bluuebunny/crossref_metadata_2025 huggingface dataset:
Pancreatic solitary and synchronous metastasis from breast cancer: a case report and systematic review of controversies in diagnosis and treatment
Authors: Molino Carlo , Mocerino Carmela , Braucci Antonio , Riccardi Ferdinando , Trunfio Martino , Carrillo Giovanna , Vitale Maria Giuseppa , Cartenì Giacomo , De Sena Guido
Published: January 2014

Background

Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare, and more frequently discovered after a primary diagnosis of breast cancer. Solitary pancreatic metastases from breast cancer, without widespread disease, are actually unusual, and only 19 cases have been previously described; truly exceptional is a solitary pancreatic metastasis becoming evident together with the primary breast cancer.

Case presentation

A 68-year-old woman reported general fatigue, lethargy, and jaundice. Abdominal ultrasound (US) and magnetic resonance imaging (MRI) showed an ampulloma of Vater’s papilla; moreover, a neoplastic nodule in the left breast was diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater’s papilla. Pathological examination of pancreatic specimen, however, did not confirm primary carcinoma of the duodenal papilla, but showed a metastatic involvement of pancreas from lobular breast cancer. Immunohistochemistry has been essential to confirm the origin of the malignancy: hormone receptors and mammaglobin were expressed in both the primary breast tumor and the pancreatic metastasis.

Conclusions

This is one of the few reported cases in literature of an isolated and synchronous pancreatic metastasis from breast cancer, where the definitive diagnosis was obtained only after surgery. We discuss the controversies in this diagnosis and the choice of correct treatment. The surgical resection of solitary metastases can be performed in the absence of disseminated disease.
Lead-free LiNbO3 nanowire-based nanocomposite for piezoelectric power generation
Authors: Yun Byung Kil , Park Yong Keun , Lee Minbaek , Lee Nuri , Jo William , Lee Seongsu , Jung Jong Hoon
Published: January 2014

In a flexible nanocomposite-based nanogenerator, in which piezoelectric nanostructures are mixed with polymers, important parameters to increase the output power include using long nanowires with high piezoelectricity and decreasing the dielectric constant of the nanocomposite. Here, we report on piezoelectric power generation from a lead-free LiNbO3 nanowire-based nanocomposite. Through ion exchange of ultra-long Na2Nb2O6-H2O nanowires, we synthesized long (approximately 50 μm in length) single-crystalline LiNbO3 nanowires having a high piezoelectric coefficient (d
33 approximately 25 pmV-1). By blending LiNbO3 nanowires with poly(dimethylsiloxane) (PDMS) polymer (volume ratio 1:100), we fabricated a flexible nanocomposite nanogenerator having a low dielectric constant (approximately 2.7). The nanogenerator generated stable electric power, even under excessive strain conditions (approximately 105 cycles). The different piezoelectric coefficients of d
33 and d
31 for LiNbO3 may have resulted in generated voltage and current for the e
33 geometry that were 20 and 100 times larger than those for the e
31 geometry, respectively. This study suggests the importance of the blending ratio and strain geometry for higher output-power generation in a piezoelectric nanocomposite-based nanogenerator.

PACS

77.65.-j; 77.84.-s; 73.21.Hb
Quantization and diagnosis of Shanghuo (Heatiness) in Chinese medicine using a diagnostic scoring scheme and salivary biochemical parameters
Authors: Liu Sijun , Huang Zhaosheng , Wu Qingguang , Huang Zhangjie , Wu Lirong , Yan Wenli , Chang David Lungpao , Yang Zheng , Wang Zongwei
Published: January 2014

Background

This study aims to establish a diagnostic scoring scheme for Shanghuo (Heatiness) and to evaluate whether Shanghuo is associated with biochemical parameters of salivary lysozyme (LYZ), salivary secreted immunoglobulin (S-IgA), salivary amylase (AMS), and saliva flow rate (SFR).

Methods

We collected 121 Shanghuo patients at the Affiliated Hospitals of Guangzhou University of Traditional Chinese Medicine in Guangdong Province, 60 cases as a Shanghuo recovered group, and 60 healthy cases as a healthy control group. The diagnostic scoring scheme was established by probability theory and maximum likelihood discriminatory analysis on the basis of epidemiology with the design of self-controlled clinical trial. Subsequently, we used the same methods to collect 120 Shanghuo patients, 60 Shanghuo recovered cases, and 60 healthy cases in both Hunan Province and Henan Province. The levels of LYZ, S-IgA, AMS, and SFR were tested when the patients suffered from Shanghuo or recovered, respectively.

Results

The diagnostic score table for Shanghuo syndrome was established first. In the retrospective tests, the sensitivity, specificity, accuracy, and positive likelihood ratio of the diagnostic score table were 98.9%, 93.5%, 97.5%, and 14.34%, respectively. In the prospective tests, the corresponding values were 94.9%, 85.7%, 91.7%, and 6.64%, respectively. Shanghuo was classified into three degrees based on the diagnostic scores, common Shanghuo: 63–120; serious Shanghuo: 121–150; very serious Shanghuo: >150. A negative correlation was found between Shanghuo and S-IgA (R = -0.428; P = 0.000). The level of S-IgA was also affected by seasonal and regional factors. No significant correlations were found between Shanghuo and the levels of LYZ, AMS, and SFR.

Conclusions

In this study, Shanghuo could be diagnosed by the combination of the diagnostic score table and S-lgA level.
A young man with myelosuppression caused by clindamycin: a case report
Authors: Morales Manuel Polanco , Carvallo Anna Paola Thome , Espinosa Karla Adriana Bautista , Murillo Edgar Enrique Meza
Published: January 2014

Introduction

Clindamycin is used to treat various bacterial infections, but its administration can cause anaphylaxis, liver reactions, pseudomembranous colitis, and peripheral blood cytopenias (anemia, neutropenia, and thrombocytopenia), alone or in combination. We report the case of a patient with a recurrent infection of the tonsils who received clindamycin. Pancytopenia, a previously unreported hematological disorder related to clindamycin use, was observed in conjunction with the infection and clindamycin treatment.

Case presentation

One month prior to hospitalization, a 22-year-old man of Hispanic origin had a tonsillar infection and cough and began to have anal pain. These conditions became exacerbated three weeks later, coinciding with a new tonsillar infection, frequent nonproductive cough, and febrile syndrome. He received clindamycin for four days prior to his admission, without improvement. While hospitalized, he was found to have fever, tonsillar abscess, hemorrhoid thrombosis, and anal fissure; the latter was immediately resected under general anesthesia. Before surgery, our patient’s blood count showed intense leukoneutropenia and mild thrombocytopenia that increased 12 hours later, along with the establishment of anemia. A bone marrow study showed decreased cell content, micromegakaryocytes, and an interruption of the differentiation of granulocytes and erythroblasts. Post-surgery, our patient received metronidazole, meropenem, and amikacin along with acetaminophen, ketoprofen, omeprazole, and pegfilgrastim, with resulting clinical and hematological improvement.

Conclusion

Our experience with this patient establishes that well-documented clinical cases should be the basis for identifying and publicizing unknown or uncommon undesirable effects of drugs. We report that, in some individuals, clindamycin can cause pancytopenia, a complication that in our patient’s case was caused by direct injury of his hematopoietic tissue.
Comparative Study on the Photocatalytic Oxidation of Glycerol Using ZnO and TiO2
Authors: Hermes Natanael A , Corsetti André , Lansarin Marla A
Published: January 2014

Herein, we have compared the behavior of ZnO and TiO2 in the photocatalytic oxidation of glycerol through detection of the main products. ZnO showed higher selectivity for the products where the carbon chain was preserved, such as glyceraldehyde (GAD) and dihydroxyacetone (DHA). TiO2 generated more products from the cleavage of the glycerol molecule, such as formaldehyde (FORM) and glycolaldehyde (GCOL). ZnO yielded about 16 times more GAD and 2.5 times more DHA than did TiO2.
ΕΡΕΥΝΑ ΤΗΣ ΠΡΕΣΒΥΑΚΟΥΣΙΑΣ ΣΤΗΝ ΗΠΕΙΡΟ
Authors: Εξαρχάκος Γιώργος
Published: January 2014

