Showing papers in "Surgery Today in 2006"
TL;DR: LS and UC are clearly the safest and most efficient methods of coagulation, whereas ME and BE could cause serious clinical and histological complications.
Abstract: Hemostasis is a fundamental principle of surgery. We compared the safety and efficacy of monopolar electrocoagulation (ME), bipolar electrocoagulation (BE), Ligasure (LS), a modern bipolar vessel sealing system, and Ultracision (UC), a system of ultrasound energy based shears. We also studied the healing process after their use. We used each of the above methods to coagulate and divide the short gastric vessels of 16 white male New Zealand rabbits. The animals were killed after 3, 7, 14, or 21 days, and the coagulation sites and the adjacent gastric wall were examined histologically. LS and UC achieved complete hemostasis without any complications. Conversely, ME and BE often resulted in failed coagulation and perforation of the neighboring gastric wall from a side thermal injury. Histologically, LS demonstrated the mildest side thermal injury and the fastest healing process. We noted greater thermal injury and inflammatory response after UC than after LS on days 7 and 14; however, ME and BE caused the most severe lesions. LS and UC are clearly the safest and most efficient methods of coagulation, whereas ME and BE could cause serious clinical and histological complications. We found histological evidence that UC causes a slightly greater inflammatory response than LS, and the clinical implications of this warrant further investigation.
160 citations
TL;DR: Patients with transitional type HCC-CC had significantly poorer survival rates than those with HCC, after hepatic resection, therefore, a more aggressive treatment modality should be explored to improve the survival rate of these patients.
Abstract: Purpose
Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a rare primary hepatic neoplasm (PHN) with features of both hepatocellular and biliary differentiation. We compared the outcome of hepatic resection in patients with HCC-CC, those with hepatocelluar carcinoma (HCC), and those with cholangiocarcinoma (ICC).
127 citations
TL;DR: The biomolecular mechanisms and interactions which lead to the inflammatory response, pneumocyte necrosis, and apoptosis following lung IR therefore warrant further investigation.
Abstract: Lung ischemia-reperfusion (IR) injury is one of the most important complications following lung transplant and cardiopulmonary bypass. The pulmonary dysfunction following lung IR has been well documented. Recent studies have shown that ischemia and reperfusion of the lung may each play significant yet differing roles in inducing lung injury. The mechanisms of injury involving neutrophil activation, and the release of numerous inflammatory mediators and oxygen radicals also contributes to lung cellular injury, pneumocyte necrosis, and apoptosis. We herein review the current understanding of the underlying mechanism involved in lung IR injury. The biomolecular mechanisms and interactions which lead to the inflammatory response, pneumocyte necrosis, and apoptosis following lung IR therefore warrant further investigation.
118 citations
TL;DR: The data suggest that pouchitis may be associated with distinctive changes in selective TLR expression in the pouch mucosa, and that TLR4 alterations in the innate response system may contribute to the pathogenesis of these disorders in particular.
Abstract: The aim of this study was to evaluate the expression pattern of Toll-like receptors (TLRs) in the pouch mucosa of ulcerative colitis patients in comparison with that in the ileum mucosa of noninflammatory bowel disease patients Pouch mucosal biopsy specimens were collected from postoperative patients who had undergone surgery for ulcerative colitis Normal ileum specimens were collected from colon cancer patients The specimens were assessed by immunofluorescence histochemistry using TLR2, TLR3, TLR4, and TLR5 polyclonal antibodies The normal ileal mucosa constitutively expressed TLR3 and TLR5, whereas TLR2 and TLR4 were barely detectable In the mucosa of active pouchitis, TLR2 and TLR4 was strongly upregulated, and TLR4 was upregulated even in a noninflamed pouch No TLR3 or TLR5 expression was detectable These data suggest that pouchitis may be associated with distinctive changes in selective TLR expression in the pouch mucosa, and that TLR4 alterations in the innate response system may contribute to the pathogenesis of these disorders in particular
90 citations
TL;DR: The data support the individualized surgical management of EP, based on careful evaluation of various patient-related factors, including CT findings.
Abstract: Esophageal perforation (EP) is still associated with a high mortality rate, even after surgical repair. We reviewed 17 cases of EP to evaluate the management of this major surgical problem. We reviewed the medical records of all patients treated for EP in our department between November 2001 and November 2004. Therapy was based on various patient-related factors. Seventeen patients, with a mean age of 63 years, presented with EP mostly caused by iatrogenic incidents (11/17). In nine patients, the perforation was located in the thoracic segment, with a mean size of 2.5 ± 0.6 cm. Thoracic computed tomography (CT) was performed in all patients to assess the periesophageal inflammation precisely. More than 50% showed signs of systemic inflammation indicative of sepsis, reflected by a dramatic increase in serum C-reactive protein and leukocytosis. Treatment consisted of debridement and drainage (n = 3), primary repair (n = 3), reinforced repair (n = 4), esophageal resection (n = 5), and conservative measures (n = 2). All patients, except for three with pre-existing liver dysfunction and other comorbidities, survived, representing a mortality rate of 17.6% (14/17). An analysis of the literature (2000–2005) revealed an overall mortality rate of 19.7% (101/521), ranging from 3% to 67%. Our data support the individualized surgical management of EP, based on careful evaluation of various patient-related factors, including CT findings.
83 citations
TL;DR: Preoperative enteral immunonutrition appears to be effective for preventing SSI in patients with colorectal cancer without malnutrition.
Abstract: A prospective study was conducted to ascertain the effects of preoperative enteral immunonutrition on a surgical site infection (SSI) in patients with colorectal cancer without malnutrition. Patients with colorectal cancer undergoing elective surgery without malnutrition, bowel obstruction, severe cardiopulmonary complications, diabetes, collagen disease, or renal failure were sequentially divided into an immunonutrition group (n = 33) and a control group (n = 34). In the immunonutrition group, an enteral diet supplemented with arginine, dietary nucleotides, and ω-3 fatty acids was administered for 5 days (750 ml/day) prior to surgery. The mean age was slightly higher in the immunonutrition group (69 ± 9 years) than in the control group (63 ± 11 years; P < 0.05), but no significant differences between the groups were noted for the body mass index, total protein, albumin, hemoglobin, surgical methods, operation time, or volume of intraoperative bleeding. The frequencies of superficial incisional SSI, deep incisional SSI and organ/space SSI in the immunonutrition and control groups were 0% and 11.8% (4/34; P < 0.05), 0% and 0%, and 0% and 2.9% (1/34), respectively. Preoperative enteral immunonutrition appears to be effective for preventing SSI in patients with colorectal cancer without malnutrition.
82 citations
TL;DR: Although FES usually presents as a multisystem disorder, the most seriously affected organs are the lung, brain, cardiovascular system, and skin, and treatment should be mainly supportive.
Abstract: Fat embolism syndrome (FES) was first described in 1862, but its frequency today is still unclear. A diagnosis of FES is often missed because of a subclinical illness or coexisting confusing injuries or disease. Fat embolism syndrome develops most commonly after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, liver injury, closed-chest cardiac massage, bone marrow transplantation, and liposuction. Although FES usually presents as a multisystem disorder, the most seriously affected organs are the lung, brain, cardiovascular system, and skin. Fat embolism syndrome is a self-limiting disease and treatment should be mainly supportive. Many drugs have been used to treat FES, but the results are inconclusive.
78 citations
TL;DR: 2D-DIGE and LC/MS/MS techniques identified nine proteins that increased significantly more in SW620 than in SW480, which suggests that alpha-enolase and triosephosphate isomerase may be associated with the metastatic process of these two cell lines.
Abstract: Purpose
The pivotal metastatic processes of colorectal cancer (CRC) have yet to be fully investigated by a comprehensive all-inclusive protein analysis. We used two-dimensional differential in-gel electrophoresis (2D-DIGE) and liquid chromatography–tandem mass spectrometry (LC/MS/MS) to investigate the protein pattern changes during the metastasis of CRC. Two CRC cell lines were investigated: SW480 derived from the primary lesion and SW620 derived from lymph node metastasis in the same patient.
75 citations
TL;DR: Laparoscopic wedge resection is a feasible treatment option for GISTs of the stomach if the lesion is <5 cm in diameter, and it was able to perform complete tumor excision with negative surgical margins in all patients.
