ISSN / EISSN : 1392-0995 / 1648-9942
Published by: Vilnius University Press (10.15388)
Total articles ≅ 592
Latest articles in this journal
Lietuvos chirurgija, Volume 21, pp 116-122; https://doi.org/10.15388/lietchirur.2022.21.63
We present a clinical case of fetal and neonatal large sacrococcygeal teratoma. Sacrococcygeal teratoma mostly found in neonates, infant, and children below 4 years old and is more common in girls than boys. Antenatal fetus ultrasound is the main diagnostic method. Antenatal diagnosis is very important making pregnancy care plan, time and method of delivery also to prevent fetal and neonatal death. Complete excision of the sacrococcygeal teratoma, including the coccyx, remains the mainstay of treatment. Patient's birth mother gives consent for information about the patient (photograph and article) to appear in a journal article.
Lietuvos chirurgija, Volume 21, pp 92-104; https://doi.org/10.15388/lietchirur.2022.21.60
The purpose of this literature review is to discuss the most effective gestational trophoblastic disease diagnostic and treatment methods. Also, to introduce some of the novel treatment options currently being explored. A comprehensive research was carried out on scientific databases of MEDLINE and PubMed over the time period of 2014 to 2021. According to literature sources initial gestational trophoblastic disease diagnosis is multimodal: encompassing clinical features, quantitative human chorionic gonadotropin titers and pelvic ultrasonography. Pelvic magnetic resonance imaging, body computed tomography, chest radiography and angiography are the methods usually used for overall disease staging and metastases detection. The best treatment method is designated with reference to individual features of the patient and the disease. Conventional treatment consists of hysterectomy and chemotherapy; however, the use of new methods, such as directed enzyme prodrug therapy is also being attempted to cure metastasized and/or resistant gestational trophoblastic neoplasias. Most women with gestational trophoblastic disease can be successfully managed with preservation of reproductive function due to early diagnosis in the first trimester of pregnancy. It is important to identify gestational trophoblastic disease promptly and adjust specific treatment for every patient properly to minimize various complications.
Lietuvos chirurgija, Volume 21, pp 105-108; https://doi.org/10.15388/lietchirur.2022.21.61
The purpose of the study. To increase the effectiveness of surgical care for the wounded with combat trauma of the colon by studying of ballistic, morphological and functional features of the gunshot wounds. Patients and methods. A study of surgical treatment of 83 wounded with combat injuries of the colon, received in the area of anti-terrorist operation in the period from 2014–2018. For comparative analysis of treatment results, two clinical groups were formed: comparison and main. The comparison group included 42 wounded who were treated from April 2014 to February 2015 (the first and second periods of ATO), who used traditional surgical tactics. The main group included 41 wounded who were treated from March 2015 to 2018. Results. Analysis of the distribution of wounded with combat trauma by type of wound / injury revealed that the vast majority of them in both groups had shrapnel wounds – 49 (59.1%). There were 30 (36.1%) victims with bullet wounds, and 4 (4.8%) with closed injuries. The wounded patients with the battle trauma of the thick bowel by type of injury had missile wounds as a rule – 49 (59.1%). There were 30 (36.1%) patients with bullet wounds, and 4 (4.8%) with closed injuries. Most of the injuries were combined – 58 (69.9%), and with only abdominal injuries – 25 (30.1%), mostly multiple – 21 (25.3%). The great majority of the thick bowel injuries belonged to sigmoid – 32 (38.6%) and transverse colon – 21 (25.3%), which is explained by relatively large size of these parts of the intestine. Conclusions. The choice of surgical tactics and scope of surgical interventions on damaged organs and structures took into account the results of experimental study of mechanogenesis and pathomorphology of gunshot wounds of the colon, obtained in bench studies by modeling gunshot wounds on “thoracoabdominal ballistic material”.
Lietuvos chirurgija, Volume 21, pp 123-159; https://doi.org/10.15388/lietchirur.2022.21.64
The Lithuanian Society of Coloproctologists X triennial meeting with International Conference Mayo Clinic days in Vilnius, Lithuanian–Turkish session and The International Society of University Colon and Rectal Surgeons Session. Vilnius, May 12 - 13, 2022.
Lietuvos chirurgija, Volume 21, pp 109-115; https://doi.org/10.15388/lietchirur.2022.21.62
Objective. This study was designed to compare the diagnosis, treatment, and results of acute appendicitis in pregnant and non-pregnant women. Material and Methods. Women between the ages of 18 and 40 who were operated for acute appendicitis between 2015 and 2020 were included in the study. Results. There were 27 (3.8%) patients in Group Pregnant, and 679 (96.2%) patients in Group non-Pregnant. The mean WBC values in Group P and Group non-P was 16.53±2.91 and 13.99±4.31 (x103), and there was a significant difference between the groups.Mean pain symptom duration time was 3.40±1.90 in Group P and 1.91±1.34 day in Group non-P, while it was significantly longer in Group P . When the preoperative USG reports were evaluated, no significant difference was found between the groups.The diagnosis was made by MRI in 2 (7.4%) pregnant patients who non-visualized according to the USG report. In Group P, 10 patients were laparoscopic, 17 patients open; In group non-P, 153 patients laparoscopic and 526 patients were operated using open surgery technique. While the mean operation time did not differ significantly between the groups. Length of hospital stay was significantly higher in Group P with 3.48±4.26 days to 1.95±1.45 days. Conclusion. Diagnosis and treatment of acute appendicitis during pregnancy may be difficult, but with advanced radiological examinations and experienced surgeons, these difficulties can be easily overcome.
Lietuvos chirurgija, Volume 21, pp 29-33; https://doi.org/10.15388/lietchirur.2022.21.54
Acute intestinal obstruction is a common surgical emergency. Most of the time, the cause lies in the gastrointestinal track. A 19 year old boy presented with clinical features of acute intestinal obstruction and radiological features suggestive of large bowel obstruction was taken up for surgery. During evaluation we found extravasation of urine inside pelvic cavity. Exploratory laparotomy showed intraperitoneal rent in dome of urinary bladder with dense adhesion of omentum kinking the transverse colon causing acute intestinal obstruction. We were surprised to see the resolution of obstruction with excision of omental band. The bladder was repaired and he was relieved of the problem. This article is a rare example of nongastrointestinal cause for intestinal obstruction. Most of these cases are seen by a general surgeon in an emergency setting. Hence this report is to enlighten the medical caregivers about the existence of this rare entity.
Lietuvos chirurgija, Volume 21, pp 34-40; https://doi.org/10.15388/lietchirur.2022.21.55
Bladder pain syndrome/interstitial cystitis is a condition characterized by chronic pelvic and bladder pain (lasting longer than 6 months) accompanied by urinary symptoms (urinary frequency, urgency and nocturia). It can have a highly negative effect on the quality of life. The treatment of this disease is impeded by lack of understanding of its etiology. Therefore, treatment recommendations and information about their efficacy are scarce. The American Urological Association recommends a step-wise therapeutic approach starting from mere patients’ lifestyle modification to pharmacological therapy or to even more complex methods, such as intravesical botulinum toxin-A injections. We present here a case of a 60-year old woman, who presented in 2020 with tiresome symptoms characteristic to bladder pain syndrome lasting for two years. Previous treatments with antibiotics, anti-inflammatory, analgesic and anticholinergic medications were unsuccessful; urine culture was negative. During the cystoscopy in our center small bladder capacity and minute glomerulations were observed. Urodynamic tests (cystometry) were performed showing hypersensitive bladder with small capacity. Bladder hydrodistention procedure was performed twice; however the positive effects only lasted up to one month each time. Therefore, it was decided to perform an intravesical botulinum toxin-A injection into bladder trigonal area after which the patient experienced a significant relief in bladder pain, reduced urinary frequency during the day and night and improved quality of life.
Lietuvos chirurgija, Volume 21, pp 47-55; https://doi.org/10.15388/lietchirur.2022.21.57
Background. Bilateral adrenal cortical hyperplasia (ACH) is one of the rare causes of adrenocorticotropic hormone (ACTH)-independent Cushing’s syndrome (CS), where lateralization of cortisol secretion and choice of treatment techniques are challenging. Percutaneous radiofrequency ablation (RFA) is a safe and effective minimally invasive treatment for benign and malignant tumors, but it is not commonly used to treat CS in bilateral ACH. Case description. A 79-year-old patient developed ACTH-independent CS with bilateral ACH. Adrenal venous sampling (AVS) showed right sided cortisol hypersecretion. Due to serious comorbidities it was decided to perform percutaneus RFA. The procedure was successful and without any complications. Hydrocortisone replacement therapy was given to manage adrenal insufficiency after the procedure. Conclusions. Percutaneous RFA is an effective minimally invasive procedure for the treatment of cortisol producing adrenal tumors. Reduction of symptoms caused by the disease has been observed after the procedure. It is also expected that hormone deficiency developed after the procedure will be transient.
Lietuvos chirurgija, Volume 21, pp 12-20; https://doi.org/10.15388/lietchirur.2022.21.52
The developement of surgery in Vilnius and Lithuania is related to the Vilnius University Clinic of surgery founded in the middle of 1808–1809 academic year, that is more than 200 years ago and it was the first specialized clinical institution of the Grand Duchy of Lithuania. This new chapter at the Faculty of Medicine was orientated to the teaching and training of surgeons and developing their scientific approach to clinical practice. The Clinic of Surgery took over the concept of clinical education from the Clinic of Therapy which was initiated by Johan Peter Frank (1745–1821) and Joseph Frank (1771–1842) 3 years earlier. They were the founders of Vilnius medical Society as well. The concept consisted of the integration of basic theoretical knowledge into clinical skills learning. The basis of clinical training was ward round teaching on patient’s bedside, round the clock duty in the Clinic, continuous observation of patients and taking part in autopsy. Further developments of the Clinic were related to the activities of surgical professors from Western Europe, as well as highly experienced local doctors who immediately started lecturing and operating patients. These were the creators, developers and cherishers of the Clinic: Jacque Briotet (1746–1819), Johan Andreas Lobenwein (1758–1820), Johan Friedrich Niszkowski (1774–1816), Jakób Szymkiewicz (1775–1818), Konstantin Porcijanka (1793–1841). Foundation and successful operation of the surgical clinic signified a higher level in the evolution of Lithuanian clinical medicine. New concept of teaching and scientific approach to the diagnosis and surgical treatment made the clinic comparable to the European innovative medical institutions of the 19th century. The effective activities and future prospects were roughly cut off by Russian tsarist policy in 1832.
Lietuvos chirurgija, Volume 21, pp 41-46; https://doi.org/10.15388/lietchirur.2022.21.56
Keratoacanthoma is a benign skin tumour caused mainly by ultraviolet A radiation. It affects 150 out of every 100 000 people worldwide. The most common location is the face, neck, and hands. Keratoacanthoma usually affects middle-aged and older men with a fair skin phenotype. More importantly, this disease may be a complication of cutaneous cornification. Keratoacanthoma is described as a circumscribed conical prominent hyperkeratotic lesion in the literature, and the main factor provoking this complication is ultraviolet radiation. Fair skin phenotype, male sex, and older age may contribute to the development of cutaneous horn disease. Another possible complication of keratoacanthoma is squamous cell carcinoma, which is defined as a malignant composed of epidermal keratinocytes skin tumour. Squamous cell carcinoma is very similar to keratoacanthoma, but is prone to metastasis and has unclear tumour borders. Ultraviolet radiation and the treatment of keratoacanthoma by using chemotherapy are some of the main provocative factors. All three of these diseases are treated surgically. The purpose of this article is to discuss the etiopathogenesis, clinic, diagnosis, treatment of keratoacanthoma, essential complications – skin horn, squamous cell carcinoma, and a clinical case related to these diseases.