Introduction: Gallbladder polyps are more common than is commonly believed. They encompass any lesions that protrude or rise from the surface of the gallbladder mucosa. Materials: We treated 112 patients with gallbladder polyps, all of whom underwent laparoscopic cholecystectomy. Results: Most frequently, polyps were localized in the body of the gallbladder (60.7%). Polyps were found in the gallbladder fundus in 33 patients (29.5%), and in the neck of the gallbladder in 12 patients (10.7%). In cases of multiple polyps, the location was determined by the largest polyp. The location of the polyp in specific anatomical regions of the gallbladder had no significant bearing on clinical symptoms. After cholecystectomy and histological examination of the polyps, we identified 7 patients with adenocarcinoma (6.2%). Differentiated adenocarcinoma predominated (4 patients). Severe pain in the right upper quadrant of the abdomen was less common in patients with adenocarcinoma (p = 0.05). For adenoma, pain that occurred after eating was predominant (p = 0.021) and accompanied by positive Ortner (p = 0.055) and Murphy (p = 0.005) symptoms. Patients with adenoma more frequently reported a loss of appetite (p = 0.017) and a deterioration in well-being (p = 0.005). Conclusions: The location of the polyp in different anatomical areas of the gallbladder results in varying clinical symptoms. The frequency of adenocarcinoma in patients with gallbladder polyps is 6.2%. The most common histological variant was differentiated adenocarcinoma.

Objectives: The purpose of this study was to evaluate the effectiveness of laparoscopic TAPE surgery versus open surgery for suprapubic ventral hernias. Methods: Over the course of a year, a randomized comparative study was done in the surgery department at ABVIMS and Dr. RML Hospital in New Delhi. A total of 24 ventral hernia patients were enrolled, and they were randomly assigned to one of two groups: Laparoscopic TAPE repair and an open retrorectus operation were both carried out (n = 12 each). All of the patients had SPH hernias. Surgery results were compared between patients. Results: Compared to the TAPE group, the ORR group’s surgery took considerably longer (107.5 9.65 vs 83.58 8.97, P.0001); however, postoperative pain levels were similar on days 1, 2, 14, 30, 60, and 90 (P > 0.05). Comparable seroma (16.67% vs 8.33%, p = 1), shoulder tip pain (0% vs 8.33%, p = 1), significantly longer post-operative hospital stay (days) (4.33 vs 0.65 vs 2.83 vs 0.39, p.0001), and significantly longer time to resume normal activity (days) (14 vs 1.6 vs 6.67 vs 0.98, p. The TAPE group underwent surgery for a considerably shorter period of time than the ORR group (83.58 8.97 vs 107.5 9.65, P.0001); postoperative pain levels were similar on days 1, 2, 14, 30, 60, and 90 (P > 0.05). TAPE group experienced comparable seroma (8.33% vs 16.67%, p = 1) and shoulder tip pain (8.33% vs 0%, p = 1), significantly shorter post-operative hospital stays (2.83 0.39 vs 4.33 0.65 vs, p.0001), and significantly shorter recovery times (6.67 0.98 vs 14 1.6 days, p.0001) before returning to normal activity. In summary, TAPE repair outperformed open repair in terms of postoperative discomfort, hospital stay, and time to resume regular activities. The short-term outcomes were positive, and TAPE treatment appears to be a promising alternative to open repair for suprapubic ventral hernia repair. TAPE, however, takes more expertise compared to open repair.

Background: Neoadjuvant chemotherapy in gastric cancer has many advantages including tumor downsizing that reduces intraoperative dissemination, enhances R0 resection rates, improves the tumor prognosis, and assesses the tumor sensitivity to chemotherapeutic agents. Methods: In this case series, fifty-one patients with gastric cancer were admitted for standard gastrectomy and D2 lymphadenectomy in the Department of Surgical Oncology, Oncology Center, Mansoura University after neoadjuvant chemotherapy (NACT) between July 2010 and March 2021, with the assessment of the operative and postoperative outcomes. Results: Twenty-four patients had open gastrectomy and twenty-seven patients had laparoscopic gastrectomy. Distal gastrectomy was done in 26 patients, total gastrectomy in 22 patients, and proximal gastrectomy in one patient. The operative time was 309.31 ± 93.37 min and EBL was 169.02 ± 72.97 ml. Forty-nine patients had R0 resection and only 2 patients had advanced disease with extensive peritoneal dissemination. The oral intake was started within 4 days. Seventeen patients had Clavien Dindo (CD) grade II postoperative complications, and six patients had CD grade III. The mean hospital stay was 7 days (range 2-25 days). Conclusion: Neoadjuvant chemotherapy has a beneficial effect on gastric cancer surgery, regarding the operative outcomes, however, it may increase the rate of postoperative complications. It has a significant impact on the patients’ disease-free and overall survival.

Background: The management of patients with secondary peritonitis remains a great surgical challenge. Both open abdomen (OA) and primary closure (PC) approaches have been described after adequate source control with conflicting results regarding which technique is better. With the lack of Egyptian studies regarding that perspective, we conducted the present trial to compare the OA and PC approaches in patients with secondary peritonitis scheduled for emergency laparotomy. Methods: We enrolled 318 patients in this prospective trial: 156 patients in the OA group and 162 cases in the PC group. Results: All preoperative parameters expressed no significant differences between the OA and PC groups. However, after the procedure, there was a significant rise in intraabdominal pressure in the latter group (26.15 vs. 20.47 mmHg in the other group). Additionally, the compartmental syndrome was frequently encountered in the PC group. The incidence of postoperative complications was comparable between the two groups, apart from wound infection, which increased significantly in the OA group. The hospitalization period also increased in the OA group due to the need for definite abdominal closure. Moreover, mortality was significantly higher in the OA group (28.8% vs. 19.1% in the PC group). Nonetheless, the etiology of mortality did not differ between the two approaches. Conclusion: Both primary OA and PC are valid options for the management of patients undergoing emergency laparotomy. However, every approach has its pros and cons. The risks and benefits of each approach should be weighted according to patient and disease criteria.

Introduction: Pancreatic fibrosis is characterized by the accumulation of fibrous tissue in the pancreas, which leads to disruption of the structure and function of the organ. It plays a key role in the pathogenesis of chronic pancreatitis and pancreatic cancer. Early diagnosis and staging of pancreatic fibrosis are important but remain challenging. Materials and methods: We conducted a retrospective analysis of 121 patients following pancreaticoduodenectomy. Density measurements of the pancreatic tissue were performed during preoperative CT scans. The obtained data were compared with the results of histological assessment of fibrosis percentage. Correlation and ROC analyses were utilized for statistical analysis. Results: We identified a strong positive correlation between pancreatic tissue density on CT and the percentage of histological fibrosis (r = 0.983, p 0.01). An optimal density threshold of 36.06 HU was established for differentiating between “soft” and “hard” pancreatic tissue (AUC 0.93). Higher density was associated with a lower risk and severity of postoperative pancreatic fistula. Conclusion: Quantitative assessment of pancreatic tissue density on CT represents a promising non-invasive method for evaluating pancreatic fibrosis and predicting postoperative outcomes.

Objectives: Breast cancer is the most common malignancy all over the world and its recurrence constitutes a burden on both patients and their managing doctors. The extent of axillary lymph node dissection is a controversial factor that may affect recurrence of breast cancer, this study aimed to find the effect of the number of excised axillary lymph nodes during modified radical mastectomy on breast cancer recurrence. Methods: A retrospective study that reviewed the medical records of consecutive female patients in Basrah Oncology Centre from January 1, 2010 to December 31, 2019 included a total of 490 female patients who were diagnosed with stage I-III breast cancer and all of them underwent modified radical mastectomy and axillary lymph nodes dissection. Results: A 350 (71.5%) of patients had no recurrence during the study period and 140 (28.5%) patients presented with recurrence and 7.7% of total number of studied patients had loco-regional recurrence. Conclusion: Factors that had statistically significant association with recurrence of breast cancer after modified radical mastectomy

