Skeletal muscle satellite cells (myoblasts) are the primary stem cells of skeletal muscle which contribute to growth, maintenance, and repair of the muscle.Satellite cells offer several advantages for cellular cardiomyoplasty: can be easily obtained without affecting one's function, vastly proliferated in culture, have high resistance to ischemic and hypoxic conditions, no identified risk for tumor generation, and more commitment to myogenic differentiation.Cellular cardiomyoplasty is a developing new therapy that use stem cells or progenitor cells for injured heart to improve cardiac function and mitigate heart failure.Since we first published cellular cardiomyoplasty in 1989, this procedure became one of the innovative methods to treat damaged myocardium other than heart transplantation.A significant improvement in cardiac function, metabolism, and perfusion is generally observed in experimental and clinical studies, but the improvement is mild and incomplete.Although safety, feasibility, and efficacy have been well documented for the procedure, the beneficial mechanisms remain unclear and optimization of the procedure requires further study.This paper briefly reviews the skeletal muscle stem cells used for cellular cardiomyoplasty and their clinical outcomes with possible improvements in future studies.
Background: Postoperative infections (POIs) contribute to morbidity and mortality of surgical patients. There was no data on the prevalence and associated risk factors of POIs in the Limbe Regional Hospital (RLH). Methods: Selected patients were those who underwent a surgical procedure and were admitted into the surgical or maternity ward of the LRH between January 2009 and August 2012. Data studied included demographic variables, type of surgical procedure performed and postoperative follow-up. Data was analyzed for evidence of POIs using the Chi-square test for categorical variables and test for significance of association between POI and sex, age, procedures performed, hospitalization ward and duration of hospital stay. Results: 848 patients were selected among whom 78.8% were females. 62.1% of the patients were selected from the Obstetric and Gynaecology ward, while 37.9%were from the surgical ward. The mean age of the study subjects was 32.3±12.4 years. 175 patients met the criteria for POI giving a prevalence of 20.6%. The Obstetrics and Gynaecology ward had the highest prevalence of POI (61.7%). Prevalence of POIs was highest (64.3%) among patients in the 0 - 10 years age group. Males (26.7%) were at a higher risk of developing POIs .There was a statistically significant difference between POI and participants' age group (p<0.05). Peritonitis displayed the highest rate of POI (36.6%) while tubal ligation had the lowest (0%). Purulent wound discharge was the most frequent diagnostic criteria for postoperative infection. Conclusion: The prevalence of POIs ranged from 0 - 36.6%. Male sex and patients' age seemed to be associated with a higher risk of POIs. Surgery for acute generalized peritonitis had the highest risk of developing POIs.
Purpose: Complete mesocolic excision for right sided colon cancer is a complex operation that might offer a survival benefit. However, studies comparing CME to standard surgery have not been published so far. Methods: One-hundred-seven patients were operated at the discretion of the surgeon either according to principles of complete mesocolic excision (CME-group, n=69) or received a standard right hemicolectomy (non-CME group, n=38). The type of surgery was prospectively recorded. Results: Patients in the non-CME group were significantly older (67,9 vs.78,1 p<0,001) and had fewer adjuvant chemotherapies in stage III (94,7 vs. 60,0% p=0,02). For the combined analysis of stages I-III actuarial 5-year overall-, recurrence free- and tumor specific survival was significantly better for the CME group (OS 89,4% vs. 71,5%, p=0,011; RFS 83,8% vs. 70,3% p=0,035; TSS 93,8% vs. 78,0% p=0,049). Conclusion: The data suggest a survival benefit for complete mesocolic excision in the treatment of right sided colon cancer. However, the data needs to be interpreted with caution because of the uneven distribution of age and number chemotherapies. The results of the large multicentre trial which is currently going on among German certified cancer is expected to further clarify this issue.
Background: Hepatic hemangiomas are the most common benign liver tumors which can be often diagnosed radiologically.However despites their typical radiologic findings, giant pedunculated hemangiomas are rare and often misdiagnosed as a supra-renal, retroperitoneal, gastric, or mesenteric mass. Methodology:The authors present a case and the summary of a thorough literature search on this rare disease entity.Results: A 35-year-old male is found to have a 12cm mesenteric mass on computed tomography and undergoes a surgical exploration.Intraoperatively, a large pedunculated hepatic hemangioma from the left lobe of the liver is encountered and removed successfully.A thorough PubMed search reveals a total of 18 publications in English with 24 cases of giant pedunculated hepatic hemangioma, most of which occur in older females, and originate from the left lobe of the liver.These tumors in general retain the typical computed tomography or magnetic resonance imaging findings of an intrahepatic hemangioma.Conclusions: When a peri-hepatic lesion possesses typical radiologic characteristics of a hemangioma, pedunculated hemangioma should be included in the differential diagnosis.
Pancreatic infection caused by Clostridium perfringens is rare and follows a characteristic course.We present a foudroyant course of a necrotizing pancreatitis in a 77-year old man with typical imaging of retro-pneumoperitoneum without visceral perforation, peripancreatic emphysema due to gas gangrene in CT and hemorrhagic pancreatic necrosis.
We report a case in which a giant Spigelian hernia presented with severe, persistent abdominal pain in a 62year-old super-obese woman with a history of total abdominal hysterectomy-bilateral salpingo-oopherectomy at the age of 40 years for benign neoplasia, who later underwent open hernia repair (maximal diameter of the hernia sac: 21 cm) because of the development of compartment syndrome.Afterward, although a large incarcerated hernia disease was found, the sac removal was technically difficult and an open procedure was carried out, with double-mesh placement.No complications were recorded during the post-operative course.We report a difficult issue related to the diagnosis and management of this pathology, underlining the complete surgical repair to avoid hernia recurrence.
Any deep cervical infection has to be aggressively treated and CT scan of the chest should be performed to exclude the possibility of downward spread of the infection within the mediastinum. Early recognition of DNM is problematic because of its rarity and the non-specific symptoms in its early phase. DNM can rapidly progress to involve the entire mediastinum. Aggressive surgery upon diagnosis has to be performed, usually through a combination of cervicomediastinal and thoracic approach. Cervicomediastinal drainage alone for DNM not extending below the carina level or combined with subxiphoid drainage or anterior mediastinotomies is associated with higher mortality rates. Thoracotomy on the most involved side or bilateral thoracotomies give the best exposure for adequate mediastinal drainage. Median sternotomy or VATS procedures can be performed if one-lung ventilation can be tolerated by the patient. Pleural and pericardial cavities and all mediastinal spaces should be properly drained. Repeat CT scan of the neck and chest should be performed in all patients 48-72 hours after drainage of the infection or even earlier in case of further deterioration of the patient or persistent sepsis. Mortality rate in recent series ranges between 10% and 30%. The development of purulent pericarditis and/or failure of more than two organs before mediastinal drainage are associated with higher risk of fatal outcome. Prolonged ICU and hospital stays are the rule, while re-intervention rate for persistent sepsis exceeds 30%. The re-intervention rate is higher after mediastinal drainage performed through approaches which offer limited exposure to the whole mediastinum.
We here present a case of stump appendicitis as a late complication after laparoscopic appendectomy.The literature showed that the occurrence of stump appendicitis correlated with the length of the remaining appendix stump.To prevent stump appendicitis it is important to correctly identify the caecum base and to ensure the complete removal of the appendix in both surgical techniques.Should this not be possible with the laparoscopic technique, then an open resection should be considered.
Background: Brain dead patients are the main source of organs for transplants.Brain death causes changes in peripheral organs.We define modifications of gene expression in specific pathways occurring in donor livers and their influence on gene expression profile of livers after transplant. Methods:We compared gene expression profile of both deceased donor livers and transplanted livers to gene expression data of liver tissue, retrieved from Array Express database, used as control.All expression data were obtained by microarray analysis. Results:The expression of about 33,000 genes has been compared in liver samples from three groups: deceased donor livers, transplanted livers two hours after reperfusion, and control livers.We found that about 900 genes are dysregulated in deceased donor versus control livers.Up-regulated genes are mainly involved in apoptosis, immune response and inflammation.Down-regulated genes are mostly involved in metabolism and electron transport.We also re-evaluated a group of genes that in a previous study were found dysregulated in transplanted livers when compared to donor livers.Most of these genes, but not all, were dysregulated also when compared to control livers.Moreover 317 additional genes, dysregulated after liver transplant, were identified in this study; they were undetectable in the previous study because they had the same dysregulation both in donor and in transplanted livers.Conclusions: Understanding molecular mechanisms that in the donor compromise graft function is crucial in order to discriminate between basal graft damages and ischemia-reperfusion injuries and therefore to identify therapeutic targets aiming to improve liver transplantation performances.
Background: Adhesions caused by previous operations increase operative time and the risk of peroperative complications as well as conversions. The aim of this study was to evaluate the complications and the extra operative time related to the dividing of adhesions caused by previous surgery in patients scheduled for elective colorectal surgery. Methods: In a consecutive series of patients with previous abdominal or pelvic surgery and scheduled for open or laparoscopic colorectal procedures, data on patient demography, previous operations, index operations, intraoperative complications, conversions, adhesion division time and the extra time needed for first trocar insertion were collected prospectively. Results: Data from 111 patients were collected. There were 29 open and 80 laparoscopic operations, and conversion was needed in two patients due to adhesions. The mean extra time needed to divide adhesions was 19.9 min (range 0.2-120 min) in open operations, 35.4 min (range 22.9-48 min) in converted cases and 9.5 min (range 0-67 min) in laparoscopic operations. The extra time corresponded for 12% of total operative time. The mean extra time needed to insert the first trocar was 1 min (range 0-8 min). There were two serosal lesions necessitating suturation (one in open and one in laparoscopic operation) and one inadvertent enterotomy. The extra time needed to divide adhesions was correlated with the number of previous operations. Conclusions: Adhesions caused by previous surgery increase operative time considerably. The increase correlates with the number of previous operations. The adhesiolysis is associated with certain amount of intraoperative complications.
Background: Adhesions caused by previous operations increase operative time and the risk of peroperative complications as well as conversions.The aim of this study was to evaluate the complications and the extra operative time related to the dividing of adhesions caused by previous surgery in patients scheduled for elective colorectal surgery.Methods: In a consecutive series of patients with previous abdominal or pelvic surgery and scheduled for open or laparoscopic colorectal procedures, data on patient demography, previous operations, index operations, intraoperative complications, conversions, adhesion division time and the extra time needed for first trocar insertion were collected prospectively.Results: Data from 111 patients were collected.There were 29 open and 80 laparoscopic operations, and conversion was needed in two patients due to adhesions.The mean extra time needed to divide adhesions was 19.9 min (range 0.2-120 min) in open operations, 35.4 min (range 22.9-48 min) in converted cases and 9.5 min (range 0-67 min) in laparoscopic operations.The extra time corresponded for 12% of total operative time.The mean extra time needed to insert the first trocar was 1 min (range 0-8 min).There were two serosal lesions necessitating suturation (one in open and one in laparoscopic operation) and one inadvertent enterotomy.The extra time needed to divide adhesions was correlated with the number of previous operations.Conclusions: Adhesions caused by previous surgery increase operative time considerably.The increase correlates with the number of previous operations.The adhesiolysis is associated with certain amount of intraoperative complications.
Amongst therapies for unresectable hepatocellular carcinomas, radiofrequency ablation (RFA) and hepatic artery chemoembolization have clinical application either for local tumor destruction or to control tumor progression and recurrence rate.Herein we present a patient with a large hepatocellular carcinoma, chronic hepatitis B and congenital absence of left hepatic lobe treated with hepatic artery chemoembolization, multiple RFA sessions and transarterial chemoembolizations resulted in long-term survival far beyond actual expected survival rate, while preserving quality of life.
We conducted a standardized review of research on the prevalence of alcohol use or misuse (including alcohol use disorders), and the association of alcohol use or misuse with post-operative surgical complications among US patients.Twenty seven studies that included a preoperative measure of alcohol use or misuse and included at least 50 US surgical patients were identified using a standardized search strategy (1950( -April 2007)).Twenty-two of the studies reported prevalence of alcohol use or misuse, which was highest in major otolaryngology surgeries (mostly for cancer and injuries: 22-88.5%)and thoracic surgery (lung transplant and cancer resections: 29-33%) and ranged from 8-28% in the remaining studies.Nineteen studies examined the association between pre-operative alcohol consumption and post-operative complications suggesting positive associations between alcohol use or misuse and risk for post-operative delirium, pneumonia, cognitive decline, overall complications, and death.Most identified studies had methodological limitations, especially the widespread use of drinking assessment methods that cannot distinguish alcohol use from misuse.
We reported a twenty years old patient with perineum injury after highway accident treated with Vacuum-Assisted Closure (VAC) therapy.The patient also had a pelvis fracture, a dislocation of the knee associated with a break leg with major loss of substance requiring associated VAC treatment.We packed the perineal cavity with four roll gauzes and Mikulicz bag, and we treated break leg by immobilization by external fixator.The first procedure has been made quickly in order to ensure the perineal haemostasis (Fig. 1a), and stabilize the hemodynamic situation.Major risk factor for delayed wound healing was smoking.
Objective: to demonstrate the efficacy of a Central Venous Pressure rule and algorithm in the elimination of postoperative pulmonary edema after major surgery.Background: Pulmonary edema in the postoperative period after major surgery is a life-threatening complication, usually due to fluid overload.Analysis of its pathogenesis in our patients during the period 1981 -1988 led to the formulation of the central venous pressure (CVP) rule in 1990.The purpose of this study was to examine whether this rule had proven to be efficient in preventing pulmonary edema without causing complications related to fluid restriction.Methods: A retrospective study was performed in our Department about the prevalence of pulmonary edema, venous thrombosis and renal insufficiency during the postoperative period in patients undergoing major abdominal surgery.Any postoperative CVP value above +5 cmH 2 O led to a slowdown of supportive IV fluid lasting until a pressure of +5 cm H 2 O was reached, unless the measurement was proven to be wrong or another cause for the high CVP value could be diagnosed.During the first period between January 1981 and December 1988, 415 patients were cared for without application of the CVP rule.During the period between January 1992 and August 2002, 682 patients had postoperative care according to the CVP rule.The results in both periods were compared.Results: Whereas during the first period 12 cases of pulmonary edema were deplored, no pulmonary edema did occur during the second period.No significant difference in prevalence of venous thrombosis or renal insufficiency was found. Conclusions:The CVP rule is a safe and very efficient method to prevent fluid overload and pulmonary edema on a surgical ward after major abdominal surgery.Training in correct CVP measurement through the central venous catheter and good collaboration between doctors and nursing staff is a prerequisite for success.
Background: Acute appendicitis has historically been considered a clinical diagnosis, necessitating a CT scan only in the face of equivocal signs and symptoms.The purpose of this study is to determine whether or not the liberal use of CT in the work up of acute appendicitis results in a decreased negative appendectomy rate (NAR). Methods:The medical records of 940 consecutive patients who underwent emergency appendectomy between January 2002 and December 2006 were reviewed.Data collected included patient demographics, length of stay (LOS), results of contrast enhanced CT scans, emergency department (ED) work up time, and final pathology.Results: During the study period 940 patients (mean age 34.5±16.7 years, 53% males) underwent emergency appendectomy (64% laparoscopic).Eight hundred thirteen (86% patients, 50% males) underwent pre-operative CT scans.Final pathology was 76.1% acute appendicitis, 10% acute appendicitis with perforation, 7.7% gangrenous appendicitis, 1.2% acute appendicitis with abscess, 0.7% chronic appendicitis, and 4.3% negative for appendicitis.No difference was noted in the overall appendicitis rate by gender in the CT (Fishers exact test, p=0.96) or non-CT group (Fishers exact test, p=0.75).Similarly, no difference was noted by age (CT p=0.14, non-CT p=0.26).The NAR was lower for the CT group (3.4%) compared to the non-CT group (9.4%) (p=0.002).The NAR did not differ significantly by gender (Fishers exact test, p=0.491).Despite prolonging the ED work up time by 4.3 hours, the perforation rate did not differ between the CT (9.5%) and non-CT (12.6%) groups (p=0.30),nor did the LOS (3.67 vs. 3.63 days, p= 0.92).The sensitivity, specificity, negative predictive value, and positive predictive value of CT scans was 99%, 61%, 68%, and 99%, with an overall accuracy of 98%.The positive and negative likelihood ratios were 2.52 and 0.02 respectively.The ROC for CT scans in predicting appendicitis was 79.8% (95% CI: 76.9%, 82.5%). Conclusions:The use of CT in the work up of acute appendicitis is associated with a lower negative appendectomy rate independent of gender and age.The additional time spent obtaining a CT does not appear to increase the risk of perforation nor increase the LOS.
We report a 68-year-old man with sigmoid colon carcinoma who previously underwent an anterior resection.Five years later, he developed a severe diverticular bleeding which required multiple blood transfusions.He underwent an emergent low anterior colectomy with a right colostomy to protect the anastomosis.Nine days after the operation, he had another severe bleeding.Due to his elderly age and two previous colectomies, recombinant coagulation factor VIIa (rFVIIa) was given to avoid re-operation.The bleeding stopped after two doses of rFVIIa, 80 g/kg followed by 40 g/kg one hour later.There was no bleeding recurrence.
Intestinal ischemia-reperfusion (IIR) injury affects other organs, like the liver.Glutamine may offer liver protection, following IIR injury.Four groups of rats were studied.In Group A, the animals were subjected to 90 minutes of IIR.In Group B Alanyl-Glutamine dipeptide was administered prior to IIR.Group C, was the sham, and in Group D, the animals were given Alanyl-Glutamine dipeptide, only.Malondialdehyde, myeloperoxidase, and total glutathione were measured in liver tissue, and transaminases in the serum.Liver tissue samples were examined under electron microscopy.Malondialdehyde values in Groups A and B were significantly higher and total glutathione levels were significantly lower, compared to Groups C and D. SGPT values of Group A were significantly higher than Groups C and D. Electron microscopy examination of Group A animals showed endothelial cell degeneration.In Group B, hepatic cell changes were unremarkable.The administration of Alanyl-Glutamine dipeptide, prior to IIR, protected hepatocytes from oxidative injury.
Roux-en-y gastric bypass (RYGB) has become the most common operation in the United States for morbid obesity. Even in the laparoscopic era many procedures are still done via laparotomy. Incisional hernias are a complication of any abdominal surgery with obese patients being at increased risk. Patients undergoing open RYGB over 6 years were reviewed to evaluate the risk factors for the development of incisional hernia. 444 adults (88 male, 3566 female) using ASBS and NIH criteria who underwent open RYGB were studied. Patients with asthma and a history of steroid use were all off steroids for at least 6 months prior to surgery. Lesser curvature RYGB was performed through a 10-14 cm upper abdominal incision. The linea alba was closed using running 1-0 polydiaxone sulfate (PDS) sutures. The mean follow up was 2 years. The incidence of incisional hernia was 18.7%, based upon post-operative office follow-up and/or CT scan. Overall, 130 (29.3%) required post-operative local wound care for drainage, 44 (33.8%) of which developed incisional hernias. 93 (23.3%) had a past medical history that included asthma, 32 (34.4%) of which developed incisional hernias. There was a statistically significant association between a history of asthma and post-operative wound infection with the development of incisional hernia. In this study, other variables, such as gender, prior incisional hernia repair, prior abdominal surgery, pre-operative BMI, history of smoking, diabetes,%EWL and post-operative pneumonia were not found to be associated with incisional hernia. Measures to minimize post-operative wound infection or excessive coughing in patients with asthma may reduce the incidence of incisional hernia following RYGB.
Fast tracking approaches in liver transplantation include postoperative extubation immediately after surgery in the operating theatre.Based on the experience of 837 liver transplantations performed between 01/97 and 05/05, we report on the safety and feasibility of this procedure in almost 80% of transplant recipients, without increasing the incidence of subsequent reintubation (11%).This patient population experienced significantly higher survival compared to patients in whom extubation succeeded at the intensive care unit (p<0.02).Special attention was required for recipients with acute liver failure or retransplantation.These patients did not participate in fast tracking protocols, as demonstrated by a multivariate regression analysis.In this context, failure of immediate tracheal extubation was independent of cold ischemic time, duration of surgery, donor / recipient age or gender, extent of preservation injury, or type of organ donation (postmortal vs living-related).ROC analysis revealed that only intraoperative transfusions of 6 units of red blood cells were associated with primary extubation in the operating theatre with high sensitivity and specifity.To conclude, postoperative mechanical ventilation is justified only in a small cohort of recipients.For the vast majority of patients, immediate postoperative tracheal extubation should be the standard procedure after liver transplantation.
