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1
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Synovial sarcoma of carotid space

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Krstic V., Milosavljevic M., Mitrovic S., Azanjac G., Knezevic M., Konstantinovic V., Nedovic J.
Open Medicine
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2012
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vol. 7
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issue 4
497-502
EN
Synovial sarcomas are malignant tumors of mesenchymal origin, extremely rarely located in the area of the head and neck. Histologically they can be monophasic, biphasic or poorly differentiated with numerous differential diagnostic dilemmas. A 54-year-old male with synovial sarcoma of the carotid space is presented. The patient refused suggested postoperative radiotherapy and, nine months after the primary surgery, local relapse was verified. Following surgical resection of the local relapse, postoperative radiotherapy treatment was utilized. Ten months after the second surgery, secondary deposits in the lungs were radiographically confirmed, and local recurrence was noticed again. Treatment was continued with symptomatic therapy and eleven months later patient died. Synovial sarcomas of the carotid space are extremely rare, with complex surgical approaches and pathohistological differential diagnostic dilemmas. Diagnosis requires determination of the immunophenotype of the tumor cells, whereas therapy requires an aggressive surgical approach and postoperative radiotherapy.
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The forgotten goiter: casuistic contribution and considerations for the choice of surgical approach

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Avenia N., Santoprete S., Monacelli M., Lucchini R., Cirocchi R., Sanguinetti A., Triola R., Vannucci J., Corsi A., Avenia S., Puma F.
Open Medicine
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2013
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vol. 8
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issue 4
415-419
EN
Aim. A residual mediastinal thyroid (“forgotten goiter”) is a well-known, though uncommon, complication of total thyroidectomy. Materials of study. The authors analyze their experience with three cases of goiter forgotten, observed in a series of 2946 thyroid resections in the period 2005–2010. In the study, a preoperative CT of the chest with three-dimensional reconstruction was always performed to examine the topographical relationships of the lesion. Excision was performed through cervicotomy, cervicosternotomic approach and cervicosternotomy, and posterolateral right thoracotomy. Results. There were no complications. Histological examination was suggestive of malignancy in one case (follicular carcinoma with pulmonary metastases). Discussion. The indication for surgery in cases of forgotten goiter is intrinsic to the diagnosis. Preoperative evaluation with accurate topographic imaging is required in all cases in order to understand the nature and location of mediastinal pathological tissue and to identify the most suitable access route. The cervicotomy is the ideal access for low surgical trauma and is easily extendable into a partial or complete sternotomy. A thoracotomy, on the other hand, which is usually reserved for the right side, must be planned preoperatively.
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A rare cause of respiratory insufficiency: case presentation

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Diaconu C., Paraschiv B., Lungu R., Bartoş D.
Open Medicine
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2014
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vol. 9
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issue 1
141-143
EN
We report the case of a 73 year old woman who presented for progressive dyspnea. Her medical history included thyroidectomy 15 years ago, myocardial infarction, recurrent paroxysmal atrial fibrillation and femoral fracture two weeks previously, conservatively treated. Physical examination revealed absent breath sounds in the left hemithorax, up to the apex, and crackles in the right hemithorax. The acid-base balance showed acute hypoxemic respiratory failure. The chest X-Ray revealed left diaphragmatic paralysis. Thoracic CT-scan was performed, which excluded the pulmonary embolism and revealed left diaphragmatic relaxation, ascension of the splenic angle of the colon, stomach and spleen up to the projection of left lung hilum, and right postero-basal alveolar condensation process. Diaphragm dysfunction can be caused by various disorders, including phrenic paralysis. This pathology should be considered in the differential diagnosis of acute respiratory failure.
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Giant common bile duct stone

