Giant bleeding post-traumatic thoracic sarcoma management: A case report

The heterogeneity of thoracic wall tumors often represents challenging clinical entities for surgeons due to diagnostic and treatment complexities. The primary tumors, metastases, or direct invasion from intrathoracic structures comprise almost half of all cases on average that are proved to be malignant. Surgery treatment usually leaves large chest defects that require further extensive reconstruction and multimodal management including radiotherapy and chemotherapy. We report a rare case of a giant (30 cm) post-traumatic bleeding thoracic sarcoma treatment in a 70-year-old female. The use of our modified Verneuil technique to close the extensive postoperative skin defect optimized surgical wound management and provided good functional and aesthetic results. Four-year follow-up outcomes after surgical and adjuvant radiation therapy reported a high level of tumor control and showed no evidence of postoperative disease recurrence

Pancreatic surface morphology and its classification

Introduction: Anomalies and variants of development of the pancreas are relatively frequent. These variations can often lead to misdiagnosis and unnecessary medical procedures. Although, pancreatic diseases are a constantly researched field, fundamental research is relatively understudied and re-evaluation of the pancreatic morphology is performed rarely. Aim: The goal of the current study was to analyse pancreatic surface morphology by means of macroscopic anatomical dissection of 78 organ complex. Material and methods: The anatomy of the pancreas was studied by means of macroscopic anatomical dissection. The study was performed on 78 organ complexes (the pancreas, spleen, and duodenum with surrounding abdominal fat) donated to the department of human anatomy from patients who died of causes not related to pancreatic diseases. The organs were fixed in a 10% formalin solution separately to accurately preserve their forms. The organs were measured by a caliper. Results: The lie of the pancreas was classified according to Kreel and co-workers into 6 types: oblique shape in 11.54% of cases, sigmoid – 30.77%, transverse – 25.64%, horseshoe – 11.54%, L-shaped – 14.1%, and inverted V shape in 5.13%. Moreover, there were two possible L-shapes, the classical (8.97%) and inverted L-shape (5.13%). In one case, the pancreas had an unusual M-shape (1.28%). One specimen was a case of short pancreas (1.28%). Surface clefts were encountered in 17.95% of cases and in 5.13% of these cases, there was a branch of the splenic artery. Conclusions: The current study demonstrates variations in the lie of the pancreas as well as several new possible variants. Moreover, we propose a modified classification based on these findings. Therefore, the pancreas can have an oblique, sigmoid, transverse, horseshoe, L shape, inverted L, inverted V, and M shaped lie. Pancreatic clefts are another frequently encountered variation that should be kept in mind. The size of the pancreas alone is variable and should be analyzed together with its structure to avoid possible misinterpretation

Bifid Pancreatic Tail: an Anatomical Case Series and their Classification

Anomalies and variants of development of the pancreas are relatively frequent. Bifid pancreatic tail is a rare anatomic variation with only a few cases reported in the literature. The present case series were encountered during dissection of 50 anatomical specimens of the pancreas, spleen, and duodenum. We observed four unusual cases (8%) of bifid pancreatic tail. One case was of a vertically oriented bifid pancreas tail (2%), in another case, the tails here horizontally oriented (2%) and in two cases the bifid tails were horizontally oriented but unequal (4%). The bifid tails had an arterial supply that penetrated the glands between the tails and two out of four were also supplied by the superior horizontal pancreatic artery of Popova. The ductal system usually bifurcated at the level of the tails, but a case of trifurcation was also encountered. The current cases should be taken into account in hepato-pancreato-biliary surgery to avoid misdiagnosis and to comprehensively assess the patient preoperatively

Spontaneous Pneumomediastinum – a Rare Asthma Complication

Asthma is the most common chronic respiratory disease worldwide and its prevalence is increasing. Acute asthma complications are often the reason for admission to emergency healthcare service. In our article we present a case of a rare asthma complication – spontaneous pneumomediastinum with a short review of its incidence, etiology, diagnosis and management. Spontaneus pneumothorax is important to differentiate with secondary pneumomediastinum as well as other conditions as cardiac diseases (acute coronary syndrome, pericarditis, cardiac tamponade, pneumopericardium), lung diseases (pneumothorax, pulmonary embolism, tracheobronchial tree rupture), musculoskeletal disorders, and diseases of the esophagus (rupture and perforation o the esophagus). A chest X-ray is often reliable for diagnosis of spontaneous pneumomediastinum and when inconclusive, can be followed by CT. The management is usually conservative with oxygen and analgesia. Surgery is required only in cases of tracheobronchial compression.

Absent celiac trunk and unusual arterial anatomy of the upper abdomen: into the deep

The celiac trunk is the first major branch of the abdominal aorta. It originates from the ventral aspect of the aorta at the level of T12–L1 vertebrae and was originally described as an artery that branches into the common hepatic artery, left gastric artery, and splenic artery. Absence of the celiac trunk and origin of the three arteries separately from the aorta is a rare entity that is reported in 0.38% to 2.6% of cases. It is even more uncommon that this variation can be accompanied by other vascular variations of the upper abdomen as accessory arteries to the liver, stomach, and pancreas. These cases arise during embryogenesis due to decreased arterial degeneration combined with decreased arterial fusion, which results in the anatomical variations present in the current case. Complex arterial variations are both a risk for iatrogenic injury during surgical procedures and beneficial during endovascular supply as they may provide additional access for embolization and chemotherapy

Prophylaxis of postoperative hypoparathyroidism in thyroid surgery

Introduction: There are a number of thyroid gland diseases that require surgical treatment. Therefore, it is important to improve the surgical approaches and treatment tactics in patients that need such surgery. Aim: To provide an algorithm to prevent parathyroid gland damage during surgery. Materials and methods: This work was based on treatment results of 226 patients with different thyroid diseases. All patients received extrafascial surgical interventions using modern methodological approaches. For prevention of postoperative hypoparathyroidism, we used the “stress-test”, 5-aminolevulenic acid, and a method of double visual-instrumental registration of photosensitizer-induced fluorescence of parathyroid glands. Results: Transient hypoparathyroidism was registered in four (1.8%) cases after surgery. Permanent hypocalcemia in patients was not recorded. Autotransplantation of parathyroid gland was required only in one case (0.44%). A deficiency or low level of vitamin D was detected in 35% of the cases, and in the majority of those cases, it was due to secondary hyperparathyroidism. The deficiency was corrected with the administration of vitamin D in all cases. In 10.17% (23 patients) of cases, there was no proper visual glow effect after administration of 5-aminolevulinic acid (5-ALA), which required proceeding to the second part of the proposed method (a helium-neon laser and registration of fluorescence using a laser spectrum analyzer). Conclusions: The proposed methodological approach allows prevention of persistent hypoparathyroidism and reduces the frequency of transient hypoparathyroidism and other complications in surgical treatment of patients with various thyroid gland diseases

Giant inflammatory pseudotumor of the lung: a case report

The inflammatory myofibroblastic tumor, which was first described in 1939, is a rare neoplasm that accounts for 0.04%–0.7% of all lung neoplasms. These neoplasms occur most often in children, as they are the most common primary lung tumors in children. Preoperative diagnosis of such patients using bronchoscopy with endoluminal biopsy and transthoracic biopsy is not always informative and often the diagnosis can only be established during surgery. The presented case shows that on rare occasions, a giant myofibroblastic tumor of the lung may be encountered in adults, and radical intervention with subsequent rehabilitation can lead to full recovery

A case of presacral teratoid cyst in an adult patient

Presacral teratoid cyst (PTC) is a congenital structural abnormality located in the pararectal area and containing tissues from different germ layers. Cases of diagnosis and treatment of PTC in adults are extremely rare and there is little information about the treatment tactics and prognosis. We describe a case of PTC in a 28-year-old woman, with a description of the diagnostic process, preoperative and postoperative management, as well as a brief review of the literature on this topic. A reconstructive surgery was performed on the perineum, including: parasacral access, excision of the presacral cyst together with removal of the coccyx and plastic of the opening. The postoperative observation of the patient was without complications

Giant inflammatory pseudotumor of the lung: a case report

The inflammatory myofibroblastic tumor, which was first described in 1939, is a rare neoplasm that accounts for 0.04%–0.7% of all lung neoplasms. These neoplasms occur most often in children, as they are the most common primary lung tumors in children. Preoperative diagnosis of such patients using bronchoscopy with endoluminal biopsy and transthoracic biopsy is not always informative and often the diagnosis can only be established during surgery. The presented case shows that on rare occasions, a giant myofibroblastic tumor of the lung may be encountered in adults, and radical intervention with subsequent rehabilitation can lead to full recovery