A prospective study of erectile dysfunction in men after pelvic surgical procedures and its association with non-modifiable risk factors.

OBJECTIVE: A pelvic surgery can cause erectile dysfunction. The purpose of this study was to evaluate erectile function at various times after pelvic surgery in male patients; to search the non-modifiable risk factors associated with the presence and intensity of sexuality in these patients. This prospective study used the erectile dysfunction IIEF scale. RESULTS: The study population comprised of 106 male patients who had undergone minor pelvic surgery at least 9 months before and during the 2010-2016 period in the 4th Surgical Clinic. A control group of healthy males (N = 106) who underwent no pelvic surgery matched for age was also used for reference values. The main age of the participants was 66.16 ± 13.07 years old. A history of colectomy was present in 36.8%, 18.9% had undergone sigmoidectomy, and 33% inguinal hernia repair. The percentage of severe erectile function increased from 38.7% before surgery to 48.1% (25% increase) after surgery, at the end of the follow-up period (p < 0.05). In the multivariate analysis model, age emerged as an independent predictor of erectile function (p < 0.001). Age was the most important determinant of the IIEF score, which was aggravated by 25% from the first to the last assessment of patients.

Iatrogenic liver trauma managed with mesh-wrapping and ligation of portal vein branch: A case report.

INTRODUCTION: Liver trauma is a critical condition that requires swift multidisciplinary approach. In complex hepatic injuries perihepatic packing is an established life-saving procedure. The aim of this study is to evaluate and highlight the value of absorbable mesh wrapping of the injured liver, combined with ipsilateral ligation of portal vein branch. CASE PRESENTATION: An 82-year-old patient underwent an open cholocystectomy, for gallbladder empyema. The second postoperative day he was re-operated on due to active hemorrhage. The bleeding was controlled by suturing the bed of the gallbladder fossa. During this maneuver a portal vein branch was torn resulting in a rapidly expanding subcapsular liver hematoma which led to the formation of two deep lacerations on the liver parenchyma. This life-threatening condition was treated by wrapping an absorbable mesh around the right liver lobe and subsequently ligating the right portal vein branch extrahepaticaly. CONCLUSION: Mesh wrapping of the fragmented liver with absorbable mesh constitutes a safe and effective method, in treating grade IV and V liver injuries, especially when combined with ipsilateral ligation of the bleeding vessel.

Effect of collagen powder on lymphorrhea after modified radical mastectomy. A randomized controlled trial.

AIM: Postoperative lymphorrhea is a major complication of axillary lymphadenectomy. The aim of our study was to evaluate the impact of type I collagen in postoperative lymphorrhea in mastectomy patients. METHODS: Eighty patients that underwent modified radical mastectomy for breast cancer were randomized in two groups. In group A (collagen group, n = 42) collagen type I (Cellerate RX powder) was applied in the axillary cavity after lymphadenectomy while in group B (control group, n = 38) lymphadenectomy was performed in the standard fashion without the use of a sealant. Suction drains remained in place until the daily amount of lymphatic drainage fell under 30 ml. The total amount and the duration of drainage, as well as the morbidity and severity of arm pain were compared in the two groups. RESULTS: There was a non significant trend towards lower overall drainage in the collagen group. The duration of drainage and postoperative pain were similar in the two groups, as was morbidity. Subgroup analysis of patients according to the number of lymph nodes excised, revealed significantly less lymphorrhea in terms of volume and duration in patients who had more than ten lymph nodes excised. CONCLUSION: Collagen type I (Cellerate RX powder) appears to attenuate postoperative lymphorrhea in patients undergoing axillary lymphadenectomy especially when > 10 lymph nodes are removed.

Results of salvage abdominoperineal resection after failed chemoradiation therapy for epidermoid anal canal carcinoma: Retrospective analysis at a single institution.

