Pub Date : 2023-05-02DOI: 10.15388/lietchirur.2023.22.83
Jūratė Vertelytė, Arnoldas Morozas
Introduction. Cholesterol granuloma is a rare benign cystic neoplasm characterised by a fibrous capsule, and a cystic fluid containing cholesterol crystals, multinucleated giant cells, erythrocytes and haemosiderin. Cholesterol granulomas are usually found in diverse parts of the temporal bone, most commonly – petrous apex. Very few cases of cholesterol granulomas in other organs have been reported, to our knowledge none are reported in the larynx. The main purpose of this case report is to highlight this extremely rare laryngeal lesion and its unique macroscopic appearance. Case report. A 55-year-old man is referred to the Ear, Nose and Throat Centre because of persistent hoarseness, globus sensation and complicated intubation due to a mass in the larynx. Videolaryngoscopy showed a large cyst-like mass in the vallecula, epiglottis was displaced towards the posterior pharyngeal wall and erythema of interarytenoid notch and arytenoid tubercle was present. A computerized tomography scan confirmed a cystic mass on the lingual surface of the epiglottis. On the basis of the examination and clinical symptoms, a diagnosis of chronic laryngitis, gastro-oesophageal reflux and an unspecified benign tumour of the respiratory system was made, surgical treatment was planned. The patient underwent microlaryngoscopy and surgical extirpation of the cyst using a CO2 laser, as the cyst was opened a yellowish, shiny, viscous fluid was observed. Two days later, laryngoscopy revealed fibrin plaque at the site of the cyst. Final diagnosis of cholesterol granuloma was formed based on histological examination of the mass. Conclusions. Cholesterol granulomas and masses in vallecula are extremly rare, but this case shows that cholesterol granuloma can be included in the differential diagnosis of cystic neoplasms of the larynx.
{"title":"Vallecular Cholesterol Granuloma: Case Report","authors":"Jūratė Vertelytė, Arnoldas Morozas","doi":"10.15388/lietchirur.2023.22.83","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.83","url":null,"abstract":"Introduction. Cholesterol granuloma is a rare benign cystic neoplasm characterised by a fibrous capsule, and a cystic fluid containing cholesterol crystals, multinucleated giant cells, erythrocytes and haemosiderin. Cholesterol granulomas are usually found in diverse parts of the temporal bone, most commonly – petrous apex. Very few cases of cholesterol granulomas in other organs have been reported, to our knowledge none are reported in the larynx. The main purpose of this case report is to highlight this extremely rare laryngeal lesion and its unique macroscopic appearance. Case report. A 55-year-old man is referred to the Ear, Nose and Throat Centre because of persistent hoarseness, globus sensation and complicated intubation due to a mass in the larynx. Videolaryngoscopy showed a large cyst-like mass in the vallecula, epiglottis was displaced towards the posterior pharyngeal wall and erythema of interarytenoid notch and arytenoid tubercle was present. A computerized tomography scan confirmed a cystic mass on the lingual surface of the epiglottis. On the basis of the examination and clinical symptoms, a diagnosis of chronic laryngitis, gastro-oesophageal reflux and an unspecified benign tumour of the respiratory system was made, surgical treatment was planned. The patient underwent microlaryngoscopy and surgical extirpation of the cyst using a CO2 laser, as the cyst was opened a yellowish, shiny, viscous fluid was observed. Two days later, laryngoscopy revealed fibrin plaque at the site of the cyst. Final diagnosis of cholesterol granuloma was formed based on histological examination of the mass. Conclusions. Cholesterol granulomas and masses in vallecula are extremly rare, but this case shows that cholesterol granuloma can be included in the differential diagnosis of cystic neoplasms of the larynx.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41870729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-02DOI: 10.15388/lietchirur.2023.22.82
V. Nair, Malik Parmjit, Pawan Sharma, Sarali Santhosh Raja, Atreya Aprajita
Internal hernia through foramen of Winslow (FoW) is rare condition as there are only 200 cases reported so far in the literature. Our patient a 78 years man presented with a clinical picture suggestive of small bowel obstruction for 5 days. Patient underwent emergency laparotomy following suspicion of internal hernia on imaging. On exploratory laparotomy there was grossly dilated bowel loops and a small segment of terminal ileum and omentum was found herniating through FoW in to the lesser sac. The bowel segment was reduced with gentle traction and herniated segment of omentum was excised due to questionable viability. Opening of FoW was unusually large and to prevent hernia recurrence it was closed partially. Postoperative period was uneventful. This unusual case presented to us diagnostic confusion and management challenge considering the previous history, multiple comorbidities and geriatric profile.
