Mesenteric Histiocytosis or Only an Inflammatory Infiltration of Histiocytes? A Case Report From a Surgical Point of View

The mesenteric sclerosing processes are very rare tumors. There are only a few cases of mesenteric fibromatosis described in literature. A case of mesenteric histiocytosis or a mesenteric infiltration by histocytes as a reactive inflammatory process is not described in the surgical literature. Because of its clinical and macroscopic similarity to a fibromatosis or a reactive inflammatory process and a lack of articles in the literature on mesenteric histiocytosis we concentrated our research in literature on the mesenteric fibromatosis and its differential diagnosis.     

Lazarus-Phänomen

Background

In the medical literature the Lazarus phenomenon is defined as the spontaneous return of circulation (SROC) after cessation of cardio-pulmonary resuscitation. Based on published literature recommendations concerning the treatment of patients after cessation of resuscitation and reasons for the Lazarus phenomenon are discussed.

Methods

A literature search in Medline, PubMed, Embase, Google Scholar and Google from 1982 to 2009 was carried out for the terms “Lazarus phenomenon”, “cessation of cardiopulmonary resuscitation and return of spontaneous circulation (ROSC)”, “spontaneous return of circulation (SROC)”, “resuscitation and spontaneous defibrillation”, “spontaneous recovery and cardiopulmonary resuscitation”. Related secondary literature which was cited in the relevant articles was included as well as publications found in our personal literature base.

Results

More than 10,000 articles and comments could be recovered and of these 45 were considered to be medically relevant articles (letters to the Editor, abstracts, case reports and literature reviews).

Conclusions

In the relevant medical literature, the Lazarus phenomenon is a rare occurrence. It seems to be a phenomenon which has often been described in non-medical literature but not published in medical literature. The pathophysiological mechanisms are poorly understood. In the literature several mechanisms are discussed which could be important for this phenomenon, e.g. autopositive end-expiratory pressure, hyperventilation and alkalosis, hyperkalemia, delayed action of drugs and unobserved minimal vital signs. In the literature it is recommended that patients should be passively monitored for at least 10 min after cessation of resuscitation. However, more scientific experimental investigations seem to be necessary to gain a better understanding of this phenomenon.     

Useful benchmarks to evaluate outcomes after esophagectomy and pancreaticoduodenectomy

BACKGROUND: Multiple publications have suggested that outcomes after complex operations are better at high-volume centers. However, of all the potential "outcomes" to measure, only mortality has been studied extensively. The broadest difference in mortality between low- and high-volume centers has been measured after esophagectomy (EG) and pancreaticoduodenectomy (PD). If a low-volume center recorded high mortality, then a broader set of outcomes beyond mortality would be useful for self-assessment. METHODS: Two single-surgeon prospective databases for outcomes of EG and PD were reviewed in a multispecialty clinic within a tertiary-referral, resident-training hospital. Between January 1996 and December 2002, 174 consecutive patients underwent EG performed by 1 surgeon (25 cases/y), and 232 consecutive patients underwent PD performed by another surgeon (34 cases/y). We measured hospital and 30-day mortality rate, mean operation time (OR time), mean estimated intraoperative blood loss (EBL), mean length of stay (LOS), and the anastomotic leak rate. These outcomes were compared with those of recently published cases for EG and PD. RESULTS: Mortality for both operations was zero. After EG, OR time was 394 minutes (literature = 336), EBL was 204 mL (literature = 964), transfusion rate was 3.5% (literature = 34%), LOS was 11.1 days (literature = 16.6), leak was 2.9% (literature = 9.1%), and reoperation was 1.7% (literature = not stated). After PD, OR time was 450 minutes (literature = 431), EBL was 382 mL (literature = 1,183), transfusion rate was 7.3% (literature = not stated), LOS was 11.2 days (literature = 17.8), leak was 6.5% (literature = 9.9%), and reoperation was 0.4% (literature = 3.8%). CONCLUSIONS: These 2 single-surgeon series provide benchmarks to help better define acceptable outcomes after EG and PD. This assessment demonstrated lower mortality and LOS in a high-volume surgical practice. These outcomes are not associated with OR time but with lower EBL, less need for transfusion, and lower need for reoperation. Anastomotic leaks occurred in both series; however, this was not associated with mortality because of early recognition and the use of nonsurgical minimally invasive techniques. If mortality is high at a low-volume center, then the additional benchmarks of this study, in addition to mortality and LOS, could be used to lower mortality through self-assessment by identifying specific outcomes that need improvement.     

