Περιεχομενα


Τόμος 18, Τεύχος 3
Ιούλιος- Σεπτέμβριος 2013


Ανασκοπήσεις
131Ψευδομύξωμα περιτοναίου: μία σπάνια νοσολογική οντότητα με ιδιαίτερο χειρουργικό ενδιαφέρον
A. A. Tέντες
Πλήρες Κείμενο | Περίληψη
Το ψευδομύξωμα περιτοναίου είναι σπάνια νοσολογική οντότητα, προερχόμενη από την σκωληκοειδή απόφυση ή τις ωοθήκες. Ο όγκος τείνει να παραμένει στις περιτοναϊκές επιφάνειες προσκολλημένος μέσα σε λίμνες βλέννης, η οποία εκκρίνεται από τα καρκινικά κύτταρα. Η θεραπεία του είναι δυνατή με κυτταρομειωτική χειρουργική και περιεγχειρητική ενδοπεριτοναϊκή χημει-οθεραπεία. Η νοσηρότητα της μεθόδου είναι υψηλή (33-56%), αλλά η νοσοκομειακή θνητότητα μικρή (2-8%). Παρότι δεν υ-πάρχουν προοπτικές τυχαιοποιημένες μελέτες, η διάμεση επιβίωση κυμαίνεται από 51-156 μήνες, η 5-ετής από 52-96% και η 10-ετής επιβίωση ανέρχεται σε 55%, σε πιστοποιημένα κέντρα αντιμετώπισης ασθενών με περιτοναϊκή κακοήθεια. Η ποιότητα ζωής των ασθενών, οι οποίοι υποβάλλονται σε κυτταρομειωτική χειρουργική και περιεγχειρητική ενδοπεριτοναϊκή χημειοθε-ραπεία είναι αρίστη στο 90% των περιπτώσεων.
135Experimental Models of Hepatocellular Carcinoma in mice
P. Gavriilidis , D. Giakoustidis
Πλήρες Κείμενο | Περίληψη
Hepatocellular carcinoma is one of the world deadliest cancers whose pathogenesis is incompletely understood, continues to increase in prevalence. According to genomic studies has classified HCC into different subgroups; the unique feature of this neo-plasm is its tendency to arise upon a background of chronic inflammatory milieu. This review seeks to present the constant evo-lution in model design and technology development in mouse models in liver cancer research. Spontaneous models, induced models, viral models, transplantable models, and genetically engineered models are used as tools to investigate basic biological mechanisms of growth and differentiation, oncogene function, and as systems to test new diagnostic and therapeutic approach-es. Advantages and disadvantages of its model are compared

Ερευνητικές εργασίες
139Superiority of octyl-2 cyanoacrylate over polyamide black for surgical site incisions. Prospective randomized trial,
H.M. Patel , M. J. Shah , D.D. Duttaroy , S.M. Kacheriwala , S.J. Patel , R.M. Patel
Πλήρες Κείμενο | Περίληψη
Background: Present study was aimed to evaluate the superiority of octyl 2 cyanoacrylate over polyamide black for primary wound closure. Methods: A total of 80 patients were enrolled in the study, 40 in polyamide group and 40 in cyanoacrylate group. The average age of the patients was 42 years (20- 70 years). Majority of the patients were male (66.25%). Maximum patients were of inguinal incisions of Hernioplasty (37.5%) followed by lumbar incisions of Pyelolithotomy (25%).The patient?s wounds were assessed in terms of rate of wound healing, rate of wound dehiscence, infection rate, postoperative pain, cosmesis and days of hospitalization. Results: There was no significant difference in between the rates of wound healing (p=0.35) and dehiscence (p=0.35) between the two groups. However infection was almost absent in the cyanoacrylate group as compared to polyamide group (p=0.03). Also pa-tients in cyanoacrylate group had less postoperative pain (p<0.05), faster recovery and consequently earlier discharge. Cosmetic out-come was significantly better with cyanoacrylate group and there was high level of surgeon as well as patient satisfaction with the method (p<0.05). Conclusion: cyanoacrylate is better in terms of decreased infection, decreased postoperative pain, better cosmesis, better patient satisfaction and a general reduction in days of hospitalization as compare to polyamide black.
