Journal articles: 'Abdominal Neoplasms, complications' – Grafiati (2024)

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Complications associated with intraductal papillary mucinous neoplasms, such as acute pancreatitis, perforation, and fistula formation, have been documented. Intraductal papillary mucinous neoplasm with intratumoral hemorrhage is rare. To the best of our knowledge, there have been no previous reports of intraductal papillary mucinous neoplasm rupture and bleeding with intra-abdominal hemorrhage. A 74-year-old woman complained of acute upper right abdominal pain. She was under follow-up for an intraductal papillary mucinous neoplasm in the pancreatic head. Contrast-enhanced computed tomography revealed intraductal papillary mucinous neoplasm rupture and bleeding with intra-abdominal hemorrhage. The bleeding was treated with selective endovascular embolization of a branch of the gastroduodenal artery. Follow-up examinations are recommended even for intraductal papillary mucinous neoplasm patients without malignant findings because of the potential risk of rupture and bleeding with intra-abdominal hemorrhage. Clinicians should be aware of this possibility to ensure that patients are appropriately treated.

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The aim – to establish the clinical and pathogenetic significance of overweight and comorbidity in patients with malignant neoplasms (MN) of the abdominal cavity. Material and methods. The study was performed on the basis of the Chernivtsi Regional Clinical Oncology Centre and the Oncology Clinic of Bukovinian State Medical University and covered observation materials of 50 patients with intra-abdominal neoplasms. Among them, 35 individualsforming the main group were obese (body mass index ≥30), the rest formed the comparison group. Comorbidity index, risk complication ratio, confidence intervals, Fisher (P) and χ2 coefficients were calculated according to Yates and Pearson. Results. In the comparison group, comorbidities were detected in only 6 patients (40.0%), in the main group, comorbidities were detected in all patients. The value of the comorbidity index in the main group was 11.23±0.98 against 6.37±0.72 (P=0.005). The risk of complications increases significantly in the presence of obesity (OR+ 2.49, min-1.29, max-4.80). The term of hospitalization increases slightly (22.36±3.14 in the main group, against 16.73±2.50 in the comparison group, P=0.18). Conclusions. In patients with malignant neoplasms of the abdominal cavity, the risk of postoperative complications is 1.29-6.96 times higher than in the absence of obesity. The presence of obesity is a significant factor in aggravating the condition, prolongs the period of hospitalization of patients with malignant neoplasms, creates additional challenges for the oncologist.

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The paper analyses the tactics of managing patients with malignant neoplasms in the pancreatobiliary area complicated by obstructive jaundice in two nosologically and clinically comparable groups of patients. The aim of the research. To evaluate the effectiveness of complex palliative treatment with the use of photodynamic therapy in patients with malignant neoplasms in the pancreatobiliary area complicated by obstructive jaundice. Material and methods. In the main group, which consisted of 41 patients, palliative complex treatment was carried out using local and systemic photodynamic therapy of neoplasms in the pancreatobiliary area complicated by obstructive jaundice, purulent cholangitis. In the comparison group, which consisted of 165 patients, palliative complex treatment of complications was carried out without the use of photodynamic therapy. Complex palliative treatment in both groups included the following surgical interventions: percutaneous transhepatic mono- and bilobar drainage of the bile ducts, stenting of the bile ducts under ultrasound and X-ray control as well as bypass biliodigestive anastomoses. Symptomatic conservative treatment included infusion, detoxification, analgesic, hepatoprotective and antibacterial therapy. Results. Against the background of local and systemic photodynamic therapy in the main group, a decrease in the largest size of the neoplasm in patients with malignant neoplasms of the pancreas from 42.5 mm to 38 mm within a week after treatment was established according to the data of multispiral computed tomography of abdominal organs with intravenous bolus contrast. The largest neoplasm size decreased from 40.5 mm to 31 mm within a month after treatment according to the ultrasound examination of the abdominal cavities. Restoration of bile excretion into the intestine in 100% of patients with malignant neoplasms of the bile ducts and the head of the pancreas was registered, as well as an increase in life expectancy of patients by more than 1 year, a decrease in the risk of complications due to a slowdown in the growth of neoplasms associated with a decrease in the concentration of the cytokine TNF-α. Conclusion. Complex treatment with the use of photodynamic therapy of malignant neoplasms of the pancreatobiliary area allows reducing the largest size and rate of neoplasm invasion and to increase the survival rate of patients.

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Chyloperitoneum is defined as the presence of lymph within the peritoneal cavity, resulting from obstruction or injury of lymph ducts, mostly at the level of the gastrointestinal tract. This can occur in the context of congenital diseases, traumas, infections, neoplasms, hepatic disease, heart disease, and postoperative complications. The most common symptoms described are abdominal distention and mild pain in a course of weeks to months, with dyspnea, peritonitis, and in a few cases weight gain is observed due to the high intra-abdominal pressure. We present a case of a 56-year-old male with no significant personal history, who has a clinical picture of approximately three months of evolution, consisting in sensation of an abdominal mass predominantly in the left hemiabdomen, associated with progressive abdominal distension, changes in intestinal habit, lower limb edema, dyspepsia, occasional postprandial emesis, and unintentional weight loss of 20 kg. In non-traumatic conditions, the most frequent cause of chylous ascites is a malignancy disease followed by cirrhosis and mycobacterial infections. Taking into consideration that adenocarcinoma is the most frequently reported histologic subtype of jejunum neoplasm, and that not all cases of lymphoma debut with chylous ascites, it can be concluded that the proportion of patients that present with this condition is exceptionally low. Chyloperitoneum is an infrequent finding, having the higher detection rate in lymphatic alterations and malignancies of gastrointestinal location, in which some of the most commonly neoplasms associated with this complication are lymphoma, neuroendocrine tumors, sarcomas, and leukemia.

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We previously found that gender influenced the JAK2 V617F allele burden, but it is unknown whether this gender difference in molecular epidemiology influences complications in the myeloproliferative neoplasms (MPNs). Historically, vascular complications represented the most common cause of mortality in polycythemia vera and essential thrombocytosis and contributed to morbidity in primary myelofibrosis. To determine the influence of gender on vascular complications, we retrospectively analyzed associations between gender and vascular complications. Despite their younger age, less prevalent dyslipidemia or smoking history, lower white blood counts, and lower JAK2 V617F allele burden, women had higher rates of abdominal venous thrombosis and comparable rates of all vascular complications. Vascular risk is currently not easily stratified by MPN-disease burden or traditional risk factors. Our analysis contributes to growing literature emphasizing gender differences in the MPN and further supports the important impact of individual and host variation on MPN clinical manifestations, and especially vascular risk.

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Uterine leiomyomas are neoplasms of the smooth muscle that can cause complications such as severe bleeding and infertility in women of reproductive age. While many individuals may be asymptomatic, others may present with anemia secondary to heavy bleeding, cyclical abdominal pain, pelvic pressure, and urinary or bowel symptoms. A rare complication of uterine leiomyomas is avulsion due to blunt abdominal trauma resulting in hemoperitoneum. We present a 49-year-old female with no pertinent medical history who presented to the emergency room following a motor vehicle accident. Computed tomography scan revealed extensive hemoperitoneum and the patient was taken to the operating room where the source of bleeding was identified as multiple avulsed leiomyomas. The patient underwent an emergency hysterectomy and bilateral salpingectomy. Pathology reported a uterus weighing 6,000 g and the presence of 20 leiomyomas, with the largest measuring 29 cm. Knowledge of leiomyoma symptoms, presentation, and complications by both the patient and clinicians may help identify diagnoses and expedite intervention in the emergency setting.

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Extra-abdominal desmoid tumors account for 0.03% of all neoplasms and rarely present in the foot. They are benign but locally aggressive, and wide local surgical excision is the treatment of choice owing to the high rate of recurrence in the lower extremities. Invasiveness into the surrounding soft-tissue structures often makes wide excision difficult without compromise of function. We describe a 34-year-old woman with a large, pedal, extra-abdominal desmoid fibroma treated by wide local surgical excision with minimal complications postoperatively and no clinical evidence of recurrence at 28 months. (J Am Podiatr Med Assoc 101(1): 70–74, 2011)

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Background: Plastic biliary stent placement has been widely used as a safe approach for the management of hilar neoplasms or the dilation of benign biliary obstruction. Despite the complexity of this procedure, this approach is followed by a few complications. The incidence rate of stent migration is about 10%. In a majority of cases, the migrated stents are retained within the gastrointestinal tract and pass through the intestine with no complication or need for medical intervention. Case Report: In this paper, we described the case of the migrated biliary stent with prolonged abdominal pain, which was removed successfully by using double-balloon. Conclusion: In the case of patient with prolonged abdominal pain and previous history of biliary stent placement, migration of stent should be considered as differential diagnosis and Double-Balloon Enteroscopy can be a safe approach in those cases.[GMJ.2020;9:e1809]

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Aim. To determine possibilities of malignant neoplasms procoagulant activity detection by idiopathic thrombosis ultrasound imaging.Methods. 587 patients were examined. 347 patients with malignant neoplasms diagnosed in the outpatient clinic settings of the Tatarstan Regional Clinical Cancer Center (Kazan), were included in the main group. 240 patients, in which cancer pathology was excluded, were included in the control group. The groups were matched on age, sex and frequency of venous thromboembolic complications development risk factors not caused by malignant neoplasms. Both groups underwent clinical examination and ultrasound examination of the inferior vena cava, distal abdominal aorta, iliac arteries and veins, lower extremities arteries and veins.Results. Thrombosis clinical manifestations were detected in 12 patients, including 9 patients of the main group and 3 patients of the control group. In most cases of venous thrombosis in the main group (34 people, 79%) there were no clinical signs of thrombosis and it was detected only by ultrasound examination, which allowed to detect venous thrombus in 43 patients of the main group (12.4%) and in 5 patients of the control group (2.1%; t=3.2, p <0.05).Conclusion. The inferior vena cava system venous thrombosis frequency in patients with malignant neoplasms was significantly higher than that in patients without cancer, which indicates malignant neoplasms high procoagulant activity; ultrasonography has high sensitivity in the idiopathic thrombosis detection in cancer patients, and it should be performed regardless of the presence or absence of venous thromboembolic complications clinical manifestations.

