The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
Gastric neuroendocrine carcinomas are rare and have a poor prognosis. The present case concerns with a 55 year old female who presented with complaints of recurrent vomiting on and off, hematemesis and weight loss and history of lumbar stenosis. Esophagogastroduedenostomy (EGD) showed a large ulcerated growth in the antrum. Computed tomography abdomen revealed an ill defined soft tissue density in the gastric antrum, a partial gastrectomy was performed. Microscopic evaluation revealed a neuroendocrine neoplasm. Immunohistochemically positive for Chromogranin A and Non Specific Enolase (NSE). A diagnosis of Neuroendocrine carcinoma of the stomach was given based on recent WHO classification of Neuroendocrine carcinoma of the stomach and on mitotic index with reference to grading scale.
Abdominal Wall Endometrioma: A Diagnostic Enigma—A Case Report and Review of ...KETAN VAGHOLKAR
Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the
gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.
Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving
rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an
incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed
clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of
this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion.
Clinical evaluation confirmed by supportive imaging is diagnostic.Wide local excision is the mainstay of treatment.
Gastric neuroendocrine carcinomas are rare and have a poor prognosis. The present case concerns with a 55 year old female who presented with complaints of recurrent vomiting on and off, hematemesis and weight loss and history of lumbar stenosis. Esophagogastroduedenostomy (EGD) showed a large ulcerated growth in the antrum. Computed tomography abdomen revealed an ill defined soft tissue density in the gastric antrum, a partial gastrectomy was performed. Microscopic evaluation revealed a neuroendocrine neoplasm. Immunohistochemically positive for Chromogranin A and Non Specific Enolase (NSE). A diagnosis of Neuroendocrine carcinoma of the stomach was given based on recent WHO classification of Neuroendocrine carcinoma of the stomach and on mitotic index with reference to grading scale.
Abdominal Wall Endometrioma: A Diagnostic Enigma—A Case Report and Review of ...KETAN VAGHOLKAR
Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the
gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.
Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving
rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an
incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed
clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of
this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion.
Clinical evaluation confirmed by supportive imaging is diagnostic.Wide local excision is the mainstay of treatment.
Abstract— Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal system. A case of 40 year old man having tense tender abdomen with obliterated liver dullness and shifting dullness was presented in emergency, it was further investigated on X rays, where pneumoperitoneum was found. This case was then decided to go for Laparatomy after routine investigations to further explore. On exploratory laparatomy, diffuse peritonitis with brown coloured fluid was observed. A 10 x 5 x 7 cm mass was found having an opening communicating with the gut lumen was present around 10 cm from the ligament of treitz. However, no adjacent structures, liver or parietal peritoneum seemed to be involved. Gross examination of the specimen revealed an outward bulging mass, which was centrally necrotic and contained hemorrhagic-necrotic material. On histo-pathological examination, features suggestive of gastrointestinal stromal tumor (GIST) with mixed spindle and epitheoid pattern was seen. Mitoses were slightly increased (<5 /> HPFs) leading to the conclusion of LOW GRADE GIST with tumor free margins of gut (R0 resection). So it was a case of Gastrointestinal stromal tumors (GIST), which is a rare medical presentation. So it was decided to report this case as a rare case presentation.
Stromal fibroepithelial polyps are benign lesions with slow-growing that appears in male and female. Those tumors are often asymptomatics and usually are diagnosed in obese patients as a mass in the genital area. Symptoms can appear depending on their location in the urinary tract or genitalia. For diagnosis, we normally use ultrasound, blood markers of testicular cancer, magnetic resonance imaging, and computed tomography scan. The treatment is surgical excision and the pathologist confirms the diagnosis with the presence of epidermal hyperplasia over a stroma of fibrous tissue, without dysplasia, usually with the presence of mucus and edema with a polymorphonuclear infiltrate at the chorion. The presence of acute vasculitis and abscess areas can be associated. The early diagnosis and treatment are important to despite the pseudosarcomatoid variant, metaplastic carcinoma and the association with the Beckwith–Wiedemann syndrome in neonates.
Information about Obstructed Recto Sigmoid Malignancy by Dr Dhaval Mangukiya.
