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Vertebroplasty was initially described by Gallibert and cols. in 1987 to treat symptomatic hemangiomas of the vertebral body [1].

Vertebroplasty and kyphoplasty are procedures that are used to treat painful vertebral compression fractures in the spine, which are a common consequence of osteoporosis. After vertebroplasty, approximately 75% of patients recover lost mobility and become more active Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of painful vertebral compression fractures (FCV), fractures that involve the vertebral bodies that make up the spine [2].

When a vertebral body fractures, the normal rectangular shape of the bone is transformed into a compressed form, causing pain. These compression fractures can include the collapse of one or more vertebrae in the spine and are a common consequence of osteoporosis. Osteoporosis is a disease that results in the loss of normal bone density, mass, and strength, leading to a condition in which the bones become more porous and vulnerable to fracture easily. The vertebra can also be weakened by cancer [3].

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000524.php

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Metaplastic breast cancer is rare and aggressive, accounting for only 0.2% of all breast cancers with a survival ranging from 40-65%. A recent case from our institution posed many diagnostic and management challenges prompting a review of our local ten-year experience with this cancer and a review of the literature to compare the behaviour of this cancer in a developing country and considering guidelines for management.

The incidence is higher with what appears to be a better prognosis in our patient population. Early diagnosis and treatment may be responsible for the apparent better outcome in our patient population. Successful treatment consists of surgery, radiotherapy and with comparable results from both breast conservation and modified radical mastectomy. Preoperative biopsy does not usually yield the correct diagnosis so most patients undergo axillary node dissection even though the mode of spread is supposed to be primarily hematogenous.

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000523.php

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Sacral Neuromodulation (SN) is a therapy consisting of electrical stimulation of sacral nerves at S3 level delivered by a cylindrical electrode connected to a full-implantable neurostimulation device. SN in adult patients for urinary tract dysfunctions other than neurogenic modulates cortical and subcortical structures involved in urination, beside modulating structures with an important role in awareness of the rate of urination and filling of the bladder. A possible explanation for SN’s therapeutic effect is due to the activation and inhibition of supraspinal brain areas by the spinal cord, which normalizes urinating functions. An important benefit of SN is that it is a minimally invasive and reversible treatment option, which includes a test phase before permanent implantation

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000522.php

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Abstract

Endometriosis is a chronic debilitating disease , which affects women of reproductive age group, although medical therapy may be helpful in managing pain associated with Endometriosis or infertility, surgery becomes an integral part of managing this disease .Although initially surgery was limited to l aporotomy associated with ovarian cystectomy and/or TAH with BSO. Laporoscopy gradually replaced that. Though diagnostic laparoscopy is used for confirmation of endometriosis by histological examination, it is not acceptable that Laporoscopy be done in multiple steps, initially to diagnose and later for treatment. Recently a lot of advancement has come in the imaging techniques by which one can combine planning of surgery based on the imaging classification. Deep endometriosis involving bowel, genitourinary tract can be dealt by careful dissection in controlled trained hands, in a well equipped set up to achieve the optimum results .Endometriosis associated infertility may or may not warrant surgery as with multiple studies operation on ovarian endometriomas might land up in reducing ovarian reserve - while doing straight IVF may result in better pregnancy rates ,getting good oocyte retrieval in contrast to poor ovarian reserve resulting from damage to ovarian morphology. Use of laser for ovarian cystectomy helps in getting better outcomes than simple drainage and coagulation procedures. Robotic surgery is the latest addition, which aids in better dissection and management but its problem is its cost, not accessible to many patients and not many trained personnel available.

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000521.php

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Fifteen Years Experience of Managing Penetrating Extra-Peritoneal Rectal Injuries by Noman Shahzad in  open access journal of surgery impact factor

Fifteen Years Experience of Managing Penetrating Extra-peritoneal Rectal Injuries.

Background: Although civilian injuries are generally less severe, they nevertheless remain a challenging problem for the surgeons. In isolated rectal injury patients, though proximal diversion, pre-sacral drainage, distal rectal wash-out and wound debridement are the various surgical options employed in various combinations, the optimum strategy especially for civilian injuries remains unknown. We reviewed our experience of managing penetrating extra peritoneal rectal injuries.

Methods: We conducted a Retrospective review of Adult patients with penetrating extra-peritoneal rectal injuries. Follow-up information of at least one month was needed for early post-operative complications.

Results: A total number of fifteen patients met inclusion criteria. Median age of our patients was 46 years with range being 20-80 years. All our patients were males. Thirteen of our patients (86%) suffered from gunshot injury while one was a blast victim and one had a stab injury to rectum. Nine patients (60%) had pelvic fracture associated with rectal injury.

Diversion stoma was made in all of our patients. Overall post-operative morbidity was 40%. Two patients developed necrotizing fasciitis and required repeated debridements followed by graft placement and one patient developed intra-abdominal abscess which was treated by radiological guided drain placement and antibiotics.

Conclusion: Drainage with fecal diversion is the most commonly employed management of extra-peritoneal rectal injuries. Delayed or inadequate drainage can lead to disastrous consequences including necrotizing fasciitis, intra-abdominal abscess

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000520.php

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The development of cutaneous metastases from gastrointestinal malignancies are rare, but they have been previously reported secondary to primary colorectal adenocarcinoma in relation to advanced disease. This case report describes a phenomenon of rapidly developing cutaneous and liver metastases within weeks, from a stage 3 rectal adeno carcinoma operated with curative intent.

A literature review of similar cases was made and contrasted to the rapidity and stage of this aggressive tumour. The current guidelines are also reflected on, as well as the rate of recurrence with different modalities of treatment.

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000519.php

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Comparison of Modified Kessler Technique versus Four Strand Cruciate Technique for Repair of Long Flexor Tendons of Fingers: A Randomized Controlled Trial by  Noman Shahzad in Open Access  Peer Reviewed High Impact Factor journals

Introduction: Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..

Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.

Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system.

Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P< 0.001).

Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000518.php

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Mentored by Me by  Rakesh Bhargava in Annals of Medicine and Surgery

Surgery I was given to understand was an art learnt by apprenticeship. When I was choosing a subject for my postgraduation, therefore, the paramount consideration was the mentor. I chose Dr P K Sethi, with whom the Jaipur Foot is associated.

https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000517.php

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