Metastatic Malignant Melanoma Causing Small Bowel Intussusception: A Case Report with 4-year Follow-up

Primary mucosal malignant melanoma of the small bowel is extremely rare. The small bowel is mostly affected by metastases of the primary malignant melanoma of the skin. Bowel obstruction is a rare complication of metastatic melanoma. We present a case of small bowel obstruction in a 49-year-old man with history of skin malignant melanoma. A segmental resection of the ileum with termino-terminal anastomosis was performed. Pathohistological examination showed metastatic melanoma. After 4 years of follow-up, the patient is still free of the disease

A Randomised Two-way Comparison of Mastectomy Performed Using Harmonic Scalpel or Monopolar Diathermy

The purpose of this study was to perform an overall evaluation and comparison of the success rate of modified radical mastectomy by harmonic scalpel and monopolar electrocauter. The prospective study included all of the patients that were planned for and mastectiomized because of breast carcinoma during July 1st 2008 until December 21 st 2008 at the Department of Surgery and Urology, University Hospital Mostar. Duration of the surgical procedure, intraoperative blood loss and operational drain secretion was measured and registered. Leukocyte number (Le), interleukin 6 (IL-6), C-reactive protein (CRP) and erythrocyte sedimentation rate was tested and registered out of peripheral venous blood before the operation, 4 hrs after it, as well as on the first, second and third day after the operation. Every patient was tested for postoperative pain intensity, amount of administered analgesics during hospital stay, number and types of postoperative complications; also the time needed for return to everyday activities was registered. 61 patients were included in the study. 31 patients were operated with the harmonic scalpel, and 30 of them with the monopolar electrocauter. There is no statistically significant difference between the operation time in the two groups: 78.50±17.50 minutes by harmonic scalpel and 82.50±18.50 minutes by electrocauter (p=0.796). The smaller amount of intraoperative blood loss is statistically significant in the group of patients mastectomized by harmonic scalpel 78±31 ml compared to 256±112 ml in the group mastectomized by electrocauter (p<0.001); as is the total operational drain secretion: patients mastectomized by harmonic scalpel 540±390 mL compared to 960±710 mL in patients mastectomized by electrocauter (p<0.001). There is no statistical difference in the number of leukocytes in blood after modified radical mastectomy using the harmonic scalpel or electrocauter (p=0.957), or in erythrocyte sedimentation rate (p=0.114), CRP (p=0.071) and IL-6 (p=0.082). The duration of postoperative hospital stay does not differ statistically between the two groups, nor does the postoperative pain intensity, amount of administered analgesics, number or types of postoperative complications, as well as the time needed for return to everyday activities. Therefore using the ultrasound harmonic scalpel in comparison to monopolar electrocauter brings certain advantages, which however do not contribute significantly to the total success rate of the operation

Comparison of Results of Surgical Treatments of Primary Inguinal Hernia with Flat Polypropylene Mesh and Three-Dimensional Prolene (Phs) Mesh – One Year Follow Up

The aim of this study was to compare the results of the surgery of inguinal hernias using flat polypropylene mesh and three-dimensional prolene (PHS) mesh. The study included two groups of 40 male patients, aged 18–50 years, with the diagnosis of inguinal hernia. One group was operated with a flat polypropylene mesh, while the second group was operated with three-dimensional prolene (PHS) mesh. The study has shown that the operation with three-dimensional prolene mesh lasted 15 minutes longer and that the patients had stronger inflammatory response. Statistically, there was no significant difference in post-operative pain intensity, post-operative use of analgesics, length of hospitalization, return to daily activities, early and late post-operative complications. No recurrence was registered in any of the groups. The analysis of results indicates that there is no difference in treatment of inguinal hernia with flat polypropylene and three-dimensional prolene (PHS) mesh