Leiomyoma of the left renal vein. A report of a case.

Only a few cases of leiomyoma of the vena cava or iliac vein and, according to our knowledge, only one case of renal vein leiomyoma have been reported. We report a patient with leiomyoma of the left renal vein. Tumour resection was performed by resecting a part of the vein along with the tumour and by ligation of the vein. Left kidney drainage was established through the preserved ovarian vein. In order to establish a diagnosis, careful pathologic examination of multiple sections has to be done and because of the potentially malignant behaviour, long-term follow-up after total resection is necessary.

Diagnosis and treatment of liver hydatid disease.

BACKGROUND/AIMS: Human echinococcosis is endemic in some areas of the world, including Mediterranean countries. The liver is the most frequent seat of echinococcosis, involved in about 70% of cases. Because there is still no effective medical therapy, surgery remains the treatment of choice. METHODOLOGY: Twenty-seven patients operated on for liver hydatid disease between 1990 and 1995 were analyzed and compared with results obtained from a study undertaken at our clinic between 1960 and 1988. RESULTS: The diagnosis was established by typical case history, clinical features and laboratory tests, of which imaging methods proved most informative. Radical procedures (total pericystectomy and liver resection) seem to be too aggressive for treatment. Marsupialization and drainage were mostly abandoned, because of high morbidity rates. CONCLUSIONS: Among surgical procedures used at our clinic, evacuation of the cyst with partial excision of the pericyst and omentoplasty resulted in the lowest morbidity and, thereupon, the shortest post-operative hospital stay and the best clinical results.

Duodenal obstruction from chronic pancreatitis.

The fibrosclerosing process of the pancreas in the chronic pancreatitis may constrict not only the pancreatic duct but also the bile duct, splenoportal venous system and duodenum. In our retrospective study we analysed 24 patients with duodenal obstruction associated with chronic pancreatitis. Duodenal obstruction was suspected whenever repeated vomiting occurred or large volumes of nasogastric aspirate were obtained. The diagnosis was confirmed by barium meal and endoscopic examination. Duodenal obstruction was relieved by gastrojejunostomy in eight patients, gastrojejunostomy and vagotomy in eight patients, gastroduodenostomy and vagotomy in two patients, vagotomy with Finney pyloroplasty in one patient, duodenoplasty with vagotomy in one patient and Whipple procedure in four patients. We concluded that vagotomy and gastroenterostomy are the procedures of choice. Bypass surgery is helpful to relieve the obstruction of the common bile duct and pancreatic duct. Whipple procedure should be reserved for the small duct form of chronic pancreatitis and for the cases in which there is high suspicion of malignancy.

[Outcome of 268 patients with pancreatic carcinoma treated surgically]. / Ergebnisse der chirurgischen Therapie bei 268 Patienten mit einem Pankreaskarzinom.

From January 1st 1987 to December 31st 2001, 268 patients (pts) with the diagnosis of pancreatic adenocarcinoma had undergone surgery at Surgical Clinic of University Hospital Rijeka. Pts were of both sexes: 154 males (57%) and 114 females (43%). The mean age of pts at the time of operation was 66 +/- 11.4 years. 36 pts (13.4%) underwent curative resection, while 198 pts (73.9%) underwent palliative operation. At 34 pts (12.7%) explorative laparotomy and biopsy were preformed. Overall 30-days postoperative mortality was 12.3% (33 pts). 44 pts (16.4%) developed postoperative complications. Mean overall survival after surgery was 5.8 months. Pts who underwent curative resection survived significantly longer (median 24.2 months) than pts with palliative surgery (median 5.4 months). 8 pts (2.98%) survived more than two years after surgery. Lymph node involvement, distant metastases and postoperative complications were predictors of significantly worse survival.

[Transhiatal esophagectomy for carcinoma of the esophagus--our ten years experience]. / 10-Jahres-Ergebnisse nach transhiataler Osophagektomie bei Osophaguskarzinomen.

During the past 10 years, at University Surgical Clinic Rijeka, 107 patients underwent operation for carcinoma of the esophagus and cardia. Transhiatal esophagectomy was performed in 29 patients; in 28 of them an esophagogastrostomy was performed, and in one patient a pharingogastrostomy. Of the 29 patients, there were 24 men (82.8 %) and 5 women (17.2 %), with an average age of 60.7 years. Histologically, 26 lesions (89.7 %) were squamous cell carcinomas, and 3 (10.3 %) were adenocarcinomas. According to the prognostic stage as defined by the UICC, 15 patients (51.7 %) were stage II A, and 14 (48.3 %) stage III. The lesion was located in the cervical esophagus in two, the thoracic esophagus in thirteen and the lower esophagus in fourteen patients. Six patients died, for a hospital mortality rate of 20.7 %; the most common cause of death was respiratory failure. Pulmonary complications occurred in 14 patients (48.3 %). Anastomotic leak with all clinical manifestations occurred in one patient, while in two patients the radiological diagnosis of anastomotic leakage was made without clinical manifestations. Five patients (17.2 %) developed anastomotic stenosis, which was satisfactory treated by endoscopic dilatation. Mean survival after surgery was 21 months. One-year survival was 65.5 %, two and three-year survival was 37.9 and 17.2 % respectively. Younger patients and patients with lower stage of disease survived significantly longer (p < 0.05).

[Portasystemic shunt--our twenty years experience]. / Portosystemische Shuntanlage--ein Rückblick nach 20 Jahren, Germany.

OBJECTIVE: It was the aim of this study to demonstrate our experiences over twenty years with portasystemic shunt surgery in patients with chronic liver disease and variceal bleeding. PATIENTS AND METHODS: From January 1 st, 1980 to December 31 st, 2000 we performed 90 portasystemic shunt operations (PSO). The patients were divided in two groups. The patients of the first group were operated upon between 1980-1988 (n = 58), patients of the second group (n = 32) between 1988-1998. Both groups did not differ in age, gender and cause of hepatic disease. In the first group the most performed type of shunt was the portacaval shunt, in group II the splenorenal shunt. RESULTS: We observed an improved early and late mortality rate, encephalopathy rate and reduction of recurrent variceal bleeding in the second group: the early mortality rate decreased from 16 to 9 % (p < 0.01), the late mortality rate from 35 to 6 % (p < 0.05), the encephalopathy rate from 43 to 12 % and the variceal rebleeding rate from 10 to 6 %. CONCLUSION: Selective shunts, such as the distal splenorenal shunt are significantly superior to the standard (end-to-side or side-to-side) portasystemic shunt. In countries where acute treatment of recurrent variceal hemorrhage with sclerotherapy is not available in remote areas or in countries where transplantation procedures are in the very beginning and where TIPPS operations are too expensive, portasystemic shunt operations are the only possibility to save the patients life when sclerotherapy fails.