Background: Abdominal visceral perfusion can be measured by measuring the abdominal pressure. Decrease perfusion leads to metabolic acidosis and hence resulting in increased levels of lactate in the peritoneal fluid and blood. Therefore, it becomes imperative to measure the intra-abdominal pressure and make a correlation with hypoperfusion. The rise in the lactate levels of the peritoneal fluid is much more rapid and sensitive as compared to that of blood lactate levels. All these factors make peritoneal fluid lactate a potent early diagnostic tool for measuring intra-abdominal pressure and may have a bearing on the early recognition of increased intra-abdominal pressure. This study is done with aim to measure, compare & correlate the levels of plasma and peritoneal lactate and intra-abdominal pressure in patients of severe acute pancreatitis, peritonitis and acute intestinal obstruction. Material & methods: This prospective observational study was conducted in the department of Surgery and Biochemistry for two years. Fifty nine patients were inducted in the study based on inclusion and exclusion criteria, presenting with acute abdominal pain attributed to intra-abdominal pathology. Results: We found increased peritoneal fluid lactate (183.49 ± 27.70 mg/dl vs 81.71 ± 29.87 mg/dl) and plasma lactate levels (10.25 ± 3.76 mg/dl vs 8.74 ± 3.16 mg/dl) in patients who had high intra-abdominal pressure compared to normal intra-abdominal pressure. Although, the level of peritoneal fluid was significantly higher than that of the plasma lactate. level of peritoneal fluid was significantly higher than that of the plasma lactate. Conclusion: There was an increase in peritoneal fluid lactate compared to plasma lactate, significantly higher in the surgical group, suggesting peritoneal fluid lactate as a more sensitive indicator of bowel ischemia.

Determination of optimal surgical approach for descending necrotizing mediastinitis (DNM) treatment still remains a challenging issue due to absence of guidelines or well-designed prospected multicenter studies. The aim of the study was to evaluate the results of patients with DNM treatment depending on spread of mediastinum lesions, characteristics of clinical course and surgical tactics. 27 patients were included in the study. The patients were assigned to groups according to Endo S. et al. and Sugio K. et al. mediastinitis classification. We investigated the cause of infection and its causative agents, time interval from symptoms onset to hospitalization, time of antibiotics administration, presence of comorbidities including diabetes mellitus, SIRS or sepsis arise during treatment, clinical course of the disease and peculiarities of surgical management. Development of types I, IIA, IIB DNM is associated with odontogenic or pharyngeal source of infection including pharyngeo-esophageal perforations. Types I, IIB, IIC – with pharyngeal infection. Patients with type I DNM have high risk of infection dissemination to inferior mediastinum in early postoperative period and requires CT monitoring during first 48-72 hours in case of certain positive clinical dynamic presence. Combined mediastinotomy in patients with type IIA DNM can require either right-sided or left-sided incision. Thoracoscopic mediastinotomy is expedient and perspective approach for treatment of patients with type IIC DNM. Fulminant clinical course with early DNM verification (2nd-4th day) suggest for high causative agents virulence and host inability to limit infection spreading. Potential predictors of unfavorable DNM course could be odontogenic etiology, presence of decompensated comorbidities and severe patient condition at the time of hospitalization.

Objective: Percutaneous dilatational tracheostomy is more comfortable and convenient for the patient in need of prolonged mechanical ventilation in intensive care units. During the procedure, retraction of the endotracheal tube and ventilation with a laryngeal mask are used to ensure airway safety. In our study, we aimed to find the efficacy and safety of these two techniques. Design: Our study was performed in patients in whom tracheostomy was planned due to the need for prolonged mechanical ventilation in the adult intensive care unit of Bolu Izzet Baysal State Hospital. Ethics committee permission was obtained. Place & duration of study: Our study was conducted in patients who underwent PDT between 01 April 2023 and 31 August 2023 in Izzet Baysal State Hospital. Materials and metohds: Demographic data of the patients were recorded. Anaesthesia preferences, duration of the procedure, blood tests, status of airway equipment renewal, complication status and mortality were recorded prospectively. Results: A total of 53 patients, 23 of whom were female, were included in the study. Twenty-six patients who underwent the procedure by retracting the endotracheal tube assigned as group 1 and 27 patients who underwent laryngeal mask were assigned as group 2. The most common comorbidity was neurological disorder with 33 patients (62.3%). There was no difference between the two groups in terms of blood tests, arterial blood gas analyses, propofol dose, mortality and development of complications. Group 1 required more rocuronium and reintubation, and the duration of the procedure was significantly longer. Conclusion: There is no difference in mortality and complication development between percutaneous dilatational tracheostomy using laryngeal mask and endotracheal tube. The use of laryngeal mask is safe and effective, especially in intensive care units with fewer staff.

Background: A protective ileostomy performed in patients with risky colorectal anastomosis is considered a good practice to prevent anastomotic leakage. A derivative ostomy seems to be able to minimize the clinical consequences of an anastomotic leakage, but not to prevent it. This study examined whether ghost ileostomy is a safe alternative to the current reference standard of conventional loop ileostomy in patients with risky colorectal anastomosis. Patients and methods: This study included 60 patients admitted to Oncology Center Mansoura University, Egypt that had undergone colorectal surgery. A total of 34 patients underwent ghost ileostomy (GH) and 26 patients underwent ileostomy (IL). Patient and tumor characteristics were compared as well as operative outcomes between the two examined groups, including the incidence of PO leak rates. Results: The ghost ileostomy group exhibited advantages over the conventional ileostomy group. Operative time was shorter in the ghost ileostomy group (30.8% of conventional ileostomy patients undergoing surgery lasting 2-3 hours, compared to 55.9% in the ghost ileostomy group). The risk of anastomotic leakage was higher in the conventional ileostomy group (p = 0.08). Moreover, the ghost ileostomy group had a lower incidence of postoperative complications. Readmission rates were significantly higher in the conventional ileostomy group (61.5% vs 14.7%, respectively p 0.001), and the median duration of hospital stay was shorter in the ghost ileostomy group (7.7 days vs 13.3 days). Conclusion: ghost ileostomy may have advantages over the conventional ileostomy in terms of lower risk of anastomotic leakage, shorter hospital stay, and lower incidence of readmission. Moreover, ghost ileostomy proved to be as safe as ileostomy in terms of outcome, morbidity and mortality. However, further research is needed to confirm these findings and evaluate the long-term outcomes of ghost ileostomy.

Background: The possible relation between cholelithiasis and hypothyroidism has been an area of interest for researchers all over the world. A deranged lipid profile and hypothyroidism may predispose patients to gallstones. Hence, we may use both of them as an independent or combined investigation to predict the susceptibility of a person to gallstones or vice versa. Aim: To know the association between hypothyroidism and gallstones and to correlate the thyroid functional status to age, sex, body mass index (BMI) and the lipid profile of the patients. Material & method: This hospital based observational study was conducted for a period of two years. All patients undergoing elective cholecystectomy for cholelithiasis were included and patients under the age of 14 years or patients of gallstones with pregnancy were excluded from the study. Result: The mean age of patients were 41.26 ± 11.45 with 4:1 female to male ratio, prevalence of 22.4% of hypothyroidism was observed with females 54 (out of 69). As per BMI, 60 (out of 69) hypothyroid patients were either in overweight or obese category. Lipid profile in hypothyroid patients was more deranged as compared to euthyroid patients. Conclusion: Both thyroid and lipid profile should become an indicator of possible gallstone disease and vice versa so patients with gallstone disease should be screened for a possible deranged lipid and thyroid disorder.

Background: Surgical operation notes are crucial in maintaining patient safety and have medico-legal importance. We aimed to quantitatively assess and improve the content of operative notes in General Surgery at a district general hospital in London. Material and methods: 100 operation notes written between 26th July and 24th October 2022 were analysed retrospectively. Operation notes were awarded a point for each of the key details recommended by the Royal College of Surgeons (RCS) that they included. A new operative template, pre-populated with headings based on the RCS guidelines, was made available to the surgical team. A further 100 operation notes between 1st December 2022 and 28th January 2023 were assessed using the same scoring system as in Cycle 1. Results: Mean operation note score significantly increased from 75.7% in Cycle 1 to 81.0% in Cycle 2 (P = 0.021). In Cycle 2, the 33% of operation notes used the new template scored significantly higher than those that did not (98.5% vs 68.2%, P < 0.0001). Conclusion: Operation note quality can be significantly improved using a template based on RCS guidelines. Templates are a cost-effective way to promote safer postoperative care and reduce the risk of medico-legal action against the operating team. Brief Abstract: We assessed the quality of surgical operation notes at a district general hospital in London using criteria recommended by the Royal College of Surgeons, before and after introducing an electronic operation note template. We observed a significant improvement in operation note quality after implementing the template, suggesting that this is a cost-effective way to promote safer postoperative care and reduce the risk of medico-legal action against the operating team.

Objective: Complicated appendicitis makes up a compelling proportion of increased morbidity and mortality. Early detection may prevent disease progression. Nevertheless, the diagnosis remains a challenge with several symptoms and signs that are ambiguous and may mimic several other different diagnoses. The main purpose of this study is to assess the value of ileocolic artery and vein diameter by pre-operative tomographic images in order to diagnose complicated ones. Design: This study is a retrospective study. Place & duration of the study: In Bursa Yüksek İhtisas Hospital General Surgery clinic, between 01 January 2019 and 01 April 2021, patients who are diagnosed with acute appendicities are evaluated. Methodology: All adults diagnosed with acute appendicitis at our institution from 2019 to 2022 were retrospectively identified using the hospital database. Patients were classified into complicated appendicitis and noncomplicated appendicitis according to pre-operative findings on tomography and/or surgical operation reports. A comparison of the two groups with respect to ileocolic artery and vein diameter was performed. Results: A total of 283 patients were identified and included in this study. Complicated appendicitis was found more frequently in patients with a larger ileocolic artery (IAD) (p < 0.001). Also, the increase in ileocolic vein size (IVD) is considerably associated with the number of complicated appendices: 4.64 ± 0.88 mm (4.5) (p < 0.001). Furthermore, the artery-vein index (AVI) is also found to be increased in complicated ones (p < 0.001). Conclusions: The present study demonstrated that ileocolic artery and vein diameter are indicators in order to classify appendices. Moreover, evaluating the size of the artery and vein, instead of wasting time with neither tomography nor another technique, could act as an accessory marker, aiding surgeons in earlier identification of complicated acute appendicitis.

Background: Breast cancer (BC) is one of the leading causes of death for women. Axillary lymph node dissection (ALND) is an effective method in treatment of BC. Unfortunately, ALND causes arm morbidities including lymphedema. Axillary reverse mapping (ARM) marks the arm’s lymphatic drainage in the axilla to differentiate it from that of the breast after injection of dyes. Our study aims at assessing the role of ARM in preservation and identification of arm lymphatic drainage to reduce the incidence of post-operative arm lymphedema. Methods: A randomized clinical trial at Kasr Alainy Hospitals, Faculty of Medicine, Cairo University involved 64 BC patients; 32 using ALND with ARM technique (Group A) and 32 underwent ALND without ARM (Group B). Evaluation of stained lymph nodes (LN/s) using intra-operative ultrasound (US) was done in group A. Patients were followed up every 3 months for 18 months for lymphedema occurrence. Results: In group A, identification rate for arm sentinel LN/s (SLN/s) was 89%, mostly located lateral to lateral thoracic vessels (LTV) & thoracodorsal bundle and above 2nd intercostobrachial nerve (ICBN). 63% of removed US-suspicious nodes confirmed metastases. Lymphedema incidence was higher in group B than in group A, but not statistically significant. We found a significant difference in lymphedema incidence among study participants of both groups who had their arm SLN/s removed or preserved. Conclusion: ARM technique can reduce arm lymphedema after ALND by mapping arm SLN/s. Oncologic safety of ARM technique could be increased by adding intra-operative US assessment whenever feasible.

Introduction: MRI has been shown to be particularly useful in detecting additional lesions that may not be identified by other imaging modalities, such as mammography or ultrasound. However, the low specificity of MRI may lead to false positive findings, which can lead to unnecessary biopsies or even surgical over treatment. Overall, while breast MRI has demonstrated value in the evaluation of extent of disease in certain patient populations, its role in routine clinical practice remains controversial and requires further investigation. Material and methods: In a retrospective study conducted at our hospital, all patients diagnosed with carcinoma breast who underwent MRI as a part of pre operative planning between January 2022 and December 2022 were considered. A comprehensive data collection including the diagnosis, planned procedure and surgery offered was done and it was compared to the final histo pathological report. Data was analyzed to study the impact of MRI in treatment planning in our set up. Results: A total of 307 patients who had breast related complaints presented at our center. 189 patients were found to have a malignant disease and were included in our study. A total of 86 patients underwent MRI as a part of pre operative work up. We had a total of 90 patients planned for BCS and 99 Mastectomies at our center. The total number of MRI conducted at our center was 86 which includes Post NACT BCS (32 patients) Upfront BCS (58 patients). Out of 32 post NACT patients, there was a change in decision for 7 patients to mastectomy due to multi centricity / diffuse disease in the affected breast and 2 patients planned for BCS initially were changed to mastectomy instead. The MRI findings of these 9 patients correlated with the final histopathology report of the patients. Conclusion: The results of this study suggest that breast MRI has an impact on surgical decision-making, with a change in treatment plan in 14-35% of patients. However, there is a risk of overtreatment and unnecessary mastectomy. The decision to perform breast MRI should be individualized based on the patient’s clinical characteristics and risk factors.

Background: In recent years, management of the axilla in breast cancer has been changing significantly. Axillary lymph node dissection (ALND) has been the standard care for axillary lymph node positive patients, however significant morbidity has been reported with the procedure. Hence, there was a need for a clinical trial to evaluate the optimal treatment for clinically node-positive breast cancer patients in terms of surgery and radiotherapy. Methods: We included thirty female patients with operable breast cancer with clinically/ultrasonographically positive axilla who were candidates for ALND. Intraoperative ultrasound guided axillary lymph node sampling is done followed by backup ALND and sent as separate specimens. Sensitivity, specificity, negative predictive value, positive predictive value, false negative rate, and overall accuracy were calculated. Results: We harvested 77 nodes guided by intraoperative ultrasound; 59 nodes found to have macroscopic metastasis (true positive) by paraffin sections. While 10 nodes had microscopic metastasis, 8 nodes had no metastasis by paraffin sections (false positive). We harvested a total number of 387 nodes as a backup axillary clearance (residual LNS); 1 node had a macroscopic metastasis (false negative) by paraffin sections. While 22 nodes had microscopic metastasis, 364 nodes had no metastasis by paraffin sections (true negative). Analysis of the previous data showed that sensitivity and specificity is 76.62% and 99.74% respectively with false negative rate (FNR) 1.6%. positive and negative predictive values are 98.33% and 95.54% respectively. The overall accuracy is 95.9%. Conclusion: The use of intraoperative ultrasound guided axillary lymph node sampling as a tailored procedure in clinically node positive patients in early breast cancer will avoid surgical overtreatment by selectively removing the lymph nodes that are affected by the cancer, thereby sparing many patients the unnecessary complications of a radical surgery, providing a better quality of life while keeping the same efficacy.

Aim: To assess the outcome of routine histopathological evaluation of stapler doughnuts obtained during anterior resection of recto sigmoid segment and bearing of doughnut positivity on eventual treatment plan for the patient. Material and methods: A prospective observational single centre study conducted at Kasturba Hospital, Manipal, for 2 years from December 2020 to October 2022. Study includes all the patients who underwent anterior resection with stapled, circular, end-to-end colo-rectal anastomosis (CEEA) for Carcinoma rectum. Results: A total of 27 cases were recruited and both proximal and distal doughnuts were sent for histopathological evaluation in all the cases. Of all the 27 cases in the study, all the resection margins and doughnuts were reported to be negative for malignancy. Conclusion: Doughnut histology had no bearing on the following course of treatment or the prognosis of the illness and clinical judgments were not revised in response to doughnut histology. There is a lack of advantage in routinely sending doughnuts for HPE in all circumstances. They can be sent only when the chance of a positive margin is thought to be higher without having a negative impact on patient care.

Background: The risk of central venous occlusion (CVO), which can lead to serious complications, is a major worry for people on hemodialysis. A safe substitute for open surgery is endovascular treatment of CVO, which includes percutaneous balloon angioplasty with or without bare-metal stenting. Aim and objectives: To evaluate the feasibility and effectiveness of endovascular intervention for CVO management in hemodialysis patients. Patients and methods: A prospective study was performed at the Vascular Surgery Department at Assiut University Hospital on 40 chronic hemodialysis patients with complicated upper limb AVF by venous hypertension due to central venous stenosis or occlusion. We excluded lower limb AVFs, mediastinal syndrome patients, infected AVFs, and steal syndrome with AVFs. They were diagnosed by duplex ultrasound (US) and computed tomography venography and managed by an endovascular approach. Clinical and radiological follow-up was done at three, six and twelve months. Results: Technical success was achieved in thirty-four (85%) of central vein lesions. Stenting was performed on the central vein lesions of three patients due to the stenotic lesion’s rigid recoil. Primary patency rate was 94, 79.5, and 70.5% at three, six and twelve months, respectively. Re-occlusion was recorded in 7 cases (20%) during the first 6 months; six cases were managed successfully by balloon dilatation only, whereas only one case needed balloon dilatation and venous stent deployment. One-year follow-up showed that there is statistically significant difference concerning the type and the length of lesions on primary patency with (P-value 0.05). Conclusion: Angioplasty or stenting as an endovascular treatment for CVO is an effective and safe approach with minimal morbidity and mortality and low incidence of technical failure.

Strokes emerge as the leading cause of death and the leading cause of disability in adulthood. Acute cerebrovascular disease is apparent at approximately 13 million cases worldwide per year, mainly due to ischemic events, resulting in more than 5 million deaths. Approximately 18 million stroke survivors go on living without being able to support themselves, which constitutes a challenge for their families, the community as well as the healthcare system. The European Union has developed a European Action Plan concerning Stroke aimed at primary and secondary prevention. Greece announced the development and the operation of an integrated network of Stroke Units. The process of creating a new Stroke Unit depends, to a large extent, on the already existing infrastructures, which probably exist in a large central nursing institution, ensuring accessibility, staff with an expertise in various specialties and special medical-technological equipment. Special emphasis should be put to the existence of procedures and to the number of the personnel who will be employed as well as to their professional competence. Stroke patients who received organized inpatient treatment in Stroke Units report greater satisfaction with the health services they received as they are more likely to be able to care for themselves one year after the stroke. The development of training and procedure programs and the adoption of state-of-the-art technologies will contribute decisively to this domain. The need to develop strategies in order to deal with the continuous reduction of the staff and the allocation of financial resources, is a challenge that should be discussed.

Third duodenum perforation is a quite challenging and rare situation in surgery. It can be caused by a diverticulum, a trauma and even a foreign body. The fact that a third duodenum is colonized by Helicobacter pylori and causes is exceptional. In this case we describe the surgical treatment of a Helicobacter pylori colonized third duodenum perforation. A female aged 43 years old, consulted for abdominal pain and vomiting, on examination she had guarding in the right half of the abdomen. The CT-scan showed a thickening in the third duodenum and retroperitoneal air. We performed an urgent laparotomy. We found a perforated third duodenum. We sutured the perforation and performed a large drainage. Pathological examination of fragments showed a Helicobacter pylori invasion. Helicobacter pylori is a benign infection, if non diagnosed and treated properly, can be life-threatening.

Background: Tailgut cysts are an extremely rare entity of presacral tumors. Women are most likely to get a diagnosis than men due to gynecologic checkups. A tail gut cyst consists of an embryologic remnant of the hindgut in the presacral space, usually asymptomatic. Here we present a sparse case report and its surgical treatment. Case presentation: A 62-year-old female patient was admitted due to diffuse perianal pain and mucinous secretions from the rectum. Physical examination with DRE revealed a palpable mass on the 6th hour of the rectum, smooth and painful. An MRI scan revealed a cystic-height formation with a few thin septa, which developed mainly in the right paraorthic space and extended to the lower retrorectal-precoccygeal space. Differential diagnosis included a tailgut cyst. The patient underwent the Kraske procedure, a posterior approach to excise presacral lesions, and the pathology exam confirmed the initial diagnosis. The patient was discharged on postoperative day three, free of symptoms. Conclusions: Despite their rarity, tailgut cysts are easy to be diagnosed through common imaging techniques. The surgeon should be aware of this entity, to proceed with the appropriate management, which is much less radical than in other presacral tumors. Their treatment remains surgical excision, which relieves patient symptoms and is considered safe, as no recurrence has been described in the literature.