Retroperitoneal hyaline-vascular variant Castleman Disease in a patient with iron-deficiency anemia and sinus bradycardia:a case report

Objective Castleman disease, also known as giant lymph node hyperplasia, involves lesions in the lymph nodes usually located in the chest_ENREF_1, particularly in the mediastinum. Meanwhile, sinus bradycardia is a sinus rhythm slower than 60 beats per min, and it can occur in both healthy and sick individuals. However, the comorbidity of these two disorders has not been previously reported. In this paper, we report a case of a 46-year-old woman who presented with persistent sinus bradycardia and irondeficiency anemia. Diagnostic work-up revealed hepatosplenomegaly and a giant mass near the splenic hilum. The mass was removed surgically; after which, the patient's bradycardia resolved immediately, while her anemia was corrected after subsequent chemotherapy. Pathological examination revealed lymph nodes with benign lesions, and the patient was diagnosed with hyaline-vascular variant of Castleman disease. This is the first documented case of sinus bradycardia associated with Castleman disease. In this paper, we describe the case characteristics, discuss the possible pathogenesis, and consider the appropriate treatment of symptomatic sinus bradycardia accompanying Castleman disease.

A case of chronic pancreatitis treated by laparoscopic duodenum-preserving pancreatic head resection

Pancreaticoduodenectomy(PD) has long been used for chronic pancreatitis(CP), but greatly affects the postoperative quality of life. A new procedure called duodenum-preserving pancreatic head resection(DPPHR) has been introduced, and has little effect on the structure and function of the digestive system. With the development of minimally invasive surgical techniques, treatment of CP can be performed with laparoscopic DPPHR(LDPPHR). We present a case of CP that was successfully treated with LDPPHR. The postoperative pathological diagnosis was pancreatitis, demonstrating the feasibility of LDPPHR. We recommend this minimally invasive surgical method as preferred treatment for CP.

Prognostic significance of preoperative Naples prognostic score on short-and long-term outcomes after pancreatoduodenectomy for ampullary carcinoma

Background:The Naples prognostic score(NPS)is an effective and objective tool to assess the immune-nutritional status of patients with malignant tumors.The aim of this study was to investigate the clinical significance of preoperative NPS on short-and long-term outcomes after pancreatoduodenectomy(PD)for ampullary carcinoma.Methods:We retrospectively analyzed 404 consecutive patients with ampullary carcinoma who underwent PD between January 2012 and June 2018.Preoperative NPS was calculated from serum albumin and total cholesterol concentrations,and the neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio(LMR).Patients were then divided into three groups according to their NPS.Clinicopathological variables,postoperative outcomes,and survival data were compared between the three groups.Univariate and multivariate Cox analysis of overall survival(OS)and recurrence-free survival(RFS)were also conducted,and time-dependent receiver operating characteristic(ROC)curves were created to evaluate the discriminatory ability of the prognostic scoring systems.Results:Patients with higher NPS had worse prognosis,and significant OS difference(group 0 vs.1,P=0.02;group 1 vs.2,P<0.001;group 0 vs.2,P<0.001)and RFS difference(group 0 vs.1,P=0.088;group 1 vs.2,P<0.001;group 0 vs.2,P<0.001).Multivariate analysis revealed that NPS was an independent significant predictor of OS(grade 2 vs.grade 1 or 0,hazard ratio:3.067;P<0.001)and RFS(grade 2 vs.grade 1 or 0,hazard ratio:2.732;P<0.001).The time-dependent receiver operating curve analysis showed that NPS had better prognostic performance for OS and RFS than other prognostic models.Additionally,significant differences in the incidence of postoperative morbidity were observed between the three groups,and the NPS was an independent risk factor of overall postoperative complications(grade 2 vs.grade 1 or 0,odds ratio:1.692;P=0.02).Conclusions:The NPS was an independent predictor of overall-and RFS in patients undergoing PD for ampullary carcinoma,and was independently associated with the incidence of postoperative complications.

Laparoscopic duodenum-preserving pancreatic head resection:a narrative review

Pancreatic surgery is one of the most complex and challenging fields in abdominal surgery associated with extensive surgical trauma,damage to adjacent organs,a long operation time and a high incidence of postoperative complications.Since the early 1990s,laparoscopic techniques have been applied to a growing number of pancreas surgeries,and great progress has been achieved in laparoscopic pancreaticoduodenectomy.As surgeons become proficient in laparoscopic pancreaticoduodenectomy techniques,laparoscopic techniques are gradually used in other pancreatic surgeries,such as laparoscopic distal pancreatectomies and laparoscopic duodenum-preserving pancreatic head resection(LDPPHR),which may benefit patients by reducing postoperative pain and hospital stays and providing a quick recovery to normal activity.Recently,a great number of literature have introduced LDPPHR.It is a good surgical method for benign and low-grade malignant tumors of the pancreatic head.Although LDPPHR is technically feasible,it is not yet generally practicable and limited to highly skilled endoscopic surgeons,and the long-term results after LDPPHR are still not well defined.This article aims to provide a literature review of LDPPHR to assess its feasibility,safety,postoperative recovery,and future outlook according to early experiences of this technique.