Nikola Milinić

Primary actinomycosis of the anterior abdominal wall: Case report and review of the literature

Abstract  Actinomycosis of the anterior abdominal wall is a rare infection caused by different Actinomyces species. We report a case of primary actinomycosis localized on the anterior abdominal wall, diagnosed by computed tomography (CT) scan, postoperatively confirmed by histopathological examination and treated by surgical resection combined with postoperative antibiotic therapy. The patient has been free of recurrence after 1 year. A review of the available literature is also presented.

Acute appendicitis in a femoral hernia

INTRODUCTION Acute appendicitis in a femoral hernia is an uncommon condition that can be serious. Complications are more frequent if the diagnosis is delayed and surgery is not performed on time. CASE REPORT We present a 71-year-old man with a painful swollen mass. The patient presented with fatigue and loss of appetite, while body temperature was normal. The abdomen was not painful, and peristaltic was normal. All laboratory findings were normal. After anamnesis and physical examination, the presumed diagnosis was incarcerated femoral hernia and the patient was sent to the operating room. Intraoperative findings revealed an incarcerated femoral hernia within a phlegmonous inflammated appendix. Appendectomy and McVay hernioplastics were done. The postoperative course was without complications. CONCLUSION It is very important to bear in mind that right femoral hernia with signs of incarceration and inflammation may contain an acutely inflamed appendix. Delayed diagnosis and misdiagnosis cause greater morbidity and mortality.

Benign Hydronephrosis and Elevated of Serum Levels of Carbohydrate Antigen CA 19-9: A Case Report

Patient: Male, 58 Final Diagnosis: Hydronephrosis Symptoms: Blunt abdominal pain • constipation • constipation Medication: — Clinical Procedure: Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Carbohydrate tumor-associated antigen (CA 19-9) has been shown to be upregulated in other malignant tumors including gastric, ovarian, hepatocellular, and colorectal carcinoma as well as benign diseases of the biliary track such as pancreatitis, cholangitis, and choledocholithiasis. According to the available literature, in several cases of benign hydronephrosis and in a few cases of benign renal diseases, elevated CA 19-9 has been noted. Case Report: A 58-year-old Caucasian male patient was admitted in our clinic with complaints about blunt abdominal pain in the past two-month period localized in the right lumbar region and irradiating into the right inguinal area, constipation, abdominal bloating, and intermittent hematuria. The concentration of serum CA 19-9 was 3500 U/mL. Urine cytology provided no signs of abnormality. Intravenous urography visualized right-sided pyelon and ureter duplex with the defect in contrast shade of the pyelon, caused by a stag horn calculus. Contrast added computerized axial tomography of the abdomen and pelvis visualized the pyelon casted concretion spreading throughout the right pyelon, with ureterohydronephrosis with the distal block for passage of the contrast to the distal part of the ureter. Conclusions: There is no doubt that CA 19-9 level is occasionally elevated in patients with obstructive urolithiasis as it was in our case. In the routine medical praxis, urolithiasis should not be neglected in the differential diagnosis of elevated concentrations of CA 19-9 marker.

Ultrasonography analysis of gallbladder motility in patients with functional dyspepsia

BACKGROUND Gallbladder motility has been studied in patients with functional gastrointestinal disorders, such as functional dyspepsia, irritable bowel syndrome and biliary disorders without gallstones and results of these observations are often inconclusive and conflicting. METHODS The investigation was performed on 180 therapy-naïve newly diagnosed patients with functional dyspepsia (97 females and 83 males), aged 20-79 in which we have investigate ultrasonographically parameters of gallbladder motility. RESULTS Bonferroni post hoc correction stressed that fasting gallbladder volume and ejection fraction were significantly distorted in individuals with postprandial distress syndrome, although, the residual gallbladder volume was significantly lower in patients with epigastric pain syndrome comparing with other examinees. Ejection fraction of the gallbladder negatively correlated with body mass index. CONCLUSION The impaired contractibility of the gall bladder in patients with functional dyspepsia, based on the results of this study, is illustrated by the changes in the ejection fraction, which was more pronounced in patients with the postprandial distress syndrome.

[Multiple anatomical malformations in 25-year old patient with heterotaxy--case report].

INTRODUCTION Heterotaxy or situs ambiguus is a rare congenital disorder, characterized by abnormal situs with either left or right isomerism that usually coincides with A complex malformation. The classic left isomerism or bilateral left-sidedness or heterotaxy syndrome with polysplenia implies that patients have bilateral bilobed lungs, bilateral pulmonary atria, a centrally located liver, a stomach in indeterminate position, and multiple spleens, occasionally associated with interruption of the inferior cava with azygos or hemiazygos continuation. CASE REPORT We present a case of situs ambiguus associated with severe heart and vascular abnormalities in a 25-year-old male patient. On the admittance to our clinic the patient had history of biliary colic, moderate jaundice of the conjunctive and sclerae, and severe central cyanosis. The echocardiography revealed a large atrial septal defect, complete absence of the interventricular septum resulting in the single ventricle and the inversion of atria. The angiography obtained the hypoplastic inferior vena cava continuing with azygos vein that flowed into the left superior vena cava. The computerized tomography scans showed three splenuli in the right upper quadrant of the abdomen, and a single gallstone appeared in the left-positioned gallbladder. The contrast radiography showed complete transposition of the guts and stomach. DISCUSSION AND CONCLUSION To our knowledge, our patient with described severity of the anomalies had the longest life span in this part of Europe, although the longer survivors have been described in the other parts of the world. Furthermore, clinical characteristics of both left and right isomerism have been obtained in the patients with anatomically pronounced left isomerism.