Unusual manifestation of an ampullary tumor presenting with severe upper gastrointestinal bleeding.

Ampullary tumors can occasionally ulcerate and present as frank gastrointestinal bleeding. The most common clinical presentation is jaundice like in other tumors of the biliary tree. We report on a 68-year-old man who presented with severe upper gastrointestinal hemorrhage secondary to an asymptomatic mass of the ampulla of Vater. An endoscopic biopsy specimen revealed a villous adenoma with moderate dysplasia. A curative resection was performed, and pathological work-up revealed the presence of an infiltrating, moderately differentiated ampullary adenocarcinoma.

Laparoscopic colorectal resections. Initial experience at the AUB-MC.

BACKGROUND: Laparoscopic colorectal surgery has many advantages to offer. However, it is a complex procedure, and demands advanced technical skills and instrumentation. In addition, its safety when applied to malignant disease is debatable. In this article, we present the early experience and short term results of laparoscopic colorectal resections performed at the American University of Beirut Medical Center. PATIENTS AND METHODS: Between March 1997 and August 1998, 14 patients with various colorectal lesions underwent attempt at laparoscopic colorectal resection, at the American University of Beirut Medical Center. Seven patients were males (50%) and 7 were females (50%); their mean age was 59 yrs (range 40-73 yrs). Ten patients (72%) had malignant disease and 4 patients (28%) had benign disease. RESULTS: The operation was completed in 13 out of 14 patients (93%). The overall mean operative time was 176 min (range 135-270 min). The operation was taking less time as surgeons gained experience. The average hospital stay was 7.6 days (range 4-11 days). The last four patients, however, stayed less than six days in the hospital. There were no mortalities. There were three complications (21%), two patients had wound infection, and one patient had a prolonged ileus. All were managed conservatively. Ten patients had malignant disease. In these patients, the operative margins were clear of disease. The average number of lymph nodes retrieved was 10.4 (range 3-19). These patients were followed up for an average period of 7.4 months (range 1-16 months). There was one recurrence. There was no port site metastasis in any patient. CONCLUSION: Laparoscopic colorectal surgery is feasible and safe. The preliminary results are encouraging. Its application in malignant disease still awaits the results of prospective studies.

Tamoxifen and endometrial pathologies: a prospective study.

OBJECTIVE: The purpose of this study was to prospectively follow a group of women with breast cancer, on tamoxifen, for the development of endometrial pathologies. MATERIALS AND METHODS: Eighty women with breast cancer, on tamoxifen, were prospectively followed every 6 months with pelvic examination, Pap smear, vaginal ultrasound, and endometrial biopsy. RESULTS: Nine women were lost to follow-up prior to initiation of treatment and 4 refused biopsies, leaving 67 patients for evaluation. Fifty (74.6%) of the 67 patients were already on tamoxifen for a mean duration of 15.8 +/- 16.6 months and had a baseline benign, unremarkable endometrium at the time of entry into the study. The total duration of treatment was 32.5 +/- 19.6 months (median 30 months). The mean age of the patients was 51.7 +/- 9.9 years (median 52 years). Of the patients, 56.7% were postmenopausal. Sixty-three patients had a benign endometrium (mean age 51.8 +/- 10.1 years, mean duration 33.1 +/- 19.6 months). Two patients had simple hyperplasia (mean age 43.5 years, duration 28.5 +/- 33.2 months), 1 patient had complex hyperplasia with atypia (age 57 years, duration 13 months), and another patient developed adenocarcinoma (grade 3) after 22 months. These 4 patients had abnormal vaginal bleeding. Seven patients developed endometrial polyps (mean age 54.0 +/- 8.5 years, duration 36 +/- 24.2 months). The mean endometrial thickness for patients with histologically unremarkable and abnormal endometrium was not significantly different (7.6 +/- 3.9 vs 8.8 +/- 5.0 mm, respectively) (median 7.0 mm for both groups). No endometrial thickness cutoff point reached statistical significance. The patient who developed endometrial cancer had a thickness of only 3 mm. CONCLUSION: All patients who developed an abnormal endometrium had abnormal vaginal bleeding. There was no correlation between endometrial thickness and endometrial pathology; thus the value of routine screening remains controversial.

Liposarcoma of the spermatic cord.

In a 57-year-old man, a suspected incarcerated left inguinal hernia proved to be multifocal dedifferentiated liposarcoma of the spermatic cord. Radical orchiectomy and wide excision were performed, but marginal biopsies were positive for tumour. Radiotherapy was given.

Results of laparoscopic treatment of hydatid cysts of the liver.

BACKGROUND: We have previously reported on the laparoscopic treatment of hydatid cysts of the liver. We now report the successful treatment of 18 cysts in 12 patients with a median follow-up of 12 months. METHODS: The standard treatment in the open technique was performed laparoscopically. The main concern was to prevent spillage of the hydatid fluid, for which the puncture and evacuation of the cyst is carried under scolicidal agents cover using 1% cetrimide, thus decreasing the chances of recurrence. RESULTS: In this group of patients we had one biliary leak that ceased spontaneously and one recurrence of hydatid cyst but not in the same lobe. CONCLUSIONS: We conclude that laparoscopic evacuation of hydatid cysts is a successful operation comparable to the open technique, with the added advantages of the laparoscopic approach.

Treatment of hydatid cysts (Echinococcus granulosus) by Cetrimide (R).

Cetrimide (R) has been efficiently assessed against hydatid protoscolices as a scolicidal adjunct to hydatid surgery. It was tested in four concentrations (0.05, 0.1, 0.5 and 1%) against the protoscolices of hydatid cysts in sheep and cattle and in 0.1% concentration against the protoscolices of hydatid cysts in humans. For each concentration, three incubations of one, five and 10 min exposure were tested in vitro and in vivo on sheep and cattle cysts, and two successive incubations each of five min exposure on human cysts. All experiments resulted in rapid mortality of the protoscolices, as judged by their loss of motility, readiness to take vital stains and inability to develop into secondary hydatid cysts when inoculated into albino mice. The low toxicity of Cetrimide (R), its rapid action against the protoscolices, its scolicidal effect at a low concentration, and its low degree of absorption by the host tissues make it the most promising drug in hydatid surgery, displaying no side effects on the host.