Lietuvos chirurgija
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Polytrauma of a Teenager in Agriculture: A Case Report
Get PDFPolytrauma is a condition when a patient has sustained multiple injuries, which can lead to disability or death. While the agriculture industry is growing, the number of polytrauma patients in children is increasing as well. It is high-energy traumas when it is important to immediately assess injuries and life-threatening conditions and to start trauma protocols guided treatment. In this article, we present a case of a 17-year-old boy who suffered extensive injuries caused by a straw pellets machine. We discussed the importance of prehospital care, multidisciplinary team involvement, and treatment methods.Politrauma – būklė, kai pacientas patiria daugybinių sužalojimų, kurie gali baigtis neįgalumu ar net mirtimi. Plečiantis žemdirbystės pramonei, daugėja vaikų politrauminių sužalojimų. Tai didelės energijos traumos, kai būtina nedelsiant tinkamai įvertinti sužalojimų keliamą riziką gyvybei ir pradėti gydymą, vadovaujantis traumų diagnostikos ir gydymo protokolais. Straipsnyje pristatomas klinikinis atvejis – 17 m. vaikinas patyrė daugybinių sužalojimų, įkritęs į šiaudų granuliatorių. Aptariama gydymo prieš atvežant pacientą į ligoninę svarba ir daugiadalykės komandos įsitraukimas į gydymo procesą
Sarginių limfmazgių nustatymo metodai, operuojant krūties vėžį: literatūros apžvalga
Get PDFIntroduction. Detecting metastases is an important part of successful breast cancer treatment. Usually, the tumor tissue first spreads to the sentinel lymph nodes. Removal of the latter during surgery and histological examination allows to assess the patient’s disease stage, prognosis and treatment. The literature provides more than one approach or a combination of them, allowing us to accurately identify the breast’s sentinel lymph nodes and avoid removing all axillary lymph nodes. Purpose. To review the methods of intraoperative detection of breast sentinel lymph nodes presented in the literature. Research material and methods. Publications were searched using the specialized information search system Google Scholar. Keywords used in the search: breast sentinel lymph nodes, intraoperative detection. After evaluating the exclusion criteria, the review was based on 25 scientific publications. Results. 4 individual measures and 2 combinations of them can be used to detect sentinel breast lymph nodes during surgery. The materials used can be injected in 6 different ways. Conclusions. The combination of technetium-99m radiocolloid and methylene blue can be evaluated as the best method for intraoperative detection of sentinel lymph nodes in breast cancer patients. On the other hand, due to radiation and operating costs, more attention is being paid to the use of indocyanine green, superparamagnetic iron oxide, methylene blue dye, and the detection of metastases without surgery. Superficial methods of injecting the substance should be combined with deep ones due to the possibility of detecting extra-axillary sentinel lymph nodes of the breast. Ultimately, all decisions must be made on a case-by-case basis.Įvadas. Svarbi krūties vėžio sėkmingo gydymo dalis – nustatyti metastazes. Piktybiniai navikai įprastai pirmiausia išplinta į sritinius limfmazgius. Šių limfmazgių pašalinimas operacijos metu ir histologinis tyrimas leidžia įvertinti paciento ligos stadiją, ligos prognozę ir parinkti tinkamą gydymą. Mokslinėje literatūroje aprašomas ne vienas metodas ar jų derinys, padedantys nustatyti sarginius limfmazgius operuojant krūties vėžį ir leidžiantys išvengti visų pažasties limfmazgių pašalinimo. Tikslas. Apžvelgti mokslinėje literatūroje nurodytus metodus krūties sarginiams limfmazgiams intraoperaciškai nustatyti. Tyrimo medžiaga ir metodai. Publikacijų paieška atlikta naudojant specializuotą informacijos paieškos sistemą Google Scholar. Paieškai naudoti