RESUMEN
PURPOSE: The aims of this case series study were to review the 10 patients who were diagnosed with left-sided gallbladder and analyze their anatomic variations in the bile duct, portal vein, and hepatic vessels. METHODS: In this case series study, 10 patients with left-sided gallbladder were retrospectively analyzed at 2 tertiary referral centers between April 2004 and May 2019. RESULTS: Mean age was 61.1 years; there were 7 women and 3 men. Ten patients underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic gallbladder stone. The mean operation time was 77.2 minutes. Three ports were used in laparoscopic cholecystectomy procedures. The mean postoperative hospital stay was 3.5 days, and there were no cases of surgery-related morbidity. Two patients had type 1 bile duct and 3 had type 3 bile duct (2 type 3B and 1 type 3A). The right posterior portal vein as the first branch of the main portal vein was observed in all patients. Segment IV branches of the left portal vein crossing over to the segment VIII territory were observed in 7 of the 10 patients. CONCLUSION: Although left-sided gallbladder is a very rare disease, it is possible to diagnose it preoperatively and perform laparoscopic cholecystectomy safely by adjusting port position. The common important features of left-sided gallbladder include distribution of the left portal vein crossing over to the right side of the liver and increased size of the left portal vein. These variations may have important clinical implications in the management of hepatic resection including donor hepatectomy.
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Femenino , Humanos , Masculino , Variación Anatómica , Conductos Biliares , Colecistectomía Laparoscópica , Colecistitis Aguda , Intercambio Genético , Vesícula Biliar , Hepatectomía , Tiempo de Internación , Hígado , Vena Porta , Enfermedades Raras , Estudios Retrospectivos , Centros de Atención Terciaria , Donantes de TejidosRESUMEN
PURPOSE: The purpose of this study is to report the results of simultaneous pancreas-kidney (SPK) transplantations and describe the lessons learned from the early experiences of a single center. METHODS: Between January 2002 and June 2013, a total of 8 patients underwent SPK transplantation. Clinical and radiologic data were reviewed retrospectively. RESULTS: Seven patients were diagnosed with type I diabetes mellitus and one patient became insulin-dependent after undergoing a total pancreatectomy because of trauma. Pancreas exocrine drainage was performed by enteric drainage in 4 patients and bladder drainage in 4 patients. Three patients required conversion from initial bladder drainage to enteric drainage due to urinary symptoms and duodenal leakage. Four patients required a relaparotomy due to hemorrhage, ureteral stricture, duodenal leakage, and venous thrombosis. There was no kidney graft loss, and 2 patients had pancreas graft loss because of venous thrombosis and new onset of type II diabetes mellitus. With a median follow-up of 76 months (range, 2-147 months), the death-censored graft survival rates for the pancreas were 85.7% at 1, 3, and 5 years and 42.9% at 10 years. The patient survival rate was 87.5% at 1, 3, 5, and 10 years. CONCLUSION: The long-term grafts and patient survival in the current series are comparable to previous studies. A successful pancreas transplant program can be established in a single small-volume institute. A meticulous surgical technique and early anticoagulation therapy are required for further improvement in the outcomes.
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Humanos , Constricción Patológica , Diabetes Mellitus , Drenaje , Estudios de Seguimiento , Supervivencia de Injerto , Hemorragia , Riñón , Corea (Geográfico) , Páncreas , Trasplante de Páncreas , Pancreatectomía , Estudios Retrospectivos , Tasa de Supervivencia , Trasplantes , Uréter , Vejiga Urinaria , Trombosis de la VenaRESUMEN
The remnant cystic duct or gallbladder neck calculus may rarely result in post-cholecystectomy Mirizzi syndrome. Various managements have been proposed for the treatment of post-cholecystectomy Mirizzi syndrome. Some previous cases of post-cholecystectomy Mirizzi syndrome have been managed with open cholecystectomy and endoscopically. We report a case of a laparoscopic stone removal of post-cholecystectomy Mirizzi syndrome that developed 7 months after laparoscopic cholecystectomy. To our knowledge, this is the first case of laparoscopic management of post-cholecystectomy Mirizzi syndrome. The mechanism, diagnosis and treatment of post-cholecystectomy Mirizzi syndrome are discussed.