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Han H., Lee J., Song T.
Open Medicine
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2012
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vol. 7
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issue 1
59-62
EN
Bile duct stones, which obstruct the common bile duct, potentially result in complications, such as acute cholangitis and pancreatitis. We present a case involving a patient with normal liver function tests from whom we removed a giant common bile duct stone measuring 7.5 centimeters × 4.0 centimeters × 4.0 centimeters. Postoperatively recurrent common bile duct stones were observed and removed with an endoscopic maneuver in the three-year follow-up period. Recurrent bile duct stones are frequently reported in the case of large size of stones or multiple stones. Surgical treatment may then be considered as a first-line treatment in cases of recurrent common bile duct stones. When an endoscopic or surgical approach is used for the treatment of giant common bile duct stones, careful observation is of the utmost importance and treatment innovations may be necessary.
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Retroperitoneal giant schwannoma eroding lumbal vertebra: A case report with a literature review

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Sakalauskaite M., Stanaitis J., Cepkus S., Pleckaitis M., Lunevicius R.
Open Medicine
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2008
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vol. 3
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issue 2
233-244
EN
A huge schwannoma, located in the retroperitoneal space, is found very rarely. The main purpose of this paper is to present the case of a giant retroperitoneal schwannoma which partly invaded L4 vertebral body. The secondary purpose is to summarize the case-report articles on retroperitoneal schwannomas. A circumscribed heterogenic tumour was revealed on transabdominal sonography. It extended into the right retroperitoneal space. CT and MRI revealed a paravertebral tumour in the size of 11 cm × 9 cm, which is causing a partial lysis of L4 vertebral body (15% of vertebral capacity), expanding intravertebral foramen and filling the right retroperitoneal space. A preoperative core needle biopsy was performed and a benign schwannoma was diagnosed. A complete surgical excision of the tumour was achieved by a two-step operation. During the first step, the neurosurgeons made L4 hemilaminectomy, facetectomy and a transverse process resection by posterior extended approach. The general surgeons excised the residual retroperitoneal part of the tumour by midline transabdominal approach 10 days later. The diagnosis of benign schwannoma was verified histochemically. There were no sign of tumour recurrence or spine destabilization at the six-month follow-up. In conclusion, although majority of giant retroperitoneal schwannomas can be completely removed performing one-step operation, a preoperative consideration about rationality of two-step operation should be mandatory when tumour destructs a part of vertebral body. Our case shows that the combined two stage complete surgical excision of a giant retroperitoneal schwannoma, eroding 15% of L4 vertebra’s osseous capacity, is effective and does not have any negative influence on spinal stability.
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Congenital heart disease and pulmonary tuberculosis

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Olguntürk R., Tunaoğlu F. S., Gökgöz L., Memiş L., Kula S.
Open Medicine
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2010
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vol. 5
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issue 2
172-175
EN
A 13-year-old boy with atrial septal defect and tricuspid valve abnormality was reported. He had crepitan ralles and signs of heart failure. He was treated with digital, diuretic and antimicrobial therapies. After clinical improvement he underwent surgery. The atrial septal defect was closed, and ringplasty was applied to the tricuspid valve. After the operation, he could not be extubated because of respiratory failure. On the seventh day following the surgery, he developed pneumothorax and hyportension and died. Postmortem examination showed bilateral diffuse pulmonary tuberculosis. The aim of this report is to emphasise the association of tuberculosis and congenital heart disease.
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Delayed closure of postinfarction ventricular septum defect in a patient with single vessel disease

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Kovacevic P., Velicki L., Vujin B.
Open Medicine
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2013
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vol. 8
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issue 5
644-647
EN
A 65-year-old patient with a systolic murmur that developed five days after acute anteroseptal myocardial infarction was referred to our Institution. He had previously been treated with fibrinolytic therapy. The patient was in a stable hemodynamic condition when admitted, with sustained diuresis. Blood gas analysis revealed normal parameters, whereas a chest X-ray showed signs of pulmonary congestion. Transthoracic echocardiography revealed a 1.5×1.2 cm post-infarction ventricular septum defect (VSD) in the apical part of the septum. Because the patient’s hemodynamic conditions were stable, we decided to postpone the operative treatment to allow scarring of the infarcted area to make VSD repair feasible, thereby increasing the chance for success. Operative treatment was performed three weeks after admission. We performed closure of the VSD with a bovine pericardial patch. The patient was discharged in good condition and remained well three months after the surgery.
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Mortality in surgical units and postoperative care

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Piechota M., Piechota A., Rysz J.
Open Medicine
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2008
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vol. 3
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issue 3
346-357
EN
In the year 2005, 10 public health care institutions in Lodz contained general surgery units. The lowest mortality rate, 0,35%, was recorded in the surgical unit of University Teaching Hospital No. 5 (UH No. 5). We performed a retrospective comparative analysis of mortality in this hospital and in the two remaining university teaching hospitals, University Teaching Hospital No. 1 (UH No. 1) and University Teaching Hospital No. 2 (UH No. 2). The study was comprised of data from 18911 patients treated in these units from 01.01.2003 to 31.12.2005. The statistical data were collected by the Provincial Centre of Public Health in Lodz. The structure of the analysed units and the structure of the selected groups of diagnoses were compared. A relative structure similarity index was used to compare the structure of hospitalised patients in the analysed units, in an attempt to discover the reasons for significantly lower mortality among patients hospitalised in surgical unit of UH No. 5. A detailed analysis of the selected diagnoses and of mortality indicated that early postoperative intensive care in severely ill patients and immediate admission to the ICU, when indicated, significantly decrease mortality.
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Incarcerated inguinal hernia? No, acute pancreatitis

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Ramia-Angel J., Sancho E., Lozoya R., Gasz A., Santos J.
Open Medicine
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2011
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vol. 6
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issue 6
770-772
EN
A 62-year-old man presented to the Emergency Department with a 2-day history of right testicular pain. The initial diagnosis was orchiepididymitis (later found to be mistaken), and intravenous antibiotic treatment was started. Twenty-four hours later, the patient had mild pain in the right inguinal area and right infra-abdominal area. We performed an inguinal ultrasound that showed an incarcerated mass of mixed echogenicity in the right inguinal area. Surgery was performed because we thought the patient had an inguinal incarcerated hernia. Two days after the surgical procedure, the patient began to have fever and erythema and pain in the back. Abdominal computed tomography (CT) showed an acute pancreatitis with a peripancreatic collection from the pancreas to right inguinal area. We have reviewed similar cases in the literature and note that, infrequently, an inguinal mass can be the first sign of mostly asymptomatic acute pancreatitis.
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A rare case of coexistent intralobar and extralobar pulmonary sequestration

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Arsenijevic M., Mitrovic S., Milosavljevic M., Petrovic M., Djurdjevic P., Milisavljevic S.
Open Medicine
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2013
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vol. 8
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issue 1
103-106
EN
In the pathology of respiratory tract, sequestration presents as a non-functional lung tissue with no communication with tracheobronchial tree. It represents a rare congenital bronchopulmonary and vascular malformation, which occurs at a frequency of 0.1 to 6%. Intralobar and extralobar sequestrations are extremely rare congenital anomalies, especially if they occur at the same time in a patient. Proper diagnosis and appropriate surgical therapy, in the absence of associated anomalies, provide an excellent prognosis. In this paper, we are describing the simultaneous presence of intralobar sequestration (ILS) in the lower lobe of the left lung and extralobar sequestration (ELS) which is positioned on the aortic arch, in a 53 years old man. Two years post surgery, there is no recurrence or any patomorphological and functional disorders in the respiratory tract.
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Pelvic Leiomyosarcoma obstructing vaginal opening - case report

88%
Terzic M., Aksam S., Bila J., Maricic S., Arsenovic N.
Open Medicine
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2012
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vol. 7
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issue 2
245-248
EN
We present a 42-year-old female admitted for a 4 month history of increasing pelvic discomfort and pain. Clinical examination revealed a large tumor obstructing the vagina. Tumor markers (CA 125, CEA, AFP and CA 19-9), white blood cells and biochemical tests were all within the normal limits. Pelvic ultrasound and magnetic resonance imaging scan confirmed the presence of a large retroperitoneal/pelvic mass. The tumor was surgically excised and pathohistologically diagnosed as a well differentiated leiomyosarcoma, staged IB. Six years after surgery the patient is well and disease free.
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Heart rate variability in patients after cardiac valve surgery

88%
Lakusic N., Slivnjak V., Baborski F., Sonicki Z.
Open Medicine
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2008
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vol. 3
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issue 1
65-70
EN
The aim of study was to analyze heart rate variability (HRV) after different cardiac valve surgery procedures and the prognostic values of these findings. This study included 101 consecutive patients who underwent surgical implantation for an artificial valve. The mean age of the patients was 62 ± 10 years. An aortic valve was implanted in 65 patients. A mitral valve was implanted in 36 patients. HRV was analyzed from 24 hours Holter electrocardiographic (ECG) records. The time from the operation to the recording of Holter ECG and measuring HRV was 3.8 ± 1.4 months. After discharged from stationary cardiac rehabilitation, all involved patients were contacted to provide data on their health in the follow-up period (33 ± 21 months). A total of 46 patients with an implanted artificial valve had decreased overall HRV or standard deviation of all normal R-R intervals (SDNN) < 93 ms. Patients with an implanted artificial mitral valve had a shorter RR interval (817 ± 122 vs. 863 ± 122ms, p=0.03) and lower values of total power (1166 ± 1888 vs. 2802 ± 3601 ms2, p<0.001) compared to patients with an implanted artificial aortic valve. The results of study show that several months after cardiac surgery, almost half of the patients with an implanted artificial valve have decreased HRV. However, postoperative decreased HRV in those patients have no importance in long-term prediction of mortality rate.
13
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Delayed diagnosis of an isolated partial anomalous pulmonary venous connection

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Glaveckaite S., Lusaite K., Grabauskiene V., Valeviciene N., Laucevicius A.
Open Medicine
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2014
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vol. 9
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issue 3
508-512
EN
In this case report we describe the delayed diagnosis of a very rare congenital anomaly - isolated partial anomalous pulmonary venous connection. This congenital anomaly should be suspected at any age in the clinical setting of right heart volume overload, especially in the absence of a large atrial septal defect. Tomographic imaging modalities (computed tomography or cardiovascular magnetic resonance) not only allow the comprehensive structural and functional assessment of this anomaly, but also help assess the patient’s suitability for surgical treatment. Surgery is the definitive treatment of a patient with a significant left-to-right shunt due to partial anomalous pulmonary venous connection.
14
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Biological markers of severity in acute pancreatitis

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Pallisera A., Jorba R., Ramia J., Rodriguez J., Subirana H., Zárate L., Gonzalez J., Navarro S.
Open Medicine
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2014
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vol. 9
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issue 4
550-555
15
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Hydatidiform mole mimicking an enlarged uterine fibromyoma four months after ART

88%
Terzic M., Dotlic J., Maricic S., Babovic I.
Open Medicine
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2011
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vol. 6
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issue 2
201-204
EN
Hydatidiform mole is a pregnancy disorder, of a benign nature. We present a case of molar tissue within a uterine myoma, the first such entity reported in the literature. In May 2006, a thirty-eight year old infertility patient was admitted for myomectomy. She had anamnesis for chronic pelvic inflammatory disease and surgeries performed for tubal pregnancies. After the sixth intracytoplasmal spermatozoa injection procedure performed in January 2006, she conceived, but curettage was performed in March 2006 for a missed abortion. Following the routine preoperative evaluation in May 2006, four months after the last artificial reproductive technology procedure, myomectomy was performed as uneventful operation, but the histological report appeared unusual, showing degenerated chorionic villi within the uterine myoma. Molar tissue within uterine myoma might evolve even after artificial reproductive procedures. Furthermore, this finding might be misinterpreted as a fibromyoma degeneration. This is the first, and a unique case, of molar tissue within uterine myoma reported in the literature.
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Effectiveness of consenting in Otorhinolaryngology

