Carcinoma developing in ectopic pancreatic tissue in the stomach: a case report

The development of pancreatic tissue outside the confines of the main gland, without anatomic or vascular connections between them, is a congenital abnormality referred to as heterotopic pancreas. A heterotopic pancreas in the gastrointestinal tract is usually discovered incidentally and the risk of its malignant transformation is extremely low. In this study, we describe the first case of endoepithelial carcinoma arising in a gastric heterotopic pancreas of a 56-year old woman in Greece. She presented with epigastric pain, periodic nausea and vomiting. Esophagogastroduodenoscopy revealed an ulcerated lesion in the gastric antrum, biopsies of which showed intense epithelial dysplasia with incipient malignant degeneration. The pathology report of the distal gastrectomy specimen demonstrated a 2 cm in diameter ulcerative mass in the gastric antrum. Microscopically, an endoepithelial (in situ) carcinoma of the gastric antrum was determined, which in places turned into an microinvasive endomucosal adenocarcinoma. It also incidentally demonstrated heterotopic pancreatic ducts, detected within the mucosa to the muscularis propria of the same region of the stomach, in which an endoepithelial (in situ) carcinoma was evolving. The follow-up course was uneventful 6 months postoperatively

Damage control surgery and the abdomen at the dawn of the 21st century

Damage control is not a modern concept, but the application of this approach is the result of the constantly raising need to care for patients sustaining multiple high-energy injuries.A Medline search was performed to locate English language articles relating to damage control procedures in trauma patients. The retrieved articles were manually cross-referenced, and additional academic and historical articles were identified.Damage control surgery, sometimes known as «damage limitation surgery» or «abbreviated laparotomy», is best defined as creating a stable anatomical environment to prevent the patient from progressing to an unsalvageable metabolic state. Patients are more likely to die from metabolic failure (hypothermia, metabolic acidosis and coagulopathy) than from failure to complete organ repairs. Is damage control surgery going to have the decaying luck of truncal vagotomy and gastrectomy in the treatment of peptic ulcer disease, for example? Probably yes, since it won’t be long before thorough knowledge of the pathophysiology of the trauma patient will result in the development of effective procoagulants, safe rewarming techniques and successful circulatory assis

An unusual case of intestinal obstruction caused by a Meckel's diverticulum

Meckel’s diverticulum is a persistent remnant of the omphalomesenteric duct. It resents the most common congenital anomaly of the small intestine (1-4%). The vast majority of the persons with a Meckel’s diverticulum remain asymptomatic throughout life. Estimates of the frequency, with which the symptoms develop range from 10-20%. We present an unusual case of intestinal obstruction caused by a Meckel’s diverticulum. A 24-year old man with no previous medical or surgical history presented with a 24-hour history of intermittent abdominal pain, nausea and vomiting. Abdominal x-rays demonstrated multiple dilated loops of small bowel with air-fluid levels, while the white blood cell count was elevated. An exploratory laparotomy revealed a Meckel’s diverticulum, at about 80 cm proximal to the ileocecal valve, the inflamed end of which adhered with the corresponding mesentery, forming a loop, which had clasped the distal part of the ileum, resulting to a closed-loop obstruction. Meckel’s diverticulum was resected. The postoperative recovery of the patient was uncomplicated. We emphasize that a Meckel’s diverticulum is an uncommon cause of intestinal obstruction, which should be taken into account in the differential diagnosis, especially in the absence a patient’s surgical history.Meckel’s diverticulum is a persistent remnant of the omphalomesenteric duct. It resents the most common congenital anomaly of the small intestine (1-4%). The vast majority of the persons with a Meckel’s diverticulum remain asymptomatic throughout life. Estimates of the frequency, with which the symptoms develop range from 10-20%. We present an unusual case of intestinal obstruction caused by a Meckel’s diverticulum. A 24-year old man with no previous medical or surgical history presented with a 24-hour history of intermittent abdominal pain, nausea and vomiting. Abdominal x-rays demonstrated multiple dilated loops of small bowel with air-fluid levels, while the white blood cell count was elevated. An exploratory laparotomy revealed a Meckel’s diverticulum, at about 80 cm proximal to the ileocecal valve, the inflamed end of which adhered with the corresponding mesentery, forming a loop, which had clasped the distal part of the ileum, resulting to a closed-loop obstruction. Meckel’s diverticulum was resected. The postoperative recovery of the patient was uncomplicated. We emphasize that a Meckel’s diverticulum is an uncommon cause of intestinal obstruction, which should be taken into account in the differential diagnosis, especially in the absence a patient’s surgical history

Effect of moxifloxacin on survival, lipid peroxidation and inflammation in immunosuppressed rats with soft tissue infection caused by Stenotrophomonas maltophilia

In order to investigate the effect of moxifloxacin on survival, lipid peroxidation and inflammation in immunosuppressed rats with soft tissue infection caused by Stenotrophomonas maltophilia, 144 white male Wistar rats were randomized into six groups: Groups A and B received saline or moxifloxacin once per day, respectively; Groups C and D received saline or moxifloxacin twice per day, respectively, and Groups E and F received saline or moxifloxacin three times per day, respectively. Blood samples were taken at 6 and 30 hr after administration of S. maltophilia. Malonodialdehyde (MDA), WBC counts, bacterial tissue overgrowth, serum concentrations of moxifloxacin and survival were assessed. Survival analysis proved that treatment with moxifloxacin every 8 hr was accompanied by longer survival than occurred in any other group. Tissue cultures 30 hr after bacterial challenge showed considerably less bacterial overgrowth in the spleens and lungs of moxifloxacin-treated than in saline-treated animals, but not in their livers. At 6 hr there were no statistically significant differences between groups. However, at 30 hr, MDA concentrations were significantly greater (P = 0.044) and WBC counts significantly lower (P = 0.026) in group D than in group C. No statistically significant variations were observed between the other groups. Moxifloxacin possibly stimulates lipid peroxidation and enhances phagocytosis, as indicated by MDA production and survival prolongation, without being toxic, as indicated by WBC count. Therefore, under the appropriate conditions, moxifloxacin has a place in treatment of infections in immunosuppressed patients and of infections caused by S. maltophilia

Post-injection retroperitoneal abscess in a drug-addicted patient: Case report

Abscesses developing within the retroperitoneal space are complicated and serious infections, with insidious presentation, which leads to high rates of mortality and morbidity. We describe a rare case of retroperitoneal abscess formation in a drug addicted patient after attempt of intravenous injection of morphine in the right femoral vein. A 22-year-old male presented to our emergency department with high fever (40OC) since two days. The patient mentioned that he was addicted to narcotics and that he used to make morphine injections in both femoral veins. The clinical examination revealed the presence of an abscess in the right inguinofemoral region as well as a second in the left thigh. Both abscesses were drained under sedation. However, despite drainage, the fever persisted over the next few days. The patient underwent computed tomography of the abdomen which showed the presence of a retroperitoneal abscess extending along the right psoas muscle and reaching the inguinal region. The patient was led again to the operating room, where the retroperitoneal abscess was drained through a right paramedian incision under general anesthesia. The residual cavity was irrigated and a wide drain tube was placed. The cultures showed the presence of Pseudomonas aeruginosa. The patient was hospitalized in the Intensive Care Unit for 46 days and was discharged from our clinic after approximately three months in good general condition.It is concluded that the extension of post-injection abscesses of the inguinal region in the retroperitoneal space is a rare but extremely life-threatening situation, which has to be diagnosed and treated abruptly