Details of introduction of obstructed recto sigmoid malignancy, Epidemiology, Pathophysiology, Complications, Early Presentation, Stools, History, Late Presentation, Diagnosis, Imaging, Contrast enema, Screenig, Treatment, Management, Surgical management, Surgical options etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsemualkaira
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsuppubs1pubs1
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Abstract— Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal system. A case of 40 year old man having tense tender abdomen with obliterated liver dullness and shifting dullness was presented in emergency, it was further investigated on X rays, where pneumoperitoneum was found. This case was then decided to go for Laparatomy after routine investigations to further explore. On exploratory laparatomy, diffuse peritonitis with brown coloured fluid was observed. A 10 x 5 x 7 cm mass was found having an opening communicating with the gut lumen was present around 10 cm from the ligament of treitz. However, no adjacent structures, liver or parietal peritoneum seemed to be involved. Gross examination of the specimen revealed an outward bulging mass, which was centrally necrotic and contained hemorrhagic-necrotic material. On histo-pathological examination, features suggestive of gastrointestinal stromal tumor (GIST) with mixed spindle and epitheoid pattern was seen. Mitoses were slightly increased (<5 /> HPFs) leading to the conclusion of LOW GRADE GIST with tumor free margins of gut (R0 resection). So it was a case of Gastrointestinal stromal tumors (GIST), which is a rare medical presentation. So it was decided to report this case as a rare case presentation.
Stromal fibroepithelial polyps are benign lesions with slow-growing that appears in male and female. Those tumors are often asymptomatics and usually are diagnosed in obese patients as a mass in the genital area. Symptoms can appear depending on their location in the urinary tract or genitalia. For diagnosis, we normally use ultrasound, blood markers of testicular cancer, magnetic resonance imaging, and computed tomography scan. The treatment is surgical excision and the pathologist confirms the diagnosis with the presence of epidermal hyperplasia over a stroma of fibrous tissue, without dysplasia, usually with the presence of mucus and edema with a polymorphonuclear infiltrate at the chorion. The presence of acute vasculitis and abscess areas can be associated. The early diagnosis and treatment are important to despite the pseudosarcomatoid variant, metaplastic carcinoma and the association with the Beckwith–Wiedemann syndrome in neonates.
Information about Obstructed Recto Sigmoid Malignancy by Dr Dhaval Mangukiya.
Details of introduction of obstructed recto sigmoid malignancy, Epidemiology, Pathophysiology, Complications, Early Presentation, Stools, History, Late Presentation, Diagnosis, Imaging, Contrast enema, Screenig, Treatment, Management, Surgical management, Surgical options etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsemualkaira
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsuppubs1pubs1
Splenosis is anuncommenprocess ofintra abdominal or extra abdominal splenic tissue seeding, mostly post traumatic.The issueof splenosismostly comesupinpatientspresentingwith suspicious nodules inthe abdominal or chest cavity. It is exactly these patients with a history of blunt abdominal trauma who should be considered as candidates for having splenosis and should be screened with a proper medical history and with the use of novel non invasive imaging modalities thus sparing the patients unnecessary and potentially dangerous procedures.
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Laparoscopic Natural Orifice Specimen Extraction (NOSE) Total Colectomy with ...semualkaira
The benefit of laparoscopic surgery in terms of
reduced pain and fewer cosmetic problems is not always obvious,
and surgeons continue to seek the best ways to limit incision trauma and improve outcomes in laparoscopic colorectal surgery
Inverted Meckel’s Diverticulum: A Rare Cause of Chronic Anaemiasubmissionclinmedima
Meckels diverticulum (MD) are vestigial remnants of the omphalomesenteric duct found in the ileum in 1-2% of people. Rarely, MD can become inverted into the lumen of the small bowel and be a cause of anemia, intussusception, and abdominal pain.
