Left hepatectomy for hepatocellular carcinoma in situs inversus totalis

INTRODUCTION

One of the most prevalent primary liver cancer, particularly in Eastern Asia, is hepatocellular carcinoma (HCC), which has a poor prognosis. A rare condition known as situs inversus totalis (SIT) causes the abdominal and thoracic organs to be completely inverted.

PRESENTATION OF CASE

A 51-year-old woman complained of a lump in the abdomen since 4 years ago, slowly enlarging to the suprapubic area, without pain. Laboratory findings showed an alpha-fetoprotein level was 13.24 IU/mL. A three-phase abdominal CT scan showed a left lobe hepatoma with local metastases and situs inversus totalis. The patient was diagnosed with left lobe HCC cT2N0M0, stage II, Barcelona Clinic Liver Cancer (BCLC) A, Child-Pugh A, Karnofsky 80 % and SIT. In this case, segment II, III, and IV left hepatectomy was performed with the crushing clamp technique. The main challenges during surgery were the inverted intra-abdominal organs, where the liver was located on the left and the spleen on the right, and the very large tumor size of approximately 28 cm × 20 cm.

DISCUSSION

This interesting case creates challenges in clinical practice, particularly in surgery, due to the reversal of the normal anatomy. Thus, accurate imaging is crucial for diagnosis and treatment planning. The surgeon should remain adaptable while performing the procedure for mirrored anatomy in situs inversus.

CONCLUSION

The unique anatomy may make the liver resection procedure for HCC in patients with SIT challenging. Surgery involving these patients with inverted anatomy can be assisted by the appropriate preoperative imaging and staging using BCLC.

Emergency Operation in Dr Wahidin Sudirohusodo and Hasanuddin University Hospital during the COVID-19 Pandemic

Introduction : In December 2019, the world was shocked by a respiratory infectious disease caused by the novel coronavirus which was later referred to as COVID-19. This virus is transmitted from human to human very quickly through droplets, aerosols, and direct contact with COVID-19 patients. One of the health services suspected of playing a role in the spread of this virus is surgery. Surgical procedures involve much medical personnel and direct contact withpatients causes surgery to be considered. In addition, surgery is also prone to causing nosocomial infections becausegenerally postoperative patients have an increased inflammatory process and decreased immune response. In contrast toelective surgery, emergency surgery has a higher risk of postoperative morbidity and mortality than elective surgerybecause of the limited time to prepare and assess the patient. To find out the number of reactive and positive cases of COVID-19 after emergency surgery at our institution. Method : The type of research conducted is descriptive where this study uses secondary data in the form of medical records of postoperative emergency patients who meet the inclusion and exclusion criteria. Results : A total of 741 medical records were obtained, with 691 of them being COVID-19 negative and 50 being COVID-19 positive. Conclusion: We found 93.3% negative post-operative COVID-19 cases and 6.7% positive post-operative COVID-19 cases in patients underwent emergency surgery procedures.

The relationship between glycine levels in collagen in the anterior rectus sheath tissue and the onset of indirect inguinal hernia: A cross-sectional study

Introduction

An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Protection against an inguinal hernia depends on the integrity of fascial tissue, which is maintained by collagen. Collagen is a structural protein consisting of amino acids, the most common of which is glycine. This study aimed to determine the relationship between glycine and the appearance of lateral inguinal hernias. To this end, the researchers examined the profile of collagen and glycine levels in the tissue of the sheath of the rectus femoris in patients with lateral inguinal hernia (indirect inguinal hernia).

Methods

The study used a cross-sectional design to determine glycine levels in rectus anterior sheath tissue in patients with indirect inguinal hernia. Examination of collagen glycine levels was conducted using the ELISA (Enzyme-Linked immunosorbent assay) method. Data were analyzed using the Statistical Package for the Social Science (SPSS) program. An ANOVA test, Pearson's correlation test, and Spearman's correlation test were also performed. A p-value <0.05 was said to be significant.

Results

Across 72 samples, the mean body mass index (BMI) was 22.5 kg/m2 and, the mean clinical onset was 28.02 months. Correlation tests showed a correlation between glycine levels and clinical onset (p = 0.026). The ANOVA test showed a difference between glycine levels with age group (p = 0.025) and BMI (p = 0.015). The correlation between glycine levels and clinical-grade (p = 0.416) was not statistically significant.

