was lately reported as a dominant structure often omitted and of high biomechanical and clinical importance. However, studies on African subjects have provided contrasting information as regards anterolateral ligament high dominance  and another prevalent ligament newly named the triradiate collateral ligament was discovered which possessed three arms and would inform  unique surgical approach. Again, It was observed that the lateral collateral ligament may not always be present. Studies on the medial aspect of knee in African subjects have re-classified the pes anserinus due to its extensive variability from the regular knowlegde. Pes anserinus in African subjects inserted differently from the regular pattern and the tendinous constitution was  also uncommon. Examination of the muscles of the posterior aspect of the knee in African subjects has also shown that the gastrocnemius muscle four-headed  pattern is dominant as against the two-headed pattern in other populations previously reported. Studies are underway to examine the cruciate ligaments  and  include wider African subjects. Magnetic resonance and ultrasographic imaging of the newly discovered ligaments and muscles are being investigated to aid clinical identification. Moreover, the unique structural patterns of the musculo-ligamentous entities of the knee in Africans suggest different development and ecomorphological adaptation, and therefore require a complementary surgical approach.

Biography:

He is working as Lecturer in Transplantation & Hepatobiliary & Pancreatic Surgery depart. National Liver Institute-Menoufyia University. He does most Hepatobiliary procedures including liver resection, bile duct excision, whipple operation, surgery for klatskin tumor, Kassai operation, and biliary reconstruction. laparotomy for peritonitis, haemorrhage and bowel obstruction, open and  laparoscopic (Cholecystectomy, CBD exploration), open and laparoscopic splenectomy, Laparoscopic appendectomy, laparoscopic hydatid endocystectomy, laparoscopic non-anatomical liver resection and left lateral segmentectomy, anal operations, all types of Hernia Repair and major wound dehiscence. He teaches the residences and the assistant lecturers the different Hepatobiliary and pancreatic surgical operations through the operative rooms and surgical rounds. I teach the postgraduate students the following 3 lecturers 1- Neonatal cholestasis 2- Recent trends in management of CBD stones. 3- Post cholecystectomy syndrome. 4- Conservative management (NOM) of adult abdominal trauma.5- NLI HCC guidelines. He is a supervisor of 3 master theses. He is one of the editorial board of the advanced in medical oncology research (AMOR) journal. He is one of the editorial boards of Gavin Journal of Oncology Research and Therapy. He is one of the editorial boards of Henry Journal of Cellular & Molecular Oncology. I am one of the editorial boards of Austin herpetology journal. I am a reviewer in the world journal of gastroenterology.
                                                   

Abstract:

Objectives: Laparoscopic cholecystectomy–associated bile duct injury (LC-BDI) continues to be a clinical problem with significant peri-operative morbidity and reduced long-term survival for patients. The aim of this study was to analyze the outcome of surgical management of LC related major bile duct injury. Patients and methods: We retrospectively reviewed and analyzed 69 patients underwent surgical management of LC related major BDI, in the period from mid 2011 to mid 2016. The overall male/female ratio was 31/38. Results: Regarding BI type; the Leaking, Obstructing, leaking and obstructing, leaking and vascular, and obstructing and vascular injuries were 43.5% (n=30), 27.5% (n=19), 18.8%(n=13), 2.9%(n=2), and7.2%(n=5) respectively. However, external biliary fistula affected 60.9 %(n=42). As regard Strasberg classification of injury, it was as follow:  D=1, D, E1=2, D, E2=5, E1=22, E2=27, E3=8, and E4=4. Laparotomy, Endoscopic, and Radiologic interventions were performed before definitive treatment in 30.4 %( n=21), 50.7 %(n=35), and 37.7%(n=26) of patients respectively. The definitive procedure was as follow: 1ry repair with stent, End to end anastomosis with stent, HJ with stent, Rt hepatectomy plus  biliary reconstruction with stent, and HJ in 1.4%(n=1), 2.9%(n=2), 58%(n=40), 8.7%(n=6), and 29%(n=20) of patients respectively. According to time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and1.5 months), and late (after1.5  months) management were 13 %( n=9), 14.5 %( n=10), and 72.5 %( n=50) respectively. The hospital and 1month (early) morbidity after definitive treatment were 21.7 %( n=15), while, late biliary morbidity was 17.4 %( n=12), however, the overall mortality was 2.9 %( n=2), on the other hand, late biliary morbidity free survival was 79.7%(n=55). On univariate analysis, the following factors were significant predictors of (early) morbidity; Sepsis at referral, E4 injury, associated vascular injury, Rt hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sep

Biography:

Dr. G. Bernard Taylor is a native Carolinian who attended North Carolina State University for his undergraduate studies before obtaining his medical degree from the University of North Carolina at Chapel Hill. He then came to Carolinas Medical Center and completed his residency in obstetrics and gynecology before entering private practice. Because of his love for teaching and the intellectual pursuits of academic medicine, he returned to training and completed a fellowship in urogynecology and pelvic surgery at Northside Medical Center in Atlanta, Georgia.

He is also a fellow of the American College of Obstetrics and Gynecology and board-certified in obstetrics and gynecology, pelvic medicine and reconstructive surgery. Dr. Taylor's clinical interests are minimally invasive gynecologic surgery, reconstructive vaginal surgery for prolapse and mesh complications, urinary and fecal incontinence and female external genitalia reconstruction. He has published several papers and served as a reviewer for a number of peer-reviewed journals in obstetrics and gynecology.

Dr. Taylor is the assistant program director of the female pelvic medicine and reconstructive surgery fellowship at Carolinas HealthCare System and sees patients at both the Charlotte and Concord locations of the Women's Center for Pelvic Health.

                                          
 

Abstract:

Background: The vaginal surgeon is challenged with performing complex procedures within a surgical field of limited light and exposure.
Instrument: The video telescopic operating microscope is an illumination and imaging system that provides visualization during open surgical procedures with a limited field of view. The imaging system is positioned within the surgical field and then secured to the operating room table with a maneuverable holding arm. A high definition camera and Xenon light source allow transmission of the magnified image to high definition monitor in the operating room. The monitor screen is positioned above the patient for the surgeon and assistants to view real-time throughout the operation.
Experience: The video telescopic operating microscope system was used to provide surgical illumination and magnification during total vaginal hysterectomy and salpingectomy, mid urethral sling, and release of vaginal scar procedures. All procedures were completed without complications. The video telescopic operating microscope provided illumination of the vaginal operative field and display of the magnified image onto high definition monitors in the operating room for the surgeon and staff to simultaneously view the procedures.
Conclusion: The video telescopic operating microscope provides high definition display, magnification, and illumination during vaginal surgery.
 

Biography:

Michaella Cameron is a core surgical trainee in her first year and works at the East Sussex Healthcare trust.

                                                        

Abstract:

Cutaneous endometriosis is rare and represents less than 5.5% of known endometriosis cases. Endometrioma typically occurs in women of reproductive age. However, we describe a postmenopausal case of cutaneous endometriosis with an atypical presentation.

A 66-year-old woman presented to the surgical assessment unit with a short history of a new palpable umbilical lesion. Nine months prior she had been diagnosed with invasive lobular breast carcinoma. Her treatment consisted of a mastectomy with axillary nodal clearance and radiotherapy. Her medical history included a hysterectomy and bilateral salpingooophrectomy for endometriosis (2000) and laparoscopic appendectomy (1986). She had been taking anastrazole following her breast cancer surgery.

A computed tomography staging scan excluded metastatic spread. An ultrasound described a soft tissue umbilical mass. Biopsy of the mass revealed endometrial type glands with surrounding endometrial type stroma, which appeared non-functional.

Subsequently, an approach of ‘watchful waiting’ was adopted instead of surgical excision.

Our patient did not present with typical symptoms of endometriosis, such as cyclical pain or bleeding. We hypothesize that the endometrial cells had implanted following her previous surgeries. However, this secondary form of cutaneous endometriosis presented markedly late and seemed to occur in the context of anastrazole (aromatase inhibitor).

