33 research outputs found
Early or Delayed Intervention for Bile Duct Injuries following Laparoscopic Cholecystectomy? A Dilemma Looking for an Answer
Background. To evaluate the effect of timing of management and intervention on outcomes of bile duct injury. Materials and Methods. We retrospectively analyzed 92 patients between 1991 and 2011. Data concerned patient’s demographic characteristics, type of injury (according to Strasberg classification), time to referral, diagnostic procedures, timing of surgical management, and final outcome. The endpoint was the comparison of postoperative morbidity (stricture, recurrent cholangitis, required interventions/dilations, and redo reconstruction) and mortality between early (less than 2 weeks) and late (over 12 weeks) surgical reconstruction. Results. Three patients were treated conservatively, two patients were treated with percutaneous drainage, and 13 patients underwent PTC or ERCP. In total 74 patients were operated on in our unit. 58 of them underwent surgical reconstruction by end-to-side Roux-en-Y hepaticojejunostomy, 11 underwent primary bile duct repair, and the remaining 5 underwent more complex procedures. Of the 56 patients, 34 patients were submitted to early reconstruction, while 22 patients were submitted to late reconstruction. After a median follow-up of 93 months, there were two deaths associated with BDI after LC. Outcomes after early repairs were equal to outcomes after late repairs when performed by specialists. Conclusions. Early repair after BDI results in equal outcomes compared with late repair. BDI patients should be referred to centers of expertise and experience
Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter Pyloriinfection
BACKGROUND: Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit. METHODS: The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis. RESULTS: The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60–70 vs. 90–100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis. CONCLUSION: Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients
Rapunzel Syndrome: A Rare Presentation with Giant Gastric Ulcer
The Rapunzel syndrome refers to an uncommon and rare form of trichobezoar that extends past the stomach into the small intestines. The Rapunzel syndrome is usually found in young female patients with a history of psychiatric disorders, mainly trichotillomania and trichophagia. We describe a case of Rapunzel syndrome in a 15-year-old girl who presented with abdominal pain, vomiting, and weight loss. We performed a surgical laparotomy and successfully removed a huge trichobezoar extending into the small intestine
Bilateral adrenocortical carcinoma in a patient with multiple endocrine neoplasia type 1 (MEN1) and a novel mutation in the MEN1 gene
The incidence of adrenal involvement in MEN1 syndrome has been reported between 9 and 45%, while the incidence of adrenocortical carcinoma (ACC) in MEN1 patients has been reported between 2.6 and 6%. In the literature data only unilateral development of ACCs in MEN1 patients has been reported. We report a 31 years-old female MEN1-patient, in whom hyperplasia of the parathyroid glands, prolactinoma, non functioning pancreatic endocrine carcinoma and functioning bilateral adrenal carcinomas were diagnosed. Interestingly, a not previously described in the literature data, novel germline mutation (p.E45V) in exon 2 of MEN1 gene, was detected. The association of exon 2 mutation of the MEN1 gene with bilateral adrenal carcinomas in MEN1 syndrome, should be further investigated
Mammographic microcalcifications and breast cancer tumorigenesis: a radiologic-pathologic analysis
Factors predisposing to conversion from laparoscopic to open cholecystectomy
The conversion of a laparoscopic cholecystectomy (LC) to an open
procedure seems to be multifactorial, be affected by factors related to
the patient, the gallbladder’s pathology and the surgeon. Among the more
than twenty parameters which have been studied as possible predisposing
factors for conversion, current literature addresses that: a male
patient, above 65 years old, with American Society of Anaesthesiology
(ASA) score >= 3, suffering from acute cholecystitis, with a thickened
gallbladder’s wall on preoperative CT and an impacted stone in
infundibulum or Mirizzi syndrome as intraoperative finding, who was
operated on more than 72 hours from the onset of symptoms, by a
non-laparoscopic surgeon, represents the most likely candidate for
conversion from LC to open surgery. The probability increases further in
the presence of malnutrition and/or cirrhosis. The proposed predictive
scores for conversion have not yet found worldwide acceptance and their
use is limited to theoretical or training purposes. Even patients with
maximum predictive score, do not have a 100% probability for
conversion. An experienced surgeon can complete a difficult LC
successfully in high-risk surgical patient using the subtotal LC. The
need for conversion to laparotomy should be considered as neither a
failure nor a complication, but as an attempt to be avoided intra-or
post-operative complications. The present review attempts to present the
most recent knowledge on the field “conversion from LC to open
surgery”
Appendiceal neuroendocrine tumors: Recent insights and clinical implications
New insights emerged last decade that enriched our knowledge regarding
the biological behavior of appendiceal neuroendocrine tumors (NETs),
which range from totally benign tumors less than 1cm to goblet cell
carcinomas which behave similarly to colorectal adenocarcinoma. The
clinical implication of that knowledge reflected to surgical strategies
which also vary from simple appendicectomy to radical abdominal
procedures based on specific clinical and histological characteristics.
