Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 588
Filtrar
1.
Khirurgiia (Mosk) ; (3): 56-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271738

RESUMO

OBJECTIVE: To analyze the results of surgical treatment of acute calculous cholecystitis depending on dates of surgery. MATERIAL AND METHODS: There were 123 patients with acute calculous cholecystitis in 2017. The sample enrolled 111 females (90.2%) and 12 (9.8%) males. Mean age of patients was 63.4±5.7 years. Patients were divided into 4 groups depending on dates of surgery. Group A - 18 (16.2%) patients with destructive forms of cholecystitis. These patients underwent surgery after a short preoperative preparation. Group B comprised of 32 patients (28.8%) who were operated within 72 hours. Group C enrolled 34 patients (30.7%). These patients underwent operation within 7-12 days after clinical manifestation of disease. Group D enrolled 27 patients (24.3%). Delayed surgical strategy was applied in this group. Surgical treatment was scheduled 2-3 months later. Duration of surgery, intraoperative technical features, length of hospital-stay and postoperative morbidity were studied. RESULTS: Similar outcomes were observed in groups A and B. Group B was characterized by less duration of surgery and hospital-stay. The most significant technical difficulties arose in group C. The best results were achieved in group D. CONCLUSION: Surgical treatment of acute calculous cholecystitis within 72 hours after clinical manifestation is the most preferable. However, surgical treatment should be performed in few months if medication is effective.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Colecistolitíase/cirurgia , Tempo para o Tratamento , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
2.
BMC Surg ; 19(1): 183, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783817

RESUMO

BACKGROUND: The cystic duct has been included in the staging classification scheme for gallbladder cancer since the 2010 publication of the AJCC Cancer Staging Manual (7th edition). To our knowledge, only seven other cases of adenocarcinoma arising in the remnant cystic duct following cholecystectomy have been reported in the English-language literature, and none has been reported as primary early-stage T1b remnant cystic duct cancer (CDC). We report, herein, a case of primary adenocarcinoma arising in the remnant cystic duct in a patient with history of laparoscopic cholecystectomy for gallstone disease. CASE PRESENTATION: An 81-year-old female presented with abdominal pain. Her medical history included a laparoscopic cholecystectomy for cholecystolithiasis two years prior. Jaundice was observed; imaging studies suggested that this was caused by choledocholithiasis. Blood chemistry findings showed severe liver dysfunction. Endoscopic retrograde cholangiography revealed haemobilia from the common bile duct with no evidence of choledocholithiasis. A bile sample showed Papanicolaou class IV cytology. As the extent of tumour spread was undetermined by abdominal ultrasonography and endoscopic ultrasonography, peroral cholangioscopy (POCS) was performed, which revealed tiny papillary lesions within the confluence of cystic duct, and fine granular lesions in the centre of bile ducts, signifying early-stage remnant CDC. Extrahepatic bile duct resection with regional lymphadenectomy was done. Histopathological findings revealed a 42-mm tubular adenocarcinoma originating from the remnant cystic duct with the considerable shallow spread across the extrahepatic bile ducts. It invaded the fibromuscular layer, with no lymphovascular or perineural invasion, no lymph node metastasis (13 nodes examined), and uninvolved surgical resection margin (R0 resection), and was staged as pT1bN0M0, Stage I. CONCLUSIONS: Primary early-stage T1b remnant CDC is an uncommon condition for which early diagnosis is challenging; if intraoperatively recognized, it can complicate surgery. Our experience of this case and an overview of the English literature suggest that POCS is an efficient tool to diagnosis this tumour and assess its spread along the extrahepatic bile ducts.


Assuntos
Adenocarcinoma/diagnóstico , Colecistectomia Laparoscópica/métodos , Neoplasias da Vesícula Biliar/diagnóstico , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Ductos Biliares Extra-Hepáticos/patologia , Colangiografia , Colecistolitíase/cirurgia , Coledocolitíase/cirurgia , Ducto Colédoco , Ducto Cístico/patologia , Feminino , Humanos , Excisão de Linfonodo
3.
J Laparoendosc Adv Surg Tech A ; 29(12): 1539-1543, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31647359

RESUMO

Aim: This study aims to analyze the efficacy and safety of the combination of laparoscope and preoperative (PODL) or intraoperative (IODL) duodenoscope in the treatment of cholecystolithiasis with choledocholithiasis. Materials and Methods: From January 2015 to February 2017, 51 patients with cholecystolithiasis and choledocholithiasis, who were treated with the PODL (n = 29) or IODL (n = 22), were reviewed retrospectively. The efficacy and safety were evaluated and compared between these two groups. Results: The success rates were 100% in IODL group and 96.6% in PODL group. There was no statistical significance in the difference of stone clearance rate and residual stone rate between two groups (P > .05). There were no significant differences in complications, like aspiration, gastrointestinal perforation, and acute cholangitis between two groups (P > .05). IODL significantly decreased numeric rating scale (NRS) scoring, reduced surgery cost and shortened hospitalization time compared to that of PODL group (P < .05). No cholangitis, reoccurrence of stones or biliary obstruction occurred in all 51 patients. Conclusion: In this retrospective study, IODL was found superior to PODL. And the IODL can significantly decrease NRS scoring, reduce surgery cost and shorten hospitalization time.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/métodos , Colecistolitíase/cirurgia , Coledocolitíase/cirurgia , Duodenoscopia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esfinterotomia Endoscópica
4.
BMC Pregnancy Childbirth ; 19(1): 382, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653246

RESUMO

BACKGROUND: Diagnosis and management of non-obstetric abdominal pathologies during pregnancy are clinically challenging for both obstetricians and general surgeons. Our aim was to evaluate the outcome of pregnant patients who had undergone non-obstetric abdominal surgery. METHODS: We retrospectively reviewed 76 pregnant patients who had required surgery for non-obstetric abdominal pathologies during pregnancy at our department from January 2005 to December 2015. Data were collected retrospectively from medical records as well as from our institutional perinatal database. We evaluated data for clinical presentation, perioperative management, preterm labor, and maternal and fetal outcomes. RESULTS: The patients' mean age was 29 (interquartile range IQR 25-33) years. Indications for surgery were acute appendicitis in 63%, adnexal pathology in 11%, cholecystolithiasis in 5% and other indications in 21%; surgery was performed in an elective setting in 18% and in an emergent/urgent setting in 82%. In five cases, complications, three of them oncological, called for further surgery. Ninety-seven percent of operations were conducted under general anesthesia. Median skin-to-skin time was 50 (37-80) minutes, median in-hospital stay was 4 (3.5-6) days, and 5 % required postoperative intensive care. Preterm labor occurred in 15%, miscarriage in 7% (none of them directly related to abdominal surgery). CONCLUSION: Abdominal surgery for non-obstetric pathology during pregnancy can be performed safely, if mandatory, without increases in maternal and fetal pathology, miscarriage, and preterm birth rates.


Assuntos
Abdome/cirurgia , Complicações na Gravidez/cirurgia , Cuidado Pré-Natal/estatística & dados numéricos , Aborto Espontâneo/etiologia , Doença Aguda , Doenças dos Anexos/cirurgia , Adulto , Apendicite/cirurgia , Colecistolitíase/cirurgia , Feminino , Humanos , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Cuidado Pré-Natal/métodos , Estudos Retrospectivos , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (7): 36-41, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355812

RESUMO

OBJECTIVE: To present a modified technique of laparoscopic surgery (Rendezvous technique) for cholecystocholedocholithiasis. MATERIAL AND METHODS: There were 41 patients with cholecystocholedocholithiasis who underwent hybrid single-stage laparoscopic surgery (Rendezvous technique) as an alternative to conventional two-stage approach. RESULTS: Two (4.8%) patients had elevated serum amylase level without signs of pancreatitis in postoperative period. Other 2 patients required redo transpapillary intervention due to residual stones. Laparoscopic interventions were successful in 95.2% of cases.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistolitíase/cirurgia , Coledocolitíase/cirurgia , Humanos
8.
J Laparoendosc Adv Surg Tech A ; 29(9): 1116-1121, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31329021

