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

Suicide Attempts from Height and Injury Patterns: An Analysis of 64 Cases

Falls from height are a common cause of death and disability. A majority of free falls occur accidentally and only a minority result from suicidal behaviour. Adolescents in many countries show high rates of suicide attempts and their repetition is a common feature. We describe the demographic characteristics of these patients, their psychiatric diagnosis at the time of the attempt and the injury patterns. We present 64 patients who sustained injuries as a result of a fall from height. They were divided into those without mental disorders (n = 32, group I) and those with mental disorders (n = 32, group II). The mean height from which the fall occurred was 5.4 m (range, 3–25 m). The mean injury severity score was 19 (range, 6–58) for all fall victims. Upper extremity fractures were found in 37 patients, while pelvic and lower extremity fractures were found in 198 cases. Spinal fractures were noted in 32 patients. Head injuries were revealed by CT scan in 16 patients. Patients following a suicidal high fall mostly had lower limb fractures, pelvis fractures, spinal fractures and head injuries

Current evidence on laparoscopic vs. open resection for gastric stromal tumours

Although the use of laparoscopic surgery is increasing, controversy still surrounds its application for malignant conditions. Gastrointestinal stromal tumours (GISTs) are less demanding in terms of lymphadenectomy, meaning that laparoscopic resection might have a more defined benefit when compared with open resection. To the best of our knowledge, no randomized study exists that compares the laparoscopic and open resection of GISTs. The current study aimed to examine the relevant literature by means of a systematic review. A systematic literature search was performed individually by two authors, in which three independent databases were searched using specific search-terms. Titles, abstracts and full texts were screened, as well as references to relevant articles, in order to comprise a comprehensive list of studies. Data were extracted using a detailed pre-agreed spreadsheet. Studies were evaluated according to the modified MINORS criteria. A total of 10 studies were included in the present review, yielding a total of 14 entries. The majority of studies reported significantly improved perioperative outcomes for the laparoscopic approach, including improved duration of operation, blood loss and length of hospital stay. Only four studies reported long-term outcomes and findings that were controversial, with some studies detecting no statistically significant differences, one reporting improved and one reporting worse disease-free and overall survival for the laparoscopic group. Three studies were deemed to be good quality, two of which had not reported significantly different long-term outcomes, while the third had reported significantly improved outcomes in the open resection group. While there is a clear benefit for performing laparoscopic surgery in patients with GIST with regards to perioperative outcomes, when it comes to long-term oncological outcomes, uncertainty over its application remains. The lack of randomized trials, as well as the poor reporting of retrospective studies, limits the amount of evidence that is currently available. Laparoscopic surgery for GIST is certainly safe, feasible and likely cost-effective; however, further studies are required to inform on whether this technique is superior to open resection

Liver transplantation as last-resort treatment for patients with bile duct injuries following cholecystectomy: A multicenter analysis

Background Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy. Methods Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed. Results Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. There was a higher probability that patients with concomitant vascular injury (hazard ratio 10.69, P=0.039) would be referred sooner for LT. Overall survival following LT at 1, 3, 5 and 10 years was 82.4%, 76.5%, 73.5% and 70.6%, respectively. Conclusion LT for selected patients with otherwise unmanageable BDI following cholecystectomy yields acceptable long-term outcomes

Comparison of Local Analysis Strategies for Exudate Detection in Fundus Images

Diabetic Retinopathy (DR) is a severe and widely spread eye disease. Exudates are one of the most prevalent signs during the early stage of DR and an early detection of these lesions is vital to prevent the patient’s blindness. Hence, detection of exudates is an important diagnostic task of DR, in which computer assistance may play a major role. In this paper, a system based on local feature extraction and Support Vector Machine (SVM) classification is used to develop and compare different strategies for automated detection of exudates. The main novelty of this work is allowing the detection of exudates using non-regular regions to perform the local feature extraction. To accomplish this objective, different methods for generating superpixels are applied to the fundus images of E-OPHTA database and texture and morphological features are extracted for each of the resulting regions. An exhaustive comparison among the proposed methods is also carried out.This paper was supported by the European Union’s Horizon 2020 research and innovation programme under the Project GALAHAD [H2020-ICT2016-2017, 732613]. The work of Adri´an Colomer has been supported by the Spanish Government under a FPI Grant [BES-2014-067889]. We gratefully acknowledge the support of NVIDIA Corporation with the donation of the Titan Xp GPU used for this research.Pereira, J.; Colomer, A.; Naranjo Ornedo, V. (2018). Comparison of Local Analysis Strategies for Exudate Detection in Fundus Images. En Intelligent Data Engineering and Automated Learning – IDEAL 2018. Springer. 174-183. https://doi.org/10.1007/978-3-030-03493-1_19S174183Sidibé, D., Sadek, I., Mériaudeau, F.: Discrimination of retinal images containing bright lesions using sparse coded features and SVM. Comput. Biol. 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Eng. 51(2), 246–254 (2004)Welfer, D., Scharcanski, J., Marinho, D.R.: A coarse-to-fine strategy for automatically detecting exudates in color eye fundus images. Comput. Med. Imaging Graph. 34(3), 228–235 (2010)Giancardo, L., et al.: Exudate-based diabetic macular edema detection in fundus images using publicly available datasets. Med. Image Anal. 16(1), 216–226 (2012)Amel, F., Mohammed, M., Abdelhafid, B.: Improvement of the hard exudates detection method used for computer-aided diagnosis of diabetic retinopathy. Int. J. Image Graph. Signal Process. 4(4), 19 (2012)Akram, M.U., Khalid, S., Tariq, A., Khan, S.A., Azam, F.: Detection and classification of retinal lesions for grading of diabetic retinopathy. Comput. Biol. Med. 45, 161–171 (2014)Akram, M.U., Tariq, A., Khan, S.A., Javed, M.Y.: Automated detection of exudates and macula for grading of diabetic macular edema. Comput. Methods Programs Biomed. 114(2), 141–152 (2014)Machairas, V.: Waterpixels and their application to image segmentation learning. Ph.D. thesis, Université de recherche Paris Sciences et Lettres (2016)Shi, J., Malik, J.: Normalized cuts and image segmentation. IEEE Trans. Pattern Anal. Mach. Intell. 22(8), 888–905 (2000)Veksler, O., Boykov, Y., Mehrani, P.: Superpixels and supervoxels in an energy optimization framework. In: Daniilidis, K., Maragos, P., Paragios, N. (eds.) ECCV 2010. LNCS, vol. 6315, pp. 211–224. Springer, Heidelberg (2010). https://doi.org/10.1007/978-3-642-15555-0_16Comaniciu, D., Meer, P.: Mean shift: a robust approach toward feature space analysis. IEEE Trans. Pattern Anal. Mach. Intell. 24(5), 603–619 (2002)Levinshtein, A., Stere, A., Kutulakos, K.N., Fleet, D.J., Dickinson, S.J., Siddiqi, K.: TurboPixels: fast superpixels using geometric flows. IEEE Trans. Pattern Anal. Mach. 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Liver Resection and Ablation for Squamous Cell Carcinoma Liver Metastases

Background Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). Method Members of the European–African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. Results Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). Conclusion Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome

Surgical outcome after spinal fractures in patients with ankylosing spondylitis

<p>Abstract</p> <p>Background</p> <p>Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine.</p> <p>The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned.</p> <p>Methods</p> <p>Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge.</p> <p>Results</p> <p>Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries.</p> <p>Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed.</p> <p>Conclusion</p> <p>The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.</p

Liver resection and ablation for squamous cell carcinoma liver metastases.

Funder: Region StockholmFunder: Region Stockholm (clinical postdoctoral appointment)BACKGROUND: Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). METHOD: Members of the European-African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. RESULTS: Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). CONCLUSION: Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome