Search

Introduction: At the time of diagnosis, most patients with lung cancer are in an inoperable stage, with distant metastases. Most often, these patients have metastases to the brain, adrenal glands, liver, or bones. This article presents the case of a patient with non-small-cell lung cancer (NSCLC) metastases in the abdominal wall.

Acute pulmonary embolism is a cardiovascular emergency with a significant morbidity and mortality. In the last decade, attempts have been made to find prognostic markers for pulmonary embolism. We conducted a systematic review of the literature for studies that assess the relationship between the neutrophil-to-lymphocyte ratio (NLR) and disease progression in patients with pulmonary embolism. We included a total of seven studies published between 2016 and 2021, reporting on a total of 4,272 patients. The mean NLR observed in these studies was 5.93, with values ranging from 5.12 to 7.3. Elevated NLR was significantly associated with an increased rate of mortality in all studies. Furthermore, the collected data revealed a 2-to-15 times higher mortality rate in the group with NLR values higher than the mean. Due to its accessibility and the simplicity with which it can be calculated, as well as the outcomes revealed in this review, we strongly emphasize that NLR should be used more in medical practice.

Introduction: Enchondromas are benign tumors originating in the cartilaginous tissue of the hyaline gristle, rarely located in the chest wall. They sometimes undergo a sarcomatous transformation, becoming secondary chondrosarcomas.

Background: Hernia of Morgagni is one of the rarest types of diaphragmatic hernias with an incidence of 2-3%, which commonly presents with non-specific symptoms, such as flatulence or indigestion, in adults, and repeated chest infection, in children. It was first described by an anatomist and pathologist, in 1769, called Giovanni Battista Morgagni, while performing a postmortem examination on a patient who died of a head injury. Objective: We present a rare case of Morgagni hernia, discovered accidentally, due to an episode of acute cholecystitis which required immediate surgery. Material and method: The patient we are discussing about is 86 years old and admitted in our clinic with the following symptoms; abdominal pain in the left flank and periumbilical, nausea, absence of bowel movement and fever (temperature: 38 degrees Celsius) that appeared 3 days before the admission. Also the patient had multiple heart conditions under medical treatment. On examination of the abdomen we can feel the rim of the liver at the umbilical level and a tumour of approximative 15 cm diameter, painful on palpation and absent bowel movement on auscultation. As preclinical investigation the patient had laboratory tests which showed an increase in the number of WBC (22870/uL) a glucose of 177mg/dL, and a bilirubin of 1,63mg/dL. She also had a computed tomography that showed a cholecystitis in hydrops with multiple stones and thickened walls up to 8mm, and a giant diaphragmatic hernia situated retrosternal, described as a Morgagni hernia, that contains small intestine, omentum and the transverse colon. We performed a laparotomy and discovered a huge liver that reached around the umbilical area with a cholecystitis of gangrenous aspect, with areas of necrosis and liquid around it. We performed a classical anterograde cholecystectomy and approached the upper abdominal area and noticed a hole of approximate 10 cm diameter in the diaphragm that contained all the omentum, transverse colon and small intestine. We reduced the content of the hernia in the abdomen, the collapsed lung was expanded and put a thoracic drain in the remaining cavity, and closed the defect with silk sutures. Results: Due to the patient's age and heart conditions associated, after surgery she remained in ICU for 6 days. On the 7th day postoperative she was transferred in our clinic feeling much better, with regaining her bowel movement, with minimum secretions on the pleural drain. On the 10th day postoperative we removed the pleural drain, did a chest x-ray before and after the removal we discharged the patient. Conclusions: Although rare and usually asymptomatic, hernia of Morgagni sometimes requires surgery because it can lead to severe complications especially when the herniar sac contains small intestine or colon. [ABSTRACT FROM AUTHOR]

Background: While partial nephrectomy is the recommended treatment for many small renal masses (4-7cm), anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of partial nephrectomy, that's why tumor location assessment is essential to plan nephron sparing surgery or radical nephrectomy. Complete removal of the primary tumor remains the most relevant outcome of the surgical therapies and from a technical point of view partial nephrectomy is a more complex procedure than radical nephrectomy and has a higher risk of complications. Three-dimensional, volume rendered computerized tomography allows better operative planning with maximal preservation of unaffected parenchyma in the remnant kidney or radical nephrectomy. Objective: To compare the effectiveness of radical nephrectomy versus a Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) Classification of Renal Tumors in Patients who are candidates for Nephron Sparing Surgery. Material and method: We present a case of 35 years old patient that we admitted in our Clinic complaining of right lumbar pain and hematuria. On admission blood tests are normal and we perform a CT scan that describes a tumoUr located at the inferior pole of the right kidney, with some necrosis areas included, with a diameter of 49/55/55 mm, without invasion of the right kidney artery and vein, and a left atrophic kidney but with good renal function. We have a preoperative urological indication for Nephron Sparing Surgery for the right kidney, due to the CT scan description and the existence of a left atrophic kidney. The second day the patient has surgery and we decide to perform a radical nephrectomy because of the intraoperative surprise, with a tumor size of 10 cm which encompasses the entire kidney and not of almost 5,5 cm diameter described by the CT, and the presence of two lymph nodes of almost 0,5 cm around the right kidney artery and vein, and one behind the inferior cava vein. Results: After surgery patient's evolution was uneventful, without any increase of the Creatinine and Urea level, and maintaining an urine output of 1700 ml per day and we decide to discharge the patient on the 10th day post surgery. Conclusions: Although Nephron Sparing Surgery is increasingly being used with an excellent technical success rate, there are cases with complex renal masses that require Radical Nephrectomy and in our case the surgeon's decision for radical nephrectomy was the right one if we consider the postoperative histological examination which was of Bifocal Right Renal Carcinoma with Clear Cell pT1bN0. [ABSTRACT FROM AUTHOR]