701
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Mata Tapia I, Galán Cabezas A, Lluch Fernández M. [Central pontine myelinolysis after a partial liver transplant]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:606-607. [PMID: 21155346 DOI: 10.1016/s0034-9356(10)70292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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702
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Santiago FM, Olmedo C, Muffak-Granero K, Comino A, Villar JM, Garrote D, Bueno P, Ferrón JA. Intraoperative pH values after N-acetylcysteine administration during liver transplantation. Transplant Proc 2010; 42:3164-6. [PMID: 20970637 DOI: 10.1016/j.transproceed.2010.05.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated whether intraoperative administration of N-acetylcysteine (NAC) to liver transplant recipients affected pH values. This prospective, randomized, double-blind clinical trial included liver transplant recipients who were randomly assigned to NAC-treated (n=25) or placebo (n=25) groups. The NAC-treated group received 100 mg/kg dissolved in 5% dextrose over 15 minutes during the anhepatic phase, followed by a continuous infusion of 50 mg/kg in 5% dextrose during the next 24 hours. The placebo group received equal amounts of 5% dextrose solution during the same times. Peripheral blood samples were drawn in Ca2+-80 IU-containing syringes after induction of anesthesia (I-1), at 15 minutes into the anhepatic phase (I-2) prior to the administration of NAC or placebo, at 5 minutes before reperfusion (I-3), at 5 minutes after reperfusion (I-4), at 20 minutes after reperfusion (I-5), at 60 minutes after reperfusion (I-6), and at 1 hour after completion of the procedure (I-7). pH levels, which were determined using a radiometer ABL77 (Copenhagen, Denmark), were significantly lower among the NAC than the placebo group at I-4 (P=.027) and I-5 (P=.031). An early decrease in pH values was detected in the NAC-treated group at 5 minutes before reperfusion (I-3; P=.051). We concluded that intraoperative NAC administration during the anhepatic phase of liver transplantation significantly decreased recipient pH values at 5 and 20 minutes after reperfusion, a decrease that was detected at 5 minutes before reperfusion (I-3). The decrease seemed to be associated with NAC metabolism.
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Affiliation(s)
- F M Santiago
- Anesthesiology Service, Virgen de las Nieves University Hospital, Granada, Spain
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703
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Suzuki K, Watada S, Yoko M, Nakahara T, Kumamoto Y. Successful Diagnosis of Gallbladder Carcinoma Coexisting with Adenomyomatosis by 18F-FDG-PET—Report of a Case. J Gastrointest Cancer 2010; 42:252-6. [DOI: 10.1007/s12029-010-9221-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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704
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Ovarian mass mimicking malignancy: a case report. Nucl Med Mol Imaging 2010; 44:290-3. [PMID: 24899966 DOI: 10.1007/s13139-010-0045-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/27/2010] [Indexed: 01/27/2023] Open
Abstract
A 32-year-old female who suffered from abdominal pain underwent (18)F-fluorodexoyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the diagnostic workup of pelvic mass lesions. Cystic mass lesions in the bilateral ovaries showed wall thickening and intense hypermetabolism along the rim. In addition, multifocal intense hypermetabolic lymphadenopathies were seen in the left paraaortic lymph node (LN), aortocaval LN, and both common iliac LNs. We interpreted these findings as bilateral ovarian cancer with retroperitoneal metastatic lymphadenopathies rather than endometriosis with reactive lymphadenopathies. However, histopathological examination confirmed the ovarian mass lesions as tubo-ovarian abscesses. We report a case that even if simultaneous hypermetabolic retroperitoneal LNs are seen, intense hypermetabolic lesions in both ovaries can be in consequence of inflammatory change.
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705
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Niederle B. Surgical endocrinology--update 2010. Langenbecks Arch Surg 2010; 395:831-5. [PMID: 20711787 DOI: 10.1007/s00423-010-0705-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 07/22/2010] [Indexed: 10/19/2022]
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706
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Acquaro P, Tagliabue F, Confalonieri G, Faccioli P, Costa M. Abdominal wall actinomycosis simulating a malignant neoplasm: Case report and review of the literature. World J Gastrointest Surg 2010; 2:247-50. [PMID: 21160882 PMCID: PMC2999246 DOI: 10.4240/wjgs.v2.i7.247] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 02/22/2010] [Accepted: 02/27/2010] [Indexed: 02/06/2023] Open
Abstract
Abdominal wall actinomycosis is a rare disease frequently associated with the presence of an intra uterine device. We report on a case of a 47-year-old woman who had used an intrauterine device for many years and had removed it about a month prior to the identification of an abdominal wall abscess caused by Actinomyces israelii. The abscess mimicked a malignancy and the patient underwent a demolitive surgical treatment. The diagnosis was obtained only after histopathological examination. Postoperatively, the patient developed an infection of the wound which was treated with daily medication. The combination of long-term high dose antibiotic therapy with surgery led to successful treatment.
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Affiliation(s)
- Paola Acquaro
- Paola Acquaro, Fulvio Tagliabue, Gianmaria Confalonieri, Melchiorre Costa, Department of Surgery, "A.Manzoni" Hospital, Via dell'Eremo 9/11, 23900 Lecco (LC), Italy
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707
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Abstract
BACKGROUND Tuberculosis (TB) and malignancy represent global threats claiming millions of lives and inflicting formidable suffering worldwide. Surprisingly, the pathophysiological and practical implications of their co-existence have received little attention. METHODS Therefore, we sought to review the available literature on the field and identify data regarding the association between TB and malignancy in order to highlight the neglected aspects of this association and probably derive clinically useful information. We searched PubMed up to June 2008 for case reports, case series, non-comparative and comparative studies that were written in English and reported data on the occurrence of both TB infection and a neoplastic disorder in the same patient(s). The development of mycobacterial infections in patients with immunocompromized conditions is well known and was considered outside the scope of this review. EVIDENCE SYNTHESIS The synthesis of the available evidence enabled us to establish three different types of association between malignancy and TB: (i) the development of cancer on the background of a previous tuberculous infection; (ii) the concurrent existence of TB and malignancy in the same patient(s) or clinical specimen(s); and (iii) the diagnostic challenges arising from the multi-faceted presentations of these two disorders. CONCLUSION We conclude that clinicians need to be aware of the protean manifestations of TB and cancer and maintain a high index of suspicion for simultaneous and/or misleading presentations. In addition, further research is required to determine if a tuberculous infection, being similar to other chronic infections and inflammatory conditions, may facilitate carcinogenesis.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
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708
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Soufi M, Benamer S, Chad B. [Pseudotumoral gallbladder tuberculosis]. Rev Med Interne 2010; 32:e32-3. [PMID: 20646794 DOI: 10.1016/j.revmed.2009.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 08/05/2009] [Accepted: 11/24/2009] [Indexed: 11/17/2022]
Abstract
Gallblader tuberculosis is uncommon and may mimic a neoplasia. We report a 55-year-old man who presented with fever and abdominal pain compatible with cholecystitis. Abdominal ultrasound and computed tomographic scan showed a tumoral aspect of the bottom of the gallbladder and invasion of adjacent liver. Diagnosis of pseudo-tumoral gallbladder tuberculosis was obtained with the histologic examination of surgical sampling. Disease course was uneventful with appropriate antituberculous therapy.
