Publications (57)59.72 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Osteogenesis imperfect (OI) is a heterogeneous group of genetic disorders that affect connective tissue integrity. The hallmark of OI is bone fragility, although other manifestations, which include osteoporosis, dentigenesis imperfecta, blue sclera, easy bruis-ing, joint laxity and scoliosis, are also common among OI patients. On the other hand, diverticular disease of the colon is the most common acquired disease affecting the large bowel in the Western World. More recent studies propose that that multiple factors among which also genetic influences on extracellular matrix molecules, could play a role in the genesis of colonic diver-ticula. We report the case of a 57 year old man with known OI type I disease which presented with acute lower left abdominal pain, who proved to suffer from sigmoid diverticulitis. We present the hypothesis that these two entities (OI and diverticulosis) as dis-eases attributed to weakening of the connective tissue could have a common causative relation.
- [Show abstract] [Hide abstract] ABSTRACT: Chronic postoperative pain is probably the most significant complication of tension-free inguinal hernia repair as its presence can considerably affect the life quality of the patient. Different mesh materials and different surgical techniques for mesh fixation have been applied to reduce chronic postoperative pain, with controversial, nevertheless, results. The aim of this prospective randomized study was to evaluate the effect of a relatively new mesh with self-fixating properties, used to repair inguinal hernia with the Lichtenstein technique, on early and chronic postoperative pain. Between June 2009 and June 2010, 50 patients with primary unilateral inguinal hernia were treated using the Lichtenstein technique. Patients were randomly assigned to receive either a polypropylene mesh, fixed with polypropylene sutures (n = 25; group A), or a self-fixating polypropylene mesh with resorbable polylactic acid microgrips (n = 25; group B). Demographic data were recorded. Early and chronic postoperative pain was evaluated using the visual analog scale (VAS). Duration of surgery, complications, length of hospitalization and recurrence were also recorded. No statistical difference was found between the two groups in association to demographic data. Operating time was 53.4 ± 12.5 and 44.4 ± 7.2 min in groups A and B, respectively, and the difference was statistically significant (p < 0.001). No difference was observed between the groups regarding the postoperative complications. The VAS of early postoperative pain was 1.7 ± 1.9 in group A and 1.3 ± 1.6 in group B, with the difference being not statistically significant (p = 0.21). Concerning chronic pain, no remarkable statistically significant difference was observed between the two groups at 3-month, 1- and 2-year follow-up period. At the end of the study, no recurrence was reported in either group. Self-fixating mesh can be safely and effectively used in inguinal hernia repair with the additional advantage of reducing the operative time compared to the classic Lichtenstein technique. However, its use is not accompanied by reduced rates in early or chronic postoperative pain.
- [Show abstract] [Hide abstract] ABSTRACT: Gastrointestinal stromal tumors (GISTs) represent a rare group of neoplasms of the digestive tract deriving from the mesenchyme. Giant GISTs (over 10 cm in diameter) represent only 20 % of all cases and are associated with a high risk of malignancy. We present the case of a giant GIST of the jejunum successfully treated by surgical resection and adjuvant therapy with imatinib.
- [Show abstract] [Hide abstract] ABSTRACT: Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy. We present a very rare case of a 34-year-old female patient with symptomatic pedunculated cecal lipoma causing intermittent colo-colonic intussusception. Despite adequate imaging studies, definite preoperative diagnosis was not established and the patient underwent exploratory laparotomy. Intraoperatively, intussusception of the cecum into the ascending colon was found and right hemicolectomy was performed. Macroscopic assessment of the resected specimen showed the presence of a giant cecal pedunculated polypoid tumor with features of lipoma, causing intussusception. Histopathological examination confirmed the diagnosis of pedunculated cecal lipoma.
- [Show abstract] [Hide abstract] ABSTRACT: One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient's decision to refuse abscess's surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.
- [Show abstract] [Hide abstract] ABSTRACT: Asymptomatic cholelithiasis with abdominal aortic aneurysm (AAA) is one of few ideal fields for simultaneous "open" repair. In AAA cases with acute lithiasic cholecystitis, the simultaneous open repair is debatable due to increased possibility for prosthetic graft contamination. We report a case of a 78-year-old, ASA IV patient suffering from acute cholecystitis and concomitant (62 mm) AAA. The patient was treated by simultaneous endovascular AAA repair with a bifurcated prosthesis Endurant and laparoscopic cholecystectomy. Operative time was 165 minutes with total blood loss <100 mL. The patient fed and mobilized the second postoperative day, and the course until patients' discharge the sixth day was uneventful. Follow-up imaging at first month confirmed the successful aneurysm's exclusion without endoleak or migration. The simultaneous endovascular AAA repair and laparoscopic cholecystectomy seems to be simple, safe, and effective technique and minimized the possibility of local and systemic postoperative complications.
