PubMed · 11561153
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D G Gilliland. 2001. Hematologic malignancies.. https://doi.org/10.1097/00062752-200107000-00001
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BACKGROUND: Previous reports of laparoscopic cholecystectomy (LC) in patients with biliary pancreatitis suggested increased operative difficulty, high rates of conversion, and greater morbidity and mortality. METHODS: Between 1990 and 1997, LC was performed for biliary pancreatitis in 63 patients (Group I) and for other causes in 829 patients (Group II). RESULTS: Patients with biliary pancreatitis were significantly older (median age 57 vs 50 years, p = 0.009), with greater co-morbidity (ASA III/IV 24% vs 11%, p = 0.008). The groups were comparable with respect to the frequency of previous abdominal operations, acute inflammation of the gallbladder, and the frequency of bile duct calculi detected by intraoperative cholangiography. Moderate to severe adhesions involving the gallbladder were significantly more frequent in patients with biliary pancreatitis (46% vs 29%, p = 0.004). No significant differences were observed between the two groups with respect to intraoperative (1.5% Group I vs 6.0% Group II, p = 0.109) or postoperative complications (10% vs 8%, p = 0.426), conversion rate (0 vs 2.7%, p = 0.181), or duration of operation (median 92 vs 85 min, p = 0.33). CONCLUSION: Despite increased age and co-morbidity and more frequent adhesions, our data showed no evidence that intraoperative or postoperative complications were more frequent in patients with biliary pancreatitis than in other patients undergoing LC.
CD4(+), CD56(+) DC2 malignancies constitute a novel disease entity, which has recently been shown to arise from a transformed lymphoid-related plasmacytoid dendritic cell (DC2). Diagnosis is primarily based on a particular immunophenotype with tumor cells expressing CD4 and CD56 antigens in the absence of common lymphoid or myeloid lineage markers. Little is currently known about the cytogenetic features of this disease entity. In this setting, the Groupe Français de Cytogénétique Hématologique (GFCH) initiated a cytogenetic study of 18 adults and 3 children with CD4(+), CD56(+) DC2 acute leukemia using conventional and fluorescence in situ hybridization/24-color karyotyping. Clonal, mostly complex chromosome aberrations were found in 14 patients (66%). Six major recurrent chromosomal targets were defined. These were 5q, 12p, 13q, 6q, 15q, and 9, which were involved in 72% (5q), 64% (12p and 13q), 50% (6q), 43% (15q), and 28% (monosomy 9) of cases, respectively. Cytogenetic features can be summarized as follows: (1) gross genomic imbalances (mostly losses) predominate, (2) no single anomaly can be considered as specific, whereas their combination/accumulation is, and (3) both lymphoid and myeloid lineage-associated rearrangements are observed in unusual combinations in the same cell. This is suggestive of complex multistep tumorigenic mechanisms and is supportive of the hypothesis that CD4(+), CD56(+) DC2 acute leukemia may arise from an undifferentiated nonmyeloid nonlymphoid progenitor cell. In conclusion, the present study documents for the first time the existence of a characteristic cytogenetic profile for this novel disease entity.
HISTORY AND CLINICAL FINDINGS: A 38-year-old man presented with acute low back pain and paraesthesia in dermatome S1. 4 hours before onset of symptoms he had finished the last of three scuba dives with a maximum depth of 30 m and a total diving time of 3 hours. No alcoholic beverages were taken during or before diving. The patient was complaining of local pain in the thoracic and lumbar spine and showed a 3/5 weakness of the big toe and impaired sensitivity in the S1 dermatome. 90 minutes later the patient developed a hemiparesis of the right side including hypaesthesia and additional meningism (stiff neck). INVESTIGATIONS: The X-rays of the thoracic and lumbar spine in two standard planes, cerebrospinal fluid examination, a cranial spiral-computer tomographie (CCT) and laboratory investigations showed no pathologic values. DIAGNOSIS: Acute decompression sickness (DCS) type II. TREATMENT AND COURSE: The patient received an intravenous infusion, antiinflammatory prophylaxis with dexamethasone and an immediate submission to hyperbaric oxygenation therapy. Complete recovery of neurological symptoms appeared after 4 decompression sessions in a hyperbaric chamber. CONCLUSIONS: In patients presenting low back pain as common symptoms the differential diagnosis needs to be worked out and DCS should be included especially if progressive neurologic deficits are present. Only emergency hyperbaric oxygen therapy can compromise a sufficient therapy of these patients.