Catheter seeding of hepatocellular carcinoma following placement of a total implantable access port system.

A 61-year-old cirrhotic patient underwent hepatic resection for hepatocellular carcinoma and placement of a total implantable access port system in the hepatic artery for chemotherapy infusion. A year later, he developed a parietal metastasis at the port site as a consequence of tumor seeding along the arterial catheter. The metastasis was excised but the patient died because of disseminated disease two years after the first operation. Tumor seeding along the catheter should be included in the group of potential complications after placement of total implantable access port systems for intrahepatic chemotherapy The possible causes of this rare but life-threatening complication are discussed.

[The effect of the administration of an amino acid solution containing acetate on the calcium balance in surgical patients]. / Effetto della somministrazione di una soluzione di aminoacidi contenente acetato sul bilancio del calcio in pazienti chirurgici.

A frequent trouble in total parenteral nutrition is the occurrence of a negative calcium balance, due to reduction of calcium tubular reabsorption in acidosis. This condition could depend on acid metabolites raise, coming from degradation of nutritional amino acid mixtures. Authors have evaluated the effect of acetates addition to amino acid solutions on calcium balance. In fact the bicarbonate excess could reduce calcium urinary excretion. Thirty surgical patients have been treated. They were randomized according to acetates presence or absence in the administered solutions. In the acetate-treated group authors noted a raise in plasma bicarbonate and pH and a reduction in urinary calcium excretion. Adding acetates to amino acidic mixtures could reduce in total parenteral nutrition the risk of hypercalciuria and its related complications.

Internal mammary blood supply for ileo-colon interposition in esophagogastroplasty: a case report.

We report on a clinical case where microsurgical techniques successfully supported traditional surgery in a wide reconstruction between the oropharynx and small bowel. Several years ago, the patient sustained a severe corrosive injury of the upper digestive tract with subsequent esophageal stricture and stiffening; at that time, an emergency gastrectomy was performed. In this case, the restoration of the defect could not rely on the classic colonic interposition. During the operation the ileo-colic flap, well-fitted for tension-free reconstruction, revealed the foreseen inadequacy of its vascularization based on the sole middle colic vascular pedicle. The blood supply to its proximal part was then increased by microanastomosis between the right internal mammary and ileo-colic vessels. The revascularization ensured the viability of the interposed tissue. Oral intake resumed after 3 weeks; nowadays the patient is able to maintain her ideal weight with adequate nutrition.