Lymphoepithelioma-like gastric carcinoma presenting as giant ulcer of the lesser curvature: case report.

Lymphoepithelioma-like gastric carcinoma (LELGC) has special clinicopathologic features that differentiate it from the common gastric adenocarcinoma. LELGC is a rare neoplasm of the stomach with an incidence of 1-4% of all gastric cancers and is characterized by desmoplastic stroma uniformaly infiltrated by abundant lymphocytes and plasma cells. LELGC is closely associated with the Epstein-Barr virus (EBV), with 80-100% of LELGC being EBV-positive. LELGC has a male predominance, occurs in elderly people and is usually located in the upper and middle portion of the stomach. We report a rare case of lymphoepithelioma-like gastric carcinoma located in the lesser curvature at the border of the gastric body to the pyloric antrum.

Duodenal gastrointestinal stromal tumor presenting with acute upper gastrointestinal bleeding treated with segmental resection.

Gastrointestinal stromal tumours (GISTs) are considered to derive from the interstitial cells of Cajal or their precursors and are defined by their expression of c-kit protein (CD117) that is positive in 95% percent of cases. These are rare mesenchymatous tumours, while they represent the most common mesenchymal tumours of the alimentary tract. The majority of GISTs develop in the stomach and small intestine and more rarely in the rectum, colon, esophagus and mesentery; only 3-5% of all GISTs are located in the duodenum. The presenting symptoms include early satiation, dysphagia, bloating, abdominal pain and gastrointestinal bleeding, either acute or chronic. Surgery remains the mainstay of treatment for localized, non-metastatic, resectable GISTs. We present a case of duodenal gastrointestinal stromal tumour of the third portion of the duodenum that presented with acute upper gastrointestinal bleeding treated with segmental duodenal resection.

Incidentally discovered white subcupsular liver nodules during laparoscopic surgery: biliary hamartoma and peribiliary gland hamartoma.

During routine laparoscopic surgery, the surgeon may encounter the presence of small white subcapsular liver nodules, either solitary or multiple. The lesions may mimic liver metastasis and in many cases are not demonstrated in the preoperative ultrasound or computed tomography. The aim of this article is to familiarize the laparoscopic surgeon with the incidental discovery of these nodules which represent the two types of intrahepatic benign bile duct proliferations and include biliary hamartomas, which are usually multiple benign malformations of the intrahepatic bile ducts, and peribiliary gland hamartoma, which is usually solitary and consists of a benign epithelial tumor of the liver derived from bile duct cells.

Persistent hyperglycemia at 24-48 h in acute hyperglycemic stroke patients is not associated with a worse functional outcome.

BACKGROUND: Recently, it was shown that the relation between admission glucose and functional outcome after ischemic stroke is described by a J-shaped curve, with a glucose range of 3.7-7.3 mmol/l associated with a favorable outcome. We tested the hypothesis that persistence of hyperglycemia above this threshold at 24-48 h after stroke onset impairs 3-month functional outcome. METHODS: We analyzed all patients with glucose >7.3 mmol/l on admission from the Acute STroke Registry and Analysis of Lausanne (ASTRAL). Patients were divided into two groups according to their subacute glucose level at 24-48 h after last well-being time (group 1: ≤7.3 mmol/l, group 2: >7.3 mmol/l). A favorable functional outcome was defined as a modified Rankin Score (mRS) ≤2 at 3 months. A multiple logistic regression analysis of multiple demographic, clinical, laboratory and neuroimaging covariates was performed to assess predictors of an unfavorable outcome. RESULTS: A total of 1,984 patients with ischemic stroke were admitted between January 1, 2003 and October 20, 2009, within 24 h after last well-being time. In the 421 patients (21.2%) with admission glucose >7.3 mmol/l, the proportion of patients with a favorable outcome was not statistically significantly different between the two groups (59.2 vs. 48.7%, respectively). In multiple logistic regression analysis, unfavorable outcome was significantly associated with age (odds ratio, OR: 1.06, 95% confidence interval, 95% CI: 1.03-1.08 for every 10-year increase), National Institute of Health Stroke Score, NIHSS score, on admission (OR: 1.16, 95% CI: 1.11-1.21), prehospital mRS (OR: 12.63, 95% CI: 2.61-61.10 for patients with score >0), antidiabetic drug usage (OR: 0.36, 95% CI: 0.15-0.86) and glucose on admission (OR: 1.16, 95% CI: 1.02-1.31 for every 1 mmol/l increase). No association was found between persistent hyperglycemia at 24-28 h and outcome in either diabetics or nondiabetics. CONCLUSIONS: In ischemic stroke patients with acute hyperglycemia, persistent hyperglycemia (>7.3 mmol/l) at 24-48 h after stroke onset is not associated with a worse functional outcome at 3 months whether the patient was previously diabetic or not.

Mesothelial mesenteric cyst in patient with ascending colon cancer. Case report.

Mesenteric cysts are rare cystic malformations of the mesentery. They are usually located at the iliac mesentery. Clinically most mesenteric cysts are asymptomatic, but sometimes they present with non-specific abdominal symptoms. Diagnosis can be aided using US, CT and MRI but careful interpretation of the images and high index of suspicion of this rare condition is essential for the correct diagnosis, which cannot always be preoperatively established. The therapeutic method of choice is complete surgical excision of the cyst which minimizes the possibility of recurrence. Histopathologically they are classified in six group. We present a case of a mesothelial mesenteric cyst in patient with colon cancer. The cyst was misdiagnosed as urinary bladder diverticulum in the preoperative CT scan.

Long term follow up of eosinophilic granuloma of the rib.

UNLABELLED: BACKROUNDS: Eosinophilic granuloma is one of the rarest causes of bone tumors, especially in adults. Eosinophilic granuloma is the commonest form of Langerhans cell histiocytosis and represents the unifocal osseous form of the disease which usually affects the skull and long bones. Eosinophilic granuloma, is a benign disease in which diagnosis and differential diagnosis presents more difficulties than treatment. OBSERVATION: We present a case of eosinophilic granuloma of the rib with long term follow-up of 14 years which was treated with a combination of surgery and chemotherapy. CONCLUSION: Prognosis of adult eosinophilic granuloma is excellent and the recurrence rate is limited. All available treatment options, including surgery, chemotherapy, corticosteroids, radiation, and even palliative treatment have very good results and in many cases the disease seems to heal spontaneously. However the disease, due to its rarity and unknown pathogenesis still remains an enigma for the clinical doctor.

Splenic artery aneurysm in a cardiac transplant patient: a case report.

We present the case of a 61-year-old woman who underwent repair of a symptomatic 4-cm splenic artery aneurysm. This patient had received heart transplantation for hypertrophic congestive cardiomyopathy 5 years before this event. She was under immunosuppression therapy with cyclosporine, prednisone and azathioprine. The aneurysm was ligated both proximally and distally without removal of the spleen. To our knowledge, this is the first reported case of an isolated splenic artery aneurysm in the heart transplant population. We discuss the potential role of immunosuppressive agents and hormonal factors in the development of this extremely rare occurrence.

Profunda femoris as an access site vessel for a hybrid approach to the treatment of a para-anastomotic common iliac artery aneurysm and intermittent claudication, occurring after previous abdominal aortic thbe graft repair and femoro-femoral bypass graft. A case report.

A true para-anastomotic right common iliac artery aneurysm and intermittent claudication developed in a 76-year-old man 5 years after open abdominal aortic aneurysm repair with a Dacron tube graft. Following the initial operation the patient developed acute left iliac occlusive disease necessitating an immediate right-to-left femoro-femoral crossover bypass graft. The patient was a poor open surgical candidate because of multiple medical comorbidities. Therefore, a hybrid approach was used consisting of exposure and catheterization of the right profunda femoris artery, which was used as the access site vessel for the deployment of a covered stent graft extending from the ostium of the common iliac artery into the external iliac artery. Simultaneously, the right profunda femoris provided inflow for an open above-knee profunda femoro-popliteal bypass graft to perfuse the right lower extremity. Postoperative angiography demonstrated primary technical success, with exclusion of the aneurysm and no endoleak. The patient is doing well 34 months postoperatively, with a patent endograft and no sign of intermittent claudication. Profunda femoris proved to be an excellent alternative to the common femoral artery for the application of a hybrid technique in a high-risk patient with complicated anatomy.

Neuroendocrine tumor of the cystic duct.

Neuroendocrine tumours of the extrahepatic bile ducts are extremely rare with less than 70 cases having been reported in the literature. Neuroendocrine tumours are neoplasms of variable malignant potential that arise from the embryonic neural crest cells. They most commonly occur in young females and usually present with painless jaundice. Preoperative diagnosis is seldom made and neuroendocrine tumours are usually incidentally found during abdominal surgical intervention for other indication. Due to their indolent biological behaviour aggressive surgical treatment is recommended. We present a case of an incidentally discovered neuroendocrine tumour of the cystic duct in a 41 year old woman following laparoscopic cholecystectomy for symptomatic gallbladder microlithiasis. The present case is the 8th case of cystic duct NET and the 63rd of extrahepatic bile duct NET. While a rare location for a NET, it is important to report cases of biliary tract neuroendocrine tumours in order for their pathogenesis and physical history to be clarified.

