Περιεχομενα


Τόμος 19, Τεύχος 3
Ιούλιος- Σεπτέμβριος 2014


Ανασκοπήσεις
113Identification of the recurrent laryngeal nerve during thyroid surgery. A review of the literature.
A. Doundis , I. Koutelidakis
Πλήρες Κείμενο | Περίληψη
Recurrent laryngeal nerve (RLN) injury leading to vocal cord palsy is the most severe complication in thyroid surgery. In order to decrease the rate of this complication intraoperative visual identification of the RLN and intraoperative nerve monitoring have been recommended. The aim of this study is to elucidate the aspects regarding these methods and to determine their role in achieving safer thyroid surgery. The MEDLINE/PubMed database was searched for publications with the medical subject heading ?identification of the RLN? and keywords "thyroid surgery," "recurrent laryngeal nerve (RLN)?, "Intraoperative Nerve Monitoring (IONM)" and "vocal cord palsy or paresis (VCP)." The search was conducted both on basis of the MESH tree and as a text search. Intraoperative visual identification of the nerve and preoperative and postoperative laryngoscopic assessment of vocal cord function remain the gold standard of RLN management in thyroid surgery. IONM cannot replace visual identification but it can be a helpful adjunct. Whether IONM will become a standard of care or not needs further studies to be determined.
119Rudolf Nissen (1896-1981)
Χ.Α. Παπανικολάου
Πλήρες Κείμενο | Περίληψη
Ο Γερμανός Rudolf Nissen, υπήρξε μια εμβληματική φυσιογνωμία της Χειρουργικής του 20ου αι. Ευρύτατα γνωστός από την επινόηση της ομώνυμης επέμβασης για την αντιμετώπιση της γαστροοισοφαγικής παλινδρόμησης, μαθητής σημαντικών προ-σωπικοτήτων και πρωτοπόρων της εποχής του, διακρίθηκε για την εργατικότητα και την επιστημονική του σκέψη. Η αντίθεση του στην ιδεολογία και τον ολοκληρωτισμό του ναζιστικού καθεστώτος της πατρίδας του τον οδήγησε στην αυτοεξορία (1933). Οργάνωσε τη Χειρουργική Κλινική της Ιατρικής Σχολής του Πανεπιστημίου της Κωνσταντινούπολης (1933-1938), εργάσθηκε στις Ηνωμένες Πολιτείες (1939-1952) και επέστρεψε στην Ευρώπη, όπου και περάτωσε τη σταδιοδρομία του στο Πανεπιστήμιο της Βασιλείας στην Ελβετία (1952-1967). Η δραστηριότητα και οι εμπνευσμένες απόψεις του για την εκπαίδευση των νέων ιατρών και χειρουργών, την εξέλιξη όχι μόνο της Χειρουργικής αλλά και της Παθολογικής Ανατομίας, της Νευροχειρουργικής και της Αναισθησιολογίας, υπήρξαν πρωτοποριακές και έθεσαν τη σφραγίδα τους στην σύγχρονη Ιατρική. Υπήρξε το παράδειγμα ελεύ-θερου ανθρώπου με βαθειά επιστημονική γνώση, δημιουργική σκέψη και διάθεση προσφοράς προς τους ασθενείς και τους συνεργάτες του, ιδίως τους νέους. Οδήγησε σε νέους δρόμους τη Xειρουργική θώρακος, τη Χειρουργική του πεπτικού συστή-ματος αλλά και την Ιατρική παγκόσμια.