Appraisal of the quality of assessment of memory in anesthesia and psychopharmacology literature

To test the hypothesis that there are important differences between studies on memory published in anesthesia literature and those published in the psychopharmacology literature, we compared the two from the period January 1978 through May 1988 to identify deficiencies in the design and methodologies used and to provide guidelines for future experiments. Eight-eight articles in each discipline were reviewed. The sample sizes were larger in the articles in anesthesia journals than in those in psychopharmacology journals (medians 52.5 vs. 18 subjects, respectively). Most (85%) of the studies in the anesthesia literature used patients, who had a median age of 38.9 yr and included a median of 28 women among the subjects per study. In contrast, the majority (60%) of the studies in the psychopharmacology literature used healthy volunteers, who had a median age of 23.6 yr and included a median of only 3.5 females among the subjects per study. Characteristics more common in the psychopharmacology than in the anesthesia literature, respectively, were use of a control or placebo group (90% vs. 42%), double-blind design (80% vs. 47%), use of pre- and posttreatment memory measurements (64% vs. 23%), use of multiple memory tests with distinct equated stimuli (83% vs. 8%), relation of methodology to some theoretical model of memory (72% vs. 17%), and use of other behavioral tests (68% vs. 48%). Relative to the psychopharmacology literature, the anesthesia literature used pictures as stimuli for the memory tests more often (44% vs. 14%, respectively) and words less often (11% vs. 67%) and relied heavily on questions about recall of perioperative events (41% vs. 0%). There is room for improvement in both types of literature, and more so in the anesthesia literature.     

Stump appendicitis: case report and review

The purpose of this study is to review the medical literature regarding the prevalence of appendicitis in patients with previous appendectomy. Stump appendicitis is a real entity not often considered when evaluating patients with right lower quadrant pain and a history of appendectomy. This leads to delays in diagnosis and treatment. An extensive review of the world literature using Medline, MD Consult, and the references of articles found using these methods to gather information regarding stump appendicitis. Results showed 29 cases of stump appendicitis have been reported in the world literature. Herein we review the literature as well as present a case study. Stump appendicitis is a real, yet probably underreported entity. It can occur after either laparoscopic or open appendectomy. Avoidance of a long appendiceal stump is the only suggested means by which to avoid its occurrence.     

Twenty years of trauma:Psychological Abstracts 1970 through 1989

The present study represents an objective assessment of the growth in trauma literature, and of the thematic trends which have been part of its historical evolution. For these purposes a systematic, manual search ofPsychological Abstracts from 1970 to 1990 was conducted to identify literature on trauma-related topics. Fifteen hundred and ninety-six (1596) citations between 1970–1990 were identified, and a trend showing increasing numbers of trauma publications was in evidence. This increase was most apparent in literature involving war- and sexual abuse-related traumatization, but not in publications about natural and technological disaster. These findings reflect a dynamic and growing field, and will provide an important benchmark for assessing the changing status of the PTSD literature.     

Focal myositis - a new presentation.

This article is a case report and review of literature of a very rare condition, not previously written in general surgical literature, including a new presentation Copyright 2000 Harcourt Publishers Ltd.     

Metachronus splenic metastasis of colon cancer. A case report

Colon cancer metastases rarely involve the spleen; in the literature only 29 cases of isolated splenic metastasis of colon cancer are reported (9 in the English literature and 29 in the Japanese literature). In this paper, a further case of isolated splenic metastasis in a 73 year- old woman, treated six years before with left emicolectomy for a mucinous colon cancer (Dukes B) is reported. A survey of the English literature shows that most of the cases had a significant period between the first original resection and the diagnosis of spleen metastasis (2-11 years). Splenectomy was performed in all the cases reported. No long-term follow-up has been published; therefore, it is not possible to define if spleen metastases of colon cancer have a better clinical behaviour than hepatic metastases and if splenectomy can prevent metastatic spreading of the disease leading to a potential survival benefit.     

Compartment syndrome of the well leg as a result of the hemilithotomy position: a report of two cases and review of literature.

Compartment syndrome in the well leg as a complication of prolonged positioning in a hemilithotomy position is a serious complication that is rarely reported in the orthopaedic literature. A similar entity has been well described in urologic, gynecologic, and general surgery literature but, to the authors' knowledge, has been reported in only seven patients in the orthopaedic literature. The authors report two cases of unilateral compartment syndrome in a well leg during femoral nailing of the contralateral leg. Risk factors, theories of pathogenesis, and preventive measures are identified and discussed.     

Pediatric delirium in the pediatric intensive care unit: a systematic review and an update on key issues and research questions

There was a dearth in awareness and knowledge regarding pediatric delirium (PD) at the pediatric intensive care unit (PICU). The aim of this study is to highlight the most recent and up-to-date findings of current literature -by means of a systematic review (SR) method-, and to present the key issues and research questions. A SR of the literature published between 24 March 2009 and 10 March 2011. Eight new articles were identified which included (literature) reviews, journal commentaries, and observational studies. There still is a dearth of literature on PD, with also a variable level of evidence (1b - 5), especially in relation to critical illness. To be able to further clarify PD in the PICU, additional research questions are provided for future research.     

Subtrochanteric fracture: a rare but severe complication after screw fixation of femoral neck fractures in the elderly

Cannulated screw fixation is a minimal invasive technique to treat undisplaced femoral neck fractures. It is the preferred method in elderly patients who often suffer co-morbidities. There is scarce literature on subtrochanteric femoral fracture as a complication of cannulated screw fixation of a femoral neck fracture. This complication occurred, without an adequate trauma, in two of 35 patients (5.7%) in this retrospective study of patients older than 65 years (mean age: 77 years) who were treated with cannulated screws for an undisplaced femoral neck fracture between 2004 and 2009. We reviewed the literature for the incidence of this complication and possible predisposing factors. The overall incidence reported in literature is 2.4-4.4% (mean: 2.97%). Despite a broad use of this type of osteosynthesis, the literature does not provide clear biomechanical or clinical indications for optimal screw placement to avoid this complication. Considering the literature and our personal results, surgeons should be aware of this severe complication; they may opt for a different implant in the very old, osteoporotic patient with an undisplaced femoral neck fracture.     

Traumatic aorto-right ventricular fistula with aortic insufficiency

We present a case of a traumatic aorto-right ventricular fistula coexistent with aortic insufficiency due to perforation of the left coronary leaflet, which is a lesion rarely described in the literature. We compare our experience with reports from the literature.     

How good is the orthopaedic literature?

Randomized trials constitute approximately 3% of the orthopaedic literature Concerns regarding quality of the orthopaedic literature stem from a widespread notion that the overall quality of the surgical literature is in need of improvement. Limitations in surgical research arises primarily from two pervasive issues: 1) A reliance on low levels of evidence to advance surgical knowledge, and 2) Poor reporting quality among the high level surgical evidence that is available. The scarcity of randomized trials may be largely attributable to several unique challenges which make them difficult to conduct. We present characteristics of the orthopaedic literature and address the challenges of conducting randomized trials in surgery.     

Review of the brachial plexus. Part I: Acute injuries

Acute injuries of the brachial plexus are open or closed, and occur by compression, traction, sharp laceration, or missile injuries. Following initial resuscitation, a proper evaluation and treatment plan must be formulated. A review of the literature showed an obvious trend away from conservative treatment of many brachial plexus lesion toward an early, aggressive surgical approach to these injuries. An extensive literature review also provided the opportunity to devise a rational classification of brachial plexus injuries, which allows for a treatment regimen that reflects the trend of the recent literature.     

La luxation métatarsophalangienne du gros orteil: variété plantaire. À propos d’un cas

Plantar dislocation of the metatarsophalangeal joint of the great toe is a rare injury. We report the third example in the literature, detailing the anatomy, the mechanism of the injury, and the radiographic diagnosis with a review of the literature.     

Primary angioleiomyosarcoma of the lesser omentum

Primary omental leiomyosarcomas are rare intra-abdominal tumours. A few cases only have been reported in the literature. We present a case of a 79-year old woman, whose tumour was surgically removed. We include a hort review of the literature.     

Successful heparin desensitization: a case report and review of the literature

Immediate hypersensitivity reactions to heparin have been described in the literature. Moreover, heparin remains the anticoagulant of choice in cardiopulmonary bypass. We describe a patient with heparin allergy who underwent successful heparin desensitization and a review of the literature.     

Sclerosing sertoli cell tumor of the testis--a case report and review of the literature.

To date, only I I cases of sclerosing Sertoli cell tumors have been reported in the literature, representing a distinctive subtype of Sertoli cell tumor in humans. We present a 12th case with a review of the current urological and pathological literature.     

Neuroanesthesiology update

With a focus on landmark investigations, common themes, and unique and innovative contributions to the literature, we provide a synopsis of the 2011 literature pertaining to general advances in neurosurgical procedures and perioperative care and anesthetic management of neurosurgical patients.