Relapse of the pseudomyxoma peritonei after a cytoreductive surgery with peritonectomy and HIPEC, 10-year follow-up - case report with a literature review

Background: Pseudomyxoma peritonei is a rare clinical condition characterized by mucin-secreting epithelial cells which lead to formation of jelly-like structures within the peritoneal cavity and the accumulation of mucinous ascites. Most commonly it arises from the intra-abdominal spread of appendiceal mucinous tumors. Few therapeutic options exist, but a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, as described by Sugarbaker, stands for the treatment of choice in many tertiary centers nowadays. Case study: We present a 62-year-old female patient who was initially presented as acute appendicitis. Later pathohistological diagnosis of Pseudomyxoma peritonei just confirmed intraoperative suspicions. Definitive diagnosis was followed with a complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. After a 10 year relapse-free follow up, she presented with colon adenocarcinoma and a recurrence of jelly-like incapsulated structures within the abdominal cavity. Conclusion: In patients diagnosed with pseudomyxoma peritonei, according to current findings, best results are achieved using complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. However, recurrences still do occur and there is no real consensus regarding their optimal treatment

Akutni abdomen kod trudnica i babinjača

Akutni abdomen u trudnoći ostaje jedna od najizazovnijih dijagnostičkih i terapeutskih dilema danas. Učestalost akutnog abdomena tijekom trudnoće iznosi 1 na 500-635 trudnoća. Unatoč napretku medicinske tehnologije, preoperativna dijagnoza akutnih abdominalnih stanja još uvijek je neprecizna. Laboratorijski parametri nisu specifični i često se mijenjaju kao psihološka posljedica trudnoće. Postavljanje dijagnoze laparoskopskim zahvatima omogućava ranije, točnije i sigurnije dijagnosticiranje takvih stanja. Apendicitis je najčešći uzrok akutnog abdomena tijekom trudnoće s učestalošću 1 na 500- 2000 trudnoća što iznosi 25% operativnih indikacija za neopstetričku operaciju tijekom trudnoće. Kirurško liječenje indicirano je u većini slučajeva, kao kod žena koje nisu trudnice. Laparoskopski zahvati akutnog abdomena u trudnoći pokazali su se kao sigurni i precizni, a u odabranim skupinama pacijenata postaju odabrani zahvat s velikom mogućnošću povećanja takvih indikacija češćom upotrebom i naknadnim optimalnim rezultatima. Unatoč ovim naprecima, laparotomija ostaje zahvat na koji se odlučujemo u kompliciranim i nesigurnim slučajevima

Historical development of intramedullary nailing of long bone fractures

Intramedularna osteosinteza ima dugu i zanimljivu povijest. Od najranijih zapisa iz 16. stoljeća sve do današnjih modernih metoda vidljiv je značajan napredak u dizajnu čavala, vijaka i materijala od kojih su izrađeni. Napredak tehnike i izbor materijala jasno prati napredak anesteziologije, asepse i antimikrobne terapije. Danas uspješna i široko prihvaćena metoda stabilizacije prijeloma dugih kostiju donjih ekstremiteta u svojim počecima nije bila prihvaćena s odobravanjem, već s velikom dozom opreza i sumnje. Tek nakon prve polovine 20. stoljeća i revolucionarnog rada njemačkog kirurga Gerharda Küntschera dolazi do smanjenja broja komplikacija i početka široke primjene modernog oblika tehnike. Ovaj rad donosi povijesni pregled napretka tehnike i korištenja intramedularne osteosinteze u liječenju prijeloma dugih kostiju.Intramedullary nailing has a long and interesting history which dates back to the 16th century. Since then, this technique has gone through a significant progress which led to the common use of its modern form today. The design of nails, screws and materials they are made of has been revaluated and improved constantly. Advances in methods and materials have clearly gone hand in hand with the progress of anesthesiology, asepsis and antimicrobial therapy. Although intramedullary nailing has become standard, when it comes to the most diaphyseal lower extremity fractures, the very begining of the method wasn\u27t met with approval. In the first half of the 20th century, a German surgeon Gerhard Küntcher introduced the modern form of intramedullary osteosynthesis, which significantly diminished the frequency of complications and led to the widespread use of nailing in the treatment of long bone fractures. This paper brings the historical overview of intramedullary nailing progress and its application to the long bone fracture treatment

Axillar Compression Syndrome: Anatomical and Clinical Study

In order to evaluate the possibility of compression of axillar artery by medial and lateral fascicle of brachial plexus, authors performed 26 axillar dissections on cadavers. Second part included analysis of 24 selective angiograms of axillar artery of patients with diagnosis of TOS. Third part included the use of modified hyperabduction test for determination of vascular bruit as safe test for diagnosis of axillar compression. Macroscopic changes of axillar artery by compression of medial and lateral fascicle of brachial plexus were present in 11.5%. Specific angiographic horizontal spike-shaped stop of contrast behind the surgical neck of humerus was present in 12.5%. Use of modified hyperabduction test revealed vascular bruit 29.5%. Specific relation of axillar artery and medial and lateral fascicle of brachial plexus revealed another possible etiologic factor in hyperabduction syndrome as a part of TOS. Use of modified hyperabduction test revealed subclinical phase of possible syndrome