ABSTRACT
Obturator hernia is a rare surgical condition, with about 800 cases being reported in the literature. It can cause significant morbidity and mortality, especially in the elderly age group. Delayed treatment is associated with high rates of strangulation (25-100 %). The mainstay of management for obturator hernia has been surgical. Non-operative management can lead to significant morbidity and mortality, but may be an option in patients who decline surgery, as described in our case.
Subject(s)
Hernia, Obturator/therapy , Intestinal Obstruction/therapy , Aged, 80 and over , Female , Hernia, Obturator/complications , Hernia, Obturator/diagnostic imaging , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , RadiographyABSTRACT
Previous studies suggest that surgical treatment of metastatic melanoma in carefully selected patients does improve survival. This paper assesses the survival of melanoma patients with hepatic metastases who underwent surgery in our unit. Fifteen (0.64%) patients had hepatic melanoma metastases. Seven patients underwent curative surgery. Surgical intervention included curative as well as palliative control of hepatic disease. Overall survival was calculated by the Kaplan-Meier method. Median survival for the 15 patients was 7 months. Median survival time in the curative surgical group and the palliative/nonsurgical group was 22 and 6 months, respectively. Patients with ocular primary, single lesions, and unilobar disease had a better outcome. Those who were selected and underwent surgery had a better overall survival compared with patients who are treated nonoperatively. Resection of hepatic melanoma metastases has a role in selected patients.
Subject(s)
Cryotherapy , Hepatectomy , Liver Neoplasms/surgery , Melanoma/surgery , Aged , Combined Modality Therapy , Female , Humans , Liver Neoplasms/secondary , Male , Melanoma/pathology , Middle Aged , Prognosis , Survival AnalysisABSTRACT
INTRODUCTION: The most effective treatment for acute or chronic liver failure is orthotopic liver transplantation. Worldwide there is a shortage of organs for transplantation. This shortage has called for research into new treatments for management of patients with liver failure. One such treatment is hepatocyte transplantation. During liver resections considerable amounts of normal liver are unavoidably resected. We aim to harvest these hepatocytes and to filter the tumor cells from them to provide a source for transplantation. MATERIALS AND METHODS: After liver resection, the largest vessel at the resected liver edge was identified and cannulated. Seglen's two-stage technique of perfusing the liver with EDTA and collagenase was performed to harvest the hepatocytes. Ep-CAM Ags are consistently present on the surface of epithelial cells and in particular in colorectal cancer cells. Therefore, MOC31 antibodies (selective Abs for Ep-CAM) attached to magnetic beads were used to target the tumor cells. These tumor cells are selectively removed using a magnet. CEA staining was then used to ensure the hepatocyte collection was tumor cell free. Five million hepatocytes were rosetted with one million HT29 CRC cells to assess the immunomagnetic filtration technique. RESULTS: The hepatocyte harvesting resulted in 864,000 viable hepatocytes to be harvested per gram of liver. Histochemical staining using CEA demonstrated 75% of the HT29 cells in the hepatocyte collection were removed after one use of magnetic beads. CONCLUSION: We have demonstrated the successful initial stages of harvesting tumor-free hepatocytes from liver resected for malignancy.
