Non-operative management of the sigmoid volvulus – case presentation

Sigmoid volvulus happens when the sigmoid wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions. This pathology generally affects adults, and it is more common in males. The etiology is multifactorial and controversial; the main symptoms are diffuse abdominal pain, distention and constipation, while the pregnant signs are abdominal distention and tenderness. Laboratory findings are not pathognomonic: abdominal X-ray radiographs show a dilated sigmoid colon and multiple intestinal air-fluid levels, abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy reveals a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%

Cholelitiasis in an adult patient with mild hereditary spherocytosis – a case report

Hereditary spherocytosis (HS) is an inherited abnormality of the red blood cell, caused by defects in structural membrane proteins. The condition is dominantly inherited in 75% of people. The severity of the disorder is related to the type and amount of membrane disruption, which is genetically determined. A patient who suffers from this disorder is commonly found in a surgical ward when the disease becomes unmanageable by a hematologist. Surgeons encounter complications such as: jaundice, splenomegaly, gallstone sand severe anemia. We present the case of a 66-year-old woman with a history of hereditary spherocytosis who presented at the emergency room for pain in the right upper quadrant, jaundice and anemia and was diagnosed with gallbladder stones and common bile duct obstruction

The Influence of the Ceramic Nanoparticles on the Thermoplastic Polymers Matrix: Their Structural, Optical, and Conductive Properties

This paper prepared composites under the free membranes form that are based on thermoplastic polymers of the type of polyurethane (TPU) and polyolefin (TPO), which are blended in the weight ratio of 2:1, and ceramic nanoparticles (CNs) such as BaSrTiO3 and SrTiO3. The structural, optical, and conductive properties of these new composite materials are reported. The X-ray diffraction studies highlight a cubic crystalline structure of these CNs. The main variations in the vibrational properties of the TPU:TPO blend induced by CNs consist of the following: (i) the increase in the intensity of the Raman line of 1616 cm−1; (ii) the down-shift of the IR band from 800 to 791 cm−1; (iii) the change of the ratio between the absorbance of IR bands localized in the spectral range 950–1200 cm−1; and (iv) the decrease in the absorbance of the IR band from 1221 cm−1. All these variations were correlated with a preferential adsorption of thermoplastic polymers on the CNs surface. A photoluminescence (PL) quenching process of thermoplastic polymers is demonstrated to occur in the presence of CNs. The anisotropic PL measurements have highlighted a change in the angle of the binding of the TPU:TPO blend, which varies from 23.7° to ≈49.3° and ≈53.4°, when the concentration of BaSrTiO3 and SrTiO3 CNs, respectively, is changed from 0 to 25 wt. %. Using dielectric spectroscopy, two mechanisms are invoked to take place in the case of the composites based on TPU:TPO blends and CNs, i.e., one regarding the type of the electrical conduction and another specifying the dielectric–dipolar relaxation processes

INCIDENTAL FINDING OF A SIGMOID INTUSSUSCEPTION ASSOCIATED WITH RECTAL PROLAPSE – A CASE REPORT

Colonic intussusception in adults is extremely rare, accounting for about 5% of all cases of intussusception. The telescoping of a proximal segment in the lumen of the adjacent segment has a classic classical triad in the symptomatology of children: abdominal pain, bloody diarrhea and palpable abdominal mass. In the adult patient, the symptoms are almost absent, and rarely they consist of constipation, bloody stool, or a malignant pathology that accompanies intussusception, weight loss, and anemia. We present the case of a 86-year-old patient who underwent a surgical procedure for repairing a rectal prolapse; intraoperatively, we discovered a sigmoid intussusception for which we performed a segmentary sigmoidectomy, repairing the rectal prolapse by rectosacropexy with alloplastic mesh

Rare small bowel obstruction due to phytobezoar – Case presentation

Phytobezoar is a rare cause of small bowel obstruction. This pathology represents 0.4%-4% of all mechanical bowel obstructions. Symptoms are similar to other small bowel obstructions. The most common localisation of the obstruction is represented by the terminal ileum. Phytobezoars are to be considered in patients who have had gastric surgery, a high fiber intake or psychiatric disorders. Also, multiple sclerosis has shown to affect bowel motility, which is important to our case. Surgery is always indicated. A low fiber diet and prokinetics are indicated for the prevention of this pathology. We present the case of a 43-year-old female who was admitted to the ICU following a car accident. The patient presented bowel obstruction symptoms (nausea and vomiting, bloating, not passing gas and severe abdominal pain) the 5th day after admission and was transferred to the operating room for exploratory laparotomy. Intraoperatively, we discovered a phytobezoar which was confirmed by the histopathological exam

Solitary cecum diverticulitis – A surprising diagnosis

Cecum diverticulosis is a benign, rare and generally asymptomatic disease that can manifest with acute diverticulitis or bleeding, thus complicating the differential diagnosis of the right iliac fossa pathology. The optimal management of this disease does not have a well-established treatment plan, as it may vary in some centers from conservative treatment, consisting of only antibiotics, to segmental colectomy or even right hemicolectomy. We present the case of a 45-year-old patient, prior diagnosed with chronic pain in the right iliac fossa after appendectomy, who was diagnosed with a single cecum diverticulum

Assessment of the Humoral Immune Response Following COVID-19 Vaccination in Healthcare Workers: A One Year Longitudinal Study

The continuous variability of SARS-CoV-2 and the rapid waning of specific antibodies threatens the efficacy of COVID-19 vaccines. We aimed to evaluate antibody kinetics one year after SARS-CoV-2 vaccination with an mRNA vaccine in healthcare workers (HCW), with or without a booster. A marked decline in anti-Spike(S)/Receptor Binding Domain (RBD) antibody levels was registered during the first eight months post-vaccination, followed by a transitory increase after the booster. At three months post-booster an increased antibody level was maintained only in HCW vaccinated after a prior infection, who also developed a higher and long-lasting level of anti-S IgA antibodies. Still, IgG anti-nucleocapsid (NCP) fades five months post-SARS-CoV-2 infection. Despite the decline in antibodies one-year post-vaccination, 68.2% of HCW preserved the neutralization capacity against the ancestral variant, with a decrease of only 17.08% in the neutralizing capacity against the Omicron variant. Nevertheless, breakthrough infections were present in 6.65% of all participants, without any correlation with the previous level of anti-S/RBD IgG. Protection against the ancestral and Omicron variants is maintained at least three months after a booster in HCW, possibly reflecting a continuous antigenic stimulation in the professional setting