Primary Pulmonary Mucinous Cystadenocarcinoma: A Case Report

Primary pulmonary mucinous cystadenocarcinoma (PMCAC) is an extremely rare cystic neoplasm. A case of a 56-year-old male with a cystic lesion of the right lower lobe is described. Preoperative fine needle aspiration cytology and bronchoscopy were inconclusive. The patient underwent a formal right lower lobectomy and mediastinal lymph node dissection. Diagnosis was established intraoperatively. The biological behavior of primary PMCAC is unknown. Therefore, careful long-term follow-up is considered necessary because of lack of experience globally

Nine years experience in surgical approach of leiomyomatosis of esophagus

<p>Abstract</p> <p>Background</p> <p>Leiomyomas of esophagus, although rare, are the most frequent benign tumors of esophagus. Aim of this study is the presentation of 7 patients with esophageal leiomyomas who underwent surgical treatment during a 9-year period.</p> <p>Methods</p> <p>Epidemiological data (sex, age), the presenting symptoms, diagnostic examinations, tumor location, histopathological findings and the safety and efficacy of surgical resection are analyzed and assessed.</p> <p>Results</p> <p>5 men and 2 women with mean age of 56.9 years were operated. In 3 cases the tumor was located at the lower esophagus, while in the other 4 cases, the leiomyoma was found at the median third of esophagus. 4 patients had severe symptoms related to the leiomyoma, such as dysphagia and epigastric pain. All patients underwent a right postolateral thoracotomy with enucleation of the lesion. None of them received resection of part of the esophagus. The mean diameter of the resected tumors was 4.3 cm. The dimensions of leiomyomas were immediately associated with the symptoms. In no case was detected malignancy or recurrence. All patients were relieved from their symptoms, while postoperative morbidity and mortality did not occur.</p> <p>Conclusions</p> <p>Esophageal leiomyoma is a benign tumor, which causes symptoms only if its size becomes large. Surgical enucleation is considered to be safe and effective, without complications.</p

Amyand's hernia-a vermiform appendix presenting in an inguinal hernia: a case series

<p>Abstract</p> <p>Introduction</p> <p>A vermiform appendix in an inguinal hernia, inflamed or not, is known as Amyand's hernia. Here we present a case series of four men with Amyand's hernia.</p> <p>Case presentations</p> <p>We retrospectively studied 963 Caucasian patients with inguinal hernia who were admitted to our surgical department over a 12-year period. Four patients presented with Amyand's hernia (0.4%). A 32-year-old Caucasian man had an inflamed vermiform appendix in his hernial sac (acute appendicitis), presenting as an incarcerated right groin hernia, and underwent simultaneous appendectomy and Bassini suture hernia repair. Two patients, Caucasian men aged 36 and 43 years old, had normal appendices in their sacs, which clinically appeared as non-incarcerated right groin hernias. Both underwent a plug-mesh hernia repair without appendectomy. The fourth patient, a 25-year-old Caucasian man with a large but not inflamed appendix in his sac, had a plug-mesh hernia repair with appendectomy.</p> <p>Conclusion</p> <p>A hernia surgeon may encounter unexpected intraoperative findings, such as Amyand's hernia. It is important to be prepared and apply the appropriate treatment.</p

Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Injury of the gallbladder after blunt abdominal trauma is an unusual finding; the reported incidence is less than 2%. Three groups of injuries are described: simple contusion, laceration, and avulsion, the last of which can be partial, complete, or total traumatic cholecystectomy.</p> <p>Case presentation</p> <p>A case of isolated complete avulsion of the gallbladder (near traumatic cholecystectomy) from its hepatic bed in a 46-year-old Caucasian man without any other sign of injury is presented. The avulsion was due to blunt abdominal trauma after a car accident. The rarity of this injury and the stable condition of our patient at the initial presentation warrant a description. The diagnosis was made incidentally after a computed tomography scan, and our patient was treated successfully with ligation of the cystic duct and artery, removal of the gallbladder, coagulation of the bleeding points, and placement of a drain.</p> <p>Conclusions</p> <p>Early diagnosis of such injuries is quite difficult because abdominal signs are poor, non-specific, or even absent. Therefore, a computed tomography scan should be performed when the mechanism of injury is indicated.</p

The anti-adhesion action of a new biomembrane cellulose base with the addition of atorvastatin: experimental study in rats

Introduction - Aims: Intraperitoneal adhesions are a common problem in abdominal surgery. Adhesion prevention is an important goal in surgical practice and many strategies have been applied, including fibrinolytic agents and synthetic solid barriers, yet none with durable results. The aim of this PhD thesis was to create and to compare subsequently the effectiveness of Statofilm, a novel antiadhesive biofilm based on crosslinked carboxymethylcellulose and the statin (3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitor) atorvastatin, with that of well-known sodium hyaluronate-carboxymethylcellulose (Seprafilm®) in the prevention of postoperative intraperitoneal adhesions in rats. Materials and Methods: Statofilm was synthesized as an adhesion barrier, similar to Seprafilm® but sodium hyaluronate was substituted by atorvastatin in safe and clinical doses. One hundred male Wistar rats underwent a laparotomy and adhesions were induced by caecal abrasion. The animals were allocated to five groups: a control group with no adhesion barrier, Seprafilm® group, placebo group with a film containing carboxymethylcellulose without atorvastatin, and low- and high-dose groups with films containing carboxymethylcellulose and atorvastatin 0∙125 and 1 mg per kg bodyweight respectively. Adhesions were classified by two independent surgeons 2 weeks after surgery. Caecal biopsies were obtained for histological evaluation of fibrosis, inflammation and vascular proliferation. Results: All antiadhesive film groups (Seprafilm®, placebo, low-dose and high-dose) had statistically significant adhesion reduction compared with the control group (P < 0∙001, P = 0∙015, P < 0∙001 and P < 0∙001 respectively). The low-dose Statofilm was superior to Seprafilm® in terms of adhesion prevention (P = 0∙001). Adhesions were present in three-quarters of rats in the Seprafilm® group, but only one-quarter in the low-dose Statofilm group. The percentage adhesion reduction in groups IV-V, III, and II was 92-95%, 29-33% and 57-63%, respectively. The comparative adhesion reduction due to atorvastatin and sodium hyaluronate was 89-93% and 39-44%, respectively. Conclusions: The experimental data suggest that the newly developed adhesion barrier Statofilm has better results than Seprafilm® in preventing postoperative adhesions in rats. A low-dose atorvastatin-containing film, such as Statofilm, could be evaluated for future clinical application.Εισαγωγή - Σκοποί: Οι ενδοπεριτοναϊκές συμφύσεις αποτελούν κοινό πρόβλημα στη χειρουργική κοιλίας. Η πρόληψη των συμφύσεων είναι σημαντικός στόχος στη χειρουργική πρακτική και πολλές στρατηγικές έχουν εφαρμοστεί, συμπεριλαμβανομένων των ινωδολυτικών παραγόντων και συνθετικών στερεών μεμβρανών, χωρίς καμία να έχει επιδείξει έως τώρα διαρκή αποτελέσματα. Ο σκοπός της παρούσας διδακτορικής διατριβής ήταν να κατασκευάσει και εν συνεχεία να συγκρίνει την αποτελεσματικότητα του Statofilm, μιας πρωτότυπης, αντισυμφυτικής βιομεμβράνης, με βάση τη χημικά τροποποιημένη - διασυνδεδεμένη καρβοξυμεθυλοκυτταρίνη και τη στατίνη (αναστολέας αναγωγάσης 3-υδροξυ-3-μεθυλ-γλουταρυλ-συνενζύμου Α) ατορβαστατίνη, με το ευρέως γνωστό, αντισυμφυτικό πλέγμα Seprafilm® (υαλουρονικό νάτριο - καρβοξυμεθυλοκυτταρίνη), στην πρόληψη εμφάνισης των μετεγχειρητικών ενδοπεριτοναϊκών συμφύσεων στους επίμυες. Υλικά και Μέθοδοι: Το Statofilm κατασκευάστηκε ως αντισυμφυτικό πλέγμα, παρόμοια με το Seprafilm®, αντικαθιστώντας το υαλουρονικό οξύ με την ατορβαστατίνη, σε ασφαλείς και κλινικές δόσεις. Εκατό άρρενες επίμυες τύπου Wistar υποβλήθηκαν σε λαπαροτομή και οι συμφύσεις προκλήθηκαν με τριβή του τυφλού. Τα πειραματόζωα διαχωρίστηκαν σε πέντε ομάδες: την ομάδα ελέγχου χωρίς αντισυμφυτικό πλέγμα, την ομάδα του Seprafilm®, την εικονική ομάδα με πλέγμα καρβοξυμεθυλοκυτταρίνης χωρίς ατορβαστατίνη, και τις ομάδες χαμηλής και υψηλής δόσης με πλέγματα περιέχοντα καρβοξυμεθυλοκυτταρίνη και ατορβαστατίνη 0.125 και 1 mg ανά κιλό βάρους σώματος, αντίστοιχα. Οι συμφύσεις αξιολογήθηκαν από δύο ανεξάρτητους χειρουργούς, 2 εβδομάδες μετεγχειρητικά. Βιοψίες τυφλού ελήφθηκαν για ιστολογική αξιολόγηση της ίνωσης, της φλεγμονής και της αγγειακής διήθησης. Αποτελέσματα: Όλες οι ομάδες με αντισυμφυτικά πλέγματα (Seprafilm®, εικονική, χαμηλής και υψηλής δόσης) είχαν στατιστικά σημαντική μείωση των συμφύσεων, συγκρινόμενες με την ομάδα ελέγχου (P < 0∙001, P = 0∙015, P < 0∙001 και P < 0∙001, αντίστοιχα). Το χαμηλής δόσης Statofilm ήταν ανώτερο του Seprafilm® σε όρους πρόληψης των συμφύσεων (P = 0∙001). Οι συμφύσεις ήταν παρούσες σε τρία τέταρτα των επίμυων της ομάδας του Seprafilm®, ενώ μόλις στο ένα τέταρτο της ομάδας Statofilm χαμηλής δόσης. Η ποσοστιαία μείωση των συμφύσεων στις ομάδες Statofilm χαμηλής και υψηλής δόσης, Seprafilm® και εικονική ήταν 92-95%, 29-33% και 57-63%, αντίστοιχα. Η συγκριτική μείωση των συμφύσεων λόγω της ατορβαστατίνης και του υαλουρονικού οξέως ήταν 89-93% και 39-44%, αντίστοιχα. Συμπεράσματα: Σύμφωνα με τα πειραματικά δεδομένα, το πρωτότυπο, αντισυμφυτικό, πλέγμα Statofilm φαίνεται να έχει καλύτερα αποτελέσματα από το Seprafilm® στην πρόληψη των μετεγχειρητικών συμφύσεων στους επίμυες. Ένα πλέγμα χαμηλής δόσης ατορβαστατίνης, όπως το Statofilm, θα μπορούσε να αξιολογηθεί σε μελλοντική κλινική εφαρμογή