Clinical presentation of cutaneous umbilical endometriosis can mimic malignancies; especially in the context of recently diagnosed cancer. Histopathological examination is the gold standard and the diagnosis will exclude malignancy. Further clinical studies are needed to investigate the effi

Biography:

Vestibular rehabilitation is one of the optimum treatments to promote the recovery among vestibular disordered patients. The effectiveness of these physical therapies has been clearly demonstrated. In fact, having an effective therapy that is home based offers many advantages to the patients and clinicians. The video-guided instructions are presented clearly in a systematic manner targeting different parts of the balance system. Zainun and her colleagues (2009) had developed the first video guided exercise that is home-based known as far; Bal Ex is available in ten languages including: Malay, English, Mandarin, Hokkien, Tamil, Persian, Arabic, Nigerian, Cantonese and Spanish version. This module was adapted with permission and underwent some modifications from the original version, i.e., CCCE (Pavlou et al., 2004). Bal Ex consists of twenty two movements divided into three levels include head and neck, positioning and postural movement. This module has many advantages which are easy to perform as there are step by step instructions presented with audio and visual cues. Second, since it is home-based, the patients do not have to travel frequently to the hospital for treatment. This is also practical for patients with reduced mobility and it also offers more flexibility. Indirectly, it is also cost-effective in a long run. Vestibular rehabilitation is one of the alternative treatments to promote the recovery among vestibular disordered patients. The effectiveness of these physical therapies has been clearly demonstrated. In fact, having an effective therapy that is home based offers many advantages to the patients and clinicians. The video-guided instructions are presented clearly in a systematic manner targeting different parts of the balance system. Future studies should concentrate on comparing the effectiveness of this video module between PVD and central vestibular disorder cases. It is also of interest to see whether this physical exercise is also helpful in other pathological group such as stroke.

Abstract:

Zuraida Z is a Senior Medical Lecturer in the Audiology program, School of Health Sciences, Universiti Sains Malaysia (USM). She has received her Medical degree (MD) from USM in 2002 and Master of Science (Medical Audiology) in 2010 from the same university. She has also been an active Researcher in the field balance and vestibular and has published more than 60 papers including journal, oral, books and proceedings. She is currently developing a virtual vestibular rehabilitation procedure for balance disordered patients.

Biography:

Introduction & Objective: There is a steady increase in prevalence of obesity over last 2-3 decades to the extent of global epidemic. Overall, 25% of world population is reported to be overweight and 10% are obese. According to one report, one in every four individuals in Pakistan is either overweight or obese. The evolutionary origin of obesity points towards survival advantage of obese
individuals, but in modern way of living, advantages of obesity are lost and hazardous effects have become more prominent including cardio-metabolic risk factors and some malignancies. There is very scanty information in medical literature about value of fat stores in critically ill patients; therefore the present study objective was to measure the impact of obesity upon mortality rate in patients admitted in surgical Intensive Care Unit.
Methodology: This was a prospective cohort study conducted in Intensive Care Unit (ICU) of Aga Khan University Hospital Karachi, Pakistan. All adult patients of both gender of age >16 years were eligible for inclusion in this study. Patients with diagnosis of malignant diseases, those shifted to other hospitals or shifted to ICU of this hospital and patients with ICU stay of <24 hours were excluded from the study group.
Results: A prospective data of 260 patients admitted to ICU was gathered on a pro forma designed for the study. The mean age and standard deviation of the study population were found to be 48.29±18.97 years. There were 172 (66.2%) male and 88 (33.8%) females in the study group. Measurement of mid arm circumference 44% of patients were found to be obese. BMI was calculated for
all patients; 35% were over-weight and 40% were in obesity class. Ninety percent of the patients were admitted through emergency department and gross ICU mortality was found to be 48.5%. Multivariate logistic regression analysis was performed to identify the risk factors of mortality in ICU patients. The results showed BMI and APACHE score to be statistically independent variables to predict mortality. Mortality rate of overweight patients were found to be low than normal weight or obese patients i.e. 40%, 48% and 56%, respectively. Ischemic heart disease was found to be statistically independent predictor of prolong ICU stay.
Conclusion: Overweight could be potentially protective for critically ill patients admitted to ICU as compared to patients in normal weight categories and those in obesity class.

Abstract:

Noman Shahzad is a General Surgery Resident at The Aga Khan University Hospital (AKUH) Pakistan. He has recently completed his licensure requirement to practice general surgery in Pakistan. He is also a Member of Royal College of Surgeons of England. He has keen interest in trauma surgery and critical care management and has published in this field.

Biography:

Dr.Sherin.A.Khalam, BDS, MDS(OMFS),MSc(PSY),FICOI, is an associate professor, Oral & Maxillofacial Surgery, PMS College of Dental Science and Research,Trivandrum,India. He is the surgical head, Department of Dental and Maxillofacial Surgery, SUT Royal Hospital,Trivandrum. He is the Director of The Khalams Medical Centre, Attingal,Trivandrum. He is a fellow of International Congress of Oral Implantologists(USA). Completed BDS from Vinayaka Missions University and MDS from Annamalai University. He completed his MSc in Clinical Psychology from Tamilnadu University. He is having more than 50 international publications in his credit. He had completed advanced training in Implantology from Lleida,Barcelona,Spain. He is a researcher in biomaterials for maxillofacial prosthesis.He is the Course Co Ordinator, University of Genova,Italy for Fellowship in Dental Implantology and Diploma In Laser Dentistry for India.Conducted many international CDE programs, workshops and scientific symposiums as Key note Speaker and Organiser.

Abstract:

Purpose: The aim of our study was to evaluate the effect of coronoidectomy with excision of fibrotic bands as an operative technique in management of oral submucous fibrosis.

Materials and Methods: A  patient  with histologically  proven lesions of category Group IV A ( severe trismus with an interincisal distance of less than 15 mm and extensive fibrosis of all the oral mucosa.) case of oral submucous fibrosis, having a mouth opening of 12mm was surgically treated. The procedure involved (1) bilateral release of fibrotic bands (2) bilateral coronoidectomy and (3) no reconstruction, covering the buccal defects with collagen membrane. Regular physiotherapy and follow up were done and results were assessed by comparing the preoperative and postoperative mean intraoperative inter incisal distance.

Results: The intraoperative inter incisal distance after band excision and coronoidectomy increased up to 38.0 mm. The mean mouth opening after 1 year follow up was found to be 39.6mm.

Conclusion: In management of oral submucous fibrosis ,the procedure of coronoidectomy after fibrotic band release had excellent results with adequate mouth opening and no recurrence was noticed until the last follow up.

Biography:

Juan C Gomez-Izquierdo is currently pursuing PhD in Experimental Surgery at McGill University. He has completed a Research Fellowship in Department of Anesthesia at the same university and obtaining Medical Residency training at Jewish General Hospital in Montreal. He has completed his Medical degree at Pontificia Universidad Javeriana. He has co-authored different papers in perioperative care and goal directed fluid therapy, including meta-analyses, randomized controlled trials, cohort studies and three book chapters. His area of interest includes epidemiology, evidence-based medicine and hospital care.

Abstract:

Goal directed fluid therapy (GDFT) optimizes oxygen delivery by guiding fluid administration using cardiac output analysis. It has demonstrated to enhance the bowel function and to decrease the incidence of postoperative primary ileus (PPOI) in some clinical trials. Bowel perfusion is critical for bowel motility; thus, an improvement of the splanchnic blood flow might explain the effects of GDFT on bowel function. Nowadays, it is feasible to evaluate tissue  microcirculation at the patient’s bedside with side stream dark field (SDF) technology. A cohort of 24 patients undergoing colorectal surgery in an enhanced recovery program at the Montreal General Hospital and receiving either intraoperative GDFT (eight patients) or standard fluid therapy (16 patients) was followed and microcirculatory measurements were done using the MicroScan, MicroVision Medical at seven different perioperative time points. Bowel function and incidence of PPOI were assessed. PPOI was found in three patients in GDFT and three patients in the standard fluid therapy exposure (p=0.643). The overall perioperative proportion of perfused vessels (PPV) was higher in the GDFT exposure (p=0.023); and specifically on postoperative (POP) day three (p=0.032). There was no significant difference in other
microcirculation outcomes. To conclude, GDFT improves the PPV, a key factor for oxygen extraction in the tissues, effect that was sustained until postoperative day three. GDFT also demonstrated a more stable oxygen delivery throughout the surgery. Nevertheless, these physiological effects did not translate into a better postoperative bowel function in GDFT compared to standard fluid therapy.

Biography:

Dr. Ronald N. Bogdasarian earned his MD degree at the age of 28 from The Commonwealth Medical College in Scranton, PA, USA.  He is currently a second year resident physian in the Rutgers New Jersey Medical School Division of Plastic Surgery.  During medical school, he published several peer reviewed articles and book chapters and presented multiple posters on various medical and surgical topics.  
                                                        

Abstract:

In this poster we will present our recent institutional experience with giant facial neurofibromas.  Drawing upon a recent comprehensive literature review, we will discuss indications for surgery, preoperative management, surgical technique, outcomes, and postoperative management for the treatment of this complex condition.

Biography:

Juan C Gomez-Izquierdo is currently pursuing PhD in Experimental Surgery at McGill University. He has completed a Research Fellowship in Department of Anesthesia at the same university and obtaining Medical Residency training at Jewish General Hospital in Montreal. He has completed his Medical degree at Pontificia Universidad Javeriana. He has co-authored different papers in perioperative care and goal directed fluid therapy, including meta-analyses, randomized controlled trials, cohort studies and three book chapters. His area of interest includes epidemiology, evidence-based medicine and hospital care.

Abstract:

Goal directed fluid therapy (GDFT) optimizes oxygen delivery by guiding fluid administration using cardiac output analysis. It has demonstrated to enhance the bowel function and to decrease the incidence of postoperative primary ileus (PPOI) in some clinical trials. Bowel perfusion is critical for bowel motility; thus, an improvement of the splanchnic blood flow might explain the effects of GDFT on bowel function. Nowadays, it is feasible to evaluate tissue microcirculation at the patient’s bedside with side stream dark field (SDF) technology. A cohort of 24 patients undergoing colorectal surgery in an enhanced recovery program at the Montreal General Hospital and receiving either intraoperative GDFT (eight patients) or standard fluid therapy (16 patients) was followed and microcirculatory measurements were done using the MicroScan, MicroVision Medical at seven different perioperative
time points. Bowel function and incidence of PPOI were assessed. PPOI was found in three patients in GDFT and three patients in the standard fluid therapy exposure (p=0.643). The overall perioperative proportion of perfused vessels (PPV) was higher in the GDFT exposure (p=0.023); and specifically on postoperative (POP) day three (p=0.032). There was no significant difference in other microcirculation outcomes. To conclude, GDFT improves the PPV, a key factor for oxygen extraction in the tissues, effect that was sustained until postoperative day three. GDFT also demonstrated a more stable oxygen delivery throughout the surgery. Nevertheless, these physiological effects did not translate into a better postoperative bowel function in GDFT compared to standard fluid therapy.

Biography:

Noman Shahzad is a General Surgery Resident at The Aga Khan University Hospital (AKUH) Pakistan. He has recently completed his licensure requirement to practice general surgery in Pakistan. He is also a Member of Royal College of Surgeons of England. He has keen interest in trauma surgery and critical care management and has published in this field.

Abstract:

Introduction: Though short term survival advantage of damage control laparotomy in management of critically ill trauma patients is established, there is little known about the long term quality of life of these patients. Facial closure rate after damage control laparotomy is reported to be 20-70%. Abdominal wall reconstruction in those who failed to achieve facial closure is challenging and can potentially affect quality of life of these patients.
Method: We conducted retrospective matched cohort study. Adult patients who underwent damage control laparotomy from January 2007 till June 2013 were identified through medical record. Patients who had concomitant disabling brain injury or limb injuries requiring amputation were excluded. Age, gender and presentation time matched non exposure group of patients who underwent
laparotomy for trauma but no damage control were identified for each damage control laparotomy patient. Quality of life assessment was done via telephonic interview at least one year after the operation, using Urdu version of EuroQol Group Quality of Life (QOL) questionnaire EQ5D after permission. Wilcoxon signed rank test was used to compare QOL scores and McNemar test was used to compare individual parameters of QOL questionnaire. Study was approved by institutional ethical review committee.
Results: Out of 32 patients who underwent damage control laparotomy during study period, 20 fulfilled the selection criteria for which 20 matched controls were selected. Median age of patients (IQ range) was 33 (26-40) years. Facial closure rate in damage control laparotomy group was 40% (8/20). One third of those who did not achieve facial closure (4/12) underwent abdominal wall
reconstruction. Self-reported QOL score of damage control laparotomy patients was significantly worse than non-damage control group (p=0.032). There was no statistically significant difference in two groups regarding individual QOL measures. Significantly more patients in damage control group were requiring use of abdominal binder and more patients in damage control group had to either change their job or had limitations in continuing previous job. Our study was not adequately powered to detect factors responsible for worse QOL in damage control group.

Conclusion: Quality of life of damage control patients is worse than their age and gender matched patients who underwent trauma laparotomy but not damage control. Adequately powered studies need to be conducted to explore factors responsible for this finding for potential improvement.

Biography:

Sherin A Khalam is an Associate Professor at PMS College of Dental Science and Research, India. He is the Surgical Head of the Department of Dental and Maxillofacial Surgery, SUT Royal Hospital, Director of Khalams Medical Centre and a Fellow of International Congress of Oral Implantologists, USA. He has completed his BDS from Vinayaka Missions University, MDS from Annamalai University and MSc in Clinical Psychology from Tamil Nadu University. He has more than 50 international publications to his credit. He has completed advanced training in Implantology from Lleida, Barcelona, Spain and was course Coordinator at University of Genova, Italy.

Abstract:

Aim: The aim of our study was to evaluate the effect of coronoidectomy with excision of fibrotic bands as an operative technique in management of oral submucous fibrosis.
Materials & Methods: A patient with histologically proven lesions of category group IV A (severe trismus with an interincisal distance of less than 15 mm and extensive fibrosis of all the oral mucosa) case of oral submucous fibrosis, having a mouth opening of 12 mm was surgically treated. The procedure involved bilateral release of fibrotic bands, bilateral coronoidectomy and no reconstruction covering the buccal defects with collagen membrane. Regular physiotherapy and follow up were done and results were assessed by comparing the preoperative and postoperative mean intraoperative inter incisal distance.
Results: The intraoperative inter incisal distance after band excision and coronoidectomy increased up to 38.0 mm. The mean mouth opening after one year follow up was found to be 39.6 mm.

Conclusion: In management of oral submucous fibrosis, the procedure of coronoidectomy after fibrotic band release had excellent results with adequate mouth opening and no recurrence was noticed until the last follow up.

Biography:

Alessandro Bucci is a Reserve Medical Officer of Italian Navy. He has Fellowship experienced in Otolaryngology at University Hospital, Cadiz, Spain. He was a Consultant in Otolaryngology. He has Fellowship in Facial Plastic Surgery (AMC) and OSAS at Sint Lucas Andreas Hospital, Amsterdam, Netherlands and in Facial Plastic Surgery at C. Garcia University Hospital, Cuba. He is a dedicated ENT Specialist Surgeon with 14 years of experience providing the highest standard of treatment. His research focused on rhinology/rhinoallergology, OSAS and dysphagia

Abstract:

The aim of this study was to identify patterns of airway collapse and sites of obstruction during drug induced sleep endoscopy (DISE) as predictors of surgical failure following multilevel airway surgery or just somnoplasty for patients with obstructive sleep apnea syndrome (OSAS). A systematic review was performed of studies using DISE to identify sites and patterns of obstruction in patients with OSAS. Medical records of all adult patients undergoing diagnostic DISE at our Centre for Diagnosis and Treatment of Respiratory Sleep Disorders as part of their surgical evaluation were reviewed. For each patient, we recorded obstruction sites, obstruction patterns and the effects of the mandibular pull-up manoeuvre on both obstruction and snoring. We compared the results of clinical and diagnostic evaluation with those of sleep endoscopy. According to other authors, considering a complete obstruction of 100%, we found that palatal obstruction was the most frequently observed site of obstruction, followed by tongue base obstruction, laryngeal obstruction and hypopharyngeal obstruction. DISE is mandatory in the diagnostic work-up of OSA and is a valid addition when surgery is considered. DISE is a dynamic, safe and easy-to-perform technique that visualizes the anatomical sites of snoring or apneas and guides the design of a tailor-made treatment plan in individual cases improving the qualitative and quantitative results of treatment. Understanding the sites of collapse is mandatory for surgical treatment decision-making in obstructive sleep-apneahypopnea syndrome patients. Moreover, it could help prevent unrealistic expectations regarding the available treatment for each patient

Biography:

Antje-Christin Deppe earned  her medical degree at the age of 27 years from Heinrich-Heine University od Düsseldorf and finished postdoctoral studies 2010. She finised cardiothoracic residency and is now the head of the cardiothoracic intensive care unit at the department of cardiothoracic surgery at university hospital of colgne.
                                               
 

Abstract:

Objectives
Severe bleeding related to cardiac surgery is associated with increased morbidity and mortality. Thrombelastography (TEG and thrombelastometry (ROTEM are point-of-care tests (POCT). Bedside  POCT provides goal-directed, individualized coagulation therapy. In this meta-analysis we aimed to determine the current evidence for or against POCT-guided algorithm with ROTEM/TEG patients with severe bleeding after cardiac surgery.

Methods
We performed a meta-analysis of randomized controlled trials (RCT) and observational trials (OT). Trials comparing transfusion strategy guided by TEG/ROTEM with a standard of care control group undergoing cardiac surgery were included. In addition at least one desiered clinical outcome had to be mentioned: mortality, re-thoracotomy rate, sternal would infection, and acute kidney injury. Also surrogate parameters such as transfusion requirements and amount of blood loss were analyzed.

