1,720,982 research outputs found
Hypothermic Machine Perfusion and Spontaneous Kidney Allograft Rupture: Causation or Correlation? A Case Report and Review of Pertinent Literature
No full textBackground. Spontaneous kidney allograft rupture (KAR) is a severe complication of kidney transplant. KAR occurs when no identifiable injuries noted at the time of the organ retrieval are present. KAR is associated with acute rejection, renal vein thrombosis, severe acute tubular necrosis, or trauma. In recent years, the introduction of hypothermic machine perfusion (HMP) has provided an excellent option for kidney allograft preservation reducing the incidence of delayed graft function. On the other hand, HMP can also represent a potentially traumatic event for a fragile graft, especially one belonging to expanded criteria donor.Case Presentation. Here, to our knowledge, we report the first case of KAR after the use of HMP, which occurred in 60-year-old women undergoing a single kidney transplant from a dona-tion after brain death donor belonging to the expanded criteria donor category. The allograft was perfused for 240 minutes with HMP with passive oxygenation. The post-transplant course was unremarkable with early graft function, but on post operatory day 14 the patient complained of severe pain over the transplant site. A computed tomography scan showed a massive fluid collec-tion in the perigraft region. Immediate surgical exploration showed 2 lacerations of 10 cm and 5 cm length at the upper and midpole of the kidney, requiring transplantectomy. Histologically, the graft did not show features of acute rejection.Conclusions. In the presented case, the repair and salvage of the kidney allograft was not possible. However, the review of the pertinent literature does not report another case linking HMP to KAR
Amyand's hernia: which oncologic risk can be hidden in the sac?
No full textAmyand's hernia (AH) is a rare condition in which the appendix is found in the sac of an inguinal hernia. It occurs in only 1% of adult inguinal hernias. The herniated appendix can occasionally range varying degrees of acute inflammation up to neoplastic transformation. An appendiceal tumor can be rarely described inside the AH sac. We describe a case of gangrenous appendicitis in AH and offer a review of the literature on AH when presenting with appendicitis associated with appendiceal cancer. As of 2022, only nine cases of AH presenting with appendicitis associated with appendiceal cancer have been reported by the pertinent literature. In order of decreasing frequency, AH, AH-related appendicitis and AH-related appendicitis associated with appendiceal cancer are three rare conditions. Particular attention should be kept in each situation as diagnosis is achieved postoperatively most of the times
Proposal of a classification system for adenocarcinoma involving the ileocecal valve (bauhin's valve): A retrospective study of 689 right hemicolectomized patients
No full textBackground/aim: As of 2020, adenocarcinoma arising in the ileocecal valve (ICV-A) has been examined along with cecal and right colon cancer (RCC) under the collective heading "ileocecal" tumor. We propose a new classification system for this cancer.
Patients and methods: We retrospectively analyzed RCC patients from 2003 to 2019. The scheme was: i) Type I cancer for adenocarcinomas residing in ICV; ii) Type II, if they reside 1 to 5 mm from ICV; iii) Type III, 6 mm to 10 mm from ICV; iv) Type IV, at 1,1 to 5 cm; v) Type V, at more than 5 cm (ascending colon cancer).
Results: Of 689 hemicolectomized patients, there were 91 (13.2%) Type I, 87 Type II (12.6%), 38 (5.5%) Type III, 157 (22.8%) Type IV and 314 (45.6%) Type V. Each type was associated with at least one clinicopathologic feature.
Conclusion: ICV-A was classified into five types (I-V) according to the distance from ICV. Further studies are needed in order to corroborate our findings
Adrenal rest tumour of the liver
No full textA 58 year old man with chronic hepatitis B and HIV infection underwent a scheduled abdominal ultrasound for liver cancer screening. A focal hypoechoic lesion of 25mm. was discovered in the segment VII of the liver. Liver function tests and tumor markers levels (α-fetoprotein, Carcinoembryonic antigen (CEA), Ca 19.9) were within normal limits. On contrast abdominal computed tomography (CT) the mass was enhanced heterogeneously in the arterial phase with minimal washout in the portal and delayed phases. On superparamagnetic iron oxide-enhanced magnetic resonance imaging (MRI) the lesion appeared to be slightly hypointense on T1 (Fig. 1A), hyperintense on T2 fat suppression and clearly hypervascular in the arterial phase (Fig 1B). Based on the above radiological findings and the clinical history a diagnosis of hepatocellular carcinoma (HCC) was suspected. The patient underwent a subsegmental liver resection and the postoperative recovery was uneventful. At histology the lesion was diagnosed as an adrenal rest tumor based on morphology and immunostaining (staining was positive for cytokeratin, vimentin, alpha-inhibin; negative for polyclonal CEA and Hepatocyte specific antigen 1). The lesion was adjacent to an area of mature adrenal cortex, surrounded by hepatic tissue. (Fig 1C).
Adrenal rest tumor is very rare in the liver and it is supposed to originate from ectopic adrenocortical tissue. Radiologically, adrenal rest tumor shares many features with HCC.(1) Presence of fat components and hypervascularity are suggestive for the diagnosis especially for lesions located beneath the posterior capsule of the right lobe
LAPAROSCOPIC VERSUS OPEN LIVER RESECTION FOR HCC: PRELIMINARY CASE-MATCHED ANALYSIS
No full textBackground: Purpose of our study was to evaluate the
safety and effectiveness of laparoscopic liver resection
(LLR) in patients with hepatocellular carcinoma (HCC) and
to compare LLR with open liver resection (ORL) in this
setting.
Methods: Our cohort consisted in patients who underwent
liver resection for HCC between December 2006 and
August 2015 in our institution. A preliminary sample of 50
patients was identified; 26 patients received LLR and 24
had ORL. Intraoperative variables, such as operative time
and estimated blood loss, as well as perioperative outcomes
were assessed for both techniques.
Results: Patients who received LLR had shorter operative
time, less blood loss, and reduced length of stay. Operative
time and blood loss were respectively 177 min versus
225 min and 107 mL versus 312 mL between the two
groups. The LLR cohort had an average length of stay of 7
days, while the ORL patients were hospitalized for an
average of 16 days. Resume of oral intake and full patient
mobilization were quicker after LLR.
Conclusions: Even in our preliminary experience, LLR
confirmed to be a safe, effective and feasible approach in
selected patients, including those with malignancy, being
associated with minor blood loss, reduced overall operative
time, short hospital stay and a prompt return to a regular
diet and physical activity with acceptable oncological
outcomes.
Still, a long-term follow-up is needed to draw definitive
conclusions in terms of long-term survival benefits
Inguinal gist: a systematic literature review of primary and metastatic cases
No full textBackground/Aim: Gastrointestinal stromal tumor (GIST) has a wide spectrum of clinical manifestations. Involvement of the groin region can cause interesting presentations but, as of 2020, has rarely been investigated. Our aim was to assess the clinicopathological and prognostic features of GIST appearing in this specific part of the body. Materials and Methods: We investigated the world literature dealing with primary or metastatic GIST appearing in the inguinal region (IGIST). A case of metastatic IGIST from our clinical records was also included. Results: We found only six cases of primary and nine of metastatic IGIST. All were of male gender, and most aged 60 years or more (10 cases). Inguinal hernia (11 cases) was the patient type most frequently affected. The association between metastatic IGIST and inguinal lymphadenopathy was statistically significant (p=0.049). Conclusion: IGIST is a rare entity with particular clinical manifestations. Inguinal hernia and inguinal lymphadenopathy should be carefully investigated in patients with a history of GIST
Omental torsion at the time of COVID-19 in Northern Italy: a case report of conservative management with a review of the pertinent literature
No full textBackground and aim: In middle-aged men, omental torsion (OT) can be a cause of acute abdomen. The right side of the omentum is longer, heavier and more mobile than the left one and, as a consequence, it can twist more easily on its vascular axis. Consequently, OT localization in the lower right quadrant is more frequent, and therefore it can mimic acute appendicitis clinical onset.In most cases, OT is defined as “pri-mary” in the absence of any other underlying pathologies, or, rarely, “secondary”, when caused by other intra-abdominal diseases such as inguinal hernia, tumors, cysts or post-surgical scarring. To date, clinical diagnosis of OT still remains a challenging one in a preoperative setting and most cases are diagnosed intraoperatively. If diagnosis is correctly achieved preoperatively by adequate imaging examinations, most patients presenting with OT do not undergo surgery anymore. Such considerations gain importance at the time of COVID 19 pandemic, where a conservative management and an early discharge may be preferred owing to in-hospital morbidity after abdominal surgery whenever surgery may be avoided. Methods and Results: We present a case of an OT successfully treated in a non-operative manner during COVID-19 outbreak in Norhern Italy and offer a review of the literature that supports such a clinical attitude. Conclusions: OT preoperative diagnosis is challenging and is usually achieved by abdominal CT-scan. The suggested OT initial management is con-servative, leaving a surgical approach, preferably by laparoscopy, for the 15% of cases not improving with a non-surgical approach. (www.actabiomedica.it)
Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases
No full textBackground: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128±43.7 minutes and 4.9±3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated
Leiomyosarcoma of the rectum: a systematic review of recent literature
No full textLeiomyosarcomas (LMSs) are rare tumors originating from the muscular layer. We performed a literature review of cases of confirmed rectal leiomyosarcomas (rLMSs) to clarify the history of such an infrequent tumor arising at such an uncommon location. In this research local recurrence was related to poorly differentiated rLMS and no other association between recurrence and any criteria was found. Concerning overall survival (OS), rLMS patients developing recurrence presented shorter longevity compared with the group without
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