Minilaparotomy Approach for Giant Mutinous Cystadenoma of the Ovary in Children: Report of Two Cases

Mucinous cystadenomas (MCAs) are rare benign neoplasms in children. To the best of our knowledge, only 22 cases in children have been described. MCAs may reach huge sizes, and thus are not readily amenable to laparoscopic treatment due to the risk of rupture and the limited working space. We report two cases of giant MCA of the ovary treated by minilaparotomy. In case 1, a 12-year-old girl was admitted with abdominal pain and vomiting. Diagnostic imaging showed a large polycystic mass occupying nearly the whole abdominal cavity. With a provisional diagnosis of ovarian cyst, surgery was performed. The cyst was punctured under direct vision though a small subumbilical incision. After aspiration of 2,000ml of mucinous fluid, laparoscopic examination revealed a tumor originating from the left ovary. Left oophorectomy was performed through an 8-cm incision in the left lower abdomen. The histopathological diagnosis was MCA. In case 2, a 15-year-old girl presented with slowly increasing abdominal distension over 5 months. A polycystic mass measuring 36 × 21 × 14cm was evident on imaging. After drainage of 9,500ml of clear mucinous fluid, right oophorectomy was performed through a small (5cm) midline incision. The final pathology revealed a benign MCA. No recurrence has been detected for 2 years postoperatively in case 1 and for 6 years postoperatively in case 2

The effect of cholecalciferol supplementation on allograft function in incident kidney transplant recipients: A randomized controlled study

It is unknown whether cholecalciferol supplementation improves allograft outcomes in kidney transplant recipients (KTRs). We conducted a single-center randomized, double-blind, placebo-controlled trial of daily 4000 IU cholecalciferol supplementation in KTRs at 1-month posttransplant. The primary endpoint was the change in eGFR from baseline to 12-month posttransplant. Secondary endpoints included severity of interstitial fibrosis and tubular atrophy (IFTA) at 12-month posttransplant and changes in urinary biomarkers. Of 193 randomized patients, 180 participants completed the study. Changes in eGFR were 1.2 mL/min/1.73 m2 (95% CI; −0.7 to 3.1) in the cholecalciferol group and 1.8 mL/min/1.73 m2 (95% CI, −0.02 to 3.7) in the placebo group, with no significant between-group difference (−0.7 mL/min/1.73 m2 [95% CI; −3.3 to 2.0], p = 0.63). Subgroup analyses showed detrimental effects of cholecalciferol in patients with eGFR <45 mL/min/1.73 m2 (Pinteraction <0.05, between-group difference; −4.3 mL/min/1.73 m2 [95% CI; −7.3 to −1.3]). The degree of IFTA, changes in urine albumin-to-creatinine ratio, or adverse events including hypercalcemia and infections requiring hospitalization did not differ between groups. In conclusion, cholecalciferol supplementation did not affect eGFR change compared to placebo among incident KTRs. These findings do not support cholecalciferol supplementation for improving allograft function in incident KTRs. Clinical trial registry: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) as UMIN000020597 (please refer to the links below). UMIN-CTR: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023776.Doi Y., Tsujita M., Hamano T., et al. The effect of cholecalciferol supplementation on allograft function in incident kidney transplant recipients: A randomized controlled study. American Journal of Transplantation 21, 3043 (2021); https://doi.org/10.1111/ajt.16530

Pedicled gastric seromuscular patch for one-stage closure of a bronchopleural fistula: a case report

Abstract Background One-stage closure and fenestration are the available surgical options for bronchopleural fistula (BPF). One-stage closure may be applicable in cases with favorable infection control. Closing the bronchopleural stump is difficult due to thick adhesion caused by inflammation and a high risk of pulmonary artery injury. We report the successful closure of a BPF using a gastric seromuscular patch with an omental pedicle flap. Case presentation A 73-year-old man underwent right lower lobectomy with ND2a-2 lymph node dissection for lung adenocarcinoma. He was admitted to a local hospital for pneumonia. Three days after admission, his thoracic cavity was drained and a BPF was suspected. During the primary operation, the latissimus dorsi muscle and anterior serratus muscle were dissected via posterolateral incision, and we decided to close the fistula using the gastric seromuscular layer and omental pedicle flap. The patient was discharged 20 days after surgery. After 2 years, he has not had cancer recurrence and currently leads an active life. Conclusions This method provided immediate airtight closure and luminal opening of the middle bronchus in our patient with a large BPF and appeared superior to using the omentum alone. This procedure is useful for one-stage closure and does not require fenestration in cases with favorable infection control