The outcome of Glioblastoma (GBM) remains poor. Standard management includes surgical resection, which is guided by Magnetic Resonance Imaging (MRI). Surgery alone however is not able to reliably remove all tumour cells, which due to their diffuse and infiltrative nature, migrate along pathways outside the confines indicated by MRI. The use of Fluid-Attenuated Inversion Recovery (FLAIR) imaging has emerged as a potential adjunct to current surgical treatment, and its rationale in order to better GBM outcomes is discussed.

bstract This study was with at least one year follow up period after surgery. The total number of patients in our study was 30 patients; 24 females (80%) and 6 males (20%). Their ages ranged from 21 to 50 years with a mean age of 37.4±7.3 years. All of our thirty patients underwent open Roux-en-Y gastric bypass operation. This study was conducted to evaluate the effectiveness of Roux-en-Y gastric bypass operation in the management of morbid obesity, study the complications that may result from the operation and monitor the changes in the complete blood count, blood glucose level, lipid profile, serum calcium, 25-hydroxyvitamin D and parathyroid hormone levels after surgery. Our patients were subjected to history taking, clinical examination, laboratory investigations, radiological investigations, electrocardiogram routinely, echocardiography, stress test, cardiac catheterization and upper GI endoscopy when indicated. Peri-operative blood loss ranged from (150 cc to 850 cc) with a mean blood loss of (298.4 cc). The operation time ranged from (150 to 240 minutes) with a mean operation time of (175 min). Postoperative hospital stay ranged from (6 to 8 days) with a mean hospital stay of (7.1 days). The incidence of intraoperative complication was 6.6% and included one case (3.3 %) of splenic injury and one case (3.3 %) of liver injury. Early postoperative complications included; postoperative chest infection in two patients (6.6%), wound infection in two patients (6.6%) and partial wound dehiscence in two patients (6.6%). Late complications included; gallstones in one patient from 27 (3.7%), Stomal stenosis in one patient (3.3%) and incisional hernia in two patients (6.6%). One year after surgery: BMI decreased significantly from 48.38 kg/m2 to 31.42 kg/m2 with a mean reduction in BMI of 16.9 kg/m2 (P-value < 0.001). The percentage of excess body weight loss was 60.6±1.5% one year after surgery. WBCs count decreased significantly, while HB concentration and platelets count decreased non-significantly. Fasting plasma glucose level decreased significantly among diabetic patients. The entire lipid profile was found to have a statistical significant improvement. Serum calcium level decreased non-significantly, while PTH, and 25 OH – vitamin D increased non-significantly. Comorbidities showed significant reduction in the prevalence of dyslipidemia and psychological upset, while, other preoperative co-morbidities related to morbid obesity decreased non-significantly. Roux-en-Y gastric bypass operation is an effective and efficient operation as regard to reduction of body weight.

Background: Peutz-Jeghers Syndrome (PJS) is one of the intestinal polyposis syndromes that can be associated with multiple polyps throughout the gastrointestinal tract in addition to characteristic circumoral mucocutaneous pigmentations. Case presentation: A 28-year old male patient with known history of PJS presented to the emergency department with acute small bowel obstruction. The patient’s history included two previous laparotomies for similar condition. Investigations revealed elevated leucocyte count, multiple air-fluid levels in plain abdominal x-ray, and dilated small bowel loops with pathognomonic target sign in abdominal ultrasonography. Midline exploratory laparotomy was performed and a double-site small bowel intussusception was found and treated with reduction of the proximal intussusception and resection of one meter of the small intestine including both lesions with re-anastomosis of the bowel ends. The patient showed a smooth, uneventful recovery and was discharged with instructions on regular follow-up. Conclusion: Patients with PJS who have history of complicated intestinal polyps are amenable for recurrent episodes of complications which may warrant surgical resection of the affected bowel. Small bowel intussusception should be included to the list of differential diagnoses of intestinal obstruction in patients with PJS and the possibility of more than one lesion should be always considered.

The management of patients with open abdomens is an evolving concept. Certain techniques for managing the open abdomen patients can be effective in treating ACS. The goal of therapy is to maximize tissue perfusion and minimize potential intra abdominal complications, such as fistulas and hernias. Meticulous care of the bowel, minimizing trauma from techniques or systems used to cover abdominal contents and protection of the bowel from exposure to the environment can reduce the complications associated with the open abdomen. A Temporal Abdominal Closure should not only protect the intra abdominal contents, but facilitate primary closure of the fascia and minimize the need for secondary repairs of ventral hernias and subsequent repair. Serial bladder pressure monitoring should be a part of post-operative management protocols in high-risk patients and decompression of the abdomen with a pressure of > 25-30 mmHg should be considered even without clear clinical evidence of ACS. While many closure techniques are reported in the literature, a dynamic closure technique, such as Vacuum pack appears to have an advantage in meeting most requirements for managing an open abdomen. IAH and ACS remain the most significant considerations for the management of the open abdomen. IAH and ACS are in part iatrogenic and can be minimized with the appropriate resuscitation protocols. Complications found in patients with open abdomens may be minimized with Vacuum pack Therapy resulting in early closure of the abdomen. Consideration for the type of closure is based on the patient’s clinical status with the optimal result of primary facial closure. When the fascia cannot be closed, skin over granulation tissue is preferred to skin grafting over granulation tissue to create ventral hernia. Several techniques have been described to repair created ventral hernias. In our work, three methods had been utilized for final reconstruction of complex midline anterior abdominal wall defects according to size of the defect and status of tissue bed ; (I) repair with autologous tissue to bridge the fascial gap using components separation technique (CST), (II) prosthetic repair to bridge fascial defects and (III) Shoelace Darn Repair.

In my view of point, overlapping surgery often needs a definitive “specialist” to perform the key part of surgery for different patients one by one even if other junior surgeons might have abilities to finish it. By comparison, concurrent surgery aims to save operative time or medical cost that often needs lots of surgeons but not one definitive specialist to perform joint-operations for one patient in one single surgery or lots of operations for multiple patients simultaneously. Sometimes it’s not easy to very clearly make difference from them because cross-part between both of their implications. Obviously, it’s frequently observed by us. But herewith, I would like to emphasize their own unique motivation that may be better to understand or define them. Simply in a word, the protagonist of overlapping surgery is one specialist who performs all key procedures for different patients, while the primary operator of concurrent surgery is one or more specialists who conduct(s) jointoperations for one patient or lots of surgeons in a work team perform different operations at the same time just aiming for cost-effectiveness of medical care. Obviously, the former more likely arouses public attention or remains controversial due to its potential loophole of motivation or its unnecessaries.