Port site metastases in laparoscopic surgery. First workshop on experimental laparoscopic surgery, Frankfurt 1997.
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Animals↗
Biomedical subjects
G Hubens
Publications and source records attributed to G Hubens.
Late peritoneal metastasis in a patient with osteosarcoma.
A 19-year-old man with a high-grade osteosarcoma of the femur, treated with neoadjuvant chemotherapy, surgery, and adjuvant chemotherapy suffered from lung metastases 15 months after diagnosis. They were resected. Thirteen months later, he had vague abdominal complaints which, after analysis, proved to be caused by peritoneal metastasis. A review of the literature, possible physiopathological mechanisms of increased occurrence of unusual metastases and the role of bone scintigraphy in the follow-up of patients with osteosarcoma are discussed.
Adult↗
Splenic rupture as a complication of P. falciparum malaria after residence in the tropics. Report of two cases.
Splenic rupture is an uncommon complication of malaria, which requires urgent medical investigation, close follow-up and adequate treatment. Until present, this complication was reported more often in P. vivax infections than in infections with other species. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The diagnosis is made by physical examination, ultrasound and CT-scan. Especially in malaria endemic areas the management of splenic rupture in malaria should be focused on splenic preservation. We describe two cases of splenic rupture during a P. falciparum infection, both requiring finally splenectomy.
Abdominal Injuries↗
Impact of CO2 and gasless laparoscopy as well as laparotomy on peritoneal tumor growth and abdominal wall metastases.
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Abdominal Neoplasms↗
Multicentric experience of the Belgian Group for Endoscopic Surgery (BGES) with endoscopic adrenalectomy.
BACKGROUND: Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed by surgeons dealing with endocrine disorders. METHODS: Some 54 videoendoscopic adrenalectomies performed on 52 patients by five surgical teams between October 1993 and December 1996 were prospectively evaluated. RESULTS: Indications for endoscopic adrenalectomy were pheochromocytoma (n = 17), primary hyperaldosteronism (n = 15), Cushing's adenoma or disease (n = 7), nonsecreting adenoma (n = 7), single metastasis from adenocarcinoma (n = 2), adenoma with dehydroepiandrostenedione (DHEAS) hypersecretion (n = 3), and ACTH-secreting metastases from a thymoma (n = 1). Of the 54 adrenalectomies performed, 31 were of the left gland, 19 of the right and two bilateral. Laparoscopic adrenalectomy was successful in 50 patients (96%). Median tumor size was 4 cm (range 1.5-12), median operation duration was 80 min (range 59-360), and median postoperative stay was 4 days (range 2-13). One patient required blood transfusion. CONCLUSIONS: Endoscopic adrenalectomy can safely be performed-even sporadically-by surgeons well versed in adrenalectomy techniques for endocrine disorders and trained in endoscopic surgery.
Adenoma↗
Shock bowel following massive pulmonary embolism.
Wide-spread abnormalities of the small bowel on CT scan after massive pulmonary embolism and acute hemodynamic collapse are described. These small bowel abnormalities are secondary to hypotension with prolonged hypoperfusion. They consist of diffuse thickening of the small-bowel wall, fluid-filled, dilated loops and increased contrast enhancement of the small-bowel wall (shock bowel). These abnormalities are reversible and should be distinguished from acute vascular occlusion.
Adult↗
Efficacy of tumoricidal agents in vitro and in vivo.
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Animals↗
The influence of a pneumoperitoneum on the peritoneal implantation of free intraperitoneal colon cancer cells.
