IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
- The patient is a 21-year-old male who was in a motor vehicle accident where the car hit a tree. He suffered a closed fracture of the left superior and inferior ramus pubis and a closed comminuted fracture of the proximal left femur. He also had a bladder rupture causing gross hematuria.
- Due to his injuries and decreased level of consciousness, he was diagnosed with polytrauma with an ISS score of 18. His management involved damage control orthopedics with skin traction applied to the left lower limb and a pelvic bandage.
- The document discusses the concepts of damage control orthopedics versus early total care, describing DCO as a temporary stabilization approach to avoid further
Pectoralis Major Injuries for BESS 2020Lennard Funk
This document discusses pectoralis major injuries, including anatomy, diagnosis, treatment options, and outcomes. It provides an overview of the author's experience treating tears in athletes from various sports. Diagnosis involves clinical exam and imaging like ultrasound or MRI. Treatment can be non-operative with strength loss, or operative with surgical repair which often provides best results, especially for distal tears. Post-operative rehabilitation is outlined in phases focusing first on range of motion and later on strengthening. Reported outcomes include patients regaining 90% of strength on average and returning to sports within 6 months.
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
This document defines pain and describes different types of pain. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It describes two types of pain fibers: A delta fibers which conduct fast, sharp pain and C fibers which conduct slow, dull pain. The document then outlines different types of pain including acute pain from tissue damage, chronic pain lasting over 6 months, somatogenic pain from body walls or viscera, neurogenic pain from nerve lesions, and psychogenic pain influenced by psychological factors.
This document discusses orthopedic implants. It begins by defining orthopedic implants as medical devices used to restore function to joints, bones, and the spine. It then discusses the historical evolution of implant materials from ivory and glass to modern alloys and polymers. The document outlines the increasing need for implants due to an aging population and injuries. It proceeds to describe various implant types including total hip replacements, internal fixation devices like plates, pins, screws, and intramedullary nails. The materials used for implants like stainless steel, titanium alloys, and cobalt-chrome alloys are also mentioned.
Soft Tissue Treatment of Musculoskeletal Disorders Utilizing Functional and Kinetic Treatment with Rehab, Provocation and Motion (FAKTR-PM) by Thomas E. Hyde, DC, DACBSP, CSTI, ICSSD, FRCCSS (Hon).
The document provides information on Lisfranc trauma, including:
- The history of Dr. Lisfranc describing this midfoot injury and its classification systems.
- The anatomy of the tarsometatarsal joint complex, focusing on its ligaments, bones, and three functional columns.
- The mechanisms of injury, typically involving high-energy trauma like motor vehicle accidents or falls.
- Diagnosis involves clinical exam finding tenderness over the midfoot and imaging to identify bone displacement at the tarsometatarsal joints.
- Treatment depends on degree of displacement, with non-operative care for non-displaced injuries and open reduction internal fixation pursued for displaced fractures or dis
- The patient is a 21-year-old male who was in a motor vehicle accident where the car hit a tree. He suffered a closed fracture of the left superior and inferior ramus pubis and a closed comminuted fracture of the proximal left femur. He also had a bladder rupture causing gross hematuria.
- Due to his injuries and decreased level of consciousness, he was diagnosed with polytrauma with an ISS score of 18. His management involved damage control orthopedics with skin traction applied to the left lower limb and a pelvic bandage.
- The document discusses the concepts of damage control orthopedics versus early total care, describing DCO as a temporary stabilization approach to avoid further
Pectoralis Major Injuries for BESS 2020Lennard Funk
This document discusses pectoralis major injuries, including anatomy, diagnosis, treatment options, and outcomes. It provides an overview of the author's experience treating tears in athletes from various sports. Diagnosis involves clinical exam and imaging like ultrasound or MRI. Treatment can be non-operative with strength loss, or operative with surgical repair which often provides best results, especially for distal tears. Post-operative rehabilitation is outlined in phases focusing first on range of motion and later on strengthening. Reported outcomes include patients regaining 90% of strength on average and returning to sports within 6 months.
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
This document defines pain and describes different types of pain. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It describes two types of pain fibers: A delta fibers which conduct fast, sharp pain and C fibers which conduct slow, dull pain. The document then outlines different types of pain including acute pain from tissue damage, chronic pain lasting over 6 months, somatogenic pain from body walls or viscera, neurogenic pain from nerve lesions, and psychogenic pain influenced by psychological factors.
