An eight-year-old, male boxer dog was referred for the treatment of a large (5.5 x 5 cm), unresectable visceral mast cell tumour. The dog had a surgical resection performed one month before referral, and it had widespread metastases to the abdominal lymph nodes. The patient was treated with lomustine and prednisone and showed a rapid improvement and increased level of activity, weight gain and consistent tumour reduction. The patient remained in partial remission (defined as a greater than 50 per cent reduction in tumour volume) for seven months. Toxicity was acceptable and was limited to moderate anaemia and two episodes of neutropenia. At the completion of the seven months of therapy, the dog experienced a chemotherapy-induced sepsis, and the owners elected for euthanasia due to financial concerns. At that time, the tumour was still in partial remission. This case report suggests that a combination of lomustine and prednisone is an effective protocol for the palliation of aggressive visceral mast cell tumours.
Results: LCBDE was performed via a transcystic approach in 7 and via choledochotomy in 13 patients. Median (range) operating time was 120 (90e210) minutes. Simultaneous cholecystectomy was performed in 16 patients. LCBDE was performed after Roux-en-Y gastric bypass surgery in 5 patients. One patient was converted to an open common bile duct exploration because of stone impaction. Stone clearance was succesful in all patients. Postoperative complications were a subcapsular liver hematoma (Clavien-Dindo type 2), a bile leak (Clavien-Dindo type 3b) and a superficial surgical site infections (Clavien-Dindo type 1) in three different patients. Median (range) length of hospital stay was 3 (1e10) days. Conclusions: LCBDE is feasible at a non-academic teaching hospital with high stone clearance and low complication rates.
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