BACKGROUND: In order to test the influence of a pneumoperitoneum on the peritoneal implantation of free intraperitoneal colon cancer cells, 40 male syngeneic WAG rats were at random divided into four groups. METHODS: Group 1 (n = 10) animals underwent a midline laparotomy and 10(4) CC531 colon cancer cells were injected intraperitoneally (IP); in group 2 (n = 10) 10(4) CC531 cells were injected IP without further manipulation; in group 3 (n = 10) a pneumoperitoneum up to 10 mmHg was created after the IP injection of the same amount of CC531 cells. The pneumoperitoneum was maintained for 15 min. Finally in group 4 (n = 10) after the IP injection of 10(4) CC531 cells and after the creation of a pneumoperitoneum, two 14-G IV catheters simulating trocars were introduced in each flank. A follow-up period of 8 weeks was used. Tumor implantation was scored according to the peritoneal cancer index of Eggermont and the index of Chauffert. RESULTS: Tumor nodules were found varying from 60% in groups 1-3 to 50% in group 4. There was no statistical difference between the implantation rate in the four groups. A port-site recurrence was seen in group 4; all the other tumor implants were located in the mesenterium, omentum, internal genitals, or parietal peritoneum. CONCLUSIONS: The presence of a pneumoperitoneum does not enhance the implantation of free intraperitoneal malignant colon cancer cells in the rat, but the presence of a "port" may lead to abdominal-wall metastases.
Adenocarcinoma↗
Laparoscopic treatment of nonparasitic liver cysts: adequate selection of patients and surgical technique.
Results of laparoscopic fenestration in patients with a highly symptomatic solitary liver cyst (17 patients) or polycystic liver disease (PLD) (9 patients) were prospectively evaluated in a multicenter practice of general surgeons. Conversion to laparotomy was required in two patients because of inaccessible deep liver cyst in one and a diffuse form of PLD in the other. There was no mortality or major morbidity. Mean postoperative hospital stay was 4.6 days after successful laparoscopic procedures. During a mean follow-up of 9 months, 23% of the patients had recurrence of symptoms and 38% had radiographic reappearance of cysts. Factors predicting failure included previous surgical treatment, deepsited cysts, incomplete deroofing technique, location in the right posterior segments of the liver, and a diffuse form of PLD with small cysts. Adequate selection of patients and type of cystic liver disease and meticulous and aggressive surgical technique are recommended.
Adult↗
Serum basic fibroblast growth factor and vascular endothelial growth factor and tumour growth kinetics in advanced colorectal cancer.
BACKGROUND: The development of new microvessels in the surrounding stroma is a prerequisite for tumour progression. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are angiogenic factors expressed in a broad range of human tumours. We have measured the concentrations of both cytokines in the serum of patients with advanced colorectal cancer. We questioned whether these levels are related to the number of tumour sites, the volume of liver and/or lung involvement and the growth kinetics. PATIENTS AND METHODS: 44 untreated colorectal adenocarcinoma patients who had developed metastatic and/or recurrent disease were evaluated. Serum levels of bFGF and VEGF were repeatedly measured using ELISA. The extent of target organ involvement and the kinetics of tumour volume growth were determined on consecutive computer tomography (CT) images. RESULTS: Patients with a tumour volume doubling time of less than 6 months showed a higher bFGF and VEGF serum level than others, independent of the number of sites involved and the extent of the metastatic disease. CONCLUSIONS: The data suggest a predictive value of serum bFGF and VEGF levels for the progression of disease in patients with untreated metastatic colorectal cancer. The results corroborate the importance of angiogenesis in the process of tumour growth. The serum levels might prove a useful tool in the quantification of angiogenesis and might be of valuable information in the decision process of initiating palliative chemotherapy. It will be of considerable importance to investigate whether the serum bFGF and VEGF levels have a predictive value on the probability of response to cytotoxic therapy.
Adenocarcinoma↗
Laparoscopic resection of an adenoma of the urachus in combination with a laparoscopic cholecystectomy.
In a 40-year-old male patient with symptomatic cholecystolithiasis, ultrasound examination disclosed a large cystic mass on the dome of the bladder. Laparoscopic resection of this mass was carried out in combination with a laparoscopic cholecystectomy. Histology disclosed an urachal adenoma. Postoperative recovery was uneventful. We conclude that urachal adenomas can be managed safely by laparoscopic means.
Adenoma↗
Mucosal proctectomy and colo-anal anastomosis as treatment of rectal atresia.
