Pancreaticoduodenal artery aneurysm (PDAA) is a rare disease that is recognized as an intra-abdominal hemorrhage differential diagnosis. This case study reports on a ruptured PDAA case in which ...ultrasonography (US) proved useful for the initial diagnosis. A 60-year-old man presented to the emergency department with pain in the epigastrium and back. An abdominal US performed at presentation suggested a PDAA and intraperitoneal hemorrhage/retroperitoneal hematoma. In addition, a contrast-enhanced computed tomogram (CT) revealed a hematoma extending from the upper abdomen to the pelvic floor and an aneurysmal pancreaticoduodenal artery arcade dilatation. Furthermore, emergency abdominal angiography findings revealed bleeding from a posterior-inferior PDAA, and coil embolization was performed. Postoperative progress was good, and the postoperative CT at 7 days showed no rebleeding signs and/or enlargement or new PDAA development. Therefore, the patient was discharged from the hospital 14 days after embolization.
Syn- and anti-9-Methoxy(1,4)naphthaleno3.3MCP-2,11-diones (4) are obtained by the coupling reaction of 2,6-bis2-cyano-2-(toluenesulfony)ethylanisoles (2) and 1,4-bis(bromomethyl)naphthalene (3) in ...dimethylformamide (DMF) with an excess of sodium hydride.
The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted ...splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.
It is difficult to diagnose the superior mesenteric venous thrombosis (SMVT) preoperatively due to nonspecific symptoms and slow progress. We report a case of SMVT that was diagnosed using ...ultrasonography (US) for observation. A 66-year-old male patient with sudden abdominal pain and distention showed localized edema of the small intestine and mesenteric edema and ascites found by US. We suspected obstruction in mesenteric blood flow, however US did not depict the thrombus in superior mesenteric artery or vein. The absence of peritoneal irritation signs suggested the low possibility of intestinal necrosis, leaving us to monitor the patient by US. Five hours later, US observation showed the enhanced spread of ascites and edema of the small intestine with dilated superior mesenteric veins in mesentery. Emergency laparotomy was performed to remove the hemorrhagic necrotic part of the small intestine from ileum (approximately 130 cm in length) and bloody ascites. Pathological diagnosis revealed the fresh thrombosis in the superior mesenteric vein and transmural hemorrhagic infarction. In conclusion, the US observation appears to be useful for the preoperative diagnosis of SMVT.
Vitamin B1 deficiency is well known as a possible complication following gastric restrictive surgery for morbid obesity; however, reduced vitamin B1 levels in patients who have undergone gastrectomy ...for gastric cancer have not been discussed previously.
Serum vitamin B1 levels were determined after the return to normal daily activity in 54 patients with distal gastrectomy for gastric cancer, 32 patients with total gastrectomy for gastric cancer, and 30 patients with radical surgery for colorectal cancer. Changes from serum vitamin B1 levels before operation to those after return to normal daily activity, without nutritional support, were investigated in 25 patients with gastrectomy for gastric cancer and 26 patients with radical surgery for colorectal cancer.
Decreased serum vitamin B1 levels, below the normal range, were recognized in 7 of the 54 distally gastrectomized patients and in 5 of the 32 totally gastrectomized patients, whereas no such decrease was recognized in any patient after colorectal surgery. Decreased serum vitamin B1 level was recognized within 6 months after the operation in 6 of the 7 distally gastrectomized patients showing a decreased vitamin B1 level and in 3 of the 5 totally gastrectomized patients showing a decreased vitamin B1 level. Postoperative serum vitamin B1 levels were significantly lower than those before operation in patients with gastrectomies, whereas there was no significant difference in serum vitamin B1 levels before and after the surgeries in patients with surgery for colorectal cancer.
Vitamin B1 levels may be reduced in gastrectomized patients, especially within 6 months after operation, even after their return to normal daily activity without nutritional support.