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Affiliation(s)
- M Soufi
- Clinique chirurgicale B Avicenne, 9 rue al kharroub, secteur 16 Riad, Rabat, Morocco.
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709
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Khan R, Vasenwala SM, Arif SH, Harris SH. Granulomatous gall bladder: A surgico-pathological challenge. Ann Saudi Med 2010; 30:244. [PMID: 20427945 PMCID: PMC2886880 DOI: 10.4103/0256-4947.62831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Roobina Khan
- From the Departments of Pathology and Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Utter Pradesh, India
| | - Shaista M Vasenwala
- From the Departments of Pathology and Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Utter Pradesh, India
| | - Shaukat H. Arif
- From the Departments of Pathology and Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Utter Pradesh, India
| | - Syed H. Harris
- From the Departments of Pathology and Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Utter Pradesh, India
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710
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Majdoub Hassani KI, El Bouhaddouti H, Ousadden A, Ankouz A, Boubou M, Tizniti S, Mazaz K, Taleb KA. Non-Hodgkin's lymphoma revealed by an ilio-colic intussusception in a Moroccan patient: a case report. Pan Afr Med J 2010; 4:11. [PMID: 21119996 PMCID: PMC2984306 DOI: 10.4314/pamj.v4i1.53599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 02/22/2010] [Indexed: 01/24/2023] Open
Abstract
Intussusceptions are rare but well-known causes of the small bowel obstruction in adults and an underlying cause is present in the majority of cases. Lymphoma's involvement of the ileum is one of the rare causes of intussusception. CT is a sensitive examination that diagnoses intussusceptions and provides an excellent pre-operative evaluation including possible extension and dissemination especially in intestinal lymphomas. The treatment is almost always surgical and the pathological study is needed for diagnostic confirmation. Authors present an unusual case of intestinal intussusception due to lymphoma of the terminal part of the ileum in a 49-year-old man. Computed tomography confirmed the diagnosis of intussusception and non-Hodgkin's lymphoma of B-cell was diagnosed by histological examination after surgical treatment. Primary intestinal lymphomas differ from gastric lymphomas in clinical features, treatment, and prognosis. They are not well characterized and the standardized concepts for their clinical diagnosis and management are absent. The aim of this rare observation is to shed light on NHL of the small bowel, its clinical and radiological diagnosis and its treatment especially in forms revealed by intussusceptions in adults.
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711
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Chakravarty KD, Chan KM, Wu TJ, Lee CF, Lee WC. Split-liver transplantation in 2 adults: significance of caudate lobe outflow reconstruction in left lobe recipient: case report. Transplant Proc 2010; 41:3937-40. [PMID: 19917417 DOI: 10.1016/j.transproceed.2009.06.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 06/19/2009] [Indexed: 01/30/2023]
Abstract
Split-liver transplantation is a well-known procedure for increasing the donor pool. The procedure is commonly used in 1 adult and 1 child, but is less commonly performed in 2 adults because of technical difficulty and poor outcome in left-lobe recipients. Preservation of caudate lobe function is important in recipients with borderline graft-recipient weight ratio to achieve better results. Herein, we report a case in which caudate lobe outflow was reconstructed in a left lobe with a caudate lobe graft in split-liver transplantation in 2 adults.
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712
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Ijtsma AJC, van der Hilst CS, de Boer MT, de Jong KP, Peeters PMJG, Porte RJ, Slooff MJH. The clinical relevance of the anhepatic phase during liver transplantation. Liver Transpl 2009; 15:1050-5. [PMID: 19718649 DOI: 10.1002/lt.21791] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study assesses the relation between the anhepatic phase duration and the outcome after liver transplantation. Of 645 patients who underwent transplantation between 1994 and 2006, 194 were recipients of consecutive adult primary piggyback liver transplants using heart-beating donors. The anhepatic phase was defined as the time from the physical removal of the liver from the recipient to recirculation of the graft. Other noted study variables were the cold and warm ischemia times, donor and recipient age, donor and recipient body mass index, perioperative red blood cell (RBC) transfusion, indication for transplantation, and Model for End-Stage Liver Disease score. The primary outcome parameter was graft dysfunction, which was defined as either primary nonfunction or initial poor function according to the Ploeg-Maring criteria. The median anhepatic phase was 71 minutes (37-321 minutes). Graft dysfunction occurred in 27 patients (14%). Logistic regression analysis showed an anhepatic phase over 100 minutes [odds ratio (OR), 4.28], a recipient body mass index over 25 kg/m(2) (OR, 3.21), and perioperative RBC transfusion (OR, 3.04) to be independently significant predictive factors for graft dysfunction. One-year patient survival in patients with graft dysfunction was 67% versus 92% in patients without graft dysfunction (P < 0.001). A direct relation between the anhepatic phase duration and patient survival could, however, not be established. In conclusion, this study shows that liver transplant patients with an anhepatic phase over 100 minutes have a higher incidence of graft dysfunction. Patients with graft dysfunction have significantly worse 1-year patient survival.
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Affiliation(s)
- Alexander J C Ijtsma
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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713
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Morera Ocón FJ, Ballestín Vicente J, Ripoll Orts F, Landete Molina F, García-Granero Ximénez M, Millán Tarín J, Tursi Rispoldi LD, Bernal Sprekelsen JC. [Gallbladder cancer in a regional hospital]. Cir Esp 2009; 86:219-23. [PMID: 19695566 DOI: 10.1016/j.ciresp.2009.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 02/16/2009] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the management of gallbladder cancer (GBC) in our region. MATERIAL AND METHODS Data on 372 patients who underwent cholecystectomy were identified from our database (January 2003 to February 2008) and 6 patients were found to have GBC. RESULTS Four patients had incidental carcinoma, one case was preoperatively suspected, and one patient presented with jaundice and locally advanced neoplasia. The incidence was 2 per 100,000 inhabitants per year; incidental carcinoma in 1.1% of cholecystecomies. The ultrasonography showed multilithiasis in 2 patients, sludge and neoplasia in 1, gallstones more than 3cm in 2, and tumor mass only in 1 case. T stage: 1 case of T0 (in situ), 1 of T1, 2 of T2 and one T4. Incidental carcinomas were reoperated on when a T2 was established: 2 underwent lymphadenectomy and cystic stump resection, 1 segmentectomy IVb-V and lymphadenectomy. In the preoperative suspected neoplasia a cholecystectomy, lymphadenectomy, and partial hepatic gallbladder bed resection was initially performed. CONCLUSIONS GBC has a low incidence but it will be found in 1% of cholecystectomies. There is no adjuvant treatment and T-based surgical treatment is the is the only opportunity to reach cure in those patients. A national GBC database would be helpful in the publication of national guidelines for this disease.
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714
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Makino I, Yamaguchi T, Sato N, Yasui T, Kita I. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET. World J Gastroenterol 2009; 15:3691-3. [PMID: 19653352 PMCID: PMC2721248 DOI: 10.3748/wjg.15.3691] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Recently, several reports have demonstrated that fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is useful in differentiating between benign and malignant lesions in the gallbladder. However, there is a limitation in the ability of FDG-PET to differentiate between inflammatory and malignant lesions. We herein present a case of xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma by ultrasonography and computed tomography. FDG-PET also showed increased activity. In this case, FDG-PET findings resulted in a false-positive for the diagnosis of gallbladder carcinoma.
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715
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Hur H, Park IY, Sung GY, Lee DS, Kim W, Won JM. Intrahepatic cholangiocarcinoma associated with intrahepatic duct stones. Asian J Surg 2009; 32:7-12. [PMID: 19321396 DOI: 10.1016/s1015-9584(09)60002-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE It has been well established that the long-term prognosis of intrahepatic duct stones (IHDS) is complicated by the late development of biliary cirrhosis with associated intrahepatic cholangiocarcinoma (IHCC). Despite recent improvements in imaging studies, accurate preoperative diagnosis of IHCC is difficult. Therefore, we attempted to elucidate the clinical features of patients with IHDS with IHCC. METHODS We reviewed 80 patients with IHDS and divided them into two groups. The DS group included 72 patients who had only IHDS. The second group was defined as the CC group and included eight patients who had IHDS and IHCC. For diagnosis of IHDS and confirmation of coexisting IHCC, patients underwent various radiological evaluations and additional laboratory tests, such as serum carbohydrate antigen 19-9 (CA 19-9). RESULTS There was no significant difference in the symptoms and stone characteristics between the two groups. For the CC group, liver resection was performed in four patients. Three patients underwent curative resection, but only one of these patients was alive at 36 months without recurrence. CONCLUSION IHCC with IHDS was difficult to diagnose in the early phase. Therefore, while performing diagnostic studies and surgery for IHDS, one should always consider the possibility of coexisting cholangiocarcinoma.
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Affiliation(s)
- Hoon Hur
- Department of Surgery, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea
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716
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Zbar AP, Ranasinghe W, Kennedy PJ. Subphrenic abscess secondary to Actinomycosis meyeri and Klebsiella ozaenae following laparoscopic cholecystectomy. South Med J 2009; 102:725-7. [PMID: 19487988 DOI: 10.1097/smj.0b013e3181abddc5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case is reported of a subphrenic abscess 12 months post-laparoscopic cholecystectomy in a 72-year-old male with identification of Actinomyces meyeri and the oropharyngeal commensal Klebsiella ozaenae. The first organism is exceptionally rare following laparoscopic cholecystectomy and is presumed to be a result of inadvertent gallstone spillage. The second organism has not previously been reported in a subphrenic abscess. The etiopathogenesis and management of this condition are presented.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery, Universities of New England and Newcastle, Tamworth Rural Referral Hospital, Newcastle, New South Wales, Australia.
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717
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Santiago FM, Bueno P, Olmedo C, Muffak-Granero K, Comino A, Serradilla M, Mansilla A, Villar JM, Garrote D, Ferrón JA. Effect of N-acetylcysteine administration on intraoperative plasma levels of interleukin-4 and interleukin-10 in liver transplant recipients. Transplant Proc 2009; 40:2978-80. [PMID: 19010165 DOI: 10.1016/j.transproceed.2008.08.103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigated whether intraoperative administration of N-acetylcysteine (NAC) in liver transplant recipients ameliorated their inflammatory responses by increasing intraoperative plasma levels of interleukin (IL)-4 and IL-10. This prospective, randomized, double-blind clinical trial included liver transplant recipients randomly assigned to the NAC-treated (n = 25) or the placebo (n = 25) group. The NAC-treated group received 100 mg/kg dissolved in 5% dextrose over 15 minutes during the anhepatic phase, followed by a continuous infusion of 50 mg/kg in 5% dextrose over the next 24 hours, whereas the placebo group received equal amounts of 5% dextrose solution during the same time. Peripheral blood samples were drawn in EDTA-containing tubes after induction of anesthesia (I-1); at 15 minutes into the anhepatic phase (I-2) prior to the administration of NAC or placebo; at 5 minutes before reperfusion (I-3); at 10 minutes after reperfusion (I-4); at 20 minutes after reperfusion (I-5); at 60 minutes after reperfusion (I-6); and at 1 hour after completion of the liver transplantation (I-7). Cytokine levels were determined using a technique which combined enzyme-linked immunosorbent assay (ELISA) and flow cytometry. Plasma IL-4 levels were significantly higher among the NAC-treated group than the placebo group at I-3 (P = .046) and I-4 (P = .041). Plasma IL-10 levels showed significant enhancement in the NAC-treated group at 5 minutes before reperfusion (I-3; P = .007). We concluded that intraoperative NAC administration during the anhepatic phase of liver transplantation significantly increased recipient IL-4 plasma levels before and after reperfusion, and IL-10 plasma values before reperfusion (I-3). These enhancements seemed to be associated with a protective effect against reperfusion injury.
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Affiliation(s)
- F M Santiago
- Anesthesiology Service, Virgen de las Nieves University Hospital, Granada, Spain
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718
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The surgical treatment and outcome for primary duodenal adenocarcinoma. J Gastrointest Cancer 2009; 40:33-7. [PMID: 19513860 DOI: 10.1007/s12029-009-9073-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 05/27/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose. METHOD Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively. RESULTS All 32 patients underwent laparotomy, including 18 patients (56.3%) pancreaticoduodenectomy (PD), six patients (18.7%) segmental resection (SR), and eight patients bypass procedures. R0 resections were obtained in 22 patients; the other 10 procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25/29), 48.3% (14/29), and 20.7% (6/29), respectively, moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19/19), 73.7% (14/19), and 31.6%(6/19), which were significantly higher than those (50.0% = 5/10, 0%, and 0%) in patients with palliative operation (P > 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05). CONCLUSION PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.
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719
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Microcoil Embolisation of Mycotic Cystic Artery Pseudoaneurysm: A Viable Option in High-Risk Patients. Cardiovasc Intervent Radiol 2009; 32:1275-9. [DOI: 10.1007/s00270-009-9590-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/03/2009] [Accepted: 04/07/2009] [Indexed: 01/04/2023]
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720
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Ramia Angel JM, De la Plaza Llamas R, Veguillas Redondo P, Quiñones Sampedro JE, García-Parreño Jofré J. [Three trocar laparoscopic hepatic adenoma resection]. Cir Esp 2009; 86:314-5. [PMID: 19403123 DOI: 10.1016/j.ciresp.2008.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 10/01/2008] [Indexed: 11/18/2022]
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721
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Han SL, Cheng J, Zhou HZ, Zeng QQ, Lan SH. The surgical treatment and outcome for primary duodenal adenocarcinoma. J Gastrointest Cancer 2009; 39:46-50. [PMID: 19399645 DOI: 10.1007/s12029-009-9061-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Primary duodenal adenocarcinomas (PDAC) are uncommon tumors characterized by non-specific symptoms and late diagnosis, and treatments of PDAC have some controversies. METHOD To investigate the early diagnosis and outcomes of surgical treatment of PDAC, 32 patients who were treated surgically between February 1990 and September 2006 were analyzed retrospectively. RESULTS All 32 patients underwent laparotomy, including 18 patients (56.3%) with pancreaticoduodenectomy (PD), six patients (18.7%) with segmental resection (SR), and eight patients with bypass procedures. And, R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25 of 29), 48.3% (14 of 29), and 20.7% (six of 29), respectively. Moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19 of 19), 73.7% (14 of 19), and 31.6% (six of 19), which were significantly higher than those (50.0% = 5/10, 0% and 0%) in patients with palliative operation (P < 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (five of 18) in pancreaticoduodenectomy patients and 16.7% (one of six) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05). CONCLUSION PD is suggested for the tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.
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Affiliation(s)
- Shao-Liang Han
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, 325000, Zhejiang Province, People's Republic of China.
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722
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Ramos-Font C, Santiago Chinchilla A, Rodríguez-Fernández A, Rebollo Aguirre Á, Gómez Río M, Llamas Elvira J. Estadificación del cáncer de vesícula mediante tomografía de positrones con 18F-fluorodesoxiglucosa. ACTA ACUST UNITED AC 2009; 28:74-7. [DOI: 10.1016/s0212-6982(09)70701-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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723
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Abstract
BACKGROUND Splenic involvement in amyloidosis is rather frequent (5-10%). An atraumatic rupture of the affected spleen is however an extremely rare event. We report on a patient with undiagnosed amyloidosis who underwent emergency splenectomy for atraumatic splenic rupture. METHODS Review of the literature and identification of 31 patients, including our own case report, with atraumatic splenic rupture in amyloidosis. Analysis of the clinical presentation, the surgical management, the nomenclature and definition of predisposing factors of splenic rupture. RESULTS We identified 15 women and 16 men (mean age 53.3 +/- 12.4 years; median 52, range: 27-82 years) with an atraumatic splenic rupture. Easy skin bruisability and factor X deficiency were detected in four (13%) and five patients (16%), respectively. The diagnosis of splenic rupture was made either by computed tomography (n = 12), ultrasound (n = 5), exploratory laparotomy (n = 9) or autopsy (n = 4). All patients underwent surgery (n = 27) or autopsy (n = 4). Amyloidosis was previously diagnosed in nine patients (29%). In the remaining 22 patients (71%), the atraumatic splenic rupture represented the initial manifestation of amyloidosis. Twenty-five patients (81%) suffered from primary (AL) and four patients (13%) from secondary amyloidosis (AA). In two patients, the type of amyloidosis was not specified. A moderate splenomegaly was a common feature (68%) and the characteristic intraoperative finding was an extended subcapsular hematoma with a limited parenchymal laceration (65%). In five patients with known amyloidosis, the atraumatic splenic rupture was closely associated with autologous stem-cell transplantation (ASCT) (16%). Three patients were suffering from multiple myeloma (10%). A biopsy-proven amyloidotic liver involvement was present in 14 patients (45%), which lead to atraumatic liver rupture in two patients. The splenic rupture related 30-day mortality was 26% (8/31). CONCLUSIONS Atraumatic splenic rupture in amyloidosis is associated with a high 30-day mortality. It occurs predominantly in patients with previously undiagnosed amyloidosis. A moderate splenomegaly, coagulation abnormalities (easy skin bruisability, factor X deficiency) and treatment of amyloidosis with ASCT are considered predisposing factors for an atraumatic splenic rupture.
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Affiliation(s)
- Pietro Renzulli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, andUniversity of Bern, Switzerland.
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724
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de Mestral C, Razek T, Khwaja K, Fata P. Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review. Eur J Trauma Emerg Surg 2008; 34:595-600. [PMID: 26816286 DOI: 10.1007/s00068-008-7102-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 12/18/2007] [Indexed: 12/07/2022]
Abstract
BACKGROUND Extrahepatic biliary tract injuries following blunt abdominal trauma are very rare and pose a diagnostic and therapeutic challenge. CASE REPORT We report a case of blunt liver injury with left extrahepatic duct transection following a motor vehicle collision. Technetium 99m dimethyliminodiacetic acid scan confirmed a bile leak and endoscopic retrograde cholangiopancreatography (ERCP) diagnosed the injury of the left extrahepatic duct. Management was initially conservative, consisting of external drainage along with trials of stent placement. Ultimately, partial left hepatectomy was required to definitively treat the injury. CONCLUSION In the setting of suspected biliary tract injury, early ERCP is essential to localize a leak and guide management decisions. In the event of a confirmed bile leak, a trial of nonoperative management consisting of endoscopic ductal decompression along with percutaneous drainage may initially be warranted although is not always successful.
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Affiliation(s)
| | | | | | - Paola Fata
- Department of Surgery, Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada, H3G 1A4.
- Department of Surgery, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, Montreal, QC, Canada, H3G 1A4.
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725
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Altet J, Rafecas A, Fabregat J, Ramos E, García-Borobia FJ, Frago R, Figueras J, Torras J, Jorba R, Valls C. Quistes de los conductos biliares del adulto: estrategia quirúrgica. Cir Esp 2008; 84:256-61. [DOI: 10.1016/s0009-739x(08)75917-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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726
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Longterm Results of a Prospective Study of 225 Femoral Hernia Repairs: Indications for Tissue and Mesh Repair. J Am Coll Surg 2008; 207:360-7. [DOI: 10.1016/j.jamcollsurg.2008.04.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 04/08/2008] [Accepted: 04/08/2008] [Indexed: 11/15/2022]
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727
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Markogiannakis H, Theodorou D, Toutouzas KG, Gloustianou G, Katsaragakis S, Bramis I. Adenocarcinoma of the third and fourth portion of the duodenum: a case report and review of the literature. CASES JOURNAL 2008; 1:98. [PMID: 18706123 PMCID: PMC2527500 DOI: 10.1186/1757-1626-1-98] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 08/18/2008] [Indexed: 12/14/2022]
Abstract
A 65-year-old woman presented with abdominal pain, weight loss, fatigue, and microcytic anemia. Esophagogastroduodenoscopy, until the second part of duodenum, was normal. Ultrasound and computed tomography demonstrated a solid mass in the distal duodenum. A repeat endoscopy confirmed an ulcerative, intraluminar mass in the third and fourth part of the duodenum. Segmental resection of the third and fourth portion of the duodenum was performed. Histology revealed an adenocarcinoma. On the 4th postoperative day, the patient developed severe acute pancreatitis leading to multiple organ failure and died on the 30th postoperative day.
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Affiliation(s)
- Haridimos Markogiannakis
- 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical, School, University of Athens, Q, Sofias 114 av,, 11527, Athens, Greece.
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728
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Abstract
A 68-year-old man had malaise, weight loss, and enlarged right cervical lymph nodes. The first biopsy from a right cervical lymph node showed granulomas with negative acid-fast bacillus (AFB) staining, and he was treated for extrapulmonary tuberculosis with isoniazid, rifampin, ethambutol, and pyrazinamide. Symptoms persisted even after receiving antituberculosis drugs for 2 months. He was transferred to our center for F-18 FDG PET/CT scan under the suspicion of occult malignancy. The PET/CT scan showed increased FDG uptake in the right cervical lymphadenopathy and multiple bony lesions. The second biopsy from the FDG-avid cervical lymph node and bone marrow confirmed nontuberculous mycobacterial (NTM) infection. After another 6 months of adjusted antituberculosis therapy with isoniazid, rifampin, ethambutol, and clarithromycin, a repeat PET/CT scan showed remission of previous lesions.
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729
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Kan WH, Hsieh CH, Schwacha MG, Choudhry MA, Raju R, Bland KI, Chaudry IH. Flutamide protects against trauma-hemorrhage-induced liver injury via attenuation of the inflammatory response, oxidative stress, and apopotosis. J Appl Physiol (1985) 2008; 105:595-602. [PMID: 18535130 DOI: 10.1152/japplphysiol.00012.2008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although studies have shown that administration of testosterone receptor antagonist, flutamide, following trauma-hemorrhage, improves hepatic, cardiovascular, and immune functions, the precise cellular/molecular mechanisms responsible for producing these salutary effects remain largely unknown. To study this, male C3H/HeN mice were subjected to a midline laparotomy and hemorrhagic shock (35+/-5 mmHg for approximately 90 min), followed by resuscitation with Ringer lactate. Flutamide (25 mg/kg) or vehicle was administered subcutaneously at the onset of resuscitation, and animals were killed 2 h thereafter. Hepatic injury was assessed by plasma alpha-glutathione S-transferase concentration, liver myeloperoxidase activity, and nitrotyrosine formation. Hepatic malondialdehyde and 4-hydroxyalkenals (lipid peroxidation indicators), cellular DNA fragmentation, and the expression of inducible nitric oxide synthase and hypoxia-inducible factor-1alpha were also evaluated. Cytokines (TNF-alpha, IL-6) and chemokines (keratinocyte-derived chemokine and monocyte chemoattractant protein-1) levels were determined by cytometric bead array. The results indicate that flutamide administration after trauma-hemorrhage reduced liver injury, which was associated with decreased levels of alpha-glutathione S-transferase, myeloperoxidase activity, nitrotyrosine formation, lipid peroxidation, and cytokines/chemokines (systemic, liver tissue, and intracellular cytokines/chemokines). Cellular apoptosis, hepatocyte hypoxia-inducible factor-1alpha, and inducible nitric oxide synthase expression were also decreased under such conditions. Thus administration of flutamide following trauma-hemorrhage protects against liver injury via reduced inflammation, cellular oxidative stress, and apoptosis.
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Affiliation(s)
- Wen-Hong Kan
- Center for Surgical Research, Department of Surgery, University of Alabama at Birmingham, G094 Volker Hall, 1670 Univ. Blvd., Birmingham, AL 35294-0019, USA
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730
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Goss JA, Barshes NR, Karpen SJ, Gao FQ, Wyllie S. Liver ischemia and ischemia-reperfusion induces and trafficks the multi-specific metal transporter Atp7b to bile duct canaliculi: possible preferential transport of iron into bile. Biol Trace Elem Res 2008; 122:26-41. [PMID: 17987273 DOI: 10.1007/s12011-007-8057-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 07/03/2006] [Indexed: 12/18/2022]
Abstract
Both Atp7b (Wilson disease gene) and Atp7a (Menkes disease gene) have been reported to be trafficked by copper. Atp7b is trafficked to the bile duct canaliculi and Atp7a to the plasma membrane. Whether or not liver ischemia or ischemia-reperfusion modulates Atp7b expression and trafficking has not been reported. In this study, we report for the first time that the multi-specific metal transporter Atp7b is significantly induced and trafficked by both liver ischemia alone and liver ischemia-reperfusion, as judged by immunohistochemistry and Western blot analyses. Although hepatocytes also stained for Atp7b, localized intense staining of Atp7b was found on bile duct canaliculi. Inductive coupled plasma-mass spectrometry analysis of bile copper, iron, zinc, and manganese found a corresponding significant increase in biliary iron. In our attempt to determine if the increased biliary iron transport observed may be a result of altered bile flow, lysosomal trafficking, or glutathione biliary transport, we measured bile flow, bile acid phosphatase activity, and glutathione content. No significant difference was found in bile flow, bile acid phosphatase activity, and glutathione, between control livers and livers subjected to ischemia-reperfusion. Thus, we conclude that liver ischemia and ischemia-reperfusion induction and trafficking Atp7b to the bile duct canaliculi may contribute to preferential iron transport into bile.
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Affiliation(s)
- John A Goss
- Michael E. DeBakey Department of Surgery, Liver Transplant Center Laboratory, Baylor College of Medicine, Houston, TX 77030, USA
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731
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Radouane B, Jidal M, EL Fenni J, Chaouir S, Amil T, Hanine A, Benameur M. Pseudo-anévrisme de l’artère cystique secondaire à une cholécystite lithiasique : à propos d’un cas. ACTA ACUST UNITED AC 2008; 89:345-6. [DOI: 10.1016/s0221-0363(08)93010-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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732
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Prieto B, Llorente E, González-Pinto I, Alvarez FV. Plasma procalcitonin measured by time-resolved amplified cryptate emission (TRACE) in liver transplant patients. A prognosis marker of early infectious and non-infectious postoperative complications. Clin Chem Lab Med 2008; 46:660-6. [DOI: 10.1515/cclm.2008.123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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733
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Peritoneal carcinomatosis secondary to carcinoid tumour. Clin Transl Oncol 2007; 9:804-5. [PMID: 18158985 DOI: 10.1007/s12094-007-0143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Carcinoid tumours are neuroendocrine neoplasms that can appear in every location of the digestive tract. They are low aggressive tumours, although they often produce local invasion and hepatic metastases, whose resection allows long-term survival. We report a case of a 64-year-old man with ileal carcinoid tumour, that underwent ileal resection and metastasectomy of one lesion in liver segment II. Surgical findings indicated peritoneal carcinomatosis. Carcinoid dissemination as peritoneal carcinomatosis has been rarely described in the literature. Cytoreductive surgery, always when complete resection is aimed, achieves asymptomatic long-term survivals.
