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Factors Affecting Liver Regeneration in Donors' Grafts in Living Donor Liver Transplant (LDLT) a Center Experience
Morsi Mohamed,
Wael Mansy,
Osama Khalil,
Yehia Attwa,
Magdy Amin,
Karim Boudjema
Issue:
Volume 7, Issue 4, August 2019
Pages:
87-95
Received:
14 May 2019
Accepted:
23 June 2019
Published:
2 July 2019
Abstract: Background: Liver regeneration for donors' graft in living donor liver transplantation (LDLT), is an example for liver regeneration in normal liver. In this study we spotted the light on liver regeneration in donors after LDLT, focusing on factors affecting it. Aim: To study the impact of different factors on liver regeneration in donors of living donor liver transplantation. Patients and methods: Between May 2013 and June 2019, 80 living donor liver transplants were performed in the liver transplant unit in EL-Maadi Armed Forces Hospital. All donors who provided liver grafts underwent volumetric spiral computed tomography (CT) scans preoperatively and postoperatively at time intervals of 1 week and 1, 3 and 6 months. Patients’ demographics, surgical data, and postoperative outcomes were correlated with liver regeneration data. 63 patients were males and 17 patients were females, with mean age 27.97yrs ± 5.3. They provided {72} right lobe (RL) grafts and 8 right posterior sector (RP) grafts. Results: No donor operation was aborted and surgical morbidity rate was {33.75%}, mostly biliary. All RP donors achieved complete liver regeneration after 3 months; only four RL donors achieved complete liver regeneration at 6 months. Conclusion: In this study, it was found that there were factors affecting regeneration like age, gender of the patient and graft size. But no effect was found with many factors as peri-operative liver function tests, steatosis, BMI, operative time, blood loss, blood transfusion and postoperative complications.
Abstract: Background: Liver regeneration for donors' graft in living donor liver transplantation (LDLT), is an example for liver regeneration in normal liver. In this study we spotted the light on liver regeneration in donors after LDLT, focusing on factors affecting it. Aim: To study the impact of different factors on liver regeneration in donors of living ...
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Amyloidosis and Spontaneous Liver Bleeding: A Case Report and Literature Review
Biying Huang,
Ioannis Gkekas,
Ernesto Sparellid
Issue:
Volume 7, Issue 4, August 2019
Pages:
96-100
Received:
6 May 2019
Accepted:
5 June 2019
Published:
11 July 2019
Abstract: Liver rupture with severe liver bleeding in patients with amyloidosis is an unusual but generally difficult to deal with and potentially fatal complication in these patients. Even patients with known manifestations to the lever can present with acute lever bleeding. Here we present a case report of a 62-year-old male with systemic immunoglobulin light chain (AL) amyloidosis, known manifestations to the lever and spontaneous liver bleeding which was treated conservatively without the need of surgical intervention. The etiology, panorama of clinical manifestations of hepatic amyloidosis and the management of liver bleeding in association with this unusual disease are reviewed. 18 cases of hepatic rupture and haemorrhage in association with amyloidosis in previously published cases are summarized. The choice of management should be individualized and the patient´s hemodynamic status and extent of liver bleeding are important factors to be taken into consideration. In all patients it is crucial to exclude underlying malignancy as the reason of bleeding. The patient´s hemodynamic status and the extent of liver bleeding are the most important factors to be taken into consideration in order to establish individualized management plan. Increased awareness of severe liver bleeding from amyloidosis may achieve reduced mortality of this potentially fatal complication.
Abstract: Liver rupture with severe liver bleeding in patients with amyloidosis is an unusual but generally difficult to deal with and potentially fatal complication in these patients. Even patients with known manifestations to the lever can present with acute lever bleeding. Here we present a case report of a 62-year-old male with systemic immunoglobulin li...