Abstract: Surgery for gastrointestinal stromal tumors (GIST) of the stomach is now frequently performed using a laparoscopic approach. We investigated the feasibility and effectiveness of laparoscopy in the management of GIST of the stomach. We reviewed the records of 12 consecutive patients who underwent laparoscopic surgery for GIST between April 2000 and April 2004, and compared their short-term outcomes with those of patients who underwent open surgery. All laparoscopic wedge resections were done using stapling devices and 3–4 trocars, often with the aid of intraoperative gastroscopy. We examined all patients preoperatively using various diagnostic modalities, including endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). A laparoscopic approach was not indicated if the tumor was located near the cardia or pylorus or if it was ≧5 cm in diameter. A specific diagnosis of GIST was obtained preoperatively by EUS-FNA in 10 of the 12 patients. The median diameter of the lesion was 2.7 cm (range, 1.5–4.8 cm). Although intraoperative complications were encountered in two patients, conversion to open surgery was not required, and we were able to perform complete tumor excision with negative surgical margins in all patients. The median operative time was 100 min (range, 65–180 min), similar to that for open surgery. First flatus was passed earlier, and the interval to resuming oral intake was shorter than after open surgery. No major postoperative complications such as leakage developed, and the median postoperative hospital stay was 7 days (range, 5–12 days). All diagnoses made by EUS-FNA were confirmed by immunohisto-pathological evaluation of resected specimens. Laparoscopic wedge resection is a feasible treatment option for GISTs of the stomach if the lesion is <5 cm in diameter.
75 citations
TL;DR: It is suggested that the routine use of drains may be abandoned in uncomplicated thyroid surgery, since serious postoperative bleeding rarely occurs and hematomas can be treated by needle aspiration if drains have not been placed, and the use of drain prolongs hospital stay and increases the risk of infection.
Abstract: Purpose
We conducted a prospective, randomized study to evaluate the necessity of drainage after uncomplicated thyroid surgery.
74 citations
TL;DR: The literature provides little evidence that interval appendicectomy is routinely indicated and would support the view that it is unnecessary in 75%–90% of cases, however, there is scope for further consideration of the use of laparoscopic interval appendixectomy and a randomised trial is needed.
Abstract: There is still much controversy surrounding whether interval appendicectomy is appropriate for adults with an appendiceal mass or abscess. The main debate centres on the recurrence rate, the complication rate of interval appendicectomy, and the potential for underlying malignancy. This review aims to assess current practice and to determine whether it is possible to define "best practice" for the asymptomatic patient who has had an appendiceal mass or abscess treated conservatively. I sent a postal questionnaire to 90 consultant general surgeons requesting information about their practice of interval appendicectomy. I also conducted a literature search confined to studies involving only adult patients. The 77.8% of questionnaires returned revealed that 53% of the surgeons perform routine interval appendicectomy, mainly because of concerns about recurrence. The preference was for open appendicectomy at 6 weeks to 3 months. The literature search revealed a recurrence rate of 10%-25%, with a complication rate of 23%. It was evident that the chances of missing malignancy are low and thorough investigation is better than interval appendicectomy in detecting colonic cancer. The practice of performing interval appendicectomy varies, with just over half of the surgeons surveyed performing this procedure routinely. The literature provides little evidence that interval appendicectomy is routinely indicated and would support the view that it is unnecessary in 75%-90% of cases. However, there is scope for further consideration of the use of laparoscopic interval appendicectomy and a randomised trial is needed to fully evaluate this issue.
TL;DR: A greater age, diabetes mellitus, and renal failure were found to be risk factors for development of cognitive impairment at 6 months after CABG with CPB, and there was no relationship between the presence of atherosclerosis in the ascending aorta and postoperative cognitive dysfunction afterCABG surgery.
Abstract: Purpose
Central nervous system complications continue to be major causes of morbidity and mortality after cardiac surgery. The purpose of this study was to identify the risk factors for postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery.
TL;DR: Cancers associated with Graves' disease seems to be more aggressive than those associated with MTG or UTG, and it is suggested that patients with Graves’ disease be carefully monitored for the detection of thyroid nodules.
Abstract: Purpose
The incidence and aggressiveness of thyroid cancer associated with hyperthyroidism remains a subject of much controversy. The aim of this study was to analyze the frequency of coexisting hyperthyroidism and thyroid cancer, and to determine whether cancer becomes more aggressive with different forms of hyperthyroidism.
TL;DR: Fibrin glue application was found to be an easy, safe, effective, and useful alternative treatment in the management of fistulas-in-ano, however, the findings need substantiation by increasing the number of patients and prolonging the follow-up duration, as well as carrying out comparative studies.
Abstract: This prospective study was done to analyze the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano. This clinical trial of 36 patients was performed during the period from November 2003 to May 2004. Thirty men and six women were treated for a fistula-in-ano with commercial fibrin glue application. None of the patients had undergone prior attempts to correct fistulas-in-ano surgically. All patients received preoperative mechanical bowel preparation and prophylactic intravenous antibiotics. In the operating room, the patients underwent an anorectal examination under spinal anesthesia. The external and internal fistula tract openings were then identified. The fistula tract was curetted. Fibrin glue was injected into the external fistula opening until fibrin glue could be seen coming from the internal opening. No dressing was applied over the external opening. Thereafter, the patient was discharged. A 1-week course of oral antibiotics was prescribed. The patients were followed up for 70 weeks with a mean of 54 weeks (range 40–70 weeks). The cause of the fistula-in-ano was cryptoglandular in all patients. The overall initial success rate was 77.8% (28/36). No complications were encountered related to the application. Two patients underwent a reapplication with fibrin glue and the fistulas of these patients were all closed. The overall success rate was 83.3% (30/36). Fibrin glue application was thus found to be an easy, safe, effective, and useful alternative treatment in the management of fistulas-in-ano. However, our findings need substantiation by increasing the number of patients and prolonging the follow-up duration, as well as carrying out comparative studies.
TL;DR: This review presents a critical and unbiased overview of the current status of neosphincter surgery according to the available data in the world literature.
Abstract: Up until about 15 years ago the only realistic option for end-stage fecal incontinence was the creation of a permanent stoma. There have since been several developments. Dynamic graciloplasty (DGP) and artificial bowel sphincter (ABS) are well-established surgical techniques, which offer the patient a chance for continence restoration and improved quality of life; however, they are unfortunately associated with high morbidity and low success rates. Several trials have been done in an attempt to clarify the advantages and disadvantages of these methods and define their place in the second-line treatment of severe, refractory fecal incontinence. This review presents a critical and unbiased overview of the current status of neosphincter surgery according to the available data in the world literature.
TL;DR: This article evaluated the combined effect of α-tocopherol and gadolinium chloride (GdCl3) in reducing lipid peroxidation after severe hepatic ischemia/reperfusion (IR) injury.
Abstract: Purpose
To evaluate the combined effect of α-tocopherol and gadolinium chloride (GdCl3) in reducing lipid peroxidation after severe hepatic ischemia/reperfusion (IR) injury.
TL;DR: The experience supports earlier reports that US and CT are effective tools in the diagnosis of bowel lipoma and performs laparoscopic partial resection of the ileum, including the tumor.
Abstract: A 63-year-old woman was admitted to our hospital for investigation of upper abdominal pain and vomiting. Ultrasonography (US) showed a hyperechoic mass in the right lower abdomen, and computed tomography (CT) showed a low-density mass and intestinal invagination. Thus, we made a diagnosis of intestinal lipoma with intussusception and performed laparoscopic partial resection of the ileum, including the tumor. The resected specimen contained a round tumor, 25 × 22 × 20 mm, which was identified as an intestinal lipoma histopathologically. Our experience supports earlier reports that US and CT are effective tools in the diagnosis of bowel lipoma. Laparoscopic surgery is the treatment of choice for benign tumors of the small intestine because it is minimally invasive, with cosmetic, physical, and economic benefits.
TL;DR: The findings of this study showed that liver function severely affected the onset of ACS and sepsis, and the liver injury resulting from sepsi plus ACS is more severe than that resulting from either one independently.
Abstract: To evaluate the extent of liver injury after the onset of sepsis and abdominal compartment syndrome (ACS) in rats We divided 60 rats into four groups of 15 Group 1 was the sham group In group 2, sepsis was induced by cecal puncture and ligation; in group 3, ACS was created by placing a catheter in the abdominal cavity; and in group 4, both sepsis and ACS were induced simultaneously Liver sections stained with hematoxylin–eosin were assessed pathologically, and liver injury was defined by the following five pathological patterns: spotty necrosis, capsular inflammation, portal inflammation, ballooning degeneration, and steatosis of the liver We revised a new scoring system, called “Hepatic Injury Severity Scoring” (HISS), to evaluate the liver injury in sepsis, ACS, and sepsis plus ACS Blood was collected for liver function tests The total scores of groups 1, 2, 3, and 4 were 18, 92, 86, and 123, respectively There were significant differences in histopathologic grade between group 1 and groups 2, 3, and 4 (P < 005) Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total bilirubin levels were significantly higher in group 4 than in the other three groups The findings of this study showed that liver function severely affected the onset of ACS and sepsis The liver injury resulting from sepsis plus ACS is more severe than that resulting from either one independently
TL;DR: Investigation of the prevalence of NASH in patients with HCC revealed NASH with moderate hepatic fibrosis in one patient and cirrhosis in the other, and clinical follow-up and screening for HCC should be done for patients with hepatic Fibrosis caused by NASH.
