Asian Journal of Surgery

Blunt adrenal gland trauma in the pediatric population

Stylianos Roupakias, Marinos Papoutsakis, Paraskevi Mitsakou — 2011-10-24

Summary: A retrospective review of the literature was performed to determine the natural history, prevalence, prognosis and management of adrenal injury associated with blunt abdominal trauma in pediatric population. Blunt adrenal injury in children is uncommon, rarely isolated, and typically present as part of a multi organ trauma. Adrenal hemorrhage is being diagnosed more frequently since the emergence of computed tomography in modern emergency rooms. Obstetric birth trauma during vaginal delivery of a macrosomic fetus may result in neonatal adrenal hemorrhage. In children appear to be an incidental finding that resolves on follow-up imaging. Most of these injuries are self-limited and do not require intervention. The differential diagnosis of an adrenal neoplasm, especially in children with an isolated adrenal hemorrhage, must be considered. The presence of adrenal hemorrhage in the absence of a trauma history should alert to the possibility of pediatric inflicted injury.

Primary colorectal lymphoma: Case series and literature review

Wong-Hoi She, Weida Day, Patrick Yin-Yu Lau, Kong-Ling Mak, Andrew Wai-Chun Yip — 2011-10-24

Summary: Primary colorectal lymphoma is a rare disease that accounts for 0.16% of colorectal malignancies. Treatments include surgical intervention with or without chemotherapy. Outcome of this intervention among the Chinese population are lacking. Perforation resulting from chemotherapy may need further exploration. A retrospective review of patient records was performed among those who were diagnosed with colorectal malignancy in a single center from January 1998 to June 2009. Ten patients met Dawson's diagnostic criteria for primary colorectal lymphoma [0.66% (10/1516) of all colorectal malignancies]. The male-to-female ratio was 9:1, and median age at diagnosis was 76 years. The most common site was the cecum (n = 5). B-cell lymphoma was present in eight patients. Seven patients underwent surgical intervention. The median follow-up of all patients was 16.5 months. Median survival was 17 months and 13 months in the surgical and chemotherapy group, respectively. Primary colonic lymphoma is a rare disease. Surgical intervention appeared to be superior to chemotherapy alone, but the findings were limited by the small number of patients in this study. Whether surgery or chemotherapy should be offered first remains unknown and requires further research.

Pelvic exenteration for men with locally advanced rectal cancer: A morbidity analysis of complicated cases

Ta-Wen Hsu, Feng-Fan Chiang, Ming-Cheng Chen, Hwei-Ming Wang — 2011-11-21

Summary: Background: The role of pelvic exenteration in locally advanced rectal cancer (LARC) has not been clearly defined. This procedure carries a mortality rate of approximately 10%. The challenges during pelvic surgery are different between men and women. The morbidity in men with LARC who received pelvic exenteration was analyzed.Methods: Medical records of men with LARC undergoing total pelvic exenteration or supralevator pelvic exenteration from January 1991 to December 2007 were retrospectively reviewed.Results: A total of 23 cases were included in the analysis. Thirteen patients had primary cancer; 10 had recurrent cancer. Microscopically clear surgical margins were obtained in 14 patients (60.9%). Sixteen patients (69.6%) experienced major or minor postoperative complications. The overall in-hospital mortality rate was 8.7%. Ten patients (43.5%) died within 1 year after surgery. All 10 patients with early mortality experienced refractory complications and repeated surgeries. The longest survival of patients with margin involvement was 25 months. The correlation between involved surgical margins and 1-year mortality was statistically significant (p = 0.001).Conclusion: Resection margins with tumor involvement after pelvic exenteration is associated with poor prognosis and early mortality in men with locally advanced rectal cancer.

Effect of postoperative fractionated radiotherapy on canine ePTFE graft neointima and anastomotic stoma healing: A preliminary experimental study

Chang Shu, Yuanyuan Guo, Xiao Zhou, Heng Wan, Jingqiang Yan, Liqing Yuan — 2011-10-24

Summary: Objective: The present study aimed to determine whether postoperative fractionated radiotherapy, at a total dose of 35 Gy, affected expanded polytetrafluoroethylene (ePTFE) graft anastomotic stoma healing and neointima formation.Methods: The subrenal abdominal aortas of 20 mongrel dogs were replaced with an ePTFE graft. The dogs were randomly divided into either a radiotherapy or nonradiotherapy control group. Grafts were harvested at 4 or 8 weeks after surgery. Hematoxylin–eosin staining, and immunohistochemistry tests for proliferating cell nuclear antigen (PCNA) and CD34 were undertaken to analyze the anastomotic healing and neointima formation.Results: The patency rate of grafts was 100% in each group. No disunion, rupture, or aneurysm was observed in the anastomotic stoma. Eight weeks after surgery, the graft neointima and anastomotic vessel wall of the radiotherapy group were significantly thinner than those of the control group (p < 0.05). Immunohistochemical examination was carried out in accordance with histomorphology.Conclusion: Postoperative fractionated radiotherapy after an ePTFE graft replacement of the abdominal aorta did not affect the healing of the anastomotic stoma. However, it suppressed the development of hyperplasia in the anastomotic stoma neointima and graft neointima formation in the short term.