Purpose: The purpose of this study was to determine the most suitable laser irradiation start position for endovenous laser ablation (EVLA) of the small saphenous vein. Methods: Ultrasonography (US) ...was used to evaluate 78 patients (151 limbs) with lower limb varices at our hospital. The distances between the tibial nerve and small saphenous vein were measured at 20-mm intervals (20, 40, 60, and 80 mm) distal to the sapheno-popliteal junction (SPJ) in 112 of the limbs. The remaining 39 limbs were excluded because the small saphenous vein did not branch off from a deep part of the vein due to a congenital abnormality. Results: The small saphenous vein and tibial nerve were immediately adjacent in 98/112 limbs at the SPJ (1.0±3.3 mm), in 25/112 limbs 20 mm distal to the SPJ (3.9±3.7 mm), in 4/112 limbs 40 mm distal to the SPJ (7.5±3.8 mm), and in none of the limbs 60 mm and 80 mm distal to the SPJ. Conclusion: We recommend points 20 to 40 mm distal from the SPJ as landmarks for the laser irradiation start position for EVLA of the small saphenous vein, because this is where the tibial nerve stops being adjacent to the small saphenous vein.
Purpose: The purpose of this study was to determine the most suitable laser irradiation start position for endovenous laser ablation (EVLA) of the small saphenous vein. Methods: Ultrasonography (US) ...was used to evaluate 78 patients (151 limbs) with lower limb varices at our hospital. The distances between the tibial nerve and small saphenous vein were measured at 20-mm intervals (20, 40, 60, and 80 mm) distal to the sapheno-popliteal junction (SPJ) in 112 of the limbs. The remaining 39 limbs were excluded because the small saphenous vein did not branch off from a deep part of the vein due to a congenital abnormality. Results: The small saphenous vein and tibial nerve were immediately adjacent in 98/112 limbs at the SPJ (1.0±3.3 mm), in 25/112 limbs 20 mm distal to the SPJ (3.9±3.7 mm), in 4/112 limbs 40 mm distal to the SPJ (7.5±3.8 mm), and in none of the limbs 60 mm and 80 mm distal to the SPJ. Conclusion: We recommend points 20 to 40 mm distal from the SPJ as landmarks for the laser irradiation start position for EVLA of the small saphenous vein, because this is where the tibial nerve stops being adjacent to the small saphenous vein.
Ganoderic acid A and α- and β-D-glucan content were compared among morphologically different basidiocarps of the medicinal mushroom Ganoderma lucidum. Ginkgo leaf-shaped basidiocarps gradually ...hardened from the base to the pileus and accumulated a higher amount of bioactive components than normal (kidney-shaped) and antler/deer horn-shaped basidiocarps. In the normal G. lucidum stipe, the outer context contained the highest amount of α- and β-D-glucan (approximately 55%) and the highest amount of ganoderic acid A (approximately 0.3%). Ginkgo leaf-shaped G. lucidum had a large area of outer layer and stout outer context, which contributed to their high α- and β-D-glucan and ganoderic acid A content.
Solitary necrotic nodule of the liver Iwase, Kazuhiro; Higaki, Jun; Yoon, Hyung‐Eun ...
Journal of Hepato‐Biliary‐Pancreatic Surgery,
2002, Letnik:
9, Številka:
1
Journal Article
Recenzirano
Solitary necrotic nodule of the liver is a rare benign lesion; only 22 cases have been reported to date. An unsolved problem in treating these lesions involves the difficulties in differential ...diagnosis; specific features of necrotic nodule of the liver in preoperative examinations have not been identified. Here, we report a patient with resected solitary necrotic nodule of the liver with preoperative features shown on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) examinations. A 48‐year‐old woman was referred to our hospital on December 13, 1999 because a hypoechoic lesion in Couinaud's segment VIII of the liver had been incidentally detected on US. A CT scan confirmed the presence of a round hypodense lesion, measuring 2 cm in diameter. No significant enhancement was recognized on dynamic MRI study. T1‐Weighted MRI examinations demonstrated a low intensity showing a triple‐layered pattern with low‐iso‐low intensity in the lesion, while T2‐weighted images demonstrated a slightly high intensity in the lesion. These features suggested fibrous tissue. Histological examinations following partial resection of the liver revealed a solitary necrotic nodule of the liver. Combination studies, including MRI examinations, would be useful for the preoperative diagnosis of a solitary necrotic nodule of the liver.
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