Abstract: Sporadic cases of hepatocellular carcinoma (HCC) originating from nonalcoholic steatohepatitis (NASH) have recently been reported. Thus, we investigated the prevalence of NASH in patients with HCC. A review of the clinical records of 481 patients who underwent liver resection for HCC in our department between January 1991 and December 2003 revealed only two (0.4%) patients with HCC associated with NASH. Both of these patients had noninsulin-dependent diabetes mellitus, and neither had a history of alcohol consumption or blood transfusion. All serologic markers for hepatitis B and C viruses were negative. Histological examination of the noncancerous hepatic tissue revealed NASH with moderate hepatic fibrosis in one patient and cirrhosis in the other. Thus, clinical follow-up and screening for HCC should be done for patients with hepatic fibrosis caused by NASH, even though this form of hepatitis is an uncommon cause of HCC.
TL;DR: Initiating early treatment for hypoxemia and reducing the volume of blood transfused intraoperatively may improve the postoperative clinical course of obese patients with preoperative Hypoxemia.
Abstract: Postoperative hypoxemia is a frequent complication of surgery for acute type A aortic dissection. We tried to determine the factors associated with postoperative hypoxemia. Between 1997 and 2003, 114 patients underwent surgery for acute type A aortic dissection. Multivariate logistic regression analysis was done to identify the independent predictors of postoperative hypoxemia, defined by an arterial partial oxygen/inspired oxygen fraction (PaO2/FiO2) ratio of 200 or lower. The overall in-hospital mortality was 6.1% (7 of 114 patients), being 5.2% in the hypoxemia group and 6.9% in the non-hypoxemia group. The ventilation time and intensive care unit stay were significantly longer in the hypoxemia group than in the non-hypoxemia group (P = 0.0044, P = 0.038, respectively). Logistic regression identified the following variables as predictors for postoperative hypoxemia: body mass index ≥25 (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.1–15.01; P < 0.001), preoperative PaO2/FiO2 ratio ≤300 (OR, 2.6; 95% CI, 1.09–6.13; P = 0.031), and the volume of transfused blood (OR, 1.08; 95% CI, 1.01–1.18; P = 0.037). Initiating early treatment for hypoxemia and reducing the volume of blood transfused intraoperatively may improve the postoperative clinical course of obese patients with preoperative hypoxemia.
TL;DR: Sivelestat sodium suppressed the production of PMN elastase and IL-8, resulting in improved respiratory function in patients with ALI caused by cardiopulmonary bypass, causing a significantly lower ratio of the respiratory index and a significantly higher ratio of PaO2/FiO2 after 24 h.
Abstract: Purpose
We evaluated the effect of sivelestat sodium (SiV), a novel synthesized polymorphonuclear (PMN) elastase inhibitor, on acute lung injury (ALI) caused by cardiopulmonary bypass (CPB).
TL;DR: The type of disease was the most important predictive factor of CVC-related infections and the types of diseases that influenced the incidence of CVM complications did not differ between the two groups.
Abstract: To determine the incidence of central venous catheter (CVC) complications and to analyze the potential risk factors for complications necessitating CVC removal in patients on home parenteral nutrition (HPN). We studied 68 patients on HPN (44 men and 24 women), examining the incidence of CVC complications and CVC-related infections. The risk factors for CVC-related infection were investigated using multivariate logistic regression analysis. the incidences of CVC complications were 0.29 episodes per CVC-year in 45 patients with an external tunneled CVC, and 0.66 episodes per CVC-year in 23 patients with an implanted port device. The incidences of CVC-related infections were 0.17 episodes per CVC-year for external tunneled CVCs and 0.17 episodes per CVC-year for implanted port devices. There were no significant differences in the incidences of CVC complications (P = 0.095), and CVC-related infections (P = 0.406). The incidences of CVC-related infections were 0.04 episodes per CVC-year in 54 patients with malignancies, and 0.68 episodes in 14 patients with benign diseases (P < 0.001). Multivariate logistic regression analysis revealed the types of diseases that influenced the incidence of CVC-related infections (P < 0.05). The incidence of CVC complications did not differ between the two groups. The type of disease was the most important predictive factor of CVC-related infections.
