ABSTRACT
Background: Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation.Objectives:To assess the outcome of surgical resection of BMCNs.Methods:A prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur Hospital Complex for BMCN from 1999 to 2015. Demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, postoperative complications and outcome.Results:Thirteen female patients (median age 45 years) had surgery. Eleven were diagnosed by imaging for symptoms. Two were jaundiced. One cyst was found during an elective cholecystectomy. Five cysts were located centrally in the liver. Before referral three cysts were treated with percutaneous drainage and two were treated with operative deroofing. Six patients had anatomical liver resections and seven patients had non anatomical liver resections of which two needed ablation of residual cyst wall. One patient needed a biliary-enteric reconstruction to treat a fistula. Median operative time was 183 minutes (range: 130375). No invasive carcinoma was found. There was no operative mortality. One surgical site infection and one intra-abdominal collection were treated. Two patients developed recurrent BMCN after 24 months.Conclusion:BMCNs should be considered in middle aged women who have well encapsulated multilocular liver cysts. Treatment of large central BMCNs adjacent to vascular and biliary structures may require technically complex liver resections and are best managed in a specialised hepato-pancreatico-biliary unit
Subject(s)
Neoplasms, Cystic, Mucinous, and Serous , Patients , South Africa , WomenABSTRACT
Although primary human immune deficiency virus (HIV) infection is a well described entity, it is frequently misdiagnosed or underdiagnosed. This has been attributed to the non-specific clinical features at presentation, inadequate history taking and a low index of suspicion by practicing clinicians. Haematological abnormalities are a recognised feature of HIV infection and may present in the form of pancytopenia or isolated cytopenias. One of the cardinal features of HIV seroconversion is leucopenia, however primary HIV infection as a cause of neutropenia and lymphopaenia in Crohn’s disease, has to our knowledge, not been described in the medical literature. We present a case of profound neutropenia in Crohn’s disease secondary to acute HIV sero-conversion illness.
ABSTRACT
Background. The procedure for prolapse and haemorrhoids (PPH) was introduced to address the postoperative pain following excisional haemorrhoidectomy (EH). Objective. To assess the efficacy of both procedures to treat haemorrhoids. Data sources. Literature review using MEDLINE. Articles addressing PPH and EH were included. Study selection. RCTs comparing EH and PPH with =20 patients. Data extraction. Primary endpoints were pain; operative time; hospital stay; satisfaction with procedure and time to return to normal activity. Secondary endpoints such as recurrence and complications were collated for descriptive analysis. A metaanalysis was performed using the random effects model on studies reporting `mean' and SD or SEM. Data synthesis. PPH was associated with less postoperative pain; less operative time; shorter hospital stay and earlier return to normal activities compared with EH. There appears to be no significant difference in satisfaction with the procedure. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH. Conclusion. Compared with EH; PPH is associated with less postoperative pain; reduced operative time and hospital stay and earlier return to normal activity; and a trend towards improved patient satisfaction. The rate of recurrence appears higher with PPH
Subject(s)
Hemorrhoids/surgery , Review , Surgical Procedures, OperativeABSTRACT
Background: The available operative procedures for perforated gastric ulcer are gastrectomy; ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution.Patients and methods: Seventy-two patients (mean age 43 years; 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. Results: Partial gastrectomy was performed in 27 patients; ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18(26for gastrectomy; 19for ulcer excision and 5for patch closure). Shock on admission (p=0.006) and Candida (p=0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. Conclusion: Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases
Subject(s)
Stomach Ulcer/surgeryABSTRACT
Background. The available operative procedures for perforated gastric ulcer are gastrectomy; ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution. Patients and methods. Seventy-two patients (mean age 43 years; 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. Results. Partial gastrectomy was performed in 27 patients; ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18(26for gastrectomy; 19for ulcer excision and 5for patch closure). Shock on admission (p = 0.006) and Candida (p = 0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. Conclusion. Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases