A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries

There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons

Sex-associated effect of CETP and LPL polymorphisms on postprandial lipids in familial hypercholesterolaemia

Background: This study assessed the gender-specific influence of the cholesteryl ester transfer protein (TaqIB, I405V) and lipoprotein lipase (S447X) polymorphisms on the response to an oral fat tolerance test in heterozygotes for familial hypercholesterolaemia.Methods: We selected and genotyped 80 men and postmenopausal women heterozygous for familial hypercholesterolaemia (main group) as well as 11 healthy control subjects. Patients were subgrouped based on their response to oral fat tolerance test. The oral fat tolerance test was defined as pathological when postprandial triglyceride concentration was higher than the highest triglyceride concentration observed in healthy subjects (220 mg/dl) at any time (2, 4, 6 or 8 h).Results: In the pathological subgroup, men had significantly higher incremental area under the curve after oral fat tolerance test than postmenopausal women. Furthermore, multivariate analysis revealed a gender association of TaqIB and I405V influence on postprandial lipaemia in this subgroup.Conclusion: In conclusion, it seems that gender and TaqIB polymorphism of the cholesteryl ester transfer protein gene were both associated with the distribution of triglyceride values after oral fat tolerance test, only in subjects with a pathological response to oral fat tolerance test. Specifically, men carrying the B2 allele of the TaqIB polymorphism showed a higher postprandial triglyceride peak and a delayed return to basal values compared with women carrying B2. However, further investigations in larger populations are required to replicate and confirm these findings

Effect of end-stage renal disease on B-lymphocyte subpopulations, IL-7, BAFF and BAFF receptor expression

Background. End-stage renal disease (ESRD) results in increased susceptibility to infections, impaired response to vaccination and diffuse B-cell lymphopenia. However, the precise nature and mechanism of ESRD-induced B-cell lymphopenia remains unclear. Therefore, we studied the distribution of major B-cell subsets, B-cell growth, differentiation and survival factors, IL-7 and BAFF, and their receptors in 21 haemodialysis patients and 21 controls

Pilonidal Sinus Carcinoma found in a Pilonidal Sinus – a surprise diagnosis from the pathologist

Introduction: Malignancy arising in long standing chronic infection is known in ulcerative colitis and non healing burns scars. It is exquisitely rare in long standing pilonidal sinus infection. We report a male case with the incidental finding of a SCC in a 20 year old untreated pilonidal sinus. Methods: Decription of the diagnostic and therapeutic course till his demise of reported world case #125. Results: A 59 yr. old male presented with extensive fistulous disease in the presacral area with induration and reddening. On surgery, tracts were found to extend into the perianal up to the perineum. Pathology specimen analysis revealed SCC with involvement of the PSD tracts with R1 situation (pT2pN0M0G2R1). Despite consecutive wide excision and tumor board advised radiochemotherapy the patient recurred twice locally, in lymph nodes and in the ischorectal fossa and demised 3 years later. Conclusion: Despite best surgical and oncological practice, the patient demised due to a – if defined by the skin SCC classification – low TNM stage carcinoma. Pilonidal carcinoma is a exquisitely rare disease which most surgeons have not experienced in their professional lifetime. As earlier carcinomas may arise within the pilonidal sinus system, all histopathological specimen should be either opened and meticulously inspected by the surgeon himself, or sent for routine histopathological examination. Despite early diagnosis, aggressive therapy may change the otherwise dismal course of disease