Abstract: INTRODUCTION: Therapeutic laparoscopy of the pancreas is still described as experimental surgery by many surgeons. Many issues remain to be clarified in determining the future of this new method. CASE PRESENTATION: The objective of the present study was to present a case of a patient who underwent totally laparoscopic distal pancreatectomy for a benign appearing tumor in the tail of the pancreas and to critically discuss the treatment of the pancreatic remnant and the need to perform splenectomy with or without ligation of the splenic vessels. CONCLUSION: Laparoscopic distal pancreatectomy is usually performed en-bloc along with resection of the spleen, for technical reasons, making the operation short and easy. However, it should only be performed in centers with expertise in both pancreatic surgery and advanced laparoscopy. Furthermore, the use of linear stapler to cut the pancreas (4.5-mm staples) seems to prevent fistula formation and ischemia of the pancreatic stump.
Abstract: ABSTRACT: Although unusual, hemangioma is the most common primary splenic neoplasm. Splenectomy is indicated when the tumor is large, with increased risk of hemorrhage. The laparoscopic approach is preferred for most elective splenectomies. Although technically feasible, laparoscopic splenectomy can be a challenge in the patient with splenomegaly. We present herein a case of an 18-year-old male asymptomatic patient who underwent laparoscopic splenectomy for the incidental finding of splenomegaly caused by a large splenic hemangioma. Laparoscopic splenectomy appears to be a safe and effective procedure, in appropriately experienced hands, for patients with splenomegaly, given the spleen's fragile anatomy and its relationship to other abdominal viscera.
Abstract: BACKGROUND: Intrabiliary rupture is a common and serious complication of hepatic hydatidosis, and its treatment remains controversial. METHODS: Sixty-seven patients who underwent surgery for rupture of a hydatid cyst in the biliary tree were studied retrospectively. The following data were analyzed: age, sex, clinical presentation, and so on. RESULTS: In 55 patients, intrabiliary rupture was diagnosed preoperatively and in 12 patients intraoperatively. In 51 patients, partial pericystectomy and closed-tube drainage followed. Pericystorraphy was performed in 9 patients. Omentoplasty was performed in 5 cases. After the meticulous cleansing of the common bile duct, T-tube drainage (60 patients), choledochoduodenostomy (4 patients), or sphincteroplasty (1 patient) was added. In 4 patients, there was a persisting external biliary fistula. The mean length of hospital stay was 18 days. Follow up (1-35 years) elicited 4 recurrences and 1 postoperative death. CONCLUSIONS: Our results in intrabiliary rupture of echinococcal cysts are considered to be satisfactory. Surgical treatment can be improved with the modern methods of investigation, wider use of newer chemotherapeutics, and appropriate modification of surgical procedures.
Abstract: BACKGROUND: Coexistence of gastrointestinal stromal tumor with synchronous or metachronous colorectal cancer represents a phenomenon with increasing number of relative reports in the last 5 years. Synchronous occurence of GISTs with other gastrointestinal tumors of different histogenesis presents a special interest. We herein report a case of GIST in Meckel's diverticulum synchronous with colorectal adenocarcinoma. CASE PRESENTATION: A 69 year old man, presented with abdominal distension and anal bleeding on defecation. Colonoscopy revealed colorectal cancer and a low anterior resection was performed, during which a tumor in Meckel's diverticulum was discovered. Histologic examination revealed GIST in Meckel's diverticulum and a rectosigmoid adenocarcinoma. CONCLUSION: Whenever GIST is encountered, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin. Correct diagnosis of synchronous tumors of different origin is the cornerstone of treatment.
Abstract: Therapeutic effects of human interferons (IFN) on malignancies and infectious diseases have been demonstrated in several clinical trials. The effects of IFN alone or combined with other treatment modalities (radiotherapy and chemotherapy) in lung cancer are under investigation. Experimental data suggest that some cytokines, such as IFN-alpha and IFN-gamma, exhibit cytogenetic properties in human normal lymphocytes from peripheral blood, but the mechanisms are not clear. The aim of the present study was to investigate the in vivo cytotoxic and cytostatic activity of IFN-gamma. Patients with certain cases of non-small cell lung cancer not eligible for chemotherapy or chemoradiotherapy were treated with thoracic radiotherapy. After tumor relapse, local treatment with instillations of IFN-gamma through the fiberoptic bronchoscope followed. To clarify the cytogenetic activity of IFN-gamma, sister chromatid exchange (SCE) and proliferation rate index (PRI) were evaluated in lymphocyte cultures from these patients' peripheral blood samples immediately after diagnosis (baseline), 30 days after radiotherapy, and after the fifth instillation of IFN-gamma. Our results show a decrease in SCE frequency and PRI values in lymphocytes after treatment with IFN-gamma, suggesting that IFN-gamma does not have cytotoxic activity but, in contrast, may induce repair mechanisms, as shown in earlier studies in other biologic models.
