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PubMed2003

Meigs syndrome revisited.

The association of a benign ovarian tumor with ascites and hydrothorax that resolve after tumor resection is known as Meigs syndrome, and its importance was first emphasized by Meigs and Cass in 1937. The importance of Meigs syndrome is that the presence of ascites and pleural effusion does not necessarily indicate that a pelvic mass is malignant. The benign tumors in Meigs syndrome are usually fibromas or fibrothecomas and constitute 4% of all ovarian neoplasms. The authors present a case of Meigs syndrome with an ovarian fibroma. They focus on the evaluation of pleural fluid in the setting of an ovarian mass and then briefly discuss the imaging of ovarian fibromas and fibrothecomas.

Diagnosis, Differential↗
PubMed2005

The role of preoperative pulmonary function tests in the surgical treatment of scoliosis.

STUDY DESIGN: A retrospective study on the correlation between preoperative pulmonary function tests, preoperative pulmonary symptoms, and postoperative pulmonary complications. OBJECTIVE: To evaluate the incidence of immediate postoperative pulmonary complications and their correlation to pulmonary function tests, preoperative pulmonary symptoms, and surgical approaches. SUMMARY OF BACKGROUND DATA: The pulmonary function of patients with scoliosis is likely to be abnormal, whereas surgical procedures may lead to further deterioration and postoperative pulmonary complications. Evaluation of the pulmonary symptoms and pulmonary function before surgery is helpful to predict and avoid postoperative pulmonary complications by selecting the appropriate surgical approach. METHODS: This study reviewed 298 scoliosis patients (107 male, 191 female) who underwent anterior and/or posterior operation. The mean age of the patients was 16.4 years (range 6-62 years). The average coronal Cobb angle was 73.26 degrees (range 45-141 degrees). Preoperative pulmonary function tests of 115 cases were normal, whereas the other 183 cases were abnormal. Seventeen cases had preoperative pulmonary symptoms and 3 of them had normal preoperative pulmonary function tests. Seventy-nine cases received transthoracic surgery, and 19 cases had postoperative pulmonary complications, including postoperative ventilation support in 6 cases, atelectasis in 4 cases, hydrothorax in 2 cases, pneumothorax in 3 cases, pneumonia in 3 cases, and hypoxemia in 1 case. Of these 19 patients, 12 patients received anterior transthoracic procedure. When the patients with abnormal pulmonary function tests were divided into 3 groups: 1) 60% < or = forced vital capacity ratio < 80%; 2) 40% < or = forced vital capacity ratio < 60%; and 3) forced vital capacity ratio < 40%, the incidence of postoperative pulmonary complications were 2.72% (3 out of 110), 7.40% (4 out of 54) and 31.60% (6 out of 19), respectively. RESULTS: There was significant correlation between abnormal preoperative pulmonary function tests and preoperative pulmonary symptoms (P = 0.0086). No significant correlation was found between preoperative pulmonary symptoms and postoperative pulmonary complications (P = 0.5164). There was a trend that the postoperative complications increased with the deterioration of pulmonary function. The correlation between postoperative pulmonary complications and the surgical approach was statistically significant (P = 0.0000); the incidence of postoperative pulmonary complication of transthoracic procedure was 18 times as that of posterior approach. No significant difference was noted regarding ages, preoperative coronal Cobb angles, and preoperative pulmonary function between these 2 groups. There was no significant correlation between preoperative pulmonary symptoms and postoperative complications. CONCLUSIONS: The incidence of postoperative pulmonary complications increased with the deterioration of pulmonary function tests. The posterior procedure had a very low incidence of postoperative pulmonary complications, but a transthoracic procedure increased the complications significantly. Preoperative pulmonary symptoms usually predicted abnormal results of pulmonary function tests but had no correlation with postoperative pulmonary complication.

Adolescent↗
PubMed2006

Clinical results of surgery for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: operative indication of posterior decompression with instrumented fusion.

STUDY DESIGN: This retrospective study was conducted to investigate the clinical outcomes of several surgical procedures for thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). OBJECTIVE: To evaluate the effect of myelopathy treatment and safety of posterior decompression with instrumented fusion. SUMMARY OF BACKGROUND DATA: Many different surgical procedures have been used for the treatment of thoracic OPLL. However, the possibility of postoperative paraplegia remains a major risk, and consistent protocols and procedures for surgical treatment of thoracic OPLL have also not been established. METHODS: A total of 51 patients who underwent surgery for thoracic OPLL were classified into 3 groups: (1) posterior decompression group (18 patients), which included 12 who underwent laminectomy and 6 who underwent cervicothoracic laminoplasty; (2) OPLL extirpation group (16 patients), which included 4 who underwent anterior decompression through thoracotomy and 12 who underwent anterior decompression through the posterior approach; and (3) posterior decompression and fusion group (17 patients), all of whom underwent laminectomy with posterior instrumented fusion. In each group, the Japanese Orthopedic Association score was used to evaluate thoracic myelopathy, and the recovery rate calculated 1 year after surgery and at final examination. RESULTS: Mean recovery rate at final follow-up was 41.9% in the posterior decompression group, 62.1% in the OPLL extirpation group, and 59.3% in the posterior decompression and fusion group. Postoperative paralysis occurred in 3 patients in the posterior decompression group and in 3 in the OPLL extirpation group. In the OPLL extirpation group, leakage of cerebrospinal fluid occurred in 8 patients and hydrothorax in 2. Late neurologic deterioration occurred in 7 patients in the posterior decompression group. There were no cases of postoperative paralysis or late neurologic deterioration in the posterior decompression and fusion group. CONCLUSIONS: A considerable degree of neurologic recovery was obtained by posterior decompression with instrumented fusion, despite the anterior impingement of the spinal cord by OPLL remaining. In addition, the rate of postoperative complications was extremely low with this procedure. We recommend that 1-stage posterior decompression and instrumented fusion be selected for patients in whom the spinal cord is severely damaged before surgery and/or when extirpation of OPLL is associated with increased risk.

Adult↗
PubMed2006

Advances in critical care management of hepatic failure and insufficiency.

BACKGROUND: Chronic liver disease is becoming an increasingly frequent diagnosis for patients in the intensive care setting with such diagnoses as symptomatic ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, or fulminant hepatic failure. OBJECTIVE: To review frequent diagnoses for patients with chronic liver disease admitted to the intensive care unit and discuss current concepts in management and investigational modalities. RESULTS: Patients with new-onset ascites in the intensive care setting should undergo immediate ultrasound to rule out acute thrombosis. A transjugular intrahepatic portosystemic shunt is indicated when control of the refractory ascites or hepatic hydrothorax is required. In patients with hepatorenal syndrome, hemodialysis can be used as a bridge to liver transplantation. Otherwise, hepatorenal syndrome carries a high mortality. When hepatic encephalopathy is present, a precipitating cause should be sought and treated, if identified. Although bioartificial support systems are under active investigation, standard treatment for hepatic encephalopathy is lactulose and alteration of gut flora. Patients with fulminant hepatic failure should be stabilized and transferred to the intensive care unit of a liver transplant center and supported with appropriate airway management, close neurologic evaluation, glucose monitoring, and correction of coagulopathy when there is overt bleeding or an invasive procedure is planned. Intracranial pressure monitoring is recommended to maintain an adequate cerebral perfusion pressure of >60 mm Hg. CONCLUSION: Review of the literature demonstrates that certain critically ill patients with chronic liver disease may benefit from invasive modalities such as transjugular intrahepatic portosystemic shunting, hemodialysis, and in some cases, liver transplantation, which may be offered only at tertiary care centers.

Ascites↗
PubMed2006

Miscellaneous indications for transjugular intrahepatic portosystemic stent-shunt.

This review will discuss the use of transjugular intrahepatic portosystemic stent-shunt in a number of relatively uncommon clinical situations. In particular, we will focus our paper on the use of transjugular intrahepatic portosystemic stent-shunt for hepatic hydrothorax, hepatopulmonary syndrome, veno-occlusive disease, portal hypertensive gastropathy and gastric antral vascular ectasia, before surgery and after liver transplantation.

Ascites↗
PubMed2005

Portal hypertension.

PURPOSE OF REVIEW: Report on significant advances in the pathophysiology, diagnosis, and management of the complications of portal hypertension that have occurred in the last year. RECENT FINDINGS: The specific areas reviewed refer to experimental studies aimed at modifying the factors that lead to portal hypertension (increased intrahepatic vascular resistance and splanchnic vasodilatation) and recent advances in the diagnosis and management of the complications of portal hypertension. The specific complications reviewed in this paper are varices and variceal bleeding (primary prophylaxis, treatment of the acute episode, and secondary prophylaxis), ascites and some of its complications (hyponatremia, hepatic hydrothorax), hepatorenal syndrome, spontaneous bacterial peritonitis, and hepatic encephalopathy. SUMMARY: Important studies, mostly prospective, regarding the management of the complications of portal hypertension are reviewed, including trials that demonstrate the value of the hepatic venous pressure gradient in predicting these complications, a trial of beta-blockers in patients with small varices, a randomized trial of transjugular intrahepatic portosystemic shunt using covered stents and another pilot study using this shunt in the treatment of hepatorenal syndrome, a trial of antibiotic prophylaxis in preventing early variceal rebleeding, and a trial of synbiotic therapy in hepatic encephalopathy. These trials will contribute to advancing the practice of hepatology and defining future research areas.

Humans↗
PubMed1993

Dilated heart failure in transgenic mice expressing the Epstein-Barr virus nuclear antigen-leader protein.

The Epstein-Barr virus nuclear antigen-leader protein (EBNA-LP) is required for high efficiency B lymphocyte growth transformation by the virus. To test the potential contribution of EBNA-LP to tumorigenesis in vivo, we produced transgenic mice carrying an EBNA-LP cDNA construct, using the widely expressed metallothionein promoter. Expression of EBNA-LP was detected in liver, kidney, heart, lung and spleen. There were no apparent oncogenic consequences of EBNA-LP expression. Unexpectedly however, at ages ranging from about 4 months to over a year, transgenic mice developed symptoms of congestive heart failure, including left ventricular dilatation, right ventricular hypertrophy, left atrial thrombosis, pulmonary oedema and hydrothorax. Fibrillation was not apparent in the electrocardiograph; however a reduction in T-wave amplitude suggested that the development of an abnormality of ventricular repolarization may precede the manifestation of overt symptoms. The highly predictable development of dilated heart failure in these transgenic mice suggests they may be a useful model for the pathophysiological changes associated with human dilated cardiomyopathy.

Animals↗
PubMed1994

Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension.

The transjugular intrahepatic portosystemic shunt (TIPS) is a non-surgical intrahepatic shunt connecting the hepatic and portal veins. The shunt can be inserted successfully in more than 90% of patients and it effectively decompresses the portal venous circulation. Serious complications, such as intraperitoneal bleeding, occur but they are uncommon. The role of TIPS in the treatment of portal hypertension is currently being evaluated. There are few controlled data available to compare TIPS with established treatment such as drugs, injection sclerotherapy, endoscopic banding or shunt surgery. TIPS has also been used to treat ascites, the Budd-Chiari syndrome and cirrhotic hydrothorax. Concerns over the long-term patency and the true incidence of encephalopathy following TIPS raise doubts about its long-term efficacy. Controlled trials are required to demonstrate the cost-effectiveness of TIPS for individual indications before it is widely adopted. TIPS may find its most immediate application in the emergency treatment of active variceal haemorrhage refractory to standard medical and endoscopic therapy, as there is no satisfactory treatment currently available for this high-risk group. TIPS may also have a role in patients awaiting liver transplantation who bleed from varices. Long-term patency should not be an issue in this patient group and portal decompression may reduce blood transfusion requirements during transplant surgery.

Clinical Trials as Topic↗
PubMed1986

Anaesthesiological complications in renal transplantation: a retrospective study of 500 transplantations.

This retrospective study consisted of 500 consecutive renal transplantations performed between September 1977 and September 1981. Preoperatively, congestive heart failure was registered in 262 cases (53.0%) and blood pressure disease in 352 cases (71.3%). The total number of patients with ischaemic heart disease was 22 (4.5%). General anaesthesia was given in 493 and regional anaesthesia in seven cases. In general anaesthesias, tubocurarine was the main relaxant and halothane the main inhalation agent used. Major complications during anaesthesia were blood pressure changes with a higher incidence of hypotension (49.6%) than hypertension (26.8%). Severe cardiac arrhythmias were rare and no intraoperative deaths occurred. One patient was successfully resuscitated in the ICU postoperatively, this being possibly related to hypoventilation caused by prolonged muscular relaxation. Other rare complications included one pneumothorax, one haemo- and hydrothorax, and two large haematomas all caused by preoperative central venous cannulation. In 69 cases (14.0%) additional neostigmine doses and in 34 cases (6.9%) naloxone was given at the end of anaesthesia. Pneumonia during the first postoperative week was recorded in 11 cases (2.2%), and occurred only in patients who received general anaesthesia. One of the three patients who died during the first week developed pneumonia postoperatively.

Adolescent↗
PubMed1998

Fumonisin B1 contamination of maize and experimental acute fumonisin toxicosis in pigs.

The fumonisin B1 content of 69 visibly mouldy and 23 mould-free maize samples grown in Hungary in 1993-1995 was determined by high-performance liquid chromatography (HPLC). Fumonisin B1 was found to occur in 70-73% of the mouldy samples. The mycotoxin level increased from year to year: the highest fumonisin B1 concentration was 75.1 mg/kg. The samples that were mould-free on visual inspection showed a much lower prevalence of fumonisin B1 contamination (30%) and contained fumonisin B1 in markedly lower concentrations (average, 1.52 mg/kg; maximum concentration, 5.1 mg/kg). Using the Fusarium moniliforme strain designated 14/A, isolated from the sample that had the highest mycotoxin concentrations, fumonisin B1 toxin was produced on maize by an internationally accepted procedure. Subsequently, two weaned piglets were fed a diet containing 330 mg fumonisin B1 per kg of feed. The experimental animals developed hydrothorax and pulmonary oedema, and died in 5-6 days. The clinical symptoms and pathological lesions were consistent with those of porcine pulmonary oedema (PPE) diagnosed in the USA in 1989-1990, as well as with those of a disease entity that had already been described in Hungary in the 1950s as the so-called fattening or unique pulmonary oedema of pigs but considered to be of unknown aetiology. The results of the feeding trial confirm that this pig disease, which has occurred in Hungary for a long time, is caused by the mycotoxin fumonisin B1.

Animal Feed↗
PubMed1980

Mesothelioma with lung cancer complicating asbestosis.

The patient had been employed in an asbestos factory for four years from the age of 16. Five years ago, she complained of sputum and cough, and she was treated for chronic bronchitis. From March, 1977, when she was 53 years old, hydrothorax and ascites increased, her weight decreased and she was hospitalized for cachexia. The clinical diagnosis of malignant diffuse mesothelioma was made on the presence of atypical cells in the effusions. Atypical cells showed a positive colloidal iron staining test and positive hyaluronidase digestion test. Asbestos bodies were found in the sputum. The patient died on February 1978. Postmortem confirmed asbestosia and mesothelioma which was scattered over the pleura, pericardial sac, diaphragma, peritoneum and pancreas. In addition, bronchiolo-alveolar cell type lung cancer was found localized in the lower lobe of the left lung. The electron beam diffraction disclosed the asbestos as amosite (brown asbestos).

Asbestosis↗
PubMed1984

An electron microscopic study of acute promyelocytic leukemia with chloroma.

Tumor forming acute promyelocytic leukemia (APL) is rare and only three cases have been documented. However, there are no reports on either the chloromatous character or electron microscopical analysis. The present paper dealt with a light, electron microscopic and histochemical study of the tumor of APL in a 55-year-old Japanese male. The tumors found in the anterior mediastinum and right lower extremity. He died from respiratory disturbance and hydrothorax due to obstruction of the pulmonary truncus by the mediastinal tumor. In electron microscopy, the tumor cells showed dilatation, colloracious pattern and honey-comb-like structure of rough endoplasmic reticula (RER) and parallel array-arrangement of smooth endoplasmic reticula (SER). These abnormalities of ER are the same as those recently recognized in leukemic cells in APL. Furthermore, the intercellular junctions composed of opposing dense patches of the cytoplasmic plasmalemma were frequently found between the more immature tumor cell of the mediastinum.

Endoplasmic Reticulum↗
PubMed2004

Upper pole access for complex lower pole renal calculi.

OBJECTIVES: To assess the efficacy of superior pole access for complex lower pole calyceal calculi. PATIENTS AND METHODS: In all, 102 patients with complex inferior calyceal calculi were included in a prospective unrandomized study. Complex inferior calyceal calculi were defined as multiple calculi in two or more inferior calyces of the lower polar group, with each calyx draining through a separate infundibulum and at an acute angle to each other. In 33 patients (32%; group 1) an inferior calyceal puncture was made and in 69 (68%; group 2) access was obtained through a superior calyceal puncture. The stone-free rates, decrease in haemoglobin, operative duration, requirement for additional tracts and second procedures in the two groups were compared. RESULTS: Stone clearance rates and blood loss values were better in group 2, although they were not significantly different. The mean operative duration, number of tracts required and the re-look procedure rate was significantly less in group 2. Two patients (3%) in group 2 had hydrothorax related to supracostal puncture and required chest tube insertion. CONCLUSIONS: Superior calyceal puncture (supracostal or infracostal) affords optimum access to complex inferior calyceal stones, providing faster and better clearance with a single puncture, and less requirement for second-look procedures.

Female↗
PubMed2005

Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports.

OBJECTIVE: To evaluate the status of tubeless percutaneous nephrolithotomy (PCNL) in managing renal and upper ureteric calculi, from initial experience and a review of previous reports. PATIENTS AND METHODS: From September 2004 to December 2004, 46 patients were scheduled for tubeless PCNL in a prospective study. Patients with solitary kidney, or undergoing bilateral simultaneous PCNL or requiring a supracostal access were also enrolled. Patients needing more than three percutaneous access tracts, or with significant bleeding or a significant residual stone burden necessitating a staged second-look nephroscopy were excluded. At the end of the procedure, a JJ ureteric stent was placed antegradely and a nephrostomy tube avoided. The patients' demographic data, the outcomes during and after surgery, complications, success rate, and stent-related morbidity were analysed. Previous reports were reviewed to evaluate the current status of tubeless PCNL. RESULTS: Of the 46 patients initially considered only 40 (45 renal units) were assessed. The mean stone size in these patients was 33 mm and 23 patients had multiple stones. Three patients had a serum creatinine level of >2 mg/dL (>177 micromol/L). Five patients had successful bilateral simultaneous tubeless PCNL. In all, 51 tracts were required in 45 renal units, 30 of which were supracostal. The mean decrease in haemoglobin was 1.2 g/dL and two patients required a blood transfusion after PCNL. There was no urine leakage or formation of urinoma after surgery, and no major chest complications in patients requiring a supracostal access tract, except for one with hydrothorax, managed conservatively. The mean hospital stay was 26 h and analgesic requirement 40.6 mg of diclofenac. Stones were completely cleared in 87% of renal units and 9% had residual fragments of < 5 mm. Two patients required extracorporeal lithotripsy for residual calculi. In all, 30% of patients had bothersome stent-related symptoms and 60% needed analgesics and/or antispasmodics to treat them. CONCLUSION: Tubeless PCNL was safe and effective even in patients with a solitary kidney, or with three renal access tracts or supracostal access, or with deranged renal values and in those requiring bilateral simultaneous PCNL. The literature review suggested a need for prospective, randomized studies to evaluate the role of fibrin sealant and/or cauterization of the nephrostomy tract in tubeless PCNL.

Adult↗
PubMed2001

Prognostic value of hepatocyte proliferative activity after transjugular intrahepatic portosystemic shunt.

