No abstract

Within the largest multi-institutional analysis of 30-day outcomes after hepaticojejunostomies for BDI in the US, morbidity and mortality rates were established at 26.3% and 2% respectively. ASA class and preoperative functional status remain the main risk factors for surgery. Earlier repair in the face of ongoing sepsis and disability is associated with worse outcomes. A multidisciplinary approach at a specialized center aimed at controlling infection and improving functional status prior to surgical reconstruction is recommended.

Clinical and experimental studies indicate that hyperthermia can cause heatstroke with cerebral ischemia and brain damage. However, no study has examined the direct effects of heating carotid artery smooth muscle and tested the hypothesis that hyperthermia induces arterial vasoconstriction and, thereby, decreases cerebral blood flow. We recorded isometric tension of rabbit carotid artery strips in organ baths during stepwise temperature elevation. The heating responses were tested at basal tone, in norepinephrine- and KCl-precontracted vessels, and after electrical field stimulation. Stepwise heating from 37 degrees C to 47 degrees C induced reproducible graded contraction proportional to temperature. The responses could be elicited at basal tone and in precontracted vessels. Heating decreased the contractile responses to norepinephrine and electrical field stimulation but increased contraction to KCl. These responses were not eliminated by pretreatment with the neuronal blocker tetrodotoxin. Our results demonstrate that heating carotid artery preparations above 37 degrees C (normothermia) induced a reversible graded vasoconstriction proportional to temperature. In vivo this reaction may lead to a decrease in cerebral blood flow and cerebral ischemia with brain damage as in heatstroke. The heating-induced contraction is not mediated by a neurogenic process but is due to altered transcellular Ca2+ transport. Cooling, in particular of the neck area, therefore, should be used in the treatment of heatstroke.

HighlightsSiliconomas of the breast develop as a result of implant rupture and present with many of the signs and symptoms of breast cancer.MRI is the preferred study for diagnosis and a preoperative tissue sample should be attempted.We present a patient with a giant breast siliconoma and perform a comprehensive literature review.Our patient underwent a modified radical mastectomy with delayed closure.The majority of patients should undergo surgery due to symptoms or the inability to rule out cancer.

HighlightsThere are several endoscopic, laparoscopic and open surgical procedures available for the management of GIST tumors near the GE junction.We present a case-report utilizing both endoscopy and laparoscopy to facilitate resection using the non-touch lesion-lifting technique.Pathology demonstrated a 4.7 cm GIST. The patient was discharged on post-operative day 3 with no complications.We include a full literature review and describe the various combined modalities available for successful resection.

HighlightsPrimary umbilical endometriosis is rare and the presence of an underlying hernia makes it a diagnostic challenge.Only 7 cases have been reported in the literature.Our patient underwent an en-bloc resection of the hernia sac, endometrioma and umbilicus with reconstruction. There is no disease recurrence at 6 months.MRI is the preoperative imaging modality of choice and there is a limited role for preoperative FNA and medical management.

Without templated radiology, surgery, and pathology reports, the ESS cannot be applied to current clinical/research practice. Although resection continues to provide significant survival benefit to patients with perihilar cholangiocarcinoma, lack of an accurate prognostic tool for resectability and outcomes continues to be a major impediment to progress in the field.

No abstract