Thyroidectomy without Ligatures in Differentiated Thyroid Cancer

Technical improvements in thyroid surgery are nearly close with the progress of the vessels sealing systems. In all cases, we need to obtain a radical and safe thyroid excision. This chapter is conducted to evaluate the technical key point and the postoperative benefits of our procedure using vessels sealing devices in differentiated thyroid cancers. A prospective study, carried out in First Surgical Clinic, Emergency County Clinical Hospital Tirgu Mureș, Romania from January 01, 2013 to March 01, 2018, based on 100 consecutive patients, divided into two groups: first group without ligatures, using Small Jaw LigaSure™, and the second group operated by conventional procedure. Statistical analysis of some parameters (the thyroid pathology, operative time, hospitalization days, analgesic drugs, immediate postoperative complications and histopathological findings) shows that this procedure provides a total and “complete” removal of the thyroid specimen, with a decreased operative time and fewer hospitalization days

Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results

Intersphincteric resections are part of the therapeutic arsenal that preserves the sphincterian apparatus. This chapter analyzes the evolution of rectal surgery leading up to intersphincteric resections, deals with anatomical and oncological aspects in rectal cancer, and finally shows our own personal experience with ISR in a series of 40 cases focusing on oncological outcomes, continence, and defecation. As a conclusion, intersphincteric resection represents a feasible therapeutic option in highly selected cases that exempts the patient from the need of a permanent colostomy bag without compromising oncological principles. The Wexner score system is simple and effective in objectifying continence in patients that undergo this type of surgery

Epehólyag-agenesia. Epekövességet utánzó ritka rendellenesség egy felnőtt nőben = Gallbladder agenesis – A rare congenital anomaly mimicking cholelithiasis in an adult woman

Absztrakt: Az epehólyag-agenesia ritka, a biliaris rendszer embriológiai hibája miatt kialakult veleszületett elváltozás. Az esetek többségében tünetmentes, más esetekben az epekólika tüneteit utánozza. Betegünk 72 éves kaukázusi nő. Anamnézisében magasvérnyomás-betegség, illetve magas koleszterinszint szerepelt, melyekre vérnyomáscsökkentő, illetve koleszterinszint-csökkentő kezelést kapott. Felvételére az epekólika tüneteinek megjelenése miatt került sor. Laparoszkópos műtéten esett át, mely alátámasztotta a végleges diagnózist. E ritka eset kapcsán bemutatjuk megközelítésünket, valamint az orvosi szakirodalom rövid áttekintését. A sebésznek intraoperatívan el kell döntenie, hogy egy lehetséges ectopiás epehólyagot keres, vagy tovább vizsgálja az esetet képalkotó eljárások segítségével. Az epehólyag-agenesia ritka állapot, mellyel a sebésznek számolnia kell. Azokban az esetekben, amikor az epekövesség tünetei nem meggyőzőek, a műtét elkerülése végett a legjobb kiegészítő képalkotó eljárás a mágnesesrezonancia-kolangiopankreatográfia. Orv Hetil. 2019; 160(38): 1510–1513. | Abstract: Gallbladder agenesis is a rare congenital malformation due to an embryological defect of the biliary system. In most cases it is asymptomatic, but it can also mimic biliary colic. We report the case of a 72-year-old Caucasian woman with a medical history of cardiovascular disease and hypercholesterolemia, under cholesterol-lowering and hypotensive treatment, who presented symptoms suggesting biliary colic. She underwent laparoscopic surgery that confirmed the final diagnosis. We present our approach in this rare case as well as a brief review of medical literature. The surgeon should decide intraoperatively whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Gallbladder agenesis is a rare condition that the surgeon must be aware of. In the cases of inconclusive or indirect signs of cholelithiasis, the best approach is complementary imaging investigations such as magnetic resonance cholangiopancreatography in order to avoid surgery. Orv Hetil. 2019; 160(38): 1510–1513

The Utility of Magnetic Resonance Imaging in the Multidisciplinary Treatment of Patients with Rectal Cancer

Rectal cancer is one of the most common types of cancer in both men and women. In recent years, the importance of magnetic resonance imaging (MRI) has greatly increased in the multidisciplinary treatment of patients with rectal cancer. MRI has a particularly important role in the most accurate preoperative staging of these patients, both in terms of assessing the local invasion of the tumor and in terms of assessing the status of pelvic lymph nodes. Many patients with rectal cancer, especially those in the advanced stage of the disease, in the preoperative period undergo neoadjuvant radio chemotherapy. The evaluation of the clinical response of these patients to neoadjuvant therapy is of crucial importance both in terms of personalized treatment and in terms of their prognosis. In this regard, MRI has its clearly defined role at present in evaluating the efficacy of neoadjuvant therapy, as well as in postoperative follow-up

Supralevator Total Pelvic Exenteration Without Colostomy — Case Report

Background: Pelvic exenteration is an ultra-radical surgical procedure described by Brunschwig in 1948, which attempts to surgically cure patients with recurrent pelvic cancer after radiotherapy. Several variants of pelvic exenteration are described that allow a more limited or extensive resection, depending on the stage of the disease

High Grade Uterine and Rectal Prolapse

Introduction: Pelvic floor hernias are encountered especially in elderly women. A combined genital, bladder, and rectal prolapse poses treatment challenges in aged women

Uncommon Differential Diagnosis of Acute Right-sided Abdominal Pain – Case Report

The appendix is a worm-like, blind-ending tube, with its base on the caecum and its tip in multiple locations. Against all odds, it plays a key role in the digestive immune system and appendectomy should therefore be cautiously considered and indicated. We report the case of a 45-year-old male with a known history of Fragile-X syndrome who presented to the emergency department with intense abdominal pain and was suspected of acute appendicitis, after a positive Dieulafoy’s triad was confirmed. The laparoscopic exploration showed no signs of inflammation of the appendix; nonetheless, its removal was carried out. Rising inflammatory laboratory parameters led to a focused identification of a pleural empyema due to a tooth inlay aspiration. Our objective is to emphasize the importance of a thorough anamnesis, even in cases of mentally impaired patients, as well as to highlight a rare differential diagnosis for appendicitis. Acute appendicitis is an emergency condition that requires a thorough assessment and appropriate therapy. Clinical examinations are important, but in this particular case, imaging methods had a much more important role in establishing the right treatment approach. Furthermore, the signs of acute appendicitis are mimicked by several medical conditions including respiratory tract infections

Skeletal Muscle Metastases and Inferior Vena Cava Involvement in a Patient with Clear Cell Renal Cell Carcinoma and Sarcomatoid Differentiation

Introduction: Renal cell carcinoma has a propensity to propagate into the renal vein and inferior vena cava. A small percentage has distant metastasis at presentation. Pulmonary, hepatic, cerebral and bone metastases are common, but skeletal muscle involvement is rare