30 research outputs found
Congenital pancreatoblastoma: a case report
The literature describes 15 cases of congenital pancreatoblastoma (PB): 5 had prenatal diagnosis, none
had metastases at diagnosis, 7 were associated with BeckwitheWiedemann syndrome (BWS). In 13 cases
resection was radical, while in 2 there were macroscopic residues. Only one patient underwent
chemotherapy after distant recurrence. All children are alive except one who died because of problems
related to BWS. Our goal is to describe the approach adopted in an infant with congenital PB treated in
our center. After a prenatal third semester diagnosis of abdominal anechoic lesion, the radiological investigations
(ultrasound, MRI) performed at birth described a cystic lesion of unclear nature. We proceeded
to laparoscopic exploration, transformed into open approach after the detection of a lesion
located in the body of the pancreas; this lesion was resected, preserving the head and tail of pancreas.
The histological diagnosis showed a completely excised PB. After excluding metastatic lesions, we
decided to perform only careful follow-up without chemotherapy. The follow-up at 12 months is
negative. Although PB is a malignant tumor that requires a multidisciplinary treatment, the congenital
cases seem to have a less aggressive biological behavior. The treatment, therefore, in case of complete
resection, could be only surgical, followed by a careful follow-up. These forms are often associated with
congenital BWS, but in our case the patient did not have the typical characteristics of the syndrome
Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model.
Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes.2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue.Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05).Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair
Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model
Background
Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes.
Materials and Methods
2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue.
Results
Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05).
Conclusions
Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair
Erector spinae plane block combined with a novel technique for selective brachial plexus block in breast cancer surgery -a case report
Prevalence and survival of patients with anorectal malformations: A population-based study
Anorectal malformations (ARMs) are the most frequent congenital intestinal anomalies. The aim of this study was to describe the epidemiology of anorectal defects between 1981 and 2014 and to evaluate patients' survival
Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study
Endoscopic tumor length should be reincluded in the esophageal cancer staging system: Analyses of 662 consecutive patients
Esophageal cancer represents the 6th cause of cancer mortality in the World. New treatments led to outcome improvements, but patient selection and prognostic stratification is a critical aspect to gain maximum benefit from therapies. Today, patients are stratified into 9 prognostic groups, according to a staging system developed by the American Joint Committee on Cancer. Recently, trying to better select patients with curing possibilities several authors are reconsidering tumor length as a valuable prognostic parameter. Specifically, endoscopic tumor length can be easily measured with an esophageal endoscopy and, if its utility in esophageal cancer staging is demonstrated, it may represent a simple method to identify high risk patients and an easy-to-obtain variable in prognostic stratification. In this study we retrospectively analyzed 662 patients treated for esophageal cancer, stratified according to cancer histology and current staging system, to assess the possible role of endoscopic tumor length. We found a significant correlation between endoscopic tumor length, current staging parameters and 5-year survival, proving that endoscopic tumor length may be used as a simple risk stratification tool. Our results suggest a possible indication for preoperative therapy in early stage squamocellular carcinoma patients without lymph nodes involvement, who are currently treated with surgery alone
Radiographic evaluation.
<p>Unoperated control (d90; A), left-convex scoliosis, postoperative changes of the 9<sup>th</sup> and 10<sup>th</sup> left rib (SIS d90; B), discrete elevation of the left diaphragm (SIS d60; C), and discrete reduced left-thoracic volume with postoperative calcifications adjacent to the 8<sup>th</sup> left rib (Matricel d90; D).</p
Histology.
<p>Representative micrographs of all groups (columns) obtained at x400 magnification with identical settings for each stain from the mesh-tissue interface. Meshes are invisible form degradation or processing, respectively. Inflammation is represented by the number of macrophages (first row, black arrows), foreign body giant cells (second row, black arrows) and polymorphonuclear cells (second row, white arrows), fibrosis depicted by the amount of neovascularization (second row, v vessel) as well as the amount and composition of collagen (third row, * muscle, â mature collagen, â immature collagen, â
patch). H&E: Hematoxylin-eosin.</p
Macroscopic findings.
<p>A. Primary repair (d60), polyglecaprone suture absorbed (<i>arrow</i>). B. Gore-Tex (d 60), encapsulated with perihepatic adhesions. Matricel patches were preserved in all (d60; C) but one animal (d90; D, <i>arrow =</i> patch remnant) with high-grade perihepatic adhesions (D). SIS patches were degraded in five animals with bulging of viscera in three (d60, E). Seroma was observed twice (d 60, F, <i>asterisk</i>).</p