Pelvic Exenteration for the Management of Pelvic Malignancies

Pelvic exenteration is a surgical procedure first described by Brunschwig in 1948 as a curative or palliative treatment for pelvic and perineal tumors. It is actually a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In patients with recurrent cervical and vaginal malignancy, it is associated with a 5-year survival of more than 50%. In spite of advances in surgical management, consequences such as stomas, are still frequently unavoidable for radical tumor excision. Most candidates for this procedure have been diagnosed with recurrent cervical cancer that has previously been treated with surgery and radiation, or radiation alone. Complications of pelvic exenteration are more severe than those of standard resection of a colorectal carcinoma, so it is not commonly performed, including wound infection, wound dehiscence (also described as burst abdomen) the creation of fistulae (perineal-fecal, uretero-vaginal, between conduit and perineal wound), urinary tract infections, perineal hernias and intestinal obstruction. Patients need to be carefully selected and counseled about risks and long-term issues related to the surgery. A comprehensive evaluation is required in order to exclude unresectable or metastatic disease. Evolution of the technique through laparoscopy and minimally invasive surgery may result in a reduction of morbidity and mortality

THE EFFECT OF MINING WASTE ON THE DURABILITY INDICATORS OF CEMENT-BASED COMPOSITES

© 2021 The Authors.The need for infrastructure development is of major importance and the projected global infrastructure investment between 2013-2030 is estimated in the excess of £30 trillion to support the rapid growth of societies and economies worldwide (1). This trend puts civil infrastructure industry under immense stress to plan properly, construct fast and deliver resilient structures. Concrete is the dominant construction material and the key element in most infrastructure assets. However, concrete’s manufacture is extremely energy and resource intensive: >4 Billion tonnes of cement are produced annually, accounting to ~8% of global anthropogenic CO2 and resulting to an annual production of ~2 tonnes of concrete for every person on the planet. The production of concrete is a process associated with very high energy consumption. In Europe, the construction sector alone is responsible for the 36% of CO2 emissions and the 40% of all energy consumption. The utilisation of mining waste in cement-based composites is an area of growing interest worldwide, with mining and excavation waste increasing considerably the last decade. Our work focuses on the replacement of cement with mineral wastes and the initial findings suggest that even at 20% replacement, the mechanical properties are marginally affected. This contribution will discuss some preliminary data on the effect of mining waste on the durability indicators of cementitious composites (oxygen permeability, capillary sorption and ion diffusion). Keywords: Mining waste, Silicates, capillary water absorption,Peer reviewedFinal Published versio

Acute appendicitis secondary to Enterobius vermicularis infection in a middle-aged man: a case report

<p>Abstract</p> <p>Introduction</p> <p>Acute appendicitis due to <it>Enterobius vermicularis </it>is very rare, affecting mostly children. Whether pinworms cause inflammation of the appendix or just appendiceal colic has been a matter of controversy.</p> <p>Case presentation</p> <p>A Caucasian 52-year-old man was referred to our Emergency Department with acute abdominal pain in his right lower quadrant. The physical and laboratory examination revealed right iliac fossa tenderness and leukocytosis with neutrophilia. An open appendectomy was performed. The pathological examination showed the lumen containing pinworms. Two oral doses of mebendazole were administered postoperatively. The follow-up to date was without incident and he was free of symptoms one year after the operation.</p> <p>Conclusion</p> <p>The finding of <it>E. vermicularis </it>in appendectomy pathological specimens is infrequent. Parasitic infections rarely cause acute appendicitis, especially in adults.</p> <p>One should keep in mind that the clinical signs of intestinal parasite infection may mimic acute appendicitis, although rare. A careful evaluation of symptoms such as pruritus ani, or eosinophilia on laboratory examination, could prevent unnecessary appendectomies.</p

Large bowel ischemia: Assessment of viability by the use of electronic contractility meter: Experimental study