{"title":"Internal Hernia Through Foramen of Winslow a Rare Cause of Small Bowel Obstruction: A Case Report","authors":"V. Nair, Malik Parmjit, Pawan Sharma, Sarali Santhosh Raja, Atreya Aprajita","doi":"10.15388/lietchirur.2023.22.82","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.82","url":null,"abstract":"Internal hernia through foramen of Winslow (FoW) is rare condition as there are only 200 cases reported so far in the literature. Our patient a 78 years man presented with a clinical picture suggestive of small bowel obstruction for 5 days. Patient underwent emergency laparotomy following suspicion of internal hernia on imaging. On exploratory laparotomy there was grossly dilated bowel loops and a small segment of terminal ileum and omentum was found herniating through FoW in to the lesser sac. The bowel segment was reduced with gentle traction and herniated segment of omentum was excised due to questionable viability. Opening of FoW was unusually large and to prevent hernia recurrence it was closed partially. Postoperative period was uneventful. This unusual case presented to us diagnostic confusion and management challenge considering the previous history, multiple comorbidities and geriatric profile.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45035629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-02DOI: 10.15388/lietchirur.2023.22.84
Kristina Marcinkevičiūtė, Dignė Jurkevičiūtė, Rokas Stulpinas, E. Stratilatovas, A. Dulskas
Background. Pancreatic mucinous cystic neoplasm (PMCN) with associated invasive carcinoma is a rare entity. According to the World Health Organisation (WHO) 2010, PMCN with associated invasive carcinoma is referred to the malignant lesions of the pancreatic epithelial tumour. Case report. A 52-year-old female patient presented with pain in the umbilical and epigastric regions for 5 months and noticed a solid visible tumour on the left side of the abdomen 3 months ago when she lied down. The level of the CA125 was 47.64 U/ml (normal value <35 U/ml). Abdominal and pelvic magnetic resonance imaging (MRI) showed a cystic multiseptal mass in the left iliac region, defined as a left ovary tumour, while Computed tomography scan revealed a cystic tumour of the pancreatic tail. The patient underwent a resection of the pancreatic tail with a 20 cm cystic solid tumour, splenectomy and left hemicolectomy. Histopathology report confirmed mucinous cystic neoplasm of the pancreatic tail with associated invasive carcinoma (combined badly differentiated (G3) ductal (40%) and undifferentiated (G4) anaplastic (60%) carcinoma) pT1bN0. Postoperative course complicated with wound infection. The patient was discharged on postoperative day 10. The patient is still alive 2 years on follow-up. Conclusions. PMCN with associated invasive carcinomas are rare lesions of pancreas with relatively benign course. This malignant pancreatic tumour displays morphologies as pleomorphic epithelial cells and relatively mononuclear spindle cells, and not always tends to have underlying ovarian type stroma. The comprehensive histopathological examination of the tumour is necessary in order to cure most MCN patients with minimally invasive types.
{"title":"Pancreatic Mucinous Cystic Neoplasm with Associated Invasive Carcinoma: A Case Report and Literature Review","authors":"Kristina Marcinkevičiūtė, Dignė Jurkevičiūtė, Rokas Stulpinas, E. Stratilatovas, A. Dulskas","doi":"10.15388/lietchirur.2023.22.84","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.84","url":null,"abstract":"Background. Pancreatic mucinous cystic neoplasm (PMCN) with associated invasive carcinoma is a rare entity. According to the World Health Organisation (WHO) 2010, PMCN with associated invasive carcinoma is referred to the malignant lesions of the pancreatic epithelial tumour. Case report. A 52-year-old female patient presented with pain in the umbilical and epigastric regions for 5 months and noticed a solid visible tumour on the left side of the abdomen 3 months ago when she lied down. The level of the CA125 was 47.64 U/ml (normal value <35 U/ml). Abdominal and pelvic magnetic resonance imaging (MRI) showed a cystic multiseptal mass in the left iliac region, defined as a left ovary tumour, while Computed tomography scan revealed a cystic tumour of the pancreatic tail. The patient underwent a resection of the pancreatic tail with a 20 cm cystic solid tumour, splenectomy and left hemicolectomy. Histopathology report confirmed mucinous cystic neoplasm of the pancreatic tail with associated invasive carcinoma (combined badly differentiated (G3) ductal (40%) and undifferentiated (G4) anaplastic (60%) carcinoma) pT1bN0. Postoperative course complicated with wound infection. The patient was discharged on postoperative day 10. The patient is still alive 2 years on follow-up. Conclusions. PMCN with associated invasive carcinomas are rare lesions of pancreas with relatively benign course. This malignant pancreatic tumour displays morphologies as pleomorphic epithelial cells and relatively mononuclear spindle cells, and not always tends to have underlying ovarian type stroma. The comprehensive histopathological examination of the tumour is necessary in order to cure most MCN patients with minimally invasive types.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47211498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-02DOI: 10.15388/lietchirur.2023.22.81
S. Iqbal, Saima Tabassum, Z. Khan
Breast tissue undergoes constant physiological changes in a woman’s life because of influence of endocrine hormones during and after reproductive life. These changes may present as pain, lumpiness or both in the breast. Breast lumps are feared for cancer. Thus, it is important for women with a breast lump to receive appropriate evaluation. Clinical breast examination is first step in evaluation of breast lump. The diagnostic sensitivity of clinical breast examination is high (98%) whereas its specificity is low, averaging 48%. Ultrasound is preferred in evaluation of radiologically dense breasts and in the study of breasts with augmentation mammoplasties. Micro-calcifications on mammography are considered to be important signs of breast cancer. X-ray mammography detects microcalcifications in 30–50% of breast cancers. FNAC is a cheap, cost effective and readily available routine diagnostic with a sensitivity ranging between 89% to 98% and specificity between 98% to 100% for palpable breast lumps. When combined together triple test achieves a higher sensitivity, specificity and diagnostic accuracy than any of the investigations taken alone. We conducted a prospective study to evaluate breast masses by clinical assessment, imaging and pathological examination. Results were compared with histopathology. We concluded that triple assessment in breast lumps gives superior results than any of its modalities taken alone.