ΕΝΑΣ ΠΛΗΘΥΣΜΟΣ 873 ΑΤΟΜΩΝ ΕΞΕΤΑΣΘΗΚΕ (ΚΛΙΝΙΚΑ) ΚΑΙ ΥΠΟΒΛΗΘΗΚΕ ΣΕ ΑΚΟΥΟΜΕΤΡΙΚΟ ΕΛΕΓΧΟ ΣΤΟ ΕΡΓΑΣΤΗΡΙΟ ΤΗΣ ΚΛΙΝΙΚΗΣ ΜΑΣ. ΧΡΗΣΙΜΟΠΟΙΗΣΑΜΕ ΑΥΣΤΗΡΑ ΚΡΙΤΗΡΙΑ ΕΠΙΛΟΓΗΣ ΚΑΙ ΑΠΟΚΛΕΙΣΑΜΕ ΤΑ ΑΤΟΜΑ ΠΟΥ ΕΠΑΣΧΑΝ ΑΠΟ ΣΥΓΓΕΝΕΙΣ 'Η ΑΛΛΕΣ ΟΡΓΑΝΙΚΕΣ ΩΤΟΛΟΓΙΚΕΣ ΠΑΘΗΣΕΙΣ. ΤΑ ΕΝΑΠΟΜΕΙΝΑΝΤΑ 777 ΑΤΟΜΑ, 460 ΑΝΔΡΕΣ ΚΑΙ 317 ΓΥΝΑΙΚΕΣ ΠΕΡΙΛΗΦΘΗΚΑΝ ΣΤΗ ΜΕΛΕΤΗ ΜΑΣ. ΤΟΥΣ ΧΩΡΙΣΑΜΕ ΣΕ ΟΜΑΔΕΣ ΗΛΙΚΙΑΣ ΑΠΟ 21 ΕΩΣ 80 ΕΤΩΝ ΚΑΙ ΤΑΞΙΝΟΜΗΣΑΜΕ ΤΑ ΑΚΟΥΟΓΡΑΦΗΜΑΤΑ ΤΟΥΣ ΣΥΜΦΩΝΑ ΜΕ ΤΟΥΣ 4 ΤΥΠΟΥΣ ΠΡΕΣΒΥΑΚΟΥΣΙΑΣ. ΜΕΛΕΤΗΣΑΜΕ ΤΗΝ ΕΠΙΠΤΩΣΗ ΤΗΣ ΠΡΕΣΒΥΑΚΟΥΣΙΑΣ ΣΤΟ ΦΑΣΜΑ ΤΩΝ ΣΥΧΝΟΤΗΤΩΝ 0,5,1,2,4 ΚΑΙ 8 ΚΗ2 ΚΑΤΑ ΟΜΑΔΕΣ ΗΛΙΚΙΩΝ ΚΑΙ ΦΥΛΟ. Η ΣΤΑΤΙΣΤΙΚΗ ΑΝΑΛΥΣΗ ΤΩΝ ΔΕΔΟΜΕΝΩΝ ΜΑΣ ΕΔΕΙΞΕ ΤΑ ΑΚΟΛΟΥΘΑ ΑΠΟΤΕΛΕΣΜΑΤΑ: 1. ΟΙ ΜΕΓΑΛΥΤΕΡΕΣ ΗΛΙΚΙΕΣ ΚΑΙ ΣΤΑ ΔΥΟ ΦΥΛΑ ΣΥΝΟΔΕΥΟΝΤΑΝ ΑΠΟ ΜΕΓΑΛΟΥ ΒΑΘΜΟΥ ΒΑΡΥΚΟΙΑ ΣΤΙΣ ΥΨΗΛΕΣ ΣΥΧΝΟΤΗΤΕΣ (2,4 ΚΑΙ 8 ΚΗ2) ΠΑΡΑΤΗΡΗΘΗΚΕ ΔΙΑΦΟΡΑ ΜΙΑΣ ΔΕΚΑΕΤΙΑΣ ΜΕΤΑΞΥ ΤΩΝ ΔΥΟ ΦΥΛΩΝ ΟΣΟΝ ΑΦΟΡΑ ΤΗΝ ΠΤΩΣΗ ΤΗΣ ΑΚΟΗΣ ΣΕ ΗΛΙΚΙΕΣ ΑΝΩ ΤΩΝ 50 ΕΤΩΝ ΣΤΙΣ ΥΨΗΛΕΣ ΣΥΧΝΟΤΗΤΕΣ (2,4ΚΑΙ 8 ΚΗ2) ΟΙ ΑΝΔΡΕΣ ΠΑΡΟΥΣΙΑΖΟΥΝ ΣΗΜΑΝΤΙΚΑ ΜΕΓΑΛΥΤΕΡΗ ΒΑΡΥΚΟΙΑ. 3. ΣΕ ΣΥΧΝΟΤΗΤΕΣ, ΚΑΤΩ ΤΩΝ 2000 ΗΖ ΣΤΙΣΝΕΩΤΕΡΕΣ ΗΛΙΚΙΕΣ ΔΕΝ ΥΠΗΡΧΕ ΚΑΜΜΙΑ ΑΞΙΟΛΟΓΗ ΔΙΑΦΟΡΑ ΜΕΤΑΞΥ ΤΩΝ ΔΥΟ ΦΥΛΩΝ, ΑΛΛΑΕΝΑΣ ΣΗΜΑΝΤΙΚΟΣ ΑΡΙΘΜΟΣ ΑΝΔΡΩΝ (25% ΗΛΙΚΙΑΣ 31 ΕΤΩΝ ΚΑΙ ΑΝΩ ΠΑΡΟΥΣΙΑΖΕ ΒΑΡΗΚΟΙΑ ΜΕΤΡΙΑ 'Η ΜΕΓΑΛΟΥ ΒΑΘΜΟΥ ΣΤΙΣ ΥΨΗΛΕΣ ΣΥΧΝΟΤΗΤΕΣ (4 ΚΑΙ 8 ΚΗ2) 4. ΤΑΞΙΝΟΜΩΝΤΑΙΤΑ ΑΚΟΥΟΓΡΑΦΗΜΑΤΑ ΣΥΜΦΩΝΑ ΜΕ ΤΟΥΣ 4 ΤΥΠ ΤΗΣ ΠΡΕΣΒΥΑΚΟΥΣΙΑΣ, ΒΡΗΚΑΜΕ ΟΤΙ ΤΑ ΠΕΡΙΣΣΟΤΕΡΑ ΑΝΗΚΟΥΝ ΣΤΟΥΣ ΤΥΠΟΥΣ Ι ΚΑΙ IV.
Θεωρητική μελέτη και υπολογισμοί χαρακτηριστικών και ιδιοτήτων διπλά διηγερμένων καταστάσεων και του φαινομένου LoSurdo-Stark σε ατομικά συστήματα
Authors: Θέμελης Σπυρίδων
Published: January 2014