Cysts of the mesentery are among surgical rarities and of varied aetiology with variable presentations and
this has surgical implications in the pediatric age group. They may be derived from the gastrointestinal
tract, the genitourinary system, previous inflammation (pseudocysts) or malignant cystic tumours, but the
commonest cause is generally considered to be a congenital lymphatic cyst. The clinical presentation is not
characteristic and in addition, the preoperative imaging although suggestive is not diagnostic. In most
cases, the diagnosis is confirmed after surgical exploration and removal of the cyst. A case report of a
baby aged 6 months is being reported. Hope that this information will reinforce the diagnostic and
treatment strategy
Mesenteric cystic lymphangioma is an uncommon, slowly growing tumor derivate from lymphatic vessels, which is rarely found
as an intra-abdominal masses usually located in small bowel mesentery. A two year old girl was presented in our service because of abdominal pain, recurrent vomiting and back pain. In the regional hospital an ultrasound has revealed a supravesical mass. We repeated an ultrasound followed by abdominal MRI which showed a cyst 12x7 cm without infi ltration aspect. We planned surgery within 3 days but this girl was returned in our service a day later because of severe pain and abdominal distention making surgery an emergency.She underwent to intervention and a large cystic formation was removed and send to pathology service. Follow up was unrevealed. The
response of pathology was compatible with a mesenteric cyst lymphangioma Lymphangiomas’ account for 5-6% of all benign tumors in children. 50% involve the head and neck, only 10 % occurring in internal organs. 60% of these masses are present at birth. Abdominal cystic lymphangioma are very uncommon. Almost 90% are detected by the mean age of 2 years, and most occurs in the mesentery of the small bowel.They result from an embryological failure of the lymphatic system; lack of communication between small bowel lymphatic tissue and the main lymphatic vessels during fetal development result in
blind cystic lymphatic spaces lined by endothelial layers. Mesenteric cystic lymphangioma frequently affect young children and are usually symptomatic making surgery sometime emergency. The diagnosis is well established by ultrasound, CT, MRI. To prevent recurrence, complete excision of the cyst with or without intestinal resection is mandatory.
Introduction
Cutaneous metastases from abdominal malignancies are rare and have been reported in less than 5% of patients [1]. Furthermore, metastases in patients suffering from colorectal neoplasia are even rarer entity. Tan et al, among 2538 of the new cases of colorectal cancer over the period of 6 years, reported only 3 cases (0.1%) with cutaneous deposits [1]. Presentation varies from cutaneous or subcutaneous small nodules, rash or large fungating lesions [1-4]. Inevitably, their presence implies the disease progression, and poor prognosis with the reported survival between 1 to 34 months [2,3,5].
We report a case of an elderly patient who initially was thought to present with a simple skin infection. Subsequently, the patient was diagnosed with the moderately differentiated mucinous adenocarcinoma and required the right hemicolectomy. This case highlights that a high index of suspicion is recommended in an unresolving skin erythema.
Omental torsion: a rare cause of acute abdomenKETAN VAGHOLKAR
Torsion of the greater omentum is one of the rare causes of acute abdomen. However with an increase in the incidence of obesity in urban population there is a steady increase in the incidence of this rare and deceptive abdominal condition. The attending surgeon needs to be aware of this condition especially when confronted with an obese patient presenting as an acute abdomen. The paper reviews the etiopathogenesis and management of this rare condition.
Colonic incarceration in an adult umbilical hernia: case report and review of...KETAN VAGHOLKAR
Umbilical hernia is one of the commonest ventral hernias constituting ten percent of all hernias. It affects obese individuals and has a high recurrence rate if repaired by suture techniques. Incarceration of the colon in an umbilical hernia is quite rare. A case of colonic incarceration in an umbilical hernia is presented to highlight the diagnostic and technical challenges in managing such a hernia. Contrast enhanced computerized tomography is essential to ascertain the contents. Open surgery is the main stay of treatment especially in such rare cases. A combined tissue and mesh repair provides excellent results.
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football athlete experienced acute posterior leg pain while pushing off on the line of scrimmage. Ultrasound (US) showed a midsubstance plantaris tendon rupture, an injury that, to our knowledge, has only been described once before in the medical literature [1]. US was also used to assist with rehab progression and return to previous level of activity, which was achieved three weeks after the injury. While there currently are no guidelines regarding return to sport after this injury, this case demonstrates that once pain is controlled and ROM restored, progression through rehabilitation and return to elite level sport is simply based on symptoms.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
Kratom is an herbal product that is derived from Southeast Asian Mitragyna speciose tree leaves [1-10]. This compound is used for many purposes such as stimulation, euphoria, or analgesia [1-10]. It has been recently identified as a drug of abuse by the United States Drug Enforcement Administration [2,8]. Side-effects from this compound have not been well documented. We describe a case of a 36-year-old female who develop nephrotoxicity after taking an herbal supplement. She took kratom as an adjunctive therapy for back pain management. She developed right upper quadrant pain and nausea. Laboratory tests showed elevated liver enzymes without evidence of bile duct obstruction. Liver enzymes normalized several weeks after Kratom discontinuation. We advise clinicians to be vigilant about Kratom’s hepatotoxic potential on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with
suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical,hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using SPSS version 21.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Open Journal of Surgery
SCIRES Literature - Volume 3 Issue 1- www.scireslit.com Page - 025
ABSTRACT
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher
predominance in males. Although it is a common finding in children, diagnosis of an esophageal duplication in adults is rare. Following
ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all
gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least
common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication
cysts are commonly located in the distal third of the esophagus. Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient
presenting with an esophageal duplication cyst with a brief literature review.
