Tumescent local anesthetic technique for inguinal hernia repairs

PURPOSE: We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. METHODS: The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. RESULTS: The mean operation time (+/-standard deviation) and hospital stay were 64.5 +/- 17.6 minutes and 2.7 +/- 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 +/- 14 months. CONCLUSION: Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs.

Candida Infection in a Patient with Gastric Carcinoma; 1 Case Report

Most gastric candida infections have been reported in immune-insufficient patients with peptic ulcer, but there have been few reports on gastric candidiasis with malignant ulcer in the stomach. We experienced a case of candida infection with gastric carcinoma in a 72-year-old female with diabetic mellitus. The endoscopic view showed multiple whitish necrotic plaques with a huge ulcer in the body of the stomach. The pathologic findings showed that budding yeast and pseudohyphae had infiltrated through the ulcerated stomach wall and the stomach wall contained tubular adenocarcinoma. After treatment with Fluconazole medication for 14 days, the patient underwent total gastrectomy along with D2 lymph node dissection. For the final pathologic results, there was no evidence of any remnant candidiasis, and the patient was discharged without specific complications. Through our experience and with reviewing articles about gastric candidiasis, we recommend that the gastric candidiasis that is accompanied with gastric malignancy should be treated before administering definite treatments for the gastric cancer.

Carcinoid Tumor of the Extrahepatic Bile Duct: A Case Report and Review of the Literature / 대한소화기내시경학회지

A carcinoid tumor of the bile duct represents between 0.2 and 2% of all gastrointestinal carcinoids, most of which are located in the gallbladder or in the ampulla of Vater. A carcinoid tumor of the extrahepatic bile duct is extremely rare. A 43-year-old man presented with epigastric discomfort for several months. An abdominal ultrasound revealed a mass of the common bile duct. An endoscopic retrograde cholangiopancreatographic (ERCP) examination showed a 1.5 cm sized filling defect in the distal common bile duct and marked dilatation of the common bile duct and intrahepatic bile ducts. A 7 F endoprosthesis was put in place during the examination. The histological finding following an intralesional biopsy was a carcinoid tumor. We performed a pylorus preserving pancreaticoduodenectomy. The final pathological diagnosis was a well-differentiated carcinoid tumor of a malignant nature.

Epidermal Growth Factor Receptor Overexpression and the Tumor Response to Preoperative Radiochemotherapy for Patients with Advanced Rectal Cancer

BACKGROUND: An association between the epidermal growth factor receptor (EGFR) signaling pathway and the response of cancer cells to ionizing radiation has been previously described. Preoperative radiochemotherapy (PRCT) has been administered for treating locally advanced rectal cancer to improve the outcomes, and to preserve the sphincter from lowlying tumor. However, the responses of tumors to PRCT are variable and there are currently no reliable markers that predict the therapeutic benefits. We studied the association between EGFR overexpression and the tumor response to PRCT in rectal cancer. METHODS: The EGFR protein expression, as determined by immunohistochemistry, was analyzed in the pretreatment biopsy specimens from 120 patients with advanced rectal cancer. The tumor response was graded in the surgically resected specimens by using a three-scale grading system: no response (NR), partial remission (PR) and complete remission (CR). RESULTS: NR was identified in 70 cases (58.3%). Fifty patients (41.7%) responded to PRCT; 27 (22.5%) achieved a PR and 23 (19.2%) achieved a CR. EGFR overexpression was detected in 78 (65%) cases. Seventy-eight percent (39/50) of the tumors with a CR/PR revealed EGFR reactivity, whereas 55.7% (39/70) of the tumors with NR showed an EGFR expression (p=0.048). CONCLUSIONS: The EGFR protein expression might be a valuable marker for identifying those patients who are most likely to benefit from PRCT.