Η ΕΠΙΛΥΣΗ ΤΗΣ ΕΞΙΣΩΣΗΣ SCΗRODINGER ΠΡΑΓΜΑΤΟΠΟΙΕΙΤΑΙ ΜΕ ΣΚΟΠΟ ΤΗ ΜΕΛΕΤΗ ΤΟΣΟ ΥΨΗΛΑ ΔΙΠΛΑ ΔΙΗΓΗΡΜΕΝΩΝ ΑΥΤΟΙΟΝΙΖΟΜΕΝΩΝ ΚΑΤΑΣΤΑΣΕΩΝ ΟΣΟ ΚΑΙ ΤΗΣ ΕΠΙΔΡΑΣΗΣ ΙΣΧΥΡΟΥ ΣΤΑΤΙΚΟΥ ΗΛΕΚΤΡΙΚΟΥ ΠΕΔΙΟΥ ΣΕ ΑΤΟΜΑ.ΟΙ ΕΝΕΡΓΕΙΑΚΕΣ ΙΔΙΟΤΙΜΕΣ ΕΙΝΑΙ ΜΙΓΑΔΙΚΕΣ ΚΑΙ ΤΟ ΦΑΝΤΑΣΤΙΚΟ ΜΕΡΟΣ ΔΙΝΕΙ ΤΟ ΦΥΣΙΚΟ Η ΚΑΙ ΤΟ ΕΠΑΓΟΜΕΝΟ ΧΡΟΝΟ ΖΩΗΣ ΠΟΥ ΑΦΟΡΑ ΤΙΣ ΙΔΙΟΚΑΤΑΣΤΑΣΕΙΣ ΤΟΥ ΣΥΣΤΗΜΑΤΟΣ ΕΞΕΤΑΖΟΝΤΑΙ ΑΥΤΟΙΟΝΙΖΟΜΕΝΕΣ ΚΑΤΑΣΤΑΣΕΙΣ ΤΟΥ ΗΕ, ΤΟΥ Η-, ΤΟΥ LI+ ΚΑΙ ΤΟΥ HE- ΚΑΙ ΑΡΚΕΤΑ ΣΥΜΠΕΡΑΣΜΑΤΑ ΠΡΟΚΥΠΤΟΥΝ ΓΙΑ ΤΗ ΦΥΣΙΚΗ ΚΑΙ ΤΗ ΔΥΝΑΜΙΚΗ ΤΟΥΣ. Η ΕΠΙΔΡΑΣΗ ΣΤΑΤΙΚΟΥ ΗΛΕΚΤΡΙΚΟΥ ΠΕΔΙΟΥ ΜΕΛΕΤΑΤΑΙ ΣΕ ΒΑΣΙΚΕΣ ,ΔΙΗΓΗΡΜΕΝΕΣ ΚΑΙ ΑΥΤΟΙΟΝΙΖΟΜΕΝΕΣ ΚΑΤΑΣΤΑΣΕΙΣ ΚΑΙ ΥΠΟΛΟΓΙΖΟΝΤΑΙ ΠΟΛΛΑ ΦΥΣΙΚΑ ΧΑΡΑΚΤΗΡΙΣΤΙΚΑ ΤΟΥΣ ΟΠΩΣ Η ΠΟΛΩΣΙΜΟΤΗΤΑ ΚΑΙ Η ΥΠΕΡΠΟΛΩΣΙΜΟΤΗΤΑ ΑΥΤΩΝ.
ΜΕΛΕΤΗ ΤΩΝ ΜΕΤΑΒΟΛΩΝ ΤΟΥ ΔΙΟΞΕΙΔΙΟΥ ΤΟΥ ΑΖΩΤΟΥ ΣΤΗΝ ΤΡΟΠΟΣΦΑΙΡΑ ΚΑΙ ΣΤΗ ΣΤΡΑΤΟΣΦΑΙΡΑ ΤΗΣ ΘΕΣΣΑΛΟΝΙΚΗΣ
Authors: Αμανατίδης Γεώργιος
Published: January 2014

ΣΤΗ ΔΙΑΤΡΙΒΗ ΑΥΤΗ ΜΕΛΕΤΑΤΑΙ Η ΟΛΙΚΗ ΣΤΗΛΗ ΤΟΥ ΝΟ2 ΣΤΗΝ ΑΤΜΟΣΦΑΙΡΑ ΤΗΣ ΘΕΣΣΑΛΟΝΙΚΗΣ, ΣΕ ΣΥΝΔΥΑΣΜΟ ΜΕ ΕΠΙΦΑΝΕΙΑΚΕΣ ΜΕΤΡΗΣΕΙΣ ΤΟΥ ΑΕΡΙΟΥ ΚΑΙ ΜΕΤΕΩΡΟΛΟΓΙΚΑ ΔΕΔΟΜΕΝΑ. ΓΙΑ ΤΗ ΜΕΤΡΗΣΗ ΤΗΣ ΟΛΙΚΗΣ ΣΤΗΛΗΣ ΤΟΥ ΑΕΡΙΟΥ ΜΕΤΑΤΡΑΠΗΚΕ ΚΑΤΑΛΛΗΛΑ ΚΑΙ ΒΑΘΜΟΛΟΓΗΘΗΚΕ ΕΝΑ ΦΩΤΟΜΕΤΡΟ ΦΙΛΤΡΩΝ ΤΥΠΟΥ CANTERBURY. ΠΑΡΟΥΣΙΑΖΟΝΤΑΙ ΠΑΡΑΤΗΡΗΣΕΙΣ ΤΗΣ ΑΜΕΣΗΣ ΗΛΙΑΚΗΣ ΚΑΙ ΣΕΛΗΝΙΑΚΗΣ ΑΚΤΙΝΟΒΟΛΙΑΣ ΓΙΑ ΤΟΝ ΠΡΟΣΔΙΟΡΙΣΜΟ ΤΗΣ ΟΛΙΚΗΣ ΣΤΗΛΗΣ ΤΟΥ ΝΟ2 ΤΗΝ ΗΜΕΡΑ ΚΑΙ ΤΗ ΝΥΧΤΑ ΑΝΤΙΣΤΟΙΧΑ, ΚΑΘΩΣ ΚΑΙ ΠΑΡΑΤΗΡΗΣΕΙΣ ΣΤΟ ΖΕΝΙΘ ΤΟΥ ΟΥΡΑΝΟΥ ΓΙΑ ΤΟΝ ΠΡΟΣΔΙΟΡΙΣΜΟ ΤΗΣ ΣΤΡΑΤΟΣΦΑΙΡΙΚΗΣ ΣΤΗΛΗΣ ΤΟΥ ΑΕΡΙΟΥ. ΑΠΟ ΤΙΣ ΠΑΡΑΤΗΡΗΣΕΙΣ ΑΥΤΕΣ ΠΡΟΚΥΠΤΕΙ ΟΤΙ Η ΟΛΙΚΗ ΠΟΣΟΤΗΤΑ ΤΟΥ ΝΟ2 ΠΑΡΟΥΣΙΑΖΕΙ ΕΝΤΟΝΗΕΠΟΧΙΚΗ ΜΕΤΑΒΟΛΗ ΜΕ ΜΕΓΙΣΤΟ ΤΟ ΚΑΛΟΚΑΙΡΙ ΚΑΙ ΕΛΑΧΙΣΤΟ ΤΟ ΧΕΙΜΩΝΑ, ΚΑΘΩΣ ΚΑΙ ΗΜΕΡΗΣΙΑ ΜΕΤΑΒΟΛΗ ΤΩΝ ΕΠΙΦΑΝΕΙΑΚΩΝ ΣΥΓΚΕΝΤΡΩΣΕΩΝ ΤΟΥ ΑΕΡΙΟΥ ΕΞΕΤΑΣΘΗΚΑΝ ΓΙΑ ΔΙΑΦΟΡΕΣ ΜΕΤΕΩΡΟΛΟΓΙΚΕΣ ΣΥΝΘΗΚΕΣ ΚΑΙ ΥΠΟΛΟΓΙΣΘΗΚΕ Η ΣΥΝΕΙΣΦΟΡΑ ΤΩΝ ΤΟΠΙΚΩΝ ΠΗΓΩΝ ΣΤΗΜΕΤΡΟΥΜΕΝΗ ΟΛΙΚΗ ΣΤΗΛΗ. ΚΑΤΑ ΤΗΝ ΨΥΧΡΗ ΠΕΡΙΟΔΟ ΤΟΥ ΕΤΟΥΣ ΤΟ 35% ΤΩΝ ΜΕΤΑΒΟΛΩΝ ΤΗΣ ΟΛΙΚΗΣ ΣΤΗΛΗΣ ΤΟΥ ΝΟ2 ΟΦΕΙΛΕΤΑΙ ΣΤΙΣ ΤΟΠΙΚΕΣ ΠΗΓΕΣ, ΕΝΩ ΤΟ ΠΟΣΟΣΤΟ ΑΥΤΟ ΜΠΟΡΕΙ ΝΑ ΦΘΑΣΕΙ ΜΕΧΡΙ ΚΑΙ 55% ΚΑΤΑ ΤΗ ΔΙΑΡΚΕΙΑ ΤΟΥ ΘΕΡΟΥΣ. ΠΑΡΑΛΛΗΛΑ, ΜΕΛΕΤΗΘΗΚΕ Ο ΡΟΛΟΣ ΤΟΥ ΑΕΡΙΟΥ ΣΤΗΝ ΦΩΤΟΧΗΜΙΚΗ ΠΑΡΑΓΩΓΗ ΟΖΟΝΤΟΣ ΣΤΗΝ ΑΤΜΟΣΦΑΙΡΑ. ΣΥΓΚΕΚΡΙΜΕΝΑ ΥΠΟΛΟΓΙΣΘΗΚΑΝ Ο ΡΥΘΜΟΣ ΦΩΤΟΛΥΣΕΩΣ ΤΟΥ ΝΟ2 ΧΡΗΣΙΜΟΠΟΙΩΝΤΑΣ ΜΕΤΡΗΣΕΙΣ ΤΗΣ ΥΠΕΡΙΩΔΟΥΣ ΗΛΙΑΚΗΣ ΑΚΤΙΝΟΒΟΛΙΑΣ ΚΑΙ ΟΙ ΑΠΟΚΛΙΣΕΙΣ ΤΗΣ ΦΩΤΟΧΗΜΙΚΗΣ ΙΣΟΡΡΟΠΙΑΣ ΜΕΤΑΞΥΤΩΝ ΝΟ, ΝΟ2 ΚΑΙ 03 ΠΟΥ ΟΔΗΓΟΥΝ ΣΕ ΠΑΡΑΓΩΓΗ 03 ΣΤΗΝ ΑΣΤΙΚΗ ΠΕΡΙΟΧΗ ΤΗΣ ΘΕΣΣΑΛΟΝΙΚΗΣ.
ΜΕΘΑΙΜΟΣΦΑΙΡΙΝΗ ΕΠΙ ΜΕΣΟΓΕΙΑΚΗΣ ΑΝΑΙΜΙΑΣ
Authors: Μανίτσα Άννα
Published: January 2014

ΕΠΙ Β - ΜΕΣΟΓΕΙΑΚΗΣ ΑΝΑΙΜΙΑΣ ΥΠΑΡΧΕΙ ΑΥΞΗΣΙΣ ΤΟΥ ΠΟΣΟΣΤΟΥ ΤΗΣ ΜΕΘΑΙΜΟΣΦΑΙΡΙΝΗΣ ΕΙΣ ΤΟ ΑΙΜΑ, ΕΝΩ ΟΥΔΕΜΙΑ ΜΕΙΩΣΙΣ ΠΑΡΑΤΗΡΕΙΤΑΙ ΟΣΟΝ ΑΦΟΡΑ ΤΟ ΕΝΖΥΜΟΝ, ΤΟ ΟΠΟΙΟΝΕΙΝΑΙ ΒΑΣΙΚΑ ΥΠΕΥΘΥΝΟΝ ΔΙΑ ΤΗΝ ΑΝΑΓΩΓΗΝ ΤΗΣ. ΕΠΙΣΗΣ ΔΕΝ ΥΠΑΡΧΕΙ ΑΜΦΙΒΟΛΙΑ, ΟΤΙ ΟΙ ΔΥΝΑΜΕΝΟΙ ΝΑ ΕΛΕΓΧΘΟΥΝ ΕΝΔΟΕΡΥΘΡΟΚΥΤΤΑΡΙΚΟΙ ΕΝΖΥΜΑΤΙΚΟΙ ΜΗΧΑΝΙΣΜΟΙ ΛΕΙΤΟΥΡΓΟΥΝ ΚΑΛΩΣ. ΑΞΙΟΝ ΠΡΟΣΟΧΗΣ ΕΙΝΑΙ ΤΟ ΓΕΓΟΝΟΣ ΟΤΙ ΥΠΑΡΧΕΙ ΣΑΦΗΣ ΔΙΑΦΟΡΑ ΤΙΜΩΝ ΜΕΘΑΙΜΟΣΦΑΙΡΙΝΗΣ ΜΕΤΑΞΥ ΣΠΛΗΝΕΚΤΟΜΗΘΕΝΤΩΝ ΚΑΙ ΜΗ ΑΣΘΕΝΩΝ, Η ΟΠΟΙΑ ΣΥΜΠΙΠΤΕΙ ΠΡΟΣ ΤΗΝ ΔΙΑΠΙΣΤΩΘΕΙΣΑΝ ΕΜΦΑΝΗ ΔΙΑΦΟΡΑΝ ΤΩΝ ΑΝΤΙΣΤΟΙΧΩΝ ΑΝΑΛΟΓΙΩΝ ΕΓΚΛΕΙΣΤΟΦΟΡΩΝ ΚΥΤΤΑΡΩΝ (ΣΩΜΑΤΙΑ HEINZ). ΑΠΑΣΑΙ ΑΙ ΑΝΕΥΡΕΘΕΙΣΑΙ ΤΙΜΑΙ ΕΠΙ ΦΥΣΙΟΛΟΓΙΚΩΝ ΜΑΡΤΥΡΩΝ, ΚΑΘ'ΟΛΑΣ ΤΑΣ ΦΑΣΕΙΣ ΤΗΣ ΠΑΡΟΥΣΗΣ ΕΡΓΑΣΙΑΣ, ΒΑΣΙΚΩΣ ΣΥΜΦΩΝΟΥΝ ΜΕ ΤΑ ΕΥΡΗΜΑΤΑ ΤΗΣ ΔΙΕΘΝΟΥΣ ΒΙΒΛΙΟΓΡΑΦΙΑΣ. ΚΑΤΑ ΤΗΝ ΚΡΙΤΙΚΗΝ ΑΝΑΛΥΣΙΝ ΤΩΝ ΔΕΔΟΜΕΝΩΝ ΓΙΝΕΤΑΙ ΠΡΟΣΠΑΘΕΙΑ ΕΡΜΗΝΕΙΑΣ ΤΩΝ ΑΝΕΥΡΕΘΕΝΤΩΝ ΑΠΟΤΕΛΕΣΜΑΤΩΝ.
ΣΥΓΚΡΙΤΙΚΗ ΜΕΛΕΤΗ ΤΗΣ ΑΝΑΣΤΡΟΦΟΥ ΠΑΘΗΤΙΚΗΣ ΑΙΜΟΣΥΓΚΟΛΛΗΣΕΩΣ (RH) ΚΑΙ ΤΗΣ ΑΝΤΙΘΕΤΟΥ ΗΛΕΚΤΡΟΦΟΡΗΣΕΩΣ (CEP) ΕΙΣ ΤΗΝ ΑΝΙΧΝΕΥΣΙΝ ΤΟΥ ΑΝΤΙΓΟΝΟΥ ΕΠΙΦΑΝΕΙΑΣ ΤΗΣ ΗΠΑΤΙΤΙΔΟΣ ΤΥΠΟΥ Β (HBSAG), ΕΠΙ ΥΓΙΟΥΣ ΠΛΗΘΥΣΜΟΥ, ΟΞΕΙΑΣ ΙΟΓΕΝΟΥΣ ΗΠΑΤΙΤΙΔΟΣ ΚΑΙ ΧΡΟΝΙΩΝ ΗΠΑΤΟΠΑΘΕΙΩΝ.
Authors: Γιώτσας Νικόλαος
Published: January 2014

