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Leiomyomas are common benign tumours that can arise in any anatomical structure containing smooth muscle. Their localization in the uterine round ligament is rare, although leiomyomas are the most frequent tumour of this structure. Leiomyomas present as inguinal, labial or intra-abdominal masses, and are often misdiagnosed as hernias or enlarged lymph nodes. The aim of the present study was to describe a rare case of a large intra-abdominal mesenchymal neoplasm arising from the right round ligament of the uterus. A 51-year-old asymptomatic female patient (gravida 3, para 3) presented herself for a routine gynaecological examination. A transvaginal ultrasound examination revealed a solid heterogeneous mass with a maximum diameter of 9 cm localized at the right parametrial space. Further preoperative evaluation using magnetic resonance imaging revealed that the mass contained solid and cystic components, which was suggestive of a mesenchymal neoplasm with possible involvement of the right ovary. Complete excision of the tumour and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed via laparotomy under general anaesthesia. The intraoperative findings, frozen section biopsies and final histological examination of the tumour established the diagnosis of an intra-abdominal myoma of the right uterine round ligament. The majority of abdominal round ligament myomas are initially asymptomatic. The role of synchronous imaging examinations, such as ultrasonography and magnetic resonance imaging, in the diagnosis of these lesions is crucial.

The outburst of plastic pollution in terrestrial ecosystems poses a potential threat to agriculture and food safety. Studies have already provided evidence for the uptake of plastic microparticles by several plant species, accompanied by numerous developmental effects, using fluorescence labelling techniques. Here, we introduce the implementation of confocal Raman spectroscopy, a label-free method, for the effective detection of microplastics (MPs) accumulation in the roots of a common edible root vegetable plant, Raphanus sativus, after treatment with acrylonitrile butadiene styrene (ABS) powder. We also demonstrate the concomitant occurrence of phenotypic defects in the polymer-treated plants. We anticipate that this work can provide new insights not only into the extent of the impact this widespread phenomenon has on crop plants but also on the methodological requirements to address it.

Background Free air after laparoscopic hysterectomy is a common finding; in rare cases, free air represents gastrointestinal perforation, requiring emergency laparotomy. Ectopic air localizations after pneumoperitoneum have been reported in various laparoscopic surgical techniques. Delayed diagnosis of visceral perforation is associated with high mortality rates. Case presentation We present a white Caucasian female in which dysphonia due to air entrapment in the cervical area, pneumomediastinum and pneumothorax, occured afterlaparoscopic hysterectomy. Conclusions Upon mobilization of the patient, air from sigmoid perforation moved cephalad. Through the same path, pneumoperitoneum, causes subcutaneous emphysema in the neck and face, pneumomediastinum and pneumothorax.

Cystic lymphangiomas are uncommon benign lesions extremely rare in the adult population. Most cases are found in the neck and axillary regions; while

This study aimed to investigate the impact of the COVID-19 disruption on university students, namely pre-service teachers from an Early Years Learning and Care Department in Greece. The study was conducted by the end of the third month of higher education lockdown and online shift, a period which coincides with the completion of the online courses for the spring semester and students’ preparation for the long-distance exams. It was based on probing students’ reflections on the impact that the COVID-19 pandemic had on their perceptions and behavior. Α questionnaire with open-ended and closed-ended questions was designed and was filled in by 127 students of the specific Department online. The questions explored: (a) the degree to which the pandemic disruption experience affected students’ perceptions and actions regarding their social roles, the organization of social life, and the management of personal time; (b) the skills they consider as most important in order for someone to respond more effectively to the new reality, including their learning practice and expertise; (c) the benefits and concerns they attached to the new learning and teaching conditions. The results show that the students were urged to have an immediate and quick response to the implications of the current situation due to its novel and intense character. There had been some shifts concerning students’ way of thinking and acting but none of the students who participated in the study was led to perspective transformation. Findings imply the need for cultivating a learning environment that supports the practicing of strategies and the development of skills that can help learner’s transformation when necessary and reinforce resilience. Article visualizations

Context: A lot of parents whose children are overweight or even obese are in no position to accurately acknowledge the real weight of their children. Parents' perception of their children's weight plays a significant role in the prevention and treatment of childhood obesity. Aims: This paper describes parents' opinions on the real weight status of their children and the sufficiency of quality nutrients in their diet. Settings and Design: The research methodology used in the particular study was based on survey research in preschool settings in West Greece. Methods and Material: The research methodology used in the particular study was based on survey research. Data were collected through questionnaires answered by parents of children attending preschool settings aged between two and five. One hundred and seventy-eight children and their parents participated. All parents had been informed of the aim of the study beforehand and gave their consent on condition that they could withdraw at any stage they wished. Statistical Analysis Used: Data were analyzed using SPSS (Statistical Package for the Social Sciences). Results: Comparing the Body Mass Index of children with the parents' opinion of their children's weight, we noticed 85,71% and 78,13% of the parents whose children were obese and overweight respectively, regarded their weight as normal. The majority of the overweight and obese children's parents were of the opinion that their children's diet was proper and healthy. Conclusions: Most parents whose children were obese or overweight underestimated the real weight of their children and considered their nutrition healthy.

Liver ischemia/reperfusion injury may significantly compromise hepatic postoperative function. Various hepatoprotective methods have been improvised, aiming at attenuating IR injury. With ischemic preconditioning (IPC), the liver is conditioned with a brief ischemic period followed by reperfusion, prior to sustained ischemia. Ischemic postconditioning (IPostC), consisting of intermittent sequential interruptions of blood flow in the early phase of reperfusion, seems to be a more feasible alternative than IPC, since the onset of reperfusion is more predictable. Regarding the potential mechanisms involved, it has been postulated that the slow intermittent oxygenation through controlled reperfusion decreases the burst production of oxygen free radicals, increases antioxidant activity, suppresses neutrophil accumulation, and modulates the apoptotic cascade. Additionally, favorable effects on mitochondrial ultrastructure and function, and upregulation of the cytoprotective properties of nitric oxide, leading to preservation of sinusoidal structure and maintenance of blood flow through the hepatic circulation could also underlie the protection afforded by postconditioning. Clinical studies are required to show whether biochemical and histological improvements afforded by the reperfusion/reocclusion cycles of postconditioning during early reperfusion can be translated to a substantial clinical benefit in liver resection and transplantation settings or to highlight more aspects of its molecular mechanisms.

To evaluate the susceptibility of high-density polypropylene mesh to contamination, 1 year after experimental hernia repair.Wistar rats were randomized into two groups: one experimental group (n = 20) and another control group (n = 10). Mesh hernia repair was performed with intra-abdominal (group I, n = 10) or subcutaneous (group II, n = 10) implantation of grafts. The three groups were exposed to an intra-abdominal E. coli administration after 1 year of operation. After 24 hr, the meshes and peritoneum were sampled from the experimental and control groups, respectively, in order to assess bacterial inoculation. Immunoreaction to E. coli inoculation was also evaluated after 24 hr by measuring serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels.Bacteriological analysis revealed increased contamination in groups I and II when compared with the control group (p = .001 and .007, respectively). IL-6 levels were increased in both groups I and II compared with the control group, 24 hr after E. coli injection (p = .034 and .022, respectively), while there was no statistically significant difference between groups concerning the concentration of CRP.Polypropylene mesh is vulnerable to bacterial inoculation during intra-abdominal sepsis 1 year after mesh placement.

