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Teh YH, Tan YP, Zain MM. Dengue shock syndrome with retroperitoneal haematoma requiring repeated artery angioembolization. Med J Malaysia 2017; 72:254-256. [PMID: 28889142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Eyelid reconstruction is complex and challenging since it is not only for structural and functional restoration, but also for an acceptable aesthetic result. In full thickness eyelid injuries, it will involve both anterior and posterior lamella. Therefore, when reconstructing the defect, it requires at least two layers; one will be a flap with blood supply, and the other can be a free graft. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid.
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Affiliation(s)
- Y H Teh
- Selayang Hospital, Department of Internal Medicine, Malaysia.
| | - Y P Tan
- Selayang Hospital, Department of Internal Medicine, Malaysia
| | - M M Zain
- Selayang Hospital, Department of Internal Medicine, Malaysia
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Wang C, Takeda K, Shiba M, Takayama H, Munakata S. [A Case of Arteriovenous Malformation Located in Retroperitoneum]. Hinyokika Kiyo 2016; 62:127-130. [PMID: 27133885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 67-year-old woman was referred to our hospital for precise examination and treatment as an abdominal computed tomographic (CT) scan showed a retroperitoneal tumor located below the hilus of the right kidney. The enhanced CT and magnetic resonance imaging (MRI) revealed contrast enhancement in both early and late phase, which confirmed that the tumor showed abundant blood perfusion and adhered to the duodenum. We performed open surgery in order to remove the tumor and make a precise diagnosis. The tumor was excised en bloc with a part of the gonadal vein because the right gonadal vein was adjacent to the tumor in the craniocaudal direction. The pathological diagnosis was arteriovenous malformation. Arteriovenous malformation located in the retroperitoneum is very rare.
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Affiliation(s)
- Cong Wang
- The Department of Urology, Sakai City Medical Center
| | - Ken Takeda
- The Department of Urology, Sakai City Medical Center
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Liu Z, Xiao Y, Chen D, Wang Z. Vascular skeletalization: a new concept to improve the resection rate in childhood neuroblastoma. J Neurosurg Sci 2014; 58:113-116. [PMID: 24819488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The surgical resection rate in childhood neuroblastoma (Stage III and IV) is relatively low and influences the prognosis greatly. This study analyzes the primary resection rate neuroblastoma in children. METHODS The tumors are shrunk with pre-operative chemotherapy and surgical resection beginning from the iliac vessels is performed to skeletalize the large retroperitoneal vascular. Using this method, 22 cases of childhood neuroblastoma received resections and the outcomes were analyzed. RESULTS The tumors were completely removed in 21 out of the 22 cases (95.45% in total). There were no serious complications and perioperative deaths. CONCLUSION Using proper surgical methods and skeletalizing the large retroperitoneal vessels significantly increases the resection rate.
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Affiliation(s)
- Z Liu
- Department of General Surgery General Hospital of People's Liberation Army Beijing, Republic of China -
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Takamura M, Watanabe J, Sakamaki A, Honda Y, Kamimura K, Tsuchiya A, Yamagiwa S, Suda T, Matsuda Y, Aoyagi Y. Alcoholic liver disease complicated by deep bleeding into the muscles or retroperitoneum: report of three cases and a review of the literature. Intern Med 2014; 53:1763-8. [PMID: 25130107 DOI: 10.2169/internalmedicine.53.2123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We herein report three cases of alcoholic cirrhosis complicated by deep bleeding. In two of the three cases, intramuscular or retroperitoneal hematomas developed spontaneously. In contrast, in the remaining case, an intramuscular hematoma developed after trauma. In the former two patients, the intramuscular hematomas recurred at other sites during hospitalization. All three patients received conservative therapy, and one patient with a retroperitoneal hematoma underwent transcatheter arterial embolization. All of the patients eventually died of liver failure. The occurrence of severe alcoholic liver disease with deep bleeding has recently been reported with increasing frequency, and clinicians should bear this condition in mind as a life-threatening complication of alcoholic liver disease.
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Affiliation(s)
- Masaaki Takamura
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Mukhtarulina SV, Kaprin AD, Astashov VL, Bobin AN, Ushakov II, Aseeva IA. [Variants of retroperitoneal vascular structure in patients with early-stage cervical cancer who underwent systematic paraaortic and pelvic lymphadenectomy]. Vopr Onkol 2013; 59:585-590. [PMID: 24260885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this study was to identify variants of retroperitoneal vascular structure during systematic paraaortic lymphadenectomy in patients with early-stage cervical cancer and to investigate the effects of these anomalies in surgical procedures. 79 patients who had undergone systematic paraaortic and bilateral pelvic lymph node dissection between 2006 and 2013 were included. Normal architecture and structural anomalies of inferior vena cava, renal arteries and veins, common iliac vein and ovarian vessels were studied. Variants of major retroperitoneal vascular structure were present in 10 patients (12.7%). Variants of renal vessels were identified in 8 patients (10.1%): supernumerary renal arteries and veins observed in 5 patients (6.3%); retroaortic left renal vein type I and II - in 3 patients (3.8%). A rare variant as double vena cava inferior was detected in 1 patient (1.3%). Vessel injury was present no one case in patients with variants of vascular structures and in 1 of 69 (1.4%) patients without variants of retroperitoneal vascular structure. There was no difference in intraoperative hemorrhage, transfusion red blood cell and rate of intraoperative hemoglobin between the groups. Thus the acquisition of knowledge and visualization of vascular variations decrease complications during systematic paraaortic and bilateral pelvic lymphadenectomy.
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Gyimadu A, Salman MC, Karcaaltincaba M, Yuce K. Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers. Arch Gynecol Obstet 2012; 286:449-55. [PMID: 22407158 DOI: 10.1007/s00404-012-2285-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 02/27/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the frequency of aberrations of retroperitoneal great vessels in patients with gynecologic cancers who were scheduled for pelvic and paraaortic lymphadenectomy, and to document the vascular complications which occurred during lymphadenectomy as well as the relationship of these vascular complications with vascular aberrations. METHODS Patients with gynecologic cancers underwent a routine preoperative abdominal multi-detector computer tomography, and an intraoperative search for aberrations of the great vessels in the retroperitoneal region was undertaken. Intraoperative vascular complications were recorded and their relations to vascular aberrations were analyzed. RESULTS The rate of vascular aberrations detected preoperatively by multi-detector computed tomography was 24.3 %. Vascular injuries occurred in six patients (16.2 %) during lymphadenectomy. Rate of intraoperative vascular injuries was significantly higher in patients who had vascular aberrations of retroperitoneal great vessels (44.4 vs. 7.1 %, p = 0.022). CONCLUSIONS Aberrations of retroperitoneal vessels are not uncommon and may increase the risk of vascular complications during lymphadenectomy. The risk of these complications may be decreased if aberrations are detected preoperatively.
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Affiliation(s)
- Adam Gyimadu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Sihhiye 06100, Ankara. Turkey
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Lazar AM, Brătucu E, Straja ND, Daha C, Marincaş M, Cirimbei C, Prunoiu V. Primitive retroperitoneal tumors. Vascular involvement--a major prognostic factor. Chirurgia (Bucur) 2012; 107:186-194. [PMID: 22712347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Primitive retroperitoneal tumors, although very rare, arouse an increased interest, because of the poor prognosis, unsatisfactory surgical and complementary therapy results. Up to now, the very low number of cases has impeded the acquisition of a unitary view of these tumors, a unanimously accepted algorithm of diagnostic and treatment being absent. Randomized trials regarding the effects of different therapies have not been possible. The main factor that can fundamentally increase the survival of these patients is radical resection, some authors even recommending compartmental surgery. We found no significant statistical difference between the survival rates of the patients with different types of non-radical interventions, that shoud be therefore, as much as possible, avoided. Our study evidences that vascular involvement is the main limiting factor in achieving radicality. The involvement of large retroperitoneal vessels makes often impossible a radical intervention, usually because of the lack of an adequate material and human endowment for ample vascular resections followed by laborious reconstructions. That is why, in our study, vascular involvement was associated with a decreased survival rate for operated patients. Therefore, we underline the necessity both of a solid material base and of establishing multidisciplinary surgical teams for adequate vascular interventions in oncologic general surgery.
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Affiliation(s)
- A M Lazar
- Clinic of Surgery I, Bucharest Oncology Institute Al. Trestioreanu, University of Medicine and Pharmacy Carol Davila, Bucharest Romania.
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Tseng WW, Wang SC, Eichler CM, Warren RS, Nakakura EK. Complete and safe resection of challenging retroperitoneal tumors: anticipation of multi-organ and major vascular resection and use of adjunct procedures. World J Surg Oncol 2011; 9:143. [PMID: 22054416 PMCID: PMC3235074 DOI: 10.1186/1477-7819-9-143] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 11/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retroperitoneal tumors are often massive and can involve adjacent organs and/or vital structures, making them difficult to resect. Completeness of resection is within the surgeon's control and critical for long-term survival, particularly for malignant disease. Few studies directly address strategies for complete and safe resection of challenging retroperitoneal tumors. METHODS Fifty-six patients representing 63 cases of primary or recurrent retroperitoneal tumor resection between 2004-2009 were identified and a retrospective chart review was performed. Rates of complete resection, use of adjunct procedures, and perioperative complications were recorded. RESULTS In 95% of cases, complete resection was achieved. Fifty-eight percent of these cases required en bloc multi-organ resection, and 8% required major vascular resection. Complete resection rates were higher for primary versus recurrent disease. Adjunct procedures (ureteral stents, femoral nerve monitoring, posterior laminotomy, etc.) were used in 54% of cases. Major postoperative complications occurred in 16% of cases, and one patient died (2% mortality). CONCLUSIONS Complete resection of challenging retroperitoneal tumors is feasible and can be done safely with important pre- and intraoperative considerations in mind.
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Affiliation(s)
- William W Tseng
- Divisions of Surgical Oncology, University of California at San Francisco (UCSF), 505 Parnassus Avenue, San Francisco, CA 94143 USA
- Current address: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030 USA
| | - Sam C Wang
- Divisions of Surgical Oncology, University of California at San Francisco (UCSF), 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Charles M Eichler
- Vascular Surgery, Department of Surgery, University of California at San Francisco (UCSF), 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Robert S Warren
- Divisions of Surgical Oncology, University of California at San Francisco (UCSF), 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Eric K Nakakura
- Divisions of Surgical Oncology, University of California at San Francisco (UCSF), 505 Parnassus Avenue, San Francisco, CA 94143 USA
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Guérin P, Obeid I, Gille O, Bourghli A, Luc S, Pointillart V, Cursolle JC, Vital JM. Safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: a morphometric study. Surg Radiol Anat 2011; 33:665-71. [PMID: 21384202 DOI: 10.1007/s00276-011-0798-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 02/18/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE The minimally invasive lateral retroperitoneal transpsoas approach is a recent technique developed for lumbar interbody fusion and discectomy. The proximity of the retroperitoneal vessels and ventral nerve roots to the surgical pathway increases the risk of injury to these anatomical structures. A precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. Preoperative examination of the axial MRI images will allow the surgeon to observe the neural structures at the operative levels and confirm that abdominal vessels do not obstruct the lateral disc space. The objective of this study was to determine the anatomic position of the ventral nerve roots and the retroperitoneal vessels in relation to the vertebral body in the degenerative spine and to delineate a safe working zone using magnetic resonance imaging (MRI). METHODS We retrospectively evaluated lumbar spine MRI in 78 patients (from L1-L2 to L4-L5). The total number of lumbar vertebrae measured was 304 levels. Sagittal MRI sections were used to measure disc height (anterior, middle, posterior). Axial MRI sections were used to measure the sagittal and transversal vertebral endplate diameters, the overlap between ventral nerve roots and the posterior border of the lower endplate of the vertebral body, and the overlap between the retroperitoneal vessels and the anterior border of the lower endplate of the vertebral body. The safe zone was subsequently calculated. It was defined as the relative lower endplate vertebral body sagittal diameter that is anterior to the nerve root and is posterior to the retroperitoneal vessels. RESULTS The safe working zone was 75.3% of the lower endplate of the vertebral body sagittal diameter at L1-L2, 59.5% at L2-L3, 51.9% at L3-L4 and 37.8% at L4-L5 levels. This area significantly decreases from L1-L2 to L4-L5 (p < 0.05). Compared with L1-L2, L2-L3 levels, the more anterior position of the nerve root and the more posterior position of the retroperitoneal vessels at the L4-L5 level causes a significant reduction of this area. Compared with the L3-L4 level, we observed that the safe zone decrease was simply secondary to the more anterior position of the nerve roots at the L4-L5 level. CONCLUSION Preoperative planning and safe zone delineation are a simple method to assess the relative position of neural and vascular anatomic structures in relation to the surgical area. This method can help spine surgeons to prevent perioperative complications.
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Affiliation(s)
- Patrick Guérin
- Laboratoire d'Anatomie Médico-Chirurgicale Appliquée, Université Victor Segalen, Bordeaux 2, 146 rue Léo Saignat, 33000, Bordeaux, France.
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Affiliation(s)
- Jennifer A Best
- Division of General Internal Medicine, University of Washington, Seattle, Washington 98104, USA.
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Mirilas P, Skandalakis JE. Surgical anatomy of the retroperitoneal spaces, Part III: Retroperitoneal blood vessels and lymphatics. Am Surg 2010; 76:139-144. [PMID: 20336888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In this article, we discuss the surgical anatomy of the blood vessels and the lymphatic vessels and lymph nodes found in the retroperitoneum. Retroperitoneal blood vessels include the aorta and all its branches--parietal and visceral--from the diaphragm to the pelvis, and the inferior vena cava and its tributaries. The retroperitoneal lymphatics form a very rich and extensive chain. As a general rule, lymphatics follow the arteries and named lymph nodes are found at the root of the arteries. Retroperitoneal nodes of the abdomen comprise the inferior diaphragmatic nodes and the lumbar nodes. The latter are classified as left lumbar (aortic), intermediate (interaorticovenous), and right lumbar (caval). These nodes surround the aorta and the inferior vena cava. Around the aorta lie the paraortic nodes, preaortic nodes (include celiac, superior mesenteric, inferior mesenteric nodes collecting lymph from the splanchna supplied by the homonymous arteries), and retroaortic nodes. Similarly, around the vena cava lie the paracaval, precaval, and retrocaval nodes. Pelvic nodes include the common iliac, external and internal iliac, obturator, and sacral nodes.
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Affiliation(s)
- Petros Mirilas
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, 1462 Clifton Road NE, Suite 303, Atlanta, GA 30322, USA.
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Sallum EA, Sinozaki S, Calil AM, Coimbra R, Silva MRE, Figueiredo LFPD, Birolini D. Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs. Clinics (Sao Paulo) 2010; 65:67-78. [PMID: 20126348 PMCID: PMC2815285 DOI: 10.1590/s1807-59322010000100011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 10/20/2009] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment. METHODS Initial blood volume was determined with Tc(99m)-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 +/- 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. RESULTS Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II). CONCLUSIONS Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.
