Ioannis Kaklamanos

Gastric Decompression and Enteral Feeding Through a Double-Lumen Gastrojejunostomy Tube Improves Outcomes After Pancreaticoduodenectomy

Objective:The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. Background:Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. Methods:Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. Results:The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 ± 7.8 days versus 11.5 ± 2.9 days, respectively; P = 0.01). Hospital charges were

Breast Angiosarcoma That Is Not Related to Radiation Exposure : A Comprehensive Review of the Literature

82,151 ± 56,632 in controls and

Tissue concentration of transforming growth factor β1 and basic fibroblast growth factor in skin wounds created with a CO2 laser and scalpel: A comparative experimental study, using an animal model of skin resurfacing

52,589 ± 15,964 in the GJT group (P = 0.036). Conclusions:In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.

Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

Breast angiosarcomas that are not related to previous radiotherapy are very rare. Surgical resection is the primary treatment for these tumors, but there is no general agreement on the extent of surgery. The role of multimodality adjuvant treatment also remains controversial. The aim of this study was to summarize the available data from the largest published series of patients in terms of management and outcome. We also sought to identify prognostic factors influencing patient survival. We have included studies presenting detailed data on multimodality therapy and survival of patients with breast angiosarcoma. Ten studies presenting data on 280 patients were included in the review. Seventyfive percent of patients underwent a total mastectomy and 25% had breast-conserving treatment (BCT). In 42% of patients, an axillary node dissection was combined with mastectomy or BCT. Thirty-six percent of patients received chemotherapy and 35% were treated with radiotherapy in an adjuvant or neoadjuvant setting. Survival varied significantly according to tumor size and grade. Adjuvant multimodality therapy may improve the outcome in selected patients with breast angiosarcoma. Tumor size, grade, and margin status are the most important prognostic factors for survival.

Prospective comparison of peritumoral and subareolar injection of blue dye alone, for identification of sentinel lymph nodes in patients with early stage breast cancer.

Although a number of ablative‐laser techniques based on CO2 and Er: YAG laser devices have been successfully developed and used in the clinical setting, the bio‐molecular processes influencing wound healing after exposure to laser energy are not well elucidated. In this study, we aim to assess the impact of the mechanism of injury on the secretion of transforming growth factor β1 (TGF‐β1) and basic fibroblast growth factor (bFGF) in various stages of wound healing, in wounds created with a CO2 laser and scalpel. Ten Wistar rats were used to determine the levels of growth factor proteins TGF‐β1 and bFGF after CO2 laser‐ and scalpel‐induced skin injury. Tissue was excised on day 0 for untreated skin (control sites), and on days 1, 10, 30, and 90 following laser and scalpel surgery. Specimens were processed for histopathological analysis and for determining the concentration of growth factors by a Western blot technique. The concentration of TGF‐β1 increased markedly, at day 1 postinjury, from a baseline of 130±16 mm2 (mean surface area of blotted‐protein lanes) to 261±23 mm2 and 394±22 mm2 for laser‐inflicted injury and scalpel wounds, respectively; the latter values were found to differ significantly (p<0.001). The concentration of b‐FGF on day 10 postinjury differed significantly (p<0.001) between the laser sites (553±45 mm2) and the corresponding scalpel sites (418±41 mm2). Laser energy alters local tissue secretion of TGF‐β1 and bFGF of skin injuries created with the CO2 laser compared with wounds created with a scalpel. These differences might have an impact on various aspects of wound healing of skin injuries created by a laser.

Congenital peritoneal encapsulation of the small intestine: A rare case report

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

Fast-track recovery after major liver and pancreatic resection from the nursing point of view.

Various techniques are used for the identification of the sentinel node (SLN). We prospectively compare the efficacy of SLN biopsy and the number of SLNs identified, by injecting methylene blue (MB) alone in the subareolar area (SA) or peritumorally (PT) in patients with early stage breast cancer

Leiomyomatosis peritonealis disseminata: A case report and meticulous review of the literature

Highlights • Be aware of the rare occasion of PE in patients with intestinal obstruction without other etiological factors.• Preoperative diagnosis of PE may be impossible.• Management of PE in case of intestinal obstruction requires urgent surgery.

Bilateral aberrant origin of the inferior thyroid artery from the common carotid artery

Postoperative fast-track recovery protocols combine various methods to support immediate care of patients who undergo major surgery. These protocols include control of postoperative pain and early beginning of oral diet and mobilization. The combination of these approaches may reduce the rate of postoperative complications and facilitate hospital discharge. The aim of this study was to evaluate progress and parameters of fast-track recovery after major liver and pancreatic resection. A descriptive bibliographical review from 2001 to 2012 via electronic databases such as MEDLINE, PubMed, and Google Scholar was undertaken. Articles that focused on a fast-track protocol were studied. Reports focusing on the implementation of a fast-track protocol in the postoperative recovery of patients after major hepatectomy or pancreatectomy were selected. Fast-track protocols may be applicable to patients recovering after major liver or pancreatic resection. Future research should be focused on particular parameters of the fast-track protocol separately.

Aberrant subvesical bile ducts identified during laparoscopic cholecystectomy: A rare case report and review of the literature

Highlights • Differential diagnosis of LPD from leiomyosarcoma or benign metastasizing leiomyoma remains difficult.• Ample history of the patient, clinical evaluation, preoperative guided FNA and histopathologic analysis of the FNA tissue and of the tumor resection are essential for differential diagnosis.• Prompt diagnosis of LPD is crucial because, although benign in nature, LPD may degenerate into malignancy.