No abstract

Echinococcus multilocularis causes infection where the most commonly affected organ is the liver, followed by the lung, kidney, bone and the brain. Other sites such as the heart, spleen, pancreas and soft tissues are very rarely affected. Surgical treatment combined with chemotherapy using various technical approaches remains the main therapeutic modality for echinococcal liver disease. To the best of our knowledge there are less than five clinical cases of cutaneous presentation of liver alveolar echinococcosis described. We present a unique case of liver echinococcosis presenting as recurrent abdominal wall fistula and abscess in a 29-year-old man. Diagnosis was based on CT imaging, serological analysis and histological findings from the fistula. Medical treatment with albendazole was initiated and liver resection was performed. The patient has no symptoms and signs of recurrence 1 year after operation, while still on albendazole therapy. This case description highlights the importance of early suspicion and treatment of unusual echinococcosis clinical presentations.

IntroductionThere are insufficient data regarding the changes in adipokine levels after laparoscopic adjustable gastric banding (LAGB) in diabetic and non-diabetic patients and their effects on insulin resistance and type 2 diabetes remission.AimTo assess leptin, adiponectin, and insulin resistance changes after LAGB in diabetic and non-diabetic morbidly obese patients.Material and methodsOne hundred and three patients (37 with and 66 without type 2 diabetes) underwent LAGB from January 2009 to January 2010. Glycated hemoglobin, insulin, adipokine levels and insulin resistance were evaluated preoperatively, and 1 and 4 years after LAGB.ResultsThe mean patient age was 45.9 ±11.7 years and mean preoperative body mass index was 47.5 ±7.3 kg/m2. A total of 80 of 103 patients (77.6%) completed the 4-year follow-up. After 4 years the mean excess weight loss was 38.8% and 39.5% in diabetic and non-diabetic patients respectively. Leptin levels decreased significantly in both groups at 1 year, but after 4 years this was noted only in non-diabetic patients. After 1 year adiponectin levels increased significantly only in non-diabetic patients (p = 0.003) and remained almost the same at 4 years. A significant decrease in insulin resistance was noted in both groups 1 year after LAGB and diabetes remission was observed in 23 (62.1%) patients. There was a negative correlation between preoperative insulin resistance and adiponectin levels throughout the follow-up period. Leptin levels positively correlated with BMI throughout the study period (baseline r = 0.45; p < 0.001; after 1 year r = 0.71; p < 0.001; after 4 years r = 0.68; p < 0.001). There was no significant correlation between leptin and adiponectin concentrations preoperatively or after 1 year; however, at 4 years it was significant (r = 0.27; p < 0.02).ConclusionsThe most significant metabolic changes occurred within 1 year after LAGB. The 4-year follow-up revealed stabilization in metabolic indices rather than significant improvement.

SAGB and MiniMizer Extra bands demonstrated similar long-term results regarding the weight loss, resolution of comorbidities, morbidity, and quality of life.

IntroductionLaparoscopic adjustable gastric banding (LAGB) is considered to be the least invasive, reversible, and the safest bariatric operation regarding mortality and morbidity, and its application to high-risk superobese (SO) individuals seems rational.AimThere are differing viewpoints regarding the effectiveness of LAGB in superobese (BMI > 50 kg/m2) patients. The aim of this study was to compare the safety and efficacy of LAGB in SO and non-superobese (NSO) patients in the long term (> 5 years).Material and methodsWe undertook a prospective single-center study to compare the safety and efficacy of LAGB in SO and NSO patients after 5 years. One hundred and three morbidly obese patients underwent LAGB in the period from January 2009 to January 2010. Sixty-four of the patients were NSO and 39 SO. After 5 years, we evaluated their weight loss, comorbidities, complications, and quality of life.ResultsA total of 90 of 103 patients (87.3%) completed the 5-year follow-up. The percentage excess weight loss was 50.4% in the NSO and 38.8% in the SO group (p = 0.072). The proportion of patients who lost > 50% excess weight was significantly larger in the NSO group (p = 0.045). There were significantly more patients in the NSO group whose metabolic syndrome had resolved (p < 0.001). There were no differences regarding the resolution of other comorbidities and postoperative complications.ConclusionsThis study suggests that LAGB can lead to substantial and long-lasting weight loss after 5 years. Our study found that SO patients demonstrate inferior weight loss results, and lower overall BAROS scores; thus we do not support the primary use of LAGB in SO patients.

