Η χειρουργική εκτομή με συνοδό λεμφαδενεκτομή αποτελεί τη μόνη μέθοδο ριζικής θεραπείας του αδενοκαρκινώματος του στομάχου. Ωστόσο, τα οφέλη και η ακριβής έκταση της λεμφαδενεκτομής, εξακολουθούν να συνιστούν αντικείμενα επιστημο-νικής έρευνας ενώ, για αυτά τα θέματα δεν έχει επιτευχθεί έως και σήμερα ομοφωνία μεταξύ ιαπωνικών και δυτικών κέντρων χειρουργικής. Σκοπός της παρούσας ανασκοπικής μελέτης είναι να καθοριστούν με βάση την πρόσφατη διεθνή βιβλιογραφία οι σύγχρονοι ορισμοί, η ακριβής έκταση και οι ενδείξεις των τύπων λεμφαδενεκτομής που διενεργούνται για τη θεραπεία του γαστρικού καρκίνου και να περιγραφεί αναλυτικά η χειρουργική τεχνική της τροποποιημένης D2 λεμφαδενεκτομής όπως διε-νεργείται στα ευρωπαϊκά κέντρα χειρουργικής.

Τα θωρακοχειρουργικά περιστατικά αντιμετωπίζονται σε προγραμματισμένα και σε επείγοντα χειρουργεία με διαγνωστικό και θεραπευτικό σκοπό. Κατά την προεγχειρητική αναισθησιολογική εκτίμηση αυτών των ασθενών η αξιολόγηση της αναπνευστι-κής λειτουργίας είναι πολύ σημαντική και περιλαμβάνει: α. την μηχανική της αναπνοής, β. την λειτουργικότητα του πνευμονι-κού παρεγχύματος για την ανταλλαγή των αερίων και γ. την αλληλεπίδραση του καρδιαγγειακού με το αναπνευστικό σύστημα. Η σημαντικότερη αναισθησιολογική εφαρμογή στην θωρακοχειρουργική αναισθησία είναι ο πλήρης διαχωρισμός των δύο πνευμόνων και ο αναισθησιολόγος έχει να αντιμετωπίσει τα προβλήματα που προκύπτουν από τον αερισμό του ενός πνεύμο-να. Κατά την μετεγχειρητική περίοδο μπορούν να εμφανισθούν σοβαρές επιπλοκές οι οποίες μπορεί να είναι και απειλητικές για τη ζωή του ασθενούς. Η μετεγχειρητική αναλγησία στην θωρακοχειρουργική είναι πολυπαραγοντική με ιδανική μέθοδο την επισκληρίδιο αναισθησία-αναλγησία

ozlemali Background: We aimed to evaluate the consistency of the histopathologic results of breast biopsies which were performed by considering BI-RADS scoring system. Patients and Methods: Pathology results of 334 female patients, who were performed breast biopsy according to mammograph-ic or sonographic BIRADS classification, were retrospectively evaluated. Results: For BI-RADS 4 cases malignancy rate was 6%; 90,9% of BI-RADS 4a cases was benign and 14,3% of BI-RADS 4c cases was benign. 13,7% of BI-RADS 4 cases was malignant. 26,7% of BI-RADS 4a cases was malignant and 75% of BI-RADS 4b cases was malignant. The malignancy rate of BI-RADS 4c cases was 100%. When the sonographic BI-RADS 4 was divided into sub-classes, the accuracy rates of BI-RADS 4, 4a and 4c were 6%, 9% and 85% respectively. The accuracy rates of BI-RADS 3, 4 and 5, which were reported by MG, were 92%, 41.8% and 100% respectively. When the mammographic BI-RADS 4 was divided into sub-classes, the accuracy rates of BI-RADS 4, 4a, 4b and 4c were 14%, 27%, 75% and 100% respectively. Conclusion: As a result, mammographic and/or the sonographic BI-RADS classifications are highly efficient methods in exhibiting the separation of benign or malignant lesions.

