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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2006.05.010 Byline: Singh Gagandeep (a)(b), Avo Artinyan (a)(b), Nicolas Jabbour (a)(b), Rodrigo Mateo (a)(b), Lea Matsuoka (a)(b), Linda Sher (a)(b), Yuri Genyk (a)(b), Rick Selby (a)(b) Keywords: Celiac axis; Modified Appleby operation; Pancreatectomy; Pancreatic cancer Abstract: Celiac axis invasion by central and distal pancreatic cancers has been considered a contraindication to resection. Appleby first described en-bloc celiac axis resection with total gastrectomy for locally advanced gastric cancer. We present our experience with a modification of this procedure in central pancreatic cancers involving the celiac trunk. Author Affiliation: (a) Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California University Hospital, 1510 San Pablo St., HCC1 Suite 200, Los Angeles, CA 90033, USA (b) Keck School of Medicine, University of Southern California University Hospital, Los Angeles, CA 90333, USA Article History: Received 28 October 2005; Revised 10 May 2006

The Railroading Merit Badge has been part of the Boy Scouts of America (BSA) program since 1943. It's one of nearly 100 hobby and special interest awards that Scouts can […]

A modern GM diesel in the Espee's new image, converted from an Anthearn model It's always exciting to watch a 1 consist of brand-new locomotives roar past at full throttle, […]

Hepatitis caused by herpes simplex virus (HSV) is rare. It occurs most frequently in patients who have a reduced ability to fight infection because the function of their immune system is impaired. In most cases, hepatitis caused by HSV results in death. This article describes the cases of 12 patients who developed HSV hepatitis following organ transplantation between 1980 and 1988. During this period, 3,536 liver, kidney and heart transplants were performed in Pittsburgh, Pennsylvania. Twelve of these patients (average age of 37 years) developed HSV hepatitis following organ transplantation. Eight of the patients had liver transplants, three had kidney transplants and one had a heart transplant. In these patients, HSV hepatitis occurred between 5 and 46 days after organ transplantation, and resulted in death in eight of the 12 patients. The clinical symptoms in the patients who died included low blood pressure, bacteria in the blood (bacteremia), bleeding in the stomach and intestines, and disseminated intravascular coagulation (DIC, widespread abnormal blood clotting). All five of the patients with DIC died, and the three patients with extensive liver damage died. Three of the patients who had liver damage that was confined to one small part of the liver were treated successfully with acyclovir. Beginning in February of 1989, all subsequent kidney and liver transplant recipients were treated with acyclovir to prevent the development of HSV hepatitis. Since then, 1,144 transplants have been performed in Pittsburgh without any cases of HSV hepatitis. These findings indicate that treatment with acyclovir is beneficial for preventing HSV hepatitis in transplant patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications after kidney transplantation occasionally include colonic perforation (a hole in the large bowel) associated with nonobstructing colonic dilatation (NCD, an enlargement of the colon without a bowel obstruction). Colonic perforation has a high mortality. The incidence and possible causes of these conditions were reviewed in 18 kidney transplant recipients who developed colonic perforation, NCD, or both. In four patients, perforations of the left side of the colon developed as a result of diverticular disease, a condition in which part of the intestine pouches out, possibly becoming inflamed. Three of these patients survived the perforation and kept their transplanted kidneys. Thirteen patients developed NCD soon after transplantation, with obvious abdominal distention. Gas was the cause of the distention. All had poorly functioning grafts (transplanted kidneys). Six underwent colonoscopy, the examination of the colon with a bright light and viewing tube, with decompression (deflating the colon). In seven patients (five who received colonoscopy), the NCD resolved. Six, however, suffered right-sided colon perforation after NCD, and one patient without NCD developed perforation in a different region of the bowel. Thus, colonic perforation occurred in a total of 11 patients, four of whom died. Surgery was delayed more than 24 hours after symptoms of perforation began in three, while six of the seven patients who were operated on within 24 hours survived. Unlike in other published reports, the majority of colonic perforations in this group (74 percent) were not due to diverticular disease. The causes for NCD are not known. Colonic decompression appeared effective, and immediate surgical intervention is essential once perforation has occurred. Six of the seven survivors of colonic perforation retained their transplanted kidneys. (Consumer Summary produced by Reliance Medical Information, Inc.)

Recycling is a popular activity today, but did you ever stop to think how railroads recycle equipment to extend its usefulness? Consider this letter from Lewis Ableidinger of Kensal, N. […]

Over the past six summers, young model railroaders from west Pennsylvania (grades 4-9) have gathered for a week of Model Railroad Camp. Part of the summer program offerings at the […]