RESUMO

Objective: This study was aimed to evaluate the correlation between clinically significant portal hypertension (CSPH) and postoperative complications and risk predictors of postoperative complications. Methods: The retrospective study was conducted to identify the effect. The cirrhotic patients were divided into two groups, those with or without CSPH. The intraoperative and postoperative conditions were evaluated. Multivariate logistic regression analysis was performed to identify potential risk predictors for postoperative complications in cirrhotic patients with CSPH. Results: The cirrhotic patients with CSPH who underwent laparoscopic cholecystectomy (LC) had postoperative hospitalization than the patients without CSPH. However, the incidence of postoperative complications between two groups showed no significant difference. The results of multivariate analysis showed that male, gallbladder wall >3 mm, size of stones ≥1 cm, scores of Model for end-stage liver disease (MELD) ≥10, and operation time >60 minutes were the potential risk predictors for postoperative complications. Conclusions: CSPH did not increase the incidence of postoperative complications in cirrhotic patients who underwent LC, but increased conversion rate and prolonged postoperative hospitalization. Furthermore, our study showed that gender, sizes of gallbladder wall and stones, scores of MELD, and operation time were the important postoperative risk predictors for cirrhotic patients with CSPH.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistolitíase/cirurgia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , China/epidemiologia , Colecistolitíase/etiologia , Feminino , Humanos , Incidência , Cirrose Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
9.
BMC Surg ; 19(1): 48, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088424

RESUMO

BACKGROUND: Performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate. However, the value of prophylactic cholecystectomy performed during gastric cancer surgery is still being debated. METHODS: We carried out a retrospective study on patients with gastric cancer who underwent subtotal or total gastrectomy, with preservation of the gallbladder or simultaneous cholecystectomy from January 2010 to March 2018. RESULTS: Cholecystolithiasis occurred in 152 of 1691 (8.98%) patients after gastric cancer surgery, with 45 (2.67%) patients undergoing subsequent cholecystectomy. Postoperative body mass index (BMI) decrease > 5% in 3 months was an independent risk factor for cholecystolithiasis [BMI decrease > 5%/≤5%: OR (95%CI): 1.812 (1.225-2.681), p = 0.003). Gastrectomy method and diabetes mellitus were independent risk factors for both cholecystolithiasis [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 1.801 (1.097-2.959), p = 0.002; diabetes mellitus (yes/no): OR (95%CI): 1.544 (1.030-2.316), p = 0.036] and subsequent cholecystectomy [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 5.432 (1.309-22.539), p = 0.020; diabetes mellitus (yes/no): OR (95%CI): 2.136 (1.106-4.125), p = 0.024]. Simultaneous cholecystectomy was performed in 62 of 1753 (3.5%) patients. The mortality and morbidity rates did not differ significantly between the combined surgery group and the gastrectomy only group (8.1% vs. 8.9 and 1.6% vs. 2.2%, respectively, p > 0.05). CONCLUSIONS: Prophylactic cholecystectomy may be necessary in gastric cancer patients without Billroth I gastrectomy and with diabetes mellitus. Simultaneous cholecystectomy during gastric cancer surgery does not increase the postoperative mortality and morbidity rates.


Assuntos
Colecistectomia , Colecistolitíase/prevenção & controle , Gastrectomia , Procedimentos Cirúrgicos Profiláticos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Complicações do Diabetes , Feminino , Gastrectomia/métodos , Gastroenterostomia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
10.
Khirurgiia (Mosk) ; (2): 32-39, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30855588

RESUMO

AIM: To develop rational tactics of surgical treatment of patients with acute calculous cholecystitis with their subsequent discharge within 1 day since admission. MATERIAL AND METHODS: There were 283 patients with acute cholecystitis and 58 patients with chronic cholecystitis. All patients underwent laparoscopic cholecystectomy. Patients with acute cholecystitis were divided into 2 groups: main group - 136 patients were discharged within 1 day since admission, control group - 147 patients who were discharged later. Age, gender, duration of attack and ASA score were similar in both groups. RESULTS: Incidence of intraoperative complications was significantly higher in the control group compared with the main group (6.1% vs. 0.7%). There were no postoperative complications in the main group; postoperative morbidity in the control group was 6.1%. Criteria preventing discharge within 1 day since admission were developed. Uneventful early postoperative period after laparoscopic cholecystectomy allows us to discharge 48% of patients with uncomplicated acute calculous cholecystitis within 1 day since hospitalization. The developed algorithm of treatment is followed by reduced hospital-stay by 4 days. CONCLUSION: The developed algorithm of treatment of patients with acute calculous cholecystitis can reduce hospital-stay up to 1 day. Favorable early postoperative period and follow-up of patients after discharge are essential for safe treatment.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Colecistolitíase/cirurgia , Algoritmos , Humanos , Tempo de Internação , Resultado do Tratamento
12.
Rev Esp Enferm Dig ; 111(3): 176-181, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30507246

RESUMO

BACKGROUND: there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. METHODS: a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. RESULTS: the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. CONCLUSIONS: the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/métodos , Colecistolitíase/cirurgia , Coledocolitíase/cirurgia , Esfinterotomia Endoscópica/métodos , Idoso de 80 Anos ou mais , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Colecistectomia Laparoscópica/efeitos adversos , Colecistolitíase/complicações , Coledocolitíase/complicações , Ducto Colédoco/cirurgia , Feminino , Humanos , Laparoscopia , Tempo de Internação , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Esfinterotomia Endoscópica/efeitos adversos
13.
Surg Laparosc Endosc Percutan Tech ; 29(4): 290-296, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30570538

RESUMO

A 59-year-old asymptomatic man underwent ultrasonography, which revealed gallstones and thickened gallbladder wall. Abdominal computed tomography (CT) showed a slightly swollen bilocular gallbladder and a soft tissue mass in the fundus site. Segmental adenomyomatosis (ADM) was suspected because numerous fundic cystic lesions were seen on magnetic resonance imaging. Endoscopic ultrasonography revealed numerous Rokitansky-Aschoff sinuses (RAS) and a papillary soft tissue shadow surrounded with irregular and remarkably thickened fundic gallbladder wall. Fluoro-2-deoxy-D-glucose-positron emission tomography/CT demonstrated slightly increased fluoro-2-deoxy-D-glucose uptake in the corresponding lesion. Surgery was performed under a diagnosis of gallbladder carcinoma (GBC) with concomitant ADM, and histopathology revealed a 30-mm papillotubular adenocarcinoma extending from the gallbladder body to fundus with invasion into the subserosa. Numerous RAS were present throughout the gallbladder showing various degrees of dysplasia. Ki67 and p53-labeling index (LI) was significantly higher in the dysplastic epithelium compared with normal fundic epithelium. p53-LI was also markedly increased (72.1%) in tissue in front of tumor invasion. Interestingly, these hyperproliferation indicators were extremely high (Ki67-LI: 28.8%; p53-LI: 91.9%) in RAS with low-grade dysplasia even in the gallbladder neck. Although, generally, tumors do not develop in the gallbladder neck with segmental ADM, our results suggest that a gallbladder with ADM has potential for carcinogenesis regardless of location, with segmental ADM. On the basis of histopathology, our patient was diagnosed with GBC arising from RAS with multicentric and multistep growth. A relationship between GBC and ADM, especially segmental ADM, has been suggested but remains controversial. Our experience is very suggestive of carcinogenesis developing from ADM.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenomiose/diagnóstico por imagem , Colecistectomia/métodos , Colecistolitíase/diagnóstico por imagem , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenomiose/patologia , Biópsia por Agulha , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistolitíase/patologia , Colecistolitíase/cirurgia , Diagnóstico Diferencial , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Hiperplasia/patologia , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Ultrassonografia Doppler/métodos
14.
Neuromodulation ; 22(5): 546-554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30277014

RESUMO

BACKGROUND: Postsurgical gastrointestinal disturbance is clinically characterized by the delayed passage of flatus and stool, delayed resumption of oral feeding, dyspepsia symptoms, and postsurgical pain. This study was designed 1) to evaluate the effects of needleless transcutaneous neuromodulation (TN) on postoperative recovery; 2) to investigate mechanisms of the TN involving autonomic functions in postoperative patients after removal of the gallbladder. METHODS: Sixty patients scheduled for laparoscopic cholecystectomy (LC) were randomized to TN (n = 30) and sham-TN (n = 30). TN was performed via acupoints ST36 and PC6 for 30 min twice daily from 24 hours before surgery to 72 hours after surgery. Sham-TN was performed using the same parameters at nonacupoints. RESULTS: 1) Compared to sham-TN, TN shortened time to first flatulence (38.9 ± 4.0 vs. 24.9 ± 2.4 hour, p = 0.004) and time to defecation (63.1 ± 4.5 vs. 42.5 ± 3.1 hour, p < 0.001). 2) Compared to sham-TN, TN increased the percentage of normal pace-making activity (66.2 ± 2.2 vs. 73.8 ± 2.3%, p = 0.018). 3) TN enhanced vagal activity. Compared to that 24 hours before surgery, surgery decreased vagal activity (HF) (0.41 ± 0.02 vs. 0.34 ± 0.02, p = 0.043) 3 hours after the operation. Compared to sham-TN, TN increased HF (0.45 ± 0.02 vs. 0.52 ± 0.02, p = 0.045) 72 hours after the operation. Further, HF was negatively correlated with time to defecation and serum norepinephrine. 4) Surgery increased serum IL-6 (1.1 ± 0.1 before surgery vs. 2.9 ± 0.7 pg/mL, p = 0.041) 72 hours after the operation, which was reduced to baseline by TN (0.9 ± 0.1). CONCLUSIONS: In conclusion, the proposed needleless TN accelerates postoperative recovery after LC, possibly mediated via the autonomic and immune-cytokine mechanisms. Needleless and self-administrable TN may be an easy-to-implement and low-cost complementary therapy for postoperative recovery.


Assuntos
Colecistolitíase/sangue , Colecistolitíase/terapia , Citocinas/sangue , Cuidados Pós-Operatórios/tendências , Recuperação de Função Fisiológica/fisiologia , Estimulação Elétrica Nervosa Transcutânea/tendências , Sistema Nervoso Autônomo/imunologia , Sistema Nervoso Autônomo/metabolismo , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/tendências , Colecistolitíase/imunologia , Citocinas/imunologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estimulação Elétrica Nervosa Transcutânea/métodos
16.
JNMA J Nepal Med Assoc ; 57(220): 464-466, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32335664

RESUMO

The thoracic kidney is the rarest form of an ectopic kidney that usually present on the left thorax and twice more common in males. No case has been reported from Nepal and very few cases are reported worldwide. We report a 24 years-old female with right thoracic kidney with Bochdalek hernia diagnosed incidentally. We have included clinico-radiological and surgical findings of the case with a review of the literature. Keywords: Bochdalek hernia; ectopic kidney; thoracic kidney.


Assuntos
Colecistectomia Laparoscópica , Colecistite/diagnóstico por imagem , Colecistolitíase/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Herniorrafia , Achados Incidentais , Rim/anormalidades , Anormalidades Urogenitais/diagnóstico por imagem , Adulto , Colecistite/complicações , Colecistite/cirurgia , Colecistolitíase/complicações , Colecistolitíase/cirurgia , Feminino , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Tórax , Tomografia Computadorizada por Raios X , Ultrassonografia , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia
17.
Medicine (Baltimore) ; 97(51): e13588, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572463

RESUMO

RATIONALE: Hemolysis induced by high dose ascorbic acid (AA) in patients with G6PD deficiency has been reported, but is rare. To our knowledge, this is the first reported case of a male with G6PD deficiency, coexpressed with cholecystolithiasis and cholecystitis, who developed extreme hemolysis and hyperbilirubinemia after receiving pharmacological doses ascorbic acid infusion. PATIENT CONCERNS: A 27-year-old man history with glucose-6-phosphate dehydrogenase deficiency was admitted to our hospital because of cholecystolithiasis and cholecystitis. He appeared with scleral jaundice and very deep colored urine after receiving pharmacological doses ascorbic acid infusion. DIAGNOSES: Clinical findings when combined with his medical history and various laboratory results confirmed the diagnosis as hemolysis and hyperbilirubinemia induced by ascorbic acid. INTERVENTIONS: The patient was treated with steroids, hepatoprotective drugs, and folic acid in addition avoidance of agents with known hemolysis risk (such as vitamin C). OUTCOMES: As a result, the patient's symptoms from hemolytic jaundice improved, hemoglobin remained stable, and the patient was discharged 11 days later. LESSONS: Clinicians should bear in mind the possibility that vitamin C exposure may result in hemolysis in patients with G6PD deficiency, especially in those with known severe disease.


