Pseudoaneurysm is a serious complication after pancreatic surgery, which mainly depends on the presence of a preceding pancreatic fistula. Postpancreatectomy hemorrhage following total pancreatectomy ...is a rare complication due to the absence of a pancreatic fistula. Here we report an unusual case of massive gastrointestinal bleeding due to right hepatic artery (RHA) pseudoaneurysm following total remnant pancreatectomy.
A 75-year-old man was diagnosed with intraductal papillary mucinous carcinoma recurrence following distal pancreatectomy and underwent total remnant pancreatectomy. After discharge, he was readmitted to our hospital with melena because of the diagnosis of gastrointestinal bleeding. Gastrointestinal endoscopy was performed to detect the origin of bleeding, but an obvious bleeding point could not be detected. Abdominal computed tomography demonstrated an expansive growth, which indicated RHA pseudoaneurysm. Emergency angiography revealed gastrointestinal bleeding into the jejunum from the ruptured RHA pseudoaneurysm. Transcatheter arterial embolization was performed; subsequently, bleeding was successfully stopped for a short duration. Because of improvements in his general condition, the patient was discharged.
To date, very few cases have described postpancreatectomy hemorrhage following total remnant pancreatectomy. We suspect that the aneurysm ruptured into the jejunum, possibly because of the scarring and inflammation associated with his two complex surgeries.
Pseudoaneurysm should be considered when the fragility of blood vessels is suspected, despite no history of anastomotic leak and intra-abdominal abscess. Our case also highlighted that detecting gastrointestinal bleeding is necessary to recognize sentinel bleeding if the origin of bleeding is undetectable.
Definitive chemoradiotherapy (dCRT) has been established as the standard treatment for esophageal squamous cell carcinoma (ESCC). However, many patients develop persistent or recurrent disease ...following dCRT. We investigated factors related to chemoradioresistance and treatment outcomes in patients with ESCC who underwent salvage esophagectomy after dCRT.
We selected 38 patients with persistent disease and 24 with recurrent disease who underwent salvage esophagectomy after dCRT, immunolocalized p53, p16, p27, murine double minute 2 (MDM2), cyclin D1, Ki-67, and epidermal growth factor receptor, and correlated the findings with clinicopathological features.
MDM2 positivity was significantly higher among patients with persistent disease than among those with recurrent disease (p<0.0001). In addition, negative p16 expression was a predictor of poor prognosis among patients with persistent disease.
MDM2 overexpression plays an important role in chemoradioresistance of ESCC; furthermore, negative p16 expression can predict poor prognosis of patients with persistent disease.
完全内臓逆位は，本邦で3,000から5,000人に1人の割合で認められる稀な先天奇形である．症例は72歳，女性．既往に完全内臓逆位を有していた．便潜血陽性の精査にて上行結腸に2型腫瘍を認め，術前診断はcT3N0M0 cStage II ...aであった．手術は内側アプローチによる腹腔鏡下右結腸切除術を行う方針とした．体位は砕石位，ポート配置はダイヤモンド型をベースにした5ポートとし術者は脚間，助手は通常患者左側に立つ所を右側に立って手術を行った．手術時間163分，出血量18g，合併症無く術後第9病日に退院した．病理組織検査で中分化型腺癌pT4b（虫垂）N0M0 pStage II cの診断であった．本症例では，3D-CTを用いて解剖学的位置関係，血管の走行を予め把握して手術を行うことができた．また，術者は脚間からの内側アプローチで通常と同様にco-axialの手術操作を行うことができ，安全に施行可能であった．
Seasonal Variations in the Incidence of Acute Appendicitis ARAI, Tomohiro; MIYATA, Go; USUDA, Masahiro ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2018, 2018-00-00, Letnik:
79, Številka:
1
Journal Article
Odprti dostop
Although acute appendicitis (AA) occurs throughout the year, seasonal variations have been reported. Some papers point out that high atmospheric pressure cause a increase of inflammatory diseases. We ...aimed to examine whether particular months are associated with a higher incidence of AA. We reviewed electronic medical records and analyzed the data of all patients with a diagnosis of AA from 2012 to 2014 who underwent appendectomies. We included 450 patients (mean age, 38.3 years ; 60% men). The number of appendectomies per month was examined, and the variation was revealed to have statistical significance. The incidence of AA was significantly higher in July, August, and September than in November and December (p<0.05). Atmospheric temperature may correlate with this variability, while it is unlikely that atmospheric pressure will be correlated. Although the reasons for this variability remain unknown, this information may contribute to understanding the cause of appendicitis.
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