ΕΙΣ ΤΗΝ ΠΑΡΟΥΣΑΝ ΔΙΑΤΡΙΒΗΝ ΕΞΗΤΑΣΘΗΣΑΝ Η ΕΥΑΙΣΘΗΣΙΑ, Η ΕΙΔΙΚΟΤΗΣ ΚΑΙ Η ΕΚΛΕΚΤΙΚΟΤΗΣ ΤΗΣ ΜΕΘΟΔΟΥ ΤΗΣ ΑΝΑΣΤΡΟΦΟΥ ΠΑΘΗΤΙΚΗΣ ΑΙΜΟΣΥΓΚΟΛΛΗΣΕΩΣ (RH) ΣΥΓΚΡΙΤΙΚΩΣ ΠΡΟΣ ΤΗΝ ΑΝΤΙΘΕΤΟΝ ΗΛΕΚΤΡΟΦΟΡΗΣΙΝ (CEP) ΕΠΙ 13.908 ΟΡΩΝ ΠΡΟΕΡΧΟΜΕΝΩΝ ΕΞ ΥΓΙΩΝΠΛΗΘΥΣΜΩΝ, ΠΟΙΚΙΛΩΝ ΗΠΑΤΙΚΩΝ ΚΑΙ ΑΛΛΩΝ ΝΟΣΗΜΑΤΩΝ. ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΤΗΣ ΜΕΛΕΤΗΣΤΑΥΤΗΣ ΩΔΗΓΗΣΑΝ ΕΙΣ ΤΑ ΕΞΗΣ ΣΥΜΠΕΡΑΣΜΑΤΑ: 1. Η ΜΕΘΟΔΟΣ ΤΗΣ ΑΝΑΣΤΡΟΦΟΥ ΠΑΘΗΤΙΚΗΣ ΑΙΜΟΣΥΓΚΟΛΛΗΣΕΩΣ (RH) ΕΙΝΑΙ ΑΠΛΗ ΚΑΙ ΕΥΚΟΛΟΣ ΕΙΣ ΤΗΝ ΕΚΤΕΛΕΣΙΝ, ΔΙΔΕΙ ΤΑΧΕΩΣ ΕΥΑΝΑΓΝΩΣΤΑ ΚΑΙ ΑΝΑΠΑΡΑΓΩΓΙΜΑ ΑΠΟΤΕΛΕΣΜΑΤΑ (ΕΝΤΟΣ 3 ΩΡΩΝ) ΚΑΙ ΔΕΝ ΑΠΑΙΤΕΙ ΙΔΙΑΙΤΕΡΩΣ ΕΙΔΙΚΕΥΜΕΝΟΝ ΠΡΟΣΩΠΙΚΟΝ ΔΙΑ ΤΗΝ ΕΚΤΕΛΕΣΙΝ. 2. ΑΠΟ ΑΠΟΨΕΩΣ ΕΥΑΙΣΘΗΣΙΑΣ ΚΑΙ ΣΥΓΚΡΙΤΙΚΩΣ ΠΡΟΣ ΤΗΝ ΕΥΡΕΩΣ ΧΡΗΣΙΜΟΠΟΙΟΥΜΕΝΗΝ ΠΑΡ'ΗΜΙΝ ΑΝΤΙΘΕΤΟΝ ΗΛΕΚΤΡΟΦΟΡΗΣΙΝ (CEP) ΑΠΕΔΕΙΧΘΗ ΚΑΤΑ 2,2% ΠΛΕΟΝ ΕΥΑΙΣΘΗΤΟΣ ΕΠΙ ΤΟΥ ΣΥΝΟΛΟΥ ΤΩΝ ΕΞΕΤΑΣΘΕΝΤΩΝ ΟΡΩΝ. ΟΥΔΕΙΣ ΟΡΟΣ ΘΕΤΙΚΟΣ ΔΙΑ ΤΗΣ CEP ΑΠΕΔΕΙΧΘΗ ΑΡΝΗΤΙΚΟΣ Η ΨΕΥΔΟΘΕΤΙΚΟΣ ΔΙΑ ΤΗΣ RH. 3. Η ΣΥΧΝΟΤΗΣ ΤΩΝ ΨΕΥΔΟΘΕΤΙΚΩΝ ΑΝΤΙΔΡΑΣΕΩΝ ΑΝΗΛΘΕΝ ΜΟΝΟΝ ΕΙΣ 1,8% ΕΠΙ ΤΟΥ ΣΥΝΟΛΟΥ ΤΩΝ ΕΞΕΤΑΣΘΕΝΤΩΝ ΟΡΩΝ, ΗΤΟ ΕΥΚΟΛΟΝ ΝΑ ΕΛΕΓΧΘΗ ΔΙΑ ΤΩΝ ΔΟΚΙΜΑΣΙΩΝ ΠΡΟΣΡΟΦΗΣΕΩΣ ΚΑΙ ΕΞΟΥΔΕΤΕΡΩΣΕΩΣ ΚΑΙ ΗΤΟ ΑΝΩΤΕΡΑ ΕΙΣ ΤΗΝ ΟΜΑΔΑ ΤΩΝ ΕΞΩΗΠΑΤΙΚΩΝ ΝΟΣΗΜΑΤΩΝ ΕΙΣ ΤΗΝ ΟΠΟΙΑΝ ΠΕΡΙΛΑΜΒΑΝΟΝΤΑΙ ΚΑΙ ΑΥΤΑ ΤΩΝ ΝΟΣΩΝ ΤΟΥ ΚΟΛΛΑΓΟΝΟΥ. 4. Η ΥΠΕΡΟΧΗ ΑΠΟ ΑΠΟΨΕΩΣ ΕΥΑΙΣΘΗΣΙΑΣ ΤΗΣ RH ΕΝΑΝΤΙ ΤΗΣ CEP ΕΠΟΙΚΙΛΛΕΝ ΚΑΤΑ ΔΙΑΓΝΩΣΤΙΚΗΝ ΟΜΑΔΑ. ΟΥΤΩ ΕΙΣ ΟΡΟΥΣ ΛΗΦΘΕΝΤΑΣ ΚΑΤΑ ΤΟ ΣΤΑΔΙΟΝ ΤΗΣ ΑΝΑΡΡΩΣΕΩΣ ΕΞ ΟΞΕΙΑΣ ΙΟΓΕΝΟΥΣ ΗΠΑΤΙΤΙΔΟΣ, ΕΠΙ ΠΕΡΙΠΤΩΣΕΩΝ ΧΡΟΝΙΑΣ ΕΝΕΡΓΟΥ ΗΠΑΤΙΤΙΔΟΣ ΜΕΤΑ Η ΑΝΕΥ ΚΙΡΡΩΣΕΩΣ, ΩΣ ΚΑΙ ΕΠΙ ΠΕΡΙΠΤΩΣΕΩΝ ΠΡΩΤΟΠΑΘΟΥΣ ΗΠΑΤΟΚΑΡΚΙΝΩΜΑΤΟΣ, Η ΥΠΕΡΟΧΗ ΤΗΣ RH ΕΚΥΜΑΝΘΗ (ΠΕΡΙΚΟΠΗ ΠΕΡΙΛΗΨΗΣ)
YouTube™ as a source of patient information for lumbar discectomy
Authors: Brooks FM , Lawrence H , Jones A , McCarthy MJH
Published: January 2014

Introduction

YouTube™ contains more than 60% of all videos on the internet. Its popularity has increased, and it has now become a source of patient education and information. It is unregulated for the quality of its videos. This project was designed to assess the quality of videos on YouTube™ on lumbar discectomy.

Methods

A systematic search of YouTube™ was performed. The search terms used were ‘lumbar’ and ‘discectomy’. The first ten pages were reviewed. Information was recorded relating to the date of publishing, the publisher and the number of viewings. The content was reviewed using criteria based on recommendations from the British Association of Spine Surgeons website. Content was assessed and points were awarded for information relating to management options, description of the procedure (including anaesthetic, likely recovery and outcome) and complications as well as information relating to the author and his or her institute. An overall rating of ‘inadequate’, ‘poor’, ‘average’ or ‘good’ was given.

Results

Overall, 81 videos were identified. The total number of viewings was 2,722,964 (range: 139–111,891), with an average number of 34,037 viewings per video. There were 16 with a rating of ‘good’, 25 with a rating of ‘average’ and 40 with a rating of ‘poor’ or ‘inadequate’. The most common missing information related to anaesthesia or complications. Most videos (69/81) were broadcast by surgeons or surgical institutes.

Conclusions

The quality of YouTube™ videos is variable and we believe this represents the unregulated nature of broadcasts on YouTube™. Thought should be given to information in videos prior to placement.
Perioperative tranexamic acid in day-case paediatric tonsillectomy
Authors: Robb PJ , Thorning G
Published: January 2014

Introduction

Tranexamic acid has been used for many years to minimise blood loss during surgery and, more recently, to reduce morbidity after major trauma. While small studies have confirmed reduction in blood loss during tonsillectomy with its use, the rate of primary haemorrhage following tonsillectomy has not been reported. In the UK, less than 50% of children having a tonsillectomy are managed as day cases, partly because of concerns about bleeding during the initial 24 hours following surgery.

Methods

A retrospective review of clinical records between January 2007 and January 2013 produced 476 children between the ages of 3 and 16 years who underwent Coblation™ tonsillectomy, with or without adenoidectomy and/or insertion of ventilation tubes. All children were ASA (American Society of Anesthesiologists) grade 1 or 2 and anaesthetised using a standard day surgery protocol. Following induction of anaesthesia, all received intravenous tranexamic acid at a dose of 10–15mg/kg.

Results

Two children (0.4%) had minor bleeding within two hours of surgery. Both returned to theatre for haemostasis and were discharged home later the same day with no further complications. The expected rate for primary haemorrhage in the UK using this technique for tonsillectomy is 1%.

Conclusions

Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial.
Favourable outcomes of coccygectomy for refractory coccygodynia
Authors: Haddad B , Prasad V , Khan W , Alam M , Tucker S
Published: January 2014

Introduction

Coccygodynia is a condition associated with severe discomfort in the region of the coccyx. While traditional procedures had poor outcomes and high complication rates, recent literature suggests better outcomes and lower complication rates with coccygectomy.

