Splenic rupture as the presenting manifestation of primary splenic angiosarcoma in a teenage woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Primary splenic angiosarcoma is a rare neoplasm of vascular origin carrying a very poor prognosis, partly due to its high metastatic potential. This disease presents frequently with splenic rupture and hemorrhage. We report the case of a 17-year-old woman who presented with rupture of a primary splenic angiosarcoma.</p> <p>Case presentation</p> <p>The patient presented with diffuse abdominal pain and distention. Clinical examination revealed severe tenderness in the left upper abdominal quadrant, a palpable abdominal mass, and hemodynamic instability with a systolic arterial blood pressure of 75 mmHg and heart rate of 135 beats per minute. Blood tests revealed anemia (hemoglobin 7.0 g/dl) and thrombocytopenia (platelets 70 × 10⁹/liter). After initial fluid resuscitation and stabilization, abdominal ultrasound and computed tomography were performed, revealing a large quantity of intraperitoneal free fluid, an enlarged spleen, and a heterogeneous low-density signal within the splenic parenchyma, which showed varying degrees of contrast enhancement. At laparotomy a huge (weight 1530 g, diameter 19 cm) actively bleeding spleen was identified and splenectomy was performed. Histopathology showed a primary splenic angiosarcoma. After an uneventful recovery, the patient was discharged on the sixth postoperative day.</p> <p>Conclusion</p> <p>Primary splenic angiosarcoma is rare. Although this malignancy is usually encountered in advanced age, there have been a few reported cases among younger patients. The case reported here presented with splenic rupture, was treated by laparotomy and splenectomy, and the patient is disease free 16 months after surgery.</p

Comparative study of the influence of combined epidural and general anaesthesia versus general anaesthesia on the apoptosis of the peripheral blood leucocytes

To examine the influence of abdominal colectomy with combined general anesthesia and epidural analgesia versus general anesthesia on the apoptosis of the circulating leucocytes. Design: Prospective randomized clinical comparison study Setting: Tertiary general hospital. Patients: Forty colon cancer patients were randomly allocated to general (group G) or combined anesthesia (group C). The Group C comprised of 21 patients while 19 patients constituted the Group G. Interventions: All patients underwent median longitudinal laparotomy. Epidural analgesia combined with general anesthesia was given to patients in group C while group G patients received general anesthesia. Postoperative pain relief was managed with PCEA in the C group while patients in the G group received PCA. Measurements: Blood samples were collected preoperatively and 24 hours postoperatively for measurement of lymphocyte and polymorphonuclear cells apoptosis, serum cortisol, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Pain scores were also assessed during the first 72 postoperative hours Main Results: There were no differences between the two groups in terms of age, weight or duration of surgery. No significant alterations in total lymphocyte counts, as well as in lymphocyte subpopulations (early apoptotic, late apoptotic, viable and necrotic), were observed between general and combined anesthesia groups. Accordingly no significant alterations in total PMN counts, as well as in PMN subpopulations (early apoptotic, late apoptotic, viable and necrotic), were observed between groups Cortisol, ESR and CRP were significantly increased postoperatively in both groups. Combined anesthesia group presented with lower serum cortisol levels postoperatively compared to the general anesthesia group. Pain scores were significamtly less in the combined anesthesia group in the postoperative measurements Conclusions: The epidural blockade was not able to suppress postoperative lymphocyte and PMN apoptosis, increases in cortisol, CRP and ESR compared to general anesthesia.Ο τραυματισμός των ιστών, το χειρουργικό stress και η γενική αναισθησία έχουν αρνητική επίδραση στο ανθρώπινο ανοσοποιητικό σύστημα. Η αναισθησία παίζει σημαντικό ρόλο στην ανοσολογική ρύθμιση γιατί καθιστώντας την επέμβαση ανώδυνη και διατηρώντας την ομοιόσταση μειώνει την αντίδραση στα χειρουργικά ερεθίσματα. Φαίνεται ότι η απόπτωση είναι κυρίως υπεύθυνη για τις μεταβολές σε λεμφοκύτταρα και ουδετερόφιλα κατά την πρώιμη μετεγχειρητική περίοδο. Επιπλέον, το παροδικό σύνδρομο ανοσολογικής ανεπάρκειας μετά το χειρουργικό τραύμα, την πρώιμη μετεγχειρητική περίοδο θα μπορούσε να οφείλεται στην αυξημένη τάση προς απόπτωση των λεμφοκυττάρων ο σκοπός αυτής της μελέτης ήταν να συγκριθεί η απόπτωση των λεμφοκυττάρων στο περιφερικό αίμα ατόμων που υπεβλήθησαν σε μείζονα ανοιχτή κοιλιακή επέμβαση υπό δύο διαφορετικές τεχνικές αναισθησίας: γενική αναισθησία και γενική αναισθησία συνδυασμένη με επισκληρίδιο αναλγησία. Πρόκειται για μια προοπτική μελέτη με σκοπό να συγκρίνει την γενική αναισθησία σε σχέση την συνδυασμένη γενική αναισθησία με επισκληρίδιο αναλγησία ως προς τις μετεγχειρητικές μεταβολές της απόπτωσης των κυκλοφορούντων λεμφοκυττάρων, πολυμορφοπυρήνων λευκοκυττάρων, κορτιζόλης ορού, CRP και ΤΚΕ, των σκορ πόνου και της κατά΄ναλωσης οποιοειδών σε ασθενείς με φυσική κατάσταση κατά ASA ? και ?? που υπεβλήθησαν σε εκλεκτική ανοικτή κολεκτομή για μη μεταστατικό καρκίνο παχέος εντέρου. Τελικά 40 ασθενείς εγγράφηκαν στην μελέτη μας. Η ομάδα συνδυασμένης αναισθησίας ( ομάδα C) περιελάμβανε 21 ασθενείς ενώ η ομάδα γενικής αναισθησίας (ομάδα G)περιελάμβανε 19 ασθενείς. Δεν υπήρξαν σημαντικές διαφορές ως προς την ηλικία , βάρος, διάρκεια αναισθησίας ή χειρουργείου μεταξύ των δύο ομάδων. Δεν υπήρξαν διαφορές ως προς την ηλικία, το βάρος ή τη διάρκεια του χειρουργείου μεταξύ των 2 ομάδων. Δεν παρατηρήθηκαν σημαντικές μεταβολές στον συνολικό αριθμό λεμφοκυττάρων ούτε και στους λεμφοκυτταρικούς υποπληθυσμούς όπως και στον συνολικό αριθμό των πολυμορφοπυρήνων και των πολυμορφοπυρηνικών υποπληθυσμών (πρώιμους αποπτωτικούς, όψιμους αποπτωτικούς, βιώσιμους και νεκρωτικούς) μεταξύ των ομάδων γενικής και συνδυασμένης αναισθησίας. Η κορτιζόλη, η ΤΚΕ και η CRP μετεγχειρητικά αυξήθηκαν σημαντικά και στις δύο ομάδες. Η ομάδα συνδυασμένης αναισθησίας είχε χαμηλότερα επίπεδα κορτιζόλης ορού μετεγχειρητικά σε σύγκριση με την ομάδα γενικής αναισθησίας

Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: A case report and review of the literature

Hydatid disease, although endemic mostly in sheep-farming countries, remains a public health issue worldwide, involving mainly the liver. Intrabiliary rupture is the most frequent complication of the hepatic hydatid cyst. Endoscopy is advocated, preoperatively, to alleviate obstructive jaundice caused by intracystic materials after a frank rupture and is also a useful and well-established adjunct in locating postoperative biliary fistulas

Primary Cavernous Hemangioma of the Thyroid Gland

A 78-year-old euthyroid patient presented for evaluation of a symptomatic, slowly growing neck mass. Ultrasound scan revealed a multinodular goiter and a hypoechoic nodule of the right thyroid lobe. Total thyroidectomy was performed and the lesion was completely excised. Definite diagnosis was obtained after histological examination of the surgical specimen. Cavernous hemangiomas of the thyroid gland are infrequent lesions which may escape diagnosis preoperatively. An effort should be made not to rupture these lesions in order to ensure a bloodless procedure

Lymphocyte apoptosis after major abdominal surgery is not influenced by anesthetic technique: a comparative study of general anesthesia versus combined general and epidural analgesia

Study Objective: To examine the influence of abdominal colectomy with combined general anesthesia and epidural analgesia versus general anesthesia on apoptosis of circulating lymphocytes. Design: Prospective, randomized, clinical comparison study. Setting: Tertiary-care general hospital. Patients: 40 ASA physical status I and II patients undergoing elective open colectomy for nonmetastatic colon carcinoma. Interventions: Patients were randomly allocated to two groups to receiver either general anesthesia alone (Group G) or general anesthesia combined with epidural analgesia (Group Q. Group C comprised 21 patients while 19 patients constituted Group G. All patients underwent median longitudinal laparotomy. Measurements: Blood samples were collected preoperatively and 24 hours postoperatively for measurement of lymphocyte apoptosis, serum cortisol, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Main Results: There were no differences between the two groups in age, weight, or duration of surgery. No significant alterations in total lymphocyte counts, as well as in lymphocyte subpopulations (early apoptotic, late apoptotic, viable, and necrotic), were observed between the general and combined anesthesia groups. Cortisol, ESR, and CRP were significantly increased postoperatively in both groups. Group C presented with lower serum cortisol levels postoperatively than Group G (b = -5.38, C195%: -8.72 to -2.05, P = 0.002). Conclusions: Epidural block could not suppress postoperative lymphocyte apoptosis, increases in cortisol, CRP, or ESR compared with general anesthesia. (C) 2009 Elsevier Inc. All rights reserved

Granisetron versus tropisetron in the prevention of postoperative nausea and vomiting after total thyroidectomy

Background: Postoperative nausea and vomiting (PONV) are frequently encountered after thyroidectomy. For PONV prevention, selective serotonin 5-hydroxytryptamine type 3 (5-HT 3 ) receptor antagonists are considered one of the first-line therapy. We report on the efficiency of granisetron and tropisetron, with that of placebo on the prevention of PONV in patients undergoing total thyroidectomy. Methods: One hundred twenty-seven patients were divided into three groups and randomized to receive intravenously, prior to induction of anesthesia, tropisetron 5 mg, or granisetron 3 mg, or normal saline. All patients received additionally 0.625 mg droperidol. All episodes of postoperative PONV during the first 24 h after surgery were evaluated. Results: Nausea visual analogue scale (VAS) score was lower in tropisetron and granisetron groups than the control group at all measurements ( P<0.01) except for the 8-h measurement for tropisetron ( P=0.075). Moreover, granisetron performed better than tropisetron ( P<0.011 at 4 h and P<0.01 at all other points of time) apart from the 2-h measurement. Vomiting occurred in 22.2%, 27.5%, and 37.5% in granisetron, tropisetron, and control groups, respectively ( P=0.43). Conclusions: The combination of the 5-HT 3 antagonists with droperidol given before induction of anesthesia is well tolerated and superior to droperidol alone in preventing nausea but not vomiting after total thyroidectomy