ABSTRACT
BACKGROUND/AIMS: Deep infiltrating endometriosis is a very painful condition and the mechanism of pain is still poorly understood. Pain and hyperalgesia can partly be explained by an increased number of nerve structures in the painful lesion. In order to clarify this issue, we assessed the nerve density in deep infiltrating endometriotic nodules of the posterior vagina and in the adjacent healthy vaginal tissue of the same patient. METHODS: A prospective clinical and pathological study of 31 cases of deep infiltrating vaginal endometriotic nodules was conducted. Fifteen patients were in the proliferative phase and 16 in the secretory phase. The nerve density was studied by immunohistochemistry with the monoclonal antibody NF against neurofilaments in deep infiltrating endometriosis and in the adjacent unaffected vaginal tissue in the proliferative and in the secretory phases. Neurofilaments constitute the main structural elements of neuronal axons and dendrites. RESULTS: The nerve density was significantly different in the endometriotic nodule than in the adjacent unaffected vaginal tissue (p = 0.0013). The same significant difference was found between endometriotic nodules and the unaffected vagina in the proliferative phase (p = 0.009) and in the secretory phase (p = 0.04). This difference was not significant between the proliferative and the secretory phases in the endometriotic lesions and in the controls. CONCLUSIONS: We hypothesize that the significantly increased number of nerve structures in the endometriotic nodules may contribute to the occurrence of severe and neuropathic pain that characterizes these lesions.
Subject(s)
Endometriosis/pathology , Nerve Tissue/pathology , Neurofilament Proteins/metabolism , Vagina/innervation , Vaginal Diseases/pathology , Female , Humans , Prospective Studies , Vagina/pathologyABSTRACT
Actinomycosis is a rare, chronic, suppurative, pseudotumoral illness caused by an anaerobic gram positive organism usually Actinomyces israelii which can mimick a tumoral pathology leading to a mutilating surgical resection. We report a case of abdominal actinomycosis and a literature review.
Subject(s)
Abscess/microbiology , Actinomyces/isolation & purification , Actinomycosis/microbiology , Laparotomy/methods , Abscess/diagnosis , Abscess/surgery , Actinomycosis/diagnosis , Actinomycosis/surgery , Diagnosis, Differential , Female , Humans , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Reported here is the case of a patient with septic shock due to multidrug-resistant Acinetobacter baumannii, which developed after complicated acute pancreatitis with intra-abdominal abscess. Treatment with colistin methanesulphonate and high doses of meropenem were initiated, but since shock persisted, tigecycline was added to the regimen, resulting in successful resolution of the infection.
Subject(s)
Acinetobacter Infections/drug therapy , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/therapeutic use , Minocycline/analogs & derivatives , Shock, Septic/drug therapy , Acinetobacter Infections/complications , Acinetobacter baumannii/isolation & purification , Adult , Colistin/therapeutic use , Drug Resistance, Multiple, Bacterial , Drug Therapy, Combination , Humans , Male , Meropenem , Minocycline/therapeutic use , Pancreatitis, Acute Necrotizing/complications , Shock, Septic/epidemiology , Thienamycins/therapeutic use , Tigecycline , Treatment OutcomeABSTRACT
Oesophageal perforation following anterior cervical fixation has been reported in the neurosurgical and orthopaedic literature as a rare complication of such procedure. The complications associated with oesophageal perforation may range from minor symptoms to mediastinitis and death. We report two oesophageal perforations following cervical fixation device migration in patients with poor prognosis, managed successfully with conservative surgical and endoscopic techniques.
Subject(s)
Bone Plates/adverse effects , Cervical Vertebrae/surgery , Esophageal Perforation/etiology , Foreign-Body Migration/surgery , Fracture Fixation, Internal/instrumentation , Spinal Fractures/surgery , Cervical Vertebrae/injuries , Esophageal Perforation/diagnostic imaging , Esophageal Perforation/surgery , Esophagoscopy/methods , Female , Follow-Up Studies , Foreign-Body Migration/diagnostic imaging , Fracture Fixation, Internal/methods , Gastroscopy/methods , Humans , Laparoscopy/methods , Male , Middle Aged , Radiography , Risk Assessment , Severity of Illness Index , Spinal Fractures/diagnostic imaging , Treatment OutcomeABSTRACT
BACKGROUND: We investigated the feasibility, safety, and efficacy of laparoscopic antireflux surgery (LARS) after failure of Enteryx injection in the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD). METHODS: Four patients underwent LARS after failure of Enteryx injection. Particular care was taken during the procedure to identify unusual material or fibrosis. RESULTS: All patients underwent LARS successfully. In three patients, tight adhesions with fibrous tissues and black foreign material were observed around the esophagus. No complications occurred during the procedures. The postoperative period was uneventful and functional results were excellent. CONCLUSION: LARS following Enteryx injection is feasible. Careful dissection is mandatory to avoid operative complications. Both techniques may be considered as options for treating GERD.