AIM Primary ovarian non-Hodgkin's lymphoma is a very rare disease. Median age at diagnosis is estimated at 42 years, something that leads to fertility preservation issues in many cases. This was a case report study, presenting a rare case of bilateral primary ovarian non-Hodgkin's lymphoma. CASE REPORT A 38-year old nulliparous woman, underwent exploratory laparotomy because of bilateral ovarian masses. Left salpingooophorectomy, partial omentectomy and excision of an ovarian mass of the right ovary was performed. Great effort in order to preserve healthy ovarian tissue of the right ovary as well as the right fallopian tube was given, due to fertility reasons. Final histology showed bilateral diffuse large B-cell primary ovarian non-Hodgkin's lymphoma. Postoperatively, the patient underwent chemotherapy with the CHOP regimen in combination with rituximab. Five years after initial diagnosis, the patient remains well with normal menstrual cycle, without evidence of recurrence. DISCUSSION Fertility preservation issues in some cases of rare gynecological malignancies could be managed via minimally invasive oncological approach.

Churg-Strauss syndrome or eosinophilic granulomatosis with polyangiitits (EGPA) is a rare multisystem disorder. A case of anaphylactic shock after induction of anesthesia, as the initial clinical presentation of Churg-Strauss syndrome in a 15-year-old girl is reported. It is extremely rare to see pediatric patients with previous perioperative anaphylaxis receiving future anesthesia; a multidisciplinary approach including allergist, rheumatologist, anesthesiologist, and surgeon is necessary in order to provide a better future anesthetic plan.

PURPOSE: In placentas from uncomplicated pregnancies, Hofbauer cells either disappear or become scanty after the fourth to fifth month of gestation. Immunohistochemistry though, reveals that a high percentage of stromal cells belong to Hofbauer cells. The aim of this study was to investigate the changes in morphology and density of Hofbauer cells in placentas from normal and pathological pregnancies. METHODS: Seventy placentas were examined: 16 specimens from normal term pregnancies, 10 from first trimester's miscarriages, 26 from cases diagnosed with chromosomal abnormality of the fetus, and placental tissue specimens complicated with intrauterine growth restriction (eight) or gestational diabetes mellitus (10). A histological study of hematoxylin-eosin (HE) sections was performed and immunohistochemical study was performed using the markers: CD 68, Lysozyme, A1 Antichymotrypsine, CK-7, vimentin, and Ki-67. RESULTS: In normal term pregnancies, HE study revealed Hofbauer cells in 37.5% of cases while immunohistochemistry revealed in 87.5% of cases. In first trimester's miscarriages and in cases with prenatal diagnosis of fetal chromosomal abnormalities, both basic and immunohistochemical study were positive for Hofbauer cells. In pregnancies complicated with intrauterine growth restriction or gestational diabetes mellitus, a positive immunoreaction was observed in 100 and 70% of cases, respectively. CONCLUSIONS: Hofbauer cells are present in placental villi during pregnancy, but with progressively reducing density. The most specific marker for their detection seems to be A1 Antichymotrypsine. It is remarkable that no mitotic activity of Hofbauer cells was noticed in our study, as the marker of cellular multiplication Ki-67 was negative in all examined specimens. OBJETIVO: Em placentas de gestações sem complicações, as células de Hofbauer desaparecem ou se tornam raras após o quarto ou quinto mês de gestação. Entretanto, a imunohistoquímica revela que uma alta porcentagem de células estromais pertencem às células de Hofbauer. O objetivo do presente estudo foi investigar as alterações da morfologia e densidade das células de Hofbauer em placentas de gestações normais e patológicas. MÉTODOS: Foram examinadas 70 placentas: 16 provenientes de gestações normais a termo, 10 de abortos espontâneos no primeiro trimestre, 26 de casos diagnosticados como anormalidade cromossômica do feto, e amostras de tecido placentário com complicações causadas pela restrição de crescimento intrauterino (8) ou pelo diabetes mellitus gestacional (10). Cortes corados com hematoxilina-eosina (HE) foram submetidos a estudo histológico e imunohistoquímico utilizando-se os seguintes marcadores: CD 68, lisozima, antiquimotripsina A1, CK-7, vimentina, e Ki-67. RESULTADOS: Em gestações normais a termo, o estudo HE revelou células de Hofbauer em 37,5% dos casos, enquanto a imunohistoquímica as revelou em 87,5% dos casos. Em abortos do primeiro trimestre e em casos de diagnóstico prenatal de anormalidades cromossômicas fetais, tanto o estudo básico como o estudo imunohistoquímico foram positivos para células de Hofbauer. Em gestações complicadas pela restrição de crescimento intrauterino ou pelo diabetes mellitus gestacional, imunoreação positiva foi observada respectivamente em 100 e 70% dos casos. CONCLUSÕES: As células de Hofbauer estão presentes nos vilos placentários durante a gestação, embora com densidade progressivamente reduzida. O marcador mais específico para sua detecção parece ser a antiquimotripsina A1. Vale salientar que atividade mitótica de células de Hofbauer não foi detectada em nosso estudo, uma vez que o marcador de multiplicação celular Ki-67 foi negativo em todas as amostras examinadas.

Introduction Total thyroidectomy has been the treatment of choice for patients with malignant thyroid disease. However, the efficacy and safety of this procedure for patients with benign disease is still a matter of debate. The aim of this study is to show that total thyroidectomy can be safely performed for both malignant and benign disease. Material and methods A retrospective study on 216 patients was conducted. Once an indication for surgery was established, our single surgical treatment was total thyroidectomy. Age, sex, nature of thyroid disease, final pathology and postoperative complications were recorded. Results For both benign and malignant disease, total thyroidectomy resulted in no permanent laryngeal nerve injury and no permanent hypoparathyroidism. Temporary laryngeal nerve palsy occurred in 0.9% and 3% of patients with benign and malignant disease respectively (p = 0.245). Six percent of patients with benign and 10.0% of patients with malignant thyroid disease suffered temporary hypoparathyroidism (p = 0.280). Immediate reoperation for postoperative hemorrhage was performed in 1.7% of patients with benign disease and in 1.0% of patients with malignancy with an uneventful outcome (p = 0.650). Conclusions When performed by surgeons experienced in endocrine surgery, total thyroidectomy may be considered as the treatment of choice for both malignant and benign thyroid disease requiring surgical treatment. Total thyroidectomy virtually eliminates the requirement of completion thyroidectomy for incidentally diagnosed thyroid carcinoma and significantly reduces the rate of reoperation for recurrent disease, as it provides an immediate and permanent cure for all benign thyroid diseases, with a low incidence of postoperative complications.

The aim of our study is to assess the effect of extrahepatic ipsilateral portal vein branch ligation in hepatectomies conducted under selective hepatic vascular exclusion with sharp transection of the liver parenchyma. Twenty-six patients (Group A) underwent major hepatectomy from January 2007 to December 2009, and hemostasis was achieved by ligation of the ipsilateral portal vein branch in addition to suture ligation of the cut surface vessels. A control group (Group B) was composed of 26 matched patients picked from our hospital's database, in which hemostasis was achieved by suture ligation of the cut surface vessels only. Warm ischemia time, intraoperative blood loss, blood transfusions, and liver function were compared. Reduced blood loss (450 vs 680 mL, P = 0.03), less transfusions (8 vs 20% of the patients, P = 0.04), and decreased warm ischemia time (34 vs 42 minutes, P = 0.04) were observed in Group A. Extrahepatic ligation of the ipsilateral portal vein branch is simple, safe, and effective in reducing blood loss and warm ischemia time in major hepatectomies performed under selective vascular exclusion.

AIM Oxidative stress has been implicated in lung injury following ischemia/reperfusion and resection of the liver. We tested whether alleviating oxidative stress with iron chelation could improve lung injury after extended hepatectomy. METHODS Twelve adult female pigs subjected to liver ischemia for 150 min, 65-70% hepatectomy and reperfusion of the remnant liver for 24 h were randomized to a desferrioxamine (DF) group (n = 6) which received i.v. desferrioxamine to a total dose of 100 mg/kg during both ischemia and reperfusion, and a control (C) group (n = 6). We recorded hemodynamic and respiratory parameters, plasma interleukin-6 and malondialdehyde levels, as well as liver malondialdehyde and protein carbonyls content. Total non-heme iron was measured in lung and liver. Pulmonary tissue was evaluated histologically for its nitrotyrosine and protein carbonyls content and for superoxide dismutase (SOD) and platelet-activating factor acetylhydrolase (PAF-AcH) activities. RESULTS Reperfusion of the remnant liver resulted in gradual deterioration of gas-exchange and pulmonary vascular abnormalities. Iron chelation significantly decreased the oxidative markers in plasma, liver and the lung and lowered activities of pulmonary SOD and PAF-AcH. The improved liver function was followed by improved arterial oxygenation and pulmonary vascular resistance. DF also improved alveolar collapse and inflammatory cell infiltration, while serum interleukin-6 increased. CONCLUSION In an experimental pig model that combines liver resection with prolonged ischemia, iron chelation during reperfusion of the remnant liver is associated with improvement of several parameters of oxidative stress, lung injury and arterial oxygenation.

Iron-deficiency anaemia (IDA) is a common problem all over the world, which mainly attacks pregnant women, infants and children. The main objectives were to assess the prevalence of IDA in children 12-24 months old in the area of Thessalia located in the central part of Greece and to identify, by means of a simple questionnaire, its nutritional risk factors. The research was applied as a cross-sectional and case-control study. In the first part of the study, the haemoglobin (Hb) levels were estimated by a mobile photometer analyser in 938 children (approximately one-third of the total children population). In the second part, children with Hb?11 g/dl were compared with their random selected healthy controls in haematological, anthropometric and nutritional parameters. The estimated laboratory values were Hb, haematocrit, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, zinc protoporphyrin, serum iron, serum ferritin, transferring saturation, total iron binding capacity and Hb electrophoresis. Finally, 75 children (34 boys, 41 girls; mean age 17.51+/-3.5 months), who were found to have IDA, constituted the case group while 75 healthy children constituted the control group. The studied nutritional variables through the application of a standardized food frequency questionnaire were: duration of breast feeding, milk that the child drinks during the research, age of solid food introduction, child's health status according to the mother's point of view, child's appetite and frequency of bread, cereals, meat, fish, egg, legumes, chocolate, marmalade, vegetables, fruit and tea intake. The prevalence of IDA in the region was 7.99%. The carriers of b-thalassaemia (2.13%) were excluded from the study. Significant statistical difference has been observed between the two groups (P?

Introduction: Focal nodular hyperplasia is a benign liver disease usually treated conservatively. However, in the setting of a previously resected renal cell carcinoma (RCC) a liver mass with imaging characteristics of focal nodular hyperplasia (FNH) raises a surgical dilemma. Case report: Four years after an initial right nephrectomy for stage I RCC and concurrent oncocytoma, a 72 year-old Caucasian male presented with a liver lesion. Imaging studies raised a question of differential diagnosis between FNH and metastatic RCC. Given the facts, firstly that the radiological findings were suggestive of FNH, secondly that the lesion of the liver was a new finding four years post-resection of the RCC and third that co-existence of FNH and metastatic disease have been reported but the age and sex of the patient were not compatible with the epidemiology of FNH the patient underwent liver resection. Histopathological findings were consistent with FNH and nests of malignant cells compatible with RCC were found in the lesion.

Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms “anesthetic,” “anesthesia,” “liver,” “hepatectomy,” “inflow,” “outflow occlusion,” “Pringle,” “hemodynamic,” “air embolism,” “blood loss,” “transfusion,” “ischemia-reperfusion,” “preconditioning,” was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed.

Administering neuraxial anesthesia to a patient with an underlying neurological disease and a combination of four other pathological disorders can be challenging. We report in this paper the case of a 45-year-old woman with neurological deficit due to ischemic brain infarct, multiple sclerosis, antiphospholipid syndrome, andβ-heterozygous thalassemia that was subjected to abdominal hysterectomy and bilateral salpingoophorectomy under epidural anesthesia for ovarian cancer.

Permanent or temporary hypoparathyroidism may be a debilitating result of radical cervical surgery, as noted most commonly following thyroid or parathyroid surgery. However, it can also be the outcome of any surgical procedure involving bilateral extensive manipulation of the anterior neck triangle, especially in order to ensure oncologically adequate surgical margins. We report our experience of three patients that underwent parathyroid immediate autotransplanation following extensive surgical manipulations of the neck region for oncological reasons. PTH levels were restored to normal by the fourth postoperative week, allowing us to wean the patients off calcium and vitamin D3 supplementation, which was attributed to full autograft function. Parathyroid autotransplantation, immediate or delayed, is a simple and safe technique which should be considered by the surgeon whenever there is a high risk for postoperative hypoparathyroidism following radical operations of the neck for oncological reasons.

Currently, albumin dialysis is the most widely used nonbiological liver support system. We hypothesized that direct peritoneal albumin exposure in the peritoneal cavity would stabilize blood flow and prevent liver and brain injury, in the same way that had previously been seen with extracorporeal albumin dialysis systems.Fourteen Landrace pigs (weight 25-30 kg) underwent 70% right hepatectomy and were randomly assigned into a control (C, n = 7) and an intraperitoneal albumin treated group (A, n = 7). The systemic, cerebral, and pulmonary hemodynamic parameters of the animals were recorded at 0, 6, 9, and 12 hr following reperfusion of the liver remnant.Mean arterial blood pressure, cardiac output, and stroke volume were significantly higher in group A at the end of the experiment. Significantly higher mean intracranial pressure (ICP) values were observed in group C compared to group A, both at 9 hr (21.3 ± 5.2 versus 14.1 ± 3.5 mmHg, p.0005) and 12 hr (23 ± 4.3 versus 11 ± 3.5 mmHg, p.0005). On the contrary, cerebral perfusion pressure (CPP) remained stable in albumin-treated groups after the sixth postreperfusion hour. Mean pulmonary artery pressure and pulmonary vascular resistance (PVR) were significantly lower in group A compared to group C at 12 hr, while pulmonary capillary wedge pressure (PCWP) stabilized in albumin-treated animals.This study provides the first evidence that intraperitoneal albumin may be able to attenuate systemic, pulmonary, and cerebral hemodynamic disturbances associated with acute liver failure.

The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery. Significant progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic surgery. However, leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic resection. Various strategies have been employed in order to manage pancreatic fistula. Nonetheless high grade pancreatic fistula evokes controversy in relation to the choice of treatment. A Medline search was performed, with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade C. Pancreatic fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative death. Many authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures, while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical interventions. There is no agreement on the best clinical management of severe pancreatic fistula after pancreatic surgery. Completion pancreatectomy is reserved for patients not improving with conventional measures.

