Surgery Case Reports最新文献

Renal cell carcinoma accounts for 85–90 % of all primary renal neoplasms and has the propensity to expand and directly invade contiguous structures such as the inferior vena cava predisposing to thrombus formation in approximately 10 % of cases. Overall, 70 % of patients survive for 5 years. While several classifications have been published to characterize the level of thrombus involvement and subsequently define the appropriate surgical treatment, the prognosis of such remains to be ascertained. Furthermore, controversies exist as to the most appropriate surgical approach particularly for atrial thrombus (Level IV). Although traditionally such thrombus level is addressed using cardiopulmonary bypass with or without deep hypothermic arrest, there have been recent reports of a less invasive maneuver using a transdiaphragmatic approach, essentially milking the thrombus down, avoiding sternotomy. We present our initial case of a 59-year-old male having a right renal mass with extensive thrombus from the inferior vena cava up to the right atrium managed with radical nephrectomy and thrombectomy under cardiopulmonary bypass with deep hypothermic circulatory arrest. Patient remains tumor-free after 1 year of follow-up.

Fingertip partial or complete amputations are the most common hand injuries among pediatric population. Different treating options are nowadays available, with microsurgery that has been pushing further and further its technical limits; nevertheless it requires extraordinary surgical skills and experience. We present our step-by-step technique according to Hirase’s composite cooling graft principles as an effective alternative to more complex solutions. This procedure showed excellent results in children, with promising results even in young adults.

Androgen Insensitivity Syndrome (AIS) is a rare genetic condition affecting individuals with 46 XY genotypes. We present a case of Complete AIS (CAIS) in a 16-year-old phenotypically female patient with primary amenorrhea and bilateral inguinal masses. Despite male karyotype (46XY), physical examination and imaging revealed the absence of Müllerian structures and the presence of testes-like structures. The diagnosis was confirmed through hormone profiling and karyotyping. Management involved multidisciplinary collaboration, including surgical interventions (gonadectomy) and counseling. Early recognition and intervention in CAIS can mitigate psychological distress and optimize outcomes. This case also highlighted the importance of considering AIS in the differential diagnosis of primary amenorrhea, particularly in the presence of inguinal hernias.

Congenital lung masses are rare and their clinical presentation is highly variable. If newborns present with respiratory distress immediately after birth, early surgical therapy can be necessary. Here, we present the case of a newborn with a very large left-sided lung tumor. The severe respiratory compromise warranted surgical resection at the age of 11 days. The surgery was conducted by an interdisciplinary team. Cardiopulmonary bypass was used to maintain hemodynamic stability. The postoperative histopathological workup identified the tumor as a Fetal Lung Interstitial Tumor (FLIT). The patient developed well and is doing fine 15 months after surgery.

Papillary Renal Cell Carcinoma (PRCC) being the second most common histological type of Renal Cell Carcinoma (RCC). Although brain metastasis is rare in RCC, it often results in poorer outcomes compared to metastases in other locations. We present a case of brain metastasis originating from PRCC classified as pT1bN0M1. Subsequently, the patient underwent successful cytoreductive nephrectomy and pazopanib therapy as a follow-up systematic treatment. This case highlights the importance of urologists being aware of brain metastases that can develop in PRCC patients, which typically have a poorer outcome.

Digital locations of hand mycetoma are rare. They are most often described within the broader context of hand mycetoma. Herein, we report three cases of digital mycetoma.

Case 1: A 33-year-old patient presenting with a mycetoma of the middle finger evolving for 5 years with osteitis of P1. A trans-P2 amputation was performed.

Case 2: A 57-year-old patient presenting with a mycetoma of the little finger evolving for 12 years without bone involvement. Management consisted of excision surgery.

Case 3: A 27-year-old patient presenting with a mycetoma of the ring finger evolving for 7 years with osteitis of P1 and fistula. Extension to the base of the little finger was noted. Digital amputation was refused by the patient.

Few case reports have discussed the incidence and management of giant recurrent phyllodes tumors with borderline to malignant features. We report that of a recurrent case in a 57-year-old female who underwent wide excision with en bloc resection of the 3rd to 7th right anterior ribs and upper abdominal wall. Rigid chest wall reconstruction was achieved using methyl methacrylate and synthetic mesh. This is the first reported case wherein three locoregional flaps, namely the latissimus dorsi, thoracoepigastric and extended external oblique flaps were used to cover a defect measuring 1452 cm² in size. With this combination of flaps, deformity was minimized, and the resultant outcome was aesthetically and functionally acceptable. Reconstructive goals of intrathoracic organ protection, restoration of chest wall rigidity, maintenance of adequate respiratory function and soft tissue closure were achieved. Careful planning and individualized treatment together with multidisciplinary collaboration remains vital in the successful management of large recurrent malignant phyllodes tumors.

Background

Proximal row carpectomy (PRC) is often recommended for advanced-stage Kienböck's disease (KD), although there is no standardized treatment protocol. This study aimed to evaluate the efficacy of the PRC in managing KD.

Methods

A literature review and a clinical case study were conducted on a 40-year-old male with stage 3 KD.

Results

Postsurgery, the patient reported mild discomfort but significant functional improvement, with the Disabilities of the Arm, Shoulder, and Hand (DASH) score decreasing from 87 to 44. Observations included reduced pain, enhanced wrist trophism, and an expanded range of motion.

Conclusions

The PRC demonstrated positive outcomes, including symptom alleviation and functional restoration, supporting its viability as a tailored surgical intervention for KD, improving quality of life and reducing hospital stay.

Laparoscopic surgery currently represents the standard approach in colorectal cancer. However, it requires general anesthesia and pneumoperitoneum, which may be contraindicated in patients with impaired lung function. We hereby present a case of tailored minimally invasive surgery for an ascending colon cancer in a patient with Primary Ciliary Dyskinesia, situs inversus totalis, and end-stage lung disease. The surgery was conducted through a 13 cm left transverse incision under locoregional anesthesia, and the patient made an uneventful recovery despite her pre-existing comorbidities. This case proves the importance of tailored surgical and anesthesiologic management to provide good oncological outcomes to all cancer patients.

Background

Congenital trigger finger is a rare pediatric condition characterized by a finger fixed in a flexed position due to tendon anomalies. This rare condition involves multiple trigger fingers in children and is not extensively covered in the medical literature.

Methods

We examined a 2-year-old boy with multiple trigger fingers present since birth. Surgical release of the A1 pulleys was performed.

Results

Surgery resulted in normal finger function at the one-year follow-up.

Conclusions

Although rare, congenital trigger finger is treatable in children. Adaptive and timely interventions can significantly improve outcomes and reduce disability. This case highlights the importance of early and effective treatment strategies.