RESUMEN
Chylous fistulas (CF) are rare surgical complications and there is no standard treatment. This study presents the treatment modalities performed on patients who developed CF over a 10-year period. During the observation period, CF developed in 29 patients, 16 of whom were women. The mean age was 55.76± 13.48. Lymphatic duct injury was mostly seen in the abdomen (58.6%) and the most common reason was nephrectomy (20.7%). Extended lymphatic dissection due to malignancy was performed in 82.7% of all cases. Chylous leakage started postoperatively on 3.78±3.94 days (range: 1-19 days). Fasting, total parenteral nutrition (TPN), and somatostatin treatment were applied to all patients, and 75.8% of the fistulas were resolved completely with medical treatment. Surgical ligation of the lymphatic canal was performed in 7 patients. One was not successful and underwent percutaneous embolization of the thoracic lymphatic leakage cavity. All fistulas were resolved in 18.18±10.4 days. The resolution time and hospital stay were significantly higher in thoracic fistulas (p=0.017; p=0.003, respectively). In addition, malignant cases had longer resolution time (32.40±28.72 vs 16.27±11.25, p=0.036) and hospital stay (35.0±29.74 vs 16.25±14.05p= 0.002 respectively) than non-malignant. There was no chylothorax, chylous ascites, or recurrence at 20.55±22.88 months follow-up. Treatment of CF with fasting, TPN, and somatostatin analogs are effective. Other interventions such as surgical ligation with or without fibrin glue and interventional radiology treatments may be considered when conservative treatments fail.
Asunto(s)
Ascitis Quilosa , Fístula , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Masculino , Estudios Retrospectivos , Estudios de Casos y Controles , Somatostatina/uso terapéutico , Ascitis Quilosa/etiología , Ascitis Quilosa/terapia , Terapia Combinada , Fístula/etiología , Fístula/cirugíaRESUMEN
OBJECTIVES: This study presents the overall long-term hepatitis B virus (HBV) recurrence rate with possible associated factors after hepatitis B immunoglobulin (HBIG) was given in combination with 4 different antiviral (lamivudine, adefovir, entecavir, and tenofovir) drugs. PATIENTS AND METHODS: Between September 2000 and October 2013, the medical records of 42 adult patients who underwent liver transplantation at the Cukurova University Medical Hospital for chronic liver failure or hepatocellular carcinoma (HCC) secondary to chronic HBV were reviewed retrospectively. The analyses of risk factors for recurrence were performed based on the efficacy of hepatitis B envelope antigen (HBeAg), hepatitis B core antibody (anti-HBc), HBV DNA, preoperative prophylaxis, and the presence of HCC. Posttransplantation HBV recurrence was defined as persistence of hepatitis B surface antigen (HBsAg) positivity after orthotopic liver transplantation, or the reappearance of HBsAg and HBV DNA after initial HBsAg undetectability despite prophylaxis. RESULTS: The mean follow-up of 28 patients having HBIG and lamivudine prophylaxis was 73.25 ± 37.5 months with a recurrence rate of 3.5%. The mean follow-up of 2 patients having HBIG and adefovir prophylaxis was 90 ± 46.6 months with a 50% recurrence rate. The mean follow-up of each 6 patients who received prophylaxis with entecavir and tenofovir groups were 27.5 ± 16.1 and 16.17 ± 5.3 respectively, with no posttransplantation recurrence for both groups. On univariate analysis, preoperative factors such as anti-HBc, HBV DNA, preoperative prophylaxis, and the presence of HCC did not show any correlation with recurrence. However, HBeAg showed statistical significance for recurrence. CONCLUSIONS: Low-dose HBIG in combination with antiviral agents (lamivudine, entecavir, and tenofovir) is efficacious in preventing recurrence of HBV in posttransplantation patients.
Asunto(s)
Enfermedad Hepática en Estado Terminal/cirugía , Virus de la Hepatitis B/inmunología , Hepatitis B Crónica/prevención & control , Hepatitis B/prevención & control , Inmunoglobulinas/administración & dosificación , Trasplante de Hígado , Adulto , Anciano , Antivirales/administración & dosificación , Relación Dosis-Respuesta a Droga , Enfermedad Hepática en Estado Terminal/etiología , Femenino , Hepatitis B Crónica/complicaciones , Humanos , Inmunización Pasiva , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: We report six cases of Alveolar Hydatid Disease (five in the liver and one in the gastrosplenic ligament invading the spleen) in which curative resection of the liver (five cases) and splenectomy (one case) were performed. MATERIAL AND METHODS: The records of the six patients with AHD were retrospectively evaluated. Demographics of the patients, symptoms, laboratory findings, including serology were recorded. Imaging studies determined the extent of the disease preoperatively. Classification of the lesions was done according to the PNM (P = parasitic mass in the liver, N = involvement of neighbouring organs, and M = metastasis) staging system designed by the World Health Organization. All the surgical procedures were performed as complete resections, where negative margins were approved by frozen sections. Chemotherapy with albendazole (10 mg/kg/day) was continued postoperatively for two years in five of the six patients who were alive. RESULTS: All of the cases were from East Anatolia of Turkey, which is an endemic region. The mean age was 39.6 years (15-54 years). Major complications occurred post-operatively in all patients, possibly due to the extensive resection. No recurrence was seen during the 5 year follow-up of two cases and 2 year follow-up of three cases. CONCLUSION: The treatment of Alveolar Hydatid Disease is curative radical resection. Thus, pre-operative imaging studies to determine the extent and stage of the disease are of crucial importance.
