Long-term Survival of Patient with Ampulla of Vater Metastasis of Renal Cell Carcinoma.

Ampulla of Vater metastases from renal cell carcinoma are rare. The time between detection of the primary tumour and its metastasis may extend to years. Management should be aggressive, since the prognosis of renal cell carcinoma is unpredictable and curative surgery of metastases may extend patient survival and even lead to definite cure.

Preoperative Endoscopic Biliary Drainage May Negatively Impact Survival Following Pancreatoduodenectomy for Ampullary Cancer.

Background/aims: Ampullary carcinoma is a rare tumour with a high resectability rate. There is an increasing body of evidence indicating not only tumour-related factors, but also jaundice influence survival following curative resection. Several modalities for preoperative biliary drainage are available; however, routine preoperative endoscopic biliary drainage (PEBD) is not recommended.

Factors influencing survival after pancreatoduodenectomy for ductal adenocarcinoma depend on patients' age.

Background: It is supposed that a prolonged lifetime will be associated with increased incidence of PDAC among the elderly. Some studies show a tendency toward decreased survival in the elderly patients following pancreatoduodenectomy for PDAC. The aim of this study was to evaluate factors, influencing survival following pancreatoduodenectomy for PDAC in different age groups.

Impact of etiology on course and outcomes of severe acute pancreatitis.

Background And Objective: Since the influence of etiological factors on the course and outcomes of acute pancreatitis (AP) is not fully understood yet, the aim of the study was to compare the outcomes of alcoholic and biliary severe acute pancreatitis (SAP).

Materials And Methods: We investigated 81 patients with alcoholic and biliary SAP. Demographic data, etiologic factors, severity scores, intra-abdominal pressure, imaging studies, interventions, and treatment outcomes were prospectively entered into specially maintained database and subsequently analyzed.

Heme oxygenase-1 gene promoter polymorphism is associated with the development of necrotizing acute pancreatitis.

Objectives: Acute pancreatitis is a severe and frequently life-threatening disease, which can lead to pancreatic necrosis, acute lung injury, systemic inflammatory response syndrome, and other complications. In this study, we hypothesized that the expression of heme oxygenase-1 determined by the number of guanidinium thiocyanate (GT) repeats can influence the occurrence of acute pancreatitis.

Methods: Patients with acute pancreatitis (n = 131) and age- and sex-matched healthy controls (n = 108) were studied.

Fatty acids of erythrocyte membrane in acute pancreatitis patients.

Aim: To evaluate changes in the fatty acid composition of erythrocyte membrane phospholipids during severe and mild acute pancreatitis (AP) of alcoholic and nonalcoholic etiology.

Methods: All consecutive patients with a diagnosis of AP and onset of the disease within the last 72 h admitted to the Hospital of Lithuanian University of Health Sciences between June and December 2007 were included. According to the Acute Physiology and Chronic Health Evaluation (APACHE II) scale, the patients were subdivided into the mild (APACHE II score < 7, n = 22) and severe (APACHE II score ≥ 7, n = 17) AP groups.

Emergent pancreaticoduodenectomy: a dual institution experience and review of the literature.

Background: Emergent pancreaticoduodenectomy (EPD) is an uncommon surgical procedure performed to treat patients with acute pancreaticoduodenal trauma, bleeding, or perforation. This study presents the experience of two university hospitals with EPD.

Methods: Clinical data on EPD in trauma and nontrauma patients from 2002-2012 were extracted from the hepatopancreatobiliary surgery databases at Thomas Jefferson University and Kaunas Medical University Hospitals.

Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study.

Background: Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment.

Whole blood DNA aberrant methylation in pancreatic adenocarcinoma shows association with the course of the disease: a pilot study.

Pancreatic tumors are usually diagnosed at an advanced stage in the progression of the disease, thus reducing the survival chances of the patients. Non-invasive early detection would greatly enhance therapy and survival rates. Toward this aim, we investigated in a pilot study the power of methylation changes in whole blood as predictive markers for the detection of pancreatic tumors.

Referral pattern, management, and long-term results of laparoscopic bile duct injuries: a case series of 44 patients.

Background And Objective: The incidence of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is higher than after open cholecystectomy, and the management of these lesions is still controversial. This study analyzed diagnostic and management strategies as well as long-term outcomes after BDI.

Material And Methods: A prospective database of patients with BDIs at the Clinic of Surgery was maintained during the 8-year period (2000-2007).

Effects of prophylactic antibiotics in acute pancreatitis.

Objectives: The use of prophylactic antibiotics in severe acute pancreatitis (SAP) is controversial. The aim of this study was to compare the effects of antibiotics administered as prophylaxis and as treatment on demand, respectively, in two prospective, non-randomized cohorts of patients.

Methods: The study population consisted of 210 patients treated for SAP.

[Early postoperative intraperitoneal chemotherapy for the treatment of advanced gastric cancer].

Unlabelled: Surgery remains the main treatment modality for gastric cancer. Adjuvant radiochemotherapy and adjuvant chemotherapy are becoming more and more popular in the treatment of advanced gastric cancer. Early postoperative intraperitoneal chemotherapy as one of the methods of adjuvant chemotherapy is currently being extensively investigated.

Measurement of melanoma thickness--comparison of two methods: ultrasound versus morphology.

Objective: The aim of our study was to investigate the association between non-invasive ultrasound examination and morphologic test results in the measurement of cutaneous melanoma thickness influencing surgical treatment strategy.

Methods: Our prospective clinical study has been conducted in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital (KUMH) since January 2004 until October 2008. A total of 100 patients with a clear clinical diagnosis of stage I-II cutaneous melanoma were enrolled in this study.

The influence of thoracic epidural anesthesia on liver hemodynamics in patients under general anesthesia.

Background And Objective: Hepatic hypoperfusion is regarded as an important factor in the pathophysiology of perioperative liver injury. Although thoracic epidural anesthesia is a widely used technique, limited data are available about the effects on hepatic blood flow with blockade restricted to thoracic segments in humans. The main objective of the present study was to investigate the effects of thoracic epidural anesthesia on hepatic blood flow under general anesthesia in humans.

Comparative diagnostic value of contrast-enhanced ultrasonography, computed tomography, and magnetic resonance imaging in diagnosis of hepatic hemangiomas.

Aim: To compare the value of intravenous contrast-enhanced ultrasonography (US), intravenous contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis of hepatic hemangiomas.

Material And Methods: The study enrolled 48 patients, aged between 20 and 79 years (35 [72.9%] women, 13 [27.

Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis.

Background And Objective: Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome.

Material And Methods: Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol.

Radiofrequency ablation of liver tumors (II): clinical application and outcomes.

Radiofrequency ablation is one of the alternatives in the management of liver tumors, especially in patients who are not candidates for surgery. The aim of this article is to review applicability of radiofrequency ablation achieving complete tumor destruction, utility of imaging techniques for patients' follow-up, indications for local ablative procedures, procedure-associated morbidity and mortality, and long-term results in patients with different tumors. The success of local thermal ablation consists in creating adequate volumes of tissue destruction with adequate "clear margin," depending on improved delivery of radiofrequency energy and modulated tissue biophysiology.

Different profiles of cytokine expression during mild and severe acute pancreatitis.

Aim: To study secretion patterns of pro- and anti-inflammatory cytokines, and activation of various cellular subsets of leukocytes in peripheral blood.

Methods: We have conducted a prospective observational study. One hundred and eight patients with a diagnosis of acute pancreatitis and onset of the disease within last 72 h were included in this study.

Value of the different prognostic systems and biological markers for predicting severity and progression of acute pancreatitis.

Objective: Several tools have been developed for severity stratification in acute pancreatitis (AP). They include single biochemical markers and complex scoring systems, all of which aim at an early detection of severe AP to optimize monitoring and treatment of these patients. The aim of this study was to reassess and compare the value of some known and newly-introduced prognostic markers in the clinical context.

A combinative effect of low-molecular-weight heparin and intermittent pneumatic compression device for thrombosis prevention during laparoscopic fundoplication.

BACKGROUND. Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. For instance, 20-30% of patients develop this problem after general surgical operations, while 5.

Radiofrequency ablation of liver tumors (I): biological background.

Majority of patients suffering from liver tumors are not candidates for surgery. Currently, minimal invasive techniques have become available for local destruction of hepatic tumors. Radiofrequency ablation is based on biological response to tissue hyperthermia.

[Pattern and causes of hemodynamic changes during hepatic resection].

Unlabelled: The aim of this study was to determine the causes and pattern of hemodynamic changes during hepatic resection, performed without vascular exclusion technique, and to select the most appropriate methods for monitoring patient's condition during the surgery.

Material And Methods: This prospective study included 55 ASA class I-III patients who had undergone hepatic resection surgery at the Clinic of Surgery, Hospital of the Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2003-2008. Additional monitoring of central hemodynamic parameters, arterial blood pressure, central venous pressure, and pressure in the inferior vena cava using invasive methods was performed.

[Comparative diagnostic value of computed tomography and contrast-enhanced ultrasonography in diagnosis of focal liver lesions].

OBJECTIVE. The aim of the study was to evaluate focal liver lesions by computed tomography and contrast-enhanced ultrasonography and to compare their diagnostic values. MATERIALS AND METHODS.

Apoptosis is activated in an early period after radiofrequency ablation of liver tissue.

Background/aims: Hyperthermia induced apoptosis may lead to tumor cell death thus expanding the volume of non-viable tissue and warrant a "safety margin" of at least 10mm to exclude the possibility of tumor recurrence. We carried out an experimental study to investigate the cellular injury produced by radiofrequency ablation in the area surrounding the ablated tissue and to describe early apoptotic processes in the transition zone following radiofrequency ablation procedure in a porcine liver model.

Methodology: Nine anesthetized pigs underwent laparotomy and local thermal ablation of the liver parenchyma.