Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 9 Articles
Background: Adrenal cavernous hemangiomas are very rare benign tumors that usually present as incidental\nfindings on abdominal imaging. Preoperative differential diagnosis from other benign or malignant adrenal\nneoplasms may be challenging.\nCase presentation: A 70-year old man was referred for an 8-cm abdominal mass incidentally discovered on\na contrast-enhanced computed tomography (CT) performed to investigate a pulmonary nodule. Biochemical\ntests ruled out any endocrine dysfunction and iodine 123 metaiodobenzylguanidine whole body scintiscan\nsingle-photon emission CT excluded a pheocromocitoma. Findings on magnetic resonance imaging were non-specific\nand the patient was elected for a left adrenalectomy. Histopathological diagnosis revealed a cavernous hemangioma.\nA portion of the resected tissue was tested for drug sensitivity to mitotane, doxorubicin, and sunitinib.\nConclusions: Adrenal hemangioma is a rare disease but should be included in the differential diagnosis of adrenal\ntumors. The surgical resection is generally required to exclude malignant disease, resolve pressure-related symptoms,\nand prevent retroperitoneal hemorrhage. Although specific features in diagnostic imaging are often lacking, if the\ndiagnosis is established preoperatively a laparoscopic adrenalectomy can be performed due to the benign\nnature of the lesion. Doxorubicin and sunitinib were both capable of reducing primary culture cell viability, this\nsuggest that similar drugs may be useful in the medical treatment of adrenal hemangiomas....
Background. Postoperative nausea and vomiting (PONV) is a common problem and may lead to catastrophic complications,\nespecially in neurosurgical cases. The aim of this study was to evaluate the effects of dexamethasone and ondansetron for\npreventing PONV in patients who underwent microvascular decompression (MVD) surgery. Methods. A prospective, doubleblinded,\nrandomized control trial was conducted with 54 patients who underwent MVD. Patients were allocated into two\ngroups. The study group (Gr. D) received intraoperative dexamethasone 4 mg iv and ondansetron 4 mg iv, whereas the control\ngroup (Gr. N) received placebo (0.9% normal saline 1 ml iv and 0.9% normal saline 2 ml iv). The incidence and severity of\nPONV were observed at 1, 2, 4, and 24 hr postsurgery. Results. At 1, 2, 4, and 24 hr postsurgery, Gr. D had a lower incidence\n(7.4%, 11.1%, 29.6%, and 66.7%) and lower severity of PONV than Gr. N (18.5%, 29.6%, 37.0%, and 81.5% at 1, 2, 4, and 24 hr;\np > 0.05). The requirement for antiemetic drugs was not significantly different between the groups (p > 0.05). Conclusion.\nAdministration of dexamethasone and ondansetron 4 mg seemed to decrease the incidence of PONV in the first 24 hours but\nnot significantly. Therefore, further studies are to be carried out by escalating either dexamethasone dose or the dose of\nondansetron or both....
Abstract: Background: As the knee joint is a common site for injury among younger people,\nthe purpose of this study was to measure the skeletal muscle endurance and strength on people\nwith prior anterior cruciate ligament (ACL) knee reconstruction surgery. Method: Young healthy\nfemale subjects who reported having knee reconstruction surgery more than one-year prior were\ntested. The skeletal muscle endurance index (EI) of the hamstrings and quadriceps muscles was\ndetermined as the decline in the specific muscle acceleration in response to 2 Hz, 4 Hz, and 6 Hz\nelectrical stimulation. Maximal isometric muscle strength (MVC) was measured in the hamstrings\nand quadriceps muscles. Results: The hamstrings muscles in the injured leg had less endurance\nthan the non-injured leg at 6 Hz stimulation (55.5 Â} 13.2% versus 78.0 Â} 13.3%, p < 0.01). Muscle\nendurance was not reduced in the quadriceps muscles in the injured leg compared to the non-injured\nleg at 6 Hz stimulation (78.0 Â} 13.3% versus 80.3 Â} 10.0%, p = 0.45). There were no differences in MVC\nbetween the injured and non-injured legs for either the hamstrings (p = 0.20) or quadriceps muscles\n(p = 0.67). Conclusions: Muscle endurance was reduced in the hamstrings muscles at least one-year\npost injury, while hamstrings strength was recovered. Reduced hamstrings muscle endurance could\nbe a result of lack of endurance training during rehabilitation. This may contribute to re-injury in the\nmuscle, even in people who have recovered muscle strength....
