• Six of seven patients with acute pancreatitis who were intractable to prolonged medical therapy underwent successful endoscopic retrograde cholangiopancreatography (ERCP) followed by immediate operative therapy. All of these patients had surgically correctable lesions consistent with chronic pancreatitis. There was one associated mortality and no morbidity. The conditions of the surviving six patients were significantly improved in the immediate postoperative period, and long-term follow-up has been encouraging. Pancreaticojejunostomy and conservative resection appeared to have good results. The timing of the operation immediately after ERCP in patients with acute pancreatic pathology eliminated problems with exacerbation or sepsis. Patients whose clinical conditions do not improve with aggressive medical therapy for acute pancreatitis may have both chronic and acute disease that is amenable to operative therapy. (Arch Surg115:552-556, 1980)
Chronic peritoneal dialysis is an option for many patients with end stage renal disease. Laparoscopy offers an alternative approach in the management of dialysis patients. Over an 18-month period, laparoscopy was used for placement or revision of seven peritoneal dialysis catheters. All were placed in patients with end stage renal disease for chronic dialysis. Two catheters were initially placed using the laparoscope, and in five other patients, the position of the catheter was revised. Of the two patients who had their catheters placed initially, one patient had a previous lower mid-line incision and underwent laparoscopic placement of a catheter and lysis of pelvic adhesions. The second patient had hepatitis C and chronically elevated liver function tests. He underwent laparoscopic placement of a peritoneal dialysis catheter and liver biopsy. Five patients had laparoscopic revision for non-functional catheters. Four were found to have omental adhesions surrounding the catheter. Three patients were found to have a fibrin clot within the catheter, and in one patient the small bowel was adhered to the catheter. All seven patients had general endotracheal anesthesia. There were no operative or anesthetic complications. The average operative time was 56 minutes. Four patients had their procedure in an ambulatory setting and were discharged home the same day. One patient was admitted for 23-hour observation, and two patients had their procedure while in the hospital for other reasons. In follow-up, there was one early failure at two weeks, which required removal of the catheter for infection. One catheter was removed at the time of a combined kidney/pancreas transplant eight months after revision. The other five catheters are still functional with an average follow-up of ten months. These results suggest that laparoscopy is another method for placement of peritoneal dialysis catheters and more importantly for revision in patients with nonfunctional catheters secondary to adhesions. It also provides an opportunity to evaluate the abdomen and perform concomitant procedures.
Postpartum depression (PPD) is common, disabling, and treatable. The strongest risk factor is a history of mood or anxiety disorder, especially having active symptoms during pregnancy. As PPD is one of the most common complications of childbirth, it is ...Read More
There were 49 insulin-dependent diabetics who received 52 renal allografts: 13 from living related and 39 from cadaveric donors. The mean age and time on dialysis were similar for both recipient groups. Patient survival at 1 and 2 years was 100 per cent for living related donor recipients, and 76 and 56 per cent at 1 and 2 years for cadaveric recipients. Renal allograft survival was 92 and 85 per cent at 1 and 2 years for living related donor recipients. Cadaveric allograft survival was 49 and 41 per cent at 1 and 2 years. The cumulative mortality rate was 39 per cent and the over-all surgical morbidity was low. Renal transplantation in diabetic patients is worthwhile from the standpoint of patient and allograft survival.
Background: Radioembolization using Yttrium-90 is increasingly being used as a locoregional therapy in the US to treat HCC. We report the use of SIRT to improve the outcome of our OLT-uHCC population. Methods: From April 2007 to March 2013, OLT (n=15) with uHCC were evaluated by multiphasic MRI and treated with SIRT alone (n=8) or in combination with transarterial chemoembolization (TACE, n=7) to downsize tumor burden and/or fulfill Milan criteria. MRI Follow up at 6 weeks and every 3 months post SIRT. Data analyzed: laboratory tests, tumor size reduction and tumor necrosis, adverse events and overall survivals. Statistics: t-test. Kaplan-Meier. Results: Demographics (n, %): male (10, 67%), race (Caucasian (7, 47%), AfroAmerican (5, 33%), Hispanics (2, 13%) and Asian (1, 6%). Etiology: HCV (7, 47%), HBV (3, 20%), Alcohol (2, 13%), Cryptogenic (2, 13%) and NASH (1, 6%). Child's class (A= 12, 80%; B= 3, 20%). Most tumors were multifocal. Four OLT-HCC had TACE initially and upon HCC progression, this was controlled with SIRT. Two OLT-HCC had SIRT first followed by TACE. Follow up range: 10 to 78 months. No HCC recurrence has been observed in any patient during this period. Most patients tolerated SIRT or combination Rx well. Side effects of SIRT included abdominal pain and worsening ascites. In the TACE group one patient had abdominal pain and other jaundice. Two OLT-HCC in the SIRT group died at 5 and 6 years respectively. One due to laryngeal CA and another due to HCV recurrence. Although there are numerical differences regarding the incidence of tumor size reduction and necrosis at explant, possibly favoring combination Rx, these are not statistical.Table: No Caption available.Conclusions: In selective OLT-uHCC patients, the use of SIRT by itself or in combination with TACE - as a rescue Rx - has contributed to downsized tumor burden and allow patients to be listed according to Milan criteria. Larger experience is needed to confirm these findings.