- [Show abstract] [Hide abstract] ABSTRACT: Chronic contained rupture (CCR) of an abdominal aortic aneurysm is a rare condition, and differential diagnosis might be difficult. We present a clinical case of a hemodynamically stable octogenarian who presented with intermittent pain in the left lower abdomen. The patient had a history of diverticulitis, and 6 years ago, he had undergone endovascular abdominal aortic aneurysm repair (EVAR) with a Talent bifurcated prosthesis. Additionally, 20 days before his admission to our hospital, he had undergone a secondary iliac limb extension for treatment of post-EVAR rupture. On admission, abdominal plain radiography identified suprarenal fixation fracture as a possible reason for CCR, but computed tomographic angiography failed to confirm any endoleak or "active" bleeding and rupture. The patient received medication treatment for possible diverticulitis and was kept under close monitoring for suspected failure of recently performed secondary endovascular procedure and CCR. A day later, the abdominal pain symptoms worsened, and a new computed tomographic angiography confirmed the suspected CCR. The patient was treated successfully by "open" repair using a Y prosthesis. To our knowledge, this is the first reported case of post-EVAR CCR due to suprarenal fixation fatigue fracture. Lifelong post-EVAR follow-up with high level of both clinical and imaging diagnostic accuracy is essential for the early recognition and proper treatment of EVAR pitfalls.
- [Show abstract] [Hide abstract] ABSTRACT: Schwannomas are generally benign, slow growing tumors, which can originate from any nerve that has a Schwann cell sheath. Digestive tract schwannomas are rare and are usually asymptomatic. We present the case of a 48-year-old woman with a symptomatic submucosal tumour of the gastric antrum. The patient underwent partial gastrectomy and the histological and immunohistochemical findings of the resected specimen established the diagnosis of schwannoma.
- [Show abstract] [Hide abstract] ABSTRACT: Secondary rectal linitis plastica is a very rare malignancy with poor prognosis. Diagnosis is difficult because of nonspecific clinical and endoscopic findings and negative biopsies in most cases owing to the fact that the mucosa is frequently unaffected. We herein describe a 68-year-old man who presented with a six-month history of tenesmus and constipation. Endoscopy revealed a narrow distal rectum with an indurated, cobblestone appearance of mucosa. Multiple biopsies and fine-needle aspiration were negative for malignancy. Abdominal MRI and transrectal ultrasonography showed findings compatible with rectal linitis plastica. He underwent rectal extirpation with total cystectomy and lymph nodes dissection. Histology demonstrated secondary rectal linitis plastica due to a poorly differentiated urinary bladder carcinoma. We emphasize the endoscopic and endosonographic features and the difficulty to establish a preoperative diagnosis of secondary rectal linitis plastica.
- [Show abstract] [Hide abstract] ABSTRACT: Mesenteric panniculitis (MP) is a rare inflammatory and fibrotic disease of the mesentery of unknown etiology. It has various clinical and radiological manifestations, posing a diagnostic challenge for clinicians. Its diagnosis is indicated via radiologic imaging and is usually confirmed via peritoneal biopsies. We describe a case of a patient with histopathologically proven MP, in which steroid dependence was successfully managed with colchicine.
- [Show abstract] [Hide abstract] ABSTRACT: Despite the knowledge gained during the last decades regarding sepsis pathophysiology, septic syndrome remains a leading cause of death. This evidence demonstrates the lack of understanding of specific stages of the cycle of sepsis and, moreover, emphasizes that we are still far away from its definitive treatment. Undoubtedly, the experimental sepsis models have contributed to the decryption of processes and reactions that occur in the chain of events of sepsis. However it remains unclear whether the results of these animal studies can be transferred to the clinical setting. The purpose of this study is to review the common experimental models used in sepsis research and answer the question regarding the clinical importance of their results.
- [Show abstract] [Hide abstract] ABSTRACT: Objective. Evisceration after abdominal surgery is a severe complication, associated with high morbidity and mortality. A number of techniques have been described in order to confront with the reclosure of the abdomen in these cases. Prosthetic mesh, ab-sorbable or non-absorbable, is often used. The aim of the present study was to assess the safety of the use of prosthetic mesh for this purpose. Material and methods. All patients who had undergone mesh repair of severe abdominal wound dehiscence between January 2003 and January 2009 were included in a retrospective cohort study. All surviving patients had physical follow-up in July 2009. Results. Seven patients were included in the study with a mean age of 71.2 years and a mean post-operative hospital stay of 26 days. Four of the initial surgical wounds were classified as clean-contaminated, two as contaminated and one as dirty-infected. Operative incisions included four midline incisions, one right subcostal incision and two right paramedian incisions. At the time of the mesh placement operation two of the patients had infected wounds. Meshes used consisted of four Composix® meshes, one Gore-Tex® mesh, one Prolene mesh and one Permacol® mesh. The first five of them were placed intraperitoneally, one was placed with the onlay technique and the last one was placed with the inlay technique. After a mean follow-up time of 45.25 months (23-77 months), three patients (43%) died while being hospitalized after the mesh placement operation, two because of progressive sepsis, not of abdominal origin though and one due to acute pulmonary embolism. Another patient died of his ma-lignant disease 13 months after the mesh placement operation. Another patient developed an enterocutaneous fistula, 6 months after the mesh placement operation, which was treated successfully, but developed an incisional hernia. The remaining two patients still had an uncomplicated post-operative course. Conclusion. Synthetic graft placement for the reclosure of the abdomen after an evisceration, especially in the presence of wound infection, has a high risk of complications and should be avoided if possible.