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The topical issue of pediatric surgery is the treatment of ovarian cysts based on the development of new technologies for surgical correction of the disease. Aim. To analyze the effectiveness of using a new minimally invasive method for removal of cystic ovarian neoplasms in children. Material and methods. A retrospective analysis of 77 female patients with ovarian cysts, aged from 3 months to 17 years, was carried out. The patients were divided into 3 groups depending on the various surgical techniques used for their treatment. Group I consisted of 32 (41 %) girls who underwent cystectomy according to the new transabdominal technique for removing ovarian cysts in children. Group II included 19 (25 %) children who underwent a laparoscopic surgery. Group III comprised 26 (34 %) children who underwent a hybrid laparoscopy-assisted cystectomy. The following indicators were analyzed: the age of patients, the nature and number of complications of the disease course, the size of cystic neoplasms, the duration of surgical interventions, the number of cases accompanied by cyst contents leaking into the abdominal cavity during surgical manipulations, and the length of hospital stay. Results. The mean age of all patients was 11.23 ± 0.57 years. Planned hospitalizations amounted to 46 (59.7 %) cases. The duration of surgery in group I was almost 1.5 times lower (P < 0.05) than that in patients of group II and 2 times shorter than in children of group III (P < 0.05). Free cyst contents leaking into the abdominal cavity was observed in 35 (91.4 %) patients of Group III, which required additional measures aimed at the abdominal cavity sanation. The proposed minimally invasive transabdominal surgical technique prevented this complication in all 32 patients of Group I. The length of hospital stay did not differ significantly (P > 0.05) between children groups I and II and did not exceed 7.50 ± 0.35 (M ± SEM) days. This indicator was almost 1.5 times higher in Group III patients. Conclusions. The new minimally invasive transabdominal method for removing cystic ovarian neoplasms in children provided minimal trauma with maximum ablasticity and cosmetic effect of the operation. The proposed technique made it possible to prevent the development of intraoperative and postoperative complications, significantly reduce the duration of surgery and the recovery time of patients.

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Diverticulosis of the appendix (DA) is a rare pathological finding that clinically imitates acute appendicitis and is most commonly found in adult males with chronic abdominal pain. It has a higher rate of perforation compared to acute appendicitis (84% vs 12%, P<0.01), and is consequently associated with a higher rate of mortality. Appendiceal diverticulitis has been found to have a significant association with incidental appendiceal neoplasms, therefore elective prophylactic appendectomy is recommended to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm. Meticulous gross examination in addition to thorough histological examination of the entire appendectomy specimen by pathologists is essential in order to identify diverticula. We present two female patients with signs and symptoms consistent with acute appendicitis, they were found to have appendiceal diverticulitis on pathologic evaluation.

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Introduction. Lymphangiomas are mature benign tumors emanating from the lymphatic vessels making up 9-10% of all benign neoplasms in pediatric oncology. In our practice, we have encountered a rare complication of the lymphangioma of the abdominal cavity - an ileus Objective: To present a clinical picture, diagnostic and surgical tactics in a rare clinical observation of mesenteric lymphangioma, complicated by ileus. Material and methods. Boy aged of 6 years 4 months. He was taken to the emergency department of the Research Institute of NDHiT by an ambulance team (SMP) with suspected acute appendicitis 6 hours after the onset of the disease. Results. According to the results of clinical, laboratory and echographic examination, a child with a clinical picture of “acute abdomen” was suspected of an abdominal lymphangioma. For the purpose of the differential diagnosis of a complicated course of the lymphangioma of the abdominal cavity with complicated destructive appendicitis, 2 hours after hospitalization, laparoscopy was performed and there was confirmed lymphangioma of the ileum mesentery, complicated by the twisting of the latter. After elimination of the torsion, a section of the ileum with a tumor was resected with an end-to-end anastomosis. Histologically, the diagnosis of lymphangioma was confirmed. Conclusion. The cause of “acute abdomen” may be the development of complications of the mesenteric lymphangioma. Timely hospitalization of the child in a specialized hospital allows making a diagnosis in a timely manner, select the optimal surgical tactics and prevent life-giving complications

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Nowadays the treatment of patients with malignant neoplasms of the abdominal organs against the background of decompensated liver cirrhosis is largely an unsolved problem. Complications of portal hypertension syndrome such as ascites, hypersplenism, recurrent bleeding from the veins of the esophagus prevent the implementation of radical surgical treatment. Low trauma of endovascular methods of treatment, low level of complications and mortality are the main advantages of interventional techniques that make it possible to prepare a patient with portal hypertension syndrome for further radical treatment of oncological disease. The presented clinical case describes the results of a combined approach to the treatment of a patient with complications of portal hypertension syndrome and a competing disease a giant tumor of the uterus. The patient was denied in surgical treatment for the neoplasm due to the presence of decompensated cirrhosis. Liver transplantation is not possible due to the presence of cancer. Transjugular intrahepatic portosystemic shunting led to relief of diuretic-resistant ascites, regression of the degree of esophageal varicose veins, which made it possible to remove the tumor with extirpation of the uterus with appendages. Up to now the observation period for the patient is more than 12 years (4 figs, bibliography: 7 refs).

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The article presents current literature data on the eff ectiveness of intersphincteric resections, as well as a comparative analysis of their results of abdominal and anal resections of the rectum.A meta-analysis of foreign and domestic literature indicates that the incidence of postoperative mortality in intersphincteric resections of the rectum is 2%, complications – 10-15%, and fi ve-year survival is over 80%, but the functional consequences of operations want to be better because unsatisfactory results have a place in almost half of the patients.Our research shows that the mortality rate after abdominal and anal resections is 2.4%, postoperative complications – 15%, and fi ve-year survival – more than 77%. The functional results of abdominal and anal resections in low-ampullary rectal cancers were quite satisfactory in more than 90% of patients.Thus, intersphincteric resections of the rectum make it possible to preserve the closing function of the rectum after radical removal of malignant neoplasms of the lower ampullary and anal canal, but the use of this operation is controversial.In our opinion, it is necessary to more actively test the method of intersphincteric resection in the proctology departments of medical institutions of Ukraine.

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Carcinoid syndrome (CS) develops in patients with hormone-producing neuroendocrine neoplasms (NENs) when hormones reach a significant level in the systemic circulation. The classical symptoms of carcinoid syndrome are flushing, diarrhoea, abdominal pain, and wheezing. Neuroendocrine neoplasms can produce multiple hormones: 5-hydroxytryptamine (serotonin) is the most well-known one, but histamine, catecholamines, and brady/tachykinins are also released. Serotonin overproduction can lead to symptoms and also stimulates fibrosis formation which can result in development of carcinoid syndrome-associated complications such as carcinoid heart disease (CaHD) and mesenteric fibrosis. Transforming growth factor beta (TGF-β) is one of the main factors in developing fibrosis, but platelet-derived growth factor (PDGF), basic fibroblast growth factor (FGF2), and connective tissue growth factor (CTGF or CCN2) are also related to fibrosis development. Treatment of CS focuses on reducing serotonin levels with somatostatin analogues (SSA’s). Telotristat ethyl and peptide receptor radionuclide therapy (PRRT) have recently become available for patients with symptoms despite being established on SSA’s. Screening for CaHD is advised, and early intervention prolongs survival. Mesenteric fibrosis is often present and associated with poorer survival, but the role for prophylactic surgery of this is unclear. Depression, anxiety, and cognitive impairment are frequently present symptoms in patients with CS but not always part of their care plan. The role of antidepressants, mainly SSRIs, is debatable, but recent retrospective studies show evidence for safe use in patients with CS. Carcinoid crisis is a life-threatening complication of CS which can appear spontaneously but mostly described during surgery, anaesthesia, chemotherapy, PRRT, and radiological procedures and may be prevented by octreotide administration.

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JAK2V617F is the most frequent driver mutation in myeloproliferative neoplasms (MPNs) and is associated with vascular complications. However, the impact of hematopoietic JAK2V617F on the aortic aneurysms (AAs) remains unknown. Our cross-sectional study indicated that 9 (23%) out of 39 MPN patients with JAK2V617F exhibited the presence of AAs. Next, to clarify whether the hematopoietic JAK2V617F contributes to the AAs, we applied a bone marrow transplantation (BMT) with the donor cells from Jak2V617F transgenic (JAK2V617F) mice or control wild-type (WT) mice into lethally irradiated apolipoprotein E-deficient mice. Five weeks after BMT, the JAK2V617F-BMT mice and WT-BMT mice were subjected to continuous angiotensin II infusion to induce AA formation. Four weeks after angiotensin II infusion, the abdominal aorta diameter in JAK2V617F-BMT mice was significantly enlarged compared to that in the WT-BMT mice. Additionally, the abdominal AA-free survival rate was significantly lower in the JAK2V617F-BMT mice. Hematopoietic JAK2V617F accelerated aortic elastic lamina degradation as well as activation of matrix metalloproteinase (MMP)-2 and MMP-9 in the abdominal aorta. The numbers of infiltrated macrophages were significantly upregulated in the abdominal aorta of the JAK2V617F-BMT mice accompanied by STAT3 phosphorylation. The accumulation of BM-derived hematopoietic cells carrying JAK2V617F in the abdominal aorta was confirmed by use of reporter GFP-transgene. BM-derived macrophages carrying JAK2V617F showed increases in mRNA expression levels of Mmp2, Mmp9, and Mmp13. Ruxolitinib decreased the abdominal aorta diameter and the incidence of abdominal AA in the JAK2V617F-BMT mice. Our findings provide a novel feature of vascular complications of AAs in MPNs with JAK2V617F.

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Acute appendiceal diverticulitis is a rare cause of acute abdomen that is commonly interpreted as acute appendicitis until definitive histological result. We herein present two cases of patients of distinct age groups and gender who presented to the emergency department with right lower quadrant abdominal pain. Laboratory and imaging studies led to the diagnosis of acute appendicitis. In both cases, intraoperative findings were compatible with the initial diagnosis and therefore appendectomy was performed. Later pathological exam showed diverticulitis of the vermiform appendix. Although appendiceal diverticulitis is associated with a higher risk of perforation and neoplasms, both patients had linear postoperative period, without complications or dysplastic findings. Despite its similarities to the acute appendicitis, appendiceal diverticulitis presents itself as a distinct entity and should be suspected in patients with right lower abdominal pain in older age and with longer duration of symptoms.

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Tumors of the ovaries in girls represent an actual problem in modern gynecology. First of all, this is due to diagnostic difficulties, due to the absence of characteristic complaints, asymptomatic course and the complexity of the gynecological examination, which leads to the establishment of an erroneous diagnosis, the lack of correct and timely treatment and, as a consequence, the occurrence of complications that often negatively affect the reproductive function of the patient in further. The differential diagnosis of ovarian tumors in girls is still one of the most important problems of modern practical gynecology. The presence of a combined pathology in many patients, which is in 30-40% according to the WHO, puts the problem of the possibility of the simultaneous correction by surgeon and gynecologist. In connection with the difficulty of diagnosing, the diagnosis of such patients must necessarily include an examination by a pediatric surgeon and gynecologist with ultrasound examination of the retroperitoneal space, abdominal cavity organs, and small pelvis. Errors in the differential diagnosis of genital and extragenital diseases occur quite often and are mainly due to the similarity of clinical symptoms. This article presents a clinical case of the diagnosis and management of a 14-year-old patient with an adjacent diagnosis, as well as diagnostic search criteria for the differential diagnosis of gynecological and surgical pathologies.

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Introduction: The goal of primary tumor resection with lymphadenectomy (PTR) in small intestine neuroendocrine neoplasms (SI-NENs) is to avoid local recurrence while sparing as much of the small bowel as possible, even in the case of extensive mesenteric fibrosis. The results of PTR with retrograde vessel-sparing lymphadenectomy (VS-LA) were compared to those of conventional lymphadenectomy (Con-LA). Methods: Prospectively collected clinical, surgical and pathological data of consecutive patients with SI-NENs who underwent small bowel resections were retrospectively analyzed regarding the resection technique performed. Results: In a 7-year period, 50 of 102 patients with SI-NENs had only small bowel resections; of those, 25 were VS-LA and 25 were Con-LA. Patients with VS-LA had tendentially more advanced diseases with slightly higher rates of abdominal pain, mesenteric shrinkage and more level III lymph node involvement compared to patients with Con-LA. VS-LA, however, resulted in shorter resected bowel segments (median 40 cm vs. 65 cm, p = 0.007) with similar rates of local R0 resections (72% vs. 84%) and resected lymph nodes (median 13 vs. 13). Postoperative clinically relevant complications occurred in 1 of 25 (4%) in the VS-LA and in 7 of 25 (28%) patients in the Con-LA group (p = 0.02). Three months after surgery, 1 of 25 (4%) patients of the VS-LA group and 10 of 25 (40%) patients in the Con-LA group (p = 0.002) complained about abdominal pain. One of eight patients in the VS-LA group and two of thirteen patients in the Con-LA group who had completely resected stage III disease complained about diarrhea (p = 0.31). Conclusion: VS-LA seems to be oncologically safe and should be considered in small bowel resections for SI-NENs.

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OBJECTIVEPituitary adenomas (PAs) are benign neoplasms that are frequently encountered during workup for endocrinopathy, headache, or visual loss. Transsphenoidal surgery remains the first-line approach for PA resection. The authors retrospectively assessed complication rates associated with transsphenoidal PA resection from an institutional database.METHODSA retrospective analysis of 1153 consecutive transsphenoidal pituitary adenoma resections performed at the Keck Hospital of USC between November 1992 and March 2017 was conducted. Microscopic transsphenoidal resection was performed in 85.3% of cases, and endoscopic transsphenoidal resection was performed in 14.7%. Analysis of perioperative complications and patient and tumor risk factors was conducted.RESULTSThe overall median hospital stay was 3 days. There was 1 perioperative death (0.1%). Surgical complications included postoperative cerebrospinal fluid leak (2.6%), epistaxis (1.1%), postoperative hematoma (1.1%), meningitis (1.0%), cranial nerve paresis (0.8%), hydrocephalus (0.8%), vision loss (0.6%), stroke (0.3%), abdominal hematoma or infection (0.2%), carotid artery injury (0.1%), and vegetative state (0.2%). Perioperative medical complications included bacteremia/sepsis (0.5%), pneumonia (0.3%), myocardial infarction (0.3%), and deep venous thrombosis/pulmonary embolism (0.1%). Endocrine complications were the most frequent, including transient diabetes insipidus (4.3%), symptomatic hyponatremia (4.2%), new hypopituitarism (any axis) (3.6%), permanent diabetes insipidus (0.3%), and adrenal insufficiency (0.2%). There were no significant differences between microscopic and endoscopic approaches with regard to surgical complications (6.4% vs 8.8%, p = 0.247) or endocrine complications (11.4 vs 11.8%, p = 0.888). Risk factors for surgical complications included prior transsphenoidal surgery (11.4% vs 6.8%, p = 0.025), preoperative vision loss (10.3% vs 6.8%, p = 0.002), and presence of PA invasion on MRI (8.5% vs 4.4%, p = 0.007).CONCLUSIONSIn this single tertiary center study assessing complications associated with transsphenoidal PA resection, the rate of death or major disability was 0.26%. Risk factors for complications included prior surgical treatment and PA invasion. No differences in complication rates between endoscopic and microscopic surgery were observed. When performed at experienced pituitary centers, transsphenoidal surgery for PAs may be performed with a high degree of safety.

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Introduction. Leiomyoma is a benign tumor, the source of which is smooth muscles of the internal organs. This neoplasm is rare in children. Leiomyomatosis of the gastrointestinal tract is most often asymptomatic; it is clinically manifested when the size of the formation reaches more than 4 cm. The most common symptoms are abdominal pain and a palpable formation in the abdominal cavity. Surgical removal is the method of choice for most leiomyomas.Description of clinical case. This article describes a clinical case of leiomyomatosis of esophagus and rectum in a child who had suffered of abdominal pain, constant constipation and dysphagia since early childhood. The correct diagnosis was put several years later after the onset of the disease. Upon examination, a solid formation was found in the anal area. The examination also revealed a volumetric formation in the submucosal layer of the rectum, causing a narrowing of its lumen, as well as a large-sized formation in the thoracic cavity, causing esophageal stenosis. The first stage of surgical intervention was to place colostomy and to take biopsy of the rectal tumor. The second stage one month later was extirpation of the esophagus affected by the tumor, plastic surgery of the esophagus by the stomach. The morphological picture corresponded to leiomyomatosis. The third stage – extirpation of the rectum which was performed at A.N. Ryzhykh State Medical Center.Conclusion. This clinical case is one of few syndromic variants of leiomyomatosis described in the literature. Surgical intervention is the basic option for treating patients with non-epithelial neoplasms of the gastrointestinal tract. Active surgical tactics in benign tumors are due to high risk of developing or developed life-threatening complications.

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Beckwith–Wiedemann syndrome (BWS) is a rare congenital condition characterized by complex overgrowth of different body parts. Children with Beckwith–Wiedemann syndrome, particularly those with hemihypertrophy, experience an increased risk of developing benign and malignant tumors. This case report presents an 18-month-old girl with features suggestive of Beckwith–Wiedemann syndrome who developed pubic hair, high levels of testosterone, and DHEAS with normal cortisol and progesterone levels. Computed tomography revealed a left adrenal mass. Histopathological examination of the resected mass showed an adrenocortical tumor. Her postoperative evaluation showed normal testosterone and DHEAS levels. Early diagnosis and detection of intra-abdominal neoplasms in infants with Beckwith–Wiedemann syndrome are essential to avoid serious clinical complications.

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Lymphatic malformations are benign neoplasms that form as a result of impaired formation of embryonic lymphatic sacs during embryogenesis. Lymphangiomas and lymphgemangiomas (visceral forms) rarely develop in the intra-abdomen, such localization does not exceed 8–15% of all observed lymphangiomas in children. Among the visceral forms are more common the forms that involve intestines, mesentery, spleen, omentum, liver in the pathological process, less often - the lymphatic vessels and lymph nodes of the mediastinum, and retroperitoneal tissue. The clinical presentation of lymphatic malformations is multivaried and depends on their localization, the patient age, and the development of complications. In case of complications, the clinic manifestation of “acute abdomen” requires emergency surgical intervention, during which the diagnosis and scope of surgical treatment are specified. a 14-year-old boy was admitted to the department of infectious diseases with complaints of fever, weakness, abdominal pain, sore throat and loose stools. Previously, the patient had complaints of abdominal pain for a year; ultrasound examination of the abdominal cavity was performed repeatedly, in which no pathological changes were detected. The patient underwent laparoscopic appendectomy; During the revision of the abdominal cavity, a space-occupying lesion emerging from the mesentery of the ascending colon and twisted around the vascular pedicle by 3 turns was revealed. Education removed. Histological and immunohistochemical examination confirmed the diagnosis of lymphatic-venous malformation. No signs of malignancy of lymphatic malformations are described in the literature. However, though lymphatic malformations are benign in nature, they tend to have an infiltrative growth pattern, often relapse, and sometimes become infected. The available literature doesn’t provide a proper description and analysis of the results of treatment of intra-abdominal lymphatic malformations using endovideo technologies. Transabdominal access provides the best exposure of the complete surgical field, freedom of movement and clarity of anatomical landmarks. The main advantages over open abdominal surgery are minimal trauma to the anterior abdominal wall and rapid rehabilitation of patients.

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Objective. To report the institutional experience of the evolution of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for chronic pancreatitis with an inflammatory tumor as well as cystic and benign, premalignant neoplasms and neuroendocrine tumors of the pancreatic head. Methods. DPPHR is associated with preservation of gastric antrum, common bile duct and duodenum/upper jejunal loop, contrary to Kausch-Whipple resection, which is a multivisceral procedure, including duodenectomy. Duodenum-preserving pancreatic head resection was first established in clinical setting in Berlin in 1969. Results. For chronic pancreatitis with an inflammatory infiltrat in the pancreatic head, duodenum-preserving pancreatic head resection has become a standard surgical treatment with worldwide acceptance. In a series of 603 patients with chronic pancreatitis following DPPHR, the frequency of pancreatic fistula was 3.3 %, intra-abdominal abscess 2.8 %, hemorrhage 2.8 %, frequency of reoperation 5.6%, in-hospital mortality 0.82 % and 90-day rehospitalisation 8 %. DPPHR for benign and premalignant cystic neoplasms of the pancreatic head is used predominantly for IPMN, MCN and SPN tumors. In a review of international publications comprising 503 patients, the general morbidity was 38.2 %, severe surgery-related complications 12.7% of them pancreatic fistula B+C 13.6 %, resurgery 2.7 % and 90-day mortality 0.4 %. When pancreatic neuroendocrine tumors of pancreatic head are treated with DPPHR, a local lymph node dissection is additionally recommended. The long-term morbidity following DPPHR revealed new onset of diabetes mellitus and exocrine dysfunctions in only 5-7 % of patients. Conclusion. Kausch-Whipple resection is associated with considerable high metabolic complications. Duodenum-sparing pancreatic head resection for inflammatory tumor, benign and premalignant neoplasms, and neuroendocrine tumors of the pancreatic head has the advantage of the duodenum preservation and maintenance of the pancreatic endocrine and exocrine functions.

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Dogs with benign intra-pelvic rectal or vagin*l masses show symptoms indicating compression on the adjacent organs. Clinical signs usually develop late when the lesion is large enough to interfere functionally. The dogs were referred for severe fecal and/or urinary tenesmus. The data collected included signalment, clinical signs, results of physical examination, pre-surgical diagnostic tests, surgical technique used, surgical complications and histological findings. Digital rectal and vagin*l examination allowed the detection of a mass occupying space in the pelvic cavity in all patients. Abdominal ultrasonography and/or total body computed tomography (CT) were used to better characterize the lesion and to exclude a metastatic spread of the tumor in case of malignancy. A dorsal approach to the rectum, a dorsal episiotomy, a midline celiotomy, and a combined perineal and abdominal approach were performed to remove the mass. No postoperative complications were observed. Benign and well-differentiated malignant mesenchymal neoplasms were histologically diagnosed. As a consequence of the chronic urethral compression caused by the mass, urinary incontinence and/or urinary retention were observed for a few postoperative days. Fecal tenesmus resolved in all cases in the immediate postoperative period. The dogs’ quality of life quickly improved after surgery, especially considering the serious and life-threatening pre-surgical clinical conditions. Both the recovery time after surgery and overall survival were also evaluated.

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Background: Gastric neoplasms are uncommon in dogs, especially those affecting smooth muscle layers. Leiomyoma is a smooth muscle benign neoplasm, which requires surgical resection. Pylorectomy and gastroduodenostomy (Billroth I procedure) is the most indicated technique in cases not affecting the biliary and pancreatic tracts. Thus, the purpose of this study was to report a successful case of Billroth I procedure in a bitch presenting antrum pyloric obstructive leiomyoma. Case: A 12-year-old, non-spayed, co*cker Spaniel bitch was admitted presenting depression, hyporexia, postprandial vomiting and sparse episodes of hematemesis, for 30 days. Clinical suspicion on obstructive gastric outflow disease was established. Bloodwork (complete blood count, BUN, albumin, ALP and ALT), abdominal ultrasound and thoracic radiographs were assessed. The patient undergone upper gastrointestinal endoscopy. On endoscopic evaluation, small hemorrhagic mucosa ulcers were visualized on the gastric body, antrum and pylorus. Moreover, a sessile, ulcerated, round-shape and infiltrated antral-pyloric mass was seen. The mass was 1.5-2.0 cm in diameter and apparently involved the smooth muscle layer, causing severe pyloric obstruction. However, endoscopic evaluation of the duodenum was possible. Several biopsy samples were taken from the neoplasm and sent for histopathologic assessment. The result was not conclusive due to low quality samples. The patient had progressive worsening of obstruction episodes and required surgery. A wide-margin pylorectomy and gastroduodenostomy (Billroth I procedure) was carried out. The retrieved specimen was sent to histopathological and immunohistochemistry (IHC) assessment. Positive staining for actin and desmin confirmed smooth muscle origin of the mass and histopathological assessment confirmed leiomyoma. The patient underwent regular periodic postoperative assessments, revealing progressive clinical improvement and normal weight gain. Control upper gastrointestinal endoscopy was performed. Gastric ulcers were completely healed and gastroduodenal anastomosis was functional. The anastomotic scar tissue was sampled and revealed chronic and normal healing process. Complete healing was confirmed and the patient was discharged. Discussion: Gastric neoplasms are not common in dogs. However, severe obstruction of gastric outflow is a potential risk for complications in those cases. Upper gastrointestinal endoscopic assessment is important not only for diagnosis, but also for surgery decision making. In the current study, gastroscopy provided accurate preoperative evaluation of severity of pyloric obstruction and diagnosis of secondary gastric ulcers. Direct visualization of lesions and multiple biopsy sampling were performed. The presence of neoplasms over 2-cm in diameter indicates need for complete laparoscopic or conventional surgical resection. In this case report, open resection was carried out due to prohibitive cost of laparoscopic approach, mass dimensions and probable involvement of deeper tissue layers. In conclusion, pylorectomy and gastroduodenostomy (Billroth I procedure) was curative and provided good prognosis following resection of an antrum pyloric obstructive leiomyoma. Endoscopy was critical for both diagnosis and decision-making towards surgery for gastric outflow obstruction due to an antrum pyloric neoplasm. Histopathological and immunohistochemistry assessment confirmed neoplasm type and assured oncological safety of resection with wide margins. Keywords: gastric neoplasms, smooth muscle tumor, endoscopy, dog.

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Summary: Introduction: The Czech Republic belongs to countries under significant strain due to malignant tumours. Despite the changes introduced in the therapy of gastrointestinal malignancies, radical removal of the tumour holds a crucial position in the mutimodal therapeutic process and is irreplaceable nowadays. From the beginning of the third millennium, minimally invasive surgery of abdominal tumours is being expanded with robotic-assisted procedures. The aim of this paper is to assess the benefits of robotic-assisted surgery in the treatment of colorectal and hepatopancreatobiliary neoplasms and to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries. Material and method: The authors summarize studies published in the PubMed, EMBASE, Medline and Cochrane Library databases that compare robotic and laparoscopic approaches in the treatment of colorectal and hepatopancreatobiliary malignancies, and present the results of their own non-randomized study. 204 patients with rectal cancer (<15 cm from the anal verge) who underwent robotic-assisted surgery at our department between 1 January 2016 and 31 December 2020 were included in the study. All demographic, clinical and oncological data were prospectively obtained and analysed. The data were analysed using descriptive statistic methods. Results: 204 patients with rectal cancer of whom 138 were men and 66 were women underwent robotic surgery at our department during the five-year period. In 97 (47.5%) cases the disease was dia­gnosed in an advanced stage (stage III and IV of the TNM classification). 18 patients had synchronous liver metastases and 2 patients had pulmonary metastases at the time of the dia­gnosis. The liver-first approach was indicated in 8 (44.4%) patients, two patients underwent a radical resection of liver lesions together with the primary neoplasm in one surgery. Total mesorectal excision was performed in 136 patients with extraperitoneal disease, partial mesorectal excision was performed in 68 cases. 18 complications were documented. Clinically relevant anastomotic leak requiring intervention occurred in 5 (3.6%) cases. One patient died due to decompensation of chronic toxonutritive liver disease. Local recurrence was documented in 6 patients, half of them underwent radical resection. Conclusion: Surgical therapy holds a crucial position in the treatment of colorectal and hepatopancreatobiliary neoplasms and represents the only potentially curative procedure in multimodal therapy. Robotic-assisted therapy has become a routine therapeutic modality for colorectal and hepatopancreatobiliary malignancies worldwide. Da Vinci assisted surgeries prevail in the surgical treatment of rectal cancer at the authors’ workplace as well as at some foreign centres. Compared to open and laparoscopic resections of rectal carcinoma, robotic-assisted operations achieve the same clinical and oncological results with a lower rate of complications. Key words: robotic surgery – colorectal cancer – liver malignancies – pancreatic carcinoma

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To demonstrate the possible difficulties in the diagnosis of hepatic echinococcosis, that a specialist in ultrasound diagnostics and a radiologist may encounter in everyday practice, russian and foreign literature as well as our own experience have been reviewed. With high accuracy and specificity of ultrasonography in the differential diagnosis of echinococcal cysts, incorrect interpretation is possible in the presence of mural hemorrhages and (or) hemorrhagic clots in a nonparasitic cyst, which aren’t also visible in ultrasonography and can imitate elements of the chitinous membrane. The degree of prevalence of the process, the exclusion of damage to the lungs and other organs of the abdominal cavity are important. In such cases CT scan is the most convenient and accurate diagnostic method due to its high spatial and temporal resolution, standardization and availability. In the most difficult cases the capabilities of MRI are used in the comparison of diffusion-weighted images and apparent diffusion coefficient, which also makes it possible to diagnose cystic neoplasms. Ultrasonography is a diagnostic technology that is still the most commonly used to differentiate cavity structures; however, all dubious clinical observations should be further examined by using CT or MRI.

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Cancer of the external genitals is up to 8 % in the overall structure of the incidence of malignant neoplasms of female genital organs. Under our observation there were 92 patients with vulvar dystrophy and suspected cancer. The effectiveness of treatment of vulvar dystrophy (VIN I-II degree) by the method of photodynamic therapy (PDT) 45.8±4.7%. However, dysplasia II - III degree, sclerotic changes with the formation of pronounced horn scales prevents the full PDT and recurrence of the disease. Reconstructive plastic surgery was performed using cryoapplication and « Harmonic» apparatus to reduce blood loss and duration of lymphorrhoea in the postoperative period. The use of new reconstructive plastic surgery, including with the use of abdominal skin and fascial flap combined with vascularized lower segments of the rectus muscles), have helped to reduce complications, improve cosmetic effect (patent for invention № 2580665 from 11.11.14).

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Background: The cancer of the ovaries tends to remain asymptomatic. Hence better understanding of the natural history of disease is essential for prevention. The objective of the present study was to observe the epidemiological and clinical profile of women with ovarian neoplasms at a tertiary care hospital.Methods: A hospital based cross sectional study was carried out among women of age up to 35 years presenting to the Obstetrics and Gynecology Department of our hospital during the study period of two years. It was possible to study a total of 56 women in the present study as per the inclusion and exclusion criteria laid down for the present study.Results: T It was found that maximum cases were in the age group of 26-30 years (42.9%). Majority of the women were nulliparous (46.5%). The most commonly reported symptom of ovarian tumor was abdominal pain in 62.5% of the cases. 50% of women having menstrual symptoms complained of amenorrhea. There were 11 cases associated with pregnancy. Among them, four (36.4%) were of dermoid cyst. There were 9 cases of torsion. Among them maximum (55.6%) were of dermoid cyst. Maximum tumors (92.9%) were unilateral. Maximum tumors (73.2%) were of size less than 10 cm. maximum tumors (53.6%) were cystic with solid component. Ascites was seen in 14.2% of the cases.Conclusions: As the age increased the incidence of the ovarian neoplasms also increased. Bilaterality, small size and cystic nature were the most common features of the ovarian neoplasms. Though majority was simple, complications like torsion, association with pregnancy can be seen and hence thorough investigations are needed.

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Introduction. The most pressing problems in abdominal oncology surgery are the development of obstructive jaundice as a complication in patients with malignant tumors in the hepatobiliary and pancreatoduodenal area, and the ways to eliminate it and to reduce the risk of adverse events. Our earlier research revealed 14 predictors that together are more likely to cause undesirable postoperative complications, including deaths during minimally invasive biliary tract decompression. On the basis of the data obtained, a computer program “Risk Assessment of Treatment Methods for Obstructive Jaundice” was created.Materials and methods. The program was introduced into clinical practice in Yaroslavl Regional Clinical Oncology Hospital and was tested on 144 patients from 2019 through 2022. Th e program issued a conclusion on the risk of adverse events and assigned the patient to one of the groups where drainage or stenting were recommended for the first stage of biliary tract decompression.Results and discussion. Following a collegial decision based on the results obtained via the program, 58 patients (40.28 %) underwent endoscopic stenting and 86 patients (59.72 %) underwent percutaneous transhepatic biliary drainage. In the study group, adverse events developed in 10 patients (6.94 %), while in the control group — in 50 patients (22.94 %), and 134 patients (93.06 %) had no complications, as compared to 168 patients (77.06 %) in the control group.Conclusion. Application of the program based on reliable and practically significant 14 predictors results in a decline in general complications induced by minimally invasive biliary tract decompression from 22.94 % to 6.94 % and a 3.5-fold decrease in mortality from 5.05 % to 1.39 % in patients with malignant neoplasms in the hepatobiliary and pancreatoduodenal area, complicated by obstructive and mixed jaundice.

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Introduction.Malformations of ecto- and mesodermal structures represent various forms of abnormality of intrauterine systemic and local morphogenesis, arising at different times of embryonic development due to environmental factors, genomic, chromosomal or gene mutations. Dysregulation of cellular functions due to mutations and accumulation of defective proteins initiates tumor transformation of tissues e.g. hereditary diseases of ectomesodermal origin phakomatosis (hamartomatosis). The aim of the studywas to determine organ specificity, clinical manifestations, morphological features and the degree of progression of tumors of the nervous system and internal organs in hereditary diseases of ectomesodermal origin. Materials and methods.103 patients with hereditary phakomatosis were examined. All of them underwent a comprehensive clinical imaging examination, including magnetic resonance imaging, echocardioscopy, ultrasound examination of the abdominal organs, kidneys, retroperitoneal space, and computed tomography of the abdominal cavity and lungs. Results.The reason for the treatment of patients was the occurrence of focal neurological symptoms, focal and/or generalized epileptic seizures. Clinical manifestations were determined by the form of the disease. The risk of the development and progression of various neoplasms is the highest in neurofibromatosis type III, tuberous sclerosis, neurocutaneous melanosis, multiple endocrine neoplasia, angiomatosis of HippelLindau, Louis-Bar . Favorable benign and stable course, low malignant potential are distinguishing characteristics of pigment-vascular phakomatoses type IV. Conclusion.Knowledge of the clinical manifestations of various malformations of the skin, blood vessels, and the nervous system associated with tumor growth in cells and tissues is practically significant. Early diagnosis and the use of modern technologies of conservative and surgical treatment allow achieving a predictable result, prevent the development of severe complications, and significantly improve the quality of life of patients with this pathology.

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Mesenteric fibrosis (MF) constitutes an underrecognized sequela in patients with small intestinal neuroendocrine neoplasms (SI-NENs), often complicating the disease clinical course. The aim of the present systematic review, carried out by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, is to provide an update in evolving aspects of MF pathogenesis and its clinical management in SI-NENs. Complex and dynamic interactions are present in the microenvironment of tumor deposits in the mesentery. Serotonin, as well as the signaling pathways of certain growth factors play a pivotal, yet not fully elucidated role in the pathogenesis of MF. Clinically, MF often results in significant morbidity by causing either acute complications, such as intestinal obstruction and/or acute ischemia or more chronic conditions involving abdominal pain, venous stasis, malabsorption and malnutrition. Surgical resection in patients with locoregional disease only or symptomatic distant stage disease, as well as palliative minimally invasive interventions in advanced inoperable cases seem clinically meaningful, whereas currently available systemic and/or targeted treatments do not unequivocally affect the development of MF in SI-NENs. Increased awareness and improved understanding of the molecular pathogenesis of MF in SI-NENs may provide better diagnostic and predictive tools for its timely recognition and intervention and also facilitates the development of agents targeting MF.

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Background: Although the use of endoscopic submucosal dissection (ESD) as a minimally invasive treatment for large superficial colorectal neoplasms is increasing, colorectal ESD remains technically challenging. As perforation in the colorectum is generally considered to be associated with a higher risk of complications, the aim of this study was to investigate the characteristics of perforation caused by colorectal ESD. Methods: This retrospective study included 635 lesions treated with colorectal ESD, between February 2011 and December 2015, in a tertiary cancer center. We evaluated and compared the clinical course and short-term outcomes of the intraprocedural perforation group with those of the delayed perforation and no perforation groups. Results: Perforation occurred in 45 (7.1%) of the 635 cases. Thirty-six cases were intraprocedural perforation (5.7%), all of which were successfully closed with endoclips during the procedure. Nine cases of delayed perforation occurred (1.4%). No emergency surgery was performed in the intraprocedural perforation group; however, 5 of 9 cases underwent emergency surgery in the delayed perforation group (56%, p < 0.0001). There were statistically significant differences between the intraprocedural and delayed perforation groups with regard to the hospitalization period, fasting period, abdominal pain scale, peak white blood cell (WBC) count, and peak C-reactive protein (CRP), and between the intraprocedural and no perforation groups with regard to the location of the lesion, hospitalization period, fasting period, abdominal pain scale, peak WBC, peak CRP, and en bloc resection rate. Conclusions: While intraprocedural perforation due to colorectal ESD can be managed conservatively, delayed perforation can lead to serious adverse events.

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Introduction. Meckel?s diverticulum (MD) is the most prevalent congenital anomaly of small intestine. It develops due to the incomplete obliteration of omphalomesenterict duct which normally undergoes obliteration during the seventh week of gestation. In the majority of cases MD is asymptomatic but it may cause various complications, such as bleeding, intestinal obstruction and inflammation. Cases of umbilical sinuses, fistulas and neoplasms related with MD have been reported, but extremely rare gangrene due to its axial torsion, especially in children, as is the case of our patients. Case Outline. An 11-year-old boy admitted to hospital due to 24 hours epigastric pain, vomiting and malaise. After a complete physical examination, and appropriate pre-surgical laboratory and radiographic tests, surgical exploration was performed with a midline abdominal incision. On 60th cm proximal to the ileocecal valve we found a long and in a narrow based ganrenous MD with axial torsion and fibrotic cord extending from the tip of MD to the ileal mesentery. Surrounding ileum had normal appearance. A demarcation and subsequent resection of MD and the surrounding ileum was performed with endto- end ileal anastomosis. Postoperative recovery was successful and the patient was discharged after six days. Conclusion. Axial torsion of MD is presented with non-specific abdominal symptoms and difficult preoperative diagnosis. The choice of diagnosis and therapy is surgical exploration and resection of MD.

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Abstract Objectives The glucagon-like peptide 2 (GLP-2) analog teduglutide (TED) is a novel therapy for intestinal failure that reduces need for parenteral support. Degree of response may correlate to location of surgical anastomoses. TED may worsen heart failure (HF) and gastrointestinal (GI) neoplasms. Using a large database we characterize American patients prescribed TED. Methods The Explorys national database (Cleveland, OH, USA) is an aggregate of de-identified patient data from 26 US healthcare systems. SNOMED classification was used to identify consecutive patients prescribed TED, 2015–2020. Demographics and comorbidities were collected. Preceding surgeries, suspected inciting conditions, and incident symptoms/events post TED were searched using the temporal attributes feature on Explorys. Results Of 72 million patients, 170 are prescribed TED. Age range of majority was 45–69 years. 70% were female, 82% caucasian and 12% African American. 70 used medicare, and 70 private insurance. In 50 patients, initial BMI was &gt; 30, 40 had BMI &lt; 19, and majority had BMI 19–29. 10 had opioid dependence, and 70 tobacco use. 30 started TED with comorbid HF; 10 had prior GI malignancy. Common underlying conditions: bowel obstruction (N = 80), Crohn's (N = 70; 50 fistulizing, 10 abscess-forming), congenital gut malformation (N = 30), mesenteric ischemia (N = 30), and perforation (N = 20). &lt;10 had radiation enteritis, traumatic intestinal injury and intestinal dysmotility. Prior surgeries: 60 had ileostomy, and 40 colostomy. 90 had partial colonic resection and 30 partial excisions of small bowel. Only 10 had jejunal bypass, and &lt;10 esophagojejunostomy, gastrojejunostomy, pancreaticojejunostomy, jejunojejunostomy, ileocolic anastomosis, and small bowel transplant. Common incident symptoms/events: abdominal pain (N = 70), nausea (N = 40), intestinal obstruction (N = 30), stoma complications (N = 20), ≤10 had colon polyps, duodenal neoplasm, biliary disorder, pancreatitis, flatulence, and fluid overload. Conclusions In 26 US centers, TED use is rare and associated with several known indications for intestinal surgery. Most were not underweight, and many were obese at initiation. Serious adverse events appear rare. Increased awareness of TED is needed, but careful risk-benefit analysis is needed prior to prescribing TED in patients with GI neoplasms and HF. Funding Sources None.

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This prospective study was conducted at College of Medical Sciences-Teaching Hospital (CMS-TH) during December 2008 to May 2010. One hundred and fifty cases were analyzed. Age of the patients, parity, presenting symptoms, types of sur­gery, clinical diagnosis and complications were retrieved from case sheets. Surface epithelial tumors were more frequently observed above 30 years of age, (62.07%) cases. During 1st to 3rd decades of life, 62.8% germ cell tumors were seen; and sex cord tumors were seen in age group 41-60 years only. For all age groups, benign tumors were common than malignant tumors. There were 10.7% unmarried patients, 5.33% nulliparous, 35.55% of parity 1 to 2; 4% pregnant and 20 % postmeno­pausal women. There were 86.67% cases neoplastic, and 13.33% non-neoplastic ovarian lesions; 93.85% benign, 5.38% malignant and 0.77% borderline tumors. Surface epithelial tumors were the most common tumors (53.84%) followed by germ cell tumors (43.85%), constituted 46.7% and 38% among all ovarian lesions. The commonest benign tumors were serous cystadenomas and mature cystic teratomas, constituted 40% cases each. Dysgerminoma was the common malignant neoplasm (2.31%), all were seen in adolescents. Most of the other malignant neoplasms were observed above 40 years of age. Seventy percent (70%) of non-neoplastic lesions were hemorrhagic corpus luteum cysts. The commonest presenting symptom was pain in the lower abdomen (82%) followed by abdominal mass/ or distension (48.7%). Constitutional symp­toms were observed in malignant cases only. Grossly, majority of the ovarian lesions were of size ranging 5 to 15 cm; and 89.93% cystic lesions. There were 48.7% lesions in the right ovary and 45.3% in the left ovary; 6% bilateral ovarian lesions, all of which were observed in benign and non-neoplastic lesions. The common complication observed was torsion (6.7%) followed by rupture of the cysts (6%). Journal of Chitwan Medical College 2013; 3(4); 17-24 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9549

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Background. Inorganic retroperitoneal tumors (IRT) are neoplasms that have no organ affiliation and develop from soft tissues located in the ret­roperitoneal space (adipose, connective, vascular, nervous), as well as from embryonic elements. IRT account for 0.03 to 1.0 % of all human neoplasms. Malignant IRT account for up to 70 %, while benign – up to 30 %. Operations for retroperitoneal tumors are accompanied by a high risk of intra- and postoperative complications [3]. With large retroperi­toneal tumors the main difficulties are compression syndrome of the ab­dominal cavity, the syndrome of compression of the inferior vena cava, difficulties of mobilizing of the tumor due to a small surgical maneuver and large size of the tumor. Purpose. Introducing the clinical course peculiarities of giant tumors of the retroperitoneal space and possible intra- and perioperative compli­cations to the medical community. Materials and methods. Clinical case of patient A., 44 years old, who was treated in the oncology surgery department of SO «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medi­cal Sciences of Ukraine». Results. Removal of the tumor of the retroperitoneal space with techni­cal difficulties was performed. In the postoperative period after surgery, bleeding from a varicose vein of the abdominal wall. Surgical treatment was performed: relaparotomy, hemostasis. The term of supervision is 3 years, there is no data for recurrence. Conclusions. If IRT is additionally accompanied by a syndrome of in­ferior vena cava compression, it is necessary to carry out careful hemo­stasis intraoperatively, and to conduct active supervision in the nearest postoperative period for control of possible bleeding after filling of earlier «empty» vessels.

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Perivascular epithelioid cell tumors (PEComas) are a heterogeneous group of rare mesenchymal neoplasms composed of epithelioid cells which express melanocytic and myogenic markers, such as HMB-45, desmin and actin. In March 2013, we visited a postmenopausal 51-year-old woman with a suspected diagnosis of uterine PEComa diagnosed by a dilation and curettage of the lining of the uterus. After the histological revision of the formalin-fixed paraffin-embedded (FFPE) material by our expert pathologist, we confirmed the diagnosis and referred the patient for complete primary surgery. On November 2013, the patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no macroscopically detectable residual cancer. However, in January 2014, due to voiding dysfunction and inconstant vagin*l bleeding, the patient underwent magnetic resonance imaging (MRI) which documented multiple irregular lesions in the pelvis suspected as recurrent PEComa. Considering the early relapse of PEComa after optimal primary surgery, we suggested a systemic treatment with the combination of gemcitabine and docetaxel. For logistic reasons, the patients started the chemotherapy in her district hospital. After two cycles of chemotherapy the patient died due to treatment-related complications.

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Abstract Introduction Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by overproduction of mature granulocytes. Up to half of the patients are asymptomatic and diagnosed during routine blood investigations; others present with fatigue and non-specific symptoms. Many patients develop gastrointestinal manifestations such as abdominal pain, bloody diarrhea, and pancreatitis during the disease course. Some presentations are related to leukemia itself, while others may be related to CML treatment. Methods We searched the English literature (PubMed, SCOPUS, and Google Scholar) for studies, reviews, case series, and case reports of patients with CML who developed any gastrointestinal manifestations involving the gastrointestinal tract from the esophagus down to the rectum Inclusion criteria comprised of patients above 18 years of age, with CML and gastrointestinal features. Pregnant women and bone marrow transplant recipients were excluded. Search terms included chronic myeloid leukemia, chronic myelogenous leukemia, with esophagitis, pancreatitis, duodenitis, gastritis, Crohn's disease, ulcerative colitis, inflammatory bowel disease, hepatocellular carcinoma, cholangiocarcinoma, colon cancer, malignancy, hepatitis, primary biliary cholangitis, primary biliary cirrhosis, primary sclerosing cholangitis, and perforation. Results A total of 129 patients were included. Patient characteristics are shown in table 1. Among the gastrointestinal manifestations, the most common treatment-related complications were drug-related hepatitis followed by reactivation of viral hepatitis B, pancreatitis, and typhlitis. Hepatitis in CML was reported with different TKIs but more commonly with imatinib. Reactivation of viral hepatitis B was common, while hepatitis C reactivation was rarely reported. Pancreatitis was associated mostly with nilotinib. Colitis is seen mainly with dasatinib. Inflammatory bowel diseases, liver diseases such as primary biliary cholangitis (PBC), were variable; some occurred after CML diagnosis while others preceded the diagnosis. Malignancies like pancreatic adenocarcinoma and hepatocellular carcinoma occurred after CML. Discussion Gastrointestinal features in patients with chronic myeloid leukemia can be the first presenting featuring of leukemia itself, arising during the course of CML or as a complication of the treatment. Interestingly, most of these presentations have been reported in patients with CML. These include inflammatory conditions such as pancreatitis and esophagitis, reactivation of viral hepatitis to the neoplastic process, and malignancy. In patients with CML, malignant tumors in the gastrointestinal tract can be caused by leukemic infiltration. Moreover, like other myeloproliferative neoplasms, CML confers a risk of developing a second non-hematological malignancy, including colonic neoplasms. Gastrointestinal complications can pose drastic impacts throughout the disease course; they may result in a change in the treatment, affect the prognosis, and may also be fatal, as in severe enterocolitis or fulminant liver failure. The treatment goal in patients with CML has changed significantly over the last decades. The current treatment goal is to achieve normal survival and good quality of life without the need for lifelong treatment. The improvement in CML treatment and prognosis is largely attributed to the introduction of tyrosine kinase inhibitors. However, most gastrointestinal features associated with treatment are related to tyrosine kinase. The exact pathogenesis of TKI injury is unclear but likely attributed to immune-related mechanisms. Imatinib is the first-line therapy for CML and is the most widely used TKI; however, not all the gastrointestinal features are associated with imatinib as expected. Various gastrointestinal features are prominent with other TKIs as well. Appropriately identifying which TKI is the likely trigger will help in avoiding highly suspected gastrointestinal complications or guide in switching to a safer TKI, thereby achieving treatment goals. Conclusion Patients with chronic myeloid leukemia can have a different gastrointestinal presentation which can alter their disease course. Such complications must be managed appropriately in order to improve outcome and quality of life in this group of patients and maintain treatment goals. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Background: The impact of rapid on-site cytologic evaluation (ROSE) on endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is widely debated. This study aims to assess the diagnostic performance of EUS-FNB in the absence of ROSE in abdominal masses. Methods: Patients with abdominal masses undergoing EUS-FNB using 22-gauge Franseen needles and the slow-pull technique were prospectively enrolled in this study. Macroscopic on-site evaluation (MOSE) was performed without ROSE. Results: 100 patients were recruited between 2018 and 2020. Seventy-eight patients had neoplasms, and twenty-two patients had benign diseases. Common diagnoses included pancreatic cancer (n = 27), mesenchymal tumors (n = 17), and metastatic tumors (n = 14). The mean mass size was 3.9 ± 2.6 cm. The median pass number was three. Eighty-nine percent had adequate specimens for histologic evaluation. Malignancy increased the odds of obtaining adequate tissue (OR 5.53, 95% CI, 1.36–22.5). For pancreatic cancer, FNB had a sensitivity of 92.3%, a specificity of 100%, a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 97%, and an AUROC of 0.96. The sensitivity, specificity, PPV, NPV, and AUROC for mesenchymal cell tumors were 100%, 95.9%, 84.2%, 100%, and 0.98, respectively. For metastatic tumors, FNB was 100% sensitive and specific, with an AUROC of 1.00. There were no procedure-related complications. Conclusions: 22-gauge Franseen needles with the slow-pull technique and MOSE without ROSE provide excellent diagnostic performances for malignant lesions. Thus, MOSE should be implemented in real-world practice, and ROSE can be obviated when EUS-FNB is employed.

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Abstract Portal hypertension is a common complication of myeloproliferative neoplasms (MPN) and portends a poor prognosis. Arising in 7-18% of MPN patients, portal hypertension develops through several distinct mechanisms, including abdominal vein thrombosis, extramedullary hematopoiesis (EMH), and nodular regenerative hyperplasia (NRH). Similar to cirrhotic patients, MPN-associated portal hypertension presents with refractory ascites, gastrointestinal bleeding, hepatic encephalopathy, and susceptibility to infections. Transjugular intrahepatic portosystemic shunt (TIPS) procedure has been used empirically to treat refractory ascites and variceal bleeding in MPN-related portal hypertension; however, there is limited data in regards to TIPS effectiveness in MPN-associated portal hypertension. To assess the safety and efficacy of TIPS for treatment of portal hypertension in MPN, we performed a retrospective analysis of outcomes of TIPS procedure in patients with MPN in our institution. Using the University of Pennsylvania electronic medical record database, we identified nine patients with MPN who underwent TIPS procedure for treatment of refractory portal hypertension between 2005 and 2015. Patients with portal hypertension from causes other than MPN were excluded from the study. Clinical characteristics and long-term outcomes were analyzed. The mean age at time of TIPS was 47 years (range 30-67 years). Seven of nine patients were female (78%) and all seven carried a diagnosis of polycythemia vera (PV) or post-PV myelofibrosis (PV-MF); both male patients had a diagnosis of primary myelofibrosis (PMF) (Table 1). All nine patients were positive for JAK2V617F mutation, and one patient had a concurrent diagnosis of Philadelphia-chromosome positive CML. The most common etiology of portal hypertension was Budd-Chiari Syndrome (BCS) in six patients (67%), followed by NRH in five patients (56%), and EMH in two patients (22%); one patient had several distinct causes of MPN-related portal hypertension. Indications for TIPS included refractory ascites in five patients (63%), ascites and esophageal varices in three patients (33%), and ascites and hydrothorax in one patient. All patients demonstrated immediate normalization of portal pressures following TIPS without any reported periprocedural complications (Table 2). Additionally, all patients received indefinite anticoagulation (low molecular weight heparin, 3 patients; vitamin K antagonist, 2 patients; fondaparinux, 2 patients). TIPS intervention had 1-year patency rate of 89%. However, one third of patients required subsequent shunt revision at a median interval of 22.3 months (range 10-34 months) due to stent stenosis or thrombosis despite anticoagulation; one patient had radiographic evidence of TIPS dysfunction without clinical symptoms. Of note, all three patients who developed TIPS stenosis/thrombosis had BCS and NRH. The majority of patients (89%) experienced complete resolution of ascites, while the remaining patient had partial improvement in ascites but no longer required routine paracentesis. Grade 1 and 2 hepatic encephalopathy was the most common complication post-TIPS (67%), occurring in half of the patients with BCS and in all three patients with portal hypertension due to EMH. One patient had variceal bleeding in the setting of TIPS thrombosis. All patients were alive 2 years post-TIPS (excluding one patient with recent TIPS; range 2-5 years). Our study represents the first systematic analysis of outcomes of TIPS procedure for management of portal hypertension in MPN using data from a single-institution over a ten-year period. Our results suggest that TIPS procedure can be performed safely in this high-risk population, and can effectively mitigate the clinical consequences of portal hypertension in patients with MPN. However, the prevalence of TIPS complications, particularly of TIPS stenosis/thrombosis and hepatic encephalopathy, remains significant and must be balanced against the desired clinical benefits. Future studies with a larger number of patients are needed to delineate prognostic factors that identify MPN patients most likely to benefit from TIPS. Disclosures No relevant conflicts of interest to declare.

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Introduction: Pancreaticoduodenectomy is the procedure of choice for periampullary neoplasms. It is considered as a major surgical procedure. It is associated with relatively higher postoperative mortality and morbidity rate, however, with development of technology, proper patient selection, meticulous operative technique, appropriate postoperative care, morbidity and mortality rate has decreased subsequently. Up to the 1970s, the operative mortality rate after pancreaticoduodenectomy approached 20% but it has been reduced to less than 5% in recent reports. This study is designed to evaluate the postoperative outcomes of pylorus-preserving pancreaticoduodenectomy procedure in our set up. Objective: To evaluate the outcome of the pylorus-preserving pancreaticoduodenectomy procedure with the intention to measure operation time and per-operative bleeding, observing postoperative anastomotic leakage and gastric emptying time. To find out postoperative wound infection and complications to detect the dumping syndrome. Materials and Methods: A prospective observational study was carried out in the Department of Hepatobiliary Surgery, Combined Military Hospital, Dhaka from July 2013 to January 2017. Fifty patients who underwent pylorus-preserving pancreaticodudenectomy procedure were included in this study. Results: Out of 50 postoperative patients, 12(24%) patients developed complications. Of these patients, 3(6%) developed wound infection, 2(4%) developed bile leakage and 2(4%) developed postoperative haemorrhage. Pancreatic fistula, vomiting, delayed gastric emptying and abdominal collection all were 1(2%) each. Postoperative mortality was 3(6%). Conclusion: The present study demonstrated the development of postoperative complications after pylorus-preserving pancreaticoduodenectomy is as similar as published in different studies. Better outcome can be achieved with meticulous pre-operative evaluation of risk factors and per-operative skill maneuvering. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 42-45

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Abstract Myeloproliferative Neoplasms (MPN) are well characterized in adults, with symptoms including thrombotic episodes, severe bleeding episodes, splenomegaly, and transformation to AML. Accepted treatment algorithms are available for management and multiple clinical trials are being done in adult patients. Much has been done to understand the pathogenesis in adults, and mutations in JAK2, MPL, and most recently CALR are established as causative lesions in these disorders. In contrast, knowledge of these disorders in children is more rudimentary, with limited information available regarding long-term clinical outcomes in children. Children have a lower frequency of the known mutations; studies to identify alternative driver mutations in children are ongoing. Eight pediatric patients with MPN have been seen at Cornell during their illness. Seven were diagnosed with Essential Thrombocytosis (ET) and the eighth had an initial diagnosis of ET but later was diagnosed with myelofibrosis (MF). One patient did not have bone marrow testing but was diagnosed by her primary hematologist on the basis of extreme thrombocytosis, and JAK2V617F positive testing on peripheral blood when no cause of reactive thrombocytosis was identified. Table 1 summarizes key features of these patients. The average age of diagnosis for these children is 10 years and 3 months. The oldest patient was diagnosed in 2006 and has had the longest consecutive period of thrombocytosis, 8 years. These patients presented with a variety of symptoms, including headache, abdominal pain, fatigue, and bleeding. All the children experienced extreme thrombocytosis (platelet count > 1,000 x 109/L) during their illness. Despite the presence of acquired von Willebrand's disease in at least three patients, none have experienced severe bleeding symptoms. There have been no reported severe thrombotic episodes, and any evaluations done for complaints of headache, chest pain, or palpitations have shown no CNS infarcts or cardiac abnormalities. One child developed pseudo tumor cerebri with no cerebral venous sinus thrombosis or CNS lesion detected. Four children have been treated with aspirin with no significant bleeding complications. Six of the eight had been treated with cytoreductive therapy (Hydroxyurea) by their primary hematologist at some point in their course, for various findings including extreme thrombocytosis, fatigue, erythromelalgia, and recurrent headache. All showed a good response in platelet count to Hydroxyurea treatment, none developed dose-limiting side effects, and the highest dose that was needed to relieve symptoms at any point was 35mg/kg. Four patients remain on therapy with Hydroxyurea. Genetic sequencing was positive for JAK2V617F in three of eight patients. All of these patients have received Hydroxyurea treatment, and the child with pseudotumor cerebri was JAK2V617F positive. Of the five patients who are negative for JAK2 mutation, four were tested for MPLW515K/L and all are negative. Two of these patients have had sequencing sent for CALR mutations, and one patient is negative for CALR mutation as well (one patient is pending.) Figure 1 summarizes the sequencing completed to date on these patients. This cohort of pediatric patients shows a lower frequency of the known causative mutations than their adult counterparts. There is variation in how these patients were managed by their primary hematologists, likely due to the lack of treatment guidelines in this patient population (Kucine et al, 2014.) With the apparent differences in clinical course and genetic drivers from adults with MPN, there is a clear need for further research on the outcomes and pathogenesis in pediatric patients with MPN. Our group is currently working to answer some of the questions regarding pathogenesis and outcomes in pediatric patients with MPN to allow for individualization of treatment recommendations and family guidance in these children. Table 1. Summary of Eight Pediatric MPN Patients Patient Age at Diagnosis (years) Diagnosis Initial Symptoms A 9 ET Weakness, Paresthesias B 7 ET Headache C 10 ET Headache, Fatigue D 7 ET Headache E 8 ET Bleeding F 13 MF Abdominal Pain, Splenomegaly G 10 ET Headache H 19 ET Fatigue, Itching Figure 1. Clinical Sequence of Genetic Testing For Pediatric Cohort Figure 1. Clinical Sequence of Genetic Testing For Pediatric Cohort References Kucine N, Chastain KM, Mahler MB, Bussel JB. Primary thrombocytosis in children. Haematologica. 2014;99(4)620-28. Disclosures Off Label Use: Hydroxyurea use in certain children with MPN is accepted practice but is technically off-label.

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Abstract Background: paragangliomas (PGN) (including adrenal PGN or pheochromocytomas) are uncommon neuroendocrine neoplasias. Their ubiquity and lack of uniform nomenclature has resulted in systematic sub-registry and limited resources for patients and clinicians. However, 40% of them are hereditary, 10–20% are hormonally active and 50% result in treatment-related complications. Objectives: to describe the clinical and biochemical characteristics of PGN in two referral centers in a 2-year period. Materials and Methods: a retrospective review of the files of patients evaluated in the Centro Medico Nacional Siglo XXI or the Instituto Nacional de Neurología y Neurocirugia between June 2018 and May 2020, even if diagnosis was prior to those dates. The search was performed using ICD-10 terms in the outpatient registries. Data is described using non-parametric statistics, including medians (interquartilic ranges, IQR). According to the reported incidences we expected to find 35 new cases per year in each hospital. Results: 237 patients, 86.4% female with a median age at diagnosis of 54 years (IQR 45–64) were found. The tumors were located in the head 23.9%, neck 63.3%, thorax 0.4%, adrenal in 11.1%, other sites in the abdomen 1.3%. The most common symptoms in head PGN were hypoacusia (85.2%) and cranial nerve palsies (39.3%), in the neck, a visible mass and pain (30.6%) while the “classic” catecholaminergic symptoms were more common in thoracic and abdominal tumors (&gt;50%). Tumors were large or invasive in 50.1% of the cases and at least one hormone was above the upper limit of normal (ULN) in 40.6% of the 64 evaluated cases, mostly urinary dopamine (70% of cases tested, 1.1–2.1 ULN) and plasma and urine metanephrines (60% of cases tested, 1.1- 33.7 ULN and 50% cases, 1.1–22 ULN, respectively). Severe systolic hypertension was more frequent in male patients &lt;30 years of age and 41.6% were candidates to genetic testing due to the tumor characteristics or patient history. Surgery was performed in 55.6%, radiotherapy in 25.2% and 12.1% are under surveillance or pending surgery, 7.1% were lost to follow up. Only 5 cases with metastasis were documented in 1215 patient-years of follow-up. Treatment-related complications were reported in 14.7% and persistence in 32.2%. Conclusions: despite the retrospective nature of the study and sub registry, we found more tumors than expected. The frequency of hormonal production was high, but it is likely related to patient selection bias (mostly symptomatic cases studied). Dopamine and metanephrines are useful in the evaluation of PGN. Endocrinologists should be aware of these common tumors and be part of the multidisciplinary team.

