Long-term results of hepatic resection for hepatolithiasis in 34 patients having intrahepatic
biliary strictures were studied. The left lateral and the right posterior segmental ducts were
commonly and often simultaneously involved. Fourteen patients had multiple segmental
involvement. Hepatic resection included left sided resection (n=27), right sided resection (n=6), and repeated bilateral resection (n=1). Seven patients had biliary tumors: 3 cholangiocarcinomas, 2 gall bladder cancers, cystadenocarcinoma, and dysplasia of intrahepatic
ducts. Nineteen patients received bilioenteric anastomosis. Retained stones and recurrent
stones developed in 3 and 4 patients, respectively. Twenty-six patients had no remaining
symptoms; 2 died of operative complication or cholangiocarcinoma; 6 presented symptoms
caused by retained stones (n=2), recurrent stones (n=2), bile stasis (n=1), or neuralgia (n=1). In
4 of the 6 patients, unrelieved posterior duct strictures caused the symptoms. With a mean
follow-up period of 4.5 years, 30 patients are symptoms free, and 27 are stone free. In patients
with right lobar or bilobar type, intra- and extrahepatic type, and confluence strictures,
bilioenteric anastomosis is required. Hepatic resection is a rational treatment for hepatolithiasis,
however, meticulous management of biliary tract abnormalities, particularly the
posterior duct stricture, is mandatory.
Primary mediastinal liposarcomas are rare malignancies, comprising fewer than 1% of all mediastinal tumors. We herein report a radical resection of a massive liposarcoma arising from the anterior mediastinum. A 63-year-old male patient presented with a 4-week history of dyspnea that had worsened over the previous several days. The patient had also experienced hoarseness for 2 weeks. Chest X-ray and computed tomography revealed a huge tumor occupying the entire left thoracic cavity. Anesthesia was induced when the patient was in the left semilateral position. The patient was moved into the right lateral position after initially stabilizing anesthesia with separate lung ventilation. The fourth rib was initially resected for thoracotomy, but there was no clearance between the tumor and the adjacent mediastinal structures, and two more ribs were therefore removed. The tumor had not invaded the other structures such as the chest wall, lung, or mediastinum. To reduce the tumor blood flow, the left internal mammary artery was ligated before the tumor was resected en bloc. The tumor was diagnosed as a liposarcoma arising from the thymus. The patient remains alive with no evidence of disease recurrence at 22 months after the operation.
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