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International Journal of Surgery Case... Oct 2023The first clinical presentation of a hernia developing along the Spigelian line had been reported by Klinkosch. The Belgian anatomist Adriaan van der Spieghel (Adrianus...
INTRODUCTION & IMPORTANCE
The first clinical presentation of a hernia developing along the Spigelian line had been reported by Klinkosch. The Belgian anatomist Adriaan van der Spieghel (Adrianus Spigelius) was the first to describe the semilunar line now known as the linea Spigeli in 1645. Spigelian hernias are rare and account for 1 % to 2 % of all abdominal wall hernias. Most of these hernia occurs in the lower abdomen where posterior sheath is deficient. The hernia ring is well defined defect in the transverse aponeurosis.
CASE PRESENTATION
A 60 year old female, presented with a palpable lump at the right lower quadrant of the abdomen since 7 month before her presentation.
CLINICAL DISCUSSION
For the first time the swelling is small and painless then gradually increase in size and associated with dull aching pain. The swelling was reducible with a defect of size 4 × 4 cm palpable in right iliac fossa. There was a positive cough impulse. The swelling was non tender. Other hernial orifices were normal. No inguinal lymphadenopathy noted. Abdominal ultrasonography done revealed a defect in abdominal wall in right iliac fossa with reducible bowel content. Depending on basis of clinical and investigations, a diagnosis of Spigelian hernia was made. After preparation for surgery, exploration done. The defect measuring 4 cm in length was identified and anatomical repair was done with nylon- 0, by suturing medial border of internal oblique and transverse abdominus muscle to the lateral border of rectum abdominal wall followed by hernioplasty by mesh.
CONCLUSION
Spigelian hernias are rare multifactorial disorder leading to defect in the transversus abdominis muscle in anterior abdominal wall. Spigelian hernias carry a significant risk of incarceration and strangulation of sac content. The management of spigelian hernias is almost always surgical which can be done in a traditional open fashion or laparoscopically.
PubMed: 37757738
DOI: 10.1016/j.ijscr.2023.108785 -
Plastic and Reconstructive Surgery Aug 2019Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce...
BACKGROUND
Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors' aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors that trigger the ordering process.
METHODS
A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of implant-based breast cancer reconstruction and had at least 1-year follow-up after fat grafting.
RESULTS
From 2006 to 2015, 166 patients underwent fat grafting as part of implant-based breast reconstruction. Forty-four women (26.5 percent) underwent at least one imaging procedure. Thirteen women (7.8 percent) underwent 17 biopsies. For a palpable mass, the initial imaging test most commonly ordered was ultrasound, followed by mammography/ultrasound. The percentage of patients with a diagnosis of fat necrosis on mammography, ultrasound, and biopsy was 4.2, 12.7, and 5.4 percent, respectively. Seven patients (4.2 percent) had distant metastases. Tissue diagnosis of local recurrence was never identified. Mean follow-up was 2.4 years.
CONCLUSIONS
Fat-grafting sequelae may lead to early unplanned invasive and noninvasive procedures initiated by a variety of providers. In this study, fat grafting had no impact on local recurrence rate. As use of fat grafting grows, communication among breast cancer care providers and enhanced patient and caregiver education will be increasingly important in optimizing the multidisciplinary evaluation and monitoring of palpable breast lesions.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Adipose Tissue; Adult; Aged; Biopsy; Breast Implantation; Breast Implants; Breast Neoplasms; Fat Necrosis; Female; Humans; Magnetic Resonance Imaging; Mammography; Mastectomy; Middle Aged; Neoplasm Recurrence, Local; Postoperative Complications; Retrospective Studies; Ultrasonography, Mammary
PubMed: 31348325
DOI: 10.1097/PRS.0000000000005790 -
The Journal of Vascular Access Jan 2023The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however,...