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Cálculos , Colecistectomía , Colecistectomía Laparoscópica , Conducto Cístico , Vesícula Biliar , Cálculos Biliares , Síndrome de Mirizzi , CuelloRESUMEN
PURPOSE: The aim of this study was to investigate the clinicopathologic features and prognosis in patients with computed tomography (CT) findings of ascites, with a focus on the correlation with peritoneal carcinomatosis. METHODS: This study included a total of 157 patients who underwent surgery for advanced gastric cancer from 2003 to 2008 at the Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea, which were analyzed retrospectively. RESULTS: Fourteen patients (8.9%) presented ascites on their CT scan. Among them, 10 patients had peritoneal carcinomatosis, and showed significant difference with CT ascites positive group in the incidence of peritoneal carcinomatosis. The presence of CT ascites was significantly correlated with pathologic T stage, tumor size, histologic type, CT T and N stages, CT peritoneal nodularity and curability of surgery, statistically. The prognosis of CT ascites positive group was much poorer in the total advanced gastric cancer patients (P < 0.001), as well as in patients with pathologic T4 (P = 0.002). Also in patients without peritoneal carcinomatosis, CT ascites positive subgroup tended to have a worse prognosis than CT ascites negative subgroup (P = 0.086). Tumor size, CT T and N stages and the presence of CT peritoneal nodularity and ascites influenced the prognosis significantly; among which, if a tumor size larger than 5 cm, CT T4 stage and the presence of CT ascites were identified as independent prognostic factors. CONCLUSION: The presence of ascites was closely associated with peritoneal metastasis, and was the most significant independent prognostic factor in advanced gastric cancer in the present study.
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Humanos , Adenocarcinoma , Ascitis , Carcinoma , Corazón , Incidencia , Corea (Geográfico) , Metástasis de la Neoplasia , Pronóstico , Estómago , Neoplasias GástricasRESUMEN
BACKGROUNDS/AIMS: Bile duct injury is one of the potential severe complications that can occur during laparoscopic cholecystectomy, which can be cause by anatomic variations in the confluence of the bile duct. Recently magnetic resonance cholangiopancreatiocography (MRCP) has become a helpful tool to detect bile duct variation on a preoperative basis and to prevent bile duct injury during laparoscopic cholecystectomy, as well other hepatic surgeries. This study aimed to clarify the types of bile duct on MRCP and to search for a method of avoiding injury during laparoscopic cholecystectomy. METHODS: Between January 2009 and December 2010, 277 patients underwent laparoscopic cholecystectomy with preoperative MRCP in our institution. On a retrospective basis, the bile ducts were categorized into 5 types according to the Couinaud classification system. RESULTS: The proportion of types was revealed type A (70.4%), type B (8.7%), type C (19.5%), type D (0.7%), type E (0%), and type F (0.7%), respectively. Bile duct injury occurred in 4 cases (1.4%) during laparoscopic cholecystectomy. In particular, the possibility of aberrant extrahepatic confluence (Type C and F) represented the highest risk of duct injury (OR=11.89 [CI: 1.21-116.53]). CONCLUSIONS: Preoperative evaluation of the bile duct anatomy is important to avoid injury of duct during laparoscopic cholecystectomy. Specific types of bile duct variation should be considered as a high risk group for bile duct injury.
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Humanos , Bilis , Conductos Biliares , Colecistectomía , Colecistectomía Laparoscópica , Espectroscopía de Resonancia Magnética , Magnetismo , Imanes , Estudios RetrospectivosRESUMEN
Liver transplantation with preservation of the recipient vena cava (piggyback technique) has been performed as an alternative to the conventional method. Outflow disturbance or obstruction of the vena cava in the early period after liver transplantation is associated with high morbidity and mortality. We used side-to-side cavo-caval anastomosis (modified piggyback technique) in a deceased-donor liver transplantation (DDLT) for venous outflow reconstruction. On postoperative day 9, the patient developed abdominal discomfort, and abnormal liver function showing serum total bilirubin of 6.2 mg/dl and serum AST/ALT of 297/597 IU/L. Doppler ultrasound showed mono-phasic wave forms of the hepatic vein. Computed tomography showed focal narrowing of 9.5 mmx12 mm in diameter at the cavo-caval anastomosis site. Liver biopsy was showed that there was no evidence of acute allograft rejection. Direct venogram showed stenosis of the cavo-caval anastomosis with a pressure gradient of 12 mmHg. An interventional stent was inserted in the stenotic site of the inferior vena cava, and the pressure gradient decreased to 2 mmHg. He was discharged from hospital on postoperative day 23 without any other complications. Herein we report a case of deceased-donor liver transplantation using the modified piggyback technique, who received an inferior vena cava stent due to stricture of the reconstructed orifice of the vena cava.
