Lipogranulema of the hernia sac. Clinical case

2021 ◽  
pp. 21-29
Author(s):  
Tatyana Ilinichna Shalaeva ◽  
Roman Nikolaevich Malushenko

Lipogranulomas in surgical practice, are the most often encountered in the mammary glands, penis and facial area associated with subcutaneous injections for cosmetic purposes of various types of fillers that cause chronic granulomatous inflammation. Atypical localization occurs due to the development of reactions to foreign bodies after traumatic injuries and reactions to suture material used in surgical interventions. The article presents a clinical case of revealing a large peritoneal lipogranuloma localized in the area of the hernial sac in a patient who 7 years ago suffered from endometrial cancer and underwent extirpation of the uterus using median incision access. Subsequently, the patient was treated for a long time in an outpatient care because of the ligature abscesses with the formation of fistulas; several rough ligatures were removed from the subcutaneous tissue. Lipogranuloma, found in the wall of the hernial sac measuring 15 × 6 × 5 cm, covered from all sides with an unaltered peritoneum, contained a cystic cavity with a light fluid, thick synthetic ligatures of a braided structure were present in the cyst wall. The use of large-diameter braided non-absorbable sutures for suturing the peritoneum does not meet modern requirements for the use of suture material and can cause complications.

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.


2012 ◽  
Vol 25 (01) ◽  
pp. 42-48 ◽  
Author(s):  
S. C. Ralphs ◽  
G Coronado ◽  
D. C. Sweet ◽  
J. Ward ◽  
C. P. Bloch ◽  
...  

SummaryObjective: To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts.Study design: Ex vivo experimental study and a single clinical case report.Sample population: Four canine cadavers and a single clinical case.Methods: Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample.Results: The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens.Clinical significance: The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.Presented at the ACVS symposium during the resident seminar, Seattle, Washington,USA on October 22, 2010.


2014 ◽  
Vol 27 (01) ◽  
pp. 62-67 ◽  
Author(s):  
A. Luján-Feliu-Pascual ◽  
C. Font ◽  
J. Mascort ◽  
D. Sánchez-Masian

Summary Objectives: To describe a novel dorsal technique for stabilization of atlantoaxial sub-luxation in toy breed dogs using 3-metric nylon suture. Study: Retrospective study. Animals: Fifteen toy breed dogs with a body weight of 2 kg or less with atlantoaxial subluxation. Materials and methods: The atlantoaxial joint of each dog was surgically stabilized through a dorsal approach by placing a double strand of non-absorbable, 3-metric, nylon suture material between the dorsal muscles of the atlanto-occipital and the atlantoaxial joint muscles. Pre- and postoperative neurological status, diagnostic imaging, and complications were reviewed. Clinical follow-up examination was performed at six months. For long-term assessment, a telephone follow-up was performed. Results: No intra-operative complications were observed. Functional improvement occurred in 12 dogs. One dog did not improve and four dogs required revision surgery. In two of those four cases, suture material breakage was proven and it was suspected in the other two. Two cases underwent a second dorsal approach with the same suture material and two cases underwent a ventral approach (transarticular fixation and multiple implants embedded with polymethylmethacrylate). Conclusions: Dorsal stabilization using 3-metric nylon may be adequate as a safe, effective, and simple alternative technique for atlantoaxial stabilization in toy breed dogs of ≤1.5 kg of weight, in which the use of ventral screws and pins is challenging.


2015 ◽  
Vol 22 (3) ◽  
pp. 78-83
Author(s):  
A. P Pozdeev ◽  
E. A Zakhar’yan ◽  
D. S Buklaev ◽  
I. N Krasnogorskiy ◽  
T. F Zubairov

Idiopathic osteolysis is a rare disorder characterized by spontaneous, massive and progressive resorption of bone tissue. Massive osteolysis results from proliferation of blood and lymphatic vessels with thin walls, resembling capillaries, in the bone and surrounding soft tissues. Literature review on this problem and clinical case of a patient successfully operated on using the technique elaborated at our clinic are presented. Surgical interventions enabled to achieve the restoration of tubular bones integrity and ensured conditions for independent patient’s movement. Possibility of the performance of reconstructive surgical interventions for the restoration of limb weight bearing ability that is reasonable to combine with bisphosphonate therapy.


2021 ◽  
pp. 160-166
Author(s):  
A. F. Nasretdinov ◽  
A. V. Sultanbaev ◽  
K. V. Menshikov ◽  
Sh. I. Musin ◽  
N. I. Sultanbaeva ◽  
...  

Hormone therapy currently open up the prospect of long-term, comfortable and relatively low-toxic treatment for patients with hormone receptor – positive advanced breast cancer. For a long time, the presence of visceral metastases prompted oncologists to abandon hormone therapy in favor of cytostatic agents. Now days, even in the presence of visceral metastases, clinical guidelines allow use of modern hormonal therapy in the absence of a visceral crisis. In particular, the so-called CDK 4/6 inhibitors, presented on the Russian market by drugs: palbociclib, ribociclib and abemacyclib, became the drugs that significantly improved the  results of  hormone therapy. Each of  them has demonstrated its effectiveness in  clinical trials; moreover, there are lots of clinical cases demonstrating the benefits of this therapy in real clinical practice. The article presents a clinical case of treatment of advanced hormone receptor-positive breast cancer. The effectiveness of treatment with CDK 4/6 inhibitors has been demonstrated, a comparatively analysed with the data obtained in the course of clinical trials. The analysis of the tactics of treatment of cytomegalovirus infection of the cornea during therapy with ribociclib was carried out. 


Author(s):  
А.В. Серёжкина ◽  
И.Г. Хмелевская ◽  
Н.С. Разинькова ◽  
Т.А. Миненкова ◽  
И.И. Жизневская ◽  
...  

Поскольку непосредственные этиологические факторы аномалии развития не известны, в работе выделены основные группы причин, способствующих формированию пороков развития головного мозга. Большое значение отводится ранней диагностике пороков развития, которая позволяет своевременно решить вопрос о возможности пролонгирования беременности, что определяется видом порока, совместимостью с жизнью и прогнозом в отношении постнатального развития. В исследовании рассматриваемого порока развития большую роль играют такие современные методы, как пренатальная ультразвуковая диагностика, нейросонография, рентгеновская компьютерная и магнитно-резонансная томография головного мозга, имеющие достаточно высокую информативность. Указаны сроки гестации, позволяющие выявить структурные дефекты головного мозга. Медико-генетическое консультирование помогает выявить риск появления больного потомства. Проведена дифференциальная диагностика семилобарной с другими формами голопрозэнцефалии. Также отмечены возможные клинические проявления рассматриваемой нозологии. В данной статье представлен клинический случай семилобарной голопрозэнцефалии, диагностированной у мальчика в возрасте 1 месяц. При поступлении мать предъявляла жалобы на срыгивания и периодическое беспокойство сына. Объем и результаты обследования ребенка изложены ниже. Выявлена сопутствующая патология в виде пупочной грыжи, врожденной аномалии развития мочевой системы: подковообразная почка; водянки яичек и головчатой формы гипоспадии. После проведения курса поддерживающей терапии пациент был выписан в стабильном состоянии. В настоящее время специфическое лечение голопрозэнцефалии отсутствует. Оперативные вмешательства на головном мозге проводятся редко ввиду тяжести состояния больных, в связи с чем лечение данной патологии возможно только с помощью хирургической коррекции симптомов. Длительная дыхательная и кардиоваскулярная дисфункция предопределяет летальный исход заболевания. Since the direct etiological factors of developmental abnormalities are not known, the main groups of causes contributing to the formation of brain malformations are identified in the work. Great importance is given to the early diagnosis of malformations, which allows us to timely resolve the issue of the possibility of prolonging pregnancy, which is determined by the type of defect, compatibility with life and the prognosis for postnatal development. In the study of the considered malformation, such modern methods as prenatal ultrasound diagnostics, neurosonography, X-ray computer and magnetic resonance imaging of the brain, which have a sufficiently high informative value, play an important role. The terms of gestation are indicated, which make it possible to identify structural defects of the brain. Medical and genetic counseling helps to identify the risk of the appearance of sick offspring. The differential diagnosis of semilobar with other forms of holoprosencephaly was carried out. Possible clinical manifestations of the nosology under consideration are also noted. This article presents a clinical case of semilobar holoprosencephaly diagnosed in a boy at the age of 1 month. Upon admission, the mother complained of regurgitation and periodic anxiety of her son. The scope and results of the child's examination are set out below. Concomitant pathology was revealed in the form of an umbilical hernia, a congenital abnormality of the development of the urinary system: a horseshoe kidney; dropsy of the testicles and a cephalic form of hypospadias. After a course of maintenance therapy, the patient was discharged in a stable condition. Currently, there is no specific treatment for holoprosencephaly. Surgical interventions on the brain are rarely performed due to the severity of the patients ' condition, and therefore, the treatment of this pathology is possible only with the help of surgical correction of symptoms. Prolonged respiratory and cardiovascular dysfunction determines the fatal outcome of the disease.


