Περιεχομενα


Τόμος 19, Τεύχος 4
Οκτώβριος-Δεκέμβριος 2014


Ανασκοπήσεις
168Adult pancreatoblastoma
P. Chaudhary , U. Bhadana
Πλήρες Κείμενο | Περίληψη
Pancreatoblastomas are rare malignant aggressive epithelial neoplasm, primarily of childhood but accounting for less than 1% of all pancreatic tumors in adults. The etiology is unknown. Most of the patients present with symptoms related to the mass, or the mass may be an incidental finding and the symptoms are non-specific. Presenting features include pain, weight loss, nausea, vomiting and diarrhoea. They are often large and size varies from 1.5 to 20 cm. Pancreatoblastomas show acinar differentiation and squamoid nests and rarely, glandular or mesenchymal differentiation. Because of its rarity in adults, very little has been de-scribed in the literature on imaging of pancreatobastomas and, therefore, imaging studies cannot specifically diagnose pancre-atoblastomas. For localized disease, the treatment of choice is complete surgical resection and it is the only treatment associat-ed with long term disease free survival. There are no established chemotherapy regimens and moreover, chemotherapy and radiotherapy are only palliative. Because of its rarity in adults, most of our knowledge about pancreatoblastoma is based on in-dividual case reports and short case series. The aim of this article is to comprehensively review all the available literature and to present detailed information and an update on adult pancreatoblastoma.
173Adrenal tumors in children
A. Pereyaslov , S. Chooklin
Πλήρες Κείμενο | Περίληψη
Background: Adrenal tumors are one of the potentially fatal causes of childhood hypertension. Adrenal tumors in children are not so often pathology like in adults. The aim of this study was to review the authors? experience with management of adreno-cortical tumors in pediatric age group. Material and Methods: Hospital retro- and prospective review of all children with adrenocortical tumors treated during 20-years period was performed. Clinical and biochemical data were obtained during routine follow-up. Results: Thirty-nine children with adrenal tumors were treated. Among of them, 13 patients had Cushing?s syndrome, 9 ? pheo-chromocytomas, 3 ? androsteromas and mixed tumors, 2 ? esteromas, 1 ? Conn syndrome, 4 ? non-functioning tumors, and 3 ? adrenocortical cancers. According the results of our study 82% of patients had functional adrenal tumors, 10.3% ? non-functioning tumors, and 7.7% ? adrenocortical cancer. Thirty-seven children were operated. Among them the open adrenalec-tomy was performed in 23 children and the laparoscopic adrenalectomy was applied in 14 patients. There were no severe in-traoperative complications in both groups of patients. Conclusion: Surgery remains the only one method for the treatment of adrenocortical tumors. The laparoscopic adrenalectomy is the method of choice for the management of this pathology. However, as more patients become aware of the advantages of this procedure over conventional surgery, the demand for minimally invasive surgery will increase, and surgeons must be up to the challenge of meeting these demands.

Ερευνητικές εργασίες
179Postoperative complications after colorectal resection for colorectal cancer
Z. Adamova , R. Slovacek , J. Sankot , P. Vlcek
Πλήρες Κείμενο | Περίληψη
Background: Colorectal cancer surgery carries a high risk of postoperative mortality and morbidity. Our aim was to identify predictive risk factors for postoperative complications after colorectal resection . Methods: This is a retrospective study of 67 patients who underwent colorectal resection for colorectal cancer between 1/2010 and 6/2013. We evaluated influence of gender, age, nutritional status indicators (preoperative serum protein, albumin and prealbumin levels), body mass index, ASA score, diabetes mellitus and local tumor stage. To determine the risk factors for postoperative complications, statistical analyses were performed using Mann-Whitney U test and Fisher?s exact test. Results: A total of 27 (40%) complications (wound and systemic) were identified. Older patients, diabetics and those with higher ASA score have higher risk of other than wound complication (p= 0,01, p=0,03, p=0,02 respectively). Higher BMI prol onged the hospital stay (p=0,03). The most important risk factor for complications development (both incisional and systemic) and longer hospital stay was a poor nutritional status. Low preoperative albumin level seems to be the most important risk factor for both systemic complications (p=0,005) and wound complications (p=0,01). Conclusion: Good preoperative nutritional status (based on albumin level) is the most important factor for complication prevention in colorectal cancer surgery.
184The Effect Of Abdominal Wall Retention Sutures On Intra-Abdominal Pressure
H. Harissis , L. Papadopoulos , G. Lianos , G. Georgiou
Πλήρες Κείμενο | Περίληψη
Background: Abdominal wall retention sutures are widely used in every-day surgical practice, but their potential effect on intra-abdominal pressure (IAP) has not been studied. Methods: we conducted a non-randomized prospective, double-blind clinical trial that enrolled a total of 37 patients who un-derwent elective surgery for abdominal pathology. Measurement of the intra-abdominal pressure was performed on the first post-operative day using the Kron method. The control group consisted of 20 individuals that underwent a lower abdominal lap-arotomy procedure, with no use of retention sutures. The study group included 17 patients receiving a lower abdominal laparot-omy procedure with the use of retention sutures. Results: Mean values of IAP for patients belonging to control group was 18,78 (SD 3,61) mmHg, while mean IAP value in the study group was 16,58 (SD 3,82) mmHg, a difference that was not statistically significant (p=0,08). Conclusions: the use of retention sutures for abdominal wall incision closure does not affect intra-abdominal pressure in elective surgery patients
187Pneumothorax ? Questionnaire
E. Metaxas , S. Zaragkas , N. Condilis , N. Tzatzadakis , M. Gerazounis
Πλήρες Κείμενο | Περίληψη
The management of Pneumothorax (spontaneous or traumatic) need knowledge and experience not only from thoracic surgeon but also from every physician, especially from general surgeon and family doctor (general practician). Knowledge is power (Decartes). So every physician should be efficient-responsible to this. We study giving answers upon questionnaire to Pneumothorax (definition, classification management) by residents in General surgery in our hospital. From our study comes to light that the knowledge and experience of our residents is good but has to be even better.
190?Second-Look? laparoscopy in the management of acute mesenteric ischemia.
B. Papaziogas , I. Koutelidakis , G. Chatzimavroudis , A. Giakoustidis , P. Christopoulos , S. Atmatzidis , K. Atmatzidis , I. Makris
Πλήρες Κείμενο | Περίληψη
The aim of this study is to evaluate the of second-look laparoscopy in patients operated upon for acute intestinal ischemia Two patients with suspected acute intestinal ischemia were submitted to laparotomy, during which a segmental resection with primary anastomosis of the small bowel was performed. In both patients a 10mm Hassson-type trocar was placed through a small incision in the left iliac fossa. On the 2nd postoperative day the two patients were submitted to laparoscopy through the trocar with the addition of 1-2 supplementary 5mm trocars for the introduction of grasping forceps. No further ischemic altera-tions were observed, whereas the anastomotic line was intact and the remaining small intestine was healthy with adequate mo-tility. After the end of the procedure the trocar was removed. Both patients had an uneventful recovery. The performance of second-look laparoscopy is a very useful diagnostic tool in patients operated for acute intestinal ischemia, in order to avoid unnecessary laparotomy.
193Superior mesenteric artery aneurysm treated expectantly: Report of a Case
S. Ray , J. Biswas , S. Khamrui , P. Ray , A. Kr Das
Πλήρες Κείμενο | Περίληψη
Background: Superior mesenteric artery aneurysm (SMA) is a rare vascular disease. Because of high risk of complications, inter-vention is recommended whenever the diagnosis is made. The role of observation in SMA aneurysm is not well documented. Case Presentation:We report a case of SMA aneurysm in the background of polyarteritis nodosa. The diagnosis was made 10 years before he came to our institution. Because of high risk of surgery, his family refused surgery at the time of initial diagnosis and sought conservative treatments. At this admission, he presented with mild epigastric pain. As he was a diagnosed case of SMA aneurysm, CT angiography was performed which revealed a large SMA aneurysm with peripheral mural thrombus and calci-fication. As the patient remained well for about 10 years with expectant treatments, his family again refused intervention. His symptoms subsided with conservative therapy. He was discharged with advice of beta blocker therapy. The patient was well at 9-month follow-up. Conclusion:Expectant treatment in SMA aneurysm can be done only when the patient is not ready to undergo intervention or very high risk for intervention. Beta blocker should be recommended because it has some protective role.

Ενδιαφέρουσες περιπτώσεις
196A rare etiology of colonic occlusion: Cecal volvulus
I.Konat , A.Toure , M. Charfi , P.A. Ba , I. Ka , M. Seck , M. Cisse , C. Toure
Πλήρες Κείμενο | Περίληψη
Background. The cecal volvulus is an acute or chronic and recurrent cecum twisting. This is the second location after the sigmoid colon. This is a surgical emergency. Preoperative diagnosis is difficult and surgical treatment is controversial. We report our experience in the management of 2 cases of cecal volvulus in our Department in Dakar. Case Presentation. Case 1: A 38 years-old female patient, with no pathological individual history, was sent for an occlusive syndrome, lasting for 5 days. Abdominal examination revealed a symmetrical bloating, without defense or contracture. Blood cell count (BCC) objectified hyper leukocytosis at 11,900 / mm3 with neutrophil predominance (89%). An abdomen X-ray revealed small bowel and colic air-fluid levels. During clinic surveillance, the patient presented secondary fever to 38 °C and diffuse abdominal sensibility. Exploration by midline laparotomy objectified cecal volvulus in a clockwise spiral turn, with lesions of ischemia. She received cecal and 10 cm of terminal ileum resection with end-to- end ileocolic anastomosis. The postoperative course was uneventful. Case 2: A 40 years old male patient was received for an occlusive syndrome lasting for 3 days. Examination on admission had objectified a patient in fairly good condition, without fever. The abdomen was distended, with diffuse sensibility without defense or contracture. A blood cell count showed leucopenia with 4700 white cells/ mm3. Abdominal X-ray highlighted many small bowel type hydro-aeric levels. Rectal way enema was performed without improvement. The patient underwent laparotomy. In exploration, was objectified cecal volvulus with ileal involvement , the cecum was distended with ischemic lesions. We performed ileo - cecal resection. Restoration of continuity was done immediately by end-to-end ileocolic anastomosis. The postoperative course was uneventful. Conclusion : The cecal volvulus is a rare abdominal emergency. The surgical resection (ileocecal resection and right hemicolectomy ) gives the best immediate and long term results. Early diagnosis and prompt management before complications occurrence manage to reduce the mortality rate.
200Small Duct Chronic Pancreatitis: A Surgical Difficulty
S. Das , P. Kumar Sonar , S. Ghatak , S. Ray , S. Sanyal
Πλήρες Κείμενο | Περίληψη
Chronic pancreatitis requires surgery for intractable pain, suspicion of malignancy and complications. Hybrid procedure comprising pancreatic head coring and main pancreatic ductal decompression is nowadays standard of care where surgery is indicated for pain. This becomes difficult if main pancreatic duct is not dilated or the disease is of small duct origin. We encountered a case of small duct chronic pancreatitis with intractable pain. We cored out deseased pancreatic tissue without searching the undilated duct. We are presenting this case with suitable figures.
202Blunt abdominal injury and cystic lesion of liver (hydatid cyst). Considerations in diagnosis and treatment
P. Petras , A. Kambaroudis , D. Kokkonis , K. Kiroplastis , O. Giouleme , V. Georgopoulou , A. Diakou , Ch. Spyridis
Πλήρες Κείμενο | Περίληψη
Blunt abdominal injuries are commonly presented in the emergency department. The most commonly injured organs are spleen, liver and small intestine. Using new imaging techniques hydatid cyst of the liver is more often incidentally diagnosed. Management of a patient with hydatid cyst of the liver who had a blunt abdominal trauma is quite difficult. A 17 years old male after a blunt abdominal trauma was transferred at a rural hospital. The initial diagnosis using CT was hematoma of the right lobe of liver. The patient was hemodynamically stable and finally transferred to our department. The new imaging with CT and MRI and the serological tests revealed a complicated ruptured hydatid cyst of the liver. The patient received treatment with albendazole for 2 months and then underwent a surgical procedure (Right Hemi-hepatectomy) taking into account multiple factors (age, complications, morphological features of the cyst). There were no postoperative complications. CT scan is the gold standard in diagnosis of hydatid cyst. It is controversial what kind of treatment is the ideal for each patient. Treatment can be medical, surgical (conservative or radical surgical methods) or percutaneous drainage. After collaboration and close interaction between surgeons, radiologists and gastroenterologists we decided that the ideal method for our patient would be Right Hemi-hepatectomy even if Hydatidosis is considered to be a benign disease. Searching at the literature we concluded that patients treated with radical surgical approach have lower recurrence and complications rates than those treated with more conservative surgical or interventional methods if those patients are treated in well organized centers from an experienced HPB surgical team. The management of Hydatidosis of the liver can be a major problem especially in patients with co-morbidities. The new imaging techniques are very useful in the diagnosis of hydatidosis. Taking in to account the experience of the center and surgical team and special features of the patient, the majority of experts agree that a more radical surgical approach is the gold standard of treatment of Hydatid cysts of liver.
207Neglected Supra Pubic Catheter Harbinger of Bladder Calculi: A Case Report
Wasif Mohammad Ali , Syed Amjad Ali Rizv , Atia Zaka-ur-Rab
Πλήρες Κείμενο | Περίληψη
Secondary bladder calculi are the most common type of calculi found in adults. Secondary infection due to stasis and presence of foreign body are known pathogenetic factors.This article reports a rare case giving evidence of the influence of both these mechanisms and thus the importance of explaining the patient about catheter care at the time of discharge

Εκπαιδευτικό video
209Laparosopic management of perforated peptic ulcer
B. Papaziogas , I. Koutelidakis , S. Kapoulas , G. Papadakis , S. Kalaitzis , N. Voloudakis , G. Chatzimavroudis , I. Makris
Πλήρες Κείμενο | video



Εικόνες στη χειρουργική
210Urinary bladder diverticulum in an inguinal hernia - A rare intra-operative finding
D. Paramythiotis , M. Koptsis , K. Kofina , V. Papadopoulos , A. Michalopoulos , K. Papapolychroniadis , G. Basdanis
Πλήρες Κείμενο

Επιστολές προς Εκδότη
212Diverting Stoma in Rectal Surgery: A Necessity?
G. Aggarwal
Πλήρες Κείμενο
213Giant Hepatic Hydatid Cyst
I.Ece
Πλήρες Κείμενο
215The role of Human deficiency syndrome in the pathogenesis of Human papilloma virus
C. Sofoudis , X. Mantakas X
Πλήρες Κείμενο