reikšminiai žodžių junginiai: „krūties sarginiai limfmazgiai“ (angl. breast sentinel lymph nodes) ir „intraoperacinis nustatymas“ (angl. intraoperative detection). Įvertinus atmetimo kriterijais, apžvalgoje remtasi 25 mokslinėmis publikacijomis. Rezultatai. Atliekant operaciją, sarginiams krūties limfmazgiams nustatyti gali būti panaudoti keturi individualūs metodai ir du jų deriniai. Naudojamos medžiagos gali būti injekuotos šešiais skirtingais būdais. Išvados. Patikimiausiu metodu sarginiams krūties limfmazgiams intraoperaciškai nustatyti laikytina technecio-99m radioaktyviojo koloido ir metileno mėlio kombinacija. Vis dėlto dėl patiriamos radiacijos ir didelių eksploatavimo kaštų ieškoma naujų, pigesnių ir techniškai paprastesnių sarginių limfmazgių nustatymo būdų. Tai galėtų būti indocianino žaliojo, superparamagnetinio geležies oksido, metileno mėlio naudojimas ir metastazių nustatymas neoperuojant. Paviršiniai medžiagos injekcijos būdai turėtų būti derinami su giliaisiais, siekiant aptikti ne tik pažastyje esančius sarginius krūties limfmazgius. Galutiniai sprendimai turi būti priimami atsižvelgiant į konkretų klinikinį atvejį
Outcomes of Laparoscopic TAPP Inguinal Hernia Repair without Mesh Fixation
Get PDFInguinal hernia repair is one of the commonest general surgical procedures performed worldwide. Laparoscopic repair is associated with faster recovery, less post operative pain and comparable rates of recurrence. Using the stapling devices increases post TAPP chronic groin pain. We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 43 patients in which we did not fix the mesh. The primary purpose of this study was to examine the rate of recurrence and chronic groin pain in patients undergoing TAPP mesh hernia repair for inguinal hernia. We observed that our rates of recurrence and chronic groin pain are comparable to those described previously in the literature. We concluded that laparoscopic inguinal hernia repair by TAPP approach can be done with acceptable rates of recurrences and decreased rates of post operative chronic groin pain
Cholesterolinė granuloma valekulėje: klinikinis atvejis
Get PDFIntroduction. Cholesterol granuloma is a rare benign cystic neoplasm characterised by a fibrous capsule, and a cystic fluid containing cholesterol crystals, multinucleated giant cells, erythrocytes and haemosiderin. Cholesterol granulomas are usually found in diverse parts of the temporal bone, most commonly – petrous apex. Very few cases of cholesterol granulomas in other organs have been reported, to our knowledge none are reported in the larynx. The main purpose of this case report is to highlight this extremely rare laryngeal lesion and its unique macroscopic appearance. Case report. A 55-year-old man is referred to the Ear, Nose and Throat Centre because of persistent hoarseness, globus sensation and complicated intubation due to a mass in the larynx. Videolaryngoscopy showed a large cyst-like mass in the vallecula, epiglottis was displaced towards the posterior pharyngeal wall and erythema of interarytenoid notch and arytenoid tubercle was present. A computerized tomography scan confirmed a cystic mass on the lingual surface of the epiglottis. On the basis of the examination and clinical symptoms, a diagnosis of chronic laryngitis, gastro-oesophageal reflux and an unspecified benign tumour of the respiratory system was made, surgical treatment was planned. The patient underwent microlaryngoscopy and surgical extirpation of the cyst using a CO2 laser, as the cyst was opened a yellowish, shiny, viscous fluid was observed. Two days later, laryngoscopy revealed fibrin plaque at the site of the cyst. Final diagnosis of cholesterol granuloma was formed based on histological examination of the mass. Conclusions. Cholesterol granulomas and masses in vallecula are extremly rare, but this case shows that cholesterol granuloma can be included in the differential diagnosis of cystic neoplasms of the larynx.Įvadas. Cholesterolinė granuloma – retas gerybinis cistinis darinys. Jam būdinga cistą gaubianti kapsulė ir cistos skystis su cholesterolio kristalais, daugiabranduolėmis gigantinėmis ląstelėmis, eritrocitais ir hemosiderinu. Dažniausiai cholesterolinės granulomos pažeidžia smilkinkaulį. Mokslinėje literatūroje aprašyta pavienių cholesterolinių granulomų atvejų kituose organuose, tačiau nėra duomenų apie cholesterolinę granulomą gerklų srityje. Straipsnio tikslas – pristatyti gerklų cholesterolinės granulomos atvejį. Klinikinis atvejis. 55 m. vyras kreipėsi į Ausų, nosies ir gerklės centrą dėl nuolatinio prikimimo, svetimkūnio pojūčio gerklėje ir komplikuotos intubacijos, kurią sukėlė gerklose nustatytas darinys. Videolaringoskopijos metu pastebėtas stambus, į cistą panašus darinys valekulės srityje, buvo matyti užpakalinės ryklės sienos link nustumtas antgerklis, tarpvedeginės įlankos ir vedeginių gumburų eritema. Atlikta kaklo kompiuterinė tomografija patvirtino cistinį darinį antgerklio liežuviniame paviršiuje. Remiantis tyrimo duomenimis ir klinikiniais simptomais, diagnozuotas lėtinis laringitas, gastroezofaginis refliuksas ir nepatikslintas gerybinis kvėpavimo sistemos navikas. Suplanuotas chirurginis gydymas. Pacientui atlikta mikrolaringoskopija ir chirurginė cistos ekstirpacija, naudojant CO2 lazerį. Atvėrus cistą, pastebėtas gelsvas, blizgantis, klampus skystis. Po dviejų dienų atlikus laringoskopiją, buvusios cistos vietoje aptikta fibrino apnašų. Darinį ištyrus histologiškai, nustatyta cholesterolinė granuloma. Išvados. Cholesterolinių granulomų ir, apskritai, darinių valekulėje aptinkama retai, tačiau cholesterolinė granuloma gali būti įtraukta į gerklų cistinių darinių diferencinę diagnostiką
Heterotopic Ossification in the Abdomen of an Elderly Patient, as an Incidental Finding During Elective Surgery: A Case Report
Get PDFIntroduction. Heterotopic ossification (HO) is a rare diverse pathologic process, with broad spectrum. Case report. This is a case report of a 73 years old patient who had ventral hernia at the medial line on the anterior abdominal wall, and underwent a routine surgery. During the surgery an incidental finding of HO was discovered. Discussion. HO is well documented to occur at increased frequency with certain predisposing conditions, including orthopedic surgery, most commonly hip arthroplasty. Non-genetic HO can occur nearly anywhere in the body, but is often designated by the tissue type it involves, such as myositis ossificans when involving skeletal muscle, or fasciitis ossificans when involving fascia
Pulmonary Vein Occlusion Requiring Lobectomy after Radiofrequency Catheter Ablation for Atrial Fibrillation: A Case Report and Review of the Literature
Get PDFPulmonary vein stenosis is a potential complication after radiofrequency ablation for atrial fibrillation. We present an unusual case of this complication that progressed to vein occlusion and required lobectomy and review the literature. A 54-year-old man presented with persistent chest pain, dry cough, and hemoptysis. Seven months before he underwent radiofrequency catheter ablation for atrial fibrillation. Chest computed tomography showed a narrowing of the left lower pulmonary vein after the procedure. The patient was treated conservatively. On the presentation, a chest computed tomography scan showed total pulmonary vein occlusion. A quantitative ventilation/perfusion scan revealed no perfusion to the left lower lobe. A balloon angioplasty was performed, however unsuccessfully. The left lower lobectomy was performed. Six years after the lobectomy the patient has neither cardiac nor pulmonary symptoms. Pulmonary vein occlusion after radiofrequency ablation for atrial fibrillation leading to lung resection is still a possible severe complication
indonesia: Indonesia