Results: The literature search retrieved a total of 17 trials (9 RCT and 8 OT) involving 8,332 cardiac surgery patients. POCT guided transfusion management significantly decreased the odds for patients to receive allogeneic blood products (OR 0.63, 95%-CI 0.56 to 0.71; p<0.00001) and the re-thoracotomy rate due to postoperative bleeding (OR 0.56, 95%CI 0.45 to 0.71; p<0.00001). Furthermore, the incidence of postoperative acute kidney injury was significantly decreased in the TEG/ROTEM group (OR 0.77; 0.61 to 0.98; p=0.0278). No statistical differences were found with regard to mortality.

Conclusions: TEG/ROTEM based coagulation management decreases the risk of allogeneic blood product exposure after cardiac surgery. Furthermore, it results in significantly lower re-exploration rate, decreased incidence of pos

Biography:

Dr. Marzan has completed his MD from the University of Santo Tomas. He is the current chief resident of the Accredited Consortium in Education for Surgery, an accredited General Surgery training program in Naga City, Philippines. In 2015, he was invited as an speaker in the American College of Surgeons Clinical Congress, Chicago, IL, USA on his video on Superficial Parotidectomy.

Abstract:

An absent or inadequate penis is a devastating condition with significant psychological, sexual, social, and physical impact. Penile carcinoma with invasion of the shaft with an inadequate length is usually treated with Total Penectomy with Perineal Urethrostomy. In the Philippines, there is no literature that can trace back the roots of penile reconstructive surgery or even a single case ever performed. This is the first documented case of Total Penile Reconstruction for Penile Carcinoma in the Philippines. This is a case of a 48 year-old Filipino male with Squamous Cell Carcinoma of the penis who underwent Total Penectomy and the first Total Penile Reconstruction using an Anterolateral Thigh Flap in the Philippines. We are presenting our technique of Penile reconstruction using an Anterolateral Thigh Flap. Elliptical incision is made around the base of the penis, dissection is commenced in the plane between the tunica albuginea and Buck fascia dorsolaterally, and the dorsal vessels are ligated and divided. Corporeal bodies are sharply transected, and the urethra is divided at the same level. The corpora are then closed with interrupted horizontal mattress sutures.The dissection started, identifying the descending branch of the lateral circumflex femoral artery to its origin, and then the lateral cutaneous nerve of the left thigh was identified at the proximal border of the flap and dissected 5 cm in length. During the dissection, two perforators within the flap were identified and maintained. The flap was harvested as an island flap based on both perforating vessels and the pedicle was dissected up to its origin. Urethra and neopenis was constructed using tube over tube technique. Inset of the neopenis was then made thru tunnelling underneath the femoris muscle through an incision in the left groin region.  Flap was then sutured to the periosteum of the pubic region. The neourethra was anastomosed to the remaining corpus spongiosum with adequate spatulation using chromic 4-0. Flap donor site closure was done with split thickness skin graft harvested from the hypogastric area. At present patient is able to urinate in a standing position.

Biography:

Susanna Simberg is a Speech Language Pathologist and Professor of Logopedics at Åbo Akademi University and University of Oslo, Norway. She has been doing
research on occupational voice disorders and exploring the rationale on voice therapy methods in the clinic.

Abstract:

Voice disorders are common but most available methods for therapeutic treatment and are not fully scientifically explored. Phonation into glass tubes, keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland since the 1960s, and more recently also in other countries. This method is used in voice therapy for different groups of patients, such as patients with functional voice disorders, vocal nodules and patient suffers from incomplete vocal fold closure, for example due to recurrent laryngeal nerve paresis. Earlier results have suggested that the method affects the vocal apparatus in various ways. It has been proposed that the training alters vocal fold vibratory patterns, collision threshold pressure and the vertical position of the larynx. The method also increases and modulates the intraoral pressure, and both the magnitudes of the pressure variations as well as the average pressure increase are directly related to the water depth. This workshop consists of two parts (45+30 min). The first part gives a clinical demonstration of the resonance tube method and presents some examples on how it can be used in various ways depending on the kind of voice disorder and the aims of the therapy. The second part will give an overview of previous results and on-going research on the method, enabling the participants to interpret the rationale of this voice therapy method with regards to current knowledge. 10 participants can take active part in the workshop, while 30 can be in the audience.

Biography:

Greta Wistbacka is a Speech Language Pathologist and pursuing her PhD in Logopedics at Åbo Akademi University in collaboration with the Karolinska Institutet in Stockholm, Sweden. The focus of her research is on “The use of semi-occluded vocal tract exercises in voice therapy”.

Abstract:

Voice disorders are common but most available methods for therapeutic treatment and are not fully scientifically explored. Phonation into glass tubes, keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland since the 1960s, and more recently also in other countries. This method is used in voice therapy for different groups of patients, such as patients with functional voice disorders, vocal nodules and patient suffers from incomplete vocal fold closure, for example due to recurrent laryngeal nerve paresis. Earlier results have suggested that the method affects the vocal apparatus in various ways. It has been proposed that the training alters vocal fold vibratory patterns, collision threshold pressure and the
vertical position of the larynx. The method also increases and modulates the intraoral pressure, and both the magnitudes of the pressure variations as well as the average pressure increase are directly related to the water depth. This workshop consists of two parts (45+30 min). The first part gives a clinical demonstration of the resonance tube method and presents some examples on how it can be used in various ways depending on the kind of voice disorder and the aims of the therapy. The second part will give an overview of previous results and on-going research on the method, enabling the participants to interpret the rationale of this voice therapy method with regards to current knowledge. 10 participants can take active part in the workshop, while 30
can be in the audience.

Biography:

Mariyah Selmi is a 3 foundation trainee with a keen interest in quality improvement and patient safety.

Abstract:

Background: Surgical ward rounds are generally fast paced. With a quick patient turn over, key information regarding pre/postoperative care as well as nutrition status often gets missed. Documentation is routinely done by ward based F1 doctors who have had little involvement in management. If seniors are unavailable, omissions in documentation can lead to detrimental outcomes for the patients, such as unnecessary antibiotics/dietary restrictions. The  patients’ notes provide a record of on-going clinical issues and serve as a medico-legal document. Therefore, the need for notes to be thorough and legible with a clear indication to all MDT members regarding future care is paramount.
Aim: Aim of this study is to quantify the information documented during ward rounds across the general surgical wards and its effect on patient care.
Method: The last ward round entry in the patients notes was analyzed against 12 parameters chosen by MDT members. This included medicolegal aspects: Dates and time, patient identifier, signature with GMC number of doctor, discussion with patient noted and overall legibility; as well as patient review aspects: Current issues, working diagnosis, plan based on current condition, medication review, dietary requirement review and estimated discharge date with follow up instructions.
Results: A total of 47 entries were analyzed, medico-legal aspects of documentation were above 79%. Medication and diet were only reviewed in 36% of cases with clinical details only being explained to the patients in 6% of cases.

Conclusion: Lack of clear documentation may have led to poor patient outcomes and difficulty for other team members to provide care. The introduction of a new pro-forma prompting daily review of the key areas has shown a vast improvement in documentation and communication between staff and patients. Questioning and reviewing these areas has also provided a learning opportunity with positive feedback from junior doctors.

Biography:

Bushra Mukhtar Alhajjaji has completed her Bachelor’s degree of General Medicine and Surgery from King Abdulaziz University. She is doing training at the King Abdulaziz University Hospital of Surgery.

Abstract:

Background & Objectives: Peripheral artery disease is considered as one of the highly prevalent public health issues, associated with major detrimental effects on quality of life and functional status; it is also the main cause of limb  amputation. When involving the carotid arteries, leading to carotid artery stenosis, makes it considered as a strong predictor of strokes and even death. Peripheral artery disease and abdominal aortic aneurysms have many risk  factors in common. Thus, our aim in this hospital based study is establishing the prevalence and demographic risk factors for each of the previously mention disorders individually, following that, we want to assess the association between them, and finally to evaluate if screening these patients who have one of the three conditions for the other two would be beneficial as a preventive measure.
Methods: This is a prospective cross-sectional study. In which PAD, CAS and AAA were screened in 34 susceptible patients in KAUH clinics, for screening we used simple non-invasive procedures ankle brachial index, carotid Doppler ultrasound, and abdominal
aortic ultrasound.
Results: ABI study showed 41.2% of patients have PAD, of which 50% of them had bilateral PAD and only 7.14% were asymptomatic. The majority of patients were classified into moderate to severe stages of the disease. The incidence of CAS in PAD patients turned out to be 21.4% with increase in severity of CAS, while the incidence of AAA in PAD patients was 7.14%. Diabetes mellitus was reported as the most significant risk factor of PAD and CAS.
Conclusions: The prevalence of CAS was markedly higher in PAD patients. These results showing a high risk of cerebral and carotid artery lesions in patients with PAD, suggest that screening for CAS is important for treatment, rehabilitation and prevention in these patients. Further studies are needed to determine the exact prevalence and risk factors for PAD and to evaluate the relation between CAS and AAA in PAD patients in a larger sample group in different facilities in Saudi Arabia.

