Notes

A growing Role for Chloroplasts throughout Condition and Protection.
lso very efficient for the detection of H. gallinarum but the additional evaluation of the worm infestation during necropsy increased the level of prevalence. Cestodes were mainly found during necropsies when the worm infestation was evaluated. The detection of parasite eggs in mucosal scrapings from the intestines was the least effective method for all helminths. These findings lead to the recommendation to combine faecal investigations with an evaluation of the worm infestation during necropsy of at least five birds.
Preoperative inguinal pain (painful inguinal hernia) is a well-known factor associated with chronic postoperative inguinal pain (CPIP). However, it remains unclear what preventive measures should be taken in such patients.

We report two patients with painful inguinal hernia who underwent pragmatic ilioinguinal nerve neurectomy during open anterior repair. The nerve was compressed by bulky spermatic cord lipoma in case 1 and by the hernia sac presenting over a few decades in case 2. Hematoxylin and eosin staining of the resected nerves revealed mucoid degeneration. Toluidine blue staining of resin-embedded nerve sections demonstrated that fully-myelinated axons had significantly decreased in case 1 and almost disappeared in case 2, indicating the development of massive demyelination of the ilioinguinal nerve in both cases.

In cases where the injured nerve is left in situ, CPIP may occur since demyelinating neuropathy sometimes becomes irreversible.

Planned nerve resection via open anterior inguinal hernia repair may be an option to prevent CPIP in patients with painful inguinal hernia.
Planned nerve resection via open anterior inguinal hernia repair may be an option to prevent CPIP in patients with painful inguinal hernia.
The Patella is very rare site for tuberculosis (TB). The knee is the third most common site for skeletal TB. The incidence of patella TB being 0.09 to 0.15%.

We report a case of primary tuberculous osteitis isolated from the patella. The complaint was a mixed knee pain without notion of trauma. The CT showed a large osteolysis of the upper half of the patella. The diagnosis was established on the histological study after biopsy. The patient was operated by a medial approach without arthrotomy and the pathological tissue was resected and curetted. Proteasome cleavage Complementary anti-bacillary antibiotic treatment was administered for 12months. At the last clinical control, the knee was free and painless, and we had no recurrence.

Aitken reported the first case in literature in 1933. The initial signs and symptoms are non-specific and sometimes confounded by a coincidental history of trauma. It is difficult to diagnose TB of patella in early stages because there are no constitutional symptoms. Sometimes serological parameters are inconclusive. CT scan can help if the osteolysis contained a central bone sequestration, bordered by peripheral sclerosis. Confirmation of patellar tuberculosis is made on biopsy.

The tuberculous localization in the patella is rare and it can pose a problem of differential diagnosis with other affections, in particular infectious and tumors. It should always be kept in mind, especially in the face of a picture of pre-patellar bursitis which progresses slowly and whose biological inflammatory syndrome is not straightforward.
The tuberculous localization in the patella is rare and it can pose a problem of differential diagnosis with other affections, in particular infectious and tumors. It should always be kept in mind, especially in the face of a picture of pre-patellar bursitis which progresses slowly and whose biological inflammatory syndrome is not straightforward.
It is difficult that doctors other than otorhinolaryngologist/radiologist find early postoperative maxillary cyst (POMC) because it tends to expand gradually with no symptoms over a period of years.

A 60-year-old Japanese male who had previously undergone a bilateral Caldwell-Luc operation for the treatment of chronic sinusitis, experienced maxillary sinus floor elevation and implant placement. Eleven years after the implant placement, we discovered that the left POMC existed close to dental implants. Fortunately, dental implants still displayed proper osseointegration. Thus, the patient has been successfully treated for POMC, which had not been proper diagnosed before the implantation, by a marsupialization using nasal endoscopy and successfully preserved dental implant.

Because the expanding POMC might result in dental implant failure after several years, we think that marsupialization is useful as a risk management for possible failure of dental implant close to POMC when it had not been found before maxillary sinus floor elevation and insertion of dental implant.

Doctors should recognize that patients will have the risk of the dental implant failure after several years due to the expanding cyst when early POMC had not been diagnosed and treated properly before the implantation.
Doctors should recognize that patients will have the risk of the dental implant failure after several years due to the expanding cyst when early POMC had not been diagnosed and treated properly before the implantation.
While the number of SAVR cases has been increasing for patients below their sixties due to the improvement of bioprosthetic valves, some early structural valve deterioration (SVD) in Trifecta valves has been reported.

We present a case of a female who presented with sudden shortness of breath. Ultrasonography diagnosed SVD. We performed redo aortic valve replacement due to SVD in Trifecta valve. With our surgical technique we could remove the bioprosthetic valve easily.

We could easily remove the mounted prosthetic valve along with the titanium band. These cases may emerge with acute heart failure due to sudden massive aortic regurgitation, not like the gradual progression of stenosis due to calcification.

The postoperative course in Trifecta recipients must be followed carefully.
The postoperative course in Trifecta recipients must be followed carefully.
Malignant peritoneal mesothelioma is a local-regional disease process that requires a comprehensive treatment plan including complete cytoreductive surgery and regional chemotherapy.

Treatments used in our patient began with a complete cytoreductive surgery. This required visceral resections, parietal peritonectomy, peritonectomy of the small bowel and its mesentery, and a peritoneal resection of the colonic mesentery with sparing of the major vasculature of the large bowel.

Peritoneal resection of the colonic mesentery and other treatments were performed in the absence of major complications. A 20-day hospitalization was required. The patient shows no internal hernias and no evidence of disease by CT follow-up at 4years postoperatively. Her quality of life is excellent.

Malignant peritoneal mesothelioma was in the past a disease of limited survival without effective treatment options. Peritoneal resection of the colonic mesentery may be required for complete cytoreduction. A sequence of cytoreductive surgical procedures and regional chemotherapy treatments has made long-term survival possible.
Malignant peritoneal mesothelioma was in the past a disease of limited survival without effective treatment options. Peritoneal resection of the colonic mesentery may be required for complete cytoreduction. A sequence of cytoreductive surgical procedures and regional chemotherapy treatments has made long-term survival possible.
Lipomas are the third most common benign tumor of the gastrointestinal (GI) tract, typically occurring in the colon or small intestine. Less than 100 cases of symptomatic duodenal lipomas have been reported. Symptoms include non-specific upper GI complaints of heartburn, fullness, or abdominal pain. This report highlights the rarity of symptomatic duodenal lipomas, lack of specific treatment guidelines, and adds to surgical literature a new treatment approach.

A 53-year-old Caucasian woman presented with 2-year history with main concerns for early satiety and constipation. CT scan with contrast of the abdomen and pelvis demonstrated a duodenal mass. Differential diagnosis included duodenal lipoma versus stricture, and IBS. Subsequent EGD revealed a 4cm transverse duodenal submucosal mass. Endoscopic removal was deemed too great a risk of bleeding. Pre-operatively, the patient expressed frustration as the patient was tolerating only a liquid diet with one bowel movement weekly. Treatment with robotic assisted transverse duodenotomy was performed, with final pathology of benign lipomatous tissue. Post-operatively the patient had immediate relief of symptoms which persisted at 2-week and 4-month follow-ups.

This case demonstrates 3 primary learning points. First, duodenal lipomas should be included in the differential of vague upper GI symptoms. Second, we propose that surgeons consider treatment of duodenal lipomas utilizing robotic assisted approach. Third, we document the first robotic-assisted transverse duodenotomy for duodenal lipomas.

Clinicians should consider duodenal lipoma for patients with vague abdominal symptoms. We present a case of successful treatment with robotic-assisted transverse duodenotomy.
Clinicians should consider duodenal lipoma for patients with vague abdominal symptoms. We present a case of successful treatment with robotic-assisted transverse duodenotomy.
Duodenal adenocarcinoma is a rare malignancy; recently, it has been found to be accompanied by operative indications.

Nine consecutive rare cases were diagnosed with duodenal carcinoma (DC), in which clinicopathological characteristics were retrospectively examined. Age was ranged over middle-aged males and females. No clinical onset with severe symptoms was observed, and the specific treatment for accompanied diseases or habits was not found.

One case of two T1 stage DCs that underwent pancreas-sparing duodenectomy. Stage II DC was diagnosed in three cases, and stage III DC was diagnosed in four cases. Pancreaticoduodenectomy (PD) mainly occurred in seven patients, and duodenectomy was limited in two patients. All operations were safely performed, and the postoperative course showed no severe morbidity. Histological findings showed R0 resection in eight cases and R1 at the retroperitoneal dissecting part in one case. Five patients with advanced-stage DC underwent adjuvant chemotherapy; however, four patients showed tumor recurrence within 12months. With additional strong chemotherapy, eight patients survived up to 84months, and one died of liver metastasis at 43months after surgery. Three representative cases of mucosal invasion with widespread pancreas-sparing duodenectomy and advanced-stage DC cases undergoing duodenectomy or PD are shown.

In the field of upper digestive tract surgery, duodenal adenocarcinoma and various applications of surgery or adjuvant chemotherapy for long-term survival are important.
In the field of upper digestive tract surgery, duodenal adenocarcinoma and various applications of surgery or adjuvant chemotherapy for long-term survival are important.
Actinomycosis is a rare chronic and suppurative infection caused by anerobic Gram Positive bacteria actinomyces. Pelvic location is extremely rare, usually associated with history of IUD contraception and doesn't have specific signs. Pelvic actinomycosis diagnosis may be confused with pelvic gynecologic malignancies or abscess. We present a retrospective and descriptive study of twelve patients with pelvic actinomycosis diagnosed and managed in our department from January 2000 to December 2011.

The patients' mean age was 47years. 75% of them had a history of IUD for a mean period of 8,44years. Pelvic pain was the most common complaint. In four cases, pre-operative clinical presumption was tubo-ovarian abscess. Gynecologic malignancies were suspected in 8 patients. Pelvic actinomycosis management was based on surgery and long-term antibiotic.

Pelvic actinomycosis is an extremely rare chronic infection, presenting 3% of human actinomycosis. Common clinical presentations include vaginal discharge, tubo-ovarian abscess and pelvic tumors mimicking gynecologic malignancies.
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