Low Molecular Weight Heparin-Induced Skin Necrosis: A Case Report

Low molecular weight heparins (LMWHs) are the standard agents used for antithrombotic therapy and prophylaxis. Despite their widespread use, reports about adverse effects from LMWHs are very scarce. Heparin-induced skin necrosis at the injection site is a rare adverse effect, more commonly associated with unfractionated heparin (UFH) rather than with LMWH, while its mechanism remains unclear. This paper deals with the enoxaparin induced skin necrosis

Primary Malignant Fibrous Histiocytoma: A Rare Case

Malignant fibrous histiocytoma (MFH) of the small intestine is an extremely rare condition. It occurs most commonly in the extremities and the trunk. We report a case of a 67-year-old woman who admitted with fever, myalgia, and altered status. After thorough investigation, a tumor of the jejunum was found. The patient underwent complete surgical removal of the tumor. A diagnosis of MFN (undifferentiated high-grade pleomorphic sarcoma) was made. The patient received adjuvant chemotherapy with Gemcitabine. Two years after the operation, the patient died due to recurrence of the disease. MFH of the small intestine is an extremely rare neoplasm with an aggressive biological behaviour. In this paper, pathogenesis, natural history, and treatment are reviewed

Late Solitary Pancreatic Metastasis from Renal Cell Carcinoma: A Case Report

We report a case of a 70-year-old man with renal cell carcinoma and metastasis to the pancreas. Symptomatic patients usually present with obstructive jaundice, abdominal pain, or GI bleeding. The diagnosis usually occurs in asymptomatic patients during followup for renal cell carcinoma. It usually befalls slowly from 2 to 18 years after the onset of the primary tumor of the kidney. A 70-year-old man presented in our department with weight loss, anorexia, and elevated blood glucose, having a large tumor on the head of the pancreas treated successfully by pancreatoduodenectomy. Three years after his treatment, the patient is doing well and without recurrence of the tumor. In conclusion, metastasis of renal cell carcinoma to the pancreas is a rare neoplasm accounting for 0.25–3% of all pancreatic tumors

Ο ρόλος της σωματοστατίνης στην παγκρεατεκτομή

Background: The postoperative morbidity following pancreatectomy remains high.The role of somatostatin and its analogues in reducing complications after pancreaticresection is controversial. It can inhibit the pancreatic secretions which, quite often,are responsible for complications during the postoperative period. The aim of thestudy was to evaluate the ability of somatostatin to influence pancreatic cell’sfunction with consequence the decrease of postoperative complications.Methods: Between January 2006 and December 2009 67 patients, for whichpancreatectomy was indicated, were randomized into two groups. In the studygroup (n=35), somatostatin was administered with continuous intravenous infusionperioperatively; before, during and after pancreatectomy. In the control group(n=32) no somatostatin was given perioperatively. Pancreatic tissues biopsies weretaken and processed for histological study with electron microscopy andultrastructural morphometric analysis.Results: The overall morbidity was 35.8% (24/67). Eighteen patients in the controlgroup (18/32; 56, 25%) and 6 patients in the treatment group (6/35; 17. 14%)developed postoperative complications (Fisher’s exact two-tailed test; p=0.001). Thetotal mortality was 4.4 % (2/67; 2 patients from the control group and 1 from thetreatment group). The most common complication was the presence of pancreaticfistula (6/67; 8.95%). The electron microscopy study of the pancreatic tissuespecimens revealed that the mean number of the secretory granules wassignificantly reduced in the treatment group compared to the control group (110.48±23.01 versus 139.51 ± 12.27; p=0.001).Conclusion: The perioperative administration of somatostatin for patientsundergoing pancreatic resection reduces the granule number and size of pancreaticcells. This finding supports the prophylactic effect of somatostatin on earlypostoperative complications of pancreatic surgery, shown in this study

The role of exercise to the control of glucose and the antioxidative capability of the blood in patients after pancreatectomy