PURPOSE: The standard therapeutic approach to epidermoid anal canal cancer consists of combined radiation therapy and chemotherapy. Although disease control has been reported to have excellent results, as many as 40% of patients will develop locoregional disease progression. The treatment of choice for patients with persistent (PD) or recurrent disease (RD) is salvage abdominoperineal resection (APR). The purpose of this study was to review our experience with salvage surgery in this group of patients. METHODS: The medical records of all patients with epidermoid anal canal cancer treated from 1997 to 2010 in our department were retrospectively reviewed. Nine patients who presented with persistent or locally recurrent anal canal cancer were subjected to salvage APR. Before surgery, all of the patients had received chemoradiation therapy (CRT). RESULTS: There were 9 patients (7 women, 2 men) with a median age of 59 years (range 40-79). Six patients underwent radical salvage APR for persistent disease and 3 patients for recurrent disease. There were no deaths attributable to operation. The median follow-up time was 31.75 months (range 3-108) after salvage surgery. Two patients died of disease progression, with a median survival time of 24 months (range 12-36). At the time of last follow-up, 6 patients were alive without evidence of recurrent disease, and one patient was lost to follow-up. The median follow-up time for survivors was 34.3 months (range 3-108). CONCLUSION: Long-term survival can be achieved in the majority of patients who undergo radical salvage APR after failed CRT for epidermoid carcinoma of the anal canal.

A novel technique for surgical reconstruction of the perineal floor following anteroposterior exenteration of the pelvis--case report and review of the literature.

Pelvic exenteration is the only potentially curative surgical procedure for patients with recurrent cervical, vaginal, vulvar or rectal cancers, especially following adjuvant chemotherapy or radiotherapy. Morbidity rates, however, remain high, which is significantly attributed to complications of the pelvic floor reconstruction techniques. We describe a novel reconstruction technique of the pelvic floor, involving a combination of an oblique rectus abdominis myocutaneous flap and a synthetic absorbable mesh as a pelvic sling for additional support, in a 63-year-old female patient with recurrent vulvar carcinoma. Combining the use of myocutaneous flaps and prosthetic mesh material can provide an effective alternative solution to the complications arising from pelvic floor reconstruction of large defects after exenteration procedures, especially in previously irradiated settings. Further studies are necessary to define the long-term outcomes and indications of these techniques, as well as the optimal combination between the available myocutaneous flaps and prosthetic materials.

Desferrioxamine attenuates minor lung injury following surgical acute liver failure.

Acute liver failure (ALF) can be complicated by lung dysfunction. The aim of this study was to test the hypothesis that inhibition of oxidative stress through iron chelation with desferrioxamine (DFX) attenuates pulmonary injury caused by ALF. 14 adult female domestic pigs were subjected to surgical devascularisation of the liver and were randomised to a study group (DFX group, n = 7), which received post-operative intravenous infusion of DFX (14.5 mg x kg(-1) x h(-1) for the first 6 h post-operatively and 2.4 mg x kg(-1) x h(-1) until completion of 24 h), and a control group (n = 7). Post-operative lung damage was evaluated by histological and bronchoalveolar lavage fluid (BALF) analysis. DFX resulted in reduced BALF protein levels and tissue phospholipase (PL)A(2) activity. Plasma malondialdehyde and BALF nitrate and nitrite concentrations were lower, while catalase activity in the lung was higher after DFX treatment. PLA(2), platelet-activating factor acetylhydrolase and total cell counts in BALF did not differ between groups. Histological examination revealed reduced alveolar collapse, pneumonocyte necrosis and total lung injury in the DFX-treated animals. DFX reduced systemic and pulmonary oxidative stress during ALF. The limited activity of PLA(2) and the attenuation of pneumonocyte necrosis could represent beneficial mechanisms by which DFX improves alveolar-capillary membrane permeability and prevents alveolar space collapse.

Extraovarian peritoneal serous papillary carcinoma mimicking colonic obstruction.

Involvement of the colon by extraovarian peritoneal serous papillary carcinoma (EPSPC) is considered as rare. During a 10-year period the records of five female patients with a mean age of 73.4 years who were admitted for colonic obstruction due to EPSPC were reviewed. Preoperative and postoperative data were studied. All patients presented with symptoms of colonic obstruction and high concentrations of CA-125. Involvement of the sigmoid colon was demonstrated preoperatively both in CT and colonoscopy. Operative findings of multiple peritoneal implantations involving the surface of the ovaries in two cases, the greater omentum in three cases and invasion of the sigmoid colon in all cases prompted us to perform sigmoidectomy and omentectomy in all cases with bilateral salpingo-oophorectomy in four of them. All patients received adjuvant paclitaxel plus platinum-based combination chemotherapy.

