1/10. warfarin-induced skin necrosis associated with acquired protein c deficiency.A 36-year-old woman developed skin necrosis of the inner thighs following the re-introduction of warfarin after a laparoscopic cholecystectomy. She had a history of liver disease and cardiomyopathy and was on warfarin for 10 years. warfarin-induced skin necrosis secondary to protein c deficiency was diagnosed. Although warfarin was ceased immediately, the prothrombin time measurements remained prolonged and warfarin levels remained therapeutic. Our patient, who had attached great significance to warfarin therapy, had continued the ingestion of warfarin despite our advice. She required three surgical debridements. Protein C levels, as measured 1 year later, were within normal limits, confirming the transient nature of the acquired deficiency during the acute event. This is the second reported case of warfarin necrosis associated with acquired protein c deficiency.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Intrabiliary rupture of a hydatid liver cyst: a case report.Intrabiliary rupture of a hydatid liver cyst is a rare occurrence which may result in the development of obstructive jaundice and cholangitis. In this report we discuss the diagnostic and therapeutic management of a patient in whom the parasitic nature of cholangitis was underestimated due to the small size and site of the cyst, and to the misleading concomitant presence of cholelithiasis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Laparoscopic cholecystectomy in anticoagulated patients.Although minimally surgically invasive, laparoscopic surgery has yet to be proven safe in patients receiving anticoagulants. Retrospectively, the laparoscopic management of four patients requiring anticoagulation for cardiac valvular prostheses or chronic atrial fibrillation was reviewed with regard to potential hemorrhagic complications. warfarin was discontinued preoperatively in all cases. heparin anticoagulation was individualized according to each patient's risk for thrombosis. Laparoscopic cholecystectomy and intraoperative cholangiography were completed in each patient without resulting hemorrhagic complications. The operative management of patients exhibiting cholecystitis may be complicated by anticoagulation therapy required for preexisting conditions/diseases such as cardiac valve prostheses, chronic atrial fibrillation, deep venous thrombosis, and pulmonary embolism. The minimally invasive nature of laparoscopic surgery lends itself well to cholecystectomy required in the face of anticoagulation treatment. This limited initial series of selected patients demonstrates the feasibility and efficacy of laparoscopic cholecystectomy in patients receiving anticoagulants.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Malignant angioendotheliomatosis (Angiotropic lymphoma) of the gallbladder.We present a case of malignant angioendotheliomatosis of the gallbladder, the first reported. Diagnostic problems connected with this rare malignancy are underlined. Immunohistochemical studies were useful in providing further evidence of the lymphoid nature of the neoplasm and avoiding possible misdiagnosis. We suggest that the term "angiotropic lymphoma" might be more appropriate to define this malignancy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. Caroli's disease. Case report with unusual features and a review of current diagnostic and treatment modalities.This is a case report of the simple form of Caroli's disease in a 36 year old Irish woman who has extensive bilobar involvement without congenital hepatic fibrosis or portal hypertension. The difficulty of diagnosis and the intractable nature of the disease are emphasised and recent improvements in diagnosis and management are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Intraoperative sonography: clinical usefulness in liver surgery.In the past 4 years intraoperative sonography was performed on 83 patients with primary hepatic carcinoma, 11 with benign hepatic tumor, nine with intrahepatic lithiasis, five with metastatic hepatic carcinoma, and four with other benign hepatic diseases, for a total of 112 patients. ultrasonography detected primary carcinoma in 80 of 83 patients (96.4%) and intrahepatic metastases in 30 of 33 patients (90.9%), as confirmed later in surgical specimens. Tumor thrombi in the portal vein were detected in nine of 13 patients (69.2%). In patients with intrahepatic lithiasis and benign space-occupying lesions, residual stones could be assessed easily and the nature and location of the lesions identified. Intraoperative sonography demonstrates intrahepatic ductal structures clearly and is the final diagnostic imaging procedure before surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. CT appearance of mirizzi syndrome.mirizzi syndrome consists of extrinsic compression of the common hepatic duct by gallstones in patients with cholecystitis. Computed tomography done with techniques that optimize spatial resolution may aid diagnosis by permitting identification of the precise level of and the extrinsic nature of the obstruction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Colonic gall-stone ileus.A case of obstruction of the colon by a solitary, large gall-stone is described. This rare event usually occurs in elderly females in whom there is frequently an underlying pathological condition at the site of obstruction in the colon. The calculus usually migrates via a cholecystocolic fistula. diagnosis may be assisted by plain abdominal X-ray and contrast radiography. Immediate operative treatment should be tailored to the patient's general condition and the nature of the pathological changes.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. Suprahepatic gallbladder with hypoplasia of the right lobe of the liver.One of the rarest congenital anomalies of the gallbladder is the suprahepatic variant of this organ. Three cases of this ectopia were seen in a ten-year period, all of which associated with hypoplasia of the right lobe of the liver and upward displacement of the hepatic flexure of the colon, which overlapped the liver border. All patients complained of recurrent pain in the right upper quadrant of the abdomen, suggestive of biliary disease, but only one case had calculi in the gallbladder that was acute cholecystitis. Two patients underwent cholecystectomy, and operative findings confirmed the preoperative diagnosis. It is speculated that the primary defect in this modality of suprahepatic gallbladder might be hypoplasia or atrophy of the right lobe of the liver of a congenital nature, with subsequent vicious orientation of the gallbladder and upward displacement of the colon.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. pneumothorax associated with laparoscopic cholecystectomy.pneumothorax is an uncommon but potentially serious complication that can occur during laparoscopic procedures. A patient under-going laparoscopic cholecystectomy developed an 80% pneumothorax during the course of the procedure and required chest tube insertion. She then underwent an uneventful recovery. The etiology of this complication as well as methods for avoiding this problem have been reviewed. Because of the potential serious nature of this complication, it is imperative that the surgeon be aware of the possibility and implement appropriate immediate therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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