Surgical Treatment of Gallstone Ileus: Less Is More

Introduction: The objective of this study was to evaluate the need for cholecystectomy in patients who underwent surgery for gallstone ileus. Methods: This was a retrospective review of the clinical history of patients who underwent surgery for gallstone ileus between December 1992 and December 2018 and follow-up until October 2020. Data regarding the surgical intervention, location of the obstruction, and surgical procedure performed were collected, as well as complications in relation to biliary pathology in the postoperative period. Results: Twenty-five patients underwent surgery for gallstone ileus. In all patients, except one, the site of the obstruction was identified. The mean age of the patients was 72 (standard deviation [SD] 13.3) years, with a female predominance (18: 7). The patients presented symptoms, on average, 2.9 (1–7) days before going to the emergency room; the primary symptoms were vomiting associated with abdominal pain and constipation (56%). Fifty-six percent of patients were diagnosed preoperatively by imaging tests. In 72% of patients, an enterolithotomy was performed alone without any other intervention on the gallbladder or bile duct. Eighty-three percent of the patients did not present any cholecystobiliary complications during the entire follow-up period, and urgent or delayed cholecystectomy was not performed after the acute episode. Conclusions: Gallstone ileus is a rare entity, and there are no randomized studies that support a preferred treatment. If surgical intervention is required, enterotomy for stone extraction is a safe and effective technique, and in our experience, urgent or delayed cholecystectomy is not necessary.

Download Full-text

Recurrent Autoimmune Hepatitis and De Novo Autoimmune Hepatitis in the Liver Allograft

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa147 ◽

2020 ◽

Author(s):

Iván A González ◽

Christopher P Hartley ◽

ILKe Nalbantoglu

Keyword(s):

Autoimmune Hepatitis ◽

De Novo ◽

Clinical Course ◽

Liver Allograft ◽

Clinicopathologic Characteristics ◽

Female Predominance ◽

History Of ◽

The Mean ◽

Aggressive Clinical Course

Abstract Objectives Autoimmune hepatitis (AIH) is a form of severe hepatitis that can recur after orthotopic liver transplant (OLT). Presentation of AIH in patients with OLT who do not have a history of AIH is called de novo AIH (DNAIH). We evaluated the clinicopathologic characteristics of AIH and DNAIH. Methods Clinicopathologic and outcome measures of 11 patients with recurrent AIH (RAIH) and 22 with DNAIH identified between 2000 and 2017 were compared. Results Both cohorts showed female predominance. The mean clinical follow-up was 13 and 7.8 years in the in the RAIH and DNAIH groups, respectively (P = .1). Moderate portal inflammation was more common in patients with RAIH (64% vs 27%, P = .043). A trend was observed for more cases of DNAIH showing severe inflammation (36% vs 9%, P = .09) and submassive necrosis compared with RAIH (23% vs 0%, P = .086). A trend for more advanced fibrosis was also noted in the RAIH group (27% vs 5%, P = .059). Three patients with RAIH lost their grafts because of RAIH. Five-year disease-specific graft survival (GS) (P = .012) and overall GS (P = .015) were worse in patients with RAIH. Complement component 4d immunohistochemistry was positive in 2 patients with RAIH and 3 with DNAIH but showed no correlation with GS or other parameters. Conclusions RAIH seems to have a more aggressive clinical course than DNAIH and warrants closer clinical follow-up and aggressive treatment.

Download Full-text

When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz240 ◽

2019 ◽

Vol 30 (1) ◽

pp. 146-148

Author(s):

Lara Girelli ◽

Elena Prisciandaro ◽

Niccolò Filippi ◽

Lorenzo Spaggiari

Keyword(s):

Clinical Presentation ◽

Clinical Status ◽

High Morbidity ◽

Conservative Approach ◽

Chronic Fistula ◽

Less Is More ◽

Primary Surgery ◽

History Of ◽

Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

Download Full-text

Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04078-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Weiwei Li ◽

Zheng Liu ◽

Xiao Xiao ◽

Zhenchao Xu ◽

Zhicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Thoracic Spinal ◽

Cobb’S Angle ◽

Perioperative Complication ◽

The Mean ◽

Early Surgical Intervention ◽

Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

Download Full-text

Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

Ear Nose & Throat Journal ◽

10.1177/0145561319841207 ◽

2019 ◽

Vol 98 (5) ◽

pp. 291-294 ◽

Cited By ~ 4

Author(s):

Saudamini J. Lele ◽

Mickie Hamiter ◽

Torrey Louise Fourrier ◽

Cherie-Ann Nathan

Keyword(s):

