Evaluation of the Management of Severe Trauma Kidney Injury and Long Term Renal Function in Children

To evaluate the management and long term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury (STKI) grade IV (STKI IV) and V (STKI V) at the trauma center of Grenoble teaching hospital.

Materials and methods: This is a single-center retrospective study between 2004 and 2014. All children under the age of 15 managed at the Grenoble teaching hospital for a STKI IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American association for surgery of trauma.

The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury.

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Evaluation on the Effectiveness of the Different Modes of Publicity for Tissue Donation among Healthcare Professionals in Singapore

In Singapore, the donation of tissues is governed by the Medical (Therapy, Education and Research) Act. For past years, our tissue banks have engaged in various publicity methods. The objective of this study is to evaluate the effectiveness of our publicity strategies among healthcare professionals.

A 6-questions survey was conducted among doctors, nurses, allied health and support services staff from Singapore General Hospital and National Heart Centre Singapore. Sample size was calculated in accordance to the occupation ratio. Results: Of the 450 respondents who completed the survey, most did not see, read or heard about tissue donation.

All occupations except doctors, reported that information on how tissue donation improved a recipient’s life will interest them. On contrary, statistics and facts will interest doctors more. Results highlighted our publicity methods have not been effective in conveying tissue donation message to healthcare audiences. Hence, there is a need to re-strategies its publicity efforts, so that information on tissue donation can be effectively delivered to them.

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Bladder Cancer Enters the Targeted Immunotherapy Age

While other cancers have seen great improvements in outcomes due to new therapies and treatment paradigms over the last decades, advanced bladder cancer has been one of the few solid tumors for which no new major breakthrough have been seen in thirty years.

However, all that changed a few weeks ago with the US Food and Drug Administration (FDA) accelerated approval of atezolizumab (Tecentriq, Genentech, Inc), for the treatment of advanced urothelial carcinoma, the most common type of bladder cancer.

Atezolizumab is a targeted immunotherapy that acts as a programmed cell death ligand inhibitor (PD-L1), and is the third agent approved in cancer that targets the PD-1/PD-L1, PD-L2 checkpoint pathway (with nivolumab and pembrolizumab being the other two).

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Isolated Free Fluid without Pneumoperitoneum on Computed Tomography in Blunt Abdominal Trauma: Laparotomy Better Based on Imaging Finding and Clinical Presentation

This study examines the clinical assessment and management of patients sustaining blunt abdominal trauma (BAT) with unexplained intra-abdominal free fluid.All adult patients (age 18 years) presenting with BAT to our trauma center over a 7-year period were reviewed.

Those with abdominal computed tomography (CT) demonstrating intra-peritoneal free fluid but neither solid organ injury nor pneumoperitoneum were studied further. Demographic data, radiologic interpretation, operative findings, clinical management and outcome were analyzed.

115 patients met the inclusion criteria. Except 9 patients for non-operative management, 91 patients (86%) underwent therapeutic laparotomy, in whom 83 patients (78%) benefited from surgical intervention and 15 patients (14%) underwent non-therapeutic laparotomy, in whom 8 patients (8/15=53%) had retroperitoneal hematoma with associated pelvic fractures.

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Metastatic Renal Cell Carcinoma to Submandibular Gland: A Rare Occurrence

Approximately 20-30% of patients affected by renal cell carcinoma (RCC) present with metastatic disease, and 20% to 40% undergoing nephrectomy for clinically localized disease will develop metastases.

A 53 years old female patient developed a left submandibular swelling. Four years before she experienced a left radical nephrectomy for a clear cell tumor and two years later right kidney was removed for a cancer having the same histologic subtype. In that circumstance duodenal pancreasectomy was required for infiltration of pancreatic gland.

A sialoadenectomy has been performed and pathology demonstrated an intraglandular neoplasm with characteristics of a clear renal cell carcinoma. Although it is extremely rare, submandibular salivary gland may be a site of RCC metastasis. Diagnosis of metastatic disease for patients affected by submandibular swelling with a previous history of RCC should be always considered.

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Evaluation on the Effectiveness of the Different Modes of Publicity for Tissue Donation among Healthcare Professionals

There are two laws that governs organ and tissue donation in Singapore-the human organ transplant act (HOTA) and the medical (Therapy, Education and Research) act (MTERA).

Unlike HOTA, which allows for the three organs and one tissue (kidney, liver, heart and corneas) of Singapore citizens and permanent residents to be donated in the event of death for the transplantation purpose, the donation of skin and heart valves are governed by MTERA. The Act provides for voluntary donation of specified organs and tissues for the purposes of transplantation, treatment, education or research.

For the past years, the National Cardiovascular Homograft Bank and the Skin Bank, which are recently merged under Singhealth’s Transplant Tissue Centre in 2015, have engaged in various publicity methods. Many international studies have shown the importance of addressing the gaps in healthcare professionals’ knowledge, attitude and education needs with regards to organ/tissue donation

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Right Versus Left Laparoscopic Donor Nephrectomy: Initial 3 year Experience from a Single Centre Transplant Program

Laparoscopic living donor nephrectomy is the standard of care at high volume transplant centers. Despite this there is still reticence to harvest the right kidney laparoscopically because of concerns regarding the shorter renal vein, higher complexity of dissection and potentially higher complication rates and worse renal allograft outcomes. The aim of this single-center study of 72 consecutive laparoscopic donor nephrectomies was to compare left versus right-sided laparoscopic donors in terms of surgical difficulty, complication rates and outcomes.

There were 56 left-sided and 16 right-sided donors. There was no significant difference in surgical outcomes or complication rates. Similarly, the recipient surgery complication rates and allograft outcomes were no different between kidney sprocured laparoscopically from the left or the right. This single center study shows comparable donor operative parameters and recipient post-operative outcomes in left and right laparoscopic donor nephrectomies. 

Different Biologic Grafts for Diaphragmatic Crura Reinforcement during Laparoscopic Repair of Large Hiatal Hernia: A 6-Year Single Surgeon Experience

Minimally invasive approach in the repair of hiatal hernias became a standard of care during the last two decades. Laparoscopy offers faster recovery, shorter hospital stay and less morbidity than traditional laparotomy.

Several studies have shown higher recurrence rates after a suture-based repair of hiatal hernias. A “tension-free” repair with prosthetic mesh allowed to decreased recurrence, but the use of synthetic materials produced potentially serious problems, such as erosion and dysphagia.

Multiple reports showed reduction in short-term recurrence rate after hiatal hernia repair with biologic grafts. However, the improvement in hiatal hernia recurrence decreased at long-term follow-up

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Life-threatening Capillary Leak Syndrome in an Adult with Refractory Acute Myeloid Leukemia during Allogeneic Transplantation

CLS is one of the life-threatening early complications which usually occur during hematopoietic stem cell infusion or hematopoietic reconstruction process in addition to graft-versus-host-disease (GVHD) and infection.

It is characterized by unexplained episodic capillary hyperpermeability, which causes the shift of fluid and protein from the intravascular space to the interstitial space. However, since the nonspecific signs and symptoms of CLS and the overlapping manifestations of early complications after transplantation, CLS tends to be easily confused with other early complications for clinicians.

In this case, we report an adult with refractory acute myeloid leukemia who developed fatal CLS during allo-HSCT with review of the literature.

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Liver Transplantation From Donor With Situs Inversus Totalis

A 32-year-old male had a severe traffic accident and was diagnosed with brain death 3 days after the admission. The potential donor has filled criteria for multiple organ donation and the family accepted the donation.

During organs harvesting, it was found that liver, kidneys, pancreas, stomach and all others organs of the abdominal and thoracic cavities were located in changed positions as if it were a mirror image, diagnosing the donor with situs inversus totalis.

The liver and the kidneys were flushed with standard preservation solution and procured using standard techniques. During routine backbench preparation of the liver graft, we identify the anatomical relations: common bile duct in the left side, liver artery locating in right, and portal vein behind it.

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The Association between Venous Thromboembolism and Lipid Profile in a Tunisian Population

Venous Thromboembolism (VTE) is the union of deep vein thrombosis (DVT) and pulmonary embolism (PE); it’s an important cause of morbidity and mortality with an estimated annual incidence of 0.67 to 1.0 per 1000 among the general population in western countries.

It is a polygenic disease with pathogenic contributions from both genetic and environmental risk factors; according to Virchow’s triad, VTE results from stasis hypercoagulability and the alteration in the blood vessel wall.

This dichotomy has been challenged in recent years, it still many unknown risk factors. Lipids and lipoproteins modulate the expression and/or the function of thrombotic, fibrinolytic and rheological factors among patients with cardiovascular disease.

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AN UNIQUE MAGNETIC ATTACHMENT RETAINING SILICONE NOSE PROSTHESIS

The face being the most noticeable part of the body when disfigured may lead to an impaired social life stemming from esthetic problems. Among facial defects, nasal defects produce severe cosmetic impairment.

Rehabilitation of such defects subsequent to surgery is done in a sequential manner, which includes a surgical, provisional, and definitive prosthesis. Prosthesis helps restore the patients' selfesteem and confidence, hence affecting the patients and their life style.

Adenoid cystic carcinoma (ACC) is a rare malignant perineural tumour of the major and minor salivary glands, accounting for 2% of all head and neck malignancies and approximately 10% of all salivary gland neoplasms.

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Infra Mammary Approach for Major Duct Excision in the Management of Multiple Duct Ectasia

In some cases, non-lactating women can experience nipple discharge that can be highly distressing. Such discharge is commonly caused by mammary ductal ectasia (MDE).Factors that can lead to mammary duct ectasia are still undefined.

However, possible causes of MDE can include congenital abnormalities of the ductal system, autoimmune reactions, trauma or infections.The pathogenesis of duct ectasia includes the dilatation of one or more of the large lactiferous ducts that are filled with a stagnant secretion.

These fluids trigger an irritation reaction in the surrounding tissues causing periductal mastitis or abscess and fistula formation. In some instances, a chronic indurated mass formation can take place underneath the areola that may resemble a carcinoma.

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PTEN and ERG Molecular Networks in Prostate Cancer

Prostate cancer (PCa) represents a common malignancy among elder males and one of the leading causes of cancer mortality. It may present with a variety of clinical behavior, including tumors of very low clinical significance but also highly aggressive tumors with increased risk of relapse after initial treatment.

Nowadays, many tumors traditionally treated either by radical prostatectomy or by external beam radiation therapy are considered of low clinical significance and such patients are placed under active surveillance protocols with purpose to reduce overtreatment.

As a result, in the “active surveillance” era, there is a need of establishing strong prognostic markers identifying aggressive tumors as well as clinical significant tumors even among these initially characterized of low or intermediate risk.

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Genitourinary Hydatid Disease

The most important parasitic diseases involving the genitourinary system in humans are helminthic, where schistosomiasis is the commonest followed by hydatid disease (HD) and filariasis. HD is a parasitic infestation, caused by tape worms of the genus Echinococcus, that usually involves the liver and lungs, although no organ is spared.

The varied presentations and complications of HD present routine surgical problems in endemic areas, although HD of the urinary tract is uncommon, comprising 2–4% of all cases. This article reviews the epidemiology, etiopathogenesis, clinical features and presentations, medical and surgical treatment of genitourinary and pelvic echinococcosis with special reference to individual organs.

In addition our own experience at our hospital in the last 4 years that we treated 4 cases of hydatid cysts of which 3 were renal HD and one was primary pelvic HD.

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Isolated Free Fluid without Pneumoperitoneum on Computed Tomography in Blunt Abdominal Trauma

Non-operative management for blunt abdominal trauma (BAT) is considered the treatment of choice for patients with stable hemodynamic status. Due to the high efficiency and accuracy of abdominal computed tomography (CT) in the identification of solid organ injury, it is increasingly utilized for stable patients sustaining BAT.

However, the diagnosis of hollow viscus or diaphragmatic injury remains difficult. The diagnostic signs of bowel perforation are oral contrast extravasation and pneumoperitoneum; however, both diagnostic signs in the case of bowel injury have high specificity, but low sensitivity.

Other suggested signs of bowel injury, including bowel wall thickening, streaking of the mesentery, dilated bowel loops, and free fluid without solid organ injury, were unreliable.

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Advances in Targeted Re-innervation

In recent years there have been numerous advances in the field of prosthetics. Targeted reinnervation is a newly developed surgical procedure used to improve the motor control and sensation of the affected limb.

In this procedure, the residual nerves from the amputated extremity are identified and transferred to new “targets” that have otherwise lost their function. These newly innervated muscles and targets are then used as amplifiers for the amputated nerves in order to restore the functional loss.

Use of these newly innervated muscles or at times even only parts of muscles (two heads of pectoralis after a forequarter amputation) would allow a more innate control of the bio-prosthetics.This will not only allow the new muscle contractions to be sensed and used to control prosthesis, it will also enable the overlying skin to have protective sensation.

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Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor)

Surgery, Condyloma acuminata is the most common sexually transmitted disease found in young, sexually active population and mostly seen in the colorectal practice.

Condylomas have been well known in history with physicians of ancient Roman Empire calling them as “figs” which were thought to result from excessive sexual exploits. The term “acuminatum” means “pointed” and was used to distinguish condyloma acuminatum from condyloma lata, the “broad” condyloma of syphilis.

Giant condyloma acuminatum or Condylomata gigantea (commonly known as Buschke-Lowenstein tumor) is a rare, aggressive, slow growing; fungating variant of condyloma that is usually found in the genital and perianal regions but may affect any portion of the anogenital region.

A Short Communication on the Need for Interdisciplinary Action with Families with Deaf Children Who Use Bilateral Cochlear Implants

Bilateral Cochlear Implantation (BCI), both simultaneous and short interval sequenced, is a widely advantageous and valuable resource with respect to unilateral cochlear implantation and long interval bilateral sequenced cochlear implantation,  generating new concerns for families with deaf children.

Lammers et al.Recently found more statistically significant results regarding the perception of sound and the expressive linguistic development of children with Simultaneous Cochlear Implantation (SCI) compared to those with sequential bilateral cochlear implantation after 1 year of hearing experience with the devices.

Moreover, the available data show that there is no proliferation in the risks associated to SCI, assuming that only one surgical, hospital episode was recorded.In this sense, relevant advances over BCI in deaf children are evident. Nevertheless, efficiency and development of bilateral cochlear implants’ performance should not be taken for a grant. Not only clinical area influences a correct usage of cochlear implants.

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PTEN and ERG Molecular Networks in Prostate Cancer

Prostate cancer (PCa) represents a common malignancy among elder males and one of the leading causes of cancer mortality. It may present with a variety of clinical behavior, including tumors of very low clinical significance but also highly aggressive tumors with increased risk of relapse after initial treatment.

Nowadays, many tumors traditionally treated either by radical prostatectomy or by external beam radiation therapy are considered of low clinical significance and such patients are placed under active surveillance protocols with purpose to reduce overtreatment.

As a result, in the “active surveillance” era, there is a need of establishing strong prognostic markers identifying aggressive tumors as well as clinical significant tumors even among these initially characterized of low or intermediate risk.