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Background:Surgery for chronic pancreatitis and pancreatic neoplasms is associated with a risk of acute destructive pancreatitis and pancreaticojejunal anastomotic leakage in the early postoperative period. Despite the availability of multiple surgical and pharmaceutical approaches to prevent these complications, they continue to be associated with high mortality.Aim:To evaluate the efficacy of the clinical use of our original preventive methods of postoperative pancreatitis and diffuse inflammatory and septic complications in patients undergoing pancreatic resection due to its benign and malignant diseases.Materials and methods: We retrospectively analyzed the results of surgical treatment of 524 patients following pancreatic resection. All patients underwent pancreatic surgery in the Rostov Regional Clinical Hospital (Rostov-on-Don, Russia) from February 2005 to April 2018 for the following indications: complicated chronic pancreatitis in 221 patient, pancreatic and major duodenal papilla tumors in 303 patients. Organ-preserving procedures were performed in 250 patients, and radical extended resections of the pancreas in 274 patients. In 489 patients, the procedures were finalized with the formation of anastomosis between the pancreatic duct and jejunum. In 373 patients, the reconstruction step included enterostomal drainage of the pancreatic duct. To prevent acute postoperative pancreatitis and diffuse septic and inflammatory complications, in 298 patients we used our original techniques, while 226 patients underwent conventional procedures.Results:Among 226 patients, who had underwent conventional procedures, the complications occurred in 75 (33.19%), with septic complications in 29.33% (22 patients). Of 298 patients, in whom any of the original prevention techniques had been used, the complications were seen in 67 (22.48%), with septic complications in 13.43% (9 patients). Seventeen (17, or 11.97% of the total number) patients had to be re-operated, with 15 (6.64%) having been initially operated without additional preventive measures, and 2 (0.67%) with the use of the original prevention techniques. Overall postoperative mortality was 2.48%. The causes of death were: peritonitis in 4 patients, arrosive bleeding from visceral arteries in 4, bleeding from pancreatic head stump into the omental sac in 2, bleeding at the pancreaticojejunal anastomosis in 1, and cardiac disorders in 2.Conclusion:The study results have shown that the use of techniques to prevent the spread of inflammation and septic in the abdominal cavity and decreasing the rates of postoperative necrotic pancreatitis in pancreatic resections allows for a reduction of these complications and related mortality.

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The spectrum of ovarian pathologies embraces wide age range among females because the risk of developing ovarian lesion starts from birth and follows diverse patterns through-out the life.1,2 The rate of development of complications, recurrence, progression to malignancy, morbidity and mortality, also varies according to the age of presentation of various ovarian pathologies.3,4,5 The prevalence of cystic lesions of ovary is more in reproductive age group as compared to post-menopausal women.6,7 Malignant neoplasms have more been observed in an advanced age group.8,9,10 The current study is aimed to observe the distribution of various histopathological patterns of ovarian lesions in different age groups. This study may be beneficial in stratifying patients, into different risk based groups and prognosis associated groups, depending upon the age of patient at the time of presentation. Methods: Total 150 cases of ovarian lesions were selected by convenient sampling in current descriptive study, carried out at Pathology department of Fatima Jinnah Medical University, Lahore from May, 2019 till June, 2020. Routine H & E stained sections, from specimens of total abdominal hysterectomy with unilateral or bilateral salpingo-oophorectomy, unilateral or bilateral oophorectomy and salpingo-oophorectomy procedures, done either for primary ovarian lesion or other than primary ovarian pathology, in all age groups, were included. Results: A majority of ovarian lesions 123 (82%) were observed in the reproductive age group, mostly being non-neoplastic (89.5%). Out of 19 post-menopausal patients, 12 presented with malignant neoplasms. All patients belonging to pre-pubertal age group had non-neoplastic pathologies. Conclusion: The malignant ovarian tumors are prevalent in post-menopausal patients while reproductive age group predominantly exhibits non-neoplastic and benign ovarian lesions. The pre-pubertal age group commonly present with non-neoplastic ovarian pathologies. Keywords: Histopathological patterns of ovarian lesion, Malignant ovarian tumors, Reproductive age group.

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Female ovariohysterectomy is one of the most common surgical interventions aimed at preventing diseases of the reproductive system and regulating the number, incl. in neglected animals. This is an abdominal operation that can be performed by various techniques. Complications after ovariohysterectomy occur infrequently, incl. reminant ovary syndrome is extremely rare.According to the results of numerous studies, bitches and cats are preferably spayed before the first estrus. Thus, reducing the risk of neoplasms of the breast, ovaries and uterus.The aim of our study was to determine the incidence of ovarioreminant syndrome in bitches after ovariohysterectomy/ovariectomy and to work out the technique for searching for residual/ectopic ovarian tissues.The study was conducted from 01.12.2020 to June 2022 in the conditions of the network of veterinary clinics "Alisavet" in Moscow. The object of the study were 557 clinically healthy females over the age of 8 months of various breeds. Castration was performed by standard laparotomy and endoscopically. Each dog underwent preoperative blood tests (general and biochemical tests), ultrasound of the genitourinary system, ECHO-KG, and an electrocardiogram was also performed for large animals.A day after surgery, ultrasound was performed using the Mindray Vetus 7 machine to check for early postoperative complications, ECHO-CG was also performed using the Mindray Vetus 7. An electrocardiogram was recorded using the Neurosoft Polyspectre 8/B. Calculation of parameters of the general blood test was carried out on the analyzer Mindray BC-2800 Vet, biochemical blood parameters - on the biochemical analyzer Fujifilm Dri-chem NX500i or in the laboratories of Mos-cow (Mitrokhina laboratory, Vetunion). All the results obtained during the research were processed statistically using Microsoft Excel.

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Introduction: Inflammatory myofibroblastic tumors (IMTs) are uncommon mesenchymal lesions classified by WHO as neoplasms of uncertain behavior. Morphologically, IMTs are composed of proliferating spindled myofibroblastic cells accompanied by a marked - usually chronic - inflammatory infiltrate. The etiology is unknown, but several theories have been suggested, including an association with Wilms’ tumor. IMTs are rarely diagnosed in adults and have been reported in various organs. IMTs are considered benign but with a potential to recur at their primary site. Case report: A 44-year-old female experienced intermittent severe abdominal pain, loose stools and a visible abdominal bulge. In early childhood the patient had been treated for a Wilms’ tumor. At admission Meckel’s diverticulitis was suspected, but during surgery a tumor in the terminal ileum, creating a conglomerate of small intestinal loops, was observed and completely resected. The pathology report characterized the tumor as a histologically benign inflammatory myofibroblastic tumor. Postoperatively, the patient experienced several complications including an anastomotic leakage and subsequent formation of an abscess and transcutaneous fistula. Discussion: IMTs rarely arise in the small intestine, and to our knowledge the manifestation of a small intestine conglomerate has not been described previously. Making the diagnosis is difficult, and numerous differential diagnoses were possible in this case. Approximately 8-25% of IMTs in the gastrointestinal tract recur locally. Complete surgical resection is the treatment of choice, and re-excision is the preferred therapy for local recurrence. To our knowledge, no guidelines concerning follow-ups are available. Conclusion: IMTs in the terminal ileum can mimic Meckel’s diverticulitis and present with symptoms of obstructive ileus due to the formation of a conglomerate of small intestinal loops. Furthermore, IMTs should be considered as a diagnostic possibility in patients with a past medical history of Wilms’ tumor.

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Introduction: Inflammatory myofibroblastic tumors (IMTs) are uncommon mesenchymal lesions classified by WHO as neoplasms of uncertain behavior. Morphologically, IMTs are composed of proliferating spindled myofibroblastic cells accompanied by a marked - usually chronic - inflammatory infiltrate. The etiology is unknown, but several theories have been suggested, including an association with Wilms’ tumor. IMTs are rarely diagnosed in adults and have been reported in various organs. IMTs are considered benign but with a potential to recur at their primary site. Case report: A 44-year-old female experienced intermittent severe abdominal pain, loose stools and a visible abdominal bulge. In early childhood the patient had been treated for a Wilms’ tumor. At admission Meckel’s diverticulitis was suspected, but during surgery a tumor in the terminal ileum, creating a conglomerate of small intestinal loops, was observed and completely resected. The pathology report characterized the tumor as a histologically benign inflammatory myofibroblastic tumor. Postoperatively, the patient experienced several complications including an anastomotic leakage and subsequent formation of an abscess and transcutaneous fistula. Discussion: IMTs rarely arise in the small intestine, and to our knowledge the manifestation of a small intestine conglomerate has not been described previously. Making the diagnosis is difficult, and numerous differential diagnoses were possible in this case. Approximately 8-25% of IMTs in the gastrointestinal tract recur locally. Complete surgical resection is the treatment of choice, and re-excision is the preferred therapy for local recurrence. To our knowledge, no guidelines concerning follow-ups are available. Conclusion: IMTs in the terminal ileum can mimic Meckel’s diverticulitis and present with symptoms of obstructive ileus due to the formation of a conglomerate of small intestinal loops. Furthermore, IMTs should be considered as a diagnostic possibility in patients with a past medical history of Wilms’ tumor.