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Affiliation(s)
- Elias Aissar Sallum
- Departamento de Cirurgia, Divisão de Cirurgia Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil.
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Pessaux P, Rosso E, Panaro F, Marzano E, Oussoultzoglou E, Bachellier P, Jaeck D. Preliminary experience with the hanging maneuver for pancreaticoduodenectomy. Eur J Surg Oncol 2009; 35:1006-10. [PMID: 19423267 DOI: 10.1016/j.ejso.2009.04.009] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 04/07/2009] [Accepted: 04/09/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malignant periampullary tumours often invade retroperitoneal peripancreatic tissues and a positive resection margin following pancreaticoduodenectomy (PD) is associated with a poor survival. The margin most frequently invaded is the retroperitoneal margin (RM). Among the different steps of PD one of the most difficult and less codified is the resection of the RM with high risk of bleeding. We have developed a surgical technique - "hanging maneuver" - which allows at the same time a standardization of this step, a complete resection of the RM, and an optimal control of bleeding. PATIENTS/METHODS We described the surgical technique, and we reported our preliminary experience. Surgical data, postoperative outcome and pathological results of patients submitted to PD for pancreatic carcinoma using "hanging maneuver" technique between January 2007 and December 2007 were reviewed. RESULTS The hanging maneuver was performed in 20 patients without any intraoperative complication and massive bleeding. No patient required blood transfusion. After had inked the surgical margins, retroperitoneal peripancreatic tissue was invaded in 12 out of 17 patients with malignant diseases (70.5%). In only one case (6%), the retroperitoneal margin was involved by the tumour (R1 resection). CONCLUSION The "hanging maneuver" is a useful and safe technical variant and should be considered in the armamentarium of the pancreatic surgeons in order to achieve negative retroperitoneal margins.
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Affiliation(s)
- P Pessaux
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg Cedex, France.
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Fang TJ, Hsu SC, Shih MC, Wang CY, Chen LI, Tsai YC, Lin YC. Spontaneous Retroperitoneal Hemorrhage in a Mediastinal Tumor in a Patient With Polymyositis: A Case Report. Kaohsiung J Med Sci 2008; 24:436-40. [PMID: 18926959 DOI: 10.1016/s1607-551x(08)70169-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tzu-Jung Fang
- Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Abstract
OBJECTIVES To investigate whether the increase of the retroperitoneal compartment pressure, as in the case of peripancreatic fluid accumulation in severe acute pancreatitis, simulated by infusing a colloid fluid into the retroperitoneum, has any effect on pancreatic tissue blood flow. METHODS Six male anesthetized swine were subjected to a transcutaneous placement of catheters into the retroperitoneal space. Through these catheters, a colloid solution was infused, under continuous retroperitoneal pressure monitoring, to achieve a pressure up to 20 mm Hg. Pancreatic tissue blood flow was assessed by colored microsphere injection technique, and pancreatic interstitial pressure was measured by means of a commercially available pressure monitor system before and after the distension of the retroperitoneal space, allowing the appropriate time for the animals to be stabilized from any intervention. RESULTS The increase in the retroperitoneal compartment pressure was found to significantly increase pancreatic interstitial pressure (from 8 +/- 1 to 20 +/- 2.4 mm Hg, P = 0.001) as well as reduce pancreatic tissue blood flow (from 1.75 +/- 0.4 to 0.56 +/- 0.12 mL . min . g, P = 0.002). CONCLUSIONS The increase of retroperitoneal pressure leads to an impairment of pancreatic tissue blood flow in the healthy pancreas. Although these findings support the hypothesis that peripancreatic fluid collection during the course of acute pancreatitis could contribute or augment pancreatic tissue ischemia, further assessment is necessary.
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Affiliation(s)
- Katerina Kotzampassi
- Department of Surgery, University of Thessaloniki Medical School, Thessaloniki, Greece
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Polyzos D, Papadopoulos N, Chapman L, Papalampros P, Varela V, Gambadauro P, Magos A. Where is the aorta? Is it worth palpating the aorta prior to laparoscopy? Acta Obstet Gynecol Scand 2007; 86:235-9. [PMID: 17364289 DOI: 10.1080/00016340601090147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Injury to major retroperitoneal vessels is the most catastrophic complication of laparoscopy. Knowledge of the site of the aortic bifurcation prior to inserting the umbilical port would be expected to reduce the risk of this type of injury. The aim of the study is to determine the feasibility of identifying the aortic bifurcation by palpation prior to the operation. METHODS We studied 100 patients undergoing laparoscopic surgery or laparotomy. After prepping and draping, the operating surgeon felt for the aortic bifurcation to determine its position in relation to the umbilicus. We then related our findings to the height, weight, and body mass index of the patient. RESULTS The aorta could not be palpated in 15% of cases, including almost 2/3 of women who were obese (body mass index >30). In the remaining 85% cases, where the aorta was palpable, the bifurcation was above the level of the umbilicus in 30 (35%) cases, at the umbilicus in 45 (53%) cases, and below in 10 (12%) cases. We did not find any significant effect of body mass index, height, or weight on the level of the aortic bifurcation by palpation. No vascular injury occurred in the laparoscopic cases during the study. CONCLUSIONS The aortic bifurcation is palpable in the majority of women undergoing surgery, including 93% of those with a low or normal body mass index who are at higher risk of vascular injury. We recommend the routine palpation for the aortic bifurcation as a simple means to reduce the risk of injury to a major retroperitoneal vessel.
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Affiliation(s)
- Dimitrios Polyzos
- Minimally Invasive Therapy Unit & Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, England
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Abstract
BACKGROUND Aim of the present study was to analyse the main causes of lumbosacral plexus lesions together with the best diagnostic and therapeutic options for better patient outcome. METHODS We report our surgical experience with eight patients in whom lesion mechanisms consisted of high-energy trauma (4 pts), firearm injuries (2 pts), spontaneous retroperitoneal haematoma in anticoagulant therapy (1 pt) and schwannoma (1 pt). The diagnosis was not straightforward and included clinical aspects, electrophysiological studies, magnetic resonance and CT myelography. Surgery was performed by lateral extraperitoneal approach for the lumbar plexus, transperitoneal approach on the midline to reach the sacral plexus, and neuronavigation was used in the schwannoma case. CONCLUSIONS Lumbosacral plexus lesions require a challenging multidisciplinary approach to diagnose and treat; the outcome, even if delayed, was very encouraging. In all our patients pain was controlled, and six patients returned to unaided walking.
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Affiliation(s)
- G Stevanato
- Department of Neurosurgery, Umberto I Hospital, Mestre-Venezia, Italy.
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Kessler J, Trerotola SO. Use of the Amplatzer Vascular Plug for embolization of a large retroperitoneal shunt during transjugular intrahepatic portosystemic shunt creation for gastric variceal bleeding. J Vasc Interv Radiol 2006; 17:135-40. [PMID: 16415142 DOI: 10.1097/01.rvi.0000186958.59457.10] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A patient undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation for gastric variceal hemorrhage was found to have a very large spontaneous splenorenal shunt requiring embolization after successful TIPS creation. The anticipated site of embolization was short and large in diameter and was therefore poorly suited for the use of conventional devices such as coils. Two Amplatzer Vascular Plugs and two platinum coils were used to occlude the shunt rapidly and completely.
