Large thoracic tumour without superior vena cava syndrome

A 62-year-old male with long-standing smoking history presented with haemoptysis. Plain chest X-ray showed abnormal findings proximate to the right pulmonary hilum. Bronchoscopy revealed a fragile exophytic tumour of the right wall of the lower third of the trachea, infiltrating the right main bronchus (75% stenosis) and the right upper lobar bronchus (near total occlusion). Contrast-enhanced chest computed tomography demonstrated a 7.2 × 4.9 cm tumour contiguous to the above-mentioned structures, mediastinal lymph node pathology, and a vessel coursing inferiorly to the left of the aortic arch and anterior to the left hilum. Despite the tumour constricting the right superior vena cava (SVC), no signs of SVC syndrome were present. In this case, the patient does not present with SVC syndrome, as expected due to the constriction of the (right) SVC caused by the tumour, since head and neck veins drain through the persistent left superior vena cava (PLSVC). PLSVC is the most common thoracic venous anomaly with an incidence of 0.3% to 0.5% of the general population and it is a congenital anomaly caused by the failure of the left anterior cardinal vein to regress and to consequently form the ligament of Marshall during foetal development. It is associated with absence of the left brachiocephalic vein and in 10% to 20% of cases the right SVC is absent. Two potential draining points of the PLSVC have been previously reported. In the majority of cases PLSVC drains directly into the coronary sinus, but less frequently it drains into the left atrium or the left superior pulmonary vein (LSPV). In cases where the PLSVC drains into the coronary sinus, congenital heart defects are rare. The patient usually remains asymptomatic and PLSVC is an incidental finding during radiographic imaging or medical procedures. When the PLSVC drains into the left atrium or the LSPV, a right-to-left shunt is formed; a condition usually asymptomatic. In some reported cases this PLSVC variant presents with persistent, unexplained hypoxia or cyanosis and embolisation causing recurrent transient ischaemic attacks and/or cerebral abscesses. This PLSVC variant is more often associated with absence of the right SVC and congenital heart abnormalities.

Peritoneal Pseudocyst Causing Acute Abdomen as a Complication of Cronh's Disease

Peritoneal pseudocysts (PPs) in patients who are diagnosed with Crohn's disease (CD), is a rarely diagnosed entity with unknown epidemiology, etiology and pathogenesis. We present the case of a 30-year old male with known CD who presented with an acute abdomen because of a PP. PPs are developed as a complication caused in patients, suffering from mainly thee conditions. Firstly, PPs appear in patients with continuous ambulatory peritoneal dialysis (CAPD), they are also developed in patients with peritoneal trauma and finally in CD patients. Our case belongs to these three reported cases in our literature review, since it refers to a CD patient that developed PPs. He underwent emergency laparotomy and excision of the cyst, with good postoperative results. A literature review of 22 publications show that PPs often represent a diagnostic and therapeutic problem as it has a variable presentation and there are no data on what the best treatment option is - surgical excision or aspiration

Abdominal emergencies in patients with stage IV Melanoma: The role of surgery: A single-centre experience

Background/Aim: Metastatic melanoma is an aggressive disease with poor prognosis. Melanoma can potentially involve any organ. In this article, we report on a single-centre experience in emergency surgery for M1c melanoma. Patients and Methods: Twenty-eight consecutive patients with M1c melanoma underwent surgical exploration due to abdominal emergencies. Pre-operative computed tomography confirmed the diagnosis and the location of the affected site. Pre-operative lactate dehydrogenase serum levels and post-operative histopathology findings were recorded. Results: Intestinal obstruction was the most frequent intraoperative finding (75%). The ileum was most frequently affected (28.6%). Multifocal disease and extra-gastrointestinal tract metastases were present in 25% of cases each. Lactate dehydrogenase serum level was increased in 75% of the patients. Most patients underwent an enterectomy. Conclusion: Curative surgery for stage IV melanoma remains debatable, but surgery for patients presenting with abdominal emergencies appears to improve both survival rate and prognosis. Combined novel therapies and surgical resection is currently being studied with promising results. © 2018 International Institute of Anticancer Research. All rights reserved

Pneumococcal vaccination strategies among HIV-infected adult patients: A review of the literature

Background/Aim: Streptococcus pneumoniae is the leading cause of bacterial pneumonia and an important cause of invasive disease. Despite the antiretroviral therapies, adults infected with human immunodeficiency virus (HIV) are at particular risk for invasive pneumococcal disease (IPD). The purpose of this study was to report the efficacy of the strategies currently being used in pneumococcal vaccination for HIV-infected adults. Materials and Methods: A literature search was performed through electronic databases, for original articles in English, from years 2000 to 2019. Clinical trials controlled or randomized, and cohort studies were included. Results: While 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for immunocompromised patients, it has been reported that it is less suitable for HIV-infected patients. Recent guidelines have added pneumococcal conjugate vaccine (PCV) to the list of recommended vaccines. Conclusion: Further studies are needed to determine the optimal vaccines and intervals for subsequent revaccinations during the lifetime. © 2019 International Institute of Anticancer Research. All rights reserved

Ethical Dilemma: Is it Worthwhile Operating an End-Stage Pancreatic Cancer Patient with Acute Mesenteric Artery Ischemia? [Moralinėdilemma-ar verta operuoti paskutinės stadijos kasos vėžiu sergantį pacientą, kuriam pasireiškė ūminė mezenterinė išemija?]

Pancreatic cancer is as an aggressive malignancy with low survival rates. We present the first case of an operation of acute mesenteric ischemia performed in a patient with end-stage pancreatic adenocarcinoma. Through this case, we also discuss raising concerns regarding the management of severe complications such as acute mesenteric ischemia in patients with progressed pancreatic carcinoma. How ethical is to leave patients untreated? The decisions for management of patients with advanced disease are strongly based on the expected quality of life, ethical principles, different religions and spiritualities, and the burden of healthcare cost. © 2021 Christos Damaskos, Nikolaos Garmpis, Anna Garmpi, Vasiliki E. Georgakopoulou, Alexandros Patsouras, Georgia Sypsa, Athanasios Syllaios, Efstathios A. Antoniou