Patologiniu nutukimu sergančių pacientų kepenų histologinių pokyčių vertinimas

Tyrimo tikslasĮvertinti patologiniu nutukimu sergančių pacientų kepenų histologinius pokyčius ir nustatyti galimus ryšius su demografiniais, kūno masės, laboratoriniais rodikliais bei gretutinėmis ligomis.Ligoniai ir metodaiPerspektyviajame tyrime dalyvavo 103 pacientai, kuriems buvo atlikta laparoskopinė skrandžio apjuosimo reguliuojama juosta operacija kūno masei mažinti. Jos metu 98 (95,1 proc.) pacientams buvo atlikta kepenų stulpelinė biopsija.RezultataiStatistiškai patikimas ryšys siejo histologinius kepenų rodiklius: 1) steatozę – su vyriška lytimi (p = 0,012), aspartataminotransferaze (AST) (p = 0,003), alaninaminotransferaze (ALT) (p = 0,003); 2) balioninę degeneraciją – su AST (p=0,036), gama-glutamiltransferaze (GGT) (p = 0,018); 3) skiltinį uždegimą – su cukriniu diabetu (CD) (p = 0,006); 4) portinį uždegimą – su trigliceridais (p = 0,011), hipertenzija (p = 0,01), miego apnėja (p = 0,028), hipertenzija su miego apnėja (p = 0,033); 5) fibrozę – su AST (p = 0,016), GGT (p = 0,013), trigliceridais (p = 0,011), CD (p = 0,006), hipertenzija (p = 0,04); 5) nealkoholinės kepenų suriebėjimo ligos aktyvumo indeksą – su kūno masės indeksu (p = 0,032), AST (p = 0,001), ALT (p = 0,012), GGT (p = 0,038), CD (p = 0,029); 6) fibrozės ir uždegimo indeksą – su AST (p = 0,048), hipertenzija (p = 0,007), CD (p = 0,007).IšvadosDidesnio laipsnio steatozė koreliuoja su padidėjusiais aspartataminotransferazės, alaninaminotransferazės, gama-glutamiltransferazės kiekiais. Didesnio laipsnio kepenų steatozė būdingesnė vyrams. Fibrozinių ir uždegiminių kepenų pokyčių sunkumą geriausiai atspindėjo aspartataminotransferazė ir trigliceridai. Patikimas ryšys siejo cukrinį diabetą, miego apnėją bei hipertenziją su nealkoholiniu steatohepatitu.Reikšminiai žodžiai: patologinis nutukimas, bariatrinė chirurgija, nealkoholinė kepenų suriebėjimo liga, nealkoholinis steatohepatitasThe histological liver evaluation in morbidly obese subjects ObjectiveTo evaluate histological liver changes in morbidly obese patients and to look for possible correlations with demographic, body mass, laboratory parameters, comorbidities.Material and methods103 patients included in our prospective study had been referred for the obesity surgery and 98 (95.1%) of them had liver biopsies.ResultsOur study assessed significant relations of these parameters: 1) steatosis and male gender (p = 0.012), aspartate transaminase (AST) (p = 0.003), alanine transaminase (ALT) (p = 0.003); 2) hepatocellular ballooning – AST (p = 0.036), gamma-glutamyltransferase (GGT) (p = 0.018); 3) lobular inflammation – diabetes mellitus (p = 0.006); 4) portal inflammation – triglycerides (p = 0.011), hypertension (p = 0.01), obstructive sleep apnea (p = 0.028), hypertension with obstructive sleep apnea (p = 0.033); 5) fibrosis – AST (p = 0.016), GGT (p = 0.013), triglycerides (p = 0.011), diabetes mellitus (p = 0.006), hypertension (p = 0.04); 5) non-alcoholic fatty liver disease activity score – body mass index (p = 0.032), AST (p = 0.001), ALT(p = 0.012), GGT (p = 0.038), diabetes mellitus (p = 0.029); 6) fibro-inflammation index – AST (p = 0.048), hypertension (p = 0.007), diabetes mellitus (p = 0.007).ConclusionsThe severity of liver steatosis preferably reflected aspartate transaminase, alanine transaminase, gamma-glutamyltransferase. The severe liver steatosis was more common among men. The severity of liver fibrosis and inflammation preferably reflected aspartate transaminase, triglycerides. Diabetes mellitus, obstructive sleep apnea and hypertension significantly correlated with non-alcoholic steatohepatitis.Key words: morbid obesity, bariatric surgery, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis

Local perianal anesthetic infiltration is safe and effective for anorectal surgery

Background: General or regional anesthesia is predominantly used for anorectal surgery, however in the recent years more attention was drawn in the use of local anesthesia for anorectal surgery. In this study we present the technique and results of the use of local perianal anesthetic infiltration for minor anorectal operations. Methods: In this cohort study patients undergoing surgery for hemorrhoids, anal fissures and low anal fistulas were included. Posterior perineal block was induced with a mixture containing 0.125% bupivacaine and 0.5% lidocaine. All patients were followed up at 30 days either by a post-operative visit or a telephone call and all post-operative complications over the post-operative 30-day period were registered. Results: One thousand and twenty-six consecutive patients were included in our study. For all patients' intraoperative analgesia was achieved after performing perianal anesthetic infiltration and no additional support from the anesthesia team was necessary in any of case. Complications were observed in 14 (1.4%). Urinary retention occurred in 5 (0.5%) cases. Six cases of bleeding occurred after hemorrhoidectomy (0.6%) and 1 (0.1%) after lateral internal sphincterotomy. Perianal abscess developed for two patients (0.2%). Conclusions: Local anesthesia using posterior perineal block technique is safe and effective for intraoperative analgesia in anorectal surgery, saving a substantial operation cost by avoiding the involvement of an anesthesia team and resulting in minimal incidence of urinary retention and other complications

Common bile duct villous adenoma: a case report and review of the literature

Background: According to the literature, benign bile duct tumors are exceedingly uncommon. To the best of our knowledge, we report the largest extrahepatic bile duct villous adenoma described in the literature. Case presentation: We present a case of a 77-year-old Caucasian woman with obstructive jaundice. Laboratory tests revealed that she had elevated bilirubin and liver enzyme levels. A computed tomographic scan showed a homogeneous 5 × 3–cm mass obstructing the common bile duct. The results of brush cytology were consistent with a bile duct villous papilloma. However, on the basis of the tumor’s radiological features, a preliminary diagnosis of extrahepatic bile duct malignant tumor was made. After discussion among the multidisciplinary team, a surgical resection of the bile duct tumor was performed. Histopathological examination confirmed a villous adenoma. The patient’s postoperative course was uneventful. Conclusions: In patients with bulky extrahepatic bile duct tumors, surgical resection alone may be safe and curative