Based on Atlanta?s criteria, acute pancreatitis is classified as:-Edematous acute pancreatitis and necrotic acute pancreatitis. Acute necrotic pancreatitis is developed in 15 to 20% of cases. The pancreatic necrotic infection occurs in the second and third week of illness in 40 to 70% of the patients with acute necrotic pancreatitis. This infection is mainly one of major risk factor which influence in complication rate and mortality. Diagnosis of acute pancreatitis is based on clinical presentation, laboratory findings and radiological examinations. There are a number of prognostic systems for detection of illness severity and patient prognosis with acute pancreati-tis, such as: Ranson?s criterias, APACHE II system, Glasgow system by Imrie, Baltazar stratification of CT-scan etc. The important thing in patients with acute pancreatitis is identification of pancreatic necrotic infection. Golden standard for necrotic infection iden-tification is aspiration with fine needle ?CHIBA? followed by US or CT-scan. The patients with acute pancreatitis can be treated con-servatively or surgically. It is widely believed that all patients with infection of pancreatic necrosis need surgical treatment. Now, all scientists agree that surgical intervention has to be delayed as long as possible. The modern way of treatment, in the future has to be focused on a single multimodal therapy, which inhibits inflammatory excessive reaction, meanwhile preserves immunitary com-petence and antimicrobial defense.

Η μεταστατική πορεία των καρκινικών κυττάρων καθορίζεται πρωταρχικά από γονίδια τα οποία προάγουν τη μετάσταση και προστατεύουν το καρκινικό κύτταρο, κατόπιν από τα μακροφάγα και τις ινοβλάστες του καρκινικού στρώματος που δημιουρ-γούν ευνοϊκό τοπικό μικροπεριβάλλον για τα μεταστατικά κύτταρα και βέβαια από τη δημιουργία λεμφαγγείων και αιμοφόρων αγγείων, που επιτρέπουν τη διασπορά των καρκινικών κυττάρων. Υπεύθυνοι για την λεμφαγγειογένεση θεωρούνται οι αυξητι-κοί παράγοντες VEGF-C, VEGF-D οι οποίοι δρουν μέσω του αντίστοιχου υποδοχέα τους VEGFR-3. Επιπρόσθετοι παράγοντες με λεμφαγγειογενετική δράση είναι οι bFGF, PDGF, IGF και ο HGF. Ειδικοί παράγοντες ρυθμίζουν την προσκόλληση των καρκινικών κυττάρων στο λεμφικό ενδοθήλιο και τη χημειοταξία τους. Τα νεόπλαστα λεμφαγγεία εντός του νεοπλασματικού παρεγχύμα-τος μειώνοντας την πίεση του διαμέσου υγρού, διευκολύνουν την αιμάτωση του όγκου και φαίνεται να επηρεάζουν μηχανι-σμούς αγγειογένεσης με διφορούμενο τρόπο. Περισσότερο λειτουργικά για τη λεμφογενή διασπορά του καρκίνου θεωρούνται τα νεόπλαστα λεμφαγγεία στην παρυφή του όγκου. Η μετάσταση στους επιχώριους λεμφαδένες είναι η πρώτη απόδειξη μετα-στατικού δυναμικού του όγκου και φαίνεται να σχετίζεται με τη δημιουργία λεμφαγγείων στις παρυφές του όγκου

Home Aim of study: Thoracoscopic surgery is widely performed in Thoracic Surgery institutes. A questionnaire was established to inves-tigate the efficiency of thoracoscopic training provided to Greek thoracic surgery trainees. Materials and methods: The questionnaire was completed by thoracic surgery residents in Greek institutes and includes (apart from the demographic data) information about the number of thoracoscopic procedures in which residents had participation in, as well as the number of procedures which were carried out by residents. The residents were also asked to evaluate their thora-coscopic training, to provide reasons for this evaluation and to propose changes, which to their opinion need to be established. Results: In total, 51 residents completed the questionnaire. They have participated in 415 thoracoscopic operations, in total (5 operations per year in 86%), being the supervised surgeon only in a percentage of 3.6%. Among residents being trained in big cities and in smaller institutions, as well as residents during their first and second year of general thoracic training, the number of operations, in which they had participation in, was equal. A 98% of the responders graded their training as basic or none, pro-posing important changes in their training. Responders reported that they had participated in simple cases, such as biopsies and pneumothorax, rather than complicated operations such as lobectomies. Conclusions: Thoracoscopic training in Greece seems inadequate, with residents being exposed to a limited number of rather simple cases. Institutes and leading authorities should make according changes towards better thoracoscopic training in Greece.

