Περιεχομενα


Τόμος 22, Τεύχος 4
Οκτώβριος-Δεκέμβριος 2017


Ανασκοπήσεις
157 Έκταση εκτομής οπισθοπεριτοναϊκών περιπαγκρεατικών νευρικών πλεγμά-των στο πλαίσιο της ριζικής-ογκολογικά άρτιας χειρουργικής αντιμετώπισης του αδενοκαρκινώματος των πόρων της κεφαλής του παγκρέατος
Κ. Βασιλειάδης
Πλήρες Κείμενο | Περίληψη
Η νευροτρόπος αύξηση του αδενοκαρκινώματος των πόρων της κεφαλής του παγκρέατος οδηγεί συχνά σε πρώιμη διήθηση των περιπαγκρεατικών νευρικών πλεγμάτων, γεγονός που αποτελεί βασικό αίτιο μετεγχειρητικής τοπικής υποτροπής της νόσου και θανάτου. Έτσι, η εκτομή του οπισθοπαγκρεατικού-οπσθοπεριτοναϊκού ιστού έχει αναγνωριστεί ως καθοριστικός χειρουργικός χρόνος για την επίτευξη R0 εκτομής. Όμως, ο ακριβής ρόλος της εκτομής του οπισθοπεριτοναϊκού-οπισθοπαγκρεατικού ιστού και της εκτεταμένης εκτομής των περιπαγκρεατικών νευρικών πλεγμάτων, στη μακροχρόνια επιβίωση των ασθενών εξακολου-θεί να αποτελεί θέμα αντιπαράθεσης. Σκοπός αυτής της μελέτης ανασκόπησης, είναι να περιγράψει τις σύγχρονες χειρουργι-κές τάσεις αναφορικά με το βέλτιστο όριο εκτομής του οπισθοπεριτοναϊκού περιπαγκρεατικού ιστού-περιπαγκρεατικών νευρι-κών πλεγμάτων, στο πλαίσιο της ριζικής χειρουργικής αντιμετώπισης του αδενοκαρκινώματος των πόρων της κεφαλής του πα-γκρέατος.
173CaroliΥs disease diagnosis and management: a clinical update
B. Morgado , P. Cabral Correia
Πλήρες Κείμενο | Περίληψη
Caroli's disease is a rare congenital malformation, included in the cystic diseases of the biliary tract, which is characterized by ectasia and dilation of the intrahepatic bile ducts. Two clinical entities can be distinguished, Caroli's disease in which congenital hepatic impairment is limited to cystic dilation, and Caroli's syndrome in which congenital hepatic fibrosis coexists. In both cases, an association with systemic pathology may occur, particularly involving the kidneys. Clinical features include jaundice, abdominal pain, and pruritus but some patients may be entirely asymptomatic. Recurrent bacterial cholangitis is the most common form of presentation. Symptomatic episodes usually begin in adolescence but can appear at any point in life. CaroliΥs syndrome is generally more insidious and usually presents with the consequences of portal hypertension due to underlying liver fibrosis. Ultrasound is frequently the best initial test but mag- netic resonance cholangiopancreatography is currently the examination of choice. Medical treatment for Caroli's disease in- cludes supportive care with antibacterial agents for cholangitis and ursodeoxycholic acid for lithiasis. Surgical resection is poten- tially curative in patients with monolobar disease. In patients with diffuse involvement, liver transplantation is the only effective modality. Patients should be closely followed with ultrasound and tumor markers given the high risk of cholangiocarcinoma

Ερευνητικές εργασίες
178Σύνδρομα μετά από μαστεκτομή
Α.Μ. Καϊμασίδου , Α. Ιγνατιάδης , Ρ. Ιωσηφίδου
Πλήρες Κείμενο | Περίληψη
Σκοπός. Σκοπός της παρούσας μελέτης είναι η διεξαγωγή μιας συστηματικής ανασκόπησης της βιβλιογραφίας για την εκτίμηση των αποτελεσμάτων σχετικά με τα σύνδρομα που εμφανίζονται μετά τη μαστεκτομή για να βοηθήσει στην καθοδήγηση της διαδικασίας λήψης αποφάσεων τόσο προεγχειρητικά όσο και μετεγχειρητικά. Μέθοδος.:Μελέτες από τις βάσεις δεδομένων Medline/PubMed και Cochrane που δημοσιεύθηκαν μέχρι και το 2017 και πλη-ρούσαν προκαθορισμένα κριτήρια ένταξης εντοπίστηκαν, αναλύθηκαν και συμπεριλήφθηκαν. Αποτελέσματα. Συνολικά 67 άρθρα συμπεριλήφθηκαν στη μελέτη οι συχνότερες άμεσες μετεγχειρητικές επιπλοκές περιλαμ-βάνουν τον οξύ μετεγχειρητικό πόνο, τη δημιουργία σερώματος και αιματώματος, την επιμόλυνση του τραύματος και τη νέ-κρωση του δερματικού κρημνού, ενώ τις συχνότερες και σοβαρότερες απώτερες μετεγχειρητικές επιπλοκές αποτελούν το λεμ-φοίδημα, το post mastectomy pain syndrome (PMPS) και το axillary web syndrome(cording). Συμπέρασμα. Η ανασκόπηση της τρέχουσας βιβλιογραφίας υποδηλώνει παρόμοια ποσοστά εμφάνισης μετεγχειρητικών επι-πλοκών. Η χειρουργική τεχνική, ο λεμφαδενικός καθαρισμός μασχάλης και η ακτινοθεραπεία της περιοχής σχετίζονται με υψη-λότερα ποσοστά εμφάνισης των συνδρόμων. Οι σύγχρονες χειρουργικές τεχνικές και κυρίως η χειρουργική προσέγγιση της μα-σχάλης μέσω του λεμφαδένα φρουρού έχουν συμβάλλει σημαντικά στον περιορισμό της εμφάνισης επιπλοκών.
184 Is obesity a risk factor for increased perioperative blood loss in South African primary hip arthroplasty patients?
N. M. van der Berg , P.V. Ryan , Y. Moodley
Πλήρες Κείμενο | Περίληψη
Background: The impact of obesity on perioperative blood loss following primary hip arthroplasty has not been described in a South African setting. This information could have important implications related to the perioperative management of obese South African primary hip arthroplasty patients. Our study sought to address this paucity in the literature.Patient and Methods: This was a matched cohort study of 40 (20 non-obese and 20 obese) patients who underwent primary hip arthroplasty at a tertiary South African hospital. Specifically, non-obese and obese primary hip arthroplasty patients were matched on established factors associated with perioperative blood loss. The estimated perioperative blood loss was deter- mined for each patient, and the mean estimated perioperative blood loss was then compared between the non-obese and obese patient groups using conventional statistical analysis methods for matched study data.Results: The estimated mean perioperative blood loss (in mL) for the non-obese and obese patient groups was 926.3 (Standard Deviation: 412.9) and 1298.5 (Standard Deviation: 595.3), respectively. A paired t-test suggested that the estimated mean peri- operative blood loss was statistically different between non-obese and obese patients (p=0.033).Conclusion: We found South African primary hip arthroplasty patients with obesity experienced higher levels of perioperative blood loss when compared with their non-obese counterparts
188Thyroid Cancer: Is hyperthyroidism protective?
C. Binarbaşı , K. C. Ozçelik , M. Demir , O. Karak?se , I. Zihni , H. Pülat , H. Eken , A. Fedayi
Πλήρες Κείμενο | Περίληψη
Introduction: In the past, hyperthyroidism was thought to be protective against thyroid cancer. However, the relationship be- tween thyroid stimulating hormone (TSH) and cancer has become more prominent within the last 15 years. In addition, surgical techniques related to thyroid cancer have also seen many changes over the past several years. In the current study, we review these changes in surgical techniques, and examine the relationship between thyroid functions and cancer development. Materials and methods: We retrospectively evaluated the records of 239 patients who underwent thyroidectomy in the General Surgery Department of I_stanbul Medeniyet University Faculty of Medicine between January 1999 and January 2014. Patients who underwent thyroidectomy between 1999 and 2006 were categorized in subgroup I, and those who underwent the surgery between 2006 and 2014 were categorized in subgroup II. Data from 2006 were included in both groups. There were 157 patients who had preoperative serum TSH levels that were either normal (0.27Π4.20 _IU/mL) or high (>4.20 _IU/mL); these patients were categorized in subgroup I for TSHΣ. There were 82 patients who had low preoperative serum TSH levels; these were categorized in subgroup II for TSHΣ.Results: Of the cases with thyroid cancer, 84.9% were women, 15.1% were men, and their mean age was 46.62±13.65 (16-80) years. Of the cases with thyroid cancer, 54.4% had papillary carcinoma, 37.2% had micropapillary carcinoma, 4.6% had follicular carcinoma, 3% had medullary carcinoma, and 0.8% had anaplastic carcinoma. When operation types were evaluated according to the years in which they were performed (1999-2014), the total thyroidectomy rate was significantly higher in Group II (2006- 2014) than in Group I (1999-2006, p<0.05). The bilateral subtotal thyroidectomy rate was significantly higher in Group I (1999- 2Ρ6, p<0.05). When we examined pathology results with respect to TSH levels, there was no significant association between TSH levels and papillary carcinoma or other carcinoma types (p>0.05). On the other hand, micropapillary carcinoma was signifi- cantly more frequent among patients with low TSH levels (p=0.003).Conclusion: The gold standard for the treatment of thyroid cancer is surgical resection, and currently, the most preferred opera- tion type is total or near-total thyroidectomy; this is due to its advantages related to recurrence and survival, as well as low complication rates.