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Isolated Testicular Tuberculosis in a 9-Year-Old Boy: An Incidental Finding
Hassan Shehu,
Maryam Shehu,
Oseni Momodu,
Sunday Gargadi
Issue:
Volume 7, Issue 4, August 2019
Pages:
101-103
Received:
17 May 2019
Accepted:
1 July 2019
Published:
12 July 2019
Abstract: Isolated testicular Tuberculosis (TB) is a rare clinical condition. A 9-year old boy presented to the paediatric surgical clinic with a 3-month history of a painless mass in the right testis and 1-month history of low- grade continuous fever. The boy had normal anthropometry, no abnormal respiratory signs, there was a right hemiscrotal swelling with a solid hard, non- tender mass felt on the upper pole of the right testis. The chest radiograph was normal, histopatholgic results of the mass showed tuberculotic granuloma with caseous necrosis, FBC revealed WBC of 9.7×103/MM3, HCT-33% Platelets-357×103/MM3, Neutrophil-24, Lymphocyte-34, Eosinophils-1O, Monocyte-30, Basophils-2, ESR-26mm/hr, Mantoux-0mm2, Cytology smear revealed a mixed inflammation consisting mainly neutrophils and plasma cells with an eosinophilic background. Hydrocele fluid aspirate for M/C/S showed no significant bacterial growth. To date, no clinical method has been defined for the definitive diagnosis of such cases and the definitive diagnosis is only achieved by surgical exploration and histopathological examination. Testicular tuberculosis (TB), a rare form of (EP-TB), may present with diagnostic challenge.
Abstract: Isolated testicular Tuberculosis (TB) is a rare clinical condition. A 9-year old boy presented to the paediatric surgical clinic with a 3-month history of a painless mass in the right testis and 1-month history of low- grade continuous fever. The boy had normal anthropometry, no abnormal respiratory signs, there was a right hemiscrotal swelling wit...
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Experience of Surgical Management of Gastrointestinal Stromal Tumors at a Tertiary Hospital of Nepal
Dhruba Narayan Sah,
Ramesh Singh Bhandari,
Paleswan Joshi Lakhey,
Yogendra Prasad Singh,
Pradeep Vaidya,
Prasan Bir Singh Kansakar,
Bikal Ghimire,
Bishnu Prasad Kandel,
Jayant Kumar Sah
Issue:
Volume 7, Issue 4, August 2019
Pages:
104-109
Received:
2 June 2019
Accepted:
1 July 2019
Published:
12 July 2019
Abstract: Gastrointestinal stromal tumors (GISTs) are rare malignancies but a most common mesenchymal tumor. A multidisciplinary team approach is the optimal care of GIST patients after the remarkable outcomes with the development of molecular-targeted therapy. The objective is to determine the clinic-pathological spectrum and risk category of GIST along with perioperative outcomes. This is a retrospective review of GIST patients between September 2015 – August 2018 at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Patients’ clinical data, histopathology, immunohistochemistry (IHC) and outcomes were recorded and analyzed. A total of 42 GIST patients were identified with age (19-81 years) and 69% were males. Stomach (35.7%) was the most common site followed by small bowel (23.8%) and duodenum (14.3%). Pain (40.5%) followed by bleeding (30.9%) were major indications. Max tumor dimensions were ranging from 2.8- 30 cm and median mitotic figures were 3 (0-35). Patients were stratified as high, intermediate, low and very low risk (36%, 32%, 32%, and 0% respectively). The majority were managed surgically out of which three cases underwent preoperative angioembolization. CD 117 was positive in 90.5%. Neoadjuvant imatinib given in 2 cases while adjuvant imatinib given in 18 cases. Over a median follow up of 18 months four patients expired while 32 had no issues. Surgical resection is the preferred choice of treatment with or without the molecular targeted drug therapy. Most tumors fall in the high-risk category.
Abstract: Gastrointestinal stromal tumors (GISTs) are rare malignancies but a most common mesenchymal tumor. A multidisciplinary team approach is the optimal care of GIST patients after the remarkable outcomes with the development of molecular-targeted therapy. The objective is to determine the clinic-pathological spectrum and risk category of GIST along wit...
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Laparoscopic Distal Pancreatectomy Preserving the Spleen and Splenic Vessels: An Operation Without Increased Morbidity
Kazuhiro Suzumura,
Kenjiro Iida,
Hideaki Iwama,
Yusuke Kawabata
Issue:
Volume 7, Issue 4, August 2019
Pages:
110-113
Received:
7 June 2019
Accepted:
15 July 2019
Published:
5 August 2019
Abstract: Background: The indications for laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and the associated morbidity in comparison to laparoscopic distal pancreatectomy with splenectomy (LDPS) are ill-defined. Objective: This study aimed to evaluate the safety, feasibility and outcomes of LSPDP. Methods: Between January 2010 and May 2014, 13 patients underwent LDPS or LSPDP in our institution, and their clinical data and the outcomes of the two procedures were retrospectively reviewed and statistically analyzed. Results: There were no significant differences in age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI) or blood loss between the LDPS and LSPDP groups. The mean tumor size (8.63 vs. 2.51 cm, P<0.005) and mean operative time (353 vs. 235 minutes, P<0.029) were greater in the LDPS group than in the LSPDP group. The rates of complications in the two groups did not differ to a statistically significant extent. All of the patients were achieved R0 resection and no mortality. Conclusion: LSPDP with conservation of the splenic artery and vein was a safe and feasible option for benign or low-grade malignant tumors in the distal pancreas, because of no mortality, no splenic infarction and R0 resection. Splenic conservation does not significantly increase the morbidity associated with the procedure.
Abstract: Background: The indications for laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and the associated morbidity in comparison to laparoscopic distal pancreatectomy with splenectomy (LDPS) are ill-defined. Objective: This study aimed to evaluate the safety, feasibility and outcomes of LSPDP. Methods: Between January 2010 and May 2014, 13 p...
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Surgical Outcomes After Pancreaticoduodenectomy in Elderly Patients
Kazuhiro Suzumura,
Kenjiro Iida,
Hideaki Iwama,
Yusuke Kawabata
Issue:
Volume 7, Issue 4, August 2019
Pages:
114-118
Received:
7 June 2019
Accepted:
15 July 2019
Published:
5 August 2019
Abstract: Background: Pancreaticoduodenectomy (PD) is an aggressive surgery with considerable operative risks. Objective: The purpose of this study was to evaluate the safety of PD in patients of≥75 years of age and to show the influence of advanced age on the mortality and morbidity associated with PD. Methods: Between July 2009 and December 2013, 131 patients underwent PD at Hyogo College of Medicine. We analyzed the perioperative data and outcomes after PD in patients of≥75 years of age (elderly group) in comparison to those of patients of<75 years of age (younger group). Results: There were no differences between the elderly group (n=28) and younger group (n=103) in terms of gender, body mass index (BMI), biochemistry test results, operative time or intraoperative blood loss. There were significant differences in the incidence of preoperative complications in the elderly and younger groups. There were no differences in the rates of mortality (0% vs. 1%; p=0.601) or morbidity (64% vs. 49%; p=0.139). Morbidities included pancreatic fistula, delayed gastric emptying, intra-abdominal bleeding, intra-abdominal abscess, ascites and pneumonia. Conclusion: The preoperative complication rate in the elderly group was significantly higher than that in the younger group. However, PD can be performed safely in elderly patients and advanced age alone should not be a contraindication to PD.
Abstract: Background: Pancreaticoduodenectomy (PD) is an aggressive surgery with considerable operative risks. Objective: The purpose of this study was to evaluate the safety of PD in patients of≥75 years of age and to show the influence of advanced age on the mortality and morbidity associated with PD. Methods: Between July 2009 and December 2013, 131 patie...
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