ABSTRACT
A baby with Down syndrome presented initial findings at the first-trimester ultrasound of increased nuchal thickness and unilateral hand agenesis. During follow-up, other elements were found mainly hypospadias. This report emphasizes through prenatal and postnatal imaging the phenotypic variability of Down syndrome babies.
ABSTRACT
Introduction of foreign bodies inside abdominal cavity may migrate to hollow organs like bladder and bowel. This can occur after various laparoscopic or open abdominal and pelvic surgeries in which synthetic materials are used. We report an exceptional case of bladder and ileal migration of tackers used to fix mesh during laparoscopic transperitonel inguinal hernia repair in a 65-year-old man who presented for recurrent fever, dysuria, frequency and suprapubic pain. A laparotomy was done showing that some tackers which served to repair the hernia had migrated into ileon and bladder. We performed limited resection of involved ileum and bladder with complete disappearance of symptoms.
Subject(s)
Foreign-Body Migration/diagnosis , Ileum , Surgical Staplers/adverse effects , Urinary Bladder , Aged , Foreign-Body Migration/surgery , Hernia, Inguinal/surgery , Humans , Laparoscopy/methods , Male , Surgical MeshABSTRACT
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is thought to be a simpler and safer operation compared with malabsorptive operations that include an enteric anastomosis. Leakage along the staple line at the gastroesophageal junction (GEJ) is difficult to treat and is a known complication of sleeve gastrectomy. Nonsurgical treatment methods often fail to heal the leaks and patients often require conversion to other procedures for definitive treatment. We report our experience with conversion to Roux-en-Y anastomosis over the leak site as a treatment option, comparing patients who had early treatment to late intervention. The purpose of the study is to stress the medical and social benefits of early surgical reintervention with conversion to Roux-en-Y anastomosis over the leak site. METHODS: Six patients underwent Roux limb placement over the leak site. Four of the patients had delayed surgery (group A), and the other 2 had early intervention (group B). RESULTS: Patients in group A had a median increase of all medical cost by 500%, whereas the 2 patients who underwent early intervention (group B) had an increase by 200%. The mean time until complete recovery (removal of all drains, adequate oral intake, and return to normal daily activity) in group A was 131.25 days (range 99-165) versus 38 days (range 28-48) in group B. CONCLUSIONS: Roux-en-Y gastrojejunostomy over the leak site is an effective technique to treat refractory staple line leakage and can be adopted as early treatment in selected patients after stabilization, thereby reducing the cost and length of hospital stays.
Subject(s)
Anastomotic Leak/surgery , Gastrectomy/adverse effects , Obesity, Morbid/surgery , Adult , Anastomosis, Roux-en-Y/methods , Anastomotic Leak/etiology , Esophagogastric Junction/surgery , Female , Humans , Middle Aged , Reoperation , Surgical Stapling/adverse effects , Young AdultABSTRACT
BACKGROUND: Granulosa cell tumors (GCT) are malignant tumors of the sex cord stroma representing 5% of all malignant ovarian tumors. Their treatment is surgery, and rarely chemotherapy and radiotherapy. Recently, salvage treatment with aromatase inhibitors was suggested based on few reported clinical cases. CASE REPORT: We present the case of a 61-year-old woman with unresectable recurrent GCT of the right ovary treated with the aromatase inhibitor letrozole. Tumor mass and peritoneal carcinomatosis decreased in size allowing almost complete surgical resection. The patient remained in complete clinical remission for at least 24 months after surgery while under letrozole. CONCLUSION: Aromatase inhibitors represent an innovative treatment for these rare and refractory tumors offering promising results while avoiding toxic and marginally active chemotherapeutic agents.