{"title":"Role of Triple Test in Evaluating Breast Lumps","authors":"S. Iqbal, Saima Tabassum, Z. Khan","doi":"10.15388/lietchirur.2023.22.81","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.81","url":null,"abstract":"Breast tissue undergoes constant physiological changes in a woman’s life because of influence of endocrine hormones during and after reproductive life. These changes may present as pain, lumpiness or both in the breast. Breast lumps are feared for cancer. Thus, it is important for women with a breast lump to receive appropriate evaluation. Clinical breast examination is first step in evaluation of breast lump. The diagnostic sensitivity of clinical breast examination is high (98%) whereas its specificity is low, averaging 48%. Ultrasound is preferred in evaluation of radiologically dense breasts and in the study of breasts with augmentation mammoplasties. Micro-calcifications on mammography are considered to be important signs of breast cancer. X-ray mammography detects microcalcifications in 30–50% of breast cancers. FNAC is a cheap, cost effective and readily available routine diagnostic with a sensitivity ranging between 89% to 98% and specificity between 98% to 100% for palpable breast lumps. \u0000When combined together triple test achieves a higher sensitivity, specificity and diagnostic accuracy than any of the investigations taken alone. We conducted a prospective study to evaluate breast masses by clinical assessment, imaging and pathological examination. Results were compared with histopathology. We concluded that triple assessment in breast lumps gives superior results than any of its modalities taken alone.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47801648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.15388/lietchirur.2023.22.73
G. Šepetys, D. Gudavičienė, N. Jakutis
Introduction. Detecting metastases is an important part of successful breast cancer treatment. Usually, the tumor tissue first spreads to the sentinel lymph nodes. Removal of the latter during surgery and histological examination allows to assess the patient’s disease stage, prognosis and treatment. The literature provides more than one approach or a combination of them, allowing us to accurately identify the breast’s sentinel lymph nodes and avoid removing all axillary lymph nodes. Purpose. To review the methods of intraoperative detection of breast sentinel lymph nodes presented in the literature. Research material and methods. Publications were searched using the specialized information search system Google Scholar. Keywords used in the search: breast sentinel lymph nodes, intraoperative detection. After evaluating the exclusion criteria, the review was based on 25 scientific publications. Results. 4 individual measures and 2 combinations of them can be used to detect sentinel breast lymph nodes during surgery. The materials used can be injected in 6 different ways. Conclusions. The combination of technetium-99m radiocolloid and methylene blue can be evaluated as the best method for intraoperative detection of sentinel lymph nodes in breast cancer patients. On the other hand, due to radiation and operating costs, more attention is being paid to the use of indocyanine green, superparamagnetic iron oxide, methylene blue dye, and the detection of metastases without surgery. Superficial methods of injecting the substance should be combined with deep ones due to the possibility of detecting extra-axillary sentinel lymph nodes of the breast. Ultimately, all decisions must be made on a case-by-case basis.
{"title":"Detection of Sentinel Lymph Nodes During Breast Cancer Surgery: A Literature Overview","authors":"G. Šepetys, D. Gudavičienė, N. Jakutis","doi":"10.15388/lietchirur.2023.22.73","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.73","url":null,"abstract":"Introduction. Detecting metastases is an important part of successful breast cancer treatment. Usually, the tumor tissue first spreads to the sentinel lymph nodes. Removal of the latter during surgery and histological examination allows to assess the patient’s disease stage, prognosis and treatment. The literature provides more than one approach or a combination of them, allowing us to accurately identify the breast’s sentinel lymph nodes and avoid removing all axillary lymph nodes. Purpose. To review the methods of intraoperative detection of breast sentinel lymph nodes presented in the literature. Research material and methods. Publications were searched using the specialized information search system Google Scholar. Keywords used in the search: breast sentinel lymph nodes, intraoperative detection. After evaluating the exclusion criteria, the review was based on 25 scientific publications. Results. 4 individual measures and 2 combinations of them can be used to detect sentinel breast lymph nodes during surgery. The materials used can be injected in 6 different ways. Conclusions. The combination of technetium-99m radiocolloid and methylene blue can be evaluated as the best method for intraoperative detection of sentinel lymph nodes in breast cancer patients. On the other hand, due to radiation and operating costs, more attention is being paid to the use of indocyanine green, superparamagnetic iron oxide, methylene blue dye, and the detection of metastases without surgery. Superficial methods of injecting the substance should be combined with deep ones due to the possibility of detecting extra-axillary sentinel lymph nodes of the breast. Ultimately, all decisions must be made on a case-by-case basis.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44724207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.15388/lietchirur.2023.22.65
Ali Sapmaz, C. Çelik, Murat Özgür Kılıç, H. Bolukbasi, S. Yılmaz
Objective. Colorectal cancer (CRC) is one of the most common and fatal malignancies worldwide. Although the clinical presentation varies according to the location of the tumor, hematochezia, tenesmus, changes in the defecation habit, chronic constipation, abdominal pain, and distension are the most common findings of CRCs. We aimed to investigate whether patients with CRC who had a surgical history for benign anal disease have more negative tumoral features or not. Material and Methods. Two-hundred fifty two patients who underwent surgery for CRC between 2010 and 2016 at general surgery clinic in Ankara Numune Training and Research Hospital included in this study. Patients were classified into two groups; patients who had undergone surgery for benign perianal disease such as hemorrhoid, anal fissure, perianal abscess and fistulae (Group 1) and patients without past history for perianal surgery (Group 2). Results. A total of 252 CRC patients with a mean age of 64.2 years were included in the study. There were 95 (37.7%) females and 157 (62.3%) males. There were 25 (9.9%) patients who had surgical history for benign perianal disease. There were no statistically differences in tumor size, lymph node positivity, presence of distant metastasis, and tumor stage between the groups (p > 0.05). Conclusion. Although not statistically significant, CRC patients with a history of surgery for benign perianal disease had less lymphatic metastases and tumor size than those without prior perianal surgery. We think that this finding is important in that it indicates the importance of detailed and appropriate evaluation of patients with CRC.
{"title":"Does Previous Perianal Surgery for Benign Diseases Have an Impact on Timing of Hospital Admission in Patients with Colorectal Cancer?","authors":"Ali Sapmaz, C. Çelik, Murat Özgür Kılıç, H. Bolukbasi, S. Yılmaz","doi":"10.15388/lietchirur.2023.22.65","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.65","url":null,"abstract":"Objective. Colorectal cancer (CRC) is one of the most common and fatal malignancies worldwide. Although the clinical presentation varies according to the location of the tumor, hematochezia, tenesmus, changes in the defecation habit, chronic constipation, abdominal pain, and distension are the most common findings of CRCs. We aimed to investigate whether patients with CRC who had a surgical history for benign anal disease have more negative tumoral features or not. Material and Methods. Two-hundred fifty two patients who underwent surgery for CRC between 2010 and 2016 at general surgery clinic in Ankara Numune Training and Research Hospital included in this study. Patients were classified into two groups; patients who had undergone surgery for benign perianal disease such as hemorrhoid, anal fissure, perianal abscess and fistulae (Group 1) and patients without past history for perianal surgery (Group 2). Results. A total of 252 CRC patients with a mean age of 64.2 years were included in the study. There were 95 (37.7%) females and 157 (62.3%) males. There were 25 (9.9%) patients who had surgical history for benign perianal disease. There were no statistically differences in tumor size, lymph node positivity, presence of distant metastasis, and tumor stage between the groups (p > 0.05). Conclusion. Although not statistically significant, CRC patients with a history of surgery for benign perianal disease had less lymphatic metastases and tumor size than those without prior perianal surgery. We think that this finding is important in that it indicates the importance of detailed and appropriate evaluation of patients with CRC.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44258291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.15388/lietchirur.2023.22.66
Karolis Varkalys, Saulius Knystautas, Kęstutis Braziulis, Vytautas Tamaliūnas, E. Zacharevskij
Background. The thickening of A1 pulley of the tendon sheath limits the excursion of flexor tendon. Stenosing tenosynovitis causes finger movements dysfunction and pain. Objective. To analyze early and late outcomes of patients with stenosing tenosynovitis after surgical treatment – anulotomy. Methods. All patients had standard surgical procedure – open anulotomy of A1 pulley. Pain (verbal pain scale), hand and arm function (QuickDASH) and complications were recorded before surgery, after 1 week, 3 months and 6 months post surgery. Results. There were 45 patients, 29 (64%) female, 16 (36%) male. The highest pain score was recorded before surgery median 5 (IQR 5). The lowest pain score median 2 (IQR 2) was recorded after 6 months post surgery. The difference of the results after 1 week, 3 months and 6 months was statistically significant p < 0.001. The worst hand and arm function was before surgery and 1 week post surgery. Accordingly: medians 52 (IQR 33) and 52 (IQR 35). Full hand function recovery was noticed after 6 months post surgery median 0 (IQR 11). The difference is statistically significant p < 0.001. Conclusions. Surgical treatment, open anulotomy is one of the most effective methods for stenosing tenosynovitis. After this procedure pain and hand function improves greatly. However, for some patients it might cause discomfort of the hand because of the scar’s sensitivity and location.
{"title":"Surgical Treatment of Stenosing Tenosynovitis: Early and Late Outcomes, Complications","authors":"Karolis Varkalys, Saulius Knystautas, Kęstutis Braziulis, Vytautas Tamaliūnas, E. Zacharevskij","doi":"10.15388/lietchirur.2023.22.66","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.66","url":null,"abstract":"Background. The thickening of A1 pulley of the tendon sheath limits the excursion of flexor tendon. Stenosing tenosynovitis causes finger movements dysfunction and pain. Objective. To analyze early and late outcomes of patients with stenosing tenosynovitis after surgical treatment – anulotomy. Methods. All patients had standard surgical procedure – open anulotomy of A1 pulley. Pain (verbal pain scale), hand and arm function (QuickDASH) and complications were recorded before surgery, after 1 week, 3 months and 6 months post surgery. Results. There were 45 patients, 29 (64%) female, 16 (36%) male. The highest pain score was recorded before surgery median 5 (IQR 5). The lowest pain score median 2 (IQR 2) was recorded after 6 months post surgery. The difference of the results after 1 week, 3 months and 6 months was statistically significant p < 0.001. The worst hand and arm function was before surgery and 1 week post surgery. Accordingly: medians 52 (IQR 33) and 52 (IQR 35). Full hand function recovery was noticed after 6 months post surgery median 0 (IQR 11). The difference is statistically significant p < 0.001. Conclusions. Surgical treatment, open anulotomy is one of the most effective methods for stenosing tenosynovitis. After this procedure pain and hand function improves greatly. However, for some patients it might cause discomfort of the hand because of the scar’s sensitivity and location.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48425484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.15388/lietchirur.2023.22.68
S. Kamalı, Cemal Ulusoy, G. Kamali
Background. Lymph node metastasis is the major determinant factor in the prognosis of gastric cancer. There is still no definite consensus on the lymph node number that should be harvested during gastric cancer surgery. Lymph Node Ratio (LNR) is defined as the ratio of metastatic nodes to the total number of pathologically examined lymph nodes. LNR has been proposed to be a sensitive prognostic factor in patients with gastric cancer. In this study the reliability of the LNR is tested for being a prognostic factor in gastric cancer survival. Methods. Medical records of 244 patients, with neither distant metastases nor neoadjuvant treatment underwent curative gastrectomy, were analyzed retrospectively in terms of survival according to the lymph node ratio (LNR). Patients were divided in two groups by using LNR cut-off value. Results. LNR of 0.4 was proved to be the best cut-off value to predict the prognosis of patients with gastric cancer. Univariate and multivariate analysis revealed that age over 65 (p < 0.001), and LNR ≥ 0.4 (p = 0.02) were independent factors in gastric cancer survival. Patients with LNR ≥ 0.4 presented with worse outcomes regarding other prognostic parameters (tumor differentiation, tumor diameter, lymphovascular invasion or perineural invasion), despite similar numbers of lymph nodes being harvested in both groups during surgery. Conclusion. Lymph node ratio is a reliable parameter to predict the survival in gastric cancer.
