Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Pancreatic cancer is one of the most aggressive tumours. Despite enormous progress in multimodal therapeutic options, surgical resection remains the only chance for curative treatment. Several surgical procedures have been developed with the intention to improve the outcome of this disease. ⋯ In case of tumour infiltration of the portal or the superior mesenteric vein, survival seems to be improved by resection of the affected vessel. Resection of the portal vein can be done safely without affecting morbidity or mortality. In the presence of tumour infiltrating the hepatic artery or other arterial vessels, there is still a need for controlled clinical trials to confirm any survival benefit from arterial resection.
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Many different causes have been described for dysphagia. An uncommon one is trichobezoars, which are mainly caused by trichotillomania. This may lead to mechanical obstruction and peritonitis due to perforation of the gut. ⋯ The patient presented unclear dysphagia and a palpable tumor in the epigastrium. Computed tomography showed an inhomogeneous tumor spreading from the upper belly to the pelvis. A B1 resection was performed and the patient recovered uneventfully.
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Osteoarthritis or instability of the acromioclavicular (AC) joint may cause significant impairment or pain in the shoulder. If symptoms of osteoarthritis persist despite conservative treatment, distal clavicular resection is usually curative. Injuries and instability are classified according to Rockwood. ⋯ An underestimated acute injury to the AC joint may result in chronic instability. Different techniques are presented for operative treatment of significant acute or chronic instability. Arthroscopic methods are now available for treating both acute and chronic instability.
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A young male patient presented with right lower quadrant abdominal pain 3 years after laparoscopic appendectomy. Clinical and radiological findings were in keeping with acute appendicitis and the diagnosis of stump appendicitis could be confirmed by laparoscopy. This case serves as a reminder of this differential diagnosis and to discuss therapy and prevention of this rare condition.