Aim: The goal of the study is to assess the impact of the etiological and risk factors in the cases of urgent gastroduodenal ulcer.
Methods: This is a prospective study which included 67 patients selected randomly, all with urgent, life-threatening complications of the gastroduodenal ulcer, treated at the University Clinic for Digestive Surgery and the University Clinic for Gastroenterohepatology. For the purpose of the study the titer of IgG antibodies to Helicobacter pylori in serum is examined, as well as the use of NSAID and aspirin. We also tested the use of nicotine and alcohol. Besides these factors, we took into consideration the sex and the age.
Results: The serological test of Helicobacter pylori was positive in 89.6% of the cases. 31.3% used NSAID and 16.4% used aspirin. Large number, 65.7% of the patients were smokers, while 25.4% used alcohol.
With regard to the sex, 83.6% were male and 16.4% were female. The most frequent age group was the one from 41 to 60 years with 40.3% and those between 61 and 80 years of age with 35.8%.
Conclusion: The presence of Helicobacter pylori with the urgent gastroduodenal ulcer was exceptionally high, in 89.6% of the duodenal and gastric ulcers. NSAID and aspirin are factors that also influence the etiology of this disease. Smoking is a significant risk factor. Alcohol is less present, but still an important factor.
Ovarian carcinosarcomas, rare variant of ovarian carcinoma, composed of both carcinomatous and mesenchymal components, solid and/or cystic, fleshy and hemorrhagic, frequently spreading beyond the ovary, are treated with surgery and adjuvant chemotherapy according to the treatment principles of ovarian carcinomas due to the small number of reported cases and lack of randomized studies. We report a case of a 37-year-old woman with clinical signs of extremely locally advanced tumor of ovarian origin, infiltrating the lower left quadrant of the abdominal wall with necrosis of the covering skin. Prior biopsy of the left ovary and omentum confirmed poorly differentiated serous adenocarcinoma. Bulky tumor the size of a child’s head, originating from the left ovary and infiltrating into the lower left quadrant abdominal wall was debulked with wide excision of the abdominal wall and creation of wide defect of the lower left part of abdominal wall covered with Dexon mesh. After the recovery, the medial part of the defect with exposed mesh was closed with pedicled tensor fasciae latae fasciomyocutaneous flap, while the lateral part of the defect was covered with split thickness skin graft. Optimal surgical cytoreduction and adjuvant chemotherapy in case of extremely locally advanced ovarian malignant Müllerian tumor provide satisfactory recurrence-free survival period.
Andrijan Kartalov, Nikola Jankulovski, Biljana Kuzmanovska, Milka Zdravkovska, Mirjana Shosholcheva, Tatjana Spirovska, Aleksandra Panovska Petrusheva, Marija Tolevska, Marija Srceva, Vesna Durnev, Gjorgji Jota, Redzep Selmani and Atanas Sivevski
Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone.
Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours.
Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2hr, 4hr, 6hr, 12hr and 24hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001).
Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).