Leiomyoma of the Vulva: A Diagnostic Challenge Case Report | Chapter 17 | Innovations in Medicine and Medical Research Vol. 1

Uterine leiomyomas are common and can affect up to 30% of women older than 35 years. Despite this, leiomyomas of the vulva are rare, masquerading and usually misdiagnosed as Bartholin cyst preoperatively. These smooth muscle tumors are typically painless, solitary and well circumscribed and can affect female of any age group. We present a case of a 46-year-old female that presented to the clinic with 2-year history of right labial mass and was diagnosed as Bartholin cyst initially. The patient underwent elective excision under spinal anaesthesia and the mass was removed. The final diagnosis after microscopy result showed benign vulvar leiomyoma.

Author(s) Details

Saad Kurdi
King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.

Abdullah S. Arafat
King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia and King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.

Maysan Almegbel
King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.

Mayson Aladham
King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia and King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.

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Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature | Chapter 16 | Innovations in Medicine and Medical Research Vol. 1

Background: Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.

Introduction: Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations.

Case Report: A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition.

Discussion: The etiopathogenesis, presentation, investigations and management are discussed briefly.

Conclusion: Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.

Author(s) Details

Ketan Vagholkar
Department of Surgery, D.Y. Patil University, School of Medicine, Navi Mumbai 400706, India.

Suvarna Vagholkar
Consultant Gynaecologist, Thane, India.

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Economic Burden of Diabetic Tuberculosis Patients from 3 Malaysian Hospitals | Chapter 15 | Innovations in Medicine and Medical Research Vol. 1

Aim: To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment.

Study Design: Prevalence based cohort.

Place and Duration of Study: Penang General Hospital, Hospital USM, and – Univesiti Malaya Medical Center; 2005 – 2008. 

Methods: Study patients were placed in the TB only, DM only, or DM-TB groups, with each group including 200 patients. Information related to demographics, chronic disease comorbidity, duration of hypertension (HTN) and DM, and economic variables were obtained from the patients’ medical files both at the beginning and end of the study period. The economic burden of DM-TB patients was assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests.

Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DM only group compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for the TB only and DM only groups, respectively; however, 43% of TB only subjects needed surgical intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for the TB only and DM only groups, respectively.

Conclusions: DM antedated HTN in our patients. Durations of both DM and HTN were longer for the DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only group required the most surgical intervention.

Author(s) Details

Daud M. I. Aweis  
Pharmacy and Medical Supply Division, Ahmadi Hospital, Kuwait Oil Company, Kuwait and School of Pharmaceutical Sciences, USM, 11800 Penang, Malaysia.

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“Tibial Blowout”- A Complication of Arthroscopic Anterior Cruciate Ligament Reconstruction | Chapter 14 | Innovations in Medicine and Medical Research Vol. 1

The reconstruction of Anterior Cruciate Ligament (ACL) has become the standard of care for a torn ACL in active, young athletes. Various technical complications during the surgery are documented. Of the complications pertaining to the bony tunnel preparation, the posterior femoral blow out is common. In this report we describe a complication that can occur while preparing the Tibial tunnel – “Tibial blow out”. This is a complication of anterior placement of the tibial tunnel and this has not been reported in the literature. We describe the identification, the possible mechanism, prevention and management of such an intra operative complication.

Author(s) Details

A. RavirajDepartment of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Ashish Anand
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Dr. Vidyasagar
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Dr. Shivareddy
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Azhar Amin
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

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Attitude and Perception to Tattoos and Scarified Skin Marks in Makurdi, North Central Nigeria | Chapter 13 | Innovations in Medicine and Medical Research Vol. 1

Aim: Tattoo art which has been practiced all over the world for centuries is undergoing a revolution. Some people like it, others don’t. The aim of the study was to estimate the prevalence of tattooing among students and residents of Makurdi, like or dislike, who gave consent before tattooing, symbolism/motive of tattooing and whom to go to for removal of tattoos.

Study Design: A survey research using structured questionnaire as instrument for data collection among students of Benue State University and residents of Makurdi over a period of one month in January, 2017.

Methodology: Views of one hundred and seventy two residents and  students  in Makurdi, North Central Nigeria, were collated via a pre-tested structured questionnaire and analyzed on the basis of sex, age, like/dislike of tattoos, symbolism, consent given, whether one would tattoo himself if given a chance and what to do when one got tired of tattoos.

