1/8. Synchronically performed laparoscopic cholecystectomy and hernioplasty.Cholecystectomies and hernioplasties are the two most frequently performed surgical interventions. The laparoscopic technique can be offered for the simultaneous treatment with both operating indications. The synchronical operation can give all the advantages of the minimally invasive technique. Authors had performed laparoscopic cholecystectomy with laparoscopic hernioplasty in five cases. Two inguinal and three postoperative hernias were reconstructed. The cholecystectomy was performed with a "three punction method", and the hernioplasty by using the same approach, completed by inserting a fourth assisting trocar as required. The hernial ring was covered with an intraperitoneally placed mesh, which was fixed by staplers (the so-called "IPOM-method": intraperitoneal on-lay mesh). There was no intra-, nor postoperative complication. The hernioplasty combined with laparoscopic cholecystectomy did not have effect on postoperative pain and nursing time. The return to the normal physical activity was short, similar to laparoscopic hernioplasty (in 1-2 weeks). Authors conclude that the simultaneous, synchronous laparoscopic cholecystectomy and hernioplasty is recommended and should be the method of choice because it is more advantageous for patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Intrahepatic biliary calculi: correlation of unusual MR findings with pathologic findings.We report a case of intrahepatic biliary calculi. A localized dilated intrahepatic duct of the left lateral segment of the liver was filled with material that showed marked hyperintensity on T1- and T2-weighted magnetic resonance (MR) images. These MR findings are unusual for intrahepatic stones. Pathologically, the stones were muddy bilirubin calculi, the chemical and physical characteristics of which are surmised to have been the cause of the unusual MR findings.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Laparoscopic cholecystectomy and appendectomy in situs inversus totalis.situs inversus totalis is an uncommon anatomic anomaly that complicates diagnosis and management of acute abdominal pain. Expedient diagnosis of common intraperitoneal disease processes such as biliary colic, acute appendicitis and diverticulitis is often delayed as a result of seemingly incongruous physical findings. We present the case of a young woman with prior emergency room visits for complaints of a vague left upper quadrant abdominal pain. An ultrasound performed on her third presentation revealed visceral situs inversus with cholelithiasis and dilated intra- and extrahepatic biliary ducts. Standard laparoscopic cholecystectomy and cholangiography with a mirror-image surgical approach was performed successfully and without complication.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Intrahepatic calculi: imaging by MR.The magnetic resonance (MR) examinations of six patients with intrahepatic calculi were reviewed retrospectively to 1) determine the ability of MR to demonstrate intrahepatic calculi and 2) assess the MR appearance of the stones. In five out of six cases, MRI demonstrated intrahepatic calculi. In three cases, stones exhibited a low intensity signal on the different spin echo (SE) sequences, as previously described by in vitro and in vivo studies. However in two other cases, a significant signal with short T1 and relatively long T2 relaxation times was noticed. These different features are discussed in relation to chemical and physical differences in intrahepatic calculi and compared with variable CT attenuation values of stones. MRI seems to provide complementary information concerning intrahepatic calculi.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. gallstones presenting as mental and physical debility in the elderly.Within 1 year six elderly patients (aged 80-89 years) were admitted because of non-specific deterioration in mental or physical well-being. In no instance was hepatobiliary disease suspected at the time of hospital admission. One patient presented with intermittent confusion only. The other five were referred with "falls" or having "gone off legs", with malaise, confusion, or incontinence. All had raised alkaline phosphatase levels of 159-1230 IU/l, which led to investigation of the biliary tree. At endoscopic retrograde cholangiopancreatography all were shown to have biliary disease (three common duct stones, one gallbladder calculus, one an abscess, and one a widely dilated common bileduct ). With appropriate treatment (endoscopic sphincterotomy for two, surgery for two, and antibiotics alone for two), all showed a gratifying return of mobility and mental function. Biliary disease is a treatable cause of chronic ill health in the elderly and should be excluded, even in the absence of "classical" symptoms, when there is abnormal liver function.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
6/8. Spontaneous external biliary fistula in a patient with heroin addiction.Spontaneous external biliary fistula, once common, is now a rare clinical entity. A patient with this lesion is described and attention is drawn to the fact that this rare condition is still being seen in certain patients with neglected cholecystitis. heroin addiction was thought to have modified his response to gallbladder disease and contributed to the perforation. diagnosis was suspected on physical examination and confirmed by spontaneous discharge of stones and fistulogram.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Pitfalls in laparoscopic cholecystectomy: unrecognized carcinoma of another site.Laparoscopic cholecystectomy has been rapidly adopted as a standard surgical treatment in symptomatic cholelithiasis. Its advantages over laparotomy are well described. However, its risks and long-term results have not been fully evaluated. We experienced three patients in whom intra-abdominal carcinomas failed to be recognized during laparoscopic surgery. The clinical manifestations, laboratory findings, and radiologic findings were carefully reviewed in each case. Limited exploration of the abdominal cavity is one of the technical pitfalls in laparoscopic cholecystectomy; so surgeons can miss the carcinoma of extrabiliary system. To prevent such problems, a careful taking of the history and physical examination should be repeated by the responsible surgeon, who must be aware of the differential diagnosis of cholelithiasis, especially in elderly patients. If needed, additional radiologic studies are recommended.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Indications for surgical resection of metastatic ocular melanoma. A case report and review of the literature.CONCLUSIONS: Ocular melanoma can metastasize to the gallbladder and porta hepatic nodes and mimic pancreatic carcinoma. If one suspects metastatic disease, a complete metastatic work-up must be done prior to surgery to prevent unnecessary surgery. If no distant disease is present or the patient is symptomatic, metastatic disease should be resected. PURPOSE: To review the literature pertaining to the spread of ocular melanoma and to determine if distant disease should be resected. patients AND methods: A 44-yr-old Egyptian male presented to an outside institution with mid-epigastric and right upper quadrant abdominal pain. His past medical history was significant for a left orbital enucleation for uveal melanoma in 1982. On physical examination, there was no supraclavicular adenopathy and no skin lesions were noted. There was a mass in the right upper quadrant. The total bilirubin was 4.8 mg/dL. A computed tomography showed a mass in the head of the pancreas and portal vein involvement could not be determined. RESULTS: The patient was taken to the operating room and a pancreatico-duodenectomy was performed for a cystic mass in the head of the pancreas. Final pathology revealed metastatic melanoma in the gallbladder and an enlarged, cystic lymph node growing into the head of the pancreas replaced with metastatic melanoma. The patient did well post-operatively and was discharged home on the eighth post-operative day.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |