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1.
Eur J Radiol ; 93: 265-272, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28668425

ABSTRACT

PURPOSE: The aim of the present study was to estimate the incidence of very early hepatic metastases (HMs) (<6 months) and their imaging patterns after cephalic duodenopancreatectomy (CDP) for periampullary carcinoma (excluding duodenal carcinoma) and to identify their associated risk factors. METHODS: From January 2003 to June 2016, all patients who underwent surgical treatment for periampullary carcinoma by CDP at our institution and with adequate pre- and postoperative CT scans were included. Univariate and multivariate logistic regressions were performed to determine factors associated with very early HM and recurrence. RESULTS: Of the 132 patients included retrospectively, 27 (20.5%) patients developed HMs. The mean time to diagnosis of HM was 103.9±55.2days. HMs were multiple in 81.4% of cases and bilobar in 59.3% of cases; their mean maximum size was 16.7±12.7mm. In univariate logistic analysis, lymphovascular emboli were significantly associated with HM (p=0.02). No independent risk factors for HM were found in multivariate analysis. In multivariate logistic analysis, two independent risk factors were identified for the occurrence of early recurrence: tumor size >23mm on preoperative CT scan (OR: 3.3; 95% CI: [1.2-9.3]; p=0.02) and tumor differentiation (poor vs. good: OR 15.5; 95 CI [1.5-158.3]; moderate vs. good: OR: 17.1; 95% CI: [1.9-154.4]; p=0.04). CONCLUSIONS: Nearly one in five patients developed HM after CDP within 6 months with a highly consistent pattern. A thorough preoperative assessment, combining CT scan and MRI with a delay of less than three weeks before surgery, appears essential. A routine systematic postoperative CT scan at 8 weeks is also required prior to initiating adjuvant chemotherapy. The type of surgical intervention does not seem to be a risk factor, although the risk of HM occurrence appears to be related to the lymphovascular invasion of the tumor and maybe its degree of differentiation, elements not assessable by imaging.


Subject(s)
Adenocarcinoma/secondary , Duodenal Neoplasms/surgery , Liver Neoplasms/secondary , Pancreatic Neoplasms/surgery , Adenocarcinoma/surgery , Adult , Aged , Chemotherapy, Adjuvant , Female , Humans , Incidence , Logistic Models , Lung Neoplasms/secondary , Male , Middle Aged , Neoplasm Recurrence, Local/surgery , Peritoneal Neoplasms/secondary , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed
2.
Ann Emerg Med ; 44(2): 99-104, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15278079

ABSTRACT

STUDY OBJECTIVE: We evaluate the efficacy of fasciotomy or crotaline snake antivenom in reducing myonecrosis. METHODS: We used a randomized, blinded, controlled acute animal preparation. Twenty anesthetized swine were injected intramuscularly in the anterior tibiales muscle of both hind limbs with 6 mg/kg of Crotalus atrox venom (total of 12 mg/kg of venom per animal). Immediately after venom injection, the right hind limb underwent fasciotomy. Muscle biopsies were obtained from the fasciotomized hind limb at 0, 4, and 8 hours and from the other hind limb at the conclusion of the study (8 hours). In addition, animals received either 8 vials of reconstituted Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) or an equal volume of normal saline solution intravenously 1 hour after venom injection. A pathologist blinded to the study determined the percentage of myonecrotic cells in each biopsy. Statistical analysis was performed using repeated measures analysis of variance for compartment pressure. Rank-order methods were used for comparison of myonecrosis between groups. RESULTS: Biopsies from hind limbs undergoing fasciotomy revealed a progressive increase in the amount of myonecrosis over time (myonecrosis median at 0, 4, or 8 hours [or death]: 0%, 14%, or 14.5%, respectively; P<.001). Comparison of the amount of myonecrosis of biopsies at death or 8 hours revealed that limbs that underwent fasciotomy had significantly more myonecrosis than those that did not (myonecrosis median: 14.5% versus 2.5%, P=.048). No difference was detected in the amount of myonecrosis when FabAV was compared with normal saline solution on final biopsies from either fasciotomy or nonfasciotomy hind limb (myonecrosis median: 10.0% versus 10.0%, P=.64). CONCLUSION: Fasciotomy significantly worsens the amount of myonecrosis in a porcine model of intramuscular crotaline venom injection. No change in the amount of myonecrosis was detected with the use of FabAV treatment at the dosages used in this animal model.


Subject(s)
Antivenins/therapeutic use , Compartment Syndromes/drug therapy , Compartment Syndromes/surgery , Crotalid Venoms/antagonists & inhibitors , Fasciotomy , Immunoglobulin Fragments/therapeutic use , Muscle, Skeletal/pathology , Animals , Biopsy , Compartment Syndromes/chemically induced , Disease Models, Animal , Immunoglobulin Fab Fragments , Necrosis/drug therapy , Necrosis/surgery , Random Allocation , Single-Blind Method , Swine
4.
Transplantation ; 68(5): 699-707, 1999 Sep 15.
Article in English | MEDLINE | ID: mdl-10507491

ABSTRACT

BACKGROUND: Intestinal microsporidiosis is a major cause of chronic diarrhea and malabsorption in patients with human immunodeficiency virus. Its occurrence in transplant recipients has exceptionally been reported to date. METHODS: We report what we believe are the first two cases of intestinal microsporidiosis in renal transplant recipients. The patients were treated with mycophenolate mofetil. RESULTS: The clinical presentation was chronic diarrhea with massive weight loss. Stool analysis revealed microsporidian spores, identified as Enterocytozoon bieneusi spores by polymerase chain reaction. The onset of this opportunistic infection in these two patients is believed to be secondary to an increase in immunosuppression after azathioprine replacement by mycophenolate mofetil. The withdrawal of mycophenolate mofetil led to clinical recovery. CONCLUSION: The incidence of microsporidiosis will probably increase in transplant recipients treated with powerful immunosuppressants. Therefore, we recommend a systematic search for microsporidian spores in stool specimens in cases of unexplained diarrhea in these patients.


Subject(s)
Immunosuppressive Agents/adverse effects , Intestines/parasitology , Kidney Transplantation , Microsporida/isolation & purification , Mycophenolic Acid/analogs & derivatives , Opportunistic Infections/chemically induced , Postoperative Complications , Protozoan Infections/chemically induced , Adult , Animals , Feces/parasitology , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Mycophenolic Acid/adverse effects , Mycophenolic Acid/therapeutic use
6.
Paediatr Anaesth ; 5(2): 89-95, 1995.
Article in English | MEDLINE | ID: mdl-7489430

ABSTRACT

The results of a prospective assessment of cardiorespiratory changes related to anaesthesia and laparoscopic Nissen fundoplication are described in 25 children aged 1.2 to 14.3 years, weighing 9.0 to 64.0 kg. Respiratory disease or oesophagitis were present in 68% cases. During balanced inhalational anaesthesia, hypotension or bradycardia occurred prior to peritoneal insufflation in three cases of reverse Trendelenburg position. During surgery, intra-abdominal pressure was in the 6-10 mmHg range. Transiently, two patients were hypotensive while ten were hypertensive. PETCO2 gradually increased but only two patients required increased minute ventilation. One bronchial intubation episode developed. Airway complications were related to isoflurane administration. Postoperatively, transient hypoxia (25% cases) was observed during the first 3 h. Analgesia duration was in the 40-1440 min range. Hospital stay was 5.6 +/- 1.5 days (mean +/- SD). Laparoscopic paediatric fundoplication is safe when hypovolaemia and postoperative hypoxia are prevented.


Subject(s)
Blood Pressure , Fundoplication , Heart Rate , Laparoscopy , Respiration , Adolescent , Anesthesia, Inhalation , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/adverse effects , Bradycardia/etiology , Bronchitis/complications , Carbon Dioxide/metabolism , Child , Child, Preschool , Esophagitis/complications , Female , Humans , Hypotension/etiology , Hypoxia/etiology , Infant , Insufflation , Intubation, Intratracheal/adverse effects , Isoflurane/administration & dosage , Isoflurane/adverse effects , Male , Posture , Pressure , Prospective Studies , Tidal Volume
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