Co-existing tubal ectopic pregnancy and appendicitis--a case report.
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Appendicitis in pregnancy has a well documented high morbidity due to the difficulty in diagnosis. However, synchronous ectopic pregnancy and appendicitis is a rare event. This report describes the case of a 22-year-old lady of Bangladeshi origin who presented with both these conditions. The importance of prompt diagnosis and early surgical intervention, the inherent difficulties in diagnosis and the possible interrelated aetiological factors are discussed. (+info)
Unretrieved gallstones presenting as a Streptococcus bovis liver abscess.
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We describe a case of a delayed liver abscess presenting two years after a laparoscopic cholecystectomy. At exploration, the patient was found to have an unretrieved gallstone as the nidus for the Streptococcus bovis abscess. (+info)
Small bowel herniation around an anterior gastropexy for a gastric volvulus: a case report.
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Gastric volvulus can be a medical emergency with life-threatening complications. Early surgical intervention is important to avoid potential ischemic complication that may lead to infarction of the stomach. The condition has been reported in children and in the elderly, but the majority of cases are reported in the fifth decade of life. We present a case of a complication arising from corrective laparoscopic surgery for gastric volvulus, whereby most of the small bowel herniated around the anterior laparoscopically performed gastropexy. The herniation was reduced during a laparotomy, and the space through which the herniation occurred was closed. (+info)
Staging laparotomy in non-Hodgkin's lymphoma.
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In 57 patients with non-Hodgkin's lymphoma, a clinical, radiographic, scintigraphic and pathological correlative study showed the following results: (1) the inferior venacavagram, lymphangiogram and gallium-67 scan have a low sensitivity in detecting lymphoma: their accuracy is high when the findings are interpreted as abnormal (93%, 83% and 80% respectively), but low when they are interpreted as normal (47%, 67% and 58% respectively); (2) the clinical evaluation of spleen and liver is unreliable; (3) the incidence of lymphocytic lymphoma in the para-aortic-iliac nodes is high; (4) a pattern of involvement by contiguity and a predilection for the spleen were observed in lymphocytic lymphoma; (5) in lymphocytic lymphoma there is no liver involve without concomitant splenic involvement; (6) no definite pattern of spread could be seen in histiocytic lymphoma; (7) surgical staging changed the classification of the lymphoma in 56% of cases, 46% being reclassified to a more advanced stage; (8) surgical staging significantly improves the assessment of the stage of disease and therefore permits accurate treatment planning. (+info)
Staging laparotomy in non-Hodgkin's lymphomata.
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Staging laparotomy was performed in 106 selected untreated adults and in 6 children. In adults the histological pattern at initial biopsy was interpreted as nodular lymphoma in 33% and as diffuse lymphoma in 67%. Diffuse histiocytic was the most frequently observed histological subtype in the present series (54%). Diffuse undifferentiated lymphoma was noted in 2/6 children. Waldeyer's ring involvement was noted in 27% of adult patients. Systemic symptoms were present in 7%. Surgery detected occult lesions in 27% of patients (para-aortic nodes 3%, spleen 12%, liver 12%, coeliac nodes 15%, splenic hilar nodes 26%, mesenteric nodes 15%, gastrointestinal tract 1%, bone marrow 12%). The chance of detecting splenic and hepatic involvement was definitely higher in patients with nodal disease above and below the diaphragm in comparison with those with either supra-diaphragmatic or infra-diaphragmatic adenopathy. Lymphography yielded a 96% accuracy proving once more to be a sufficiently reliable diagnostic method. Staging laparotomy is a useful procedure in non-Hodgkin's lymphomata in order to gain information on the natural history and to plan treatment. It remains to be determined whether findings observed through surgical staging will lead to improved treatment and survival. (+info)
Small-bowel obstruction secondary to malignant disease: an 11-year audit.
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OBJECTIVE: To determine the efficacy and long-term prognosis for operative versus nonoperative treatment of small-bowel obstruction (SBO) secondary to malignant disease. DESIGN: A chart review. SETTING: A university-affiliated teaching hospital. PATIENTS: The medical records of all patients with malignant disease as the established etiology of their obstruction who presented to the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, between 1986 and 1996 were reviewed. There were 32 patients accounting for 74 admissions. INTERVENTIONS: Selective nonoperative management and exploratory laparotomy, immediate or delayed. MAIN OUTCOME MEASURES: The value of nonoperative management and need for operation. RESULTS: Colorectal and ovarian neoplasms were the principal primary malignant diseases that led to SBO. The median time between diagnosis of the malignant disease and SBO was 1.1 years. At their initial presentation, 80% of patients were treated by operation, but 47% of these patients had an initial trial of nonoperative treatment. Reobstruction occurred in 57% of patients who were operated on compared with 72% of patients who were not. The median time to reobstruction was 17 months for patients who underwent operation compared with 2.5 months for patients who did not. Also, 71% of patients were alive and symptom free 30 days after discharge from operative treatment compared with 52% after nonoperative treatment. Postoperative morbidity was 67%. Mortality was 13%, and 94% of patients eventually died from complications of their primary disease. CONCLUSIONS: SBO secondary to malignant disease usually indicates a grim prognosis. Operative treatment has better outcome than nonoperative management in terms of symptom free interval and reobstruction rates. However, it is marked by high postoperative morbidity. We recommend that, after short trial of nasogastric decompression, patients with obstruction secondary to malignant disease be operated on if clinical factors indicate they they will survive the operation. (+info)
Glomerular lesions in renal biopsies of Saimiri boliviensis (primate) examined by light and electron microscopy and immunohistochemistry.
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In order to determine the existence of glomerular lesions in Saimiri boliviensis, renal biopsies were performed in 20 clinically healthy animals of similar age and both sexes. Biopsies were obtained by laparotomy with a Tru-Cut biopsy needle. Mesangioproliferative glomerulonephritis characterized by an increased number of mesangial cells and increased mesangial matrix was present in 35% of the animals. Proliferative glomerulonephritis characterized by increased numbers of epithelial and endothelial cells with narrowed capillary lumen, and membranous glomerulonephritis characterized by diffuse thickening, wrinkling, and occasional lamellation of basement membranes, were present in 15% of the samples. Ultrastructural features included increased mesangial matrix, fusion of the visceral epithelial foot processes, thickened glomerular basement membranes, and incipient lamellation. Immunohistochemical examination revealed granular deposits of immunoglobulin M in the cytoplasm of mesangial cells and in the mesangial matrix in 50% of the samples. (+info)
Reduction of vein graft disease using photodynamic therapy with motexafin lutetium in a rodent isograft model.
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BACKGROUND: Motexafin lutetium (Lu-Tex) is a photosensitizer that targets atheromatous plaque. Subsequent photoactivation (photodynamic therapy [PDT]) induces local cytotoxic effects. The aim of the present study was to investigate whether Lu-Tex targets vein graft intimal hyperplasia and whether subsequent photoactivation attenuates the disease process. METHODS AND RESULTS: The subcellular localization of Lu-Tex and postillumination viability were studied in cultured human vein graft smooth muscle cells. Inferior vena cava-grafted rats were injected with Lu-Tex (10 mg/kg) 4 or 12 weeks after grafting. Biodistribution was assessed in a subgroup 24 hours after administration. Light therapy (742 nm) was performed 24 hours after Lu-Tex injection by illuminating intraperitoneally placed isografts using a laparotomy. Animals were divided into the following 4 groups: PDT (n=15), Lu-Tex injection and laparotomy (n=13), light treatment (n=14), and laparotomy only (n=13). Grafts were harvested 14 days after treatment for histochemical analysis. Lu-Tex localized within subcellular organelles of smooth muscle cells, and subsequent photoactivation induced cell death via apoptosis. The Lu-Tex concentrations present in the vein grafts were 9.3 times higher than those in the normal inferior vena cava. Postoperative PDT at 4 weeks after surgery significantly reduced the intima/media ratio, whereas treatment at 12 weeks did not reduce the intima/media ratio. Activated macrophages were observed 4 weeks after grafting; however, a significant reduction occurred in these cells by 12 weeks. The mechanism by which PDT works may be related to the presence of activated macrophages. CONCLUSIONS: PDT significantly reduces the intima/media ratio in the early phase of vein graft disease. Lu-Tex-mediated PDT may be a viable method for the attenuation of atherosclerotic disease in vein grafts. (+info)