Role of lipid emulsion administration in acute lung injury during liver transplant rejection: a case report.

We report the case of a 58-year-old woman who developed rejection and acute lung injury 10 days after an orthotopic liver transplantation while receiving total parenteral nutrition. Examination of bronchoalveolar lavage fluid revealed large lipid droplets in the alveolar macrophages. Intensification of the immunosuppressive therapy attenuated the liver allograft rejection followed by resolution of lung injury.

Effect of the portacaval shunt on reperfusion injury after 65% hepatectomy in pigs.

BACKGROUND: Portal flow diversion by portacaval shunts (PCS) has been shown to prevent primary graft nonfunction in liver transplantation using small-for-size grafts. In this study, we examine whether PCS can improve reperfusion injury after major hepatectomy in pigs. MATERIALS AND METHODS: In 14 pigs, a partial PCS was constructed following 65% hepatectomy and 1 h of inflow ischemia. During 24 h of reperfusion, the shunt was either closed (group A, n = 7) or left open (group B, n = 7). RESULTS: 24 h after reperfusion, group A had higher levels of alanine aminotransferase (70 +/- 12 IU/l vs. 51 +/- 5.9 IU/l; p < 0.05), alanine aminotransferase per gram of liver remnant (0.41 +/- 0.07 IU/l/g vs. 0.21 +/- 0.05 IU/l/g; p < 0.05), prothrombin time (24.1 +/- 2.4 s vs. 14.3 +/- 2.9 s; p < 0.05), international normalized ratio (2.11 +/- 0.15 vs. 1.29 +/- 0.28; p < 0.05), hepatocyte necrosis scores and percentages of nuclei stained for proliferating cell nuclear antigen (52.57 +/- 8.9% vs. 36.71 +/- 6%; p < 0.05) compared to group B. CONCLUSIONS: Partial portal flow diversion appears to attenuate reperfusion injury in a porcine model of major hepatectomy.

A malignant eccrine poroma in a pregnant woman: case report and review of the literature.

Malignant eccrine poroma is a rare cutaneous neoplasm that originates from the intraepidermal portion of the eccrine gland. It affects mainly elderly people while its occurrence in younger adults is extremely rare. We present the first reported case of a malignant eccrine poroma in a pregnant woman, with emphasis on its pathologic and immunohistochemical features. Early diagnosis and treatment of eccrine neoplasms are of crucial importance when pregnancy coexists, because of their tendency to aggravate under the influence of gestation-related changes.

Beck Depression Inventory: exploring its psychometric properties in a palliative care population of advanced cancer patients.

To validate the Greek version of the Beck Depression Inventory (BDI)-21 items in advanced cancer patents attending a palliative care unit. The scale was translated with the forward-backward procedure into Greek. It was administered twice, with a 1-week interval, to 105 patients with advanced cancer. The patients also completed the Hospital Anxiety and Depression (HAD) scale, while researchers recorded data on demographic characteristics, disease status and treatment regimen. The Greek version of the BDI had overall Cronbach's alpha 0.906. The most significant correlations were found between BDI and performance status (P < 0.0005), gender (P = 0.031) and family status (P = 0.009). The test-retest reliability in terms of Spearman-rho, Pearson-rho coefficient and Kendall's tau-b was also satisfactory (P < 0.0005). Validity as performed using known-group analysis showed good results. The Inventory discriminated well between subgroups of patients differing in disease severity as defined by the Eastern Cooperative Oncology Group performance status. Correlations between the BDI and the HAD scale was 0.544 for the anxiety subscale and 0.657 for the depression subscale. Multiple regression analysis was conducted and predicted that the contribution of gender, family status and performance status to BDI is high. These psychometric properties of the Greek version of the BDI confirm it as a valid and reliable measure when administered to patients with advanced cancer.

Malignant paraganglioma of the urinary bladder in a 44-year-old female: clinicopathological and immunohistochemical study of a rare entity and literature review.

