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INTRODUCTION: Transoesophageal echocardiography is generally considered to be a safe monitoring and diagnostic tool. Even though the severe morbidity rate is relatively low and mortality rate exceptional, sometimes life-threatening events may occur during this procedure. PRESENTATION OF CASE: We described the case of a 79-year-old woman with an extremely rare case of Zenker's diverticulum perforation following a transoesophageal echocardiography and its successful management with a 6 months follow-up. DISCUSSION: Several specific endoscopic techniques have been described in the literature in case of Zenker's diverticulum and we believe the use of check lists should be implemented. CONCLUSION: We hope that the documentation of this rare iatrogenic complication will remind the operators of this procedure to be aware of a documented Zenker's diverticulum and when necessary, to take the published precautions to prevent a highly severe complication.
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BACKGROUND: Transanal endoscopic microsurgery (TEM), first described by Buess enables a less aggressive approach of benign rectal lesions, or even early rectal cancer in a curative intent. MATERIALS AND METHODS: The SILS Port, initially designed for laparoscopic surgery, was successfully used for 20 TEM procedures in 16 patients. Local resection was sufficient in 15 procedures (benign tumours or pT1) out of 20, whereas 5 TEM operations required additional surgery: 3 rectal resections (pT1Nx, pT1sm3Nx and pT2N1) and 1 TEM revision (1 patient refused the rectal resection (pT1Nx). Postoperative complications following Dindo-Clavien were: grade II in 4 patients (pain: 2; fever: 1; bleeding: 1) and grade IIIb in 2 patients (bleeding). No long-term faecal incontinence was noted. CONCLUSION: TEM using the SILS Port is a safe and effective procedure for local resection of benign and certain malignant tumours. Using such a cheaper device, TEM procedure could be available in any operating theatre.
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Adenocarcinoma/cirugía , Colectomía/métodos , Laparoscopía/métodos , Microcirugia/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Neoplasias del Recto/cirugía , Adenocarcinoma/patología , Anciano , Anciano de 80 o más Años , Canal Anal , Biopsia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias del Recto/patología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We present the case of a 45-year-old woman presenting with a spontaneous cerebrospinal fluid (CSF) rhinorrhoea. A CSF leak, arising from a posterior ethmoidal left cell, was closed using an underlay procedure with a turbinate composite graft with applied fibrin glue. Twenty-three months later the CSF rhinorrhoea recurred. Recurrence was imputed to morbid obesity (BMI 48) responsible for benign intracranial hypertension. The patient underwent a laparoscopic adjustable gastric banding. CSF rhinorrhoea gradually decreased during the 12 months following surgery, in correlation with the weight loss, until total resolution was achieved. To our knowledge, this is the second reported case of a spontaneous CSF leak treated by bariatric surgery. This observation strengthens the theory that severe obesity can cause benign intracranial hypertension which can lead to CSF leak.
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Rinorrea de Líquido Cefalorraquídeo/cirugía , Gastroplastia , Hipertensión Intracraneal/cirugía , Obesidad/complicaciones , Rinorrea de Líquido Cefalorraquídeo/etiología , Femenino , Humanos , Hipertensión Intracraneal/etiología , Laparoscopía , Persona de Mediana Edad , Obesidad/cirugía , RecurrenciaRESUMEN
Interleukin-6 (Il-6) has a complex spectrum of biological activities (growth and differentiation of B cells and synthesis of acute-phase proteins by liver). To evaluate the role of this cytokine in the inflammatory response induced by blood interaction with haemodialysis membranes, we have investigated Il-6 synthesis and release in supernatant of 24-h cultured peripheral blood mononuclear cells (PBMC) isolated from ten haemodialysed patients and eight healthy control subjects. In haemodialysed patients, blood samples were drawn before and after their usual dialytic treatment with cuprophane membranes and following 1 and 2 months with polymethylmethacrylate (PMMA) membranes. Il-6 was determined by 72-h incubation of serial dilutions of PBMC supernatant with Il-6-dependent cell line 7TD1; dilutions of rIl-6 were included as standard. Compared to Il-6 synthesis in control subjects (3.3 +/- 2.8 U/ml) the patients usually haemodialysed with cuprophane membranes showed significantly greater values (9.8 +/- 4.5 U/ml, P less than 0.02 before the treatment, and 10.4 +/- 6.1 U/ml, P less than 0.05 after the treatment). A significant reduction, in comparison with the values obtained with cuprophane membranes, was obtained after 1 month (5.3 +/- 2 U/ml, P less than 0.02 before the treatment, and 7.5 +/- 6 U/ml after the treatment) and especially after 2 months (3.4 +/- 3.2 U/ml, P less than 0.02 before the treatment, and 4.4 +/- 3.4 U/ml, P less than 0.05 after the treatment) of dialysis with PMMA membranes. In conclusion, our results show increased Il-6 production in haemodialysed patients usually treated with cuprophane membranes, suggesting a chronic stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)