In the emergency department, patients frequently present with abdominal pain, with a variety of different causes ranging from intra-abdominal to extra-abdominal and retroperitoneal pathologies which ...can affect all age groups. Chronic appendicitis is a rare medical condition characterized by less severe and continuous abdominal pain and a clinical picture lasting longer than 1-2 days and extending over months, even years, and it is not always possible to consider it as a preliminary diagnosis. We represent a case report of chronic appendicitis where the patient’s clinical picture led the diagnostics and treatment in different directions and delayed the diagnosis. Namely, our patient was radiologically diagnosed with a collection of denser content retroperitoneally in the right lower quadrant of the abdomen, which in the first place was not related to possible appendicitis, regarding complaints. The existence of chronic appendicitis is a diagnosis unfamiliar to many clinicians and has no official diagnostic criteria. After diagnosis, treatment usually begins with antibiotics, and the next most common step is surgery. The optimal treatment for this condition is unknown. With this case report, we wish to draw attention to chronic appendicitis as a possible differential diagnosis in patients with chronic abdominal pain.
Recently, it was found that when confronted with major vessel occlusion and vascular failure, stable gastric pentadecapeptide BPC 157 therapy might rapidly functionally improve minor vessels to take ...over the function of disabled major vessels, reorganize blood flow, and compensate failed vessel function. We focused on the BPC 157 therapy effect obtained by giving 10 ng/kg ip to rats 5 min before sacrifice on the rat thoracic aorta, which we assessed with Fourier transform infrared spectroscopy (FTIR) 90 min thereafter. We applied a principal component analysis (PCA). The PCA model showed, with a clear distinction being mostly due to the PC1 score, differences between the spectra of BPC 157- and saline-treated rats. The comparison of the averaged spectra of these two groups with their differential spectrum and PC loadings allowed us to identify the parts of the FTIR spectra that contributed the most to the spectral separation of the two observed groups. The PC1 loadings and the differential spectrum showed that the main bands affecting the separation were the amid I band around 1650 cm
, the amid II band around 1540 cm
, and the vibrational band around 1744 cm
. Fitting the spectral range between 1450 and 1800 cm
showed changes in protein conformation and confirmed the appearance of the vibrational band at 1744 cm
. Controls had a substantially more intense vibrational band at 1744 cm
. These spectral results showed the cells from saline-treated (control) rats to be in the early stage of cell death, while the samples from BPC 157-rats were protected. Thus, BPC 157 therapy changed the lipid contents and protein secondary structure conformation, with a rapid effect on vessels, within a short time upon application.
Identification and preservation of testicular artery and lymphatic vessels during microsurgical varicocelectomy can be tedious if adhered encompassing venous network is encountered. A venous bypass ...from internal spermatic to saphenous or inferior epigastric vein, that have been described for varicocele treatment, may be used in such situations. This paper describes a simplified modification of the venous bypass technique that reroutes the testicular blood to the superficial epigastric vein, which can easily be found in the incisional wound. Surgical technique and anastomotic patency test are described, and indications and results are discussed.
During 2020 and 2021, 32 adolescent patients underwent microsurgical varicocelectomy. In eight patients additional microsurgical testicular vein-superficial epigastric vein microvascular bypass was done. The indication for bypass was difficult identification of testicular artery and/or lymphatic vessels due to adhered venous plexus.
Varicocele resolution was noted in all eight patients with clinical and/or semen analysis improvement. There were no complications or recurrences. Average length of procedure was 65 minutes. All patients were discharged within 24 hours and no antiplatelet or anticoagulant therapy was used.
Testicular vein to superficial epigastric vein anastomosis is a useful and simplified venous bypass technique that reroutes the blood from the pampiniform plexus to the femoral vein. It can be done as an adjunct to microsurgical varicocelectomy in selected patients through a standard incision.
This case shows the risk of severe cardiovascular complications following lumbar spine surgery, with progressive high output heart failure caused by an iatrogenic iliac arteriovenous fistula. Careful ...history taking and thorough physical examination are essential in guiding the diagnosis. Endovascular repair can provide excellent short- and long-term outcomes.