2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S47-S47 ◽  
Author(s):  
Alvaro Ibarra ◽  
Juan Donaire ◽  
Carolina Behnke ◽  
Alberto Salas ◽  
Camila Sanhueza

Abstract Introduction Cystic neutrophilic granulomatous mastitis (CNGM) is a form of breast lobulocentric granulomatous inflammation characterized by cystic spaces of dissolved lipid, surrounded by neutrophils. Corynebacterium is frequently the etiological agent, specially C kroppenstedtii. It is often painful and can simulate malignancy by clinical and imaging features. Clinical Case A 36-year-old woman, three pregnancies with puerperal mastitis in all. Consults by increase in left breast volume, painful, 1-month evolution, with erythema and not quantified fever. With antibiotherapy, erythema resolved, but the mass persisted. Ultrasound showed a 28-mm right nodule and extensive left architecture distortion, hypoechogenic, poorly delimited, which compromised superior quadrants, both BIRADS 4. Bilateral core biopsies had typical findings of CNGM, with bacteria inside cysts, identified with HE, which were Gram positive. The cultures gave Corynebacterium, typified as tuberculostearicum by MALDI-TOF methodology, with antibiotic multisensitivity. After 6 weeks of evolution, the last two with ciprofloxacin, on the left the mass had decreased, with 3-cm periareolar collection. Right lesion fistulized on the biopsy path. Conclusions We present a case of bilateral cystic neutrophilic granulomatous mastitis with clinical and imaging features suspected of malignancy. After 6 weeks of evolution, the last two with ciprofloxacin therapy, she had reduction of volume of the larger lesion and fistulization contralateral. She would probably require in its management, in addition to surgery to resolve the fistula, use of lipophilic antibiotics and corticosteroids.


2019 ◽  
Vol 12 (7) ◽  
pp. e229388
Author(s):  
Zhe Chen ◽  
Masayuki Araya ◽  
Hiroshi Onishi

We report the first clinical case on the successful use of proton beam therapy in the management of malignant transformation of intracranial epidermoid cyst. A 43-year-old man was initially diagnosed as this disease with left facial paresis, hypesthesia and hypoalgesia in the territories of the trigeminal nerve. After failure of surgical interventions, he was referred to our radiation centre. We performed a postoperative proton beam therapy for treatment. We delivered a total dose of 57 GyE in 31 fractions. He tolerated the treatment well with mild acute toxicities and remained healthy and functional by 2-year follow-up postradiotherapy. No evidence of delayed radiation-induced neurotoxicity was observed.


1999 ◽  
Vol 12 (02) ◽  
pp. 78-80 ◽  
Author(s):  
A. Miller ◽  
W. M. McKee

SummaryMaintaining adequate tension when knotting large diameter monofilament sutures can be challenging, especially without surgical assistance. A self-locking knot is described for lateral fabellotibial suture stabilisation of the canine cranial cruciate ligament deficient stifle. The self-locking knot enables maintenance of tension during tying and the knot can be tied by an unassisted surgeon. The inherent ability of the knot to maintain tension on the fabellotibial suture is due to the first throw of the knot creating a locking-loop effect. Increasing the tension on the suture material is readily achieved by applying traction on the free ends and tightening the first throw of the knot to remove the slack created. When the suture is tightened sufficiently four additional square throws are applied to the knot.A self-locking knot is described for lateral fabellotibial suture stabilisation of the canine cranial cruciate ligament deficient stifle. The inherent ability of the knot to maintain tension on the suture material is due to the first throw of the knot creating a locking-loop effect. Tension on the knot can be readily adjusted and the knot may be tied by an unassisted surgeon.


2019 ◽  
Vol 12 (3) ◽  
pp. e227510
Author(s):  
Cláudia Santos ◽  
Ana Virgínia Araújo ◽  
Helena Contente ◽  
Cláudia Branco

Granular cell tumours are rare neoplasms that may occur anywhere in the body. The most common locations are the oral cavity, skin and subcutaneous tissue, with only 8% of these tumours occurring at a gastrointestinal site. In the specific case of gastric granular cell tumours, only a few cases have been published until today. Granular cell tumours are usually benign; however, some malignant forms have been reported. Both endoscopic and surgical resection represent the treatment of choice. The authors report a new clinical case of a gastric granular cell tumour, treated with laparoscopic surgical resection, describing some endoscopic, imagiological and anatomopathological features.


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