Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer.

Complete duplication of ureters is a very rare clinical entity that may either be asymptomatic or present with a variety of clinical findings. In the presented case a 51-year-old Caucasian female underwent an intersphincteric resection for low rectal cancer. Intraoperatively, during the standard bilateral recognition and mobilization of the ureters, complete unilateral duplication of the left ureter was incidentally detected, deriving from a single renal parenchyma. Such a congenital abnormality though constitutes a major risk-factor of accidental ureteral injury during operations including pelvis. Conclusively, meticulous exposure of both ureters combined with surgeons' unceasing awareness constitute the cornerstone of a safe operation.

Middle colic vein draining to splenic vein: a rare anatomic variation encountered during a right hemicolectomy.

Right or subtotal colectomy either open or laparoscopic may be a challenging operation owing to technical difficulties. One of these, is to identify a safe and adequate dissection plane, ligating and dissecting lymph nodes around middle colic vessels. The purpose of this study was to depict a rare anatomic variation of middle colic vein (MCV) draining to splenic vein. We report the case of a 55-year-old male patient, who was subjected to a right hemicolectomy for an adenocarcinoma in the ascending colon. During dissecting the transverse mesocolon from the greater omentum, for complete mesocolic excision (CME), we encountered that the MCV drained in the splenic vein. With respect of this rare anatomic variability, CME was completed without hemorrhage. Our aim is to depict that deep knowledge of MCV anatomy and its variations is of paramount importance to achieve CME and to avoid dangerous or massive bleeding.

Experimental Hemorrhagic Shock Protocol in Swine Models: The Effects of 21-Aminosteroid on the Small Intestine.

BACKGROUND: The protective potential of lazaroids has been reported in previous studies on ischemia/reperfusion and induced hemorrhagic shock protocols. OBJECTIVES: The present study is the first experimental protocol on the effects of the antioxidant factor U-74389G on the small intestine of swine models in a hemorrhagic shock protocol and resuscitation with 3 different types of fluids. METHODS: The study included 49 Landrace breed swine that were divided into groups of 7 each. Hemorrhage was provoked 45 minutes after starting the surgical protocol (0 minutes), followed by resuscitation starting 30 minutes after haemorrhage ceased by using 3 different fluids. Three groups (Group A, resuscitation using blood; Group B, resuscitation with Ringer's lactate solution; and Group C, resuscitation with hypertonic saline solution) underwent resuscitation with fluid alone, and another 3 groups (named A', B,' and C') were administered lazaroid U-74389G in addition to fluid. Control Group S underwent all the surgical procedures without hemorrhagic shock. Vital signs, complete blood count, and biochemical markers were analyzed, and tissue samples of the small intestine were collected from all animals. Further, malondialdehyde, tumor necrosis factor-α, and levels of inflammation in the tissue sample were measured. RESULTS: In Group S-A-A' and Group S-C-C', the analysis did not show statistically significant differences in the percentage changes of histopathology, malondialdehyde, and tumor necrosis factor-α through time. In Group S-B-B', the malondialdehyde levels in the small intestine were reduced in both the B and B' groups, without lazaroid (Group B) (P = 0.038) and lazaroid (Group B') (P = 0.011), compared with Group S (control), but the group without lazaroid (Group B) had greater reduction in malondialdehyde levels than the group treated with lazaroid (Group B'). With regard to the biochemistry results, 24% reduction was observed for alkaline phosphatase (P = 0.022) in Group A' treated with lazaroid compared with that in the untreated group. Lastly, for the complete blood count parameters, a 14% reduction in white blood cells was observed in Group B', which was treated with lazaroid in all phases (P = 0.015) (absolute value = 6.23) compared with Group B (absolute value = 13.74). CONCLUSIONS: Despite few initial findings of this study suggesting that administration of lazaroid U-74389G may have some potential in attenuation of the effects of hemorrhagic shock in the small intestine of swine models, no differences remained after correction for multiple comparisons was made. Therefore, further research is required to investigate this result thoroughly.

Anomalous course of the sigmoid colon and the mesosigmoid encountered during colectomy. A case report of a redundant loop of sigmoid colon.

Introduction Sigmoid colon constitutes a part of the large intestine that presents several congenital anatomic variations. In particular, the presence of a redundant loop of sigmoid colon is of tremendous importance for surgeons, obstetricians and radiologists, since it is closely related to multiple pathological conditions and functional implications of the neighboring anatomical structures. PRESENTATION OF CASE: An unusual anatomic variation in position and length of the sigmoid colon and its mesocolon was unexpectedly detected during right hemicolectomy to a 67-year-old Caucasian male patient due to colon cancer. The operation was uneventful. A meticulous review of the literature was conducted as well. DISCUSSION: A redundant loop of sigmoid colon may go unnoticed or it might lead to urinary, digestive and vascular complications. Its presence is associated with acute and chronic pathological conditions, sigmoid volvulus and serious confusions in radiological diagnosis and instrumentation. CONCLUSION: Surgeons' thorough knowledge concerning this rare anatomic variation is fundamental and crucial in order to establish a correct diagnosis and assert the appropriate management when performing operations including pelvis and abdomen.

The ligament of Parks as a key anatomical structure for safer hemorrhoidectomy: Anatomic study and a simple surgical note.