This document discusses orthopedic implants. It begins by defining orthopedic implants as medical devices used to restore function to joints, bones, and the spine. It then discusses the historical evolution of implant materials from ivory and glass to modern alloys and polymers. The document outlines the increasing need for implants due to an aging population and injuries. It proceeds to describe various implant types including total hip replacements, internal fixation devices like plates, pins, screws, and intramedullary nails. The materials used for implants like stainless steel, titanium alloys, and cobalt-chrome alloys are also mentioned.
Soft Tissue Treatment of Musculoskeletal Disorders Utilizing Functional and Kinetic Treatment with Rehab, Provocation and Motion (FAKTR-PM) by Thomas E. Hyde, DC, DACBSP, CSTI, ICSSD, FRCCSS (Hon).
The document provides information on Lisfranc trauma, including:
- The history of Dr. Lisfranc describing this midfoot injury and its classification systems.
- The anatomy of the tarsometatarsal joint complex, focusing on its ligaments, bones, and three functional columns.
- The mechanisms of injury, typically involving high-energy trauma like motor vehicle accidents or falls.
- Diagnosis involves clinical exam finding tenderness over the midfoot and imaging to identify bone displacement at the tarsometatarsal joints.
- Treatment depends on degree of displacement, with non-operative care for non-displaced injuries and open reduction internal fixation pursued for displaced fractures or dis
The document provides an overview of external fixation principles and techniques. It discusses indications such as unstable fractures, open fractures, and limb lengthening. Contraindications include inability to safely place pins. Key principles are described, such as maximizing pin size and number to optimize stability. Complications like pin site infection and malunion are reviewed. The goals of external fixation are to maintain length, alignment and rotation while preserving soft tissues.
Bone grafting involves surgically placing new bone material into bone fractures or defects to aid healing. Autografts from the patient's own bone are considered the gold standard but are limited in supply and can cause donor site morbidity. Allografts from other humans are also commonly used. The ideal bone graft substitutes provide osteoconductivity, osteoinductivity, and osteogenicity to support new bone formation. Common sources of autografts include the iliac crest, tibia, and fibula. Complications can include pain, infection, or fracture at the donor site.
Absolute stability refers to no micro-motion between fracture fragments under normal loads, allowing direct bone healing without callus formation. Absolute stability is achieved through open reduction, anatomical reduction, and interfragmentary compression techniques like lag screw fixation or compression plating. Implants that provide absolute stability include lag screws, axial compression plates, and buttress plates. Absolute stability is indicated for articular, simple diaphyseal, and certain metaphyseal fractures to promote direct bone healing without deformity.
Modified Mason-Allen Technique For Rotator Cuff Repairluantran92
Modified Mason-Allen technique is described for arthroscopic rotator cuff repair. It combines vertical simple sutures for strength with a horizontal mattress suture to act as a "rip-stop stitch". This technique provides high fixation strength, minimal gap formation, and maintains mechanical stability until tendon healing. A case report demonstrates the technique used to repair a partial supraspinatus tendon tear, with the patient showing functional improvement post-operatively. The Modified Mason-Allen technique offers biomechanical and clinical outcomes comparable to double-row repair, but with lower cost and use for partial-full thickness tears.
Bone grafts and bone grafts substitutessiddharth438
This document summarizes different types of bone grafts and bone graft substitutes. It discusses autogenous bone grafts which are considered the gold standard but have limitations related to donor site morbidity. Allografts from cadaveric donors are also discussed. Bone graft substitutes described include ceramics like calcium sulfate and calcium phosphate, demineralized bone matrix, and growth factors like bone morphogenetic proteins which provide osteoinduction. The properties, advantages, and limitations of each type of graft and substitute are summarized.
Arthroscopy principles were discussed. Arthroscopy involves inserting an arthroscope through small incisions to examine the inside of a joint. It allows diagnosis and treatment of injuries with less invasive techniques compared to open surgery. Common procedures include repairing torn cartilage or ligaments. Proper instrumentation, irrigation, and triangulation techniques are important for optimal visualization and treatment. Potential complications are rare but include damage to structures or infection. Recovery time depends on the procedure but most activities can be resumed within a few weeks.
Bone cement, also known as polymethyl methacrylate (PMMA), is widely used in orthopedic and trauma surgery to fix implants. It was first used in the late 1800s but its modern use began in the 1950s when Sir John Charnley used it for total hip arthroplasty. Bone cement is a two-component system consisting of PMMA powder and methyl methacrylate liquid that undergo an exothermic polymerization reaction. It has optimal strength in compression and provides a tight bond between implant and bone, but is brittle. Modern antibiotic-loaded bone cement allows targeted delivery of antibiotics to surgical sites.
1. Periprosthetic fractures are fractures that occur near a joint replacement prosthesis. They can occur in the femur, patella, or tibia.
2. Risk factors include increasing age, female sex, osteoporosis, revision arthroplasty, rheumatoid arthritis, steroid use, and neurological diseases.
3. Surgical treatment depends on the fracture classification and stability of the prosthesis. Options include open reduction internal fixation with a locking plate, intramedullary nailing, or revision arthroplasty.
This document discusses fractures of the calcaneus bone, also known as the heel bone. It begins with an introduction stating that calcaneus fractures make up approximately 2% of all fractures and are most common in males aged 21-45. The document then covers the anatomy and mechanisms of injury, describing how these fractures usually occur from high-energy impacts like falls from heights. It classifies fractures as either extra-articular or intra-articular and discusses the clinical features, imaging, treatment, and complications associated with calcaneus fractures.
1) Osteosynthesis-associated infection (OAI) treatment aims to eradicate infection while allowing fracture healing. Key factors are mechanical stability, time since fixation, and presence of union. 2) For acute infections (<2 weeks), antibiotics and drainage may suffice; deeper infections require debridement. Delayed (3-10 weeks) and late (>10 weeks) infections often involve biofilm/osteomyelitis and may require implant removal. 3) Management strategies include debridement, implant retention/removal, external fixation, local antibiotic therapy, and staged reconstruction. Outcomes depend on fracture stability, soft tissue integrity, and infection control.
Description of 13 years of orthopaedic practice in a prison, without facilities under desperate situations. During this time not only were 14000 patients treated, many startling orthopaedic discoveries were made. This is an award winning talk by Dr L.Prakash
The Future of Orthobiologics in Trauma ProceduresApril Bright
Based on his clinical research interests in utilization of Alpha-BSM bone graft substitute and OP-1 recombinant BMP in the repair of fractures, Daniel N. Segina, M.D., outlined opportunities and challenges for surgeons and device companies in biologic development. To make his case, Dr. Segina reviewed the spectrum of orthobiologics used in trauma cases today, shared perspective on what is and isn’t working and forecasted the future of regenerative medicine.
1. The Masquelet technique is a two-stage procedure used to treat bone defects and non-unions. In the first stage, radical debridement is performed and a cement spacer is implanted to induce membrane formation. In the second stage, the membrane and spacer are removed and the defect is filled with bone graft contained by the induced membrane.
2. The induced membrane forms a chamber that vascularizes the graft and prevents resorption. It expresses growth factors that aid bone regeneration. Keys to success include thorough debridement, stable fixation, adequate soft tissue coverage, and membrane protection of graft at the second stage.
3. The technique is indicated for defects from trauma, infection, or tumor resection.
An olecranon fracture is a break of the proximal end of the ulna bone where it forms part of the elbow joint. It most often occurs from a fall on an outstretched arm. Diagnosis is made through physical exam finding tenderness and a gap at the fracture site as well as x-rays. Treatment depends on the severity of the break, with minor fractures treated by casting and more severe displaced fractures requiring surgical fixation such as screws, plates or wires to stabilize the bone fragments. Complications can include stiffness, non-healing of the fracture and arthritis if not properly treated.
Surgical tips and tricks in fractures of femurPraveen Mehar J
This document provides surgical tips and tricks for fractures of the femur, including the neck and intertrochanteric regions. For femoral neck fractures, it discusses anatomy, classifications, reduction techniques, fixation methods, and considerations for blood supply. Intertrochanteric fractures are discussed in terms of classification, reduction methods, implant options, and the importance of screw position. Subtrochanteric fractures are also addressed, emphasizing biomechanical advantages of intramedullary nailing and tips for achieving reduction. Throughout, the importance of anatomical reduction and screw positioning is stressed for optimal outcomes.
La tendinitis es la inflamación de un tendón o bursa causada por sobrecarga o sobreuso, lo que produce dolor y rigidez en las manos o el tendón de Aquiles. El tratamiento incluye descanso, antiinflamatorios, frío local y ergonomía para prevenir la sobrecarga a través de teclados, mouse y calzado adecuados. La prevención requiere identificar y eliminar factores de riesgo como mala técnica y deshidratación.
