BACKGROUND The outcomes of liver transplantation(LT)from different grafts have been studied individually and in combination,but the reports were conflicting with some researchers finding no difference in both short-te...BACKGROUND The outcomes of liver transplantation(LT)from different grafts have been studied individually and in combination,but the reports were conflicting with some researchers finding no difference in both short-term and long-term outcomes between the deceased donor split LT(DD-SLT)and living donor LT(LDLT).AIM To compare the outcomes of DD-SLT and LDLT we performed this systematic review and meta-analysis.METHODS This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.The following databases were searched for articles comparing outcomes of DD-SLT and LDLT:PubMed;Google Scholar;Embase;Cochrane Central Register of Controlled Trials;the Cochrane Database of Systematic Reviews;and Reference Citation Analysis(https://www.referencecitationanalysis.com/).The search terms used were:“liver transplantation;”“liver transplant;”“split liver transplant;”“living donor liver transplant;”“partial liver transplant;”“partial liver graft;”“ex vivo splitting;”and“in vivo splitting.”RESULTS Ten studies were included for the data synthesis and meta-analysis.There were a total of 4836 patients.The overall survival rate at 1 year,3 years and 5 years was superior in patients that received LDLT compared to DD-SLT.At 1 year,the hazard ratios was 1.44(95%confidence interval:1.16-1.78;P=0.001).The graft survival rate at 3 years and 5 years was superior in the LDLT group(3 year hazard ratio:1.28;95%confidence interval:1.01-1.63;P=0.04).CONCLUSION This meta-analysis showed that LDLT has better graft survival and overall survival when compared to DD-SLT.展开更多
BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their...BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents.More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs.AIM To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic characteristics.The PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of parents.The IFS was used to assess the impact of the child’s CLD status on the family.Demographic variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent groups.Finally,PedsQL and IFS results were also analyzed according to demographic variables.RESULTS A total of 185 parents aged 19 to 65 years were included.There were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,personal strain,and total impact were consistently higher for the LT group(P<0.001).There were statistically significant relationships between education level,monthly income,and place of residence according to the IFS results but not the PedsQL results.There were inverse relationships between the difficulties that parents experience because of their child’s health and education levels,monthly income,and place of residence.However,no relationship was found between education level,monthly income,or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results.CONCLUSION Parents of children who underwent LT were very satisfied with the health care services provided to their children.However,they had more difficulties than parents of children with CLD.展开更多
AIM To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery. METHODS We retrospectively analyzed parameters, including ...AIM To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery. METHODS We retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinicalparameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric MannWhitney U test was used to compare quantitative data that were not normally distributed, and Pearson's chisquared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method.RESULTS This study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy(P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively.CONCLUSION This study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.展开更多
AIM: To review the literature on idiopathic sclerosing encapsulating peritonitis(SEP), also known as abdominal cocoon syndrome. METHODS: The Pub Med, MEDLINE, Google Scholar, and Google databases were searched using s...AIM: To review the literature on idiopathic sclerosing encapsulating peritonitis(SEP), also known as abdominal cocoon syndrome. METHODS: The Pub Med, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters tothe editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS: The literature search yielded 73 articles on idiopathic(primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India(n = 21), Turkey(n = 14), China(n = 8) and Nigeria(n = 3). The four countries that reported the greatest number of cases were China(n = 104; 53.88%), India(n = 35; 18.13%), Turkey(n = 17; 8.80%) and Nigeria(n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients(range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65(43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis(one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy(n = 2) and immunosuppressive therapy(n = 1). CONCLUSION: Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standardmanagement strategy.展开更多
Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor...Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.展开更多
AIM: To investigate whether amifostine contributes to the antioxidant and cytoprotective effects of histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) preservation solutions.
Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal s...Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and midrectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodenojejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.展开更多
Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. The...Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm × 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximaljejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised enbloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.展开更多
BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications d...BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.展开更多
To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy(LDH) has been reported in the English language medical literature. We present two cases in which grade Ⅰ neuroe...To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy(LDH) has been reported in the English language medical literature. We present two cases in which grade Ⅰ neuroendocrine tumors(NET) were incidentally detected during our twelve-year LDH experience. First Case: A 26-yearold male underwent LDH for his brother suffering from HBV-related chronic liver disease(CLD). After right lobe LDH, intestinal length was measured as part of a study concerning the relationship between small intestinal lengths and surgical procedure. At this stage, a mass lesion with a size of 10 mm × 10 mm was detected on the antimesenteric surface, approximately 90 cm proximal to the ileocecal valve. A wedge resection with primary intestinal anastomosis was performed. Second Case: A 29-year-old male underwent right lobe LDH for his father with hepatitis B virus(HBV)-related CLD. An abdominal exploration immediately prior to the closure of the incision revealed that the appendix vermiformis was edematous and had firmness with a size of 8-10 mm at its tip. An appendectomy was performed. The pathological examinations of the specimens of both patients revealedgrade 1 NET. In conclusion, even if patients undergoing LDH are healthy individuals, whole abdominal cavity should be gently palpated and all findings recorded after completing laparotomy. Suspected masses or lesions should be confirmed by frozen section examination. Such an approach would avert potential medicolegal issues.展开更多
BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIM To compare the demographi...BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIM To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy.METHODS The demographic, biochemical, and histopathological data of 72 patients(Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients(Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists.RESULTS Statistically significant differences were found between groups in terms of age(P= 0.044), white blood cell count(P < 0.001), neutrophil(P < 0.001), lymphocyte(P< 0.001), red cell distribution width(P = 0.036), mean corpuscular hemoglobin(P= 0.001), bilirubin(P = 0.002), appendix width(P < 0.001), and presence of acute appendicitis histopathologically(P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis(72.2%), fibrous obliteration(9.7%)and acute appendicitis(6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis(62.8%), perforated appendicitis(16.7%), lymphoid hyperplasia(8.3%), and appendix vermiformis(6.3%).CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon's foresight, and we should not hesitate to perform incidental appendectomy when展开更多
BACKGROUND Since the first living donor liver transplantation(LDLT)was performed by Raia and colleagues in December 1988,LDLT has become the gold standard treatment in countries where cadaveric organ donation is not s...BACKGROUND Since the first living donor liver transplantation(LDLT)was performed by Raia and colleagues in December 1988,LDLT has become the gold standard treatment in countries where cadaveric organ donation is not sufficient.Adequate hepatic venous outflow reconstruction in LDLT is essential to prevent graft congestion and its complications including graft loss.However,this can be complex and technically demanding especially in the presence of complex variations and congenital anomalies in the graft hepatic veins.CASE SUMMARY Herein,we aimed to present two cases who underwent successful right lobe LDLT using a right lobe liver graft with rudimentary or congenital absence of the right hepatic vein and describe the utility of a common large opening drainage model in such complex cases.CONCLUSION Thanks to this venous reconstruction model,none of the patients developed postoperative complications related to venous drainage.Our experience with venous drainage reconstruction models shows that congenital variations in the hepatic venous structure of living liver donors are not absolute contraindications for LDLT.展开更多
Hydatid cysts are a zoonotic disease that can involve many organs and tissues in the human body but primarily involve the liver and lungs. Of the main organs, adrenal glands are those seldom affected by hydatid cysts....Hydatid cysts are a zoonotic disease that can involve many organs and tissues in the human body but primarily involve the liver and lungs. Of the main organs, adrenal glands are those seldom affected by hydatid cysts. The purpose of this study was to present a case with an incidentally detected hydatid cyst of the right adrenal gland on computed tomography, and a positive echincoccus Ig G enzyme-linked immunosorbent assay test on top of a toxic multinodular thyroid goiter for which thyroidectomy was indicated.展开更多
Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management.However,the diagnosis and management of complicated hepatic hydatid disease is a special issue.One of the most common and seri...Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management.However,the diagnosis and management of complicated hepatic hydatid disease is a special issue.One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts.The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice,cholecystitis,cholangitis,liver abscess,pancreatitis and septicemia.Current treatments for major ruptures can result in high morbidity and mortality rates.Furthermore,ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae,biloma,cavitary infection and obstructive jaundice.In the past,these complications were diagnosed and treated by surgical methods.Currently,complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods.In clinical practice,endoscopic retrograde cholangiopancreatography(ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts,or for biliary adverse events after surgery,including persistent biliary fistulae and jaundice.However,controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains.In this article,the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed.展开更多
Pancreatic head adenocarcinoma(PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC includ...Pancreatic head adenocarcinoma(PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC include higher frequencies of regional or distant lymph node metastases and vascular involvement, and positive resection margins in pancreatic and retroperitoneal tissues. Radical resections increase margin negativity and life expectancy;however, the extend of the surgery applied is controversial. Thus, western and eastern centers may use different approaches. Multiorgan, peripancreatic nerve plexus, and vascular resections have been discussed in relation to radical surgery for pancreatic cancer as have the roles of neoadjuvant and adjuvant therapy regimens. Determining the appropriate limits for surgery, standardizing definitions and surgical techniques according to guidelines, and centralizing pancreatic surgery within high-volume institutions to reduce mortality and morbidity rates are among the most important issues to consider. In this review,we evaluate the basic concepts underlying and the roles of radical surgery for PHAC, and lymphadenectomy, nerve plexus, retroperitoneal tissue, vascular,and multivisceral resections, total pancreatectomy, and liver metastases are discussed.展开更多
AIM: To provide an overview of the literature on pan-creatic extragastrointestinal stromal tumors(EGISTs).METHODS: We report a case of pancreatic EGIST and review published studies on pancreatic EGIST ac-cessed via th...AIM: To provide an overview of the literature on pan-creatic extragastrointestinal stromal tumors(EGISTs).METHODS: We report a case of pancreatic EGIST and review published studies on pancreatic EGIST ac-cessed via the PubMed, MEDlInE, Google Scholar, and Google databases. The keywords used were "pancreas and GIST", "pancreas and extra GIST", "pancreas and gastrointestinal stromal tumor", and "pancreas and ex-tragastrointestinal stromal tumor". literature reviews and/or duplicate studies were excluded. The search included articles published in the English language be-tween January 1, 2000 and May 15, 2014.RESULTS: From our literature survey, 30 manuscripts on pancreatic EGISTs were considered, of which 27met the search criteria and three were excluded. The studies involved 30 patients(15 men, 15 women) with a mean age of 55.3 ± 14.3 years(range 30-84 years). The mean age of the male patients was 50.8 ± 13.7 years(range 30-84 years); that of the female patients was 59.9 ± 13.3 years(range 38-81 years). Tumor dimensions were obtained for 28 cases(mean 114.4 ± 78.6 mm; range 20-350 mm). Tumors were diagnosed incidentally in 23.3% of patients; abdominal discomfort and weight loss were the major complaints in symp-tomatic patients. Risk of aggressive behavior according to Fletcher criteria was determined in 25 of 30 patients(68%: high risk, 28%: intermediate risk, 4%: low risk). Histopathological examination revealed the presence of spindle cells in 96.1% of cases; CD117 and CD34 were present immunohistochemically in 96.6% and 84% of patients, respectively. The most common surgical pro-cedures were distal pancreatectomy with splenectomy(n = 9) and pancreaticoduodenectomy(n = 7). The to-tal follow-up period for the 28 patients ranged from 3-66 mo, during which locoregional or distant metastases were diagnosed in six patients and two patients died.CONCLUSION: Studies on EGISTs have only been published in the last decade. The lack of studies with large patient cohorts and long-term follow-up limits evidence-based commentary. In theory, each case should be assessed individually and further genetic and immunohistochemical studies are needed.展开更多
Hepatic arterial complications include hepatic artery thrombosis(HAT),stenosis,and aneurysm.HAT may occur in the early as well as the late period.Late HAT has typically been associated with less severe complications a...Hepatic arterial complications include hepatic artery thrombosis(HAT),stenosis,and aneurysm.HAT may occur in the early as well as the late period.Late HAT has typically been associated with less severe complications and may even be asymptomatic.This article,focuses on HAT,which is more likely to occur in the early period after liver transplantation(LT).展开更多
Hepatic artery reconstruction(HAR)is the most valuable step in correcting graft and recipient survival after liver transplantation(LT).Hepatic artery thrombosis(HAT)in immediate postoperative period may lead to fatal ...Hepatic artery reconstruction(HAR)is the most valuable step in correcting graft and recipient survival after liver transplantation(LT).Hepatic artery thrombosis(HAT)in immediate postoperative period may lead to fatal complications.Hepatic allograft is partial in a living donor liver transplantation(LDLT),and HAR is technically much more difficult than deceased donor liver transplantation(DDLT).The likelihood of HAT in LDLT is higher due to the narrower diameters of arterial vessels.展开更多
BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or wit...BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or without cholesterol clefts.AIM To review the medical literature on xanthogranulomatous appendicitis(XGA).METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed,MEDLINE,Google Scholar,and Google databases.Keywords used were“appendix vermiformis,”“appendectomy,”“acute appendicitis,”and“XGA.”The search included articles published before May 2020,and the publication language was not restricted.The search included letters to the editor,case reports,review articles,original articles,and meeting presentations.Articles or abstracts containing adequate information about age,sex,clinical presentation,white blood cells,initial diagnosis,surgical approach,histopathological and immunohistochemical features of appendectomy specimens were included in the study.RESULTS A total of 29 articles involving 38 patients with XGA,were retrospectively analyzed.Twenty(52.6%)of the 38 patients,aged 3 to 78 years(median:34;IQR:31)were female,and the remaining 18(47.4%)were male.Twenty-five patients were diagnosed with acute appendicitis,ruptured appendicitis,or subacute appendicitis,and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region.Twenty-two of the patients underwent urgent or semi-urgent surgery,and the remaining 16 patients underwent interval appendectomy.CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis.It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation.It is often associated with interval appendectomies,and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.展开更多
文摘BACKGROUND The outcomes of liver transplantation(LT)from different grafts have been studied individually and in combination,but the reports were conflicting with some researchers finding no difference in both short-term and long-term outcomes between the deceased donor split LT(DD-SLT)and living donor LT(LDLT).AIM To compare the outcomes of DD-SLT and LDLT we performed this systematic review and meta-analysis.METHODS This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.The following databases were searched for articles comparing outcomes of DD-SLT and LDLT:PubMed;Google Scholar;Embase;Cochrane Central Register of Controlled Trials;the Cochrane Database of Systematic Reviews;and Reference Citation Analysis(https://www.referencecitationanalysis.com/).The search terms used were:“liver transplantation;”“liver transplant;”“split liver transplant;”“living donor liver transplant;”“partial liver transplant;”“partial liver graft;”“ex vivo splitting;”and“in vivo splitting.”RESULTS Ten studies were included for the data synthesis and meta-analysis.There were a total of 4836 patients.The overall survival rate at 1 year,3 years and 5 years was superior in patients that received LDLT compared to DD-SLT.At 1 year,the hazard ratios was 1.44(95%confidence interval:1.16-1.78;P=0.001).The graft survival rate at 3 years and 5 years was superior in the LDLT group(3 year hazard ratio:1.28;95%confidence interval:1.01-1.63;P=0.04).CONCLUSION This meta-analysis showed that LDLT has better graft survival and overall survival when compared to DD-SLT.
文摘BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents.More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs.AIM To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic characteristics.The PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of parents.The IFS was used to assess the impact of the child’s CLD status on the family.Demographic variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent groups.Finally,PedsQL and IFS results were also analyzed according to demographic variables.RESULTS A total of 185 parents aged 19 to 65 years were included.There were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,personal strain,and total impact were consistently higher for the LT group(P<0.001).There were statistically significant relationships between education level,monthly income,and place of residence according to the IFS results but not the PedsQL results.There were inverse relationships between the difficulties that parents experience because of their child’s health and education levels,monthly income,and place of residence.However,no relationship was found between education level,monthly income,or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results.CONCLUSION Parents of children who underwent LT were very satisfied with the health care services provided to their children.However,they had more difficulties than parents of children with CLD.
文摘AIM To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery. METHODS We retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinicalparameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric MannWhitney U test was used to compare quantitative data that were not normally distributed, and Pearson's chisquared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method.RESULTS This study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy(P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively.CONCLUSION This study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.
文摘AIM: To review the literature on idiopathic sclerosing encapsulating peritonitis(SEP), also known as abdominal cocoon syndrome. METHODS: The Pub Med, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters tothe editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS: The literature search yielded 73 articles on idiopathic(primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India(n = 21), Turkey(n = 14), China(n = 8) and Nigeria(n = 3). The four countries that reported the greatest number of cases were China(n = 104; 53.88%), India(n = 35; 18.13%), Turkey(n = 17; 8.80%) and Nigeria(n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients(range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65(43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis(one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy(n = 2) and immunosuppressive therapy(n = 1). CONCLUSION: Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standardmanagement strategy.
文摘Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.
文摘AIM: To investigate whether amifostine contributes to the antioxidant and cytoprotective effects of histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) preservation solutions.
文摘Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and midrectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodenojejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.
文摘Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm × 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximaljejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised enbloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.
文摘BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.
