Giant inframuscular lipoma disclosed 14 years after a blunt trauma: A case report

<p>Abstract</p> <p>Introduction</p> <p>Lipoma is the most frequent benign tumor of the soft tissue. This lesion is often asymptomatic except in cases of enormous masses compressing nervous-vascular structures. Although the diagnosis is mostly clinical, imaging tools are useful to confirm the adipose nature of the lesion and to define its anatomic border. Sometimes, lipomas may be the result of a previous trauma, such as in this patient.</p> <p>Case presentation</p> <p>A 45-year-old man presented at our institution with a giant hard firm mass in the upper external quadrant of the right buttock disclosed after a weight loss diet. Subsequent magnetic resonance imaging showed a giant adipose mass developed beneath the large gluteal muscle and among the fibers of the medium and small gluteal muscles. When questioned on his medical history, the patient reported a blunt trauma of the lower back 14 years earlier. He underwent surgery and histological examination confirmed a giant lipoma.</p> <p>Conclusion</p> <p>Lipomas might result from a previous trauma. It is hypothesized that the trigger mechanism is activated by cytokine and growth factors released after the trauma. We herein present an exceptional case of a giant post-traumatic lipoma which caused a painful compression on the right sciatic nerve.</p

Inhalation therapy in the next decade : Determinants of adherence to treatment in asthma and COPD

Peer reviewedPublisher PD

Testis Sparing Surgery of Small Testicular Masses: Retrospective Analysis of a Multicenter Cohort

PURPOSE: We evaluated possible factors predicting testicular cancer in patients undergoing testis sparing surgery. MATERIALS AND METHODS: We retrospectively analyzed the records of all patients who underwent testis sparing surgery for a small testicular mass at a total of 5 centers. All patients with 1 solitary lesion 2 cm or less on preoperative ultrasound were enrolled in the study. Testis sparing surgery consisted of tumor enucleation for frozen section examination. Immediate radical orchiectomy was performed in all cases of malignancy at frozen section examination but otherwise the testes were spared. Univariate and multivariate analysis were performed and ROC curves were produced to evaluate preoperative factors predicting testicular cancer. RESULTS: Overall 147 patients were included in the study. No patient had elevated serum tumor markers. Overall 21 of the 147 men (14%) presented with testicular cancer. On multivariate analysis the preoperative ultrasound diameter of the lesion was a predictor of malignancy (OR 6.62, 95% CI 2.26-19.39, p=0.01). On ROC analysis lesion diameter had an AUC of 0.75 (95% CI 0.63-0.86, p=0.01) to predict testicular cancer. At the best cutoff of 0.85 the diameter of the lesion had 81% sensitivity, 58% specificity, 24% positive predictive value and 95% negative predictive value. CONCLUSIONS: Our study confirms that small testicular masses are often benign and do not always require radical orchiectomy. Preoperative ultrasound can assess lesion size and the smaller the nodule, the less likely that it is malignant. Therefore, we suggest a stepwise approach to small testicular masses, including tumorectomy, frozen section examination and radical orchiectomy or testis sparing surgery according to frozen section examination results

Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n\uc2&nbsp;=\uc2&nbsp;36) and robotic (n\uc2&nbsp;=\uc2&nbsp;26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center\ue2\u80\u99s protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2\uc2&nbsp;\uc2\ub1\uc2&nbsp;71.9\uc2&nbsp;cc for the laparoscopic and 47.2\uc2&nbsp;\uc2\ub1\uc2&nbsp;32.3\uc2&nbsp;cc for the robotic, respectively (p\uc2&nbsp;=\uc2&nbsp;0.004). Mean days of hospitalization were 5.9\uc2&nbsp;\uc2\ub1\uc2&nbsp;2.4 for the laparoscopic group and 7.6\uc2&nbsp;\uc2\ub1\uc2&nbsp;3.4 for the robotic group (p\uc2&nbsp;=\uc2&nbsp;0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27\uc2&nbsp;months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p\uc2&nbsp;=\uc2&nbsp;0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence

Gastrointestinal stromal tumor of the anal canal: an unusual presentation

BACKGROUND: Gastrointestinal stromal tumors (GIST) of the stomach are the most frequent followed by those of the intestinal tract, while colon and rectum represent rare sites. GIST of the anal canal are extremely rare. They have been studied along with GIST of the rectum, as a single entity, and along with them they represent 5% of GIST. GIST arising from the anal canal account for only 2%–8% of the anorectal GIST. Thus anal GIST must be considered an exceptional case. CASE PRESENTATION: A 78-year-old man was referred to our Institution for an anal mass, in absence of any symptom. The patient was treated by local excision. An histological diagnosis of a low grade GIST was made. No further treatment was necessary. No local recurrence of distant metastases were found at follow-up. CONCLUSION: At the moment, only ten cases of c-kit positive anal GIST are reported in the literature. These few data are not sufficient to establish a widely accepted approach for this neoplasia. We recommend to perform an initial local excision, to define the risk of aggressive behavior and the resection margins and proceed to a more aggressive treatment, if the GIST belongs to high or very high risk group. The role of adjuvant therapy is still uncertain. Although inhibitors of tyrosine-kinase receptor needs further studies before their routine use, their role in case of distant or local recurrence has been accepted. Patients' close follow up is mandatory to disclose as soon as possible local recurrences or metastases

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

Peer reviewe

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

Peer reviewe

True mediastinal ectopic goitre. Case report

Heterotopic thyroid tissue is described to usually lie at the tongue base, while the 10% at the hyoid bone. We report a case of incidental diagnosis of a true mediastinal goitre with preoperative chest X-ray in a 35-year old woman with a multinodular cervical goitre

A mechanistic approach to delayed coking modeling

The valorisation of oil distillation residues constitutes a major problem for refineries. Thermal processes like visbreaking and delayed coking are still quite diffused technologies. This paper presents some major aspects of the delayed coking kinetic modelling and some preliminary results compared with experimental data. A mechanistic approach has been adopted; it allows describing the process in wide ranges of operating condition and feedstocks. The developed model can be a useful tool for feedstock selection, production planning, control and optimisation. A special attention is devoted in the paper to substitutive addition reactions responsible of coke formation into the drums