Abstract: Introduction: This study tries to determine the impact of stereotaxy on cognitive domains of patients with glioma. Methods and Materials: It was a cross-sectional study performed on 42 glioma patients aged from 15 to 65 years old. All of the patients were examined by neurosurgeons, neurologists and psychiatrists and then 42 patients were referred to stereotaxy. Cognitive evaluations were done through Stroop, CPT, and TOL tests. Results: Based on the performance assessment of the patients before and after stereotaxy, a significant difference was observed between Stroop, CPT and TOL tests measures (P<0.05). Conclusion: The present study indicated that cognitive impairments could be found in patients with glioma after stereotaxy so that for survival, longevity and better life quality they need cognitive rehabilitation simultaneous with stereotaxy.

Abstract: Obturator hernia is a rare type of hernia which accounts for only 0.07–1.4% of all intra-abdominal hernias and 0.2–5.8% of small-intestinal obstructions. It develops predominantly in elderly underweight women. It has nonspecific early symptoms, so these hernias are usually discovered only after they have become incarcerated. Incarcerated obturator hernias are usually discovered on abdominal computed tomography scan or emergency surgery due to bowel obstruction. Here we present a case of a 65-year-old female who presented with intermittent abdominal pain, distension and nausea for last 3 days. She was a known case of hypothyroidism, taking Levothyroxine in inadequate dose. Her intial abdominal Xray was showing few air-fluid level with air present in rectum. She was initially managed conservatively but later developed features of peritonitis for which she was operated. In laparotomy, Richter type of right-sided incarcerated obturator hernia was discovered with a small necrotic area and perforation of small bowel. Bowel resection was performed and obturator hernia was closed with interrupted sutures. The patient recovered without complications. Obturator hernia, due to its rarity and nonspecific early symptoms, can still be misleading even to the most experienced clinicians. Delay in diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.

Abstract: Abstract Sleeve gastrectomy (SG) has become the primary surgical modality of treatment for obesity. This operation could be associated with motor gastric dysfunction and abnormal gastric emptying. The purpose of this prospective study is to present a comparison study of gastric emptying to solids after performing sleeve gastrectomy with two different techniques using scintigraphy. Prospectively; 26 morbidly obese patients were submitted for laparoscopic SG. Group A: 15 patients had sleeve gastrectomy started 7 cm from the pylorus and then vertical gastrectomy along a 40 French size tube. Group B: 11 patients have the sleeve started at 4 cm from the pylorus and then vertical gastrectomy along a 40 french size gastric tube. Gastric emptying of solids was measured by scintigraphic technique. Results of gastric emptying after SG is variable according to point of starting sleeve gastrectomy from the pylorus. At 4 cm it is associated with delayed emptying in 73% of patients and at 7 cm it is associated with accelerated emptying for solids in 87% of patients. These results should be considered to select the appropriate technique according to gender and preoperative foregut condition.

Abstract: In recent years, a wide range of wound dressings containing elemental silver or a silver-releasing compound have been developed. The anti-microbial activity of silver is well documented in the literature with multiple studies illustrating its effect on a wide variety of organisms, including anaerobic and aerobic bacteria, fungi and viruses. As a metal, silver results in the appearance of artifacts in imaging studies. We report three cases that used different types of silver loaded dressings for the treatment of infected wounds. Computer tomography initially reported the silver loaded dressings as extravasations of the gastrograffin contrast medium. However, once the dressing was removed, the density disappeared. We present this case series to demonstrate this phenomenon.

Abstract: Primary nonunion of intertrochanteric fractures is rare due to the excellent blood supply and good cancellous bone in the intertrochanteric region of the femur. A diagnosis of primary intertrochanteric nonunion is made when at least 15 weeks after the fracture there is radiological evidence of a fracture line, with either no callus (atrophic) or with callus that does not bridge the fracture site (hypertrophic). There is only one published series that exclusively describes seven primary nonunions of intertrochanteric fractures. We present a case of a 2 year old neglected primary non union of intertrochanteric fracture in a 43 year old male which was managed by heavy skeletal traction followed by an inverted L osteotomy of the distal fragment with DHS (Dynamic Hip Screw) fixation using the distal peg to fit into a trough made into the proximal fragment. No bone grafting was done and the fracture united at 21 weeks.

