Intramuscular myxoma associated with an increased carbohydrate antigen 19.9 level in a woman: a case report.

INTRODUCTION: Intramuscular myxoma is a rare benign soft tissue tumor. The lack of specific symptoms and widely used laboratory tests makes the diagnosis quite difficult. We present a case of an Intramuscular myxoma associated with an increased carbohydrate antigen 19.9 level. To the best of our knowledge, there have not been any reported cases of an association of Intramuscular myxoma with tumor markers in the literature. CASE PRESENTATION: A 45-year-old Caucasian woman presented to our department for resection of a mass in her left groin area, discovered incidentally on a triplex ultrasonography of her lower extremities. The diagnosis of Intramuscular myxoma was confirmed on histopathology after the complete surgical excision of the tumor. On laboratory examination, the serum level of carbohydrate antigen 19.9 was found to be elevated, but it returned to normal six months after resection of the mass. CONCLUSION: Carbohydrate antigen 19.9 is a tumor marker that increases in a variety of malignant and benign conditions. After the exclusion of all other possible reasons for carbohydrate antigen 19.9 elevation, we assumed a possible connection of carbohydrate antigen 19.9 elevation and Intramuscular myxoma, an issue that requires needs further investigation.

Advanced Trauma Life Support certified physicians in a non trauma system setting: is it enough?

OBJECTIVE: The purpose of this study was to evaluate the impact of ATLS(®) on trauma mortality in a non-trauma system setting. ATLS represents a fundamental element of trauma training in every trauma curriculum. Nevertheless, there are limited studies in the literature as for the impact of ATLS training in trauma mortality, especially outside the US. DESIGN: This is a prospective observational study. The primary end point was to investigate factors that affect mortality of trauma patients in our health care system. We performed a multivariate analysis for this purpose and we identified ATLS certification as a predictor of overall mortality. Following this finding we stratified patients according to the severity of injury as expressed by the ISS score and we compared outcome between those treated by an ATLS certified physician and those treated by non-certified ones. MAIN OUTCOME MEASURES: Trauma volume and demographics of trauma patients, factors that affect mortality of traumatized patients and mortality between patients treated by ATLS(®) certified and non-certified physicians. RESULTS: In total, 8862 trauma patients were included in the analysis. The majority of trauma patients (5988, 67.6%) were treated by a general surgeon, followed by those treated by an orthopedic surgeon (2194, 24.8%). There were 446 deaths in the registry but, 260 arrived dead in the Emergency Department and were excluded from the analysis. Multivariate analysis of the 186 deaths that occurred in the hospital revealed age, high ISS score, low GCS score, urban location of injury, neck injury and ATLS(®) certification as factors predisposing to mortality. Cross tabulation of ATLS(®) certification and ISS of the trauma patients shows that those treated by certified physicians died more often in all subcategories of ISS score (p<0.05). CONCLUSIONS: In Greece, with no formal trauma system implementation, ATLS(®) certified physicians achieve worse outcomes than their non-certified colleagues when managing trauma patients. We believe that these findings must be interpreted in the context of the National health care system. There is considerable room for improvement in our country, and further analysis is required.

Traumatic brain injury in Greece: report of a countrywide registry.

INTRODUCTION: The purpose of this study was to evaluate the incidence of TBI in Greece and to provide evidence on the epidemiologic characteristics of the disease. PATIENTS AND METHODS: This is a prospective observational study initiated by the Hellenic Society of Trauma and Emergency Surgery. Thirty hospitals participated in the registry. All trauma patients requiring admission transfer to a higher level centre and those who arrived dead were included in the study. This report evaluated the epidemiologic characteristics of patients with brain trauma, the cause and the severity of the injury and the final outcome. RESULTS: Eight thousand eight hundred and sixty-two patients were included in the registry. Of them, 3383 had at least one brain injury. There were 2451 males and 932 females. Traffic accidents were the leading cause of TBI (54.1%), followed by falls (27.7%). The most affected age group was the 15-44 year olds (48.0%), but TBIs were more lethal in the 45-64 age group (17.8%). Interestingly, a 3.4% mortality was recorded if a TBI was present, even if ISS was relatively low (0-9 ISS group). CONCLUSION: TBI is a major element of trauma. Knowledge of the epidemiologic characteristics of the disease is imperative for adequate planning and future quality assessment.

Interfacility transfers in a non-trauma system setting: an assessment of the Greek reality.

BACKGROUND: Quality assessment of any trauma system involves the evaluation of the transferring patterns. This study aims to assess interfacility transfers in the absence of a formal trauma system setting and to estimate the benefits from implementing a more organized structure. METHODS: The 'Report of the Epidemiology and Management of Trauma in Greece' is a one year project of trauma patient reporting throughout the country. It provided data concerning the patterns of interfacility transfers. We compared the transferred patient group to the non transferred patient group. Information reviewed included patient and injury characteristics, need for an operation, Intensive Care Unit (ICU) admittance and mortality. Analysis employed descriptive statistics and Chi-square test. Interfacility transfers were then assessed according to each health care facility's availability of five requirements; Computed Tomography scanner, ICU, neurosurgeon, orthopedic and vascular surgeon. RESULTS: Data on 8,524 patients were analyzed; 86.3% were treated at the same facility, whereas 13.7% were transferred. Transferred patients tended to be younger, male, and more severely injured than non transferred patients. Moreover, they were admitted to ICU more often, had a higher mortality rate but were less operated on compared to non transferred patients. The 34.3% of transfers was from facilities with none of the five requirements, whereas the 12.4% was from those with one requirement. Low level facilities, with up to three requirements transferred 43.2% of their transfer volume to units of equal resources. CONCLUSION: Trauma management in Greece results in a high number of transfers. Patients are frequently transferred between low level facilities. Better coordination could lead to improved outcomes and less cost.

