A tale of spilled stones

Cholecystectomies are one of the commonest surgeries done in India. Gallbladder perforation and stone spillage is common and occurs in 15 to 40% of laparoscopic and 5 to 20% of open cholecystectomy procedures. In up to a third of these cases, stones are not retrieved and complications can arise many years post-operatively. In majority of cases these lost stones either in laparoscopic or open surgery remain silent but rarely can become symptomatic and cause range of complications like intra-abdominal abscesses, empyema, abdominal wall abscesses, cutaneous sinus tract and bladder fistulas. Diagnosis can be difficult and patients may present to many specialties within medicine and surgery. We seek to present our case and on a rare complication and management of one such “lost” stone.

Malignant pleural effusion of renal adenocarcinoma

The malignant pleural effusion is a frequent complication of the cancer, is diagnosed by means of the finding cell neoplasicas in the pleural liquid or a cytology of positive pleura for malignant, can be present in 15 % of patients with diseases neoplasicas; the difficulty in breathing, cough or thoracic pain are the most frequent symptoms. The carcinoma of renal cells (CRC) or adenocarcinoma renal it represents approximately 2-3% of the neoplasias of the adult with an approximate incident of 5/100 000 persons, appears between 50 and 70 years, most of the times being characterized by the lack of clinical manifestations, since consequence of it the majority of the cases are diagnosed as advanced disease. The pleural metastasis is comparatively rarer than the pulmonary metastasis. We report the case of male patient with pleural malignant spillage of adenocarcinoma renal.

Bioaccumulation of heavy metals in some tissues of croaker fish from oil spilled rivers of Niger Delta region, Nigeria

Objective: To investigate the level of heavy metals (Cu, Zn, Fe Mn Ni, Pb and Cd) in muscles, gills and liver tissue of Croaker fish from oil spilled rivers of Bonny and Finima, Niger Delta region, Nigeria. Methods: Twenty four Croacker fishes (Genyonemus lineatus) weighing between 250 and 260 g and 24–26 cm length were collected from each sampling sites (Bonny and finima rivers). The frozen fishes were thawed and dried at 105 ℃ until they reach a constant weight. The dried samples were homogenized and digested with 10 ml tri-acid mixture (HNO3: HClO4:H2SO4), and then the digested samples were diluted to 100 ml with deionized water. Heavy metals (Cu, Ni, Zn, Pb, Mn, Iron Fe, and Cd) concentrations were determined by atomic absorption spectrophotometer. Results: Our results revealed that concentrations and distribution patterns of all heavy metals studied varied significantly (P < 0.05) amongst the fish tissues analyzed and sampling sites. Moreover, liver tissue of fish caught from Finima creek accumulated the highest concentrations of Cu (52.64 ± 3.01μg/g dry wt), Zn (166.50 ± 6.45μg/g dry wt) and Fe (801.50 ± 14.15μg/g dry wt) in comparison to the liver of fish caught from Bonny river in which the levels of Cu, Zn and Fe were (45.00 ± 2.79), (49.90 ± 2.91) and (216 ± 6.11μg/g dry wt), respectively. In addition, Mn, Ni, Pb and Cd exhibited their highest concentrations in gills from both locations. As expected, muscle tissue contained the least concentrations of all metals investigated from both sampling sites. Furthermore, all the metals investigated exhibited highest concentration in fish collected from Finima creek. These abnormal high level heavy metals accumulation observed in this location could be linked to the frequent crude oil spills as well as industrial activity around the area which might get discharged into Finima creek. In general, the mean concentrations of some toxic heavy metals investigated exceed the recommended maximum permissible limits set by the Joint FAO/WHO committee. However, some metals are within the acceptable limits. Conclusions: In conclusion, our data showed the abnormal higher concentration of these metals and this might be toxic to the fish and other aquatic organisms directly or by extension to humans that frequently consumed such contaminated fishes.

Bioaccumulation of heavy metals in some tissues of croaker fish from oil spilled rivers of Niger Delta region, Nigeria

Objective To investigate the level of heavy metals (Cu, Zn, Fe Mn Ni, Pb and Cd) in muscles, gills and liver tissue of Croaker fish from oil spilled rivers of Bonny and Finima, Niger Delta region, Nigeria. Methods Twenty four Croacker fishes (Genyonemus lineatus) weighing between 250 and 260 g and 24–26 cm length were collected from each sampling sites (Bonny and finima rivers). The frozen fishes were thawed and dried at 105 °C until they reach a constant weight. The dried samples were homogenized and digested with 10 ml tri-acid mixture (HNO

Biodegradation of Petroleum by Fungi Isolated From Unpolluted Tropical Soil.

Bioremediation studies on the capabilities of Aspergillus niger A1, Candida sp C10 and Rhizopus stolonifer R7 isolated from unpolluted soil in Minna, Niger State Nigeria was investigated and rate of degradation measured by weight loss. Aspergillus niger A1, exhibited the highest ability in degrading the crude oil than Candida sp C10, and Rhizopus stolonifer R7. Aspergillus niger A1 degraded 53.7% of the crude oil after 16 days period of incubation while Candida sp C10 and Rhizopus stolonifer R7 degraded 45.0% and 35.0% respectively over the same period of incubation.. The result obtained demonstrated that the three fungi isolates are competent petroleum degrading organisms and may be used as best approaches to restoring oil contaminated environments through bioremediation process.

Improvements to the FIGO staging for ovarian cancer: reconsideration of lymphatic spread and intraoperative tumor rupture / 부인종양

OBJECTIVE: To evaluate the improvement in prognosis prediction with reassignment of International Federation of Gynecology and Obstetrics (FIGO) stages for ovarian carcinoma. METHODS: This was a retrospective study of patients with epithelial ovarian, fallopian tube, and primary peritoneal cancers. Sub-staging criteria used in stage reassignment were defined as follows: surgical spillage (IC1), capsule rupture before surgery or tumor on the surface (IC2), and positive cytology results (IC3); microscopic (IIB1) and macroscopic (IIB2) pelvic spread; microscopic extrapelvic spread (IIIA1) and retroperitoneal lymph node (LN) metastasis without extrapelvic spread (IIIA2); and supraclavicular LN metastasis (IVA) and other distant metastasis (IVB). Survival outcomes associated with the current and reassigned stages were compared. RESULTS: Overall, 870 patients were eligible for analysis. The median follow-up period was 45 months (range, 0 to 263 months). The 5-year overall survival rates (5YSRs) according to the current staging were 93.5% (IA), 82.5% (IC), 75.0% (IIB), 74.5% (IIC), 57.5% (IIIA), 54.0% (IIIB), 38.5% (IIIC), and 33.0% (IV). The 5YSRs of patients with IC1, IC2, and IC3 after sub-staging were 92.0%, 85.0%, and 71.0%, respectively (p=0.004). Patients who were reassigned to stage IIIA2 had a better 5YSR than those with extrapelvic tumors >2 cm (66.3% vs. 35.8%; p=0.005). Additionally, patients with newly assigned stage IVA disease had a significantly better 5YSR than those with stage IVB disease (52.0% vs. 28.0%; p=0.015). CONCLUSION: The modified FIGO staging for ovarian carcinoma appears superior to the current staging for discriminating survival outcomes of patients with surgical spillage, retroperitoneal LN metastasis without extrapelvic peritoneal involvement, or distant metastasis to supraclavicular LNs.

Effect of Preoperative Chemotherapy on Outcome of Wilms Tumor / 임상소아혈액종양

BACKGROUND: Wilms tumor is the most common renal tumor in children. The aim of this study was to assess the effect of preoperative chemotherapy after needle biopsy on outcome of Wilms tumor and suggest an optimal treatment scheme on Wilms tumor.METHODS: We reviewed the medical records of 52 patients who were diagnosed with Wilms tumor from 1995 to 2010. Before 2000, primary nephrectomy was usually done. After 2000, preoperative chemotherapy was usually done.RESULTS: Preoperative chemotherapy was given to 39 cases while primary nephrectomy was done in 13 cases. Five year survival rate and five year event-free survival rate were 96.2+/-2.7% and 87.9+/-4.7%, respectively. Tumor spillage occurred more frequently in primary nephrectomy group than in preoperative chemotherapy after needle biopsy group (P=0.014). There was no significant difference in survival between the two groups (P=0.599).CONCLUSION: Preoperative chemotherapy after needle biopsy improved diagnostic accuracy and decreased tumor spillage while strengthened chemotherapy intensity. Further studies are needed to optimize chemotherapy intensity.

Effect of Preoperative Chemotherapy on Outcome of Wilms Tumor / 임상소아혈액종양

BACKGROUND: Wilms tumor is the most common renal tumor in children. The aim of this study was to assess the effect of preoperative chemotherapy after needle biopsy on outcome of Wilms tumor and suggest an optimal treatment scheme on Wilms tumor. METHODS: We reviewed the medical records of 52 patients who were diagnosed with Wilms tumor from 1995 to 2010. Before 2000, primary nephrectomy was usually done. After 2000, preoperative chemotherapy was usually done. RESULTS: Preoperative chemotherapy was given to 39 cases while primary nephrectomy was done in 13 cases. Five year survival rate and five year event-free survival rate were 96.2+/-2.7% and 87.9+/-4.7%, respectively. Tumor spillage occurred more frequently in primary nephrectomy group than in preoperative chemotherapy after needle biopsy group (P=0.014). There was no significant difference in survival between the two groups (P=0.599). CONCLUSION: Preoperative chemotherapy after needle biopsy improved diagnostic accuracy and decreased tumor spillage while strengthened chemotherapy intensity. Further studies are needed to optimize chemotherapy intensity.

Tuberculosis pleural: Utilidad de la reacción en cadena de la polimerasa en muestras de tejido / Pleural tuberculosis: use of the polymerase chain reaction in tissue samples

El diagnóstico etiológico del derrame pleural tuberculoso, es difícil. La clínica y los ensayos paraclínicos suelen ser inespecíficos. El objetivo de este trabajo fue evaluar la sensibilidad y especificidad de la reacción en cadena de la polimerasa en tejido pleural para el diagnóstico de tuberculosis en comparación con el cultivo e histopatología, en pacientes con derrame pleural que ingresaron al servicio de Medicina Interna del Hospital “Dr. Domingo Luciani”, Caracas, Venezuela, entre abril de 2005 y agosto de 2006. Se estudiaron 52 pacientes, M/F (30 (57,7 por ciento)/22 (42,3 por ciento), con una edad promedio de 39 años. El valor de sospecha clínica fue del 69,2 por ciento. El cultivo resultó positivo en 6 casos (11,5 por ciento) y se identificaron lesiones granulomatosas tuberculoides en 40,4 por ciento. La reacción en cadena de la polimerasa mostró una sensibilidad del 50 por ciento y especificidad del 61 por ciento. Se concluyó que es una prueba eficaz para el diagnóstico de tuberculosis pleural

The diagnosis of tuberculous pleural effusion is difficult. The clinical trials and paraclinical essays are often nonspecific. The aim of this study was to evaluate the sensitivity and specificity of the polymerase chain reaction in pleural tissue for the diagnosis of tuberculosis in comparison with the culture and histopathological studies in patients with pleural effusion admited to the service of Internal Medicine Hospital Dr. Domingo Luciani, Caracas, Venezuela, between April 2005 and August 2006. We studied 52 patients, M/F (30 (57.7 percent)/22 (42.3 percent), with an average age of 39 years. The value of clinical suspicion was 69.2 percent. The culture was positive in 6 cases (11.5 percent) and tuberculoides granulomatous lesions were identified in 40.4 percent. Polymerase chain reaction showed a sensitivity of 50 percent and specificity of 61 percent. It was concluded that it is an effective test for the diagnosis of pleural tuberculosis

Prevention of spillage by adding chemotherapeutic drugs into transfusion bottles under negative pressure / 中国实用护理杂志

ObjectiveThe purpose of the present study was to discuss the method to avoid spillage by means of adding chemotherapeutic drugs into sealed transfusion bottles.Methods90 penicillin sealed bottles of the same batch number were randomly divided into the test group and the control group,each with 45 bottles.Standard method according to Basic Nursing was used to add chemotherapeutic drugs into transfusion bottles in the control group.Drugs were added into transfusion bottles under negative pressure in the test group.The operating time was measured,the spillage volume of puncture site was calculated and microbial detection of syringe was observed in the two groups.ResultsThere was a significant difference in the spillage volume of puncture site between the two groups (P<0.01),but no difference was seen in the operating time and microbial detection of syringe (P>0.05),ConclusionsThe spillage volume of puncture site was reduced significantly by means of adding chemotherapeutic drugs into transfusion bottles under negative pressure.This can decrease chemotherapeutic professional exposing risks and drug wastage.

Long Term Follow-up of Wilms' Tumor: 20 Year Experience in a Single Pediatric Center

PURPOSE: Wilms' tumor is the most common malignant tumor of the kidney during the childhood period. This is a potentially curable disease with an excellent prognosis due to the development of the multimodal treatments, including chemotherapy, radiotherapy and nephrectomy. The aim of this study was 1) to analyze our clinical experiences with of Wilms' tumor at a single tertiary medical center, including the survival rate and recurrence of disease after treatment and 2) to investigate the prognostic factors affecting the survival of patients. METHODS: We performed retrospective analysis of the clinicopathologic data of 68 patients who underwent operation for Wilms' tumor during 20 years from March 1986 to March 2005 at Yonsei Medical Center. RESULTS: 40 (58.8%) patients were male and 28 patients (41.2%) were female. The median age at diagnosis was 25 month (range: 2 month to~10 year 10 month). Preoperative neoadjuvant chemotherapy was given in 27 patients (39.7%), and initial nephrectomy followed by chemotherapy was performed in 41 patients (60.3%). Postoperative adjuvant radiotherapy was performed in 27 patients (39.7%). The median duration of follow-up period was 8 year 2 month (range: 24 day to~18 year 6 month). The overall 5-year survival rate and 5-year disease free survival rate were 87.0% and 76.9%, respectively. Univariate analysis showed that the significant prognostic factors affecting survival were age at diagnosis (P=0.016), pathologic stage (P=0.032) and, Tumor spillage or rupture during operation (P=0.005) and tumor cell anaplasia (P=0.031). Multivariate analysis showed that tumor spillage or rupture during operation was the most significant prognostic factor (Relative Risk=4.5). CONCLUSION: Early diagnosis, meticulous surgical technique and proper pre-or postoperative adjuvant chemotherapy and radiotherapy according to the tumor histology significantly increase the patient's survival rates.

Vaginal removal of mature cystic teratoma in postmenopausal woman / 영남의대학술지

Mature cystic teratomas, commonly called dermoid cysts, are the most common benign germ cell tumors of ovary in women of reproductive age. Mature cystic teratoma that constitutes 10-25% of ovarian tumors and 95% of teratoma, is germ cell tumor of the ovary. This occurs frequently in women less than 20 years old, but it can be found upto 10-20% in postmenopausal women. And in women over the age of 50, a mature cystic teratoma is likely to change into malignant form. Traditional surgical methods of mature cystic teratoma treatment include transabdominal cystectomy, oophorectomy, hysterectomy and(or) bilateral salphingooophorectomy. Recently laparoscopic approach replaces transabdominal surgeries in many cases. Vaginal removal of mature cystic teratoma is unique and rare. Compared with laparotomy, transvaginal approach is characterized by shorter hospital stay and lower morbidity rate. Compared with laparoscopic operation, transvaginal approach has advantages of no visible operative scar and lower intra-operative tumor spillage. The decision for surgical methods is related with patients' situations and surgeon's preference. We report 1 case of vaginal removal of mature cystic teratoma as a part of vaginal hysterectomy in old age patient.