Abstract: ABSTRACT: INTRODUCTION: Kaposi's sarcoma is a vascular neoplasm mainly affecting the skin of the lower extremities. Although it is the most common neoplasm affecting patients with AIDS, sporadic cases in HIV-negative people have been reported. It is a lesion mainly affecting men and its clinical presentation presents a challenge, as it can resemble other benign or malignant skin lesions. CASE PRESENTATION: We report a rare case of Kaposi's sarcoma presenting in a 68-year-old Mediterranean woman with no evidence of HIV infection. The patient had a 6-month history of a slowly progressing pigmented lesion on the dorsum of her left hand. The lesion clinically resembled a squamous cell carcinoma. The patient was treated with a wide excision of the lesion and primary reconstruction with a full thickness skin graft. Histopathological and immunohistochemical analysis of the excised lesion revealed the presence of Kaposi's sarcoma. Serologic investigation for HIV was negative but polymerase chain reaction for human herpes virus type 8 infection was positive. Thorough clinical and imaging investigation of the abdomen and chest were both negative for loci of disease. CONCLUSION: Kaposi's sarcoma, although rare in its sporadic form, should be considered in the differential diagnosis of indeterminate skin lesions, especially those affecting the extremities.
Abstract: ABSTRACT: BACKGROUND: Patients with adrenal metastasis from various primary tumours are regarded as cases of diffuse systemic spread and considered unsuitable for surgical resection. We herein report an operable case of heterochronic adrenal metastasis from colorectal carcinoma in a 63-year-old woman. CASE PRESENTATION: Sixteen months after low anterior resection for the primary tumour, left lower pneumonectomy was performed for a solitary lung metastasis. Four months later a right adrenal metastasis was detected by magnetic resonance imaging (MRI), as sole evidence of metastatic disease. A right adrenalectomy was performed. The histopathological examination revealed adenocarcinoma compatible with the colorectal carcinoma resected 19 months earlier. The patient received adjuvant chemotherapy after each operation and is alive and free of disease 21 months after the adrenalectomy. CONCLUSION: The possibility of adrenal metastasis should be considered in the follow-up of patients after primary surgery for colorectal cancer, even though other sites are the main metastatic sites. Although the prognosis of adrenal metastasis from colorectal cancer is poor, we suggest that patients with solitary adrenal metastasis may benefit from complete removal of it.
Abstract: ABSTRACT: BACKGROUND: Barber's disease is an acquired occupational disease produced by short customers' hairs that penetrate the interdigital spaces of the hands. The lesion has been reported to occur mostly on the hands of male hairdressers. The purpose of this article is to report a rare case of a female hairdresser who developed a pilonidal sinus in the interdigital web of her non-dominant hand and review the relevant literature. CASE PRESENTATION: A 29 year-old Greek female hairdresser underwent surgical excision of the pilonidal sinus and curettage. She was not hospitalised, while prompt resolution of the condition and prevention of recurrence was achieved. CONCLUSION: Pilonidal sinus of the interdigital spaces of the hand is a rare and preventable acquired occupational disease. The personal hygiene with thorough removal of any hairs that have penetrated the epidermis during the working day could prevent the formation of the disease. Surgical excision, curettage and primary healing seem to be a safe method of treatment.
Abstract: Background and aim. The aim of this study was to report our 44-year experience (1963-2006) in the management of primarily infected hydatid cyst of the liver. This is a retrospective review of demographic data, clinical presentation, diagnostic work-up, surgical management, and long-term outcome of patients treated at our center. Material and methods. There were 77 patients with operated infected liver cysts. In the same period, a total of 460 cases with liver hydatidosis were treated surgically. Of those with suppurated cysts, 27 were men and 50 were women, with a mean age 54.5 years. Results. Clinical manifestations of an abscess were identified in 75% of the patients. In the earlier cases of the study, the diagnosis was made from the clinical picture, laboratory studies, in combination with plain X-ray, hepatic scintigraphy, and in the later cases with US (ultrasonography), CT (computed tomography) or MRI (magnetic resonance imaging), and ERCP (endoscopic cholangiopangreatography). Abdominal and, rarely, thoracic and abdominal or thoracoabdominal incisions were used. Total cystopericystectomy in 8 patients and partial pericystectomy and proper drainage with one or two drainage tubes of the cystic cavity in the other 69 patients were carried out. Hospital stay was between 13 and 146 days with 5 re-operations. Two patients with grossly suppurated cysts and coexistent medical problems died. The disease recurred in five patients. Conclusions. We conclude that, under good perioperative antibiotic and metabolic coverage, the infected hydatid cysts have to be completely evacuated and properly drained. The application of "conservative" surgical procedures should be preferred. Further studies are needed to solve the clinical and therapeutic problems of this serious complication.
