A rare posterior mediastinal mass: chordoma.

A 72-year-old female presented with 2 years of pro-gradient pain in the upper thoracic spine radiating to the left arm and leg. MRI revealed a 2.7 × 2.0 × 12 cm paravertebral mass at T2/T3, extending into the foraminal and epidural nerves with extensive dural sac contact in the left hemithorax. The removed tumour was surprisingly soft for a schwannoma or chordoma. However, after the surgery, histopathology revealed the presence of brachyury protein (T-box transcription factor T), which is characteristic of a chordoma. While chordomas are extremely rare, it is important that they are kept in mind for the differential diagnosis of a posterior mediastinal mass. Successful treatment can only be achieved through a complete en bloc resection. This can often be complex due to their location along the spine. This case report aims to highlight the features and treatment of this rare disease.

Complete Jejunal Transection After Blunt Abdominal Trauma: A Case Report.

INTRODUCTION: Isolated complete transection of the small bowel is extremely rare in blunt abdominal trauma. If it occurs, it is often associated with high-energy impact, as seen in motor vehicle accidents and falls from heights. In this case, a trivial trauma due to a handlebar injury caused a complete transection of the middle jejunum. CASE PRESENTATION: A 47-year-old man walked into the emergency department with moderate abdominal pain ∼10 hours after a fall on to a bicycle's handlebar from a standing position. A bedside ultrasound showed minimal amount of free fluid and a following performed computed tomographic scan indicated an edematous loop of small bowel with diminutive amount of extraluminal air, suggesting small bowel perforation. Because of the absence of abdominal peritonism in a hemodynamically stable patient, a conservative treatment and surveillance was established. In the follow-up, the patient suddenly developed severe abdominal pain with now clear signs of peritonism. An emergency laparoscopy showed a complete transection of the middle jejunum. A primary anastomosis was performed. The patient had an uneventful recovery and was discharged after 7 days. CONCLUSIONS: Even seemingly trivial blunt abdominal traumas can cause complete transection of the small bowel, as shown in this case. Patients with blunt abdominal trauma need to be reviewed frequently by an experienced clinician. Diagnostic laparoscopy attaches a great importance to early detection and treatment of small bowel injuries. The mechanical pattern of the injury seems to be more important than the energy of the impact itself.

Appendicitis after laparoscopic ovarian cystectomy-coincidence or complication.

Diagnosis of appendicitis, particularly in young women, may be challenging. In case of abdominal pain in the postoperative period of laparoscopic surgery, one should not only think of complications such as bleeding and injury of the bowel but also such as acute appendicitis. We report a case of a 26-year-old female patient with a post-laparoscopic acute appendicitis with appendicolithiasis 3 days after a laparoscopic ovarian cystectomy during which the appendix appeared inconspicuous. Appendicitis after gynecologic laparoscopy is a rare but potentially dangerous condition. One should consider the possibility of a postoperative appendicitis in case of an acute abdomen after laparoscopic surgery. Further studies might be of value to re-evaluate incidental appendectomy especially in cases of appendicolithiasis.

Physical and psychosocial outcome in morbidly obese patients with and without bariatric surgery: a 4 1/2-year follow-up.

BACKGROUND: Morbidly obese patients show high somatic and psychiatric co-morbidity. Bariatric surgery is accepted as the obesity treatment with the greatest long-term success. There is growing evidence that follow-up studies should address somatic as well as psychosocial conditions of patients undergoing bariatric surgery and non-operatively treated patients. This study investigates the physical and psychosocial outcomes of patients with and without bariatric surgery. METHODS: A sample of 131 morbidly obese patients applying for bariatric surgery underwent somatic and psychological assessment (T0). A first follow-up study (T1) was conducted 2 years after T0 in 119 patients. The present second follow-up (T2) was carried out 4 1/2 years after T0 and 3.2 years after potential bariatric surgery. Psychological/psychosocial measures were collected in the 93 patients, 63 of whom were treated surgically, via the Psychosocial Stress and Symptom Questionnaire (PSSQ) and a telephone interview covering BMI, employability, medication, doctor consultations, eating behavior, and physical/psychological well-being. RESULTS: Patients with and without bariatric surgery showed a BMI reduction, which was significantly greater in those who underwent surgery (P<.001). The average percentage of excess weight loss (%EWL) between T0 and T2 was 11.5% in patients with no bariatric surgery, 36.0% in patients with laparoscopic gastric banding, and 52.8% in patients with laparoscopic gastric bypass (%EWL between T0 and T2 in patients of all groups significant, P<.001). Patients with and without surgical treatment showed significant improvement with regard to depressive symptoms and binge-eating behavior. Three-quarters of the surgically-treated and two-thirds of the non-treated patients rated their physical, psychological, and psychosocial well-being as "good" at T2. CONCLUSION: After 3 to 4 years, all of the patients have adapted well to their weight and body appearance, regardless of whether they have undergone surgery. Weight loss is, however, greater for operated patients, which strongly decreases the risk of developing obesity-related co-morbidities.

Retroperitoneal Endoscopically Assisted Minilaparotomy for Anterior Lumbar Interbody Fusion: Technical Feasibility and Complications.

STUDY DESIGN: Description of a novel less invasive technique and prospective evaluation of associated morbidity and potential complications. OBJECTIVE: To investigate the feasibility of a novel endoscope-assisted retroperitoneal approach (REAM) for anterior lumbar interbody fusion (ALIF). SUMMARY OF BACKGROUND DATA: Minimally and less invasive approaches are currently favored to perform ALIF. However, the present endoscopic techniques have not found widespread acceptance, because they are technically demanding, and microsurgical techniques are not time effective when two separate approaches are needed for L5-S1 (transperitoneal) and L4-L5 (retroperitoneal). METHODS: The authors have developed the technique of REAM, which consists of three stages: 1) endoscopic retroperitoneal mobilization of the peritoneal sac, 2) midline minilaparotomy (4-6 cm), and 3) standard open anterior lumbar interbody fusion. Twenty patients were prospectively enrolled in this study and perioperative data (i.e., blood loss, operative time, intra- and postoperative complications) were collected to assess the feasibility of this approach. RESULTS: Six single-level and 14 two-level ALIFs from L3-L4 to L5-S1 were performed with a mean operative time of 108 minutes (range, 85-150) and an average estimated blood loss of 200 mL (range, 50-500). The follow-up (range, 12-29 months) on 20 patients showed that there were no perioperative or postoperative complications related directly to this approach. CONCLUSION: Anterior lumbar interbody fusion by REAM can be performed without additional hazard to the patient and appears to be a reasonable alternative to existing less invasive procedures.