Abstract: Background: In some patients with refractory lumbar spinal stenosis (LSS) surgical decompression is necessary. However, a fear of iatrogenic instability has always been associated with extensive decompression. In this study, we aim to evaluate the surgical outcomes of laminotomy versus laminectomy in the geriatric patients with multilevel LSS. Methods: We retrospectively evaluated 79 (29 male and 50 female) geriatric patients with multilevel degenerative but stable LSS from August 2008 to September 2011. The mean age and follow-up period was 74 ± 12.1 (ranged; 65 to 83 years old) and 34 ± 6.5 (ranged; 25 to 51 months), respectively. We placed our patients into two groups; A: laminotomy (44 cases) and B: laminectomy (35 patients). Preoperatively and at the last follow-up visit, the patients were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI). Satisfaction rate was also recorded. Then, an intra- and postoperative comparison between these two techniques was carried out, statistically. Results: No significant differences existed between the two groups in terms of sex distribution, age and duration of follow-up. Intergroup comparison showed that patient satisfaction rate and the mean improvement in VAS and ODI was comparable. Mean blood loss and operating time were both greater in laminotomy group but only the latter was statistically significant. Conclusions: In geriatric patients more than 65 years old with multilevel but stable degenerative LSS, due to its more simplicity and less operative time, we still prefer and recommend laminectomy versus laminotomy.

Abstract: Background: Preeclampsia is the most common pregnancy problems which are characterized by hypertension and proteinuria. This status can be further complicated by eclamptic seizures. Preeclampsia is among the leading causes of mortality in mothers, fetuses and newborns around the world. The exact mechanism causing preeclampsia has much been controversial and has not yet fully known. The current study sought to identify the diagnostic value of changes in the serum levels of placental growth factor in predicting the occurrence of preeclampsia. Materials and Methods: Serum samples were taken from 700 mothers who were between 8 to 12 weeks of pregnancy. Placental growth factor levels were compared and examined in 35 healthy pregnant women and 35 pregnant women with preeclampsia who were randomly selected. Results: Serum concentration of placental growth factor had a significant difference between healthy pregnant women and pregnant women with preeclampsia (P<0.05). Based on the results of the present study, placental growth factor has 57% sensitivity, 77% specificity, 71% positive predictive power and 64% negative predictive power in predicting the occurrence of preeclampsia. Conclusion: Serum levels of placental growth factor in the first trimester of pregnancy can be used to predict the occurrence of preeclampsia.

Abstract: We present a curious case of spontaneous reformation of patella/patellar tendon ossification after partial patellectomy. This is a very rare pathology that has been reported as a complication after sleeve fractures of the tibial tuberosity, total patellectomy during total knee arthroplasty, intramedullary nailing of tibial fractures, anterior cruciate ligament reconstruction with patellar tendon autograft and knee injury without fracture. Patellar tendon ossification after partial patellectomy has been reported just once in literature. We present the second one of this nature. The patellar tendon ossification resembled a reformation of the patella and could easily be mistaken for an inadequate removal of the patellar remnant.

Abstract: Introduction: Meckel’s diverticulum is one of the common congenital anomaly of the small intestine, occurs in approximately 2% population, with equal incidence in both sexes; caused by an incomplete obliteration of omphalomesenteric duct. It is a true diverticulum, containing all the three layers; Complications are known in 4% cases in adults. Case presentation: In this present case report, we are reporting a two and half year-old male child with an eight days old gangrenous, perforated Meckel's diverticulum with abscess and acute intestinal obstruction mimicking an appendicular lump. Conclusion: Even it is rare finding, but we should be vigilant for this entity while dealing with it in emergency and patient should not be kept on nonsurgical management assuming it to be an appendicular lump.

Abstract: A 12-year-old girl presented with a chronically draining lesion on her left cheek. The lesion was refractory to treatment with oral antibiotics. Physical examination revealed a decayed left mandibular first molar, and a panoramic radiograph demonstrated periapical lesion associated with the incriminated teeth. A diagnosis of cutaneous fistula of odontogenic origin was made, and the patient was treated with elective tooth extraction. The cutaneous fistula subsequently resolved. Intraoral examinations and radiographs are critical for making the diagnosis of cutaneous draining sinus tract of odontogenic origin. Many patients undergo unnecessary surgical therapies before having the correct diagnosis made, but root canal therapy or surgical extraction is the treatment of choice. A dental origin must be considered for any chronically draining sinus of the face or neck.