Assuntos
Ácido Ascórbico/efeitos adversos , Deficiência de Glucosefosfato Desidrogenase/tratamento farmacológico , Icterícia/induzido quimicamente , Adulto , Colecistite/congênito , Colecistolitíase/congênito , Deficiência de Glucosefosfato Desidrogenase/complicações , Humanos , Hiperbilirrubinemia/induzido quimicamente , Masculino
18.
Medicine (Baltimore) ; 97(39): e12549, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278551

RESUMO

RATIONALE: Sarcomatous intrahepatic cholangiocarcinoma is a rare histological variant of cholangiocarcinoma (ICC). Previous medical literature has not mentioned the prevalence of this kind of disease, but a poorer prognosis than that of ordinary ICC was indicated. The diagnosis of the sarcomatous ICC is established on histopathological and immunohistochemical examinations. In this article, we present a new case of a patient with sarcomatous ICC who had no radiographic sign of intrahepatic tumor preoperatively. PATIENT CONCERNS: A 63-year-old man was noted with cholecystolithiasis and right upper abdominal pain. Liver function was within normal limits, although the gamma-glutamyl transpeptidase level was elevated. Serum carbohydrate antigen 19-9 level was elevated. Radiography showed atrophy of the left lobe of the liver, high-intensity signals on T1 weighted images, and low/high-intensity signals on T2 weighted images in hepatic ducts. DIAGNOSES: The preoperative diagnoses were hepatolithiasis, choledocholithiasis, and cholecystolithiasis. INTERVENTIONS: Exploratory laparotomy, adhesion release, cholecystectomy, choledocholithotomy, and T tube drainage were performed. During the surgery, an ill-defined tumor was detected on the atrophic left lateral lobe of the liver. Hepatic left lateral lobectomy was performed to remove the mass. OUTCOMES: The final diagnosis of sarcomatous ICC was made by histopathology after surgery. No evidence of local recurrence or distant metastasis was noted on imaging during follow-up. LESSONS: Although rare, sarcomatous ICC does exist in patients presented with cholecystolithiasis and liver atrophy. Surgeons should be aware of the existence of sarcomatous ICC due to the poor prognosis. We recommend that multidisciplinary approaches may be key to improve prognosis, including adjuvant chemotherapy or radiotherapy.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Colecistectomia/métodos , Hepatectomia/métodos , Fígado , Atrofia/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/fisiopatologia , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/patologia , Colangiocarcinoma/fisiopatologia , Colangiocarcinoma/cirurgia , Colecistolitíase/diagnóstico , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Prognóstico
20.
Surg Laparosc Endosc Percutan Tech ; 28(5): 324-327, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30074528

RESUMO

Common bile duct (CBD) suturing is a difficult procedure in laparoscopic CBD exploration. We sought to develop a simpler CBD suture technique using running barbed sutures. We retrospectively compared 2 suture techniques for CBD closure after T-tube placement. The barbed group comprised of 46 patients who underwent CBD closure using running barbed sutures, whereas the standard group comprised of 39 patients who received interrupted sutures. Mean CBD suturing time (6.2±0.9 vs. 12.2±1.1 min; P<0.001), total operating time (79.7±9.4 vs. 90.8±12.4 min; P<0.001), and hospital stay (6.1±1.8 vs. 7.0±1.7 d; P=0.024) were significantly shorter and less patients experienced leakage after T-tube flushing (P=0.041) with the barbed suture technique. There were 2 cases of postoperative bile leakage in the standard group, with no statistical significance. The running barbed suture technique is safe and effective for CBD closure, which can decrease operating time and risk of complications.


Assuntos
Colecistolitíase/cirurgia , Ducto Colédoco/cirurgia , Laparoscopia/métodos , Suturas , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA