SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A case of an unusually large chondroid syringoma of the abdominal wall is described. Chondroid syringomas are rare neoplasms believed to be of sweat gland origin. They are often slow-growing and benign. Local recurrence and distal spread characterise the malignant form.
Phacomatosis pigmentokeratotica (PPK) represents a specific "twin nevus" syndrome in which a speckled lentiginous nevus (SLN) is associated with an organoid nevus with sebaceous differentiation. A boy with a large nevus sebaceus on the left face and upper part of the trunk, a giant segmental SLN extending from the abdomen to the feet bilaterally, and right hemihypertrophy developed an embryonal rhabdomyosarcoma of the right abdominal wall at age 6 months. A variety of musculoskeletal, neurologic, and ocular anomalies have been observed in patients with PPK, reflecting the individual manifestations of both SLN and Schimmelpenning syndromes. This report adds hemihypertrophy to the spectrum of extracutaneous manifestations of PPK and, to our knowledge, represents the first observation of a rhabdomyosarcoma arising in contiguity with an SLN in a patient with PPK. The development of a rhabdomyosarcoma in our patient likely reflects both increased propensity for growth (as evidenced by the hemihypertrophy) and the pluripotent nature of neural-crest derived cells within the field defect that underlies an SLN.
The use of transfascial sutures in the laparoscopic repair of incisional hernia has considerably facilitated the accurate intraperitoneal placement and fixation of the synthetic mesh. The laparoscopic procedure has a number of advantages, including less morbidity and pain. Moreover, the use of a mesh prosthesis results in a low rate of hernia recurrence. Despite the benefits associated with this technique, several (minor) complications have been documented. Herein we describe a case of prolonged abdominal wall pain after laparoscopic hernia mesh repair that was caused by the use of transfascial sutures.
Three stillborn fetuses are reported in which an abdominal wall defect was associated with defects in the urogenital and anal region. Autopsy of these fetuses provided clues indicative of how and where the embryonic development went wrong. The malformation involved a disturbance of the cell deposition process, occurring in the caudal part of the embryo. During the cell deposition process, which takes place in the neural crest and the body wall placode, ectodermal cells are added to the mesodermal compartment of the embryo, thus contributing to the anlagen of several structures, including the ventral body wall. In addition, a change in the shape of the embryo is generated. The sequence of events resulting from a disturbance of the cell deposition process is explained.
The development of surgical staplers devised for laparoscopy has enabled advancements in complex laparoscopic procedures, such as gastric bypass. This procedure, considered by many as the gold standard for bariatric surgery, is now frequently performed laparoscopically, with the advantages inherent in the minimally invasive approach. Technical failure of surgical staplers is, however, a well known complication of these devices in digestive surgery. We report the case of a leak of the bypassed stomach into the abdominal wall through a trocar site following laparoscopic gastric bypass. The mechanisms responsible for this life-threatening complication and the options to avoid it are discussed.
Postradiation sarcomas are rare, and the most commonly reported ones are malignant fibrous histiocytoma, osteosarcoma, angiosarcoma, fibrosarcoma, malignant peripheral nerve sheath tumor, and high-grade pleomorphic sarcoma, not otherwise specified. There are a few case reports of postradiation rhabdomyosarcomas following treatment of retinoblastoma, breast cancer, endometrial adenocarcinoma, and Hodgkin's disease. Secondary neoplasms following radiation and surgical treatment of rectal adenocarcinomas have not been reported in the English literature. We report a case of pleomorphic rhabdomyosarcoma of the anterior abdominal wall following treatment of rectal carcinoma, and we review the literature.