- [Show abstract] [Hide abstract] ABSTRACT: Burkholderia cepacia is a pathogen usually causing infection to immunocompromised or hospitalized patients. It is also associated with infections in patients with underlying lung disease, such as cystic fibrosis and chronic granulomatous disease. We present a case of B. cepacia bacteremia in a patient with COPD who was hospitalized due to type II respiratory failure. We speculate that B. cepacia, as a chronic colonizer, may cause infections in patients with lung disease other than cystic fibrosis. Previous antibiotic administration may have a role in development of such infections.
- [Show abstract] [Hide abstract] ABSTRACT: Apoptosis of lymphocytes is considered a late sequelum in the sepsis cascade. The role of apoptosis of lymphocytes as a driver of final outcome was investigated. Abdominal sepsis was induced after cecal ligation and puncture (CLP) in 31 rabbits. Blood was sampled at serial time intervals and peripheral blood mononuclear cells (PBMCs) were isolated. Apoptosis of lymphocytes and monocytes was measured through flow cytometric analysis. PBMCs were stimulated with LPS and Pam3Cys for the release of tumor necrosis factor-alpha (TNFα). Tissue bacterial growth was quantitatively measured. In a second set of experiments, CLP was performed in another 40 rabbits; 20 received single intravenous infusions of ciprofloxacin and of metronidazole 4 hours after surgery. Animals were divided into two groups based on the percentage of lymphocyte apoptosis at 4 hours after surgery; less than or equal to 32% and more than 32%. Survival of the former was shorter than the latter (p: 0.017). Tissue growth was similar between groups. Apoptosis of lymphocytes and of monocytes was lower in the former group over follow-up. Release of ΤNFα did not differ. The above findings on survival were repeated in the second set of experiments. Administration of antimicrobials prolonged survival of the former group (p: 0.039) but not of the latter group (pNS). Lymphocyte apoptosis at an early time point of experimental peritonitis is a major driver for death. A lower percentage of apoptosis leads earlier to death. Antimicrobials were beneficial even at that disease state.
- [Show abstract] [Hide abstract] ABSTRACT: Wireless capsule endoscopy has become the gold standard for the examination of small bowel. However, its role in the evaluation of patients suffering from chronic abdominal pain is not yet clearly defined. We conducted an open-label prospective multi-center study to evaluate the yield and clinical outcome of capsule endoscopy in patients with chronic abdominal pain with/without diarrhea. Seventy-two patients with chronic (>3months) abdominal pain with/without diarrhea in whom the underlying pathology could not be diagnosed by conventional modalities, underwent capsule endoscopy in either of the 6 participating centers. Patients were then followed up for clinical outcomes. The overall diagnostic yield of capsule endoscopy was 44.4%. More specifically, its diagnostic yield was 21.4% in patients with abdominal pain and negative inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), 66.7% in patients with abdominal pain and positive inflammatory markers, 0% in patients with abdominal pain, diarrhea and negative inflammatory markers, and 90.1% in patients with abdominal pain, diarrhea and positive inflammatory markers. Both univariate and multivariate regression analyses showed that abnormal C-reactive protein and erythrocyte sedimentation rate were significant factors related with positive capsule endoscopy findings. Chronic abdominal pain with/without diarrhea should be accompanied by elevated inflammatory markers to be regarded as a valid indication for capsule endoscopy. The yield of capsule endoscopy in such patients is reasonably high and clinical outcomes of patients treated with capsule endoscopy findings as a guide are significant.
- [Show abstract] [Hide abstract] ABSTRACT: Le syndrome de myopathie compressive (SCM) est un syndrome caractérisé par la lésion du muscle squelettique ayant pour résultat le relargage du contenu intracellulaire (myoglobine, créatine phosphokinase, potassium, etc.) dans l’appareil circulatoire, ce qui peut causer des complications potentiellement mortelles. Il y a de nombreuses causes qui peuvent mener à un SCM avec rhabdomyolyse aiguë, et beaucoup de patients ont des causes multiples. La complication potentiellement mortelle la plus fréquente est l’insuffisance rénale aiguë. La survenue d’une rhabdomyolyse aiguë devrait être considérée comme possible chez n’importe quel patient qui peut rester immobile pendant de longues périodes, ou est dans le coma, ou est intoxiqué de quelque manière que ce soit. Nous rapportons le rare cas d’un patient de 26 ans qui a développé un SCM provoqué par l’ischémie reperfusion, avec rhabdomyolyse et insuffisance rénale aiguë après compression prolongée du membre supérieur droit.
Central Peninsula HospitalSXQ, Alaska, United States