Biography:

M Tayyar Kalcioglu has graduated from Medical faculty of Hacettepe University and worked as an ENT Resident in Inonu University, Department of Otorhinolaryngology, Turkey. He became an Associate Professor and Professor in Inonu University and has been working in Istanbul Medeniyet University since 2012. He has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

Objective: The aim of that experimental study was to investigate the possible neurotoxic effects of the bone cement (BC) on the facial nerve with the electrophysiological and histological examinations.
Materials & Methods: Twenty male Wistar albino rats; divided into 4 groups were used in the study. Group A was determined as a control group and the group B as a sham. In group C; one drop BC was dropped on facial nerve trunk and washed with saline after waiting 5 seconds. In group D; one drop BC was dropped on facial nerve trunk and the wound was closed primarily after waiting 5 minutes to set BC. Electromyographic measurements (EMG) were performed preoperatively and postoperatively at the fourth week. Animals were euthanized after applying EMG at the fourth week, facial nerve tissue and environmental samples were taken for the histopathological examination.
Results: When the EMG wave parameters evaluated in four groups, there was a statistically significant decrease of the postoperative amplitude levels compared with preoperative amplitude levels in Group D (p<0.05, p=0,014). There was no significant difference between the groups in terms of inflammation in histopathological evaluation. Foreign body reaction or granulation tissue was not detected in none of the groups. Conclusion: To the best of our knowledge, that is the first experimental study which investigates the possible neurotoxic effects of the BC on the facial nerve with the electrophysiological and histological examinations. Any facial nerve paralysis or nerve conduction block was not detected in animals by EMG. Opinion of the authors is to show special care to avoid the direct neural contact with BC
in the middle ear surgery, if the contact occurs removal of BC would be beneficial by aspiration and washing with saline.

Biography:

Professor of Otorhinolaryngology, Istanbul Kemerburgaz University, Medical Park GaziosmanpaÅŸa Hospital, Department of Otorhinolaryngology, 2010 – 2015 Clinical Director of Otorhinolaryngology Department,Turkish Ministery of Health,Haseki Training and Research Hospital,2013 - 2015 Vice President , Education Planning and Coordination Committee ,Haseki Training and Research Hospital, Coordinator,Operating Rooms Service,Haseki Training and Research Hospital, 2013-2015 Member, Infection Control  ommittee,HasekiTraining and Research Hospital, 2012-2015 Member,Clinical Research Financial Support Appraisal Committee,Haseki, 2001 2010 Clinical Chief, Otorhinolaryngology Department, Vakıf Gureba Teaching and Research Hospital, 2000 Associated Professor of Otorhinolaryngology, Hacettepe University Medical Faculty, 1989 - 2000: Chief Intern,Vakıf Gureba Training and Research Hospital

Abstract:

Eustachian tube (ET) is a valve activated by levator and tensor veli palatine muscles and its duty is to equalize the pressure inside the tympanic cavity (TC) with outside pressure. Eustachian tube activation is commonly believed to be a sporadic activity which is initiated by swallowing or yawning action. Although there have been numerous electromyographic (EMG )studies to understand the synergistic behavior of the two muscles, these studies never revealed the heart beat like periodic activity, reflex like nature and the tight relationship between the two muscle signals in terms of amplitude and delay. In a recent clinical study done on 50+ patients we have discovered extraordinarily periodic behavior of EMG signals of ET muscles alongside a very tight relationship between the two signals. Furthermore, there is strong evidence that the relationship of the EMG signals may indicate health status of ET. The study has been done using an unusual location for picking up ET muscle EMG signals which is being used for the first time. The new signal location enabled us to use commercially available subdermal EMG electrodes submucosally firmly placed at target location and furthermore enabled picking without using any local or topical anesthetics. The signals picked up from patients were all high fidelity signals and this led the discovery of periodic, clock-like synergistic signal pattern observed in all patients. This discovery sheds light into the behavior of tubal muscles which appears to be much more complex then what we used to think. Hopefully this discovery may lead to new understanding of electrical activity of ET and may pave the way for solving ET dysfunction (ETD) problem.

Biography:

Zuraida Z is a Senior Medical Lecturer in the Audiology program, School of Health Sciences, Universiti Sains Malaysia (USM). She has received her Medical degree (MD) from USM in 2002 and Master of Science (Medical Audiology) in 2010 from the same university. She has also been an active Researcher in the field balance and vestibular and has published more than 60 papers including journal, oral, books and proceedings. She is currently developing a virtual vestibular rehabilitation procedure for balance disordered patients.

Abstract:

Tinnitus is known to unfavorably affect patients’ quality of life. Cognitive impairments such as inadequate concentration and attention have been reported in some tinnitus patients. This preliminary study was performed to determine the memory abilities of tinnitus patients using the N100 and p300 evoked residual potential tests. We recruited seven patients with tinnitus who underwent 6 months treatment with Quranic rhythm (group-1) and Broadband noise (BBN) (group-2). All subjects completed the tasks successfully. Statistical analysis showed no significant difference in 4 groups (preBBN, post BBN, pre Quranic and post Quranic) for both tests (p>0.05). The amplitude of N100 wave targeted stimuli in group-1 showed mild cognitive improvement (8 out of 19 channels improvement) compared to group-2 where there was 7 out of 19 channels. The latency of N100 wave target group-2 showed better improvement than group-1. The amplitude of P300 wave targeted stimuli in group-2 patients with mild cognitive improvement compared to group-1. The latency of p300 wave targeted stimuli in group-1 and 2 showed equal improvements after intervention. Our findings suggest that Quranic rhythm is one of the alternatives and a potentially new treatment option for tinnitus patients in addition to the use of Broadband noise.

Biography:

Dione Lother completed her medical training at the University of Birmingham, England where she was awarded an honours degree. She has subsequently commenced surgical training and is a member of the Royal College of Surgery, England.  She has presented at a number of conferences at both national and international level.

                                                             

Abstract:

Introduction: Airway emergencies are a common clinical presentation. Surgical doctors (especially those working within ENT surgery) may be involved in cases requiring invasive interventions such as cricothyroidoctomy.  Furthermore, junior trainees in ENT may be required to provide emergency on-call airway services, sometimes without immediate senior supervision or support. Despite this, currently, no formal curriculum around airway management exists within the core surgical training program.  SBME offers an opportunity for trainees to learn within a safe, controlled environment without compromising patient safety and in addition, enables exposure to rare clinical scenarios as well as assessment and feedback.

Objective: Design a SBME program utilising intermediate-fidelity simulation to teach junior medical staff the clinical skills required to manage airway emergencies and non-technical/human factors required to function safely as a member of the wider team.

Methods: Trainees will rotate through three skills stations that provide the opportunity for hands-on practice in basic airway skills (simple adjuncts) and intubation, surgical airways (both cricothyroidotomy and tracheostomy) and fibro-optic nasoendoscopy. These stations will be followed by a series of simulation scenarios using a SimMan patient simulator; all with the common theme of management of patients with rapidly deteriorating airways.

Conclusion:  SBME is proving to be important in airway management education and as such may be an invaluable adjunct in higher surgical ENT training. Within core surgical training however, SBME in airway management may offer the only opportunity for formal teaching around this topic before junior trainees s are faced with a real life patient with airway compromise.
 

Biography:

Dione Lother completed her medical training at the University of Birmingham, England where she was awarded an honours degree. She has subsequently commenced surgical training and is a member of the Royal College of Surgery, England.  She has presented at a number of conferences at both national and international level.
                                                            
 

Abstract:

Introduction: Clinical trials have shown that GES is an effective and safe treatment for intractable nausea and vomiting in adults.  However, less is known about the efficacy and safety of this treatment in the paediatric population.

Objective: We performed a small prospective study to assess the feasibility and effectiveness of GES in children with refractory nausea and vomiting.

