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This patient had a sebaceous carcinoma. Magnetic resonance imaging showed local infiltration only. He underwent a wide excision with a 2-cm margin including the superficial part of the trapezius muscle, followed by a latissimus dorsi flap reconstruction. Histological examination confirmed sebaceous carcinoma, typical of the Muir–Torre syndrome.
Watch Mr Alberti deliver his presentation on the history of the Journal, which includes fascinating figures and illustrations of the past century.
A 45-year-old woman developed tachycardia and hypotension on day 1 following Roux-en-Y gastric bypass for obesity. On examination, a blue discoloration of the skin was noted in relation to a laparoscopic port site. Anastomotic leak at the enteroenterostomy explained this. During the initial procedure, the integrity of the gastrojejunostomy was assessed using methylene blue dye. At reoperation, an anastomotic leak secondary to staple-line failure at the enteroenterostomy was identified. The blue discoloration of the skin resulted from leakage of the dye at this site and subsequent extravasation through the port site. In addition to the physiological deterioration on day 1, the bright blue ‘bruising’ was a further cutaneous indication of an underlying anastomotic leak.
Journal publishing: Professor Alderson talks through what he describes as the good, the bad and the ugly. His talk covers areas such as peer review, grading research evidence, misconduct in publishing, and qualifications for authorship.
Stoma prolapse is a full-thickness protrusion of intestine through the stoma. Loop stomas have a higher incidence of prolapse than end stomas. Predisposing factors include obesity, increased intra-abdominal pressure, chronic obstructive pulmonary disease, bowel redundancy and weak fascia. Sugar can be sprinkled on the oedematous stoma to reduce the swelling before an attempt at manual reduction. If there is vascular compromise, exploratory laparotomy is mandatory. Surgical revision of the stoma is the treatment of choice.
Sir Muir Gray discusses the first and second healthcare revolutions, and his views on the approaching 'iceberg' of the third healthcare revolution: the increase in need and demand and how to meet those demands.
The magnetic resonance image (MRI) shows an osteochondroma of the proximal tibia. An osteochondroma is a cartilaginous exostosis. In most cases, treatment consists of regular monitoring to identify any changes or complications. a The MRI shows compression of the popliteal vessels (arrow) threatening vascular complications. The tumour can cause damage to the vessel wall resulting in a pseudoaneurysm or occlusion of the popliteal artery. b The osteochondroma was removed surgically using a dorsal approach.
All four speakers have articles published in the Special Issue. The development of emergency surgery as a surgical specialty in its own right is discussed along with the growing burden of global disease requiring emergency surgery.
Twenty years after a McBurney incision, this woman developed an incisional hernia. Because the hernia volume to peritoneal cavity volume ratio was more than 20 per cent, the procedure was prepared with preoperative progressive pneumoperitoneum (Goni-Moreno) in order to perform a tension-free closure. The photograph shows the incisional hernia with preservation of pneumoperitoneum. A mesh was positioned preperitoneally and retromuscularly. It was fixed laterally forward of the psoas muscle and on the iliac crest. The other edges were fixed with anchors transfixing the entire abdominal wall. The postoperative course and follow-up showed no complications or recurrence.
Pathological examination of this right-sided mass revealed a solid and cystic mass, weighing 765.0 g and measuring 13.8×11.0×9.0 cm. The cystic areas contained gelatinous mucus (red arrow) and sebaceous material with hair (yellow arrows), measuring 3.0×2.5 cm in aggregate. The final pathological diagnosis was consistent with a teratoma. Although no further treatment was indicated, the patient remains under surveillance owing to the mucinous nature of the lesion.
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