Blunt trauma of the thoracic aortic isthmus.

Blunt trauma of the thoracic aorta is the second leading cause of death in traffic accidents, after head injuries. A polytraumatized patient, aged 40, was admitted, with trauma of the thoracic aortic isthmus, after a traffic accident. Adequate resuscitation and intensive therapy, angiographic and MSCT diagnostics enabled the urgent surgical treatment. On the sixty-seventh day of surgery, the patient was successfully transferred to a regional health center in good general condition. Blunt aortic injury occurs in 1% of casualties in traffic and causes 16% mortality. More than 80% of patients die before arrival to hospital. In conclusion, we point out with satisfaction the successful surgical treatment and survival of injured patients admitted to our hospital.

Squamous cell carcinoma in mature cystic teratoma of the ovary.

INTRODUCTION: Malignant transformation is a rare complication of mature cystic teratoma, with squamous cell carcinoma as the most common malignancy (in 75% of cases). In this article we present a case of a well-differentiated squamous cell carcinoma arising in a mature cystic teratoma and discuss the morphological and clinico-pathological features of malignant transformation in teratoma. CASE REPORT: An 80-year-old woman with symptoms of acute abdomen underwent left salpingo-oophorectomy. Gross examination showed a cystic mass measuring 20 cm in diameter, with papillary formation on its internal surface. Histology revealed a well-differentiated squamous cell carcinoma arising in mature cystic teratoma. Squamous epithelium surrounding the tumor was dysplastic. CONCLUSION: Squamous cell carcinoma in mature cystic teratoma is a rare pathologic event and in most cases it is an accidental pathohistological finding.

A surgical thread as a nidus for the common bile duct stone formation.

A 68-year old patient, who had had cholecistectomy when he was 30 years old and had been hospitalized in several occasions, with clinical presentation of recidivant cholangitis was admitted to county hospital. Computed tomography was performed, where a bile duct dilatation was noted, with suspected 12 mm concrement. After that the patient was referred to the hospital in order to undergo therapeutic endoscopic retrograde cholangiopancreatography. After performing the procedure, the presence of the concrement, 12x25mm in size was confirmed. It was evacuated during mechanical lithotripsy along with a part of surgical thread, which could not have been extracted entirely. A surgery had to be performed because the patient developed cholestasis. Forming of choledocholith most likely developed on the matrix of surgical thread, which is a rare cause of choledocholithiasis.

Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy.

BACKGROUND: Information-based scoring systems predictive of outcomes of midline laparotomy are needed; these systems can support surgical decisions with the aim of improving patient outcomes and quality of life, and reducing the risk of secondary surgical procedures. STUDY DESIGN: All study subjects were followed for a minimum of 6 months after operation. Numerous demographic, clinical, treatment, and outcomes-related perioperative factors were recorded to determine statistical association with the primary end point: incisional hernia development. The first analysis was designed to establish the statistical model (scoring system) for estimating the risk of incisional hernia within 6 months of midline laparotomy. Univariate and multivariate analyses were performed. A simple additive model was constructed using stepwise logistic and linear regression. The second part of the study analysis was validation of the scoring systems developed initially. RESULTS: A logistic linear minimum regression model was developed based on four covariates independently predictive of incisional hernia: Body mass index (BMI) > 24.4kg/m(2); fascial suture to incision ratio (SIR) < 4.2; deep surgical site, deep space, or organ infection (SSI); and time to suture removal or complete epithelialization >16 days (TIME). The hernia risk scoring system equation [p(%) = 32(SIR) + 30(SSI) + 9(TIME) + 2(BMI)] provided accurate estimates of incisional hernia according to stratified risk groups based on total score: low (0 to 5 points), 1.0%; moderate (6 to 15 points), 9.7%; increased (16 to 50 points), 30.2%; and markedly increased (>50 points), 73.1%. CONCLUSIONS: A statistically valid, straightforward, and clinically useful predictive model was developed for estimating the risk of incisional hernia within 6 months of midline laparotomy. Prospective independent validation of this model appears indicated.