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734
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Intra-abdominal Actinomycosis 11 Years After Spilled Gallstones at the Time of Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2007; 17:542-4. [DOI: 10.1097/sle.0b013e3181469069] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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735
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Baierlein SA, Wistop A, Looser C, Peters T, Riehle HM, von Flüe M, Peterli R. Abdominal actinomycosis: a rare complication after laparoscopic gastric bypass. Obes Surg 2007; 17:1123-6. [PMID: 17953250 DOI: 10.1007/s11695-007-9189-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 33-year-old, morbidity obese woman underwent a laparoscopic Roux-en-Y gastric bypass in November 2004. She presented 18 months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and endoscopic evaluations revealed wall thickening in the transverse colon and a solid tumor near the liver. Therefore, a sonography-guided biopsy of the tumor was performed. Cytopathological examination revealed actinomycosis. Thus, therapy with penicillin was started, after which the parameters associated with the infection decreased. The symptoms persisted, however, and the decision was made to operate on the patient to resect the abdominal masses. Nearly 90% of the masses could be removed. Histological analysis showed a fibro-productive inflammation with an actinomycotic etiology. Antibiotic therapy with penicillin was continued for 6 months. Actinomycosis must be considered in the differential diagnosis of patients with abdominal mass, wall thickening of the intestine, and other such symptoms, including abdominal pain following bariatric surgery, even many years after the intervention.
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736
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Gennari R, Audisio RA. Breast cancer in elderly women. Optimizing the treatment. Breast Cancer Res Treat 2007; 110:199-209. [PMID: 17851758 DOI: 10.1007/s10549-007-9723-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
The elderly population is on the rise. Breast cancer is the most common cancer in western women and its incidence increases with age. Despite the epidemiological burden of this condition, there is a lack of knowledge regarding the management of older patients, as treatment planning is mainly based on personal preferences rather than hard data. Older women are often offered sub-optimal treatment when compared to their younger counterpart at any particular stage. This is due to various reasons, including the lack of scientific evidence from well-conducted clinical trials. Reluctance to prescribe systemic treatments may be explained by the complexity of cost-benefit evaluations in such patients. It is also an ethical dilemma to decide how aggressive one should be when it comes to treat cancer in the elderly in view of the higher rate of cognitive impairment and specific patients' expectations. This paper reviews the currently available evidence and attempts presenting and discussing chemoprevention of breast cancer, risk and benefit of hormone replacement therapy and the various treatment options for older women with breast cancer.
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737
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Núñez R, Yeung HW, Swanston NM, Macapinlac HA. Captación de fluordesoxiglucosa en la vesícula biliar en la PET y la PET-TAC de tres pacientes oncológicos. ACTA ACUST UNITED AC 2007; 26:234-6. [PMID: 17662192 DOI: 10.1157/13107977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- R Núñez
- Servicio de Medicina Nuclear, Centro Oncológico MD Anderson, Houston, Texas, USA.
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738
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Suppiah A, Gatt M, Barandiaran J, Heng MS, Perry EP. Outcomes of emergency and elective femoral hernia surgery in four district general hospitals: a 4-year study. Hernia 2007; 11:509-12. [PMID: 17628736 DOI: 10.1007/s10029-007-0262-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 06/14/2007] [Indexed: 01/29/2023]
Abstract
INTRODUCTION A large number of femoral herniae present as emergencies accounting for significant morbidity and mortality, which have remained unchanged over the last decade. Reports of outcomes in femoral hernia surgery are scarce, even more so in district general hospitals where a significant proportion of surgeries are performed. This study compares results of emergency and elective femoral hernia surgery in four district general hospitals against published rates up to a decade ago. MATERIALS AND METHODS A retrospective study of all patients undergoing femoral hernia surgery in four district hospitals between 2000 and 2004. RESULTS Seventy-three patients had 75 (28 emergency, 47 elective) femoral hernia repairs. Emergency presentations were associated with increased age(P = 0.001) and right-sided hernias (P = 0.024). Emergency surgery led to increased bowel resection (10.7 vs. 0%, P < 0.001) and longer hospital stays (8 vs. 1 day, P < 0.001) compared to elective surgery. There was no difference in complication rates between emergency and elective surgery (21.4 vs. 12.8%, P = 0.322) or opposition and pectineal flap repair (12.9 vs. 36.4%, P = 0.149). Overall recurrence, morbidity, and mortality were 4.2, 16 and 1.3%, respectively. One patient (3.6%) died after emergency surgery, and no deaths occurred with elective surgery. CONCLUSION The proportion of femoral herniae presenting as emergencies remained unchanged. This accounts for the morbidity and mortality in femoral surgery, which remains high and similar to a decade ago. Early diagnosis by clinicians and general practitioners and elective surgery are required to reduce mortality. Further investigation into the effect of the opposition technique on femoral vein compression and deep venous thrombosis is warranted.
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Affiliation(s)
- A Suppiah
- Scarborough General Hospital, Woodlands Drive, Scarborough, Yorkshire YO12 6QL, UK.
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739
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Zhang W, Wang M, Xie HY, Zhou L, Meng XQ, Shi J, Zheng S. Role of Reactive Oxygen Species in Mediating Hepatic Ischemia-Reperfusion Injury and Its Therapeutic Applications in Liver Transplantation. Transplant Proc 2007; 39:1332-7. [PMID: 17580134 DOI: 10.1016/j.transproceed.2006.11.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 11/16/2006] [Indexed: 01/09/2023]
Abstract
Increasing evidence has shown that reactive oxygen species (ROS) are important mediators in liver ischemia/reperfusion injury(IRI). ROS include hydrogen peroxide (H(2)O(2)), superoxide anion (O(-2)), and hydroxyl radical (HO(-)), which may be generated by activated Kupffer cells in the liver, contributing to reperfusion injury. Hepatic IRI is a multistep process that damages liver graft function. To establish a series of therapeutic strategies to improve the outcome of liver transplantation, a good understanding of the mechanisms of IRI is essential. However, the detail mechanisms of how ROS lead to hepatocyte damage in IRI remains unclear. The aim of this review was to describe recent developments in the field of oxidative stress research. The first part of this review focused on the key roles and possible mechanisms of ROS in hepatic IRI. The second part of this review summarizes some findings including novel and classic antioxidant methods to ameliorate the hepatocyte damage during IRI.