Treatment Option ◽

Case Series ◽

Complete Response ◽

Definitive Treatment ◽

Invasive Technique ◽

Effective Treatment Option ◽

Patient Reported ◽

History Of ◽

The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

Download Full-text

Frequency, Predictors, and Outcome of Seizures in Patients With Myelomeningocele: Single-Center Retrospective Cohort Study

Journal of Child Neurology ◽

10.1177/08830738211053132 ◽

2021 ◽

pp. 088307382110531

Author(s):

Cemal Karakas ◽

Emin Fidan ◽

Kapil Arya ◽

Troy Webber ◽

Joan B. Cracco

Keyword(s):

Good Prognosis ◽

Cortical Atrophy ◽

Seizure Freedom ◽

Single Center ◽

Seizure Onset ◽

Shunt Procedure ◽

History Of ◽

The Mean

To determine the frequency, predictors, and outcomes of seizures in patients with myelomeningocele, we retrospectively analyzed the data from patients with myelomeningocele followed longitudinally at a single center from 1975 to 2013. We identified a total of 122 patients (61% female). The mean follow-up duration was 11.1 years (minimum-maximum = 0-34.5 years, SD = 8.8, median = 9.1 years). A total of 108 (88.5%) patients had hydrocephalus, and 98 (90.7%) of those patients required a ventriculoperitoneal shunt procedure. Twenty-four (19.7%) patients manifested with seizures, 23 of whom had hydrocephalus. The average age of seizure onset was 4.8 years (median 2 years of age). Falx dysgenesis ( P = .004), lumbar myelomeningocele ( P = .007), and cortical atrophy ( P = .028) were significantly associated with epileptic seizure development. The average seizure-free period at the last follow-up in patients with a history of myelomeningocele and seizures was 8.1 years. We conclude that myelomeningocele patients with seizures have an overall good prognosis with considerable long-term seizure freedom.

Download Full-text

Palliative Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Embolization

Acta Radiologica ◽

10.1177/028418519303400106 ◽

1993 ◽

Vol 34 (1) ◽

pp. 26-29 ◽

Cited By ~ 4

Author(s):

S. Savastano ◽

G. P. Feltrin ◽

D. Neri ◽

P. da Pian ◽

M. Chiesura-Corona ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transcatheter Arterial Embolization ◽

Palliative Treatment ◽

Arterial Embolization ◽

Percutaneous Ethanol Injection ◽

Ethanol Injection ◽

History Of ◽

The Mean ◽

Hcc Recurrence

Thirty-three consecutive patients with previously untreated hepatocellular carcinoma (HCC) and 6 patients with recurrent HCC were treated with transcatheter arterial embolization (TAE). The patients were not eligible for surgical resection or percutaneous ethanol injection. TAE was performed with Lipiodol Ultra-Fluid, epidoxorubicin and Gelfoam, with a mean of 1.7 treatments per patient. CT was performed 15 days after TAE. The mean cumulative survival was 14.2 months in patients with previously untreated HCC. The survival of patients stages Okuda I and II did not differ significantly (p > 0.05); tumor size did not affect survival (p > 0.05). Two patients with recurrent HCC died 7.0 and 9.3 months after the diagnosis of tumor recurrence; the remaining 4 patients are still alive with a maximum follow-up of 22.5 months from the diagnosis of HCC recurrence. Ten complications occurred in 8 patients, and were controlled by medical therapy. Eleven patients died during the study; no death was related to TAE. The series was not randomized, but comparison with the natural history of HCC suggests that TAE is effective as palliative treatment of advanced or recurrent HCC.

Download Full-text

Complications in Mandibular Midline Distraction

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1600902 ◽

2017 ◽

Vol 10 (3) ◽

pp. 204-207 ◽

Cited By ~ 2

Author(s):

Jan Pieter de Gijt ◽

Atilla Gül ◽

Eppo B. Wolvius ◽

Karel G.H. van der Wal ◽

Maarten J. Koudstaal

Keyword(s):

Retrospective Cohort ◽

Mental Nerve ◽

Safe Method ◽

Congenital Deformities ◽

Area Of Interest ◽

Sensory Disturbances ◽

History Of ◽

The Mean ◽

New Surgical Technique

Mandibular midline distraction (MMD) is a relatively new surgical technique for correction of transverse discrepancies of the mandible. This study assesses the amount and burden of complications in MMD. A retrospective cohort study was performed on patients who underwent MMD between 2002 and 2014. Patients with congenital deformities or a history of radiation therapy in the area of interest were excluded. Patient records were obtained and individually assessed for any complications. Complications were graded using the Clavien-Dindo classification system (CDS). Seventy-three patients were included of which 33 were males and 40 were females. The mean follow-up was 2.1 years. Twenty-nine patients had minor complications, grades I and II. Two patients had a grade IIIa and three patients had a grade IIIb complication. Common complications were pressure ulcers, dehiscence, and (transient) sensory disturbances of the mental nerve. This study shows that although MMD is a relatively safe method, complications can occur. Mostly the complications are mild, transient, and manageable without the need for any reoperation.

Download Full-text

Haglund’s disease: surgical outcome of calcaneal osteotomy

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170786 ◽

2017 ◽

Vol 3 (2) ◽

pp. 278 ◽

Cited By ~ 1

Author(s):

Veerabhadra Javali ◽

Virupaksha N. Reddy

Keyword(s):

Conservative Treatment ◽

Surgical Outcome ◽

Surgical Intervention ◽

Lateral Approach ◽

Lateral View ◽

Aofas Score ◽

Postoperative Score ◽

Calcaneal Osteotomy ◽

The Mean

Background: The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy.Methods: 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.Results: 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. Three minor complications were noted. Conclusions: The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease.

Download Full-text

The Small Blue Cell Dilemma Associated With Tamoxifen Therapy

Archives of Pathology & Laboratory Medicine ◽

10.5858/2001-125-1047-tsbcda ◽

2001 ◽

Vol 125 (8) ◽

pp. 1047-1050 ◽

Cited By ~ 1

Author(s):

Yi Jun Yang ◽

Linda K. Trapkin ◽

Roberta K. Demoski ◽

Jeannette Bellerdine ◽

Celeste N. Powers

Keyword(s):

Older Patients ◽

Endometrial Hyperplasia ◽

Clinical History ◽

Tamoxifen Therapy ◽

Tamoxifen Treatment ◽

Endometrial Polyps ◽

High Incidence ◽

History Of ◽

Blue Cell

Abstract Context.—Several endometrial diseases, such as endometrial hyperplasia, endometrial carcinoma, and endometrial polyps, have been reported to be associated with tamoxifen administration. We recently observed a high incidence of distinctive small blue cells in Papanicolaou tests of women who had received tamoxifen treatment for breast carcinoma. Objectives.—To define the characteristics of these small blue cells, to identify the patient population in which they are found, and to determine the clinical significance and possible etiology of these findings. Design.—A total of 154 Papanicolaou tests from 60 patients with a clinical history of tamoxifen therapy were reviewed retrospectively. Results.—Small blue cells were found in 40% of Papanicolaou tests from patients who received tamoxifen therapy. Patients with small blue cells in their Papanicolaou tests were an average of 9 years older at the time tamoxifen therapy was initiated than those without. Among the available follow-up surgical biopsies, no malignant diagnoses were made. Conclusions.—We conclude that these distinctive small blue cells are found more frequently in older patients and most probably represent proliferative reserve cells of cervical/vaginal epithelium resulting from the estrogenic agonist effect of tamoxifen. More importantly, they are nonneoplastic in nature.

Download Full-text

Revising Recommendations and Outcome Measurements after Complex Open Abdominal Wall Reconstruction

The American Surgeon ◽

10.1177/000313481508101009 ◽

2015 ◽

Vol 81 (10) ◽

pp. 955-960 ◽

Cited By ~ 7

Author(s):

Shawn Diamond ◽

H. Gill Cryer

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Clinical History ◽

Long Term Results ◽

Functional Domain ◽

Grading Systems ◽

History Of ◽

Grade Ii ◽

Restricted Use

Grading systems developed by the Ventral Hernia Working Group (VHWG) for complex open abdominal wall reconstruction rely on limited outcomes: surgical site occurrence (SSO) and hernia recurrence. This does not account for the longitudinal restoration of a functional abdominal wall and the ability to correct complications. We performed a single-site, retrospective review of consecutive complex open abdominal wall reconstruction interventions with 24-month minimum follow-up to establish reoperation rates and compare long-term results to the VHWG. About 125 midline hernia repairs (>200 cm2) were studied. All had loss of functional domain and 47-month average follow-up. Demographics included: mean age 57 years, 47 per cent male, 63 per cent obese, and 34 per cent with contamination. Rates of SSO per VHWG grade were 9 per cent grade I, 45 per cent grade II, and 55 per cent grade III. Forty-three of 59 patients who developed complications were eventually successful after reoperation leading to an 87 per cent restoration rate. Select factors independently associated with reoperation included biological mesh and clinical history of infection. Although rates of SSO were higher than the VHWG published, we experienced high salvage rates except in patients who underwent biologic repair. We recommend restricted use of biologic mesh in contaminated and clean fields as well as modifications to the VHWG grading and recommendations.

Download Full-text