Gallstone ileus of the sigmoid colon: a rare complication of cholelithiasis.

The authors report a case of gallstone ileus of the sigmoid colon in an 80-year-old woman admitted to the hospital with symptoms and signs of large bowel obstruction and asymptomatic cholelithiasis. Radiological investigation (abdominal X-ray and CT scan) showed a large gallstone impacted in the sigmoid colon. At first, the patient was managed conservatively, but the recurrence of the intestinal obstruction required open cholecystectomy, suturing of the colonic fistula and sigmoidectomy.

Reduced mobilisation of hematopoietic stem cells after hepatic resection for malignant liver disease.

Recent studies have demonstrated that hematopoietic stem cells (HSCs) can mobilize following liver resection, thus contributing to the repair of hepatic damage. Aim of this study has been to determine whether the nature of the hepatic lesion (benign vs. malignant disease) can give rise to a different degree of mobilisation of HSCs. Two groups of patients were selected: the first included seven patients undergoing hepatic resection (five major and two minor) for a benign liver disease (focal nodular hyperplasia, hemangioma cavernosa, angioma, biliary adenofibroma) and the second included seven patients undergoing hepatic resection (five major and two minor) for a malignant (either primary or secondary) liver disease. White blood cell count and CD34+ (percentage and total number) at time T(0) (basal value before surgery) and at time T(1) (value on the sixth-eighth day after surgery) have been evaluated by standard methods. In the group undergoing hepatic resection for a benign liver disease, a significant increase of CD34+ cells, both in percentage (0.082 +/- 0.043 vs. 0.048 +/- 0,026, p = 0.041) and in absolute number (8.14 +/- 5.95 vs. 3.26 +/- 2.63, p = 0.018) have been documented, as opposed to the group of patients affected with a malignant liver disease, where no significant variation has been observed (CD34+ %: 0.044 +/- 0.033 vs. 0.041 +/- 0.031, p: n.s.; CD34+ total number: 3.52 +/- 2.56 vs. 2.27 +/- 2.01, p = n.s.) These results show a different bone marrow response to the surgical liver resection depending on the nature of the lesion, thus emphasizing a reduced mobilisation of HSCs in the malignant diseases. Since it has been documented that the type of the hepatic lesion can induce a different regenerative response, it has to be explained how the neoplastic lesions can negatively influence the mobilization of HSCs. It can be hypothesized that a variety of humoral factors, including stromal cell-derived factor, matrix metalloproteinases, hepatocyte growth factor and interleukin-8 can influence the process of mobilization of HSCs after liver resection surgery. These substances are also involved in the mechanisms of development and metastasising of many tumours. It is probably in this context that a reason may be found for the different mobilisation of hematopoietic stem cells, depending on the nature of the hepatic lesion treated, that was encountered in this study.

Mobilization of peripheral blood hematopoietic stem cells following liver resection surgery.

BACKGROUND/AIMS: Stem cells are characterized by plasticity, namely the ability of interchanging between various tissue and organs. In this regard, many studies have demonstrated the presence of antigenic structures relevant to the hematopoietic stem cell on hepatocytes, thus suggesting that in certain conditions liver cells may derive from the hematopoietic compartment. The aim of this study has been to verify whether surgical liver resection can activate bone marrow, by mobilizing peripheral blood hematopoietic stem cells (CD34+ cells) putatively able to induce liver repopulation. METHODOLOGY: White blood cell and CD34+ cell count was determined at baseline (before surgery) and then monitored in the postoperative period in 13 patients undergoing liver resection (in most cases because of malignant, primary or secondary liver diseases) and, as a control group, in 12 patients affected with other diseases requiring abdominal surgery, but not liver resection. Moreover, to assess the basal value of circulating CD34+ cells, 50 healthy blood donors were included in the study. The CD34+ cell count has been carried out by flow cytometry, by applying conventional protocols. RESULTS: Patients, as altogether considered, showed at baseline a significantly higher white blood cell count as compared to healthy controls (7.41+/-2.89 x 10(3)/microL vs. 6.00+/-1.37 x 10(3)/microL, P<0.01), as opposed to the CD34+ cell count, the results of which were significantly lower (2.8+/-1.8/microL vs. 4.1+/-1.9/microL, P<0.01). The increase of CD34+ cells was significantly higher in patients following liver resection as compared to others (+6.5+/-4.1/microL vs. +0.7+/-1.4/microL, P<0.001), whereas the variation of white blood cell count was not statistically significant (+1.87+/-3.76 x 10(3)/microL vs. + 1.51+/-2.87 x 10(3)/microL). CONCLUSIONS: Our results indicate that hepatic injury caused by extensive liver resection may constitute a trigger to the mobilization of hematopoietic stem cells putatively able to differentiate into hepatocytes, thus starting the recovery process of liver. These data could open innovative views to the treatment of certain liver diseases (e.g. fulminant hepatic failure), in particular by the administration of hematopoietic growth factors, such as G-CSF or GM-CSF, after the hepatic damage, to contribute, through the activation of the hematopoietic compartment, to a more efficient liver regeneration.

[Pancreatic neck rupture: report of a clinical case]. / La rottura dell'istmo pancreatico: presentazione di un caso clinico.

The authors report a case of pancreatic neck rupture in a 45-year-old female patient due to blunt trauma in a car crash. An emergency laparotomy was performed and the pancreatic head side was sutured, whereas the left side was anastomosed to a Roux-en-Y jejunal loop. The aim of this report is to emphasize the advantages of conservative surgery with internal drainage. This technique has been described for benign pancreatic tumours and protects the patient against exocrine and/or endocrine insufficiency.