Darbo tikslasRemiantis literatūros duomenimis išanalizuoti vėlyvuosius (≥5 metų) laparoskopinės vertikalios skrandžio rezekcijos rezultatus gydant morbidinį nutukimą. Tiriamoji medžiaga ir metodai Publikacijų paieška atlikta "Medline", "Current Contents" ir "Cochrane Library" duomenų bazėse. Apžvelgtos visos laparoskopinės vertikalios skrandžio rezekcijos 5 metų ir vėlesnius rezultatus pateikiančios publikacijos, paskelbtos iki 2015 m. sausio 1 dienos. Rezultatai Atlikus literatūros šaltinių paiešką, rasta 20 publikacijų, pateikiančių 5 metų ir vėlesnius vertikalios skrandžio rezekcijos rezultatus. Įtrauktose studijose tirti 4354 ligoniai, iš kurių 1536 buvo stebėti 5 metus ir ilgiau. Tiriamųjų amžiaus vidurkis buvo 37,9 metai. Vidutinis priešoperacinis KMI buvo 46,3 kg/m 2 . Vidutinis procentinis perteklinės kūno masės netekimas po 5, 6, 7 ir 8 metų atitinkamai buvo 59,9 %, 58,5 %, 56,6 % ir 56,4 %. Bendras komplikacijų dažnis -6,47 %, o pooperacinis 30 dienų mirštamumas -0,19 %. Po 5 metų nustatyta gretutinių ligų remisija ar pagerėjimas: antro tipo cukrinio diabeto -71,4 %, arterinės hipertenzijos -61,4 %, dislipidemijos -50,1 %, miego apnėjos -86,9 %, gastroezofaginio refliukso ligos -41,8 %, degeneracinių sąnarių ligų -83,9 % ligonių. Vidutinis BAROS skalės balų skaičius praėjus 5 metams po vertikalios skrandžio rezekcijos buvo 6, tai atitinka labai gerus rezultatus. Išvados Laparoskopinė vertikali skrandžio rezekcija yra efektyvi ir saugi nutukimo gydymo operacija, pasižyminti gera pooperacine gyvenimo kokybe ir gretutinių ligų kontrole, o perteklinės masės netekimas 5 metų laikotarpiu yra ženklus ir stabilus. Reikšminiai žodžiai: nutukimas, bariatrinė chirurgija, vertikali skrandžio rezekcija