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This case shows the risk of severe cardiovascular complications following lumbar spine surgery, with progressive high output heart failure caused by an iatrogenic iliac arteriovenous fistula. Careful ...history taking and thorough physical examination are essential in guiding the diagnosis. Endovascular repair can provide excellent short- and long-term outcomes.
Aim: To describe the surgical technique and present outcomes of the first 20 boys and adolescents that underwent microsurgical varicocelectomy at the Department of pediatric surgery, University ...Hospital Center Zagreb. According to the literature data, this method has the lowest incidence of recurrence and complications. Patients and Methods: Indications for microsurgical varicocelectomy are the same as for other methods of varicocele treatment: presence of symptoms, testicular hypotrophy (affected testicle smaller >20% in volume compared to the contralateral testicle), or abnormal semen analysis in adolescent that reached the final (Tanner 5) stage of pubertal development. The diagnoses of varicocele and testicular hypotrophy were established by clinical examination, ultrasound volumetry and Doppler examination. The surgery was done through a 3–4 cm incision above the external inguinal ring. The patients were followed prospectively, with an average follow-up of 10 months (range 6–12 months). Results: Average surgery duration was 65 minutes. All patients were discharged within 24 hours after surgery, and returned to all preoperative activities within two weeks postoperatively. No recurrences were noted during follow-up, symptoms resolved in all patients operated for symptomatic varicocele, and sperm count normalized in all patients that underwent surgery for abnormal semen analysis. Regarding complications, one patient reported a transitory discomfort during ejaculation. In one patient the testicular artery was inadvertently ligated during surgery, but was immediately reconstructed with an end-to-end anastomosis. Control Doppler examinations of the spermatic cord showed a patent anastomosis with normal flow. Conclusion: Microsurgical varicocelectomy is a safe method for varicocele treatment with a high success rate and low incidence of complications.
SAŽETAK
Ciljprikazati metodu i rane ishode prvih 20 dječaka i adolescenata kod kojih je učinjena mikrokirurška varikokelektomija na Zavodu za dječju kirurgiju Kliničkoga bolničkog centra Zagreb. Ova ...metoda prema literaturnim podatcima ima najmanju učestalost recidiva i komplikacija.
Ispitanici i metodeIndikacije za mikrokiruršku operaciju jesu simptomatska varikokela, hipotrofija testisa (zahvaćeni testis volumno manji od zdravog za >20%), te poremećaj spermiograma kod adolescenata u završnom (Tanner 5) stadiju spolnog razvoja. Varikokela i hipotrofija testisa utvrđeni su kliničkim pregledom, ultrazvučnom volumetrijom i dopplerskim pregledom. Operacija se izvodi kroz rez duljine 3 – 4 cm u razini vanjskoga ingvinalnog otvora. Pacijenti su praćeni prospektivno nakon operacije, a prosječno vrijeme praćenja bilo je deset mjeseci (raspon 6 – 12 mjeseci).
RezultatiProsječno trajanje operacije bilo je 65 minuta. Svi pacijenti su otpušteni kući unutar 24 sata od operacije, a vratili su se svim aktivnostima unutar dva tjedna nakon operacije. Tijekom kontrolnih pregleda nije zabilježen recidiv varikokele, kod svih pacijenata koji su operirani zbog simptoma došlo je do nestanka tegoba, dok je kod onih koji su operirani zbog lošeg spermiograma došlo do oporavka ejakulata. Od komplikacija, jedan pacijent je imao prolaznu nelagodu kod ejakulacije. Kod jednog pacijenta je intraoperativno neželjeno podvezana testikularna arterija koja je odmah rekonstruirana termino-terminalnom anastomozom uz uredne protoke na kontrolnim dopplerskim pregledima sjemenskog snopa, bez znakova atrofije testisa.
ZaključakMikrokirurška varikokelektomija je sigurna metoda za liječenje varikokele sa visokom uspješnošću i malim brojem komplikacija.
