No abstract available.
Breast Neoplasms/*complications/*surgery ; Female ; Humans ; Liver Neoplasms/*secondary/*surgery ; Male

Education, Medical, Graduate ; standards ; General Surgery ; education ; Humans ; Singapore ; Workload ; statistics & numerical data

Aged ; Bile Duct Diseases ; complications ; diagnostic imaging ; pathology ; Bile Duct Neoplasms ; diagnosis ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Jaundice, Obstructive ; etiology ; Klatskin Tumor ; diagnosis ; Liver Neoplasms ; complications ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Thrombosis ; complications ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

Aims: Solanum trilobatum Linn., (Solanaceae) is one of the most widely used plants as food supplement in southern part of India and some parts of Southeast Asia. This plant is traditionally used for the treatment of respiratory illness. In animal studies, the extract of S. trilobatum showed significant antimicrobial, hepatoprotective and anticancer activities. The complete phytochemical profile, antimicrobial and mast cell stabilizing activities of S. trilobatum remains unclear. This study tests the antimicrobial, antihistaminic and mast cell stabilizing activities of ethanolic extract of leaves of S. trilobatum (EEST). Methodology and results: The phytochemical test was carried out using chemical and instrumental [Gas Chromatography Mass Spectrometry (GC-MS)] analytical methods. Antimicrobial effect of EEST was tested against Streptococcus pneumonia, Escherichia coli and Staphylococcus aureus. Intestinal mesentery of Sprague Dawley (SD) rats was used to study the peritoneal mast cell stabilization activity of EEST. The rat intestinal mesentery was exposed to 50, 100, 200, 300, 400 and 600 μg/mL of EEST and the peritoneal mast cell stabilization activity was compared with that of standards (pheniramine 20 μg/mL and ketotifen 20 μg/mL). The phytochemical test showed the presence of carbohydrates, saponins, flavonoids, alkaloids, tannins and phenolic compounds. GC-MS analysis indicated the presence of 45 fragmented compounds which included epoxylinalol, himachalol, illudol, epibuphanamine, baimuxinal and edulan IV. EEST exhibited antimicrobial activity at 10 mg/mL against S. aureus, S. pneumonia. Significant mast cell stabilizing activity was observed from the dose of 100 μg/mL to 600 μg/mL. Conclusion: Ethanolic extract of leaves of S. trilobatum possess significant antimicrobial and antihistaminic activity.

INTRODUCTIONThe extent of lymph nodes (LNs) metastasis is a major determinant for the staging and the most reliable adverse prognostic factor. Primary tumours can induce lymphatics and vasculature reorganisations within sentinel LN before the arrival of cancer cells and these key blood vessels are identified as high endothelial venules (HEV). The alterations of HEV in the presence of cancer, coupled with the increased proliferation rate of the endothelial cells, results in a functional shift of HEV from immune response mediator to blood flow carrier. We aim to evaluate tumour-induced vascularisation in regional LN of cancer patients by studying the morphological and functional alterations of HEV and its correlation to clinico-pathological features.

MATERIALS AND METHODSThis multi-centre study with a prospective database identified 65 consecutive patients with tongue squamous cell carcinoma (SCC) who underwent primary surgical treatment from 2001 to 2005. Immunohistochemical staining for HEV and image analysis were performed and analysed with correlation to the patients' clinico-pathological features.

RESULTSThe total number of HEV is significantly associated to disease-free interval when controlling for the group (P = 0.022) as well as combining both groups as one cohort (P = 0.023). There is also a similar association comparing the HEV parameters to overall survival.

CONCLUSIONOur results suggest that HEV possibly plays a key role in the pathogenesis of lymphatic and subsequent distant metastases and may provide the missing link in cancer metastasis. Confirmation of this hypothesis would offer a novel therapeutic approach to preventing metastasis by blocking the remodeling processes of HEV in LN.

Awards and Prizes ; Biomarkers ; Databases, Factual ; Endothelial Cells ; physiology ; General Surgery ; Humans ; Lymph Nodes ; blood supply ; pathology ; Neoplasm Metastasis ; diagnosis ; Neovascularization, Pathologic ; pathology ; Prospective Studies ; Venules ; pathology

Adult ; Aged ; Betacoronavirus ; Coronavirus Infections ; complications ; therapy ; Critical Care ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Pandemics ; Patient Positioning ; Pneumonia, Viral ; complications ; therapy ; Prone Position ; Respiratory Distress Syndrome, Adult ; therapy ; virology ; Respiratory Function Tests ; Retrospective Studies ; Treatment Outcome

INTRODUCTIONExperience with robot-assisted laparoscopic (RAL) hepatobiliary and pancreatic (HPB) surgery remains limited worldwide. In this study, we report our early experience with RAL HPB surgery in Singapore.

METHODSA retrospective review of the first 20 consecutive patients who underwent RAL HPB surgery at a single institution over a 34-month period from February 2013 to November 2015 was conducted. The 20 cases were performed by three principal surgeons, of which 17 (85.0%) were performed by a single surgeon.

