Intrathoracic cancer of the splenic flexure.

Blunt traumatic rupture of the diaphragm is a well known but uncommon event of thoracoabdominal traumatic injuries. It occurs in 1-5% of polytrauma patients and requires a high degree of suspicion for a rapid diagnosis. The frequency of delayed diagnosis is difficult to be estimated and up to 30% of blunt diaphragmatic ruptures present late.

Lipoma of the interatrial septum in a patient with chronic atrial fibrillation: A case report.

The authors report on a 70-year-old woman with chronic atrial fibrillation that was hospitalized for digitalis intoxication and incidentally was found to have an interatrial lipoma. The diagnosis was established by transesophageal echocardiography, computed tomography (CT) scanning, and magnetic resonance imaging (MRI). Owing to the asymptomatic character and the benign nature of the tumor, a decision for conservative management was made.

A 15-year experience (1988-2003) in the management of liver hydatidosis in northwestern Greece.

Hydatid disease (HD) is a parasitic infection often caused by the larvae of Echinococcus granulosus and rarely by Echinococcus multilocularis in endemic areas. This study aims to emphasize the perioperative administration of anthelmintic therapy over the different surgical procedures aimed at curing HD, because radical resection remains the only potentially curative treatment for hepatic echinococcosis. From October 1988 to September 2003, a total of 140 patients with echinococcal disease were studied: 125 presented with liver HD and 15 with extrahepatic echinococcus cysts (79 men and 62 women; median age, 47.

Acute myocardial infarction after a European hornet sting--a case report.

The authors briefly describe an 87-year-old man who experienced an acute ST-elevation myocardial infarction in the context of an anaphylactic reaction caused by a European hornet (Vespa cabro linnaeus) envenomation. This unusual case highlights the potential cardiovascular complications associated with common insect stings such as those caused by hymenoptera. Thus, a thorough cardiovascular evaluation is essential in such cases since the vasoactive, inflammatory, and thrombogenic mediators of anaphylactic reactions may provoke myocardial ischemia.

Acute non-ST-elevation myocardial infarction presented as occipital headache with impaired level of consciousness--a case report.

Headache represents a rare manifestation of myocardial ischemic pain. It is believed that this clinical symptom results from convergence of heart autonomic fibers with somatic inputs originating from the head. The authors describe for the first time the case of a 73-year-old woman who experienced an acute non-ST-elevation myocardial infarction that manifested solely with intense occipital headache associated with vomiting and impaired level of consciousness.

Errors and pitfalls in the non-invasive management of atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice while it has a significant impact on morbidity and mortality. The errors and pitfalls in the management of AF patients are not uncommon. These include errors in detection and management of the underlying conditions that promote and perpetuate the arrhythmia, in the selection and monitoring of antithrombotic treatment, in the selection of appropriate strategy for arrhythmia management (rate or rhythm control), in the cardioversion procedure, in the prevention of recurrence after cardioversion, in the acute or chronic control of heart rate, and in the monitoring of drug toxicities.

Alterations in plasma oxidative stress markers after laparoscopic operations of the upper and lower abdomen.

The patient's position during laparoscopic surgery can have a clinically relevant effect on lower limb and splanchnic circulation; this factor has not yet been investigated with respect to oxidative stress markers. In order to assess this effect, a prospective clinical trial was designed wherein 2 groups of patients were studied. In group A, 15 patients underwent upper abdominal nonhepatobiliary operations (13 modified Nissen fundoplications and 2 Taylor vagotomies) in the head-up position.

Variation of inflammatory indexes after electrical cardioversion of persistent atrial fibrillation. Is there an association with early recurrence rates?

Inflammation has been recently implicated in the pathophysiology of atrial fibrillation (AF). The aim of this study was to examine the variation of inflammatory indexes during the first week after successful electrical cardioversion of persistent AF. Successive measurements of white blood cell (WBC) count, C-reactive protein (CRP) and fibrinogen levels were performed in 30 cardioverted patients.

Oral vitamin C administration reduces early recurrence rates after electrical cardioversion of persistent atrial fibrillation and attenuates associated inflammation.

Background: Inflammation and oxidative stress have been recently implicated in the pathophysiology of atrial fibrillation (AF). The aim of this study was to examine the potential benefit of vitamin C on the early recurrence rates and on inflammatory indices after successful cardioversion of persistent AF, as well as to investigate the time course of changes in these indices post-cardioversion.

Methods: We prospectively studied 44 consecutive patients after successful electrical cardioversion of persistent AF.

The heart in Wegener's granulomatosis.

Wegener's granulomatosis (WG) is a necrotizing vasculitis that mainly affects the respiratory tract and kidneys. Of note, involvement of the heart is being increasingly recognized in these patients. Cardiac manifestations can arise from the coronary arteries, pericardium, myocardium, endocardium, valves, conduction system and great vessels, but in most cases cardiac involvement is clinically silent.

Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress.

Atrial fibrillation (AF) represents the most common arrhythmia encountered in clinical practice. The pathophysiology of AF is complex, but in most cases it may be caused by multiple random re-entering wavelets. As generally known, the development of AF leads to electrophysiological and cellular changes in the atria that tend to sustain AF, a process known as electrical remodeling.

Prognostic significance of p53, bcl-2 and Ki-67 in high risk superficial bladder cancer.

Background: Although tumor grade and stage are the most accurate prognostic factors in the evaluation of transitional cell bladder cancer, they cannot always predict the true tumor biological potential since superficial tumors of the same stage and grade may have completely different clinical courses. This study was performed in order to examine whether p53, bcl-2 and Ki-67 have any validity in predicting the course of superficial bladder tumors, with high risk for recurrence or progression, over the traditional prognostic factors that are currently used. Furthermore, we investigated whether any one of these markers maintains its prognostic capability after one course of intravesical instillations of IFN gamma.

CD44 standard form expression as a predictor of progression in high risk superficial bladder tumors.

Objective: The purpose of this study was to assess the significance of the standard CD44 adhesion molecule expression in predicting progression of high risk superficial bladder carcinoma in the short term.

Methods: Sixty-six patients (51 males and 15 females, aged 27 to 89 years (mean 64.75 years) with primary superficial transitional cell bladder cancer initially treated with transurethral resection (TURBT) were enrolled in the study.

Intravesical instillations of interferon gamma in the prophylaxis of high risk superficial bladder cancer--results of a controlled prospective study.

Objective: To determine if intravesically administered recombinant interferon (IFN) gamma may serve as adjuvant first line treatment in prophylaxis of superficial bladder cancer by reducing its risk for recurrence, in the short term.

Material And Methods: A total of 54 patients (43 males and 11 females) with superficial bladder tumours (Ta/T1) initially treated with transurethral resection for their tumors were randomized into two groups: Twenty-eight patients were left untreated after the transurethral resection (controls) whereas 26 patients received intravesical IFN gamma adjuvantly, at a dosage of 0.7 mg per week for 8 weeks.

Varicocele in schoolboys.

This study was conducted to examine the effect of height and weight on the incidence of varicocele in schoolboys aged 5-16 years and the impact of varicocele on testicular size. Genital stage, height, weight, varicocele grade, and testicular size were recorded for 3047 school boys who were clinically examined while standing by a specialist in urology. Left varicocele was detected in 98 of the boys who were all aged 9-16 years.

Ultrasonically activated shears in extended lymphadenectomy for gastric cancer.

Gastrectomy, followed by extended lymphadenectomy, is the treatment of choice in some stages of advanced gastric cancer. Lymphorrhea, as a result of the many divided lymphatic vessels, increases the morbidity. Ultrasonically activated coagulated shears (UACS) may divide all small vessels followed by immediate sealing of the coapted vessel walls.

Laparoscopic surgery-induced changes in oxidative stress markers in human plasma.

