The pre-operative radiological assessment of proximal bile duct tumours is clinically important as resection may be limited by tumour extension along the bile ducts, into hepatic parenchyma or the adjacent vascular structures. Demonstration of the extent of biliary and vascular involvement can direct additional investigations and definitive treatment. 22 patients with hilar cholangiocarcinoma were studied pre-operatively by conventional ultrasound (US) and duplex sonography (DS). The extent of tumour infiltration and vascular involvement was compared with arteriography and operative findings. Bile duct dilatation and the level of obstruction was documented by US in 22 (100%), and the tumour was shown by US in 19 (86%). In these 19 patients, the extent of extraductal extension compared with operative findings was correct in 13, underestimated in two, and in four infiltration was massed. Vascular patency or involvement was correctly determined by DS in 19 (86%), and by arteriography in 18 (82%). In two of the three incorrect DS interpretations, lobar atrophy and contralateral hypertrophy distorted the hilar anatomy. US with DS is valuable in the pre-operative staging of proximal bile duct tumours in predicting ductal and vascular involvement.
A 33-year-old, morbidity obese woman underwent a laparoscopic Roux-en-Y gastric bypass in November 2004. She presented 18 months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and endoscopic evaluations revealed wall thickening in the transverse colon and a solid tumor near the liver. Therefore, a sonography-guided biopsy of the tumor was performed. Cytopathological examination revealed actinomycosis. Thus, therapy with penicillin was started, after which the parameters associated with the infection decreased. The symptoms persisted, however, and the decision was made to operate on the patient to resect the abdominal masses. Nearly 90% of the masses could be removed. Histological analysis showed a fibro-productive inflammation with an actinomycotic etiology. Antibiotic therapy with penicillin was continued for 6 months. Actinomycosis must be considered in the differential diagnosis of patients with abdominal mass, wall thickening of the intestine, and other such symptoms, including abdominal pain following bariatric surgery, even many years after the intervention.
The Chiari osteotomy and various shelf procedures are used to augment the weight-bearing area in dysplastic acetabula.The new articular surface derives by metaplasia from the acetabular rim andjoint capsule, and is therefore of poorer quality than congruous hyaline cartilage. We reviewed 32 patients after augmentation procedures, using conventional radiographs and three-dimen-
RFA is an effective and low risk treatment modality in patients with liver metastases. The procedure is safe (complication rate < 6%) with low morbidity. RFA can be performed repeatedly on an outpatient basis with good palliative effects. Of note, surgery remains the treatment of choice in resectable liver metastases of colorectal origin.
Hepatic vein outflow obstruction induces remarkable changes of intra–hepatic blood circulation;
the significance of these changes remains uncertain. Six patients with obstruction of the
hepatic veins were evaluated by duplex Doppler ultrasound and computed tomography. The
adaptive changes secondary to obstruction were analyzed and their significance was correlated
with the clinical findings. Four patients presenting unilateral hepatic vein occlusion had
unilateral reversed portal flow. Two of them, with lobar liver atrophy and contralateral
compensatory hypertrophy required operation; the other two, with normal appearance of the
liver, benefitted from conservative treatment. Two patients with bilateral hepatic vein occlusion,
intra-hepatic bypasses, bilateral lobar atrophy and caudate lobe hypertrophy, received operations.
Intrahepatic unilateral portal flow reversal compensates for unilateral hepatic outflow
obstruction. The combination of complete or subtotal hepatic vein obstruction and atrophy–hypertrophy
complex predicates advanced disease despite flow reversal or spontaneous shunt.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.