Pelvic splenosis: A systematic review of the literature.

Background: Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma. Methods: A systematic PubMed and Scopus search was conducted. Results: The mean age of the patients was 51.7 years. The majority of patients were of female gender. An emergency presentation was noted in 30 out of 85 patients, having abdominal pain as main symptom. The principal reason for splenectomy were traffic accidents. The time span between splenectomy and the initial symptoms ranged between 1 and 57 years. The most frequent symptom at presentation of pelvic splenosis was abdominal pain. Almost a quarter of the included patients were without any symptom. Presence of extrapelvic splenosis was de-scripted in almost half of the included patients. With regards to the type of treatment provided, exploratory laparotomy, laparoscopic surgical exploration / laparoscopy, robotic removal of splenium and watchful waiting, were performed in 35 (41.2%), 32 (37.6%), 3 (3.5%) and 15 (16.3%) patients, respectively. No fatality was reported. Conclusion: Pelvic splenosis is a rare clinical condition. It may mimic several clinical conditions and mislead diagnosis. The clinical history of splenectomy for trauma or different other reasons may es-tablish diagnosis and exclude other morbidities. Excision and complete removal of pelvic splenosis nodules is not always necessary and it depends on the clinical symptomatology. Careful imaging and precise assessment with the assistance of nuclear medicine may lead to correct diagnosis and avoid unnecessary surgical interventions.

Anal Cryptitis: A misdiagnosed condition.

Introduction: Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized infection of one or more of the anal crypts. Case presentation: A 42-year-old woman presented to our practice, complaining intermittently of anal pain and pruritus ani over a span of 1 year. She was referred multiple times to various surgeons, and she was treated conservatively for anal fissure without any evident improvement. The referred symptoms were increased often after defecation. Under general anesthesia, a hooked fistula probe was introduced into the inflamed anal crypt and the whole length of the crypt was layed open. Conclusion: Anal cryptitis is a misdiagnosed condition. The un-specific symptomatology of the disease can easily mislead. The clinical suspicion is fundamental for the diagnosis. Patient's history, digital ex-amination, and anoscopy are essential for the diagnosis of anal cryptitis.

Sweetening the pain: The role of sugar in acutely prolapsed haemorrhoids.

Abstract: Haemorrhoids are considered among the most frequent proctologi-cal condition at a general practitioner (GP) practice. Acute prolapse of internal haemorrhoids is presented with oedema, inflammation and acute pain. The application of granulated sugar on swollen hae-morrhoids leads to an immediate reduction of their edema and to the patient's relief. After the topical application of sugar, haemorrhoids begin to shrink immediately and edema is drastically reduced, while haemorrhoidal tissue can easily retracted back into the anal canal. The method is a cheap, quick and painless way to control the worsening symptoms such as swelling, bleeding and irritation. In addition, this method can easily be applied in the GP practice without the necessity of any form of anaesthesia.

Parietal cell/oncocytic gastric carcinoma: systematic review and first-time assessment of HER2 status in two new cases.

INTRODUCTION: Parietal cell/oncocytic gastric carcinomas are very rare and various aspects of this group remain unclear. The human epithelial growth factor receptor 2 (HER2) status of these tumours is largely unknown. METHODS: We performed a systematic electronic search of the literature and clinicopathological presentation of two cases including first-time complete assessment of HER2 status. Thirty-two patients with a mean age of 64.3 years, 87.5% of whom were male, were included in this review. FINDINGS: Half of the cases were recorded in Asia. Median follow-up was 24 months. There was no predominant site of development, while underlying histological abnormalities were present in 25%. At initial presentation, lymph node involvement was evident in 46.6% while distant metastatic disease was present in 9.3%. Presentation at stage I occurred in 55.6%. Potentially curative surgical/interventional treatment was intended in 90.6%. Recurrence occurred in 6.6%, while death was recorded in 19.2%, with cancer-related deaths reaching 11.5%. The one- and three-year survival rates were 84.2% and 79%, respectively. Our two cases displayed negative HER2 expression. CONCLUSIONS: This systematic review demonstrates that this group of malignancies is very rare but possibly underdiagnosed. The disease commonly presents at early stage, mainly affecting middle-aged men. The prognosis is generally favourable even in cases of advanced disease. The HER2 expression and its correlation with the outcomes need to be further explored.

Obesity surgery and Ehlers-Danlos syndrome: challenges and considerations based on a case report.

Ehlers-Danlos syndrome is a hereditary connective tissue disorder that has gastrointestinal manifestations in over 50% of its cases. We present the first case of bariatric surgery in a patient with Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for morbid obesity. His comorbidity included type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks later, he presented with 43.9% excess weight loss and improved glycaemic control. Three months postoperatively, however, he complained of dysphagia, regurgitation and postprandial pain. A barium meal and gastroscopy suggested the presence of a gastric diverticulum. A surgical exploration was planned. Intraoperative gastroscopy demonstrated an asymmetrical gastric pouch dilatation and the pouch was therefore refashioned laparoscopically. Despite the initial symptomatic relief, two months later he experienced retrosternal pain with progressive dysphagia. Since then, multiple endoscopic dilatations of the gastro-oesophageal junction have been performed for recurrence of symptoms. Finally, a laparoscopic hiatus hernia repair and adhesiolysis was performed resulting in complete relief of patient's symptoms. Bariatric management of patients with Ehlers-Danlos syndrome can prove challenging. The bariatric team must implement a careful management plan including a detailed consent process, a tailored surgical intervention and a follow-up focused on potential gastrointestinal manifestations.

Is fertility sparing surgery a treatment option for premenopausal patients with dysgerminoma?

Dysgerminoma is the most common ovarian germ cell type ovarian tumour. Primarily, it presents in young women at reproductive age and thus, the preservation of fertility is considered to be fundamental when it is possible for these patients. In comparison to the past the restriction of the extent of the surgical procedure as well as the introduction of innovative chemotherapeutic regimens improved significantly both, the prognosis and the clinical outcomes of this rare neoplasia. As dysgerminomas are extremely radio- and chemosensitive, fertility sparing approach and less aggressive operations should be favoured. We present a narrative review of the multispecialty fertility sparing surgical and medical approach for women with dysgerminoma (Ref. 21).

Contrast Enhanced Ultrasound (CEU) Using Microbubbles for Sentinel Lymph Node Biopsy in Breast Cancer: a Systematic Review.

BACKGROUND: The concept of sentinel lymph node (SLN) is not new to medical practice especially in breast cancer patients. CEU microbubble technique is an innovative technique which is applied with the same purpose. It utilizes ultrasound contrast agents based on the use of dispersion with sulfur hexafluoride gas. The aim of this review is to examine the clinical evidence on the role of intradermally injected microbubbles as a technique of preoperative identification of SLNs in patients with breast cancer. METHODS: A systematic search was performed in PubMed (5 October 2014), Scopus (5 October 2014) and Cochrane libraries (5 October 2014). RESULTS: Five prospective studies were included in the study. The total number of patients included was 727. The age of the included patients ranged from 19 to 93 years old. The median diameter of tumor ranged from 2 to 120 mm. Regarding the histological type, ductal carcinoma in situ was present in 31 patients, invasive ductal carcinoma in 438, invasive lobular carcinoma in 71 and not defined invasive breast tumors in 52 patients. The SLN identification rate ranged from 9.3% to 55.2% and the sensitivity from 61% to 89% while the false negative rate from 6.6% to 39% and the presence of micro/macrometastases from 1.9% to 64.3%. CONCLUSIONS: CEU microbubble technique is an alternative technique of SLN detection in breast cancer patients. Further studies are necessary to standardize the method and clarify its specificity and sensitivity. Moreover, randomized control trials are suggested in order to compare this technique with the current techniques used for SLN detection.

The implantation of cervical neoplasia at postpartum episiotomy scar: the clinical evidence.

BACKGROUND: Cervical cancer recurrence in episiotomy scars after vaginal deliveries is a rather rare event. AIM: We present a review of the current literature data on the field. METHODS: A systematic search was performed in PubMed and Scopus. RESULTS: 10 case reports and 3 case series with total 18 patients were included. The mean age of the patients was 33.3 years. One of them was diagnosed 1 year before her pregnancy, two of them were diagnosed during pregnancy, six of them during labor and eight patients at postpartum follow-up appointments from 1 week to 8 months postpartum. Twelve cases were squamous cell carcinoma, five cases adenocarcinoma and one case adenosquamous carcinoma with the majority of them staged as Ib1-2. The interval time from initial diagnosis to detection of recurrence had a wide range from 5 weeks to 5.5 years. The diameter of the recurrence was also ranging (5-60 mm). The management of such a recurrence included different extent of wide local excision or chemotherapy or radiotherapy or combinations of them. CONCLUSION: Clinicians should be aware about the importance of carefully examining not only the cervix at the time of labor, but also the episiotomy scar in women following a pregnancy complicated by cervical cancer.

Fertility sparing management and pregnancy in patients with granulosa cell tumour of the ovaries.

Granulosa cell tumours (GCTs) of the ovary are a rare entity among the neoplasms of gynaecological oncology. Deriving from the stroma of the ovary, GCTs are generally characterised by insidious growth, low malignancy potential and late recurrence. The standard treatment for these tumours is principally surgical, consisting of bilateral adnexectomy and hysterectomy. This is a narrative review of the current literature regarding the role of fertility sparing surgery in ovarian granulosa tumour. In the included studies, fertility sparing surgery was performed in 171 out of 350 patients. Recurrence rates ranged between 9.8-27.4%. Out of 131 patients, 15 achieved pregnancy. The data were limited regarding completion post-pregnancy surgery. Due to the fact that GCTs often affect younger ages, of crucial importance is the preservation of fertility by conserving the uterus and the contralateral ovary, while close monitoring is essential in order to achieve early identification and treatment of a possible recurrence. After completion of family planning, hysterectomy and salpingo-oophorectomy are recommended.

Incidence, characteristics, and outcomes of patients with bone and joint infections due to community-associated methicillin-resistant Staphylococcus aureus: a systematic review.

To summarize the published evidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) bone and joint infections. PubMed and Scopus electronic databases were searched. The annual incidence of invasive CA-MRSA infections ranged from 1.6 to 29.7 cases per 100,000, depending on the location of the population studied; bone and joint infections accounted for 2.8 to 43 % of invasive CA-MRSA infections. Surveillance studies showed that patients <2 years of age are mainly affected. Incidence rates were higher in blacks. Sixty-seven case reports and case series were identified; the majority of the patients included were children. Vancomycin and clindamycin were used effectively, in addition to surgical interventions. Seven patients out of 413 died (1.7 %) in total. Chronic osteomyelitis developed in 19 patients (data for 164 patients were available). The published evidence for CA-MRSA bone and joint infections refers mainly to children; their incidence depends on the location and race of the population. Vancomycin and clindamycin have been used effectively for their treatment.