Paraganglioma of the urinary bladder is a rare pathologic entity with no definitive histological, immunohistochemical or molecular features to determine its malignant potency. Malignancy is essentially determined by the presence of deep local invasion, invasion of adjacent structures, and lymph node or distant metastases. So far, up to 180 cases of paraganglioma have been reported, with less than 30 being malignant. We present a case of malignant paraganglioma of the urinary bladder in a 44-year-old woman. The patient's symptoms were painless hematuria and micturitional headache. The tumor presented the characteristic "zellballen" pattern of growth and immunohistochemically was positive for all neuroendocrine markers. The patient underwent partial cystectomy and the following two postoperative years were uneventful. The literature on paraganglioma of the urinary bladder, analyzing the histological, immunohistochemical and molecular characteristics, is reviewed.

Effect of packed red blood cells transfusion on plasma fibronectin during liver resection.

Our study aimed at evaluating the effect of blood transfusion - allogeneic or autologous - on plasma levels of fibronectin during liver resections. Thirty-five patients scheduled for liver resection were randomly allocated to receive autologous (group autologous blood transfusion (ABT), n= 19) or allogeneic (homologous) (homologous blood transfusion (HBT), n= 16) packed red blood cell to maintain serum haemoglobin concentration above 9 g. Serum levels of fibronectin were measured before induction of anaesthesia, at the end of operation and at first, third and sixth postoperative day. Perioperative morbidity and survival rate were also recorded. Serum fibronectin levels were significantly higher (P < 0.05) in the autologous group than in the allogeneic, at the first (134 +/- 49 microg mL(-1) vs. 89 +/- 31 microg mL(-1)) and third (178 +/- 51 microg mL(-1) vs. 96 +/- 41 microg mL(-1)) postoperative day. No differences in survival and complication rate between the two groups were observed. Concentrations of serum fibronectin seem to be adversely affected by allogeneic blood transfusion during liver resection surgery, although this does not seem to affect patients' morbidity and mortality.

Incidental finding of a malignant peritoneal mesothelioma in an inguinal hernia sac: report of a case.

We report the case of a 46-year-old female who underwent a routine operation of herniorraphy for a right inguinal hernia. Physical findings revealed a moveable tender mass in the right lower inguinal area. Pathological examination revealed a mass with multiple nodules scattered in the inguinal hernia sac. The histological features of these nodules were compatible with malignant peritoneal mesothelioma (MPM). The incidental finding of MPM in the inguinal hernia sac is very rare. The incidence of this neoplasm is 2-2.6 cases per million annually, and the prognosis is very poor.

Colorectal cancer emergencies during pregnancy case reports.

Colorectal carcinoma emergencies during pregnancy are exceptionally rare. Three women 38, 31 and 36 years old, in the third trimester of gestation received treatment, respectively, for acute abdomen due to perforation of rectal carcinoma, ileus due to a sigmoid tumor, and deep venous thrombosis (DVT) from a cecal tumor compromising the right iliac vein. In the first two patients urgent cesarean sections were carried out with Hartmann's procedure and a loop colostomy was performed to resolve the ensuing intraabdominal sepsis and ileus, respectively. In the third patient, a cesarean section was carried out to treat the underlying DVT more aggressively, while right colectomy was postponed for three weeks. Restoration of the alimentary tract was achieved two months later in the first case, while in the second and third cases total colectomy due to familial polyposis and right colectomy were performed three weeks after the cesarean section. An overview of the clinical features, diagnostic pitfalls and therapeutic approaches to manage complications of colorectal cancer during pregnancy are discussed.

Clinicopathological features of unusual vascular lesions of the pelvis, retroperitoneum and colon in females: a report of five cases and review of the literature.

Vascular lesions comprise benign and malignant neoplasms as well as non-neoplastic conditions that may be located in various sites but only rarely in the pelvis or the retroperitoneum. In our study we describe five diverse and unusual cases of vascular lesions of the pelvis, retroperitoneum and colon in female patients: a case of retroperitoneal angiosarcoma, pelvic hemangioendothelioma, pelvic angiomyxoma, retroperitoneal lymphangioleiomyomatosis and a case of diffuse cavernous hemangiomatosis of the colon, with emphasis on their clinicopathological features and differential diagnosis. The recent literature on the subject is also briefly reviewed.

Endometriosis mimicking soft tissue tumors: diagnosis and treatment.

The clinical manifestations, the radiologic appearance and the treatment of four women with extragenital endometriosis of the abdominal wall are presented. In two patients endometriosis was found adherent with the structures of the inguinal canal and in the other two the tumors infiltrated structures of the abdominal wall. Symptoms included cyclical pain and palpable subcutaneous masses fixed to the surrounding tissues. Computed tomography and magnetic resonance imaging failed to differentiate the lesions from other soft tissue tumors. Resection to healthy tissue margins is the treatment of choice, in order to avoid local recurrence.

The effect of acutely induced hepatic failure on remifentanil and fentanyl blood levels in a pig model.

BACKGROUND AND OBJECTIVE: Opioids and especially fentanyl are widely used during the intensive care unit management of intracranial pressure in fulminant hepatic failure patients as well as during and after liver transplantation. The newer synthetic opioid remifentanil is also increasingly being used in critical care patients. Due to a lack of data relating to the influence of acute hepatic failure on remifentanil and fentanyl pharmacokinetics, this study was designed in order to determine the impact of this condition on the blood levels of these opioids using a pig model. METHODS: Twenty pigs were randomly assigned to one of two groups: A group with surgically induced acute hepatic failure by hepatic devascularization (acute hepatic failure, n=10) and a control group (SHAM, n=10), subjected to a SHAM operation. Postoperatively, five animals in each group were administered remifentanil (1 microg kg-1 min-1) or fentanyl (0.2 microg kg-1 min-1) by continuous intravenous infusion. Blood samples for determination of drug concentrations were withdrawn at 0 h and 0.5, 1, 5, 7, 9 h after initiation of dosing. RESULTS: Significantly higher blood concentrations were found in animals with acute hepatic failure compared to SHAM-operated animals receiving remifentanil at 5 h (P=0.003), 7 h (P=0.007) and 9 h (P=0.004) and fentanyl at 7 h (P<0.0005) and 9 h (P=0.05). The small number and the great variability in drug concentrations did not allow a detailed kinetic analysis to be performed. Approximate clearance values were found to be greater for the SHAM compared with the acute hepatic failure animals for both fentanyl and remifentanil. CONCLUSIONS: Hepatic devascularization in our porcine acute hepatic failure model, appears to have significantly altered the disposition of fentanyl and unexpectedly remifentanil. These changes were thought to be brought about by severe disruption of blood flow and biotransformation in the liver, as well as by haemodynamic changes in the acute hepatic failure animals.

Secondary tumors of the intestines in females: a retrospective clinicopathologic study of seven cases.

OBJECTIVE: To investigate the primary site and the pathological features of secondary intestinal tumors in females, with emphasis on their differential diagnosis from primary neoplasms of the intestines. METHODS: Seven cases of secondary intestinal tumors in females were retrieved from the archival files of our laboratory. The relative clinical data were also reviewed. Inmmunohistochemistry was performed in cases with diagnostic difficulties. RESULTS: The primary site of the tumor was defined as follows: the ovary (ovarian adenocarcinoma) in five cases (71.4%), the skin (cutaneous malignant melanoma) in one case (14.28%) and the uterine corpus (mixed mullerian tumor) in one case (14.28%). In two cases the primary site was not determined initially, but the investigation showed that the primary tumor was ovarian in origin. In five cases the existence of a primary tumor was already known. Immunohistochemistry was applied in three cases for confirmation of the suspected primary tumor by histological examination. CONCLUSION: Histological diagnosis of secondary intestinal tumors may be extremely difficult, especially when the primary site is not previously known, and because of the tendency of certain secondary tumors to mimic, both grossly and microscopically, the primary ones. Immunohistochemistry is extremely helpful in resolving these diagnostic difficulties.

Urgent thyroidectomy for acute airway obstruction caused by a goiter in a euthyroid pregnant woman.

Pregnancy constitutes a significant factor for thyroid enlargement. However, acute respiratory failure as a result of airway obstruction from an enlarged thyroid gland is an unusual incident. The case presented here concerns a 27-year-old black woman in her 20th gestational week who underwent an urgent operation for removal of a nontoxic, multinodular, mildly substernal goiter that was causing severe upper airway obstruction leading to acute life-threatening respiratory failure. Diagnosis of an extrathoracic tracheal stenosis was based on spirometry with analysis of the flow volume curve and was confirmed by magnetic resonance imaging of the neck. Despite operational risks to the mother as well as the fetus during gestation, an urgent thyroidectomy was carried out successfully. The postoperative period progressed normally and the patient completed her pregnancy with no further respiratory symptoms.