Total Pancreatectomy for Ampullary Adenocarcinoma in a 74-Year-Old Patient: Case Report and Literature Review.

Primary ampullary neoplasms have origin in the ampulla of Vater, an anatomical structure where the common bile duct and the pancreatic duct join together as a common channel. It represents <0.5% of all gastrointestinal cancers and approximately 7% of all periampullary cancers. The adenocarcinomas arising in this region originate from different epithelial cellular constituents present at the site, the histopathological classification encompass: intestinal type, pancreaticobiliary type, and mixed type. Pancreaticoduodenectomy is the treatment of choice when there is an overt or highly suspicious malignant behaviour. We present here the case of a 74-year-old male patient who presented to our department for further investigation of obstructive jaundice and a pancreatic mass associated with a six-month history of significant weight loss and mild epigastric pain. Eventually, a total splenopancreatectomy was performed given the extension of structural anomalies of the organ secondary to an ampullary adenocarcinoma.

Surgical treatment of renal carcinoma with atrial tumor thrombus avoiding cardiopulmonary bypass: step-by-step description.

Tumor thrombus in the inferior vena cava (IVC) occurs in 4-10% of patients with renal cell carcinoma (RCC) and poses a challenge for the surgical team. Because there is no systemic therapy available to significantly reduce tumor burden, surgical intervention is the only treatment. However, the surgical approach is associated with significant morbidity and mortality. When the thrombus extends above the diaphragm, the use of cardiopulmonary bypass (CPB) and accompanying deep hypothermic circulatory arrest (DHCA) has usually been advocated. However, complications inherent to CPB and DHCA, such as coagulopathy and central nervous system complications, have led us to search for an alternative surgical approach to these tumors. The purpose of this study is to describe the surgical technique used in five patients with large RCC with tumor thrombus extending into the supradiaphragmatic IVC and Right atrium (RA), Right atrium, who underwent extensive resection without CPB and DHCA.

Interleukin-10 induces the upregulation of the inhibitory receptor ILT4 in monocytes from HIV positive individuals.

A characteristic of human immunodeficiency virus infected individuals is an impairment of immune responses, which can result in opportunistic infections. Elevated levels of interleukin-10 (IL-10), produced by virally infected monocytes, are found in the sera of HIV infected individuals. Such elevated levels have been associated with the impaired function of CD4(+) and CD8(+) T cells, and antigen presenting cells (APC), such as monocytes. IL-10 has been reported to upregulate the cell surface expression of the inhibitory receptors ILT3 and ILT4 on monocytes and dendritic cells. This study demonstrates that the decreased antigen presenting ability of monocytes in HIV(+) individuals is in part due to the upregulation of ILT4 on the monocytes caused by the elevated serum IL-10 levels seen in these individuals.