Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with traces of blood and mucus and ...had experienced fatigue after hiking. After the initial evaluation, it became clear that prolapse bares a large rectal tumor as a leading point. The prolapse was reduced under general anesthesia, along with a tumor biopsy. Further workup confirmed locally advanced adenocarcinoma of the rectum, which was treated with neoadjuvant chemoradiation followed by curative surgery in another hospital after repatriation. Rectal prolapse affects people of all ages, but it is more common in older adults, particularly women. Treatment options vary depending on the severity of the prolapse and can range from conservative measures to surgical interventions. This case report highlights the importance of early recognition and appropriate management of rectal prolapse in the emergency setting and the possibility of an underlying malignancy.
To the Editor,
Intussusception is a true pediatric emergency requiring a multidisciplinary approach. Clinical suspicion should lead directly toward an abdominal ultrasound or a contrast enema. As a ...part of modern point-of-care management, ultrasound has emerged as a readily available diagnostic modality even in rural hospitals. After establishing a diagnosis, the pediatric or general surgeon should decide upon further treatment, preferably enema reduction (1). The drawbacks of conservative treatment are reduction failure in 20% of the cases, risk of perforation, radiation load, higher rate of recurrence than that with operative treatment, and oversight of the potential leading point.
Gas gangrene is infectious disease caused by Clostridium perfringens infection.
We are presenting extremely rare case of gluteal clostridial myonecrosis after intramuscular injection of diclofenac in ...immunocompromised young patient on a long-standing corticosteroid therapy presented with sepsis and initially absent clinical signs of severe anaerobic infection. After delayed diagnosis, she was treated with aggressive surgical removal of necrosed tissue and targeted antibiotic therapy which led to a rapid improvement allowing application of a negative-pressure wound therapy device with favorable outcome.
This report shows the importance of timely diagnosis with pitfalls of imaging. It confirms that surgical debridement along with specific antibiotic therapy is the mainstay of treatment, but also promotes negative-pressure wound therapy which has proved convenient for accelerated closure of large incisions with tissue loss without any adverse effects or the need for complex reconstructive procedures.
Prospective, randomized, pilot clinical study was conducted to evaluate the beneficial effects of inositol hexaphosphate (IP6) + Inositol in breast cancer patients treated with adjuvant therapy.
...Patients with invasive ductal breast cancer where polychemotherapy was indicated were monitored in the period from 2005-2007. Fourteen patients in the same stage of ductal invasive breast cancer were involved in the study, divided in two randomized groups. One group was subjected to take IP6 + Inositol while the other group was taking placebo. In both groups of patients the same laboratory parameters were monitored. When the treatment was finished, all patients have filled questionnaires QLQ C30 and QLQ-BR23 to determine the quality of life.
Patients receiving chemotherapy, along with IP6 + Inositol did not have cytopenia, drop in leukocyte and platelet counts. Red blood cell counts and tumor markers were unaltered in both groups. However, patients who took IP6 + Inositol had significantly better quality of life (p = 0.05) and functional status (p = 0.0003) and were able to perform their daily activities.
IP6 + Inositol as an adjunctive therapy is valuable help in ameliorating the side effects and preserving quality of life among the patients treated with chemotherapy.
Treatment of clavicle fracture is principally outpatient. Operative treatment is accompanied by the need for more x-rays and possible complications. Fractures with absolute indications for operative ...treatment occur only sporadically and these indications are relatively clear, but children often undergo surgery because of relative indications (shortening, fragment displacement, multifragmentary fractures), which are open to debate. In a retrospective study on 256 children, of 44 (17%) patients that received operative treatment only one 17-year-old boy had an absolute indication for surgical intervention. Other indications were fragment distraction (22 mm on average), age, associated injuries, and multifragmentary fracture. The placement of K-wire of appropriate thickness is often difficult, since the wire tends to bend and break, and patients have to undergo two additional operations of plate and screw fixation and later removal. In this retrospective study, we considered the advantages of using titanium or an elastic steel pin. All patients had favorable outcome, although some experienced numbness around the operation scar (4.5%), skin infections around the wire (15%), and/or the implanted K-wire damage (7%).
Background
The aim of this study was to compare lateral thermal damage of the appendix and clinical outcomes after laparoscopic appendectomy using new versus reused Harmonic scalpels.
Methods
A total ...of 100 consecutive patients with acute appendicitis who underwent laparoscopic appendectomy were enrolled in the two-center, randomized clinical trial. Using a computer random number generator, patients were allocated to
new
or
reused
group. Histopathological measurement of lateral thermal damage of the appendiceal base and mesoappendix, speed of transection of the appendiceal base, duration of surgery, subjective rating of device functionality, length of hospital stay, and complications were compared within groups.
Results
The median lateral thermal damage on the appendiceal base in the
new
group (
N
= 49) was 0.2 mm (IQR 0.1–0.2) and 0.1 mm (IQR 0.1–0.3) in the
reused
group (
N
= 51) (
P
= 0.644), while on the mesoappendix for both groups, thermal damage was 0.1 mm (IQR 0.1–0.2) (
P
= 0.418). The median time required for base transection in both groups was 8 s (IQR 7–9) (
P
= 0.776). The median duration of surgery was also comparable between the groups (22 min, IQR 20–30 vs 25 min, IQR 21–35;
P
= 0.233). Two postoperative complications in the new group and one in the reused group were recorded (4% vs 2%;
P
= 0.536). Surgeons’ subjective assessment of the instrument did not reveal significant difference between the groups in all of the investigated categories.
