Περιεχομενα


Τόμος 16, Τεύχος 3
Ιούλιος- Σεπτέμβριος 2011


Ανασκοπήσεις
130Διάχυτο κακόηθες μεσοθηλίωμα του περιτοναίου
Α.Α. Τέντες
Πλήρες Κείμενο | Περίληψη
Το μεσοθηλίωμα του περιτοναίου είναι σπάνια νοσολογική οντότητα, της οποίας η πρόγνωση στο παρελθόν ήταν δυσμενέστα-τη. Ο αμίαντος ενοχοποιείται στην ανάπτυξη της νόσου με ποικίλους μηχανισμούς. Η μέγιστη δυνατή κυτταρομειωτική χειρουργική εξαίρεση του όγκου, σε συνδυασμό με ενδοπεριτοναϊκή χημειοθεραπεία, έχει προσφέρει σημαντικό όφελος στην επιβίωση. Η κυτταρομειωτική χειρουργική, η οποία επιτυγχάνεται με τη διενέργεια των τυπικών περιτοναιοεκτομών αποσκοπεί στην ε-ξαίρεση του μακροσκοπικά ορατού όγκου. Η ενδοπεριτοναϊκή χημειοθεραπεία, είτε υπό την μορφή της διεγχειρητικής υπέρ-θερμης, είτε υπό την μορφή της πρώιμης μετεγχειρητικής, υπό νορμοθερμία, αποσκοπεί στην εκρίζωση του μικροσκοπικού υπολειμματικού όγκου. Η νοσοκομειακή θνητότητα των επεμβάσεων αυτού του τύπου είναι χαμηλή, αλλά η νοσηρότητα υψηλή. Η έκταση της περιτο-ναϊκής καρκινωμάτωσης και η επάρκεια της κυτταρομειωτικής επέμβασης είναι οι δύο σημαντικότεροι προγνωστικοί παράγο-ντες επιβίωσης.
134Καρκίνος μαστού και εγκυμοσύνη. Ανασκόπηση διεθνούς βιβλιογραφίας
Π. Διαμαντόπουλος , Χ. Σοφούδης , Α. Βαιβάη , Μ. Μπούτσικου , Ε. Πέτρακα , Κ. Καλογεράκος , Ι. Νομικός
Πλήρες Κείμενο | Περίληψη
Ο καρκίνος του μαστού αποτελεί την πρώτη γυναικολογική κακοήθεια στην κύηση με συχνότητα 1 : 3.000-10.000 κυήσεις. Η κύηση δεν φαίνεται να επηρεάζει τον κίνδυνο εμφάνισης καρκίνου του μαστού ούτε την πρόγνωσή του. Η υπερηχογραφία των μαστών αποτελεί τη διαγνωστική εξέταση εκλογής, ενώ συμπληρωματικά μπορεί να χρησιμοποιηθεί η εξέταση μαγνητικού συντονισμού (MRI). Ως κύριο σταδιοποιητικό έλεγχο συνιστώνται η ακτινογραφία θώρακος και η υπερηχο-γραφία κοιλίας. Θεραπεία εκλογής αποτελεί η τροποποιημένη ριζική μαστεκτομή για τα δύο πρώτα τρίμηνα και η ογκεκτομή ή μερική μαστε-κτομή με ακτινοθεραπεία μετά τον τοκετό για ασθενείς που διαγιγνώσκονται στο τρίτο τρίμηνο της εγκυμοσύνης. Η χορήγηση χημειοθεραπείας κρίνεται αποδεκτή στο 2ο και 3ο τρίμηνο, ενώ η ορμονοθεραπεία πρέπει να αποφεύγεται για λόγους ασφά-λειας του εμβρύου.

Ερευνητικές εργασίες
139The use of ankaferd might lead to wound dehiscence in midline laparotomy incision
H. Alptekin , H. Yilmaz , S. Erdem , H. Esen , S. Kurban , M. Sahin
Πλήρες Κείμενο | Περίληψη
Background: Ankaferd Blood Stopper? offered as a hemostatic agent is a standardized herbal extract obtained from five different plants. The effects of ABS on laparotomy incision are unknown. This study was designed to assess potential effects on the healing of midline laparotomy in an experimental animal model. Material and Methods: Sixteen male Wistar albino rats were randomized into two groups and subjected to laparotomy. The study group subjected to laparotomy with local application of ABS to the bleeding points in the subcutaneous tissue, muscle and fascia and the control group subjected to laparotomy only. The rats were killed on postoperative day 7. Three types of assessment were performed: wound breaking strength, histopathology, and biochemical analysis. Results: Compared to the control group, rats in the ABS group displayed a lower wound breaking strength (p<0.05) and tissue hydroxyproline content (p<0.05). The use of ABS leads to a significant increase in malondealdehyde levels (p<0.05). Total histopathological score of groups were similar (p>0.05). Conclusion: Topical application of ABS to the subcutaneous tissue, muscle and fascia significantly impairs the wound healing by means of decreasing mechanical strength and tissue HPL levels.
143Limb skeletal muscle histological lesions during acute ischemia- reperfusion
A. Kamparoudis , D. Gerasimidou , P.Kamparoudi , M. Kanellaki-Kiparissi , I. Fardellas , Th. Gerasimidis
Πλήρες Κείμενο | Περίληψη
Background: The histological changes observed in skeletal muscles after acute ischemia and reperfusion depend on the duration and extent of ischemia. The aim of this study was: a) the study of skeletal muscle alterations in the limbs of canines during 12 hours of acute ischemia and their time-dependent progression during reperfusion, and b) the assessment of those cellular ele-ments, whose degree and alterations of histological lesions during reperfusion can determine limb viability. Materials-Methods: Ten non-thoroughbred canines were used. Acute posterior limb ischemia, lasting 12 hours, was induced at the common femoral artery level. Angiography was performed before and after ischemia, and after reperfusion. Biopsies were obtained from the gastrocnemius muscles of the healthy and affected limbs for microscopic and hyper-microscopic study of his-tological changes prior to ischemia, 6 and 12 hours after the onset of ischemia and 6 and 12 hours after reperfusion. The histo-logical study focused on the alterations in intercellular space, muscle fiber texture and the vascular wall. The hyper-microscopic study focused on the observation of lesions of hypo-cellular structures (sarcolemma, sarcoplasm, mitochondria, Golgi apparatus, muscle fibrils and nuclei structure), vascular wall and interstitial space. Results: According to the studied data, lesions of mitochondria, sarcolemma and basal septa of capillaries were the determi-nants of muscle cells viability. In 12 hours post-reperfusion there was restoration of the function of hypo cellular elements, lead-ing to the final conclusion that the functional viability of muscle cells after 12 hours of ischemia can be slowly but fully restored. Conclusion: The extent of lesions with complete disorganization and homogenization of muscle fibers during acute ischemia determines the viability of a limb after reperfusion. The presence of gigantic mitochondria during reperfusion is an important indication of regenerative procedure and the survivability of the limb. Edema of the capillaries basal membrane, basal septa of sarcolemma and of the interstitial space is one of the most persistent lesions. Evidence of subsidence show a possibility of limb survival, because it entails improvement of exchange functions.
149Albumin versus an artificial colloid in rectal surgery patients
K. Kotzampasi , B. Grosomanidis , K. Andreopoulos , I. Tzeveleki , K. Fotiadis , G. Mpasdanis , E. Eleftheriadis
Πλήρες Κείμενο | Περίληψη
Background: In colon surgery, human albumin administration is considered to be the gold standard for anastomotic dehiscence prevention. In recent years its use has become controversial, thus we aimed to investigate the effect of an artificial colloid, as a postoperative regimen against routinely given albumin in patients subjected to low anterior resection for colon cancer. Methods: Seventy one rectal surgery patients with actual indication for early postoperative albumin treatment were randomized to HA group [20% human albumin, 100mL/day, n=33] or to HES group [6%HES130/0.4, (Voluven, Fresenius Kabi, Bad Homburg), 500mL/day, n=38], for 4 consecutive early postoperative days. Thirty-day morbidity, including anastomotic leakage, abdominal wound infection and dehiscence, as well as organ specific and systemic infections, sepsis and septic shock, were assessed. Results: In the HA and HES groups anastomotic leakage was prominent in 5 and 1 patients, [p=0.05]; wound infection in 11 and 5 [p=0.04]; bacteraemia in 7 and 2 [p=0.04]; and sepsis in 6 and 2, respectively [p=0.08]. One patient finally died from sepsis [HA group, p=0.27]. Median hospitalization days was 14 and 10 [p=0.05]; number of patients needed re-intubation - mechanical ventilation were 7 and 2 [p=0.04]; and median days in ICU 9 and 7 [p=0.44], respectively. Conclusion: Patients receiving Voluven against human albumin as a perioperative 4-day treatment exhibited significantly lower morbidity rates. However, further research is required.
157Laparoscopic surgery for total rectal prolapse: the expected results of hospital experience, body image, cosmesis and functional status
S. Demirbas , E. Yucel , l. Sucullu , A. Ziya Balta , H. Sinan
Πλήρες Κείμενο | Περίληψη
Background: Laparoscopic approach is becoming a chosen one to treat the total rectal prolapse (TRP) in recent years. The aim of the study was to demonstrate the outcomes of the comparison of the patients? hospital experience, body image and cosmesis, functional status and quality of life of patients underwent laparoscopic rectopexy (LR) and open rectopexy (OR) for TRP. Methods and patients: Patients filled out the questionnaires at the time either been controlled or phone call in order to evaluate the patients? hospital experience, body image and cosmesis, functional conditions and life quality during the follow up. Total 105 patients (68 LRR/LR and 37 OR) were included in the study. Results: no significant difference was examined between the groups in terms of demographic characteristics, prolapsed time and indication for rectopexy. The preoperative functional disorders such as constipation and fecal incontinence was occurred 35,2% and 16,2% respectively. There was no difference in the postoperative complications in both groups. Hospital stay took significantly shorter in LR group (p<0,0001). Scores from the modified patiens? hospital experience, body image and cosmesis questionnaires were higher in LR group when the data had been compared with OR group. Functional status when considered the constipation and fecal incontinence did not display any difference between the groups. However the functional condition of the patients had been occurred well after surgery. Health-related disease specific questionnaire (SF36) demonstrated statistically significant difference favored LR group between both groups. Conclusion: LR is one of the surgeries that have been increasingly used in the treatment of TRP. It can be chosen for better perioperative outcomes, complication rate and the benefits of better patients? hospital experience, body image, and cosmesis as well when was compared with OR. Our results showed the improved functional status after both surgical procedures however the outcomes of SF36 showed better mental grade for the patients underwent LR.
163Intuition versus evidence in surgical practice. Questions and suggestions rose from an observational study in medical students
H. Harisis , X. Mantakas X , C. Katsios , H. Batsis , G. Lianos , M. Sarandi , A. Lianou , Z. Anastasiadi
Πλήρες Κείμενο | Περίληψη
Objective: Heuristics - fast decision-making methods that even trained emergency physicians often misapply to situations where evidence-based medicine methods should be applied instead - shape part of what is referred to as clinical expertise. Their prevalence among subjects, who are already familiar to the principles of evidence-based medicine but lack clinical expertise, such as medical students, is unknown. Knowing this prevalence would permit us to tell in which phase of decision-making development are heuristics acquired and have an insight on their interdependence with non-medical ways of thinking and an estimation of the difficulty of their elimination. Methods: We asked two groups of medical students (192 subjects in total) already familiar to the basic principles of evidencebased medicine to answer five questions inspired by cognitive studies on five heuristics, albeit with an emergency medical context to them. Results: With the exception of the heuristic of insensitivity to prior probability which was found to be used only by the minority of students (36.4%) the prevalence of the other four heuristics was very high, ranging from 80.9%-91.5%. Conclusions: Heuristics are inherent and difficult to eliminate, cognitive mechanisms prevailing among both medical students and trained physicians. Their predominance in an early phase of decision-making development could be explained by their capital role in making adaptive inferences in the real social and physical world given limited time and knowledge and their use as helpful tools for adaptive thinking and beneficial acting in many medical and non-medical situations. Since their combination with probabilistic tools is profoundly contradictory, the applicability of the principles of evidence based medicine seems less realistic.

Ενδιαφέρουσες περιπτώσεις
169Diaphragm disease of the ileum: an unexpected cause of small bowel obstruction in an elderly female
D. Irabor , I. Oyegbile
Πλήρες Κείμενο | Περίληψη
Small bowel obstruction can be caused by a myriad of factors; extrinsic, intramural or intraluminal. These factors are too numerous to mention here for the purpose of this report. However the pathogenic factor being presented here is unusual to the point of being highly unexpected; a pin-hole within a septum inside the distal ileum in two places about 20cm from each other. This unusual lesion is termed diaphragm disease of the ileum. A case is presented here with a discussion of presentation, diagnosis and treatment with a review of available literature. This case is the first reported case in West Africa.
