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PubMed1998

Association of extrarenal Wilms' tumor with a horseshoe kidney.

Nephroblastoma (Wilms' tumor) is the most common renal malignancy in childhood. Extrarenal Wilms' tumor is uncommon, and the diagnosis is almost always postsurgical. The authors report two cases, located in the sigmoid mesocolon, one of these having an associated horseshoe kidney. Both were treated with excision followed by chemotherapy. They are now 36 months and 7 months postchemotherapy, respectively, and are symptom and recurrence free. Both had favorable histological findings. Association with a horseshoe kidney raises an important issue regarding the histogenesis of these tumors. The authors believe that there is a nexus between the fusion of metanephric blastema during the sixth to seventh week of intrauterine life and the "ectopic" metanephric blastema cells that may give rise to extrarenal Wilms' tumor. Association with a horseshoe kidney with an extrarenal Wilms' tumor has been reported on five previous occasions. The authors closely examine the link between the two.

Child, Preschool↗
PubMed1994

Laparoscopic approach to the left kidney avoiding colonic mobilization.

A technique for laparoscopic removal of the left kidney is described. Using a transperitoneal approach, a window is created in the mesocolon lateral to the inferior mesenteric vein. Through this window the renal vessels can be secured and the kidney removed without mobilization of the left colon. Preoperative stenting facilitates removal of a hydronephrotic kidney with this technique.

Adolescent↗
PubMed1978

Gray scale ultrasonography in the diagnosis of pseudocysts of the pancreas simulating renal pathology.

Ultrasonography has proved to be a reliable tool in the diagnosis of pseudocysts. A case is reported of a patient with a pseudocyst in the transverse mesocolon adjacent to the left kidney and spleen. Initial examination by computerized tomography and angiography failed to visualize the mass, while a renal cyst was simulated on nephrotomography. Repeat ultrasound examinations showed progressive increases in the size of the pseudocyst. This diagnosis was confirmed at operation. We believe that ultrasound is the modality of choice in patients with clinical suspicion of a pseudocyst.

Adult↗
PubMed1997

The effects of parturition and peripartum complications on the peritoneal fluid composition of mares.

Abnormalities in peritoneal fluid are diagnostically useful for managing equine colic; however, their significance in post-dystocia mares is not known. This study was to determine what changes, if any, occurred following obstetrical manipulations. Peritoneal fluid samples were collected from 2 groups of foaling mares to establish control values, and from a third group that had developed clinical abnormalities (CAb,n = 14) or had made an uneventful recovery (CN,n = 36) following fetal extraction. In Group 1 mares, samples were collected before and after induced parturitions (n = 7), and although the total nucleated cell count was increased (P < 0.02) the median values for peritoneal fluid composition remained within the normal reference range. In Group 2 mares, samples were collected after unassisted foalings (n = 10) on postpartum Days 1, 3, 5 and 7, and the peritoneal fluid values remained within the normal reference range. In the Group 3 (CN) mares neither assisted vaginal delivery or fetotomy caused median peritoneal fluid values to rise above the normal reference range. Although remaining within normal limits, the total nucleated cell count was increased (P < 0.01) on Day 2. The median peritoneal fluid total protein value for Group 3 (CAb) mares was greater than the median value for Group 3 (CN) mares on Day 1 (P < 0.05) and Day 2 (P < 0.001). The peritoneal fluid total nucleated cell count in Group 3 (CAb) mares with a uterine tear, vaginal laceration involving the peritoneal cavity, or a ruptured mesocolon was greater than in Group 3 (CN) mares (P < 0.02). The median peritoneal fluid percentage of neutrophils value for Group 3 (CAb) mares was higher than for Group 3 (CN) mares on both Days 1 and 2 (P < 0.02). Elevation of a single peritoneal fluid value in the postpartum mare may be incidental; however, increases in 2 or more of these (total protein > 3.0 g/dl; total nucleated cell count > 15,000 cells/microl; percentage of neutrophils > 80%) is clinically significant.

Journal Article↗
PubMed1997

Cystic retroperitoneal lymphangiomas in adults.

Lymphangioma (LA) is a rare benign tumour of the lymphatic tissue, most common in the neck and head, and clinically manifests itself mostly in childhood. Within this group, intra-abdominal and retroperitonal LA are the rarest tumours, especially when occurring in adults. We report four LAs localized in the retroperitoneum of patients aged between 28 and 72 years. One of these tumours infiltrated the transverse mesocolon and greater omentum, others were situated in the left retroperitoneum and retroperitoneally at the duodeno-jejunal flexure, and in the retrosplenal and retropancreatic area. Diagnosis was made by light microscopy supported by immunohistochemistry. In three cases the tumour could be removed by radical surgery and none of these patients had a recurrence (median follow-up time: 4 years). The tumour could not be removed completely from one patient with pre-operative chylascos. Six months after diagnosis of LA this patient died of cardiopulmonary failure due to progressive tumour chylascos. Isolation and ligation of the cystic LA's peduncle as well as ligation of lymph channels can prevent recurrences and chylascos.

Adult↗
PubMed2001

Direct vascular actions of methyclothiazide in remodeled mesenteric arteries from hypertensive patients.

In vitro experiments were designed to assess the inhibitory effect of the thiazide diuretic methyclothiazide (MCTZ) on contractile responses to norepinephrine (NE) of mesenteric rings from hypertensive patients and normotensive controls. Arteries were taken from portions of mesocolon from 24 patients: 13 hypertensives and 11 normotensives. Changes in the tension of mesenteric ring preparations were measured isometrically. Histologic studies showed that the arteries from hypertensive patients exhibited 1) a greater media thickness-to-lumen diameter ratio, 2) a smaller lumen diameter, and 3) identical media cross-sectional area as those of normotensive controls. At the physiologic level, the hypertensive and normotensive arteries display similar contractile responses to KCl and NE. Furthermore, our results indicate that MCTZ induces concentration-dependent inhibition of the vasoconstrictor responses to NE. This study provides evidence that hypertension is associated with the remodeling of the human mesenteric artery and that MCTZ is as efficient in inhibiting the contractile response induced by NE on hypertensive than on normotensive arteries.

Adult↗
PubMed2006

Unusual presentation of abdominal Castleman's disease.

Castleman's disease is a rare lymphoproliferative disorder of uncertain origin. We report an unusual presentation of Castleman's disease in the transverse mesocolon that mimicked a vascular gastrointestinal stromal tumour and review the literature surrounding this peculiar entity.

Abdominal Neoplasms↗
PubMedDate not supplied

Delayed gastric emptying after pylorus-preserving pancreatoduodenectomy is strongly related to other postoperative complications.

Patients undergoing pylorus-preserving pancreatoduodenenectomy (PPPD) have a risk of up to 50% for developing delayed gastric emptying (DGE) in the early postoperative course. From 1994 to August 2002, a total of 204 patients underwent PPPD for pancreatic or periampullary cancer (50%), chronic pancreatitis (42%), and other indications (8%). Retrocolic end-to-side duodenojejunostomy was performed below the mesocolon. DGE was defined by the inability to tolerate a regular diet after day 10 (DGE10) or day 14 (DGE14) postoperatively, as well as the need for a nasogastric tube at or beyond day 10 (DGE10GT). Postoperative morbidity was 38%, 30-day mortality was 2.9%, and median postoperative length of stay was 15 days. DGE occurred in 14.7% (DGE10), 5.9% (DGE14), and 6.4% (DGE10GT), respectively. After further exclusion of 21 patients (10.3%) with major complications and no possible oral intake (because of death, reoperation, or mechanical ventilation), the frequencies of DGE10, DGE14, and DGE10GT in the remaining group of 183 patients were 9%, 2%, and 2%, respectively. Multivariate analysis revealed postoperative complications (P<0.001), the presence of portalvenous hypertension (P<0.01), and tumors as indications for surgery (P<0.01) as independent risk factors for DGE10. The overall incidence of DGE was low after PPPD. In those patients experiencing DGE, however, other postoperative complications were the most important factor associated with its occurrence.

Adult↗
PubMed2000

Detection of ICAM-1 in experimentally induced colitis of ICAM-1-deficient and wild-type mice: an immunohistochemical study.

Adhesion molecules (e.g. ICAM-1, CD 54) are known to be upregulated on activated vascular endothelial cells during inflammatory reactions. To study the role of ICAM-1 in intestinal inflammation in vivo, we induced acute experimental colitis in wild-type (C57BL/6) mice and ICAM-1-deficient mice, by feeding the animals with 3% dextran sodium sulphate (DSS) in drinking water for 7 days. In the control strain the immunohistochemical staining showed a very pronounced endothelial upregulation of ICAM-1 after the DSS treatment observed in areas of inflammatory infiltrate, especially in venules or arterioles of the propria and submucosa, and partly in the mesocolon. DSS-fed ICAM-1-deficient mice showed no endothelial enhancement and only faint staining of venules or capillaries approaching that encountered in the control ICAM-1-deficient animals. Our data indicate that ICAM-1 may play a crucial role in the development of acute intestinal inflammation, consistent with our finding that ICAM-1 deficiency can obviate severe forms of experimentally induced colitis in mice.

