ABSTRACT
BACKGROUND: Little information is available on short and long-term outcome of therapeutic endoscopic retrograde colangiopancreatography (ERCP) for choledocholithiasis in nonagenarians (>=90 years). The aim of this study was to evaluate retrospectively the feasibility of therapeutic ERCP in nonagenarians with choledocholithiasis, as compared with patients aged between 75 and 89 years. PATIENTS AND METHODS: During a 9-year period, therapeutic ERCP was performed for choledocholithiasis in 33 nonagenarian patients (group A) and 272 patients aged 75 to 89 years (group B). Clinical features, endoscopic findings, interventions, early and long-term results of therapeutic ERCP for a mean follow-up of 36 months were assessed and compared between the two groups. RESULTS: Group A patients had a higher incidence of acute cholangitis, concomitant diseases and gallbladder stones, as compared to group B patients. Furthermore, they required an emergency procedure, multiple sessions, stent insertion, and needle knife fistulotomy significantly more frequently (p<0.001). Group B patients underwent significantly more endoscopic manipulations and had a longer procedure time than group A patients. Complete bile duct stone clearance was achieved in 24.2% of group A patients and in 90.8% of group B patients (p<0.001). No ERCP related deaths occurred in group A patients. Cholecystectomy was not routinely performed in Group A patients having gallbladder stones. The rate of early and late complications was not significantly different between the two age groups. CONCLUSION: Therapeutic ERCP and biliary stenting have proved to be a feasible treatment option for the management of choledocholithiasis in nonagenarians.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Choledocholithiasis/surgery , Age Factors , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Feasibility Studies , Female , Humans , Intraoperative Complications , Male , Medical Audit , Postoperative Complications , Retrospective Studies , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/methods , Treatment OutcomeABSTRACT
UNLABELLED: The aim of our study is to present our experience in the surgical treatment of nonfunctioning pancreatic endocrine tumors (NFPETs) in patients with multiple endocrine neoplasia type 1 (MEN-1). PATIENTS AND METHOD: Between 1996 and 2006 a total of 11 patients with clinically confirmed MEN 1 syndrome were monitored in an annual screening program that included evaluation of the pancreas. Our policy was to use Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasound (EUS) in combination with biochemical screening in an effort to early diagnose and categorize the pancreatic involvement in MEN-1. RESULTS: NFPETs were identified in 4 female patients (36.4%). Diagnosis of NFPET was established 4.2 years later than that of MEN 1. The median tumor diameter at diagnosis was 2.2 cm (range 1.8-2.6 cm). All patients were treated by distal pancreatectomy. Diagnosis of NFPET was established in histological sections by staining with neuroendocrine tumor markers. Adjuvant therapy with streptozocin in combination with 5-fluorouracil was applied in two patients. After surgery the patients were followed up annually with clinical evaluation, biochemical tests and imaging studies. CONCLUSIONS: Early detection of NFPETs in patients with MEN-1 syndrome can be accomplished by biochemical and radiological screening program. NFPETs should be removed when diagnosed, in order to achieve a timely and efficient prophylaxis against further tumor growth and malignant development.
Subject(s)
Multiple Endocrine Neoplasia Type 1/surgery , Pancreatectomy , Pancreatic Neoplasms/surgery , Adolescent , Adult , Chemotherapy, Adjuvant , Drug Therapy, Combination , Endosonography , Female , Fluorouracil/administration & dosage , Fluorouracil/therapeutic use , Follow-Up Studies , Humans , Immunohistochemistry , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Endocrine Neoplasia Type 1/diagnosis , Multiple Endocrine Neoplasia Type 1/drug therapy , Multiple Endocrine Neoplasia Type 1/pathology , Pancreas/pathology , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/pathology , Streptozocin/administration & dosage , Streptozocin/therapeutic use , Time Factors , Tomography, X-Ray ComputedABSTRACT
The aim of this study was to assess the feasibility and safety of laparoscopic hepatectomy using radiofrequency (RF) thermal energy in a porcine model. Fifteen female domestic pigs weighing 29.3 kg (range 25 to 35 kg) were used. Five transversal abdominal incisions (3 of 1 cm and 2 of 0.5 cm) were made for the introduction of the video camera and the other laparoscopic instruments. With the porta hepatis not clamped, the liver was inspected and the preferred lobe each time was divided using RF (cool-tip electrode 3 cm) with minimum bleeding. Serum liver enzymes and blood counts were drawn pre and postoperatively. All animals were killed after 1 week. The mean time of the procedures was 119 minutes (range 100 to 155 min). There were no intraoperative complications. Mean blood loss was 27 mL (range 5 to 60 mL), and the mass of the resected specimen was 132.5 g (range 65 to 305 g). There were no postoperative complications or deaths. Bloodless laparoscopic hepatectomy was technically feasible and safe in the porcine model using cool-tip electrode and 500-kHz RF Generator.
