Minerva chirurgica
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Review Case Reports
[Hemolysis and multiple trauma. A clinical case report].
A patient is described who presented hemolysis after a chest and head trauma. We checked out every possible cause of anemia and our conclusion is that trauma itself was the cause of hemolysis. As an explanation, we suggest that red blood cells were broken in lung capillaries because of endothelial damage due to pulmonary injury.
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The results obtained in 172 cases of non metastatic Ewing's sarcoma of the extremities are reported. The patients were advised to undergo surgical treatment, followed by radiotherapy (40-45 Gy) in case of inadequate surgical margins. 48 patients who refused surgical treatment, were locally treated with radiotherapy alone (50-65 Gy). With a mean follow-up of 8 years (R. 3-15) 101 patients (58.7%) are free of disease and 68 relapsed with metastases and/or local recurrence. ⋯ A better DFS was observed in the patients treated with surgery (66.9%) in comparison with those treated with radiotherapy alone. The higher percentage of local recurrences observed in patients treated with radiotherapy alone seems to be responsible for the worse prognosis observed in these patients. The authors' conclusion is that the local control in patients with non metastatic Ewing's sarcoma should always be achieved by means of surgery.
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Review Case Reports
[Cystic adenomatoid malformation of the lung in an adult].
Congenital cystic adenomatoid malformation of the lung (CCAM) is characterized by an adenomatoid proliferation of bronchiole-like structures and cysts formation. The condition is most commonly found in newborns and children and it may be associated with other malformations; rarely, the presentation is delayed until adulthood. This paper presents a case of CCAM in a 62-year-old male, who presented with recurrent bacterial pneumonias and breathlessness one exertion. ⋯ Similarly, other diagnostic methods add no further useful informations. Surgical treatment is necessary also in adult patients, because of the risk of recurrent pulmonary infections and malignancies associated with CCAM. Lobectomy is the treatment of choice, but sometimes a larger resection is required, when the lesion involves more than one lobe.
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Review Case Reports
[Retroperitoneal hematoma during heparin therapy. Comments on 3 cases].
The authors review the literature during the past ten years relating to the onset of retroperitoneal hemorrhage during heparin treatment. The phenomenon may be attributed to a thrombotic genesis involving the adrenal glands and may or may not be correlated to the presence of heparin-induced immune phenomena. The severity of the phenomenon is readily understood: given that the pathology is heparin-dependent, suspension of heparin treatment is the first main step to be taken; this is evidently a cause of risk in relation to the pathology that imposes the use of heparin. ⋯ They report three cases which were brought to their attention over the past three years. On the basis of their experience, the authors underline the importance of knowing the causes that are supposed to be responsible for the complication and the study of blood coagulative status. In order not to overlook the possible adrenal genesis of the phenomenon they also recommend a careful exploration of the adrenal glands when faced with a retroperitoneal hematoma in which the source of hemorrhage cannot be identified.
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Authors report their experience concerning surgical treatment of thoracic recurrence from previously operated breast cancer. 96 patients were treated: 9 with loco-regional chest wall recurrence, 84 with malignant pleural effusion, 3 with solitary lung metastasis. Eight of 9 cases with chest wall recurrence underwent skin and soft tissue "en bloc" resection while in one case a thoracectomy was performed. Malignant pleural effusions were treated by thoracentesis in 21 cases (25%), tube thoracostomy in 8 (4.76%), tube thoracostomy plus chemical pleurodesis in 54 (64.2%) and pleurectomy in one case (1.19%). ⋯ Among the 3 patients with solitary lung metastasis 2 died respectively 26 and 31 months after procedure and 1 is alive at 28 months. Above 54 patients treated by tube thoracostomy plus pleurodesis for malignant pleural effusion, 35 showed a complete response, 13 a partial response and 6 were non-responders. No postoperative complications were observed in the patient who underwent pleurectomy while an almost complete resolution of the pain was achieved.