AIM： While hepatocellular adenomas （HAs） have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs. METHODS： Twenty-five consecutive patients operated for...AIM： While hepatocellular adenomas （HAs） have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs. METHODS： Twenty-five consecutive patients operated for solitary-uncomplicated （9）, multiple （6）, and ruptured （10） HAs were reviewed according to management strategies and outcomes. RESULTS： All solitary-uncomplicated HAs （ranged 2.2- 14 cm in size） were removed. Out of 25 HAs, 2 （8%） included loci of carcinoma. In the multiple HA group, previously undiagnosed tumors were identified during surgery in 5/6 cases. In three cases with multiple spread HA, several lesions had to be left unresected. They remained unmodified after 4-, 6-, and 6-year radiological follow-up. Patients with ruptured HA （ranged 1.7-10 cm in size） were initially managed with hemodynamic support and angiography, allowing the embolizaUon of actively bleeding tumors in two patients. All ruptured tumors were subsequently removed 5.5 d （range 4-70 d） after admission. CONCLUSION： Tumors suspected of HA, regardless of the size, should be resected, because of high chances of rupture causing bleeding, and/or containing malignant foci. Although it is desirable to remove all lesions of multiple HA, this may not be possible in some patients, for whom long-term radiological follow-up is advised. Ruptured HA can be managed by hemodynamic support and angiography, allowing scheduled surgery. 2005 The WJG Press and Elsevier Inc. All rights reserved展开更多
The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube inser...The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube insertion, with chest radiograph obtained only after complete inflation of the gastric balloon. Two patients died of hemorrhagic shock and one died of mediastinitis.The author suggests that confirmation of SB tube placement by auscultation alone may not be adequate.Routine chest radiographs should be obtained before and after full inflation of the gastric balloon to confirm tube position and to detect tube dislocation.展开更多
文摘AIM： While hepatocellular adenomas （HAs） have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs. METHODS： Twenty-five consecutive patients operated for solitary-uncomplicated （9）, multiple （6）, and ruptured （10） HAs were reviewed according to management strategies and outcomes. RESULTS： All solitary-uncomplicated HAs （ranged 2.2- 14 cm in size） were removed. Out of 25 HAs, 2 （8%） included loci of carcinoma. In the multiple HA group, previously undiagnosed tumors were identified during surgery in 5/6 cases. In three cases with multiple spread HA, several lesions had to be left unresected. They remained unmodified after 4-, 6-, and 6-year radiological follow-up. Patients with ruptured HA （ranged 1.7-10 cm in size） were initially managed with hemodynamic support and angiography, allowing the embolizaUon of actively bleeding tumors in two patients. All ruptured tumors were subsequently removed 5.5 d （range 4-70 d） after admission. CONCLUSION： Tumors suspected of HA, regardless of the size, should be resected, because of high chances of rupture causing bleeding, and/or containing malignant foci. Although it is desirable to remove all lesions of multiple HA, this may not be possible in some patients, for whom long-term radiological follow-up is advised. Ruptured HA can be managed by hemodynamic support and angiography, allowing scheduled surgery. 2005 The WJG Press and Elsevier Inc. All rights reserved
文摘The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube insertion, with chest radiograph obtained only after complete inflation of the gastric balloon. Two patients died of hemorrhagic shock and one died of mediastinitis.The author suggests that confirmation of SB tube placement by auscultation alone may not be adequate.Routine chest radiographs should be obtained before and after full inflation of the gastric balloon to confirm tube position and to detect tube dislocation.