文摘To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy(LDH) has been reported in the English language medical literature. We present two cases in which grade Ⅰ neuroendocrine tumors(NET) were incidentally detected during our twelve-year LDH experience. First Case: A 26-yearold male underwent LDH for his brother suffering from HBV-related chronic liver disease(CLD). After right lobe LDH, intestinal length was measured as part of a study concerning the relationship between small intestinal lengths and surgical procedure. At this stage, a mass lesion with a size of 10 mm × 10 mm was detected on the antimesenteric surface, approximately 90 cm proximal to the ileocecal valve. A wedge resection with primary intestinal anastomosis was performed. Second Case: A 29-year-old male underwent right lobe LDH for his father with hepatitis B virus(HBV)-related CLD. An abdominal exploration immediately prior to the closure of the incision revealed that the appendix vermiformis was edematous and had firmness with a size of 8-10 mm at its tip. An appendectomy was performed. The pathological examinations of the specimens of both patients revealedgrade 1 NET. In conclusion, even if patients undergoing LDH are healthy individuals, whole abdominal cavity should be gently palpated and all findings recorded after completing laparotomy. Suspected masses or lesions should be confirmed by frozen section examination. Such an approach would avert potential medicolegal issues.
文摘BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIM To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy.METHODS The demographic, biochemical, and histopathological data of 72 patients(Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients(Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists.RESULTS Statistically significant differences were found between groups in terms of age(P= 0.044), white blood cell count(P < 0.001), neutrophil(P < 0.001), lymphocyte(P< 0.001), red cell distribution width(P = 0.036), mean corpuscular hemoglobin(P= 0.001), bilirubin(P = 0.002), appendix width(P < 0.001), and presence of acute appendicitis histopathologically(P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis(72.2%), fibrous obliteration(9.7%)and acute appendicitis(6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis(62.8%), perforated appendicitis(16.7%), lymphoid hyperplasia(8.3%), and appendix vermiformis(6.3%).CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon's foresight, and we should not hesitate to perform incidental appendectomy when
文摘BACKGROUND Since the first living donor liver transplantation(LDLT)was performed by Raia and colleagues in December 1988,LDLT has become the gold standard treatment in countries where cadaveric organ donation is not sufficient.Adequate hepatic venous outflow reconstruction in LDLT is essential to prevent graft congestion and its complications including graft loss.However,this can be complex and technically demanding especially in the presence of complex variations and congenital anomalies in the graft hepatic veins.CASE SUMMARY Herein,we aimed to present two cases who underwent successful right lobe LDLT using a right lobe liver graft with rudimentary or congenital absence of the right hepatic vein and describe the utility of a common large opening drainage model in such complex cases.CONCLUSION Thanks to this venous reconstruction model,none of the patients developed postoperative complications related to venous drainage.Our experience with venous drainage reconstruction models shows that congenital variations in the hepatic venous structure of living liver donors are not absolute contraindications for LDLT.
文摘Hydatid cysts are a zoonotic disease that can involve many organs and tissues in the human body but primarily involve the liver and lungs. Of the main organs, adrenal glands are those seldom affected by hydatid cysts. The purpose of this study was to present a case with an incidentally detected hydatid cyst of the right adrenal gland on computed tomography, and a positive echincoccus Ig G enzyme-linked immunosorbent assay test on top of a toxic multinodular thyroid goiter for which thyroidectomy was indicated.
文摘Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management.However,the diagnosis and management of complicated hepatic hydatid disease is a special issue.One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts.The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice,cholecystitis,cholangitis,liver abscess,pancreatitis and septicemia.Current treatments for major ruptures can result in high morbidity and mortality rates.Furthermore,ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae,biloma,cavitary infection and obstructive jaundice.In the past,these complications were diagnosed and treated by surgical methods.Currently,complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods.In clinical practice,endoscopic retrograde cholangiopancreatography(ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts,or for biliary adverse events after surgery,including persistent biliary fistulae and jaundice.However,controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains.In this article,the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed.
文摘Pancreatic head adenocarcinoma(PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC include higher frequencies of regional or distant lymph node metastases and vascular involvement, and positive resection margins in pancreatic and retroperitoneal tissues. Radical resections increase margin negativity and life expectancy;however, the extend of the surgery applied is controversial. Thus, western and eastern centers may use different approaches. Multiorgan, peripancreatic nerve plexus, and vascular resections have been discussed in relation to radical surgery for pancreatic cancer as have the roles of neoadjuvant and adjuvant therapy regimens. Determining the appropriate limits for surgery, standardizing definitions and surgical techniques according to guidelines, and centralizing pancreatic surgery within high-volume institutions to reduce mortality and morbidity rates are among the most important issues to consider. In this review,we evaluate the basic concepts underlying and the roles of radical surgery for PHAC, and lymphadenectomy, nerve plexus, retroperitoneal tissue, vascular,and multivisceral resections, total pancreatectomy, and liver metastases are discussed.