Žygimantas Juodeikis, Juozas Stanaitis, Algimantas Stašinskas 1 Vilniaus universiteto Gastroenterologijos, nefrourologijos ir chirurgijos klinika, Bendrosios chirurgijos centras, Respublikinė Vilniaus universitetinė ligoninė, Šiltnamių g. 29, LT-04130 Vilnius El. paštas: zjuodeikis@yahoo.com Tikslas Pateikti mūsų gydymo patirtį ir palyginti šios patologijos gydymo rezultatus su užsienio autorių duomenimis. Ligoniai ir metodai Atlikome 14 ligonių, 1992–2011 m. sirgusių mechaniniu žarnų nepraeinamumu dėl tulžies akmenų, retrospektyviąją analizę. Rezultatai Išanalizuoti 14 ligonių duomenys. Visi ligoniai buvo vyresni nei 70 metų (nuo 71 iki 88 metų), amžiaus vidurkis 76,9 metų. Vyrų ir moterų santykis buvo atitinkamai 3:11. Visi ligoniai buvo hospitalizuoti dėl ūminio žarnų nepraeinamumo ir skubiai operuoti. Operacijos metu dažniausiai nustatyta obstrukcijos vieta buvo klubinėje žarnoje ir tuščiojoje žarnoje, rečiau – dvylikapirštėje žarnoje. Septyniems ligoniams operacijos apimtis apsiribojo enterolitotomija, trims buvo atlikta enterolitotomija ir cholecistektomija, vienam ligoniui atlikta plonosios žarnos rezekcija, dviem ligoniams pavyko konkrementą mechaniškai nustumti į storąją žarną. Vienu atveju dėl Bouveret sindromo atlikta cholecistektomija ir Finney piloroplastika. Pooperaciniu laikotarpiu du ligoniai mirė, trims pasireiškė komplikacijų. Išvados Tulžies akmenų sukeltas žarnų nepraeinamumas yra reta, dideliu mirtingumu pasižymėti patologija, dažniausiai pasitaikanti senyvo amžiaus ligoniams. Enterolitotomija yra saugesnis, mažesnį mirtingumą lemiantis gydymo metodas nei enterolitotomija su cholecistektomija. Reikšminiai žodžiai: žarnų nepraeinamumas, enterolitotomija, Bouveret sindromas. Gallstone ileus: retrospective review of 14 cases and case report Žygimantas Juodeikis, Juozas Stanaitis, Algimantas Stašinskas 1 Vilnius University, Institute of Oncology, Santariškių Str. 1, LT-08660 Vilnius, Lithuania2 Vilnius University, Faculty of Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Santariškių Str. 2, LT-08661 Vilnius, Lithuania E-mail: zjuodeikis@yahoo.com Objective The objective of this study was to present the resuts of our treatment of gallstone ileus and to compare them with the results reported by other authors. Patients and methods A retrospective study with the revision of clinical stories of patients diagnosed with gallstone ileus between 1991 and 2011 was performed. Results Analysis of data on 14 patients was performed. All of the patients were older than 70 years (median, 76.9). The men-to-women ratio was 3 : 11. All patients were admitted with small bowel obstruction symtoms and operated on rapidly. The most common obstruction location was the ileum and the jejunum, and a less frequent location was the duodenum. Enterolithotomy was performed in 7 cases cholecystectomy and enterolithotomy in 3 cases. There was a single case when small bowel resection was necessary. Concrements were succesfully mechanically pushed into the colon in 2 cases. In one case, the Finney pyloroplasty and cholecystectomy were performed. Postoperatively, 2 patients died. Postoperative complications were observed in 3 cases. Conclusions Gallstone ileus is a rare and highly lethal pathology which mostly occurs in the elderly. Enterolithotomy with cholecystectomy is related to a higher mortality rate than enterolithotomy alone. Key words: gallstone ileus, enterolithotomy, Bouveret syndrome

Priešoperacinių veiksnių įtaka prognozuojant kūno masės sumažėjimą praėjus penkeriems metams po nutukimo gydymo skrandžio apjuosimo reguliuojama juosta operacijos: perspektyvusis atsitiktinių imčių tyrimas BackgroundLaparoscopic adjustable gastric banding (LAGB) is used as a bariatric procedure for more than 30 years, but there is still insuf ficient data regarding postoperative weightloss predicting factors. ObjectiveWe carried out a prospective randomized study to compare two different bands (SAGB and Minimizer Extra) and aimed to find weightloss predicting factors. Methods A total of 103 morbidly obese patients underwent LAGB from January 2009 to January 2010. The SAGB was used in 49 and MiniMizer Extra in 54 patients. Weight loss was evaluated after 1 and 5 years. Factors which significantly correlated with per centage excess weight loss (%EWL) were used to build predicting regression models. ResultsThe mean patient age was 45.9 ± 11.7 years, and mean preoperative body mass index (BMI) was 47.5 ± 7.3 kg/m 2 . A total of 90 (87.3%) patients completed the 5year followup. The mean overall excess weight loss after 5 years was 47.3 ± 29.7%, and there was no difference between SAGB and MiniMizer bands (47.3% vs 50.3%; p = 0.14). After 1 year, BMI ≤ 47 MiniMizer, pa tients demonstrated better weight loss results. %EWL was also significantly greater in >40yearold MiniMizer group patients (p =0.012) and remained significantly higher after 5 years (p = 0.035). ConclusionsIn > 40yearold patient group better %EWL can be achieved by using MiniMizer Extra bands compared to SAGB. The con structed prognostic models could be used to predict %EWL after application of SAGB and MiniMizer bands.