Management of Sigmoid Volvulus Avoiding Sigmoid Resection

Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided

A case of typical pulmonary carcinoid tumor treated with bronchoscopic therapy followed by lobectomy

Carcinoid bronchopulmonary tumors represent approximately 25% of all carcinoid tumors and 1%–2% of all lung neoplasms. The most common symptoms are: persistent cough, asthma-like wheezing, chest pain, dyspnea, hemoptysis and obstructive pneumonitis. We present a case of a young adult diagnosed with a typical carcinoid tumor. The diagnosis was established on the basis of imaging examination and bronchoscopic biopsy. The patient was treated with bronchoscopic electrocautery therapy to relieve the obstructed airway, followed by surgical lobectomy in order to entirely remove the exophytic damage. This approach was not only a palliative management to bronchial obstruction but also avoided pneumonectomy. Recent studies support the use of such interventional resection methods, as they may result in a more conservative surgical resection

Endometriosis of the lung: report of a case and literature review

This paper reports a case of endometriosis of the lung in a 29-year-old woman with long-term periodic catamenial hemoptysis. A chest computed tomography image obtained during menstruation revealed a radiographic opaque lesion in the lingular segment of the left superior lobe. During bronchoscopy, bleeding in the mucosa of the distal bronchus of the lingular segment of the left superior lobe was observed. Histopathology subsequent to an exploratory thoracotomy confirmed the diagnosis of endometriosis of the left lung. The 2-year follow-up after lingular lobectomy of the left superior lobe showed no recurrence or complications

Current surgical status of thyroid diseases

Thyroid nodules are a common clinical problem for surgeons. The clinical importance of nodules is the need to exclude thyroid cancer, which occurs in 5%–15% of patients. If fine needle aspiration cytology is positive, or suspicious for malignancy, surgery is recommended. During the past decade, with the tendency to develop smaller incisions, an endoscopic approach has been applied to thyroid surgery, called minimally invasive video-assisted thyroidectomy. This approach was immediately followed by other minimally invasive or scarless neck techniques, such as the breast approach, axillary-breast approach, and robot-assisted method. All these techniques follow the same principles of surgery and oncology. This review presents the current surgical management of the thyroid gland, including the surgical techniques and compares them by describing benefits and drawbacks of each one

Percutaneous tracheostomy-beware of the thyroidea-ima artery

Percutaneous tracheostomy is a minimally invasive operation performed in patients, in order to provide an air passage through the windpipe. A rare cause of severe bleeding during such operation is the injury of the thyroidea-ima artery. This case report presents a patient with hemorrhage after thyroidea-ima injury during percutaneous dilatational tracheostomy. Surgeons should always be aware of such anatomic variation, in order to prevent urgent sternotomy

EXPERIMENTAL USE OF A PEDICLE GALLBLADDER GRAFT FOR REPAIR OF LARGE DUODENAL DEFECTS. (EXPERIMENTAL STUDY IN DOGS)

VARIOUS SURGICAL METHODS HAVE BEEN USED FOR COVERING LARGE DUODENAL WALL DEFECTS. NONE OF THEM HAS BEEN WIDELY ACCEPTED. THIS EXPERIMENTAL WORK WAS UNDERTAKEN IN ORDER TO ESTABLISH THE EFFICACY OF PEDICLE GALLBLADDER GRAFTS IN LARGE DEFECTS OF THE SECOND PART OF THE DUODENUM. THE USE OF GALLBLADDER PATCH COVERING DUODENAL WALL DEFECTS WAS ATTEMPTED IN 18 DOGS. THIS DEFECT WAS SURGICALLY INDUCED ON THE SECOND PART OF THE DUODENUM. ALL THE DOGS SURVIVED AND FOLLOWED AN UNEVENTFUL POSTOPERATIVE COURSE. THE HEALING OF THE DEFECT WAS SATISFACTORYAND THE STRUCTURE AND THICKNESS OF THE GRAFT REMAINED UNCHANGED. THIS METHOD COULD BE A SUITABLE ALTERNATIVE IN THE TREATMENT OF LARGE DUODENAL DEFECTS, ESPECIALLY IN THE PRESENCE OF ANOTHER INTRAABDOMINAL INJURIES AND WHEN THE USE OF THE GRAFT TISSUE IS UNFEASIBLE.18 ΠΕΙΡΑΜΑΤΟΖΩΑ ΥΠΟΒΛΗΘΗΚΑΝ ΣΤΗΝ ΑΠΟΚΑΤΑΣΤΑΣΗ ΜΕ ΜΙΣΧΩΤΟ ΜΟΣΧΕΥΜΑ ΧΟΛΗΔΟΧΟΥ ΚΥΣΤΗΣ ΜΕΓΑΛΟΥ ΕΛΛΕΙΜΜΑΤΟΣ ΤΟΥ ΤΟΙΧΩΜΑΤΟΣ ΤΗΣ 2ΗΣ ΜΟΙΡΑΣ ΤΟΥ ΔΩΔΕΚΑΔΑΚΤΥΛΟΥ ΠΟΥ ΠΡΟΚΛΗΘΗΚΕ ΧΕΙΡΟΥΡΓΙΚΑ ΕΝΩ 9 ΠΕΙΡΑΜΑΤΟΖΩΑ ΑΠΟΤΕΛΟΥΣΑΝ ΤΗΝ ΟΜΑΔΑ ΕΛΕΓΧΟΥ. ΟΛΑ ΤΑ ΠΕΙΡΑΜΑΤΟΖΩΑ ΕΠΕΖΗΣΑΝ ΚΑΙ ΕΙΧΑΝ ΟΜΑΛΗ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗ ΠΕΡΙΟΔΟ. Η ΕΠΟΥΛΩΣΗ ΤΟΥ ΜΟΣΧΕΥΜΑΤΟΣ ΗΤΑΝ ΦΥΣΙΟΛΟΓΙΚΑ ΑΝΑΜΕΝΟΜΕΝΗ ΚΑΙ Η ΥΦΗ ΤΟΥ ΔΙΑΤΗΡΗΘΗΚΕ. ΤΑ ΙΚΑΝΟΠΟΙΗΤΙΚΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΤΟΥ ΠΕΙΡΑΜΑΤΟΣ ΘΑ ΔΙΚΑΙΟΛΟΓΟΥΣΑΝ ΤΗΝ ΕΦΑΡΜΟΓΗ ΤΗΣ ΜΕΘΟΔΟΥ ΣΤΟΝ ΑΝΘΡΩΠΟ ΣΕ ΠΕΡΙΠΤΩΣΕΙΣ ΜΕΓΑΛΩΝ ΤΟΙΧΩΜΑΤΙΚΩΝ ΕΛΛΕΙΜΜΑΤΩΝ ΤΟΥ ΔΩΔΕΚΑΔΑΚΤΥΛΟΥ ΠΡΟΗΓΗΘΕΝΤΩΝ ΕΠΕΜΒΑΣΕΩΝ Η ΣΥΝΥΠΑΡΞΗΣ ΚΑΚΩΣΕΩΝ ΤΩΝ ΕΝΔΟΚΟΙΛΙΑΚΩΝ ΣΠΛΑΧΝΩΝΟΠΟΥ ΔΕΝ ΕΙΝΑΙ ΔΥΝΑΤΗ Η ΧΡΗΣΗ ΕΝΤΕΡΙΚΟΥ Η ΑΛΛΟΥ ΜΟΣΧΕΥΜΑΤΟΣ

Optimal civil aircraft missions exploiting free routing possibilities

A method is presented for optimizing burnt fuel and flight time of civil aircraft missions, under the scope of a full-scale free route airspace implementation as well as usage of actual environmental data, focusing on ambient temperature and pressure. A computational analysis model, using online available aircraft data is considered, for flight envelopes defined by the user, is used as the base tool. The model is validated over real flight data, before it is used as the main tool for optimization of flight missions. Flight paths are analyzed by considering both their vertical and horizontal aspect. Optimal paths are derived, for each chosen mission, through an optimization process that takes advantage of the flexibilities that become available by implementation of Free Route Airspace. Vertical flight path is shown to play very important role in achieving optimal flights, while horizontal paths also offer optimality possibilities, with a strong dependence on weather conditions