Rupture of totally implantable central venous access devices (Intraports) in patients with cancer: report of four cases

BACKGROUND: Totally implantable central venous access devices (intraports) are commonly used in cancer patients to administer chemotherapy or parenteral nutrition. Rupture of intraport is a rare complication. PATIENTS AND METHODS: During 3 years period, a total of 245 intraports were placed in cancer patients for chemotherapy. Four of these cases (two colon cancer and one each of pancreas and breast cancer) had rupture of the intraport catheter, these forms the basis of present report. RESULTS: Mean time insitu for intraports was 164∀35 days. Median follow-up time was 290 days and total port time in situ was 40180 days. The incidence of port rupture was 1 per 10,000 port days. Three of the 4 cases were managed by successful removal of catheters. In two of these the catheter was removed under fluoroscopic control using femoral route, while in the third patient the catheter (partial rupture) was removed surgically. One of the catheters could not be removed and migrated to right ventricle on manipulations. CONCLUSION: Port catheter rupture is a rare but dreaded complication associated with subcutaneous port catheter device placement for chemotherapy. In case of such an event the patient should be managed by an experienced vascular surgeon and interventional radiologist, as in most cases the ruptured catheter can be retrieved by non operative interventional measures

Corona Mortis: Surgical Anatomy, Physiology and Clinical Significance

Corona mortis (CM) is classically defined as the arterial anastomosis between the obturator artery and the inferior epigastric artery that crosses the posterior aspect of the superior ramus of the symphysis pubis. Its clinical impact is considered great, as it lies within the surgical field of numerous specialties (general surgeons, orthopedists, gynecologists, urologists). Our systematic study of the literature revealed a diversity in the incidence of the Corona Mortis between cadaveric and patient studies. The new technological advances and especially the CT angiography, applied on the retropubic region vessels, have given the chance to obtain more precise depictions and thus estimations on the real incidence of corona mortis. This review intends to extract for the first time the corona mortisrsquo incidence from the major CT angiographic studies in bibliography and compare it with the incidence of CM in the major cadaveric studies. Special attention was given to the question whether this anastomosis is that important as its name implies (mortis) in the clinical setting or not

Bilateral giant femoropopliteal artery aneurysms: a case report

<p>Abstract</p> <p>Introduction</p> <p>Popliteal artery aneurysms are the most common peripheral arterial aneurysms, and are frequently bilateral. Acute limb ischemia, rupture and compression phenomena can complicate these aneurysms when the diameter exceeds 2 cm.</p> <p>Case Presentation</p> <p>We report an 82-year-old male patient with two giant femoropopliteal aneurysms, 10.5 and 8.5 cm diameters, managed in our institution. Both aneurysms were resected and a polytetrafluoroethylene (PTFE) femoropopliteal interposition graft was placed successfully. Management and literature review are discussed.</p> <p>Conclusion</p> <p>We believe this is the first report in the medical literature of bilateral giant femoropopliteal aneurysms.</p

Modified capitonage in partial cystectomy performed for liver hydatid disease: Report of 2 cases

BACKGROUND: Several techniques have been described in liver hydatid disease surgery, with most well known partial cystectomy, capitonage and introflexion. METHODS: We present a technical modification on open partial cystectomy for liver hydatid disease. We performed this operation in 2 patients with liver echinococcosis. The cyst is being unroofed and evacuated from the daughter cysts. The identified bile vessels ligated. The remnants of the anterior wall (capsule of the cyst) are anchored with sutures in the posterior wall in a manner that the cavity of the cyst disappears. RESULTS: In both patients the disease eradicated. No postoperative complications were observed including bile leaking and/or abscess formation. CONCLUSIONS: Our technique helps in the fast, and effective mobilization of the patient, as well as in the minimization of postoperative bile leaking

Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Introduction: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF). Methods: We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral haemorrhage (sICH) and any ICH. Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p = 0.1677; p = 0.8941; and p = 0.7786, respectively). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality. Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs

Intoxicação hídrica durante histeroscopia: relato de caso Intoxicación hídrica durante histeroscopia: relato de caso Water intoxication during hysteroscopy: case report

