Malignant pigmented spinal nerve root schwannoma metastasizing in the brain and viscera

A 46-year-old woman suffered a meningococcal meningitis followed by a rapidly progressive lumbosacral pluriradicular syndrome. Myelography showed multiple nodules on the lumbar radices. A biopsy showed tissue with numerous Verocay-like bodies, spindle shaped and lymphocytoid cells which was diagnosed as schwannoma. There was a small group of polygonal cells with somewhat irregular and hyperchromatic nuclei. Postoperatively, she developed intracranial hypertension and died. CT scan and MRI revealed multiple occipital lesions consistent with metastases. At autopsy the cauda equina showed multiple nodular lesions with morphology comparable to the biopsy. However, pigment producing cells were also present. There were metastases with distinct morphological features in the brain, myocardium, thyroid gland and pancreas. Some consisted of pigmented, large, pleomorphic cells, others of non-pigmented, spindle-shaped and less pleomorphic cells. In this case, the diagnosis of metastasizing pigmented schwannoma is the most plausible hypothesis.     

Gastro-tracheal fistula - unusual and life threatening complication after esophagectomy for cancer: a case report

Purpose

The aim of this study is evaluate the efficacy of TachoSil^® patches in controlling suture-hole bleeding after elective infrarenal abdominal aortic aneurysm (AAA) replacement with Dacron graft.

Materials and methods

Patients undergoing elective replacement of infrarenal AAA with Dacron grafts were prospectively randomized to TachoSil^® patches (Group I) or standard compression with surgical swabs (Group II). We evaluated time to haemostasis, blood loss during the operation, blood loss after cross-clamp removal, duration of operation, drain volume, requirement for blood transfusion and surgeons rating of efficacy.

Results

Twenty patients were randomized (10 patients in each treatment Group). The mean time to haemostasis was 264 ± 127.1 s (range: 180-600 s) in Group I and 408 ± 159.5 s (range: 120-720 s) in Group II (p = 0.026); mean blood loss during the operation was 503.5 ± 20.7 cc (range: 474-545 cc) in Group I and 615.7 ± 60.3 cc (range: 530-720 cc) in Group II (p < 0.001); mean blood loss after cross-clamp removal was 26.5 ± 4 g (range: 22-34 g) in Group I and 45.4 ± 4.6 (range: 38-52 g) in Group II (p < 0.001) and mean drain volume was 116.7 ± 41.4 cc (range: 79-230 cc) in Group I and 134.5 ± 42.8 cc (range: 101-250 cc) in Group II (p = 0.034). There were no serious adverse events associated with use of TachoSil^® patches.

Conclusion

For patients undergoing aortic reconstruction with Dacron grafts, TachoSil^® patches were found to be safe and effective for the control of suture-hole bleeding.     

Gastro-tracheal fistula - unusual and life threatening complication after esophagectomy for cancer: a case report

Background  

A gastro-tracheal fistula following esophagectomy for cancer is a rare but potentially lethal complication. We report the successful surgical closure after failed endoscopic treatment, of a gastro-tracheal fistula following esophago-gastrectomy for cancer after induction chemo-radiotherapy.     

MR imaging of tuberculous spondylitis.

This case report describes a patient presenting with symptoms of progressive paresis of both legs. An X-ray of the thorax demonstrated an aspect consistent with miliary tuberculosis. Magnetic resonance imaging (MRI) of the thoracic spine revealed medullary compression. The patient underwent a laminectomy and the diagnosis of spinal epidural tuberculoma was made. The patient has been treated with isoniazid, rifampicin and pyrazinamide. After a period of six months, she made a complete recovery.     

Intracerebral hemorrhage due to cerebral amyloid angiopathy. Case report

The case is presented of a 59-year-old man with cerebral amyloid angiopathy and three consecutive hemorrhages in the occipital lobes. The clinicopathological features and the relationship to Alzheimer's dementia are discussed. The correct treatment of intracerebral hemorrhage related to cerebral amyloid angiopathy is a matter of controversy.     

Risk factors of perioperative morbimortality after laparoscopic sleeve gastrectomy: a club coelio multicenter study

Objectives: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient’s outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications.

Methods: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications.

Results: Mean age and body mass index were respectively 39 years and 41.5kg/m². Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p?=?.0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p?=?.0129).

Conclusions: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.     

Intrasacral meningeal cyst demonstrated by sacral epidurography

Summary A case of intrasacral meningeal cyst is reported in which radiculography and computed tomography were not conclusive in diagnosing the lesion. Sacral epidurography delineated the cyst very clearly and is proposed as a complementary imaging technique in lesions of the sacral canal.     

Chronic perineal pain related to sacral meningeal cysts.

Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.     

Different laparoscopic treatment modalities for splenic artery aneurysms: about 3 cases with review of the literature

Introduction: The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion.

Patients and methods: An updated literature review of the English medical literature using the following MeSH, ‘Lapaorscopic splenic artery aneurysm’, ‘laparoscopic aneurysectomy’, ‘Laparoscopic Splenic artery Aneurysm Ligation’ and ‘Laparoscopic Splenic artery aneurysm excision’ was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes.

Results: About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results.

Conclusions: Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.