36 research outputs found
Laparoscopic-assisted one-stage resection of rectal cancer with synchronous liver metastasis utilizing a pfannenstiel incision
No full textLaparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer. However, simultaneous resection of colorectal carcinoma with synchronous liver metastases is still a subject of debate. The present case describes combined laparoscopic rectal and liver resections for a patient with primary rectal cancer and a synchronous liver metastasis utilizing a Pfannenstiel incision for specimen extraction. The operative time was 370 min and estimated blood loss was 400 mL. Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation. A laparoscopic approach utilizing a Pfannenstiel extraction incision may present an advantageous and attractive option for simultaneous laparoscopic rectal and liver resection in selected patients with the aim of improving short-term outcomes
Anti-inflammatory therapy with high dose insulin in brain dead organ donors
No full textBrain death is considered a major stress on the body that is associated with a massive inflammatory response or what is known as the "cytokine storm", which is characterized by the exaggerated release of pro-inflammatory cytokines. This heightened inflammatory response in brain dead organ donors leads to major disturbances in glucose homeostasis resulting in insulin resistance and systemic hyperglycemia. Acute hyperglycemia is intimately related to the inflammatory response and marks an increased risk of morbidity and mortality. Severe inflammation in brain dead donors can also lead to increased graft immunogenicity before transplantation and increased risk of graft dysfunction following transplantation. In addition, to the maintenance of normoglycemia Insulin therapy has expressed anti-inflammatory effects in clinical and experimental studies. The rational of this project was to investigate the anti-inflammatory properties of high dose insulin therapy on brain dead organ donors and if this therapy is successful in maintaining normoglycemia in these donors. The anti-inflammatory effect was measured by comparing the change in the levels of serum cytokines in these donors. Insulin therapy was delivered using the hyperinsulinemic normoglycemic clamp (HNC) technique. The study was carried out in the context of a prospective pilot trial registered at clinicaltrial.gov (NCT01304290). Fifteen brain dead organ donors were recruited including 6 donors were given the HNC protocol "experimental group" and 9 donors received routine management "control group". The insulin therapy was provided for a minimum of 6 hours and continued until the organ retrieval procedure. The donors were assigned to either experimental or control groups based on the location of the donation procedure. Blood samples were taken from all patients at various time points. The samples were analyzed to identify the levels of several predetermined inflammatory cytokines. Comparison of the changes in these levels with therapy in both groups was performed. High dose insulin therapy in the form of HNC was successful in maintaining normoglycemia in the brain dead organ donors, without severe hypoglycemia. Furthermore, the anti-inflammatory effect was clearly demonstrated in the experimental group as expressed by the decreased levels of several pro-inflammatory cytokines as compared to the control group following treatment. Future studies with a focus on the effect of such therapy on the transplanted organs and patients are warranted.L'état de mort cérébrale est considéré comme un stress majeur pour l'organisme qui est associé à une réaction inflammatoire massive, que l'on appelle la « tempête de cytokine », caractérisée par la libération excessive de cytokines pro inflammatoires. Cette réaction inflammatoire aiguë chez les donneurs d'organe en état de mort cérébrale est à l'origine de perturbations majeures de l'homéostasie du glucose qui provoquent l'insulinorésistance et l'hyperglycémie systémique. L'hyperglycémie aiguë est étroitement liée à la réaction inflammatoire et se traduit par un risque accru de morbidité et de mortalité. Une inflammation sévère chez les donneurs en état de mort cérébrale peut également augmenter l'immunogénicité du greffon avant la transplantation et le risque de dysfonctionnement de ce dernier à l'issue de la transplantation. Outre qu'elle permet de maintenir la normoglycémie, l'insulinothérapie a des effets anti inflammatoires selon des études cliniques ou expérimentales. L'objectif du présent projet était d'étudier les propriétés anti-inflammatoires de l'insuline administrée à fortes doses à des donneurs en état de mort cérébrale et d'établir si