144A ?sandwich? procedure associated to components separation technique in the treatment of large and complex incisional hernias and abdominal wall defects. A 30-case series
JA. Martin Cartes , MJ. Tamayo-Lopez , M. Bustos Jimenez
Πλήρες Κείμενο | Περίληψη
Aim. Reconstruction of large, complex abdominal wall hernias is an interesting challenge. Primary closure of those hernias is often not possible. There is little agreement about the most appropriate technique or prosthetic to repair these defects, in spite the fact of the prevalence of ventral hernias. Sometimes despite being contaminated surgical fields, we are often faced to reinforce with bio-prosthetic meshes. The components separation technique (CST) is a practical option, however, recurrence rates remain unacceptably high. In an attempt to reduce recurrences, we frequently added a biologic underlay mesh and a lightweight polypropylene onlay mesh to the traditional components separation technique. Our objective was to determine biologic mesh practice patterns of reconstructive surgeons with regard to indications, most appropriate technique, choice of prosthetics, and experience with complications in order to work those large and complex hernias out. Methods. 30 consecutive patients who underwent abdominal wall reconstruction by means of a components separations associated with non cross-linked porcine dermal scaffolds (NCPDS) or a synthetic tissue scaffolds (STS) reinforcement between October 2009 and December 2011 were retrospectively reviewed. Analysis of demographics, indications for NCPDS or STS placement, surgical technique, complications, and follow-up data was performed. They underwent a ?sandwich? procedure with a biologic underlay mesh and a lightweight polypropylene onlay mesh added to the traditional components separation technique, we chose NCPDS or STC underlay mesh according to the fact of the presence or absence of a contaminated field. Results. A ?sandwich? procedure was used for abdominal wall repair in 30 patients. In all of them, NCPDS or STC was positioned using an intraperitoneal technique associated to a lightweight polypropylene onlay mesh and the components separation technique. At a mean follow-up time of 30.1 months, most patients had successful outcomes. Complications included seroma, recurrence, and infection. One of our patients died from multi-organ failure unrelated to hernia repair. Conclusions.This study shows that complex abdominal wall defects can be successfully reconstructed using a ?sandwich? procedure with a low rate of recurrence and complications. Moreover, repair of large, complex abdominal wall hernias by CST augmented with a biologic underlay mesh and a lightweight polypropylene onlay mesh results in lower recurrence rates compared to historical re-ports of CST alone.
151Benign cysts and tumors of esophagus: case series and review of the literature
E. Cakar , H.Bektas , Y. Duzkoylu , S. Bayrak , E. Pasaoglu , S. Colak , A. Guney , K. Buyukasik , M. Summak
Πλήρες Κείμενο | Περίληψη
Benign cyts/tumors of the esophagus are usually asymptomatic and detected through endoscopic and radiologic procedures. When they are symptomatic, there is an indication of treatment and in the literature, it is advised to treat asymptomatic lesions to avoid possible complications. In this study, we aimed to revise our results in cases of benign esophageal lesions and review the literature.
155Helicobacter pylori: Treatment for the patient only or the whole family? Results obtained from long-term follow-up gastroscopies
E. Gunes , M. Kucukyilmaz , G. Uzum , Y. Duzkoylu , O. Koc , S. Sari , V. Tunali , N. Dursun
Πλήρες Κείμενο | Περίληψη
Aim. Although the mode of transmission of Helicobacter pylori (HP) infection is not completely clear, body fluids and personal contact seem to be key factors. Thus, the rate of infection in countries such as Turkey is much higher than in countries with bet-ter hygienic conditions. We have compared the long-term (5-year) effects of individual- and family-based treatment of H. pylori infection. Methods. Between January and December 2011, we attempted to recruit the 70 H. pylori positive patients who had received individual and family therapy 5 years earlier (Group I) and the 70 who received individual treatment only (Group II). Twenty pa-tients of each group were identified; each underwent gastroscopy with biopsy, and the histopathology of the biopsy samples were assessed. Parameters such as endoscopic diagnosis, chronic inflammation, glandular atrophy and intestinal metaplasia were assessed 9 months and 5 years after treatment Results. The 40 patients consisted of 18 men (45%) and 22 women (55%). All 70 patients in each group had been initially positive for H. pylori Nine months after treatment, 7.1% of the 70 patients in Group I and 38.6% of those in Group II were positive for H. pylori (p<0.05). Five years after treatment, 11 of the 20 (55%) patients in Group I and 13 of 20 (65%) in Group II were positive (p>0.05). Conclusion. We found that treatment of H. pylori positive family members results in lower H. pylori rates in probands 9 months after H. pylori eradication, stressing the importance of treatment of infected family members. The lack of long-term between group differences, however, suggests that infected patients should be monitored for reinfection at regular intervals
159Concordance between Fine needle aspiration cytology, Core needle biopsy and Excisional biopsy for breast lesions. Efficacy of core needle biopsy material in the identification of biomarkers. One center experience and review of the literature
P. Lazari , S. Lanitis , V. Samaras , G.E.Thomopoulou , C. Barbatis , C.Salla
Πλήρες Κείμενο | Περίληψη
Objectives: Assess concordance rate between fine needle aspiration (FNAC), core needle biopsy (CNB) and excisional biopsy (EB) of breast lesions. Examine whether immunohistochemical markers (ER, PgR, HER2/neu, Ki-67, and p53) performed on CNB spec-imens accurately reflect the marker status of the excised tumor. Material/Methods: We examined 136 cases divided into two groups: 80 patients underwent FNAC, CNB and EB and 56 patients only FNAC and EB. FNAC results were classified into 5 categories. CNB and EB samples analyzed immunohistochemically (IHC). We also examined the concordance of the histological type and nuclear grade between CNB and EB.. Results: The C1 (insufficient) and C3 (atypical, probably benign) categories of both groups proved to include undetected carci-nomas in 57.14% and 42.3% (first group) and 14.28% and 40% (second group) respectively. Using kappa statistics and Spearman correlation, the agreement between the CNB and EB for the histologic type was perfect (K=1) and the grade for CNB proved substantial agreement (K=0.766). The concordance between the CNB and EB was perfect (K=1) for HER2 and almost perfect for ER (K=0.932). Conclusions: Concurrent FNAC and CNB can provide accurate preoperative diagnosis of breast lesions and the latter is also highly sensitive for the detection of HER2/neu and ER.

Ενδιαφέρουσες περιπτώσεις
164Spontaneous rupture of the ovarian artery in a post-menopausal woman and spontaneous rupture of the spleen 40 days later. Case report and review of the literature.
S. Panidis , E. Karamanlis , A. Ioannidis , G. Stavrou , K. Fotiadis , J. Tsouskas , G. Basdanis , K. Kotzampassi
Πλήρες Κείμενο | Περίληψη
Introduction: Spontaneous rupture of the ovarian artery, as well as spontaneous rupture of the spleen are very rare incidents, affecting mainly patients under particular circumstances. Herein we present a case of a post-menopausal woman who was treat-ed for spontaneous rupture of the ovarian artery and spontaneous splenic rupture within a 40-day interval. Case presentation: A 78-year-old woman was admitted to the nephrology department due to deterioration of renal function. After 7 days she presented a sudden onset of diffuse abdominal pain, hemodynamic instability and a decrease of haematocrit. Laparotomy revealed haemoperitoneum due to ovarian artery rupture, the pathology exam of which indicated middle and large arteries vasculitis. On the 40th post-operative day she experienced a new episode of hypovolaemia, after spontaneous spleen rupture and was thus subjected to a splenectomy. Conclusion: Spontaneous ruptures of the ovarian artery as well as of the spleen are rare causes of hemorrhage, having no patho-logical association. Our patient experienced both pathologies within a 40-day interval. No such case, to our knowledge, has been described before
168A case of giant angiomyolipoma of the kidney without tuberosclerosis. Ten years follow-up
S. Yakan , A. Coskun , M. Yildirim , N. Erkan , G. Ozk?k , O. Sipahi
Πλήρες Κείμενο | Περίληψη
Angiomyolipoma is a benign hamartomatous tumor, which characteristically exhibits mature or immature fat tissue, thick-walled blood vessels, and smooth muscle fibers . It is estimated to occur in 0.3% of the population and comprises 3-5% of the solid renal masses. A 18-year-old caucasian woman presented to our institution complaining of vague abdominal pain, inability to gain weight, nause, vomiting and abdominal distention for several months. Indeed, she dispatched to a physician by general practitioner to be treated for anorexia nervosa. Contrast enhanced computed tomography and magnetic resonance imaging of the abdomen revealed a well-encapsulated, large, heterogeneous retroperitoneal mass measuring 30 x 20 x 12 cm. The intraoperative exploration revealed a well encapsulated tumour which was adherent to the right kidney. The patient underwent right nephrectomy with mass excision. The mass lesion measured 32 x 22 x 14 cm in size and it weighed approximately 6000 grams. Histopathological specimen revealed angiomyolipoma of the kidney. The patient had no evidence of recurrence during follow-up 10 years postoperatively.
171Amyand hernia, femoral hernia and diverfticulosis of appendix verformis: a very rare clinical coincidence
S.Arikan , O. Sahin , A. Haslak , Y. Duzkoylu , K. Behzatoglou
Πλήρες Κείμενο | Περίληψη
AIM: Presentation of a very rare clinical coincidence MATERIAL-METHOD: A 61-year-old male patient admitted to a surgery clinic suffer.ng from right inguinal pain and a mass which sometimes now and then descended down to his scrotum. He had those complaints for 5 years and explained that the mass was located outside extracorporeally but he could push it inside by himself temporarely. In physical examination a reducible right inguinal hernia with gut inside the sac was observed. Surg.cal procedure was advised with the diagnosis of right inguinal hernia. No pathological sign was found in the preoperative tests and he was operated on with spinal anesthesia. FINDINGS: Caecum made partially one wall of the indirect hernia sac and a round shaped appendix vermiformis tough elastical masses on it was observed in the sac. Caecum and the other stuructures that could be seen in the region were macroscopically normal but a femoral hernia sac with omentum inside was found during digital exploration of the femoral canal. Appendectomy was performed because of a possibility of a neoplasia in appendix vermiformis. Then femoral hernia sac was reduced to abdomen by opening of the fascia transversalis. Caecum was prepared and reduced to the abdomen and excess part of the hernia sacs were resected. The operat.on was finished after Mc Way repair had been completed. RESULTS: The patient had no complaint in the postoperat.ve period and was discharged on the third postoperative day. The microscopical diagnosis of the specimen was diverticulosis of the appendix vermiformis. The patient had no problems after 30 days following the operation. No similar coincidence had been found in the literature search.
174Ectopic gastric mucosa in Meckel?s diverticulum as a source of lower GI bleeding in a teen patient
D. Paramythiotis , A. Michalopoulos , V. Papadopoulos , G. Stavrou , D. Panagiotou , C. Poulios , E. Vrettou , G. Basdanis
Πλήρες Κείμενο | Περίληψη
Introduction. Meckel's diverticulum with ectopic gastric mucosa is the most frequent cause of gastrointestinal bleeding in pa-tients less than 18 years. Despite advances in imaging techniques this pathology remains largely non-specific and early and accu-rate diagnosis requires a high index of clinical suspicion. Case report: A 16-year-old patient presented to the emergency department complaining of lower gastrointestinal tract bleeding. Laboratory examinations did not reveal significant findings, except a low hemoglobin value (Hgb: 11,3 g/dl- Hct: 35,3%). Rectos-copy and gastroscopy was unable to locate any site of the bleeding. The control chest and abdomen X-ray, and CT of the abdo-men failed to demonstrate any pathology, as well. The patient underwent scintigraphy with technetium T99 scan, which showed the presence of probable bleeding ectopic gastric mucosa in the left oblique abdomen. At operation, the diagnosis of bleeding Meckel?s diverticulum with ectopic gastric mucosa was confirmed and resection of the diverticulum was performed. The postop-erative course was uneventful and the patient was discharged on the fourth postoperative day. Conclusion: Meckel's diverticulum may experience serious complications such as bleeding, intestinal obstruction, inflammation, torsion or intussusception. Imaging tests are often non-specific and increased vigilance and suspicion is required.
178Inflammatory myofibroblastic tumor of the mesocolon revealed by an appendicular abscess. Case report and review of the literature
K. I. Majdoub Hassani , I.Toughrai , S.Ait laalim , K. Mazaz
Πλήρες Κείμενο | Περίληψη
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.
182Pedunculated cellular angiofibroma of the vulva. A rare tumor of soft tissue characteristic of the perineal region
J.A.Martin-Cartes , M. Bustos-Jimenez , M.J.Tamayo-Lopez , S. Garcia-Ruiz
Πλήρες Κείμενο | Περίληψη
We present the case of a huge pedunculated benign mesenchymal myxoid tumor that developed on the right labia majora of a 48-year-old-woman. Cellular angiofibroma (CAF) is a recently characterized histologically distinctive benign mesenchymal neoplasm originally de-scribed by Nuci et al in 1997. CAF has a predilection for the vulval region, and comprised by two principal components; cellular spindle cell and prominent stromal blood vessels. Characteristically CAF are small tumors (< 3 cm) that are generally well circum-scribed, typically arising in middle-aged patients (average age 47). By immunohistochemistry these cases are positive for vi-mentin and CD34 (60 %) but negative for actin and desmin, which is important in excluding many of the other vulvovaginal mes-enchymal lesions which enter into the differential diagnosis, such as angiomyxoma and angiomyofibroblastoma. CAFs are almost always positive for estrogen and progesterone receptors, suggesting that they probably arise from the hormone receptorpositive subepithelial mesenchymal layer from the lower female genital tract. We present herein a case of cellular angiofibroma,in a 42 year-old woman; who presented clinically as a Bartholin?s glandular cyst. CAFs belong to the group of fibrous spindle cell lesions that affect the vulva

Εικόνες στη χειρουργική
185Total excision of retroperitoneal peripancreatic tissues (mesopancreas) as an integral part of curative resection of periampullary cancer
K. Vasiliadis , C. Papavasiliou , P. Delivorias , C. Makridis
Πλήρες Κείμενο
187Cutaneous horn a rare case presentation
D. Patil , G. Umare , V. Jadhav
Πλήρες Κείμενο

Επιστολές προς Εκδότη
189Re: Conventional Ferguson?s versus ligature hemorrhoidectomy: our long term results in patients with symptomatic hemorrhoids? by M. Gunes , Y. Duzkoylu , F. D. Trablus , E. K?nac?. Surg Chron 2013; 18(1): 26-27
O. Irkorucu , E. Reyan , K. Cumhur Deger
Πλήρες Κείμενο