No abstract available.
Liver Transplantation* ; Liver*

Familial adenomatous poliposis is autosomal, predominantly inherited, premalignant disease, which is caused by a mutation in adenomatous poliposis coli gene in chromosome 5q21. Intestinal transplantation is an evolving procedure and has become a lifesaving procedure for pediatrics and adults with intestinal failure who cannot be managed by conventional therapies. Long-term outcome and cost effectiveness continue to improve and will be comparable to those of total parenteral nutrition. The short gut syndrome is the most common indication. Pancreas transplantation, as a solid organ, vascularized graft, has im proved the quality of life for diabetic patients by establishing an insulin-independent, constant normo glycemic state and is a well-established treatment for patients with insulin-dependent diabetes. The bene ficial effect is the maintenance of normoglycemia and possibly the reversal of diabetic complications, such as vasculopathy, neuropathy, and nephropathy. We report a case of pancreas-intestinal transplantation in a familial adenomatous polyposis patient along with a review of the literature.
Adenomatous Polyposis Coli* ; Adult ; Cost-Benefit Analysis ; Diabetes Complications ; Humans ; Pancreas Transplantation ; Parenteral Nutrition, Total ; Pediatrics ; Quality of Life ; Transplants

OBJECTIVES: Hereditary hemorrhagic telangiectasia (HHT) is characterized by the presence of vascular malformations with an absence of capillaries between arteries and veins. One major manifestation site is the nasal mucous membrane where recurrent nosebleeds occur. Our clinical strategy to treat patients with HHT has the aim to reduce nasal bleeding long-term with minimal local and general side effects. METHODS: We describe staged diagnosis and therapy including individual medical treatments of 97 patients with HHT. The success of treatment is monitored with a systematic questionnaire. RESULTS: The neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy remains standard treatment of choice with no major side effects despite the need for repeated treatment. In addition new treatment strategies like nasal occlusion, local drug therapy, and nasal septal splinting show initial success. CONCLUSION: Improvement of the quality of life of HHT patients can be achieved by a multimodal concept. Several new treatment strategies like nasal septal splinting and nasal occlusion successfully expand the range of established methods. Further studies have to prove the safety and long-term effectiveness of the described individual medical treatments.
Arteries ; Arteriovenous Malformations ; Bevacizumab ; Capillaries ; Diagnosis ; Drug Therapy ; Epistaxis ; Humans ; Laser Therapy ; Mucous Membrane ; Quality of Life ; Splints ; Telangiectasia, Hereditary Hemorrhagic* ; Vascular Malformations ; Veins ; Yttrium

*Chemoembolization, Therapeutic ; Liver Neoplasms, Experimental/*therapy ; Microspheres ; Polyglactin 910/*therapeutic use ; Rats, Inbred ACI

Clostridium difficile, an anaerobic toxigenic bacterium, causes a severe infectious colitis that leads to significant morbidity and mortality worldwide. Both enhanced bacterial toxins and diminished host immune response contribute to symptomatic disease. C. difficile has been a well-established pathogen in North America and Europe for decades, but is just emerging in Asia. This article reviews the epidemiology, microbiology, pathophysiology, and clinical management of C. difficile. Prompt recognition of C. difficile is necessary to implement appropriate infection control practices.
Asia/epidemiology ; Clostridium Infections/*diagnosis/epidemiology/microbiology/*therapy ; Clostridium difficile/genetics/*pathogenicity ; Europe/epidemiology ; Global Health ; Humans ; North America/epidemiology

Animals ; Chemoembolization, Therapeutic ; Liver Neoplasms, Experimental ; therapy ; Male ; Microspheres ; Polyglactin 910 ; therapeutic use ; Rats ; Rats, Inbred ACI

Methods: A retrospective chart review of 1- and 2-level MIS-TLIFs performed from 2014 to 2020 was reviewed. Radiographic measurements were obtained preoperatively, 6 weeks postoperatively, and at final follow-up. Patient-reported outcome measures (PROMs) including the Oswestry Disability Index, Visual Analog Scale (VAS) back, and VAS leg were evaluated. Multivariate linear regression analysis determined the effect of cage type on the change in PROMs, controlling for demographic characteristics. Alpha was set at 0.05. Results: A total of 221 patients underwent MIS-TLIF including 136 static and 85 expandable cages. Expandable cages had significantly greater anterior (static: 11.41 mm vs. expandable: 13.11 mm, p <0.001) and posterior disk heights (static: 7.22 mm vs. expandable: 8.11 mm, p <0.001) at 1-year follow-up. Expandable cages offered similar improvements in segmental lordosis at 6 weeks (static: 1.69° vs. expandable: 2.81°, p =0.243), but segmental lordosis was better maintained with expandable cages leading to significant differences at 1-year follow-up (static: 0.86° vs. expandable: 2.45°, p =0.001). No significant differences were noted in total complication (static: 12.5% vs. expandable: 16.5%, p =0.191) or cage subsidence rates (static: 19.7% vs. expandable: 22.4%, p =0.502) groups at 1-year follow-up. Conclusions Expandable devices provide greater improvements in radiographic measurements including anterior disk height, posterior disk height, and segmental lordosis, but this did not lead to significant improvements in PROMs, complication rates, subsidence rates, or subsidence distance.

Liposarcomas of the spermatic cord are rare and often clinically and histologically misdiagnosed, leading to ineffective management and poor outcomes. We present a case of metastatic dedifferentiated liposarcoma of the spermatic cord, which recurred after excision of a misdiagnosed well-differentiated liposarcoma 3 years prior. Due to its size and high-grade metastasis, the tumor was unresectable, leading to treatment with systemic chemotherapy. Complications arose including partial compression of the testicular artery and urethral obstruction secondary to local mass effect. Tumor biopsy was characterized by a unique immunohistochemical profile which helped to explain the unique processes leading to mass effect, vascular and urethral compression, and bilateral scrotal swelling. The patient’s family history of malignancy and 22/22q trisomy identified in the tumor biopsy were also interesting contributors. In conclusion, accurate diagnosis of spermatic cord tumors is essential for effective treatment, and further data collection is required to improve management of advanced metastatic disease.

We evaluated the effect of nicotinamide on cellular O2 consumption and metabolic status i.e., adenylate phosphates and NAD+ in-vitro, and changes in blood flow in-vivo, to determine whether changes in cellular metabolism or increased oxygen availability, was responsible for increased tumor oxygenation. Thirty min. Pre-incubation of cells with~4mM (=500mg/kg) nicotinamide resulted in no change in cellular O2 consumption. Similarly, neither the adenylate phosphates nor the cellular NAD+ levels were altered in the presence of~4mM nicotinamide. In-vivo, nicotinamide (500mg/kg) increased O2availability as estimated by changes in relative tumor blood flow (RBC flux). The changes in RBC flux measured by the laser Doppler method, were tumor volume dependent and increased from~35% in~150mmdegree tumors to~75% in~500mmdegree tumors. In conclusion, these observations indicate a reduction in local tissue O2 consumption is not a mechanism of improved tumor oxygenation by nicotinamide in FsaII murine tumor model. The primary mechanism of increased pO2 appears to be an increased local tumor blood flow.
Laser-Doppler Flowmetry ; Metabolism ; Niacinamide ; Oxygen ; Phosphates ; Tumor Burden

A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck.
Carotid Body Tumor/blood supply/*therapy ; Cyanoacrylates/administration & dosage/*adverse effects ; Embolization, Therapeutic/*methods ; Enbucrilate ; Foreign-Body Migration/*complications ; Humans ; Injections, Intralesional ; Male ; Middle Aged ; Stroke/*etiology