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951.
Inflammatory Pseudotumor of the Spleen: Report of a Case 总被引:1,自引:0,他引:1
We report the case of an inflammatory pseudotumor of the spleen in an asymptomatic 55-year-old woman, whose lesion was accidentally found and clinically misdiagnosed to be lymphoma. An inflammatory pseudotumor of the spleen was histopathologically diagnosed following a splenectomy. This lesion is a benign, reactive, and inflammatory process and its etiopathogenesis still remains elusive. The preoperative diagnosis is difficult and the optimal management of the asymptomastic patient with the disease is unclear. This entity should be kept in mind in the differential diagnosis of splenic space-occupying lesions. 相似文献
952.
Nigel Balfour Jamieson Alan K. Foulis Karin A. Oien Euan J. Dickson Clem W. Imrie Ross Carter Colin J. McKay 《Journal of gastrointestinal surgery》2011,15(3):512-524
Background
Following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), identification of peripancreatic fat tumor invasion promotes a tumor to stage T3. We sought to understand better the impact of histological peripancreatic fat invasion on prognosis and site of recurrence in a cohort of patients with PDAC. 相似文献953.
Background Cancer patients undergoing major abdominal or pelvic surgery are at considerable risk of venous thromboembolism (VTE). The
genesis of thromboses in malignancy is complicated, and reflects the interaction and derangement of multiple molecular pathways.
Furthermore, the nature and location of the cancer, as well as the type surgery involved, are thought to affect the level
of VTE risk. These considerations may therefore affect treatment decisions.
Methods We performed multiple Medline searches with terms including but not limited to VTE, cancer, surgery, abdominal, colorectal,
unfractionated heparin (UFH), and low-molecular-weight heparin (LMWH) to identify reviews, meta-analyses, nonrandomized and
randomized controlled trials, and clinical guidelines relating to management of VTE in patients with abdominal cancer.
Results VTE incidence in patients with malignancy varied according to cancer type, location, stage of progression, and the use of
catheters and/or chemotherapy. Thromboprophylaxis with UFH or LMWH reduces the risk of developing VTE in these patients. However,
LMWHs have a favorable risk-benefit profile over UFH and extending the duration prophylaxis may improve outcomes.
Conclusion A number of recommendations can be made for the prevention of VTE in patients undergoing abdominal or pelvic surgery for cancer:
(1) risk-stratify all patients according to defined evidence-based guidelines; (2) for most abdominal surgical oncology patients
at risk, use of both an anticoagulant and mechanical means are indicated and beneficial; and (3) consider extended-duration
prophylaxis (up to 28 days) in those patients with major abdominal/pelvic operations and impaired mobility, preferably with
LMWH. 相似文献
954.
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently the gold standard bariatric procedure for the treatment of morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is a relatively innovative procedure which has been increasingly applied lately as a sole bariatric procedure. A randomized trial was conducted in a Greek population to evaluate perioperative safety and 3-years results. 相似文献955.
Squamous cell carcinoma of the breast is a rare type of cancer, the origin of which is still uncertain. We report a case of
squamous cell carcinoma of the breast with a recurrent tumor that showed undifferentiated features. The patient was a 55-year-old
woman who originally presented with a left breast mass in the upper outer quadrant. Echography showed a 46 × 29 × 23-mm mass
with cavity formation, and aspiration cytology confirmed a diagnosis of squamous cell carcinoma. A modified radical mastectomy
with level III lymph node dissection was performed. Pathologically, the tumor was composed of squamous cell carcinoma and
noninvasive ductal carcinoma. A recurrent tumor showing undifferentiated features was detected in the left forechest 3 months
after the operation, and tumorectomy with partial resection of the major and minor pectoralis muscles was performed. Despite
intensive therapy including chemotherapy (CEF: cyclophosphamide, epirubicin, 5-fluorouracil) and irradiation (50 Gy), the
patient died from pulmonary and skin metastases 20 months after her initial operation. The squamous cell carcinoma of the
breast in this patient grew rapidly and her prognosis was poor. Immunohistochemical findings indicated the possibility that
the squamous cell carcinoma developed from noninvasive ductal carcinoma of the comedo type, and that the undifferentiated
cells from the site of recurrence developed from dedifferentiation of the squamous cell carcinoma.
Received: August 10, 2001 / Accepted: March 5, 2002 相似文献
956.
Yamamoto S Sato Y Nakatsuka H Oya H Kobayashi T Hatakeyama K 《World journal of surgery》2007,31(6):1266-1271
BACKGROUND: Use of the inferior mesenteric vein (IMV) for partial portal decompression has not been recommended as a first-line option for intractable gastroesophageal variceal bleeding because of the thin diameter of the vein. Although these indications remain relevant, few reports have compared partial portal decompression using the IMV with other therapies. We propose that partial portal decompression using the IMV is a useful alternative treatment for intractable variceal bleeding. METHODS: We performed partial portal decompression using the IMV in eight patients with intractable variceal bleeding that had been uncontrolled using medical and endoscopic therapies. All patients were classified into Child's class B or C. The surgical data, morbidity, and mortality were assessed. RESULTS: Mean portal venous pressure significantly decreased from 26.9 +/- 2.0 mmHg before the surgery to 19.8 +/- 3.9 mmHg after the surgery. The operative mortality rate was 0%. The mean duration of hospital stay was 25.5 +/- 13.3 days. Although one patient experienced recurrent bleeding, shunt patency was well maintained in all patients during the follow-up period (mean 28.9 +/- 14.1 months). Six patients are still alive and well without ascites or hepatic encephalopathy. Two of the Child's class C patients who underwent emergency shunt died owing to hepatic decompensation. CONCLUSION: Partial portal decompression using the IMV can be a safe, effective way to treat intractable variceal bleeding in patients with liver cirrhosis. However, use of the shunt procedure may have the most survival benefits for cirrhotic patients with preserved liver function. 相似文献
957.
Maher El Chaar Peter Lundberg Jill Stoltzfus 《Surgery for obesity and related diseases》2018,14(5):545-551
Background
According to recent American Society for Metabolic and Bariatric Surgery estimates, sleeve gastrectomy (SG) is now the most commonly performed procedure in the United States (~53.8% of all bariatric procedures), followed by Roux-en-Y gastric bypass (RYGB; 23.1% of all procedures).Objectives
The objective of this study was to evaluate outcomes and safety of these 2 procedures in the first 30 days postoperatively using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.Setting
University health network, United States.Methods
We reviewed all SG and RYGB cases entered between January 1 and December 31, 2015 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2, or Fisher's exact tests as appropriate, with P<.05 denoting statistical significance and no adjustment for multiple testing.Results
A total of 141,646 patients were analyzed; 98,292 underwent SG and 43,354 underwent RYGB. Average age was 44.5 and 45.4 years for SG and RYGB, respectively. Preoperative body mass index was 45.1 and 46.1 for SG and RYGB, respectively. The 30-day mortality was .1% for SG and .2% for RYGB (P<.05). The incidence of unplanned intensive care unit admission after RYGB was twice as high compared with SG (1.3% versus .6%, respectively, P<.05). The incidence of at least 1 intervention or reoperation after RYGB was significantly higher compared with SG (2.8% and 2.5% for GB versus 1.2% and 1% for SG, P<.05). After RYGB, .4% of patients had a drain left in place at 30 days postoperatively versus .3% for SG (P<.05). The incidence of readmission was 2.8% for RYGB and 1.2% for SG (P<.05).Conclusions
The incidence of postoperative complications in the first 30 days after surgery is low for both RYGB and SG. However, SG seems to have a better safety profile in the first 30 days postoperatively compared with RYGB. These findings should be considered in the preoperative evaluation and counseling of bariatric patients. Long-term follow-up is needed to compare safety and efficacy of SG versus RYGB. 相似文献958.
Hiromichi Ito Michael Abramson Kaori Ito Edward Swanson Nancy Cho Daniel T. Ruan Richard S. Swanson Edward E. Whang 《Journal of gastrointestinal surgery》2010,14(5):891-898
Background
The aims of this study were to evaluate contemporary outcomes associated with the surgical management of pancreatic neuroendocrine tumors (PNETs) and to assess the prognostic value of the World Health Organization (WHO) classification and TNM staging for PNETs. 相似文献959.
Sasaki A Kai S Endo Y Iwaki K Uchida H Shibata K Ohta M Kitano S 《Annals of surgical oncology》2007,14(11):3181-3187
Background Although extrahepatic metastasis occurs rarely after hepatic resection for hepatocellular carcinoma (HCC), the prognosis of
these patients is extremely poor. Predictors of extrahepatic metastasis have not been fully investigated.
Methods To identify predictors of extrahepatic metastasis after resection, we retrospectively investigated 77 patients with HCC tumors
>50 mm in diameter who underwent hepatic resection. We investigated correlations between postoperative extrahepatic metastasis
and clinicopathologic factors as well as extrahepatic metastasis-free survival rate by log rank test and predictors of extrahepatic
metastasis by univariate and multivariate logistic regression models.
Results Hepatitis B surface antigen (HBs-Ag) was found in 25 (32.5%) of 77 patients, and extrahepatic metastasis occurred in 26 (33.8%).
Patients with extrahepatic metastasis showed better liver function and a high occurrence of HBs-Ag positivity than those without.
The 5-year extrahepatic metastasis-free survival rate was worse in patients with HBs-Ag positivity, larger tumors (≥70 mm),
higher alfa-fetoprotein level (≥300 ng/mL), and lower indocyanine green retention rate at 15 minutes (ICGR15) (<15%) than in those without. By univariate logistic regression analysis, HBs-Ag positivity, larger HCC tumor (≥70 mm),
lower ICGR15 (<15%), and lower preoperative lymphocyte count (<1000/mm3) were predictors of extrahepatic metastasis (P < .1). By multivariate analysis, HBs-Ag positivity was an independent predictor of postoperative extrahepatic metastasis
(P = .04).
Conclusions In patients positive for HBs-Ag, radiologic examination of extrahepatic organs should be performed as a part of the postoperative
surveillance. Hepatitis B virus infection may promote establishment of extrahepatic metastasis. 相似文献
960.