Abstract: The aim of this study was to examine the anorectal physiological and clinical changes that occur after low anterior resection for rectal cancer. Since 1998, 30 patients underwent laboratory tests of anorectal function, preoperatively and 1 month and 6 months after low anterior resection. Postoperatively all patients presented with increased bowel frequency, 60% of the patients with mild soiling and 30% with urgency for defecation. Six months after surgery there was a significant improvement of these symptoms. The anal resting pressure was significantly decreased postoperatively, while maximum squeezing pressure remained unchanged. The rectoanal inhibitory reflex was absent in 80% of the patients and at 6 months after surgery it tended to recover. Rectal capacity and compliance were reduced in all patients. In the current study, the majority of patients demonstrated manometric anorectal changes and clinical anorectal function disorders during the first year after surgery. We observed that these disorders correlated with the low level of the anastomosis.
Abstract: BACKGROUND: The aim of this study was to examine the therapeutic efficacy of radiofrequency tumour ablation in patients with liver metastases from colorectal cancer who are not suitable for hepatic resection. PATIENTS AND METHODS: Between April 2002 and January 2004, 18 patients underwent open radiofrequency ablation (RFA) for colorectal liver metastases. Median lesion size was 5.6 cm (range 3.0-8.0 cm). Patient's follow-up included ultrasound and computed tomography imaging at 3, 6 and 18 months postoperatively. RESULTS: Mean total procedure time was 86 min. The average hospital stay was 5 days. There was no treatment-related mortality. Twelve patients (66.7%) experienced mild right hypochondrium discomfort for 3 days and 6 patients (33.4%) low-grade fever for 4 days. Four patients died within 12 months with extrahepatic disease. In 4 patients lesions increased in size or new lesions developed, 7 patients are alive, symptom-free, with stable disease and 4 patients are free of disease. CONCLUSIONS: RFA is a safe, well tolerated procedure for the treatment of unresectable colorectal liver metastases.
Abstract: BackgroundMultiple hydatid disease is a complex surgical problem, and its treatment can follow either conservative principles (drainage or obliteration of the cavity) or radical principles (cystoperi-cystectomy or liver or lung resection).MethodsA total of 220 patients with multiple cystic echinococcosis (428 cysts) were managed between 1967 and 1998 with conservative operations (group A) or radical operation (group B). There were 90 men and 130 women, with a mean age of 52 years (range 18-77 years). There were two cysts in 124 patients, three cysts in 40 patients, four in 15 and more than four in 41 patients. These multiple cysts were located at one anatomical site (n=140) or at more than one site (n=80). Multiple (2-3) hepatic cysts occurred in 142 patients, multiple (2-3) lung cysts in 15 and multiple peritoneal cysts in 13 patients. Hepatic cysts co-existed with lung cysts in another 32 patients, with peritoneal cysts in 14 patients and once each with splenic, splenic plus lung cysts and renal cysts, one retroperitoneal cyst coincided with small peritoneal cysts.ResultsThe operative procedure employed was dependent on the type and site of the parasite and the condition of the host. Three of 208 patients operated conservatively (group A) died postoperatively as opposed to receiving radical treatment. Morbidity rates were 8.8% and 12.5% in group A and B and mean hospital stay was 15.8 and 15.1 days, respectively. In group A there was an 8.6% recurrence rate, and recurrent disease was finally managed in each group the overall result could be considered satisfactory.DiscussionWe conclude that conservative surgery can provide good results in multiple cystic echinococcosis. Radical surgery, with its time-consuming major procedures, is ideal but only in properly selected cases.
Abstract: Hydatid disease of the liver is still a major cause of morbidity in Greece. Beside the common complications of rupture and suppuration, calcification of the hepatic cysts represent a not well studied, less frequent and sometimes difficult surgical problem. In the present study 75 cases with calcified symptomatic liver echinococcosis were operated on in the 1st Propedeutic Surgical Clinic between 1964 to 1996. Twenty-eight patients were male and 47 female with ages from 23 to 78 years. The diagnosis was based mainly on the clinical picture and radiological studies. In 5 cases the operative method was cystopericystectomy. We performed evacuation of the cystic cavity and partial pericystectomy and primary closure of the residual cavity in 6 cases, omentoplasty or filling of the residual cavity with a piece of muscle of the diaphragm in 4 cases and external drainage by closed tube, in 60 cases. In 12 of those with drainage, after a period of time, a second operation with easy, removal of most of the calcareous wall plaques was performed. The mortality rate was 2%. Our results could be considered satisfactory. In the calcified parasitic cysts of the liver the proposed technique is cystopericystectomy. An alternative procedure is pericystectomy and drainage with a "planned" reoperation with a bloodless, due to intervening inflammation, chiseling of the calcification.