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Humanos , Bilirrubina , Biopsia , Constricción Patológica , Venas Hepáticas , Hígado , Trasplante de Hígado , Rechazo en Psicología , Stents , Trasplante Homólogo , Vena Cava InferiorRESUMEN
An intra-abdominal cystic lymphangioma is a benign neoplasm that rarely occurs within the abdominal cavity. Intra-abdominal cystic lymphangioma is treated by a resection performed through a radical procedure. We report a case of a 37-year-old woman who had an asymptomatic mesenteric cyst that was discovered incidentally during a routine physical check-up. Treatment was completed without complications using a laparoscope.
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Adulto , Femenino , Humanos , Cavidad Abdominal , Laparoscopios , Linfangioma , Linfangioma Quístico , Quiste MesentéricoRESUMEN
BACKGROUND: Chronic allograft nephropathy (CAN), which causes graft failure, is related to tubular atrophy and interstitial fibrosis. E-cadherin is a well-known epithelial marker and heat shock protein (HSP)-47 is a collagen-specific molecular chaperone that regulates collagen synthesis. Transforming growth factor (TGF)-beta1, a profibrotic cytokine, downregulates E-cadherin and induces expression of mesenchymal markers in an in vitro model. C4d expression is considered a poor prognostic marker for graft survival. This study evaluated the relationship between the expression of E-cadherin, HSP47, TGF-beta1, and C4d with the prognosis for CAN. METHODS: Between March 1991 and August 2007, we performed renal allograft biopsies on 42 recipients with deteriorating renal function. CAN was diagnosed according to the chronic allograft damage index (Banff classification). Renal allograft biopsies were examined for the expression of E-cadherin, HSP47, TGF-beta1, or C4d by immunohistochemistry. The HSP47, TGF-beta1, and E-cadherin staining was scored semiquantitatively by analyzing ten different fields of cortical interstitium and tubules. Biopsies with endothelial C4d staining in peri-tubular capillaries (> or =25%) were designated as C4d-positive. RESULTS: Of 42 recipients, 17 (40.5%) were in the graft survival group (GS) and 25 (59.5%) were in the graft failure group (GF). E-cadherin expression in tubular cells of the GS was much higher than that of the GF (94.1% vs 52%, P=0.04). HSP47 expression in tubular cells and interstitium in the GF was much higher than that in the GS (84% vs 35.3%, P=0.001). TGF-beta1 expression in tubular cells and interstitium in the GF was much higher than that in the GS (72% vs 23.5%, P=0.02). CONCLUSIONS: E-cadherin, HSP47, and TGF-beta1 expression was strongly correlated with the CAN prognosis.
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Atrofia , Biopsia , Cadherinas , Capilares , Colágeno , Fibrosis , Supervivencia de Injerto , Proteínas de Choque Térmico , Calor , Proteínas del Choque Térmico HSP47 , Inmunohistoquímica , Chaperonas Moleculares , Pronóstico , Factor de Crecimiento Transformador beta1 , Factores de Crecimiento Transformadores , Trasplante Homólogo , TrasplantesRESUMEN
Paraduodenal pancreatitis (PP) is a rare, distinct form of chronic pancreatitis, and it is related to alcohol abuse in middle-aged men. A 36-year-old man with a history of chronic recurrent pancreatitis for 4 years and alcohol abuse for 15 years presented with abdominal pain. Computed tomography revealed a multilocular cystic mass 3.2 x 3 x 3 cm in size and it was located within the muscular layer of the duodenal wall. The cysts were lined by a single layer of eosinophilic cuboidal epithelial cells that stained positively for mucin (MUC)1, MUC6, cytokeratin (CK)7 and CK19 and they stained negatively for MUC2, MUC5AC and CK5/6. Mild, chronic inflammatory reaction around the cystic wall, Brunner's gland hyperplasia and several clusters of heterotopic pancreatic tissue were noted. We report here on a case of PP and we demonstrated that the pancreatitis was of pancreatic ductal cell origin according to the MUC and CK expression patterns we observed on the immunohistochemical analysis.
