ABSTRACT
Intra-thoracic herniation of abdominal organs following diaphragmatic rupture represents an unusual clinical occurrence with great diagnostic difficulty. The authors present a case of right diaphragmatic rupture related to peritonitis due to perforated duodenal ulcer in previous (1 year before) thoraco-abdominal trauma with complete intra-thoracic herniation of the liver, gallbladder, ascending and transverse colon and lung collapse. The preoperative diagnosis has been based on clinical, chest X-ray, and ultrasound examination. The patient, because of very serious respiratory and hemodynamic distress, immediately underwent surgery (thoraco-laparotomic approach) with reduction of the liver, gallbladder, ascending and transverse colon in the abdominal cavity, perforated duodenal ulcer suture and repair of diaphragmatic tear using an unusual repair mode: suture of autologous fascia lata graft to the diaphragm. Postoperative chest radiography showed the normal location of right diaphragmatic border.
Subject(s)
Duodenal Ulcer/complications , Hernia, Diaphragmatic/microbiology , Hernia, Diaphragmatic/surgery , Peritonitis/microbiology , Pulmonary Atelectasis/surgery , Wounds, Nonpenetrating/surgery , Adult , Colon, Ascending/surgery , Colon, Transverse/surgery , Gallbladder/surgery , Hernia, Diaphragmatic/diagnostic imaging , Hernia, Diaphragmatic/etiology , Herniorrhaphy , Humans , Liver/surgery , Male , Peritonitis/complications , Pulmonary Atelectasis/diagnostic imaging , Pulmonary Atelectasis/etiology , Rupture, Spontaneous/etiology , Treatment Outcome , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/etiologyABSTRACT
Valproic acid (VPA) is commonly prescribed medication for epilepsy, migraine and bipolar disorder. Although the common adverse effect associated with VPA are typically benign, less common adverse effect can occur; these include hepatotixicity, teratogenicity and acute pancreatitis (AP). VPA-induced pancreatitis does not depend on valproic acid serum level and may occur anytime after onset of therapy. Re-challenge with VPA is dangerous and should be avoided. The diagnosis of VPA-induced pancreatitis seems to be underestimated because of difficulties in determining the causative agent and the need for a retrospective re-evaluation of the causative factor. More of idiopathic pancreatitis should be a drug-induced pancreatitis. We report four cases of VPA-induced AP found in a group of 52 cases of AP in children come to our attention from January 2008 to December 2012. The aim of these reports is to point out our experience about clinical presentation, diagnosis, management, outcome in children with VPA-induced AP and review of literature.
Subject(s)
Anticonvulsants/adverse effects , Pancreatitis/chemically induced , Valproic Acid/adverse effects , Acute Disease , Child , Child, Preschool , Female , Humans , Male , Pancreatitis/diagnosis , Pancreatitis/therapy , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
The authors intend to contribute to the knowledge of this complex and in part not fully defined subject of apudomas, in particular with regard to classification criteria and physiopathological aspects. After having examined the characteristics of these neoplasias (probably common embryonal origin, similar radioimmunological, immunohistochemical and ultrastructural characteristics, the capacity to convert amine precursors into amines), the authors focus on the most significant aspect of these carcinoids which, in the light of current knowledge, possess varying but undisputed degrees of biological aggressiveness. They also highlight the importance of the gastroenteric tract as an organ with an endocrine function and lastly affirm the value of the classification which, using the pancreas as the reference organ, distinguishes endocrine neoplasias in this tract into entopic and ectotopic examples.
Subject(s)
Apudoma , Pancreatic Neoplasms , Apudoma/diagnosis , Apudoma/surgery , Apudoma/therapy , Carcinoid Tumor/diagnosis , Carcinoid Tumor/therapy , Diagnosis, Differential , Gastrinoma/diagnosis , Gastrinoma/therapy , Glucagonoma/diagnosis , Glucagonoma/therapy , Humans , Insulinoma/diagnosis , Insulinoma/therapy , Lymphatic Metastasis , Neoplasm Metastasis , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/therapy , Somatostatinoma/diagnosis , Somatostatinoma/therapy , Vipoma/diagnosis , Vipoma/therapyABSTRACT
The observation of two cases of phyllode tumors of the breast, one benign and the other malignant, brought the Authors to focus the fundamental aspects of these neoplasias. The histologic coexistence of both epithelial and connectival components, a relative unpredictable clinical evolution, the high frequency of recurrences, the stromal hyperproduction and modifications as expression of malignancy, and the need for large excisions are the fundamental characteristics of these tumors, which are considered transitional forms between benignity and malignancy.