Background The liver presents a remarkable capacity for regeneration after hepatectomy but the exact mechanisms and mediators involved are not yet fully clarified. Erythropoietin (EPO) and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) have been shown to promote liver regeneration after major hepatectomy. Aim of this experimental study is to compare the impact of exogenous administration of EPO, GM-CSF, as well as their combination on the promotion of liver regeneration after major hepatectomy. Methods Wistar rats were submitted to 70% major hepatectomy. The animals were assigned to 4 experimental groups: a control group (n = 21) that received normal saline, an EPO group (n = 21), that received EPO 500 IU/kg, a GM-CSF group (n = 21) that received 20 mcg/kg of GM-CSF and a EPO+GMCSF group (n = 21) which received a combination of the above. Seven animals of each group were killed on the 1st, 3rd and 7th postoperative day and their remnant liver was removed to evaluate liver regeneration by immunochemistry for PCNA and Ki 67. Results Our data suggest that EPO and GM-CSF increases liver regeneration following major hepatectomy when administered perioperatively. EPO has a more significant effect than GM-CSF (p < 0.01). When administering both, the effect of EPO seems to fade as EPO and GM-CSF treated rats have decreased regeneration compared to EPO administration alone (p < 0.01). Conclusion EPO, GM-CSF and their combination enhance liver regeneration after hepatectomy in rats when administered perioperatively. However their combination has a weaker effect on liver regeneration compared to EPO alone. Further investigation is needed to assess the exact mechanisms that mediate this finding.

Ischemic preconditioning is one of the therapeutic interventions aiming at preventing ischemia/reperfusion-related injury. Numerous experimental studies and a few clinical series have shown that during liver resections, ischemic preconditioning is a promising strategy for optimizing the postoperative outcome. Moreover, various types of pharmacological intervention as well as different types of preconditioning, such as remote preconditioning, the use of heat shock, and hyperbaric oxygen, have been developed to attenuate the functional impairment accompanying ischemia/reperfusion injury. This review summarizes the various forms of preconditioning, thus suggesting that close cooperation between surgeons and anesthesiologists paves the way to apply novel strategies to improve the outcome of liver resection.

Gastric glomus tumors are rare mesenchymal tumors of the gastrointestinal tract. We describe a 72-year-old patient who presented with episodes of melena and was subsequently investigated for a tumor of the antrum of the stomach. Surgical resection revealed a 2 × 2 × 1.7 cm well circumscribed submucosal tumor, extending into the muscularis propria. The histopathologic examination of the specimen demonstrated a glomus tumor of the stomach. We discuss the preoperative investigation, the diagnostic problems and the surgical treatment of the patient with this rare submucosal lesion.

To the Editor: We report herein a case of Horner syndrome following bolus low dose epidural analgesia for labor and vaginal delivery. Although benign and transient, Horner syndrome may be distressing for the patient and confusing on diagnostic approach. A 27-year-old, 68-kg, 161-cm, ASA I primagravida presented in labor at 39 weeks of gestation. Epidural analgesia was provided upon request when the cervix was dilated to 4 cm. With the patient positioned in the left lateral decubitus position, a 18-gauge Tuohy needle was inserted at the L3–L4 intervertebral space; the epidural space was found using the loss-of-resistance technique. A polyamide catheter was easily introduced and placed at the 11-cm catheter mark. A test dose of 2.5 ml 2 % lidocaine was injected. After catheter placement the patient was turned supine with left uterine displacement and was given 8 ml ropivacaine 0.2 % and 50 lg fentanyl. A sensory block to T9 was established a few minutes later. Thirty minutes from the epidural bolus, the patient complained of numbness over the right side of her face and heaviness in her right eyelid. On physical examination, the patient was awake and alert. No signs of hypotension, bradycardia, or desaturation were observed. Right-sided ptosis and miosis were noted; there were no other sensory or motor deficits, and further neurological examination was unremarkable. During this period, fetal monitoring showed no decelerations or bradycardia. Forty minutes after the initial epidural injection, the patient’s symptoms were completely resolved and labor progressed. The same initial bolus dose was repeated and was given in small increments over a 10-min period under close monitoring. Right-sided Horner syndrome developed once again and resolved after approximately 40 min. During the same time, labor progressed uneventfully with vaginal delivery of a healthy male infant. As the patient requested further pain control for perineotomy repair, she was repositioned and then given 5 ml lidocaine 2 %. This dose was effective and was not associated with the development of Horner syndrome. In this case there was no evidence of excessive blockade. Pregnancy venous congestion resulting in decreased epidural compliance and Valsalva maneuver during labor is not always the cause of Horner syndrome, as the same symptoms following low dose epidural infusions have been described in male adults [1] and the pediatric population [2], as well as in trauma patients [3]. An autonomic-like explanation would seem more logical. The true mechanism of this complication may not yet have been discovered. Anesthesiologists, gynecologists, and personnel attending labor should be aware of this rare and confusing complication to reassure the patient and guide their practice according to the patient’s safety and satisfaction.

