Clostridium difficile small-bowel enteritis after total proctocolectomy: a rare but fatal, easily missed diagnosis. Report of a case.

Purpose: Clostridium difficile enteritis is a rare infection, with less than a dozen cases reported in the literature. We present a case of a patient with total proctocolectomy and ileostomy, developing Clostridium difficile infection of small bowel. We discuss the role of Clostridium difficile toxins and review previously reported cases of Clostridium difficile enteritis after total colectomy.

Differential regulation of adiponectin secretion from cultured human omental and subcutaneous adipocytes: effects of insulin and rosiglitazone.

Adiponectin is an adipocyte-derived plasma protein with insulin-sensitizing and antiatherosclerotic properties. Because adipose tissue depots differ in the strength of their association with the adverse metabolic consequences of obesity, we studied the secretion of adiponectin in vitro from paired samples of isolated human omental and sc adipocytes and its regulation by insulin and rosiglitazone. Cells were incubated for 12 or 24 h with and without treatment with 100 nM insulin, 8 micro M rosiglitazone, or both combined; adiponectin secreted into the culture medium was measured by a RIA with a human adiponectin standard and normalized for cellular DNA content.

Intraoperative radiotherapy in the combined-modality management of pancreatic cancer.

The purpose of this study is to assess the feasibility, clinical tolerance, local control, and survival rates using a combined-modality treatment program of intraoperative radiation, chemotherapy, and external beam radiation for the management of patients with pancreatic cancer. One hundred eighty patients with biopsy-proven adenocarcinoma of the pancreas have been treated by a single surgical practice between 1979 and 1992. Of these, 105 had locally advanced but unresectable primary tumors (stages 2 and 3).

Pancreatic resection combined with intraoperative radiation therapy for pancreatic cancer.

Objective: The objective of the study was to analyze a single center's experience in the treatment of pancreatic carcinoma with a combination of pancreatic resection and intraoperative radiation therapy (IORT).

Summary Background Data: Pancreatic cancer is the most lethal form of gastrointestinal malignancy. Historically, it carries a 20% 1-year survival and a 5-year survival of 3% to 5%.

Improved staging of liver tumors using laparoscopic intraoperative ultrasound.

Background: Intraoperative ultrasound has been shown to provide significant assistance in operative staging and management of patients with liver tumors during open surgery. The availability of the 5.0-7.

Laparoscopic liver sonography: preliminary experience in liver metastases compared with CT portography.

This study evaluated the ability of laparoscopic ultrasonography to detect, localize, and characterize focal liver masses. Laparoscopic ultrasonography and CT portography of the liver were performed in 13 patients with known or suspected malignancy. Laparoscopic ultrasonography directly influenced surgical management in four (31%) cases; three by detection of small focal masses and one by exclusion of masses suspected on CT portography.

Laparoscopic Ultrasound: Its Role in Laparoscopic Surgery.

Laparoscopic surgery has been accepted as the surgery of choice for may diagnostic and therapeutic abdominal procedures because of decreased morbidity, reduced cost, and improvement in long-term outcomes compared with open procedures. However, this approach has inherent limitations in the evaluation of diseases concealed within solid organs, hollow viscera, or the retroperitoneum. Laparoscopic ultrasound, which evolved from the concepts of intraoperative and endoscopic ultrasound, opens a whole new dimension to accurately diagnose and treat conditions laparoscopically.

Combined intraoperative radiation and perioperative chemotherapy for unresectable cancers of the pancreas.

Purpose: To evaluate the effectiveness of combined intraoperative radiation therapy (IORT) and perioperative chemotherapy in the management of unresectable pancreatic cancer.

Materials And Methods: Forty-nine patients with localized unresectable adenocarcinoma of the pancreas were treated in a multimodality program of initial IORT and perioperative chemotherapy (fluorouracil [5-FU]/leucovorin) followed by combined external-beam radiation (40 to 55 Gy) and continued chemotherapy. Patients were evaluated for toxicity, pattern of failure, and survival.

Cholangiocarcinoma: clinical significance of tumor location along the extrahepatic bile duct.

Purpose: To define the criteria for resection and/or radiation therapy (RT) of extrahepatic bile duct cancer.

Materials And Methods: Of 81 patients with extrahepatic bile duct cancer treated from 1983 to 1992, those with proximal duct lesions (n = 56) underwent RT and/or resection or palliative care, and those with distal lesions (n = 25) underwent resection with or without RT. Follow-up was available 3-114 months (median, 28 months).

Laparoscopic pelvic lymphadenectomy combined with inguinal herniorrhaphy.

Laparoscopic surgical interventions are being widely applied for a variety of procedures that have been traditionally managed through open surgical approaches. Laparoscopic pelvic lymphadenectomy is used as a staging tool for prostate cancer, and the laparoscopic repair of inguinal hernias is becoming commonplace. We report on a case of laparoscopic inguinal hernia repair combined with lymphadenectomy in a patient who was to undergo definitive radiation therapy for localized carcinoma of the prostate.

Laparoscopic gray-scale and color Doppler US: preliminary animal and clinical studies.

Purpose: To evaluate a semiflexible ultrasound (US) transducer inserted through a laparoscopic port to image abdominal structures.

Materials And Methods: Laparoscopic US with a 9.6-mm-diameter, 5.

Perioperative implantation of iridium-192 as the boost technique for stage I and II breast cancer: results of a 10-year study of 655 patients.

Purpose: To assess the efficacy of perioperative implantation of iridium-192 for stage I and II breast cancer.

Materials And Methods: The authors retrospectively reviewed findings from 655 patients with stage I and II cancer treated with conservative surgery and Ir-192 implantation between 1982 and 1992. Hollow plastic tubes were placed in the tumor bed as a single- or double-plane implant at lumpectomy.

Carcinoma of the pancreas--the Jefferson experience 1975-1988.

A retrospective review of 410 patients with carcinoma of the pancreas seen at Thomas Jefferson University from 1975-1988 was undertaken to provide a global view of the effectiveness of different modalities of treatment in the management of this disease. There were seven patients with Stage I disease, 141 patients with Stage II disease, 91 with Stage III, and 171 with Stage IV disease. The overall median survival was 7 months and a 1-year survival of 30% was observed.

Management of infected pancreatic fluid collections.

Percutaneous drainage of pancreatic collections has recently been advocated as a means of diagnosis of bacterial contamination, for temporizing unstable patients, and as definitive treatment in itself. In order to assess its efficacy, the role of percutaneous drainage of infected pancreatic fluid collections was retrospectively reviewed by a single surgical practice. Seventeen patients were treated over a 5-year period from 1987 to 1992.

Sonographically guided laparoscopy and mediastinoscopy using miniature catheter-based transducers.

Miniature ultrasound transducers (12.5 MHz) housed in 9 Fr catheters were passed through a laparoscope or mediastinoscope to image a variety of normal and abnormal structures within the peritoneal cavity and mediastinum in 20 patients. These transducers made it possible to visualize the gallbladder and bile ducts and evaluate for the presence of stones, to detect masses and provide guidance for their aspiration or biopsy, and to image the internal structures of the ovary and fallopian tube.

Pancreatic disease: findings on state-of-the-art MR images.

Recent technical innovations have made MR imaging a useful technique for imaging the pancreas. The potential impact of MR imaging on the management and outcome of cases can be determined only by controlled prospective comparative studies; however, these cannot be performed adequately until the normal and abnormal appearances of the pancreas on state-of-the-art MR images are understood. This pictorial essay is presented to further this intermediate goal.

Long-term results of combined modality treatment with I-125 implantation for carcinoma of the pancreas.

From 1981 to 1987, 81 patients with localized, unresectable carcinoma of the pancreas were treated at Thomas Jefferson University Hospital with a combination of intraoperative Iodine-125 implantation, external beam radiation, and peri-operative systemic chemotherapy. Fifty patients had Stage II disease and 31 patients had Stage III disease. Radioactive Iodine-125 seeds were implanted intraoperatively into the tumor to deliver a minimum peripheral dose of 12,000 cGy over one year.

Adenocarcinoma of the pancreas: a multimodality approach--a single surgeon's experience (1979-1988).

A retrospective review of a single surgeon's experience with adenocarcinoma of the pancreas was performed. One hundred-one patients were treated over a 10-year period from 1979 to 1988. Seven patients underwent potentially curative resections and 28 patients presented with metastatic (stage IV) disease.

[Severe life-threatening in an infant due to deficiency rickets].

The authors report on a case of cardiocirculatory arrest in a 4-month old infant, related to severe vitamin D deficiency rickets with hypocalcemia. Despite medical follow-up, this infant, who was breast-fed during the first 3 weeks of life, did not receive any vitamin D prophylaxis. This observation shows the potential severity of vitamin D deficiency rickets.

Selective arterial stimulation of secretin in localization of gastrinomas.

In two patients with malignant gastrinoma and the Zollinger-Ellison syndrome, we were able to use selective arterial stimulation with secretin as a technique to localize the lesions accurately, allowing resection. The technique of selected arterial secretin stimulation is one of measuring variations in gastrin levels in both the hepatic vein and a peripheral artery at specified times after injection of secretin into a specific artery. When the criteria for localization have been met, one can plot the presence of the gastrinoma within the blood supply of the injected artery and, using angiograms, thus accurately localize the lesion.

Recurrent esophageal carcinoma at thoracotomy incisions: diagnostic contributions of CT.

Three cases of surgical implantation of esophageal carcinoma during esophagogastrectomy are presented. The CT and radiographic appearance is demonstrated. A possible etiology and method for decreasing the risk of surgical spread of tumor are discussed.

Combined modality treatment of localized unresectable adenocarcinoma of the pancreas.

Since 1978, 86 patients with unresectable localized adenocarcinoma of the pancreas have been treated with a combined modality program using radioactive iodine 125-Implantation, external beam radiation, and systemic chemotherapy. Three treatment approaches were used with sequential modifications of the technique based on the course of disease and patterns of failure. Group 1 was comprised of 13 patients treated with a combination of implantation followed by a planned external radiation dose of 5000 to 6000 cGy delivered in 6 weeks.