ABSTRACT
Primary diffuse malignant peritoneal mesothelioma is a rare malignancy with an estimated incidence of 200 to 400 new cases annually in the USA. We describe a case of diffuse malignant peritoneal mesothelioma arising in a 65-year old man who presented ascites of unknown origin. The importance of laparoscopy with subsequent histology of biopsy specimens in the diagnosis of this disease is emphasized. Because of his poor general condition, the patient had no further treatment. Update of treatment is briefly described with particular attention to multimodality approach.
Subject(s)
Ascites/etiology , Laparoscopy/methods , Mesothelioma/pathology , Peritoneal Neoplasms/pathology , Aged , Diagnosis, Differential , Humans , Male , Mesothelioma/complications , Mesothelioma/drug therapy , Peritoneal Diseases/diagnosis , Peritoneal Neoplasms/complications , Peritoneal Neoplasms/drug therapy , PrognosisABSTRACT
Fewer than 20% of patients with pancreatic cancer have resectable tumours at the time of diagnosis. In two patients with a pancreas neoplasm a laparoscopic staging work-up was performed. Because of the described limitations of laparoscopy, we propose to switch to a hand-assisted procedure. In our opinion the benefits of hand-assisted laparoscopic surgery, such as safe blunt digital dissection, restoration of tactile feedback and restored proprioception, account for greater accuracy in TNM staging and in the assessment of resectability of pancreatic cancer.
Subject(s)
Laparoscopy/methods , Pancreatic Neoplasms/surgery , Humans , Male , Middle Aged , Pneumoperitoneum, ArtificialABSTRACT
A rare form of male pseudohermaphroditism is characterized by the persistence of Müllerian derivatives in phenotypic males. To determine the etiology of this syndrome, we studied the expression of anti-Müllerian hormone (AMH) in six boys, including three brothers, with the persistent Müllerian duct syndrome. All except one presented with an inguinal hernia containing the Müllerian derivatives, and in two boys the hernial sac contained the contralateral testis. AMH was normally expressed in the testicular tissue of two patients, as shown by bioassay of anti-Müllerian activity and immunocytochemistry. The testicular tissue of the other patients had no detectable bioactive or immunoreactive AMH, yet they expressed AMH mRNA with a normal transcription initiation site and in the amount expected for their age. These results prove the heterogeneity of the persistent Müllerian duct syndrome and suggest that it may sometimes involve peripheral insensitivity to AMH.
Subject(s)
Disorders of Sex Development/etiology , Glycoproteins , Growth Inhibitors , Mullerian Ducts , Testicular Hormones/blood , Animals , Anti-Mullerian Hormone , Child, Preschool , Cryptorchidism/complications , Disorders of Sex Development/genetics , Disorders of Sex Development/physiopathology , Hernia, Inguinal/complications , Humans , Infant , Male , Rats , Syndrome , Testis/physiopathologySubject(s)
Dumping Syndrome/surgery , Pylorus/surgery , Vagotomy/adverse effects , Aged , Dumping Syndrome/etiology , Female , HumansABSTRACT
The case of a 41 year-old female presenting a voluminous (2 kg) non-functioning tumor of the adrenal cortex with excellent survival at 5 years and 3 months is reported. The tumor extended mainly cephalad and occupied the cerebral right hepatic space. The importance of preoperative inferior cavogram as well as a large thoraco-abdominal approach is stressed. The key to success is exposure and control of the entire segment of the inferior vena cava between renal vein and diaphragm. Particular attention must be paid to the middle (principal) suprarenal vein, a very short vessel (less than or equal to 1 cm) on the right side, which may enter either the inferior vena cava on the right suprahepatic vein.
Subject(s)
Adrenal Cortex Neoplasms/surgery , Abdomen/surgery , Adult , Humans , Male , Thoracic SurgeryABSTRACT
Intra-operative radiomanometry with serial conventional films (panoramic cholangiography) and intra-abdominally placed large dental films (selective low cholangiography) produce a dynamic and static, millimetric study of the lower part of the common duct. It revealed in 2,095 patients with benign biliary pathology 119 cases of stenosis of the papilla of which 34 are detected during secondary operations of 85 patients. With the procedure of the authors a clear definition of the benign stenosis of the papilla is obtained radiomanometrically: 1. moderate hypertony; 2. disappearance of the normal rhythmical sphincter activity; 3. the biliary infundibulum, no longer conical, is wider than the intrapancreatic part of the common bile duct above it; 4. the biliary pancreatic reflux more rarely appears and, if it is discernible, pancreatic reflux is shorter than expected and the pancreatic duct obviously enlarged. These signs are quite characteristic of chronic stasis in both common bile duct and pancreatic duct, from infundibulum to intrahepatic ducts above the stenosic papilla (Acta chir. belg., 1977,76,523-532).