Methods

Data were collected retrospectively from clinical notes. A questionnaire was used to evaluate the outcomes. The outcome measures included pain analogue score (PAS) in sitting and during daily activities as well as patients’ overall pain relief. Overall improvement in pain and complications were documented.

Results

Between 2000 and 2010, 14 patients underwent total coccygectomy for refractory coccygodynia. All patients were available for follow-up appointments and the follow-up duration ranged from 24 to 132 months (mean: 80 months). The aetiology was traumatic in eight patients and non-traumatic in six. The PAS improved from a median of 9 to 4 for sitting and from 7.5 to 2.5 for daily activities. One patient had mild discharge for more than two weeks. No patients required further surgery. Twelve patients (85.7%) had excellent or good pain relief. Only one patient was unsatisfied. A Wilcoxon signed-rank test revealed significant improvement in pain when sitting (p<0.05) and during activities of daily living (p<0.05) at the final follow-up visit. A Mann–Whitney U test did not show a significant difference in improvement in PAS between the traumatic and non-traumatic groups (p=0.282 and 0.755).

Conclusions

In our series, total coccygectomy offered satisfactory relief of pain in the majority of patients with a low wound complication rate.
Patterns of arteriosclerotic lesions of the lower extremity in a West Indian population based on angiographic findings and ethnicity
Authors: Ramdass MJ , Harnarayan P , Mooteeram N , Nath A , Naraynsingh V , Budhooram S , Dookie T , Henry R
Published: January 2014

Introduction

This study aimed to determine whether ethnic differences show different patterns of arterial disease in the lower limb.

Methods

A prospective analysis of 100 consecutive patients with 160 lower limb arteriograms was performed looking at the pattern of disease with relation to ethnicity in Trinidad and Tobago.

Results

There were 53 male and 47 female patients with an age range of 43–90 years (mean: 66 years). Of the 100 patients, 45 were of East Indian descent, 36 of Afro-Caribbean descent, 14 of mixed descent and 5 had other backgrounds. There were 32 smokers and 69 diabetics. The most commonly affected artery in East Indians was the anterior tibial artery (ATA, 70%) followed by the peroneal artery (60%), superficial femoral artery (SFA, 60%), posterior tibial artery (PTA, 57%) and tibioperoneal trunk (TPT, 39%). In Afro-Caribbeans, the most commonly affected artery was the ATA (79%) followed by the PTA (74%), peroneal artery (66%) and TPT (55%). The mixed group showed the PTA (85%) to be most diseased followed by the peroneal artery (75%), ATA (70%), SFA (70%), dorsalis pedis artery (DPA, 60%) and TPT (50%). Overall, the most diseased vessel in all groups was the ATA (73%) followed by the PTA (66%), peroneal artery (64%), SFA (59%), TPT (46%), DPA (38%), popliteal artery (31%) and medial plantar artery (MPA, 29%), with the proximal vessels not being affected severely.

Conclusions

Ethnic divisions were only statistically significant (p<0.05) with East Indians showing worse disease in the profunda femoris artery and Afro-Caribbeans showing worse disease in the PTA, DPA and MPA. This suggests that environmental factors may play a significant role in the disease process including smoking and dietary factors rather than purely genetics.
Primary myxoid chondrosarcoma of the breast
Authors: Farahat A , Magdy N , Elaffandi A
Published: January 2014

Primary breast chondrosarcoma has been rarely reported in the literature. Conservative breast surgery has never been part of the management of previously reported cases. Surgery remains the mainstay management of such a disease as it is resistant to chemotherapy and radiotherapy. In this report, we present a case of rare primary myxoid chondrosarcoma of the breast that was managed successfully with a conservative approach.
Spontaneous choledochoduodenal fistula with tuberculous duodenal ulceration
Authors: Karthikeyan VS , Sistla SC , Ram D , Ali SM , Rajkumar N , Balasubramaniam G , Sanker MS
Published: January 2014

Spontaneous choledochoduodenal fistulas (CDFs) are rare. The most common aetiology is penetrating duodenal ulcers, observed in 80% of cases. Even in areas where acid peptic disease is common, tuberculosis should be considered as a cause, especially in developing countries like India, where tuberculosis is common. The management of CDF due to acid peptic disease is predominantly surgical while healing of tuberculous CDF has been reported with antitubercular treatment. A preoperative diagnosis of tuberculous CDF by endoscopic biopsy from the duodenal ulcer or image guided fine needle aspiration if abdominal lymph nodes are present can eliminate the need for surgery and achieve a cure with antitubercular treatment. The CDF in this case was due to caseation of periduodenal lymph nodes rupturing into the duodenum and the bile duct.
A cross-sectional study of knife injuries at a London major trauma centre
Authors: Pallett JR , Sutherland E , Glucksman E , Tunnicliff M , Keep JW
Published: January 2014

INTRODUCTION

No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period.

METHODS

A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected.

RESULTS

A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team’s caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16–24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury.

CONCLUSIONS

Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED.
Acute Budd–Chiari syndrome due to a simple liver cyst
Authors: Long J , Vaughan-Williams H , Moorhouse J , Sethi H , Kumar N
Published: January 2014

Simple liver cysts are common, rarely causing significant morbidity or mortality. Budd–Chiari syndrome (BCS) is caused by obstruction of hepatic venous outflow and is the leading cause of postsinusoidal liver failure. We present a rare case of BCS caused by a simple hepatic cyst.

A 16cm × 16cm liver cyst was found on computed tomography of a 66-year-old woman presenting with abdominal pain. The cyst had become infected, thus enlarged, exerting mass effect with almost complete compression of the inferior vena cava. Shortly after admission, the patient developed acute liver failure, with deranged clotting and hepatic encephalopathy requiring full organ support on the intensive care unit. Cardiac output studies showed a low cardiac index of 1.4l/min/m2.

An emergency laparotomy with fenestration of the cyst and drainage of 2l of purulent material led to a full recovery. Intraoperative cystic fluid aspirates later confirmed no evidence of Echinococcus. Histology confirmed a simple cyst. Liver biopsies showed severe, confluent, bridging necrosis, without background parenchymal liver disease.

Acute BCS due to rapid compression of all major hepatic veins leading to fulminant hepatic failure is rare. Our case highlights a clinically significant complication of a simple liver cyst of which clinicians should be aware when managing these ‘innocent’ lesions.
MELAS syndrome presenting as an acute surgical abdomen
Authors: Dindyal S , Mistry K , Angamuthu N , Smith G , Hilton D , P Arumugam , Mathew J
Published: January 2014

MELAS (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke-like episodes) is a syndrome in which signs and symptoms of gastrointestinal disease are uncommon if not rare. We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. MELAS syndrome was suspected postoperatively owing to persistent lactic acidosis and neurological symptoms. The diagnosis was later confirmed with histological and genetic studies. This case highlights the difficulties in diagnosing MELAS because of its unpredictable presentation and clinical course. We therefore recommend a high index of suspicion in cases of an acute surgical abdomen with additional neurological features or raised lactate.
Hip arthroplasty fatality related to dabigatran induced gastrointestinal haemorrhage
Authors: Carter A , Sarda P , George M , Corbett S
Published: January 2014

We report a fatality due to massive gastrointestinal haemorrhage in a patient receiving prophylactic dabigatran etexilate following a total hip replacement. A 79-year-old woman was commenced on dabigatran for venous thromboembolic prophylaxis following a total hip replacement. She presented again four days after surgery with haematemesis and hypotension but her coagulopathy could not be corrected, leading to her death. This case highlights the lack of reversal agent for dabigatran etexilate that resulted in this fatal complication.
Surgical extraction after thrombosis around the Avalon dual lumen cannula
Authors: Kalem V , Buchwald D , Strauch J , Sidiropoulos A , Meindl R , Schildhauer TA , Swol J
Published: January 2014

The use of a dual lumen cannula (DLC) for venovenous extracorporeal membrane oxygenation (ECMO) has several advantages and reports of complications are rare. We present a case of thrombosis around and inside the Avalon Elite™ bicaval DLC (Avalon Laboratories, Rancho Dominguez, CA, US), for which simple removal by retraction was impossible.

A 30-year-old man had experienced an unstable C6/7 fracture with spinal contusion and haematoma in the spinal canal with incomplete neurological paraplegia and thoracic trauma. He developed acute respiratory failure due to posttraumatic systemic inflammatory response syndrome and venovenous extracorporeal membrane oxygenation (ECMO) support was indicated. The cannulation was performed with an Avalon Elite™ cannula (31Fr) in the right jugular vein under fluoroscopy. After 18 days of ECMO therapy, despite the continuous administration of heparin (400iu/h), ECMO was discontinued because of the formation of a massive thrombus in the oxygenator. At that time, the patient’s haemodynamic and respiratory parameters were stable, and we were able to induce a rapid weaning from ECMO. The surgical removal of the cannula became necessary and was performed using a small neck incision without complications.

We report this case to emphasise that any resistance encountered during an attempt to extract the Avalon Elite™ cannula may cause serious complications. In such cases, surgical removal must be considered.
Hip resurfacing arthroplasty at a non-specialist centre
Authors: Patel N K , Wright J , Sabharwal S , Afsharpad A , Bajekal R
Published: January 2014

INTRODUCTION

Few studies have reported the outcome of hip resurfacing arthroplasty (HRA) with respect to implant characteristics from non-specialist centres. We report the survival, clinical and radiological outcomes of a single surgeon series of HRA with an average follow-up duration of five years.

METHODS

All consecutive HRAs performed by a single surgeon between 2003 and 2011 at a district general hospital were retrospectively examined clinically and radiologically.

RESULTS

A total of 85 patients underwent 109 HRAs (58 male [53.2%] and 51 female patients [46.8%]) with a mean follow-up period of 62 months (range: 12–102 months). The median age was 57 years (range: 25–75 years). The mean acetabular and femoral head component sizes were 54mm (range: 48–64mm) and 48mm (range: 42–58mm) respectively with a mean acetabular inclination angle of 42.9° (range: 20–75°). The survival rate was 95% with five revisions due to aseptic loosening (n=3) and fracture (n=2): these were predominantly for female patients (n=4), with significantly smaller mean acetabular (51mm, p=0.04) and femoral (44mm, p=0.02) implant sizes. Furthermore, they had a higher mean acetabular inclination angle of 48.1° (p=0.74). The mean Oxford hip score was 43.8 (range: 25–48) and the mean University of California Los Angeles (UCLA) activity score was 6.8 (range: 3–10). Radiological findings included heterotopic ossification in 13 (11.9%), radiolucent lines in 6 (5.5%), femoral neck thinning in 2 (1.8%) and femoral neck notching in 5 patients (4.6%).

CONCLUSIONS

We have shown that HRA at a non-specialist centre has short to medium-term outcomes comparable with those at specialist centres. HRA therefore remains a viable option although vigilance is required in case selection and follow-up according to national guidance.
A cyamella causing popliteal tendonitis
Authors: Rehmatullah N , McNair R , Sanchez-Ballester J
Published: January 2014

A 64-year-old man presented with intermittent but progressive lateral-sided knee pain. Symptoms mimicked those of a lateral meniscal tear. Magnetic resonance imaging revealed a cyamella associated with popliteal tendonitis and an intact lateral meniscus.
Gastric duplication cyst masquerading as a mucinous pancreatic cyst: case report and literature review
Authors: Bailey CE , Fritz MB , Webb L , Merchant NB , Parikh AA
Published: January 2014

Gastric duplication cysts are rare cystic neoplasms that are often difficult to distinguish from other entities. We describe a healthy 44-year-old woman who presented with acute right lower quadrant abdominal and flank pain as well as chronic nausea and constipation. Her physical examination was unremarkable but contrasted computed tomography revealed a 6cm cystic lesion between the stomach and body of the pancreas. Endoscopic ultrasonography and fluid analysis were consistent with a mucinous cyst with a markedly elevated fluid carcinoembryonic antigen level. The patient subsequently underwent a laparoscopic distal pancreatectomy, which was converted to an open procedure when the lesion was noted to be adherent to the coeliac axis. Intraoperative endoscopy revealed no abnormality. Final pathology revealed a gastric duplication cyst. The patient recovered well and was asymptomatic on follow-up. In this report, we discuss the incidence, natural history and management of this rare entity.
Perforation as a rare presentation of gastric gastrointestinal stromal tumours: a case report and review of the literature
Authors: Skipworth JRA , Fanshawe AEE , West MJ , Al-Bahrani A
Published: January 2014

INTRODUCTION

Gastrointestinal stromal tumours (GISTs) are the most common connective tissue neoplasms of the gastrointestinal tract, the most common clinical presentation of which is with abdominal pain or gastrointestinal bleeding.

METHODS

We describe a case of a perforated gastric GIST as well as reviewing the relevant published literature.

RESULTS

A 51-year-old woman presented to the acute assessment unit with a 1-day history of severe epigastric pain on a background of longstanding reflux symptoms. Radiological investigation demonstrated a perforated mass in the gastric antrum and the patient subsequently underwent an emergency distal gastrectomy. She recovered well postoperatively and was discharged home. Her condition remains stable six months following surgery. Histological analysis revealed the perforated lesion to be a GIST. A PubMed search suggests that this is the first English report to describe a perforated gastric GIST. Six further published reports (written in English or with an English abstract) describing the presentation of small bowel GISTs with perforation are reviewed.

CONCLUSIONS

We present the first English report of a perforated gastric GIST. More common presentations include abdominal pain and gastrointestinal bleeding. Although rare, GISTs should be considered in the differential diagnoses of perforated gastrointestinal masses.
A case report on over-replacement of oral calcium supplements causing acute pancreatitis
Authors: Pronisceva V , Sebastian J , Joseph S , Sharp E
Published: January 2014

A 42-year-old female teetotaller presented via the accident and emergency department with a 2-day history of vomiting and upper abdominal pain. She was diagnosed with acute pancreatitis. The aetiology of the pancreatitis was identified as hypercalcaemia secondary to oral calcium supplementation. The hypercalcaemia was corrected by stopping calcium supplements and aggressive fluid resuscitation. A thorough literature search did not show any case reports in which the aetiology of pancreatitis was oral calcium supplement over-replacement.
Right upper quadrant pain and raised alkaline phosphatase is not always a hepatobiliary problem
Authors: Cheyne G , Runau F , Lloyd DM
Published: January 2014

Right upper quadrant pain is a common presenting complaint to the general and hepatobiliary surgical team. Differential diagnoses include gallstones, cholecystitis, liver and pancreatic pathology. A 64-year-old man presented to our general surgical unit with right upper quadrant pain and deranged liver function tests. He underwent ultrasonography several times as well as magnetic resonance cholangiopancreatography (MRCP) in pursuit of hepatobiliary pathology. However, it was the identification of an empyema on MRCP that led to computed tomography of the thorax and the eventual discovery of the cause of the pain: a paraspinal abscess causing T10/T11 discitis. Right upper quadrant pain and deranged liver function tests justify hepatobiliary investigation. Nevertheless, after several negative tests, the differential diagnoses should be broadened and referred pain considered.
A case-control study of risk factors for wound infection in a colorectal unit
Authors: Power K , Davies MM , Hargest R , Phillips S , Torkington J , Morris C
Published: January 2014

INTRODUCTION

Postoperative wound infections have been responsible for increasing morbidity and are associated with an increased use of hospital resources. Previous studies have identified several risk factors. However, most studies are outdated, and few relate to the era of enhanced recovery and laparoscopic surgery. This study investigated the association between patient and operative factors and the development of postoperative wound infections in colorectal surgery.

METHODS

Patients with documented wound infections or dehiscences were identified from a database of elective and emergency colorectal surgery. Patients with wound infections were matched by operation type to a control group of colorectal patients. Differences in patient and operative factors between case and control group were analysed using conditional logistic regression.

RESULTS

A total of 56 patients with wound infection were identified from 647 operations (8.6%). Fifty-seven per cent were emergency operations and eighty-eight per cent were performed as open surgery or as laparoscopic surgery converted to open. Forty per cent of patients had high ASA (American Society of Anesthesiologists) grades (3 or 4). Multivariate logistical regression showed that obese patients and those having open surgery had the highest risk of infections. The median postoperative hospital stay for patients with wound infections was twice as long as for those patients without wound infections.

