Catecholamines and atrial natriuretic peptide (ANP) are major regulators of adipocyte lipolysis. Although obesity is characterized by catecholamine resistance in subcutaneous adipose tissue (SCAT), data on ANP lipolytic response and sensitivity in different adipose tissue (AT) depots of metabolically distinct humans are scarce. Ex vivo catecholamine- and ANP-induced lipolysis was investigated in adipocytes derived from SCAT and visceral AT (VAT) depot of lean (n=13) and obese men, with (n=11) or without (n=18) type 2 diabetes (HbA1c < or ≥ 6.5%). Underlying molecular mechanisms were examined by looking at functional receptors in the NP signalling pathway at the mRNA and protein level. Maximal ANP- and catecholamine-induced lipolysis in SCAT was blunted in obese type 2 diabetics compared with age-matched lean men whereas non-diabetic obese subjects showed intermediate responses. This blunted ANP-mediated lipolytic response was accompanied by lower mRNA and protein expression of the type-A natriuretic peptide (NP) receptor and higher mRNA but reduced protein expression of the scavenging type-C receptor. Maximal ANP-induced lipolysis was lower in VAT compared with SCAT but not different between groups. Collectively, our data show that both ANP- and catecholamine-mediated lipolysis is attenuated in SCAT of obese men with type 2 diabetes, and might be partially explained by NP receptor defects. Therefore, improving maximal ANP responsiveness in adipose tissue might be a potential novel strategy to improve obesity-associated metabolic complications.
Indications for single-stage LCBDE are not standardized and do not appear well established across E-AHPBA members.
Malignant rectal melanoma is a rare tumour. We report a case of a 66-year-old man who presented with a two-month history of rectal bleeding, pain, and tenesmus. A semicircular rectal tumour was seen, just above the dentate line. Biopsies proved it to be an amelanotic malignant melanoma, as protein S100, melanoma antigen HMB45 and Melan-A expression were found. CT scan and rectal ultrasound showed invasion into the internal sphincter and several enlarged perirectal nodes. No distant lesions were detected on CT scan, nor on PET scan. An abdominoperineal resection was performed as a substantial part of the internal anal sphincter was invaded. Histology confirmed an amelanotic malignant melanoma. The patient recovered well from the operation, and received no adjuvant therapy. Four months later, multiple liver metastases were seen on CT scan. With this case we want to illustrate that malignant rectal melanoma can be difficult to diagnose, as patients have non-specific symptoms, and histology may be misleading. One should always check for protein S-100, melanoma antigen HMN-45 and Melan-A expression, as they are strongly suggestive of melanoma. Wide local excision is the preferred procedure when technically feasible, but abdominoperineal resection has to be done if the tumour invades a substantial portion of the anal sphincter or is circumferential. Rectal melanoma has a poor outcome with a 5-year survival rate of between 10-20%. The extent of the disease correlates with the overall survival. The role of radiotherapy, chemotherapy or immunotherapy looks promising, but further investigations are needed.
Three types of colonic sphincter substitutes were placed at an abdominal colostomy in dogs. Simple valve construction (8) was based on orthograde intussusception of the colon over 3.5 cm. In calibrated valves (6) the intraluminal pressure was increased by reducing the diameter of the overlying muscle coat. Reverse smooth muscle plasties (5) and simple colostomies (5) served as controls. Immediately after construction highest pressure (50 ± 8.9 mm Hg) was obtained in calibrated valves. After 1 month the pressure dropped to 20 mm Hg, but remained stable thereafter. Although valvular constructions cannot maintain high pressure, they may be useful as substitutes for the internal anal sphincter by filling up the lumen so that the action of a surrounding striated muscle ring becomes more effective.
Pelvic actinomycosis is a rare complication of a long-term intrauterine contraceptive device. Early diagnosis is important, as clinical and radiological imaging may mimic a malignant pathology and lead to radical and unnecessary surgery. We report a case of pelvic actinomycosis in a woman who had used an intrauterine contraceptive device for the last 13 years. The actinomycosis appeared as a malignant pelvic mass with invasion into the sigmoid and left ureter, with high-grade stenosis of these structures. Because of its rapidly developing obstructive character, an urgent Hartmann procedure with resection of the uterus and both ovaries was performed. Histology revealed actinomycosis. With this case we want to illustrate that for a woman presenting with an intrauterine contraceptive device and a malignant appearing mass in the pelvis, pelvic actinomycosis must be considered in the list of differential diagnosis, so that appropriate diagnostic work out and treatment can be made.
IPM). The liver parenchyma was divided by a combination of CUSAÒ;, Thunderbeat (OlympusÒ;) and LigasureÒ; keeping the transaction line as close as possible to the cystic neoplasm. Locking clips and vascular stapler were used to divide the RPPP and branches of RHV in contact with the neoplasm. Results: Operative time was 300 min. Blood loss was 150 ml and IPM was used twice. The patient did not develop any complication. Total hospital stay was five days. The histologic reports confirmed the preoperative diagnosis of BCA with ovarian stroma. Conclusions: The laparoscopic approach is a feasible and safe option to treat patients with large BCA in need for a radical resection even when the lesion is localized in the right posterior segments as far as the surgeon is skilled with advanced minimally invasive liver procedures.
Laparoscopic resection of Segment 1 is technically challenging and reports remain limited. In this video we demonstrate our experience and technique for laparoscopic Segment 1 resection in three different settings. Methods: 1) A 56 y-old man diagnosed with solitary Segment 1 liver metastasis from conventional renal cell carcinoma received laparoscopic isolated Segment 1 resection. 2) A 72 y-old man diagnosed with bilobar colorectal liver metastases was submitted to laparoscopic left lateral sectionectomy and simultaneous Segment 1, 7 and 8 wedge resections. 3) A 79 y-old man diagnosed with intrahepatic cholangiocarcinoma underwent a laparoscopic left hemihepatectomy with enbloc Segment 1 resection. Low CVP and careful dissection are essential for a safe and oncologically efficient resection. Results: For all three patients postoperative course was uneventful and R0 resection was confirmed on histological exam. Conclusions: Although challenging, laparoscopic management of lesions in Segment 1 can be completed safely and efficiently for malignant lesions. In this video we demonstrate the surgical techniques we developed and adopted in different clinical settings.
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