Laparoscopic appendectomy is safe and feasible in pregnant women during second trimester: A retrospective study in a top-level Chinese center.

Acute appendicitis (AA) is the most common nonobstetric surgical emergency during pregnancy. According to the current guidelines and meta-analyses, traditional open appendectomy (OA) is still recommended for pregnant patients over laparoscopic appendectomy (LA), which might be associated with higher rates of fetal loss. Previous studies and experiences indicated that LA might be safe in the second trimester of pregnancy. The current study aimed to evaluate the safety and feasibility of LA in pregnant women during the second trimester.At our institution, a retrospective study was conducted with pregnant patients who underwent LA or OA during the second trimester between January 2016 and August 2018.A total of 48 patients were enrolled. Of them, 12 were managed with laparoscopy and 36 with the open approach. We found that the LA group had higher BMIs than the OA group (4.0 ±â€Š4.3 vs 21.5 ±â€Š2.9, P = .031). The financial results showed that the average daily medical costs for patients who underwent LA was higher than those who underwent OA (444 ±â€Š107 US$ vs 340 ±â€Š115 US$, P = .009), while the total cost of hospitalization was comparable between the 2 approaches. The perioperative and obstetric outcomes were comparable between LA and OA. In each group, only 1 patient had fetal loss. No "Yinao" was found in any of the patients in the LA group.In this study, with the proven advantages of the laparoscopic techniques, LA was found to be safe and feasible for pregnant women during the second trimester.

Hepatic Paragonimiasis Mimicking Hepatocellular Carcinoma.

Paragonimiasis is a parasitic lung infection caused by lung flukes of the genus Paragonimus. Ectopic infection may occur but rarely involves the liver. Here, we report a case of hepatic paragonimiasis in a Chinese man who was initially suspected to have hepatocellular carcinoma. He had been previously diagnosed with chronic hepatitis B. No specific symptoms or abnormal blood test results were observed, except for a significant rise in serum alfa-fetoprotein. Magnetic resonance imaging revealed a 12-cm mass with inhomogeneous signal intensity at the left lobe of the liver. Laparoscopic left hemihepatectomy was performed. He was finally diagnosed as hepatic paragonimiasis upon pathological examination and antibody serology. The postoperative course was uneventful. He received a standard course of praziquantel and recovered well. Our case is unique in its tumor-like characteristic and protrudes the difficulty of differential diagnosis with both benignant and malignant hepatic diseases by imaging studies or non-specific symptoms. Hepatic paragonimiasis is unusual; however, it should be considered in the differential diagnosis of liver malignancy by clinicians.

Mixed Adenoneuroendocrine Carcinoma of the Gallbladder.

Mixed adenoneuroendocrine carcinoma rarely occurs in the gallbladder. Most cases of cholecystic mixed adenoneuroendocrine carcinoma have been reported from Asia, North American, and Europe; however, there is scarce literature available on this tumor in other populations. Here, we report a case of mixed adenoneuroendocrine carcinoma in a Melanoderm woman who was initially suspected to have gallbladder cancer. No specific symptoms or abnormal blood test results were observed preoperatively. Magnetic resonance imaging revealed a 7-cm hypointense mass in the gallbladder fossa, which invaded the surrounding liver segments. Radical cholecystectomy, partial liver resection, and regional lymphadenectomy were performed. Finally, she was diagnosed as mixed adenoneuroendocrine carcinoma of the gallbladder upon postoperative pathological examination and immunohistochemical staining. She received six cycles of systemic chemotherapy and somatostatin treatment and survived 21 months after surgery. Our case highlights the fact that mixed adenoneuroendocrine carcinoma of the gallbladder can occur in African populations as well. Surgical approach combined with adjuvant chemotherapy and somatostatin treatment may contribute a relatively good survival outcome.

[Effect of glucagon-like peptide-2 (GLP-2) on intestinal barrier function in bile duct ligated rats].

