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ABSTRACT: INTRODUCTION: Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) during pregnancy is even rarer. Due to limited experience, management of these patients remains challenging. PRESENTATION OF CASE: A 33-year old pregnant lady presented with HCC at 28 weeks of gestation. She underwent synchronous cesarean section and right hepatectomy at 32 weeks of gestation. The post-operative course was uneventful. She was discharged home on day 10 after surgery. Histolopathology confirmed HCC. The surgical resection margins were clear. At a follow-up of 3 months after surgery, the mother was disease free and the infant was well. DISCUSSION: HCC during pregnancy is extremely rare. The experience in its management and outcomes are lacking. In managing any patient diagnosed with a malignant neoplasm in pregnancy, both the mother and the fetus have to be considered. CONCLUSION: With adequate preoperative assessment and a good management strategy, good results can be obtained for both the mother and the baby for a pregnant patient with HCC.
International journal of surgery case reports. 10/2012; 4(1):112-114.
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ABSTRACT: Total pancreatectomy is the treatment of choice for multicentric diseases involving the pancreas. Middle-preserving pancreatectomy is a recently reported alternative procedure when the pancreatic body is spared from disease.
We report a 63-year old lady who underwent a combined Whipple's operation and distal splenopancreatectomy for her synchronous ampullary carcinoma and solid-pseudopapillary tumor of the distal pancreas.
For multiple tumors of the pancreas, the choice of surgery should be based on the nature of pathology and follow the principle of oncological resection.
Middle-preserving pancreatectomy is a safe and feasible option for patient with multicentric or synchronous pancreatic pathologies.
International journal of surgery case reports. 01/2011; 2(8):267-8.
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ABSTRACT: To explore the feasibility of passage of bone-marrow-derived liver stem cells (BDLSCs) in culture systems that contain cholestatic serum.
Whole bone marrow cells of rats were purified with conditioning selection media that contained 50 mL/L cholestatic serum. The selected BDLSCs were grown in a proliferating culture system and a differentiating culture system. The culture systems contained factors that stimulated the proliferation and differentiation of BDLSCs. Each passage of the proliferated stem cells was subjected to flow cytometry to detect stem cell markers. The morphology and phenotypic markers of BDLSCs were characterized using immunohistochemistry, reverse transcription polymerase chain reaction (RT-PCR) and electron microscopy. The metabolic functions of differentiated cells were also determined by glycogen staining and urea assay.
The conditioning selection medium isolated BDLSCs directly from cultured bone marrow cells. The selected BDLSCs could be proliferated for six passages and maintained stable markers in our proliferating system. When the culture system was changed to a differentiating system, hepatocyte-like colony-forming units (H-CFUs) were formed. H-CFUs expressed markers of embryonic hepatocytes (alpha-fetoprotein, albumin and cytokeratin 8/18), biliary cells (cytokeratin 19), hepatocyte functional proteins (transthyretin and cytochrome P450-2b1), and hepatocyte nuclear factors 1alpha and -3beta). They also had glycogen storage and urea synthesis functions, two of the critical features of hepatocytes.
BDLSCs can be selected directly from bone marrow cells, and pure BDLSCs can be proliferated for six passages. The differentiated cells have hepatocyte-like phenotypes and functions. BDLSCs represent a new method to provide a readily available alternate source of cells for clinical hepatocyte therapy.
World Journal of Gastroenterology 05/2009; 15(13):1630-5. · 2.47 Impact Factor
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ABSTRACT: Leakage from pancreatic anastomoses remains the single most important morbidity after pancreaticoduodenectomy and contributes to prolonged hospitalization and mortality. This observational cohort study reported the surgical outcome of a modified invagination technique of pancreaticojejunostomy after pancreaticoduodenectomy.
Between December 2001 and December 2007, a total of 52 consecutive patients underwent elective pancreaticoduodenectomy for benign or malignant pathologies of the pancreas or the periampullary region in a tertiary referral center. All patients underwent our modified invagination technique of pancreaticojejunostomy regardless of the characteristics of the pancreatic stump. Data were collected prospectively.
The mean hospital stay was 12.6 +/- 3.2 days. The incidence of overall surgical complications was 9.6%. No patient developed pancreatic fistula. One patient (1.9%) died of respiratory failure on postoperative day 7.
We reported our pancreaticojejunostomy anastomosis technique with a pancreatic fistula rate of 0% and low intra-abdominal complication rate. The favorable results of this technique warrant further investigation in large prospective cohort studies and prospective randomized controlled studies.
World Journal of Surgery 11/2008; 32(12):2695-700. · 2.36 Impact Factor
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ABSTRACT: Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm. Generally, these lesions have a benign behaviour, but the possibility of malignant transformation exists. We report the rare case of a 43-year-old woman with metachronous IMTs in the spleen and the liver. The patient was treated with laparoscopic splenectomy and partial hepatectomy. The patient recovered uneventfully. This case emphasizes the difficulties in diagnosis and the possibility of a metachronous occurrence.
Asian Journal of Surgery 02/2008; 31(1):25-8. · 0.57 Impact Factor
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ABSTRACT: To explore the value of percutaneous radiofrequency ablation (PRFA) combined with transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the management of recurrent small hepatocellular carcinoma.
Between March 2001 and March 2005, 52 patients with recurrent hepatocellular carcinoma (tumor size< or =5 cm) underwent PRFA, and 14 of the patients (tumor size 3-5 cm) also received TACE and PEI, and their clinical data were analyzed retrospectively.
MRI or CT after PRFA revealed complete coagulative necrosis of the tumor in 38 cases (tumor size <3 cm). In the 14 patients (tumor size 3-5 cm) with also TACE and PEI, complete necrosis occurred in 11 cases (78.6%). In the patients involved in this study, the 1-, 2-, 3- and 4-year survival rates were 96.2%, 69.4%, 45.5% and 30.0%, respectively.
PRFA is an effective modality for local treatment of recurrent small hepatocellular carcinoma, capable of total elimination of tumors <3 cm. For tumors of 3-5 cm, combination with TACE and PEI may help increase the tumor necrosis rate following the ablation and raise the patients' survival rate.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 11/2006; 26(11):1626-8.
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ABSTRACT: To investigate experience in diagnosis and treatment of postoperative complications in patients undergoing orthotopic liver transplantation (OLT).
Complications, treatment and management following liver transplantation in 16 cases were analyzed retrospectively.
Of 16 patients, 5 patients had advanced liver cirrhosis, 7 primary liver carcinoma, 1 liver failure after hepatectomy for liver cancer, 1 Wilson's disease, 1 chronic renal failure and liver cirrhosis and 1 acute live failure. Twelve patients survived, the longest survival was 4 years. Complications following OLT included: intra-abdominal bleeding in 3 cases, intracerebral vascular lesions in 2, pulmonary infection in 6, adult respiratory distress syndrome in 2, suprahepatic inferior vena caval occlusion in 2, hepatic artery thrombus in 1 case, bile duct stone or sludge in 3, bile leakage in 1 case, acute rejection in 2, chronic rejection in 2, acute renal failure in 2. Six patients died during perioperative period, one patient died of intracerebral bleeding, one from adult respiratory distress syndrome, one of acute renal failure one of hepatic artery thrombus, one of acute rejection and one of liver failure.
Proper prevention and treatment can effectively reduce complications following OLT during perioperative period. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.
Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA 09/2004; 24(8):950-2.
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ABSTRACT: To review our experience with orthotopic liver transplantation.
Thirteen liver transplantation were performed in 12 patients (including one liver retransplantation), of whom 5 patients received the transplantation for end stage liver cirrhosis, 4 for primary liver carcinoma, 1 for liver failure after hepatectomy for liver cancer, 1 for Wilson's disease, and 1 for chronic renal failure and liver cirrhosis. Retransplantation was done in 1 patient for chronic graft rejection. Of the 13 operations, 10 underwent the classical procedures of orthotopic liver transplantation, while 2 adopted modified piggyback technique, with 1 of the patients receiving retransplantation.
Nine patients survived the transplantation with the longest survival over 2 years. Four patients died in the perioperative period, due to intracerebral bleeding, adult respiratory distress syndrome, acute renal failure and hepatic artery thrombus, respectively.
Liver transplantation is an effective treatment for various end-stage liver diseases. Strict patient selection, appropriate timing of the operation and proper perioperative care are all essential for the success of liver transplantation.
Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA 05/2004; 24(4):445-7.