Animals↗
PubMed1997

Change in colonic motility after extrinsic autonomic denervation in dogs.

Changes in colonic motility were compared in dogs undergoing autonomic denervation of the paraaortic and presacral (group A), paraaortic (group B), or mesocolonic region (group C), and sham operation (group D). Five bipolar recording electrodes were placed into the seromuscular layer of the colon and rectum. The numbers of continuous electrical response activity and contractile electrical complex after an intragastric olive oil injection were smaller in group A than in the other groups (P < 0.05) from three weeks through six months after denervation. This difference was significant even in the proximal colon. These data suggest that the pelvic plexus may play an important role in colonic motility including the proximal colon. The damage to the plexus did not recover for at least six months after denevation. Pelvic plexus injury may thus be one of possible explanations for the prolonged change in bowel habit after anterior resection of the rectum.

Animals↗
PubMed2000

Laparoscopic live donor nephrectomy: pre-operative assessment of technical difficulty.

Laparoscopic live donor nephrectomy decreases disincentives to live kidney donation. Thus, many centers are interested in adopting this procedure. However, the high stakes involved for both the donor and the recipient, and the technical difficulties of the operation, have tempered the enthusiasm of some surgeons. Ideally, if early in their series, surgeons could select patients that would be the least challenging technically, it would facilitate the dissemination of this operation. The purpose of this study is to determine if anatomic or radiologic parameters can accurately assess pre-operatively the degree of technical difficulty of laparoscopic live donor nephrectomy for any individual patient. Abdominal spiral three-dimensional CT scanning was performed prior to laparoscopic donor nephrectomy. CT scans were reviewed for six radiographic anatomic parameters. Seven clinical anatomic measurements relating to body habitus were recorded upon induction anesthesia at the time of surgery. Demographic data for gender, age, race, weight, height, and smoking history were collected. Following laparoscopic live donor nephrectomy, the following six component parts of the operation were graded on a scale of 1-4 (1 = easy, 4 = very difficult) for technical difficulty: a) mobilization of the colon; b) mobilization of the upper pole; c) dissection of the renal vein; d) dissection of the renal artery; e) division of the adrenal vein; and f) dissection of the ureter. Also, operative time, estimated blood loss, and intra-operative fluid requirements were recorded as surrogate markers of operative difficulty. Forty-one patients were included in the study. Laparoscopic donor nephrectomy was successfully completed in all cases. The sum of the difficulty scores was 9.9+/-3.1 (mean) (range, 6-18). No anatomic, demographic, or radiologic parameters were predictive of the total operative difficulty score. Of the surrogate markers, only operative time correlated with total difficulty score (R = 0.47, p = 0.003). Donor weight and abdominal girth correlated with operative time (R = 0.50, p = 0.002; R = 0.38, p = 0.019) but not with total difficulty score (R = 0.10, p = 0.51; R = -0.02, p = 0.90, respectively). When the easiest cases and the hardest cases (< or = 25th percentile and > or =75th percentile total difficulty score, respectively) were segregated out, again no anatomic, demographic, or radiologic parameters were predictive of operative technical difficulty. In conclusion, laparoscopic live donor nephrectomy technical difficulty could not be predicted by body habitus from the variables examined in this study. Hence, it was equally likely that performing laparoscopic live donor nephrectomy using a heavy donor would be technically easy, as using a thin donor would be difficult. Although, in general, operative time increased with donor size and weight, it appears that laparoscopic live donor nephrectomy operative technical difficulty is dependent upon such factors as amount of laparoscopic working space, quality of tissue planes, and retractability of the colon and mesocolon; factors that, to date, are not quantifiable.

Adult↗
PubMed2001

Giant cell arteritis localized to the colon associated with Crohn's disease.

AIMS: Intestinal vasculitis is uncommon and usually accompanies systemic vasculitis. Although intestinal vascular changes including vasculitis have been studied intensively, and are found regularly in Crohn's disease, giant cell arteritis is distinctly unusual. We describe a case of giant cell arteritis localized to the colon of an 18-year-old girl suffering from Crohn's disease. METHODS AND RESULTS: After three years of medical treatment, the patient underwent a proctocolectomy. The medium-sized arteries of the mesocolon demonstrated striking changes characterized by intimal fibrous thickening and an inflammatory infiltrate with giant cells, most predominant at the intima-media junction. Epithelioid cells and sarcoid-like granulomas were not observed. The internal elastic lamina was fragmented. Neither clinical symptoms nor laboratory findings showed evidence of systemic vasculitis. Neither the chest CT scan nor the echo-Doppler of the temporal arteries, supra-aortic and abdominal vessels revealed any abnormality. CONCLUSIONS: This case illustrates an extremely rare feature in the spectrum of vascular lesions in Crohn's disease which have to be differentiated from temporal and Takayasu's arteritis.

Adolescent↗
PubMed2004

Internal hernia of the small bowel after right-lobe live donor liver transplantation.

Internal hernia of small bowel is an uncommon but potentially fatal complication of liver transplantation. We report on four patients in whom internal hernia of small bowel occurred after right-lobe live donor liver transplantation (LDLT). Three patients had small bowel herniation with volvulus around the Roux-en-Y loop whereas the other patient had herniation through the mesenteric window of transverse mesocolon after hepaticojejunostomy for biliary reconstruction. Based on clinical and radiologic findings, early diagnosis was made in all cases. All patients survived following surgical reduction of the hernia and closure of the mesenteric defect without bowel resection. Transplant surgeons should be aware of this serious complication so that early diagnosis and appropriate operative intervention can be made. The complication can be avoided with duct-to-duct biliary reconstruction or meticulous closure of all mesenteric defects with non-absorbable suture materials after hepaticojejunostomy in patients undergoing right-lobe LDLT.

Adult↗
PubMed2000

Large bowel volvulus in childhood.

BACKGROUND: Large bowel volvulus is extremely uncommon in children. The probable pathogenesis, predisposing factors and management of large bowel volvulus in children are debatable. METHODS: Seven consecutive cases of large bowel volvulus occurring over a 6-year period are reported. RESULTS: Two patients with caecal volvulus, one with transverse and subsequent sigmoid volvulus, one with transverse colon volvulus and three children with sigmoid volvulus are reported. Four girls and one boy with cerebral palsy, one female with Moya Moya disease and spastic paraplegia and an otherwise healthy boy presented at a mean age of 8.3 years (range: 3-15 years). The common presentation was abdominal distension (n = 6), tenderness (n = 6), constipation (n = 7) and bloody mucoid discharge per rectum (n = 6). Plain abdominal X-ray and barium enema were diagnostic. Resection with primary ileocolic, colocolic or colorectal anastomosis was performed in all cases. The mean follow-up was 3.4 years (range: 1-6 years) and there was no mortality. CONCLUSIONS: Large bowel volvulus in children may be due to congenital anomalous or absent ligamentous fixation of the large bowel, and abnormal mesocolon or a common ileocolo-mesentery. Large bowel obstruction due to volvulus must be considered in the differential diagnosis in a child presenting with constipation associated with bloody mucoid discharge per rectum. Resection of the involved segment and primary anastomosis is the definitive treatment for large bowel volvulus in children.

Adolescent↗
PubMed2003

Retroperitoneal kaposiform hemangioendothelioma with tufted angioma-like features in an infant with Kasabach-Merritt syndrome.

Kasabach-Merritt syndrome denotes profound thrombocytopenia and coagulopathy in an infant with a vascular tumor. A retroperitoneal vascular tumor with an unusual combination of histopathological features is reported, and compared with vascular lesions described in the reported cases of Kasabach-Merritt syndrome in the literature. A large retroperitoneal tumor that had expanded through the sigmoid mesocolon into the sigmoid colon wall was resected from an 8-month-old infant with fully developed Kasabach-Merritt syndrome. Histological examination revealed a combination of venous (cavernous) malformation, kaposiform hemangioendothelioma and tufted angioma-like areas. Cellular tumor components (especially tufted angioma-like parts) infiltrated the wall of the sigmoid colon to the submucosal level. Immunohistochemical staining with antibodies to the Ki-67 antigen and proliferating cell nuclear antigen showed a low proliferative activity, whereas the antiapoptotic bcl-2 protein was expressed diffusely in tumor cells. This is the first reported case of a vascular tumor with tufted angioma-like elements found in the retroperitoneum, and the first reported in combination with kaposiform hemangioendothelioma and venous malformation in the same lesion. Considering the immunohistochemical results and overlapping histological features, it may be considered that tufted angioma and kaposiform hemangioendothelioma represent different growth patterns or stages in the development of a single type of hemangioma.

Biomarkers, Tumor↗
PubMed2000

Method of specimen fixation and pathological dissection of colorectal cancer influences retrieval of lymph nodes and tumour nodal stage.

