Περιεχομενα


Τόμος 23, Τεύχος 3
Ιούλιος- Σεπτέμβριος 2018


Ερευνητικές εργασίες
157Management of choledocholithiasis: current opinions and personal experience
P. Cianci , N. Tartaglia , A. Fersini , A. Ambrosi , V. Neri
Πλήρες Κείμενο | Περίληψη
Background: The main therapeutic choices for choledocholithiasis are between endoscopic approach and laparoscopic approach. Usually the option for endoscopic or laparoscopic approach is largely connetted by the experience of the surgeons and endoscopists. The purpose of this study was to demonstrate the advantages, high success rate, contained morbidity, prevention of possible recurrent pancreatitis in our management experience.Material and Methods: in the period june 2000-june 2017 we have observed and treated 167 patients with choledocholithiasis without pancreatic involvement. In the same period we have treated 351 patients with acute pancreatitis; the majority of these cases was of biliary etiology. In all our patients the certain diagnosis of choledocholithiasis has been performed preoperatively with the usual diagnostic procedures, from the suspicious clinical data as biliary colic, laboratory data as increase of cholestasis indexes, instrumental data as CBD dilation, to direct detection of CBD stones by US or, more frequently, by MRCP or, in few cases with highest risk patients of choledocholithiasis, by ERC, employed simultaneously as diagnostic and therapeutic procedure.Results: ERC has been performed in 148 patients for therapeutic purpose of stones removal, at the same time of the diagnostic confirmation. The therapeutic success rate of ERC has been 89,18% (132 patients). All patients were submitted to laparoscopic cholecystectomy, waiting steady pancreatic conditions after ERC, usually after 5-7 days. We observed 9 cases (6,08%) of unbelical port-site infection treated with medical therapy and 3 umbelical hernias (2,02%). Complications post-ERC were: 1 duodenal perforation (0,6%), 3 severe acute pancreatitis, 2 hemorrhage, treated with medical approach.Conclusion: Our choice is sequential procedure ERCP/ES, CBD cleaning, LC. This choice is based on high frequency of small and moved stones and high success rates, very low morbidity of this procedure.
162Η χειρουργική αντιμετώπιση των παθήσεων του θυρεοειδούς αδένα. Επιδημιολογικά χαρακτηριστικά και επιπλοκές σε 303 ασθενείς που υποβλήθηκαν σε θυρεοειδεκτομή
Κ. Κασπαριάν , Α. Κοκολάκης , Α. Τοουλιάς , Ι. Α. Ζιώγας , Σ. Μηλιαράς , B. Παπαδόπουλος
Πλήρες Κείμενο | Περίληψη
Σκοπός: Οι παθήσεις του θυρεοειδούς αδένα αποτελούν ένα από τα συχνότερα θέματα ενδοκρινικής χειρουργικής τις τελευταίες δεκαετίες. Η επιλογή της καταλληλότερης χειρουργικής προσέγγισης για την ασφαλή και αποτελεσματική τους αντιμετώπιση απο-τελεί σημείο μεγάλης συζήτησης. Οι συχνότερα εμφανιζόμενες και σοβαρότερες επιπλοκές μίας χειρουργικής επέμβασης στο θυ-ρεοειδή αδένα, είναι η βλάβη του παλίνδρομου λαρυγγικού νεύρου, ο υποπαραθυρεοειδισμός και το μετεγχειρητικό αιμάτωμα στην τραχηλική χώρα. Σκοπός της παρούσας μελέτης αποτελεί η παρουσίαση και αξιολόγηση των αποτελεσμάτων του κέντρου μας, στην αντιμετώπιση των παθήσεων του θυρεοειδούς αδένα.