BACKGROUND
The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however, reports related to the effectiveness of using ultrasonography in increasing the success rate for visible and palpable veins is limited. Furthermore, according to a previous study, first attempt success in catheterization contributes to low catheter failure incidence. Thus, we developed a catheterization method using ultrasonography for peripheral veins including visible and palpable veins. This study investigates the effectiveness of ultrasonography use in improving the success rate of catheterization and preventing the catheter failure for peripheral veins including visible and palpable veins.
METHODS
Adult inpatients were recruited. Trained nurses inserted intravenous catheters using ultrasonography. Ultrasonography was used for all vein assessment, target vein selection, and puncturing (i.e. target point selection and/or needle guidance), regardless of the target vein's visibility or palpability. Catheters with over a 24-h dwelling time were followed for catheter failure incidence.
RESULTS
Thirty-one patients were recruited, and they required 34 catheterizations. Total number of catheterization attempts were 39. Of the peripheral veins, 51.3% (20/39) were visible and palpable, 48.7% (19/39) were DIVA. The rate of successful intravenous cannulation was 29 of 34 (85.3%) after one attempt and 4 of 34 (total 97.0%) after two attempts. The catheterization failure incidence was 3.2% (1/31) in the catheter that had an over 24-h dwelling time.
CONCLUSIONS
Using ultrasonography to all target veins might have contributed to higher success rates of catheterization and extremely low incidence of catheter failure based on objective findings. Selecting the vein with larger diameters and healthy tissue as puncture point and showing center of vessel lumen clearly using ultrasonography might have been contributed the results.
Topics: Adult; Humans; Veins; Catheters; Catheterization, Peripheral; Ultrasonography; Infusions, Intravenous; Ultrasonography, Interventional
PubMed: 34075824
DOI: 10.1177/11297298211022078 -
Plastic and Reconstructive Surgery Sep 2021After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of prepectoral breast reconstruction. 2. Have... (Review)
Review
LEARNING OBJECTIVES
After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of prepectoral breast reconstruction. 2. Have knowledge of primary immediate and delayed prepectoral breast reconstruction techniques and secondary procedures required. 3. Describe data on outcomes of prepectoral breast reconstruction.
SUMMARY
Once considered to have an unacceptable complication profile, prepectoral breast reconstruction is increasing in popularity because of decreased surgical invasiveness and postoperative pain and the absence of animation deformity. Short-term outcomes studies comparing prepectoral breast reconstruction to partially submuscular techniques demonstrate similarly acceptable rates of postoperative complications. Aesthetic outcomes demonstrate similar rates of capsular contracture but increased rippling and implant palpability of the upper pole. Postoperative functional data are limited but overall show decreased pain and more rapid return of function but equivalent satisfaction on the BREAST-Q. Long-term aesthetic data and rates of revision are lacking.
Topics: Acellular Dermis; Breast; Breast Implantation; Breast Implants; Breast Neoplasms; Esthetics; Evidence-Based Medicine; Female; Humans; Mastectomy; Pectoralis Muscles; Postoperative Complications; Retrospective Studies; Tissue Expansion
PubMed: 34432700
DOI: 10.1097/PRS.0000000000008229 -
The American Surgeon Sep 2023Lymph nodes are common basins for cancer recurrence; however, during surgery, lymphatic tissue is often indistinguishable from surrounding tissue making local excision...
Lymph nodes are common basins for cancer recurrence; however, during surgery, lymphatic tissue is often indistinguishable from surrounding tissue making local excision difficult. Novel breast surgery techniques have utilized radioactive seed localization (RSL) to preoperatively tag tissue so it can be identified intraoperatively with a gamma probe. Our goal was to assess the use of RSL in non-breast tissues. This was a retrospective case series of non-breast cancer patients undergoing RSL. Overall, 42 patients met inclusion criteria. Pathology results indicated benign findings in 20 patients (47.62%), toxoplasma in 1 patient (2.38%), non-necrotizing granulomatous disease in 2 patients (4.76%), and malignant progression in 19 patients (45.24%). Two patients had non-lymphatic tissue removed: one in the abdominal wall and one in the lower lumbar region. Radioactive seed localization is an effective technique to localize and excise non-palpable lymph nodes and masses identified on imaging, highlighting its wide variety of uses in non-breast cancer cases.
