Research progress in liver transplantation in patients with situs inversus totalis / 器官移植

Situs inversus totalis (SIT) is a rare congenital condition, with an extremely low incidence. There is no difference between SIT individuals without onset of diseases and healthy counterparts. However, when SIT individuals suffer from diseases, the diagnosis and treatment are highly challenging due to insufficient understanding of SIT populations, especially for those complicated with end-stage liver disease and requiring liver transplantation. It is a huge challenge for surgeons whether SIT individuals serve as donors or recipients of liver transplantation. In this article, recent case reports related to liver transplantation in SIT patients were summarized, and the development, key procedures, clinical prognosis and postoperative complications of liver transplantation in SIT patients were reviewed.

Colecistectomía laparoscópica en una paciente con situs inversus totalis. Reporte de un caso y revisión de la literatura

Introducción: El situs inversus totalis es una condición congénita en la cual los órganos torácicos y abdominales se encuentran en posición contraria a la posición habitual. En la literatura quirúrgica internacional se encuentran publicados no más de 55 casos de colecistectomía en pacientes con situs inversus totalis. La resolución laparoscópica de una paciente en nuestra Institución nos permite revisar esta particular condición patológica. Caso Clínico: Paciente femenino de 43 años de edad hospitalizada por una colecistitis aguda la cual es resuelta por vía laparoscópica sin incidentes. Material y Método: Se resume la literatura actual mediante una extensa revisión en PubMed de los reportes más relevantes. Considerando que todos los artículos publicados son casos clínicos o pequeñas series de casos, se presentan los resultados de esta revisión en tablas con estadística descriptiva básica. Discusión: Se discuten las características generales de estos pacientes, la presentación clínica, diagnóstico y técnica quirúrgica. Conclusión: La colecistectomía laparoscópica constituye el estándar de oro en pacientes con situs inversus y patología biliar, la cual debe ser realizada por un cirujano experimentado acomodando los trocares apropiadamente, debido a las dificultades técnicas que se encuentran en estos pacientes por las anomalías anatómicas propias de esta condición. El diagnóstico radiológico actual permite la planificación del abordaje y del procedimiento quirúrgico apropiado para cada paciente.

Introduction: Situs inversus totalis is a congenital condition in which the thoracic and abdominal organs are in the opposite position from normal anatomy. We found no more than 55 cases of cholecystectomy in patients with situs inversus totalis published in the international surgical literature. The laparoscopic resolution of a patient in our Institution allows us to review this particular pathological condition. Clinical Case: A 43-year-old female patient was admitted for acute cholecystitis and was resolved laparoscopically without any incidents. Material and Method: We summarized the current literature through an extensive PubMed review of the most relevant reports. Considering that all published articles are clinical cases or small case series, we present the results of this review in a table with basic descriptive statistics. Discussion: We discuss the general characteristics of these patients, clinical presentation, diagnosis, and surgical technique. Conclusions: Laparoscopic cholecystectomy is the gold standard in patients with situs inversus and biliary pathology, which must be performed by an experienced surgeon, properly accommodating the trocars due to the technical difficulties in these patients secondary to anatomical anomalies typical of this condition. Current radiological diagnosis allows planning the appropriate approach and surgical procedure for each patient.

A Case of Tricuspid Valve Repair with a Flexible Band in a Patient with Situs Inversus Totalis / 日本心臓血管外科学会雑誌

Tricuspid annulus has an asymmetric three-dimensional structure with the posteroseptalportion lowest toward the apex from the right atrium and the anteroseptal portion the highest. The tricuspid annulus of a patient with situs inversus has a mirror image of a patient with situs solitus, and the posteroseptal and the anteroseptal portion remains the lowest and the highest toward the apex, respectively, as the situs solitus. Therefore, we assumed that the posteroseptal portion would become higher and the anteroseptal portion would become lower using a conventional three-dimensional rigid ring turned over for tricuspid regurgitation in the situs inversus, and the coaptation of the three leaflets would be poor. In this case, we performed tricuspid annuloplasty using a tricuspid flexible band, mitral valve plasty, left atrial plication, left atrial appendage closure for a situs inversus dextrocardia patient with tricuspid regurgitation, mitral regurgitation, and chronic atrial fibrillation.

