A huge low-grade fibromyxoid sarcoma of small bowel mesentery simulating hyper immune splenomegaly syndrome: a case report and review of literature

Introduction

Low-grade fibromyxoid sarcoma (LGFMS) is a rare non epithelial tumour. It usually arises from the smooth muscles of the extremities. It is, however, occasionally reported to arise from other regions of the body.

Case report

We report the case of a 32 year old man who complained of a progressive abdominal swelling of 4 months duration. There was associated abdominal discomfort and weight loss. Abdominal examination revealed a non-tender intra abdominal mass filling the abdomen completely. Abdominal ultrasound suggested a massive splenomegaly. Abdomina Computerized Tomography (CT) scan was not done due to financial constraints. At laparotomy, a large, pearl-coloured mass was found within the mesentery of the proximal jejunum, with dilated, tortuous vessels. It was resected along with the overlying 60cm of jejunum. It weighed 7.5kg. Histology and immunohistochemistry confirmed the diagnosis of lowgrade fibromyxoid sarcoma. Post-operative period was uneventful and there were no features of recurrent after 2 year of follow up.

Conclusion

LGFMS may cause a diagnostic dilemma, especially in a third world setting where preoperative diagnosis is hampered by lack of facilities and poverty. A high index of suspicion is needed for preoperative diagnosis, which is necessary for proper planning of the operation.     

Effect of wound infiltration with bupivacaine on pulmonary function after elective lower abdominal operations

Background

Subcutaneous or intrafascial wound infiltration of local anaesthetic with systemic opioids has been shown to enhance patient comfort with improved analgesia and reduced opioid requirements.

Objective

To demonstrate improved pulmonary function when postoperative analgesia was provided by combined bupivacaine wound infiltration and systemic opioid.

Methods

In a prospective, randomized, placebo-controlled study, 46 patients (23 per group) scheduled for elective gynaecological surgery under general anaesthesia had subcutaneous and intrafascial wound infiltration of 40 ml, 0.25% bupivacaine (study patients) or 40 ml 0.9% saline (control) just before the end of surgery. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) were done before surgery and at 6, 12 and 24 hours postoperatively. Student''s T and chi-square tests were used for tests of significance set at P < 0.05.Postoperative analgesia was provided with intramuscular morphine 0.15mg/kg 4hourly and 10mg/kg of intravenous paracetamol as rescue analgesia.

Results

PEFR, FVC and FEV1 were reduced in both the control and study groups but the reduction was greater in the control group.

Conclusion

Bupivacaine wound infiltration produced statistically significant elevations in pulmonary function tests results at all assessment periods.     

Die proximale Humerusschaftfraktur als Komplikation nach der Schlüssellochplastik

Six weeks after operative treatment of a rupture of the long head of biceps brachii using keyhole tenodesis on the left arm in a man 69 years old a fracture of the upper arm happened. The reason seems to be the localization of keyhole osteotomy being probably to much distal.     

Ocular and cerebral metastases in the VX2 rabbit tumor model: contrast- enhanced MR imaging

Ocular and cerebral metastases developed after the inoculation of a VX2 tumor cell suspension into the internal carotid artery of 15 rabbits. The hematogenous spread of tumor cells resulted in ocular metastases in 13 of 15 animals (86.7%) and cerebral system metastases in 14 of 15 animals (93%). Magnetic resonance (MR) imaging with Gd-DTPA demonstrated early disruption of the blood-ocular barrier and blood-brain barrier 5-7 days after infusion of tumor cells. Quantitative assessment of contrast enhancement revealed a mean increase in signal intensity of 145% +/- 51% in the anterior chambers, 102% +/- 70% for choroidal metastases, and 51% +/- 29% for central nervous system (CNS) metastases. These results indicate that contrast-enhanced MR imaging can be used to demonstrate a loss of blood-ocular barrier integrity that is similar to the breakdown of the blood-brain barrier associated with metastatic tumors to the CNS and eye.     

Zur Endemiefrage der Papillome

Zusammenfassung Für das Bundesland Steiermark mit einer Bev?lkerung von 1,2 Millionen wurde die Morbidit?tsrate an sogenannten gutartigen Blasenpapillomen festgestellt. In den Industriebereichen ist eine dreifach h?here Erkrankungszahl als in l?ndlicher Umgebung nachzuweisen. Es k?nnen Vergleiche mit Luftqualit?t und Grundwasserbefunden vorgenommen werden.

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Summary In the province of Steiermark with a population of 1,2 millions the incidence of “so called” benign bladder papillomas was surveyed. In industrial areas the disease occurred three times more frequently than in rural districts. Quality of water and air in relation with this pattern is discussed.

     

Operationen an Hirn und Rückenmark mit dem CO2-Laser

Zusammenfassung Der CO₂-Laser vom Typ Sharplan 791 ist dank seiner Dosierbarkeit und Fokussierbarkeit ein gut geeignetes Ger?t, um am Nervensystem des Menschen pr?zise und sicher schneiden, koagulieren und vaporieren zu k?nnen. Dies hat sich im Tierexperiment erwiesen und bei 22 Patienten best?tigt.

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Summary The CO₂-Laser model Sharplan 791 is a suitable instrument for surgery on the central nervous system. Because of its ability to focus and select the power in such an exact manner it is possible to cut, coagulate and vaporate very precisely. This has been shown in animal experiences and proven in 22 patients.