BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a...BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy,the patient's condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.展开更多
This preliminary research project has been conducted to evaluate different elastic polymer materials in terms of their applicability in peripheral nerve regeneration. Poly(tetrafluoroetylene-co-difluorovinylidene-co-p...This preliminary research project has been conducted to evaluate different elastic polymer materials in terms of their applicability in peripheral nerve regeneration. Poly(tetrafluoroetylene-co-difluorovinylidene-co-propylene), poly(L-lactide-co-D,L-lactide), and polyurethane were used for the manufacture of tubular implants. Alginate sodium gel and fibers were used as a scaffold to fill in tube nerve grafts and enhance nerve regeneration. The tubes were implanted to reconstruct a 10 mm gap in the sciatic nerve in rats. After 3, 7, 14, 28 days the tubes were retrieved for histological examination. Among tested tubes polyurethane implants were found to be the most suitable because of their mechanical and surgical properties. Other tested implants were found to be unfavorable due to their inappropriate rigidity, elasticity or surgical convenience. Alginate transformation into dense gel form was observed that hindered inner tube space cellular colonization. In consequence of this transformation nerve regeneration was inhibited inside tube nerve grafts. Histological examination showed massive colonization of the implants with Schwann cells, and growth of new axons was found within Schwann cells growing on tubes external surface. Appropriate time rates for alginate gelation and dissolving must be determined to allow undisturbed tissue growth and maturation.展开更多
文摘BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a hepatectomy.CASE SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy,the patient's condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this procedure.CONCLUSION Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.
文摘This preliminary research project has been conducted to evaluate different elastic polymer materials in terms of their applicability in peripheral nerve regeneration. Poly(tetrafluoroetylene-co-difluorovinylidene-co-propylene), poly(L-lactide-co-D,L-lactide), and polyurethane were used for the manufacture of tubular implants. Alginate sodium gel and fibers were used as a scaffold to fill in tube nerve grafts and enhance nerve regeneration. The tubes were implanted to reconstruct a 10 mm gap in the sciatic nerve in rats. After 3, 7, 14, 28 days the tubes were retrieved for histological examination. Among tested tubes polyurethane implants were found to be the most suitable because of their mechanical and surgical properties. Other tested implants were found to be unfavorable due to their inappropriate rigidity, elasticity or surgical convenience. Alginate transformation into dense gel form was observed that hindered inner tube space cellular colonization. In consequence of this transformation nerve regeneration was inhibited inside tube nerve grafts. Histological examination showed massive colonization of the implants with Schwann cells, and growth of new axons was found within Schwann cells growing on tubes external surface. Appropriate time rates for alginate gelation and dissolving must be determined to allow undisturbed tissue growth and maturation.
