Early postoperative mortality in the elderly: a pilot study

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Aberrant accessory abductor digiti minimi manus muscle: a rare anatomical variation

The hypothenar muscle with the greatest frequency of variations is the abductor digiti minimi manus. Except from morphological variations of this muscle, have also been reported cases of an extra wrist muscle, the accessory abductor digiti minimi manus muscle. This case report presents a rare case of an accessory abductor digiti minimi muscle characterized by an unusual origin from the tendons of the flexor digitorum superficialis. This anatomical variation was identified on a formalin – fixed male cadaver of Greek origin during routine dissection. This anatomical variation, which may result in Guyon's canal syndrome or complicate common wrist and hand surgical procedures such as the carpal tunnel release, should be known to orthopedic surgeons and hand surgeons in particular

Arteriovenous malformation of the spermatic cord as the cause of acute scrotal pain: a case report

Arteriovenous malformations of the lower urinary tract are uncommon lesions, usually presenting as scrotal masses. A case of recurrent acute scrotal pain mimicking testicular torsion that was attributed to the presence of an arteriovenous malformation of the spermatic cord is described. To our knowledge this is the first reported case of an arteriovenous malformation of the spermatic cord presenting with acute scrotal pain

Oxidative and pre-inflammatory stress in wedge resection of pulmonary parenchyma using the radiofrequency ablation technique in a swine model

<p>Abstract</p> <p>Background</p> <p>Radiofrequency ablation (RFA) is a thermal energy delivery system used for coagulative cellular destruction of small tumors through percutaneous or intraoperative application of its needle electrode to the target area, and for assisting partial resection of liver and kidney. We tried to evaluate the regional oxidative and pre-inflammatory stress of RFA-assisted wedge lung resection, by measuring the MDA and tumor Necrosis Factor Alpha (TNF-α) concentration in the resected lung tissue of a swine model.</p> <p>Method</p> <p>Fourteen white male swines, divided in two groups, the RFA-group and the control group (C-group) underwent a small left thoracotomy and wedge lung resection of the lingula. The wedge resection in the RFA-group was performed using the RFA technique whereas in C-group the simple "cut and sew" method was performed. We measured the malondialdehyde (MDA) and TNF-α concentration in the resected lung tissue of both groups.</p> <p>Results</p> <p>In C-group the MDA mean deviation rate was 113 ± 42.6 whereas in RFA-group the MDA mean deviation rate was significantly higher 353 ± 184 (p = 0.006). A statistically significant increase in TNF-α levels was also observed in the RFA-group (5.25 ± 1.36) compared to C-group (mean ± SD = 8.48 ± 2.82) (p = 0.006).</p> <p>Conclusion</p> <p>Our data indicate that RFA-assisted wedge lung resection in a swine model increases regional MDA and TNF-a factors affecting by this oxidative and pre-inflammatory stress of the procedure. Although RFA-assisted liver resection can be well tolerated in humans, the possible use of this method to the lung has to be further investigated in terms of regional and systemic reactions and the feasibility of performing larger lung resections.</p

Somatosensory Evoked Potentials suppression due to remifentanil during spinal operations; a prospective clinical study

<p>Abstract</p> <p>Background</p> <p>Somatosensory evoked potentials (SSEP) are being used for the investigation and monitoring of the integrity of neural pathways during surgical procedures. Intraoperative neurophysiologic monitoring is affected by the type of anesthetic agents. Remifentanil is supposed to produce minimal or no changes in SSEP amplitude and latency. This study aims to investigate whether high doses of remifentanil influence the SSEP during spinal surgery under total intravenous anesthesia.</p> <p>Methods</p> <p>Ten patients underwent spinal surgery. Anesthesia was induced with propofol (2 mg/Kg), fentanyl (2 mcg/Kg) and a single dose of cis-atracurium (0.15 mg/Kg), followed by infusion of 0.8 mcg/kg/min of remifentanil and propofol (30-50 mcg/kg/min). The depth of anesthesia was monitored by Bispectral Index (BIS) and an adequate level (40-50) of anesthesia was maintained. Somatosensory evoked potentials (SSEPs) were recorded intraoperatively from the tibial nerve (P37) 15 min before initiation of remifentanil infusion. Data were analysed over that period.</p> <p>Results</p> <p>Remifentanil induced prolongation of the tibial SSEP latency which however was not significant (p > 0.05). The suppression of the amplitude was significant (p < 0.001), varying from 20-80% with this decrease being time related.</p> <p>Conclusion</p> <p>Remifentanil in high doses induces significant changes in SSEP components that should be taken under consideration during intraoperative neuromonitoring.</p