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Liver Transplantation for Hepatocellular Carcinoma: A Time to Push Forward

Despite improvements in therapeutic modalities over the past decade hepatocellular carcinoma (HCC) remains the second leading cause of cancer related deaths accounting for approximately 700,000 deaths worldwide each year.

HCC is frequently multifocal and arises in setting of cirrhosis (>80%), hence surgical resection of HCC with curative intent is only feasible in 20-30% of patients at time of diagnosis. We have known for years that liver transplantation (LT) is the gold standard for HCC therapy in the setting of significant liver disease given its oncologic advantage of replacing the organ harboring malignancy all while reversing the physiologic liver dysfunction.

In 1996 Mazzafero et al. demonstrated that by limiting LT to HCC patients with a single tumor of ≤ 5 cm, or up to 3 tumor nodules ≤ 3 cm, excellent outcomes could be achieved giving rise to the influential Milan Criteria.

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The Effectiveness of Polypropylene Mesh in the Open and Laparoscopic Repair of Divarication of the Recti

Divarication of the recti (Diastasis recti) is the separation of the rectus abdominis muscle into right and left halves (a gap of roughly 2.7 cm or greater), usually due to thinning and stretching of the linea alba resulting from various reasons.

Typically, the two sides of the muscle are joined at the linea alba at the body midline. Divarication of the recti would appear as a long ridge extending down the abdominal midline from the xiphoid process to the umbilicus. It will become more prominent with straining and may disappear when the abdominal muscles are relaxed.

It is reported to be more common in multiparous women (about 66%) due to the repeated episodes of stretching [1,2].The most common reported etiologic factors include chronic or intermittent abdominal distension, advancing age, or familial weakness of the abdominal musculofascial tissues.

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Life-threatening Capillary Leak Syndrome in an Adult with Refractory Acute Myeloid Leukemia during Allogeneic Transplantation

A 27-year-old male was first admitted to our hospital in August 2014 with complaints of chills and fever. He exhibited obvious pain and swelling of gastrocnemius and activity abstacle. Peripheral blood counts revealed white cell counts of 29.9 × 109/L, hemoglobin lever of 89g/L, platelet counts of 179 × 109/L.

Bone marrow was hypercellular exhibiting infiltration with 30% blast cells comprising myeloblasts and promonocytes. Immunophenotype analysis showed 54% abnormal cells which were positive for CD13, HLA-DR, CD11b, CD11c, CD33, CD14, CD64 and CD15, and weakly positive for CD34 and MPO. The overall findings were consistent with acute myeloid leukemia.

G-banding revealed 46, XY. Moreover, genetic testing revealed positive for dupMLL fusion. He did not respond to “HA”(HHT 4 mg/d × 7d, Ara-c 0.2 g/d × 7d) and subsequent “IA” (IDA 30 mg d1, 20 mg d2-3, Ara-c 0.2 g/d × 7d) induction chemotherapy.Salvage therapy consisted of DAC (decitabine) (20 mg/m2/d × 5d), Ara-c (cytarabine) (10 mg/m2/d × 2d) and Ara-c (10 mg/m2 every 12 h × 3d) was planned.

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Portal Hypertension Model in Pigs

Every year in western countries millions of people are diagnosed with portal hypertension (PHT) which rapidly complicates hepatic cirrhosis and causes esophageal varices, ascites and encephalopathy. This determines higher risk of morbidity and mortality and contributes to elevate costs for the Health Care System.

PHT is defined as the elevation of the portal vein pressure gradient over 5-10 mmHg. Common causes are: Pre-hepatic such as portal vein thrombosis or congenital atresia; intra-hepatic as liver cirrhosis, hepatic fibrosis and less commonly non-cirrhotic causes such as schistosomiasis, massive fatty change and granulomatous diseases; post-hepatic including obstruction that occurs at any level between liver and right heart (i.e., Budd Chiari syndrome and veno-occlusive disease VOD).

