Robotic management of huge hepatic angiomyolipoma: A case report and literature review.

Hepatic angiomyolipoma (HAML) is a rare, benign mesenchymal liver tumor encountered in Asia, primarily in females, and can be found within the right hepatic lobe, but also in other areas of the liver. Immunohistochemically, HAMLs are characteristically positive for human melanoma black-45 antigen (HMB-45) and can histochemically vary in the composition of angiomatous, lipomatous, and myomatous tissue, together with the presence of epithelioid cells. In this case report, we discuss a previously healthy patient presenting with bloating and previously documented concern of liver lesions, found to have HAML confirmed by surgical pathology. Surgery was decided, as HAMLs greater than 10 cm are at risk of rupture. This is one of the first documented cases of HAML resected through robot-assisted bisegmentectomy and cholecystectomy, and therefore, intraoperative images have been included to assist in the planning of future robotic cases.

Robotic hepatectomy and cholecystectomy in the management of intraductal papillary mucinous neoplasm of the biliary tract: A case report and literature review.

BACKGROUND: In the Western Hemisphere, Intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B) is a rare lesion with uncertain aetiology. This report outlines a scarcely documented instance of IPMN-B treated using robotic hepatectomy and cholecystectomy supplemented with intraoperative imagery aimed at informing future robotic procedures. METHODS: A healthy person with acute cholangitis symptoms underwent diagnostic imaging followed by successful robotic hepatectomy and cholecystectomy. Pathological examination confirmed IPMN-B. RESULTS: The patient was consulted regarding the proposed procedure of robotic left hepatectomy, cholecystectomy, and potential hepaticojejunostomy, to which she provided consent. Subsequent surgical intervention resulted in clear margins for malignancy, and the patient recovered without complications. CONCLUSIONS: This case emphasises the importance of early diagnosis and intervention in managing IPMN. The use of a robotic approach, specifically through robotic left hepatectomy combined with cholecystectomy, offers minimally invasive surgery that provides exceptional visualisation and precise control.

Third Renal Transplant in a Patient With Prune Belly Syndrome.

Kidneys are the most frequently transplanted organ in the United States. An infrequently encountered cause of end-stage renal disease requiring permanent dialysis is prune belly syndrome. Prune belly syndrome is mostly seen in males and over a third of patients require permanent dialysis. Due to defects in abdominal wall musculature, transplantation in these patients is technically challenging. We present a novel case of a third renal transplant in a patient with prune belly syndrome with two previous failed transplants.

Tuning polarity of polyphenylene dendrimers by patched surface amphiphilicity--precise control over size, shape, and polarity.

In the ideal case, a precise synthesis yields molecules with a constitutional as well as a conformational perfectness. Such a case of precision is demonstrated by the synthesis of semi-rigid amphiphilic polyphenylene dendrimers (PPDs). Polar sulfonate groups are precisely placed on their periphery in such a manner that patches of polar and non-polar regions are created. Key structural features are the semi-rigid framework and shape-persistent nature of PPDs since the limited flexibility introduces a nano-phase-separated amphiphilic rim of the dendrimer. This results in both attractive and repulsive interactions with a given solvent. Frustrated solvent structures then lead to a remarkable solubility in solvents of different polarity such as toluene, methanol, and water or their mixtures. Water solubility combined with defined surface structuring and variable hydrophobicity of PPDs that resemble the delicate surface textures of proteins are important prerequisites for their biological and medical applications based upon cellular internalization.

Evaluating the safety and efficacy of BMI-based preoperative administration of low-molecular-weight heparin in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery.

BACKGROUND: One of the most concerning and potentially fatal complications of gastric bypass surgery is pulmonary embolism (PE) with published rates exceeding 1%. Although this procedure has been proven effective in reducing the morbidity and mortality of obesity and associated health care costs, it is elective and risk must be minimized. No dosing guidelines exist for pharmacologic prophylaxis in obese patients who are already at increased risk for these events. Although the current ASMBS and Chest guidelines recommend preoperative pharmacologic prophylaxis against thromboembolic events, no standard dosing protocols exist for the obese population. We propose a protocol including immediate pre followed by twice daily postoperative BMI-based dosing of low-molecular-weight heparin (LMWH), along pneumatic compression devices, and early ambulation. METHODS: We retrospectively reviewed the charts of 170 patients who underwent Roux-en-Y gastric bypass surgery between March 2004 and December 2007. The incidence of deep venous thrombosis (DVT) and PE and bleeding complications associated with a BMI-based preoperative dosing protocol of LMWH was determined. RESULTS: All patients received LMWH preoperatively within 1 h of the incision, with doses varying between 30 and 60 mg given subcutaneously. Eleven patients received 30 mg, 145 patients received 40 mg, 9 patients received 50 mg, and 5 patients received 60 mg. None of the patients suffered from clinically significant DVT or PE during the hospital stay or in follow up (>2 years). Five patients (2.9%) were treated with discontinuation of lovenox and blood transfusion for postoperative bleeding. One of those patients returned to the operating room for exploration. CONCLUSIONS: We propose that immediate BMI-based preoperative dosing of LMWH along with postoperative prophylaxis is both safe and effective and should be standard for all patients undergoing Roux-en-Y gastric bypass surgery.

Synthesis and structural analysis of half-titanocenes containing eta(2)-pyrazolato ligands, and their use in catalysis for ethylene polymerization.

Cp*TiCl(2)(L) [L = C(3)H(3)N(2) (1), 3,5-Me(2)C(3)HN(2) (2) and 3,5-(i)Pr(2)C(3)HN(2) (3)], and Cp*Ti(C(3)H(3)N(2))(3) (4) were prepared in moderate yields by treating Cp*TiCl(3) with the pyrazoles in the presence of Et(3)N or with their corresponding lithium salts in Et(2)O. The structures of 1 and 2 determined by X-ray crystallography indicate that these complexes fold a distorted tetrahedral geometry around Ti, and the pyrazolato ligands coordinate to Ti with eta(2)-N,N'-coordination mode. In contrast, one of the pyrazolato ligand in 4 coordinates to Ti with eta(1)-N-bonding, whereas the other two ligands were bound to Ti with eta(2)-N,N'-fashion. The Cp analogues, CpTiCl(2)(L) [L = C(3)H(3)N(2) (5), 3,5-Me(2)C(3)HN(2) (6), 3,5-(i)Pr(2)C(3)HN(2) (7), and 3,5-Ph(2)C(3)HN(2) (8)], were also prepared by the reaction of CpTiCl(3) with the corresponding lithium salts in Et(2)O or n-hexane. The crystallographic analyses of 5 and 6 revealed that the pyrazolato ligands coordinate to Ti with eta(2)-N,N'-coordination mode. These complexes (1-3, 5-8) exhibited moderate catalytic activities for ethylene polymerization in the presence of methylaluminoxane (MAO), and the activities were highly affected by the substituent on the pyrazolato ligand employed. Complex 1 exhibited the highest activity affording polymer with uniform molecular weight distribution, suggesting that the polymerization proceeded with uniform catalytically active species. An increase in the steric bulk in the pyrazolato ligand led to a slight decrease in the activity by the Cp* analogues, whereas the activity by the Cp analogues increased upon increasing the steric bulk in the pyrazolato ligand employed.

Acute epiglottic abscess in an adult.

A case of acute epiglottic abscess is reported in an adult female patient who presented with odynophagia and fever. Initial treatment with parenteral antibiotics was not much of a success until incision and drainage of abscess was carried out under general anaesthesia after securing airway with preliminary tracheostomy. Diagnostic difficulties due to different mode of presentation in adults are emphasized. The diagnostic workup and treatment options are discussed.