ABSTRACT
Robotic total pancreatectomy (RTP) is a novel surgical approach currently performed by a select group of skilled surgeons. As robotic approaches to pancreatic surgery increase worldwide, rates of RTP are expected to increase. However, the standard technique is still evolving and several technical problems still require evaluation. Here, we describe our approach in a stepwise fashion and discuss solutions to overcome technical difficulties.
Subject(s)
Minimally Invasive Surgical Procedures/methods , Pancreas/surgery , Pancreatectomy/methods , Pancreatic Neoplasms/surgery , Robotic Surgical Procedures/methods , Aged , Aged, 80 and over , Biliary Tract Surgical Procedures/methods , Female , Gastrointestinal Tract/surgery , Humans , Male , Middle Aged , Pancreaticoduodenectomy/methods , Plastic Surgery Procedures/methods , Treatment OutcomeABSTRACT
PURPOSE: Nonalcoholic steatohepatitis (NASH) has been associated with irinotecan (IRI)-based cancer chemotherapy regimens. The purpose of this study was to propose and test a consistent model of IRI-induced NASH, filling a gap in the medical literature. METHODS: Swiss male mice were distributed in groups (n = 8) and injected with saline (5 mL/kg, i.p.; control) or IRI (25, 50, 75 or 100 mg/kg, i.p.) thrice a week for 7 weeks. Blood samples were collected to measure the serum concentrations of proteins, alanine and aspartate aminotransferases (ALT and AST). Each week animals were euthanized, and the livers were submitted to myeloperoxidase (MPO) assay, lipid dosage, immunohistochemistry for inducible nitric oxide synthase (iNOS), TNF-α and interleukin-1ß (IL-1ß), and histopathological analysis. Survival rates were also determined. RESULTS: Mice treated with IRI had a significantly (p < 0.05) lower survival rate than controls and time- and dose-dependent body weight loss. ALT and AST plasma levels increased in relation to controls only in mice receiving IRI 50 mg/kg (p < 0.05). The histopathological features characteristic of NASH was observed, including steatosis, lobular neutrophil infiltration and ballooning hepatocytic degeneration. Additional findings included increased MPO, lipid accumulation, portal neutrophil infiltration, IL-1ß and iNOS expression and fibrosis in liver tissues and low serum protein levels compared to controls. CONCLUSION: This is the first report of a consistent model of IRI-induced NASH capable of mimicking clinical findings.
Subject(s)
Camptothecin/analogs & derivatives , Fatty Liver , Liver , Mice , Alanine Transaminase/blood , Animals , Antineoplastic Agents, Phytogenic/metabolism , Aspartate Aminotransferases/blood , Camptothecin/metabolism , Camptothecin/pharmacology , Disease Models, Animal , Dose-Response Relationship, Drug , Drug Screening Assays, Antitumor , Fatty Liver/chemically induced , Fatty Liver/metabolism , Fatty Liver/pathology , Fatty Liver/physiopathology , Humans , Interleukin-1beta/metabolism , Irinotecan , Liver/metabolism , Liver/pathology , Male , Peroxidase/metabolism , Time Factors , Tumor Necrosis Factor-alpha/metabolism , Weight Loss/drug effectsABSTRACT
A 78-year-old woman presented with an abdominal mass diagnosed by ultrasound and computed tomography. The patient underwent a laparotomy, during which a retroperitoneal tumor adherent to the cecum wall was identified. Microscopically, it showed spindle-cell proliferation in whorls, with low mitotic count (2 per 50 high-power fields) and was strongly positive for S-100 protein and vimentin. The final diagnosis was benign schwannoma of the cecum and no further treatment was required. Large intestine schwannomas are extremely rare tumors and only a few cases of schwannoma of the cecum have been reported to date.
