RESUMEN
Chondromyxoid fibroma (CMF) is a benign cartilaginous tumor that typically occurs in the long bones of young adult males, with the clinical presentation varying from asymptomatic to localized pain, swelling, and movement restriction. We report an unusual presentation of CMF involving a rib, along with a literature review of the management of CMF. Although benign, local recurrence is not uncommon, and malignant transformation has been reported on rare occasions. En bloc surgical excision, with adequate tumor-free resection margins, of radiologically suspected chondromyxoid fibroma is crucial for the treatment and confirmation of diagnosis. A high index of suspicion, adequate treatment, and follow-up are critical for the successful management of these uncommon benign chondroid tumors.
RESUMEN
Background Despite ample evidence of continuing preoperative aspirin to improve coronary artery bypass surgery outcomes, practice for the routine continuation of preoperative aspirin is inconsistent due to concern for increased postoperative bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on postoperative bleeding after off-pump coronary artery bypass grafting (OPCABG). Methodology This cohort study involved patients (n = 74) who underwent OPCABG at a single center between August 2017 and January 2018. After considering the inclusion and exclusion criteria, the patients were divided into two groups: one (n = 37) received tablet aspirin 75 mg till the day of the surgery, and for the other group (n = 37) aspirin was stopped five days before the surgery. Postoperative bleeding was recorded in both groups. After considering preoperative, intraoperative, and postoperative variables, statistical analysis was performed. Results There was no significant difference between the two groups concerning peroperative and postoperative variables. In addition, no significant difference was observed between the two groups in chest tube drainage at one, two, three, twenty-four, forty-eight, and seventy-two hours (p = 0.845, 0.126, 0.568, 0.478, 0.342, and 0.717, respectively). No significant difference was seen in the transfusion requirement of blood and fresh frozen plasma (FFP). Conclusions Continuation of preoperative aspirin till the day of the surgery is neither associated with an increase in chest tube drainage, reoperation for bleeding complications nor transfusion of blood and FFP.
RESUMEN
INTRODUCTION: Gastric volvulus is a rare medical emergency that can be fatal if not recognized early. Its rarity makes it quite challenging to diagnose but delaying in diagnosis and treatment can lead to fatal complications. Meticulous assessment and broadened differential diagnosis are thus crucial. Organoaxial volvulus, in which the stomach rotates 180 degrees around its long axis, is the most common subtype of gastric volvulus, occurring predominantly in infants and older adults. PRESENTATION OF THE CASE: Here, we present a case of acute organoaxial gastric volvulus in a 17-year-old male presenting to a low-resource hospital in Bangladesh with severe upper abdominal pain and postprandial vomiting. Initial assessment revealed severe epigastric tenderness and mild dehydration. Plain abdominal x-ray showed a hugely distended bowel with single air fluid level and thoracic herniation of the stomach. The patient was resuscitated then sent to the operating theatre for urgent laparotomy and sleeve gastrectomy with anterior gastropexy. Treatment was successful, and the patient survived. DISCUSSION: Acute gastric volvulus, a life-threatening surgical emergency can be treated successfully if identified timely. Though the CT scan is diagnostic, Borchardt's triad can be helpful as well. CONCLUSION: This is the second consecutive case managed by the same surgeon in the same hospital, highlighting that high index of clinical suspicion is an important tool to diagnose this condition early. Timely diagnosis and treatment are essential to avoid fatal complications, denoting the importance of documenting such cases.
