Day 2 :
- General Surgery and its specialties | Tinnitus
Universiti Sains Malaysia, Malaysia
Title: Update on latest vestibular rehabilitation: Spanish version of home-based video module of balance exercises for balance disordered patients
Time : 10:00-10:20
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.
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.
Aga Khan University Hospital, Pakistan
Title: Risk stratification of surgical patients with obesity in Intensive Care Unit: A prospective cohort study
Time : 10:20-10:40
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.
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.
- Video presentation
University of Oradea, Romania
Time : 10:40-11:00
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.
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.
- Networking and Refreshment Break 11:00-11:20 @ La Plaza
- Poster Presentations
University of Saskatchewan, Canada
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.
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.
B.P. Koirala Institute of Health Sciences, Nepal
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.
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.
Sahlgrenska University Hospital, Sweden
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.
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.
Hallym University- Sacred Heart Hospital, South Korea
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.
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.
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.
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.
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.
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.
University of Ulsan, South Korea
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.
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.
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.
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.
Kyung Hee University, South Korea
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.
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
- Session Continues
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)
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.