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Adulto , Humanos , Masculino , Dolor Abdominal , Alcoholismo , Eosinófilos , Células Epiteliales , Hiperplasia , Queratinas , Mucinas , Conductos Pancreáticos , Pancreatitis , Pancreatitis CrónicaRESUMEN
PURPOSE: Conventional three-port laparoscopic appendectomy (LA) is more commonly performed than transumbilical single port laparoscopic appendectomy (TUSPLA). In this report, we performed a prospective randomized study comparing the outcomes of LA and TUSPLA. METHODS: Between April 14, 2009 and June 10, 2009, 40 patients who required laparoscopic appendectomies were randomly selected to receive either a TUSPLA or a LA. None of these patients had perforation or abscess. Twenty of the patients received a LA and the other 20 received a TUSPLA. The clinical outcomes and visual analog pain scores (VAS) were compared between the groups. RESULTS: The TUSPLA procedures were performed successfully in every indicated patient. Clinical outcomes were similar in both study groups. The TUSPLA group showed a significantly higher VAS score 24 hours postoperatively than the LA group. CONCLUSION: Compared with LA, TUSPLA was technically feasible and safe in patients with non-complicated appendicitis. However, the patients in the TUSPLA group reported more postoperative pain than those in the LA group.
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Humanos , Absceso , Apendicectomía , Apendicitis , Dolor Postoperatorio , Estudios ProspectivosRESUMEN
PURPOSE: Hepatocellular carcinoma (HCC) shows various molecular and genetic alterations in its development and progression. Recently, microsatellite instability (MSI) and the loss of heterozygosity (LOH), have been postulated as useful prognostic factors in many malignant tumors. LOH is related to the allelic loss of various tumor suppressor genes, however, MSI has been found to be the result of a mismatched DNA pairing. Our objectives were to evaluate MSI and p53 gene LOH and to correlate this to clinicopathological factors. METHODS: MSI analysis was performed by using polymerase chain reaction with 5 microsatellite markers (BAT25, BAT26, D2S123, D5S346 and D17S250 recommended in the 1998 NCI International Workshop) on 50 surgically resected tumors. p53 LOH was detected with 4 markers (D17S796, TP53, D17S5, D17S513). RESULTS: MSI and p53 LOH were detected in 30% and 66%, respectively. 18% of HCCs exhibited MSI in 5 NCI-recommended markers and 18% of HCCs demonstrated MSI in 4 p53 markers. MSI was mostly detected in BAT25 and BAT26 markers. MSI was more frequently detected in tumor grade I, small HCC, and non-lymphovascular group. For the most part, p53 LOH was detected by D17S513 marker (38.1%). p53 LOH results were correlated with higher tumor grade and invasiveness. LOH-High group showed a significant correlation with advanced HCCs and lymphovascular invasion. There was no demonstrated correlation between MSI and p53 LOH was not demonstrated. CONCLUSION: These results suggest that MSI may be involved to some extent in hepatocarcinogenesis and tumor invasion. Also MSI and p53 gene LOH may be a useful clinical indicator in determining the prognosis among patients with HCC.
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Humanos , Carcinoma Hepatocelular , ADN , Genes p53 , Genes Supresores de Tumor , Pérdida de Heterocigocidad , Inestabilidad de Microsatélites , Repeticiones de Microsatélite , Reacción en Cadena de la Polimerasa , Pronóstico , SuccinimidasRESUMEN
Kaposi's sarcoma occurs in higher rates in the setting of immunosuppression, especially in patients with acquired immunodeficiency syndrome (AIDS), immunosuppressive therapy or posttransplantation, commonly involving the skin, visceral, oral cavity or respiratory tract. Of the de novo malignancies in transplantation patients, the incidence of Kaposi's sarcoma is increasing steadily. We report a case of a 37-year-old male patient who was diagnosed with Kaposi's sarcoma 16 years after his first renal transplantation and 5 months after his second transplantation. He presented with lymphoproliferative lesions in the mediastinum and supraclavicular area without showing any typical cutaneous lesions. Diagnosis was confirmed by gun biopsy of the enlarged axillary lymph nodes. Tacrolimus, the initial immunosuppressive drug, was tapered while sirolimus therapy and chemotherapy with vincristine was initiated. The enlarged lymph nodes decreased in size and the patient has been treated with vincristin and conversion of tacrolimus to sirolimus.
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Adulto , Humanos , Masculino , Síndrome de Inmunodeficiencia Adquirida , Biopsia , Terapia de Inmunosupresión , Incidencia , Trasplante de Riñón , Ganglios Linfáticos , Mediastino , Boca , Sistema Respiratorio , Sarcoma de Kaposi , Sirolimus , Piel , Tacrolimus , Trasplantes , VincristinaRESUMEN
PURPOSE: Laparoscopic appendectomy (LA) is now widely practiced in most medical centers, yet there is no consensus regarding the indications and advantages of LA over the conventional technique. Various reports have demonstrated conflicting results about the merit of LA. Especially, complicated appendicitis was initially considered as a contraindication for LA. However, with the improvements of laparoscopic instruments and the technical proficiency, the choice of the operative approach mostly depends on the surgeon's experience or the patient's preference. Here we compared the outcome of LA versus open appendectomy (OA) overall and specifically in the patients with complicated appendicitis. METHODS: From January 2007 to December 2007, the records of 495 patients with the diagnosis of appendicitis were retrieved from the computer database for analysis. All the patients had given informed consent for LA or the OA technique and the patients chose the operative method. The two groups were compared with respect to the patients' demographic data, the clinical outcomes, the cost and the type of pathology RESULTS: During the study period, 195 patients (39.4%) underwent LA and 300 patients (60.6%) underwent OA. There were 53 cases (27.1%) of complicated appendicitis and 105 cases each (35%) in the LA and OA groups, respectively. The patients of the LA group revealed a significant female prevalence, a shorter hospital stay, less use of analgesics, a lower complication rate and a higher cost (p<0.005), and also a comparable operation time to the OA group. As for the complicated appendicitis, there was benefit for only the hospital stay. CONCLUSION: Usually LA has more advantage than OA except cost. Even in complicated appendicitis, LA is feasible without increase of complication.
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Femenino , Humanos , Analgésicos , Apendicectomía , Apendicitis , Consenso , Imidazoles , Consentimiento Informado , Tiempo de Internación , Nitrocompuestos , PrevalenciaRESUMEN
BACKGROUND: New onset diabetes is a common complication after kidney transplantation. However, the clinical course of post-transplant diabetes mellitus (PTDM) remains unclear. The aim of the present study is to analyze the natural courses and risk factors of PTDM according to the time of onset. METHODS: A total of 216 consecutive kidney transplant recipients were enrolled and patient medical records were investigated retrospectively. PTDM was defined as glucose > or =126mg without previous diabetic history. Patients were classified according to the onset (12 months): early PTDM (E-PTDM) and late PTDM (L-PTDM). RESULTS: PTDM was observed in 34 (17.4%) patients. The number of E-PTDM and L-PTDM patients was 17 and 17. Compared with normoglycemic patients, the PTDM group was older and showed higher pre-transplant HbA1c level. The use of tacrolimus was associated with the development of E-PTDM (OR=4.87, 1.71~13.8 in 95% CI) but not L-PTDM (OR=0.34, 0.04~2.70 in 95% CI) CONCLUSIONS: The development of E-PTDM and L-PTDM may have different risk factors. It will be important to choose different therapeutic strategy according to the onset of PTDM.
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Humanos , Diabetes Mellitus , Glucosa , Riñón , Trasplante de Riñón , Registros Médicos , Estudios Retrospectivos , Factores de Riesgo , Tacrolimus , TrasplantesRESUMEN
Laparoscopic cholecystectomy has been widely performed as the gold standard for patients suffering with symptomatic gallstone disease. However, conversion to open cholecystectomy is a dilemma when the surgeon encounters a variant biliary anomaly. A gallbladder lying to the left of the round ligament represents a rare congenital anomaly, which is termed as a left-sided gallbladder. The true left-sided gallbladder, situated on the inferior aspect of the left lobe of the liver, is extremely rare and this represents a truly ectopic gallbladder that may developmentally arise as a second gallbladder from the left hepatic duct. This is accompanied by the disappearance of the normal gallbladder on the right side. We report here on 2 cases of left-sided gallbladder that were successfully treated with laparoscopic cholecystectomy at Hallym Medical Center. In both cases, the true left-sided gallbladders were identified intraoperatively. The round ligament was indeed located in its normal position, and the gallbladder was located to the left of the round ligament, which is a type of malposition known as sinistroposition. The operation was carried out in the usual manner with the trocars placed their usual location. Although operations can be carried out with using the standard port sites, a better arrangement for laparoscopic cholecystectomy consists of more medial positioning of the gallbladder-retracting port and placement of the right hand operating port to the left side of the round ligament.
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Humanos , Colecistectomía , Colecistectomía Laparoscópica , Decepción , Vesícula Biliar , Enfermedades de la Vesícula Biliar , Cálculos Biliares , Mano , Conducto Hepático Común , Hígado , Ligamento Redondo del Útero , Ligamentos Redondos , Estrés Psicológico , Instrumentos QuirúrgicosRESUMEN
BACKGROUND: Previous studies have shown that kidney transplant recipients' quality of life depend on compliance of treatment, family support, socioeconomic status. The purpose of this study was to determine whether estimated glomerular filtration rate (GFR) by Modification of Diet in Renal Disease (MDRD) study as a index of graft function influence recipients' quality of life including above mentioned factors. METHODS: One hundred and ten patients who visited out-patient department at least 3 months after kidney transplantation were included in this study. A structured questionnaire was used to collect data. This tool included; quality of life, compliance and family support scale as well as medical record review. The analysing of data was performed with SPSS version 11.5 (SPSS Inc. Chicago, IL, USA). RESULTS: The mean score of the recipients' quality of life (3.59/5), compliance (3.81/5), the support of family (4.02/5) and GFR (63 ml/min/1.73 m2) were revealed respectively. The quality of life was correlated with compliance (r=.260, P<.001) and family support (r=.377, P<.001) statistically. and compliance and family support also revealed correlation (r=.452, P<.001). Family support was the most explainable factor for the quality of life (R2=.142). however, the quality of life was not correlated with recipients' GFR (r=.013 P=0.819). CONCLUSIONS: Results of this study showed that kidney transplant recipients had a moderate quality of life. These findings suggest that emotional aspect like family support is as important as clinical factors such as GFR or compliance for recipients' quality of life. To optimize post-transplant quality of life, implication for interventional programming should be focused on family support.
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Humanos , Chicago , Adaptabilidad , Dieta , Tasa de Filtración Glomerular , Riñón , Trasplante de Riñón , Registros Médicos , Pacientes Ambulatorios , Calidad de Vida , Encuestas y Cuestionarios , Clase Social , TrasplantesRESUMEN
Simultaneous pancreas-kidney (SPK) transplantation is a well-established treatment for patients with insulin-dependent DM complicated by ESRD. The current shortage of cadaver donors and the increasing number of diabetic patients on the transplant waiting list has prompted the use of cadaveric organ from pediatric donors. But the lower age limit of the pancreatic donors has not yet been established. We report the successful result using a 10 years old donor for a 36-year-old SPK transplant recipient.
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Adulto , Niño , Humanos , Cadáver , Fallo Renal Crónico , Donantes de Tejidos , Trasplante , Listas de EsperaRESUMEN
PURPOSE: Hypoxia inducible factor-1 alpha (HIF-1 alpha) is induced in response to ischemic states and in turn activates transcription of several growth factors implicated in cell survival. These growth factors have been recognized as role players in the development of chronic allograft nephropathy (CAN). C4d depositions in the peritubular capillaries of renal allografts have been reported to be sensitive markers of acute humoral rejection. The purpose of this study was to determine the effects of HIF-1 alpha expression and C4d deposition in implantation biopsies of renal allografts. METHODS: Implantation biopsies and 22 rejection proven biopsies of 54 renal transplantation recipients (Male:Female=31:23) in Kangdong Sacred Heart Hospital from December 1996 to July 1999 were done. Immunohistochemical studies were performed using mouse monoclonal antibody (1:1000, Novus Biological Inc., Littleton, CO, USA) as the primary antibody and CSA (Catalyzed Signal Amplification System, Dako, Denmark) as the secondary antibody for HIF-1 alpha. Rabbit polyclonal antibody (1:200 Biogenesis, UK) and DAB kit (Dako) were used for C4d detection. Expression of HIF-1 alpha was defined as positive nuclei staining under 10 HPF (high power field) and C4d deposition was defined as 1+ when the pericapillary deposition was under 50% and 2+ when over 50% and 0 when there were no traces of depo sition. RESULTS: HIF-1 alpha was demonstrated in 19 cases (35%) of the 54 implantation biopsy cases. The expression of HIF-1 alpha was statistically higher in the deceased donor group compared to the living donor group. The HIF-1 alpha positive group had a longer mean cold ischemic time than the HIF-1 alpha negative group but was not statistically significant. The age of the donor and HIF-1 alpha expression showed no correlation. Expression of HIF-1 alpha of the implantation biopsies also showed no difference in the rejection group (n=22) compared to the non-rejection group (n=32). There was no significant difference of HIF-1 alpha expression in the graft loss group (n=7) and the graft functioning group (n=47). C4d deposition was detected in one implantation allograft biopsy (1.9%). The C4d positive patient developed acute accelerated rejection on the fourth postoperative day. HIF-1 alpha and C4d were demonstrated in 22 (100%) and 11 (50%) of the 22 rejection biopsies, respectively. In patients who showed rejection, HIF-1 alpha expression was significantly higher in the rejection biopsies compared to the implantation biopsy group. HIF-1 alpha expression of the patients who showed rejection within one month and those with rejection later than three months after engraftment showed no significant difference. CONCLUSION: Expression of HIF-1 alpha in implantation biopsies showed significant correlation with deceased kidney donors. The relation with cold ischemic time was not statistically proven but the HIF-1 alpha positive group showed a tendency of longer cold ischemic time. Biopsies from the renal allografts with rejection showed significantly higher expression of HIF-1 alpha compared to the implantation biopsies. The deposition rate of C4d was extremely low in implantation biopsies that we could not prove any relevance with acute rejection.
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Animales , Humanos , Ratones , Aloinjertos , Hipoxia , Biopsia , Capilares , Supervivencia Celular , Isquemia Fría , Corazón , Péptidos y Proteínas de Señalización Intercelular , Riñón , Trasplante de Riñón , Donadores Vivos , Biogénesis de Organelos , Donantes de Tejidos , TrasplantesRESUMEN
Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor's suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient's inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.
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Adulto , Humanos , Aneurisma Falso , Cadáver , Decepción , Selección de Donante , Urgencias Médicas , Arteria Hepática , Hemorragias Intracraneales , Laparotomía , Ligadura , Hepatopatías , Trasplante de Hígado , Hígado , Docilidad , Rotura , Situs Inversus , Donantes de Tejidos , Trasplantes , Vena Cava Inferior , VíscerasRESUMEN
PURPOSE: Xanthogranulomatous cholecystitis_(XGC) is an unusual and destructive inflammatory process of the gallbladder and it's characterized by severe proliferative fibrosis. XGC usually presents with features of chronic cholecystitis or acute cholecystitis, yet clinically, radiologically and macroscopically, XGC may be difficult to differentiate from gallbladder cancer. The purpose of our study was to evaluate the radiologic features of XGC and their correlation with the clinical, pathologic and surgical findings. METHODS: We performed retrospective analysis on 14 cases of XGCs that were operated on between March 1999 and December 2005. The clinical features, preoperative radiologic findings, operative findings and postoperative courses were reviewed. RESULTS: Fourteen cases of XGC were found among 1451 cases of cholecystectomy (0.96%). Mirizzi's syndrome was observed in 35.7% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic CT finding was hypodense intramural nodule like microabscess, and this was seen in 42.8% of the patients. The most characteristic sonographic finding was the presence of hypoechoic nodule in the gallbladder wall, and this was seen in 55.5% of the patients. 9 patients underwent open cholecystectomy including one case of T-tube choledocholithotomy. Four of five patients who underwent laparoscopic cholecystectomy required conversion to open surgery. A malignant lesion was suspected preoperatively in two cases, and both underwent frozen biopsy during surgery. CONCLUSIONS: Although the preoperative diagnosis of XGC is difficult, the presence of hypodense intramural nodule on CT or hypoechoic nodule in the gallbladder wall on sonography is highly suggestive of XGC. As XGC may resemble malignancy, differentiation is essential, via intraoperative frozen biopsy to deliver the optimal surgical treatment.