Υλικό και Μέθοδος: Στα πλαίσια της έρευνάς μας μελετήθηκαν, αναδρομικά, οι φάκελοι των ασθενών που υποβλήθηκαν σε χει-ρουργική επέμβαση του θυρεοειδούς αδένα, στην Α’ Χειρουργική Κλινική Α.Π.Θ. του Γενικού Νοσοκομείου Παπαγεωργίου, Θεσσα-λονίκης, από το Φεβρουάριο του 2009 έως το Φεβρουάριο του 2017. Καταγράφηκαν ο τύπος της θυρεοειδεκτομής (ολική, υφολική, λοβεκτομή), η έκθεση της ιστοπαθολογικής εξέτασης, καθώς και οι εκάστοτε μετεγχειρητικές επιπλοκές, όπως ο υποπαραθυρεοει-δισμός, η υπασβεστιαιμία, το βράγχος φωνής και η μετεγχειρητική αιμορραγία.Αποτελέσματα: Από τους συνολικά 303 ασθενείς που υποβλήθηκαν σε επέμβαση του θυρεοειδούς αδένα, στους 276 επιλέχθηκε ως καταλληλότερη θεραπεία η ολική θυρεοειδεκτομή, στους 2 η σχεδόν ολική, στους 6 η υφολική θυρεοειδεκτομή, ενώ στους 13 προτιμήθηκε η λοβεκτομή και σε 3 ασθενείς η επέμβαση κατά Hartley-Dunhill. Σε ό,τι αφορά στις μετεγχειρητικές επιπλοκές, από τους παραπάνω ασθενείς, οι 8 εμφάνισαν βράγχος φωνής (2,64%), οι 3 μετεγχειρητικό αιμάτωμα στην τραχηλική χώρα (0,99%) και οι 8 συμπτωματική υπασβεστιαιμία (4,61%).Συμπεράσματα: Από τα αποτελέσματα της παρούσας μελέτης φαίνεται ότι η ολική θυρεοειδεκτομή αποτελεί ασφαλής επέμβαση στην αντιμετώπιση των παθήσεων του αδένα. Η ολική θυρεοειδεκτομή αποτελεί, σήμερα, τη μέθοδο εκλογής για την αντιμετώπιση των χειρουργικών παθήσεων του θυρεοειδούς αδένα, βάσει των αποτελεσμάτων της κλινικής μας μελέτης.
167Prognostic Value of Neutrophil / Lymphocyte Ratio and Mean Platelet Volume Value in the Diagnosis of Acute Appendicitis
A. Senlikci , R. Guven
Πλήρες Κείμενο | Περίληψη
Aim: Although acute appendicitis is the most frequently observed disease requiring emergency surgery., diagnosis is difficult. Delay in diagnosis also increases possibility of complications. In this study, we aimed to evaluate the usefulness of NLR and MPV values in diagnosing acute appendicitis and to differentiate between simple and complicated appendicitis.Methods: Records of 620 patients who underwent appendectomy in a 6 year period were reviewed retrospectively. Based on pathology examination, the cases were grouped as non-appendicitis (Group 1), uncomplicated (Group 2) and complicated (Group 3) cases. Preoperative white blood cell, neutrophil/lymphocyte ratio and mean platelet volume were noted.Results: There was a statistically significant difference between WBC and NLR values when Group I and Group II-III were compared. No statistically significant difference was found between age, sex and MPV values. There was statistically significant difference between WBC and NLR values when group II and group III were compared. No statistically significant difference was found between age, sex and MPV values.Conclusion: NLR value is useful in diagnosing acute appendicitis and to differentiate between simple and complicated appendicitis but MPV value is concluded that there is no diagnostic value in the diagnosis of acute appendicitis and to differentiate between simple and complicated appendicitis.
170Postoperative major adverse cardiovascular events in South African non-cardiac surgery patients: Does gender play a role?