Thoraco-abdominal injuries: the general surgeon's perspective.

BACKGROUND: Thoraco-abdominal traumatic injuries affect the inferior part of the thoracic cavity and the superior part of the abdominal cavity. This study summarizes five years of our surgical department's experience in the diagnosis and management of thoracoabdominal trauma patients. METHODS: We examined records from our surgical and emergency room departments from January 1996 to December 2000, and selected patients with thoraco-abdominal injuries. RESULTS: Fifty-five patients were treated who suffered coexisting trauma of the thoracic and abdominal cavity. Males represented the majority of patients and mean age was 38.2 years. Traffic accidents were the major cause (55%) followed by criminal acts of violence (32%) and falls (13%). The most common thoracic injuries were rib fractures (40%) and simple lung contusions (35%) and the abdominal organs most commonly injured were the spleen (35%), liver (25%) and kidney (20%). Surgical interventions were performed in 68% of patients, whereas the remaining patients were treated conservatively. CONCLUSIONS: Thoraco-abdominal injuries are characterized by high heterogeneity and can provide significant decision-making challenges. The accurate diagnosis of all coexisting injuries is critically important, as the diagnosis will determine surgical or non-operative management of these injuries.

Streptococcus mutans: a rare cause of retroperitoneal abscess.

Retroperitoneal abscesses are uncommonly encountered clinical entities and they represent serious surgical infections associated with significant mortality rates because of their insidious clinical manifestations and diagnostic difficulty. The source of retroperitoneal infections is usually an organ contained within or abutting the retroperitoneum, usually the kidney and the microorganisms most commonly isolated are gram-negative bacilli. Gram-positive cocci, mainly staphylococcal species and rarely streptococcal species, are a less common cause of retroperitoneal abscess and are usually isolated in cases of hematogenous spread. Treatment of retroperitoneal abscesses includes identification and treatment of underlying conditions, intravenous antibiotics and adequate surgical drainage of all well-defined collections. We present a rare case of retroperitoneal abscess caused by monomicrobial Streprococcus mutans infection and discuss the possible pathogenesis, clinical presentation, diagnosis and treatment.

Assessing generated quantities of infectious medical wastes: a case study for a health region administration in Central Macedonia, Greece.

In the present study, the quantities of infectious medical wastes, generated from 12 public hospitals supervised by the 2nd Health Region Administration of Central Macedonia, Northern Greece, were calculated at a very disaggregated level for the first time and were compared to other reported characterization studies. Data was recorded by using an appropriately designed questionnaire, which was completed for each day of one week, in every department, clinic, unit or laboratory of each one of the 12 aforementioned hospitals. Afterwards, average generation indexes were determined in relation to certain important organizational and functional factors, such as the number of beds, bed coverage, the different hospital sections and wards, and the type of hospital. The way that sources of infectious wastes, generated from hospitals, vary by ward and department, was also illustrated and the most important sources were identified. Generated infectious hospital wastes vary from 0.26 to 0.89 kg/bed/day or 0.51 to 1.22 kg/patient/day, excluding the three specialised hospitals of the Health Region. The total amount of medical waste generated from the 2nd Health Region (only public hospitals) was estimated to be 691 tonnes/yr or 0.73 kg/cap/yr.

Ingested toothpick fistula of the ileum mimicking Crohn's disease.

Foreign body ingestion is an accidental or an intentional event, with most of the ingested foreign bodies passing spontaneously through the gastrointestinal tract without incidents. About 10-20% of them, especially long and sharp objects like toothpicks, will fail to pass through the entire gastrointestinal tract and may cause symptoms. Toothpick injury of the gastrointestinal tract is often associated with considerable morbidity and mortality. The complications that can be caused by toothpick ingestion are obstruction, perforation, hemorrhage, fistula formation, small bowel inflammation, sepsis and even death. Diagnosis of toothpick injury can be difficult as there are no specific physical findings or laboratory examinations which may aid the diagnosis and even imaging studies are of little help as wooden toothpicks are radiolucent. We report a rare case of incidental toothpick ingestion which caused an ileum fistula and mimicked Crohn's disease.

Primary myeloid sarcoma of the jejunum and greater omentum causing small intestine obstruction.

Myeloid sarcoma, which is highly associated with acute myeloid leukemia, is defined as an extramedullary discrete tumor mass, consisted by immature myeloid cells or myeloblasts. Myeloid sarcoma usually involves the skin, lymph node, bone, soft tissue and testis, while involvement of the gastrointestinal tract is rather uncommon. The diagnosis depends on histological features and immunohistochemical results. We present a rare case of myeloid sarcoma, with synchronous involvement of the jejunum and the greater omentum, manifesting with small bowel obstruction.