Στο κείμενο που ακολουθεί αναφέρονται στοιχεία από τις τελευταίες κατευθυντήριες οδηγίες που εξέδωσαν από κοινού η Ευ-ρωπαϊκή Καρδιολογική Εταιρία (ESC) μαζί με την Ευρωπαϊκή Αναισθησιολογική Εταιρία (ESA) και αφορούν την αξιολόγηση και τη διαχείριση του καρδιοπαθούς ασθενούς που πρόκειται να υποβληθεί σε μη καρδιοχειρουργική επέμβαση. Γίνεται ανάλυση των οδηγιών σε έναν απλό αλγόριθμο επτά βημάτων. Στόχος του αλγορίθμου είναι η βέλτιστη προετοιμασία και αντιμετώπιση του καρδιοπαθούς ασθενούς, εκτιμώντας τον κίνδυνο αλλά το όφελος της εκάστοτε παρέμβασης. Οι χειρουργικές επεμβάσεις κατατάσσονται σε χαμηλού, μετρίου ή υψηλού κινδύνου με κριτήριο την πιθανότητα πρόκλησης εμφράγματος του μυοκαρδί-ου και καρδιαγγειακού θανάτου εντός των πρώτων τριάντα μετεγχειρητικών ημερών. Αναφέρονται οι οδηγίες που αφορούν την διαχείριση της προεγχειρητικής φαρμακευτικής αγωγή με σκοπό τη σταθεροποίηση αλλά και τη βελτίωση των παραγό-ντων καρδιαγγειακού κινδύνου. Oι κατευθυντήριες οδηγίες είναι συστάσεις που προκύπτουν από σημαντικό αριθμό τεκμηριω-μένων κλινικών μελετών, θα πρέπει πάντα να λαμβάνονται υπόψη, δεν υποκαθιστούν όμως σε καμιά περίπτωση την προσωπι-κή κρίση και την ευθύνη του ιατρού στην επιλογή της καλύτερης αντιμετώπισης του ασθενούς.

Η περιεγχειρητική αντιμετώπιση των νευρολογικών ασθενών αποτελεί ένα συχνό και σύνθετο πρόβλημα στην κλινική πρακτική. Οι συγκεκριμένοι ασθενείς είναι συχνά μεγάλης ηλικίας και εμφανίζουν αυξημένη νοσηρότητα από διάφορες συνυπάρχουσες παθήσεις, γεγονός που σε συνδυασμό με τη νευρολογική νόσο και την χορηγούμενη αγωγή, αυξάνει τον περιεγχειρητικό κίν-δυνο και απαιτεί κατάλληλους χειρισμούς. Η αντιμετώπιση περιλαμβάνει ενδελεχή προεγχειρητική προετοιμασία με συνεργασία πολλών κλινικών ειδικοτήτων όπως χει-ρουργό, αναισθησιολόγο, νευρολόγο, καρδιολόγο, πνευμονιολόγο, με σκοπό τον προσδιορισμό και κατάλληλο έλεγχο και πρό-ληψη των διαφόρων παραγόντων κινδύνου, νευρολογικών και μη. Η λεπτομερής κλινική εκτίμηση, μέρος της οποίας αποτελεί η νευρολογική εκτίμηση, ο στοχευμένος παρακλινικός έλεγχος (ανάλογα με τη νευρολογική νόσο αλλά και τον συγκεκριμένο α-σθενή) και η σύμφωνα με την περίπτωση κατάλληλη προσαρμογή της νευρολογικής αγωγής (συνέχιση / διακοπή / τροποποίη-ση) αποτελούν τα βασικά εργαλεία αυτής της προετοιμασίας. Οι διεγχειρητικοί χειρισμοί περιλαμβάνουν την κατά περίπτωση βέλτιστη μέθοδο αναισθησίας, τις κατάλληλες τεχνικές διασω-λήνωσης καθώς επίσης και την χρήση των συμβατών με τη νευρολογική νόσο και αγωγή αναισθητικών. Επιπλέον, ο πάντα α-παραίτητος έλεγχος αρτηριακής πίεσης και όγκου αίματος είναι ιδιαίτερα κρίσιμος σε ορισμένους νευρολογικούς ασθενείς με ήδη ευπαθή εγκεφαλική λειτουργία. Οι μετεγχειρητικοί χειρισμοί περιλαμβάνουν την ταχύτερη δυνατή επαναχορήγηση της νευρολογικής αγωγής (εφόσον είχε δια-κοπεί), την αποφυγή ορισμένων κοινών μετεγχειρητικά χορηγούμενων φαρμάκων που μπορεί είτε να έχουν αλληλεπιδράσεις με την αγωγή είτε επιπτώσεις στη νευρολογική νόσο, τον χειρισμό πρακτικών δυσκολιών που δημιουργεί η νόσος σε βασικές παραμέτρους όπως η κινητικότητα, η σίτιση και η ούρηση και την αντιμετώπιση μετεγχειρητικών επιπλοκών που μπορεί να σχετίζονται με τη νόσο, το είδος της χειρουργικής επέμβασης ή με συνυπάρχουσες παθήσεις

Background. The objective of this study is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal he is to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal heis to identify and evaluate the chronic neurogenic pain after laparoscopic inguinal hernia nia surgery.surgery.surgery.surgery.surgery.surgery. surgery.

Aim of the study: Diverticular hemorrhage is a common cause of lower gastrointestinal bleeding, but studies about risk factors for colonic diverticular hemorrhage are limited, most of them are dedicated to Asian population. Our aim was to identify risk factors for diverticular bleeding in westernized population. Material and Methods: This is a retrospective study. There were included 333 consecutive patients, treated for symptomatic diverticular disease between January 2000 and December 2011. Seventy-four (22 %) had signs of diverticular bleeding. The influence of comorbidities (overweight, hypertension, ischemic cardiac disease, atrial fibrillation, renal failure, gastroduodenal disease), nicotine abuse and medication (anticoagulant drugs, aspirin) was evaluated. To determine the risk factors for colonic diverticular bleeding statistical analysis were performed using Mann?Whitney U test and Fisher?s exact test. Results: There was no difference between patients with diverticular hemorrhage and those with non bleeding symptomatic diverticulosis regarding gender ratio. Bleeding patients were older (p<0,00001). Hypertension (p= 0,00001), ischemic heart disease (p=0,04), gastroduodenal disease (p<0,00001) and use of aspirin(p=0,007) were significant risk factors for diverticular bleeding. Conclusions: Age, hypertension, ischemic heart disease, gastroduodenal disease and use of aspirin increase significantly the risk of diverticular hemorrhage.

Background/Aim: The aim of study is to assess to examine postoperative complications and recurrences and to aim to deter-mine the efficacy of Povidone-iodine soap brushing (PISB) on surgical treatment of pilonidal sinus. Although pilonidal sinus seems like a simple lesion, its treatment may be very difficult because of high postoperative complication and recurrence rates. Material and Methods: Four hundred and fifty patients who were operated for pilonidal sinus between 1997 and 2012 were included in the study. Excision + Povidone-iodine brushing + primary repair in 230 (51%) cases (Brushing group), excision + pri-mary repair in 220 (49%) cases (Surgery group) were applied. Results: While four recurrences (1.8%) were detected in the polyvidon iodine brushing technique, fifty recurrences (22.7%) were detected in the surgery group (p<0.0001). Postoperative complication rates were also lower in the brushing technique group than the surgery group (p<0.0001). Conclusion: It is concluded that excision + Povidone-iodine brushing + primary repair in the treatment of pilonidal sinus may be a preferable method because of lower complication and recurrence rates

Aim of the study. To improve the results of surgical treatment of patients with hepatic cirrhosis complicated by esophageal and gastric variceal hemorrhage by means of use of active surgical approach. Material and Methods: Clinical analysis of the results of treatment of 105 hepatic cirrhosis patients with the syndrome of intra-hepatic portal hypertension was conducted for the period of 2006 to 2014. Treatment programs included waiting conservative tactics with the use of surgical methods only as the operation of despair, as well as the active surgical tactics. Results: The inclusion of active surgical tactics into the treatment program of patients with compensated and sub-compensated hepatic cirrhosis provides reduction in the total number of complications and postoperative hospital mortality, as well as the time of hospital treatment of patients with a favorable outcome. In addition, it was found that operational risk of death from multiple organ failure was very high in patients with decompensated hepatic cirrhosis; therefore, the operation should be avoid-ed. Conclusion: The article suggests taking into account data related to the two types of changes in intrahepatic vascular pattern while choosing the treatment tactics.

Vaginal evisceration is rare complication of vaginal hysterectomy and should be considered a surgical emergency. We present relevant data related to risk factors and operative management of vaginal evisceration after transvaginal hysterectomy. Currently, there is no consensus about the ideal method of surgical repair. The surgical treatment of vaginal evisceration is basically a two-step process consisting of replacement and repair of the eviscerated viscous, followed by closure and ideally reinforcement of the vaginal defect. The method of surgical repair should be individualized. Minimally invasive approach, such as transvaginal repair or laparoscopy, is feasible.

Hemangioma is considered the most common benign hepatic tumor. Giant hemangiomas present a diameter bigger than 5cm and show various symptoms, ranging from non-typical abdominal pain to hemorrhagic shock due to rupture. We present a case of a patient with a giant ruptured hemangioma of the liver, which was treated successfully through embolism.

Perineuriomas are rare tumours composed of a bland spindle cell proliferation. It usually occurs in subcutaneous, soft-tissue or intraneural locations. Very few reports in the literature have described perineuriomas in the gastrointestinal tract, including the stomach, colon and jejunum. We report the clinicopathological and immunohistochemical features of a case of ?colonic perineurioma? that was incidentally detected in colorectum during colonoscopy. He had a history of ?embryonal carcinoma of the testis? and ?fibrous dysplasia?.

Accidental and suicidal ingestion of corrosive agents is a common occurrence in developing nations and it is a frequent cause of morbidity secondary to stricture formation. In most of the cases there is involvement of the esophagus which later on manifests as esophageal stricture. Isolated corrosive pyloric stenosis without oesophageal involvement is an uncommon phenomenon and the reported incidence in the literature is only 3.8%. Like esophageal stricture gastric outlet obstruction secondary due to pyloric steno-sis also presents as a delayed complication of acid ingestion. We hereby report 2 cases of isolated gastric outlet obstruction following acid ingestion that were managed surgically with gastrojejunostomy and recovered well.

Introduction: Ectopic liver tissue (ELT) is a rare condition. It differs from accessory liver because ELT is not connected to the mother liver. Most authors support that ELT occurs due to aberrant migration during the embryological development of the liv-er. Case presentation: A 41-years-old man was found to have a tongue of liver tissue attached to the diaphragm during cholecystec-tomy for gallstones. It was excised and the histological examination showed liver tissue containing normal tissue elements. He had an uneventful postoperative recovery and was discharged home 48 hours later. Conclusions: The number of reported cases of ELT is less than 100 so far, and the majority concerns the gallbladder. The dia-phragm is a really rare origin of ectopic liver with few references. Other sides of ectopic liver tissue are hepatic ligaments, omen-tum, stomach, spleen, retroperitoneum and thorax (lungs and heart). The gallbladder is the commonest site of origin with an incidence <0.3%. Most cases are found incidentally in asymptomatic patients. Ectopic liver tissue is also at increased risk of car-cinogenesis, especially these with ?non-gallbladder? attached cases. So, intraoperative diagnosis of this entity should be accom-panied with excision and histological examination. Radiographic diagnosis is very rare and occurs incidentally also. In this case we have to follow up the ectopic liver tissue especially the ?non-gallbladder? attached lesions, due to the increased malignancy potential. If a pathological change take place, we have to proceed to the excision.

Introduction. Dysphagia lusoria is a rare clinical condition resulting from extrinsic oesophageal compression from an aberrant right subclavian artery (ARSA). We describe an approach to surgical management and discuss current literature. Case Report. A 43-year-old female presented with a history of dysphagia for solids. Barium swallow demonstrated extrinsic oe-sophageal compression and MR angiography confirmed aberrant aortic arch anatomy (ARSA). A right subclavian-carotid transpo-sition was performed under general anaesthesia via a supraclavicular incision. The post-operative recovery was unremarkable. There was complete resolution of dysphagia

Background. Fibromatosis is a benign tumour arising from a consistent proliferation of a well differentiated fibroblast. Desmoid-type fibromatosis is a rare benign soft tissue tumour but locally invasive via mass effect compressing on vital structures of the body. The lesion has an unpredictable clinical course. The rarity provides a treatment dilemma on the suitability and appropriate timing for surgical resection versus conservative close monitoring. We aim to report the first reported aggressive desmoid-type fibromatosis in Malaysia. Case Report. A-72-years-old woman presented with a huge and tender swelling over her anterior chest wall. She denies any ma-lignancy constitutional symptoms. Computer Tomography (CT) scan showed a well-defined heterogeneous enhancing mass over-lying the seventh rib, indenting the pleural cavity, with no deeper structure involvements. En-bloc resection done and the cavity was reconstructed using physio-mesh, anchored creating an air-tight seal and reinforced using artificial tissue reinforcement. Histopathology report confirmed desmoid-type fibromatosis with clear resection margin. Conclusion. Desmoid-type fibromatosis is a rare condition with only little experience available through literature. Some evidence suggests close monitoring was adequate for slow growing lesion while others recommend surgical resection for rapid growing lesion whereby increasing the chances of vital structure compression. However, the question of what is the exact determinant for slow versus rapid growing lesion is still unknown.

Many anatomical structures beyond their descriptive anatomical terms are characterized by the so-called clinical an-atomical or eponymic terms. However, these eponymic terms sometimes are incorrect since the scientists who firstly designed, observed or described less or more analytically the relative anatomical elements are other than those re-ferring to these terms. In that brief communication, an attempt was made to display the first descriptions of the fol-lowing anatomical structures: anterior abdominal fat pad, cysto-duodeno-colic ligament, greater vestibular glands, lacteal veins of Aselli