Τhyroid storm induced by trauma due to spear-fishing gun trident impaction in the neck.

A rare case of thyroid storm induced by thyroid gland injury because of penetrating neck trauma is reported. The injury was the result of a spear-fishing gun trident impaction in the neck. The diagnosis of thyroid gland injury was suspected by preoperative clinical examination and established during neck exploration in the theatre. The gland injury led to thyroid storm owing to the rupture of acini and liberation of thyroxine (T4) into the bloodstream. Withdrawal of the impacted trident along with subtotal thyroid lobectomy and repair of soft tissue damage in addition to supported treatments, which corrected the hyperthyroid state, led to uneventful recovery.

Retractile mesenteritis presenting with malabsorption syndrome. Successful treatment with oral pentoxifylline.

Retractile mesenteritis is a rare benign inflammatory disease of the mesentery. Computed tomographic findings usually suggest the diagnosis, which is confirmed by surgical biopsies. Conservative treatment is empirical, based on corticosteroids, colchicine, immunosuppressive agents and progesterone. Surgical resection is sometimes attempted for definitive therapy, although the surgical approach is often limited. This report describes a 62-year old man with histologically proven retractile mesenteritis presenting with malabsorbtion syndrome, who presented pulmonary tuberculosis after initial therapy with corticosteroids. He was subsequently treated with oral pentoxifylline (800 mg/day), with substantial clinical and radiological improvement.

Thyroid storm induced by trauma due to spear fishing-gun trident impaction in the neck.

A rare case of thyroid storm induced by thyroid gland injury because of penetrating neck trauma is reported. The injury was because of a spear fishing-gun trident impaction in the neck. The diagnosis of thyroid gland injury was suspected by preoperative clinical examination and established during neck exploration in the theatre. The gland injury led to thyroid storm owing to the rupture of acini and liberation of T4 into the bloodstream. Withdrawal of the impacted trident along with subtotal thyroid lobectomy and repair of soft tissue damage in addition to supported treatments, which corrected the hyperthyroid state, led to uneventful recovery.

Thyroid storm induced by blunt thyroid gland trauma.

Isolated thyroid gland injury due to blunt neck trauma is uncommon and rarely complicated by thyroid storm in patients without known hyperthyroidism. The aim of this study was to report our experience on blunt thyroid gland injury followed by massive gland hemorrhage, acute airway obstruction, and symptoms of thyroid storm. Among 231 patients with neck trauma, four patients appeared with isolated thyroid gland injury. In two of them, the diagnosis of simultaneous thyrotoxic crisis was made on the basis of clinical findings and confirmed on emergency laboratory tests. The diagnosis of thyroid gland injury was supposed by the history and physical examination and established after neck exploration. Therapy was directed at stabilizing the patients by correcting the hyperthyroid state, followed by operative treatment. Left lobectomy and total thyroidectomy were performed and, along with postoperative medical measures, led to uneventful recovery. This study demonstrates that thyroid gland injury due to blunt neck trauma, although uncommon, may result in potentially life-threatening thyroid storm due to rupture of acini and liberation of thyroid hormones into the bloodstream. This may occur in patients without known hyperthyroidism.

Multiple small bowel ruptures due to ischemic enteritis: a case report.

A rare case of multiple small bowel ruptures due to ischemic enteritis (ISE) is reported. The patient was admitted to the hospital with acute abdominal pain followed by bloody diarrhoeas. Preoperative colonoscopic findings were similar to those presented in Crohn's disease. Intraoperatively, ischemic lesions and multiple ruptures were localized at the jejunum and the proximal ileum. Histopathological examination of the resected bowel segment established the diagnosis of ISE. Although ISE is not common, concurred multiple ruptures of the small bowel is a rare but actual complication.

Local posterior perianal block for proctologic surgery.

We present our experience with proctologic operations under local posterior perianal block (LPPB), along with short- and medium-term results of this technique. A total of 72 patients with proctologic disorders consented to operation under LPPB for stapled hemorrhoidectomy, Milligan-Morgan hemorrhoidectomy, subanodermal fistula resection, perianal abscess revision, and anal tumor electrocoagulation. The anesthetic technique, postoperative complications, the pain score, and follow-up were recorded and analyzed retrospectively. Almost all patients were pain-free during surgery. The pain score in visual analog scale (VAS) during the first 24 hours was 1.6 to 3.4 and varied with the type of surgery performed. At follow-up 1-2 weeks later, the patients were satisfied with LPPB (mean level of satisfaction, 8.6 +/- 1.2 on the VAS). Seventy of 72 patients (97.2%) would willingly have surgery again under LPPB if it was required. This study shows that LPPB can be widely and safely applied in proctologic surgery.

Stapled hemorrhoidectomy under local anesthesia: tips and tricks.

Stapled hemorrhoidectomy--a new, evolving technique--is considered to be safe and painless. General and spinal anesthesia are the "gold standard" anesthetic techniques for the procedure. The stapled hemorrhoidectomy under local anesthesia is described. Emphasis is given in few tips and tricks for safe and successful application of the local anesthesia.