194Is preoperative anaemia associated with poor postoperative outcomes in non-cardiac surgery patients?
Susan Mtshali , Yoshan Moodley
Πλήρες Κείμενο | Περίληψη
Background: Preoperative anaemia (PA), defined by the World Health Organisation (WHO) as a haemoglobin (Hb) measurement of <12.0 g/dL in women and <13.0 g/dL in men, is associated with poor postoperative outcomes (PPO) in overseas noncardiac surgery settings. This relationship has not been investigated in a South African (SA) setting. Addressing this gap in the knowledge would have implications related to perioperative risk stratification/perioperative blood management strategies in SA. Our study sought to answer the question: Is PA associated with PPO in SA noncardiac surgery patients?ΣPatients and Methods: We conducted a case-control analysis of data from the South African Surgical Outcomes StudyΣ to ad- dress our research question. Cases were defined as patients who suffered a PPO (either postoperative inpatient mortality or postoperative unplanned critical care admission), while controls were defined as patients who did not suffer a PPO. The sample size used in this case-control analysis was 624 patients, with a case-control ratio of 1:3. Preoperative anaemia was determined from preoperative Hb measurements using WHO definitions. Other patient/clinical characteristics were included in the data analysis in order to control for potential confounders. Data were analyzed using crude (chi-squared or FisherΥs Exact tests) and adjusted (unconditional logistic regression) statistical analysis.Results: After controlling for potential confounders, PA was associated with an almost two-fold higher risk of PPO in SA noncar- diac surgery patients (Odds Ratio: 1.93, 95% Confidence Interval: 1.20-3.11, p=0.007).Conclusion: Preoperative anaemia is an important risk factor for PPO in SA noncardiac surgery patients.
198Extended surgery for Non-Small Cell Lung Cancer (NSCLC)
C. N. Foroulis
Πλήρες Κείμενο | Περίληψη
Extended resections for Non-Small Cell Lung Cancer (NSCLC) are performed for the radical resection of locally advanced T3 and T4 tumors and it is required in less than 5% of all lung resections performed for NSCLC. Extended resections are complex proce- dures which include resection of lung parenchyma en bloc with the neighboring invaded by the tumor structures such as chest wall, diaphragm, spine, main carina or major mediastinal vessels. Exclusion of N2 disease is of paramount importance before any attempt to proceed with extended resection in NSCLC. The expected benefits of surgery are the better local control of the dis- ease, the prolongation of overall survival and the possible cure in 15-35% of the well selected patients for extended resection. The relatively high possibility of occult distant or mediastinal lymph node micrometastases at the time of surgery and the rela- tively high possibility of incomplete resection or open-close thoracotomy are the main drawbacks of extended resections for NSCLC. Induction treatment could result in effective tumor downstaging , indeed restaging of locally advanced tumors after in- duction treatment is a quite difficult process and the available PET criteria should be used for appropriate restaging. Extended resections after induction treatment are associated with increased morbidity and mortality rates.The completeness of resection and the absence of N2 disease are the main determinants of prolonged survival in locally ad- vanced tumors undergoing extended resection. Incomplete resections are associated with survival rates similar to that of no resection, while involvement of mediastinal nodes precludes any chance of cure
201Spectrum of disease and outcomes of patients presenting with obstructive jaundice in a setting with a high prevalence of HIV
K. Dunywa , F. Anderson , S. Mtshali , Y. Moodley
Πλήρες Κείμενο | Περίληψη
Background: Literature describing the presentation of obstructive jaundice (OJ) and subsequent clinical outcomes in a setting with a high prevalence of HIV, such as South Africa, is sparse. The objective of this study was to investigate differences in the presentation and clinical outcomes associated with OJ in HIV-uninfected (HIV-ve) and HIV-infected (HIV+ve) patients in a South African setting.Patients and Methods: This retrospective chart review study involved 100 patients with OJ who attended a South African regional/district hospital over a two year period. Data related to medical history (including HIV status, demographic information, clinical symptoms, and biochemical test results), and diagnostic investigations were collected for each patient. The clinical outcomes investigated in this study were diagnostic findings (benign or malignant), surgical intervention, and inpatient mortality. These variables were compared between HIV-ve and HIV+ve patient groups.Results: HIV-ve and HIV+ve patients differed in several aspects of clinical presentation, including: age (p<0.001), ethnicity (p<0.001), vomiting (p=0.013), and having >1 diagnostic test performed (p=0.034). Admission haemoglobin, platelet, and alkaline phosphatase levels were statistically different between HIV-ve and HIV+ve patients (p=0.005, p=0.028, and p=0.001). Pre-endoscopic retrograde cholangiopancreatography white cell counts and albumin levels were statistically different between HIV-ve and HIV+ve patients (p=0.036 and p=0.036). There were no differences in diagnostic findings or inpatient mortality between HIV-ve and HIV+ve patients (p=0.610 and p=0.457). Fewer HIV+ve patients underwent surgery when compared with HIV-ve patients (p=0.009).Conclusion: There are differences in certain aspects of clinical/biochemical presentation and clinical outcomes of OJ between HIV-ve and HIV+ve patients.

Ενδιαφέρουσες περιπτώσεις
206Reconstruction with rotation skin flap of acute retraction and mucocutaneous separation of colostomy
G.D. Lianos , N. Hasemaki , V. Tatsis , D. Nastos , M. Mitsis
Πλήρες Κείμενο | Περίληψη
Background. Mucocutaneous separation is reported as the detachment of the stoma from the skin, usually arises as an early complication and potentially can lead to infection, peritonitis and stomal stenosis.Case Presentation. Herein, we report a unique case of reconstruction with rotation skin flap of postoperative mucocutaneous separation after HartmannsΥ procedure in an 80-year-old Caucasian male.Discussion. In the majority of cases, mucocutaneous separation is treated conservatively. To the best of our knowledge, this is the first case suggesting reconstruction surgery for mucocutaneous stoma separation.Conclusion. In the era of personalized medicine, management of postoperative complications should be designed in line with patientsΥ characteristics
209Hepatic duct transection with biloma formation
Affirul Chairil Ariffin , Zamri Zuhdi , Azlanudin Azman , Ikhwan Sani Mohamad , Hairol Othman , Razman Jarmin
Πλήρες Κείμενο | Περίληψη
Background: A liver-related injury such as bile leak and biloma formation is common in high-grade liver injury (grade III-VI). The presentation is usually non-specific requiring a high index of suspicion in its diagnosis. Although this condition is considered benign, the implication of an untreated biloma is severe. Case presentation: We presented a case of a 25-year-old man who is involved in a road traffic accident and sustained multiple liver lacerations. Liver packing was done with no immediate complication. However, he developed an infected biloma during recovery. Magnetic resonance cholangiopancreatography confirmed a transected right hepatic duct. Biliary duct stenting and percutaneous was done successfully. Conclusion: Biloma is common in high-grade liver injury. Early diagnosis is needed to ensure treatment success.
212Non-Umbilical Metastases of a Pancreatic Adenocarcinoma: Case Report and Re-view of Literature
JH Lai , MS. Aznan , R. Reynu , MM. Taher , H. Firdaus , NR. Kosai
Πλήρες Κείμενο | Περίληψη
Cutaneous manifestation of a tumor arising from pancreas is rare. Even more rare is a non-umbilical cutaneous metastasis of a pan- creatic cancer. Non-umbilical cutaneous metastases pose a grave prognosis and is often the first presentation of an advanced cancer state. We report a case of non-umbilical cutaneous metastasis as the first presentation of a pancreatic carcinoma and present a brief literature review on the same
216An uncommon cause of persistent, life-threatening upper gastrointestinal bleeding
M.Markou , E.I.Efremidou , V.Vamvakerou , N. Liratzopoulos , A.Polychronidis
Πλήρες Κείμενο | Περίληψη
Introduction. GISTs of the duodenum occur in less than 4% of all cases and frequently involve the descending portion, while GISTs in the third part of the duodenum and massive bleeding are extremely rare.We report such a case of persistent, life- threatening hemorrhage.Case Presentation. A 50-year-old man with recurrent hematemesis and hemodynamic instability was referred from a regional hospital. Computed tomography scan and gastroscopy revealed an ulcerating tumor in the third part of the duodenum. Limited wedge resection of the tumor was successfully performed, while histopathology confirmed a duodenal GIST. Unfortunately, at 5- years the disease had recurred with multiple metastases.Conclusion. In cases of relatively large duodenal GISTs causing acute upper gastrointestinal hemorrhage, tumors can be treated with limited wedge resection. This is a preferable alternative as it leads to lower morbidity and mortality and has a comparable oncologic outcome to that of others procedures
219Infected Squamous Cell Carcinoma of the Gallbladder Resembling Liver Abscess
L.V. Meng , W.Z. Wan Zain , M.N.M. Hashim , N. Zawani Zainudin
Πλήρες Κείμενο | Περίληψη
Gallbladder carcinoma is an uncommon but yet an aggressive cancer. Due to its rarity and its vague presentations most patients pre- sent as an advanced stage. The common histological type of gallbladder cancer is adenocarcinoma and squamous cell carcinoma is one of the rare subtype of gallbladder carcinoma. According to Surveillance Epidemiology and End Results (SEER), the incidence of gallbladder carcinoma is estimated 2.5 per 100 000 persons in United States. Female to male ratio is 3:1 and the mean age is 65 years old. Despite advances in technology, sadly most of the cases present at the late stage of the disease and has poor prognosis. Herein, we report a case of infected squamous cell carcinoma of the gallbladder which mimics the features of liver abscess
221Stercoral perforation ofthe rectum:reportof two casesandliteraturereview
E.C. Kaptue , P. Gryc , A.D. Dia , R. Sondrotsy , S. Pandolfi , S. Frey , R. Frey , J.C. Barthel , I.Hawaril , F. Hassam
Πλήρες Κείμενο | Περίληψη
Stercoral perforation of the rectum is a rare live-threatening entity unknown by physicians, affecting mainly nursing home pa- tients. Its precise and early diagnosis which allows a rapid and adequate management in order to reduce the mortality rate re- mains a challenge for surgeons. We report here two cases of stercoral perforation of the rectum under peritoneal in elderly and frail patients managed by HartmanΥs intervention. Epidemiology, pathogenesis, clinical and treatment of this heavy price condi- tion will be discussed according to the current literature
226Male Occult Breast Cancer with Axillary Metastasis Π A rare encounter with challenging diagnosis
S.L. Kiat , S.J. Jasmin
Πλήρες Κείμενο | Περίληψη
Male breast cancer is rare. Occult breast cancer in male is even rarer. Occult breast cancer is the absence of clinical palpable breast tumour with undetectable breast lesion on imagining like ultrasound and mammogram. We report a case of 68 year old elderly man presented as an occult breast cancer with metastatic axillary lymphadenopathy and lymphoedema of the ipsilateral arm. Immunohistochemistry staining plays an important role in influencing tissue diagnosis of occult breast cancer. To date, treatment for occult breast cancer in male is still not well established

Εικόνες στη χειρουργική
229Giant Appendicolith Mimicking Gallstone Ileus
SM. Ikhwan , MG. Syed Adli Syed , M.R.A. Samad
Πλήρες Κείμενο

Εκπαιδευτικό video
231Laparoscopic repair of slipped fundoplication
B. Papaziogas , T. Kaltsikis , N. Voloudakis , M. Penlidis , L. Papathanasiou , I. Koutelidakis , G. Chatzimavroudis , AM. Kaimassidou , E. Christoforidis
Πλήρες Κείμενο | video



Επιστολές προς Εκδότη
232Illuminating the life and scientific work of Abraham Vater (1684-1751)
K.N. Koutsouflianiotis , G.K. Paraskevas , B. Papaziogas , K. Iliou , N. Kalitsa , T. Bitsis , G. Noussios
Πλήρες Κείμενο | Περίληψη
One of the most known clinical and surgical anatomical eponyms is that of the ampulla of VaterΣ in recognition of the famous Anatomist Abraham Vater, who among others scientists discovered the hepatopancreatic ampulla. An effort is made in the cur- rent study to introduce the reader into the life, the scientific work and some personal aspects of Abraham Vater. The quality of the personality of the famous anatomist apart from his scientific discoveries could be an example to every modern scientist while seeking his path into the scientific community
235Words Matter
P. Gavriilidis
Πλήρες Κείμενο
236Large Malignant ProliferatingTrichilemmal Tumor of The Scalp
A. Jagwani , K Palaniandy , M. Azizi
Πλήρες Κείμενο
239Priapism as an initial presentation of chronic myelogenous leukemia
A. Adham , Y. Azhan , N. Azam
Πλήρες Κείμενο
240Primary Breast Angiosarcom
BP. Balakumaran , S. Abirami , EHB Ng , I. Mazita , M. Kirubakaran , YW Yan
Πλήρες Κείμενο