Surgery today
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Case Reports
Simultaneous bilateral spontaneous pneumothorax secondary to metastatic angiosarcoma of the scalp: report of a case.
Angiosarcoma is a highly malignant neoplasm, which most often develops on the scalp or face of elderly people. Common distant metastatic sites include the lung, liver, lymph nodes, and skin. ⋯ Chest computed tomography showed multiple thin-walled cavitary metastatic pulmonary lesions, which increased in size as new lesions appeared over the clinical course of several months. This case suggests that a finding of simultaneous bilateral spontaneous pneumothorax may indicate a serious parenchymal lung disorder.
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Comparative Study
Receiver-operating characteristic analysis of leukocyte counts and serum C-reactive protein levels in children with advanced appendicitis.
To assess the diagnostic value of the white blood cell count (WBC) and serum C-reactive protein (CRP) level in children with advanced appendicitis. ⋯ These findings suggest that increased values of CRP and WBC more than 48 h after the onset of acute abdominal symptoms are indicators of advanced appendicitis.
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Case Reports
Tension pneumothorax secondary to colonic perforation during diagnostic colonoscopy: report of a case.
We report a case of tension pneumothorax, which occurred secondary to colonic perforation during a colonoscopy. The patient was a 77-year-old woman in whom acute respiratory decompensation developed suddenly during a diagnostic colonoscopy for iron deficiency anemia. We diagnosed bilateral pneumothoraces, tension pneumothorax, pneumomediastinum, pneumoperitoneum, and emphysema of the face, neck, and chest. ⋯ Occasionally, air spreads from the retroperitoneum into continuous tissue planes and decompresses into the adjacent structures. To our knowledge, this is the first report of two unique manifestations of diagnostic colonoscopy-induced intestinal perforation: tension pneumothorax and perforation at the site of a previous anastomosis. Both of these conditions should be considered in the event of acute respiratory failure in the endoscopy suite.
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Aortic root replacement after aortic valve replacement (AVR) is often complicated by bleeding around the aortic root, which increases the risk of morbidity and mortality, making it a technically challenging procedure. We describe a new technique of aortic root replacement designed to minimize bleeding around the aortic root. This surgical technique focuses on safe dissection and exposure of the aortic root to avoid inadvertent entry into the right atrium or right ventricle; on modifying the proximal anastomosis of the graft to the aortic annulus; and on performing a coronary artery reimplantation that achieves complete hemostasis at the suture lines. We performed aortic root replacement after AVR in four patients over a 4-year period, without encountering any bleeding around the aortic root.
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Case Reports
Isolated superior mesenteric vein injury from blunt abdominal trauma: report of a case.
Solitary injury of the superior mesenteric vein (SMV) after blunt abdominal trauma is a rare but frequently fatal injury. A 63-year-old man was admitted to our hospital after falling on his right side from a height of 5 m. Computed tomography (CT) showed blood in the peritoneal cavity, but no liver or spleen injury. ⋯ There was slight stenosis at the site of the suture and no sign of development of collateral venous circulation into the liver. This case report shows that primary repair of an SMV injury can be done in a stable patient without concomitant life-threatening injuries once proximal and distal control of bleeding has been achieved. Ligation should be reserved for patients with multiple injuries and an unstable condition.