40 research outputs found
Endopancreatic Bile Duct Cholangiocarcinoma in a Patient with Peutz-Jeghers Syndrome
Peutz-Jeghers syndrome is a rare autosomal dominant inherited disease characterized by a special type of hamartomatous gastrointestinal polyps combined with mucocutaneous melanin pigmentations. Patients with the syndrome have a high risk of developing neoplasia, with colon, small bowel, and stomach being the most common gastrointestinal sites. Herein, we present the occurrence of a rare tumor in patients with Peutz-Jeghers syndrome; a cholangiocarcinoma of the endopancreatic bile duct. A minireview is also presented. It can be concluded that cholangiocarcinoma remains a possible diagnosis in PJS patients, as in others that present with biliary obstruction. PJS patients may be at higher risk than others in view of their propensity for malignancy
A Pleomorphic Rhabdomyosarcoma Mimicking an Inguinal Hernia: A Case Report and Review of the Literature
A 59-year-old male presented with a painful right inguinal swelling and deep vein thrombosis at the ipsilateral leg. An inguinal hernia was initially diagnosed, but during surgery a large mass was found anteriorly to the peritoneal sheaths. Histology revealed a high-grade pleomorphic rhabdomyosarcoma. The mass advanced rapidly, occupying the whole right iliac fossa and metastasizing to the lung. Despite first- and second-line chemotherapy, the patient deteriorated rapidly and died. Rhabdomyosarcomas should be managed in specialized centres as they have prognostic factors and histologic features still controversial and poorly clarified
Case Report Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy
A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ∼6 mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25 mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal IgG protein in urine. The patient's jaundice gradually deteriorated and she died one week later from hepatic insufficiency
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Gastrointestinal Stromal Tumors (GISTs): An Updated Experience
Gastrointestinal stromal tumors (GISTs) are relatively common
mesenchymal tumors of the digestive tract characterized by c-KIT
mutations. This is a comprehensive review of the current data of the
literature on the various aspects of the diagnosis and treatment of
these tumors.
The stomach is the most commonly involved site for these tumors in the
digestive tract. Computed tomography and endoscopy can usually establish
the diagnosis. The study of certain specific immunohistochemical markers
may contribute to better characterization of these tumors.
Surgical resection of GISTs has been the most effective therapy. In
addition, targeted therapy with tyrosine kinase inhibitors may reduce
the development of recurrence or decrease the disease progression in
patients with metastatic disease.
The introduction of tyrosine kinase inhibitors has resulted in
significant improvement in the overall prognosis of these patients.
Furthermore, preoperative imatinib can decrease tumor volume and is
associated with complete surgical resection in locally advanced primary
GISTs
Laparoscopic splenectomy: Current concepts
Since early 1990's, when it was inaugurally introduced, laparoscopic
splenectomy has been performed with excellent results in terms of
intraoperative and postoperative complications. Nowadays laparoscopic
splenectomy is the approach of choice for both benign and malignant
diseases of the spleen. However some contraindications still apply. The
evolution of the technology has allowed though, cases which were
considered to be absolute contraindications for performing a minimal
invasive procedure to be treated with modified laparoscopic approaches.
Moreover, the introduction of advanced laparoscopic tools for ligation
resulted in less intraoperative complications. Today, laparoscopic
splenectomy is considered safe, with better outcomes in comparison to
open splenectomy, and the increased experience of surgeons allows
operative times comparable to those of an open splenectomy. In this
review we discuss the indications and the contraindications of
laparoscopic splenectomy. Moreover we analyze the standard and modified
surgical approaches, and we evaluate the short-term and long-term
outcomes
Current Trends in Laparoscopic Ventral Hernia Repair
Background and Objectives: The purpose of this study was to analyze the
surgical technique, postoperative complications, and possible recurrence
after laparoscopic ventral hernia repair (LVHR) in comparison with open
ventral hernia repair (OVHR), based on the international literature.
Database: A Medline search of the current English literature was
performed using the terms laparoscopic ventral hernia repair and
incisional hernia repair.
Conclusions: LVHR is a safe alternative to the open method, with the
main advantages being minimal postoperative pain, shorter recovery, and
decreased wound and mesh infections. Incidental enterotomy can be
avoided by using a meticulous technique and sharp dissection to avoid
thermal injury