Apendicitis aguda no complicada en situs inversus totalis. Reporte de un caso

Introducción: El situs inversus totalis es una malformación congénita rara, caracterizado por una posición invertida de los órganos torácicos y abdominales, influyendo negativamente en la aproximación diagnóstica y en el tratamiento quirúrgico. Reporte: Se diagnosticó apendicitis aguda en un paciente varón de 28 años que conocía su anormalidad anatómica y se corroboró con imágenes tomográficas y la exploración laparoscópica. Ingresó a emergencia con 30 horas de dolor abdominal con inicio en epigastrio y posterior irradiación hacia la fosa iliaca izquierda. La tomografía confirmó su condición de situs inversus totalis y signos patológicos en la apendicitis localizada en FII; se realizó la intervención por laparoscopia sin complicaciones. Discusión: En pacientes con dolor en el cuadrante inferior izquierdo es importante un adecuado diagnóstico diferencial y el conocimiento previo de una anormalidad anatómica comunicada oportunamente hace viable un diagnóstico adecuado y una resolución quirúrgica exitosa.

Introduction: Situs inversus totalis is a rare congenital malformation, characterized by an inverted position of the thoracic and abdominal organs, negatively influencing the diagnostic approach and surgical treatment. Report: Acute appendicitis was diagnosed in a 28-year-old male patient who knew his anatomical abnormality and was corroborated with tomographic images and laparoscopic exploration. He was admitted to the emergency room with 30 hours of abdominal pain with onset in the epigastrium and subsequent radiation to the left iliac fossa. The tomography confirmed his condition of situs inversus totalis and pathological signs in localized appendicitis in FII; The laparoscopic intervention was performed without complications. Discusions: In patients with pain in the left lower quadrant, an adequate differential diagnosis is important and prior knowledge of an anatomical abnormality communicated in a timely manner, that makes feasible an adequate diagnosis and successful surgical resolution.

Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis / 日本心臓血管外科学会雑誌

A 75-year-old man with situs inversus totalis, presented to our hospital complaining of chest pain. ECG showed ST depression in the leads of Ⅰ, aVL, V5, and V6. Blood tests showed cardiac enzyme (Troponin I) elevation. Coronary angiography revealed severe calcification and stenosis of the anatomical left anterior descending artery (LAD) , and the anatomical right coronary artery (RCA). The Patient underwent coronary artery bypass grafting (CABG) using the right internal thoracic artery and saphenous vein graft. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.

Exceptionally Rare Krukenberg Tumour in a Patient With Dextrocardia and Situs Inversus Totalis

@#Krukenberg tumour is a rare clinical entity and accounts for about 1-2% of all ovarian tumours. It is a metastatic ovarian tumour in which accurate diagnosis requires proper endoscopic evaluation and histopathological confirmation to exclude primary ovarian tumours. Dextrocardia with situs inversus totalis is another unusual clinical entity, with an incidence of 1 in 10,000 of the general population. Many patients with this unusual condition are unaware of their structural abnormality and mostly are diagnosed incidentally when they present with other medical conditions. Herein, we report a case of 47 years old woman who presented with bilateral ovarian tumour and incidental diagnosis of Dextrocardia with situs inversus totalis. She underwent surgery and histopathological examination confirms Krukenberg tumour. Both conditions existing together, an exceptionally rare clinical entity.

Alopecia areata y vitamina D sérica en pacientes iraquíes: un estudio de casos y controles / Alopecia Areata And Serum Vitamin D in Iraqi Patients: a case-control study

Background: Alopecia areata (AA) is a typical hair issue, which may have obliterating mental and social outcomes and is portrayed by the nearness of nonscarring alopecia. Objective: This examination has targets to assess the serum nutrient D levels , with AA; contrast the outcome and clearly sound control; and confirm relationship between AA types and serum nutrient D levels. Patients Also Methods: the examine might have been led clinched alongside Tikrit educating healing facility throughout those time starting with June 2019 of the limit for January 2020. Irrefutably the quantity of subjects associated with the assessment was ninety individuals isolated in two social events; the patients bundle were forty five the people who whimper of AA while the resulting gathering including a forty five age and sex-made solid volunteers were picked as a benchmark gathering. The degree and movement of the alopecia were noted and the patients were meticulously broke down for signs of various ailments. Research center assessments were led to patients and also to those control population, these included serum vitamin D levels were measured as 25-hydroxyvitamin D {25(OH)D} using a chemiluminescence microparticle immunoassay. Blood models were gotten starting with patients and control subjects after totally taught consent was gotten. Results : An essential complexity may have been found for serum 25-OH Vit D levels between patients other than controls. Vitamin D sufficiency were more common in controls than in patients. Serum Vitamin D was deficient in both cases and controls group; but, the deficiency was significantly more throughout AA group (35. 6%) compared to the handle group (11. 1%). Among the list patients gathering, levels associated with nutrient D were totally higher in guys in contrast with females. Conclusions: AA might be related with nutrient D deficiency as mean degrees of nutrient D of patients were seen as fundamentally lower than typical sound controls.

Dextrocardia and situs inversus totalis in a Turkish subject: a case report / Dextrocardia y situs inversus totalis en un sujeto turco: reporte de un caso

Dextrocardia with situs inversus is an uncommon anomaly affecting about 1 to 2 per 10,000 in the general population. This report describes an adult male patient with dextrocardia and in a Turkish subject. The photographic illustrations revealed transposition of some of the visceral organs such as the spleen was located right and the liver and gall bladder on the left. The heart was flattened and flipped to the right. Many people with situs inversus totalis are unaware of their unusual anatomy until they seek medical attention for an unrelated condition. So, early detection may lead to a successful surgical management and consequently offer a safer chance of survival. This report showed that dextrocardia and situs inversus can be seen amongst Turkish subjects.

La dextrocardia con situs inversus es una anomalía poco frecuente que afecta aproximadamente de 1 a 2 personas por 10.000 en la población general. Este informe describe un paciente masculino adulto con dextrocardia. Las figuras revelaron que la transposición de algunos de los órganos viscerales, como el bazo, se ubicada a la derecha y el hígado y la vesícula biliar a la izquierda. El corazón fue aplastado y girado hacia la derecha. Muchas personas con situs inversus totalis desconocen su anatomía inusual hasta que buscan atención médica por una afección no relacionada. Por lo tanto, la detección temprana puede llevar a un manejo quirúrgico exitoso y, en consecuencia, ofrecer una posibilidad más segura de supervivencia. Este informe mostró que la dextrocardia y el situs inversus se pueden encontrar entre los sujetos turcos.

Ascending colon cancer and situs inversus totalis: a case report in Sanglah general hospital Denpasar, Bali

Situs inversus totalis is a rare congenital condition that occurs in one out of 4,000-20,000 people, characterized by complete transposition of the thoracic and abdominal viscera that creates a mirror image. The etiologic nature of this anomaly is not known. Situs inversus totalis is typically associated with normal life expectancy unless a gastrointestinal or cardiac anomaly is present. This anomaly is not a premalignant condition. Association between colorectal cancer and situs inversus totalis is rare. The transposition of the organs imposes special demands on the diagnostic and technical skills of the surgeon. We report a case of colorectal cancer and situs inversus totalis in a 51-year-old male presenting with intermittent left lower abdominal pain and change of bowel habit since 9 months before admission. We found a palpable solid mass on the left paraumbilical region, mobile, with no tenderness. Laboratory results show moderate anemia with high CEA level. Fecal Occult Blood Test (FOBT) was positive. Plain chest radiography showed suspected situs inversus. We found descending colon tumor on colonoscopy, with histopathology result intramucosal carcinoma. The contrast abdomen CT scan showed situs inversus and irregular thickening on ascending colon with partial stenosis. We performed extended left hemicolectomy and intraoperative we found a mass in the hepatic flexure of the colon with no sign of lymph node and liver metastases. The histopathologic diagnosis was adenocarcinoma moderately differentiated. The patient was diagnosed with adenocarcinoma of ascending colon T3N0M0, stage II.

Single Port Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis: A Case Report

The use and application of a laparoscopic cholecystectomy has been regarded as a first-choice treatment option for benign gallbladder disease, even if patients have situs inversus totalis. Furthermore, surgical procedures in general are becoming less invasive, because of both patient and surgeon preferences for reduced trauma and improved cosmetic outcomes attributable to minimized incisions. A 37 years old man was aware of situs inversus totalis with chronic cholecystitis. The operation was successfully performed without any specific complications. Single port laparoscopic cholecystectomy, in an experienced operator, is possible even in patients with situs inversus totalis.

Anesthetic considerations for a patient with situs inversus totalis undergoing cardiac surgery: A case report

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.

Efficacy of Oral Tofacitinib in Patients with Alopecia Areata: Tofacitinib Was Ineffective for Recalcitrant Alopecia Totalis of a Long Duration / 대한피부과학회지

No abstract available.

Azathiopine for the treatment of extensive forms of alopecia areata: A systematic review

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Alopecia areata (AA) is an autoimmune hair disorder, with the clinical variants ophiasis and extensive variants AA totalis and universalis, having poor response to therapy. Oral steroids are used to treat the severe variants, requiring prolonged therapy, which leads to side effects while discontinuation leads to high relapse rate. Azathioprine is a steroid-sparing agent for the severe AA forms.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review the current evidence on the therapeutic efficacy and adverse effects of azathioprine for severe forms of alopecia areata</p><p style="text-align: justify;"><strong>METHODS:</strong> Published articles utilizing azathioprine for alopecia areata were obtained until July 2018 from PubMed, MEDLINE, Cochrane Library, TRIP database, HERDIN, and Google Scholar.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Seven articles underwent a full-length review. Clinical variants include patchy, diffuse, steroid-resistant, reticulate, totalis, universalis, ophiasis, and sisaipho. Doses ranged from 2 to 2.5 mg/kg/day or weekly 5 mg/kg pulse therapy. Initial response ranged from 6 to 12 weeks, with almost complete resolution by 32 weeks. Response was sustained for 6 months upon discontinuation, with only 14% relapsing at 2.5 months. Adverse effects were gastrointestinal discomfort, elevated liver function tests, and myelosuppression.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> There is emerging evidence on the efficacy and safety of azathioprine for the treatment of extensive forms of alopecia areata. Randomized-controlled trials are needed to evaluate its efficacy.</p>

Laparoscopic Cholecystectomy in Two Patients with Situs Inversus Totalis: A Case Report

Situs inversus totalis (SIT) is a rare condition in which the viscera are transposed in a mirror image reversal. We report two cases of laparoscopic cholecystectomy (LC) performed for SIT patients. A 63-year old male patient with SIT was diagnosed with symptomatic gallstones. We performed LC by 3-port method. The patient was discharged uneventfully on postoperative day 2. A 57-year old female patient with SIT underwent LC for acute cholecystitis. Due to severe inflammation an assistant was needed. The patient was discharged uneventfully on postoperative day 3. Over 80 cases of LCs in SIT patients have been reported so far and LC has become the standard treatment. The current report confirms the safety of laparoscopy in such cases. Laparoscopic cholecystectomy can be performed safely in SIT patients if care is taken. Surgeons need to be careful of reversed anatomy and unaccustomed working hand.

Colecistectomía laparoscópica en situs inversus totalis / Laparoscopic cholecystectomy in situs inversus totalis

Situs inversus totalis es una anomalía congénita poco frecuente. Se caracteriza por la transposición de los órganos tóraco-abdominales en sentido sagital al brindar una imagen llamada en espejo. Reportamos paciente de 59 años con diagnóstico de litiasis vesicular y situs inversus totalis resuelto por colecistectomía videolaparoscópica, en el Hospital Universitario Comandante Manuel Fajardo de La Habana. El cuadro clínico tuvo seis meses de evolución, con dolor a tipo cólico en hipocondrio izquierdo acompañado de náuseas, que se relacionaban con la ingestión de alimentos colecistoquinéticos. Los exámenes de laboratorio estuvieron dentro de parámetros normales. La ecografía abdominal informó litiasis vesicular, así como, el situs inversus totalis que se confirmó con Rayos X de tórax. Su evolución posoperatoria, luego de un año, fue satisfactoria, la cual mostró la factibilidad de la técnica quirúrgica empleada(AU)

Situs inversus totalis (SIT) is a rare congenital anomaly characterized by the transposition of the thoracic-abdominal organs towards the sagittal direction, producing an image called in mirror. The case is presented of a 59-year-old female patient, with a diagnosis of vesicular lithiasis and situs inversus totalis for cholelithiasis, treated by laparoscopic cholecystectomy in Comandante Manuel Fajardo University Hospital of Havana. The patient's clinical picture had a natural history of 6 months, with left colic pain in the left hipocondrium, with nauseas, accentuated on ingestion of greasy meals. The laboratory test results showed normal parameters. X-rays of the abdomen confirmed vesicular cholestasis and situs inversus totalis. The patient's postoperative evolution after one year was satisfactory, showing the feasibility of the surgical technique used(AU)