The document provides an overview of external fixation principles and techniques. It discusses indications such as unstable fractures, open fractures, and limb lengthening. Contraindications include inability to safely place pins. Key principles are described, such as maximizing pin size and number to optimize stability. Complications like pin site infection and malunion are reviewed. The goals of external fixation are to maintain length, alignment and rotation while preserving soft tissues.
Bone grafting involves surgically placing new bone material into bone fractures or defects to aid healing. Autografts from the patient's own bone are considered the gold standard but are limited in supply and can cause donor site morbidity. Allografts from other humans are also commonly used. The ideal bone graft substitutes provide osteoconductivity, osteoinductivity, and osteogenicity to support new bone formation. Common sources of autografts include the iliac crest, tibia, and fibula. Complications can include pain, infection, or fracture at the donor site.
Absolute stability refers to no micro-motion between fracture fragments under normal loads, allowing direct bone healing without callus formation. Absolute stability is achieved through open reduction, anatomical reduction, and interfragmentary compression techniques like lag screw fixation or compression plating. Implants that provide absolute stability include lag screws, axial compression plates, and buttress plates. Absolute stability is indicated for articular, simple diaphyseal, and certain metaphyseal fractures to promote direct bone healing without deformity.
Modified Mason-Allen Technique For Rotator Cuff Repairluantran92
Modified Mason-Allen technique is described for arthroscopic rotator cuff repair. It combines vertical simple sutures for strength with a horizontal mattress suture to act as a "rip-stop stitch". This technique provides high fixation strength, minimal gap formation, and maintains mechanical stability until tendon healing. A case report demonstrates the technique used to repair a partial supraspinatus tendon tear, with the patient showing functional improvement post-operatively. The Modified Mason-Allen technique offers biomechanical and clinical outcomes comparable to double-row repair, but with lower cost and use for partial-full thickness tears.
Bone grafts and bone grafts substitutessiddharth438
This document summarizes different types of bone grafts and bone graft substitutes. It discusses autogenous bone grafts which are considered the gold standard but have limitations related to donor site morbidity. Allografts from cadaveric donors are also discussed. Bone graft substitutes described include ceramics like calcium sulfate and calcium phosphate, demineralized bone matrix, and growth factors like bone morphogenetic proteins which provide osteoinduction. The properties, advantages, and limitations of each type of graft and substitute are summarized.
Arthroscopy principles were discussed. Arthroscopy involves inserting an arthroscope through small incisions to examine the inside of a joint. It allows diagnosis and treatment of injuries with less invasive techniques compared to open surgery. Common procedures include repairing torn cartilage or ligaments. Proper instrumentation, irrigation, and triangulation techniques are important for optimal visualization and treatment. Potential complications are rare but include damage to structures or infection. Recovery time depends on the procedure but most activities can be resumed within a few weeks.
Bone cement, also known as polymethyl methacrylate (PMMA), is widely used in orthopedic and trauma surgery to fix implants. It was first used in the late 1800s but its modern use began in the 1950s when Sir John Charnley used it for total hip arthroplasty. Bone cement is a two-component system consisting of PMMA powder and methyl methacrylate liquid that undergo an exothermic polymerization reaction. It has optimal strength in compression and provides a tight bond between implant and bone, but is brittle. Modern antibiotic-loaded bone cement allows targeted delivery of antibiotics to surgical sites.
1. Periprosthetic fractures are fractures that occur near a joint replacement prosthesis. They can occur in the femur, patella, or tibia.
2. Risk factors include increasing age, female sex, osteoporosis, revision arthroplasty, rheumatoid arthritis, steroid use, and neurological diseases.
3. Surgical treatment depends on the fracture classification and stability of the prosthesis. Options include open reduction internal fixation with a locking plate, intramedullary nailing, or revision arthroplasty.
This document discusses fractures of the calcaneus bone, also known as the heel bone. It begins with an introduction stating that calcaneus fractures make up approximately 2% of all fractures and are most common in males aged 21-45. The document then covers the anatomy and mechanisms of injury, describing how these fractures usually occur from high-energy impacts like falls from heights. It classifies fractures as either extra-articular or intra-articular and discusses the clinical features, imaging, treatment, and complications associated with calcaneus fractures.
1) Osteosynthesis-associated infection (OAI) treatment aims to eradicate infection while allowing fracture healing. Key factors are mechanical stability, time since fixation, and presence of union. 2) For acute infections (<2 weeks), antibiotics and drainage may suffice; deeper infections require debridement. Delayed (3-10 weeks) and late (>10 weeks) infections often involve biofilm/osteomyelitis and may require implant removal. 3) Management strategies include debridement, implant retention/removal, external fixation, local antibiotic therapy, and staged reconstruction. Outcomes depend on fracture stability, soft tissue integrity, and infection control.
Description of 13 years of orthopaedic practice in a prison, without facilities under desperate situations. During this time not only were 14000 patients treated, many startling orthopaedic discoveries were made. This is an award winning talk by Dr L.Prakash
The Future of Orthobiologics in Trauma ProceduresApril Bright
Based on his clinical research interests in utilization of Alpha-BSM bone graft substitute and OP-1 recombinant BMP in the repair of fractures, Daniel N. Segina, M.D., outlined opportunities and challenges for surgeons and device companies in biologic development. To make his case, Dr. Segina reviewed the spectrum of orthobiologics used in trauma cases today, shared perspective on what is and isn’t working and forecasted the future of regenerative medicine.
1. The Masquelet technique is a two-stage procedure used to treat bone defects and non-unions. In the first stage, radical debridement is performed and a cement spacer is implanted to induce membrane formation. In the second stage, the membrane and spacer are removed and the defect is filled with bone graft contained by the induced membrane.
2. The induced membrane forms a chamber that vascularizes the graft and prevents resorption. It expresses growth factors that aid bone regeneration. Keys to success include thorough debridement, stable fixation, adequate soft tissue coverage, and membrane protection of graft at the second stage.
3. The technique is indicated for defects from trauma, infection, or tumor resection.
An olecranon fracture is a break of the proximal end of the ulna bone where it forms part of the elbow joint. It most often occurs from a fall on an outstretched arm. Diagnosis is made through physical exam finding tenderness and a gap at the fracture site as well as x-rays. Treatment depends on the severity of the break, with minor fractures treated by casting and more severe displaced fractures requiring surgical fixation such as screws, plates or wires to stabilize the bone fragments. Complications can include stiffness, non-healing of the fracture and arthritis if not properly treated.
Surgical tips and tricks in fractures of femurPraveen Mehar J
This document provides surgical tips and tricks for fractures of the femur, including the neck and intertrochanteric regions. For femoral neck fractures, it discusses anatomy, classifications, reduction techniques, fixation methods, and considerations for blood supply. Intertrochanteric fractures are discussed in terms of classification, reduction methods, implant options, and the importance of screw position. Subtrochanteric fractures are also addressed, emphasizing biomechanical advantages of intramedullary nailing and tips for achieving reduction. Throughout, the importance of anatomical reduction and screw positioning is stressed for optimal outcomes.
La tendinitis es la inflamación de un tendón o bursa causada por sobrecarga o sobreuso, lo que produce dolor y rigidez en las manos o el tendón de Aquiles. El tratamiento incluye descanso, antiinflamatorios, frío local y ergonomía para prevenir la sobrecarga a través de teclados, mouse y calzado adecuados. La prevención requiere identificar y eliminar factores de riesgo como mala técnica y deshidratación.
ETUDE DE PERITONITE GENERALISEE PAR LESIONS DE L’INTESTIN GRELE TRAUMATIQUE F...Sargata SIN
ETUDE DE PERITONITE GENERALISEE PAR LESIONS DE L’INTESTIN GRELE TRAUMATIQUE FERME CHEZ L’ADULTE,
A PROPOS DE 71 CAS, A L’HOPITAL PREAH KOSSAMAK,
PHNOM PENH, DU 1ER JANVIER 2010 AU 31 DECEMBRE 2015
ETUDE RETROSPECTIVE DE L’APPENDICITE AIGUE CHEZ L’ADULTE, A PROPOS DE 1094 CA...Sargata SIN
ETUDE RETROSPECTIVE DE L’APPENDICITE AIGUE CHEZ L’ADULTE, A PROPOS DE 1094 CAS, A L’HOPITAL PREAH
KOSSAMAK, PHNOM PENH, DU 1ER JANVIER 2009
AU 31 DECEMBRE 2015
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Emotional Intelligence and Work Performance Relationship: A Study on Sales Pe...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumer Perspectives on Brand Preference: A Choice Based Model Approachiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Student`S Approach towards Social Network Sitesiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Broadcast Management in Nigeria: The systems approach as an imperativeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study on Retailer’s Perception on Soya Products with Special Reference to T...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study Factors Influence on Organisation Citizenship Behaviour in Corporate ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Consumers’ Behaviour on Sony Xperia: A Case Study on Bangladeshiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Design of a Balanced Scorecard on Nonprofit Organizations (Study on Yayasan P...iosrjce
1. The document describes a study that designed a balanced scorecard for a nonprofit organization called Yayasan Pembinaan dan Kesembuhan Batin (YPKB) in Malang, Indonesia.
2. The balanced scorecard translated YPKB's vision and mission into strategic objectives across four perspectives: financial, customer, internal processes, and learning and growth.
3. Key strategic objectives included donation growth, budget effectiveness, customer satisfaction, reputation, service quality, innovation, and employee development. Customers perspective had the highest weighting, suggesting a focus on public service over financial growth.
Public Sector Reforms and Outsourcing Services in Nigeria: An Empirical Evalu...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Media Innovations and its Impact on Brand awareness & Considerationiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer experience in supermarkets and hypermarkets – A comparative studyiosrjce
- The document examines customer experience in supermarkets and hypermarkets in India through a survey of 418 customers.
- It finds that in supermarkets, previous experience, atmosphere, price, social environment and experience in other channels most influence customer experience, while in hypermarkets, previous experience, product assortment, social environment and experience in other channels are most influential.
- The study provides insights for retailers on key determinants of customer experience in each format to help them improve strategies and competitive positioning.
Social Media and Small Businesses: A Combinational Strategic Approach under t...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Secretarial Performance and the Gender Question (A Study of Selected Tertiary...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Implementation of Quality Management principles at Zimbabwe Open University (...iosrjce
This document discusses the implementation of quality management principles at Zimbabwe Open University's Matabeleland North Regional Centre. It begins with background information on ZOU and the importance of quality management in open and distance learning institutions. The study aimed to determine if quality management and its principles were being implemented at the regional centre. Key findings included that the centre prioritized customer focus and staff involvement. Decisions were made based on data analysis. The regional centre implemented a quality system informed by its policy documents. The document recommends ensuring staffing levels match needs and providing sufficient resources to the regional centre.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Organizational Conflicts Management In Selected Organizaions In Lagos State, ...
Pénectomie partielle pour un carcinome de la verge: A propos de 24 cas
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 12 Ver. VI (Dec. 2015), PP 115-118
www.iosrjournals.org
DOI: 10.9790/0853-14126115118 www.iosrjournals.org 115 | Page
Pénectomie partielle pour un carcinome de la verge: A propos de
24 cas
Hanen Bouaziz1
, Maher Slimane,2
Riadh Chargui 3
, Jamel Ben Hassouna4
,
Hatem Bouzaiene5
, Monia Hechiche6
, Tarek Ben Dhiab7
, Khaled Rahal8
Service de Chirurgie Carcinologique, Institut Salah Azaïz, Tunis, Tunisie
Abstract Les tumeurs de pénis majoritairement représentés par le carcinome épidermoide de la verge sont
relativement rares dans les pays occidentaux, et dans les populations qui pratiquent la circoncision à l’enfance,
mais plus fréquent dans des pays à niveaux socio-économique faible. Le traitement chirurgical apporte le
meilleur contrôle tumoral mais est un geste mutilant, tout par son impact psychologique que par les séquelles
opératoires potentielles. Les traitements conservateurs constituent une alternative thérapeutique séduisante. Le
traitement optimal des aires ganglionnaires reste un domaine controversé. Les facteurs pronostiques péjoratifs
de cette pathologie sont l’atteinte ganglionnaire, celle du corps caverneux et la faible différenciation
histologique.
Mots clés: Curage ganglionnaire, IRM, Pénectomie partielle, Verge
I. Introduction
Le carcinome épidermoide de la verge représente la majorité des tumeurs malignes du pénis (97% des
tumeurs de la verge), son incidence est variable selon les régions géographiques, les coutumes et le niveau
socio-économique. C’est un cancer du sujet âgé qui touche le pus souvent l’homme après 50 ans. L’IRM
pénienne peut aider pour apprécier l’extension en profondeur. Le traitement de la tumeur pénienne est au
maximum conservateur, soit par chirurgie, soit par curiethérapie. Le risque de récidive locale est de 20 %. La
prise en charge ganglionnaire doit être systématique, bilatéral et réalisée lors du diagnostic.