Acute aortic dissection: be aware of misdiagnosis

<p>Abstract</p> <p>Background</p> <p>Acute aortic dissection (AAD) is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used.</p> <p>Methods</p> <p>From January 2000 to December 2004, 49 patients (41 men and 8 women, aged from 18–75 years old) presented to the Emergency Department of our hospital for different reasons and finally diagnosed with AAD. Fifteen of those patients suffered from arterial hypertension, one from giant cell arteritis and another patient from Marfan's syndrome. The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT), transthoracic echocardiography (TTE) and coronary angiography.</p> <p>Results</p> <p>Initial misdiagnosis occurred in fifteen patients (31%) later found to be suffering from AAD. The misdiagnosis was myocardial infarction in 12 patients and cerebral infarction in another three patients.</p> <p>Conclusion</p> <p>Aortic dissection may present with a variety of clinical manifestations, like syncope, chest pain, anuria, pulse deficits, abdominal pain, back pain, or acute congestive heart failure. Nearly a third of the patients found to be suffering from AD, were initially otherwise diagnosed. Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.</p

“Vanishing Penis” and Urinary Retention due to Locally Destructive Penile Cancer

Penile carcinomas are relatively rare. They usually arise from precancerous lesions and present in the form of ulcerative or exophytic tumors. They rarely give rise to urinary symptoms and complications, and are usually easy to diagnose. We present a case of an 82-year-old man with chronic urinary retention due to urethral dissemination by a locally destructive penile lesion. The penis was literally “vanished” by the lesion down to the level of the pubic bone without, interestingly, having spread to the local lymph nodes or given rise to distant metastases. A temporary suprapubic catheter was placed, followed by a perineal urethrostomy in order to reverse the established renal failure

&quot;Vanishing Penis&quot; and Urinary Retention due to Locally Destructive Penile Cancer

Penile carcinomas are relatively rare. They usually arise from precancerous lesions and present in the form of ulcerative or exophytic tumors. They rarely give rise to urinary symptoms and complications, and are usually easy to diagnose. We present a case of an 82-year-old man with chronic urinary retention due to urethral dissemination by a locally destructive penile lesion. The penis was literally &quot;vanished&quot; by the lesion down to the level of the pubic bone without, interestingly, having spread to the local lymph nodes or given rise to distant metastases. A temporary suprapubic catheter was placed, followed by a perineal urethrostomy in order to reverse the established renal failure. KEYWORDS: penile cancer, urinary retention, vanishing penis CASE An 82-year-old patient was brought to our hospital by his relatives who, over the past few days, had noticed a gradual deterioration of his mental status, accompanied by low urine output, fatigue, and anorexia. According to his relatives, the patient was living alone and had been wearing pads for the last 6 months due to deteriorating urinary incontinence for which he never sought medical advice. The patient was under no medication whatsoever. History taking from the patient was tedious; however, he admitted noticing an exophytic, painless, penile lesion some months ago for which he, again, did not ask for medical advice. Physical examination revealed marked suprapubic tenderness due to a largely distended urinary bladder. Examination of his external genitalia revealed complete absence of the shaft and glans of the penis, replaced by a hard, ulcerative lesion. In accordance with the patient&apos;s history, the finding was attributed to destruction of the penile shaft and glans by an invasive, ulcerated, obviously neglected, penile carcinoma Blood results showed evidence of severe renal insufficiency (blood urea: 347 mg/dl; creatinine: 14.1 mg/dl; K + : 5.5 mmol/l), while ultrasonography in the E.R. showed bilateral hydronephrosis and a largely distended bladder. A suprapubic catheter was placed under ultrasound guidance and immediately drained 1200 ml of urin