Notes

Absolute and also comparative danger exams: proof for that energy of adding inner evaluations directly into types of threat belief.
Idiopathic omental infraction is a rare cause of acute abdominal symptoms that has been known with growing recurrence in the past ten years. It presents as right iliac fossa pain, and it's sometimes misdiagnosed as acute appendicitis. In this study we present a case Report of idiopathic omental infraction as a cause of acute abdomen.

A 25 year old male, presented to the casualty complaing of intermittent worsening pain in the right side of the abdomen, this symptom which mimiced the other commoner causes of acute abdomen. On further investigations he had leukocytosis, high C-reactive protein and ESR levels, A contrast computed tomography suggested acute appendicitis, In due course patient was operated after taking his consent, inside the operation 70 % of the greater omentum was necrotic with a black colour, An omentectomy was performed and he was discharged after two days with good recovery.

A right side abdominal pain is not only confined to appendeceal diseases, So other disease should be put in consideration.
A right side abdominal pain is not only confined to appendeceal diseases, So other disease should be put in consideration.
Gigantomastia is a breast disorder characterized by exaggerated rapid growth of the breasts, generally bilaterally. In some severe cases, mastectomy is required to ensure safe delivery or control disease progression or recurrence. Subsequently, most patients want to undergo breast reconstruction, including the nipple-areola complex (NAC).

Here, we report our experience with temporary banking of the NAC in a patient who underwent mastectomy for severe Gigantomastia. Each NAC was temporarily transplanted into the axilla as banking tissue for NAC reconstruction at a later date. Although the color of the NAC was slightly lighter after reconstruction, it mainly kept its original color and texture in addition to medical tattooing technique. At present, there has been no recurrence and the patient is fully satisfied with her appearance.

In this case, mastectomy was recommended because of an unbearable breast size that disturb a safety delivery, as well as respiratory and cardiac complications and skin ulcer control. Because the disease is not pathologically malignant, temporary preservation of NAC allows it to be safely used again for later nipple reconstruction.

Temporary banking of the nipple-areola complex in breast reconstruction following breast resection including NAC, would be one of good surgical options for benign breast tumors like　gigantomastia.
Temporary banking of the nipple-areola complex in breast reconstruction following breast resection including NAC, would be one of good surgical options for benign breast tumors like　gigantomastia.
Juvenile giant fibroadenoma is a rare type of fibroadenoma characterized by rapid growth of a breast tumor in an adolescent. Benign in nature, they rarely present as fungating and ulcerating tumors. Benign tumors masquerading as malignancies are surgical conundrums. No co nsensus exists yet on the management of these cases. We aim to discuss the dilemma in managing a bleeding, fungating giant fibroadenoma in an adolescent female and highlight risks of alternative therapies.

A 19-year-old lady presented with a bleeding, fungating breast mass worsened with topical herbal concoction. Examination revealed a 10 × 15 cm fungating breast mass that obliterated her nipple- areolar complex (NAC). Computed Tomography (CT) scan reported a huge heterogeneously enhancing mass 10.6 × 14.5 × 15.1 cm with loss of normal fat plane with the overlying skin but a clear fat plane with the pectoralis muscle posteriorly.

Giant breast masses that fungate and ulcerate usually indicate a sinister pathology. Traditional remedies have been reported to exacerbate growth. In cases where most of the breast parenchyma and NAC has been destroyed, it is no longer possible to proceed with breast conserving techniques. selleck chemical Breast reconstruction is crucial in adolescents and should be tailored to the patient's existing breast size as well as body habitus.

In juvenile giant fibroadenomas where breast parenchyma and NAC has been destroyed, breast reconstruction is the goal. The lack of consensus in both diagnosis and management further compounds the difficulty in dealing with this sensitive population. Awareness needs to be raised regarding negative effects related to traditional medicine.
In juvenile giant fibroadenomas where breast parenchyma and NAC has been destroyed, breast reconstruction is the goal. The lack of consensus in both diagnosis and management further compounds the difficulty in dealing with this sensitive population. Awareness needs to be raised regarding negative effects related to traditional medicine.
Pheochromocytoma is an adrenal medullary tumor of the chromaffin cells first described in 1886, remains an entity not fully discovered that case reports keep showing its diversity in clinical presentation, diagnosis methods treatment and follow up challenges.

We report the case of a 47 year old woman with complaining from abdominal pain and major weightless with a 09 cm tumor of the body of the pancreas viewed in imaging with no hormonal secretion but high levels of chromogranine A open surgery conducted that revealed the tumor to be located between the adrenal medulla and the Aorta misleading the team between an adrenal tumor or a zuckerkandl body tumor. The hemodynamic changes after manipulation of the tumor and the histopathology confirming the diagnosis of pheochromocytoma. Our main surprise was the aspect of the tumor bombing in the peritoneal cavity firstly thought to be mesenteric tumor; and the stability of the patient with no premedication until the tumor had been manipulated, enlarging the hypot complications and the main treatment is the tumor complete resection CONCLUSION The malignancy of the pheochromocytoma is no near to be reliably identified which imposes a lifetime follow up of these patients as for metastasis were described even after 40 years after diagnosis.
Portosystemic shunts associated with portal hypertension are generally treated using non-invasive procedures, with open surgery required for refractory cases. Herein, we present a case of refractory pleural fluid and ascites associated with primary biliary cirrhosis (PBC), successfully treated using a hybrid laparoscopic Inokuchi shunt procedure.

The patient was a 74-year-old woman with a history of PBC, presenting with breathing difficulty. Computed tomography revealed massive pleural fluid and ascites and engorged coronary and azygos veins, indicative of a portosystemic circulation shunt and a 3-cm wide hepatocellular carcinoma (HCC) on liver segment 2. The Child-Pugh score was 11. With the portosystemic shunt outflow considered as the cause of pleural fluid and ascites; therefore, we proceeded with a hybrid laparoscopic selective Inokuchi shunt procedure and tumor enucleation. Laparoscopically, the greater omentum was divided for devascularization, a 7-cm right subcostal skin incision was made, and the abdomen was opened for HCC enucleation under direct vision.
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