ABSTRACT
Solitary primary extraosseous plasmacytoma is a rare disease in the gastrointestinal tract, recently classified as an "exceptional" tumor of the colon site. The real incidence (one case/population/year) is unknown but reasonably less than 1/10,000,000 cases/year with very few descriptions in the literature. The rare cases described in the literature are often diagnosed after surgery for perforation and with predominant localization of the left colon. The main endoscopic presentation mimics colon carcinoma with ulcerated mass and obstructing lumen. In this paper, we report a rare case of isolated mass mimicking a submucosal lesion of the ascending colon diagnosed in an older female patient by colonoscopy. The patient was almost asymptomatic; she reported only a history of hematochezia without anemia. This mass was successfully treated by surgery and followed by hematological investigations, including bone marrow biopsy, specific laboratory tests, and CT/PET scan, which confirmed primary isolated plasmacytoma of the colon.
ABSTRACT
BACKGROUND: Limited studies have applied thoracic continuous spinal anesthesia in abdominal surgery, relying exclusively on opioids. This retrospective study analyzes 2 different schemes of thoracic continuous spinal anesthesia and postoperative analgesia in elderly patients undergoing major abdominal surgery. METHODS: A total of 98 patients aged ≥ 75â¯years were divided into 2 groups. The control group (60 patients) received bupivacaine plus fentanyl, whereas the study group (38 patients) received bupivacaine plus ketamine and midazolam. Both received analogous postoperative continuous intrathecal analgesia. Several perioperative variables were evaluated. RESULTS: Spinal anesthesia was performed without complications in all patients. Doses of noradrenaline administered, incidence of respiratory depression, need for intraoperative sedation, and time to first flatus were significantly reduced in the bupivacaine plus ketamine and midazolam group. CONCLUSION: In a population of frail, elderly patients, thoracic continuous spinal anesthesia with local anesthetic plus midazolam and ketamine was superior to local anesthetic plus fentanyl. In the group receiving local anesthetic plus midazolam and ketamine, the incidence of respiratory depression was reduced, and doses of norepinephrine and intraoperative sedating medications were lower. Intraoperative anesthesia and postoperative analgesia were similar in both groups.
ABSTRACT
Many lasers are widely used in urological surgery for several applications. Their use to treat the superficial bladder cancer (SBC) is safe and minimally invasive. The Holmium:YAG (Ho:YAG) laser represents the pinnacle of laser technology in Urology. The authors carried out this study on safety, efficacy, complication rates, postoperative catheterization time, and hospital stay of high-risk patients who underwent Ho:YAG vs. transurethral resection (TUR). Two groups of high-risk patients with SBC and comorbidities underwent either Ho:YAG or TUR. Different clinical aspects of the tumours and recurrences were considered. No significant difference between the two groups was noted regarding number, progression of grade and stage and place and time of recurrences. In the Ho:YAG patients, perioperative complications occurred at a lower percent than in the TUR group. Also, in 54% of patients, the catheter was removed within 24 hours; 76% had a postoperative hospital stay of 24 to 48 hours. In the TUR patients: 4% had the catheter removed within 24 hours and 6% left the hospital within 24 to 48 hours. In SBC treatment, Ho:YAG and TUR were equally as effective; the Ho:YAG laser was associated with shorter catheterization time and hospital stay. These Ho:YAG features could be advantageous from a psychological standpoint, particularly for elderly, high-risk patients and in terms of cost:benefit ratios.