Keywords: Esophageal cyst; Esophageal duplication
INTRODUCTION
Duplication of the gastrointestinal tract is observed in 1 of 25,000
deliveries [1]. Although diagnosis in children is common, esophageal
duplication is a very infrequent entity in the adult [1]. Esophageal
duplication can happen in two different modalities: cystic in 80% of
the cases, and tubular in 20% [2]. A literature review carried out by
Arbona, et al found a total of 91 cases reported worldwide [3].
The pathophysiology of the disease starts during the 5th
to 8th
week
of embryological development, when there is a failure in vacuolar
coalescence form the esophageal secretions [3,4]. Mediastinal cysts
can be classified as esophageal duplications if they are located near
the esophageal wall and if they are covered by two muscle layers,
with squamous, columnar, cuboid, or pseudostratified epithelium.
Esophageal duplication cysts occur in the lower third esophagus
in 60% of the cases [3]. Esophageal cysts in adults are often
incidental findings, and it has been described that they are usually
more symptomatic in older ages. Furthermore, the appearance of
complications such as intracystic hemorrhage, perforation, infection,
and squamous metaplasia is greater with age [5,6].
In adults, the esophageal duplication cysts often present as
asymptomatic, however; in some cases, symptoms depend on
the location and size of the cyst. In adults, the most common
symptoms include dysphagia, abdominal pain, and chest discomfort
secondary to compression. Less frequent symptoms are bleeding,
lymphadenopathy, difficulty breathing, and weight loss. Diagnosis
of an esophageal duplication cyst is established with a thoracic
Computed Tomography (CT), an Upper Gastrointestinal Series
(UGI), and a Transesophageal Echocardiography (TEE) [7]. However,
in order to evaluate the content of the cyst and differentiate between
the solid and liquid components, the Endoscopic Ultrasound (EUS)
is the most useful tool for diagnosis [8].Magnetic Resonance Imaging
(MRI) can also play an important role in diagnosis, especially when
trying to differentiate between an esophageal cyst and mediastinal
tumors, and to delineate the anatomic relationships of the cyst to
adjacent structures [3,7]. In all cases, the gold standard for treatment
is the surgical resection by thoracotomy or videothoracoscopy [9-11].
CASE PRESENTATION
We present the case of a 41-year-old male patient, with an
unremarkable medical history. The chief complaint started 3 months
before admission, and it was characterized by occasional dysphagia
to solids that progressed to dysphagia to liquids. He also presented
with hyporexia, sitophobia, asthenia, and weight loss. The initial
workup suggested the presence of esophageal stenosis. Therefore,
it was decided to perform an Esophagogastroduodenoscopy (EGD)
that showed proximal esophageal dilation with distal stenosis (Figure
1). After the EGD, a panendoscopy was performed, and revealed an
abscess on the distal 2/3 of the esophagus, that required endoscopic
drainage.Furthermore,abiopsywastakenfromthesiteofthestenosis.
The histopathologic report revealed an esophageal adenocarcinoma.
A new CT scan showed the presence of a cystic structure of 117 x 57
x 59 mm in size, located in the posterior mediastinum, close to the
esophageal wall. The cyst was composed by its own walls and they did
not communicate with adjacent structures. The CT scan also revealed
multiple hepatic lesions with solid characteristics (Figure 2).
Altogether, these results led to the diagnosis of an esophageal
duplication cyst, accompanied by stage IV esophageal cancer that was
causing esophageal stenosis. Due to the diagnosis, the patient was not
eligibleforresectivesurgery,however;thepersistenceofsymptomsled
to the performance of palliative surgery. An exploratory laparotomy
with an anterior gastrotomy, retrograde dilation of the distal part of
the esophagus and the esophagogastric junction, with placement of
endoprosthesis (Figure 3) was carried out. The patient had a favorable
evolution and tolerated food at the 4th
day after surgery and was
discharged afterwards.
