Acral Lentiginous Melanoma: A Case Control Study and Guidelines Update

Background. Malignant melanoma incidence is increasing dramatically. We report herein a case of the rarest acral lentiginous type. Case Report. A 58-year-old man presented with a melanoma resembling lesion over the sole of his right foot, measuring 15–20 mm in diameter. An excisional biopsy with a narrow (2 mm) margin of surrounding skin was obtained. Histological findings were consistent with a diagnosis of acral lentiginous melanoma. Sentinel lymph node biopsy was also performed and micrometastases were not identified in frozen-section examination. According to the AJCC system, the tumor stage was IB (T2aN0M0). A wide local excision of the biopsy scar with a margin of 2 cm was performed. A split-thickness thick skin graft was used to reconstruct the excisional defect. During an 18-month followup, no local or distant recurrence has been observed. This paper aims to extract an updated rational approach to the management of this disease out of an enormous body of knowledge

A variant of the double gallbladder. A possible cause of cholelithiasis?

Congenital duplication of the gallbladder is a rare anatomical malformation, which is usually discovered as an incidental finding during cholecystectomy. We report a case of a double gallbladder in a 45-year-old woman, which was discovered during laparoscopic cholecystectomy for symptomatic cholelithiasis. As it was not possible to identify the anatomical structures safely, the procedure was converted to open cholecystectomy. Inspection of the resected gallbladder showed that it consisted of 2 chambers with separate cystic ducts, which communicated through an ostium. Both chambers contained multiple gallstones. The inadequate drainage of the second chamber could be considered as a predisposing factor for the development of cholelithiasis in this case

Transperitoneal laparoscopic right radical nephrectomy for renal cell carcinoma and end-stage renal disease: a case report

Nephron-sparing surgery (partial nephrectomy) results are similar to those of radical nephrectomy for small (<4 cm) renal tumors. However, in patients with end-stage renal disease, radical nephrectomy emerges as a more efficient treatment for localized renal cell cancer. Laparoscopic radical nephrectomy (LRN) increasingly is being performed. The objective of the present study was to present a case of a patient under hemodialysis who was submitted to LRN for a small renal mass and discuss the current issues concerning this approach. It appears that radical nephrectomy should be the standard treatment in dialysis patients even for small tumors. The laparoscopic technique is associated with acceptable cancer-specific survival and recurrence rate along with shorter hospital stay, less postoperative pain and earlier return to normal activities

Elective laparoscopic splenectomy for giant hemangioma: a case report

Although unusual, hemangioma is the most common primary splenic neoplasm. Splenectomy is indicated when the tumor is large, with increased risk of hemorrhage. The laparoscopic approach is preferred for most elective splenectomies. Although technically feasible, laparoscopic splenectomy can be a challenge in the patient with splenomegaly. We present herein a case of an 18-year-old male asymptomatic patient who underwent laparoscopic splenectomy for the incidental finding of splenomegaly caused by a large splenic hemangioma. Laparoscopic splenectomy appears to be a safe and effective procedure, in appropriately experienced hands, for patients with splenomegaly, given the spleen's fragile anatomy and its relationship to other abdominal viscera

Kaposi's sarcoma of the hand mimicking squamous cell carcinoma in a woman with no evidence of HIV infection: a case report

<p>Abstract</p> <p>Introduction</p> <p>Kaposi's sarcoma is a vascular neoplasm mainly affecting the skin of the lower extremities. Although it is the most common neoplasm affecting patients with AIDS, sporadic cases in HIV-negative people have been reported. It is a lesion mainly affecting men and its clinical presentation presents a challenge, as it can resemble other benign or malignant skin lesions.</p> <p>Case presentation</p> <p>We report a rare case of Kaposi's sarcoma presenting in a 68-year-old Mediterranean woman with no evidence of HIV infection. The patient had a 6-month history of a slowly progressing pigmented lesion on the dorsum of her left hand. The lesion clinically resembled a squamous cell carcinoma. The patient was treated with a wide excision of the lesion and primary reconstruction with a full thickness skin graft. Histopathological and immunohistochemical analysis of the excised lesion revealed the presence of Kaposi's sarcoma. Serologic investigation for HIV was negative but polymerase chain reaction for human herpes virus type 8 infection was positive. Thorough clinical and imaging investigation of the abdomen and chest were both negative for loci of disease.</p> <p>Conclusion</p> <p>Kaposi's sarcoma, although rare in its sporadic form, should be considered in the differential diagnosis of indeterminate skin lesions, especially those affecting the extremities.</p

Peripheral blood markers in intestinal ischemia

Acute intestinal ischemia is a life threatening situation, if it is not recognized at an early stage. Common causes of ischemia, such as arterial occlusion, normally affect a large part, if not the entire length, of the small intestine and produce loud symptoms, thus facilitating the diagnostic approach. On the other hand other causes of intestinal ischemia of extravascular origin influence smaller segments of the small intestine and produce milder or vague clinical symptoms delaying the diagnosis sometimes until the affected intestine is no longer viable or until perforation occurs. Extravascular causes of intestinal ischemia that are commonly seen in surgical patients include hernias, adhesive bands, intussusception and small intestine obstructive ileus. The aim of our study was to investigate the possible value of serum Endothelin -1 (ET-1), Magnesium (Mg), inorganic Phosphorus (iP), Nitrogen monoxide (NO), transaminases (AST,ALT) and Creatinine Kinase (CPK) concentrations, as well as the white blood cell count (WBC) as early markers of intestinal ischemia in an animal model of intestinal strangulation. An animal model of intestinal strangulation obstruction was used. Seventeen animals were included, eleven of which were subjected to intestinal strangulation while six animals were subjected to a sham laparotomy as a control group. ET-1, Mg, iP, NO, CPK, AST, ALT concentrations and WBC count in peripheral blood samples were determined preoperatively and after 30, 60, 180 and 360 min of ischemia or the sham operation respectively. At the same time intervals transmural biopsies from the affected intestinal loop were obtained to establish the extend of ischemic injury. The analysis showed that the increase of ET-1 and iP levels were statistically significant (p<0,05) at every time interval, whereas AST, ALT and Mg levels were significantly elevated (p<0.05) after 360 min of ischemia compared to the baseline in the strangulation group, whereas the variations in the control group were not of statistical significance. Analysis of ET-1, iP, Mg, AST and ALT plasma concentrations between the strangulation and the control group at the time intervals were increase was significant revealed statistically significant differences (p<0,05) between the two groups. Evaluating the results of our study, we can assume that ET-1, Mg, iP, AST, and ALT concentrations per se or in combination might be reliable markers for the early diagnosis of ischemia in cases of intestinal strangulation - obstruction. They may also contribute to the evaluation of the progress of ischemic injury by consequent measurements.Σκοπός αυτής της διδακτορικής διατριβής, η οποία έγινε σε πειραματικό πρότυπο στραγγαλισμού του λεπτού εντέρου σε κονίκλους, αποτελεί η μελέτη των αρχικών παθοφυσιολογικών μεταβολών, τόσο τοπικά όσο και συστηματικά, που προκύπτουν από την έναρξη της ισχαιμίας μέχρι την νέκρωση του εντέρου, σε μια προσπάθεια αναγνώρισης βιοχημικών και αιματολογικών παραμέτρων, που θα μπορούσαν να συνδράμουν στην πρώϊμη διάγνωση της νόσου. Επίσης τα ευρήματα αυτά, σε συνδυασμό με την ιστολογική και ανοσοϊστοχημική μελέτη ολοτοιχωματικών βιοψιών του εντέρου κατά την διάρκεια της χρονικής εξέλιξης του φαινομένου, θα μπορούσαν να αποτελέσουν χρήσιμο βοήθημα όχι μόνο για την τεκμηρίωση των ισχαιμικών αλλοιώσεων, αλλά και για την εκτίμηση της βαρύτητας της βλάβης και της βιωσιμότητας του οργάνου