Background: In this study, we investigated the effects of Botulinum type A toxin (Btx-A) injection into salivary glands on body weight at rabbits. Material and Methods: Forty five rabbits were used in this study, and were divided into three groups of 15 rabbits each, as fol-lows: Group I: Control group , Group II: Btx-A was injected with a dosage of 50 IU into left submandibular gland., Group III: Btx-A was injected with a dosage of 50 IU into each of submandibular glands. The rabbits were weighed monthly. At the end of the 6 months, all animals were sacrificed. Small intestine and submandibular salivary glands were excised. The tissue sections was stained with hematoxylin-eosin and immunostained with primary antibodies for epidermal growth factor receptor (EGFR). The length of villi was measured, and the immunostained cells were counted. Results: Body weights measurement showed an increase of 65.2 % over the initial weight in group I, a decrease of 12.1 % in group II and a decrease of 30.6 % in group III (P<0.001). The villi length was 893±63 μ in group I, 712±30 μ in group II and 621±41 μ in group III (P<0.001). The mean immunostained cells count of submandibular glands was 527±90.7 in group I, 267.8±71.1 in group II and 260.2±76.4 in group III (P<0.001). The mean immunostained cells count of intestinal villi was 906.2±45.7 in group I, 786.4±75.6 in group II and 658±84.3 in group III (P<0.001). Conclusion: In this experimental study, Btx-A injection into submandibular salivary glands lead to intestinal villi atrophy and weight loss in rabbit model.

The paper admits that patients with HIV and AIDS receive sub-optimal surgical care in the University College Hospital Ibadan, Nigeria. Reasons adduced are, in the majority, of a psychosocial hue and these are explained under subheadings of the rigid mindset of the surgical care-givers themselves, the stigma attached to both infected patient and non-infected family members, the fraudulent ?AIDS for gain? population and lastly the socio-cultural practices that do not augur well for good surgical health-care delivery. The paper concludes that without a mental paradigm shift, adequate and speedy surgical care will continue to elude HIV and AIDS patients in Ibadan, Nigeria.

Primary mesenchymal adrenal tumors are extremely rare and present mainly as vascular, lipomatous and smooth muscle cell neoplasms. Most reported cases regard to adrenal hemangiomas, which are mostly found during autopsy, with an incidence of 00.1%. We present the clinicopathological characteristic of five rare cases of primary mesenchymal adrenal tumors examined in our laboratory during a 15 years period. Our material consists of three adrenal haemangiomas, one lymphangioma and a single lipoma. These lesions mostly affect middle-age patients, between the 5th and 6th decade of life, and women twice as often as men. Their presentation varies but most of the times they are incidental findings during tomographic imaging for unrelated reasons, or due to large tumor size non-specific symptoms arise as early satiety and abdominal discomfort. Most adrenal vascular tumors arise at the cortical area and behave as benign neoplasms. Malignant mesenchymal tumors of the adrenal gland are considered primarily as metastatic or extensive disease from retroperitoneal tumors. Co-existence of mesenchymal adrenal tumors with various car-cinomas (lung,breast,GI tract) is reported and it was observed in one of our cases as well, but no underlying common factor or hereditary predisposition is established.

Aim This study was designed to compare the outcome of Ligasure hemorrhoidectomy and conventional ?closed? Ferguson?s hemorrhoidectomy for grade III and IV hemorrhoids. Method A total of 82 consecutive patients with grade III or IV hemorrhoids were randomized to undergo Ligasure (42 patients) or Ferguson?s (40 patients) hemorrhoidectomy. The operation time, length of hospital stay and postoperative complications were prospectively documented. Results Patient demographic and clinical characteristics were similar in the two groups. The median operative time was 13.5 minutes for the Ligasure group and 22 minutes for the conventional group. VAS pain scores and postoperative complications were less in the Ligasure group. Conclusion Ligasure hemorrhoidectomy is a simpler and superior method to conventional technique by reducing the operation time and postoperative complications.

Primary liposarcoma of the breast is one of the most uncommon malignant breast tumors. Mixed-type liposarcoma represents the rarest histological subtype of liposarcoma with only few cases reported in the literature. It is noteworthy to present a unique occasion with a combination of rarities consisting of a mixed-type liposarcoma with a diam-eter of 23cm arising in a 56 year-old male breast. The patient was treated with surgical excision and adjuvant radiotherapy. The reported case represents an exceedingly rare occasion of mixed-type liposarcoma arising in a male breast with the largest size ever reported. MRI imaging is considered to be valuable in demonstrating the biphasic pattern of the mixed-type liposar-coma. This case is reported to highlight the importance of surgical excision followed by adjuvant radiotherapy.

Brain metastases from colorectal cancer (CRC) are rare, occurring in only 4% of cases and are concomitant with lung metastases in 55% to 85% of patients and liver metastases in up to 75%. In very small subpopulation of patients, cranial disease may be the only site of involvement. Herein we present the case of 63-year-old woman who developed a solitary brain metastasis from colo-rectal cancer without systemic metastases. The patient was operated for pT4a pNo pMo adenocarcinoma of grade 3 of the sig-moid colon. She received adjuvant therapy with FOLFOX 12 cycles. After 11months she appeared complaining for severe head-ache. Furthermore, magnetic resonance imaging of the brain revealed a 2cm lesion in the right parietal lobe. She underwent surgical excision with postoperative whole brain radiation therapy. Histopathological report was brain metastasis from colorectal cancer.

The occurrence of gastro-tracheal fistula after esophagectomy for carcinoma with gastric pull-up is an uncommon and life-threatening event. A 43 year-old male patient underwent transhiatal esophagectomy for esophageal cancer. Two years follow-ing the operation the patient developed dyspnea, cough and respiratory distress with an increase in tracheal secretion. A gastro-tracheal fistula was diagnosed with a concomitant pneumo-mediastinum and subcutaneous emphysema. A covered metallic tracheal stent was used to close the fistula. This attempt proved successful, and the patient began eating an oral diet and was discharged on the 3rd postoperative day. The patient died from cachexia 4 months after stent insertion.

Primary renal synovial sarcoma is a rare pathological entity with less than 50 cases reported. We report a case of primary renal syno-vial sarcoma in a 27?year-old male, who underwent radical nephrectomy with a preoperative-diagnosis of renal cell carcinoma. The tumour was identified as primary renal synovial sarcoma with renal vein invasion on histopathology. Diagnosis was confirmed by immunohistochemistry but not supported by molecular studies. Patient was treated by an ifosfamide based chemotherapy regime. This case demonstrates that primary renal synovial sarcoma should form an important differential diagnosis of renal tumours, par-ticularly in the younger age group. Although there are no established guidelines about the comprehensive management of this tu-mor due to the limited number of cases reported, postoperative Ifosfamide based chemotherapy regimens have been effective

Achalasia has been well recognized as an esophageal motility disorder for more than three centuries. However, etiology and pathogenesis are still elusive and genetic, infectious, degenerative and autoimmune mechanisms have been proposed. The important role of interstitial cells of Cajal (ICC) in formation of achalasia has been determined recently. These cells are found in various organs and their physiological role is still not clear. Another pathology related with ICC is the gastrointestinal stromal tumors (GIST). GIST has a wider range of associated disorders when compared to achalasia. This manuscript is a case report, in which achalasia and gastric GIST coexisted. Today the question whether there is a relationship between the two pathologies remains unanswered. Since achalasia is a rarely seen disease, extra luminal abdominal pathologies may be overlooked in the course of routine examination and treatment plan. Knowing more about the association between these two diseases may be helpful during the preoperative assessments and postoperative follow-up of patients with achalasia.

Introduction: Epidermoid splenic cysts are rare lesions, comprising less than 10% of the benign non-parasitic splenic cysts (NPSCs). Their histological characteristic is the presence of an epidermoid (stratified non-keratinising squamous) epithelial lining in the inner surface. Their clinical presentation can either be silent or they can cause symptoms of displacement and pressure on adjacent viscera. Case presentation: We present the case of a 41-year-old female patient, admitted to our clinic with a dull pain on the left hypo-chondrium, a sense of fullness after meals and indigestion. Full clinical, laboratory and imaging investigation took place in her. Abdominal ultrosonography and C.T. scanning manifested a cystic, splenic lesion with calcified wall and a size of 7,7 x 6,5 cm. She underwent an exploratory laparotomy and splenectomy according to the protocol of treatment for hydatid cysts. Histologi-cal examination revealed the presence of an epirmoid splenic cyst. Conclusions: Surgical treatment of splenic cysts larger than 5 cm in diameter, trying to preserve as much of splenic parenchyma as possible, is recommended in order to avoid complications including infection, hemorrhage or rupture. Verification of their benign nature establishes simple excision of the cysts as an efficient treatment. Ultrasonographic screening of siblings should be warranted, so as to exclude the case of a familial splenic epidermoid cyst.