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Affiliation(s)
- Jonathan Kessler
- Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce Street, 1 Silverstein, Philadelphia, Pennsylvania 19104, USA
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Liu Y, Gu BF, Yang L, Wang CX. [The anatomic relationship of the umbilicus to retroperitoneal major vessels]. Zhonghua Yi Xue Za Zhi 2006; 86:450-2. [PMID: 16677569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To study the anatomic relationship of the umbilicus to the retroperitoneal major vessels and the characteristics of such relationships among the Chinese with different body weights so as to provide a clear reference to the operator of laparoscopy. METHODS Eighty-nine patients without pelvic disease, 57 males and 32 females who accepted digital subtraction angiography (DSA) of aorta were randomly selected and divided into 3 groups: non-obese group, overweight group, and obese group according to body mass index (BMI). All the patients lied supine with a round block of lead 1 cm in diameter located on the umbilicus. Seldinger technique was used to puncture the right femoral artery so as to conduct DSA. Using the bifurcation of the abdominal aorta as reference point the vertical projection relationships of the umbilicus to the retroperitoneal major vessels, abdominal aorta, right common iliac artery, and left common iliac artery were evaluated and the distance from the umbilicus to the aortic bifurcation was measured. The distance was regarded as positive if the umbilicus was cephalic to the aortic bifurcation and as negative if the umbilicus was caudal to the aortic bifurcation RESULTS There were 32 patients in the normal body weight group, 35 in the overweight group, and 22 in the obese group with the mean distances from the umbilicus to the aortic bifurcation of (14.8 +/- 19.7) mm, (0.04 +/- 2.5) mm, and (-12.6 +/- 15.4) mm respectively. In 50 of the 89 patients (63.9%) the location of umbilicus corresponded to the retroperitoneal major vessels, among which the umbilicus of 47 patients (94%) projected vertically to the abdominal aorta or the right common iliac, and the umbilicus of 3 patients (6%) projected vertically to the left common iliac artery. Compared to the above-mentioned 50 patients, in the other 39 patients (36.1%) the location of umbilicus did not corresponded to the retroperitoneal major vessels (P < 0.05), among which the umbilicus of 32 patients (82.1%) projected vertically to the right side of the aorta or of the right common iliac artery, and the umbilicus of 7 patients (17.9%) projected vertically to the internal side of the right iliac common artery. Along with the increase of body weight the projection of umbilicus gradually moved downward to the inferior side of the bifurcation of the abdominal artery. For example, among the male subjects, the distance were (10.4 +/- 4.0) mm, (-0.51 +/- 5.5) mm, and (-13.1 +/- 2.2) mm respectively in the normal body weight group, overweight group, and obese group (all P < 0.05), and in the females, the distance were (13.7 +/- 2.8) mm, (-0.14 +/- 4.4) mm, and (-11.5 +/- 3.2) mm respectively in the normal body weight group, overweight group, and obese group (all P < 0.05). CONCLUSION The location of umbilicus was more caudal with the increase of BMI. So once the retroperitoneal major vessels are injured, the incidence of aorta or the right common iliac artery is higher than that of other vessels.
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Affiliation(s)
- Yan Liu
- Department of Obstetrics and Gynecology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Nakamura Y, Yi SQ, Iimura A, Terayama H, Naito M, Itoh M. Morphological observation of the horseshoe kidney with special reference to the vascular system in 2 Japanese cadavers. Okajimas Folia Anat Jpn 2005; 82:89-94. [PMID: 16350421 DOI: 10.2535/ofaj.82.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two cases of the horseshoe kidney in Japanese cadaver were reported in this paper. The kidneys and their associated vessels in the retroperitoneal cavity were carefully examined, and the histological examination of the isthmus was performed. In Case 1, four arteries arose from the abdominal aorta. One right and two left renal arteries were distributed to the apical, upper, middle and posterior regions of the kidney, respectively, and the artery of isthmus entered the lower segments and the isthmus. In Case 2, six arteries arose from the abdominal aorta. Among three arteries arose from the inferior end of the aorta and entered the lower segments and the isthmus. Histological study revealed that the isthmuses consisted of collecting tubes, glomeruli and urinary tubules and fibrous connective tissue. The incidence of the horseshoe kidney during the dissecting practice at Tokyo Medical University in a period of 24 years from 1980 to 2003 was estimated to be 0.16% (2 out of the 1,219 cadavers). The anatomical and embryological significance of this anomaly and its associated vascular system were discussed. And the histology of the parenchymal structure of the isthmus in the horseshoe kidney containing either fibrous connective tissue or renal parenchyma was also analyzed in this report.
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Affiliation(s)
- Yoichi Nakamura
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku Shinjuku-ku, Tokyo, 160-8402, Japan
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Fiorella D, Albuquerque FC, Masaryk TJ, Rasmussen PA, McDougall CG. Balloon-in-Stent Technique for the Constructive Endovascular Treatment of “Ultra-Wide Necked” Circumferential Aneurysms. Neurosurgery 2005; 57:1218-27; discussion 1218-27. [PMID: 16331170 DOI: 10.1227/01.neu.0000186036.35823.10] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
INTRODUCTION:
Circumferential aneurysms, which incorporate >180 degrees of the circumference of the parent vessel, present a unique therapeutic challenge, particularly in circumstances in which a deconstructive treatment strategy is not feasible. We detail a novel technique for endovascular parent vessel reconstruction with aneurysm embolization.
METHODS:
We performed a retrospective review of the prospectively maintained databases of our two institutions to identify cases in which a balloon-in-stent technique had been used to treat circumferential aneurysms. During the first stage of this technique, a stent (Neuroform [Boston Scientific, Natick, MA], Multilink Vision [Guidant, Indianapolis, IN], or Bx Velocity [Cordis, New Brunswick, NJ]) is placed across the neck of the aneurysm to achieve parent vessel reconstruction. During the second stage, aneurysm coil embolization is performed with a compliant temporary occlusion balloon (Sentry [Boston Scientific, Natick, MA] or Hyperglide [Microtherapeutics, Irvine, CA]) placed within the stent to unambiguously demarcate and protect the parent vessel. In some cases, during the course of the embolization, coils project over and obscure the parent vessel in both working views. Before each coil detachment, the protection balloon is deflated under blank fluoroscopic roadmap visualization. The absence of shifting of any portion of the coil mass during balloon deflation indicates that the introduced coil is external to the stent-reconstructed parent vessel (i.e., within the aneurysm) and can be detached. This process is repeated until satisfactory aneurysm embolization is achieved. After embolization, the balloon catheter may be exchanged for a stent delivery system to facilitate the placement of a second stent.
RESULTS:
Seven patients underwent balloon-in-stent-assisted embolization over a 15-month period. Three were performed for internal carotid aneurysms, three for basilar trunk or basilar apex aneurysms, and one for a dissecting/fusiform V4 segment vertebral artery aneurysm. In three cases, the presence of the inflated balloon facilitated the manipulation of the image intensifier into a position which produced a “down-the-barrel” view of the parent vessel. In the four additional cases, for anatomic reasons, this view could not be achieved and coil mass projected over the reconstructed parent vessel in both views. Partial aneurysm occlusion (75–90%), was achieved in five cases, and near complete (>95%) occlusion was achieved in two cases. Complications included two significant retroperitoneal hematomas and two brainstem infarcts, both of which resulted in hemisensory symptoms.
CONCLUSION:
The balloon-in-stent technique provides a practical and safe treatment strategy for the management of circumferential aneurysms that are not amenable to deconstructive embolization.