Results: Two hundred and ten questionnaires were administered and one hundred and seventy two were returned giving attrition rate of 18.1%. All returned questionnaires were completely filled. One hundred and seventy two respondents participated in the study comprising 123 males and 49 females giving a male to female ratio of 2.5:1. Twenty one respondents had tattoos giving a tattoo prevalence of 12.2%. One hundred and thirty eight (80.2%) did not like tattoos and forty two (24.4%) indicated that there was no significance to symbolism of tattoos and indeed thirty (17.4%) felt tattoos are a body mutilation. One hundred and fifty one (87.8%) indicated they will not have tattoos when given a chance to do so. Ninety seven (56.4%) believed the best person to go to for tattoo removal is a Plastic Surgeon.

Conclusion: The study showed that majority of students and residents of Makurdi metropolis in Nigeria do not like tattoos and would not like to have one when given a chance to do so. A large scale study involving other parts of Nigeria needs to be done to assess a true like/dislike of tattoos in this environment.

Author(s) Details

Dr. P. Denen Akaa
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Dr. C. N. Ahachi
Benue State University Teaching Hospital, Makurdi, Nigeria.

Dr. Ojo Babarinde
Benue State University Teaching Hospital, Makurdi, Nigeria.

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Factors Affecting the Surgical Outcome of Primary Exotropia in Children | Chapter 12 | Innovations in Medicine and Medical Research Vol. 1

Objective: The objective of current study to evaluate the outcome results of the surgical correction and as well as the effects of some factors on the outcome and surgical response of primary exotropia.

Study Design: Retrospective Clinical Study.

Place and Duration of Study: Hamad Medical Corporation– Tertiary Hospital in Qatar, study done over six months.

Methods: Medical records of patients who underwent surgical correction of primary exotropia procedures between the years 2008 and 2013 were retrospectively reviewed. Patients less than 15 years of age were included in the study and the following data were collected: Onset age of squint, age at surgery, type of exotropia, visual acuity, presence of amblyopia, anisometropia, refractive error (spherical equivalent), preoperative deviation, AV pattern, stereopsis, type of surgery and analysis using descriptive statistics, unpaired t- and chi-square statistical tests.

Results: Of 74 patients we studied, 30 Male (40.5%), 44 Female (59.5%), 46 patients (62.2%) had successful surgical outcome and 28 patients (37.8%) had unsuccessful outcome (all under correction). The response to surgery correlated mainly to with the preoperative angle. A higher response resulted from larger preoperative deviation and it this was better with lateral plus medial rectus muscle recessions than with bilateral lateral rectus recession.

Conclusions: Preoperative deviation was the most important factor in determining better response to surgical correction of primary exotropia and accurate measurement of the angle of deviation can improve the outcome and response to surgery.

Author(s) Details

S. Al Mahdi Huda
Department of Ophthalmology, Rumailah Hospital, P.O.Box 3050, Doha, Qatar.

Tajummal Asim
Department of Ophthalmology, Rumailah Hospital, P.O.Box 3050, Doha, Qatar.

Bener Abdulbari
Department of Biostatistics and Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, 34098 Cerrahpasa-Istanbul, Turkey.

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Antibacterial Activity of Polyphenolic Extracts from Different Algerian Honeys against Methicillin Resistant Staphylococcus aureus | Chapter 11 | Innovations in Medicine and Medical Research Vol. 1

The prevalence of patients infected with Methicillin resistant Staphylococcus aureus present different problems of nosocomial infections diseases in addition to multidrug resistance. This work aim to evaluate the antibacterial effect of four polyphenolic extracts from honey against Methicillin resistant Staphylococcus aureus. An extraction of polyphenol was carried out from different honey samples collected from different regions of the Algerian territory. First, the physicochemical, microbiological quality and pollen analysis was studied. Then, the evaluation of the antibacterial effect was performed by the determination of inhibition diameter and the minimal inhibitory concentration. The results clearly show the sensitivity of Methicillin Resistant Staphylococcus aureus against the polyphenolic extracts. The four samples presented an inhibitory effect and the polyphenolic extract of Jijel has the highest inhibitory effect among all extracts. This activity depend not only with the type of polyphenolic compounds but also with the botanical origin and the type of honey as honeydew honeys which is more effective than nectar honey.

Author(s) Details

Belkhodja Hamza
Laboratory of Bioconversion, Microbiology Engineering and Health Safety, University of Mustapha Stambouli, Mascara, Algeria.

Belmimoun Asmaa
Laboratory of Bioconversion, Microbiology Engineering and Health Safety, University of Mustapha Stambouli, Mascara, Algeria.

Pr. Meddah Boumediene
Laboratory of Bioconversion, Microbiology Engineering and Health Safety, University of Mustapha Stambouli, Mascara, Algeria.

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