II. Patients et méthodes
Nous rapportons une étude rétrospective de 24 hommes atteints d’un carcinome épidermoide de la
verge non métastatique, colligés et traités selon une approche conservatrice (chirurgie et/ou radiothérapie) dans
notre institut sur une période de 30 ans. Tous nos patients de religion musulmane étaient circoncis dès le jeune
âge. La tumeur était classée selon la classification TNM 2009. Les distributions des estimations de survie
globale et de survie sans récidive ont été calculées à partir de la méthode de Kaplan –Meier. Les facteurs
pronostiques étudiés en analyse uni et multi variées étaient les suivantes :
- L’âge (≤ contre> 70 ans) ;
- La taille tumorale (≤ contre > 3 cm) ;
- Des ganglions inguinaux palpables ;
- Stade T
- Stade N
- Le traitement (chirurgie associée ou non à la radiothérapie) ;
- L’évolution (récidive ou progression contre rémission)
- L’infiltration du corps caverneux
- Le grade
- L’envahissement inguinal (N+ contre N-)
- Les limites chirurgicales (saine contre non précisées)
III. Result at
L’âge médian de nos patients était de 66 ans. La taille tumorale moyenne était de 4 cm. Selon la
classification TNM, il y avait : 16 patients T1 (66,6%) (Fig 1), quatre T2 (16,6%), deux T3 (8,3%) (Fig 2) ; six
patientes N0 (25%), huit N1 (33,3%) et deux N3 (8,3%). Dix patients (41,6%) seulement ont eu une IRM de la
verge pour des problèmes de disponibilité ou économique (Fig 3, 4). Le reste des patients a été exploré par une
échographie. Vingt patients (83,3%) ont eu une chirurgie première type pénectomie (Fig 5). Quatre patients
(16,6%), ont une radiothérapie préopératoire. Dans deux cas la radiothérapie était concomitante à cinq cures de
chimiothérapie. Après un suivi médian de 70 mois, la survie globale et la survie sans récidive à cinq ans étaient
de 81 et 85% respectivement. Neuf malades étaient irradiés en postopératoire : deux (8,3%) au niveau du lit
tumoral, deux (8,3%) au niveau du creux inguinal, quatre au niveau du lit tumoral et du creux inguinal. A la fin
2. Pénectomie partielle pour un carcinome de la verge: A propos de 24 cas
DOI: 10.9790/0853-14126115118 www.iosrjournals.org 116 | Page
du traitement, deux patients étaient en progression et six ont présenté une récidive : lit tumoral (n=2), inguinal
(n=1), lit tumoral et inguinal (n=3). Un patient a présenté une métastase axillaire homolatérale .
Dans l’analyse univariée, les facteurs pronostiques influençant la survie globale, sont les ganglions
inguinaux palpables (p=0,005), le stade N (p=0,005) et une récidive ou une progression (p= 0,0001). Pour la
survie sans récidive, les facteurs pronostiques significatifs étaient : le stade T (p=0.016), le stade N (p=0,012),
le grade (p= 0,00). Dans l’analyse multivariée, aucun facteur n’a été retrouvé au test chi2, il y avait une relation
significative entre la taille tumorale (>3cm) et la présence des ganglions inguinaux (p=0,037).
IV. Discussion
L’âge moyen du diagnostic du cancer dans notre étude (66 ans) est conforme avec les données de la
littérature où l’incidence maximale survient après 50 ans [1,2]. La localisation était le plus souvent distale
(prépuce et gland) conformément à ce qui est décrit [3]. Le manque d’hygiène surtout chez les hommes non
circoncis et l’infection par le virus du papillome humain (HPV) sont des facteurs prédisposants. Le diagnostic
est histologique, le plus fréquemment c’est un carcinome épidermoide( >90% des cas) .
À ses débuts, la lésion est indolore. Les signes cliniques apparaissent au cours de l’évolution de la
tumeur : brûlures, démangeaisons, saignement au contact, et surtout augmentation de volume du gland du pénis,
parfois masquée par un phimosis. Chez nos patients le principal motif de consultation était la douleur. Les
signes urinaires sont rares. Dans notre série l’évaluation de l’extension locale au niveau du pénis était basée sur
l’examen du pénis et l’échographie. L’intérêt de l’échographie réalisée avec une sonde 7.5 MHz réside dans son
caractère non invasif. Les lésions tumorales sont le plus souvent hypoéchogènes (47 à 100 % des cas),
hyperéchogènes dans 36 % des cas, d’échogénicité mixte dans 17 % des cas [4]. Les auteurs s’accordent pour
considérer que l’échographie n’est pas un bon examen pour apprécier l’extension au niveau du fascia de BUCK
(Ta versus T1). Par contre, le franchissement l’albuginée des corps caverneux est plus facile à reconnaître,
surtout au niveau du corps de la verge L’IRM est l’examen le plus sensible pour identifier une extension urétrale
ou caverneuse, mais elle n’apporte rien de plus que l’examen clinique dans les stades T1. La réalisation de cet
examen lors d’un test d’érection pharmacologique permet de mieux apprécier l’éventuelle infiltration du corps
caverneux et peut aider à déterminer si une chirurgie conservatrice est envisageable [3]. Pour le bilan
ganglionnaire, La palpation des aires doit être systématique et bilatérale. Un complément d’exploration par
TDM est nécessaire pour le bilan d’extension.
Le choix du traitement dépend surtout de facteurs comme la localisation, la dimension, le stade et le
grade tumoral. En cas de stade évolué, de haut grade tumoral et de site tumoral proximal, le traitement est
obligatoirement la chirurgie et consiste en une amputation de verge (partielle ou totale) ou en une émasculation.
Dans les stades peu évolués ou les faibles grades tumoraux, en particulier dans les tumeurs distales de petite
dimension, il est possible parfois de choisir entre la chirurgie partielle et le traitement conservateur [5]. Chez
tous nos patients qui ont eu un traitement conservateur, l’impératif carcinologique a également tenu compte des
résultats cosmétique et fonctionnel. Malheureusement notre travail est rétrospectif, et la notion de qualité de
vie : les facteurs émotionnels, le bien-être psychologique, l’intégration sociale, le fonctionnement global de la
sexualité et l'entourage psychologique familial n’ont pas été bien évalué. Nous avons surtout cherché à évaluéer
les facteurs pronostics. La présence de métastase ganglionnaire est le facteur pronostic le plus important de
survie [6]. Dans notre série l’envahissement ganglionnaire influençait la survie globale et la survie sans récidive.
Après la pénectomie partielle, le risque de récidive locale varie entre 0et 15% [7]. Chez nos patients
Les marges étaient saines, vérifiées en extemporané. la survie globale et la survie sans récidive à cinq ans étaient
de 81 et 85% respectivement.
V. Conclusion
La circoncision néonatale semble avoir un rôle protecteur. Le pronostic du carcinome épidermoïde est
conditionné par sa profondeur d’infiltration, son grade histo-pronostique et la précocité de la prise en charge. La
faible incidence de cette lésion et sa répartition géographique, rend difficile à mettre en place des essais
cliniques randomisés, des études et travaux prospectifs.
References
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radiothérapie, Progrès en Urologie, 9 (1999), 715-720.
[6] Machele Donats et coll . Surgery of penile and urethral carcinoma, Campelle’s urology, 8th
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3. Pénectomie partielle pour un carcinome de la verge: A propos de 24 cas
DOI: 10.9790/0853-14126115118 www.iosrjournals.org 117 | Page
FIG 1: Processus bourgeonnant hémi circonférentiel de la face inférieure et latérale gauche du prépuce
FIG 2: Carcinome épidermoide qui infiltre la peau et s'étend au niveau de la face inférieure du corps
spongieux et au niveau de la partie inférieure et latérale du corps caverneux gauche avec envahissement
de l’urètre.
4. Pénectomie partielle pour un carcinome de la verge: A propos de 24 cas
DOI: 10.9790/0853-14126115118 www.iosrjournals.org 118 | Page
FIG 3 : IRM de la verge (coupe axiale )montrant un processus bourgeonnant hémi circonférentiel de la face
inférieure et latérale gauche du prépuce en signal intermédiaire T2
FIG 4 : IRM de la verge (coupe axiale T1) montrant un processus bourgeonnant hémi circonférentiel de la
face inférieure et latérale gauche du prépuce rehaussé après injection de Gadolinium
FIG 5 : Aspect post opératoire après une pénectomie partielle