1,720,984 research outputs found
Massive transaminase rise after vicryl mesh wrapping for liver trauma
No full textMesh wrapping hepatorrhaphy is an established method to control severe hepatic bleeding after trauma. Besides the multiple advantages of this technique, only a few complications are described in literature. We report a patient with severe liver trauma showing ischemia of the liver caused by post-traumatic edema and compression of the liver after mesh wrapping hepatorraphy to control the bleeding. To avoid this complication, early and frequent control of liver enzymes is highly recommended and, in case of elevation, laparotomy and decompression should be performed
Significance of occult lymphatic tumor spread in pancreatic cancer
No full textPurpose. The aim of this study was to determine the frequency and effect on prognosis of occult tumor cells in regional lymph nodes judged to be tumor-free in conventional histopathology of pancreatic cancer patients. Patients and methods. Among 115 patients who underwent pancreatic resection for pancreatic (n=84) or distal common bile duct malignancy (n=12) or carcinoma of the papilla (n=19),48 (42%) were staged pN0. Archival paraffin blocks of 271 resected regional lymph nodes of 41 pN0 patients were reevaluated for occult tumor cells using monoclonal antibody Ber-EP4. Cases with or without isolated tumor cells were compared regarding the distribution of various clinicopathological factors. Results. Of 41 pN0 patients, 16 (39%) exhibited single Ber-Ep4 immunoreactive cells or small cell clusters in at least one lymph node. The occurrence of occult tumor cells was not dependent on other clinicopathological factors such as pT stage, grading, or curative resection. However, those cells were encountered more frequently in common bile duct carcinomas (1100%) than in pancreatic (36%) or papilla (20%) carcinomas (P=0.009). Occult tumor cells impaired prognosis significantly in uni- and multivariate analyses (estimated 5-year survival 53% for pNO((i-)) vs 10% for pNO((i+)) and 9% for pN1/N2; P=0.0047). Conclusion. Occult tumor cells are frequent in apparently tumor-free lymph nodes of pancreatic cancer patients and often overlooked in conventional histopathology. They are encountered even in limited stages of disease and they impair prognosis, which is comparable to that of patients with true lymphatic metastases. Occult tumor cells in lymph nodes of pancreatic cancer patients could be used to stratify adjuvant therapy
Pylorus preservation has no impact on delayed gastric emptying after pancreatic head resection
No full textObjectives: Delayed gastric emptying (DGE) has been specifically attributed to pylorus-preserving pancreaticoduodenectomy (PPPD). As PPPD has been shown to be comparable with the classic Kausch-Whipple pancreaticoduodenectomy (KWPD) in terms of oncological radicality, DGE has advanced to be the leading argument for hemigastrectomy in PD. Methods: A prospective, nonrandomized comparison of patients undergoing PPPD (n=113), KWPD (n=19), and duodenum-preserving, pancreatic head resection (DPPHR, n=18) for various diseases was performed. First, groups were analyzed with regard to structural similarity; then, they were compared with special emphasis on DGE and other postoperative complications. Finally, further prognostic factors were sought that had an impact on DGE. Results: The PPPD group was comparable with the KWPD group, but not to the DPPHR population. The in-clinic course after DPPHR compared favorably with PPPD as well as KWPD, and, here, no DGE occurred. The overall morbidity rates of PPPD and KWPD were comparable; 1 patient died in hospital (mortality rate, 0.7%). The gastric tube after PPPD and KWPD could be withdrawn at a median of 2 and 3 days, respectively, a liquid diet was started after 4 and 5 days, respectively, and a full diet was tolerated after 10 days each (n.s.). DGE was distributed evenly among PPPD (12%) and KWPD patients (21%, n.s.), and it was noted almost exclusively when other postoperative complications were present (P<0.0001). No further prognostic factors influencing DGE could be identified. Conclusion: Pylorus preservation does not increase the frequency of DGE. DGE almost exclusively occurs as a consequence of other postoperative complications. Therefore, DGE should not be used as an argument to advocate hemigastrectomy in PPPD
Gasless balloon laparoscopy
Full text linkThe concept of balloon laparoscopy (B-LSC) pursues the simplification of conventional diagnostic laparoscopy (LSC). The pneumoperitoneum is replaced by a transparent balloon, which is positioned in front of the optical system. It shall be shown that with this arrangement diagnostic LSC can be performed outside of the operating room without requiring general anesthesia.An inflatable balloon was developed for a 30°/3.5-mm rod lens. Intra-abdominally the balloon was expanded to a diameter of 30 mm by air insufflation, and B-LSC was performed. Twelve patients were examined in general anesthesia before laparoscopic surgery. Twelve patients were subjected to B-LSC fully awake or with sedation (midazolam or propofol/S-ketamine) as a “second-look” procedure by way of a flexible trocar (port) left in the abdominal wall at the end of previous operation. Eight patients have been first provided with a trocar under sedation (midazolam or propofol/S-ketamine) combined with local anesthesia, and B-LSC was performed before laparoscopic surgery.On a scale of 1–5, the general impression was rated 1.9, the navigability to the different abdominal organs 2.5, the resolution 1.5, the stability of the system optic/trocar 2.1, the suitability of the balloon format 1.9, and the stability of the balloon against lateral shear forces 2.4. The degree of painfulness of the examination was rated 2.8, the tolerance of the port 1.4, and the degree of painfulness of trocar placement at 2.5. On a scale of 1 to 3, the strain of the abdominal musculature was rated 1.4 and the obstruction by adhesions 1.7.B-LSC is technically practicable with good imaging qualities and without requiring pneumoperitoneum. It is tolerated in great extent under slight sedation and particularly well under deep sedation. The procedure is suitable for diagnostics of unclear abdominal conditions, as a second-look LSC and also as a staging LSC
Conventional gamma and high energy probe for radioguided dissection of metastases in a patient with recurrent thyroid carcinoma with Tc-99m-MIBI and F-18-FDG
No full textSignificance of isolated tumor cells in lymph nodes among gastric cancer patients
No full textPurpose: To determine the frequency and prognostic impact of isolated tumor cells (ITC) in regional lymph nodes judged to be tumor free in conventional histopathology among gastric cancer patients. Methods: Among 161 patients who underwent gastrectomy and D2-lymphadenectomy, 56 were staged pN0 (35%). Archival paraffin blocks of 1148 resected regional lymph nodes of those pN0 patients were reevaluated for ITC using monoclonal antibody Ber-EP4. Patients with and without ITC were compared with regard to the distribution of various clinicopathological factors. Prognostic impact of ITC was tested in uni- and multivariate analysis. Results: Of 56 pN0 patients, 33 (59%) exhibited single Ber-Ep4 immunoreactive cells or small cell clusters in at least one lymph node. The occurrence of ITC was not dependent on other clinicopathological factors. ITC impaired patients' prognoses significantly in uni- as well as multivariate analyses [ estimated 5-year survival rate: 82% for pN0((i-)) vs 58% for pN0((i+)) ( p= 0.059) and 15% for pN1/2 ( p= 0.0005 and p< 0.0001, respectively)]. Conclusion: ITC are a frequent event in apparently tumor-free lymph nodes of gastric cancer patients and are overlooked by conventional histopathology. They are encountered even in limited stages of disease and impair patients' prognoses. This should be borne in mind when advocating local resection for early gastric cancer
An analysis of the use and effect of surgical training courses
No full textThe course in Gastrointestinal Surgery (GISC) aims at teaching and training resection, reconstruction and suture techniques of the upper gastrointestinal tract. Prior to, after and 5 years following the first course, participants were asked to answer a questionnaire requesting information regarding the adequacy of surgical training in their residency program and how much they had benefited from the GISC. While 1/3 of the participants described the surgical training during their residency as inadequate, more than 90% benefited from the GISC. Although the single-layer-continuous suture technique was implemented by only 8% of the participating surgeons, other techniques such as cross-section gastroenterostomy were accepted by 38%. Only 7% of the participants rejected these new techniques, while 41% of the senior surgeons at home could not be convinced. Besides the teaching of new techniques, participants benefited above all from the repetitive training in surgical procedures
Conventional gamma and high energy probe for radioguided dissection of metastases in a patient with recurrent thyroid carcinoma with Tc-99m-MIBI and F-18-FDG
No full textImproved demonstration of gastrointestinal bleeding sites by means of Tc-99m-labeled autologous erythrocytes and continuous dynamic scintigraphy with cine-mode display
No full textBackground: Scintigraphic studies of gastrointestinal bleeding an usually performed in static acquisition mode and without continuous imaging over a longer period. The aim of this study was to evaluate the diagnostic accuracy of continuous dynamic Tc-99m red blood cell scintigraphy (BQS) and cine-mode display in the assessment of unexplained gastrointestinal bleeding. Patients and methods: We performed BQS in 40 patients (mean age 57 years) with gastrointestinal bleeding from an undetermined source. All these patients had negative findings of previous examinations. Blood transfusions were required in 16 patients. Continuous dynamic scintigraphic acquisition was performed up to 6 h post injection (p. i.). The scintigraphic data were reviewed without knowledge of the patient's final diagnosis. For this purpose we used a cine-mode display. Results: Dynamic Tc-99m I-ed blood cell scintigraphy correctly identified the site of active bleeding in 22 of 23 patients with positive scintigraphic findings. The sensitivity of the scan was 95 %, the specificity 94 %, the positive and negative predictive values 95 % and 94 %, respectively. Forty-three percent of the scans became positive within 1.5 h and 82 % within 5 h. Positive scans were more likely in patients who required blood transfusions than in patients without transfusion requirement (16 vs 7 patients), and the bleeding site was identified earlier in the former group (mean 2.83 vs 5.28 h p. i.). The scintigraphic identification of the bleeding lesions enabled the performance of a more limited surgical approach in the colon as well as in the distal small intestine, while exact scintigraphic localization was not possible if the bleeding site was located in the proximal small intestine. Discussion: Continuous dynamic Tc-99m red blood cell scintigraphy interpreted by cine-mode display is highly accurate in the identification of a bleeding site. When performed correctly, scintigraphy enables usually segmental resection of these lesions
Neoadjuvant and adjuvant radiochemotherapy of pancreatic cancer with 5-FU, cisplatin and interferon-alpha
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