Although the mortality rate after abdominal aortic aneurysm rupture approximates 90% despite the urgent management, a few cases of chronic rupture and delayed repair have been reported in the world literature; anatomic and hemodynamic reasons occasionally allow for the fortunate course of these patients. We report in this article the case of 76-year-old man with a ruptured abdominal aortic aneurysm who was transferred to our facility 4 weeks after his initial hospitalization in a district institution and who finally had a successful open repair.

Alpha-methyldopa has been demonstrated to be safe for use during pregnancy and is now used to treat gestational hypertension. In pregnancy, alpha-methyldopa-induced autoimmune hemolytic anemia does not have typical features and the severity of symptoms ranges from mild fatigue to dyspnea, respiratory failure, and death if left untreated. A case of alpha-methyldopa-induced autoimmune hemolytic anemia in a 36-year-old gravida 2, para 1 woman at 37+6weeks of gestation is reported herein along with the differential diagnostic procedure and the potential risks to the mother and the fetus.

The diagnosis of intestinal obstruction in pregnancy is difficult, as the symptoms may mimic pregnancy-associated complaints. The surgical management is challenging, as the mortality rate of midgut volvulus in pregnancy is high. We report the case of a 35-year-old woman at 21 weeks and 5 days of gestation with small bowel obstruction who presented to our institution with a 24 h history of colicky abdominal pain and nausea and who finally had a successful open repair.

Bien que le taux de mortalite apres rupture d'anevrysme aortique abdominal approche 90% en depit du traitement en urgence, quelques cas de rupture chronique et de cure retardee ont ete rapportes dans la litterature mondiale ; des raisons anatomiques et hemodynamiques permettent de temps en temps une evolution favorable chez ces patients. Nous rapportons dans cet article le cas d'un homme de 76 ans avec un anevrysme aortique abdominal rompu transfere dans notre centre 4 semaines apres son hospitalisation initiale dans un etablissement local et qui a finalement eu une reparation ouverte reussie.

IntroductionLiver trauma is a critical condition that requires swift multidisciplinary approach. In complex hepatic injuries perihepatic packing is an established life-saving procedure. The aim of this study is to evaluate and highlight the value of absorbable mesh wrapping of the injured liver, combined with ipsilateral ligation of portal vein branch.Case presentationAn 82-year-old patient underwent an open cholocystectomy, for gallbladder empyema. The second postoperative day he was re-operated on due to active hemorrhage. The bleeding was controlled by suturing the bed of the gallbladder fossa. During this maneuver a portal vein branch was torn resulting in a rapidly expanding subcapsular liver hematoma which led to the formation of two deep lacerations on the liver parenchyma. This life-threatening condition was treated by wrapping an absorbable mesh around the right liver lobe and subsequently ligating the right portal vein branch extrahepaticaly.ConclusionMesh wrapping of the fragmented liver with absorbable mesh constitutes a safe and effective method, in treating grade IV and V liver injuries, especially when combined with ipsilateral ligation of the bleeding vessel.

Carcinoid tumours of the common bile duct represent an extremely rare entity. Similarly, primary follicular lymphomas of the ampulla of Vater constitute an infrequent neoplasia. Herein, we report the first case of a synchronous development of a carcinoid tumour of the common bile duct and an ampullary follicular lymphoma that was treated surgically with a Whipple's procedure, due to inability to establish definitive preoperative diagnosis despite the extensive diagnostic investigation.