Pelvic arteriovenous malformation with iliac vein thrombosis. A case report.

BACKGROUND: Congenital arteriovenous malformations (AVMs) of the pelvis are relatively rare and are difficult to treat because of diffuse extension and the number of feeding vessels. METHODS: We describe a patient with a pelvic AVM with shunts who also developed iliac vein thrombosis. The AVM was diagnosed during evaluation of what had initially appeared to be a venous stasis ulcer. RESULTS: The ulcer was successfully treated by Palma s procedure, partial resection of the feeding vessels, and transcatheter arterial embolization. CONCLUSIONS: Coexistence of a pelvic AVM with an iliac vein thrombosis has not previously been reported.

Advanced endocrine cell carcinoma of the gallbladder: a patient with 12-year survival.

Gallbladder carcinoid is a rare disease. In previous reports, classical carcinoid, an entity with a good prognosis, has not been distinguished from endocrine cell carcinoma, a tumor associated with marked cell atypia and mitosis, and a poor prognosis. The patient was a 66 year old woman who presented to our hospital with a chief complaint of jaundice. Pre-operatively, she was diagnosed as having advanced gallbladder carcinoma invading the liver and the hepatic hilus. The patient underwent right hepatic trisegmentectomy with en bloc resection of the caudate lobe and extrahepatic bile ducts, extended lymph node clearance and left hepaticojejunostomy. Histopathological examination showed positive Grimelius staining, marked mitosis, and intense atypism, hence, the tumor was diagnosed as an endocrine cell carcinoma. Twelve years after surgery, the patient is healthy, without any sign of recurrence. We present this novel case of long-term survival and review the literature.

Comparison of laser vascular welding, interrupted sutures, and continuous sutures in growing vascular anastomoses.

BACKGROUND AND OBJECTIVES: The argon laser-assisted vascular anastomosis may solve the problems of conventional sutured anastomosis, such as vascular stenosis and arrest of growth owing to a foreign-body reaction to suture material. STUDY DESIGN/MATERIALS AND METHODS: Twelve argon laser-assisted vascular anastomoses, seven conventional anastomoses with interrupted sutures, and five conventional anastomoses with continuous sutures were performed in 12 young mongrel dogs. RESULTS: Five months later, the external diameter at the anastomosis had increased 70.5% in the laser group, 67.0% in the interrupted suture group, and 22.9% in the continuous suture group. Histological examination of the laser-assisted anastomoses showed almost complete healing, with no granulomatous response around the anastomotic site. In the interrupted suture group, marked scaring and foreign body reactions were observed on the vessel wall at the site of the anastomosis. The continuous suture group showed more remarkable disorientation of the vascular layer and intimal hyperplasia than the interrupted suture group. CONCLUSION: Vascular anastomosis using the argon laser offers advantages over the conventional procedure in growing vessels.

Correlation between number of anastomosed vessels and survival rate in finger replantation.

In replantation surgery, an attempt is made to repair as many vessels as possible. However, operative procedures might be simplified to reduce the operative time and the number of personnel required. In an attempt to determine the essential number of vascular anastomoses in finger replantation, the correlation between the number of anastomosed vessels and survival rates was examined in 216 replanted fingers that had been completely amputated. Digits with two arteries repaired had higher survival rates than those with only one artery repaired; however, there was no significant difference between survival rates and the number of arterial anastomoses in any of the zones. The number of anastomosed veins was well-correlated statistically with the survival rate. In Zone I (distal to the lunula), there was no significant difference in the survival rates between no venous anastomosis and one to two venous anastomoses. A statistically significant difference between the survival rates with one venous anastomosis and two or three venous anastomoses was observed only in Zone III (middle phalangeal region). These results support the following conclusions: 1) The essential amount of arterial repair appears to be one arterial anastomosis. 2) The essential venous repair appears to be no veins in Zone I, one vein in Zone II (lunula to distal interphalangeal joint), two veins in Zone III, and one vein in Zone IV (proximal phalangeal region).

[Role of carcinoembryonic antigen, carbohydrate antigen 19-9 and cytology of bile in diagnosis of biliary and pancreatic cancer].

To evaluate the clinical value in diagnosis of biliary and pancreatic cancer carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9) and cytology in the bile were examined in 343 patients with benign biliary disease and 71 patients with biliary and pancreatic cancer. An abnormal CEA level was defined as a level of more than 500 ng/ml in the gallbladder bile and 40 ng/ml in the bile duct bile. Increased bile CEA levels were observed in 50.0% in 22 patients with bile duct cancer, 60.0% in 20 with gallbladder cancer and 23.8% in 21 with pancreas cancer. False positive rate in 343 patients with benign diseases was only 1.2%. Bile CA19-9 levels were measured in 195 patients with benign disease and 30 with malignancy. However, the overlap between the values of the 2 groups was too great for differentiation of malignancy from benign disease. The positive rates of bile cytology were 52.2% in 23 patients with bile duct cancer, 40.0% in 15 with gallbladder cancer and 27.3% in 22 with pancreatic cancer. The diagnostic accuracies of combined assessment of bile CEA and cytology were 68.0% in 25 patients with bile duct cancer, 77.3% in 22 with gallbladder cancer and 37.5% in 24 with pancreatic cancer. The sensitivity of this combined test was 60.6% (43/71), and the specificity was 98.8% (339/343). This combined test is considered to be reliable screening test especially for biliary cancer.