Umbilical endometriosis associated with large umbilical hernia. Case report.

Umbilical endometriosis is a rare condition, usually following laparoscopic and surgical procedures involving the umbilicus.Spontaneous umbilical endometriosis occurring without any previous abdominal or uterine surgery is extremely rare. The maximal depth of penetration of the umbilical endometriosis described is up to fascial level. There have been only two cases of endometriosis reported arising within umbilical hernia. The authors report a case of a patient with spontaneous umbilical endometriosis associated with a large umbilical hernia, treated by surgical excision and mesh repair of the abdominal wall. To the best of our knowledge, this is the first described case of the association of umbilical endometriosis with a large umbilical hernia that requires prosthetic mesh repair of the abdominal wall defect.

Tuberculous lymphadenitis as a cause of obstructive jaundice.

Obstructive jaundice secondary to abdominal tuberculosis is extremely rare. We present a patient with jaundice secondary to compression of the common bile duct by TB lymphadenitis. A 49-year-old woman was admitted to our department for nausea,epigastric pain and jaundice. Abdominal ultrasonography and computer tomography scan were suggestive of stenosis of the distal common bile duct caused by a retro pancreatic mass. At laparotomy, an enlarged lymph node behind the head of the pancreas was found, causing compression and stenosis of the distal parts of the choledochus. The lymph node frozen section analysis showed epithelioid granuloma with caseous necrosis,strongly suggesting tuberculous origin. Choledochoduodenal anastomosis was performed. Definitive pathohistological examination confirmed TB lymphadenitis. ATB should be considered as a potential cause of jaundice especially in immuno compromised patients and endemic areas. Diagnosing abdominal tuberculosis can be a challenging task. No satisfactory diagnostic gold standard is available so that in most cases the diagnosis cannot be reached before exploratory laparotomy.Early detection enables successful conservative treatment and eliminates the necessity of surgery.

Intermittent or continuous occlusion of hepatic inflow.

THE AIM OF THE STUDY: The aim was to compare the effects of intermittent and continuous inflow occlusion on liver I/R injury in an experimental model. METHOD: The experiment was done using the Wistar rats that underwent continuous and intermittent inflow liver vascular occlusion. Blood and liver tissue samples were taken and parameters of hepatic ischemia/reperfusion injury were analyzed and compared. RESULTS: Serum activities of ALT, AST and LDH were significantly higher and ALP activity and albumin concentration were markedly lower in rats with continuous liver ischemia. Also, histopathological examination revealed more severe changes in animals with continuous liver vascular occlusion. CONCLUSION: The results of biochemical assay and histopathological examination were concurrent, both indicating more serious parenchymatous damage caused by continuous hepatic pedicle clamping. Study results clearly demonstrated a better tolerance of the liver to intermittent Pringle maneuver (Tab. 1, Fig. 5, Ref. 9).

Malignant biliary stenosis treated with two percutaneous stents--case report.

INTRODUCTION: During last three decades interventional radiology became most powerfull tool in palliative treatment of patients with malignant biliary stenosis. CASE REPORT: We report a case of 62-year-old patient with malignant biliary obstruction caused by recidivant tumor of common bile duct remnant with infiltration of previously created hepaticojejunostomia. Biliary decompression was achieved by placement of two self-expanding metallic stents. DISCUSSION: In presented patient, due to previous surgery percutaneous approach was mandatory. Also, considering the unresectability of recidivant lesion and poor prognosis, definitive, preferable internal biliary drainage was to be achieved. Therefore the placement of metallic self-expanding stent was the therapeutic method of choice. CONCLUSION: The aim of percutaneous minimally invasive radiological interventions is to achieve effective biliary decompression with internal bile drainage if possible.

Electron-ionization-induced fragmentation of N-monosubstituted 2-phenylacetamides.

Electron-ionization-induced mass spectra of N-monosubstituted 2-phenylacetamides were recorded and their fragmentation patterns were studied by metastable-ion analyses. Representative deuterated analogues of these compounds have also been synthesized and their mass spectra compared with those of the unlabelled parent compounds. The most typical fragmentation for N-alkyl-, N-isoalkyl- and N-cycloalkyl-2-phenylacetamides is cleavage of the bond alpha to the carbonyl function, resulting in an ion fragment of m/z 92, following the transfer of hydrogen and elimination of a corresponding ketene. The primary fragmentation process for N-aryl substituted 2-phenylacetamides is the loss of an aromatic hydrogen atom from the molecular ion. The other principal fragmentation processes observed with these compounds are discussed.