The lack of a single reliable, objective and quantitative method for the assessment of intestinal ischemia, led us to study the large bowel viability by using the Electronic Contractility Meter. Our device was designed according to RE Brolin's prototype with the addition of some new functional units, so as to become easier to use and more reliable on measurements. A new method of recording was added, through the connection to a computer, in order to increase the accuracy of the method and avoid misinterpretations, because of artifacts and subjective determinations of the operator. The experiments were performed on 12 healthy mongrel dogs. On the first day of the experiment, a study was carried out on both the normal large and small bowel. The large bowel was devascularized for a length of 20cm. On the second day, measurements were taken on the ischemic part of the intestine and were followed by resection and anastomosis on the 40mAmp threshold level. Comparison of the method was performed to the visual and doppler observations. On the 10th day, the animals were sacrificed in order to determine the integrity of the anastomoses and their proper healing. The mean threshold stimulus level for the small bowel, was found to be 13.53 ± 3.30mAmps and for the large bowel 12.28 ± 3.00mAmps. The method was found to be more accurate and reliable than the visual and doppler observations. The optimal level of 40mAmps for the large bowel viability was found to be safe, because 10 animals exhibited no ruptured anastomoses with proper healing. One animal died because of anastomosis disruption on the 3rd postoperative day, for the reason of vascular disorder; another did not recover from anesthesia. It seems that the method of myoelectric analysis, as it has been modified in the present study, is safe enough and reliable for the assessment of large bowel viability. Without considering this study as the definite solution to the problem of intestinal ischemia, we believe it is a considerable contribution to the right direction.Η έλλειψη μιας αξιόπιστης, αντικειμενικής και ποσοτικής μεθόδου εκτίμησης της εντερικής ισχαιμίας οδήγησε στη μελέτη της βιωσιμότητας του ισχαιμικού παχέος εντέρου με τη χρήση του ηλεκτρονικού μετρητή της συσταλτότητας (ΗΜΣ). Η συσκευή σχεδιάσθηκε κατά το πρότυπο εκείνης του RE Brolin, με την προσθήκη ορισμένων νέων λειτουργικών μονάδων ώστε να καταστεί πιο εύχρηστη και αξιόπιστη στις μετρήσεις. Ακόμη προστέθηκε σύστημα καταγραφής των αποτελεσμάτων μέσω ηλεκτρονικού υπολογιστή, ώστε να μεγαλώσει η ακρίβεια της μεθόδου και να αποφευχθούν λάθη από παράσιτα ή υποκειμενικές ερμηνείες από το χρήστη. Για το πειραματικό μέρος της αξιολόγησης της συσκευής του ΗΜΣ στην εκτίμηση της βιωσιμότητας του ισχαιμικού παχέος εντέρου, χρησιμοποιήθηκαν 12 κοινοί υγιείς σκύλοι. Κατά την πρώτη ημέρα του πειράματος γινόταν αποσκελέτωση τμήματος 20εκ. του παχέος εντέρου. Συγχρόνως λαμβάνονταν μετρήσεις στο φυσιολογικό λεπτό και παχύ έντερο. Κατά τη δεύτερη ημέρα του πειράματος πραγματοποιούνταν μετρήσεις στην ισχαιμική έλικα και εκτελείτο εκτομή και αναστόμωση επί ισχαιμικού εδάφους, στην περιοχή που γινόταν σύσπαση με ρεύμα διέγερσης 40mAmp. Η σύγκριση της μεθόδου γινόταν με την οπτική παρατήρηση και με την χρήση συσκευής Doppler. Την 10η μετεγχειρητική ημέρα τα πειραματόζωα θυσιάζονταν για τον έλεγχο της ακεραιότητας της αναστόμωσης και της φυσιολογικής εξέλιξης της επούλωσης της. Βρέθηκε ουδός πρόκλησης σύσπασης, το ρεύμα διέγερσης για το φυσιολογικό λεπτό έντερο 13.53 ± 3.3mAmp και για το φυσιολογικό παχύ έντερο 12.28 ± 3.00mAmp. Η μέθοδος της χρήσης του ΗΜΣ βρέθηκε πιο αξιόπιστη και ακριβής από την οπτική παρατήρηση και τη συσκευή Doppler. Το όριο των 40mAmp για την εκτίμηση της βιωσιμότητας του παχέος εντέρου κρίθηκε ασφαλές, αφού στα 10 πειραματόζωα παρατηρήθηκε ακεραιότητα και καλή επούλωση στην αναστόμωση. Σε ένα πειραματόζωο, λόγω διάχυτης αγγειακής βλάβης, επήλθε ρήξη της αναστόμωσης την 3η μετεγχειρητική ημέρα, ενώ ένα ακόμη πειραματόζωο δεν έγινε δυνατόν να ανανήψει από την αναισθησία. Φαίνεται λοιπόν ότι η μέθοδος της χρήσης του ΗΜΣ, ιδιαίτερα όπως τροποποιήθηκε είναι αρκετά ασφαλής και αξιόπιστη στην εκτίμηση της βιωσιμότητας του παχέος εντέρου. Χωρίς να αποτελεί η παρούσα εργασία την οριστική λύση του προβλήματος, φαίνεται να προσφέρει μια σημαντική συμβολή σε αυτή την κατεύθυνση

Diagnostic and Therapeutic Approach to HIVKaposi’s Sarcoma Patients-Case Report

Background/Aim: The Acquired Immune Deficiency Syndrome (AIDS) is an immunologic entity, which is due to an RNA virus. AIDS is relatively easy transmitted and has a poor prognosis. The main mechanism of this Syndrome is characterized by the destruction and diminishing of T4 lymphocytes or helper/suppressor T-cells. Kaposi’s sarcoma is a neoplasm due to human herpes HHV-8. Kaposi’s sarcoma is one of the entities that determines the disease of AIDS. Kaposi’s sarcoma appears as skin lesions and attacks the oral cavity and lymph nodes

Diagnostic Colonoscopy Leading to Perforated Appendicitis: A Case Report and Systematic Literature Review

Introduction. Intestinal perforation is a known complication after colonoscopy. However, appendiceal involvement with inflammation and perforation is extremely rare and only 37 cases of postcolonoscopy appendicitis have been reported so far. We describe a case of perforated appendicitis 24 hours after colonoscopy that was treated successfully in our Department. Case Report. A 60-year-old female patient underwent a colonoscopy during the investigation of nontypical abdominal pain without pathologic findings. 24 hours after the examination she presented gradually increased right lower quadrant abdominal pain and a CT scan was performed, showing an inflammation of the appendiceal area with free peritoneal air. Through laparotomy, perforated appendicitis was diagnosed and an appendectomy was performed. The patient was discharged on the tenth postoperative day in good health condition. Discussion. The characteristics of all cases reported in the literature are described, including our case. Perforated appendicitis soon after a colonoscopy is a rare, but serious complication; therefore, it is crucial to be included in the differential diagnosis of postcolonoscopy acute abdominal pain

Richter’s hernia in a 5-mm trocar site

We present an unusual case of a trocar site incision hernia at a 5-mm trocar port occurring approximately 2 weeks post-operatively after a laparoscopic cholecystectomy. The patient, in her mid-60s, reported diffuse abdominal pain, constipation, nausea and vomiting. An abdominal X-ray demonstrated dilated small bowel loops with gas-fluid levels. Abdominal computed tomography revealed the small bowel herniation through the 5-mm port site. Laparotomy confirmed a Richter’s hernia of the small bowel in the fascia defect. This case highlights the necessity to examine and investigate any complaint post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying disease or risk factors, a rare complication could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure. High clinical suspicion is essential in order to avoid further deterioration of the patient condition and optimal treatment