Conclusion

There is a significant relationship between glycine levels and age, BMI, and clinical onset of indirect inguinal hernia.

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The stability of the abdominal wall depends on the integrity of muscle and fascial tissue.

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Collagen is a structural protein that helps tissues maintain their mechanical characteristics, structure, and shape.

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The collagen structure contains amino acids such as glycine, proline, hydroxyproline, alanine, and hydroxylysine.

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The high glycine content of collagen is vital to promoting collagen turnover, as its deficiency reduces collagen turnover.

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There is a relationship between glycine levels and age, body mass index, and clinical onset of indirect inguinal hernia.

Profile of collagen prolines level of anterior rectus sheath tissue in indirect inguinal hernia: A cross-sectional study

Introduction

A hernia is a protrusion of an organ or tissue through an abnormal anatomical channel or opening. Epidemiological data indicated an increased prevalence of inguinal hernias in patients with connective tissue diseases. The biomechanical strength of connective tissue is highly dependent on the constituent of the matrix, including collagen. Fibroblasts produce and secrete procollagen containing high concentrations of proline and lysine. Collagen integrity plays an essential role in preventing hernia formation in the abdominal wall. To investigate the relationship between collagen proline levels of the anterior rectus sheath tissue in patients with lateral inguinal hernias (indirect inguinal hernia).

Methods

The study participants consisted of 67 inguinal hernia patients. A sample of anterior rectus tissue was obtained at the time of surgery, then being washed in a PBS buffer (pH 7.4). The measurement of collagen proline levels was subsequently carried out with enzyme linked immunosorbent assay (ELISA).

Results

All study participants were male with mean age of 44 years, mean body mass index of 22.6 kg/m² and mean onset of events of 27 months. Study subjects with reducible, irreducible, and incarcerated hernias were 45.7% (44/67 cases), 14.9% (10/67) and 19.4% (13/67), respectively. The mean proline level of the study subjects was 9.20. Correlation tests showed a correlation of proline levels and age (p = 0.001), body mass index (p = 0.006), and the onset of events (p = 0.023). Meanwhile, correlation of proline levels and occupation (p = 0.235) and clinical degree (p = 0.164) were not statistically significant.

Conclusion

Presence if relationship between proline levels with age, and onset of incidence among indirect inguinal hernia patients.

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Collagen is the main structural protein in the muscle wall layer.

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Defects in collagenases will result in abnormal collagen synthesis leading to pathological collagen degradation.

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Decreases in hydroxyproline and collagen were observed in the fascia and muscle tissue of patients with inguinal hernias.

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There are a relationship between proline levels with age, and onset of incidence among indirect inguinal hernia.

Association of clinicopathological features and gastric cancer incidence in a single institution

BACKGROUND

Stomach cancer is the fifth most common malignancy. In 2012, 952,000 cancers were diagnosed worldwide, which led to 723,000 deaths. Elderly men are the most frequently observed category of gastric cancer patients, mostly affecting the antrum. The objective of this study was to analyze the association of age with sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies in cases of gastric cancer.

METHODS

This cross-sectional descriptive study analyzed the associations between age, sex, tumor sites, types of surgical intervention, and diagnosed anatomical pathologies among the total gastric cancer incidences during medical treatments from January 2016 to May 2019. The study samples were collected from the total gastric cancer respondents who met the inclusion criteria during medical treatments within the study period.

RESULTS

Gastric cancer was most frequently observed among females (56%) and those aged 50-70 years old (47%). Most respondents had advanced stages of gastric cancer at first enrollment at our institution. The most frequently found tumor site was the corpus (43%). The most frequently performed type of surgical intervention was jejunostomy feeding (26%), and the most frequently diagnosed anatomical pathology was adenocarcinoma with poorly differentiation (39%). Overall, age had statistically significant correlations with sex (p < 0.001), tumor sites (p < 0.001), types of surgical intervention (p < 0.001), and diagnosed anatomical pathologies (p < 0.001).

CONCLUSION

Gastric cancer was more common in males than females. In the older age group (>50 years old), gastric cancer was more prevalent in women than men, and the gastric tumor tended to be more distal. Non-cardia gastric cancers were more prevalent than cardia gastric cancers.