Patients: Six children underwent surgical insertion of gastric stimulators for chronic unexplained nausea and vomiting; all were females Median duration of symptoms prior to GES insertion 2.25 years (range 1.25-11years).  Median age at the insertion was 15.5 (range 13-18 years).  Five of 6 patients had proven gastroparesis on gastric emptying studies.  Electrogastrography showed gastric dysrhythmias in all six (increased episodes of tachygastria in 3, bradygastria in 1 and mixed dysrhythmias in 2). None were diabetics.  Surgical approach was via laparotomy in two patients and laparoscopic surgery in the remaining 4 patients (2 robotic-assisted laparoscopic).  

Results: Statistically significant reduction in symptoms (nausea, vomiting, abdominal pain and early satiety) and requirement for nutritional support following GES insertion. There were no peri or immediate/early post-operative complications.

Conclusion: Our study shows GES to be an effective and safe treatment in children with intractable nausea and vomiting.  However, the small sample size is a significant limitation of the study.  Despite this, the results show promise that warrants further investigation of this novel treatment.
 

Biography:

Abstract:

Introduction:

Chronic otitis media is a widespread disease that affects up to 2% of the population.  The COMQ-12 was developed to assess the patient-reported health-related quality of life (HRQoL) due to chronic otitis media.  The aim of this study is to develop a Russian version of the COMQ-12 and evaluate its effectiveness amongst different groups of patients with and without chronic otitis media.

Materials and methods:

The RCOMQ-12 was obtained through a formal process of translation and back-translation.  108 patients with different forms of COM completed the RCOMQ-12. The internal consistency of this questionnaire was evaluated using Cronbach’s alpha coefficient.  Questionnaire data was also acquired from a population of healthy volunteers.

Results:

The average RCOMQ-12 score was 19.4 (SD 8.3) in patients with COM.  The internal consistency of the RCOMQ-12 was high, with a Cronbach’s alpha value of 0.860.  Of the participants with COM, 91% of respondents achieved a score of 30 or less, 55% of respondents achieved a score of 20 or less.  In contrast to this, of the participants identified from a group of healthy volunteers, 75% of respondents achieved a score of 5 or less, 95% of respondents achieved a score of 10 or less.

Conclusions:

The Russian version of the COMQ-12 is a reliable tool for assessment of HRQoL in patients with chronic otitis media.  This sets the scene for further work to determine the effectiveness of this tool to plan surgical treatment and to assess outcome.

Biography:

Main surgical and scientific expertise is in the fields of Femtosecondlaser-assisted anterior and posterior segment surgery. Besides many other microsurgical approaches in general ophthalmology Dr. Hengerer covers the whole field in refractive surgery and research focuses on individual use of the light-adjustable lens as well as and iolAMD implantation in patients suffering from macular disorders.
He has already published more than forty-five peer-reviewed papers and is member of several ophthalmological organizations like ASCRS, ESCRS, AAO and DOG and DGII.

                                                       
 

Abstract:

Purpose: To evaluate intraoperative complications during capsulorrhexis and phacoemulsification in intumescent white cataracts using two different viscosurgical techniques  for the capsulorrhexis or performing a femtosecond laser-assisted capsulotomy.
Methods: In the two manual groups after capsular staining with trypan blue in the first group (21 patients) a medium viscous OVD was used whereas in the second group (20 cases) both medium and high viscous OVD have been used to create a central indentation of the anterior lens capsule before a CCC had been performed. In the third group (24 patients) the capsulorrhexis was performed with a femtosecond lasersystem. The capsule was stained intraoperatively with trypan blue and pulled out using a microsurgical forceps. Main outcome measures were the size of the CCC and analysis of complications during surgery.
Results: In the first group deviation from target CCC diameter appeared in 12 cases compared to 6 cases in the second group. In the first group in two cases a capsular tear appeared and one case had to be converted to ECCE with anterior vitrectomy. In the second group there were no capsular tears. In the femtosecond laser-assisted group one radial anterior tear occurred and in 7 eyes an adherent tongue-like capsular adhesion; the mean deviation from the target diameter of the extracted capsule-discs valued 62 ± 41 µm. An IOL could be implanted into the capsular bag in all cases.
Conclusions:  Combination of two different OVDs with high viscous OVD placed centrally lead to a safe indentation of the anterior lens capsule and reduced intraoperative complications. Femtosecond laser-assisted capsulotomy in intumescent white cataracts was superior according to size, shape and safety.
 

Biography:

Assoc. Prof. Dr. Dida Kazakova has completed her PhD from University of Cologne – Germany. She is a fellow of the European Glaucoma Society. She is elected Associated Professor in Ophthalmology in the Medical Faculty of the Sofia University. She is Professor of Ophthalmology in the Medical Faculty of the Sofia University. She has several specializations in the field of glaucoma in Moscow, London, Lausanne, Basel, Leipzig, Cologne, etc. She has published more than 50 papers in the field of glaucoma.

                                                  

Abstract:

For more than 30 years patients with glaucoma have been treated with laser trabeculoplasty. While looking for  an effective and save alternative to argon laser trabecoloplasty. Mark Latina et al. develop the selective laser trabeculoplasty. For nearly 12 years of usage, it not only replaces argon laser trabeculoplasty, but also establishes as a trustful method for IOP lowering with extremely low post-operative complications. The results of many researchers prove that selective laser trabeculoplasty is successful in wide range of open angle glaucoma patients. Recent data shows that under some conditions, patients with angle closure glaucoma and steroid induced glaucoma can also be treated. One of the most discussed issues about the selective laser trabeculoplasty remains the duration of the IOP -lowering effect of the procedure. The procedure shows a very good IOP lowering effect as a first line therapy as well as when it is used as an adjunctive therapy to a drug treatment. The aim of presentation is to summarize the information in the open literature about mechanisms of action, indications, procedure modifications and effectiveness of the selective laser trabeculoplasty.

Biography:

Graduated in Dentistry, Federal University of Pernambuco (2001), Recidence in Oral and Maxillofacial Surgery [OMFS] (2004), Graduate Course Training Officer (GCTO) at the School of Army Health - Brazilian Army (2005) and Masters Dentistry (Oral and Maxillofacial Surgery) from the University of Pernambuco (2009). He is currently a Captain Dental Maxillo-Facial Surgeon in Military Hospital Area of Recife (HMAR) and Staff of the Hospital Emergency  and  Trauma Senator Humberto Lucena (HETSHL) and doctoral student in the Post-Graduate Program in Oral and Maxillofacial Surgery and Traumatology, School of Dentistry of Pernambuco (FOP / UPE).  Has experience in dentistry, with emphasis on OMFS, acting on the following topics: traumatology, wisdom teeth, oral pathologies, orthognathic surgery and implantology. Full Member of Brazilian College of Oral and Maxillofacial Surgeons, Member of International Association Oral and Maxillofacial   Surgeons   (IAOMS)   and   University   of   Kentucky   Honorary   Research Fellow

                                                            

Abstract:

Loss of teeth results in resorption of the alveolar process and, in more advanced stages, resorption  of the underlying basal bone. A severely resorbed maxilla and mandible generally results in problems for the prosthesis, such as insufficient retention, pain by overloading the mucosa,  impaired masticatory function, speech difficulties, loss of soft tissue support, altered facial appearance, and psychosocial problems. Reconstruction of a moderated resorbed maxilla and/or mandibular alveolar ridges to restore oral function does not remain as a surgical and prosthetic challenge due to the possibility to easily restore the minimal amount of residual bone support with conventional sinus lift, onlay grafts or even with zygomatic implants. On the other hand, when the maxillary ridges presents with anatomical changes or severely resorbed it still be critical to place implants without consider great bone reconstructions. The purpose of this presentation is to report a case series of a patients with severely resorbed maxilla and madible. This cases were treated lifting and grafting the areas using a mixed graft of BMP and bovine demineralized bone and mash, as an option of uses of zygomatic implants or positional/onlay autogenously bone grafts.

Biography:

Bachelor’s degree : Hallym University School of Medicine
Specialty: Cardiothoracic surgery
Present affiliation : Hallym University Sacred Heart Hospital
 

Abstract:

A 20-year-old man presented after a fall with a femur fracture and epidural hemorrhage (EDH). One month after fracture surgery, swelling developed in both legs, and he was diagnosed as having a deep vein thrombosis and pulmonary embolism. A retrievable inferior vena cava filter (IVCF) was inserted, because EDH is a contraindication to anticoagulants. Four months later, he complained of abdominal pain, and computed tomography scan showed a fractured IVCF strut. After percutaneous removal failed three times, the IVCF was surgically removed by orthopedists using a portable image intensifier without cardiopulmonary bypass.

Biography:

Weon Yong Lee ; M.D. and PhD from Seoul National University, College of Medicine. A chief, Cardiothoracic department, Hallym University Sacred Heart Hospital. A chief, Cardiothoracic department, College of Medicine, Hallym University.