Since the diagnosis is usually established post-appendicectomy, current
recommendations focus on the early detection of: (1) the subgroup of
patients who require further therapy; (2) the recurrence based on the
chromogranin a plasma levels; and (3) other malignancies which are
commonly developed in patients with appendiceal NETs. (C) 2010
Baishideng. All rights reserved
The prognostic significance of: prostate specific antigen (PSA), mutant p53 protein, estrogen receptors (ER) and progesteron receptors (PgR) in breast cancer patients
THERE IS NO, AS YET, A SINGLE TUMOR INDEX SUFFICIENTLY SPECIFIC TO PREDICT WITH ACCURACY THE OUTCOME FOR EACH BREAST CANCER PATIENT. IN RECENT YEARS, PROGRESS IN BIOCHEMISTRY AND MOLECULAR BIOLOGY HAD ALLOWED THE DETERMINATION OF VARIOUS PROTEINS WHO WERE STUDIED FOR THEIR PROGNOSTIC SIGNIFICANCE IN BREAST CANCER PATIENTS. PROSTATE SPECIFIC ANTIGEN (PSA) WHICH WAS THOUGHT TO BE EXCRETED ONLY BY THE EPITHELIAL CELLS OF PROSTATE, HAS ALSO BEEN RECENTLY DETERMINED IN BREAST TUMORS. ALSO, THE PRESENT OF MUTANT P53 PROTEIN IN BREAST TUMORS SUGGEST AN UNFAVORABLE PROGNOSTIC MARKER FOR BREAST CANCER PATIENTS. TO ESTIMATE THE PROGNOSTIC SIGNIFICANCE OF PSA AND P53 EXPRESSION IN BREAST TUMOR CYTOSOL, WE RETROSPECTIVELY STUDIED 219 CANCER PATIENTS (27 PRE- AND 192 POSTMENOPAUSAL) WHO WERE SURGICALLY TREATED IN OUR INSTITUTE FROM OCT. 1992 TOSEPT. 1995. PSA AND P53 IMMUNOREACTIVITY WAS DETERMINED WITH ULTRASENSITIVE TIME-RESOLVED IMMUNOFLUOROMETRIC ASSAY. PATIENTS WERE DEFINED AS PSA POSITIVEAND PSA NEGATIVE ACCORDING TO A CUT-OFF POINT OF 1 PR/MG. IN PREMENOPAUSAL CANCER PATIENTS, 15 WERE PSA POSITIVE, WHILST, 131 POSTMENOPAUSAL PATIENTS WERE PSA POSITIVE. ACCORDING TO A CUT-OFF POINT OF 0,4 ΜG/G FOR P53 EXPRESSION 14 PREMENOPAUSAL AND 37 POSTMENOPAUSAL CANCER PATIENTS WERE P53+. WE CLASSIFIED THE PATIENTS IN THE SUBGROUPS OF PSA+ AND PSA-, P53+ AND P53- AND ALSO PSA+/P53- AND PSA- /P53+ AND WE SEARCH FOR THEIR RELATIONSHIP TO OTHER PROGNOSTIC INDICES, TO CANCER RELAPSE AND DESEASE FREE INTERVAL. (ABSTRACT TRUNCATED)ΜΕΧΡΙ ΣΗΜΕΡΑ ΔΕΝ ΕΧΕΙ ΑΝΑΔΕΙΧΘΕΙ ΚΑΠΟΙΟΣ ΕΙΔΙΚΟΣ ΠΡΟΓΝΩΣΤΙΚΟΣ ΔΕΙΚΤΗΣ, Ο ΟΠΟΙΟΣ ΝΑ ΕΠΙΤΡΕΠΕΙ ΜΕ ΙΚΑΝΟΠΟΙΗΤΙΚΗ ΑΚΡΙΒΕΙΑ ΤΗΣ ΕΚΤΙΜΗΣΗ ΤΗΣ ΕΚΒΑΣΗΣ ΤΩΝ ΑΣΘΕΝΩΝ ΜΕ ΚΑΡΚΙΝΟ ΤΟΥ ΜΑΣΤΟΥ. ΤΑ ΤΕΛΕΥΤΑΙΑ ΧΡΟΝΙΑ ΜΕ ΤΙΣ ΣΗΜΑΝΤΙΚΕΣ ΠΡΟΟΔΟΥΣ ΠΟΥ ΣΗΜΕΙΩΣΑΝ Η ΒΙΟΧΗΜΕΙΑ ΚΑΙ Η ΜΟΡΙΑΚΗ ΒΙΟΛΟΓΙΑ ΕΧΟΥΝ ΑΠΟΜΟΝΩΘΕΙ ΚΑΙ ΕΧΟΥΝ ΜΕΛΕΤΗΘΕΙ ΓΙΑ ΤΗΝ ΠΡΟΓΝΩΣΤΙΚΗ ΤΟΥΣ ΑΞΙΑ ΔΙΑΦΟΡΕΣ ΜΕΓΑΛΟΜΟΡΙΑΚΕΣ ΟΥΣΙΕΣ.ΤΟ ΕΙΔΙΚΟ ΠΡΟΣΤΑΤΙΚΟ ΑΝΤΙΓΟΝΟ (PSA), ΤΟ ΟΠΟΙΟ ΜΕΧΡΙ ΣΗΜΕΡΑ ΠΙΣΤΕΥΕΤΟ ΟΤΙ ΠΑΡΑΓΕΤΑΙ ΜΟΝΟ ΑΠΟ ΤΑ ΕΠΙΘΗΛΙΑΚΑ ΚΥΤΤΑΡΑ ΤΟΥ ΠΡΟΣΤΑΤΗ, ΠΡΟΣΦΑΤΑ ΑΠΟΜΟΝΩΘΗΚΕ ΚΑΙ ΣΕ ΟΓΚΟΥΣ ΤΟΥ ΜΑΣΤΟΥ. Η ΜΕΤΑΛΛΑΓΜΕΝΗ ΠΡΩΤΕΙΝΗ P53 ΟΤΑΝ ΕΚΦΡΑΖΕΤΑΙ ΣΤΟΝ ΠΡΩΤΟΠΑΘΗ ΟΓΚΟ ΘΕΩΡΕΙΤΑΙ ΩΣ ΕΝΑΣ ΔΥΣΜΕΝΗΣ ΠΑΡΑΓΟΝΤΑΣ ΓΙΑ ΤΗΝ ΕΚΒΑΣΗ ΤΗΣ ΝΟΣΟΥ. ΠΡΟΚΕΙΜΕΝΟΥ ΝΑ ΕΡΕΥΝΗΣΟΥΜΕ ΤΗΝ ΠΡΟΓΝΩΣΤΙΚΗ ΣΗΜΑΣΙΑ ΤΗΣ ΕΚΦΡΑΣΗΣ ΤΩΝ ΠΑΡΑΠΑΝΩ ΠΡΩΤΕΙΝΩΝ ΣΤΟΥΣ ΟΓΚΟΥΣ ΤΟΥ ΜΑΣΤΟΥ ΠΡΟΧΩΡΗΣΑΜΕ ΣΤΗΝ ΠΑΡΟΥΣΑ ΑΝΑΔΡΟΜΙΚΗ ΚΛΙΝΙΚΟΕΡΓΑΣΤΗΡΙΑΚΗ ΜΕΛΕΤΗ. Ο ΠΡΟΣΔΙΟΡΙΣΜΟΣ ΚΑΙ ΤΩΝ ΔΥΟ ΑΥΤΩΝ ΟΥΣΙΩΝ ΗΤΑΝ ΠΟΣΟΣΤΙΚΟΣ ΚΑΙ ΠΡΑΓΜΑΤΟΠΟΙΗΘΗΚΕΜΕ ΜΙΑ ΥΠΕΡΕΥΑΙΣΘΗΤΗ ΚΑΙ ΧΡΟΝΙΚΑ ΑΚΡΙΒΗ ΜΕΘΟΔΟ ΑΝΟΣΟΦΘΟΡΙΣΜΟΥ. ΜΕΛΕΤΗΘΗΚΑΝ 219 ΑΣΘΕΝΕΙΣ, 27 ΠΡΟ ΚΑΙ 192 ΜΕΤΕΜΜΗΝΟΠΑΥΣΙΑΚΕΣ. ΜΕ ΟΡΙΟ ΘΕΤΙΚΟΤΗΤΑΣ ΓΙΑ ΤΗΝ ΕΚΦΡΑΣΗ ΤΟΥ PSA ΤΟ 1 PG /MG, PSA+ ΗΤΑΝ 131 ΜΕΤΕΜΜΗΝΟΠΑΥΣΙΑΚΕΣ ΚΑΙ 15 ΠΡΟΕΜΜΗΝΟΠΑΥΣΙΑΚΕΣ.(ΠΕΡΙΚΟΠΗ ΠΕΡΙΛΗΨΗΣ