(i) Purpose. The fluid challenge (FC) is a well-established test of preload reserve.Only limited data exist in regard to the FC efficacy\nbased on infusion time. Slow administration may be associated with lack of effect based on fluid redistribution and external\nconditions changes. On the contrary, fast administration may lead to brisk fluid overload and damage to the endothelium and\nendothelial glycocalyx (EG). The aim of this trial was to compare the FC infusion time on its hemodynamic effects and EG. (ii)\nMethods. Prospective randomized single-center trial of fast (5-10 minutes) versus slow (20-30 minutes) administration of 500ml\nbalanced crystalloid FCin spinal surgery (cohort OR) and septic shock (cohort SEP) patients.Hemodynamic response was assessed\nusing standard monitoring and blood flow measurements; damage to EG was assessed using the perfused boundary region (PBR)\nvia intravital microscopy monitoring in the sublingual region within relevant time points ranging up to 120 minutes. (iii) Results.\nOverall, 66 FCs in 50 surgical and 16 septic patients were assessed. Fluid administration was associated with increase of PBR in\ngeneral (1.9 (1.8-2.1) vs. 2.0 (1.8-2.2); p= 0.008). These changes were transient in OR cohort whereas they were long-lasting in septic\nfluid responders.Therate of fluidresponsiveness after fast versus slowadministrationwas comparable in global population (15 (47%)\nvs. 17 (50%); p=0.801) as well as in both cohorts. (iv) Conclusions. Fluid challenge administration was associatedwith increased PBR\n(and presumable EG volume changes) which normalized within the next 60 minutes in surgical patients but remained impeded\nin septic fluid responders. The fluid responsiveness rate after fast and slow FC was comparable, but fast administration tended to\ninduce higher, though transient, response in blood pressure....
Background: Laparoscopic splenectomy (LS) is regarded as a second-line treatment for medically refractory\nidiopathic thrombocytopenic purpura (ITP), but the predictive factors for the long-term postoperative responses to\nITP are still a matter of debate. We aimed to investigate the factors that can predict the long-term response after LS\nfor Chinese patients with medically refractory ITP.\nMethods: From January 2011 to September 2016, 78 Chinese patients with ITP who underwent LS were\nretrospectively analyzed. Twelve parameters were analyzed by univariate and multivariate methods.\nResults: Univariate analysis revealed that platelet count on preoperative day (PRD) 1 (P < 0.001) and operative time\n(P = 0.011) were significantly associated with long-term response of ITP after LS. Multivariate analysis revealed that\nplatelet count on PRD 1 was a predictive factor of long-term response (P < 0.001). Furthermore, a long-term, stable\nresponse of platelet count on PRD 1 of > 30.0 � 109/L was easier to achieve than a platelet count on PRD���...
Background: While LAGB has become uncommon in the bariatric surgery practice, band removal with or without\nrevision surgery is still common. Retained postoperative foreign body, of which surgical sponges are the most\ncommon, is a rare condition. We report a rare case of retained gastric band port and the attached tube.\nCase presentation: A 31-year-old Caucasian female presented to the outpatient clinic, 5 years after her last surgery,\ncomplaining of a left upper quadrant abdominal mass over the last 2 years. She had a history of 2 weight loss\noperations. She had no significant family history nor smoking. CT of the abdomen and pelvis revealed a retained\nforeign body. On exploration, the port with 10 cm of the connected tube was found and removed through a small\nincision without laparotomy. The patient made an uneventful recovery.\nConclusion: A bariatric surgeon should be involved in the evaluation of any patient who complains of abdominal\npain and/or palpable mass if she/he has a previous weight loss procedure because the bariatric surgeon is fully\naware of the possible complications of the bariatric surgeries....
Background: Spigelian hernia (SH) is rare and constitutes less than 2% of all hernias. It is reported that more than\n90% of SHs lie in the â??Spigelian beltâ?, but SH in the upper abdominal wall is extremely uncommon. Here, we report\na case of SH in the right upper quadrant of abdomen.\nCase presentation: A 38-year-old female was admitted to hospital with complaints of abdominal pain and right\nupper quadrant mass for 10 days. Contrast-enhanced computed tomography (CECT) of abdomen revealed the\ndilated small intestine between the swelling ventral muscles in the right upper abdominal wall which suggested a\nventral hernia. The surgeons considered it was a spontaneous hernia because there was no history of surgery or\ntrauma in the upper abdomen. About two hours later, the patient underwent emergency surgery. According to\nlaparotomy, a diagnosis of SH with ileum herniation in the right upper abdominal wall was confirmed. The necrotic\nileum segment was resected. Meanwhile the abdominal wall defect was repaired by suturing the internal oblique\nand transverse muscles to the rectus sheath. The patient had a favorable outcome for 1 year without recurrence.\nConclusion: A mass and pain in the upper abdominal wall may suggest an atypical SH. SH occurring in the upper\nabdominal wall is a rare condition with possibility of dire outcome if not managed early....
Background: Synovial cyst of the hip joint is a rare clinical condition in need of evidence-based guidelines for its\ndiagnosis and management. Normally, synovial cyst of the hip joint requires no treatment, but when it intrudes into\nsurrounding structures, various clinical symptoms appear. Because of its rarity, a symptomatic synovial cyst is often\nconfounded with a tumor as a space-occupying lesion or with other diseases, depending on its various clinical\npresentations. Therefore, guidelines for the precise diagnosis and appropriate management for synovial cyst of the\nhip joint are required.\nMethods: We retrospectively studied 7 cases of symptomatic synovial cyst of the hip joint, some of which showed\nlower limb edema due to mass effect. We compared physical exam findings on presentation, imaging findings, and\nsize and location of the cyst.\nResults: All cases were managed successfully with surgical excision. We found that, instead of the size of the cyst,\nthe location of the cyst was an important contributor to venous compression. The recurrence rate was 0%, and\nsome patients have significantly long follow-up of 2 years, 4 years, 6 years and 10 years, respectively.\nConclusions: For symptomatic synovial cyst of the hip joint, surgical excision can successfully resolve the symptoms\nwithout recurrence. This retrospective study discusses the clinical presentations, diagnostic approaches, and surgical\ntreatment of symptomatic synovial cyst of the hip joint, hence shedding more light on the clinical management of this\ncondition....
Background: Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases.\nDuring the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to\nclarify whether its use plays a role in preventing infections.\nMethods: Inclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local\nor systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy,\nimmunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE\ndatabases was carried out independently by two researchers, according to the PRISMA guidelines and applying the\nGRADE approach. Terms used were (â??gallbladderâ?AND(â??specimentâ?ORâ??extractionâ?ORâ??extractâ?))\nOR(â??gallbladderâ?ORâ??cholecystectomyâ?)AND(â??bagâ?ORâ??retrieval|â?OR|â??endobagâ?ORâ??endocatchâ?).\nResults: The comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a\nmulticentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a\nretrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis\nrevealed a risk ratio (RR) of 0.82 (0.41â??1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged\nfrom 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect\n(p = 0.892) and the funnel-plot showed no noteworthy pattern.\nConclusions: The results of this review highlight the paucity of well-designed large studies and despite limitations\nrelated to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing\nthe infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental\nintraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that,\nfurther studies focusing on complex cases are needed....
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