RESULTSThe median age of patients was 56 (range 22-75) years and median tumour size was 4.0 (range 1.2-7.5) cm. The surgeries performed included left-sided pancreatectomies (n = 10), hepatectomies (n = 7), triple bypass with bile duct exploration for obstructing pancreatic head cancer with choledocholithiasis (n = 1), cholecystectomy for Mirizzi's syndrome (n = 1) and gastric resection for gastrointestinal stromal tumour (n = 1). The median operation time was 445 (range 80-825) minutes and median blood loss was 350 (range 0-1,200) mL. There was only 1 (5%) open conversion. There were 2 (10.0%) major morbidities (> Grade II on the Clavien-Dindo classification) and no 30-day/in-hospital mortalities. There was no reoperation for postoperative complications. The median postoperative stay was 5.5 (range 3-22) days.

CONCLUSIONOur initial experience confirms the feasibility and safety of RAL HPB surgery.

Adult ; Aged ; Bile Ducts ; surgery ; Cholecystectomy ; Female ; Hepatectomy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Operative Time ; Pancreas ; surgery ; Pancreatectomy ; Postoperative Complications ; etiology ; Reoperation ; Retrospective Studies ; Robotic Surgical Procedures ; Singapore ; Young Adult

There has been growing concern surrounding the use of unconfined power morcellation in laparoscopic surgeries for uterine leiomyoma due to its associated risks and long-term clinical sequelae, including parasitic leiomyomas and disseminated peritoneal leiomyomatosis (DPL). We present a case of DPL resulting from previous laparoscopic morcellation and a review of the existing literature. DPL is a potentially devastating consequence of unconfined laparoscopic morcellation in the surgical management of uterine fibroids. A multidisciplinary approach is recommended in the management of DPL, especially in cases of multivisceral involvement. Clinical caution ought to be exercised when using power morcellators; when unavoidable, confined laparoscopic morcellation offers a promising mitigation and should be adopted if practicable.

INTRODUCTION: Fluorescence imaging (FI) with indocyanine green (ICG) is increasingly implemented as an intraoperative navigation tool in hepatobiliary surgery to identify hepatic tumours. This is useful in minimally invasive hepatectomy, where gross inspection and palpation are limited. This study aimed to evaluate the feasibility, safety and optimal timing of using ICG for tumour localisation in patients undergoing hepatic resection. METHODS: From 2015 to 2018, a prospective multicentre study was conducted to evaluate feasibility and safety of ICG in tumour localisation following preoperative administration of ICG either on Day 0-3 or Day 4-7. RESULTS: Among 32 patients, a total of 46 lesions were resected: 23 were hepatocellular carcinomas (HCCs), 12 were colorectal liver metastases (CRLM) and 11 were benign lesions. ICG FI identified 38 (82.6%) lesions prior to resection. The majority of HCCs were homogeneous fluorescing lesions (56.6%), while CLRM were homogeneous (41.7%) or rim-enhancing (33.3%). The majority (75.0%) of the lesions not detected by ICG FI were in cirrhotic livers. Most (84.1%) of ICG-positive lesions detected were < 1 cm deep, and half of the lesions ≥ 1 cm in depth were not detected. In cirrhotic patients with malignant lesions, those given ICG on preoperative Day 0-3 and Day 4-7 had detection rates of 66.7% and 91.7%, respectively. There were no adverse events. CONCLUSION ICG FI is a safe and feasible method to assist tumour localisation in liver surgery. Different tumours appear to display characteristic fluorescent patterns. There may be no disadvantage of administering ICG closer to the operative date if it is more convenient, except in patients with liver cirrhosis.

INTRODUCTIONWe aimed to analyse the changing trends, safety and outcomes associated with the adoption of laparoscopic liver resection (LLR) at a single centre.

METHODSA retrospective review of patients who underwent LLR from 2006 to 2014 at our institution was performed. To explore the evolution of LLR, the study was divided into three equal consecutive time periods (Period 1: 2006-2008, Period 2: 2009-2011, and Period 3: 2012-2014).

RESULTSAmong 195 patients who underwent LLR, 24 (12.3%) required open conversions, 68 (34.9%) had resection of tumours in the difficult posterosuperior segments and 12 (6.2%) underwent major (≥ 3 segments) hepatectomies. Median operation time was 210 (range 40-620) minutes and median postoperative stay was 4 (range 1-26) days. Major postoperative morbidity (> Grade II) occurred in 11 (5.6%) patients and 90-day/in-hospital mortality was 1 (0.5%). During the study, the number of LLRs performed showed an increasing trend (Period 1: n = 22; Period 2: n = 19; Period 3: n = 154). Other statistically significant trends were: (a) increase in malignant neoplasms resected; (b) increase in resections of difficult posterosuperior segments; (c) longer median operation time; and (d) decrease in open conversion rates.

CONCLUSIONOver the study period, the number of LLRs increased rapidly. LLR was increasingly performed for malignant neoplasms and lesions located in the difficult posterosuperior segments, resulting in longer operation times. However, open conversion rates decreased, and there was no change in postoperative morbidity and other perioperative outcomes.