24 research outputs found
Leukocyte alkaline phosphatase (LAP) as a marker for colon cancer patients: the sensitivity and specificity of LAP compared with CEA and CA 19-9
No full textThis study was undertaken to test the hypothesis of a possible correlation of LAP activity with biological behavior of the colon cancer. Lap score were measured in the blood of 70 patients operated for colon cancer during 1995-1997 in the 1st Surgical Department of Athens University Medical School in Hippocration Hospital and 30 healthy controls. Measurements of the score were conducted preoperatively and every 3 months until 1 year postoperatively using an histochemical method. The method includes procedures for preparing fixative, buffer, and counter stains; for staining blood smears; scoring criteria for determining LAP activity. The sensitivity of LAP compared with CEA and CA19-9. The results of the study revealed that:❖ Cancer patients have increased LAP score preoperatively compared with healthy controls.❖ LAP score levels are gradually elevated with direct relationship to the stage of the tumor. Low values indicate early stage of the tumor, while high values indicate a more aggressive tumor❖ There was no significant correlation between LAP score levels and patient's age or sex.❖ Patients are found to have lower LAP score levels for the firsts three months after operation. The next months the score levels hang on the presentation of métastasés or disease recurrence❖ CAI9-9 has very low sensitivity for colon cancer.❖ CEA and LAP score have the same sensitivity.The study concludes that the activity of Leukocyte Alkaline Phosphatase could be used as a new marker for colon cancer patients.Η μελέτη αυτή έχει σα σκοπό να διερευνήσει αν υπάρχει σχέση μεταξύ της δράσης της Αλκαλικής Φωσφατάσης των Λευκοκυττάρων (LAP score) και της βιολογικής συμπεριφοράς του αδενοκαρκινώματος του παχέος εντέρου. Ο προσδιορισμός της δράσης της LAP έγινε σε 70 ασθενείς, οι οποίοι έπασχαν από αδενοκαρκίνωμα παχέος εντέρου και υπεβλήθησαν σε χειρουργική επέμβαση κατά τα έτη 1995-1997 στην Α' Προπαιδευτική Χειρουργική Κλινική του Πανεπιστημίου Αθηνών, και σε 40 υγιείς μάρτυρες. Οι μετρήσεις πραγματοποιήθηκαν προεγχειρητικά όσο και σε τακτά χρονικά διαστήματα (κάθε 3 μήνες) μέχρι την ολοκλήρωση 1 έτους μετεγχειρητικά. Για το προσδιορισμό της δράσης του ενζύμου χρησιμοποιήσαμε μια κυτταροχυμική μέθοδο και το Kaplow score. Συγκρίναμε την ευαισθησία του LAP score με αυτή των νεοπλασματικών δεικτών CEA και CAI9-9 Τα αποτελέσματα της παρούσης μελέτης αποδεικνύουν ότι:❖ Προεγχειρητικά το LAP score των ασθενών έχει σε υψηλό ποσοστό παθολογικές τιμές σε σχέση με αυτές των μαρτύρων.❖ Οι διακυμάνσεις των τιμών του LAP score συμβαδίζουν με τα στάδια της νόσου. Οσο πιο προχωρημένο είναι το στάδιο της νόσου τόσο πιο υψηλές είναι οι τιμές του score.❖ Οι τιμές του LAP score δεν επηρεάζονται από το φύλο και την ηλικία των ασθενών.❖ Στους πρώτους μετεγχειρητικούς μήνες έχουμε μείωση των τιμών του LAP score. Οι διακυμάνσεις του στους επόμενους μετεγχειρητικούς μήνες εξαρτώνται από την ύπαρξη μεταστάσεων ή την υποτροπή της νόσου.❖ Το CAI9-9 έχει πολύ μικρή ευαισθησία για το καρκίνο του παχέος εντέρου.❖ To LAP score έχει την ίδια αξιοπιστία με το CEA.Συμπερασματικά μπορούμε να πούμε ότι η μέτρηση της δράσης της Αλκαλικής Φωσφατάσης των Λευκοκυττάρων στους ασθενείς με αδενοκαρκίνωμα του παχέος εντέρου μπορεί να προστεθεί με αξιοπιστία στο σύγχρονο φάσμα των καρκινικών δεικτών
Blunt Pulmonary Contusion: Admission Computed Tomography Scan Predicts Mechanical Ventilation
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The Effect of Cumulative Length of Hospital Stay on the Antifungal Resistance of Candida Strains Isolated from Critically Ill Surgical Patients
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Spontaneous Splenic Rupture Secondary to Infectious Mononucleosis
No full textSpontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. As adolescents and young adults are the most affected population group, with this case report, we intend to raise the vigilance of any doctor treating those patients in the emergency department. We present the case of a 16-year-old patient with an atraumatic splenic rupture and hemoperitoneum secondary to an Epstein–Barr virus (EBV) infection. The patient underwent an exploratory laparotomy, and a splenectomy was performed. This case demonstrates that, even if SSR in patients with IM is extremely rare, it should always be considered in a patient with a relevant clinical presentation
Small Bowel Obstruction Masking a Perforated Dermoid Ovarian Cyst
No full textA 58-year-old female presented with abdominal pain, vomiting and constipation. Laboratory tests indicated elevated white blood cell count and C-reactive protein levels. Imaging via CT scan revealed a large cystic mass in the right ovary, abscesses and generalized small bowel distension, which initially raised suspicion of the existence of ovarian cancer with peritoneal carcinomatosis. Despite conservative management, the patient’s condition did not improve, prompting a laparotomy. Intraoperative findings included generalized peritonitis, significant small bowel dilation due to inflammatory adhesions and a perforated dermoid ovarian cyst. The cyst was resected and a prophylactic ileostomy was installed. Histopathological examination confirmed the diagnosis of a benign dermoid ovarian cyst. This case illustrates the rare presentation of a perforated dermoid cyst mimicking peritoneal carcinomatosis and emphasizes the importance of considering such complications in the differential diagnosis of bowel obstruction and peritoneal disease. Early recognition and appropriate surgical intervention are crucial for optimal outcomes
A Unique Case of Unilateral Pseudogynecomastia
No full textBackground/Objectives: Gynecomastia is a common condition characterized by the benign enlargement of male breast tissue, often resulting from hormonal imbalances. A rare variant, unilateral pseudogynecomastia, involves enlargement due to adipose tissue accumulation without glandular proliferation and can be associated with occupational factors. Methods: We report the case of a 45-year-old male mechanic presenting with unilateral enlargement of the left breast. The patient reported daily microtrauma on his left axilla and chest wall. The clinical evaluation and imaging revealed lipomatosis with pronounced fibrous tissue and no glandular tissue involvement. The hormonal assays were within the normal limits. The patient underwent surgical excision of excess adipose tissue using the Kornstein technique, preserving the nipple–areola complex. Results: The histopathological examination confirmed the absence of malignancy. The postoperative recovery was uneventful, and the follow-up examination at 12 months demonstrated a symmetrical breast appearance with no recurrence. This case underscores the importance of differentiating pseudogynecomastia from true gynecomastia and recognizing potential occupational risks. Surgical management using techniques that preserve the nipple–areola complex can achieve excellent cosmetic outcomes
Spontaneous Transvaginal Small Bowel Evisceration After Laparoscopic Hysterectomy
No full textVaginal cuff dehiscence can be a rare complication of total hysterectomy, with an estimated prevalence of 0.032% to 1.25% and a high mortality rate of 6 to 10%. Dehiscence is also reported in cases following total laparoscopic hysterectomy, with a prevalence of 0.87%. This case report details the emergency management of a 59-year-old female who complained of abdominal and pelvic pain and the feeling of a foreign body in her vagina. The patient reported a history of laparoscopic total hysterectomy 6 months prior to presenting at the Emergency Department. A clinical examination revealed small bowel loops protruding through the vagina. The patient underwent exploratory laparotomy through a Pfannenstiel incision, and the terminal ileum was found prolapsing through the vaginal cuff. The bowel loops were identified as viable and the vagina was sutured. The patient had an unremarked post operative course. This case report showcases that in patients with transvaginal evisceration, immediate surgical management is crucial in order to avoid serious life threatening complications, and both surgeons and gynecologists should remain vigilant regarding this pathology
The Challenging Management of Short Bowel Syndrome
No full textA 62-year-old female presented to the Emergency Department of the General Hospital of Katerini, Greece, complaining of abdominal pain, fever, and general discomfort. Laboratory tests indicated an elevated white blood cell count and an elevated C-reactive protein level. A computed tomography (CT) scan revealed dilated small bowel loops and free intraperitoneal fluid. During laparotomy, extensive ischemia and necrosis of both the small and large bowel were discovered, and a resection of the small bowel and the right colon was performed, leaving the patient with only 90 cm of small intestine and a jejunocolic anastomosis. Postoperative management was particularly challenging, requiring a multidisciplinary approach, an intensive care unit stay, reoperations due to anastomotic leaks, continuous parenteral nutrition and electrolyte management, and aggressive antibiotic treatment for persistent bacterial infections. This case report highlights the importance of appropriate management of this life-threatening complication following extensive bowel resection