171Spontaneous Cutaneous Fistula of a Liver Hydatid Cyst: A Rare Complication of Hydatid Disease
E. Martin-Perez , J. Gomez , I. Rubio , M. Posada , E. Larra?aga
Πλήρες Κείμενο | Περίληψη
Background: The liver represents one of the most common sites of human hydatid disease. Although common sites of rupture are into the bile duct, bronchi, peritoneal and pleural cavity, and the gastrointestinal tract, spontaneous cutaneous fistula is an extremely rare presentation of liver hydatid disease. In this article, a rare case of spontaneous cutaneous fistula of a liver hydatid cyst is reported. Case presentation: An 87-year-old man presented with a painless mass and a cutaneous fistula in the right hypochondrium. Computed tomography demonstrated a hydatid cyst measuring 18 x 7 cm in diameter in the upper part of the right hepatic lobe, and a direct communication between the cyst and the subcutaneous tissue. At operation, partial cystectomy and drainage was performed. The histological examination confirmed hydatid cyst of the liver and subcutaneous tissue. The postoperative course was uneventful, and follow-up abdominal computed tomography scans showed no evidence of relapse. Conclusion: Though very rare, rupture of a liver hydatid cyst into the subcutaneous tissue should be included in the differential diagnosis of swelling of the abdominal wall especially in endemic regions of the world.
174Laparoscopic cholecystectomy in situs viscerum inversus partialis
B. Papaziogas , I. Koutelidakis , P. Tsiaousis , G. Paraskevas , G. Chatzimavroudis , S. Atmatzidis , K. Atmatzidis
Πλήρες Κείμενο | Περίληψη
Since laparoscopic cholecystectomy has become the standard procedure for the treatment of gallstone disease, several cases have been reported in patients with situs viscerum inversus, a rare condition characterized by transposition of organs to the opposite side of the body. Herein, we report on a patient with symptomatic cholelithiasis and known situs viscerum inversus partialis. Successful laparoscopic cholecystectomy was performed and the patient recovered successfully. We further affirm the safety and efficacy of laparoscopy in the setting of situs viscerum inversus after giving due attention to the details of left-right reversal.
178Solitary pancreatic metastases from renal cell carcinoma 31 years after nephrectomy
J. Ruiz-Tovar , C. Gamallo
Πλήρες Κείμενο | Περίληψη
In patients with renal cell carcinoma (RCC), late recurrence as solitary pancreatic metastasis is not uncommon. Solitary pancreatic metastases are difficult to differentiate and may be misdiagnosed as primary pancreatic cancer. A 63-years-old man, who underwent a left nephrectomy 31 years ago because of a renal cell adenocarcinoma (T1G1N0M0), presented at CT scan a 9 cm mass in the pancreatic tail. Late recurrence of the renal tumour was initially discarded because 31 years was considered a too long period for recurrence, and the mass was finally diagnosed as primary pancreatic adenocarcinoma. Distal pancreatectomy and splenectomy was performed. Pathology confirmed the diagnosis of solitary metastasis of renal cell adenocarcinoma infiltrating pancreas
180Adenocarcinoma of the rectum presenting as a prolapsed haemorrhoid: report of a case
M.E.C. McFarlane , M. Stennett
Πλήρες Κείμενο | Περίληψη
Background: The finding of adenocarcinoma arising in an excised haemorrhoid is an unexpected phenomenon that has been rarely reported. Even the pathological examination of all haemorrhoids has been questioned and no standard recommendation regarding this practice has been adopted. Case Presentation: Herein we present the case of a 59 year-old patient who presented with a three-year history of third degree prolapsing haemorrhoids who underwent an uncomplicated haemorrhoidectomy operation. The pathological examination revealed a moderately differentiated adenocarcinoma arising from the anorectal junction. Follow-up evaluation for evidence of distant spread was satisfactory. There was no evidence of recurrent or metastatic disease at five years. Conclusion: The detection of an adenocarcinoma in a haemorrhoidectomy specimen is exceedingly rare. Despite this presentation the surgical literature does not routinely recommend pathological examination of all excised haemorrhoids.

Εικόνες στη χειρουργική
183Locally advanced breast cancer
Y.C. Madhu , K. Harish
Πλήρες Κείμενο
184Massive haemothorax due to rupture of the intrathoracic inferior vena cava by gunshot; a rare entity of chest trauma
N. Baikoussis , S. Siminelakis , J. Beis , E. Sintou , G. Papadopoulos
Πλήρες Κείμενο
185Uterus perforation causing protrusion of small bowel through the vagina as a disastrous complication of curettage
I. Wani , M. Wani , N. Khan , M. Shah , N. Choudri , S. Naqash , K. Wani
Πλήρες Κείμενο

Επιστολές προς Εκδότη
186Dietary Risk Factors for Acute Pancreatitis: A Case-Control study
, S.G. Barreto , J.Rodrigues
Πλήρες Κείμενο