The Experts below are selected from a list of 1680 Experts worldwide ranked by ideXlab platform
Go Wakabayashi - One of the best experts on this subject based on the ideXlab platform.
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Pure Laparoscopic Right Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus (with Video)
Annals of Surgical Oncology, 2020Co-Authors: Naotake Funamizu, Kohei Mishima, Takahiro Ozaki, Kazuma Nakanishi, Kazuharu Igarashi, Kenji Omura, Yasutsugu Takada, Go WakabayashiAbstract:Background Laparoscopic liver resection has been increasingly utilized due to its less invasiveness approach compared with open surgery, 1 ^– 3 but often creates challenges. Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) portends a poorer prognosis and often precludes patients from potential liver resection. 4 ^– 6 We herein report a case of laparoscopic hepatectomy and thrombectomy in a patient with HCC and BDTT. Methods CT, ERCP, and POCS showed a 40-mm tumor located in the right lobe with BDTT. A five 12-mm trocar was inserted at the umbilicus for laparoscope, the epigastrium, both sides of the Hypochondrium, and right lateral region. Moreover, a 5-mm trocar was inserted at left Hypochondrium. After cholecystectomy, hepatoduodenal ligament was encircled using the tourniquet through 5-mm trocar site. The right portal vein was transected by stapler following transection of the right hepatic artery. After ICG staining (0.5 mg/body i.v.), 7 hepatic parenchymal transection was performed using clamp-crashing technique. Moreover, CUSA also was used near Glissonian sheath. BDTT was removed from the right BD. Moreover, the cholangioscopy confirmed no BDTT remnants. The resection stump was then sutured. Finally, the right hepatic vein was divided with a stapler. A drainage tube was placed in the right subphrenic space. Operation time was 496 min, and blood loss was 91 ml. The patient was discharged without complications on postoperative day 11. Pathological diagnosis showed moderately differentiated HCC, tumor size 40 × 45 mm with negative surgical margins. Conclusions Pure laparoscopic resection for HCC with BDTT is a radical, yet feasible procedure.
Anastasios Macheras - One of the best experts on this subject based on the ideXlab platform.
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gallbaldder perforation causing a subcutaneous abscess
International Journal of Surgery Case Reports, 2014Co-Authors: Evangelos P Misiakos, Ira Tzepi, Ilias Brountzos, Nick Zavras, Anestis Charalampopoulos, Anastasios MacherasAbstract:INTRODUCTION This is a report of a rare case of an old woman with a large round mass in the right Hypochondrium that was proven to be an abscess.
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Gallbaldder perforation causing a subcutaneous abscess
Elsevier, 2014Co-Authors: Evangelos P Misiakos, Ira Tzepi, Ilias Brountzos, Nick Zavras, Anestis Charalampopoulos, Anastasios MacherasAbstract:INTRODUCTION: This is a report of a rare case of an old woman with a large round mass in the right Hypochondrium that was proven to be an abscess. PRESENTATION OF CASE: A 82-year old woman with a firm round mass in the right Hypochondrium was admitted for evaluation. The abdominal CT showed an abscess produced by a gallbladder perforation, and a gallstone impacted at the Hartmann's pouch. DISCUSSION: The abscess was treated with a transcutaneous paracentesis, while the stone passed to the gastrointestinal tract through a cholecystoenteric fistula, without causing any further problems. CONCLUSION: Gallbaldder perforation can rarely create a subcutaneous abscess especially in thin, elder subjects. Abscess drainage is the first line of treatment
Stefano Grifoni - One of the best experts on this subject based on the ideXlab platform.
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accuracy of abdominal ultrasound for the diagnosis of pneumoperitoneum in patients with acute abdominal pain a pilot study
Critical Ultrasound Journal, 2015Co-Authors: Peiman Nazerian, Camilla Tozzetti, Simone Vanni, Maurizio Bartolucci, Simona Gualtieri, Federica Trausi, Marco Vittorini, Elisabetta Catini, Gian Alfonso Cibinel, Stefano GrifoniAbstract:Pneumoperitoneum is a rare cause of abdominal pain characterized by a high mortality. Ultrasonography (US) can detect free intraperitoneal air; however, its accuracy remains unclear. The aims of this pilot study were to define the diagnostic performance and the reliability of abdominal US for the diagnosis of pneumoperitoneum. This was a prospective observational study. Four senior and two junior physicians were shown, in an unpaired randomized order, abdominal US videos from 11 patients with and 11 patients without pneumoperitoneum. Abdominal US videos were obtained from consecutive patients presenting to ED complaining abdominal pain with the diagnosis of pneumoperitoneum established by CT. Abdominal US was performed according to a standardized protocol that included the following scans: epigastrium, right and left Hypochondrium, umbilical area and right Hypochondrium with the patient lying on the left flank. We evaluated accuracy, intra- and inter-observer agreement of abdominal US when reviewed by senior physicians. Furthermore, we compared the accuracy of a “2 scan-fast exam” (epigastrium and right Hypochondrium) vs the full US examination and the accuracy of physicians expert in US vs nonexpert ones. Finally, accuracy of US was compared with abdominal radiography in patients with available images. Considering senior revision, accuracy of abdominal US was 88.6 % (95 % CI 79.4-92.4 %) with a sensitivity of 95.5 % (95 % CI 86.3–99.2 %) and a specificity of 81.8 % (95 % CI 72.6–85.5 %). Inter- and intra-observer agreement (k) were 0.64 and 0.95, respectively. Accuracy of a “2 scan-fast exam” (87.5 %, 95 % CI 77.9–92.4 %) was similar to global exam. Sensitivity of abdominal radiography (72.2 %, 95 % CI 54.8–85.7 %) was lower than that of abdominal US, while specificity (92.5 %, 95 % CI 79.5–98.3 %) was higher. Accuracy (68.2 %, 95 % CI 51.4–80.9 %) of junior reviewers evaluating US was lower than senior reviewers. Senior physicians can recognize US signs of pneumoperitoneum with a good accuracy and reliability; sensitivity of US could be superior to abdominal radiography and a 2 fast-scan exam seems as accurate as full abdominal examination. US could be a useful bedside screening test for pneumoperitoneum. Trial registry ClinicalTrials.gov; No.: NCT02004925; URL: http://www.clinicaltrials.gov
Antonio Claudio De Godoy - One of the best experts on this subject based on the ideXlab platform.
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Azevedo OC et al
2015Co-Authors: Otavio Cansancao Azevedo, Albino Augusto Sorbello, João Luiz, Moreira Coutinho Azevedo, Gustavo Peixoto Soares, Rodrigo Santa, Cruz Guindalini, Antonio Claudio De GodoyAbstract:Veress needle insertion in the left Hypochondrium in creation of the pneumoperitoneum1 Punção no hipocôndrio esquerdo com agulha de Veress para a criação do pneumoperitôni
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veress needle insertion in the left Hypochondrium in creation of the pneumoperitoneum
Acta Cirurgica Brasileira, 2006Co-Authors: Otavio Cansancao Azevedo, Joao Luiz Moreira Coutinho Azevedo, Albino Augusto Sorbello, Gustavo Peixoto Soares Miguel, Rodrigo Santa Cruz Guindalini, Antonio Claudio De GodoyAbstract:Purpose. To test the efficacy of the puncture in the left Hypochondrium as an alternative method. Methods: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left Hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. Results: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. Conclusion: Puncture in the left Hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.
Otavio Cansancao Azevedo - One of the best experts on this subject based on the ideXlab platform.
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Azevedo OC et al
2015Co-Authors: Otavio Cansancao Azevedo, Albino Augusto Sorbello, João Luiz, Moreira Coutinho Azevedo, Gustavo Peixoto Soares, Rodrigo Santa, Cruz Guindalini, Antonio Claudio De GodoyAbstract:Veress needle insertion in the left Hypochondrium in creation of the pneumoperitoneum1 Punção no hipocôndrio esquerdo com agulha de Veress para a criação do pneumoperitôni
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veress needle insertion in the left Hypochondrium in creation of the pneumoperitoneum validation of the technique value of tests and importance of intraperitoneal pressure and volume of gas injected during insufflations
2008Co-Authors: Joao Luiz Moreira Coutinho Azevedo, Otávio Monteiro, Otavio Cansancao Azevedo, Octavio Henrique, Afonso Cesar Cabral, Dalmer FreireAbstract:Objectives: To validate the efficacy of Veress needle insertion into the left Hypochondrium, to evaluate the accuracy of the tests used to check the position of the needle, and to establish parameters for pressure and volume at different moments of insufflations. Methods: It was compared thirty-two patients who were punctured into the abdominal midline (ML group), to 30 patients into the left Hypochondrium (LH group). Afterwards, 70 patients were also punctured in the left Hypochondrium and, together with those of the LH group, comprised a total of 100 patients of the left Hypochondrium (TLH) group. Tests were performed and considered positive when: organic material was aspirated in the aspiration test (AT) ; only a small amount of pressure was applied to inject the liquid in the injection test (IT); the injected liquid was not recovered in the recovery test (RT) ; drops drained quickly in the hanging drop test (HDT); pressure levels were 8 mmHg or lower in the initial intraperitoneal pressure test (IIPT). Sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were established for each test. Volume and pressure were recorded at every 20 seconds, until intraperitoneal pressure reached 12 mmHg. Pressure and volume values were correlated with predetermined moments of insufflations. Results: two failed attempts at creating pneumoperitoneum were observed in the ML group and three in the LH group. In the TLH group, ten failed attempts were observed. For the AT, S and PPV could not be determined, SP = 100% and NPV = 100%. For the IT, S = 100%, SP = 0%, PPV = 90%, and NPV could not be determined. For the RT and SDT, S = 100%, SP = 50%, PPV = 94.7% and NPV = 100%. For the IIPT, S, SP, PPV and NPV were 100%. Pressure and volume showed a strongly positive correlation with predetermined moments of insufflations (coefficient of explanation of 0.8011and 0.9604, respectively). Conclusions: Punctures in the left Hypochondrium are effective. The tests assessed can guide surgeons. Values of pressure and volume at predetermined moments of insufflations can be predicted.
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veress needle insertion in the left Hypochondrium in creation of the pneumoperitoneum
Acta Cirurgica Brasileira, 2006Co-Authors: Otavio Cansancao Azevedo, Joao Luiz Moreira Coutinho Azevedo, Albino Augusto Sorbello, Gustavo Peixoto Soares Miguel, Rodrigo Santa Cruz Guindalini, Antonio Claudio De GodoyAbstract:Purpose. To test the efficacy of the puncture in the left Hypochondrium as an alternative method. Methods: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left Hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. Results: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. Conclusion: Puncture in the left Hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.