Apocrine Fibroadenoma of the Perianal Region Associated with Perianal Fistula

A case of a 45 year-old woman who presented with a perianal fistula was reported. Histologically, the excised lesion showed features of apocrine fibroadenoma. In addition, the lesion had both glandular and stromal growth patterns and active chronic inflammation in the background. Malignant or benign counterparts of these types of lesions are widely described in literature. However fistula does not usually accompany and is very rare. Therefore, it is crucial for the pathologists and clinicians to be aware of such lesions. The relationship between apocrine fibroadenoma and perianal region was also discussed

Ruptured mesenteric cyst: a rare presentation after trauma

Mesenteric cysts are rare intraabdominal benign cystic lesions. These lesions are most commonly located in the ileal mesentery, without any sex predilection. Mesenteric cysts may be totally asymptomatic and discovered incidentally during routine radiologic examinations. Chronic abdominal pain or acute abdomen may be accompanying to these lesions. Ultrasonography, computed tomography and magnetic resonance imaging are valuable in the diagnosis. Rarely, these lesions may be presented with rupture after trauma. We present a patient with a ruptured ileal mesenteric cyst due to a blunt abdominal trauma and diagnosed by emergency laparotomy

Transdiaphragmatic blockage of the lymphatic may reduce bacterial translocation

PURPOSE: Bacterial translocation is a spread of living and non-living bacteria and bacterial end-products, passing over the mucosal barrier distending mesenteric lymph nodes, blood and viscera. DuraSeal(polyglycolic acid glue) has adhesive power and it usually used in brain or spinal surgery. We aimed to show the barrier system effect using experiments, in which intraabdominal infection induced and translocation from diaphragm to thorax is researched

Chemoradiation for anal squamous cell carcinoma: case report

ntroduction. Anal squamous cell carcinoma is rare and seems to be associated with chronic inflammatory conditions, infections and immunosuppression. Their incidence has been arising since the last 25 years. Compared to adenocarcinoma of the rectum and squamous cell cancer of the anal canal, squamous cell carcinoma is a distinct entity with a different etiology, pathogenesis, prognosis and requires a different therapeutic approach. Even if surgery remains the main therapeutic option, recent advances have made chemoradiation a valuable therapeutic addition. This case discuss the efficacy of chemoradiation wich can prevent complications and can improve the quality of life. Case report. A 63-year-old woman presented with history of bloody stool for the last past month. The colonoscopy showed a 2 cm circular lesion on the posterior wall of the anal canal. Biopsy was positive for squamous cell carcinoma and afterwards the patient underwent chemoradiation. At 1 year of follow-up the patient is disease free, with a good sphincter control and had no late complications. Conclusion. Since the first studies in 1974, chemoradiation seems to be a good option for most patients with squamous cell carcinoma avoiding surgery

How to treat hemorrhagic shock and head trauma in the emergency department: isotonic or hypertonic saline?

Aims: This study was performed to compare the effects of physiological saline and hypertonic saline administered at an early stage in a model of traumatic brain injury associated with hemorrhagic shock. Material and methods: Twenty-eight male Sprague Dawley rats were divided into four groups. The rats in the control group (S) underwent a sham experimental hemorrhagic shock followed by a sham operation. The rats in the trauma group (T) underwent a hemorrhagic shock followed by head trauma and no treatment. The rats in the NS group underwent a hemorrhagic shock followed by head trauma and received 0.9% NaCl. The rats in the HS group underwent a hemorrhagic shock followed by head trauma and received a 7.5% NaCl solution. The weight-drop method was used for achieving head trauma. After the head trauma, hypovolemia was induced by the controlled hemorrhage of 30% of the blood volume. The animals were exposed to hypovolemic shock for a further 30 min prior to fluid resuscitation. Each animal received a single volume infusion of their assigned fluid within few minutes. The effects of different fluids were evaluated after 24-hours by their brain water contents, and histological, and biochemical tests. Results: Group T had a significantly higher mean value for brain water content than did the NS group (P < 0.0001). Also, the HS group had significantly higher mean values for brain water content than the NS group (P = 0.003). Edema and bleeding were more marked in the HS group compared to the NS group (both, P < 0.001) in the histopathological evaluation. Leukocyte accumulation was significantly increased in the untreated rats compared to the HS and NS groups (both, P < 0.001). More red neurons were observed in the rats in the T group than in the NS and HS groups (both, P < 0.001). The mean serum osmolarity was higher in the T group compared to NS, HS, and S groups (all, P < 0.001). The mean plasma ADH levels and the mean plasma aldosterone levels were significantly higher in the T group than in the S, NS, and HS groups (all, P < 0.0001). Conclusion: Although not significantly different in biochemistry, animals treated with HS early in hemorrhagic shock secondary to head injury had more brain water than those the received NS as defined histopathologically. Therefore, in emergency settings, NS should be used safely in the early stage of hemorrhagic shock secondary to head trauma

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57\u201375) years (54\ub79 per cent men). Some 1153 (27\ub77 per cent) received NSAIDs on postoperative days 1\u20133, of whom 1061 (92\ub70 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4\ub76 versus 4\ub78 days; hazard ratio 1\ub704, 95 per cent c.i. 0\ub796 to 1\ub712; P = 0\ub7360). There were no significant differences in anastomotic leak rate (5\ub74 versus 4\ub76 per cent; P = 0\ub7349) or acute kidney injury (14\ub73 versus 13\ub78 per cent; P = 0\ub7666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35\ub73 versus 56\ub77 per cent; P &lt; 0\ub7001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement