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Lobar Atrophy (lobar + atrophy)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Motor neuron disease group accompanied by inclusions of unidentified protein signaled by ubiquitin

NEUROPATHOLOGY, Issue 2 2004
Kenji Ikeda
Peculiar tau-negative, ubiquitin-positive inclusions appear in dementia with ALS (ALS-D), the majority of lobar atrophy (Pick's disease) without Pick body and a small portion of ALS. Another common neuropathological lesion in these diseases is the motor neuron involvement with the degenerative processes. The lower motor neuron is predominantly involved in ALS and ALS-D while the upper motor neuron is predominantly involved, but in varying degrees in a considerable number of patients with lobar atrophy that lack Pick bodies. There are, however, some points that have yet to be elucidated. The boundary between these diseases is not always clear and a significant number of cases are considered to be the transitional form. Lobar atrophy without Pick body seems to be a heterogeneous disease group. The nature of ubiquitin inclusions also needs to be clarified. Nevertheless, we postulate that these diseases are grouped with the concept of motor neuron disease-inclusion dementia. [source]

Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2008
J. Li
Background: Concomitant hepatic artery injury is a rare but severe complication associated with bile duct injury during laparoscopic cholecystectomy (LC). Methods: Sixty patients referred with biliary injury after LC between April 1998 and December 2005 were divided into two groups according to the time elapsed between injury and definitive surgical revision; patients in group 1 were referred early (within 4 days) after operation and those in group 2 were referred later. Hepatic rearterialization was performed in addition to biliary reconstruction when technically possible. Results: Damage to the hepatic artery was detected in ten patients. Hepatic rearterialization was carried out in five patients by end-to-end anastomosis (one), or by using an autologous graft (three) or allogeneic vascular graft (one). Three patients in group 2 underwent right hemihepatectomy without arterial reconstruction owing to liver necrosis or lobar atrophy. Three of ten patients died from postoperative complications. Conclusion: Combined bile duct and hepatic artery injury during LC led to a complicated clinical course, with a high mortality rate. Reconstruction of the right hepatic artery might be helpful in reducing hepatic ischaemia, but is usually feasible only if the injury is identified early. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Role of hepatectomy in the management of bile duct injuries

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001
C. H. Wakefield
Background: Laparoscopic cholecystectomy is associated with bile duct injuries of a more severe nature than open cholecystectomy. This study examined the emerging role of hepatectomy in the management of major iatrogenic bile duct injuries in the laparoscopic era. Methods: This was a retrospective cohort study of patients referred to a tertiary hepatobiliary unit with bile duct injuries over a 16-year period until April 2000. Data are expressed as median (range). Results: Eighty-eight patients (34 men, 54 women) were referred during this interval; their median age was 55 (19,83) years. Injuries resulted from 50 laparoscopic cholecystectomies and 35 open cholecystectomies, with three occurring during gastroduodenal procedures. Laparoscopic surgery was associated with injuries of greater severity than open cholecystectomy: Bismuth type I,II, 32 per cent versus 69 per cent for the open operation; type III,IV, 66 per cent versus 31 per cent for the open procedure (P = 0·02, ,2 test). After referral 73 patients underwent definitive surgical interventions: 57 hepaticojejunostomies, 11 revisions of hepaticojejunostomy, two orthotopic liver transplants and three right hepatectomies. Two patients had subsequent hepatectomy following initial hepaticojejunostomy. Four of the five hepatectomies were for the management of injuries perpetrated at laparoscopic cholecystectomy. Criteria necessitating hepatectomy were liver atrophy on computed tomography (80 versus 11 per cent; P = 0·0001, ,2 test) and a greater incidence of angiographically proven vascular injury (40 versus 6 per cent; P = 0·006, ,2 test); in addition, type III,IV injuries were more frequent (60 versus 42 per cent) in the hepatectomy group. There were no procedure-related deaths. The overall postoperative morbidity rate was 13 per cent. Median hospital stay was 10 days. Conclusion: Major hepatectomy allows the successful and safe repair of cholecystectomy-related bile duct injuries complicated by concomitant vascular injury, unilateral lobar atrophy and destruction of the biliary confluence. © 2001 British Journal of Surgery Society Ltd [source]