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Optimizing management of pancreaticopleural fistulas

world Journal of Gastroenterology 2011年第42期17卷 4696-4703页

作者： Marek wronski Maciej Slodkowski wlodzimierz Cebulski Daniel Moronczyk ireneusz w krasnodebski Department of General Gastroenterological and Oncological SurgeryMedical University of Warsaw

AIM:To evaluate the management of pancreaticopleural fistulas involving early endoscopic instrumentation of the pancreatic ***:Eight patients with a spontaneous pancre-aticopleural fistula underwent endoscopic retrograde cholang iopancreatography(ERCP) with an intentionto stent the site of a ductal disruption as the primarytreatment. Imaging features and management were evaluated retrospectively and compared with ***:In one case,the stent bridged the site of aductal disruption. The fistula in this patient closed with in3 wk. The main pancreatic duct in this case appearednormal,except for a leak located in the body of the pancreas. In another patient,the papilla of Vater couldnot be found and cannulation of the pancreatic ductfailed. This patient underwent surgical treatment. In the remaining 6 cases,it was impossible to insert a stentinto the main pancreatic duct properly so as to coverthe site of leakage or traverse a stenosis situated down-stream to the fistula. The placement of the stent failed because intraductal stones(n = 2) and ductal strictures(n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pancreas(n = 2) . In 3 out of these 6 patients,the pancre-aticopleural fistula closed on further medical *** these cases,the main pancreatic duct was normalor only mildly dilated,and there was a leakage at the body/tail of the pancreas. In one of these 3 patients,additional percutaneous drainage of the peripancre atic fluid collections allowed better control of the leakageand facilitated resolution of the fistula. The remaining3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not beinserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. Aftera failed the rapeutic ERCP,3 patients in our series developed superinfection of the pleural or peripancreatic fluid collections. Four out of

关键词： Pancreaticopleural fistula Pancreatitis Surgery Endoscopic retrograde cholangiopancreatography Magnetic resonance cholangiopancreatography

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Synchronous occurrence of gastrointestinal stromal tumors and other primary gastrointestinal neoplasms

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world Journal of Gastroenterology 2006年第33期12卷 5360-5362页

作者： Marek wronski Bogna Ziarkiewicz-wroblewska Barbara Gornicka wlodzimierz Cebulski Maciej Slodkowski Aleksander wasiutynski ireneusz w krasnodebski Department of General andGastroenterological Surgery and Nutrition Warsaw University of Medicine ul. Banacha 1A 02-097 Warsaw Poland Department of Pathology WarsawUniversity of Medicine ul. Pawinskiego 7 02-106 Warsaw Poland

AIM： To review clinical and pathologic features of Gastrointestinal strornal tumors （GISTs） occurring synchronously with other primary gastrointestinal neoplasms. METHODS： 28 patients with primary GIST were treated at our institution between 1989 and 2005. Clinical and pathologic records were reviewed. RESULTS： The gastrointestinal stromal tumor occurred simultaneously with other primary GI malignancies in 14% of all patients with GIST. The synchronous stromal tumors were located in the stomach and were incidentally found during the operation. The coexistent neoplasms were colon adenocarcinoma, gastric cancer （2 cases） and gastric lymphoma. CONCLUSION： The synchronous occurrence of GISTs and other gastrointestinal malignancies is more common than it has been considered. The development of gastrointestinal stromal tumors and other neoplasms may involve the same carcinogenic agents.

关键词： Gastrointestinal stromal tumors Synchronousneoplasms

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Giant gastrointestinal stromal tumour of rare sarcomatoid epithelioid subtype:Case study and literature review

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world Journal of Gastroenterology 2015年第11期21卷 3388-3393页

作者： Gustaw Lech wojciech Korcz Emilia Kowalczyk Tomasz Guzel Marcin Radoch ireneusz wojciech krasnodebski Department of General Gastroenterological and Oncological SurgeryMedical University of Warsaw Students’ Scientific Group at Department of General Gastroenterological and Oncological SurgeryMedical University of Warsaw

Gastrointestinal stromal tumours(GISTs) are the most common mesenchymal tumours of the gastrointestinal tract,but they represent less than 3% of all gastrointestinal tract *** is a detailed case study of a 52-yearold male patient treated for very uncommon histological subtype of gastric GIST with atypical clinical presentation,asymptomatic progress and late *** resected tumour,giant in diameters,was confirmed to represent the most rare histopathologic subtype of GISTs- sarcomatoid epithelioid *** report this case and review the literature with a special focus on pathomorphological evaluation,biological aggressiveness and prognostic *** our knowledge this is the first report of giant GIST of very uncommon sarcomatoid epithelioid *** is concluded that clinicians should pay attention to the fact that initial diagnosis may be delayed due to mildly asymptomatic and non-specific clinical *** tumours diagnosed at a late stage,which is often the case,can be large on *** for patients diagnosed with GIST depend on tumour size,mitotic rate,histopathologic subtype and tumour *** is why early diagnosis and R0 resection,which is usually feasible and safe even in giant gastric sarcomatoid epithelioid subtype of GISTs,are the key factors for further treatment and good prognosis.

关键词： Gastrointestinal stromal tumour Sarcomatoid epithe

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Fulminant liver failure following a marathon: Five case reports and review of literature

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world Journal of Clinical Cases 2019年第12期7卷 1467-1474页

作者： wojciech Figiel Marcin Morawski Michal Grat Oskar Kornasiewicz Grzegorz Niewiński Joanna Raszeja-wyszomirska Maciej krasnodebski Arkadiusz Kowalczyk waclaw Holówko waldemar Patkowski Krzysztof Zieniewicz Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw 02097 Poland Department of Anaesthesiology and Intensive Care Medical University of Warsaw Warsaw 02097 Poland Liver and Internal Medicine Unit Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw 02097 Poland

BACKGROUND The growing popularity of marathon and half-marathon runs has led to an increased number of patients presenting with exertion-induced heat stroke. Mild hepatic involvement is often observed in these patients;however, fulminant liver failure may occur in approximately 5% of all cases. Liver transplantation is a potentially curative approach for exertion-induced liver failure, although there is a lack of consensus regarding the criteria and optimal timing of this intervention. CASE SUMMARY This paper describes 5 patients (4 men and 1 woman) who were referred to the department where this study was performed with the diagnosis of exertioninduced acute liver failure. Three patients underwent liver transplantation, 1 recovered spontaneously, and 1 patient died on day 11 following the exertion. CONCLUSION Exertion-induced heat stroke may present as fulminant liver failure. These patients may recover with conservative treatment, may require liver transplantation, or may die. No definitive criteria are available to determine patient suitability for a conservative vs surgical approach.

关键词： Heat Stroke Hepatic insufficiency Liver transplantation Case report

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