Mirizzi syndrome type V complicated with triple fistula: a case report

Abstract Background Mirizzi syndrome (MS) is a complicated form of longstanding, symptomatic cholelithiasis. According to Beltran Classification MS Type V has been introduced to describe the cholecystoenteric fistula, with or without gallstone ileus. Mirizzi syndrome Type V with double fistula has been reported in the past; however, the triple fistula is an even rarer case, first described in the international literature so far. Case presentation A 77-year-old male was admitted to our surgical department with recurrent episodes of abdominal pain, which initially presented in the last 6 months and was accompanied with jaundice. Computed tomography showed findings of cholelithiasis, pneumobilia and choledocholithiasis. We performed an ERCP, which showed two fistulas of the gallbladder with the pyloric antrum and the duodenum, respectively. Surgical treatment was immediately undergone and during laparotomy, we confirmed these findings. We ligated and dissected these communications. In addition, a third fistula between the gallbladder and the common bile duct was identified. An insertion of a Kehr T-tube into the common bile duct was performed via the gallbladder. After 3 months, the Kehr T-tube was removed and in the subsequent 2 years of follow-up the patient was presented without complications. Conclusions Mirizzi syndrome complicated with triple fistula, first described in the international literature, to the best of our knowledge, confirms the long natural history of inflammation