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A study of pulmonary embolism after abdominal surgery in patients undergoing prophylaxis

World Journal of Gastroenterology 2009年第3期15卷 344-348页

作者： Mirko D Kerkez Dorde M ulafi Dragana D Mija vitomir i rankovi Nebja S Leki Dejan Z Stefanovi Clinic of Surgery institute of Digestive Diseases Clinical Center of SerbiaMedical Faculty11000 BelgradeRepublic of Serbia Clinic of Gastroenterology and Hepatology Institute of Digestive DiseasesClinical Center of SerbiaMedical Faculty11000 BelgradeRepublic of Serbia

AiM： To determine risk factors for pulmonary embolism and estimate effects and benefits of prophylaxis. METHODS： We included 78 patients who died subsequently to a pulmonary embolism after major abdominal surgery from 1985 to 2003. A first, retrospective analysis involved 41 patients who underwent elective surgery between 1985 and 1990 without receiving any prophylaxis. in the prospectively evaluated subgroup, 37 patients undergoing major surgery between 1991 and 2003 were enrolled： all of them had received a prophylaxis consisting in lowmolecular weight heparin, given subcutaneously at a dose of 2850 iU AXa/0.3 mL （body weight 〈 50 kg） or 5700 iU AXa/0.6 mL （body weight ≥ 50 kg）. RESULTS： A higher incidence of thromboembolism （43.9% and 46.34% in the two groups, respectively） was found in older patients （〉 60 years）. The incidence of pulmonary embolism after major abdominal surgery in patients who had received the prophylaxis was significantly lower compared to the subjects with the same condition who had not received any prophylaxis （P 〈 0.001, OR = 2.825; 95% Ci, 1.811-4.408）. Furthermore, the incidence of pulmonary embolism after colorectal cancer surgery was significantly higher compared to incidence of pulmonary embolism after other abdominal surgical procedures. Finally, the incidence of pulmonary embolism after colorectal cancer surgery among the patients who had received the prophylaxis （11/4316, 0.26%） was significantly lower compared to subjects undergoing a surgical procedure for the same indication but without prophylaxis （10/1562, 0.64%）（P 〈 0.05, OR = 2.522; 95% Ct, 1.069-5.949）. CONCLUSiON： Prophylaxis with low molecular weight heparin is highly recommended during the preoperative period in patients with diagnosis of colorectal cancer due to high risk of pulmonary embolism after elective surgery.

关键词： Pulmonary embolism Surgery Colorectal cancer Risk factor Prevention

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Color Doppler sonography and angioscintigraphy in hepatic Hodgkin's lymphoma

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World Journal of Gastroenterology 2009年第26期15卷 3269-3275页

作者： Mirjana V Stojkovi Vera M Artiko irena B Radoman Slavko J Knezevi Snezana M Luki Mirko D Kerkez Nebojsa S Leki Andrija A Anti Marinko M Zuvela vitomir i rankovi Milorad N Petrovi Dragana P obi Vladimir B Obradovi institute for Digestive Diseases Clinical Center of Serbia institute for Nuclear Medicine Clinical Center of Serbia Gastroenterology Department Clinical Center Podgorica Gastroenterology Department Clinical Center Kragujevac

AiM： To estimate the characteristics of Color Doppler findings and the results of hepatic radionuclide angiography （HRA） in secondary Hodgkin＇s hepatic lymphoma. METHODS： The research included patients with a diagnosis of Hodgkin＇s lymphoma with metastatic focal lesions in the liver and controls. Morphologic characteristics of focal liver lesions and hemodynamic parameters were examined by pulsed and Color Doppler in the portal, hepatic and splenic veins were examined. Hepatic perfusion index （HPi） estimated by HRA was calculated. was observed. Lesions were mostly hypoechoic and mixed, solitary or multiple. Some of the patients presented with dilated splenic veins and hepatofugal blood flow. A pulse wave was registered in the centre and at the margins of lymphoma. The average velocity of the pulse wave was higher at the margins （P 〉 0.05）. A continuous venous wave was found only at the margins of lymphoma. There was no linear correlation between lymphoma size and velocity of pulse and continuous wave （r = 390, P 〈 0.01）. HPi was significantly lower in patients with lymphomas than in controls （P 〈 0.05）, pointing out increased arterial perfusion in comparison to portal perfusion. CONCLUSiON： Color Doppler ultrasonography is a sensitive method for the detection of neovascularization in Hodgkin＇s hepatic lymphoma and estimation of its intensity. Hepatic radionuclide angiography can additionally help in the assesment of vascularisation of liver lesions.

关键词： Color Doppler ultrasonography Hodgkin's disease Lymphoma Liver Radionuclide angiography Velocity Hepatic artery Portal vein Blood flow Splenomegaly

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Cystic lymphangioma of the pancreas

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World Journal of Gastroenterology 2008年第44期14卷 6873-6875页

作者： Radoje B Colovic Nikica M Grubor Marjan T Micev Henry Dushan E Atkinson vitomir i rankovic Mihajlo M Jagodic institute for Digestive Diseases Clinical Center of SerbiaFirst Surgical ClinicKoste Todorovica 6Belgrade11000Serbia imperial College School of Medicine St Mary's HospitalPraed StreetLondon W21NYUnited Kingdom

Lymphangioma of the pancreas is an extremely rare benign tumour of lymphatic origin, with fewer than 60 published cases. Histologically, it is polycystic, with the cysts separated by thin septa and lined with endothelial cells. Though congenital, it can affect all age groups, and occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable mass. Complete excision is curative, even though, depending on the tumour location, surgery may be simple or involve extensive pancreatic resection and anastomoses. The authors present a 49-year-old woman in whom a polycystic septated mass, 35 mm× 35 mm in size, was discovered by ultrasonography （US） in the body of the pancreas during investigations for epigastric pain and nausea. At surgery, a well circumscribed polycystic tumor was completely excised, with preservation of the pancreatic duct. The postoperative recovery was uneventful. Histology confirmed a microcystic lymphangioma of the pancreas. immunohistochemistry showed cystic endothelial cells reactivity to factor Ⅷ -RA （＋＋）, CD31 （＋＋＋） and CD34 （-）. Postoperatively, abdominal pain disappeared and the patient remained symptomfree for 12 mo until now. Although extremely rare, lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of a pancreatic cystic lesion, especially in women.

关键词： Pancreas Cystic lymphangioma Localsurgical excision

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