                                                                 

 

Abstract:

Objective: Off-pump coronary artery bypass (OPCAB) has been a reasonable alternative to conventional CABG. Nevertheless, it carries significant risk factors related to conversion from off-pump to on-pump surgery. Therefore, this study evaluated the effects of left ventricular (LV) function and dimension on the success rates of OPCAB. Methods: From 2008 to 2012, 100 OPCAB were performed. Of these, 84 (84 %) patients underwent OPCBA without events (OPCAB group), and 16 (16 %) cases were converted to C-CABG (conversion group). The causes of conversion were hemodynamic instability in 12, difficulty of anastomosis in 3, and ventricular arrhythmia in 1 patient. The present study evaluated risk factors, such as LV ejection fraction, wall thickness, dimension, and mitral insufficiency, for conversion to on-pump surgery between 2 groups. Results: The preoperative demographics and operative characteristics were not statistically different between 2 groups. There were no independent risk factors for conversion to on-pump CABG related with LV function and dimension. ( p= .154 for LV ejection fraction, p=.287 for LV diastolic dimension, p=.739 for LV wall thickness) The mitral regurgitation did not raise the conversion rate (p= 1.0). Conclusions: The deteriorated LV function and increased LV dimension, and wall thickness including valvular insufficiency has been regarded as increasing the rate of conversion during OPCAB.
The present study demonstrated that LV parameters including LV wall thickness, dimension, function, and valvar insufficiency did not increase the conversion rate of OPCAB.
 

Biography:

Dr. Aniceto Baltasar is one of the leaders of the Spanish and Latin American bariatric communities. He was born in
Guadalupe, Cáceres, Spain, site of a fifteenth century medical school where the first autopsy was done (with the Pope’s permission).
Dr. Baltasar attended Madrid Complutense University Medical School (1961–1967). He passed the EFMG examination and did his internship training at Good Samaritan Hospital in 1968 in West Islip, New York, and received his surgical residency training at The Long Island College Hospital in New York City from 1969 to 1974. He has been the Chief of the General Surgery Department ever since, at BVirgen de los Lirios^ Hospital in Alcoy, Spain. In 1978, Dr.  Baltasar received US Board Certification in General Surgery, and in 1982, he became a Fellow of the American College of Surgeons (FACS).
                                                  

Abstract:

Introduction
We want to present the evolution of  bariatrics in a  Community Hospital setting since the 70´s Evolution The 19/06/1977 we made the first open gastric bypass (DGA) in Spain and published 18 patients and we developed hypercholesterolaemia surgery in 1987, thus beginning bariatric and metabolic surgery in Spain.
80-The GVA
We published in 1986 the VBG and the radiologist described the "peanut deformity" related to the GVA. To avoid gastro-gastric fistulas we devised in 1989, the "vertical division of the sleeve suture and stapled the suture-line" and separate the two lines with a continuous suture in 130 patients.
We reviewed the same patients 5 years later and published "The VBG ... is a frustrated experience" in Spanish, and English. The VBG disappeared in 2 years. Arlandis publishes a complicated case of bulimia nervosa with gastric perforation the first in Spanish.
90´s. Gastric Bands. We helped Dr. Favretti 25/09/1995 of Italy to perform in Spain the insertion of first gastric band in Hospital La Paz in Madrid.
Duodenal Switch on the 90´s .In 03.17.1994 we started our first Open DS in 527 patients with 5 deaths (0.9%). The 06/05/1995 at ASMBS meeting in Seattle present a video using division of the stomach with staples and continuous on-suture staples.We used the abdominal supraumbilical giving a transverse incision incisional hernias 10% instead of 39% in the vertical incision. The transverse incision facilitates body contouring surgery
LAPAROSCOPY IN THE MID-90. On 01.14.1997 we made the first LGBP (Lap Gastric bypass) in Spain, and presented at Second National Meeting of SECO of Granada Cir Esp the 4.12.1997 and 2000 and was awarded the National Prize By REEAD  with 1st non-use of the circular stapler without trocar in the world. Serra in 1999 described the world 1st internal hernia after LGBP.
Founding of Spanish Society for Surgery of Obesity (SECO)

Biography:

Dr. Juan C. Gómez-Izquierdo is a Ph.D candidate in experimental surgery at McGill University. He finished a research fellowship at the Department of Anesthesia at the same university and is currently completing his medical residency training at the Jewish General Hospital in Montreal. He obtained his medical degree at Pontificia Universidad Javeriana. He has co-authored different papers in perioperative care and goal directed fluid therapy, including meta-analyses, a randomized controlled trials, cohort studies, and 3 book chapters. His areas of interest also include epidemiology, evidence-based medicine and hospital care.  
   
                                               
                                                                

Abstract:

Goal directed fluid therapy (GDFT) optimizes oxygen delivery by guiding fluid administration using cardiac output analysis. It has demonstrated to enhance the bowel function and to decrease the incidence of postoperative primary ileus (PPOI) in some clinical trials. Bowel perfusion is critical for bowel motility; thus, an improvement of the splanchnic blood flow might explain the effects of GDFT on bowel function. Nowadays, it is feasible to evaluate tissue microcirculation at the patient’s bedside with sidestream dark field (SDF) technology. A cohort of 24 patients undergoing colorectal surgery in an enhanced recovery program at the Montreal General Hospital and receiving either intraoperative GDFT (8 patients) or Standard fluid therapy (16 patients) was followed and microcirculatory measurements were acquired using the Microscan, Microvision Medical, at 7 different perioperative time points. Bowel function and incidence of PPOI were assessed. PPOI was found in 3 patients in GDFT and 3 patients in the standard fluid therapy exposure (p = 0.643). The overall perioperative Proportion of Perfused Vessels (PPV) was higher in the GDFT exposure (p = 0.023); and specifically on postoperative (POP) day 3 (p = 0.032). There was no significant difference in other microcirculation outcomes. To conclude, GDFT improves the PPV, a key factor for oxygen extraction in the tissues, effect that was sustained until postoperative day 3. GDFT also demonstrated a more stable oxygen delivery throughout the surgery. Nevertheless, these physiological effects did not translate into a better postoperative bowel function in GDFT compared to standard fluid therapy.

Biography:

Manuela Stoicescu, Consultant Internal Medicine Doctor (PhD in Internal Medicine) now is Assistant Professor of Medical Disciplines Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania, Internal Medicine Hospital and Office. She is Member of Romanian Society of Internal Medicine, Member of Romanian Society of Cardiology, Chemistry, Biochemistry and Member of Balcanic Society of Medicine.

                                              

Abstract:

Objectives: The most important objective of this clinical case presentation is to found the real cause of a patient who came in the Emergency Department for a clinical picture of a left renal colic.                                                                                                                                                              Material and Methods: I present the clinical case of a man 42 years old, prisoner-convict who came in the Emergency Department together with a policeman who supervise him,                                                   
with sudden onset of left lumbar pain irradiate into the left flank and left iliac fosse(on the way of left ureter), polakiuria, dysuria and macroscopic hematuria. At the objective examination: BP=130/80mmHg, HR rhythmic=78 bates/min, normal vesicular sound, Giordano sign positive on left side, costo-vertebral and costo-muscle points sensible on left side, superior and middle ureteral points sensible. For this reasons the doctor from penitentiary sent the patient in emergency with the diagnosis: left renal colic, left kidney stone. The results of blood tests were in normal range, except the level of Hb=10g/dl, Ht=42%, red blood cells =3,7 million cells/mcL. The abdominal ultrasound image showed all the organs normal, the both kidneys normal as well but unexpected a free fluid collection around the spleen, in small quantity but the capsule of the spleen apparent intact and without free liquid collection in the Douglas cavity. An abdominal CT was performed and relieved the same image with fluid collection around the spleen and all the organs normal. The patient was referred to the Surgery Department with suspicion of possible spleen fine fissure unobservable at echo and CT scan, because of the free fluid collection around the spleen, indifferent that the patient didn’t recognize any trauma. After abdominal laparotomy, unexpected the spleen was normal, with intact capsule, without any fissure and fresh blood was around the spleen, but this came from a big hematoma localized in the posterior wall of the left kidney and migrate around the spleen and was solved with good evolution of the patient.
 

Biography:

He is working as Lecturer in Transplantation & Hepatobiliary & Pancreatic Surgery depart. National Liver Institute-Menoufyia University. He does most Hepatobiliary procedures including liver resection, bile duct excision, whipple operation, surgery for klatskin tumor, Kassai operation, and biliary reconstruction. laparotomy for peritonitis, haemorrhage and bowel obstruction, open and  laparoscopic (Cholecystectomy, CBD exploration), open and laparoscopic splenectomy, Laparoscopic appendectomy, laparoscopic hydatid endocystectomy, laparoscopic non-anatomical liver resection and left lateral segmentectomy, anal operations, all types of Hernia Repair and major wound dehiscence. He teaches the residences and the assistant lecturers the different Hepatobiliary and pancreatic surgical operations through the operative rooms and surgical rounds. I teach the postgraduate students the following 3 lecturers 1- Neonatal cholestasis 2- Recent trends in management of CBD stones. 3- Post cholecystectomy syndrome. 4- Conservative management (NOM) of adult abdominal trauma.5- NLI HCC guidelines. He is a supervisor of 3 master theses. He is one of the editorial board of the advanced in medical oncology research (AMOR) journal. He is one of the editorial boards of Gavin Journal of Oncology Research and Therapy. He is one of the editorial boards of Henry Journal of Cellular & Molecular Oncology. I am one of the editorial boards of Austin herpetology journal. I am a reviewer in the world journal of gastroenterology.

                                                      

Abstract:

Objectives: Since the introduction of ERCP and LC, the majority of patients suffering from concomitant gallstone and CBD stone have been managed by endoscopic extraction before or after cholecystectomy.   However, for complicated large difficult CBD stones that cannot be extracted by ERCP, patients can be managed safely by open or laparoscopic CBD exploration. The aim of this study was to assess these surgical procedures of CBDE after endoscopic failure. Methods: We retrospectively reviewed and analyzed 85 patients underwent surgical management of large difficult CBD stones after ERCP failure, in the period from mid 2011 to mid 2016. The overall male/female ratio was 27/58. Results: Sixty seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively with significant correlation between number of ERCP sessions and post ERCP complications (P=0.001).  Impacted large stone was the most frequent cause of ERCP failure (60%). LCBDE and OCBDE were 29.4% (n=25), 70.6% (n=60) respectively. Primary CBD repair, T-tube insertion, HJ and TDS were done in 45.9%, 40%, 8.3% and 5.9% respectively. The mean operative time and hospital stay were 185± 61.4 minutes and 4.9±2.07 days respectively.  Conclusion: Large difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, choledocoscope has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and hospital stay.

Biography:

Alaa el sewefy is Lecturer & consultant of general surgery & laparoendoscopy at minia university hospital Egypt. He was published many papers in national and international journals.
 

Abstract:

consultant of general surgery & laparoendoscopy at minia university hospital
Background: sacroccygeal pilonidal sinus disease (SPSD) disease is a worldwide disease, affecting young adult, mainly male, with a tendency for recurrence. Various modalities have been used for treating this disease. The asymmetric flap procedures associated with lowest recurrence rate with short hospital stay and early return to work. One of most commonly used asymmetric flap is karydakis procedure.
 Aim of the work: was to evaluate modification of karydakis procedure as regard the hospital stay, return to work and recurrence rate.
Patients and method: between January 2011 and December 2014, 32 patients with (SPSD) operated by karykadis flap. In all patients no drains were used and instead tie-over interrupted compression sutures were used to close the dead space, preventing seroma formation.
Results: 30 patients were males (93.8%) and 2 were females (6.2%). The mean age was 25.2 ± 5.6 years (ranged from 19-45 years). The mean operative time was 72.7 ± 14.5 min (range from 50-110 min). All patients discharged on the same day of surgery. No patient developed serous collection in the wound. One patient (3.1%) developed superficial wound infection; the mean time for return to work was 11.8 ±2.2 (range from 11-21). the median period of follow-up was 28 months with no recurrences were noted in any of the cases.
Conclusion: karykadis flap with tie-over compression interrupted sutures without drain is save procedure with least complications, short hospital stay and early return to work
 

Biography:

Dr Tuhin Shah has completed his MS in general surgery at the age of 31 years from BP Koirala Institute of Health Sciences, Nepal. He is currently at the post of Senior Resident. He has presented a few papers in the national conference and the scientific sessions.

Abstract:

A 35 year female presented to our hospital with recurrent pain in right lower abdomen for 4 months which had increased in intensity in the last 24 hrs. She used to have on and off passage of altered blood in stool during previous attacks of pain but absent on this presentation. She had undergone open appendectomy 4 and half months back at another center. Her last pain episode was one month ago and was diagnosed as ileo-colic intussusception and was managed conservatively, at another center without an adverse outcome.

On clinical examination, the patient was afebrile and her vital signs were otherwise normal. Physical examination revealed a tender mass in right iliac fossa of 3 X 2 cm² without evidence of guarding, rebound tenderness, or other peritoneal signs. Routine laboratory studies were remarkable for a WBC count of 10,000/mm³ with 88% neutrophils. Urinalysis was negative.

An ultrasound of the abdomen and pelvis was performed which showed invagination of one bowel loop into another bowel loop with characteristic target sign which suggested the preoperative diagnosis of ileo-colic intussusception. Exploratory laparotomy with a lower midline incision was done under general anesthesia. The operative findings were adhered inflamed omentum forming a lump over the ileo-cecal junction with inflamed surrounding mesentery and acutely inflamed stump of appendix (~2cm). Rest of the bowel was normal. Completion Appendectomy was done and the post-operative period was uneventful. The patient was discharged on post-operative day 4 and is asymptomatic till date. Her histopathological report showed acutely inflamed appendix.

Biography:

Dr. Phong Jhiew, Khoo has completed his M.D. at the age of 25 years from Brawijaya University, Indonesia. He has also completed the Membership of Royal Colleges of Surgery (MRCS) Part A examination on April 2016 and planned to sit for the Part B examination on January 2017. Currently, he is working as a medical officer at the Department of General Surgery, Labuan Hospital, Malaysia.

Abstract:

We present a case of omental fibroma, which posed a surgical diagnostic dilemma. Primary tumours of the omentum are uncommon, and omental fibromas account for 2% of these. The rarity of omental fibroma and paucity of available information hamper an accurate diagnosis. In this particular case, the diagnostic process was misleading. The history was classical of an irreducible inguinal hernia, but the physical examination and imaging studies were suggestive of a testicular tumour. However, intraoperatively, an omental tumour and a normal testicle were found in the scrotum. Histopathological examination proved the tumour to be a fibroma. The presentation of an omental fibroma in an inguinal hernia sac had never been reported in literature. Due to the rarity of such cases, a thorough history, detailed examination, and objective investigation are the pillars to attain the correct diagnosis.

Biography:

Rapunzel syndrome is a vey rare form of trichobezoar found in young  patients with a history of psychiatric disorders, trichotillomania  and trichophagia consequently developing gastric bezoars followed by their extension into the intestines. The principal symptoms are vomiting and epigastric mass. In this case report,  a complicated  presentation of this syndrome in a young woman and its surgical management is documented.

Abstract:

Dr Balasubramaniam  comleted  his undergrduate and postgraduate training in surgery from Coimbatore Medical College Hospital, affiliated to the TN Dr MGR Medical University, Chennai, India and  laparoscopy training from the world renowned GEM Hospital, Coimbatore, India. He is the Chairman and surgeon of S M Hospitala hospital under B S Surgicare India, a laparoscopic and general surgical centre in Ooty, South India. He is also the Superintendent of the 400 bedded Goverment Medical Hospital in the same town.

Biography:

Dr. Aniceto Baltasar is one of the leaders of the Spanish and Latin American bariatric communities. He was born in Guadalupe, Cáceres, Spain, site of a fifteenth century medical school where the first autopsy was done (with the Pope’s permission). Dr. Baltasar attended Madrid Complutense University Medical School (1961–1967). He passed the EFMG examination and did his internship training at Good Samaritan Hospital in 1968 in West Islip, New York, and received his surgical residency training at The Long Island College Hospital in New York City from 1969 to 1974. He has been the Chief of the General Surgery Department ever since, at BVirgen de los Lirios^ Hospital in Alcoy, Spain. In 1978, Dr.  Baltasar received US Board Certification in General Surgery, and in 1982, he became a Fellow of the American College of Surgeons (FACS).                                                 

Abstract:

Laparoscopic Sleeve-forming gastrectomy (LSFG) is the most popular bariatric surgery operation. Based on the lesser curvature, the sleeve, is created with endo-staplers, which separate the lesser curvature longitudinally and vertically from the rest of the stomach including the greater curvature. The use of a bougie (Bougie, a medical instrument, used in an esophageal dilatation) helps to calibrate the diameter of the sleeve. Intra-operative bougie stapling (ISB) is a serious complication that should be prevented and when it happening correction is mandatory. We present three cases with a video.