scholarly journals SURGICAL OPTIONS FOR NONPARASITIC SPLENIC CYSTS

2021 ◽  
Vol 29 (5) ◽  
pp. 617-623
Author(s):  
K.F. Chernousov ◽  
◽  
R.V. Karpova ◽  
K.S. Russkova ◽  
◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Complete Removal ◽  
Infectious Complications ◽  
Early Postoperative Period ◽  
Coagulation Necrosis ◽  
General Tendency ◽  
Spleen Preserving ◽  
Splenic Cysts ◽  
Life Threatening ◽  
Pathological Focus

Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen,clinically, they may be asymptomatic. Their classification includes two basic groups: the true cysts or primary cysts and false or pseudo cysts based on the presence or absence of an epithelial lining. The need for surgery of nonparasitic cysts is due to the development of complications: suppuration, hemorrhage into the cavity of the cyst and its rupture. Historically, the conventional surgical method was splenectomy, however, complete removal of the organ, especially at a young age, often led to life-threatening infectious complications. Spleen-preserving surgeryis considered to be analternative to classicalsplenectomy: partial resection of the spleen and fenestration with excisionof extra-hepaticcyst wall. However, as clinical practice has shown, these methods can be effectively used exclusively for the treatment of superficial cysts, and during the operation the ruptures of the capsule of the pathological focus with bleeding are observed. According to the general tendency in surgery to reduce the traumatization all patients were worked up with an ultrasound and X-Ray examination of the abdomen to look for the size and location of the splenic cysts. These operations include: drainage with sclerosing of the cyst and deepithelialization with superselective arterial embolization of the feeding vascular pedicle of the pathological focus. The study of these techniques revealed their weak points: the recurrence rate of cysts after sclerosis was 30-50%, and the use of embolizing agents in 50% of cases is complicated by ischemia of an organ segment with possible formation of an infarction zone in the early postoperative period. Nowadays the most promising method is considered to be a microwave ablation. Its thermal effect creates coagulation necrosis of the pathological focus and surrounding tissues with minimal toxic effects. This approach decidedly requires further research.

scholarly journals A simple nomogram for early postoperative risk prediction of clinically relevant pancreatic fistula after pancreatoduodenectomy

2021 ◽  
Author(s):  
K. C. Honselmann ◽  
C. Antoine ◽  
L. Frohneberg ◽  
S. Deichmann ◽  
L. Bolm ◽  
...  
Keyword(s):  
Delayed Gastric Emptying ◽  
Model Building ◽  
Pancreatic Head ◽  
Operation Time ◽  
Early Postoperative Period ◽  
Serum Lipase ◽  
Internal Validation ◽  
Model Method ◽  
Postoperative Risk ◽  
Life Threatening

Abstract Purpose Postoperative pancreatic fistulae (POPF) present a serious and life-threatening complication after pancreatic head resections (PD). Therefore, reliable risk stratification to identify those at risk is urgently needed. The aim of this study was to identify postoperative laboratory parameters for the prediction of POPF in the early postoperative period. Methods One hundred eighty-two patients who underwent PD from 2012 until 2017 were retrospectively analyzed. Multivariate logistic regression was performed using the GLM (general linear model) method for model building. Two nomograms were created based on the GLM models of postoperative day one and postoperative day one to five. A cohort of 48 patients operated between 2018 and 2019 served as internal validation. Results Clinically relevant pancreatic fistulae (CR-POPF) were present in 16% (n = 29) of patients. Patients with CR-POPF experienced significantly more insufficiencies of gastroenterostomies, delayed gastric emptying, and more extraluminal bleeding than patients without CR-POPF. Multivariate analysis revealed multiple postoperative predictive models, the best one including ASA, main pancreatic duct diameter, operation time, and serum lipase as well as leucocytes on day one. This model was able to predict CR-POPF with an accuracy of 90% and an AUC of 0.903. Two nomograms were created for easier use. Conclusion Clinically relevant fistula can be predicted using simple laboratory and clinical parameters. Not serum amylase, but serum lipase is an independent predictor of CR-POPF. Our simple nomograms may help in the identification of patients for early postoperative interventions.

scholarly journals Vibrio vulnificus necrotizing fasciitis associated with acupuncture

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Yael Kotton ◽  
Soboh Soboh ◽  
Naiel Bisharat
Keyword(s):  
Necrotizing Fasciitis ◽  
Unusual Case ◽  
Vibrio Vulnificus ◽  
Needle Insertion ◽  
Infectious Complications ◽  
Alcoholic Fatty Liver ◽  
Acupuncture Needle ◽  
Life Threatening ◽  
Subcutaneous Tissues ◽  
Alcoholic Fatty Liver Disease

Necrotizing fasciitis is a severe life-threatening infection of the deep subcutaneous tissues and fascia. Infection with <em>Vibrio vulnificus</em>, a halophilic Gram-negative bacillus found worldwide in warm coastal waters, can lead to severe complications, particularly among patients with chronic liver diseases. We herein present an unusual case of necrotizing fasciitis caused by <em>V</em>. <em>vulnificus</em> triggered by acupuncture needle insertion. The patient, who suffered from diabetes mellitus and non-alcoholic fatty liver disease and worked at a fish hatchery, denied any injury prior to acupuncture. This is the first ever reported case of <em>V. vulnificus</em> infection triggered by acupuncture needle insertion, clearly emphasizing the potential hazards of the prolonged survival of <em>V. vulnificus</em> on the skin. The potential infectious complications of acupuncture needle insertion are discussed.

scholarly journals Hyperacute graft-v-host disease in patients not given immunosuppression after allogeneic marrow transplantation

Blood ◽  
1986 ◽  
Vol 67 (4) ◽  
pp. 1172-1175 ◽  
Author(s):  
KM Sullivan ◽  
HJ Deeg ◽  
J Sanders ◽  
A Klosterman ◽  
D Amos ◽  
...  
Keyword(s):  
Acute Gvhd ◽  
Graft Function ◽  
Infectious Complications ◽  
Actuarial Survival ◽  
Host Disease ◽  
Life Threatening ◽  
Poor Graft Function ◽  
Allogeneic Marrow Transplantation ◽  
Grade Ii ◽  
Total Body

Sixteen patients with leukemia in relapse or second to third remission, 5 to 27 years old (median, 17), were given cyclophosphamide (60 mg/kg X 2) and total body irradiation (2.25 Gy for each of seven days) followed by unmodified marrow grafts from HLA-identical siblings. Patients did not receive posttransplant immunosuppression and were followed a median of nine months (range, 5–17). Prompt engraftment was sustained in 12 patients with a median time of 16 days (range, 10 to 63) to achieve 500 neutrophils/mm3. One patient failed to engraft, one had delayed engraftment, and two had late poor graft function. All 15 with engraftment developed moderate to life-threatening graft-v-host disease (GVHD, eight grade II and seven grade III-IV). This syndrome was hyperacute (median onset eight days [range, 7 to 29] posttransplant) and manifest by severe skin disease (14 patients at stage 3 and one at stage 4), fever (ten patients), and liver (four patients, stage 3–4) or gut (four patients, stage 3–4) involvement. Serial tissue biopsies confirmed acute GVHD in 13 of 15 patients. Ten were treated with antithymocyte globulin and cyclosporine (four survive), and four with corticosteroids (two survive). Actuarial survival to 17 months was 37%. Causes of death included interstitial pneumonia (four), infection (three), graft failure (one), venocclusive disease (one), and relapse of leukemia (one). Age-matched controls receiving standard methotrexate after transplant had comparable relapse-free survival but only a 25% incidence of grade II-IV acute GVHD (P less than .0001). We conclude that deleting posttransplant immunosuppression is associated with frequent and severe hyperacute GVHD, infectious complications, and occasional poor graft function.

scholarly journals Surgery Combined With Embolization in the Treatment of Plexiform Neurofibroma: A Case Report and Literature Review

2021 ◽  
Vol 6 (4) ◽  
pp. 01-04
Author(s):  
Reinaldo Filho
Keyword(s):  
Plexiform Neurofibroma ◽  
Arterial Embolization ◽  
Neurofibromatosis Type ◽  
Self Esteem ◽  
Life Threatening ◽  
Feeding Vessels ◽  
The Right ◽  
Polyvinyl Alcohol Particles

Neurofibromatosis type 1 (NF1) is an autosomal dominant multisystem genodermatosis resulting from a mutation on chromosome 17q11.2, characterized by diverse clinical expression with involvement of the skin, nervous system, bones, eyes and other systems. Neurofibromas are tumors located along nerve bundles; when they become large, they are called plexiform neurofibromas. Complications of neurofibromas are rare, but include malignant transformation and potentially life-threatening hemorrhages. A comprehensive perioperative management, including arterial embolization of feeding vessels, is required in order to perform a safe surgical procedure and to reduce potential surgical complications. We report a case of a large plexiform neurofibroma on the right flank, treated in a two-stage approach: first, embolization with polyvinyl alcohol particles of the inferior epigastric, lumbar and superior gluteal arteries on the right and, second, 24 hours after embolization, exeresis of the lesion, which weighed 2.5 kg. Two years after surgery, the patient was asymptomatic, without tumor recurrence and with an important improvement in self-esteem and quality of life.

scholarly journals A successful hybrid operation for life-threatening hemorrhagic shock secondary to an iatrogenic ruptured pseudoaneurysm of the external iliac artery following percutaneous arterial access

2018 ◽  
Vol 14 (3) ◽  
Author(s):  
Takahiro Shoji ◽  
Hirohisa Harada ◽  
Shinji Yamazoe ◽  
Yoshihiro Yamaguchi
Keyword(s):  
Renal Artery ◽  
Iliac Artery ◽  
Arterial Embolization ◽  
External Iliac Artery ◽  
Vascular Trauma ◽  
Balloon Occlusion ◽  
Arterial Access ◽  
Iatrogenic Complications ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

Intravascular treatments such as arterial embolization and resuscitative endovascular balloon occlusion of the aorta are being increasingly performed in emergency cases, in addition to the increasing use of arterial access as an intensive care monitoring tool. Thus, arterial access-related complications are being commonly reported. A 40- year-old man with renal artery stenosis underwent renal artery stent placement via the left inguinal puncture approach. After the procedure, his groin was manually compressed to hemostasis for 30 min. He unexpectedly developed shock the following day, and computed tomography revealed a ruptured pseudoaneurysm of the left external iliac artery (EIA) following iatrogenic vascular trauma owing to an inappropriately performed groin puncture. We initially controlled the hemorrhage using endovascular balloon occlusion of the left EIA. Subsequently, the injured EIA was repaired using a direct suture. The postoperative course was uneventful. Herein, we evaluated the causes of iatrogenic complications and the effectiveness of our treatment strategy.

scholarly journals Surgical procedure of segmentectomy as a possible cause of postoperative cerebral embolism: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Peirui Chen ◽  
Qiusha Qing ◽  
Mingqiang Diao ◽  
Xiaokang Sun ◽  
Junrong Yang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Surgical Procedure ◽  
Mechanical Thrombectomy ◽  
Early Postoperative Period ◽  
Cerebral Embolism ◽  
Case Presentation ◽  
Early Symptom ◽  
Life Threatening ◽  
Pulmonary Vein Stump ◽  
Possible Cause

Abstract Background Cerebral embolism after lobectomy is a life-threatening complication during the early postoperative period. However, it is unclear if cerebral embolism can develop after segmentectomy. Case presentation We experienced a case of a 37-year-old man who demonstrated early symptom of acute ischemic stroke in early postoperative period after right upper posterior segmentectomy and performed intra-arterial mechanical thrombectomy (IAMT) successfully. Conclusions Long and irregular pulmonary vein stump (PVS) and endothelial injury caused by surgical procedure may lead to cerebral embolism after segmentectomy. We believe that doing preoperative pulmonary vascular assessment and using appropriate surgical procedure may reduce the rate of cerebral embolism.

scholarly journals Hyperacute graft-v-host disease in patients not given immunosuppression after allogeneic marrow transplantation

Blood ◽  
1986 ◽  
Vol 67 (4) ◽  
pp. 1172-1175 ◽  
Author(s):  
KM Sullivan ◽  
HJ Deeg ◽  
J Sanders ◽  
A Klosterman ◽  
D Amos ◽  
...  
Keyword(s):  
Acute Gvhd ◽  
Graft Function ◽  
Infectious Complications ◽  
Actuarial Survival ◽  
Host Disease ◽  
Life Threatening ◽  
Poor Graft Function ◽  
Allogeneic Marrow Transplantation ◽  
Grade Ii ◽  
Total Body

Abstract Sixteen patients with leukemia in relapse or second to third remission, 5 to 27 years old (median, 17), were given cyclophosphamide (60 mg/kg X 2) and total body irradiation (2.25 Gy for each of seven days) followed by unmodified marrow grafts from HLA-identical siblings. Patients did not receive posttransplant immunosuppression and were followed a median of nine months (range, 5–17). Prompt engraftment was sustained in 12 patients with a median time of 16 days (range, 10 to 63) to achieve 500 neutrophils/mm3. One patient failed to engraft, one had delayed engraftment, and two had late poor graft function. All 15 with engraftment developed moderate to life-threatening graft-v-host disease (GVHD, eight grade II and seven grade III-IV). This syndrome was hyperacute (median onset eight days [range, 7 to 29] posttransplant) and manifest by severe skin disease (14 patients at stage 3 and one at stage 4), fever (ten patients), and liver (four patients, stage 3–4) or gut (four patients, stage 3–4) involvement. Serial tissue biopsies confirmed acute GVHD in 13 of 15 patients. Ten were treated with antithymocyte globulin and cyclosporine (four survive), and four with corticosteroids (two survive). Actuarial survival to 17 months was 37%. Causes of death included interstitial pneumonia (four), infection (three), graft failure (one), venocclusive disease (one), and relapse of leukemia (one). Age-matched controls receiving standard methotrexate after transplant had comparable relapse-free survival but only a 25% incidence of grade II-IV acute GVHD (P less than .0001). We conclude that deleting posttransplant immunosuppression is associated with frequent and severe hyperacute GVHD, infectious complications, and occasional poor graft function.

scholarly journals Variable Presentation of the CYBB Mutation in One Family, Approach to Management, and a Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Tatyana Gavrilova ◽  
Ari Zelig ◽  
Diana H. Lee
Keyword(s):  
Infectious Complications ◽  
Granulomatous Disease ◽  
Review Of The Literature ◽  
Primary Immunodeficiency Disorder ◽  
Family Approach ◽  
Immunodeficiency Disorder ◽  
Cybb Gene ◽  
Life Threatening ◽  
Heterozygous Carriers ◽  
Variable Presentation

Chronic granulomatous disease (CGD) is a primary immunodeficiency disorder marked by abnormal phagocytic function. CGD affects primarily neutrophils and manifests as an early predisposition to severe life-threatening infections. Additionally, patients with CGD are predisposed to unique autoimmune manifestations. While generally spared from infectious complications, heterozygous carriers of the abnormal genes implicated in CGD pathogenesis can still present with autoimmune disorders. A mutation in the CYBB gene is the only X-linked variant of this disease. This article describes a family with the CYBB mutation, its heterogenous presentation, and reviews the literature discussing disease management.

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