Successful Treatment of immune Reconstitution Inflammatory syndrome-related Hemophagocytic Syndrome in an HIV Patient with Primary Effusion Lymphoma.

Although the connection of [secondary hemophagocytic syndrome (sHS)] with HIV has been well documented, optimal treatment regimen is not well established. This is due not only to the rarity of the syndrome, but also to the heterogeneity of the involved population. Most cases are related to opportunistic infections or malignancies in advanced stage, but many cases are also related to seroconversion, in the primary infection setting. Moreover, in the [antiretroviral treatment (ART)] era, rare cases of ART-related sHS have been reported. In these, often fatal cases, an [immune reconstitution inflammatory syndrome (IRIS)] process is involved, posing a serious challenge to the treating physician. We hereby report a case of successful treatment of an HIV patient with primary effusion lymphoma who experienced sHS shortly after ART onset. Our patient, treated with high dose dexamethasone and gamma globulin, achieved complete remission. This case might hint possible therapeutic insights in the treatment of IRIS-related sHS.

Laparoscopy for acute small bowel obstruction: indication or contraindication?

BACKGROUND: Acute small bowel obstruction (SBO) is a relatively common cause of emergency hospital admission, most frequently due to postoperative adhesions. With increased experience and technical advances in laparoscopic surgery, the laparoscopic management of acute SBO has become feasible and potentially superior to the open approach. This retrospective study presents the authors' experience with laparoscopic treatment of SBO over a 6-year period to assess the feasibility, efficacy, and clinical outcome of this therapeutic method and to present the author's methodology. METHODS: From April 2003 to January 2009, 32 patients hospitalized in the author's department for acute SBO underwent elective laparoscopic treatment after failure of conservative measures. Standard laparoscopic techniques and instruments were used. RESULTS: Postoperative adhesions were identified in 62.5% of patients (n=20) as well as tumor (n=3), incarcerated ventral hernia (n=4), incarcerated femoral hernia (n=3), internal hernia (n=1), and Crohn's disease (n=1). The conversion rate was 18.7% (n=6), and the postoperative complication rate was 3.25% (n=1). The mean operative time was 78 min. Bowel function returned after a mean of 3.2 days, and the mean hospital stay was 4.6 days. CONCLUSIONS: The laparoscopic treatment of acute SBO is an attractive alternative to the open approach. However, it must be kept in mind that surgery longer than 120 min is a significant predictor of postoperative morbidity, that bowel injury may be missed at the time of operation and can be avoided with improved surgical techniques and appropriate instrumentation, that lysis of all intraabdominal adhesions is unnecessary, and that a low threshold for conversion should be maintained, especially in cases of severe, dense, extensive adhesions.

Radiofrequency ablation of unresectable liver tumors: factors associated with incomplete ablation or local recurrence.

BACKGROUND: Radiofrequency ablation (RFA) of liver tumors is associated with a risk of incomplete ablation or local recurrence. METHODS: One hundred sixty-eight patients with 311 unresectable liver tumors were included. Effects of different variables on incomplete ablation and local recurrence were analyzed. RESULTS: There were 132 hepatocellular carcinomas and 179 liver metastases. Tumor size was 24 (±13) mm. Two hundred twenty-six tumors were treated percutaneously, and 85 through open approach (associated with liver resection in 42 cases). There was no mortality. Major morbidity rate was 7%. Incomplete ablation and local recurrence rates were 14% and 18.6%. Follow-up was 29 months. On multivariate analysis, factors associated with incomplete ablation were tumor size (>30 mm vs ≤30 mm, P = .004) and approach (percutaneous vs open, P = .0001). Factors associated with local recurrence were tumor size (>30 mm vs ≤30 mm, P = .02) and patient age (>65 years vs ≤65 years, P = .05). CONCLUSIONS: RFA is effective to treat unresectable liver tumors. However, there is a risk of incomplete ablation when percutaneously treating tumors >30 mm. When tumor ablation is completely achieved, the main factor associated with local recurrence is tumor size >30 mm.

The relationship between five kinds of laparoscopic knots and five types of suture materials and histological findings in tissues: an experimental study on rabbits.

The aim of the current study was to examine the slipping and the tightening of laparoscopic knots with various kinds of sutures, as well as the histologic alterations in tissues. Fifty rabbits and five kinds of sutures were used-silk, polyglactine-910 (Vicryl), Polydioxanone (PDS), Polyglycol (Dexon), and cat-gut chromic-and five laparoscopic knots were used-Tayside, Roeder, Melzer, Cross, and Blood. The knots were performed extracorporeally and were used to ligate a part of the omentum. Sliding and tightening of the knots were evaluated. The omentum, the suture, and the knots were checked 10 days and 1 month after operation. Histologic examination was performed 1 month after surgery. Polyglactine-910 (Vicryl) and silk were the most qualitative sutures used in Tayside, Roeder, and Blood knots and the least harmful for the tissues. Catgut chromic and Polydioxanone (PDS) were the most defective sutures. The most efficient laparoscopic slipknots are Tayside, Roeder, and Blood, especially when constructed with silk and polyglactine-910 (Vicryl).