Subject(s)
Aortic Diseases/etiology , Arterial Occlusive Diseases/etiology , Cardiomyopathy, Dilated/complications , Embolism/etiology , Femoral Artery , Iliac Artery , Ischemia/etiology , Adolescent , Anthracyclines/adverse effects , Antibiotics, Antineoplastic/adverse effects , Anticoagulants/therapeutic use , Aortic Diseases/diagnosis , Aortic Diseases/therapy , Aortography/methods , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/therapy , Cardiomyopathy, Dilated/chemically induced , Cardiomyopathy, Dilated/diagnosis , Embolectomy , Embolism/diagnosis , Embolism/therapy , Fatal Outcome , Femoral Artery/diagnostic imaging , Humans , Iliac Artery/diagnostic imaging , Ischemia/diagnosis , Ischemia/therapy , Male , Pulmonary Edema/etiology , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: The aim of the present study was to describe the laboratory development and the subsequent clinical utility of the U-stitching technique for splenorraphy over the recent years in a general non-trauma hospital. Patients with splenectomies and patients treated conservatively during the same time period, are also presented. METHODS: In the 15-year period from September 1988 until September 2003, 65 patients were diagnosed with splenic injury following admission to 2nd Department of Surgery, Democritus University Hospital, after blunt abdominal trauma. During the first 3 years, 14 patients were admitted; one of them was treated conservatively and 13 had splenectomies. Because computed tomography (CT) was not available at that time, these 14 patients form a control group. During the remaining 12-year period, 51 patients (39 male and 12 female; age, 4-82 years; mean, 31.1 years; SD, 19.7 years) were treated conservatively or surgically, either with splenectomy or with splenorraphy. Splenorraphy was performed using the U-stitching technique. This alternative splenorraphy technique was first tested on experimental models at 2nd Department of Surgery, Democritus University Hospital, then followed by successful clinical application. The medical records for these patients were reviewed to extract the data for the present study. RESULTS: Thirty-six patients (70.6% of 51 patients) were treated surgically; of these, 21 (41.2% of 51 patients) had splenectomy and 15 (29.4% of 51 patients) had splenorraphy. Non-operative treatment was initially given to 15 patients (29.4% of 51 patients). Two of them had delayed rupture of the spleen and underwent splenectomy (at 8 and 40 days). The total number of preserved spleens was 28 of 51 (54.9%). None of the patients with conservative treatment or splenorraphy died. One patient with splenectomy died later from overwhelming sepsis. CONCLUSIONS: Splenic salvage is now a treatment goal. If the patient is haemodynamically unstable and splenorraphy is possible, the U-stitching technique is a promising approach.
Subject(s)
Minimally Invasive Surgical Procedures/methods , Spleen/injuries , Spleen/surgery , Suture Techniques , Wounds, Nonpenetrating/surgery , Adult , Aged , Aged, 80 and over , Animals , Child , Child, Preschool , Dogs , Female , Humans , Male , Middle Aged , Radiography , Retrospective Studies , Splenectomy , Trauma Severity Indices , Treatment Outcome , Ultrasonography , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
BACKGROUND: Primary adenocarcinomas of the appendix are uncommon. Mucoceles that result from mucinous adenocarcinomas of the appendix may be incidentally detected on imaging. CASE PRESENTATION: A case of a mucocele of the appendix, due to cystadenocarcinoma, is presented as an incidental imaging finding in a female, 86-year-old patient. The patient was admitted due to rectal hemorrhage and underwent colonoscopy, x-ray, US and CT. Adenocarcinoma of the ascending colon, adenomatous polyp of the sigmoid colon and a cystic lesion in the right iliac fossa were diagnosed. The cystic lesion was characterized as mucocele. The patient underwent right hemicolectomy, excision of the mucocele and sigmoidectomy. She recovered well and in two-year follow-up is free from cancer. CONCLUSIONS: Preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management, but it is difficult on imaging studies. Small lymph nodes or soft tissue stranding in the surrounding fat on computed tomography examination may suggest the possibility of malignancy.
Subject(s)
Adenocarcinoma/diagnosis , Appendiceal Neoplasms/diagnosis , Colonic Neoplasms/diagnosis , Cystadenocarcinoma/diagnosis , Mucocele/etiology , Neoplasms, Multiple Primary/diagnosis , Aged , Aged, 80 and over , Appendiceal Neoplasms/complications , Colon/pathology , Cystadenocarcinoma/complications , Diagnosis, Differential , Female , Gastrointestinal Hemorrhage/etiology , Humans , Mucocele/diagnosis , RectumABSTRACT
We report on an 8-year-old child with avulsions of the left L3, L4 and L5 nerve roots and traumatic meningoceles that were not associated with lumbar spine or pelvic girdle fractures. The patient had a history of a road traffic accident. Plain radiographs of the pelvis revealed left hip dysplasia. The magnetic resonance imaging findings of the lumbar spine are illustrated. The pathogenesis of lumbar nerve root avulsions and their association with ipsilateral hip dysplasia are discussed.