BACKGROUND: Despite numerous experimental studies, conducted most often with the open small-animal model, the ideal structure for a mesh with maximum biocompatibility in the intraabdominal region has yet to be found. To date, few experimental models have been concerned with the laparoscopic intraabdominal implantation of meshes. Numerous experimental and clinical studies appear to have identified expanded polytetrafluoroethylene (ePTFE), in the form of DualMesh, as the gold standard. Since publications have reported fistula formation and marked adhesions to be associated with the use of polypropylene meshes, only few studies have investigated meshes made of this material. It is known, however, that a reduction in the amount of material and an increase in pore size results in better mesh biocompatibility. METHODS: Six pigs each underwent laparoscopic intraabdominal placement of either a TiMesh or a DualMesh, both of which were prepared for implantation in standardized fashion. After 87 +/- 2 days, the pigs were killed, and postmortem laparoscopy was performed, followed by the removal of the tissue embedding the mesh for assessment of adhesions and shrinkage, and for histologic workup. The specimens were processed both histologically and immunohistochemically. RESULTS: In all but one case, the greater omentum adhered, usually over discrete areas, to the mesh. In every case the omentum was separable from the mesh surface only by sharp dissection. With the titanium-coated polypropylene meshes, the average total adhesion area was only 0.085, as compared with 0.25 for the GoreTex meshes (p = 0.055). The GoreTex meshes showed an average shrinkage to almost half of the original surface area (median, 0.435). The average shrinkage of the TiMesh, was to 0.18 of the original area (p = 0.006), which thus was significantly smaller. Determination of the partial volume of the inflammatory cells showed significantly lower median figures for the TiMesh (p = 0.009). Measurements of the proliferation marker Ki67 showed significantly higher values for ePTFE than for TiMesh (p = 0.011). The apoptosis index was significantly higher for the ePTFE membranes (p = 0.002). CONCLUSIONS: Titanium-coated polypropylene mesh (TiMesh) is clearly superior to the DualMesh in terms of biocompatibility, and is thus suitable for the laparoscopic intraperitoneal repair of abdominal wall and incisional hernias.
PURPOSE: Inadvertent peritoneal tearing causes pneumoperitoneum and makes retroperitoneal laparoscopic procedures technically more difficult. We describe some simple techniques of atraumatic peritoneal dissection and the prevention of peritoneal injury during trocar placement under retroperitoneoscopic guidance. MATERIALS AND METHODS: After balloon dilation and the establishment of pneumoretroperitoneum a laparoscopic swab stick was used for peritoneal dissection from the abdominal wall under retroperitoneoscopic guidance. Exploratory puncture using a Cathelin (Terumo, Tokyo, Japan) needle was performed before trocar placement in close proximity to the lateral peritoneal reflection. RESULTS: We applied this technique in our last 10 consecutive retroperitoneal laparoscopic procedures. No peritoneal rents occurred during dissection of the lateral peritoneal reflection or trocar insertion. CONCLUSIONS: The laparoscopic swab stick technique described facilitates atraumatic peritoneal dissection as well as creation of an adequate working space. Exploratory puncture using a Cathelin needle is useful for preventing inadvertent peritoneal injury during trocar placement.
An autopsy case with the syndrome of combined congenital defects involving the supraumbilical abdominal wall, sternum, diaphragm, pericardium, and heart is reported. In this case, abnormal arterial plexus including anastomosis of the left coronary artery and the left internal mammary artery is recognized at the hernial pericardial wall, in addition to the already reported anomaly complex, i.e. diastasis recti abdominis with pericardial hernia, ventral defect of the diaphragm, partial defect of the sternum, and tetralogy of Fallot. It is suggested that this newly revealed vascular anomaly also comes within a specific syndrome of combined congenital defects.
A 59-year-old woman was admitted to our hospital complaining of intractable abdominal wall fistula. Several examinations led to the suspicion of a fistula due to liver cell tumor. Histologically, the tumor was diagnosed as cholangioma. Chemotherapy was very effective after fistulectomy, and to date, she has been doing well for 34 months.
Laparostomy wound management is a difficult problem especially with a stoma and the potential risk of infection. A case describing the use of a permanent porcine dermal collagen implant in the repair of a massive ventral hernia, in a patient with a large post-laparostomy defect and colostomy is outlined. The implant was not rejected, and after 12 months, there was no evidence of residual or recurrent hernia. The search for the ultimate biomaterial for reconstructing abdominal wall defects is ongoing. Collagen based implants appear to have many of the requirements that an ideal material should possess.
Spilled gallstones left in the abdominal cavity or trapped at trocar sites may cause considerable morbidity. We saw a patient with an abdominal wall abscess 2 years after laparoscopic cholecystectomy secondary to spilled stones. After we reviewed the operative procedure in addition to the accumulated experience in laparoscopic surgery, we believe that retrieval of specimens and their contents is of paramount importance, especially when the gallbladder is infected, contains several stones, or may harbor malignancy. Therefore, we made use of a simple surgical glove with a long pursestring suture surrounding the opening to collect the specimen. This method proved to be simple and quite convenient, with the needed materials readily available. It can collect the spilled stones within the abdominal cavity as well as the gallbladder and can transport these stones out of the abdominal cavity with ease and safety. It also protects the specimen in contact with the wound and cuts short the operating time. The technique and advantages are described.
Three pregnant women presented with disabling lower abdominal wall pain unresponsive to conventional therapies. The striking similarities among the clinical signs and symptoms prompted a review of the literature and led to the suspicion of thoracic lateral cutaneous nerve entrapment, a syndrome reported in other conditions, including after surgery, but not during pregnancy. Treatment by nerve block with local anesthetics was rapidly and completely successful in relieving the symptoms.
During a gross anatomy dissection, a piece of the calvarial bone was found between aponeuroses of the anterior abdominal wall in an 82-year-old male cadaver. It corresponded closely in size to the calvarial defect after the neurosurgery performed 5 years before death, showing that very little resorption had occurred over the years. Moreover, 13 percent of the transplant was new bone, indicating that membranous bone can, in the long term, induce new bone formation in humans.
BACKGROUND AND PURPOSE: The aim of this paper is to present an alternative method of cranioplasty with the use of an autologous cranial bone flap stored between primary and restorative surgery in the subcutaneous pocket in the lateral hypogastric region. MATERIAL AND METHODS: Between January 1999 and April 2002, in the Department of Neurosurgery of Medical University of Łódź we performed 36 procedures of the bone flap implantation into the abdominal subcutaneous fat tissue. These procedures followed craniectomy, mainly in cases of acute subdural hematomas and ruptured intracranial aneurysms. RESULTS: After storage, the bone flap was reimplanted in 28 patients. The mean time between operations was 14 days (range 8-53 days). In the cranioplasty group we had only one infection of the bone flap. Among patients excluded from the bone flap restoration we observed one inflammatory complication in the abdominal wall and one subcutaneous hematoma requiring evacuation. CONCLUSIONS: In our opinion, the presented method of the cranial defect's supplementation may be competitive to procedures utilizing synthetic prostheses in the population of patients for whom reimplantation of the bone flap will be expected in 2-3 months after the primary operation. Advantages of the procedure are: the autologous bone graft, the excellent cosmetic effect, low costs of the procedure and low rate of inflammatory complications.
We present a case of a right external hemipelvectomy for chondroblastic osteosarcoma originating from the right ilium and reconstruction with salvage parts; cardiopulmonary bypass preserved anterior thigh free flap. The resection required sacrifice of the right common iliac artery and vein and the entire right gluteus maximus muscle. The first stage of the procedure was a high above-knee amputation on the ipsilateral leg. The amputated extremity was placed on extracorporeal bypass utilizing the common femoral artery and vein. This technique, previously unreported, supported the successful utilization of the anterior thigh free flap for both soft tissue and abdominal wall facial reconstruction.
From 1986 to 1989 46 newborn were examined after correction of oesophageal atresia, defects of diaphragm or abdominal wall, to record postoperative cardial insufficiency. In 15 of 40 long-time pH metry analysis (37.5%) and in 11 of 22 x-ray studies (50%) a pathological result was found; in 8 times these findings were followed by operation and in 8 times by conservative therapy. pH metry is suitable even in very small newborn for postoperative screening of cardial function; if the results are positive, x-ray examination is supplementary to diagnosis and therapeutical planning.
INTRODUCTION: The type of skin incision affects the course of surgery during radical nephrectomy. We investigated the efficacy of a new type of incision for the surgical approach to large renal masses. PATIENTS AND METHODS: Fourty patients (23 males and 17 females, mean age 63 years) who underwent radical nephrectomy in our department between 2002 and 2004 were evaluated. The outcomes in the groups with chevron incision and abdominal wall flap incision (AFI) were compared in terms of greatest tumor diameter, operation duration, perioperative blood loss, postoperative complications, and duration of hospitalization. Statistical analysis was made by independent-samples t test. RESULTS: Chevron incision was used in the first 15 patients, while subsequent 25 patients were operated via AFI. The operation duration was slightly longer in the AFI group (3.78 vs. 3 h); however, the mean largest tumor diameter was significantly greater in patients operated via AFI (11.3 vs. 7.4 cm, p < 0.05). The mean blood losses were 1,100 and 590 ml in the chevron incision and AFI groups, respectively (p < 0.05). There was no significant difference in terms of duration of hospitalization and postoperative morbidity. CONCLUSION: In our experience, AFI provides the best exposure and improved control of renal vessels and vena cava during radical nephrectomy and enables a safe dissection even in very large tumors with minimal blood loss.