Background: The induction of the pneumoperitoneum increases intraabdominal pressure (IAP), causing splanchnic ischemia, whereas its deflation normalizes IAP and splanchnic blood flow. This procedure appears to represent an ischemia-reperfusion model in humans.

Methods: Thirty laparoscopic cholecystectomies (LC) were performed in 30 patients with a mean age of 54.

Seroma in laparoscopic ventral hernioplasty.

Seroma is a frequent complication of laparoscopic or open repair of ventral hernias using expanded polytetrafluoroethylene mesh. Aspiration of this seroma has the risk of introducing bacteria, resulting in infection and the recurrence of the hernia. Between May 1996 and December 2000, 51 patents who underwent 53 laparoscopic ventral hernioplasties (44 incisional, 5 large epigastric, and 4 large umbilical) were randomized to participate in a trial comparing the intraperitoneal onlay mesh repair with or without cauterization of the hernia sac.

Lipid peroxidation and the use of emulsified propofol in laparoscopic surgery.

Background: Free radical-induced lipid peroxidation associated with a decrease of antioxidant capacity in plasma is observed after the deflation of the pneumoperitoneum in laparoscopic surgery. In this study, we evaluated the effect of the continuous administration of lipid peroxidation derivatives on emulsified propofol.

Methods: Two groups of 20 patients each who underwent laparoscopic surgery were studied prospectively.

Intracystic pressure and viability in hydatid disease of the liver.

Background: Knowledge on the viability of hydatid cysts of the liver during operation is important to the surgeon may dictate the peri-operative therapeutic manoeuvre undertaken.

Patients And Methods: A prospective study was performed on 23 patients with 28 hydatid cysts of the liver to assess whether intracystic pressure (ICP) could predict viability of protoscoleces. All patients received albendazole (10 mg/kg body weight/day) for 5 days pre-operatively.

Continuous propofol administration for suxamethonium-induced postoperative myalgia.

The effect of continuous propofol administration on creatine kinase and suxamethonium-induced postoperative myalgia was evaluated in 50 patients randomised into two groups of 25 patients each. Induction of anaesthesia was identical in all patients. Anaesthesia was maintained with 66% nitrous oxide in oxygen supplemented by either isoflurane 1% or continuous propofol.

Laparoscopic placement of the Tenckhoff catheter for peritoneal dialysis.

Continuous ambulatory peritoneal dialysis catheters can be inserted by open laparotomy as well as by laparoscopy. A prospective randomized study was scheduled to investigate the results of the laparoscopic versus open laparotomy technique for placement of continuous ambulatory peritoneal dialysis catheters. Fifty patients were enrolled and randomly allocated into two groups of 25 patients each.

Antiproliferative activity of interferon gamma in superficial bladder cancer.

Background: Although the antiproliferative activity of interferon gamma has been reported in various tumours, this has not been studied in bladder cancer. Proliferative cell nuclear antigen and Ki67 growth fractions were estimated in this study in superficial bladder cancer, as a measure of the antiproliferative effect of interferon gamma.

Materials And Methods: Superficial bladder cancer samples before and after four weekly intravesical instillations of 0.

Interleukins, TNF-alpha and beta-2M in patients with B cell chronic lymphocytic leukemia.

In order to investigate the possible existence of a prognostic factor for B cell chronic lymphocytic leukemia (B-CLL), we determined the serum levels of TNF-alpha, IL-1a, IL-1b, IL-2, sIL-2R, IL-6, IL-10 and beta-2M in 20 patients. We observed significant changes in sIL-2R and beta-2M levels, whereas in all stages of disease, TNF-alpha and other interleukins exhibited only mild changes. An excellent correlation between sIL-2R and beta-2M levels and disease activity wes reported.

Laparoscopic cholecystectomy using ultrasonically activated coagulating shears.

Ultrasonic energy has recently been used for surgical cutting and coagulating. A prospective randomized study was undertaken to determine the effectiveness of ultrasonic energy versus monopolar electrosurgery in human laparoscopic cholecystectomy. Two hundred patients were enrolled and randomized into two groups of 100 patients each.