Multidisciplinary approach to palliation of obstructive jaundice caused by a central hepatocellular carcinoma.

BACKGROUND/AIMS: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). METHODS: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. RESULTS: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. CONCLUSION: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.

Prevalence of Salmonella in municipal sewage treatment plant effluents in southern California.

Effluents from 12 sewage treatment plants in southern California were examined for Salmonella using a Moore swab technique. Eight of the 12 plants were positive for Salmonella when sampled at the chlorination/dechlorination site (inside the plant). Effluents from 11 of 12 sewage treatment plants were positive for Salmonella when samples were analyzed downstream of the chlorination/dechlorination site, before effluents merge with the receiving stream (outside the plant). Two of the three control sites, an urban runoff, a raw potable water reservoir, and two other sites were also positive for Salmonella. A total of 683 Salmonella isolations were represented by 11 serogroups and 54 serotypes from 26 of 32 sampling sites. Effluents from three treatment plants and one control site (raw potable water resevior) yielded Salmonella enteritidis phage type 4, in addition to other serotypes.

[Case report: renal oncocytoma and Basedow hyperthyroidism]. / Fallbeschreibung: Renales Onkozytom und Basedow-Hyperthyreose.

Renal oncocytomas are reported as benign, rare neoplasms of the kidney. We describe a patient with renal oncocytoma and hyperthyreosis. Problems in diagnosis in radiology and pathology are described.

In vitro and in vivo effect of antibiotics on catheters colonized by staphylococci.

An in vitro model was used to study whether and how catheter infections can be cured. Silastic catheters were "infected" with Staphylococcus aureus ATCC 25923 and Staphylococcus epidermidis KH11 and V2; these "infections" were then treated with 24, 48 and 96 h continuous infusions of various antimicrobial agents administered both as monotherapy and in combination. The Staphylococcus aureus strain was considerably more difficult to eliminate from catheters than were the Staphylococcus epidermidis strains. This experience gained in the laboratory was then applied in vivo to 16 episodes of catheter sepsis in seven children. Treatment for at least six days with imipenem/cilastatin combined with fosfomycin or an aminoglycoside successfully eliminated the pathogens isolated from 11 of the 16 episodes of infection. The broad-spectrum combination was chosen because it could not be assumed that individual pathogens would be sensitive to a single substance. Nine of the infected catheters could be retained in the patients. This experience suggests that it may be possible to successfully eliminate the colonization of central venous catheters by coagulase-negative staphylococci using the antimicrobial agents employed here.

[Therapy and course of malignant extrahepatic bile duct tumors. Results in 93 cases]. / Therapie und Verlauf der malignen extrahepatischen Gallenwegstumoren. Ergebnisse von 93 Fällen.

Based on a retrospective study concerning the years 1974 to 1987 93 malignant extrahepatic bile duct tumors are being analyzed with regard to its histology, therapy and time of survival. The cases referred to herein are 49 tumors of the gallbladder and 44 bile duct tumors (25 tumors of the hepatic confluation, 10 tumors of the middle and 9 tumors of the distal portion of the bile duct). The middle and the distal hepatic duct tumors with 15.1 and 14.5 months respectively from the beginning of therapy have the longest time of survival on average. In contrast to those figures there are the bifurcation tumors with 9.9 months and the gallbladder tumors with 6.1 months of survival. So far 3 patients (2 with a gallbladder and 1 with a middle hepatic duct tumor) have survived as long as 3 years and are still alive. Only 1 patient, relating to a time of survival of 5 years, has been cured (gallbladder). 26.5% of these patients needed a second, 9.5% of them a third operation. A lengthy resection with curative intentions was done on 20.4% of the patients. 76.3% were treated palliatively, preferring, whenever possible internal drainage methods such as endoprosthesis or direct anastomosis drainage (hepaticojejunostomy, hepaticoduodenostomy, etc.).

[The nonresectable pancreatic tumor, an interdisciplinary problem. The surgeon's viewpoint]. / Der nichtresezierbare Pankreastumor, ein interdisziplinäres Problem. Standpunkt des Chirurgen.

In 204 patients with cancer of the pancreas (1973-1984), palliative treatment in 157 non-resectable tumors is analyzed retrospectively. 124 patients underwent biliodigestive anastomosis, 11 with simultaneous gastroenterostomy. In 13 patients a secondary gastroenterostomy was necessary due to duodenal obstruction. The mortality rate in this group was 38.5% compared with 9% in patients who underwent simultaneous gastroenterostomy. Where there is a calculated risk, the aim should be a single, definitive intervention, especially where the patient can no longer be provided with an endoscopic discharge.