Limb salvage after gas gangrene: a case report and review of the literature

Gas gangrene is a necrotic infection of soft tissue associated with high mortality, often necessitating amputation in order to control the infection. Herein we present a case of gas gangrene of the arm in an intravenous drug user with a history of intramuscular injections with normal saline in the shoulder used to provoke pain for recovery after drug induced coma. The patient was early treated with surgery and antibiotics rendering possible the preservation of the limb and some of its function. Additionally, a review of the literature regarding case reports of limb salvage after gas gangrene is presented

Artificial intelligence in surgical risk prediction

Risk prediction and stratification of short-term and long-term postoperative outcomes are growing in importance and scope of application in everyday clinical practice [...

Improving Melanoma Classification by Integrating Genetic and Morphologic Features

Boris Bastian and colleagues present a refined morphological classification of primary melanomas that can be used to improve existing melanoma classifications by defining genetically homogeneous subgroups

Time Course and Pattern of Metastasis of Cutaneous Melanoma Differ between Men and Women

Background: This study identified sex differences in progression of cutaneous melanoma. Methodology/Principal Findings: Of 7,338 patients who were diagnosed as an invasive primary CM without clinically detectable metastases from 1976 to 2008 at the University of Tuebingen in Germany, 1,078 developed subsequent metastases during follow up. The metastatic pathways were defined in these patients and analyzed using the Kaplan-Meier method. Multivariate survival analysis was performed using Cox modeling. In 18.7 % of men and 29.2 % of women (P,0.001) the first metastasis following diagnosis of primary tumor was locoregional as satellite/in-transit metastasis. The majority of men (54.0%) and women (47.6%, P = 0.035) exhibited direct regional lymph node metastasis. Direct distant metastasis from the stage of the primary tumor was observed in 27.3 % of men and 23.2 % of women (P = 0.13). Site of first metastasis was the most important prognostic factor of survival after recurrence in multivariate analysis (HR:1.3; 95 % CI: 1.0–1.6 for metastasis to the regional lymph nodes vs. satellite/in-transit recurrence, and HR:5.5; 95 % CI: 4.2–7.1 for distant metastasis vs. satellite/ in-transit recurrence, P,0.001). Median time to distant metastasis was 40.5 months (IQR, 58.75) in women and 33 months (IQR, 44.25) in men (P = 0.002). Five-year survival after distant recurrence probability was 5.2 % (95 % CI: 1.4–2.5) for men compared with 15.3 % (95 % CI: 11.1–19.5; P = 0.008) for women. Conclusions/Significance: Both, the pattern of metastatic spread with more locoregional metastasis in women, and th

Renovation and Reuse of Waste Electrical and Electronic Equipment in the Direction of Eco-Design

Nowadays there is a higher need of strict and broader legislation in waste electrical and electronic equipment (WEEE) recycling industry to reduce environmental effects of WEEE. Environmental challenges include pollution, exhaustion of natural resources, waste management and reduction of landfills. High speed in technological development in many sectors puts many products in great challenge of obsoleting almost immediately after their purchase. In particular, this is the fate for electrical and electronic equipment (EEE). They are forever-improving and incorporate state of the art innovations. This provide many benefits; however, at the same time, its expansion results in rapidly growing waste stream of WEEE. WEEE contains a combination of all these situations, including for example, batteries, plastics of quality, precious metals and toxic soldering metals. The reuse and renovation of WEEE are therefore very critical because of its significant ecological environmental impacts. Sustainable development is not a static situation, but a state of dynamic balance between human and environmental system. The current chapter explores sustainability planning and strategies such as eco-design, and design for dismantling and recycling, and what they mean for electronic products. It examines the incentives, methods and tools for sustainable electronic product design, with particular emphasis on reuse, recycling, selection of sustainable materials and processes, and lack of resources

Clear cell sarcoma of the jejunum: a case report

BACKGROUND: Clear cell sarcoma (CCS), also known as malignant melanoma of soft parts, is a rare type of soft tissue sarcoma which exhibits morphological, immunohistochemical and ultrastructural similarity with malignant melanoma. It is rarely localized in the intestine and the natural history of this tumor is not yet clear. CASE REPORT: A 49-year-old woman presented with diffuse abdominal colicky pain and vomitus over the previous seven days. An X-ray of the abdomen revealed obstruction of the small intestine. The patient underwent contrast enhanced abdominal computerized tomography (CT), which confirmed the obstruction at the jejunum and an associated circumferential wall thickening extending about 3 cm in length, causing concentric narrowing of the lumen. At laparotomy, a mass was recognized at the level of the jejunum in the small intestine, which caused almost complete obstruction of the lumen. At the point of obstruction, adhered loops of small intestine were found. A segmental small bowel resection was performed with 5 cm clear margins and its respective mesenteric lymph nodes. RESULTS: Histological examination of the specimen revealed a tumor (3×3×2cm) with epithelioid cell characteristics and eosinophilic or clear cytoplasm and focal translucent nuclei. Immunohistochemistry was positive for S100, epithelial membrane antigen (EMA) and synaptophysin. The tumor was pankeratin AE1/AE2, GFAP, HMB45 and MART-1/Melan-A negative. Twelve lymph nodes were retrieved and were free of neoplastic infiltration. Cytogenetic examination revealed translocation of the EWSR1 gene. The patient had an uncomplicated postoperative course and left the hospital seven days after her admission in good general condition. After 20 months of follow-up the patient remains asymptomatic without any clinical or radiological evidence of recurrence. CONCLUSION: CCS sarcoma can be rarely localized in the jejunum. Due to its morphological similarity to malignant melanoma, cytogenetic examination is necessary for its diagnosis. Wide resection of the tumor and its respective lymph nodes was associated with a 20-month disease free survival in this patient

Pancreatectomy for metastasis to the pancreas from colorectal cancer and reconstruction of superior mesenteric vein: a case report

<p>Abstract</p> <p>Introduction</p> <p>Tumors of the pancreatic head can infiltrate the superior mesenteric vein. In such cases, the deep veins of the lower limbs can serve as suitable autologous conduits for superior mesenteric vein reconstruction after its resection. Few data exist, however, describing the technique and the immediate patency of such reconstruction.</p> <p>Case report</p> <p>We present the case of a 70-year-old Caucasian man with a metachronous metastasis of colon cancer and infiltration of the uncinate pancreatic process, on the anterior surface of which the tumor was located. <it>En bloc </it>resection of the tumor was performed with resection of the superior mesenteric vein and reconstruction. A 10 cm segment of the superficial femoral vein was harvested for the reconstruction. The superficial femoral vein segment was inter-positioned in an end-to-end fashion. The post-operative conduit patency was documented ultrasonographically immediately post-operatively and after a six-month period. The vein donor limb presented subtle signs of post-operative venous hypertension with edema, which was managed with compression stockings and led to significant improvement after six months.</p> <p>Conclusion</p> <p>In cases of exploratory laparotomies with high clinical suspicion of pancreatic involvement, the potential need for vascular reconstruction dictates the preparation for leg vein harvest in advance. The superficial femoral vein provides a suitable conduit for the reconstruction of the superior mesenteric vein. This report supports the uncomplicated nature of this technique, since few data exist about this type of reconstruction.</p

Behavioral determinants of successful early melanoma detection

BACKGROUND. Reduced melanoma mortality should result from an improved understanding of modifiable factors related to early detection. The authors of this report surveyed newly diagnosed patients to identify differences in prediagnosis behavioral and medical care factors associated with thinner versus thicker melanoma. METHODS. In total, 566 adults with invasive melanoma completed questionnaires within 3 months of diagnosis on demographics, health care access, skin self‐examination (SSE), and physician skin examination (PSE) practices in the year before diagnosis. SSE was measured by us e of a melanoma picture aid and routine examination of some/all body sites versus none. Patient‐reported partial or full‐body PSE also was assessed. Melanoma thickness was dichotomized at 1 mm. RESULTS. Patient ranged in age from 18 years to 99 years, and 61% were men. The median tumor thickness was 1.25 mm, and 321 tumors (57%) were >1 mm thick. Thinner tumors (≤1 mm) were associated with age ≤60 years ( P = .0002), women ( P = .0127), higher education level ( P = .0122), and physician discovery ( P ≤ .0001). Patients who used a melanoma picture aid and performed routine SSE were more likely to have thinner tumors than those who did not (odds ratio [OR], 2.66; 95% confidence interval [CI], 1.48‐4.80). Full‐body PSE was associated with thinner tumors (OR, 2.51; 95% CI, 1.62‐3.87), largely because of the effect of PSE in men aged >60 years (OR, 4.09 95% CI, 1.88‐8.89). CONCLUSIONS. SSE and PSE were identified as complementary early detection strategies, particularly in men aged >60 years, in whom both partial and full‐body PSE were associated with thinner tumors. Given the high rates of physician access, PSE may be a more practical approach for successful early detection in this subgroup with highest mortality. Cancer 2012. © 2011 American Cancer Society. Physician skin examination (PSE) in the year before melanoma diagnosis is strongly associated with thinner tumors in men aged >60 years. Improving rates of PSE in this high‐risk group is likely to result in earlier detection of melanoma.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92369/1/26707_ftp.pd