Giant fibrovascular polyp.

This is a classic case report of a rare giant fibrovascular polyp (GFP) of the oesophagus in a 50-year-old male patient, who two years prior had regurgitated the polyp and swallowed it again. He only sought medical professionals after losing 25 kg and having severe dysphagia. The GFP, weight 520 g and size 21 × 9 × 7 cm, was removed in toto with a cervical excision following intraluminal marking of the base of the polyp during oesophagoscopy. On histological examination the GFP was found to represent a well-differentiated liposarcoma.

Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study.

BACKGROUND: The aim of this retrospective study was to evaluate the peri-operative and long-term outcome after early repair with a hepaticojejunostomy (HJ). METHODS: Between 1995 and 2010, a nationwide, retrospective multi-centre study was conducted. All iatrogenic bile duct injury (BDI) sustained during a cholecystectomy and repaired with HJ in the five Hepato-Pancreatico-Biliary centres in Denmark were included. RESULTS: In total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Post-operative morbidity was 36% and mortality was 4%. Forty-two patients (30%) had a stricture of the HJ. The median follow-up time without stricture was 102 months. Nineteen out of the 42 patients with post-reconstruction biliary strictures had a re-HJ. Twenty-three patients were managed with percutaneous transhepatic cholangiography and dilation. The overall success rate of re-establishing the biliodigestive flow approached 93%. No association was found between timing of repair, concomitant vascular injury, level of injury and stricture formation. CONCLUSION: In this national, unselected and consecutive cohort of patients with BDI repaired by early HJ we found a considerable risk of long-term complications (e.g. 30% stricture rate) and mortality in both the short- and the long-term perspective.

Acceptable outcome after laparoscopic appendectomy in children.

INTRODUCTION: An increasing proportion of childhood -appendicitis is being treated with laparoscopic appendectomy (LA). We wanted to elucidate the outcome of childhood appendicitis treated primarily by residents in a university hospital. MATERIAL AND METHODS: All children (age<16 years) with appendectomy treated surgically in our department between January 2006 and January 2011 were identified retrospectively. Readmission, reoperation or post-operative length of hospital stay (LOS) exceeding five days were considered non-satisfactory outcomes. RESULTS: A total of 390 children had an appendectomy performed. The mean age was 9.8 years, and mortality was 0.0%. The surgeon was a resident in 92% of the cases. A total of 246 (63.1%) had an LA. The rate of LA increased over the five-year period from 45% to 88% (p=0.01). The conversion rate decreased from 28% to 15% (p=0.02). The median post-operative LOS was one and three days for simple and complicated appendicitis, respectively. A total of 45 patients (11.5%) had a complication, 40 patients (10.3%) were readmitted, and 56 patients (14.4%) had a non-satisfactory outcome. Logistic regression found open surgery and complicated appendicitis to be associated with an increased risk of complications (p<0.01). CONCLUSION: Increased use of LA did not increase the number of patients with a non-satisfactory outcome. Residents manage this treatment at a highly professional level. Readmission due to pain and discomfort was frequent and more targeted and systematic post-operative analgesic care of our children is called for. FUNDING: Not relevant. TRIAL REGISTRATION: The study was submitted to ClinicalTrials.gov (NCT01657565).

Retrograde ureteroscopic holmium laser endopyelotomy in a selected population of patients with ureteropelvic junction obstruction.

OBJECTIVE: Significant controversy remains concerning the best way to treat ureteropelvic junction obstruction (UPJO). This study evaluates subjective and objective outcomes of retrograde holmium laser endopyelotomy in a selected population with UPJO. MATERIAL AND METHODS: Forty-seven patients with UPJO were referred to retrograde endopyelotomy between April 2004 and March 2007. Patients with a very large pelvis, a high insertion of the ureter, a renal split function below 20% or a long (>2 cm) stenosed ureteropelvic segment, and patients younger than 18 years were not selected for endopyelotomy, but subjected to laparoscopic pyeloplasty. Renal function was estimated on renal diuretic scan before and after surgery with a mean renographic follow-up of 35 weeks. Subjective results were based on questionnaires which were returned from 44 patients with primary (n=37) or secondary (n=7) obstruction (mean follow-up 110 weeks). Success criteria were defined as symptom relief and improved or preserved renal function. RESULTS: Twenty-nine patients (66%) experienced complete symptom resolution and 10 patients (23%) had significant symptom improvement (i.e. no need for pain-killing medication). Five patients (11%) had unchanged symptoms. No difference in postoperative renal function was observed between these three groups of patients. The differences between preoperative and postoperative renal function were non-significant in each group. No major complications were observed. Five patients (11%) were referred to retreatment owing to unchanged symptoms. CONCLUSION: Retrograde ureteroscopic endopyelotomy is a safe and effective treatment option in patients with primary and secondary UPJO when selected properly.

Rifampicin seems to act as both an inducer and an inhibitor of the metabolism of repaglinide.

OBJECTIVE: To investigate if rifampicin is both an inducer and an inhibitor of repaglinide metabolism, it was determined whether the timing of rifampicin co-administration influences the pharmacokinetics of repaglinide. METHODS: Male volunteers ( n=12) participated in a randomised, two-period, crossover trial evaluating the effect of multiple doses of 600 mg rifampicin once daily for 7 days on repaglinide metabolism. Subjects were, after baseline measurements of repaglinide pharmacokinetics, randomised to receive, on either day 7 or day 8 of the rifampicin administration period, a single dose of 4 mg repaglinide and vice versa in the following period. RESULTS: When repaglinide was given, together with the last rifampicin dose, on day 7, an almost 50% reduction of the median repaglinide area under the plasma concentration-time curve (AUC) was observed. Neither the peak plasma concentration (C(max)), time to reach C(max) (t(max)) nor terminal half-life (t(1/2)) was statistically significantly affected. When repaglinide was given on day 8, 24 h after the last rifampicin dose, an almost 80% reduction of the median repaglinide AUC was observed. The median C(max) was now statistically significantly reduced from 35 ng/ml to 7.5 ng/ml. Neither t(max) nor t(1/2) was significantly affected. CONCLUSION: When rifampicin and repaglinide are administered concomitantly, rifampicin seems to act as both an inducer and an inhibitor of the metabolism of repaglinide. After discontinuing rifampicin administration, while the inductive effect on CYP3A4 and probably also CYP2C8 is still present, an even more marked reduction in the plasma concentration of repaglinide was observed. Our results suggest that concomitant administration of rifampicin and repaglinide may cause a clinically relevant decrease in the glucose-lowering effect of repaglinide, in particular when rifampicin treatment is discontinued or if the drugs are not administered simultaneously or within a few hours of each other.