Rectal atresia is a rare condition in which the anus and sphincter muscles are normally developed. Therefore it seems logical to preserve those structures unaltered during surgical therapy. Mucosal proctectomy and colo-anal anastomosis is a safe, technically well known technique that achieves this goal.
Anal Canal↗
Microvessel quantification in primary colorectal carcinoma: an immunohistochemical study.
The vascularisation of human primary colorectal carcinomas was studied immunohistochemically using the endothelial cell markers CD31 and factor VIII-related antigen. Tumour sections were systematically scanned at a magnification of x 100 to find areas of intense neovascularisation. Microvessel counts within these vascular 'hotspots' were performed at magnification x 250. Regions in which tumour cords were surrounded by a collagen IV-positive basement membrane were compared with those in which this was absent and with normal mucosa. CD31 appeared to be a more sensitive marker for endothelial cells than factor VIII-related antigen (mean 185 +/- 59 and 120 +/- 38 microvessels mm-2). Within individual tumour sections microvessel counts in vascular hotspots with highest vessel density correlated significantly with microvessel counts in vascular hotspots with second highest vessel density (P < 0.01). Microvessel counts in tumour areas where collagen IV-positive basement membrane were absent exceeded those in areas where it was present (factor of 1.7) and those in normal mucosa (factor of 1.6). The differences in vessel density between individual tumours and the low variability in vessel density within individual tumours using this quantification technique allow us to investigate the prognostic value of vessel density in areas of intense neovascularisation in human primary colorectal carcinomas.
Adult↗
Microvessel density, endothelial cell proliferation and tumour cell proliferation in human colorectal adenocarcinomas.
BACKGROUND: Thymidine incorporation studies performed in animal tumour models, revealed major differences in endothelial cell proliferation when tumour tissue was compared with normal tissue. The fraction of proliferating endothelial cells is reported to be increased by a factor of 30 to 40 in tumour tissue. PATIENTS AND METHODS: To make it possible to analyze the endothelial cell proliferation in human tumours, an immunohistochemical double staining technique comprising CD31, an endothelial cell marker, and Ki-67, a proliferation marker, was developed. Endothelial cell proliferation was analysed in 21 primary human colorectal adenocarcinomas and in the adjacent mucosa. RESULTS: Proliferating endothelial cells were found throughout the entire carcinoma. The mean overall endothelial cell labeling index (ECLI) was 9.9% (range, 5.4-18.0), and the labeling index of endothelial cells in areas of intense neovascularisation was even higher. Mean ECLI in the vascular hot spots was 21.0% (range, 6.8-35.0), and the mean tumour cell labeling index (TCLI) in the maximally Ki-67 immunostained areas was 78.3% (range 47.0-89.7). In 14 of 21 carcinomas, these areas were predominantly found at the luminal margin of the tumour, as were the vascular hot spots. A significant positive correlation was found between tumour vascularity, measured in the vascular hot spots, and tumour cell proliferation, measured in the maximally Ki-67 immunostained areas (p < 0.05). To analyse this relation in more detail, microvessel density (MVD), TCLI and ECLI were determined per x400 microscopic field by scanning in sequence from the luminal tumour margin to the invasive tumour base. In all tumours, the pattern of the MVD per x400 field, from the luminal margin to the tumour base, was similar to that of the TCLI and ECLI. CONCLUSIONS: These findings confirm that the fraction of cycling endothelial cells is higher in human colorectal carcinoma than in the adjacent mucosa which suggests that endothelial cells are proliferating in most of the individual capillaries in tumour tissue. Regional differences in MVD correlate with differences in tumour cell proliferation in these tumours.
Adenocarcinoma↗
Pneumatosis cystoides intestinalis. Conservative approach in non surgical pneumoperitoneum: a case report and literature review.
An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His general condition allowed a thorough clinical and laboratory investigation which resulted in the diagnosis of the disease and the avoidance of an unnecessary laparotomy. PCI is a relatively rare condition characterized by multiple intramural pockets of gas involving any portion of the gastro intestinal tract. Various theories reflect either a mechanical or a bacterial etiology. Most of the patients are asymptomatic although some experience gastrointestinal complaints. The majority of patients require no treatment.