文摘AIM: To provide an overview of the literature on pan-creatic extragastrointestinal stromal tumors(EGISTs).METHODS: We report a case of pancreatic EGIST and review published studies on pancreatic EGIST ac-cessed via the PubMed, MEDlInE, Google Scholar, and Google databases. The keywords used were "pancreas and GIST", "pancreas and extra GIST", "pancreas and gastrointestinal stromal tumor", and "pancreas and ex-tragastrointestinal stromal tumor". literature reviews and/or duplicate studies were excluded. The search included articles published in the English language be-tween January 1, 2000 and May 15, 2014.RESULTS: From our literature survey, 30 manuscripts on pancreatic EGISTs were considered, of which 27met the search criteria and three were excluded. The studies involved 30 patients(15 men, 15 women) with a mean age of 55.3 ± 14.3 years(range 30-84 years). The mean age of the male patients was 50.8 ± 13.7 years(range 30-84 years); that of the female patients was 59.9 ± 13.3 years(range 38-81 years). Tumor dimensions were obtained for 28 cases(mean 114.4 ± 78.6 mm; range 20-350 mm). Tumors were diagnosed incidentally in 23.3% of patients; abdominal discomfort and weight loss were the major complaints in symp-tomatic patients. Risk of aggressive behavior according to Fletcher criteria was determined in 25 of 30 patients(68%: high risk, 28%: intermediate risk, 4%: low risk). Histopathological examination revealed the presence of spindle cells in 96.1% of cases; CD117 and CD34 were present immunohistochemically in 96.6% and 84% of patients, respectively. The most common surgical pro-cedures were distal pancreatectomy with splenectomy(n = 9) and pancreaticoduodenectomy(n = 7). The to-tal follow-up period for the 28 patients ranged from 3-66 mo, during which locoregional or distant metastases were diagnosed in six patients and two patients died.CONCLUSION: Studies on EGISTs have only been published in the last decade. The lack of studies with large patient cohorts and long-term follow-up limits evidence-based commentary. In theory, each case should be assessed individually and further genetic and immunohistochemical studies are needed.
文摘Hepatic arterial complications include hepatic artery thrombosis(HAT),stenosis,and aneurysm.HAT may occur in the early as well as the late period.Late HAT has typically been associated with less severe complications and may even be asymptomatic.This article,focuses on HAT,which is more likely to occur in the early period after liver transplantation(LT).
文摘Hepatic artery reconstruction(HAR)is the most valuable step in correcting graft and recipient survival after liver transplantation(LT).Hepatic artery thrombosis(HAT)in immediate postoperative period may lead to fatal complications.Hepatic allograft is partial in a living donor liver transplantation(LDLT),and HAR is technically much more difficult than deceased donor liver transplantation(DDLT).The likelihood of HAT in LDLT is higher due to the narrower diameters of arterial vessels.
文摘BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or without cholesterol clefts.AIM To review the medical literature on xanthogranulomatous appendicitis(XGA).METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed,MEDLINE,Google Scholar,and Google databases.Keywords used were“appendix vermiformis,”“appendectomy,”“acute appendicitis,”and“XGA.”The search included articles published before May 2020,and the publication language was not restricted.The search included letters to the editor,case reports,review articles,original articles,and meeting presentations.Articles or abstracts containing adequate information about age,sex,clinical presentation,white blood cells,initial diagnosis,surgical approach,histopathological and immunohistochemical features of appendectomy specimens were included in the study.RESULTS A total of 29 articles involving 38 patients with XGA,were retrospectively analyzed.Twenty(52.6%)of the 38 patients,aged 3 to 78 years(median:34;IQR:31)were female,and the remaining 18(47.4%)were male.Twenty-five patients were diagnosed with acute appendicitis,ruptured appendicitis,or subacute appendicitis,and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region.Twenty-two of the patients underwent urgent or semi-urgent surgery,and the remaining 16 patients underwent interval appendectomy.CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis.It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation.It is often associated with interval appendectomies,and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.
