Mesenchymal hamartoma of the liver in adults--case report.

INTRODUCTION: Mesenchymal hamartoma of the liver is a benign lesion presenting as an enlarging abdominal mass in children less than 2 years of age. Fewer than 5% cases are present in individuals over 5 years of age, and this lesion is extremely rare in adults. It may affect the left or the right lobe of liver as a cystic or solid mass or both components may be present. The pathogenesis remains incompletely understood, but these lesions have generally been considered to represent a development abnormality in the bile duct plate formation. CASE REPORT: In this report, we present a case of a 44-year-old man who was surgically treated at the Department of Abdominal, Endocrine and Transplantation Surgery of the Clinical Center of Vojvodina due to cystic lesion in the liver segment IV that had been verified by computed tomography imaging diagnostics. The patient was sent from a smaller health center with the diagnosis of echinococcosis. After the adequate preparation of the patient, surgical excision ofthe liver cystic lesion was done. Once a thorough histological examination had been performed, the diagnosis of mesenchymal hamartoma was made. CONCLUSION: Mesenchymal hamartoma of the liver is a benign tumor resulting from abnormal, intra-uterine development of bile ducts and has a delayed clinical manifestation, thus this lesion appears to be related to the processes of maturation. It is potentially pre-malignant lesion presenting as a solid and/or cystic neoplasm. Symptoms, laboratory results and radiographic imaging are nonspecific and inconclusive, so surgical excision of the whole lesion is the imperative for the definitive diagnosis.

[Histopathological finding as a prognostic factor of the surgical treatment outcome in colorectal cancer].

BACKGROUND/AIM: Adenocarcinomas of the colon are the most common malignant colorectal tumors. Macroscopic and histopahtological features of colorectal cancer significantly affect its outcome. The aim of this study was to analyze the impact of histopahological finding as a prognostic factor on the surgical treatment outcome and the course of the disease. METHODS: In the first part of this study the distribution (numerical and proportional) of certain histopathological parameters in the examined groups of patients were reviewed; in the second part of the study the statistical significance of the impact of the certain elements of a histopahtological finding on the surgical treratment outcome was analyzed. The histopathological elements analyzed included: the hsitological tumor type grading according to Duke, ie Astler-Coller, and tumor, nodes, metastases (TNM) staging in the examined sample of 100 patients. RESULTS: Statistically significant prognostic factors of the outcome of surgical treatment were selected after multivariant analysis. These factors comprise Astler-Coller-Dukes stage D (revealed in 77.78% patients died), stage IV according TNM classification (T1-4, N0-2, M1), histological structure (poorly diferentiated adenocarcinoma in 85.2% patents died) and type of tumor (mucynous adenocarcinoma was more often present in died, 77.78%). Since phi = 0.000 for four risk factors were formed using discriminant analysus, it was proved their significant influence on the outcome of surgical treatment Discriminant coefficient showed that the greatest influence on surgical treatment were registred in patients with tumor of Astler-Coller-Dukes stage D (0.255), poorly differentiated adenocarcinoma (histological structure) (0.139), mucynous adenocarcinoma (type of tumor) (0.074) and stage IV according to the TNM classification (T1-4, N0-2, M1) (0.39). CONCLUSION: The prognostic factors influencing the outcome of surgery for colorectal carcinoma were defined. Patients with pathohistological finding of Astler-Coller-Dukes stage D, stage IV according to the TNM classification (T1-4, N0-2, M1) and poorly differentiated adenocarcioma have statistically highly significant mortality during the perioperative course of the disease.

Cadaveric organ transplantation and religion.

Multiple organ procurement is a surgical procedure by which organs of a brain dead donor are taken for transplantation. Cadaveric organ donors must be those who have suffered a sudden structural and irreversible damage of the brain or brainstem. Social and scientific aspects of organ transplantation have been widely discussed so far, whereas the religious factor, which should be also respected, has rarely been analyzed. Considering the fact that Serbia is a multicultural and multi-confessional society, opinions of all confessions practised in the Republic of Serbia should be taken into account. The Orthodox Church permits transplantation from one man to another and transplantation is strongly recommended from the standpoint of Christian morality. These attitudes are accepted and respected by the Roman Catholic Church, Reformers, Judaism and Islam as well. For the future development of organ transplantation it is necessary to have a sufficient number of organ donors. Valid and complete laws must strictly define brain death, organ donation and waiting lists. The public should be fully informed about this issue in order to build mutual confidence between the population and medical staff.

[Total colectomy--options in management of acute obstruction of the left-side colon].

INTRODUCTION: Emergency colorectal surgery has been associated with a high morbidity and mortality rate. The current trend for the management of obstruction of left-sided colorectal carcinoma favours primary resection and anastomosis, as a safe and acceptable approach to selected patients. METHOD: Retrospective review of 81 patients (46 male and 35 female, mean 64 years). RESULTS: Morbidity after emergency total colectomy was 21%, and mortality was 6%. There were 6 anastomotic complications (2 anastomotic disruptions and 4 anastomotic leaks). Mean hospital stay was 13 days. 82% patients had adequate continence. DISCUSSION: Traditional approach for left-sided colon obstruction is three-stage procedure (Bloch-Paul-Mikulicz). The idea of removing dilated colon proximal to an obstructing tumor is not new, since Lane suggested this option in 1914. In 1965 Hughes and Cuthberson described their experience with 12 patients. At the moment of laparotomy 20% patients had advanced malignant disease. The cumulative morbidity and mortality are high in three-stage procedure. Three-stage approach is associated with high permanent colostomy rate. One-stage resection with primary anastomosis of the obstructed left-sided colon is a safe alternative to staged procedures. Emergency radical resection can be safely performed in majority of patients with left-colon obstruction. CONCLUSIONS: Total colectomy with anastomosis is a suitable procedure for treating left-sided colonic obstruction provided that pelvic floor is adequate. Total colectomy has low mortality, acceptable morbidity and good quality of life. The success of the surgery depends on the selection of patients.

[Multiple organ transplantation].

INTRODUCTION: Liver transplantation is the most demanding of all solid organ tranplantations. It requires perfect organization and motivation of health care professionals, patients and their families. This article deals with the procedure for multiple organ procurement, reviews criteria for organ donation and describes the surgical tehnique for multiple organ procurement. DISCUSSION: Adequate selection and evaluation of cadaveric donors and of organs for transplantation should include early identification of potential donors, and early diagnosis of brain death. The procurement of the highest number of viable organs jbfor transplantation requires excellence in each of the phases. Early and aggressive physiologic support in the maintenance of fotential donors can reduce organ donor loss due to irreversible asystole or multiorgan jafiure (it is almost always possible to maintain organ perfusion pressure) and increase the number of organs without increasing post-transplant morbidity or mortality. The ideal donor is a young, previously healthy, brain dead, victim of an accident. CONCLUSION: The surgical procedure for multiple organ procurement from brain death donors must be performed without intraopertive organ damage.

[A gastrointestinal stromal tumor--case report].

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. They frequently occur in the stomach and small intestine, but they rarely occur in the colon and rectum. CASE REPORT: This is a case report of a patient with a GIST involving the cecum, and acute obstruction of the small intestine. A 47-year-old male patient was admitted to the emergency surgery department with abdominal pain and distension lasting for a few days. Clinical examination revealed tenderness in the right iliac fossa. Routine hematologic testing revealed anemia, and abdominal x-ray multiple air-fluid levels in the small intestine. Based on the clinical findings, we decided to perform an explorative laparotomy. A large cecal tumor was detected. The proximal parts of the small intestine were severely distended. DISCUSSION AND CONCLUSION: GISTs are more common in the stomach (60-70%) and the small intestine (25-35%), than in the colon, rectum and esophagus. The most frequent complications associated with GISTs are obstructions and hemorrhages. Surgical resection is the primary treatment of GISTs. Radiotherapy and chemotherapy are generally ineffective. Continuous postoperative follow-up is necessary, because most recurrences occur within the first 2 years after complete surgical resection. In the past few years, surgical resection was followed by adjuvant tyrosine kinase inhibitor therapy.

[The role of enteroclysis and roentgen anatomy of jejunumand ileum in Crohn's disease].

INTRODUCTION: The aims of this research were: 1) to establish the value of enteroclysis in detection of morphological changes of jejunum and ileum in cases with suspected Crohn's disease and 2) to establish types of morphological changes of jejunum and ileum in patients with Crohn's disease. MATERIAL AND METHODS: The study compared two groups of people who voluntarely accepted to be examined: a control group and a study group. The control group included 11 healthy people, without gastrointestinal symptom. The study group included 16 patients with Crohn's disease. Single and double-contrast enteroclysis were performed in both groups. Afterwards, we defined parameters which were compared in these groups. CONCLUSIONS: We concluded that according to statistics there are significantly lower values of the width of the jejunal and ileal lumen and the number of mucosal folds (per 1 cm) of the jejunal and ileal wall in the examined group in contrast to the control group. Also, according to statistics there are significantly higher values of the width of the jejunal and ileal wall and the thickness of mucosal folds of the jejunum and ileum in the study group in contrast to the control group.