ABSTRACT
A 47-year-old female was seen in an outpatient surgical setting for intermittent obstructive symptoms and abdominal pain. Computed tomography scan and upper GI series showed typical findings of intussusception. Laparoscopic-assisted small bowel resection was carried out. Histologic diagnosis revealed malignant melanoma. The patient had a history of right maxillary sinus melanoma greater than 12 years before presentation. We report the first case of a jejunojejunal intussusception caused by metastatic sinonasal melanoma, and its subsequent laparoscopic-assisted resection.
Subject(s)
Intussusception/etiology , Intussusception/surgery , Jejunal Diseases/etiology , Jejunal Diseases/surgery , Jejunal Neoplasms/secondary , Laparoscopy/methods , Maxillary Sinus Neoplasms/pathology , Melanoma/pathology , Melanoma/surgery , Female , Humans , Jejunal Neoplasms/surgery , Melanoma/complications , Middle AgedABSTRACT
BACKGROUND: This study examined whether systemic infusion of lidocaine, a local anesthetic with anti-inflammatory properties, can decrease surgical pain, length of postsurgical ileus, and hospital stay. METHODS: Twenty-two patients at a community hospital were randomized into 2 groups. Subjects were allocated to receive either lidocaine or a placebo infusion for the first 24 hours after surgery. RESULTS: Patients in the lidocaine group appeared to report less pain as reflected by a decrease in overall visual analogue scale pain scores 24 hours after surgery. The return of flatus after surgery was not considered significant (lidocaine 68.2 +/- 9.7 hours vs placebo 86.9 +/- 13.6 hours; P = .2802). The return of bowel movement after surgery was considered significant (lidocaine 88.3 +/- 6.08 hours vs placebo group 116 +/- 10.1 hours; P = .0286). The lidocaine group was discharged by mean day 3.76 +/- .24 versus placebo at mean day 4.93 +/- .42; P = .0277. CONCLUSIONS: Patients in the lidocaine group had bowel movements >24 hours earlier than those in the placebo group and were discharged earlier.
Subject(s)
Anesthetics, Local/therapeutic use , Ileus/drug therapy , Intestines/surgery , Length of Stay/statistics & numerical data , Lidocaine/therapeutic use , Postoperative Complications/drug therapy , Aged , Analgesia, Patient-Controlled , Analgesics, Opioid/therapeutic use , Defecation , Double-Blind Method , Elective Surgical Procedures , Female , Hospitals, Community , Humans , Infusions, Intravenous , Male , Middle Aged , Morphine/therapeutic use , Pain Measurement , Pain, Postoperative/prevention & control , Pilot ProjectsSubject(s)
Blister/surgery , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Pulmonary Emphysema/surgery , Blister/complications , Blister/diagnosis , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/diagnosis , Humans , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Male , Middle Aged , Pulmonary Emphysema/complications , Pulmonary Emphysema/diagnosisABSTRACT
To our knowledge, this is the first reported case of a seat belt-related rupture of the pectoralis major muscle and its successful delayed repair using mesh. We report a case of a 34-year-old white man who sustained a right pectoralis major muscle rupture from a seat belt during a motor vehicle crash. The patient presented to us 2 years after the injury. We introduce a technique using mesh that results in a successful repair of a cosmetically disfiguring chest wall defect.
Subject(s)
Pectoralis Muscles/injuries , Pectoralis Muscles/surgery , Seat Belts/adverse effects , Surgical Mesh , Adult , Humans , Male , Time FactorsABSTRACT
Mucinous carcinoma of the breast, also known as colloid carcinoma, is a less common variant of breast cancer constituting less than five per cent of breast cancers. We report the case of a 42-year-old premenopausal female who presented with a palpable chest wall recurrence 4 years after simple mastectomy, axillary node dissection, and TRAM flap reconstruction for pure mucinous carcinoma. The recurrent neoplasm was a pure mucinous carcinoma and was found to be invading the mediastinum into the great vessels. The tumor was estrogen receptor positive, progesterone receptor negative, and HER-2/neu positive, which is an unusual finding for mucinous carcinoma. The fact that this tumor demonstrated HER-2/neu positivity may explain the uncharacteristic aggressive nature of this normally indolent type of breast tumor. To our knowledge, this is the first reported case of any mucinous breast cancer invading the mediastinal great vessels and its subsequent en-bloc resection.
Subject(s)
Adenocarcinoma, Mucinous/pathology , Brachiocephalic Veins , Breast Neoplasms/pathology , Neoplasms, Second Primary/pathology , Vascular Neoplasms/pathology , Vena Cava, Superior , Adenocarcinoma, Mucinous/genetics , Adenocarcinoma, Mucinous/surgery , Adult , Breast Neoplasms/genetics , Breast Neoplasms/surgery , Female , Gene Expression Regulation, Neoplastic , Genes, erbB-2/physiology , Humans , Mediastinum , Neoplasm Invasiveness , Neoplasms, Second Primary/genetics , Vascular Neoplasms/geneticsABSTRACT
Inferior vena cava filter migration is an uncommon event. Temporary inferior vena cava filters offer protection against pulmonary embolism in the trauma patient in whom anticoagulation is contraindicated. We present the case of a 53-year-old man who suffered a lower extremity injury, which left him unable to walk for an extended period of time. The patient developed a deep venous thrombosis in the early postoperative course and decision was made to place a retrievable inferior vena cava (IVC) filter. One week later the IVC filter had migrated to the right ventricle and destroyed the tricuspid valve. Although there are a limited number of cases describing the migration of IVC filters to the heart, there have been no cases in the literature, to our knowledge, where an IVC filter has destroyed the tricuspid valve and required valve replacement.
