Revista de Cirugía

The pancreas, an endodermal organ, is the primary regulator of protein and carbohydrate digestion as well as glucose homeostasis. The exocrine pancreas is made up of a network of branching acinar and duct cells that create and distribute digestive zymogens into the gastrointestinal tract. In response to signals from the stomach and duodenum, the acinar cells, which are arranged in functional units along the duct network, generate and exude zymogens into the ductal lumen. Centroacinar cells are found in the acinar units near the ducts. The endocrine pancreas, which regulates metabolism and glucose homeostasis by secreting hormones into the circulation, is made up of four specialised endocrine cell types organised into Islets of Langerhans clusters.

Introduction: Atherosclerosis is mainly a worsening problem related to advancing age with a chronic inflammatory involvement. It leads to the blockage of normal blood flow pathway and hence ischemia of the distal part of limb. The saliva of leech contains number of anti-thrombotic chemicals such as hirudin, bfrudin, haemadin and granulin-like. These chemicals inhibit thrombin fibrin binding and prevent formation of atheroma or plaque. Marham-e-raal is well known formulation for non-healing ulcers irrespective of their origin. It contains potent healing agents that are greatly beneficial for achieving the healing of ulcers.

Methodology: One patient of atherosclerotic gangrene of lower limbs was taken into study after written informed consent. Hirudo medicinalis applied at the course of arteries of occlusion twice weekly and Marham-e-raal was used for local application after proper washing with Alusol (alum powder solution). The treatment continued for two months.

Discussion: The patients especially belong to older age group and present with chronic non healing ulcer at distal limbs with severe burning pain. These ulcers are resilient to healing by modern treatment.

Conclusion: The optimal treatment of atherosclerotic ischemic ulcer is application of medicinal leeches over the course of arteries showing occlusion with local application of Marham-e-raal.

In this research work in recent years, Low Dose Computed Tomography (LDCT) is being used for lung cancer screening in high risk groups. According to USPSTF guidelines, people aged between 55 and 80 years old, who have a smoking history of 30 pack-years or have quit for less than 15 years, are recommended to take a LDCT scan. Other possible candidates for lung cancer screening can be patients with radon exposure, family history associated with lung cancer or history of pulmonary fibrosis or chronic obstructive lung disease. Detecting lung cancer at an early stage raises the question of optimal treatment and overall survival. This article aims to compare segmentectomy vs. lobectomy as surgical options, in case of stage I Non-Small-Cell Lung Carcinoma (NSCLC), ideally IA.

In order to compare the two previously referred strategies, data has been collected from articles (40 studies have been reviewed), reviews and systematic analyses in PubMed Central and also reviewing recent literature. Tumor size and location, patient age, comorbidities and nodal status have been examined as factors that affect the choice between segmental or lobar tumor resection. R0 resection and distance between resection margin and tumor was taken into consideration.

Segmentectomy could be an equal alternative to lobectomy in early stage NSCLC (tumor<2 cm). It could mainly be preferred for >75 y.o. and/or multimorbid patients with low cardiopulmonary reserve and struggle to survive a lobectomy. However, the anatomical segmentectomy requires among other a peripheral tumor position. Some segments, such as posterior segments of left upper lobe, are not removed separately. In this case, for anatomic reasons a bi- or tri-segmentectomy could be performed.

As far as early stage NSCLC is concerned anatomic segmentectomy is an acceptable procedure in a selective group of patients. For a better tumor and stage classification a systematic lymph node dissection should be performed.