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Affiliation(s)
- W Zhang
- Key Lab of Zhejiang Province Combined Multi-Organ Transplantation, Ministry of Public Health, and Dept. of Hepato-Biliary-Pancreatic Surgery, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, P.R. China
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740
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Akatsu T, Tanabe M, Shimizu T, Handa K, Kawachi S, Aiura K, Ueda M, Shimazu M, Kitajima M. Pseudoaneurysm of the cystic artery secondary to cholecystitis as a cause of hemobilia: report of a case. Surg Today 2007; 37:412-7. [PMID: 17468824 DOI: 10.1007/s00595-006-3423-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 12/04/2006] [Indexed: 02/07/2023]
Abstract
Spontaneous intracholecystic bleeding is very rare. We report herein a very rare case of a pseudoaneurysm of the cystic artery due to acute cholecystitis. A 58-year-old man presented at the emergency department complaining of colicky pain in the right upper quadrant. Dynamic magnetic resonance imaging demonstrated an early-enhanced pooling of contrast material (suggestive of a pseudoaneurysm of the cystic artery) inside the neck of the gallbladder. After the proximal control of the hepatic artery, the patient underwent a cholecystectomy and a ligation of the cystic artery. The resected specimen of the gallbladder showed evidence of a massive intracholecystic hematoma. Proximal to the impacted gallstone in the neck, a 2-cm diameter saccular-type pseudoaneurysm was identified. Although a pseudoaneurysm of the cystic artery is very rare, it should be included in the differential diagnosis of hemobilia. Once the pseudoaneurysm is confirmed, its embolization before a cholecystectomy (which can be attempted laparoscopically) may be useful to ensure the safety of the patient.
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Affiliation(s)
- Tomotaka Akatsu
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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741
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Saluja SS, Ray S, Gulati MS, Pal S, Sahni P, Chattopadhyay TK. Acute cholecystitis with massive upper gastrointestinal bleed: a case report and review of the literature. BMC Gastroenterol 2007; 7:12. [PMID: 17386110 PMCID: PMC1851966 DOI: 10.1186/1471-230x-7-12] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 03/26/2007] [Indexed: 01/04/2023] Open
Abstract
Background Cystic artery pseudoaneurysm is a rare complication following cholecystitis. Its presentation with upper gastrointestinal hemorrhage (UGIH) is even rarer. Thirteen patients with cystic artery pseudoaneurysm have been reported in the literature but only 2 of them presented with UGIH alone. Case presentation We report a 43-year-old woman who developed a cystic artery pseudoaneurysm following an episode of acute cholecystitis. She presented with haematemesis and melaena associated with postural symptoms. Upper gastrointestinal endoscopy revealed a duodenal ulcer with adherent clots in the first part of the duodenum. Ultrasonography detected gallstones and a pseudoaneurysm at the porta hepatis. Selective hepatic angiography showed two small pseudoaneurysms in relation to the cystic artery, which were selectively embolized. However, the patient developed abdominal signs suggestive of gangrene of the gall bladder and underwent an emergency laparotomy. Cholecystectomy with common bile duct exploration along with repair of the duodenal rent, and pyloric exclusion and gastrojejunostomy was done. Conclusion This case illustrates the occurrence of a rare complication (pseudoaneurysm) following cholecystitis with an unusual presentation (UGIH). Cholecystectomy, ligation of the pseudoaneurysm and repair of the intestinal communication is an effective modality of treatment.
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Affiliation(s)
- Sundeep S Saluja
- Department of Gastrointestinal surgery, Room No 1005, PC block, 1floor, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Sukanta Ray
- Department of Gastrointestinal surgery, Room No 1005, PC block, 1floor, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Manpreet S Gulati
- Department of Radiology Ground floor, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Sujoy Pal
- Department of Gastrointestinal surgery, Room No 1005, PC block, 1floor, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Peush Sahni
- Department of Gastrointestinal surgery, Room No 1005, PC block, 1floor, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Tushar K Chattopadhyay
- Department of Gastrointestinal surgery, Room No 1005, PC block, 1floor, AIIMS, Ansari Nagar, New Delhi, 110029, India
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742
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Dulundu E, Ozel Y, Topaloglu U, Sehirli O, Ercan F, Gedik N, Sener G. Alpha-lipoic acid protects against hepatic ischemia-reperfusion injury in rats. Pharmacology 2007; 79:163-70. [PMID: 17259747 DOI: 10.1159/000098953] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 10/17/2006] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM To evaluate the protective effect of alpha-lipoic acid in reducing oxidative damage after severe hepatic ischemia/reperfusion (IR) injury. METHODS Wistar albino rats were subjected to 45 min of hepatic ischemia, followed by 60 min reperfusion period. Lipoic acid (100 mg/kg i.p.) was administered 15 min prior to ischemia and immediately before reperfusion period. At the end of the reperfusion period aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) activity, and cytokine, TNF-alpha and IL-1beta levels were determined in serum samples. Malondialdehyde (MDA), and glutathione (GSH) levels and myeloperoxidase (MPO) activity were determined in the liver tissue samples while formation of reactive oxygen species was monitored by using chemiluminescence (CL) technique with luminol and lucigenin probes. Tissues were also analyzed histologically. RESULTS Serum ALT, AST, and LDH activities and TNF-alpha and IL-1beta levels were elevated in the I/R group, while this increase was significantly lower in the group of animals treated concomitantly with lipoic acid. Hepatic GSH levels, significantly depressed by I/R, were elevated back to control levels in lipoic acid-treated I/R group. Furthermore, increases in tissue luminol and lucigenin CL, MDA levels and MPO activity due to I/R injury were reduced back to control levels with lipoic acid treatment. CONCLUSION Since lipoic acid administration alleviated the I/R-induced liver injury and improved the hepatic structure and function, it seems likely that lipoic acid with its antioxidant and oxidant-scavenging properties may be of potential therapeutic value in protecting the liver against oxidative injury due to ischemia-reperfusion.
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Affiliation(s)
- Ender Dulundu
- Department of 5th Surgery, Haydarpasa Numune Educational and Research Hospital, Istanbul, Turkey
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743
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Vyas JM, Kasmar A, Chang HR, Holden J, Hohmann E. Abdominal Abscesses Due to Actinomycosis after Laparoscopic Cholecystectomy: Case Reports and Review. Clin Infect Dis 2007; 44:e1-4. [PMID: 17173208 DOI: 10.1086/510077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 09/11/2006] [Indexed: 11/03/2022] Open
Abstract
We describe 2 patients who presented to a health care facility with abdominal abscesses years after undergoing laparoscopic cholecystectomy that was complicated by gallstone spillage. In both patients, sample cultures yielded Actinomyces species and enteric organisms. In 1 patient, crystallographic analysis of abscess debris confirmed the presence of gallstones. Actinomyces species is a rare cause of abdominal abscesses that should be considered in this patient population.
