Portal Vein Embolization Followed by Liver Resection versus Liver Resection Alone: a Comparison of Liver Regeneration Dynamics.

Background/aims: Portal vein embolization (PVE) is an accepted procedure, which, by redirecting portal vein flow toward specific hepatic segments, is able to pre-operatively increase the volume of the future liver remnant (FLR). The consequent reduction of liver dysfunction risk enables to extend the number of pa tients eligible for major hepatic resection. This study aims at comparing liver regeneration dynamics and long-term volumetric recovery after major hepatic re section preceded by PVE versus major hepatic resec tion not preceded by PVE.

Walking unsteadily: a case of acute cerebellar ataxia.

Acute cerebellar ataxia is an infrequent neurological syndrome in adults especially if complicated by additional neurological deficits. We report the case of a 69-year-old woman who presented with sudden onset of left facial droop, dizziness, slurred speech and impaired balance. Her medical history included paroxysmal atrial fibrillation and a sigmoid diverticular abscess treated with ciprofloxacin and metronidazole.

Randomised comparison of complications from three different permanent central venous access systems.

Principles: We present a prospective randomised trial comparing complications from three different permanent central venous access systems (PCVAS).

Methods: The PCVAS trial groups were I, polyurethane ChemoSite (AutoSuture); II, polyurethane Port-a-Cath (Pharmacia-Upjohn); and III, silicone Port-a-Cath. The PCVAS were inserted under local anaesthesia by direct puncture of the subclavian vein, using the Seldinger technique.

Localized hepatic ischemia after liver resection: a prospective evaluation.

Objective: To prospectively assess the frequency, severity, and extension of localized ischemia in the remaining liver parenchyma after hepatectomy.

Background: Major blood loss and postoperative ischemia of the remnant liver are known factors contributing to morbidity after liver surgery. The segmental anatomy of the liver and the techniques of selective hilar or suprahilar clamping of the Glissonian sheaths permit identification of ischemia on the surface of the corresponding segments for precise section of the parenchyma.

Middle mesenteric artery: contraindication to endovascular repair of an abdominal aortic aneurysm?

Middle mesenteric artery has been described in 1923. We report the observation of a patient with an abdominal aortic aneurysm who had this rare artery arising from the anterior wall of the aneurysmal sac. His inferior mesenteric artery was occluded at its origin from the aorta and the middle and the distal colon was vascularized only by the middle mesenteric artery.

Stenting of a spontaneous dissection of the superior mesenteric artery: a new therapeutic approach?

Spontaneous dissection of the superior mesenteric artery (SMA) is rare and has been reported only sporadically. Therapeutic options are either a surgical approach, which is the more frequently adopted, or a simple observation. We report a case of spontaneous dissection of the SMA with a review of the literature and present a new therapeutic approach.

Thrombus aspiration as a bailout procedure during percutaneous renal angioplasty.

Purpose: To present a case in which thrombus aspiration, urokinase, and abciximab were used to recanalize a sudden acute thrombotic occlusion of the right renal artery during percutaneous renal angioplasty.

Case Report: A 72-year-old man with severe arterial hypertension, impaired renal function, and peripheral artery disease was referred for interventional renal revascularization of a proximal stenosis of the right renal artery. Predilation was unsuccessful, and stent placement was followed by immediate occlusion of the distal renal artery, probably due to dislocation of a mural thrombus.

Extrahepatic arterioportal fistula: three-dimensional reconstruction of computerized tomodensitometric scan for diagnosis and morphologic assessment.

Arterioportal fistulae (APFs) are rare. An asymptomatic APF was suspected by computed tomography. Multiplanar, maximum intensity projection, and surface shaded display reconstructions showed its anatomy.

CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules.

Objective: Evaluation of the efficiency of our technique of methylene-blue labelling of pulmonary nodules to facilitate thoracoscopic recognition and excision.

Design: Patients with a peripheral pulmonary nodule smaller than 2.5 cm and not in contact with the visceral pleura were included.

Thoracoscopic pleurodesis for prolonged (or intractable) air leak after lung resection.

Air leaks are common after lung resection, and normally seal with conservative therapy. Re-thoracotomy is rarely indicated. We present three patients with prolonged air leak and partial pneumothorax treated by thoracoscopy.

[Thoracoscopic treatment of recurrent pneumothorax].

Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO.

Bacteriuria during urinary tract catheterization: suprapubic versus urethral route: a prospective randomized trial.

In this randomized prospective trial urethral and suprapubic routes were compared in terms of tolerance and infectious potential. Daily bacteriuria determined infectious danger and patients were interrogated on the pain and discomfort induced by their catheter every day. Identical single dose pre-operative antibiotic prophylaxis was routinely applied.

Rectal leiomyosarcoma: acute presentation after local injury.

Rectal leiomyosarcoma is rare, often large and found in the distal third of the rectum. Most symptoms differ from those of an adenocarcinoma. Staging is difficult and should include tumour size, necrosis, cellularity, number of mitoses and anaplasia.