Conclusions
The results of our study support the reuse of Harmonic scalpels especially in the settings where economic constraints might hamper access to minimally invasive surgery to a larger number of patients. The results obtained on laparoscopic appendectomy might not be reproducible to other more demanding surgical procedures.
Trial registration
ClinicalTrials.gov
registry under identifier NCT04226482
Prijelomi podlaktice najčešći su prijelomi dječje dobi. Najčešći uzrok prijeloma u ovoj dobi je pad na ispruženu ruku gdje dolazi do izbijanja osovine donjeg dijela podlaktičnih kostiju. Cilj ...istraživanja je utvrditi načine i mjesto prijeloma u populaciji djece Zadarske županije. Provedena je retrospektivna analiza 1603-je djece liječene tijekom vremenskog razdoblja 2014. do 2018. u Općoj bolnici Zadar. Od 1476-ero ambulantno liječene djece, 940 dječaka (63,7%) i 536 djevojčica (36,3%). Od djece liječene bolnički bilo je 87 (68,5%) dječaka i 40 (31,5%) djevojčica. Prosječna dob u trenutku ozljeđivanja je 9,6 godina (dječaci 9,7, a djevojčice 9,5 godina). Od liječene djece njih 173-je (10,8%) bilo je u dobi od 0-4 godine, 633-je (39,5 %) u dobi od 5-9 godina, 656-ero (40,9 %) u dobi od 10-14 godina i 141-no (8,8%) u dobi od 15-18 godina. Na prometnicama je ozlijeđeno 18-ero (1,1%), kod kuće 49-ero (3,1%), u školi 65-ero (4,1%), a na prostorima za izvannastavne aktivnosti i slobodno vrijeme 1369-ero (86,5%) djece. Pad je uzrokovao prijelome u 468-ero (29,2%) naše djece. Ozljede u športu i rekreaciji (padovi, udarci, posrtanja, sudar sa suigračem, loptom) uzrok su prijelomima u 956-ero djece (59,6%). Ostali uzroci su odgovorni za prijelome u 92-je djece (5,7%). U športovima s loptom najveći broj ozlijeđene djece je u nogometu 411-ero (25,6%), rukometu 143-je (8,9%) i košarci njih 115-ero (7,2%). Djeca u Zadarskoj županiji rijetko zadobiju prijelom kostiju podlaktice u prometu, školi i kod kuće, a dominantan način ozljeđivanja je pad na igralištima i u parkovima. Pretežita aktivnost su šport i rekreacija.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The aim of the present study was to evaluate angiogenesis by determining the micro vascular density (MVD) and the expression of vascular endothelial growth factor (VEGF-A) in advanced non-small cell ...lung cancer (NSCLC) tumor samples, and to analyze their associations with clinical parameters and survival. Tumor tissue specimens of fifty patients (41 males and 9 females), who underwent radical surgical treatment for NSCLC in stage IIIA (T1-3N2) were collected for immunohistochemical analysis. MVD evaluation was performed using an anti-CD31 monoclonal antibody and VEGF-A expression using a polyclonal anti-VEGF-A antibody. The results were associated with two-year survival. Statistical analysis revealed significant associations in the level of angiogenesis (high MVD) and shorter survival of patients with NSCLC (P=0.0007). VEGF-A expression showed no association with micro vascular density (P=0.51) or survival (P=0.68). There was no significant association between MVD and VEGF-A. The measurable, clinical MVD parameters could be used as a reliable prognostic factor for the survival of patients with advanced NSCLC.
Abstract Background Elastic stable intramedullary nailing (ESIN) osteosynthesis has been used in our department for the treatment of long-bone fractures in children and adolescents for more than 17 ...years. During this period we have shown that ESIN has several advantages compared with other methods of treatment. However, as with every other method, ESIN has its drawbacks and complications. These occur primarily if indication criteria are not respected or ESIN technique is inadequate. This paper presents the rate of complications that occurred with this method in our patients, and the means of prevention and treatment of these complications. Patients and methods A total of 270 patients treated with ESIN osteosynthesis for fractures of long bones of the extremities completed treatment. The study was conducted at the Department of Child Surgery and Orthopaedics of the Clinical Hospital Centre in Rijeka. All the Nancy Nails used in the study were of the same quality, from one manufacturer and were applied using the standard ESIN technique. In 228 patients (84%), ESIN was the primary treatment, whereas in the remaining 42 patients (16%), ESIN was applied after an attempt at manual reposition and immobilisation of bone fragments. All patients had control radiography at least three times and postoperative monitoring was conducted for at least two years. Results A total of 35 of the 270 observed patients developed complications; some patients had several complications. There were 53 early intraoperational complications and 29 late postoperative complications. All complications resolved with appropriate therapy. The treatment was satisfactory in all patients except those with an elongation of the extremity (leg) of more than 1 cm. Conclusion Postoperative complications related to the ESIN method of osteosynthesis in the patients in this study were detected by radiological control examinations and long-term clinical monitoring. All the complications of ESIN were relatively easy to treat with current medical methods. The frequency of particular complications is significantly reduced if indication criteria for ESIN are respected and correct ESIN technique is used.
PDF