No full textBackground. Omental cysts are rare intra-abdominal tumors in children. It is challenging to diagnose since other big abdominal cysts are difficult to distinguish from in clinical and CT imaging. Aim. This case report aims to accurately and thoroughly determine the diagnosis based on the anamnesis, clinical and imaging examinations to choose the best treatment for the patient. Case Report. A 4-year-old girl reported having an enlarged belly in the past two months; the anamnesis provided the diagnosis. A mobile, 15 cm by 15 cm mass with dull percussion was discovered during clinical investigations in the top border. It was determined by anamnesis, physical examination, and imaging that the diagnosis was an ovarian cyst. Instead of an ovarian cyst, we found an omental cyst during the operation, thus we had to conduct an excision and omentectomy and postoperatively achieved favorable results. She was discharged three day after. Discussion. An abdominal CT scan showed an ovarian cyst. In laparotomy, we found a giant omental cyst, not originating from the ovaries, and did an omentectomy to excision the cyst. CT scan shows that the giant abdominal cyst is difficult to distinguish between omental, mesenteric, and ovarian cysts. Precise identification of stomach cysts is necessary. Also, doctors need to read the CT scan image more carefully. Conclusion. Giant omentum cysts are difficult to distinguish clinically and imaging from ovarian and mesenteric cysts. There is a need for a more detailed history, physical examination, and support, as well as a more thorough reading of the CT scan
Antrojo pošlaplinio raiščio implantavimas dėl šlapimo nelaikymo, atlikus radikaliąją prostatektomiją, esant neefektyviai pirmojo raiščio implatacijos operacijai: klinikinis atvejis
Get PDFStress urinary incontinence is a complication after radical prostatectomy. The suburethral sling implantation operation is often performed for mild to moderate male urinary incontinence after radical prostatectomy. There are non-adjustable suburethral slings that are effective up to 73.7% and adjustable slings that are effective up to 92%. We present a case report of a 62-year-old man who underwent radical prostatectomy due to prostate cancer in 2018 and experienced moderate degree urinary incontinence. After non-effective conservative treatment in 2020-02-27, the suburethral transobturator sling implantation was performed in another hospital, but it did not yield effective results. After further examinations in 2023-03-25, an adjustable ATOMS system suburethral male sling implantation was performed and it was effective. 2023-05-03 ATOMS system was adjusted and after this there was no urinary incontinence. ATOMS system is an effective surgical method for the treatment of male recurrent urinary incontinence or for cases where the initial sling implantation has failed.Įtampos (stresinis) šlapimo nelaikymas yra prostatos pašalinimo radikaliosios operacijos komplikacija. Atlikus radikaliąją prostatektomiją, esant lengvo ar vidutinio laipsnio šlapimo nelaikymui, dažnai pasirenkamas operacinis gydymas – implantuojamas pošlaplinis raištis. Išskirtini nereguliuojamieji (efektyvumas iki 73,7 proc.) ir reguliuojamieji raiščiai (efektyvumas iki 92 proc.). Straipsnyje aprašomas 62 m. vyro klinikinis atvejis. Pacientui dėl 2018 m. diagnozuotos prostatos karcinomos ir atliktos radikaliosios prostatektomijos nustatytas vidutinio laipsnio įtampos šlapimo nelaikymas. Nesant konservatyvaus gydymo efekto, 2020-02-27 kitoje gydymo įstaigoje transobturatoriniu būdu implantuotas nereguliuojamasis pošlaplinis raištis, tačiau šlapimo nelaikymas po operacijos išliko. Pacientą ištyrus 2023-03-25, implantuotas reguliuojamasis raištis – ATOMS sistema, šlapimo sulaikymas pagerėjo. 2023-05-03 ATOMS sistema papildyta. Šiandien pacientas gerai sulaiko šlapimą. ATOMS reguliuojamoji sistema yra efektyvus metodas vyrų šlapimo nelaikymui gydyti, esant neefektyviai pirmojo raiščio implantacijai