Emergency Surgery for Small Bowel Hemangioma. A review of the literature.

Background: Hemangiomas of the small intestine are tumors rarely found in practice. Patients usually present in emergency settings with anemia, gastrointestinal bleeding or abdominal pain. The purpose of this review of the literature is to evaluate the diagnostic modalities, therapeutic options and their results in cases of intestinal hemangiomas. Methods: This is a review of the recent literature concerning intestinal hemangioma with bleeding in the last five years including one case from our institution. Search criteria were defined using MeSH terms. The descriptive analysis was performed accordingly. Results: In the last five years there was a total of 24 cases ours being the 25th with a predominance of male patients (20 cases). Literature search found a low threshold for preoperative diagnostic (only in 28% of the cases). More than half of the tumors were in the ileum. Surgery is the main therapeutic option (in 88% of the cases). Nonsurgical treatment (endoscopic or radiological) can rarely be employed successfully. Conclusions: Surgery is the main treatment for larger hemangiomas while for smaller ones nonsurgical treatment methods are available.

Polytrauma: The European Paradigm.

This review of the literature aims to describe the main advantages and disadvantages of the trauma systems in Europe. Moreover, the purpose of this article is to present the last concepts regarding the management of the polytrauma patients and the newest sets of measures to prevent car crashes in European Union. The articles published regarding the management of the polytrauma patient and trauma systems were identified using PubMed search. Optimal management of major polytrauma requires a national trauma system which should detail every level of organization from the trauma centers to the every member of the trauma team. European trauma systems varies a lot depending on the country and the specialized trauma surgery training programs are more advanced in countries with complex trauma systems. Introducing road safety performance indicators for trauma management decreased the rate of deaths by car crashes in Europe.

Review of calcium-sulphate-based ceramics and synthetic bone substitutes used for antibiotic delivery in PJI and osteomyelitis treatment.

Infection in orthopaedic and trauma surgery remains a destructive complication with particularly challenging diagnosis and treatment due to bacterial antibiotic resistance and biofilm formation.Along with surgical debridement and systemic antibiotics, an important type of adjuvant therapy is local antibiotic delivery, with the purpose of eliminating bacterial colonization and biofilm development.Calcium sulphate, as a synthetic absorbable biomaterial used for local antibiotic delivery, has experienced an increasing popularity during the last decade, with multiple promoted advantages such as predictable antibiotic elution kinetics, complete and quick biodegradation, good biocompatibility, and limited associated complications.A series of commercially available antibiotic-delivery systems based on calcium sulphate are under investigation and in clinical use, with different presentations, compositions, and application techniques.The current article presents the main available calcium-sulphate-based products and the existing data about the clinical and preclinical research results, stemming from their implementation as local antibiotic carriers for surgical site and implant-associated infections treatment and prevention. Cite this article: EFORT Open Rev 2021;6:297-304. DOI: 10.1302/2058-5241.6.200083.

The Management of Pancreatic Trauma - A Continuous Challenge.

Background: The aim of this analysis was to assess the factors that influence the severity of pancreatic trauma cases, also underlining the importance of early and accurate diagnosis and proper management of each case. Methods: This study is a retrospective analysis of patients that were presented to the Clinical Emergency Hospital of Bucharest, Romania, in several periods of time: 1985-1990 (50 patients); 1990-1999 (102 patients); 2000-2005 (56 patients); 2012-2019 (48 patients). Results: The mean age was around 40 years old, with predominance of male incidence in all the groups and traffic accidents (blunt trauma) as the main cause of injury. Most patients (almost 50% in each group) were operated on within the first 24 hours from hospital presentation. The general mortality rate varied: 42% (1985-1990), 23.5% (1990-1999), 12.7% (2000-2005) and 33% (2012-2015). Pancreatic mortality rate was 6% (1985-1990 and 1990-1999), 3.5% (2000-2005) and 8% (2012-2019). Conclusions: During the last 35 years, the preoperative diagnosis in patients with trauma of the pancreas remained a challenge and the treatment of the pancreatic trauma suffered a very interesting evolution- from the very frequent laparotomy to the nonoperative management and the damage control. These procedures produced a significant decreasing of the negative or nontherapeutic laparotomies. For the effectiveness of treatment, methods must be correlated with the lesion score.

An extremely uncommon case of pancreatic extragastrointestinal stromal tumor in a 53-year-old female patient.

Gastrointestinal stromal tumors (GISTs) are the most frequently encountered mesenchymal tumors that develop anywhere along the gastrointestinal (GI) tract, but they account for less than 1% of all GI tumors. However, GISTs can also develop outside the GI tract. They are referred to as extragastrointestinal stromal tumors (EGISTs) and represent around 5-10% of all GISTs. In this latter case, the tumor itself is not connected to the GI tract and can affect the omentum, mesentery, and retroperitoneum. EGISTs can also originate from the pancreas, but they are extremely uncommon. It is estimated that pancreatic EGISTs account for about 5% of all EGISTs, with around 30 cases being reported in the literature so far. The current report presents an extremely rare case of pancreatic EGIST encountered in a 53-year-old woman with no remarkable personal or family medical history. Surgical resection of the pancreatic head tumor through pancreaticoduodenectomy using Whipple procedure combined with negative resection margins and adjuvant Imatinib mesylate treatment led to a favorable postoperative evolution. The follow-up at six months after surgery did not reveal any malignant changes.

Spatio-temporal discrimination of molecular, aerosol and cloud scattering and polarization using a combination of a Raman lidar, Doppler cloud radar and microwave radiometer.

The combined data from the ESA Mobile Raman Polarization and Water Vapor Lidar (EMORAL), the LATMOS Bistatic Doppler Cloud Radar System for Atmospheric Studies (BASTA), and the INOE Microwave Radiometer (HATPRO-G2) have been used to explore the synergy for the spatio-temporal discrimination of polarization and molecular, aerosol and cloud scattering. The threshold-based methodology is proposed to perform an aerosol-cloud typing using the three instruments. It is demonstrated for 24 hours of observations on 10 June 2019 in Rzecin, Poland. A new scheme for target classification, developed collaboratively by the FUW and the OUC, can help determine molecules, aerosol (spherical, non-spherical, fine, coarse), cloud phase (liquid, ice, supercooled droplets) and precipitation (drizzle, rain). For molecular, aerosol, and cloud discrimination, the thresholds are set on the backward scattering ratio, the linear particle depolarization ratio and the backscatter colour ratio, all calculated from lidar signals. For the cloud phase and precipitation categorization, the thresholds are set on the reflectivity and the Doppler velocity derived from cloud radar signals. For boundary layer particles, precipitation, and supercooled droplets separation, the thresholds are set on the profiles of temperature and relative humidity obtained by the microwave radiometer. The algorithm is able to perform separation even under complicated meteorological situation, as in the presented case study.

Failure Analysis of Retrieved Osteosynthesis Implants.

Failure of osteosynthesis implants is an intricate matter with challenging management that calls for efficient investigation and prevention. Using implant retrieval analysis combined with standard radiological examination, we evaluated the main causes for osteosynthesis implant breakdown and the relations among them for a series of cases. Twenty-one patients diagnosed with implant failure were assessed for this work. For metallurgical analysis, microscopy techniques such as scanning electron microscopy (SEM), stereomicroscopy, and optical microscopy were employed. The results showed that material structural deficiencies (nine patients) and faulty surgical techniques (eight patients) were the main causes for failure. An important number of patients presented with material structural deficiencies superimposed on an imperfect osteosynthesis technique (six patients). Consequently, the importance of failure retrieval analysis should not be overlooked, and in combination with other investigational techniques, must provide information for both implant manufacturing and design improvement, as well as osteosynthesis technique optimization.

Proximal humerus chondrosarcoma in a young male patient.

Proximal humerus chondrosarcoma is a rare localization of the common primary malignant cartilaginous tumor. Management is based on oncological surgical excision because of the inherent resistance to chemotherapy and radiation therapy. The most important prognostic factors with great impact on treatment strategy are histological grading and localization of the tumor. Proximal humerus chondrosarcoma carries a slightly better prognosis, especially for the low and moderate grade tumors. We present the case of a young patient with proximal humerus chondrosarcoma surgically managed in our Department, with the purpose of underlining the challenges posed by this localization for oncological excision and reconstruction but also the importance of histological grading for the treatment algorithm.

An extremely rare case of distal common bile duct adenocarcinoma in a 65-year-old male patient.

Cholangiocarcinoma is an extremely rare and highly aggressive primary malignancy of the biliary tract. The current report illustrates a rare case of distal common bile duct adenocarcinoma encountered in a 65-year-old male patient who was thoroughly investigated after presenting with a two weeks history of pain in the right hypochondrium, jaundice and unintentional weight loss (6 kg in two weeks). The medical team opted for a pancreaticoduodenectomy (Whipple procedure) managing to obtain negative resection margins of the tumor with a favorable immediate postoperative evolution. However, the surgical team was forced to reintervene twice due to complications caused mainly by the patient's disregard.

A Rare Case of Upper Digestive Hemorrhage due to Bleeding Duodenal Tumor.

We present the case of a 48-year-old patient with no medical history, who presents himself to the emergency room with melena, asthenia and dizziness. The blood tests revealed a severe anemia (Hb = 4,8 g/dL). He is admitted in the Gastroenterology ward, where a first superior digestive endoscopy is performed which shows a duodenal bleeding tumor (second duodenum) of 7 cm in length. After the administration of red blood cell mass, plasma and haemostatic agents the level of the hemoglobin increases. The abdominal CT scan reveals a 3/5 tumor localized in the second and third duodenum. The superior digestive endoscopy is repeated and haemostasis of the bleeding tumor is accomplished. The surgical exploration of the peritoneal cavity discovered a partial stenosing, ulcerated duodenal tumor (third and fourth duodenum) and duodenectomy (third and fourth duodenum), segmental enterectomy (first loop of the jejunum), end to end duodeno-jejunal anastomosis, transgastric closure of the pylorus, gastro-enteric anastomosis on Omega loop with Braun fistula were performed, after the result of the extemporaneous histopathological exam suggested a GIST tumor. The postoperative evolution was favorable. The histopathological exam diagnosed the duodenal tumor as a gastrointestinal stromal tumor (GIST) with tumor free resection margins. The particularity of this case is the rare etiology of the upper gastrointestinal hemorrhage and its severity.