The implementation of a national trauma registry in Greece. Methodology and preliminary results.

BACKGROUND: Trauma is a leading cause of death worldwide and a major health problem of the modern society. Trauma systems are considered the gold standard of managing patients with trauma. An integral part of any trauma system is a trauma registry. In Europe, and particularly in Greece, trauma registries and systems are in an embryonic stage. In this study, we present an attempt to record trauma in Greece. METHODS: The Hellenic Society of Trauma and Emergency Surgery invited all the official representatives of the society throughout the country to participate in the study. In succeeding meetings of the representatives, the reporting form was developed and the inclusion criteria were defined meticulously. Inclusion criteria were defined as patients with trauma requiring admission, transfer to a higher level center, or arrived dead or died in the emergency department of the reporting hospital. All reports were accumulated by the Hellenic Trauma society, imported in an electronic database, and analyzed. RESULTS: Thirty-two hospitals receiving patients with trauma participated in the country, representing 40% of the country's healthcare facilities and serving 40% of the country's population. In 12 months time, (October 2005 to September 2006), 8,862 patients were included in the study. Of them, 66.9% were men and 31.3% were women. The compilation rate of the reporting forms was surprisingly high, considering that the final reporting form included 150 data points and that there were no independent personnel in charge of filling the forms. CONCLUSIONS: Trauma registries are feasible even in health care systems where funding of medical research is sparse.

Anastomotic leak management after a low anterior resection leading to recurrent abdominal compartment syndrome: a case report and review of the literature.

INTRODUCTION: Low anterior resection is usually the procedure of choice for rectal cancer, but a series of complications often accompany this procedure. This case report describes successful management of an intricate anastomotic leak after a low anterior resection. CASE PRESENTATION: A 66-year-old Caucasian man was admitted to our hospital and diagnosed with a low rectal adenocarcinoma. He underwent a low anterior resection but subsequently developed fecal peritonitis due to an anastomotic leak. He was operated on again but developed abdominal compartment syndrome, multi-organ failure and sepsis. He was aggressively treated in the intensive care unit and in the operating room. Overall, the patient underwent four laparotomies and stayed in the intensive care unit for 75 days. He was discharged after 3 months of hospitalization. CONCLUSION: Abdominal compartment syndrome may present as a devastating complication of damage control laparotomy. Prompt recognition and goal-directed management are the cornerstones of treatment.

The effects of vasopressors on perfusion of gastric graft after esophagectomy. An experimental study.

AIMS: To evaluate the impact of the perioperative administration of norepinephrine on the perfusion of the esophageal graft. METHODS: This is an experimental study. Six swine underwent transhiatal esophagectomy; the stomach was used to replace the resected esophagus. We provoked hemorrhagic shock to the animals and then we administered noradrenaline to restore the blood pressure. We monitored the graft perfusion perioperatively using the technique of microdialysis. RESULTS: In all animals, the graft experienced severe hypoperfusion after the administration of noradrenaline that was statistically significant. CONCLUSIONS: Our data support the hypothesis that norepinephrine should be used with extreme caution in the perioperative setting after esophagectomy. Further studies, however, will be required to evaluate the clinical significance of this finding.

The use of a harmonic scalpel in thyroid surgery: report of a 3-year experience.

BACKGROUND: Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. The present article reports a single surgeon's 3-year experience in the use of the harmonic scalpel. The device was developed in the early 1990s and offered adequate and safe hemostasis for vessels up to 3 mm in width. METHODS: This was a prospective observational study. Data sheets from all patients who had surgery by a single endocrine surgeon in the period from 1999 to 2004 were evaluated. Patients were divided into 3 groups based on the surgical technique used: group I comprised the conventional knot-and-tie technique, group II comprised the ligation of all but the superior thyroid vessels with a scalpel, and group III comprised patients in whom the device was used exclusively. The groups were compared in regard to surgical time, cost, and complication rate. RESULTS: A total of 272 patients were included in the study: 107 patients were included in group I, 77 in group II, and 88 group III. The surgical time of group I differed significantly compared with groups II and III (P < .0001 in both cases). Surgical times between groups II and III did not differ significantly (P = .701). CONCLUSIONS: The use of the harmonic scalpel reduces surgical time, but it increases the cost of the surgery. It is our belief that by including in the absolute cost the time saved and the reduction in human resources needed, the use of the scalpel would prove to be economic.

Unusual site of recurrent musculoskeletal hydatid cyst: case report and brief review of the literature.

A case of a large multiplex recurrent hydatid cyst involving the left gluteal muscle and the left iliopsoas, accompanied with degeneration of the musculature of the left upper leg is presented along with a review of the relevant literature. Very few such cases have been reported worldwide. The presented case is also distinguished by the involvement of muscles of distant anatomic areas.