1,721,112 research outputs found
Laparoscopic resection of multiple aneurysms of the gastroepiploic arterial arcade
No full textGastroepiploic arterial aneurysms (GEAA) represent a very rare disorder [1, 2]. The risk of GEAA rupture is high, and it is associated with a high mortality rate [3]. GEAAs are usually identified following rupture or are incidentally diagnosed. In emergency, an open surgical approach to treat GEAAs has been most frequently reported [4]. Alternatively, if the patient is hemodynamically stable, an angiography and embolization can be attempted. Herein we report the case of a patient presenting with two fissurated GEAAs that were successfully excised laparoscopically after failure of the endovascular approach
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Resezioni coliche in urgenza. Un fattore critico per il rispetto dei criteri oncologici?
No full textE' possibile rispettare anche in urgenza, mediante una appropriata tecnica chirurgica, il rispetto dei criteri resettivi oncologici (T,N) della chirurgia colorettale
Adenocarcinoma on j-pouch after proctocolectomy for ulcerative colitis - Case report and review of literature (International Journal of Colorectal Disease DOI: 10.1007/s00384-014-1864-4)
No full textPouch adenocarcinoma following restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has been reported and reviewed. We present a case-report of poorly differentiated mucinous adenocarcinoma of the pouch following 13 years after IPAA for UC with entirely stapled anastomosis and the review of all the previous experiences in the published literature.
The ileo-anal pouch mucosa and the anorectal mucosa below the ileo-anal anastomosis are at potential risk of developing dysplasia and adenocarcinoma. The risk of neoplastic degeneration of the mucosa remaining after RPC is very low, but it is assumed that it increases in time. Since the incidence of ileal pouch cancer after IPAA for RCU is 4.2% at 20 years and 5.1% at 25 years. The interval between IPAA and the development of cancer was 13 years in our patient. In the 38 cases reported to date, the cancers developed on average 10 years after construction of the IPAA. The longest reported interval was 27 years, the shortest 10 months. These data suggest the need of an endoscopic follow up to prevent or, occasionally, diagnose as early as possible, ileal pouch adenocarcinoma, which can occur both early or after many years by a PCR for RCU. For this reason it would be necessary to refer operated patients for a regular follow-up, ideally for the rest of life, which consists of endoscopic surveillance with multiple biopsies of the small residual rectal stump if present and of the pouch
A Floating Heart: Large Pericardial Effusion with Extensive Lung Atelectasis
No full textIn extraordinary circumstances, large pericardial effusions cause pulmonary atelectasis (Amin et al., Cureus 11:e5287, 2019; Manhas and Gokhale, Indian J Crit Care Med 22: 191–194, 2018). Fluid builds up slowly and enlarges the pericardial sac, which can then compress the lung with minimal hemodynamic consequences. However, these patients are at risk of life-threatening tamponade.
A morbidly obese 57-year-old man presented for mild chest pain and shortness of breath developed within several days. His medical history included an episode of idiopathic acute pericarditis, recurrent atrial fibrillation-flutter, and obstructive sleep apnea syndrome. There were no definite signs of cardiac tamponade. At first, the chest radiograph suggested a large effusion, which the computed tomography (CT) scans revealed to be the heart ‘floating’ within a large pericardial sac, together with extensive atelectasis. Considering the hazard of puncturing the heart, an intercostal catheter was inserted under Visiport optical guidance. An ultrasound-guided pericardiocentesis completed the procedure, draining 1.6 l of blood-stained fluid in total.
The floating heart, coupled with extensive atelectasis, poses a therapeutic challenge. This case shows that an optical trocar allows for controlled drainage, thus reversing both the effusion and the atelectasis
Anatomy and Classification of Pelvic Trauma
No full textPelvic fracture is one of the most complex injuries in trauma treatment. Bleeding continues to be one of the primary causes of death from pelvic fracture, and the severity of bleeding is not necessarily correlated with the fracture pattern. The priorities in managing pelvic fractures include controlling bleeding. Historically, classification systems only consider the anatomical fracture pattern, which does not correlate with the outcomes. The World Society of Emergency Surgery (WSES) classification considers both the pelvic fracture pattern and the hemodynamic condition of the patient. Vascular injuries caused by pelvic fractures are potentially lethal because they often manifest as non-compressible multifocal venous bleeding (80-85% of pelvic bleeding) and less frequently as arterial bleeding (15-20% of pelvic bleeding). The presence of vascular injury and open pelvic fractures are independent factors contributing to mortality. Another fundamental factor in the management of pelvic vascular trauma is time [1]. In this context, the assessment of potentially significant vascular injury and timely hemorrhage control should be the highest priorities in the acute management of these injuries. Classification of pelvic injuries that considers both the fracture pattern and the hemodynamic status of the patient, such as the WSES classification, appears to have greater utility in clinical practice compared to the diffused anatomical classification
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