Η οξεία παγκρεατίτιδα (ΟΠ), αποτελεί μία από τις πιο κοινές παθήσεις του γαστρεντερικού σωλήνα με ετήσια επίπτωση 4.9-73.4/100000 άτομα. Η θνητότητα της κυμαίνεται σε ποσοστά μικρότερα από 5%, ενώ μπορεί να φτάσει το 20-30% για την οξεία νεκρωτική παγκρεατίτιδα (ΟΝΠ). Η ΟΝΠ εμφανίζεται σε ποσοστό περίπου 15% των ασθενών με ΟΠ. Η διάγνωση της ΟΠ βασίζε-ται σε κλινικά κι εργαστηριακά ευρήματα ενώ ο απεικονιστικός έλεγχος πρέπει να γίνεται με ειδικές ενδείξεις, και γενικά ο ιδα-νικός χρόνος για την εκτέλεση αρχικής αξονική κοιλίας με σκιαστικό (contrast-enhanced computed tomography, CECT) είναι τουλάχιστον 72-96 ώρες από την εισβολή των συμπτωμάτων της ΟΠ. Η πρόβλεψη της εξέλιξης μιας ΟΠ σε ΟΝΠ βασίζεται στην αναγνώριση της σοβαρής παγκρεατίτιδας. Χρήσιμα για αυτό το σκοπό είναι: οι παράγοντες κινδύνου του ασθενούς, συστήματα βαθμολόγησης που βασίζονται σε κλινικο-εργαστηριακά δεδομένα του πρώτου 24-48ώρου, απεικονιστικά συστήματα βαθμο-λόγησης, η παρουσία SIRS (systemic inflammatory response syndrome,SIRS) και εργαστηριακές εξετάσεις που έχει φανεί ότι σχετίζονται με την εξέλιξη μιας παγκρεατίτιδας σε σοβαρή. Ασθενείς με ανεπάρκεια οργάνων πρέπει να εισάγονται στην μονά-δα εντατικής θεραπείας (ΜΕΘ). Η αντιμετώπιση στη ΜΕΘ περιλαμβάνει την άμεση ανάνηψη με ισότονα κρυσταλλοειδή υγρά, όπως και την διαρκή αξιολόγηση τις πρώτες 6 ώρες και για τις επόμενες 24-48 ώρες με κλινικές κι εργαστηριακές παραμέτρους. Σημαντικό επίσης στον ασθενή με ΟΠ είναι ο έλεγχος του πόνου με οπιοειδή και η θρεπτική υποστήριξη του. Η χρήση προφυ-λακτικής αντιβιοτικής αγωγής δεν συνιστάται ως ρουτίνα στην ΟΠ και σε ασθενείς με στείρα νέκρωση προκειμένου να εμποδι-στεί η επιμόλυνση της νέκρωσης. Η χρήση εμπειρικής αντιμυκητιασικής θεραπείας συνιστάται μόνο στις περιπτώσεις ΟΝΠ. Σε περιπτώσεις στείρας νέκρωσης επείγουσα χειρουργική παρέμβαση απαιτείται σε διάτρηση σπλάγχνου, οξεία αιμορραγία, συ-ρίγγιο, απόφραξη σπλάγχνου, σύνδρομο κοιλιακού διαμερίσματος. Σε αποδεδειγμένη επιμολυνθείσα νέκρωση, ο ασθενής μπορεί να αντιμετωπιστεί με αντιβιοτικά, υποστηρικτική θεραπεία κι αυστηρή παρακολούθηση μέχρι οι νεκρωτικές συλλογές να ρευστοποιηθούν μερικώς, να αποκτήσουν τοίχωμα και να επιτρέπουν πιο αποτελεσματικές και λιγότερο ακρωτηριαστικές επεμβάσεις. Επείγουσα χειρουργική παρέμβαση απαιτείται μόνο εάν ο ασθενής με επιμολυνθείσα νέκρωση εμφανίζει εικόνα SIRS και ανεπάρκειας οργάνων. Η εκλεκτική αποστείρωση του εντέρου και ο ρόλος της πεντοξυφυλλίνης στην ΟΠ αξίζει περαι-τέρω μελέτη δεδομένου ότι υπάρχουν θετικά δεδομένα. Η προφυλακτική χορήγηση προβιοτικών και η χρήση της οκτρεοτίδης δεν υποστηρίζονται.

Internal hernias consist a surgical condition that can cause intestinal obstruction. They can be congenital or acquired. The incidence of internal hernias becomes more and more common due to the increasing number of surgical procedures that cause defects in the abdominal cavity such as the bariatric surgical procedures. Their complications can lead to ischemia and necrosis of the intestine, so the early diagnosis is of significant importance. A high index of clinical suspicion is needed to de-tect internal hernias. Computed tomography is the most helpful imaging tool, to lead the differential diagnosis to internal hernias. Each type of internal hernias has its own characteristics but the treatment is common for all; surgical repair.

Background. Cystic lymphangioma of the pancreas (CLP) is extremely rare, accounting for less than 1% of pancreatic tumors

Medullary thyroid carcinoma (MTC) is a rare C-cell calcitonin-producing tumour, representing approximately 5% of all thyroid tumours. It occurs in sporadic and hereditary form. The hereditary form of MTC accounts for 20?25% of cases. Mutation of RET proto-oncogene is well known cause of this entity. The pure FMTC is very rare. There were only three documented families that fulfil the criteria of pure FMTC in the literature. Most of the kindred of familial MTC are later associated with Multiple Endocrine Neoplasia (MEN) 2A or 2B. Here we present a 26 year-old patient with bilateral neck swelling, where fine needle aspiration (FNA) cytology of the nodule showed medullary thyroid carcinoma. Hence the siblings were investigated for familial MTC. His elder brother, a 30 year-old man also had anterior neck swelling and FNA cytology of the nodule confirmed of MTC. Their sister, a 28 year-old female had a screening ultrasound of the neck showed three suspicious thyroid nodules. Ultrasound guided biopsy of the lesions were suggestive of MTC. All of them underwent total thyroidectomy with bilateral and central lymph node dissection. Post-operatively, the serum calcitonin level of all these patients were still elevated and serial imaging confirmed of recurrence disease. In all our patients, clinical and biochemical screening for MEN2 were negative and they refused to have genetic testing for RET proto-oncogenes. In summary, screening for MTC and early treatment is essential as the inherited MTC is normally more aggressive than the spo-radic. Vigilant surveillance with calcitonin and imaging is important to detect early recurrence as well as to detect any occurrence of phaeochromocytoma.

Background: The aim of this study was to evaluate the effect of ursodeoxycholic acid in patients with obstructive jaundice after endoscopic treatment.

Background: In recent years there has been a tendency of increasing of the number of antibiotic-resistant strains of microorgan-isms as causative agents of surgical wound infections, and increasing of the number of patients who have a multiple allergy to antibiotics. This significantly increases the duration and cost of treatment, and puts some questions on its efficiency. Aim of our research is to study how the bacteriophages act as agents to deal with purulent infection in the presence of allergy to antibiotics.

Trachea injury is a rare but life threatening complication, especially in situations where the mediastinum has undergone inter-ventions or is not in virgin conditions. It is essential to adjust the therapeutic strategy in both the preoperative period and during surgery. It is recommended to perform esophagectomy in highly rated reference center.

Introduction: Subtotal gallbladder removal is sometimes followed, especially in cases of "difficult cholecystectomy". However, the gallbladder remnant can present with the formation of residual gallstones.

Papillary thyroid carcinoma is the commonest well differentiated thyroid carcinoma comprising about 80 - 85%1 of all thyroid malignancy. It has an excellent prognosis with survival rate of more than 95% at 25 years1. However, incidence of thyroid malig-nancy from this ectopic thyroid tissue is extremely rare and may manifest as a spectrum of thyroid disease. Thyroid malignancy arising from ectopic thyroid tissue is extremely rare with only few reported cases in literature. Papillary thyroid carcinoma arising from ectopic thyroid tissue is most commonly reported in the branchial cyst. The questions that perplexing about it are; is it aris-ing de novo in the ectopic thyroid tissue or is it reflects a metastasis? Here we report a 43-year-old man incidentally found to have an ectopic papillary thyroid carcinoma arising from the left branchial cyst following excision of the cyst. Examination of the neck revealed a mass arising from left sided of the neck. A pre operative computed tomography (CT) scan only showed a large branchial cyst compressing on the left thyroid gland and displacing left carotid sheath. A total thyroidectomy with left central neck dissection was performed showed a focus of 22x12x9mm tumour at left lower lobe with three out four left central neck nodes involvement.

Background Esophageal perforation is one of the causes of fatal chest pain that is not so common at the emergency departments but should not be missed due to the high morbidity and mortality. Although there is a need for imaging methods for diagnosis such as chest x-ray, computed tomography (CT) and esophagoscopy, it is important to first suspect esophageal perforation.

A Spigelian hernia, a rare variant of an abdominal wall hernia, tends to be a diagnostic challenge for many surgeons. Protruding through the spigelian fascia, between the semilunar line laterally, and the lateral border of the rectus medially, this condition pre-sents unlike most other hernias, due to the tensile strength of the anteriorly placed external oblique fascia. We present such a case which was clinically diagnosed as a subcutaneous lipoma causing a diagnostic dilemma, along with a relevant review of literature.

Conclusion The key points for the management of esophageal perforation are the clinical suspicion, early diagnosis and definitive surgical approach