Anatomical variations of the hepatic artery are important in the planning and performance of abdominal surgical procedures. Normal hepatic anatomy occurs in approximately 80% of cases, for the remaining 20% multiple variations have been described. The purpose of this study was to review the existing literature on the hepatic anatomy and to stress out its importance in surgical practice. Two main databases were searched for eligible articles during the period 2000 - 2015, and results concerning more than 19,000 patients were included in the study. The most common variation was the replaced right hepatic artery (type III according to Michels classification) which is the chief source of blood supply to the bile duct.
Patient: Female, 27Final Diagnosis: Invasive thyroglossal duct cyst papillary carcinomaSymptoms: Painless cervical enlargementMedication: —Clinical Procedure: Sistrunk’s procedureSpecialty: SurgeryObjective:Rare diseaseBackground:Thyroglossal duct cyst is a common congenital anomaly of the thyroid gland, usually found centrally. The presence of malignancy occurring in a thyroglossal duct cyst is a rare condition, accounting only for 1% of all cases of thyroglossal duct cyst. This report is of a rare case of papillary carcinoma arising in a thyroglossal duct cyst and includes a review of the literature.Case Report:A 27-year-old female patient was referred to our department with a painless cystic mass in the neck. After initial physical examination and endocrinology investigations, a fine needle aspiration (FNA) of the cyst was performed. Cytology showed a papillary neoplasm. The patient underwent total thyroidectomy and surgical excision of the thyroglossal duct cyst (the Sistrunk’s procedure). Histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7.5 cm containing a primary invasive papillary carcinoma, measuring 1.5 cm in diameter that infiltrated into the cyst wall. The remaining thyroid gland was normal.Conclusions:Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery and complete excision is the main treatment and the optimal patient management includes multidisciplinary consultation in order to improve survival. The diagnosis of malignancy is made postoperatively, as in the present case.
The Erector Spinae Plane Block (ESP) is a novel regional technique for anesthesia or analgesia. Originally the ESP block was described in 2016 in a case report regarding analgesia intervention for a case of thoracic neuropathic pain. Since then, there has been growing interest and research adding experience about the ESP block as regional anesthetic and analgesic technique. Reviewing the literature about this novel technique in databases like PubMed using the key words “erector spinae plane block” returns approximately 56 publications. So far there is no available big series of cases or reviews regarding the ESP block. The literature is limited to case reports or case series. With the present case we are interested in exploring the efficacy of ESP block as a postoperative analgesic method for laparoscopic cholecystectomy. We describe the case of a 76-year-old female patient scheduled for laparoscopic cholecystectomy. Written informed consent was granted (for procedure and publication of photos). We applied a bilateral ultrasound-guided ESP block at T6 level while the patient was awake before general anesthesia induction. The anesthetic solution we used consisted of 12 mL Ropivacaine 0.375% plus 2 mg dexamethasone (on each side). After the successful administration of the block (observation of the solution spread between transverse process and the erector spinae muscles), general anesthesia was induced and the procedure was started. Procedure and recovery was uneventful with the patient experiencing very good analgesia (NRS pain score 0 up to 6 hours after block placement). The patient presented mild pain (NRS score of 2–3) after 6 hours and requested the “on demand” pain medication (1 g paracetamol IV) only 10 hours after the ESP block (NRS pain score of 4–5). The patient experienced no nausea or vomiting, was mobilized easily about 6 hours after the block and was discharged the next day. This relatively simple and safe block dramatically reduced the amount of IV pain medication we usually administer for the specific procedure. The overall result was increased satisfaction of the patient and avoidance of opioid use.
We present a case of small bowel stricture and obstruction with delayed and subtle presentation 3 months after a car accident. Such a presentation is a rare clinical entity. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischaemic bowel stenosis may result from even small tears and contusions. These lesions may cause partial thickness ischaemia of the bowel wall, with mucosal ulceration and submucosal inflammation and fibrosis, or may cause full-thickness ischaemia with fibrosis of all layers. Mesenteric tears or intramural haematomas have been found on close inspection of the specimens. Our case supports the mesenteric injury theory since there is the initial CT-scan proof of retroperitoneal and consequently, mesenteric haematomas. Regardless of the pathophysiology of this clinical entity, it is very important that the condition of post-traumatic small bowel stricture should be suspected when a patient experiences bowel obstruction weeks, or even years, after sustaining abdominal injury, especially in connection with a seat-belt injury.
Background: Thyroidectomy is a quite common daily operation in general surgery. However, the anatomical structures of the region, mainly the relationship of recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) makes the procedure challenging. The current review of the literature aims to report the anatomical variations of this relationship. Methods: The preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines were used for the systematic review of the articles found after an extensive research through Pub-Med, Science Direct, EMBASE and Web of Science. A total of 16 studies were included for the statistical analysis. Results: The results showed that the most common type of RLN was posterior to the ITA. However, according to Higgins I 2 statistics the heterogeneity of the studies was quite high. Conclusions: The relationship between the RLN and the ITA is quite variable. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the nerve during thyroidectomy.
Background: Inguinal hernia repair is one of the most common daily operations in general surgery. However, the anatomical structures of the region, such as the corona mortis (the crown of death), make this procedure quite challenging. A comprehensive knowledge of its anatomy is essential, since massive hemorrhage may occur if the vessel is injured. The current review of the literature aimed to report the frequency and anatomical variations of vascular corona mortis. Methods: A substantial study was coordinated through PubMed, Scopus and Google Scholar. The Prisma guidelines were used for the systematic review of the articles found. A total of 13 studies and 1,455 patients were included for the statistical analysis. Results: The results showed that corona mortis was present in about half the hemi-pelvises, and to be more accurate, the prevalence was 46%. Venous corona mortis was more frequent than the arterial type (42% vs. 25%). Conclusions: Considering the percentages mentioned above, every surgeon who schedules an operation on the retro-pubic area, especially during a hernioplasty procedure, should evaluate the possibility of the presence of corona mortis. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the corona mortis during surgery.
Background: One of the most challenging operations is the resection of the pancreas, which is associated with high morbidity. Metabolic control during the perioperative period remains an issue that is sometimes difficult to manage. Objectives: Exercise has a positive effect on glycaemic control. The objective of this trial was determining whether exercise has any benefit for oxidative stress and glucose levels. Method:The study was an open-label, randomised clinical trial. It has been registered in the International Standard Randomised Controlled Trial registry. The patients were selected according to the Consolidated Standard of Reporting Trials criteria. Results: In total, 56 patients were assessed for eligibility. There was no statistical difference between the 2 groups (the exercise and the control one) regarding the disease characteristics, morbidity or influence of exercise on oxidative stress; however, the control of glucose was superior in the exercise group. Conclusions: Exercise has a positive effect on glycaemic control in patients after pancreatic resection.
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