DISCUSSION
The diagnosis of an esophageal duplication cyst is incidental in
approximately 37% of the cases [12]. In adults, the most frequent
symptoms are dysphagia and chest pain. Also, it has been described
that the most common location for esophageal duplication cysts is at
the posterior mediastinum. It is important to consider that the cyst
topography is of greater importance than its volume, due to the risk of
compression to adjacent and vital structures [3]. Cysts located in the
superior mediastinum may produce more compression symptoms
Figure 1: Upper Gastrointestinal Series
Dilation of the medial and proximal esophagus, with concentric stenosis in the
distal third of the esophagus and the gastroesophageal junction.
3. Open Journal of Surgery
SCIRES Literature - Volume 3 Issue 1- www.scireslit.com Page - 026
than those located in the middle and lower areas. However, dysphagia
only occurs if the esophageal lumen is being considerably compressed
by the cyst [13]. In the case presented here, the cyst was located
in the posterior mediastinum, with right predominance. It was
firmly attached to the esophagus, which could explain the patient’s
dysphagia.
Imaging studies like CT, UGI, TTE, and MRI can help to rule
out malignancy and evaluate the topographic relationships of
the lesion, in order to plan the most appropriate surgical strategy
[3,7,8]. Furthermore, esophageal endoscopy allows the evaluation
of the esophageal epithelia status, the presence of vessels, and the
transesophageal aspiration of the cyst, which has been described
as a method for both diagnosis and treatment of the disease [14].
However, it has been reported that puncture and aspiration of the
cyst through endoscopy does not provide any additional information
for diagnosis and increases the risk of cyst infection [15]. Definitive
diagnosis can only be established by the pathology evaluation of the
surgical piece. Because of the high risk of neoplastic transformation
of the epithelia, the treatment of choice for esophageal duplication
cysts is the complete resection of the lesion. This intervention is not
inherently complex, but when the cyst becomes symptomatic, it can
become dangerous. Therefore, any mediastinal lesion radiologically-
compatible with an esophageal duplication cyst, should be resected.
During the surgical procedure, the esophageal duplication cysts
should be carefully handled and removed, with preservation of
the esophageal muscles and vagus nerve. Then, the integrity of the
esophageal mucosa should be verified by insufflating a nasogastric
tube. After enucleating the cyst, it is of great importance to adequately
approximate the muscular ends of the esophagus, to avoid the
appearance of a pseudodiverticulum and postoperative dysphagia.
Some authors use the video-assisted thoracoscopy to treat these type
of lesion, as it has shown to be as effective and safe as open surgery in
the treatment of esophageal duplication cysts. It has been described
that the use of video-assisted thoracoscopy leads to a better and faster
recovery, when compared to open surgery [9]. These lesions tend
to be poorly vascularized and resection should not be complicated.
In the presented case, the lesion presented a firm adherence to the
esophagus with an accompanying finding of adenocarcinoma located
at the distal portion of the esophagus. These were determining factors
with the decision to not resect the cyst and to only alleviate the
esophageal obstruction with dilation and endoprosthesis.
CONCLUSION
The diagnosis of an esophageal duplication cyst in the adult is
rare. These have a higher predominance in males and they mainly
remain asymptomatic [3]. The esophageal duplication cysts may be
diagnosed as an incidental finding, however; depending on their
location and size, these may be associated with typical symptoms of
dysphagia, chest compression, and weight loss. Once diagnosed, even
when they are asymptomatic, esophageal cysts should be completely
resected.
Other surgical options including esophagectomy, myocutaneous
flaps and esophageal replacement procedures, is complex, and carries
significant morbidity and mortality but may be indicated as needed
[16].
In this case, the diagnosis of an esophageal duplication cyst was an
incidental finding when treating an adult with dysphagia secondary
to an esophagogastric adenocarcinoma. The present case is extremely
rare because the diagnosis of the esophageal adenocarcinoma led to
the discovery of the duplication cysts. The prevalence of two intrinsic
esophageal diseases is not common and they should always be treated
to avoid complications, or in this case; disease progression.
