Int Surg
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Case Reports
A rare complication of the hepatic hydatid cyst: intraperitoneal perforation without anaphylaxis.
The hepatic hydatid cyst can lead to serious complications as a perforation into the biliary system or into the respiratory tract. The perforation into the peritoneal cavity can become dramatic, characterized by acute abdomen, usually with anaphylaxis. We recently treated a patient with a liver hydatid cyst perforated into the abdominal cavity. ⋯ The critical clinical picture did not allow a cholecystectomy or a probe of the common hepatic duct to verify a biliary leakage. A biliary fistula appeared after 4 days and was successfully treated by endoscopic sphincterotomy. No anaphylactic phenomena were seen, probably because the great quantity of purulent material caused inactivity of the allergic component.
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Endoscopic thoracic sympathicotomy, or sympathectomy by a 2-mm scope, is an effective method for treating palmar hyperhidrosis. However, postoperative compensatory sweating may be troublesome in some patients. We report needlescopic T2 sympathetic block by clipping, which may provide reverse operation for patients encountering compensatory sweating. ⋯ Eighty-six patients (84%) have developed compensatory sweating of the trunk and lower limbs. Two patients had a reverse operation and had improvement of compensatory sweating at 2 and 13 days after removal of endo clips. Needlescopic T2 sympathetic block by clipping is a safe and effective method for treating palmar hyperhidrosis; compensatory sweating may be improved after reverse operation removal of endo clip.
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Review Case Reports
Gunshot wound of the heart with embolism to the right axillary artery.
The rarity of bullet emboli leads to frequent delays in diagnosis and inadequate early management. A case report of a bullet entering the right ventricle and embolization to the right axillary artery is presented. Our recent experience with this entity is described, and 160 cases reported in the English literature are reviewed and summarized.
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During the process of treating a complicated gunshot wound of an upper limb, chest, abdomen, and spine, there appeared--sometime after the initial treatment--a necrosis of the right hepatic duct in the bullet path within the liver. Although laparotomy was the life-saving operation during the first and second period, the final diagnosis and solution were based on bypassing the defect, i.e., a combination of a percutaneous and endoscopic approach. The efficiency of this method was also proved by an examination carried out 1 year after the end of the treatment.
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The incidence of portal vein thrombosis in end-stage liver disease is estimated as varying between 5% and 21%, whereas in candidates undergoing liver transplantation, this is 3-13%. Portal vein thrombosis occurring after liver transplantation can be managed surgically by thrombectomy, retransplantation, splenorenal shunt, or Wall-stent placement, or nonsurgically by angioplasty, local high-dose infusion of thrombolytic agents, combination of portal thrombolysis, or embolization of a pre-existing spontaneous splenorenal shunt. ⋯ Portal vein thrombosis, in this case, was considered to be secondary to size discrepancy between the donor and the recipient portal veins. Routine use of daily Doppler ultrasound was the key factor in early diagnosis.