OBJECTIVE: To investigate the effect of glucagon-like peptide-2 (GLP-2) on intestinal barrier function in bile duct ligated rats. METHODS: Seventy-two SD rats were randomly divided into three groups: GLP-2 treated group (T), obstructive jaundice control group (C) and sham operation group (SO). Proliferating cell nuclear antigen (PCNA) and caspase-3 expression in the intestinal mucosa were measured by immunohistochemistry staining equiped image analyzing systems (Image proplus Version 4.5), and the height of the intestinal villi was observed and measured with light microscope, in the rats 1, 3 and 7 days after operation. RESULTS: The expression of PCNA in the intestinal villi of rats in C group decreased significantly (P < 0.05), which was more serious than those in the SO and T groups especially on the third and seventh day after operation (P < 0.05). Compared with the SO and T groups, the expression of caspase-3 in the rats of C group increased significantly. The expression of caspase-3 increased with timeafter operation (P < 0.05). The height of the villi of the rats in C group was shorter than those of the rats in SO and T groups, and it became shorter and shorter day by day(P < 0.05). The height of the intestinal villi of the rats in SO group and T groups had no significant changes post operation. CONCLUSION: GLP-2 may stimulate the growth of intestinal mucosa, increase the intestinal mucosa cell proliferation, diminish the number of the apoptosis cells, and protect the intestinal barrier function in obstructive jaundice rats.

Synchronous incidental gastrointestinal stromal and epithelial malignant tumors.

AIM: To investigate the incidence of incidental gastrointestinal stromal tumor (GIST) and its etiopathogenesis. METHODS: From January 1, 2000 to December 31, 2007, 13804 cases of gastrointestinal epithelial malignant tumor (EMT) and 521 cases of pancreatic adenocarcinoma (PAC) were successfully treated with surgery at the Department of General Surgery and the Department of Thoracic Surgery, West China Hospital, Sichuan University, China. The clinical and pathologic data of 311 cases of primary GIST, including 257 cases with clinical GIST and 54 cases of incidental GIST were analyzed. RESULTS: Of the 311 patients, 54 had incidental GIST, accounting for 17.4%. Of these tumors, 27 were found in 1.13% patients with esophageal squamous cell carcinoma (ESCC), 22 in 0.53% patients with gastric adenocarcinoma (GAC), 2 in 0.38% patients with PAC, 2 in 0.03% patients with colorectal adenocarcinoma, and 1 in one patient with GAC accompanying ESCC, respectively. Patients with incidental GIST presented symptoms indistinguishable from those with EMT. All incidental GIST lesions were small in size, and the majority had a low mitotic activity while only 1.9% (5/257) of clinical GIST lesions had a high risk. CONCLUSION: Incidental GIST may occur synchronously with other tumors and has a high prevalence in males. Surgery is its best treatment modality.

[The change of glucagon-like peptide-1 and its effect on blood glucose metabolism after major surgery].

OBJECTIVE: To investigate the change of glucagon-like peptide-1(GLP-1) and its effect on blood glucose metabolism after major surgery. METHODS: Eleven patients, who had undergone major surgical procedures in our Department of General Surgery, were studied on the day before surgery, the first, third, and fifth day after surgery. Then, 42 rats were allocated randomly into three groups. The rats in control, which had not undergone any operation, received an intravenous glucose load (0.5 g/kg glucose + normal saline). The rats in operated group, which had undergone about 65% liver resection, received a same glucose load on the first, third,and fifth postoperative day. And the rats in GLP-1 group, which had undergone same hepatectomy, received a same glucose load with GLP-1 (0.3 nmol/kg) on the first, third,and fifth day after surgery. All rats would be killed by abdominal aorta exsanguinated in five minutes after drugs were infused of which the bloods were collected for determination of glucose (glucose oxidase), insulin, glucagon, and GLP-1 (radioimmunoassays) at each time-point. RESULTS: There was an increasing postoperative plasma concentration of glucose, insulin, and glucagon on the first day (P < 0.01), but the plasma GLP-1 was just elevated on the third day (P < 0.05). Then, the plasma glucose concentration was significantly lowered after GLP-1 given to rats undergoing hepatectomy (P < 0.001), which might reach the glucose range in controls. Lowering of blood glucose was achieved by a significant rise of insulin secretion (P < 0.001) and a suppression of glucagon secretion (P < 0.05). CONCLUSION: As far as can be concluded on basis of our data from patients and rats, GLP-1 can be used to reduce the plasma glucose concentrations when it is in stress status after major surgery.

[Diagnosis and treatment of intrahepatic biliary cystadenocarcinoma-a report of 11 cases].

BACKGROUND & OBJECTIVE: Intrahepatic biliary cystadenocarcinoma (IBC) is a rare intrahepatic malignant tumor which is scarcely reported, and there is relatively little experience in the diagnosis and treatment. This study was to analyze the clinicopathologic features, diagnosis, and treatment of IBC. METHODS: Clinical data of 11 patients with pathologically confirmed papillary IBC, treated between Mar. 1999 and Oct. 2006 with surgical operation in West China Hospital, were analyzed retrospectively. Of the 11 patients, 2 were men and 9 were women, with a median age of 54 (range 45-68). RESULTS: The chief complaints of the IBC patients were pain and distention in the epigastrium. Four cases were determined by immunohistochemistry, and showed cytokeratin 7 (CK7) expression. Four patients showed infiltration of carcinoma cells in the surrounding liver tissues; 3 of them received palliative hepatectomy and 1 received radical excision; they survived for 12-23 months. The rest 7 showed carcinoma cells confined to the cyst wall, and received radical excision; 3 of them survived for over 3 years; of the rest 4 patients, 1 received operation again 10 months later because of tumor recurrence and was still alive 14 months after the second operation, 1 suffered from intrahepatic multi-metastasis 12 months after operation and received expectant treatment, 1 suffered from ascites 15 month after operation and died without further treatment, 1 was lost during follow-up. CONCLUSIONS: IBC occurs mainly in elder women, and its malignant degree is lower than that of solid carcinoma. The prognosis of the patients with IBC confined to the cyst wall after complete tumor removal is better than that of the patients with IBC infiltrated into the liver.

[Evaluation of the liver reserve using lidocaine test on experimental liver injuries in rats].

OBJECTIVES: To study the effectiveness of the lidocaine test in evaluating the liver reserve of rats with experimental liver injury in different phases. METHODS: 40 healthy male Wistar rats were divided randomly into experimental and control groups. Rats of the experimental group received subcutaneous CCl4 in oil injection, and rats of the control group received saline injections. Monoethylglycinexylidide (MEGX) test, common hepatic function tests and histological examination of the livers were performed on all the rats. RESULTS: With the development of the severity in liver injury, the concentrations of the serum MEGX in lidocaine test decreased gradually, which were consistent with liver histological changes. However, the results from the common liver function tests were all abnormal in the experimental group and were not consistent with the liver histological changes. CONCLUSION: The results obtained from the MEGX test are more agreeable to liver histological changes than those from common liver function tests. The results from the MEGX test can represent liver histological changes concisely.

Venovenous bypass ahead of mobilization of the liver in orthotopic liver transplantation.

BACKGROUND: To evaluate feasibility and safety of venovenous bypass prior to mobilization of the liver during orthotopic liver transplantation (OLT). METHODS: Fifty-four patients were classified into two groups. Group A consisted of 23 patients receiving OLT with classical venovenous bypass. Group B consisted of 31 patients who received a modified-procedure: venovenous bypass ahead of the mobilization of the liver during OLT. The blood loss, duration of venovenous bypass, cold ischemia time, anhepatic phase, and transfusion during operation in the two groups were compared. Complications after the operation were also compared between the two groups. RESULTS: The duration of venovenous bypass and cold ischemia time in group A were longer than those in group B [(99.78+/-21.36 min) vs (96.32+/-22.25 min) and (484.78+/-134.01 min) vs (443.15+/- 85.27 min)]. The anhepatic phase lasted for about 100 min averagely in the two groups. The volumes of blood loss and transfusion during the operation were larger in group A than in group B [(5096+/-4243 ml) vs (1726+/-1125 ml) and (3676+/-2938.74 ml) vs (1217.69+/-829.72 ml)]. Postoperative complications occurred in 26 patients of group A and in 19 patients of group B. CONCLUSION: This modified-procedure or venovenous bypass ahead of mobilization of the liver in OLT can reduce the blood loss during OLT and the incidence of postoperative complications without prolongation of the anhepatic phase and duration of venovenous bypass.