Characterization of hepatocellular carcinoma recurrence after liver transplantation: Perioperative prognostic factors, patterns, and outcome

2011-10-24

Summary: Objective: Liver transplantation (LT) is known to be a promising treatment for patients with liver cirrhosis associated with hepatocellular carcinoma (HCC). This study, however, found that HCC recurrence remains to be a concern.Methods: A total of 126 HCC patients who had undergone LT between January 2000 and December 2009 were retrospectively reviewed. The clinicopathological features of the patients were analyzed by univariate and multivariate analyses to determine prognostic factors. Patients who had HCC recurrence were further analyzed in terms of recurrent pattern, management, and outcome.Results: Seventeen patients (13.5%) exhibited HCC recurrence following LT. Univariate and multivariate analyses identified two prognostic factors: tumor number > three [hazard ratio (HR) = 3.249] and presence of microvascular invasion (HR = 4.336). Among patients with HCC recurrence, 15 out of 17 (88%) patients developed extrahepatic metastasis shortly after recurrence. The survival of patients after HCC recurrence was dismal with 18.3 months of median survival.Conclusions: Multiple tumors (>three) are an important prognostic factor for HCC recurrence following LT, but an accurate assessment of tumor status by pretransplantation radiological examination is required. The outcome of patients with HCC recurrence after LT remains very poor because of a tendency of HCC to recur as extrahepatic metastasis.

Efficacy and safety of photoselective vaporization of the prostate in patients with prostatic obstruction induced by advanced prostate cancer

Yuan-Tso Cheng, Po-Hui Chiang, Yen-Ta Chen, Chun-Chien Hsu, Yao-Chi Chuang — 2011-10-24

Summary: Objective: We evaluated the efficacy and outcome of laser photoselective vaporization of prostate (PVP) in patients with voiding difficulty due to prostatic obstruction induced by advanced prostate cancer (PC).Methods: We retrospectively studied the records of 13 patients with advanced PC and prostatic obstruction with a mean prostate volume of 65.0 ml. All of the 13 patients received PVP between 2006 and 2010 due to the symptoms of voiding difficulty or acute urinary retention (AUR; N = 10) refractory to medical treatment. Perioperative safety and functional results were evaluated.Results: Lasering time ranged from 24 to 20 minutes (mean 67 ± 26), during which 66–423 KJ (mean 172 ± 95) of laser energy was delivered. All patients could resume voiding function with a mean catheterization time of 3.0 days.Conclusions: Our preliminary results suggest that PVP is a safe and effective procedure for relieving prostatic obstruction without intraoperative blood transfusion, water intoxication, or other complications in patients with advanced prostate cancer.

Successful extirpation of thoracic pleural lipoma by single-port thoracoscopic surgery

Soichi Oka, Hidetaka Uramoto, Takeshi Hanagiri — 2011-10-24

Summary: Video-assisted thorascopic surgery (VATS) is a common technique for thoracic operations. Surgery with access via a single port has gradually become popular. We herein report the unusual case of a 53-year-old Japanese male patient whose chest X-rays revealed an abnormal shadow, which continued to increase in size. The tumor was excised by single-port access surgery. The resected tumor was a pedunculated pleural mass, yellowish in color, and pathological diagnosis confirmed a lipoma. We describe the first known successful treatment by single-port VATS.

Surgical pitfalls in patients with Ehlers–Danlos type IV: A case of spontaneous sigmoid perforation in a 17-year-old male

Kai Lyn Ng, Wai Kit Cheong — 2011-10-24

Summary: Ehlers–Danlos syndrome (EDS) is a group of well described connective tissue disorders in which collagen production is impaired. The surgical management of affected individuals remains challenging, with no general consensus. We report a case of spontaneous sigmoid perforation in a 17-year-old Eurasian male, in whom we subsequently established the diagnosis of EDS type IV (EDS-IV). We review the literature to discuss the clinical features and diagnosis, and the recommended therapeutic management.