Analysis of closure of the pancreatic remnant after distal pancreatic resection

BACKGROUND

The appropriate management of the pancreatic remnant following distal pancreatic resection remains a clinically relevant problem. We carried out a retrospective analysis which focused on this issue and compared the two favored techniques of suture and staple closure.

PATIENTS AND METHODS

Forty-six patients underwent distal pancreatectomy between October 1999 and January 2006. The patients were retrospectively analysed based on the management of the remaining pancreatic gland. Thirty-seven patients had suture and nine patients had staple closure. The morbidity, mortality, incidence of pancreatic fistula, necessity of secondary surgical intervention, and the duration of hospital stay for the two groups were compared. Pancreatic fistula was considered according to the novel international standard definition (ISGPF). In addition, subgroup analysis of patients receiving octreotide was carried out.

RESULTS

Overall, postoperative morbidity due to pancreatic fistula occurred in seven patients (19%) after suture and in one patient (11%) after staple closure (p = 0.54), with no deaths. The number of patients with surgical revision related to pancreatic leakage was two (5%) after suture closure vs no revision after staple closure (p = 0.65). The median number of total hospital days for the suture group was 19 (range 7-78 days) vs 21 (range 12-96 days) for the stapler group (p = 0.21). No significant benefit for the octreotide application could be determined.

CONCLUSION

According to the data, no significant difference for either suture or stapler closure was observed, with the tendency for staple closure to be superior.

Nematode infection of the liver mimicking metastasis of malignant melanoma

BACKGROUND

The differential diagnoses of a circumscribed mass of the liver are varied. Especially if a malignant tumor, capable of setting metastases to the liver, is known in a patient's medical history, there might be difficulties in differentiating the tumor's entity. CASUISTRY: We report a case of a 40-year-old male with a history of malignant melanoma in whom follow-up investigations revealed a mass in the liver.

RESULTS

The histopathological and microbiological results, however, showed an infestation of liver tissue with nematodes. Malignant tumor cells could not be detected.

CONCLUSIONS

Roundworm-infections of the liver can present as lesions suspicious of being malignant. Therefore, along with e.g. microhamartoma, microabscesses and hepatocellular carcinoma, infestation with nematodes should be taken into consideration.

[Thoughts on the problem of expert assessment of severe disability in very young children]

Opinions on the necessity of nursing severely disabled infants (section 53 SGB V) are very often difficult for experts of sickness insurances, because even healthy infants in their first years require a much assistance and must be permanently looked after. By evaluating 17 such cases an attempt is made to find aspects of retardation of development and possibly simultaneously existing mental handicaps and moreover factors to substantiate a considerably greater need for help compared to normal infants of the same age.