Surgery today
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Case Reports
Composite tumor with papillary adenocarcinoma and squamous cell carcinoma of the esophagus: report of a case.
Papillary adenocarcinoma is extremely rare in the squamous epithelium-lined esophagus. The histopathologic and immunohistochemical characteristics were examined in a composite tumor showing distinct papillary adenocarcinoma and squamous cell carcinoma of the esophagus resected from a 66-year-old man. The esophageal tumor consisted both grossly and histologically of two distinct components: an ulcerative part showing a squamous cell carcinoma, and a polypoid part corresponding to a papillary adenocarcinoma. ⋯ Immunohistochemically, tumor cells of the papillary adenocarcinoma component were positive for carcinoembryonic antigen, secretory component, and lactoferrin. These staining patterns were similar to those of the normal esophageal gland proper. These histologic, mucin-histochemical, and immunohistochemical findings suggest that the papillary adenocarcinoma originated from the submucosal esophageal gland and the squamous cell carcinoma from the squamous epithelium lining the esophagus.
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Case Reports
Successful surgical treatment for spontaneous retroperitoneal hematoma in polycythemia vera: report of a case.
Bleeding is a common complication of such myeloproliferative disorders as polycythemia vera, and it usually occurs in either the skin or mucosa. We experienced a case of a massive retroperitoneal hematoma with no history of trauma in association with polycythemia vera. ⋯ Because the mass effect of the hematoma caused a progressive deterioration of his respiratory condition, surgical drainage was necessitated and successfully undertaken. Although conservative treatment is reportedly sufficient and uncontrollable intraoperative bleeding may occur, especially in cases of myeloproliferative disorders, our experience suggests that an operation may nevertheless be occasionally advisable for this rare condition.
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Case Reports
Tension hemothorax caused by a ruptured aneurysm of the descending thoracic aorta: report of a a case.
The rupture of an aneurysm of the descending thoracic aorta into the right thoracic cavity is a comparatively rare event, and it is very difficult to establish a diagnosis immediately and rescue such patients. We describe herein the successful surgical treatment of a patient with this life-threatening emergency by initiating immediate cardiopulmonary bypass. It is mandatory to drain the right thoracic bleeding through a left thoracotomy without delay to release the tension hemothorax. Furthermore, it is necessary to evacuate the right thoracic hematoma through a right thoracotomy because complete removal o f a hugh hematoma through a left thoracotomy cannot be effectively achieved.
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Case Reports
Capillary hemangioma of the liver with Kasabach-Merritt syndrome in a neonate: report of a case.
Hepatic hemangiomas are benign tumors, and therefore minimally invasive treatment such as irradiation or steroid therapy is often recommended. However, in patients who have a hemangioma complicated by Kasabach-Merritt syndrome, surgical intervention should also be considered because of its confirmative therapeutic effect. We present herein the case of a 32-day-old male infant in whom a huge hepatic hemangioma associated with Kasabach-Merritt syndrome was treated by surgical intervention together with strong antidisseminated intravascular coagulation therapy.
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The elimination of endotoxin by direct hemoperfusion over immobilized polymyxin B fiber (PMX-F) was carried out in two patients who developed septic shock associated with severe acute pancreatitis. Parameters such as blood pressure, body temperature, and plasma endotoxin level improved after PMX-F treatment, and the infected lesions were successfully and safely removed by surgery. Although an aggressive operative strategy of debridement with ultimate closure over drains is generally associated with low mortality in patients with this devastating disease, we often hesitate to perform this operation due to the poor condition of the patient in the acute period, with multiple organ failure and/or septic shock status, and also because of the difficulty in diagnosing the pancreatic infection. In this situation, endotoxin elimination using PMX-F is a useful tool for treating secondary pancreatic infections to help the patient recover in preparation for surgery, or for treating perioperative endotoxemia.