cette thérapie permet de maintenir la normoglycémie chez ces donneurs. L'effet anti-inflammatoire a été mesuré en comparant les fluctuations des niveaux de cytokines sériques chez ces donneurs. L'insulinothérapie a été administrée à l'aide de la pince hyperinsulinémique normoglycémique (PHN). L'étude a été effectuée dans le contexte d'un essai pilote prospectif inscrit sur le site clinicaltrial.gov (NCT01304290). Quinze donneurs en état de mort cérébrale y ont pris part, dont six ont fait partie du « groupe expérimental » qui a suivi le protocole PHN et neuf du « groupe de contrôle ». L'administration d'insuline a duré au moins six heures et s'est poursuivie jusqu'au moment du prélèvement d'organe. La répartition des donneurs dans le groupe expérimental ou le groupe de contrôle était fondée sur le lieu de la procédure de don. Des échantillons de sang ont été prélevés chez tous les patients à différents moments. Ces échantillons ont été analysés afin de mesurer les niveaux de plusieurs cytokines inflammatoires prédéterminées. Des comparaisons ont été établies entre les fluctuations de ces niveaux et l'administration de la thérapie chez les patients des deux groupes. L'insulinothérapie à forte dose à l'aide de la PHN a permis de maintenir la normoglycémie chez les donneurs d'organe en état de mort cérébrale sans provoquer d'hypoglycémie sévère. Qui plus est, à l'issue du traitement, l'effet anti inflammatoire a été clairement démontré dans le groupe expérimental, comme en témoignent les niveaux réduits de plusieurs cytokines pro inflammatoires, comparativement au groupe de contrôle. Des études ultérieures s'imposent qui porteraient essentiellement sur l'effet de cette thérapie sur les organes transplantés et les patients
Assessment of postoperative venous thromboembolic complications
No full textBACKGROUND: Postoperative venous thromboembolic events (VTEs) are a preventable cause of death. Adherence to available guidelines and prophylactic measures is suboptimal. This study examined postoperative VTEs prevalence, prophylaxis guideline adherence, and VTEs risk factors among surgical patients at King Abdulaziz University Hospital in Saudi Arabia.
METHODOLOGY: This retrospective study analyzed VTEs patients from August 2020 to November 2022. Medical records collected data on patients, procedures, prevention, guideline adherence, and VTEs diagnosis. The statistical analysis evaluated the link between prophylactic measures and VTEs occurrence.
RESULTS: Thirty-one (32%) of the 97 VTEs diagnosed in patients were postoperative VTEs. Mortality rates were 18.5%, and for postoperative VTEs patients were 12.9%. Most patients (87.1%) were at high risk (Caprini score ≥ 5) for VTEs. Abdominopelvic procedures were 64.5% of cases. Approximately 60% of patients received postoperative prophylaxis. Enoxaparin was the most frequently used prophylaxis method (63.1%). Mechanical prophylaxis was used in 36.8% of patients who received prophylaxis. Compliance for extended prophylaxis was only 10.5%. Late initiation of prophylactic measures was significantly associated with deep vein thrombosis occurrence.
CONCLUSION: The study emphasizes the need to follow prophylaxis guidelines. Improving compliance with prophylactic measures, especially for high-risk patients, can potentially reduce postoperative VTEs
Ruptured spontaneous splenic artery aneurysm: A case report and review of the literature
No full textAbstractINTRODUCTIONSplenic artery aneurysm is a rare condition, however, potentially fatal. The importance of splenic artery aneurysm lies in the risk for rupture and life threatening hemorrhage.PRESENTATION OF CASEThis is a case of a ruptured splenic artery aneurysm in a 58-year-old lady. She presented with hypovolemic shock and intra-peritoneal bleeding. Diagnosis was confirmed by CT angiography and she was managed by operative ligation of the aneurysm with splenectomy and distal pancreatectomy.DISCUSSIONThe literature pointed the presence of some risk factors correlating to the development of splenic artery aneurysm. In this article we discuss a rare case of spontaneous (idiopathic) splenic artery aneurysm and review the literature of this challenging surgical condition.CONCLUSIONSplenic artery aneurysm needs prompt diagnosis and management to achieve a favorable outcome, high index of suspicion is needed to make the diagnosis in the absence of known risk factors
Type II Gall Bladder Perforation with Abdominal Wall Abscess in a Cirrhotic Patient: Case Report and Review of the Literature
No full textTransient small bowel intussusception in an adult: case report with intraoperative video and literature review
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