JUSTIFICATIVA E OBJETIVOS: Intoxicação hídrica e distúrbios eletrolíticos produzindo toxicidade sistêmica podem ocorrer durante ressecção prostática transuretral e cirurgia histeroscópica, sendo em geral causados pelo volume de líquido e pela duração do procedimento. RELATO DO CASO: Apresenta-se um caso incomum de intoxicação hídrica em uma paciente de 42 anos submetida à ressecção endoscópica de mioma uterino submucoso, com descrição do diagnóstico e do tratamento. CONCLUSÕES: A intoxicação hídrica pode ser resultado de sobrecarga líquida, sendo importante o controle cuidadoso dos líquidos empregados e monitorização clínica.<br>JUSTIFICATIVA Y OBJETIVOS: Intoxicación hídrica y disturbios electrolíticos produciendo toxicidad sistémica pueden acontecer durante resección prostática transuretral y cirugía histeroscópica, siendo en general causados por el volumen de líquido y por la duración del procedimiento. RELATO DEL CASO: Se presenta un caso no frecuente de intoxicación hídrica en una paciente de 42 años sometida a resección endoscópica de un mioma uterino submucoso, con la descripción del diagnóstico y del tratamiento. CONCLUSIONES: La intoxicación hídrica puede ser resultado de recargo líquido, siendo importante el control cuidadoso de los líquidos empleados y monitorización clínica.<br>BACKGROUND AND OBJECTIVES: Water intoxication and electrolyte disturbances that produce systemic toxicity can be developed during transurethral prostatic resection procedures and hysteroscopic surgery. Usual causes are considered the fluid load and the duration of the operation. CASE REPORT: We present an unusual case of water intoxication in a 42 years old, female patient who underwent endoscopic resection of uterine submucuous myoma. The diagnosis and treatment is also described. CONCLUSIONS: Water intoxication may develop as a result of distending fluid overload, therefore careful fluid measurement and monitoring is crucial

Medical Applications in Everyday Surgical Practice

Technological evolution has lead to great inventions and smart phones are certainly one. This perception article investigates the possible advantages and disadvantages of using smart phone applications in different surgical subspecialties.nbspnbsp Since phones can now store a huge amount of data and can send and receive multimedia such as video and sound these applications could benefit surgeons not only in terms of telemedicine but also as an educational or decision-making tool.nbsp However, such applications raise some significant ethical questions for the surgeon.nbspnbs

Could Unnecessary Appendectomies be Avoided Using Neutrophil Count and CRP as a Diagnostic Criterion? Answering an Every-Day Clinical Question

Background: Despite improvements in diagnostic medicine the accuracy diagnosis of acute appendicitis in several cases is yet difficult. Methods: 76 patients were admitted in the hospital for possible acute appendicitis. White blood cells count (WBC) measurement and C-reactive protein (CRP) were assessed in all patients. Of 76 patients, 62 (81%) were operated on by the diagnosis of acute appendicitis, 2 (3%) were operated on without diagnosis of acute appendicitis and served as a control group, and the remainder 12 patients remained under observation, were finally not operated on and served as controls, too. The 64 patients, who were managed by appendicectomy, were divided in four groups proportionally to the operative findings and histopathological reports. Each grouprsquos laboratory tests were investigated for WBC and CRP elevation and sensitivity and specificity of these tests were also estimated . Results: The sensitivity and specificity of these tests were 69% and 71% for neutrophil count and 87% and 100% for CRP, respectively. Conclusion: Thereby, patients with normal results in all tests (CRP and WBC) together are unlikely to have acute appendicitis, but it is not absolute and that is why should be evaluated with greater caution

Anorectal incontinence: a challenge in diagnostic and therapeutic approach

Anorectal incontinence is a symptom of a complex multifactorial disorder involving the pelvic floor and anorectum, which is a severe disability and a major social problem. Various causes may affect the anatomical and functional integrity of the pelvic floor and anorectum, leading to the anorectal continence disorder and incontinence. The most common cause of anorectal incontinence is injury of the sphincter muscles following delivery or anorectal surgeries. Although the exact incidence of anorectal incontinence is unknown, various studies suggest that it affects approximate to 2.2-8.3% of adults, with a significant prevalence in the elderly (&gt;50%). The successful treatment of anorectal incontinence depends on the accurate diagnosis of its cause. This can be achieved by a thorough assessment of patients. The management of incontinent patients involves conservative therapeutic procedures, surgical techniques, and minimally invasive approaches. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams &amp; Wilkins