Laparoscopic hemicolectomy for a patient with situs inversus totalis and colorectal cancer / Colectomia laparóscopica para um paciente com situs inversus totalis e câncer colorretal

ABSTRACT Situs inversus totalis is a congenital anatomic anomaly characterized by a complete inversion of thoracic and abdominal organs. We present a case of a 67 year-old patient diagnosed with situs inversus totals in his childhood who was referred for a two-month history of hematoquezia. Ascending colon cancer where found and he underwent a laparoscopic hemicolectomy with radical lymphadenectomy. An exhaustive preoperative study and a detailed planning of laparoscopic surgery including positions of operator and assistants and trocar sites have been performed to be aware of anatomic challenges. The operating time was 120 min and blood loss was minimal. Histologic examination showed a well-differentiated adenocarcinoma with serosal invasion and without lymph nodes metastasis (pT3N0). The patient was discharged on postoperative 6th day without complications. Laparoscopic surgery for colon cancer in patients with situs inversus totalis could be more difficult nevertheless a safe and feasible procedure should be performed successfully.

RESUMO Situs inversus totalis é uma anomalia anatómica consistindo em um investimento de órgãos abdominais. Nesse estudo, descrevemos um paciente, homem 67 anos, que foi diagnosticado com situs inversus totalis na infância. Apresentava sintomas de sangramento retal e foi diagnosticado com câncer de cólon direito e tratado cirurgicamente com receção laparoscópica. Para a realização da colectomia laparoscopica precisamos de um estudo pré-operatória completa e um plano detalhado de cirurgia com localização do trocateres e cirurgiões. A cirurgia durou 120 minutos e perde de sangue foi mínima. O resultado do exame patológico relatou adenocarcinoma (T3N0). Nosso paciente foi admitido por 7 dias e não apresentaram complicações. Para os pacientes com situs inversus totalis e câncer colorretal a receção laparoscópica pode ser mais difícil mas eficaz e segura.

Alopecia Areata - A literature Review

Alopecia areata (AA) is a disease marked by extreme variability in hair loss, not only at the time of initial onset of hair loss but in the duration, extent and pattern of hair loss during any given episode. This variable and unpredictable nature of spontaneous re-growth and lack of a uniform response to various therapies has made clinical trials in alopecia areata difficult to plan and implement. It is a type of alopecia that affects males and females equally. It occurs in both children and adults. The peak age of occurrence is 20 to 50 years .The most common clinical presentation is asymptomatic shedding of telogen hairs followed by patchy non scarring hair loss in association with nail pitting, Beau’s line and nail dystrophy. The disease may progress from this limited presentation to total loss of all scalp hairs (Alopecia totalis) or all body hair (alopecia universalis) with significant onychodystrophy. Mostly it is characterised by reversible hair loss involving the scalp although others areas of head including eyelashes, eyebrows and beard may also be affected. Although, it is a mostly cosmetic problem but it often has devastating effects on quality of life and self-esteem. The paper aims at providing an overview of Alopecia areata.

A study of clinical profile of Alopecia areata in a tertiary care hospital in Western Odisha

Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.

Pectus Excavatum e Situs Inversus Totalis: um relato de caso / Pectus excavatum and situs inversus totalis: a case report

O Pectus Excavatum consiste em uma deformidade óssea torácica caracterizada, basicamente, pela depressão do esterno e das cartilagens costais inferiores, podendo cursar com alterações da extremidade anterior das costelas na sua articulação com as cartilagens costais. Ademais, o Situs Inversus Totalis (STI) é caracterizado pelo desenvolvimento das vísceras no lado oposto de sua topografia habitual acompanhada de dextrocardia; ápice cardíaco voltado para a direita. Os autores relatam um caso combinado de Pectus Excavatum e Situs Inversus Totalis em um paciente jovem, do sexo masculino, diagnosticado no período da puberdade e discutem brevemente acerca de uma revisão literária do caso(AU)

Pectus excavatum is a chest bone deformity characterized primarily by depression of the sternum and the lower costal cartilages, which may be accompanied by changes in the anterior end of the ribs in its articulation with rib cartilage. In addition, the situs inversus totalis (SIT) is characterized by the development of the viscera on the opposite side of its usual topography accompanied by dextrocardia; cardiac apex facing the right. The authors report a combined case of pectus excavatum and situs inversus totalis in a young male patient diagnosed in the puberty period and briefly discuss about a literature review of the case(AU)