We aim to search relation between pre-postoperative serum carcinoembryonic antigen (s-CEA) blood level and prognos-tic factors in colorectal carcinoma (CRC) in this study. We retrospectively reviewed 337 patients with CRC who had un-dergone radical surgery between January 2004 and January 2009 in two academic hospital. In this study two parts inves-tigated. The first part is the relationship assessment between preoperative s-CEA levels and prognostic factors, the sec-ond part is the relationship assessment between preoperative and postoperative s-CEA levels and prognostic factors in CRC patients. In the first part of the study in terms of TNM, there is statistically significant difference in favor of Pre-operative Low s-CEA (PreL) group between the groups p?0.001. In the second part of the study in terms of estimated survival, the results were in the Preoperative Low Postoperative Low s-CEA (PLPL) group: 174.75 months, Preoperative Low Postoperative High s-CEA (PLPH) group: 27.33 months, Preoperative High Postoperative High s-CEA (PHPH) group: 71.64 months, Preoperative High Postoperative Low s-CEA (PHPL) group: 69.21 months. There was no statistically signif-icant difference in terms of T (p=0.81) but there were statistically difference among the groups in terms of N and M (p?0.001). PLPL group predict excellent survival chance for CRC patients. Conversely PLPH group predict poor survival chance for CRC patients. According to our results there is no evidence to prove, significant relationship with CEA levels and gender, age, tumor localization, preoperative chemoradiotherapy(CRT). Preoperative and postoperative CEA levels detecting is crucial not only for survival but also predicting the prognosis of CRC patients.

Background: Acute variceal bleeding is a very common problem in Egypt. Traditionally, injection sclerotherapy (EST) is used to con-trol acute bleeding. Unfortunately, it has its well-known long term sequelae. Endoscopic band ligation (EVL), on the other hand, is a safer technique that is probably under-utilized in emergency situations. This study aims to compare the use of endoscopic band liga-tion (EVL) to endoscopic injection sclerotherapy (EST) in acute esophageal variceal bleeding. Patients and Methods: this is a prospective randomized trial. Four hundred and forty four patients with acute hematemesis present-ing to the hematemesis unit of the Alexandria Main University Hospital were examined. Patients with bleeding esophageal varices were randomized into two groups: group A was treated by endoscopic sclerotherapy and group B was treated by endoscopic band ligation. Patients were observed for cessation of bleeding and for recurrent hematemesis within 48 hours. Those with recurrent bleeding were re-examined by endoscopy. Results: We examined 867 patients to find 466 were eligible for the study. They were randomized into the two groups. Cessation bleeding was achieved in 95.3% of patients in group A and 96.1% of group B (p=0.46999). Recurrence of hematemesis occurred in 15.9% in group A and 2.6% in group B (p=0.0008). Child?s C patients were particularly more liable to re-bleeding (p=0.0108). There were four mortalities: three due to liver failure and one due to torrential bleeding. Conclusion: Endoscopic band ligation, using the proposed technique, is as effective as sclerotherapy in acute esophageal variceal bleeding. Band ligation has significantly less re-bleeding rate particularly in Child?s C patients.

Introduction: Hydatid disease is still a health problem in endemic areas. Extrahepatic hydatid cyst is rare, and primary (isolated) splenic cyst is a rare clinical entity, constituting 1.5 to 3.5% of all hydatid cysts. Objective: to determine the incidence and treatment options of isolated splenic hydatidosis Patients & Methods: We reported series of isolated splenic hydatid cysts admitted at Hepatobiliary tertiary center, National Liver Institute, Menophyia University, in a period from March 2005 to January 2012 managed surgically with open splenectomy (total and partial). Results: Out of 439 patients of abdominal hydatidosis 18 (4%) had isolated splenic hydatidosis, Aged range 26-67 years, Twelve (66.5%) were male and six (33.5%) were female. Nine patients (50%) were presented by splenomagly, four patients (22.2%) were presented by left hypochondruim mass, two patients (11%) had acute abdomen and other 3 patients (16.5%) diagnosed incidentally. Fourteen patients (78%) underwent elective splenectomy, two patients (11%) had urgent abdominal exploration and open splenec-tomy and two patients (11%) had elective partial splenectomy. No mortality, but complications occurred in 4 patients (22.2%). Hospi-tal stay was 4-11 days. No recurrence was noted during follow up period 12-60 months proved clinically and radiologically. Conclusion: A high degree of suspicion of hydatid should be there whenever a splenic cyst is encountered in clinical practice and treatment options should be tailored for each case.

The success rates in the treatment of fistula in ano depend on factors such as the type of the fistula, the etiology and the technique of repair. This study describes the presentation pattern, management and outcome of patients presenting with fistula-in-ano at our institution over a two year period. Method. This was a retrospective study from January 2010 to December 2011. The extracted information consisted of the bio-data of the patients, associated morbidity, and the type of fistula based on Parks classification. The anatomical sites of the sinuses and the findings at surgery were noted. The histological findings of resected tissues were documented. Average follow up period was six months. Results. Fifty three patients were treated within this period. The mean age was 40.75 years. The mean duration of symptoms before surgery was twenty months. 48 (90.5%) were classified as the low type while 5(9%) were of the high type. Eight (15.1%) patients were on antiretroviral therapy. The range of surgical procedures were fistulotomy (28.3%), fistulectomy (66%), while one and two patients had a colostomy and drainage seton respectively. Two patients had partial anal incontinence within the first week of surgery which reduced significantly within two weeks. Five of the patients had recurrent fistula following surgery. Conclusion. High fistulae continue to be difficult to treat. HIVAIDS may not be a risk factor for recurrence. There is a need to consider other surgical techniques apart from fistulectomy and fistulotomy in the treatment of high fistula.

Introduction. Parietal endometrioma is an uncommon pathology. It can occur on all scars, most often after surgical procedure with hysterotomy. Surgical scar endometriosis following cesarean section has an incidence of 0.03% to 1.5%. The correct diagno-sis is frequently overlooked due to the rarity of this entity. Case presentation. A 32-year-old female patient referred to our surgical department owing to continuous right lower quadrant pain associated with a palpable mass 25 days after the onset of symptoms. The location of the tender mass was 2 cm under the right pole of a Pfannenstiel incision performed 2.5 years before for a cesarean section. Sonography showed a 25?8 mm subcuta-neous roundish hypoechoic nodule with fibrotic changes, irregularly margins and a single vascular pedicle. Wide local excision performed. Cut section demonstrated a grey white nodular tissue with areas of reddish discoloration representing hemorrhage. Histopathology revealed endometrial glands and stroma embedded in fibrous tissue. Conclusion. The clinical scenario (palpable mass near cesarean section scar and pain, especially if cyclic with menses) along with a careful sonographic examination are sufficient for a confident preoperative diagnosis of abdominal wall endometrioma. Defini-tive diagnosis is established only after excision and histopathology of the lesion.

Small bowel perforation due to mesh migration can be seen rarely but it is the one of the most important complication of using the prostetic mesh. A 48 year old female, who hadseven ventral hernia repairs performed in the past was admittedto our emergency department for observation. On physical examination the patient had rigidity, tenderness and rebaund on all quadrants of abdomen. The patient was brought to the operating room in an emergent setting. A median superior-inferior laparotomy was performed on the site of a previous surgical operation site.10 cm of gangrenous, infarcted and perforated small bowel was found in the surgery. The necrotic segment was resected.Opening the specimen on patological examination, retained mesh in the lumen of the small bowel was found.

Combined pancreatic and duodenal injuries are rare and more common due to penetrating than blunt trauma. Because of the retroperitoneal location of these organs, high index of suspicion is demanded and in most cases are accompanied with injuries of other organs like liver, spleen and great vessels. The increase in morbidity and mortality (M&M) is the result of a concomitant injury of other abdominal organs beyond the pancreas and duodenum. The first step is the hemodynamic stabilization of the patient and repairing of injuries in pancreas and/or duodenum follows next. Management depends on the grade of the lesion in every case. We present a case of a 32-year-old female patient with a combined pancreatic and duodenal injury, without damage in other organs, which occurred after blunt trauma ? traffic collision and seat belt injury.

Myofibroblastic tumors are inflammatory tumors that arise in viscera and soft tissue. Their etiopathology is thus poorly under-stood. These tumorous formations consist essentially of a proliferation of fibrous and inflammatory cells. As for the clinical presentation, it is determined by the site of origin and the effects of the mass. The said formations are also capable of infiltration of adjacent organs. Local recurrence and distant metastasis may also happen even after incomplete surgical resection. The tradi-tional management consists of complete surgical resection. Yet, this may be hard or even impossible when the lesion spreads to vital structures. The present report sheds light on an Inflammatory myofibroblastic tumor (IMT) underlying an appendicular abscess. The Treatment was surgical; the mass was completely resected. In addition, there were no complications.

Background: Endoluminal grafts? (ELGs?) proximal infolding or ?collapse? has been associated mainly with thoracic aortic ELGs and very rarely with abdominal aorta aneurysms? (AAA) endovascular systems. There have been scarce reports of such cases concerning AAA?s ELGs? but this is only the second case of an Endologix Powerlink endograft resulted to complete collapse. Case presentation: We present a case of a 64 year old male patient who presented himself with a 57mm abdominal aortic aneurysm (AAA) and significant proximal neck angulation but fairly adequate proximal neck length (25mm). Patient received an Endologix ELG with main body and proximal infrarenal aortic cuff without suprarenal fixation and was discharged on the 1st postoperative day. On the 5th postoperative day he was admitted in another hospital (700Km away) with symptoms of acute limb ischemia. CT-angio revealed collapse of the proximal cuff that resulted in complete occlusion of blood flow towards both limbs. Patient underwent open surgical repair (removal of the collapsed ELG and an aorto-bi-iliac bypass). Conclusion: Reports of such cases have in common the exceedingly proximal neck angulation. In our case Endologix endograft?s inner skeleton ?collapse? resulted in ?locking? of the stent?s alloy structure, making it impossible to re-expand once was folded. In such cases addition of a suprarenal cuff is mandatory in order to achieve further fixation

Introduction: Several cases of bladder wall rupture after minor abdominal trauma have been reported in the literature and these have been associated with chronic diseases of the bladder wall or alcohol intoxication. Unless bladder rupture is included in the differential diagnosis, it may not be recognized and serious consequences may result. Case report: We present a case of urinary bladder rupture in an intoxicated male patient with a 24 hours history of acute lower abdominal pain after minor abdominal trauma. Laboratory investigation revealed leukocytosis and elevated blood urea and se-rum creatinine and urinanalysis revealed hematuria of 80-100 red blood cells by visual field. CT revealed the presence of sub-stantial intraabdominal fluid around liver, spleen and in all lower pelvis containing blebs. A laparotomy of lower pelvis was per-formed and a rupture of about 10 cm was found at the dome of urinary bladder which was closed primary by a double layer technique using absorbable suture number 2.0. Conclusion: Highly clinical suspicious in intoxicated patients with abdominal pain, ascites and uremia, even without a history of major abdominal trauma, is crucial in order to establish the definite diagnosis of urinary bladder rupture.

Valued Acer Customer Background: After verifying the effectiveness of the fibrin sponge Tachosil? as a haemostatic and control of air leakage, biliary and vascular anastomoses, we believe may play an important role in sealing intestinal sutures. The aim of our study is it applica-tion as precarious sutures strengthening in emergency abdominal surgery, checking promote healing and reduce complications. Material and methods: We performed 11 cases which after the completion of a precarious suture in emergency abdominal sur-gery, we considered necessary its reinforcement with Tachosil?. We understood as suture precarious, what it was not done in perfect conditions due to not a ideal situation (hypoproteinemia, ischemia, no preoperative preparation, hypoalbuminemia...) and therefore a high risk of dehiscence. Results: Patients, aged between 20 and 92 years (mean 57'45), are 7 men (63?63%) and 4 women (36?36%). Diagnoses were hollow viscus perforation (6 cases), bladder perforation (2), perforated appendicitis (2) and pancreatic laceration (1). All patients underwent emergency abdominal surgery, with laparoscopic approach in 36?36%. The sutures were 6 closures hollow visceral perforation, 2 bladder perforation closures,2 reinforcements appendicular stump and 1 closure of pancreatic stump. 81?81% required postoperative ICU from the context in which it was surgery. The average hospital stay was 11?36 days (6-20), without major complications or mortality. Conclusion: We believe this trend to strengthen fragile sutures have yet to be studied and protocol with prospective randomized studies, but as a first contact, seems to have a safe and important role in our clinical experience.