Malignant fibrous histiocytoma of the gallbladder: case report and review of the literature.

Malignant fibrous histiocytoma is a soft tissue sarcoma of mesenchymal origin. It can rarely present as a primary gallbladder tumor with only five cases having been reported to date in the English literature. Here we report the sixth documented case of malignant fibrous histiocytoma of the gallbladder, and we review all other cases reported. The outcome of the visceral sarcomas is poor when compared with tumors arising from the soft tissues. The treatment of primary malignant fibrous histiocytomas of the gallbladder is surgery. However, tumor recurrence is the norm even if wide clean margins are obtained. In contrast to tumors arising from the extremities the role of adjuvant radiotherapy and chemotherapy is less clear in the case of retroperitoneal and visceral sarcomas. Our patient is still alive and free of disease 46 weeks after surgery. The fact that this is the longest survival reported to date underscores the dismal prognosis of this disease.

Lactate levels in open interstitial thermal ablation for liver tumors.

Intraoperative radio frequency interstitial thermal ablation (RITA) may result in a reduction of the functional hepatic reserve. To assess this further, we evaluated perioperative lactate levels as a measure of hepatic dysfunction. Sixteen patients scheduled for open RITA (O-RITA) were enrolled in the study. Arterial lactate levels (mmol/L) were measured prior to tumor needle insertion (T0), after O-RITA completion (T1), after wound closure (T2) and 24 hrs after surgery (T3). Correlation between hemodynamic parameters including MAP, and CVP, at T0, T1, T2, T3 and the perioperative rate of lactate production were also analyzed. Total bilirubin, transaminases and international normalized ratio for prothrombin activity (INR) were measured preoperatively and postoperative at day 1, 2, 3 and 7. Data are expressed as mean +/- SD and analyzed with ANOVA. Additionally, the Duncan post hoc test was used for multiple comparisons of the differences in mean values. A p-value <0.05 was considered significant. Lactate levels did not increase significantly at time points specified above (P = NS). Similarly, hemodynamic parameters analyzed did not show any significant change at the different time points (P = NS). Total bilirubin and INR did not demonstrate statistically significant changes at the aforementioned time points. Serum transaminases peaked during the immediate postoperative period and normalized to preoperative values by one-week post surgery. These results demonstrate that O-RITA does not induce hyperlactatemia and does not reduce the functional residual liver parenchyma.

[Familial adenomatous polyposis. Problems encountered with rectum preservation in surgical treatment and life expectancy]. / La poliposi adenomatosa familiare. Problemi offerti dalla conservazione del retto nel trattamento chirurgico ed aspettative di vita.

Familial adenomatous polyposis is a genetically inherited disease with very high risk of colorectal cancer and with a large expression of multiple extracolonic malignancies. In recent years two surgical options are available for the treatment of FAP: total colectomy with ileorectal anastomosis and restorative proctocolectomy with ileoanal reservoir. The preservation of the rectum offers good quality of life and good functional results, but needs an accurate surveillance of the rectal stump and screening for the development of cancer. Restorative proctocolectomy is reserved for patients with large or confluent polyps of the rectum, for older patients and for those who had already had an ileorectal anastomosis and who develops subsequently large adenomas at increased risk for rectal cancer. Prophylactic procedures of surveillance, screening and surgery have reduced in patients at risk the incidence of colorectal cancer. But recently an increased number of malignant extracolonic tumors (gastric cancer, duodenal and periampullary cancer, small intestinal cancer, adrenal and thyroid cancer) and abdominal desmoid tumors, that causes a significant mortality, has been documented. The knowledge of the extracolonic features of FAP suggests a careful follow-up of the patients and the prevention and treatment of upper gastrointestinal cancers and desmoid disease.

A new therapeutic approach for hydatid liver cysts. Aspiration and alcohol injection under sonographic guidance.

The treatment of hydatid disease is still rather difficult; surgery is not always feasible, and there are no definite methods to evaluate the outcome of medical treatment. Although percutaneous needle aspiration of hydatid cysts has been discouraged because of potential complications, e.g., anaphylactic shock or spreading of daughter cysts, these risks have never been quantified. Therefore, it was decided to treat hydatid liver cysts by aspiration and alcohol injection under sonographic guidance using 95% sterile ethanol. Five patients are reported who were treated by this procedure without complications or relapses during a follow-up period ranging from 10-26 mo.

The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases.

The purpose of this study is to report the variations in hepatic arterial supply of a mixed population of organ donors in which the anatomy was individually examined during the bench surgery, and patients who underwent a selective angiogram of the celiac axis and superior mesenteric artery. We reviewed the donor forms and/or angiograms of 701 patients. The donor forms were completed personally by one of the authors, while all the radiology images were obtained through studies performed by one single radiologist. The arterial anatomy was anomalous in 296 out of 701 cases with an overall incidence of hepatic artery anomalies of 42.22%. In this paper we describe previously unreported arterial anomalies of the hepatic artery, collecting the second largest series of hepatic artery anatomical variations of the English literature. This anatomical update can be useful for transplant and general surgeons, as well as vascular radiologists.

Screening for candidate hepatic growth factors by selective portal infusion after canine Eck's fistula.

Completely diverting portacaval shunt (Eck's fistula) in dogs causes hepatocyte atrophy, disruption of hepatocyte organelles, fatty infiltration and low-grade hyperplasia. The effect of hepatic growth regulatory substances on these changes was assessed by constantly infusing test substances for four postoperative days after Eck's fistula into the detached left protal vein above the shunt. The directly infused left lobes were compared histopathologically with the untreated right lobes. In what has been called an hepatotrophic effect, stimulatory substances prevented the atrophy and increased hepatocyte mitoses. Of the hormones tested, only insulin was strongly hepatotrophic; T3 had a minor effect, and glucagon, prolactin, angiotensin II, vasopressin, norepinephrine and estradiol were inert. Insulin-like growth factor, hepatic stimulatory substance, transforming growth factor-alpha and hepatocyte growth factor (also known as hematopoietin A) were powerfully hepatotrophic, but epidermal growth factor had a barely discernible effect. Transforming growth factor-beta was inhibitory, but tamoxifen, interleukin-1 and interleukin-2 had no effect. The hepatotrophic action of insulin was not altered when the insulin infusate was mixed with transforming growth factor-beta or tamoxifen. These experiments show the importance of in vivo in addition to in vitro testing of putative growth control factors. They illustrate how Eck's fistula model can be used to screen for such substances and possibly to help delineate their mechanisms of action.