TL;DR: Intraperitoneal tenoxicam inhibited the formation of postoperative intra-abdominal adhesions without compromising wound healing in this bacterial peritonitis rat model.
Abstract: We investigated the effects of intraperitoneal tenoxicam on the development of postoperative intra-abdominal adhesions and oxidative stress in a model of bacterial peritonitis. Bacterial peritonitis was induced in 24 rats by cecal ligation and puncture. The rats were randomly assigned to one of three groups. Group 1 (n = 8) received 2 ml saline intraperitoneally, group 2 (n = 8) received 2 ml (0.5 mg/kg) tenoxicam (Oksamen) intraperitoneally, and group 3 (n = 8) was a control, which did not receive any injection. All animals were killed 14 days later so we could assess the adhesion score and measure anastomotic bursting pressures. Tissue antioxidant levels were measured in 1-g tissue samples taken from the abdominal wall. The adhesion score was significantly lower in the tenoxicam group than in the saline and control groups. The anastomotic bursting pressures were higher in the saline and tenoxicam groups than in the control group. The catalase (CAT) levels were higher in the saline and tenoxicam groups than in the control group. The malondialdehyde (MDH) levels were higher in the saline group than in the tenoxicam and control groups. Intraperitoneal tenoxicam inhibited the formation of postoperative intra-abdominal adhesions without compromising wound healing in this bacterial peritonitis rat model. Tenoxicam also decreased the oxidative stress during peritonitis.
TL;DR: Although surgery is not mandatory, surgical removal is recommended if there is a possibility of malignancy, and the histopathological diagnosis was IPT, recent evidence suggests that this entity has changed from an extremely rare pathology to an established disease.
Abstract: We report a rare case of hepatic inflammatory pseudotumor (IPT) after a hepatitis B virus (HBV) infection. Early contrast enhancement on computed tomography (CT) with a washout phenomenon at the delayed phase, and depleted Kupffer cell function on superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) suggested hepatocellular carcinoma (HCC). However, the lack of a tumor capsule, absence of liver cirrhosis, and normal serum levels of alpha-fetoprotein and PIVKA-II (protein induced by vitamin K absence; descarboxyprothrombin) contradicted this diagnosis. We excised the tumor to exclude malignancy, and the histopathological diagnosis was IPT. Recent evidence suggests that this entity has changed from an extremely rare pathology to an established disease. Thus, IPT should be considered in the differential diagnosis of a liver mass with an infectious-inflammatory antecedent. Although surgery is not mandatory, surgical removal is recommended if there is a possibility of malignancy. Further investigations are warranted to elucidate the mechanisms of IPT developing after an HBV infection.
TL;DR: Case number-dependent anastomotic reliability using microsurgical techniques is important for safer arterial reconstruction and reducing the chance of complications in living donor liver transplantation (LDLT).
Abstract: Microsurgical reconstruction of the fine hepatic arteries (HA) reduces the chance of complications in living donor liver transplantation (LDLT). We reviewed HA reconstructions and analyzed their complications and treatment in a single center. Between August 1996 and September 2004, we performed LDLT on 71 adults and 19 children. Patients received a lateral segment graft (n = 16), a left lobe graft (n = 11), an extended left lobe graft (n = 12), or a right lobe graft (n = 51). Hepatic artery reconstruction was performed by end-to-end anastomosis under an operating microscope in all except five adults who received right lobe grafts with loupe magnification. Arterial complications developed in 5 (5.6%) of the 90 patients. Three patients required reanastomosis during their primary operation because of HA thrombosis, anastomotic kinking, and stenosis, respectively. There were three postoperative complications: an anastomotic stenosis, revised by percutaneous transluminal angioplasty; rupture of an HA pseudoaneurysm, treated by embolization; and anastomotic kinking, revised by reanastomosis. The patient with the pseudoaneurysm died of arterial complications. Multivariate analysis of cases before (4/13, 30.8%) and after 2000 (1/77, 1.3%) revealed that surgical experience was the only significant factor in reducing the incidence of HA complications (P = 0.007). Case number-dependent anastomotic reliability using microsurgical techniques is important for safer arterial reconstruction.