OBJECTIVES: Previous data indicated that the proliferating cell nuclear antigen-labeling index (PCNA-LI) reflects the liver functional reserve in human liver cirrhosis. The aim of the study was to evaluate the hepatocyte proliferative activity as a marker for the outcome of patients after transjugular intrahepatic portosystemic shunt (TIPS). METHODS: Twenty-eight consecutive patients were electively treated with TIPS for recurrent variceal bleeding (n = 14), refractory ascites (n = 12), or hydrothorax (n = 2). PCNA immunostaining was analyzed on methanol-fixed, paraffin-embedded liver biopsies. RESULTS: After TIPS, six patients died within the first 3 months, eight other patients died later, two were transplanted, and 12 were alive at the time of analysis. Early death occurred in patients with refractory ascites (5/12) and/or in Child C patients (3/6). Among the evaluated variables, there was a statistical trend for the PCNA-LI to be lower in patients who died early after TIPS than in those having long term survival (1.55% vs 2.65%, p = 0.07). After TIPS insertion, the probability of remaining alive during the first 6 months of follow-up was significantly higher in patients with a preprocedural PCNA-LI > 2.9%. CONCLUSIONS: The PCNA-LI measured on liver biopsy before the TIPS procedure might be a pre-TIPS marker to discriminate those patients for whom TIPS is likely to be beneficial.

Adult↗
PubMed1998

The first decade of the transjugular intrahepatic portosystemic shunt (TIPS): state of the art.

The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side portosystemic anastomosis. Since its introduction 10 years ago, more than 500 publications have appeared demonstrating rapid acceptance and increasing clinical use. This review summarizes the present knowledge of technical aspects and complications, follow-up of patients, and indications. With respect to the technique, the TIPS procedure is probably one of the most difficult interventions and, therefore, technical success and complications clearly depend on the skills of the operator. Thus, the number and kind of complications reported in this review do not necessarily relate to the procedural complications of an experienced center. The follow-up of the TIPS patient has to assess shunt patency, liver function and hepatic encephalopathy. Shunt patency can best be monitored by duplex-sonography. Routine radiological revision seems not to be helpful and does not improve results, i.e., rebleeding and survival. Short term patency may be improved by anticoagulation, while such a treatment does not influence long-term patency. With respect to the indications of TIPS, much is known about treatment of variceal bleeding. The nine randomized studies that are available to date show that survival is comparable between patients receiving TIPS or endoscopic treatment. The second group of patients is the group with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrated that TIPS improves these complications, but randomized studies are still lacking. In addition, TIPS has been applied successfully to patients with Budd-Chiari syndrome, portal vein thrombosis, before liver transplantation, and for the treatment of ectopic portal hypertensive bleeding.

Ascites↗
PubMed1997

Catheter drainage of pleural fluid collections and pneumothorax.

A technique for virtually atraumatic placement of small size chest catheters for suction drainage of pleural effusions and pneumothorax in the dog and cat is described. Thirty-nine dogs and two cats were treated for pyothorax (10 cases), hydrothorax (eight), chylothorax (three), haemothorax (three), haemothorax/ pneumothorax (three) and pneumothorax (14). In all 41 cases, thin or viscous fluid and/or air were efficiently drained. The mean period of drainage was four days (range, 0.5 to 18 days). The average amount of fluid removed from each patient in 24 hours was 530 ml in pyothorax cases (range, 140 to 1100 ml) and 1300 ml in the other cases (range, 20 to 5000 ml). In 40 cases there were no complications related to the procedure. One dog with severe pleural adhesions was euthanased because of lung perforation and pneumothorax secondary to misplacement of the catheter.

Animals↗
PubMed2003

Pulmonary adenocarcinoma with osteoblastic bone metastases in a cat.

A 12-year-old male cat with depression and dyspnoea was presented for investigation. Radiography and computed tomography revealed hydrothorax and solid masses involving the sternum, ribs and thoracic vertebrae. The cat died two days after first presentation, and postmortem examination revealed lung masses and proliferative bony lesions. Histologically, a neoplastic proliferation of epithelial cells was seen in the lungs, with a large amount of collagen and deposits of cholesterin. The bone lesions were also composed of neoplastic epithelial cells and abundant calcified osteoid, without atypia. A diagnosis of pulmonary adenocarcinoma with osteoblastic bone metastases was made. This is the first reported case of osteoblastic metastases in the cat.

Adenocarcinoma↗