Aged↗
Management of digestive fistulas.
BACKGROUND: The efficacy of total parenteral nutrition and somatostatin was assessed in reducing output and promoting spontaneous closure of postoperative digestive fistulas. METHODS: In a consecutive series of 23 patients, closure was achieved in 83% of patients after a mean fistula duration of 11.0 +/- 7.9 days and a mean of 13.2 +/- 7.0 days of drug treatment, and without mortality. RESULTS: A marked first-day effect (output drop > 50%) was noted in 60% of patients and had a good prognosis. Infection of the fistula markedly prolonged fistula closure time, but did not affect total outcome. CONCLUSION: Somatostatin has been shown to be very useful in the conservative treatment of digestive fistulas because of its ability to reduce output significantly and to accelerate spontaneous closure.
Adolescent↗
The influence of the interaction of sutures with the mucosa on tumour formation at colonic anastomoses in rats.
In order to explore the respective role of wound healing and suture material on metachronous carcinogenesis at colonic lines in rats, tumour yield was studied after the administration of a chemical carcinogen (azoxymethane) at the moment that in one group of rats most of the suture material was still present and crypt cell proliferation elevated, while in another group, no more suture material was present and crypt cell proliferation rate (CCPR) normalized at the anastomotic site. Azoxymethane (15 mg/kg/week, s.c., during 6 weeks) was administered in male Sprague-Dawley rats (n = 105) 8 weeks after the creation of an anastomosis in the ascending and descending colon with either stainless steel sutures (group A, n = 30) or fast-absorption Vicryl (Vicryl Rapide, group B, n = 30). A control group (group C, n = 30) underwent a sham laparotomy before the administration of azoxymethane, while the animals of a fourth group (group D, n = 15) were not operated upon and received no azoxymethane. Twenty-six weeks after the first injection of azoxymethane there was no significant difference in the total colorectal tumour yield in the three operated groups (A, B, C), but a significantly greater proportion of anastomotic tumours (28/68 vs. 13/88, p < 0.01) and more anastomotic tumours per rat (28/23 vs. 13/28, p = 0.01) as well as more rats with anastomotic tumours (16/23 vs. 11/28, p = 0.04) were found in the steel-sutured group (A), compared with the control group (C).(ABSTRACT TRUNCATED AT 250 WORDS)
Anastomosis, Surgical↗
Effect of nonabsorbable and rapidly absorbable suture material on the cytokinetics of crypt cells in colonic anastomoses in the rat.
The effect of non-absorbable and rapidly absorbable suture material on the cytokinetics of crypt cells was studied in right and left colonic anastomoses in the rat by using stathmokinetic methods. Forty-five male Sprague-Dawley rats were allocated to three groups. In group A (n = 15), colonic anastomoses were performed in the right and left colon using nonabsorbable, stainless steel sutures. Groups B (n = 15) animals had identically located anastomoses but a rapidly absorbable suture material (Vicryl Rapide) was used. Animals of group C (n = 15) acted as controls. Eight weeks postoperatively, the crypt cell production rate (CCPR) was determined after measuring the slope of the metaphase accumulation line. At this time, no suture material was detected in any of group B (Vicryl Rapide) animals, while in group A rats (stainless steel), 79% of the animals had suture material in place. A steel-sutured anastomosis significantly increased the CCPR in the right colon from 6.2 to 10.6 cells/crypt/h and in the left colon from 5.6 to 9.8 cells/crypt/h compared with controls (p less than 0.05). An anastomosis performed with Vicryl Rapide, whether in the proximal or descending colon, did not influence the CCPR when compared with the control group (right 6.4 vs. 6.2 cells/crypt/h; left 4.2 vs. 5.6 cells/crypt/h). The CCPR at steel-sutured anastomoses was significantly higher than the CCPR at the Vicryl Rapide anastomotic site both in the right (10.6 vs. 6.4 cells/crypt/h) as well as in the left colonic sites (9.8 vs. 4.2 cells/crypt/h) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Anastomosis, Surgical↗