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Affiliation(s)
- Jatin M Vyas
- Infectious Diseases Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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744
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Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 2007; 193:73-8. [PMID: 17188092 DOI: 10.1016/j.amjsurg.2006.05.015] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 05/01/2006] [Accepted: 05/01/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for 15 years. During that time, several studies and case reports have been published which outline the possible complications of lost gallstones. The aim of this review is to categorize these complications and to evaluate the frequency and management of lost gallstones. DATA SOURCES A Medline search from 1987 to 2005 was performed. A total of 111 case reports and studies were found, and all reported complications were listed alphabetically. Eight studies with more than 500 LCs that reported lost gallstones and perforated gallbladder were analyzed for frequency and management of lost gallstones. CONCLUSION Lost gallstones have a low incidence of causing complications but have a large variety of possible postoperative problems. Every effort should be made to remove spilled gallstones to prevent further complications, but conversion is not mandatory.
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Affiliation(s)
- Jörg Zehetner
- Department of Surgery, Ludwig Boltzmann Institute for Operative Laparoscopy, AKH Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
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745
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Garner JP, Macdonald M, Kumar PK. Abdominal actinomycosis. Int J Surg 2006; 5:441-8. [PMID: 18078685 DOI: 10.1016/j.ijsu.2006.06.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 06/08/2006] [Accepted: 06/14/2006] [Indexed: 11/24/2022]
Abstract
Abdominal actinomycosis has been recognised for over 150 years yet remains largely unknown to most clinicians. It's varied presentations are usually considered to represent malignancy rather than an infective process - and was once described as 'the most misdiagnosed disease'. Actinomyces are gram positive bacilli of the Actinomycetales genus, and A. israelii is responsible for the majority of human disease. They are normal commensal inhabitants of the human bronchial and gastrointestinal tracts and seem to only cause pathological infection after preceding mucosal breakdown. Patients who have undergone appendicectomy, have had a missed perforated appendicitis or women with a history of intrauterine contraceptive device use are at an increased risk. Florid abscess formation with fistulation, abundant granulation and dense surrounding fibrosis are common. Diagnosis prior to, or even during, surgery is rare and the findings are usually mistaken for acute inflammatory pathologies or malignancy. The treatment of choice is prolonged antibiotic therapy, usually with penicillin to which the organisms remain exquisitely sensitive, although delayed recurrence is possible. This review outlines the historical background of actinomyceal infection and considers the epidemiology, pathophysiology and clinical features of abdominal actinomycosis.
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Affiliation(s)
- J P Garner
- Department of Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, North Derbyshire S44 5BL, UK.
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746
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Lee JW, Kim MY, Kim YJ, Suh CH. CT of acute lower GI bleeding in chronic cholecystitis: concomitant pseudoaneurysm of cystic artery and cholecystocolonic fistula. Clin Radiol 2006; 61:634-6. [PMID: 16784952 DOI: 10.1016/j.crad.2006.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 02/22/2006] [Indexed: 11/21/2022]
Affiliation(s)
- J W Lee
- Department of Radiology, Inha University College of Medicine, Inha University Hospital, Sinheung-dong, Jung-gu, Incheon City, South Korea
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747
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Villar del Moral JM, Villegas-Herrera MT, Medina-Benítez A, Ramia-Angel JM, Garrote-Lara D, Ferrón-Orihuela JA. Retroperitoneoscopy to Extract Dropped Gallstones After Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2006; 16:290-3. [PMID: 16796443 DOI: 10.1089/lap.2006.16.290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.
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748
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Ceriani V, Faleschini E, Sarli D, Lodi T, Roncaglia O, Bignami P, Osio C, Somalvico F. Femoral hernia repair. Hernia 2006; 10:169-74. [PMID: 16482402 DOI: 10.1007/s10029-005-0059-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 11/30/2005] [Indexed: 10/25/2022]
Abstract
Plug insertion for primary femoral hernia repair may cause p.o. discomfort. The Kugel technique may avoid this problem. Patients' satisfaction to the Kugel and the plug techniques is compared in the present study. Demographics, surgical, outcome and analgesic consumption data of 26 patients treated for with the plug technique (P group) are compared with 24 operated with the Kugel patch (K group). Patients' p.o. discomfort to the two procedures was measured with quantitative (VAS score) and a qualitative (the short form of McGill pain questionnaire, SF-MPQ) methods, and compared. P group presented higher early p.o. pain (P<0.001), higher analgesic consumption and a significative delay in the return to physical activity (P<0.001). SF-MPQ scores at p.o. day 8, day 30 and month 6 were significantly lower for K group (P<0.001, P<0.001, P<0.005). The Kugel technique for femoral hernia treatment seems to cause less p.o. discomfort to patients than the plug technique.
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Affiliation(s)
- V Ceriani
- General Surgery Unit, Policlinico Polispecialistico Multimedica, Sesto San Giovanni, Milan, Italy.
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749
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Dwivedi AJ, Greben C, Krishnasastry KV. Catheter embolization of an hepatic artery aneurysm: a case report. Vasc Endovascular Surg 2006; 40:79-83. [PMID: 16456611 DOI: 10.1177/153857440604000112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hepatic artery aneurysms (HAAs) are considered rare. The great improvement in the diagnosis of vascular diseases and the increasing incidence of atherosclerosis have resulted in a wider recognition of these pathologies. Differently from other splanchnic locations, HAAs have a high risk of rupture so that an aggressive treatment is required. Different therapeutic options are currently available: simple ligation of the artery, aneurysm excision with vascular reconstruction, and transcatheter embolization. We describe the usefulness of transcatheter arterial embolization of an 8 cm hepatic artery aneurysm incidentally found on an abdominal computed tomography (CT) scan in an asymptomatic patient.
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Affiliation(s)
- Amit J Dwivedi
- Department of Vascular Surgery, North Shore University and Long Island Jewish Medical Centers, Manhasset, NY 11374, USA.
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750
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Abstract
Many techniques have been described for the repair of femoral hernia. The technique applying the principles of the tension-free method of McVay's Cooper ligament repair by covering all potential hernia sites in the myopectineal orifice with a mesh has also been described, but no report has yet been published with large number of cases and long follow-up period. We used this technique in 28 patients (19 females and 9 males) with femoral hernia. The average operating time was 40 min (range 25-75) and average follow-up period was 40 months (range 6-75). No postoperative infection or seroma was recorded. There was no recurrence at the time of writing. This technique seems to be a good alternative for the repair of femoral hernia and also for concurrent femoral hernia with inguinal hernia.
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Affiliation(s)
- N N Gönüllü
- Department of Surgery, School of Medicine, University of Kocaeli, Izmit, Turkey.
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