Asunto(s)
Diagnóstico por Imagen , Equinococosis Hepática/diagnóstico , Equinococosis Hepática/cirugía , Echinococcus multilocularis , Dolor Abdominal/etiología , Adolescente , Adulto , Animales , Drenaje , Equinococosis Hepática/complicaciones , Equinococosis Hepática/parasitología , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Chylous fistula is a complication related to thoracic duct injury, appearing in upper abdominal, thoracic and neck surgery. Occurrence of chylous fistula is very rare after modified radical mastectomy. We encountered a chylous fistula case after breast cancer surgery and successfully treated it conservatively. It is important that all surgeons dealing with breast surgery should be aware that, altough rarely, a chylous fistula can develop after axillary dissection. Experience related to the occurrence of this complication and its management when it occurs is quite restricted.
Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma/cirugía , Quilo , Fístula/etiología , Enfermedades Linfáticas/etiología , Mastectomía Radical Modificada , Complicaciones Posoperatorias/etiología , Conducto Torácico/lesiones , Anciano , Neoplasias de la Mama/patología , Carcinoma/patología , Femenino , Fístula/terapia , Humanos , Escisión del Ganglio Linfático , Enfermedades Linfáticas/terapia , Estadificación de Neoplasias , Nutrición Parenteral Total , Complicaciones Posoperatorias/terapiaRESUMEN
Fasciola hepatica is a trematode rarely causing disease in humans. In symptomatic cases, while various pathologies such as damage to liver parenchyma, acute cholecystitis, and obstructive jaundice can be seen, the development of pancreatitis is rarely mentioned in the literature. The treatment of the disease is medical. In cases where no definite diagnosis can be made or in incidental cases where common bile duct exploration is being done, F. hepatica can be detected accidentally during operation. No consensus has yet been reached on the surgical procedure to be applied in this condition. We report on our case due to the rare occurrence of pancreatitis as a complication. In surgical cases, external drainage of the bile is both crucial in observing the response to the treatment, and also should be accepted as part of the treatment.
Asunto(s)
Fascioliasis/cirugía , Pancreatitis/cirugía , Albendazol/administración & dosificación , Animales , Bencimidazoles/administración & dosificación , Bilis/parasitología , Colangiopancreatografia Retrógrada Endoscópica , Colestasis Extrahepática/diagnóstico por imagen , Colestasis Extrahepática/patología , Colestasis Extrahepática/cirugía , Conducto Colédoco/patología , Enfermedades del Conducto Colédoco/diagnóstico , Enfermedades del Conducto Colédoco/patología , Enfermedades del Conducto Colédoco/cirugía , Diagnóstico Diferencial , Drenaje , Fasciola hepatica , Fascioliasis/diagnóstico por imagen , Fascioliasis/patología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Óvulo , Páncreas/patología , Pancreatitis/diagnóstico por imagen , Pancreatitis/patología , Tomografía Computarizada por Rayos X , TriclabendazolRESUMEN
Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in any organ, although the liver is the most commonly involved. Hydatid cysts can rupture either spontaneously or following trauma. Surgical treatment can be life-saving. This paper reports the atypical presentation of a young girl admitted to the emergency department. She presented with pain on her palms due to falling down a few steps. Because of the rebound tenderness on the right upper quadrant of her abdomen on physical examination, bedside ultrasonography was performed to identify the underlying cause, and promptly revealed a 62 x 72 mm lobular cyst on the right lobe of the liver with free fluid in the subcapsular area. Shortly afterwards, urticaria developed. Fluid resuscitation, methylprednisolone and diphenylhydramine were administered intravenously. Afterwards she was taken to the operation room for unroofing, drainage and capitonage. In conclusion, primary care and emergency physicians should perform a complete physical examination on all admitted patients with vague symptoms and a high index of suspicion for a ruptured hydatid cyst, even following trivial trauma, especially in endemic regions.