Asunto(s)
Neoplasias de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/terapia , Conductos Biliares Intrahepáticos , Colangiocarcinoma/diagnóstico por imagen , Colangiocarcinoma/terapia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Terapia por Ultrasonido/instrumentación , Anciano , Neoplasias de los Conductos Biliares/patología , Colangiocarcinoma/patología , Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Fotomicrografía , Resultado del Tratamiento , Terapia por Ultrasonido/métodos , UltrasonografíaRESUMEN
The main impediment to effective ex vivo liver gene therapy of metabolic diseases is the lack of experimental work on large animals to resolve such important issues as effective gene delivery, cell-processing techniques, and the development of appropriate vectors. We have used a nonhuman primate, as a preclinical model, to analyze the limiting steps of this approach using recombinant retroviruses. Seven monkeys (Macaca fascicularis) underwent the complete protocol: their left liver lobe was resected, a catheter was placed in the inferior mesenteric vein and connected to an infusion chamber, and the hepatocytes were isolated, cultured, and transduced with a retroviral vector containing the beta-galactosidase gene. The hepatocytes were harvested and returned to the host via the infusion chamber. Biopsies were taken 4-40 days later. No animal was killed in the course of the experiments. They all tolerated the procedure well. We have developed and defined conditions that permit the proliferation and transduction of up to 90% of the plated hepatocytes. A significant proportion of genetically modified cells, representing up to 3% of the liver mass, were safely delivered to the liver via the chamber. Polymerase chain reaction analysis detected integrated viral DNA sequences and quantitative analysis of the in situ beta-Gal-expressing hepatocytes indicated that a significant amount of transduced hepatocytes, up to 2%, had become integrated into the liver and were functional. These results represent substantial advances in the development of the ex vivo approach and suggest that this approach is of clinical relevance for liver-directed gene therapy.
Asunto(s)
Terapia Genética , Hepatocitos/trasplante , Hígado/cirugía , Virus de la Leucemia Murina de Moloney/genética , Transducción Genética , Animales , Bromodesoxiuridina/metabolismo , Trasplante de Células/métodos , Células Cultivadas , ADN Viral/análisis , Estudios de Factibilidad , Femenino , Vectores Genéticos , Hepatocitos/metabolismo , Hepatocitos/virología , Técnicas para Inmunoenzimas , Técnicas In Vitro , Operón Lac/genética , Macaca fascicularis , Ratones , Reacción en Cadena de la Polimerasa , Vena Porta , Trasplante Autólogo , beta-Galactosidasa/biosíntesis , beta-Galactosidasa/genéticaRESUMEN
Intraluminal duodenal diverticulum is a rare congenital web of membrane which may be symptomatic when it becomes distended. This report describes a case revealed by presenting as an acute pancreatitis. The radiological findings are reported. The findings at CT, upper gastro-intestinal series, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography are described and differential diagnostic features from choledochocele and duodenal duplication are discussed. By endoscopic ultrasonography, observation of a thin wall, without different layers such as choledochocele or duodenal duplication, may be useful for diagnosis.
Asunto(s)
Diverticulitis/diagnóstico , Enfermedades Duodenales/diagnóstico , Endosonografía , Pancreatitis/diagnóstico , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Diagnóstico Diferencial , Diverticulitis/complicaciones , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/congénito , Enfermedades Duodenales/cirugía , Duodenoscopía , Duodeno/anomalías , Duodeno/diagnóstico por imagen , Duodeno/cirugía , Humanos , Masculino , Pancreatitis/etiologíaRESUMEN
STUDY AIM: The aim of this retrospective survey was to evaluate the results of laparoscopic treatment in perforated peptic ulcer. PATIENTS AND METHODS: From 1989 to 1998, 84 patients were operated on for perforated ulcer. Sixty nine patients, operated on with videolaparoscopy, were included in this study: 53 men and 12 women with a mean age of 45 +/- 16 years (19-85). Nine had a history of peptic ulcer disease and 12 received anti-inflammatory drugs. Perforation occurred in the duodenum (60 patients) and in the stomach (five patients). Laparoscopic treatment included peritoneal lavage and either a simple duodenal closure (51 patients), a closure with a highly selective vagotomy (one patient), an epiplooplasty (eight patients), or an excision-closure for the gastric ulcers (five patients). Drainage was associated in 38 patients (58%). RESULTS: A conversion into laparotomy was necessary in six patients. Among the 59 patients treated with laparoscopy, 56 were only managed laparoscopically, three had exploration and peritoneal lavage through laparoscopy, and underwent suture of the perforation through minilaparotomy. Mean operative time was 105 +/- 40 minutes (30-240). Mean postoperative hospital stay was 8.2 +/- 4 days. Reoperation was performed in three patients for leakage (n = 2) and gall bladder perforation (n = 1). Complications were medically treated in three patients. There was no in-hospital mortality. CONCLUSION: Laparoscopic management in perforated peptic ulcer is successful in 90% of the patients. Results are good. There was no postoperative death in this series.
Asunto(s)
Úlcera Duodenal/cirugía , Laparoscopía , Úlcera Péptica Perforada/cirugía , Úlcera Gástrica/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios/efectos adversos , Drenaje , Femenino , Vesícula Biliar/lesiones , Humanos , Laparotomía/métodos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Epiplón/trasplante , Lavado Peritoneal , Reoperación , Estudios Retrospectivos , Tasa de Supervivencia , Técnicas de Sutura , Factores de Tiempo , Vagotomía Gástrica Proximal , Grabación de Cinta de VideoRESUMEN
OBJECTIVES: Occasional malignant transformation after partial thyroidectomy for Hürthle cell tumours has led certain authors to propose total thyroidectomy in all cases. The aim of this retrospective study was to evaluate outcome 4 years after partial thyroidectomy in patients with Hürthle cell tumours. METHODS: Ten patients (9 females, 1 male; mean age 45 years; age range 21-65 years) underwent thyroid surgery for Hürthle cell tumours from 1980 to 1989. Lobectomy was performed in 7, subtotal thyroidectomy in 2 and tumourectomy in 1. The extemporaneous pathology examination reported 4 apparently benign vesicular lesions, 2 apparently benign oncocyte lesions, 2 fetal adenomas, 1 thyroiditis, 1 trabecular adenocarcinoma. Pathology examination of the surgical specimen reported isolated benign oncocyte tumours in 4 cases and benign oncocyte tumours with associated vesicular adenomas in 5. In 1 case it was not possible to confirm whether the oncocyte lesion was benign or malignant. All 10 patients were seen again 6 months later for consultation and thyroid hormone assays and thyroid echography in doubtful cases. RESULTS: All patients were seen for follow-up (mean 88 months; range 47-148 months). New thyroid nodules were observed in 2 but did not require surgery. No cervical lymph node enlargement was found. CONCLUSION: The diagnosis of Hürthle cell tumour was confirmed intraoperatively in 8 of the 10 cases. No malignant transformation was observed. These findings demonstrate that total thyroidectomy cannot be indicated intraoperatively and would not appear to be indicated after partial thyroidectomy.
Asunto(s)
Adenoma Oxifílico/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
In rats injected with DPH the morphological changes induced in the thymus and lymph nodes were studied. In the thymus, features suggesting block of cellular differentiation were found, and in lymph nodes depletion of the paracortical zone and intense plasma cell hyperplasia could be observed. The correlation of these findings with the functional changes in the immunological response induced by the drug, and the possible implications of these changes in the induction of lymphoma are discussed.