N. Padayachee , C. Rout , Y. Moodley
Πλήρες Κείμενο | Περίληψη
Background: Evidence from overseas non-cardiac surgery settings suggests a possible gender disparity in postoperative cardio-vascular complications. This has yet to be studied in a South African (SA) population, where it could have important implications related to perioperative cardiovascular risk stratification and risk communication during the informed consent process. This was the impetus for our study.Patients and Methods: We performed a matched case-control analysis of data from a pre-existing registry of non-cardiac sur-gery patients who attended a tertiary-level SA hospital. Data related to age, gender, and established cardiovascular risk factors were collected for each patient as part of the registry. The study sample size was 112 patients (case:control ratio of 1:1). Cases were defined as patients who suffered postoperative major adverse cardiovascular events (MACE), a composite inpatient out-come of postoperative myocardial infarction, stroke, or all-cause mortality. Controls were patients who did not suffer postoper-ative MACE. Data were analysed using recommended statistical analysis methods for matched case-control studies.Results: When all potential confounders are accounted for, neither an equivocal harmful nor an equivocal protective independ-ent statistical association between gender and postoperative MACE could be established in our study (Odds ratio: 0.73, 95% Con-fidence interval: 0.33-1.63; p=0.438).Conclusion: We found the association between gender and postoperative MACE in SA non-cardiac surgery patients to be un-clear. Further research is required to establish the relationship between gender and postoperative MACE in SA settings.

Ενδιαφέρουσες περιπτώσεις
174Surgical management of tracheobronchial ruptures without concomitant injury
AM. Shamsuddin , A. Zuhdi Mamat , M. Ziyadi Ghazali
Πλήρες Κείμενο | Περίληψη
Background: A tracheobronchial rupture is a life-threatening situation and usually involved with high impact trauma. Isolated tracheobronchial ruptures without concomitant vascular injury are rare.Methods: 2 patients presented to us from 2003 until 2018 with post-traumatic isolated complete tracheobronchial transection. The tentative diagnosis was based on clinical features and repeated chest x-rays. Only 1 patient had computed scan (CT) for con-firmation of diagnosis. Bronchoscopy was not performed in both cases due to hemodynamics instability. 1 patient required im-mediate surgical exploration, while the other was performed on day 7 post trauma. During surgical exploration, 1 patient had complete tear of the left main bronchus, whilst the other had a complete tear of the right intermediate bronchus. Both patients had complete transverse tear, while 1 patient had combination with transverse tear of the proximal bronchus.Results: After surgery, both patients required prolonged ventilation, ranging from 3-10 days, with mean hospital stays ranging from 15 to 23 days. The follow up was done ranging from 1 to 7 months, with no early or late deaths, and without clinical deteri-oration.Conclusions: Early identification is crucial in management of this lesion. The diagnostic dilemma (repeated chest x-ray vs CT scan vs bronchoscopy) remains a challenge to achieve the correct diagnosis. However, surgical repair ensures a good outcome in managing this critical life-threatening condition.
177Thoracoscopic enucleation of esophageal schwannoma
S. M. Mohammed , S. Gulati , A. Kar , R. V. Mithun , M. Chhabra , M. Agarwal , A. Bhattacharyya , T. Dhar , S. Ghatak
Πλήρες Κείμενο | Περίληψη
Benign tumors of esophagus are uncommon and constitute 2% of all esophageal tumors. Leiomyoma is the most common benign neoplasm , schwannomas being extremely rare. Our patient was diagnosed to have asubmucosal esophageal tumor which was enucleated thoracoscopically. On histopathological examination it was found to be schwannoma.In comparison to open surgery thoracoscopic surgery is less invasive, requires shorter hospital stay and postoperative pain is less at the wound site.
