An unusual finding after adrenal surgery: a case series of adrenal schwannomas

Adrenal schwannomas are rare benign tumors with no specific imaging and laboratory findings to diagnose preoperatively. Due to the limited number of cases in the literature, clinical, imaging, and pathological findings are presented in this study. Case 1 is a 61-year-old woman patient who has a 31-mm mass in the right adrenal gland. This mass was nonfunctional; in imaging studies, this mass had a cystic necrotic component, and high 18-fluorodeoxyglucose (FDG) uptake was seen. There was no metaiodobenzylguanidine (MIBG) uptake. Laparoscopic transabdominal right adrenalectomy was performed, and the pathology result was consistent with adrenal schwannomas. Case 2 is a 63-year-old man patient who presented with a 38-mm mass in the left adrenal gland. This mass was nonfunctional and similar to that in Case 1; this mass had a cystic component. Laparoscopic transabdominal left adrenalectomy was performed. The diagnosis of adrenal schwannoma with degeneration was revealed. Case 3 was a 72-year-old woman patient admitted to the hospital for a 125-mm left adrenal mass. Similar to Case 1, this mass also had a cystic necrotic component in imaging studies. High FDG uptake was seen, and the patient underwent conventional adrenalectomy due to the suspicion of malignancy. After pathological evaluation, a diagnosis of adrenal schwannoma was made. A main diagnostic challenge in adrenal schwannomas is the preoperative diagnosis. These masses have no pathognomonic finding or specific hormonal function. Imaging findings of these masses may increase the suspicion of malignancy, which may affect decisions for surgery and the surgical technique

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Metastatic gastric signet-ring cell carcinoma: A rare cause of acute appendicitis

WOS: 000383289200015PubMed ID: 27436940We report a 32-year-old patient who underwent laparoscopy with classical symptoms and signs of acute appendicitis. An inflamed, edematous and non-perforated appendix, also a large amount gelatinous ascites, omental and peritoneal implants were seen. Appendectomy was performed and multiple biopsies were taken from omentum and peritoneum for definitive diagnosis. Histopathologic diagnosis was a metastatic gastric signet-ring cell carcinoma (GSRCC) involving appendix and other specimens. A flat lesion involving corpus to antrum was diagnosed by gastroscopy and GSRCC was verified histopathologically in a tertiary centre and the case evaluated as stage IV gastric carcinoma. This case with no sign of gastric cancer was presented as an acute appendicitis. Metastatic carcinoma to the appendix, causing acute appendicitis is extremely rare in clinical practice and usually associated with high morbidity and mortality

Comparing simultaneous versus staged resection in patients with synchronous colorectal liver metastases: case match study

INTRODUCTION: There is no consensus on the optimal timing of liver resection in patients with synchronous colorectal liver metastasis. METHODS: Patients undergoing hepatic resections between 2004- 2013 for synchronous colorectal liver metastases were analyzed from a prospectively maintained and institutional review board approved database. Patients who underwent simultaneous resection of a colorectal primary and hepatic metastasis in a single operation (Group I) were case-matched 1:1with patients who underwent staged operation (Group II) according to age, sex, ASA classification, size of liver lesion and number of liver lesion. RESULTS: 66 patients (33 Group I, 33 Group II) were matched from a total cohort of 106 patients with synchronous colorectal liver metastasis. The patients’ characteristics of both groups were similar. 62% were male and the mean age was 55.511 years. Blood loss and duration of surgery did not differ between simultaneous resections and staged resection (p¼0.63; p¼0.14, respectively). Perioperative complication rate were similar in both groups (P¼0.70). There was no mortality. The median number of in-hospital days during the course of treatment was 9 (4-23) days in Group I and 6 (3-17) days in Group II (p <0.001). There was no difference in 2 years disease free survival and overall survival were found between Group I and Group II ( 30% and 34%, p¼ 0.58; 67% and 62%, p¼0.86 respectively). CONCLUSIONS: Simultaneous liver resections result in similar short and long eterm outcomes as in patients undergoing sequential resections for synchronous colorectal cancer with comparable metastatic disease burden

Dağınık kırsal yerleşim bölgesinde boğulmuş fıtık ve geç başvuru sonuçları

Amaç: Dağınık nüfus yerleşimli ilimizde, hastanemize başvuran boğulmuş fıtık olgularının başvuru yeri ve süresine göre değerlendirilmesi amaçlandı. Yöntem Mayıs 2009–2011 arasında boğulmuş fıtık tanısı ile ameliyat edilen olgular retrospektif olarak değerlendirildi. Bulgular: Elli iki olgunun yaş ortalaması 53,6 , erkek/kadın oranı 48/4 idi. Kırsal bölgeden başvuru % 52 idi n=27 . Gecikmiş başvuru oranı, kırsal bölge yerleşimli olgularda % 33,3 idi n=9 . Ameliyat öncesi değerlendirmede olguların % 50’si n=26 ASA II-III idi. En sık % 52 omental inkarserasyon n=27 görüldü. Olguların % 13,4’ünde rezeksiyon gerekli oldu. Olguların % 88,4’ünde Lichtenstein yöntemi ile herni tamiri uygulandı. Komplikasyon oranı % 15,3 n=8 iken, kırsal bölge başvurularında % 18,5 idi. Ortalama hastanede kalış süresi 3,8 gün idi. Bir yıllık takip sürecinde 3 olguda % 5,7 nüks görüldü. Sonuç: Kırsal bölgeden gecikmiş başvuru oranı yüksek olup anlamlı fark gözlenmedi. Elliiki olgunun değerlendirilmesinde; ilk 24 saat içinde girişim yapılan olgularda komplikasyon oranı ve hastanede kalış süresinin daha az olduğu görüld

Metastatic gastric signet-ring cell carcinoma: A rare cause of acute appendicitis

WOS: 000383289200015PubMed ID: 27436940We report a 32-year-old patient who underwent laparoscopy with classical symptoms and signs of acute appendicitis. An inflamed, edematous and non-perforated appendix, also a large amount gelatinous ascites, omental and peritoneal implants were seen. Appendectomy was performed and multiple biopsies were taken from omentum and peritoneum for definitive diagnosis. Histopathologic diagnosis was a metastatic gastric signet-ring cell carcinoma (GSRCC) involving appendix and other specimens. A flat lesion involving corpus to antrum was diagnosed by gastroscopy and GSRCC was verified histopathologically in a tertiary centre and the case evaluated as stage IV gastric carcinoma. This case with no sign of gastric cancer was presented as an acute appendicitis. Metastatic carcinoma to the appendix, causing acute appendicitis is extremely rare in clinical practice and usually associated with high morbidity and mortality

LAPAROSCOPIC APPROACH TO OBTURATOR LYMPH NODE POSITIVITY IN POSITRON EMISSION TOMOGRAPHY ASSISTED COMPUTERIZED TOMOGRAPHY (PET-CT) OF A PREOPERATIVE STAGE 1B1 CERVICAL CANCER PATIENT

Objektive: Although positron emission tomography assisted computerized tomography (PET-CT) is used to evaluate staging, treatment planning and prognosis in cervical cancer, its definite role is not established. It is especially used to rule out lymph node and distant metastasis in early stage cervical cancer patients who are candidates for radical hysterectomy. Recent literature suggests that by doing so unnecessary surgery, in patients who will ultimately require radiotherapy, would be prevented. We are presenting a case of cervical cancer patient preoperatively staged as 1B1 but revealed a lymph node positivity in PET-CT scan in left obturator fossa. She had a laparoscopic lymph node dissection and frozen section