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Affiliation(s)
- David Fiorella
- Department of Neuroradiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Szpinda M, Frackiewicz P, Flisiński P, Wiśniewski M, Krakowiak-Sarnowska E. The retroperitoneal anastomoses of the gonadal veins in human foetuses. Folia Morphol (Warsz) 2005; 64:72-7. [PMID: 16121322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In the retroperitoneal space the gonadal veins form a collateral circulation that has a great clinical impact on sclerotherapy or surgical ligation of varicoceles. The aim of this study was to examine the communications of the gonadal veins (according to classification, frequency of appearance, gender and syntopic differences) in human foetuses of both sexes (71 males and 59 females) aged 4--6 months of intrauterine life. On the right side the most frequently were found the gonadal-periureteral anastomosis (23%) and the gonadal-perirenal anastomosis (22%). A gonadal-lumbar anastomosis on the right side appeared in 7% of cases. On the left side the most frequent (37%) was the gonadalperirenal anastomosis, more frequently occurring as an ovarian-perirenal anastomosis (48%) than as a testicular-perirenal anastomosis (29%). Gonadal-periureteral anastomoses were found in a quarter of cases. Gonadal-lumbar anastomoses were observed in 7% of individuals. On the left side the gonadal-mesenteric inferior anastomosis was specifically observed (21%) as an ovarian-mesenteric inferior anastomosis (24%) and a testicular-mesenteric inferior anastomosis (19%). The cross-communications between the right and left gonadal veins (7%) were more frequently as the bilateral testicular (9.7%) than as the bilateral ovarian one (3%). In female foetuses gonadal-perirenal anastomoses occurred with statistically greater frequency than gonadal-periureteral anastomoses (p<=0.05). The frequency of cross-communications of the gonadal veins was three times greater in male foetuses (p</=0.01). Statistical analysis revealed a significantly greater frequency of left-sided anastomoses: the gonadal-perirenal in both sexes (p</=0.05), the gonadal-periureteral in males (P</=0.05) and the gonadalmesenteric inferior in both sexes (p</=0.01).
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, the Ludwik Rydygier Collegium Medicum, Bydgoszcz, the Nicolaus Copernicus University, Toruń, Poland.
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Dixon BP, Devarajan P, Mitsnefes M. Neonatal renovascular hypertension due to prenatal traumatic retroperitoneal hematoma. Pediatr Nephrol 2005; 20:670-2. [PMID: 15711950 DOI: 10.1007/s00467-004-1753-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Revised: 10/15/2004] [Accepted: 10/15/2004] [Indexed: 11/26/2022]
Abstract
This report describes severe hypertension in a 7-week-old male infant found to have renovascular disease from an organized hematoma due to prenatal trauma. As such, this case illustrates a novel acquired, congenital mechanism of renovascular hypertension. The importance of considering prenatal as well as postnatal etiologies of acquired renovascular hypertension in neonates is emphasized. Likewise, attention must be drawn to the classic presentation of congestive heart failure in a child with severe hypertension.
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Affiliation(s)
- Bradley P Dixon
- Department of Pediatrics, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Dryjski ML, Litwinski RA, Karakousis CP. Internal packing in the control of hemorrhage from large retroperitoneal veins. Am J Surg 2005; 189:208-10. [PMID: 15720992 DOI: 10.1016/j.amjsurg.2004.08.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 08/24/2004] [Accepted: 08/24/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hemorrhage from large retroperitoneal veins is usually controlled by suturing the venous tear. Infrequently, the extent and location of the tear and amount of hemorrhage preclude successful suturing. METHODS In seven patients with severe hemorrhage from large retroperitoneal veins encountered in association with resection of retroperitoneal sarcoma (6) or repair of a ruptured abdominal aortic aneurysm (1), packing of the area with sufficient amounts of Surgicel (Ethicon, Johnson & Johnson, Somerville, NJ) and pressure for one half hour was used. RESULTS All seven patients did not show any bleeding postoperatively and no clinical sequelae developed, with the exception of one patient who developed an abscess requiring drainage. CONCLUSION Internal packing with Surgicel appears to be reliable in controlling venous hemorrhage not manageable by the standard methods and may be preferable to roll gauze packing.
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Affiliation(s)
- Maciej L Dryjski
- Department of Surgery, Kaleida Health, Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209, USA.
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Chan KY, Teoh CM, Sukumar N. Case report of a difficult venous access: retroperitoneal approach of inserting an improved non-heparinised port for long-term use. Med J Malaysia 2005; 60:94-6. [PMID: 16250289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This is a case report of a patient with difficult venous access following thrombosis of major superficial and deep veins of the limbs as documented by ultrasound doppler and venography. The insertion of a few central ports were infected and the vein thrombosed. Venography revealed that central venous access was no longer feasible. The previous laparotomies had resulted in dense intra-peritoneal adhesions, and rendered further laparotomy virtually impossible. The patient had occasional adhesion colics, vomiting and hypoglycemic episodes. A rarely performed retro-peritoneal approach of inserting an improved non-heparinised port proved to be effective for long-term management of this patient. The surgical approach and the selected port are discussed.
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Affiliation(s)
- K Y Chan
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur
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Ghanem H, Anis T, El-Nashar A, Shamloul R. Subinguinal microvaricocelectomy versus retroperitoneal varicocelectomy: comparative study of complications and surgical outcome. Urology 2004; 64:1005-9. [PMID: 15533495 DOI: 10.1016/j.urology.2004.06.060] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Accepted: 06/24/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare and assess objectively the postoperative outcome parameters of both microsurgical subinguinal artery sparing and retroperitoneal high ligation techniques for varicocele in infertile men. METHODS We performed a prospective study that included 413 consecutive patients who presented with varicocele. Of the 413 patients, 304 underwent subinguinal varicocelectomy (group 1) and 109 patients underwent high ligation varicocelectomy (group 2). Subinguinal varicocelectomies were performed under local anesthesia, with intravenous propofol sedation administered as needed. The operating microscope (x10 to x16) was used to spare the arteries and lymphatics. High ligation was performed through a retroperitoneal approach. RESULTS All patients went home on the evening after surgery with minimal discomfort. No intraoperative complications occurred. The internal spermatic artery was identified in all microvaricocelectomy cases. No testicular atrophy occurred in either group. Five (1.6%) and seven (6.4%) hydroceles were identified at the 3-month postoperative visit in groups 1 and 2, respectively. CONCLUSIONS Microvaricocelectomy is safe and effective and associated with a rapid recovery and minimal morbidity. However, it requires microsurgical training.
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Affiliation(s)
- H Ghanem
- Department of Andrology, Cairo University Faculty of Medicine, Cairo, Egypt
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27
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Gauvrit JY, Oppenheim C, Girot M, Lambert M, Gautier C, Hatron PY, Pruvo JP, Leclerc X. High Resolution Images Obtained With Ultrasound and Magnetic Resonance Imaging of Pericarotid Fibrosis in Erdheim-Chester Disease. Circulation 2004; 110:e443-4. [PMID: 15477423 DOI: 10.1161/01.cir.0000144473.95742.9a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jean-Yves Gauvrit
- Department of Neuroradiology and EA 2691, University Hospital of Lille, Lille, France.
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Abstract
A healthy 17-year-old girl presented to the emergency department with a 1-day history of left upper quadrant abdominal pain associated with nausea and vomiting. Her hematocrit was 22. On physical examination, she had left upper quadrant fullness and tenderness. Initial computed tomography revealed a large, loculated, left-sided retroperitoneal hematoma. Blood pool scintigraphy with labeled red cells revealed a very large photon-deficient area with 3 areas of active bleeding in the upper margin of the cold area. An angiogram showed active extravasation from the left inferior phrenic artery. The patient was felt to have had spontaneous adrenal hemorrhage, likely within a preexisting, large adrenal cyst. Spontaneous hemorrhage into an adrenal cyst is a rare entity that can be life-threatening if not treated early in its course.
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Affiliation(s)
- Daniel B Lerer
- Department of Nuclear Medicine and Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA
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29
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Recurrent bleeding from intercostal arterial pseudoaneurysm after retroperitoneal laparoscopic radical nephrectomy. Urology 2003; 62:390. [PMID: 12893370 DOI: 10.1016/s0090-4295(03)00140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Omoto K, Tanabe K, Tokumoto T, Kondo T, Yamanouchi E, Toma H. Spontaneous retroperitoneal bleeding caused by rupture of an iliolumbar artery in a renal transplant patient. Transplantation 2003; 76:273-4. [PMID: 12865830 DOI: 10.1097/01.tp.0000073738.12566.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santa-Cruz RW, Auge BK, Lallas CD, Preminger GM, Polascik TJ. Use of bipolar laparoscopic forceps to occlude and transect the retroperitoneal vasculature: a porcine model. J Endourol 2003; 17:181-5. [PMID: 12803992 DOI: 10.1089/089277903321618761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Surgical clips are commonly employed during laparoscopic radical nephrectomy to ligate perihilar vessels reliably, yet these clips can interfere with the application of a vascular stapler to major vessels, potentially leading to catastrophic hemorrhage. We assessed the efficacy of the PlasmaKinetic trade mark (PK) bipolar cutting forceps (Gyrus Medical, Minneapolis, MN) as a single modality in coagulating and dividing the retroperitoneal vessels in a swine model. MATERIALS AND METHODS Three 40- to 50-kg domestic swine (six renal units) underwent celiotomy and retroperitoneal exposure. The inferior vena cava (IVC) and the renal, gonadal, and iliac vessels were isolated, and, using 5- and 10-mm forceps, coagulated and divided. The mean diameter of the renal vein was 8.7 mm, the renal artery 6.5 mm, and the IVC 14 mm. RESULTS Hemostasis was achieved consistently using the 5-mm and 10-mm PK Cutting Forceps on the renal artery, renal vein, and gonadal vein. The 10-mm forceps coagulated the iliac veins and IVC 83% of the time with only a single application. Larger vessels or vessels with higher inherent vascular pressure required additional applications of the device to achieve hemostasis. All animals were hemodynamically stable through division of the IVC, as measured by heart rate and pulse oximetry. No complications were noted with the device or using the cutting element. CONCLUSIONS The PK bipolar cutting forceps appear to be effective in controlling and dividing the renal hilar vessels and larger low-pressure vessels of the porcine retroperitoneum, with no gross damage to adjacent structures. Although further studies are necessary before use during laparoscopic nephrectomy in humans, these results are promising. Bipolar cutting forceps may prove to be a safe, cost-effective, and time-saving device with numerous applications during urologic laparoscopy.
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Affiliation(s)
- Robert W Santa-Cruz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27110, USA
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Abstract
PURPOSE We report on vascular and bowel complications during major retroperitoneal laparoscopic renal and adrenal surgery. MATERIALS AND METHODS A total of 404 patients underwent retroperitoneoscopy for various renal and adrenal pathology between July 1997 and February 2001. The occurrence of intraoperative vascular and bowel injuries, specific intraoperative circumstances, management techniques and outcomes were evaluated. RESULTS There were 7 vascular injuries (1.7%) and 1 bowel injury (0.25%), which involved the right adrenal vein (2), left renal vein (2), right renal vein (1), right renal artery (1), inferior vena cava (1) and a superficial, small serosal injury to the duodenum (1). Of these 8 cases 5 (63%) had been treated prior with major open intra-abdominal surgery. Average blood loss for patients with vascular injuries was 1,186 cc (range 300 to 3,000). Of the 8 cases 1 was converted to open surgery and in another 2 cases the vascular injury was controlled through the extraction incision, which had already been created. Retroperitoneoscopic control and repair without open conversion were possible in each of the most recent 5 cases. Of the 404 cases open conversion has not been necessary for control of vascular or bowel complications in the most recent 200 cases, demonstrating the impact of the learning curve. CONCLUSIONS During major renal and adrenal retroperitoneoscopic surgery our incidence of vascular and bowel injuries was 1.7% and 0.25%, respectively. With experience inadvertent vascular and bowel injuries can be efficaciously controlled retroperitoneoscopically despite the somewhat small operative field available.
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Affiliation(s)
- Anoop M Meraney
- Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Ohio 44195, USA
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Wilson MW, Fidelman N, Lull RJ, Marder SR, Laberge JM, Kerlan RK, Gordon RL. Evaluation of active bleeding into hematomas by technetium-99m red blood cell scintigraphy before angiography. Clin Nucl Med 2002; 27:763-6. [PMID: 12394121 DOI: 10.1097/00003072-200211000-00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the utility of technetium-99m red blood cell (Tc-99m RBC) scintigraphy in the diagnosis of active hemorrhage into large intra-abdominal hematomas before arteriography. METHODS This retrospective case series describes four patients (1 man and 3 women) with large abdominal wall and retroperitoneal hematomas confirmed by computed tomography who underwent Tc-99m RBC scintigraphy before angiography. Arterial transcatheter embolization was performed if active hemorrhage was found. RESULTS Three of the patients had positive findings on Tc-99m RBC scans, which showed spreading of the labeled erythrocytes into the hematoma space. Positive scintigraphy was diagnostic for active hemorrhage and helped localize the bleeding sites. Angiography confirmed the diagnosis in all patients with positive scintigraphy and ruled out active bleeding in the patient with a negative Tc-99m-labeled RBC scan. CONCLUSION Tc-99m RBC scintigraphy appears to be sensitive and accurate in detecting active hemorrhage into intra-abdominal hematomas.
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Affiliation(s)
- Mark W Wilson
- Division of Interventional Radiology, University of California, San Francisco, California 94143-0628, USA.
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Abstract
PURPOSE We report on vascular and bowel complications during major retroperitoneal laparoscopic renal and adrenal surgery. MATERIALS AND METHODS A total of 404 patients underwent retroperitoneoscopy for various renal and adrenal pathology between July 1997 and February 2001. The occurrence of intraoperative vascular and bowel injuries, specific intraoperative circumstances, management techniques and outcomes were evaluated. RESULTS There were 7 vascular injuries (1.7%) and 1 bowel injury (0.25%), which involved the right adrenal vein (2), left renal vein (2), right renal vein (1), right renal artery (1), inferior vena cava (1) and a superficial, small serosal injury to the duodenum (1). Of these 8 cases 5 (63%) had been treated prior with major open intra-abdominal surgery. Average blood loss for patients with vascular injuries was 1,186 cc (range 300 to 3,000). Of the 8 cases 1 was converted to open surgery and in another 2 cases the vascular injury was controlled through the extraction incision, which had already been created. Retroperitoneoscopic control and repair without open conversion were possible in each of the most recent 5 cases. Of the 404 cases open conversion has not been necessary for control of vascular or bowel complications in the most recent 200 cases, demonstrating the impact of the learning curve. CONCLUSIONS During major renal and adrenal retroperitoneoscopic surgery our incidence of vascular and bowel injuries was 1.7% and 0.25%, respectively. With experience inadvertent vascular and bowel injuries can be efficaciously controlled retroperitoneoscopically despite the somewhat small operative field available.
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Affiliation(s)
- Anoop M Meraney
- Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Ohio 44195, USA
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Peschel R, Gettman MT, Neururer R, Hobisch A, Bartsch G. Laparoscopic retroperitoneal lymph node dissection: description of the nerve-sparing technique. Urology 2002; 60:339-43; discussion 343. [PMID: 12137839 DOI: 10.1016/s0090-4295(02)01827-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Laparoscopic retroperitoneal lymph node dissection (RPLND) is associated with a more favorable postoperative recovery and decreased morbidity compared with open RPLND. To date, laparoscopic RPLND is used as a diagnostic tool for patients with clinical Stage I nonseminomatous germ cell tumor and as a diagnostic and therapeutic tool for patients with low-volume Stage II nonseminomatous germ cell tumor after chemotherapy. In an effort to further expand the therapeutic implications for laparoscopic RPLND, we describe a nerve-sparing technique for laparoscopic RPLND. TECHNICAL CONSIDERATIONS In all cases, a four-port transperitoneal approach was used to perform a unilateral nerve-sparing technique. Laparoscopic nerve-sparing RPLND requires complete exposure of the retroperitoneum, similar to the standard procedure. A stepwise surgical approach is required for prospective identification of the sympathetic trunk and postganglionic nerve fibers. Identification and division of the lumbar veins is required for complete mobilization of the vena cava to facilitate dissection of the postganglionic nerves on the right side as they course dorsal to the vena cava. Meticulous dissection was required for preservation of the postganglionic nerves in the interaortocaval and para-aortic regions. CONCLUSIONS Laparoscopic nerve-sparing RPLND is technically feasible. Performance of laparoscopic nerve-sparing RPLND decreases the potential morbidity associated with the standard laparoscopic technique further and may help expand the therapeutic potential for this minimally invasive procedure.
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Affiliation(s)
- Reinhard Peschel
- Department of Urology, University of Innsbruck, Innsbruck, Austria
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Abstract
A case of complex anomalies (variations) of the veins of the retroperitoneum in a 57 year old male cadaver is presented. The anomaly involved a double inferior vena cava, with the left suprarenal v. draining into the left vena cava and the right testicular v. drained into the right renal v.. There was also no left common iliac v., with the left external iliac v. draining into the left vena cava and the left internal iliac v. into the right common iliac v.. Although duplication of the inferior vena cava has previously been reported the present case is interesting because of the complexity of the associated anomalies.
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Affiliation(s)
- H S Sürücü
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Affiliation(s)
- A Strauss
- Abteilung für Angiologie, Dominikus-Krankenhaus, Am Heerdter Krankenhaus 2, 40549 Düsseldorf.
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38
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Affiliation(s)
- S M Henry
- Department of Surgery, University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, Maryland 21201, USA
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Abstract
Three-dimensional ultrasonic angiography is a new power Doppler ultrasonographic imaging mode that appears to improve the visualization of vascular anatomy in abdominal sonography. This study illustrates the utility of three-dimensional ultrasonic angiography in the abdomen, especially with respect to liver and portal vein anatomy, vascularization of the kidney, and vessels localized in the retroperitoneum.
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Affiliation(s)
- A von Herbay
- Department of Medicine, University of Düsseldorf, Germany
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40
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Bliznashki I. [The pathomorphological changes of the retroperitoneum in acute pancreatitis]. Khirurgiia (Mosk) 2000; 55:44-7. [PMID: 10838820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Attention is focused on the development of a news idea. A comparative assessment of the body tissue tegmina--peritoneum and skin--is performed using a precise measuring unit--the square centimeter. Rating of pathological changes in the retroperitoneum in acute pancreatitis, similar to the one in thermal or chemical burns of skin, expressed in percents corresponding to the square centimeters of pathologically altered surface, is proposed.
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41
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Singletary LA, Karcnik TJ, Abujudeh H. Hyaline vascular-type Castleman disease: a rare cause of a hypervascular retroperitoneal mass. Abdom Imaging 2000; 25:207-9. [PMID: 10675469 DOI: 10.1007/s002619910047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We present the cross-sectional imaging and angiographic findings of hyaline vascular-type Castleman disease located in the retroperitoneum. The diagnosis was made postoperatively. This entity can simulate a malignant neoplasm. The histologic subtypes and presentations of Castleman disease and the differential diagnosis of retroperitoneal masses are discussed.
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Affiliation(s)
- L A Singletary
- Department of Radiology, University of Medicine and Dentistry of New Jersey, Room C320 University Hospital, Newark, NJ 07103-2406, USA
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42
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Abstract
BACKGROUND A very rare case of retroperitoneal bleeding due to spontaneous rupture of a large adrenal myelolipoma in a 62-year-old woman is reported. METHODS/RESULTS She consulted the emergency room of the Nagano Red Cross Hospital with a complaint of sudden left flank pain. A computerized tomography (CT) scan revealed a tumor with areas of fat density and hematoma in the left retroperitoneal space. After her general condition improved, an operation was performed. The tumor strongly adhered to the left kidney and a left nephrectomy with the tumor was curative. Histologic diagnosis was adrenal myelolipoma. No blood transfusion was required. CONCLUSIONS A CT scan is very useful in the pre-operative diagnosis of adrenal myelolipoma with retroperitoneal hemorrhage. Watch and wait treatments before operation and nephrectomy with adhered tumor are safe and curative.
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Affiliation(s)
- T Amano
- Department of Urology, Nagano Red Cross Hospital, Wakasato, Japan.
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43
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Falcone RA, Luchette FA, Choe KA, Tiao G, Ottaway M, Davis K, Hurst JM, Johannigman JA, Frame SB. Zone I retroperitoneal hematoma identified by computed tomography scan as an indicator of significant abdominal injury. Surgery 1999; 126:608-14; discussion 614-5. [PMID: 10520905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE All zone I retroperitoneal hematomas (Z1RPHs) identified at laparotomy for blunt trauma traditionally require exploration. The purpose of this study was to correlate patient outcome after blunt abdominal trauma with the presence of Z1RPH diagnosed on admission computed tomography (CT) scan. METHODS This is a retrospective review of patients with blunt trauma who were admitted to a Level 1 trauma center and who underwent CT scan during a 40-month period. All scans with a traumatic injury were reviewed to identify and grade Z1RPH as mild, moderate, or severe. Patients requiring operative treatment were compared with those who were observed. Statistical analysis was performed with Student's t test and chi-square test, with P < .05 considered significant. RESULTS Eighty-five (15.5%) of the CT scans were positive for Z1RPH. None of the 50 patients with a mild Z1RPH had their treatment altered. Of the 29 patients with a moderate or severe Z1RPH, 8 required celiotomy. The patients requiring celiotomy had significant elevations of solid viscus score (SVS) (4.9 +/- 1.6 versus 1.8 +/- 0.3), abdominal Abbreviated Injury Scale (3.8 +/- 0.3 versus 2.6 +/- 0.3), and transfusion requirements (13 +/- 4 versus 2 +/- 1). All patients (N = 4) with an SVS >4 required operative treatment. Seventy-two percent of patients with more than 1 intra-abdominal injury required abdominal exploration. CONCLUSIONS The presence of a moderate or severe Z1RPH and more than 1 intra-abdominal injury or an SVS >4 on admission CT scan is an important radiographic finding. This injury pattern should be considered a contraindication for nonoperative treatment of the associated solid organ injury.
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Affiliation(s)
- R A Falcone
- Department of Surgery, University of Cincinnati College of Medicine, Ohio, USA
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44
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Temes G, Szilágyi K. [Diagnostic and therapeutic problems of sponaneous retroperitoneal hematoma]. Orv Hetil 1998; 139:2369-71. [PMID: 9796353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The authors report four cases of spontaneous retroperitoneal haematomas, which occurred in their department during a half year period. The patients were admitted from different internal medicine departments. They had anaemia, and bleeding with unknown origin and localisation, and were in a bad condition. Three patients could be suitable for operation after general preparation. One of these patients died and another one died without operation. Two of them went home after recovering. The patients were transferred to surgical department on average three days after the symptoms developed. Hypoprothrombinaemia was the reason for bleeding in three cases. One patient got overdosed Syncumar, and two patients suffered from alcoholic cirrhosis who had other serious diseases as well. The authors found that the fourth patient, who had the gluteal arterial rupture with inexplicable origin, also had hypoprothrombinaemia. It is very difficult to diagnose these disease. Bleeding always has to be taken into consideration, if the patients have liver disease, or any type of coagulopathy, or take some anticoagulant medicine. The blood test examinations, ultrasound, CT, MR, angiography, laparoscopy can be helpful in the diagnosis of these cases.
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Affiliation(s)
- G Temes
- Baranya Megyei Kórház Sebészeti Osztály, Pécsi Orvostudományi Egyetem, Pécs
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45
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Lüttges J, Vogel I, Menke M, Henne-Bruns D, Kremer B, Klöppel G. The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Virchows Arch 1998; 433:237-42. [PMID: 9769127 DOI: 10.1007/s004280050242] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The prognosis of ductal adenocarcinoma of the pancreas is still poor. We analysed the factors that have a major influence on the survival of patients. Surgical specimens from 51 patients with ductal adenocarcinoma of the head of the pancreas were examined for tumour size, histological type, grade and local extension. In 7 patients the retroperitoneal resection margin was involved either macroscopically or histologically. Their mean survival was 10.6 months (1-17 months), compared with 22.7 months for the 44 patients with curative R0 resection. In 10 patients large vessels (portal and/or mesenteric vein) had to be resected; they survived for only 2-11 months, with a mean of 5 months (P<0.05). Non-R0-resected patients and patients in whom tumour-invaded vessels had to be resected constitute a high-risk group with a significantly shorter mean survival of 8.8 months, compared with 24.3 months for R0 resected patients without vessel invasion (P<0.05). Lymph node metastases were seen in 35 of 51 patients. Survival analysis based on nodal status revealed a mean survival of 33 months for patients staged as N0, 21.4 for N1a patients and 14 month for N1b patients. The differences were not statistically significant, however. Our data suggest that tumour invasion of the retroperitoneal resection margin and large vessel involvement are the major factors determining survival in patients with pancreatic cancer.
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Affiliation(s)
- J Lüttges
- Department of Pathology, University of Kiel, Germany
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46
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Cavallaro A, Amato D, Cavallaro G, Rossi P. [A rare complication of the Greenfield vena cava filter]. Ann Ital Chir 1998; 69:655-9. [PMID: 10052217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The authors report an unusual case of retroperitoneal haemorrhage following the application of a Greenfield modified titanium filter: haematoma due to the lesion of a lumbar vein was favoured by anticoagulant therapy and complicated by infection, ending in frank disruption of the vein wall. A review is made of the modalities of caval penetration and perforation with the Greenfield filter.
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Affiliation(s)
- A Cavallaro
- I Istituto di Clinica Chirurgica, Università di Roma La Sapienza
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47
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Born M, Decker P, Layer G, Heider J, Schild H. [Aortic rupture and retroperitoneal bleeding im Behcet disease]. Aktuelle Radiol 1998; 8:101-3. [PMID: 9592586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although retroperitoneal hemorrhage is a rather seldom complication of Behçet's syndrome it is in no way unusual. Younger patients in particular those from the eastern Mediterranean or east Asian regions in whom a retroperitoneal hemorrhage or an aneurysm in the aorto-iliaco-femoral flow region has be diagnosed must be considered for the differential diagnosis of Behçet's syndrome. The consequences for the surgeon are resection deep into healthy tissue and in general an appropriately close follow-up with strict avoidance of arterial angiography.
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Affiliation(s)
- M Born
- Radiologische Klinik, Rheinische Friedrich-Wilhelms-Universität Bonn
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48
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Furuset AS, Bjerklund Johansen TE, Majak B. [Renal angiomyolipoma as a cause of acute retroperitoneal hemorrhage]. Tidsskr Nor Laegeforen 1997; 117:4215-7. [PMID: 9441463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Angiomyolipoma is a mesenchymal tumor, usually found in the kidney. The pleomorphic appearance and involvement of regional lymph nodes may simulate malignancy, but angiomyolipomas are classified as benign. Renal angiomyolipomas are found in approximately 40% of tuberous sclerosis patients and are usually small, bilateral and asymptomatic nodules. Spontaneous rupture and retroperitoneal haemorrhage may be experienced with larger tumours. Although findings by ultrasonography and computerized tomography are specific for this lesion, histological examination is necessary for a final diagnosis. Small asymptomatic angiomyolipomas should be followed up with sequential CT scans and be removed by enucleation or partial nephrectomy when they reach a size of more than 4 cm in diameter. If the patient suffers from massive bleeding, it is very difficult to preserve the kidney. We report on a 61-year old women who experienced acute retroperitoneal haemorrhage. She was given ten blood transfusions before she was operated on with en bloc removal of the left kidney, an angiomyolipoma with a diameter of 10 cm and a large haematoma.
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Affiliation(s)
- A S Furuset
- Kirurgisk avdeling Telemark sentralsjukehus, Porsgrunn
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49
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Abstract
We sought to assess the outcome of large retroperitoneal vascular injury that occurred during operative laparoscopy but was not related to trocar or Veress needle injury. We conducted a retrospective review of cases operated and reviewed by our centres. Eight cases were identified. Four women were undergoing lymphadenectomy, where vascular injury is a recognized risk. Distorted anatomy was a compounding factor in three of the remaining four patients who were undergoing intraperitoneal procedures. The injuries involved the inferior vena cava (n = 2), the right external iliac artery (n = 2), the left external iliac artery (n = 1), the right external iliac vein (n = 1), the hypogastric artery (n = 1) and the inferior mesenteric artery (n = 1). Injuries were caused by unipolar electrode (n = 1), electrosurgical scissors (n = 3), sharp scissors (n = 2) and CO(2) laser (n = 2). The vessel injury was repaired at laparotomy in four women. The other four cases were managed laparoscopically. Transfusion attributable to the vascular injury occurred in two cases. The outcome in all cases was good, except for one in which the patient died. These cases demonstrate that all energy sources used without proper understanding and caution can cause significant vascular injury. The adequacy and safety of laparoscopic control of major vessel bleeding should be investigated further and consultation with a vascular surgeon should be considered in all cases.
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Affiliation(s)
- C Nezhat
- Department of Gynecology and Obstetrics, Stanford University School of Medicine, CA, USA
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50
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Kinahan J, Sullivan LD, Nantel S, Rowley A, Vickars L. Retroperitoneal chloroma presenting with uremia, bilateral ureteral obstruction and encasement of the great vessels. J Urol 1996; 155:1388. [PMID: 8632586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J Kinahan
- Department of Urology, University of British Columbia, Vancouver, British Columbia
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