179Ruptured Popliteal Artery Aneurysm - a Rare Entity yet a Great Mimic
JH Lai , S. Lenny , K. Krishna , I. Azim I , H. Harunarashid
Πλήρες Κείμενο | Περίληψη
Popliteal artery aneurysm is rare, even rarer is a ruptured one. A 75-year-old man had painful swelling of left leg. Several days before the symptoms onset, he had left foot gouty attack rendering him relatively immobile. On examination, he was pale but hemodynam-ically stable. The leg was tender, warm and edematous. Doppler signals of lower limb arteries were present. With the initial impres-sion of deep vein thrombosis, duplex ultrasound was performed which surprisingly suggested a popliteal pseudoaneurysm. Subse-quently, computed tomography angiography revealed a ruptured left and a concomitant unruptured right popliteal artery aneurysm. Emergency exploration and ligation of the aneurysm was done followed by saphenous vein bypass graft of superficial femoral to be-low-knee popliteal artery. The manifestations of a ruptured popliteal aneurysm are relatively nonspecific. It can mimic various com-mon diseases notably deep vein thrombosis. A high index of suspicion is needed
182Asymptomatic migrating fish bone to the skin: A rare presentation
S. Aisyah Aliyas , L. Ghazali , K. Abdullah , I. Mohamad
Πλήρες Κείμενο | Περίληψη
Background: Fish bone is one of the commonest foreign body of aerodigestive tract encountered in adult. Presentations include foreign body sensation, odynophagia and dysphagia. It may also present with complications such as injury to neighboring struc-tures such as big vessels, development of neck abscess or perforation of oesophagus. It has a tendency to migrate to adjacent structure due to the sharp-pointed edge in nature facilitated by neck movements.Case presentation: An elderly male presented with whitish foreign body emerging from the anterior part of the neck. He admit-ted had ingested a fish bone 2 weeks prior. Radiograph confirmed the fish bone location. It was removed completely in clinic. The migrating fish bone bypassed the vital structures and projected through the anterior neck of the patient.Conclusion: On extremely rare occasions, the migrated fish bone can extrude without any complication, spontaneously and safe-ly through the neck.
185Surgical management of a duodenal Gastrointestinal Stromal Tumor
M. Ikhwan Sani , J. Shindoh , Y. Nishioka , M. Hashimoto
Πλήρες Κείμενο | Περίληψη
Duodenal Gastrointestinal Tumour (GIST) is a very rare entity of its type. However, it represent a unique dilemma in choosing the right surgical methods to ensure completeness of resection with minimal operative morbidities. We presented a case of an-80-year-old man who presented with recurrent history of upper gastrointestinal bleeding. Serial OesophagoGastroDuodenoscopy (OGDS) showed bleeding arise from mass at second part of duodenum. Biopsy revealed proliferation of spindle cell type which represent GIST. He successfully underwent local resection with negative margin
188Migration of ventriculoperitoneal shunt into the bladder with protrusion from urethral meatus: A rare presentation
MF. Ghazali , M. Ikhwan Sani , WM. Mokhzani , AH. Azhar
Πλήρες Κείμενο | Περίληψη
Ventriculoperitoneal (VP) shunt surgery is the most common treatment procedure in managing hydrocephalus. Although it is consid-ered to be safe, many complications can occur including migration of the distal tip of VP shunt into various nearby organs. Many literatures have been reported regarding the migration site including colon, oral cavity, heart, vagina and rarely bladder. We re-ported a case of a-42-year-old gentleman who had removal of VP shunt 2 months prior to presentation at Urology Clinic with urinary tract infection symptoms and was investigated for stone disease. However he came to emergency department with painful micturi-tion and protrusion of foreign body at his urethral meatus and noted to be tip of VP shunt. The foreign body was self-dislodged dur-ing admission that required no surgical intervention
191The Chameleon Breast Cancer: Breast Ductal Carcinoma to Metaplastic Carcinoma– A Change in Cancer Morphology
I. Chik , A. Norlia , Y. Azyani
Πλήρες Κείμενο | Περίληψη
Metaplastic breast carcinoma (MBC) is a rare malignancy and represents 1% of all newly diagnosed breast cancers. The cellular components of MBC may consist of mesenchymal, epithelial or poorly differentiated adenocarcinoma, or a mix of two cell line-age. In comparison, infiltrating ductal carcinoma originates from ductal cells.In this is a case report, we describe a patient diagnosed of metaplastic breast carcinoma, which developed over a mastectomy scar of a patient with previous infiltrating ductal carcinoma.We discuss the possible pathophysiology of developing two different types of breast cancer as we believe this is a first occur-rence ever reported, with an unknown pathophysiology.

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Επιστολές προς Εκδότη
195Granulomatous appendicitis
Ahmad Adham Ali , Huzairi Yaacob
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197Hidradenocarcinoma of the Breast
YC. Chong , HH. Yoong , I. Khalid , Z. Zakaria
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199Locally Advanced Papillary Thyroid Carcinoma infiltrating trachea and oesophagus
YL Quek , N.F.A. Rashid , S.N. Abdullah Suhaimi
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