THE ROLE OF SURGERY IN A PATIENT WITH CARCINOID SYNDROME, COMPLICATED BY CARCINOID HEART DISEASE.

A 55-year-old female patient was admitted for flushing and abdominal pain in the right upper quadrant. Her past medical history revealed high blood pressure and a recent echocardiography showed thickened appearance of tricuspid valve with coaptation defect and grade II tricuspid regurgitation. Contrast enhanced abdominal CT scan and MRI were subsequently performed and revealed a large macronodular liver mass, as well as other micronodular lesions disseminated in the liver parenchyma. CT guided biopsy from the main liver mass revealed neuroendocrine tumor of unknown origin (probably GI) with Ki-67 of 8%. Surgical exploration was decided. During laparotomy, the primary tumor was found in the proximal ileum and the patient underwent segmental enterectomy. Non-anatomical hepatectomy was also performed to remove the bulk of the tumor burden (more than 90%). Postoperative course was uneventful and the carcinoid syndrome relieved. At present, 15 months postoperatively, the patient is under treatment with somatostatin analogue for its antiproliferative effect, with good clinical, biochemical and tumoral control and stable heart disease. In patients with neuroendocrine liver metastases from unknown primary, surgical exploration could allow detection (and resection) of the primary tumor and surgical debulking of liver metastases to control carcinoid syndrome and carcinoid heart disease.

Metachronous Ampulla of Vater Carcinoma after Curative-Intent Surgery for Klatskin Tumor.

Resection represents the single hope for long-term survival in a patient diagnosed with a hilar cholangiocarcinoma (Klatskin tumor). However, the largest part of these patients develops a recurrent disease. Second metachronous periampullary cancers after a curative-intent surgery for a Klatskin tumor represent an exceptional pathology, and the management of these patients was poorly documented. Hereby, it is presented a 32-year-old patient with bile duct resection, left hemi-hepatectomy and loco-regional lymph nodes dissection, for a type IIIB Bismuth-Corlette Klatskin tumor, which, furthermore, 6 years later, underwent a pancreaticoduodenectomy for a metachronous carcinoma of the ampulla of Vater. The management and outcomes were discussed in the reported case, along with a literature review of the previously published patients. In conclusion, a metachronous periampullary carcinoma after resection of a Klatskin tumor should be distinguished from a loco-regional recurrent disease. While most of the patients with recurrences are suitable to only chemotherapy and or radiotherapy, a second curative-intent surgery (i.e., pancreaticoduodenectomy) is feasible in the largest part of the patients with a metachronous cancer, with good long-term outcomes.

Left-sided duplication of inferior vena cava: clinical implications in a patient with sigmoid adenocarcinoma.

Double inferior vena cava is a rare congenital anomaly, usually detected by computed tomography or magnetic resonance imaging. Although asymptomatic, it may have a clinical significance, as it may mimic a para-aortic lymphadenopaty. A case of left-sided duplication of the inferior vena cava in a patient with sigmoid colon cancer is presented. The diagnostic pitfalls and clinical implications are discussed. Accurate preoperative assessment of such an anatomical variant is of utmost importance, this way potentially life-threatening surgical complications, particularly when a minimally invasive approach is planned, are prevented.

Evaluation of health-related Internet use in Germany.

OBJECTIVE: An eHealth survey was conducted in a major Bavarian region in order to evaluate health-related Internet use in Germany. METHODS: A specific questionnaire was developed by the authors to collect sociodemographic data as well as data on general and health-related Internet use. This questionnaire was distributed to patients visiting medical practices in the above mentioned Bavarian region. RESULTS: Whereas many Internet users look for health-related information and products on the Internet, more advanced web-based techniques such as chat rooms and electronic patient records are hardly used. CONCLUSIONS: Although modern information technologies have the potential to enable citizens to handle their own health-related information in a self-determined and informed manner, at present the general population in Germany is hardly taking this opportunity.

[The hyperbaric method in the treatment of diabetic retinopathy, an alternative to laser therapy?]. / Metoda hiperbara în tratamentul retinopatiei diabetice, alternativa a terapiei cu laser?

The hyperbaric oxygen inhaled at the pressure od 2-3 atmospheres raises considerably the blood concentration of the gas, which becomes sufficient for tissular needs sometimes without soliciting hemoglobin intervention. This makes possible the survival of some tissues insufficiently supplied with blood. We forecast therapeutical indications in diabetic retinopathy, hypertensive retinopathy, retinal venous obstructions, Eales disease. In proliferative diabetic retinopathy the hyperbaric oxygen might substitute the laser therapy.

The hemolysin/bacteriocin produced by enterococci is a marker of pathogenicity.

The hemolysin/bacteriocin produced by some strains of Enterococcus faecalis is active in the lysis of human, rabbit, and horse erythrocytes, but not those from sheep. In this study, we determined that 20% of clinical enterococcal isolates tested in the clinical microbiology laboratory produced hemolysin and that pathogenic human E. faecalis were more likely to be hemolysin-producing isolates. Among the organisms isolated from different anatomic sites, variability in the degree of hemolysin production existed. We used an isogenic pair of E. faecalis organisms to demonstrate that hemolysin production was due to a hemolysin/bacteriocin determinant transmissible by a plasmid and was not strain dependent. This determinant may be linked to antibiotic resistance genes in some instances. Also, the erythrocyte lysis occurred only when hemolysin was in the presence of E. faecalis organisms, suggesting a bacterial cell dependency for activity of the hemolysin.

Relationship between the lead concentration in hair and occupational exposure.

The lead content of hair in workers occupationally exposed was correlated with the blood lead concentration. Determinations of lead in blood and hair were performed by electrothermal atomic absorption spectrophotometry in two exposed groups and a control group. A significant correlation was observed between the blood lead and hair lead concentrations, and a regression analysis showed an exponential accumulation of the lead content in hair, simultaneously with the increase of the values in blood. The colour of the hair and the age of the subject did not influence the lead accumulation in hair in the occupationally exposed subjects. The assessment of lead in hair is considered a useful screening test in estimating occupational exposure.