TL;DR: Results show that microscopic lymphatic vessel-isolated vein anastomosis is a minimally invasive operation, with good long-term effects, making it the treatment of choice for intractable secondary lymphedema of the lower extremities refractory to physiotherapy.
Abstract: Purpose
To evaluate the effectiveness of microscopic lymphatic vessel-isolated vein anastomosis in patients with secondary obstructive lymphedema of a lower extremity, refractory to nonoperative management.
TL;DR: It is essential to diagnose the functional potential of adrenal incidentaloma preoperatively, and not to perform laparoscopic adrenalectomy without careful evaluation first, to determine the incidence and importance of functioning tumors among incidentally discovered adrenal masses in the era of Laparoscopic surgery.
Abstract: To determine the incidence and importance of functioning tumors among incidentally discovered adrenal masses in the era of laparoscopic surgery. We defined adrenal incidentaloma as a tumor detected during abdominal imaging for adrenal-unrelated reasons, and we reviewed 197 consecutive patients with adrenal incidentaloma diagnosed since we started laparoscopic adrenalectomy. Incidentaloma was discovered initially in 91 (46%) patients and pheochromocytoma was detected as an incidentaloma in 21 (39%) of 54 patients. One patient, a 21-year-old woman taking mesalamine for ulcerative colitis, had a remarkably elevated urinary normetanephrine level, which resulted in the initial misdiagnosis of a 10-cm right adrenal incidentaloma as a pheochromocytoma. Laparoscopic right adrenalectomy resulted in a pathological diagnosis of ganglioneuroma. A series of urinary normetanephrine measurements were taken in parallel with the mesalamine doses. We found that other patients medicated with mesalamine, without adrenal tumors, had elevated urinary normetanephrine levels, confirming that mesalamine metabolites interfere with urinary normetanephrine measurements. It is essential to diagnose the functional potential of adrenal incidentaloma preoperatively, and not to perform laparoscopic adrenalectomy for adrenal incidentaloma without careful evaluation first.
TL;DR: Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.
Abstract: We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh. Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two. All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months. Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.
TL;DR: This report reports the first report of pancreatic lymphangioma occurring in association with BRBNS in a patient with genetic alteration, and describes the clinical features of this case and discusses a possible correlation between these two uncommon conditions.
Abstract: Abdominal lymphangioma is a rare tumor in adults. The most common location is the mesentery, but this tumor occasionally develops in the pancreas. We report a case of pancreatic lymphangioma associated with blue rubber-bleb nevus syndrome (BRBNS) in a Japanese woman. The pancreatic lymphangioma spread extensively throughout the retroperitoneum without causing any symptoms for more than 4 years after its histological diagnosis by laparoscopic biopsy. Multiple hemangiomas were also seen in the mucous membranes and on the skin. The hemangiomatosis was segregated in the dominant fashion in her family, and a germ-line gain-of-function mutation (Arg849Trp) in TIE2 gene was confirmed. To our knowledge, this is the first report of pancreatic lymphangioma occurring in association with BRBNS in a patient with genetic alteration. We describe the clinical features of this case and discuss a possible correlation between these two uncommon conditions.
TL;DR: Findings suggest that increased values of CRP and WBC more than 48 h after the onset of acute abdominal symptoms are indicators of advanced appendicitis.
Abstract: To assess the diagnostic value of the white blood cell count (WBC) and serum C-reactive protein (CRP) level in children with advanced appendicitis. We reviewed 289 children ranging in age from 3 to 15 years old, who underwent appendectomy in our hospital between 1993 and 2003. The advanced appendicitis group consisted of patients with associated perforation, abscess formation, or purulent ascites, and the simple appendicitis group consisted of patients who underwent uncomplicated appendectomy. We compared the age, sex, duration of abdominal pain before surgery, preoperative WBC and CRP level, and hospital stay in the two groups. We analyzed the diagnostic value of WBC and CRP level using a receiver-operating characteristic (ROC) curve. The children in the advanced appendicitis group had a significantly longer duration of pain, a higher serum CRP level, and longer hospitalization than those in the simple group. The serum CRP levels had good diagnostic value in differentiating between the advanced and simple groups. Both the CRP level and the WBC in the patients who suffered abdominal pain for longer than 48 h before surgery had diagnostic value in differentiating between the advanced and simple groups. These findings suggest that increased values of CRP and WBC more than 48 h after the onset of acute abdominal symptoms are indicators of advanced appendicitis.