One of the most challenging operations is the resection of the pancreas, which is associated with high morbidity. Metabolic control during the perioperative period remains an issue that is sometimes difficult to manage. Exercise has a positive effect on glycaemic control. The objective of this trial was determining whether exercise has any benefit to the oxidative stress, the control of the glucose levels as well as to the quality of life. The study was an open-label, randomised clinical trial. It has been registered in the International Standard Randomised Controlled Trial registry (ISRCTN). With the study ID ISRCTN1087174. The study was approved by the Bioethics and Deontology Committee, Medical School of Aristotle University, Thessaloniki (ref: 166/29.10.2015). The patients were selected according to the Consolidated Standard of Reporting Trials criteria. Non parametric tests were used for the results due to the low number of participants. The statistical power of the test was calculated using the power package of the R statistical package. In total, 56 patients were assessed for eligibility. Once the allocation and the follow up were completed, 21 patients in the exercise group and 22 in the control group were analysed. There was no statistical difference between the two groups (the exercise and the control one) regarding the disease characteristics, morbidity or influence of exercise on oxidative stress; however, the control of glucose and the quality of life was superior in the exercise group. Results which were statistical significant. In conclusion, exercise plays a very important role in our daily life, which is becoming more stressful and demanding over the years. Our study has proved that exercise improves the QoL in patients after large operations characterised by high morbidity like pancreas resections. This result may change the way we treat and manage these patients in the future.Η εκτομή του παγκρέατος αποτελεί πάντα μια πρόκληση για τον χειρουργό, η οποία σχετίζεται με υψηλή νοσηρότητα. Ο μεταβολικός έλεγχος κατά τη διάρκεια της μετεγχειρητικής περιόδου παραμένει ένα ζήτημα που είναι μερικές φορές δύσκολο να διαχειριστεί. Η άσκηση έχει θετική επίδραση στον γλυκαιμικό έλεγχο. Σκοπός αυτής της δοκιμής ήταν να καθοριστεί αν η άσκηση έχει οφέλη για το οξειδωτικό στρες, τον έλεγχο των επιπέδων γλυκόζης καθώς και την ποιότητα ζωής. Η μελέτη ήταν μια ανοιχτή, τυχαιοποιημένη κλινική δοκιμή. Είχε καταχωρηθεί στο διεθνές τυποποιημένο μητρώο τυχαίων ελεγχόμενων δοκιμών (ISRCTN), με το αναγνωριστικό μελέτης ISRCTN1087174. Η μελέτη εγκρίθηκε από την Επιτροπή Βιοηθικής και Δεοντολογίας, Ιατρική Σχολή του Αριστοτελείου Πανεπιστημίου,(ΑΜ : 166 / 29.10.2015). Οι ασθενείς επελέγησαν σύμφωνα με τα δεδομένα των ενοποιημένων κριτηρίων αναφοράς (CONSORT). Για τα αποτελέσματα χρησιμοποιήθηκαν μη παραμετρικά τεστ λόγω του χαμηλού αριθμού συμμετεχόντων. Η στατιστική ισχύς της δοκιμής υπολογίστηκε χρησιμοποιώντας το πακέτο ισχύος της στατιστικής δέσμης R. Συνολικά, 56 ασθενείς αξιολογήθηκαν ως προς την επιλεξιμότητα. Μόλις ολοκληρώθηκε η κατανομή και η παρακολούθηση, αναλύθηκαν 21 ασθενείς στην ομάδα άσκησης και 22 στην ομάδα ελέγχου. Δεν υπήρξε στατιστική διαφορά μεταξύ των δύο ομάδων (άσκησης και ελέγχου) σχετικά με τα χαρακτηριστικά της νόσου, τη νοσηρότητα ή την επίδραση της άσκησης στο οξειδωτικό στρες. Ωστόσο, ο έλεγχος της γλυκόζης και η ποιότητα ζωής ήταν ανώτερος στην ομάδα άσκησης. Τα αποτελέσματα ήταν στατιστικά σημαντικά. Η άσκηση παίζει πολύ σημαντικό ρόλο στην καθημερινή μας ζωή, η οποία γίνεται όλο και πιο αγχωτική και απαιτητική με την πάροδο των ετών. Η μελέτη μας απέδειξε ότι η άσκηση βελτιώνει την ποιότητα ζωής και τα επίπεδα της γλυκόζης μετεγχειρητικά, σε ασθενείς μετά από μείζονες επεμβάσεις που χαρακτηρίζονται από υψηλή νοσηρότητα όπως οι εκτομές του παγκρέατος. Αυτό το αποτέλεσμα μπορεί να αλλάξει τον τρόπο που αντιμετωπίζουμε και διαχειριζόμαστε αυτούς τους ασθενείς στο μέλλον