REFERENCES
1. Kim SK, Lim HK, Lee SK, Park CK. Completely isolated enteric duplication
cyst: case report. Abdom Imaging. 2003; 28: 12-14. https://bit.ly/2LCOpaj
2. Arbona JL, Fazzi J, Mayoral J. Congenital esophageal cysts: case report
and review of literature. Am J Gastroenterol. 1984; 79: 177-182. https://bit.
ly/2y9kJZP
3. Yeung C, MacDonald B, Gilbert S. Esophageal duplication cyst. Shackelford’s
Surgery of the Alimentary Tract. 2 Vol Set. 2019; 1: 490-495. https://bit.
ly/2Mbpt9A
4. Ikuo Watanobe, Yuzuru Ito, Eigo Akimoto, Yuuki Sekine, Yurie Haruyama,
Kota Amemiya, et al. Laparoscopic resection of an intra-abdominal
esophageal duplication cyst: a case report and literature review. Case
Reports in Surgery. 2015; 1-8. https://bit.ly/2M9xzj2
5. Zheng J, Jing H. Adenocarcinoma arising from a gastric duplication cyst.
Surgical Oncology. 2012; 21: e97-101. https://bit.ly/2K3Ghwf
6. Han IS, Kim GH, Lee SJ, Lee BE, I H, Kim YD. A case of hemorrhage of
an esophageal duplication cyst improved by endoscopic drainage. Korean J
Gastroenterol. 2017; 69: 363-367. https://bit.ly/2LEuUhA
7. Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance
imaging of mediastinal tumors. J Magn Reson Imaging. 2010; 32: 1325-1339.
https://bit.ly/2JYK9il
8. Liu R, Adler DG. Duplication cysts: diagnosis, management, and the role
of endoscopic ultrasound. Endosc Ultrasound. 2014; 3: 152-160. https://bit.
ly/2SzP110
Figure 2: Computed Tomography
A-Axial cut showing an anterior esophageal lumen with esophageal
duplication at the 5th costal level.
B-Coronal cut with reconstruction, showing a right esophageal duplication,
with left esophageal stenosis at the distal third and esophagogastric junction.
Figure 3: Surgical Procedure
Thoracolaparotomy with esophagogastric stenosis, anterior gastrostomy, and
retrograde esophageal dilation with intraluminal prothesis placement.
4. Open Journal of Surgery
SCIRES Literature - Volume 3 Issue 1- www.scireslit.com Page - 027
9. Herbella FAM, Tedesco P, Muthusamy R, Patti MG. Thoracoscopic resection
of esophageal duplication cysts. Dis Esophagus. 2006; 19: 132-134. https://
bit.ly/2May9wK
10. Noguchi T, Hashimoto T, Takeno S, Wada S, Tohara K, Uchida Y.
Laparoscopic resection of esophageal duplication cyst in an adult. Dis
Esophagus. 2003; 16: 148-150. https://bit.ly/30POYBe
11. Aldrink JH, Kenney BD. Laparoscopic excision of an esophageal duplication
cyst. Surg Laparosc Endosc Percutan Tech. 2011; 21: 280-283. https://bit.
ly/2Z88DMv
12. Cioffi U, Bonavina L, De Simone M, Santambrogio L, Pavoni G, Testori A, et
al. Presentation and surgical management of bronchogenic and esophageal
duplication cysts in adults. Chest. 1998; 113: 1492-1496. https://bit.ly/32NkIJ7
13. Banner K, Helft S, Kadam J, Miah A, Kaushik N. An ususual cause of
dysphagia in a young woman: esophageal duplication cyst. Gastrointest
Endosc. 2008; 68: 793- 795. https://bit.ly/2SAo9hK
14. Wiechowska-Kizlowska A, Wunsch E, Majewski M, Milkiewicz P. Esophageal
duplication cysts: endosonographic findings in asymptomatic patients. World
J Gastroenterol. 2012; 18: 1270-1272. https://bit.ly/2SDJ0Rg
15. Diehl DL, Cheruvattath R, Facktor MA, et al. Infection after endoscopic
ultrasound-guided aspiration of mediastinal cysts. Interact Cardiovasc Thorac
Surg. 2010; 10: 338- 340. https://bit.ly/32MZuLg
16. Gambardella C, Allaria A, Siciliano G, Mauriello C, Patrone R, Avenia N, et al.
Recurrent esophageal stricture from previous caustic ingestion treated with
40-year self-dilation: case report and review of literature. BMC Gastroenterol.
2018; 18: 68. https://bit.ly/2JLcHgm