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Percutaneous neurolysis of the celiac plexus via the anterior approach with sonographic guidance.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of sonographically guided percutaneous neurolysis of the celiac plexus in patients with abdominal tumors or chronic pancreatitis in whom systemic analgesics were ineffective. SUBJECTS AND METHODS: Neurolysis of the celiac plexus was performed in 38 patients, 34 with neoplastic disease and four with chronic pancreatitis. Under sonographic guidance, a 22-gauge needle was advanced by the anterior route to the area above the celiac plexus, and 30-40 ml of 50% alcohol was injected. Pain relief was assessed 1 week, 6 months, and 1 year after the procedure. Patients subjectively rated the pain after treatment as totally relieved, partially relieved, or unchanged. RESULTS: At 1 week and at 6 months after treatment, pain was totally relieved in 61% of patients, partially relieved in 31%, and unchanged in 8%. After 1 year, pain was totally relieved in 39%, partially relieved in 52%, and unchanged in 9%. The complications observed were five cases of mild diarrhea and one case of retroperitoneal pain, which subsided with conservative treatment. CONCLUSION: The anterior, sonographically guided approach appears to be as successful as other percutaneous techniques for neurolysis of the celiac plexus.

Abdominal Neoplasms↗

Surgical treatment of carcinoids and endocrine pancreatic tumours.

The common association of neuroendocrine abdominal neoplasms, carcinoids and endocrine pancreatic tumours, with often severe endocrine symptoms has justified considerable efforts to improve treatment in these conditions. Surgery still constitutes the principle therapy for the majority of these tumours. However, the introduction of new means of medical treatment with cytostatic agents, or more recently interferon and a somatostatin analogue, seem to have impact on indications and the extent of surgery in malignant forms of these tumours. It is thus probable that a surgical tumour reduction will increase the possibilities to achieve positive effects of the medical treatment even in advanced malignancies. However, the existence of an alternative medical therapy has increased obligations that surgery should be performed without morbidity or mortality.

Adenoma, Islet Cell↗

Late radiation injury of the small intestine. Clinical, pathophysiologic and radiobiologic aspects. A review.

Transient symptoms due to injury of the intestinal mucosa occur in the majority of patients receiving radiation therapy for pelvic or intra-abdominal neoplasms. Late (chronic) radiation enteropathy, although less common, is a more serious condition, associated with high morbidity and mortality. The manifestations of late radiation enteropathy are primarily due to changes in compartments other than the mucosa, such as intestinal wall fibrosis and obliterating vascular sclerosis. As a result of recent clinical and experimental studies, considerable knowledge about the pathogenesis, dose-response relationship, and time-course of development of late radiation enteropathy has been obtained. Also, the advent of new animal models has facilitated studies of time-dose-fractionation relationships in the intestine. The present paper summarizes clinical, pathophysiologic, and radiobiologic aspects pertinent to the development of chronic intestinal radiation injury.

Humans↗

Direct effects of recombinant human endostatin on tumor cell IL-8 production are associated with increased endothelial cell apoptosis in an orthotopic model of human pancreatic cancer.

PURPOSE: Recombinant human endostatin (rhES) is an antiangiogenic agent derived from collagen XVIII which inhibits tumor growth in subcutaneous models of various human malignancies. However, its effectiveness in an orthotopic xenograft model of an abdominal neoplasm has not been demonstrated. DESIGN: An orthotopic model of pancreatic cancer was established in 6-week-old male athymic mice from either of 2 human cell lines (L3.6pl or BxPC3). Established tumors were treated with 40 mg/kg rhES or vehicle controls for up to 3 weeks. Tumors were analyzed by immunohistochemistry for TUNEL/CD31, IL-8, VEGF, and bFGF. We also measured direct effects of rhES on tumor cell angiogenic factor production by ELISA in vitro. RESULTS: Overall tumor burden was not reduced with rhES treatment in mice inoculated with either cell line. Peritoneal carcinomatosis in the L3.6pl mice was greater in those treated with rhES than in those treated with normal saline or citrate buffer (p < 0.05). Treatment with rhES lowered IL-8 levels 32-47% in vivo (p < 0.001) and 40-65% in vitro (p < 0.05) in the fast-growing L3.6pl tumors but not in the slow-growing BxPC3 tumors (p < 0.05). rhES also increased the levels of endothelial cell apoptosis 16- to 24-fold in vivo in the L3.6pl mice, but not in the BxPC3 mice (p < 0.05). CONCLUSIONS: rhES downregulated IL-8 levels and induced endothelial cell apoptosis in the more aggressive cell line in a xenograft model of pancreatic cancer. Nonetheless, these effects were not sufficient to produce significant inhibition of tumor growth.

Animals↗

Fine-needle aspiration cytology of intra-abdominal wall extraskeletal myxoid chondrosarcoma: a case report and review of the literature.

Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumor. Most of the reported cases that were diagnosed by fine-needle aspiration were taken from the extremities, where the tumor is often found. Problems can occur when the site is unusual and cellular differentiation is not distinct. We present a case in which the tumor was located in the intra-abdominal wall, an unusual location. Cytologic features and immunocytochemistry are helpful in distinguishing this tumor from others that share similar myxoid background.

12E7 Antigen↗

[Intraabdominal hemangiopericytoma. Diagnosed during surgery for suspected acute appendicitis].

A 39 year-old febrile man with lower abdominal pain and peritoneal reaction was operated on suspicion of acute appendicitis. During the past eighteen months he had been hospitalized twice due to similar symptoms, both times with spontaneous remission. The operative finding was a large multilobular vascular tumour which on pathological examination was a haemangiopericytoma, with no degree of malignancy. The tumour was removed in toto.

Abdomen, Acute↗

[Ileal endometriosis. A clinical case and a review of the literature].

Ileal localization of intestinal endometriosis is not extremely rare, but there are always problems related to the preoperative diagnosis. Symptoms of intestinal endometriosis offer often problems to the surgeon in the differential diagnosis with many more pregnant illnesses like appendicitis, diverticulitis, inflammatory bowel diseases and abdominal neoplasms. The authors report a case of endometriosis of the ileum clinically mimicking Crohn's disease. Crohn's disease of the ileum is the most frequently reported illness that is considered in the differential diagnosis. The review of the literature shows that a correct preoperative diagnosis of endometriosis of the ileum is very seldom done. All common diagnostic tools are not able to resolve diagnostic doubts. Also during explorative surgery the diagnosis of endometriosis is not easy. The authors conclude that endometriosis of the ileum has to be more often considered as possible cause of common intestinal symptoms mimicking inflammatory bowel disease and that this illness induces to reevaluate the importance for a correct diagnosis of an accurate clinical history.

Adult↗

[Intra-abdominal desmoplastic small round-cell tumors. An entity among peritoneal carcinomatoses in young adults].

Desmoplastic small round-cell tumors in young adults were first described in 1989. They may be revealed by an abdominal mass or a peritoneal carcinomatosis. The diagnosis and the initial treatment are based on debulking surgery. Chemotherapy using doxorubicin, ifosfamide, etoposide and cisplatin can then be proposed. Despite some initial chemosensitivity, prognosis remains poor.

Abdominal Neoplasms↗

Obstructive jaundice in adult Ethiopians in a referral hospital.

Forty-nine adult Ethiopians with obstructive jaundice were studied. Right upper quadrant pain was the main presenting complaint (89%). Most (94%) of the jaundiced patients had right upper quadrant tenderness. In 87% the obstruction was corroborated by ultrasonographic examination, but causal factors were identified in only 39%. Operative findings showed that choledocholithiasis (41%) and malignant conditions (22%) were the two important causes of obstructive jaundice among the adult patients seen at a referral hospital in Addis Ababa. The causes and the outcome of the different types of surgical procedures used in the management are discussed.

Abdominal Neoplasms↗

[Ultrasound guidance technique in celiac plexus block].

The aim of our study was to describe the technique and the efficacy of ultrasound-guidance for celiac plexus block in cancer patients in our institution Antoine Lacassagne Center. Celiac plexus block was performed in 13 cancer patients under ultrasound-guidance (n=13). All patients had excruciating epigastric and generalized abdominal pain caused by cancer. Feasibility and complication rates were analyzed. Notable pain relief was obtained in 9/13 (69%) of the patients and the technical success rate was 93% (12/13). There were 2 minor complications: orthostatic arterial hypotension (n=1) and transient left shoulder pain (n=1). Color Doppler sonography improved visualization of the 21 Gauge Chiba needle when the needle shaft was vibrated. Echogenic foci were observed around the origin of the celiac trunk and superior mesenteric artery in all cases. Ultrasound guidance is safe and effective and should be attempted for celiac plexus block whenever possible.

Abdominal Neoplasms↗

A bizarre giant leiomyoma.

We report the clinical and imaging features of a huge deep leiomyoma of the rectus abdominis treated surgically in an 84-year-old man. Hypotheses are put forward to elucidate the etiology of this enigmatic localization, apparently the first described in the literature.

Abdominal Neoplasms↗

Gastric endo-organ access: technique and complications.

Since laparoscopic cholecystectomy was introduced in 1987 by Phillipe Mouret, a variety of gastrointestinal operations such as laparoscopic Nissen fundoplication, herniorrhaphy, splenectomy, vagotomy, adrenalectomy, appendectomy, nephrectomy, staging of intra-abdominal neoplasms, and laparoscopic colectomy have gained popularity. The minimal invasive nature of these procedures and the reported benefits of a short hospital stay, reduced postoperative pain, and better cosmesis have encouraged investigation of new methods of access for gastric and colonic pathology untreatable by endoscopic or standard laparoscopic techniques.

Journal Article↗

[Experience for reconstruction of defects of abdominal wall with Gore-tex].

OBJECTIVE: To evaluate the outcome of prevention of abdominal hernia in reconstruction of defect of abdominal wall with Gore-tex clinically. METHODS: Six cases of the large defects of abdominal wall were repaired with Gore-tex after surgical removal of abdominal wall tumor. RESULTS: The reconstructed cases were followed up six months to three years and there was no postoperative complication. CONCLUSION: Gore-tex is a reliable and effective biomaterial for reconstruction of the large defect of abdominal wall.

Abdominal Neoplasms↗

[Diagnostic value of abdominal pain in intra-abdominal desmoid tumor].

Desmoid tumors are rare, less than 0.1% of all tumors (6.2%). The word desmoid has been recognized since 1838, and applied to non-encapsulated tumors, of connective origin and locally infiltrative. Generally, their course is painless and the recurrence rate is high if resection has not been complete. Most of these tumors can be found in different anatomic areas, most commonly the anterior abdominal wall although other sites, intra- or extra-abdominal, have been reported. We describe the case of a 50 year old female patient, with abdominal pain caused by an intraabdominal desmoid tumor.

Abdominal Neoplasms↗

[Celiac ganglion blockade: the effectiveness of CT guided percutaneous anterior approach].

PURPOSE: To investigate the effectiveness and safety of celiac ganglion blockade in cases with abdominal malignancies who are narcotic analgesic dependent for control of severe abdominal pain. MATERIALS AND METHODS: A total of 30 celiac ganglion blockades were performed in 27 patients between the ages of 19 and 75. A 22 G Chiba needle was placed through the percutaneous anterior approach into the celiac ganglion region under the guidance of CT, and 98% alcohol was administered. The procedure was repeated in three cases due to insufficient response. RESULTS: In 24 (88.8%) of the 27 cases, the severity of pain decreased. Total relief of the pain was achieved in 13 (48.1%) cases. In 9 (33.3%) cases pain was controlled with non-narcotic analgesics. In 2 (7.4%) cases, the dose of the narcotic analgesic decreased. There was no change in the severity of the pain in 3 (11.1%) cases. Transient complications were diarrhea in 4 (14.8%), hypotension in 6 (22.2%) cases and hemiparesis in one (3.7%) case. CONCLUSION: Celiac ganglion blockade through the percutaneous anterior approach under the guidance of CT should be preferred for the control of pain in the early periods in cases with abdominal malignancies, especially gastric and pancreatic, due to easy performance, safety, lower incidence of complications, high success rate and low cost.

Abdominal Neoplasms↗