CONCLUSIONS

Open surgery and obesity are independent risk factor for wound infections. An increase in laparoscopically performed operations and new strategies for managing wounds in obese patients may help to reduce the rate of wound infection.
Posterior hemivertebra resection and monosegmental fusion in the treatment of congenital scoliosis
Authors: Zhu X , Wei X , Chen J , Li C , Li M , Qiao Y , Ran B
Published: January 2014

INTRODUCTION

Posterior hemivertebra resection combined with multisegmental or bisegmental fusion has been applied successfully for congenital scoliosis. However, there are several immature bones and their growth can be influenced by long segmental fusion in congenital patients. Posterior hemivertebra resection and monosegmental fusion was therefore suggested for treatment of congenital scoliosis caused by hemivertebra.

METHODS

Between June 2001 and June 2010, 60 congenital scoliosis patients (aged 2–18 years) who underwent posterior hemivertebra resection and monosegmental fusion were enrolled in our study. A standing anteroposterior x-ray of the whole spine was obtained preoperatively, postoperatively and at the last follow-up appointment to analyse the Cobb angle in the coronal and sagittal planes as well as the trunk shift.

RESULTS

The mean preoperative coronal plane Cobb angle was 41.6°. This was corrected to 5.1° postoperatively and 5.3° at the last follow-up visit (correction 87.3%). The compensatory cranial curve was improved from 18.1° preoperatively to 7.1° postoperatively and 6.5° at the last follow-up visit while the compensatory caudal curve was improved from 21.5° to 6.1° after surgery and 5.6° at the last follow-up visit. The mean sagittal plane Cobb angle was 23.3° before surgery, 7.3° after surgery and 6.8° at the last follow-up visit (correction 70.1%). The trunk shift of 18.5mm was improved to 15.2mm.

CONCLUSIONS

Posterior hemivertebra resection and monosegmental fusion seems to be an effective approach for treatment of congenital scoliosis caused by hemivertebra, allowing for excellent correction in both the frontal and sagittal planes.
Comparison of patient reported outcomes after Triathlon® and Kinemax Plus prostheses
Authors: Dixon S , Blom AW , Whitehouse MR , Wylde V
Published: January 2014

INTRODUCTION

The Triathlon® (Stryker, Kalamazoo, MI, US) total knee replacement was designed to improve patient function and survivorship. The aim of this study was to determine whether the Triathlon® prosthesis produces better patient reported outcomes than a previous design by the same manufacturer, the Kinemax Plus.

METHODS

The outcome of 233 knees of patients with a mean age of 68 years (range: 40–80 years) who received the Kinemax Plus prosthesis were compared with the outcomes of 220 knees of patients with a mean age of 70 years (range: 42–90 years) who received the Triathlon® prosthesis. Data were collected via postal questionnaire prior to surgery as well as at 8–12 weeks and at 1 year following surgery. Validated questionnaires were used including the WOMAC® (Western Ontario and McMaster Universities) pain and function scales, the Knee injury and Osteoarthritis Outcome Score quality of life scale and the self-administered patient satisfaction scale.

RESULTS

This study found that patients who had the Triathlon® prosthesis had significantly better pain relief (p<0.0001), function (p=0.028), knee related quality of life (p<0.0001) and satisfaction (p=0.0003) at three months after surgery than those who received the Kinemax Plus prosthesis. In addition, knee related quality of life (p=0.002) and satisfaction (p=0.021) were significantly higher at one year after surgery in Triathlon® patients.

CONCLUSIONS

The findings suggest that return to function and reduction in pain may occur more quickly in patients with a Triathlon® prosthesis than in those with the Kinemax Plus.
Does the DVR® plate restore bony anatomy following distal radius fractures?
Authors: Patel S , Menéndez PB , Hossain FS , Colaço HB , Lee MH , Sorene ED , Taylor EJ
Published: January 2014

INTRODUCTION

Fractures of the distal radius are common. Malreduced fractures are associated with residual functional deficiency. There has been a trend over the last few years for using fixed angle volar locking plates to surgically stabilise this injury. Our unit uses the DVR® plate (DePuy, Warsaw, IN, US). Nevertheless, it is unknown whether the normal bony anatomy is recreated or merely restored to acceptable limits with its usage. The aim of this study was to evaluate the reduction achieved compared with an uninjured population and pre-existing quoted ‘normal’ values. Furthermore, we wanted to identify the percentage of cases that were reduced to acceptable limits, and determine whether the grade of the surgeon and fracture type was a confounding influence on this reduction.

METHODS

A retrospective review of the 3-month postoperative radiography of 48 eligible patients who underwent open reduction and internal fixation of a distal radius fracture with a DVR® plate was undertaken.

RESULTS

Volar tilt, radial length and inclination were different to quoted normal values (p<0.01). Despite this, these parameters fell within acceptable limits in 46 cases; this was not influenced by fracture type or grade of operating surgeon.

CONCLUSIONS

The DVR® plate restores the bony anatomy to within acceptable limits in the majority of patients who have sustained a fracture of the distal radius although of all parameters investigated, the widest variability is seen in volar tilt.
Endoscopic retrograde cholangiopancreatography in the treatment of intraoperatively demonstrated choledocholithiasis
Authors: Lynn AP , Chong G , Thomson A
Published: January 2014

INTRODUCTION

The aim of this study was to determine the efficacy and complications of postoperative endoscopic retrograde cholangiopancreatography (ERCP) in confirming and treating choledocholithiasis found at intraoperative cholangiography during laparoscopic cholecystectomy.

METHODS

Patients who had undergone ERCP following a cholecystectomy between 2008 and 2011 with an indication of intraoperative cholangiography findings consistent with choledocholithiasis were identified from a prospectively collected database of a single endoscopist. Deep biliary access rate, confirmation of choledocholithiasis, clearance rate of bile duct stones, delay between cholecystectomy and postoperative ERCP, and the complication rates following the procedure were analysed.

RESULTS

The median age of the 41 patients (16 male, 25 female) was 42 years (range: 18–82 years). Sixteen surgeons performed the operations with a median delay of 6 days (range: 1–103 days) between cholecystectomy and postoperative ERCP. Common bile duct access was achieved in 100% of the patients, with ERCP taking a median time of 16 minutes (range: 6–40 minutes). Initial ERCP confirmed the presence of a stone in 30 patients (73%) and successful stone removal occurred in 28 of these 30 patients (93%) during the first ERCP and in the remaining 2 on a subsequent ERCP. Following ERCP, two patients (4.9%) experienced extended hospital stays for four and eight days owing to complications, including one patient (2.4%) with mild acute pancreatitis.

CONCLUSIONS

This study demonstrates that postoperative ERCP is highly effective in both confirming and treating choledocholithiasis. However, there is a significant risk of short-term complications that must be taken into consideration when deciding management.
Size of metastatic deposits affects prognosis in patients undergoing pulmonary metastectomy for colorectal cancer
Authors: Javed MA , Sheel ARG , Sheikh AA , Page RD , Rooney PS
Published: January 2014

INTRODUCTION

Pulmonary metastectomy for colorectal cancer (CRC) is a well accepted procedure although data regarding indications and prognostic outcomes are inconsistent. This study aimed to analyse our experience with resection of pulmonary CRC metastases to evaluate clinically relevant prognostic factors affecting survival.

METHODS

A retrospective analysis was undertaken of the records of all patients with pulmonary metastases from CRC who underwent a thoracotomy between 2004 and 2010 at a single surgical centre.

RESULTS

Sixty-six patients with pulmonary metastases from the colon (n=34) and the rectum (n=32) were identified. The 30-day hospital mortality rate was 0%, with 63 patients undergoing a R0 resection and 3 having a R1 resection. The median survival was 45 months and the cumulative 3-year survival rate was 61%. Size of pulmonary metastasis and ASA (American Society of Anesthesiologists) grade were statistically significant prognostic factors (p=0.047 and p=0.009 respectively) with lesions over 20mm associated with a worse prognosis. Sex, age, site, disease free interval (cut-off 36 months), primary tumour stage, hepatic metastases, number of metastases (solitary vs multiple), type of operation (wedge vs lobe resection), hilar lymph node involvement and administration of adjuvant chemotherapy were not found to be statistically significant prognostic factors.

CONCLUSIONS

Pulmonary metastectomy has a potential survival benefit for patients with metastatic CRC. Improved survival even in the presence of hepatic metastases or multiple pulmonary lesions justifies aggressive surgical management in carefully selected patients. In our cohort, size of metastatic deposit was a statistically significant poor prognostic factor.