INTRODUCTION: There is now evidence that meticulous specimen dissection may 'upstage' around one-quarter of colorectal cancers from node negative to node positive, although there is much debate as to how to achieve this: some authors prefer fat clearance techniques while others have opted for more conventional lymph-node retrieval with manual specimen 'breadknifing' and lymph-node palpation. While fat clearance is probably the optimum technique, it is time-consuming, costly and does not provide rapid diagnostic results. METHODS: A prospective pathological study of 50 colorectal cancer resections was conducted with 100 comparison cases, the study group receiving at least an additional 24-h fixation of the mesocolonic or mesorectal fat in 10% aqueous formaldehyde prior to specimen dissection. RESULTS: The percentage of node-negative colorectal cancer was significantly lower in the study group compared with the matched comparison group: (18) 36% compared with (55) 55% of comparison cases. CONCLUSIONS: Effective lymph-node retrieval techniques require mesocolic/mesorectal fat to be adequately fixed prior to pathological dissection. This study suggests that satisfactory lymph-node retrieval is possible without fat clearance, provided the mesenteric fat is suitably fixed prior to colorectal cancer specimen dissection.

Biopsy↗
PubMed2004

Laparoscopic-assisted approaches for the definitive surgery for Hirschsprung's disease.

The surgical management of Hirschsprung's disease has progressed from a two- or three-stage procedure to a primary operation over the last 25 years. More recently, definitive surgery for Hirschsprung's disease has been performed using minimally invasive techniques. The Swenson, Duhamel and Soave endorectal pull-through procedures have all been reported using minimally invasive approaches. The endorectal dissection has become the dominant minimal access procedure because of the ease and reliability in performing this technique and the excellent results obtained. Although a transanal endorectal pull-through can be performed without laparoscopy, the laparoscopic-assisted transanal endorectal pull-through is a much more versatile technique and allows early biopsies to determine the extent of aganglionic and dysfunctional bowel before ablation of the rectum and mesocolon. The authors use a laparoscopic-assisted transanal pull-through for aganglionosis of the left and transverse colon. Total colon aganglionosis or aganglionosis of the ascending colon is managed by a laparoscopic-assisted Duhamel procedure which provides a better reservoir in patients with a short or absent colon.

Child, Preschool↗
PubMed2002

Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis.

BACKGROUND: In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Traditionally, it was believed that early intrajejunal nutrition (EIN) in severe acute pancreatitis (SAP) may exacerbate the clinical pathological features, lead to recurrence of symptoms and delay complications. OBJECTIVE: To compare the effect of EIN vs TPN on the pancreatic pathological features and gut barrier function in dogs with acute pancreatitis (AP). METHODS: Fifteen dogs (surviving over 7 days, the death rate being 32%, 7/22) were divided into parenteral nutrition (PN) group (n=7) and EIN group (n=8). SAP model was induced by injecting 1 ml/kg of combined solution of 2.5% sodium taurocholate and 8000-10000 BAEE units trypsin/ml into the pancreas via the pancreatic duct. Nutrients were delivered to the EIN group by catheter via a jejunostomy feeding 24 h postoperatively. The two groups were isocaloric and isonitrogenous. Systemic blood samples were obtained before and 1, 4, 7 d following AP, and cultured by aerobic as well as anaerobic bacterial growth. Systemic plasma and portal vein endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. Portal vein blood and specimens of tissue from mesenteriolum and mesocolon lymph nodes, lung, pulmonary portal lymph nodes and pancreas were adopted before the experiment was finished. Aliquots of the homogenata were cultured as blood mentioned above. Serum glucose, calcium, amylase and lysosomal enzymes were determined. All dogs were injected with 50 microCi (125)I-BSA 4 h at the 7th day before being sacrificed. The (125)I-BSA indexes of the pancreas/muscle and pancreas/blood were measured, and pancreatitic pathological scores (PPSs) of the different partial pancreas were observed. The content of mucosa protein, DNA and the villi, the thickness of mucosa and the whole bowel wall of the ileum and transverse colon were measured. RESULTS: The study showed that serum glucose in the PN group was higher than in the EIN group after SAP 3 d; the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ reduced significantly in the EIN group P<0.01. There were no differences between the two groups in the data of serum calcium, amylase and lysosomal enzymes, P>0.05; the (125)I-BSA index of pancreas/muscle and pancreas/blood, and PPS of the head, body, tail and total pancreas did not reach significant difference between the two groups, P>0.05. The contents of protein and DNA, the height of villi, the thickness of mucosa and the whole bowel wall of the ileum and transverse colon in the EIN group were higher than that in the PN group,P <0.01. CONCLUSION: Our results suggested that EIN was safe and effective to be adopted by intrajejunal delivery of nutrients in SAP dogs, did not make SAP clinical pathological features deteriorate, and decreased the occurrence rate of endotoxin and gut bacterial translocation.

Acute Disease↗