Topics: Humans; Female; Retrospective Studies; Iodine Radioisotopes; Lymph Nodes; Reoperation; Mastectomy, Segmental; Neoplasms; Breast Neoplasms
PubMed: 37225666
DOI: 10.1177/00031348231177925 -
Cirugia Y Cirujanos 2020The objective of the study was to present the experience of the family planning service Hospital General de México, in locating and removing no palpable subdermal...
OBJECTIVE
The objective of the study was to present the experience of the family planning service Hospital General de México, in locating and removing no palpable subdermal single-rod contraceptive implants.
MATERIALS AND METHODS
A descriptive, prospective, and cross-sectional study was performed from January 2011 to April 2018.
RESULTS
Hundred and sixty-four patients in whom the implant was not palpable were reviewed, the time between insertion and removal averaged 3.3 years (maximum 10 years and minimum 3 months). Three implants were inserted in the right arm, the rest on the left one. Forty-seven implants were found in fatty tissue (29%), 18 in fascia (11%), 94 in muscle (57%), 2 in the armpit (1.2%), and 3 were not found (1.8%).
CONCLUSIONS
The no palpable implant is caused by an incorrect insertion technique. Migration should not be assumed as a cause of difficult location. Amount of non-palpable implants is not possible to determine due to a lack of records, but approximately 3% are considered non-palpable. Ultrasound has proven to be the study of choice to locate an incorrect inserted implant. In this case, the total number of implants was located, except in two patients.
Topics: Adult; Arm; Contraceptive Agents, Female; Contraceptive Devices, Female; Cross-Sectional Studies; Desogestrel; Device Removal; Family Planning Services; Female; Humans; Palpation; Prospective Studies; Radiography; Time Factors; Ultrasonography
PubMed: 32567592
DOI: 10.24875/CIRU.20001370 -
BMJ Case Reports Feb 2020Aneurysm of the pedal arteries is uncommon. Dorsalis pedis aneurysms are a clinically rare phenomenon. We present a case of traumatic fusiform aneurysm of the dorsalis...
Aneurysm of the pedal arteries is uncommon. Dorsalis pedis aneurysms are a clinically rare phenomenon. We present a case of traumatic fusiform aneurysm of the dorsalis pedis artery in an otherwise well 53-year-old Caucasian man. Initial history was suggestive of micro-embolic disease to the medial toes of the left foot and on examination pulses were palpable throughout the lower limbs with a strong, palpable dorasalis pedis pulse. Ankle brachial pressure indexes were normal but reduced toe pressures to the left toes. Colour flow duplex imaging revealed aneurysmal dilation, involving all layers of artery wall, with irregular intraluminal thrombus across a 16-mm segment. Subsequent CTA run-off revealed all vessels were patent in the left lower limb. Due to concerns over further embolisation, our patient underwent successful ligation of the his dorsalis pedis. He had an uneventful post-operative recovery.
Topics: Aneurysm; Computed Tomography Angiography; Foot; Humans; Ligation; Male; Middle Aged; Tibial Arteries; Ultrasonography, Doppler, Color
PubMed: 32075813
DOI: 10.1136/bcr-2019-231969 -
The Journal of Craniofacial SurgeryA 59-year-old man with a palpable mass above the left eyebrow that had appeared over a 1-year period presented to our clinic. He previously had been administered...
A 59-year-old man with a palpable mass above the left eyebrow that had appeared over a 1-year period presented to our clinic. He previously had been administered antiglaucoma eyedrops for pseudophakic glaucoma of the left eye and had undergone Ahmed glaucoma valve implant surgery. The palpable mass above the left eyebrow was soft, nontender, and large. On slit lamp examination, the Ahmed valve was positioned in the superotemporal quadrant of the limbal conjunctiva, and there was no other abnormal finding. Computerized tomography (CT) imaging showed a dense, soft tissue lesion in the left upper lateral periorbital area. The patient underwent tumor excision with biopsy under general anesthesia, and the histopathologic result was myxoma. To rule out Carney complex, dermatological and cardiac evaluation were performed, and the results were normal. Finally, the tumor was diagnosed as isolated myxoma. Isolated myxoma around the upper eyelid is very rare, and complete surgical excision is needed because it has a high recurrence rate.
Topics: Carney Complex; Eyebrows; Heart Neoplasms; Humans; Male; Middle Aged; Myxoma; Neoplasm Recurrence, Local; Tomography, X-Ray Computed
PubMed: 33252525
DOI: 10.1097/SCS.0000000000007278 -
Translational Breast Cancer Research :... 2024With an increasing number of non-palpable breast lesions detected due to improved screening, accurate localization of these lesions for surgery is crucial. This... (Review)
Review
BACKGROUND AND OBJECTIVE
With an increasing number of non-palpable breast lesions detected due to improved screening, accurate localization of these lesions for surgery is crucial. This literature review explores the evolution of localization methods for non-palpable breast lesions, highlighting the translational journey from concept to clinical practice.
METHODS
A comprehensive search of PubMed, Embase, and Scopus databases until September 2023 was conducted.
KEY CONTENT AND FINDINGS
Multiple methods have been developed throughout the past few decades. (I) Wire-guided localization (WGL) introduced in 1966, has become a reliable method for localization. Its simplicity and cost-effectiveness are its key advantages, but challenges include logistical constraints, patient discomfort, and potential wire migration. (II) Intraoperative ultrasound localization (IOUS) has shown promise in ensuring complete lesion removal with higher negative margin rates. However, its utility is limited to lesions visible on ultrasound (US) imaging. (III) Breast biopsy marker localization: the use of markers has improved the precision of localization without the need for wire. However, marker visibility remains a challenge despite improvements in their design. (IV) Radioactive techniques: radio-guided occult lesion localization (ROLL) and radioactive seed localization (RSL) offer flexibility in scheduling and improved patient comfort. However, they require close multidisciplinary collaboration and specific equipment due to radioactive concerns. (V) Other wireless non-radioactive techniques: wireless non-radioactive techniques have been developed in recent three decades to provide flexible and patient-friendly alternatives. It includes magnetic seed localization, radar techniques, and radiofrequency techniques. Their usage has been gaining popularity due to their safety profile and allowance of more flexible scheduling. However, their high cost and need for additional training remain a barrier to a wider adoption.
CONCLUSIONS
The evolution of breast lesion localization methods has progressed to more patient-friendly techniques, each with its unique advantages and limitations. Future research on patient-reported outcomes, cosmetic outcomes, breast biopsy markers and integration of augmented reality with breast lesion localization are needed.
PubMed: 38751684
DOI: 10.21037/tbcr-23-49 -
Radiology Case Reports May 2023Mammary fibromatosis is a rare neoplastic proliferation of fibroblastic cells. Usually seen in abdominal and extra-abdominal sites, it is rarely seen in the breast....
Mammary fibromatosis is a rare neoplastic proliferation of fibroblastic cells. Usually seen in abdominal and extra-abdominal sites, it is rarely seen in the breast. Patients with mammary fibromatosis usually present with a firm palpable mass with or without dimpling and skin retraction-often mimicking breast carcinoma. Here, we present a case of mammary fibromatosis in a 49-year-old woman who presented with a palpable lump in her right breast. Mammography tomosynthesis revealed architectural distortion which was seen on ultrasonography as a hypoechoic area. The patient underwent a wire-guided excision where the histology of this specimen showed irregular spindle cell proliferation with hemosiderin deposition, confirming mammary fibromatosis. Further re-excision of margins revealed no evidence of residual fibromatosis, and the patient underwent subsequent surveillance mammograms to ensure there was no recurrence.
PubMed: 36970238
DOI: 10.1016/j.radcr.2023.02.019