Hemorrhoids are a common anal disorder which affects both men and women of all ages. One out of ten patients with hemorrhoidal disease, requires surgical treatment. Unfortunately though, hemorrhoidectomy is closely related to complications that can be present early or late postoperatively. In the present manuscript, the safe surgical technique which emphasizes to the identification of the key anatomical structure of the ligament of Parks (Trietz's muscle) is adequately described. A total of 200 patients with grades III and IV hemorrhoids, underwent Milligan-Morgan or Ferguson's hemorrhoidectomy. The mucosal ligament of Parks was identified to all patients and was used as a key anatomical structure through the excision of the hemorrhoids. Its identification guides surgeons during the operation and reduces the major problem of postoperative complications. Finally, since the mucosal ligament of Parks represents a constantly identifiable landmark, it allows simple and reliable identification of the internal sphincter muscle and minimizes the probability of postoperative complications.

Anatomic variation of the relation between the facial nerve and the retromandibular vein during superficial parotidectomy: A rare case report.

INTRODUCTION: Identification and preservation of the facial nerve (FN) is a major challenge when performing parotidectomy. Anatomic variations of the relation between the FN and the retromandibular vein (RMV) pose a high risk of nerve injury and bleeding during the operation. PRESENTATION OF CASE: An unusual anatomic variation of the relation between the FN and the RMV was unexpectedly detected during superficial parotidectomy. The operation was uneventful. A meticulous review of the recent literature was conducted as well. DISCUSSION: Variations of the relation between the FN and the RMV are mainly identified during the operation, since when performing parotidectomy, surgeons typically detect all the FN branches by locating the RMV. Such kind of variations, are not as rare as considered and their presence complicates parotid surgery and increases the potentiality of nerve injury and hemorrhage. CONCLUSION: Surgeons' deep knowledge and perpetual awareness concerning the probable anatomic variations of the relation between the FN and the RMV combined with detailed exposure of the operative field and of the relationship between these adjacent anatomical structures lead to safe parotid surgery.

Effects of U-74389G (21-Lazaroid) and Ascorbic Acid on Liver Recovery After Acute Ischemia and Reperfusion in Rats.

BACKGROUND/AIM: The free radical-scavenging effects of the lazaroid U-74389G have been shown in several experimental models to protect the liver from ischemia/reperfusion (I/R), however, the mechanism of cytoprotection is not fully understood. Similar findings were observed when ascorbic acid was administered. This study investigates the effects of infusion of lazaroid U-74389G and ascorbic acid on cytokines and liver structure in a liver I/R rat model. MATERIALS AND METHODS: Sixty male Wistars rats, weighting 220-290 g, were used in the study. Six experimental groups were formed: Group 1 (control group): ischemia for 30 min and reperfusion for 60 min; group 2 (control group): ischemia for 30 min and reperfusion for 120 min; group 3: ischemia for 30 min, intraportal injection of ascorbic acid, and reperfusion for 60 min; group 4: ischemia for 30 min, ascorbic acid administration, and reperfusion for 120 min; group 5: ischemia for 30 min, U-74389G administration, and reperfusion for 60 min; and group 6: ischemia for 30 min, U-74389G administration, and reperfusion for 120 min. Tissue and blood sampling took place upon completion of each model's reperfusion. U-74389G was administered at 10 mg/kg animal body weight and ascorbic acid at 100 mg/kg. Anesthesia was induced with ketamine and xylazine. Surgery was performed through a midline laparotomy. The portal vein and the common hepatic artery were isolated and prepared for occlusion. Blood samples and wedge liver biopsies were taken to measure levels of liver enzymes, cytokines and for microscopic analysis upon completion of reperfusion once for each model. RESULTS: Histopathological evaluation revealed a statistically significant reduction in the degree of necrosis of liver tissue in the treated groups compared to the control groups 1 and 2 [groups 3, 5 (p=0.010) and 4, 6 (p<0.0005)]. On the other hand, tissue malondialdehyde levels (MDA) were statistically significantly increased only between control group 2 and groups 4, 6 (p<0.0005). There was no statistically significant difference in tumor necrosis factor-α between groups. As for liver enzymes, only alkaline phosphatase (ALP) and gamma-glutamyl transferase (gGT) were statistically significantly reduced in treated groups 3 and 5 (ALP: p=0.027, and gGT: p=0.002) and 4 and 6 (ALP: p=0.004, and gGT: p=0.015) compared to control groups 1 and 2. CONCLUSION: Based on histological data and the reduction of some of the liver enzymes, in spite of a rise of malondialdehyde, in this rat model, administration of U-74389G in liver ischemia/reperfusion (I/R) injury has potential in attenuating liver damage.

Bilateral aberrant origin of the inferior thyroid artery from the common carotid artery.

The thyroid gland is mainly supplied by the superior and inferior thyroid arteries, with the latter being its principal arterial supply in adults. The inferior thyroid artery usually arises from the thyrocervical trunk, and less frequently from the subclavian artery. Rarely, it may originate from the vertebral artery or the common carotid artery. In the present report, we describe a unique case of a 56-year-old patient, undergoing total thyroidectomy and level VI lymph node dissection for papillary thyroid carcinoma, with aberrant origin of both inferior thyroid arteries from the common carotid arteries.

Subcutaneous splenosis of the abdominal wall: report of a case and review of the literature.

Splenosis is a common benign condition that occurs after splenic rupture via trauma or surgery. The mechanism behind splenic cell autotransplantation begins with the splenic rupture, either from trauma or surgical removal. Splenosis is usually found incidentally and, unless symptomatic, surgical therapy is not indicated. Subcutaneous splenosis is an extremely rare form of splenosis, mostly observed in abdominal surgical scars. We report a case of subcutaneous splenosis, as well as a comprehensive review of the literature. In our case, a 43-year-old woman who had splenectomy after traumatic splenic rupture at the age of 7 years old presented for plastic reconstruction of her postoperative scar. Upon surgery, two asymptomatic subcutaneous nodules were incidentally discovered. The presence of splenic tissue was confirmed by the histological study. The nodules were not excised, as the patient was not symptomatic.