Wound infiltration with bupivacaine 0.5% with or without adrenaline does not decrease pain after thyroidectomy. A randomized controlled study.

[No Abstract Available].

Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation (TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries.

Spontaneous ileostomy closure.

[No Abstract Available].

Foregut caustic injuries: results of the world society of emergency surgery consensus conference.

Introduction: Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available.

Purpose Of The Study: The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition.

A hand-made supplementary food for malnourished children.

We tested the possibility to prepare a hyperproteic and hyperenergetic supplementary food for malnutrition rehabilitation in children starting from available ingredients in popular markets in Sierra Leone. Twelve residents in Paediatrics from University of Parma, Italy, prepared in a hospital near the capital Freetown with modest technology a mixture of peanut flour, palm oil, milk powder, sugar and vitamins to which they gave the name of "Parma pap". Three hundred and thirty-two malnourished children (mean age 14±6.

Low-grade myofibroblastic proliferations of the urinary bladder.

Context: Myofibroblastic proliferations of the urinary bladder, which share some similarities with nodular fasciitis, were first reported in 1980. Since then, they have had several designations, the most frequently used being inflammatory myofibroblastic tumor. Based on both histopathologic and prognostic grounds, some authors prefer the term pseudosarcomatous myofibroblastic proliferation, at least for some of the proliferations.

Caustic injury of the upper gastrointestinal tract: a comprehensive review.

Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands.

Evaluation of clinical outcome after laparoscopic antireflux surgery in clinical practice: still a controversial issue.

Background. Laparoscopic antireflux surgery has shown to be effective in controlling gastroesophageal reflux (GERD). Yet, a universally accepted definition and evaluation for treatment success/failure in GERD is still controversial.

Features and management of esophageal corrosive lesions in children in Sierra Leone: lessons learned from 175 consecutive patients.

Purpose: This study aims to highlight the peculiar presentation and management of children's corrosive ingestions in developing countries associated with malnutrition, delay in management, lack of technology, and sporadic follow-up.

Methods: An observational study was carried out since 2005 on all children (<15 years old) admitted for caustic soda ingestion to the "Emergency" Surgical Center in Sierra Leone, either in the acute postinjury phase or for dilatation of esophageal strictures. Complications, mortality, stricture recurrence, and ability to swallow were the main outcome measures.

Challenges of meeting surgical needs in the developing world.

The burden of surgical conditions and diseases is increasing in low-income and middle-income countries, but the capacity to meet the demands they present is not following pace. Ongoing initiatives, such as brief visits by surgeons from advantaged countries, sending surgical residents to spend time in a developing country as part of their training, or ships weighing anchor offshore and offering some limited on-shore or on-board services, have not proven successful. More comprehensive and sustainable solutions include the development of local training programs, better retention of trainees with adequate incentives particularly in rural areas, and engaging government and professional associations, as well as academic institutions, to develop and implement policies to address local training needs.

Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries.

Problem: An unsafe environment is a risk factor for child injury and violence. Among those injuries that are caused by an unsafe environment, the accidental ingestion of corrosive substances is significant, especially in developing countries where it is generally underreported.

Approach: To address this challenging, unmet medical need, we started a humanitarian programme in Sierra Leone.

Emergency and essential surgical services in Afghanistan: still a missing challenge.

Background: In Afghanistan, the number of surgically amenable injuries related to civil unrest and ongoing conflict or consequent to road traffic accidents, trauma, or pregnancy-related complications is rising and becoming a major cause of death and disability. This study was designed to evaluate availability of basic lifesaving and disability-preventive emergency surgical and anesthesia interventions representing most of the country.

Methods: Evaluation was performed outside Kabul to represent a cross-section of the country.

Gallbladder ulcer eroding the cystic artery: a rare cause of hemobilia.

We report a hemorrhage from an eroded cystic artery in an ulcer of an inflamed calcolous gallbladder. Bleeding from the papilla was observed at side-view endoscopy. Echo endoscopy and contrast-enhanced computed tomography suggested a gallbladder bleeding.

Corrosive esophageal injuries in children. A shortlived experience in Sierra Leone.

Objective: Children with caustic ingestions in developing countries are often treated at home, sometimes by traditional healers, or are referred, frequently late, to tertiary hospitals, which only seldom offer adequate endoscopic and dilatation facilities. Therefore, when dilatations are performed, the stricture is often already well established, making dilatation more difficult. The aim of this paper is to report our experience in the management of corrosive injuries in a group of children of Sierra Leone, all complaining accidental ingestion of caustic soda, many of them treated months after the ingestion.

Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia.

Objective: To compare laparoscopic cardia myotomy and fundoplication with botulinum toxin (BoTx) injection in patients with esophageal achalasia.

Summary Background Data: Although myotomy is thought to offer better results, recent studies have reported 80% success rates after 2 BoTx injections a month apart. No randomized controlled trials comparing the 2 treatments have been published so far.

Long-term outcome after inflammatory abdominal aortic aneurysm repair: case-matched study.

The purpose of this study was to compare early and late outcomes after inflammatory and noninflammatory abdominal aortic aneurysm (AAA) repair with emphasis on graft-related complications. Of 625 consecutive patients submitted to AAA repair, 18 were classified as having inflammatory AAAs (group 1). The results of this group were compared with those of 54 patients (group 2) retrospectively drawn from patients who underwent aortic replacement for noninflammatory AAAs.

Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy.

Background And Aims: Management of haemorrhagic radiation proctitis remains controversial. Both endoscopically delivered argon plasma coagulation and rectal administration of formalin have been recommended. We evaluated the efficacy of argon plasma coagulation according to endoscopic severity of radiation proctitis.

Dysphagia and clinical outcome after laparoscopic Nissen or Rossetti fundoplication: sequential prospective study.

Laparoscopic fundoplication represents the most widely used operation in the surgical treatment of gastroesophageal reflux disease (GERD). Besides being operator-dependent, the clinical outcome (efficacy and side-effects) seems also to be dependent on the specific surgical technique. In this prospective trial we compared the results of two groups of patients who were submitted sequentially to the Rossetti or Nissen fundoplication procedure.