Surgery today
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Diaphragmatic rupture following trauma is often an associated and missed injury. This report documents our experience of treating traumatic diaphragmatic rupture (TDR). ⋯ A high index of suspicion and early surgical treatment determine the successful management of TDR, with or without the herniation of abdominal organs. The surgical approach to TDR is individualized. Acute left-sided injuries are best approached through the abdomen, although we prefer the chest approach, adding laparotomy when necessary. Acute right-sided injuries and chronic injuries should be approached through the chest.
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To investigate the results of wide rhomboid excision with Limberg transposition flap reconstruction to treat pilonidal sinus. ⋯ These results provide further evidence that wide excision with a Limberg transposition flap reconstruction is an effective surgical method for primary or recurrent pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate. A modification of the technique was devised to further enhance wound healing and reduce the risk of recurrence.
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Case Reports
Successful resection of a recurrent mediastinal liposarcoma invading the pericardium: report of a case.
Primary liposarcoma of the mediastinum is rare, but cases of recurrence have been reported in the English literature. We successfully resected a recurrent pericardial liposarcoma, detected 5 years after the initial resection of a liposarcoma of the anterior mediastinum invading the pericardium. ⋯ As cine-magnetic resonance imaging suggested that the tumor was resectable, an operation was performed. Histopathology confirmed the diagnosis of recurrent liposarcoma and showed clear surgical margins.
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Comparative Study
Lung injury after intestinal ischemia-reperfusion may be avoided by the reduced absorption of locally produced cytokines.
It has been suggested that inflammatory mediators such as cytokines released during intestinal ischemia and reperfusion increase permeability in the lungs. Cytokines exist at concentrations several hundred times higher at the site of inflammation than in the blood. When absorbed, the locally produced cytokines may affect multiple remote organs. We thus investigated whether the isolation of the intestine in a bag during ischemia and reperfusion can reduce subsequent lung injury. ⋯ The isolation of the intestine during ischemia and reperfusion was found to reduce the degree of subsequent lung injury, possibly due to the reduced absorption of locally produced cytokines via the parietal peritoneum.
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A 36-year-old woman without any relevant medical history was admitted to our hospital with an abdominal tumor that had caused recurrent right hypochondral and back pain for 3 months. Retroperitoneal cystic lymphangioma was diagnosed by abdominal ultrasonography and computed tomography. ⋯ Most patients experience chronic symptoms, necessitating therapeutic intervention. Excision is the treatment of choice, and can be performed laparoscopically in selected patients.