The pathophysiology of portal hypertension is explained by the increasing of vascular resistance into the blood flow of the liver; as consequence the hepatic micro vasculature is compressed by regenerative nodules and fibrotic scars of the cirrhosis.

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Genitourinary Hydatid Disease

The most important parasitic diseases involving the genitourinary system in humans are helminthic, where schistosomiasis is the commonest followed by hydatid disease (HD) and filariasis [1]. HD is a parasitic infestation, caused by tape worms of the genus Echinococcus, that usually involves the liver and lungs, although no organ is spared.

The varied presentations and complications of HD present routine surgical problems in endemic areas, although HD of the urinary tract is uncommon, comprising 2–4% of all cases. This article reviews the epidemiology, etiopathogenesis, clinical features and presentations, medical and surgical treatment of genitourinary and pelvic echinococcosiswith special reference to individual organs.

In addition our own experience at our hospital in the last 4 years that we treated 4 cases of hydatid cysts of which 3 were renal HD and one was primary pelvic HD.

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Complete Sciatic Nerve Transection Associated with a Closed Femoral Shaft Fracture

Femoral shaft fractures are usually the result of a high-energy injuries. It is estimated that annually between 1.0 and 2.9 million femoral shaft fractures occur worldwide. In high-income countries the annual incidence of femoral shaft fractures ranges between 8.2 and 23.9 per 100,000 people.

Due to the high-energy mechanism, associated injuries are common in this patient population and the inhospital mortality has been reported to be approximately 1.4%. In particular, musculoskeletal injuries to the ipsilateral limb, such as hip fractures, patella fractures, tibial plateau fractures, and ligamentous knee injuries have been reported to commonly occur in conjunction with high-energy femoral shaft fracture.

However, reports on peripheral nerve injuries as a result of a femoral shaft fracture are limited in the orthopaedic literature. Rodriguez-Merchan et al. reported on 150 femoral shaft fractures and observed temporary neurologic deficits in 10 patients. A few case reports have reported on injuries to the sciatic nerve associated with femoral shaft fractures.

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Secondary Augmentation Mastopexy to Correct Malpositioned Nipple Areola Complex (NAC) and Baker's Grade III Capsular Contracture 15 Years Later

Augmentation mastopexy is a complex procedure that combines two surgical procedures in a single operation. Augmentation mastopexy attempts to correct both mammary volume loss or depletion and ptosis.

Some surgeons have suggested performing both procedures in a separate setting- performing the mastopexy first if the primary problem is one of ptosis and performing augmentation mammaplasty as a second procedure. If the primary problem is of volume loss or deflation, augmentation mammaplasty is carried out first followed by mastopexy in another setting.

Splitting the surgery into two stages have both economical and social drawbacks to the patient and surgeon. The patient now has to pay for and undergo two separate surgeries as well as be subjected to two separate postoperative recovery periods.Augmentation mastopexy does have its advantages that it allows the surgeon to pick an appropriate implant volume for the breast while accurately determining how much skin or tissue needs to be resected thereafter.

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Thoracic Wall Siliconoma after Silicone Leaking from a Defective Breast Implant in Patient with Poland Syndrome

Silicone breast implants are widely used in both aesthetic and reconstructive breast surgery. Within the rare complications that can appear in patients with this type of implant there is the formation of local and peripheral siliconomas, due to the diffusion of the silicone gel contained within the implant, that can appear in case of both damaged and intact implants.

The use of new generation breast implants (double lumen envelope and content of cohesive gel) has considerably lowered, but not eliminated, the risk of rupture and the possible formation of siliconomas.

The reported case regards a patient who, affected by Poland Syndrome, underwent breast augmentation surgery in order to correct the defect at the age of 18. A P.I.P. implant (Poly Implant Prothese, France) was positioned and, after 10 years, at the diagnostic exams revealed a nodular mass of the thoracic wall compatible with siliconoma without evident rupture of the implant.

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Complete Sciatic Nerve Transection Associated with a Closed Femoral Shaft Fracture

Femoral shaft fractures are usually the result of a high-energy injuries. It is estimated that annually between 1.0 and 2.9 million femoral shaft fractures occur worldwide. In high-income countries the annual incidence of femoral shaft fractures ranges between 8.2 and 23.9 per 100,000 people.

In particular, musculoskeletal injuries to the ipsilateral limb, such as hip fractures, patella fractures, tibial plateau fractures, and ligamentous knee injuries have been reported to commonly occur in conjunction with high-energy femoral shaft fracture.

Rodriguez-Merchan et al. reported on 150 femoral shaft fractures and observed temporary neurologic deficits in 10 patients. A few case reports have reported on injuries to the sciatic nerve associated with femoral shaft fractures.

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A Strange Evolution of Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune and a chronic disease that causes pain, stiffness, swelling and limited motion and function of many joints. While rheumatoid arthritis can affect any joint, the small joints in the hands and feet tend to be involved most often. Inflammation sometimes can affect organs as well, for instance, the eyes or lungs.

It is characterized by synovial proliferation and a symmetric erosive arthritis of peripheral joints. For the Romanian geographic particularity, it is appreciated that rheumatoid arthritis affects around 1% from general population, so the total number of suffering people are estimated to be up to 180,000. One of the gold standard in treating rheumatoid arthritis are the biologicals one, they are new class of drugs that have been used since 1998. Currently available biologic agents act as inhibitors of the cytokines IL-1 or TNF.

The tumor necrosis factor-alpha (TNF-alpha) blockers and the recombinant interleukin 1 (IL-1) receptor antagonist are effective in patients with active rheumatoid arthritis, they have been associated with reactivation of tuberculosis and possibly development of other opportunistic infections (histoplasmosis, listeriosis. and pneumocystis).

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Aspasia and Cleopatra Metrodora, Two Majestic Female Physician Surgeons in the Early Byzantine Era

Female physicians in antiquity were doomed to oblivion, pushed aside by their male colleagues. Aspasia and Metrodora have accomplished to leave their stigma and ameliorated the surgical techniques of the era.

The objective of this review is to provide all available knowledge concerning to those two significant female historical medical figures. A thorough search in the digital library of the Greek literature TLG (Thesaurus Linguae Graecae) was performed combined with a search in electronic databases such as Google Scholar, Scopus and PubMed. The key terms that have been used during the review were Aspasia, Metrodora, surgery, gynaecology, and Byzantium.

Both Aspasia and Metrodora performed a series of innovative surgical operations during their era. Aspasia's venesection, shemorrhoidectomy, hysterectomy, open subinguinal varicelectomy and hydrocelectomy and Metrodora's breast and face reconstruction, re-suturing of the vaginal hymen and breast and uterus cancer excisions, present great similarities to modern surgery.

Pilot Study of Alternative Therapy with Minerals in Patients of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine system disorder among women of reproductive age. Women with PCOS may have enlarged ovaries that contain small collections of fluid (Follicles). Alternative therapy including natural minerals has been emerging in addition to established medical and surgical treatment for PCOS.

In present non-randomized, open label pilot study, we have studied safety and effectiveness of exclusive natural mineral solution with use of reserve wellness wrapping technique in PCOS patients. Methods: A total of 20 females (10 married and 10 unmarried) who had with PCOS were enrolled in present study. Natural Mineral powder used for study consist of mixture of Bentonite Clay, Magnesium Chloride, Magnesium Sulphate, Sodium Chloride and Zinc Oxide 2%. Patients were underwent standard study procedure.

Changes in hormonal level (AMH, LH, FSH, Prolactin, TSH, Insulin resistance) measured on 3rd day of menstrual cycle pre-treatment and post treatment was evaluated to assess the efficacy of study treatment. Safety was evaluated throughout study procedure by observing adverse events. Compliance to study treatment was documented on individual case report form of the patient.

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