Ερευνητικές εργασίες
124Risk factors associated to postoperative complications and early reinterventions after laparoscopic cholecystectomy
P. Priego , J. Ruiz-Tovar , C. Ramiro , J. Manuel Molina , E. Lobo , V. Morales
Πλήρες Κείμενο | Περίληψη
Background. Although Laparoscopic Cholecystectomy (LC) has shown to be a safe and feasible procedure, this technique is not devoid of risks and complications, and patients could run the risk of death. Patients and methods. An observational retrospective study was performed in 2084 patients who underwent LC at Ram?n y Cajal Hospital between January 2001 and December 2007. A descriptive study was performed and a logistic regression analysis was applied to identify risk factors associated to postoperative complications and early reinterventions. Results. The intra and postoperative complication rate was 9,3% and 8,4% respectively. Thirty-one patients were early re-operated (1,49%), being the most frequent cause haemoperitoneum (19 cases). A statistical association was seen between postoperative complications and intraoperative bleeding (RR 2,4, CI 95% (1,5-3,1); p<0,001), male gender (RR 1,5, CI 95% (1,1-2,0); p=0,018), performance of cholecystectomy by a staff surgeon (RR 1,7, CI 95% (1,2-2,3); p=0,002) and emergency surgery (Cholecystitis) (RR 1,9, CI 95% (1,2-3,1); p=0,005). Risk factors for reinterventions were not identified. Conclusion. Our study showed that intraoperative bleeding, male gender, performance of cholecystectomy by a staff surgeon and emergency surgery were risk factors for postoperative complications.
129Easy, safe, reusable, cost-effective specimen retrieval bag for laparoscopic surgery
A.E. Lasheen , K. Safwat , A. Salem , Z. Allam , W. Awad
Πλήρες Κείμενο | Περίληψη
To offer easy, mini-invasive and reusable specimen retrieval bag that can be used to reduce the cost of laparoscopic surgery. One hundred patients (55 laparoscopic appendectomy and 45 laparoscopic cholecystectomy) from April 2012 to October 2013, during which the reusable retrieval bag was used to remove the specimen. This bag was formed of stainless steel part and covered by transparent strong plastic bag. Follow up period ranged from 3 to 18 months. This reusable retrieval bag was used to extract the specimens from 55 patients who underwent laparoscopic appendectomy and 45 patients who underwent laparoscopic cholecystectomy. This technique was easy, safe and no bags rupture. No complications were observed in this patients group such as wound infection or herniation, ileus, and intestinal adhesion. The total cost of operation was reduced. The retrieval of specimens during laparoscopic surgery by using reusable retrieval bag is safe, easy, minimal invasive and cost-effective.
132Penile fracture and its outcome: Our experience at R.G.Kar Medical College
B. Roy , R. Mukherjee , P. Ghosh , S.Kr. Halder , D. Dhar
Πλήρες Κείμενο | Περίληψη
Penile fracture is so called uncommon but real urosurgical emergency. Penile fracture is defined as traumatic rupture of the tu-nica albuginea of one or both corpora cavernosa of an erect penis. There may be an associated injury to the corpus spongiosum or urethra. Sudden direct trauma to the penis or an abnormal bending of the penis in an erect state can cause tearing of the tunica albuginea, with injury to the underlying corpus cavernosum. The most common mechanism of injury is blunt trauma to erect penis during sexual intercourse when erect penis misses the introitus and hits the pubic bone or perineum. Diagnosis can usually be based on history and clinical findings alone. The recent recommendation for the management of penile fracture is early surgical exploration. The goal of early surgical exploration is to evacuate the haematoma, ligation of bleeding vessels, deb-ridement, suturing of tears in the tunica albuginea and urethral stenting with end-to-end urethral anastomosis in case of urethral injury. The long term complication include erectile dysfunction, chordee, fibrous plaque, there may be palpable knots of non absorbable suture material used to repair the tunical defect. The aim of this article is to share our experience of managing few cases of penile fracture and their outcome at A & E department of R.G.Kar Medical College and Hospital over last 4 years.
136Small intestine perforations in abdominal traumas at Aristide Le Dantec teaching hospital: anatomic/clinical aspects and therapeutic evaluation
Konate Ibrahima
Πλήρες Κείμενο | Περίληψη
Aim of the study: To describe the anatomic and clinical aspects of traumatic perforations of the small intestine and evaluate the surgical treatment. Patients and methods: this is a retrospective study over 9 years (January 1997 to December 2005) with a 5-years follow-up. The study focused on the patients who were referred for abdominal trauma with presence of a perforation of the small intestine. Thirty-five patients were concerned with an incidence of 2.7 %. Patients were divided into two groups: Group I included 11 pa-tients who had a closed abdominal trauma and group II included 24 patients who had a penetrating abdominal trauma. The parameters studied were: the clinical signs, the location and the number of perforations and the results of the surgical treat-ment. Results: 19 patients had a generalized peritonitis. The perforation was single in 25 cases and multiple in 10 cases. There was an associated injury of another segment of the digestive tract in 14.3 % of cases (n= 5) and a lesion of a solid organ in 8.6 % of cases (n= 3). The overall morbidity was 20% (n= 7) and consisted of 6 infectious complications and a scarring complication. The overall mortality was 5.7 % (n= 2) and only concerned group II. Conclusion: the traumatic perforation of the small intestine is more frequent in open traumas of the abdomen. The surgical treatment gives satisfactory results and the complications are most often septic.
139Advanced oxidation protein products in acute pancreatitis
S. Chooklin
Πλήρες Κείμενο | Περίληψη
Background: Understudied part of acute pancreatitis is evaluating the significance of activation of lipid and protein deficiency and inadequate antioxidant system. The focus was on determining the concentration of advanced oxidation protein products (AOPP) in patients with acute pancreatitis, depending on the severity and duration of disease. Material and Methods: Level of AOPP determined in dynamics in 53 patients with acute pancreatitis of different severity (25 ? with mild and 28 ? with severe pancreatitis). The control group comprised 14 volunteers. AOPP concentration in plasma was determined by photometric assay. Results: In severe acute pancreatitis patients concentration of AOPP increased in plasma. This correlates with the level of hydro-gen peroxide. Sensitivity determination of AOPP to predict severe acute pancreatitis was 96,4%, specificity ? 100%. A significant direct correlation between the concentration of AOPP and the level of creatinine, glucose, and C-reactive protein in serum was established. Conclusion: In acute pancreatitis observed intensive oxidation proteins processes that play an important role in the pathogene-sis of the disease. AOPP can be a potential marker of the severity of acute pancreatitis.

Ενδιαφέρουσες περιπτώσεις
143Ileocolic Intussusception in a Young Female Patient. Coexistence of Appendiceal Agenesia
E. Synekidou , A. Moshidis , S. Arapoglou , A. Marneri , N. Tona , I. Venizelos , C. Nikolaidou , C. Papanikolaou
Πλήρες Κείμενο | Περίληψη
Intussusception represents the most common cause of obstruction in childhood but is rarely diagnosed in school age children. This case report describes a case of a fifteen year-old female with ileocolic intussusception due to lymphoid hyperplasia and agenesia of the appendix. The diagnosis of intussusception was confirmed through abdominal CT of the patient. The patient underwent a right hemicolectomy and latero-lateral ileocolic anastomosis. She had an uneventful recovery. Intussusception is an unusual cause of acute abdomen in teenagers. Diagnosis demands a high index of suspicion. Early treatment is important to prevent complications.
146Primary gastrointestinal stromal tumor of the stomach in an HIV-positive patient
D. Paramythiotis , P. Baggeas , O. Tsahouridou , D. Panagiotou , P. Kollaras , V. Papadopoulos , A. Michalopoulos , G. Basdanis
Πλήρες Κείμενο | Περίληψη
Introduction: Gastrointestinal Stromal Tumors (GISTs) are unique mesenchymal tumours arising from the interstitial cells of Cajal and occur anywhere in the digestive system, from esophagus to anorectum. Such tumors are found, most often, in the wall of the stomach thus representing 1-3% of all gastrointestinal malignancies. Their behavior is driven, 90-95% of the times, by mutations in the Kit gene. Prognosis depends on tumor?s size and the number of mitosis, with a 5-year survival range from 50-80%. As far as HIV positive patients are concerned, there has been observed no greater incidence of GISTs. Case report: A HIV-positive 49-year-old male patient presented to the surgical out-patient clinic citing melena. Endoscopy dis-played a sizeable tumor on the lesser curvature, macroscopically resembling to a GIST neoplasm. An abdominal CT was per-formed, pre-operatively, so as to clarify the stage of the tumor. In laparotomy, a gastrotomy was performed followed by enuclea-tion of the tumor to healthy tissue margins. Post-operatively course was uneventful and the patient was discharged on the 7th post-operative day. Pathology examination showed the existence of moderate differentiated spindle cells and the immunohisto-chemical study came out positive for the classic GIST cell markers CD34 and CD117, confirming the stromal origin of the tumor. Conclusion: In HIV positive patients, the differential diagnosis between GISTs and GI Kaposi tumors is yet challenging. In such pa-tients, GISTs? diagnosis requires thorough imaging examination, accompanied by a complete immunohistochemical analysis. Thus, the help of an experienced pathologist is crucial in order to set accurate diagnosis and to provide the right treatment.
150A rare case of carotid body tumour
N. Kamargiannis , D. Papadopoulou , I. Anagnostou , A. Potouridis , K. Valsamidis , D. Christopoulos
Πλήρες Κείμενο
153Giant Malignant Phyllodes Tumor
G. Uzum , K. Tomaoglu , M. Kucukyilmaz , Y. Duzkoylu , O. Koc , Y. Selim Sari , C. Kelten
Πλήρες Κείμενο | Περίληψη
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156Osteogenesis imperfecta and diverticular disease of the colon ? do they relate?
B. Papaziogas , I. Koutelidakis , P. Tsiaousis , G. Paraskevas , S. Atmatzidis , P. Christopoulos , K. Atmatzidis
Πλήρες Κείμενο | Περίληψη
Osteogenesis imperfect (OI) is a heterogeneous group of genetic disorders that affect connective tissue integrity. The hallmark of OI is bone fragility, although other manifestations, which include osteoporosis, dentigenesis imperfecta, blue sclera, easy bruis-ing, joint laxity and scoliosis, are also common among OI patients. On the other hand, diverticular disease of the colon is the most common acquired disease affecting the large bowel in the Western World. More recent studies propose that that multiple factors among which also genetic influences on extracellular matrix molecules, could play a role in the genesis of colonic diver-ticula. We report the case of a 57 year old man with known OI type I disease which presented with acute lower left abdominal pain, who proved to suffer from sigmoid diverticulitis. We present the hypothesis that these two entities (OI and diverticulosis) as dis-eases attributed to weakening of the connective tissue could have a common causative relation.

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