As US and FNAC did not consistently detect cancer in patients with diffuse multinodular goiter in our endemic area, evidence-based indications for surgery in this group of patients is needed, although radical surgery and favorable tumor histology offer favorable outcomes in commonly diagnosed thyroid cancer after total thyroidectomy for endemic multinodular goiter.
Only 5% of all cases of intussusceptions occur in adults. Intussusception complicating colonoscopy is an extremely rare event. Herein, we present a case of a 58-year-old man who developed ileocolic intussusception after a colonoscopy during which an adenomatous polyp was discovered in the terminal ileum. Eight hours after colonoscopy, the patient developed diffuse abdominal pain associated with vomiting and bloody diarrhea. A contrast-enhanced abdominal computed tomography scan revealed features of mechanical intestinal obstruction and a round soft tissue mass inside the right colon, followed by the wall of the intussusceptum. Emergency laparotomy revealed extended ileocecal intussusception with the polyp incarcerated by the ileocecal valve. A typical right hemicolectomy was performed, and the patient had an uneventful recovery. Histologic examination of the surgical specimen revealed an inflammatory fibroid polyp. Ileocolic intussusception due to an ileal polyp may be precipitated by colonoscopy and should be included in the differential diagnosis of acute abdomen after colonoscopy.
Key Clinical MessageAn alternative surgical approach for downsizing an existed modified Blalock‐Taussig shunt is described as a reoperation in a hemodynamically unstable patient. This method was selected in order to minimize the surgical manipulations in the setting of a critically ill infant.
The brain natriuretic peptide (BNP) is a peptide responsible for the homeostasis of the cardiovascular system. In this study, the kinetics of BNP blood plasma levels after pneumonectomy, where certain hemodynamic alterations do occur were analyzed and a possible predictive value of postoperative complications is examined. Thirtyfive patients enrolled, underwent a scheduled pneumonectomy for non-small cell cancer of the lung. The BNP plasma levels were recorded pre-operatively, immediately after the ligation of pulmonary artery, at 3, and at 24 hours post-operatively. The collected data were analyzed with descriptive statistical analysis, using students t-test, Chisquare, ANOVA, and Pearson's correlation coefficient. The differences considered significant at p<0.05. BNP showed a statistically significant increase after the ligation of the pulmonary artery in all of the patients. The patients were divided into 2 groups according to the presence or not of the complications. In the complications group the BNP increase was significantly greater than in the non-complication group. There was direct correlation of BNP value at 24 hours postoperatively and the occurrence of complications. The cutoff value was set at 100 pgr/ml (sensitivity 91.6% and specificity 93.75%). Preoperatively BNP values above 15 pgr/ml have 17.41% probability for a complication to occur (60% sensitivity and 70.83% specificity). The results of the study of the BNP after pneumonectomy are interesting and are in the path of a safety and economical routine clinical use for the prediction and prevention of post-operative complications.
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