Surgery today
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Review Case Reports
Living donor liver transplantation in a patient with giant hepatic hemangioma complicated by Kasabach-Merritt syndrome: report of a case.
We herein present a case of unresectable giant hepatic hemangiomas with Kasabach-Merritt syndrome which was successfully treated by living donor liver transplantation using a left lobe graft. The patient was a 45-year-old woman who complained of abdominal distension. Two sessions of transarterial embolization were performed, but failed to reduce the size of the tumor. ⋯ The postoperative course of the recipient was complicated by small-for-size graft syndrome, which developed after episodes of acute cellular rejection on postoperative day 8 and sepsis on day 31. The patient successfully recovered from the complications and was discharged on day 72, and she remains well at 10 months after transplantation. In conclusion, living donor liver transplantation was found to be an effective option for the treatment of a patient with unresectable giant hepatic hemangiomas complicated by Kasabach-Merritt syndrome.
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Multicenter Study
Effectiveness of leukocytapheresis in suppressing the occurrence of surgical site infections following surgery for ulcerative colitis.
Surgical site infections (SSIs) occur more frequently in surgery for patients with ulcerative colitis than in regular colon surgery. We report here on a joint study that was prospectively conducted by six facilities to verify that performing leukocytapheresis (LCAP) therapy immediately following surgery regulates neutrophil activity and acts to suppress the occurrence of SSIs. ⋯ LCAP therapy was effective in suppressing the occurrence of SSIs following 2-stage surgery for ulcerative colitis and also reduced the length of postoperative hospitalization.
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Compartment syndrome is a pathophysiological term, comprising a variety of tissues and organ alterations, due to a higher than normal pressure in an anatomically detached space (compartment). In the human body, areas denoted as compartments include the orbital globe, the sub and epidural space, the abdomen, pleura, pericardium, and others. Compartment syndrome was described initially in limbs. ⋯ The key to recognizing abdominal compartment syndrome is the demonstration of elevated intra-abdominal pressure which is performed most often via the urinary bladder, and it is considered to be the "gold standard." Multiorgan failure includes damage to the cardiac, pulmonary, renal, neurological, gastrointestinal, abdominal wall, and ophthalmic systems. The gut is the most sensitive to intra-abdominal hypertension, and it develops evidence of end-organ damage before alterations are observed in other systems. The surgical decompression of the abdomen remains the treatment of choice of abdominal compartment syndrome; this usually improves the organ changes, and is followed by one of the temporary abdominal closure techniques in order to prevent secondary intra-abdominal hypertension.
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Comparative Study
Complications of total thyroidectomy performed by surgical residents versus specialist surgeons.
Surgeon inexperience has been defined as a significant predictor of deleterious outcome in thyroid surgery; however, the safety of training programs in which residents are the primary surgeons is controversial. The objective of this prospective study was to compare the complication rates of total thyroidectomy (TT) performed by residents with those of TT performed by specialist surgeons in similar patient groups. ⋯ The complication rates of TT performed by residents and attending surgeons were similar. Thus, residents can perform TT safely and effectively under the direct supervision of a senior surgeon. Ultimately, strict adherence to the contemporary principles of thyroid surgery is of paramount importance.
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A solitary metastatic tumor from thyroid papillary carcinoma is rarely diagnosed preoperatively. A 61-year-old woman was referred to us for investigation of a solitary nodule in the right lung field on a chest X-ray, several years after a right hemithyroidectomy for thyroid carcinoma. ⋯ Immunohistochemical examination of histological cores obtained from the EBUS-TBNA proved extremely helpful in confirming the diagnosis. We performed right lower lobectomy with lymph node sampling, and the final pathological diagnosis was papillary carcinoma without lymph node metastasis.