{"title":"Reliability of the Lymph Node Ratio in the Prediction of Gastric Cancer Survival","authors":"S. Kamalı, Cemal Ulusoy, G. Kamali","doi":"10.15388/lietchirur.2023.22.68","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.68","url":null,"abstract":"Background. Lymph node metastasis is the major determinant factor in the prognosis of gastric cancer. There is still no definite consensus on the lymph node number that should be harvested during gastric cancer surgery. Lymph Node Ratio (LNR) is defined as the ratio of metastatic nodes to the total number of pathologically examined lymph nodes. LNR has been proposed to be a sensitive prognostic factor in patients with gastric cancer. In this study the reliability of the LNR is tested for being a prognostic factor in gastric cancer survival. Methods. Medical records of 244 patients, with neither distant metastases nor neoadjuvant treatment underwent curative gastrectomy, were analyzed retrospectively in terms of survival according to the lymph node ratio (LNR). Patients were divided in two groups by using LNR cut-off value. Results. LNR of 0.4 was proved to be the best cut-off value to predict the prognosis of patients with gastric cancer. Univariate and multivariate analysis revealed that age over 65 (p < 0.001), and LNR ≥ 0.4 (p = 0.02) were independent factors in gastric cancer survival. Patients with LNR ≥ 0.4 presented with worse outcomes regarding other prognostic parameters (tumor differentiation, tumor diameter, lymphovascular invasion or perineural invasion), despite similar numbers of lymph nodes being harvested in both groups during surgery. Conclusion. Lymph node ratio is a reliable parameter to predict the survival in gastric cancer.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48788618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.15388/lietchirur.2023.22.67
S. Iqbal, Saima Tabassum
Laparoscopic cholecystectomy is a widely practiced procedure for symptomatic cholelithiasis. Haemostasis of cystic artery can be achieved with clips electrocautery and ultra modern vessel sealing energy devices. Bipolar electro coagulation of cystic artery is safe and a cost effective measure in developing countries. Our aim was to establish the feasibility of bipolar electrocautery in securing cystic artery. We conducted a prospective study on 120 patients in different age and sex groups. Correctable co morbidities were not a contraindication to inclusion criteria. Anatomical variations in size, origin and number of cystic artery were noted.
{"title":"Cystic Artery Control with Bipolar Electrocauterization During Laparoscopic Cholecystectomy","authors":"S. Iqbal, Saima Tabassum","doi":"10.15388/lietchirur.2023.22.67","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.67","url":null,"abstract":"Laparoscopic cholecystectomy is a widely practiced procedure for symptomatic cholelithiasis. Haemostasis of cystic artery can be achieved with clips electrocautery and ultra modern vessel sealing energy devices. Bipolar electro coagulation of cystic artery is safe and a cost effective measure in developing countries. Our aim was to establish the feasibility of bipolar electrocautery in securing cystic artery. We conducted a prospective study on 120 patients in different age and sex groups. Correctable co morbidities were not a contraindication to inclusion criteria. Anatomical variations in size, origin and number of cystic artery were noted.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46196442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.15388/lietchirur.2023.22.69
Kamilė Bagdonaitė, Emilija Sugintaitė, Inga Dekerytė, Aušra Lukošiūtė-Urbonienė, Artūras Kilda
Polytrauma is a condition when a patient has sustained multiple injuries, which can lead to disability or death. While the agriculture industry is growing, the number of polytrauma patients in children is increasing as well. It is high-energy traumas when it is important to immediately assess injuries and life-threatening conditions and to start trauma protocols guided treatment. In this article, we present a case of a 17-year-old boy who suffered extensive injuries caused by a straw pellets machine. We discussed the importance of prehospital care, multidisciplinary team involvement, and treatment methods.
{"title":"Paauglio politrauma žemdirbystės pramonėje: klinikinio atvejo analizė","authors":"Kamilė Bagdonaitė, Emilija Sugintaitė, Inga Dekerytė, Aušra Lukošiūtė-Urbonienė, Artūras Kilda","doi":"10.15388/lietchirur.2023.22.69","DOIUrl":"https://doi.org/10.15388/lietchirur.2023.22.69","url":null,"abstract":"Polytrauma is a condition when a patient has sustained multiple injuries, which can lead to disability or death. While the agriculture industry is growing, the number of polytrauma patients in children is increasing as well. It is high-energy traumas when it is important to immediately assess injuries and life-threatening conditions and to start trauma protocols guided treatment. In this article, we present a case of a 17-year-old boy who suffered extensive injuries caused by a straw pellets machine. We discussed the importance of prehospital care, multidisciplinary team involvement, and treatment methods.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47761625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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