Endoscopic surgery in athletes with a symptomatic calcaneal lipoma.

PURPOSE: This study shows that endoscopy is an effective treatment modality for athletes with a symptomatic calcaneal lipoma. METHODS: Between 2013 and 2016, five professional athletes with symptomatic calcaneal lipoma underwent endoscopic-assisted curettage and bone graft treatment. Lipoma size was measured by magnetic resonance imaging (MRI) and rated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). All athletes were followed up for 12 months postoperatively and monitored on return to previous activity level. RESULTS: The mean ankle-hindfoot scale score improved from a preoperative 71.3 +/-3.9 points (median 67-81) to a postoperative 97.8 +/-3.4 points (median 89-100). Radiological assessment revealed no recurrence or pathologic fracture, with adequate bone fill-up in all 5 cases. All athletes returned to their previous level of activity within 8 weeks of surgery (mean period 7.2 weeks, median 5-8 weeks). CONCLUSION: Endoscopic surgery can be used as a valid treatment tool for athletes with a calcaneal lipoma. It allows for a safe and early return to sports activities and minimises risk for recurrence and pathological fracture after initial return to play. LEVEL OF EVIDENCE: IV.

Mucinous adenocarcinoma of the urinary bladder after long-term duodeno-renal and colovesical fistula--case report.

Primary adenocarcinoma of the urinary bladder is a rare neoplasm. It accounts for 1-2% of all bladder carcinomas and sometimes may be found in the bladder diverticula. Fistula between duodenum and renal pelvis is another rarity while colovesical fistula is not so uncommon. We present a case of a 40 years old man who had surgery for colovesical and duodenorenal fistula and subsequently developed adenocarcinoma of the urinary bladder.

[Cardiac surgery in patients with heparin-induced thrombocytopenia (HIT II)].

Heparin-induced thrombocytopenia (HIT) might be life-threatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or direct thrombin inhibitors. Female patient was switched from per oral anticoagulant therapy to low molecular heparin therapy preparing for reredo mitral valve replacement due to endocarditis and artificial valve thrombosis. In next 10 days, thrombocytopenia was obvious (Tr 302,000 mm3 to 11,000 mm3) , and diagnoses of HIT were done. Anticoagulant therapy was continued with danaparoid, 750 IU/12 h sc. During the surgery, reredo mitral valve replacement and aortocoronary bypass on anterior descending coronary artery, blood salvage technique with rhirudin (intravenous bolus 0.4 mg/kg, in CPB prajming solution 0.4 mg/kg and continuous infusion during CPB 0.15 mg/kg/h) during cardiopulmonary bypass was used. Active coagulation time and +++ were monitored, without any sign of micro thrombosis in circuit. Postoperatively, per oral anticoagulation therapy was initiated with prolonged postoperative treatment due to basic disease, endocarditis. Patient was discharged from hospital on 21st postoperative day without any complication.

[Use of a 7.5% NaCl/6% Dextran 70 solution in the prevention of hemodynamic disorders during surgery of abdominal aortic aneurysms]. / Primena rastvora 7.5% NaCl/6% Dextran 70 u prevenciji hemodinamskih poremecaja u toku operacija aneurizmi abdominalne aorte.

The experience in the application of infusion solutions Ringer lactate (RL) and 6% of Dextran 70 is shown in order to replenish intravascular volume in 19 patients with the abdominal aorta aneurysm after the removal of the aortal clamp and hypertonic-hyper oncotic 7.5% NaCl/6% Dextran 70 solution in 4 to 5 ml/kg dose in 9 patients. The application 7.5% NaCl/6%Dextran 70 at the optimum time, 15-20 min before the removal of aortal clamp, in a dose of 4-5 ml/kg allowed the support of normal hemodynamic function and decreased the need for some solutions or blood, as well as the incidence of intra- and postoperative complications.