88%
Okpala N., Okpala A., John G., Cox H.
|
EN
Informed consent in today’s medical practice has become a cornerstone and a routine ethical component playing a major role in forming a therapeutic alliance with the patient. The present study sought to analyse the effectiveness of the consent forms and the consenting process in Otorhinolaryngology. This three month questionnaire-based study covered varying operations which ranged from tonsillectomies, grommet insertions to pharyngeal pouch stapling. Twenty-nine percent of consent forms were signed on the day of the operation. Of the patients who received leaflets (51%) during the process of informed consent, a majority (88%) found it useful. The respondents were satisfied with the explanation of the procedure, benefits and complications (70–74%). Majority kept their consent forms at home (60%) and did not bother engaging in further search with regards to the information in the consent form (81%). Majority of the patients agreed that they had enough time to make an informed consent. Patients were satisfied with the consent process but more can be done to improve the consenting process.
17
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Abdominal giant lymph node hyperplasia (Castleman’s disease): report of two cases

88%
Si S.-F., Wu Z.-H., Wang L.-X.
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18
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Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl

88%
Mujagić Z., Čičko E., Vegar-Brozović V., Prašo M.
Open Medicine
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2008
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vol. 3
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issue 4
459-463
EN
The study was designed to determine pre-, intra-and postoperative serum cortisol and prolactin (PRL) concentrations in patients subjected to low abdominal surgery under total intravenous anesthesia (TIVA) with propofol-fentanyl, and under general balanced anesthesia with isoflurane-fentanyl. The prospective study included 50 patients of both sexes, aged between 35 and 60 years, subjected to elective low abdominal surgery. Patients were randomly divided into two groups: an experimental group, consisting of 25 ASA I/II (American Society of Anesthesiologists I/II classification) patients treated under TIVA with propofol-fentanyl, and a control group consisting of 25 ASA I/II patients treated under balanced anesthesia with isoflurane-fentanyl. The length of the surgery and the degree of the surgical trauma did not differ significantly between the two anesthesia groups. Blood samples for cortisol and PRL measurements were drawn at exact time points: 30 minutes before the beginning of the surgery (T0), 30 minutes after the beginning of the surgery (T1), at the end of the surgery (T2), 2 hours after the surgery (T3), and 24 hours after the surgery (T4). Serum levels of cortisol and PRL were measured using commercially available kits. The results were evaluated with the nonparametric Mann-Whitney test. The serum concentration of cortisol measured at T1 time point in patients treated under TIVA was significantly lower (p=0.04) than that in patients treated under general balanced anesthesia. The average circulating levels of PRL measured at T1, T2 and T3 time points in patients treated under TIVA were significantly lower (p=0.003; p=0.002; p<0.05; respectively) than those in patients treated under balanced anesthesia. The results obtained suggest that the endocrine stress response developed in response to surgery is probably attenuated in patients treated under TIVA with propofol-fentanyl and, thus, that these patients are less stressed in comparison to patients treated under general balanced anesthesia with isoflurane-fentanyl.
19
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Rafał Józef Czerwiakowski: a pioneer of Polish rehabilitation

75%
Kałamacka E.
Medical Rehabilitation
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2013
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vol. 17(4)
49-55
PL
Rafał Józef Czerwiakowski (1743-1816), wybitny lekarz i uczony, profesor Uniwersytetu Jagiellońskiego, prekursor chirurgii to zarazem pionier rehabilitacji polskiej. W swych licznych, medycznych opracowaniach zajmował się leczeniem „bezkształtności ciała”, omawiał sprzęty poprawcze i dodawcze, czyli „brak części nagradzających”, zalecał wodolecznictwo, masaże, „elektryzowanie i galwanizowanie”, ćwiczenia ciała („agitacyje” i „komocyje”). Jako pierwszy w Polsce opisał przyrządy ortopedyczne i ich zastosowanie. Toteż wydaje się celowym przypomnienie postaci Czerwiakowskiego, którego możemy uznać za faktycznego pioniera fizjoterapii w Polsce. Spuścizna Czerwiakowskiego ma duże znaczenie dla dziejów fizjoterapii w Polsce. Jego poglądy, chociaż ukształtowane w XIX wieku, w dużej mierze nic nie straciły na wartości. A zatem warto pochylić się nad niektórymi myślami i wskazaniami, które Czerwiakowski przekazał jemu współczesnym i potomnym, chociaż zawierają historyczne już prawdy. Ale, jak wiadomo „Antiqua quae nunc, fuerunt olim nova” („To, co dziś jest stare, było kiedyś nowe”). Z perspektywy czasu lepiej możemy dostrzec znaczenie jego nauki, będącej zapowiedzią postępów, które w fizjoterapii miały dopiero nadejść.
EN
Rafał Józef Czerwiakowski (1743-1816) was an eminent doctor and academic, a professor of the Jagiellonian University, a precursor of surgery and at the same time a pioneer within Polish rehabilitation. In his numerous medical works he took up the treatment of ‘bodily deformity,’ discussed corrective and supplementary equipment, or ‘the lack of compensating parts,’ he recommended water therapy, massages, ‘electrifising and galvanising’, body exercises (‘agitations’ and ‘commotions’). He was the first in Poland to describe orthopaedic instruments and their application. Which is why it seems of importance to recall the figure of Czerwiakowski, who we may consider to be the actual pioneer of physiotherapy in Poland. Czerwiakowski’s legacy is of significance for the history of physiotherapy in Poland. His views, although shaped in the 19th century, have to a large degree not lost their value. And consequently it is worth considering some of the notions and recommendations which he conveyed to his contemporaries and those who followed, although these contain already historical truths. Yet, as is known Antiqua quae nunc, fuerunt olim nova (what today is old once was new). From the perspective of time we are able to perceive the significance and meaning of his work, which foresaw the innovations which were yet to arrived in physiotherapy.
20
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Endonasal Triangular Technique for nasal valve rhinoplasty: a ten year review

63%
Havea N. a., Tang C., Rockey J., Lynch A.
Polish Journal of Otolaryngology
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2018
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vol. 72
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issue 5
45-50
EN
Introduction: The nasal valve is the main regulator of airflow in the nose. Consequently, the collapse of the nasal valve has a significant impact on nasal obstruction and hence quality-of-life of patients. Several nasal valve rhinoplasty techniques are being used, from cartilage grafts to endonasal resection of the upper lateral cartilage. We describe a new endonasal approach to nasal valve rhinoplasty, the Triangular Technique, and assess its efficacy and complication rate over ten years. Materials and Methods: A retrospective study of patients who underwent nasal valve rhinoplasty at three regional hospitals from Jan 2004 to May 2014 was conducted. Subjective reports were used to assess the improvement of nasal obstruction. A total of 24 patients were included. Results: Three months postoperatively, 19 patients reported improvement in nasal obstruction. Four patients required revision surgery. Two of these 4 patients had substantial symptom resolution post revision surgery. Ten patients were followed up for more than 5 years (range: 5.8 to 10.3 years), 9 of who reported continued satisfaction and none or minimal nasal obstruction after nasal valve rhinoplasty compared to before surgery. There were no reported complications. Discussion: The Triangular Technique is a straightforward endonasal technique to address collapsed nasal valves with minimal associated co-morbidities.
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