Greater Omentum Research Articles

Appendicular Abscess in General Surgery at the Bocar Sidi Sall University Hospital in Kati

Introduction: Appendicular abscess is a progressive complication of acute appendicitis in which the spread of infection is contained by the greater omentum and the slender loops resulting in the formation of a true septate abscess of the large peritoneal cavity. Materials and Methods: This was a retrospective study from January 2010 to December 2019 carried out at the Bocar Sidi Sall University Hospital in Kati (CHU BSS in Kati) in general surgery. It concerned all patients operated on for appendicular abscess in the department. Results: 75 cases of appendicular abscess were collected, which represented 5.76% of surgical emergencies and 25% of acute appendicitis. The average age of the patients was 29 years. The male sex represented 67% of our patients with a sex ratio of 2. The average consultation time was 5 days. Abdominal pain was noted in all patients. It was localized in the right iliac fossa in 80% (n = 60) and diffuse in 2.7% of cases (n = 2). It was accompanied by nausea and vomiting in 93% of cases (n = 70), urinary disorders in 20% (n = 15), fever in 94% (n = 71), cessation of materials and gas in 1.33% (n = 1). Abdominal ultrasound was performed in 86% (n = 65). It made it possible to suggest a peri-appendicular effusion. Biological examination revealed a neutrophilic hyperleukocytosis greater than 20,000/mm3 in 47 patients, or 63%. All the patients were operated on by laparotomy (Marc Burney or midline subumbilical) under general anesthesia. The length of hospitalization was 6 days. We have not recorded any deaths. Morbidity was 8% (n = 6) represented by parietal suppuration. The postoperative course was straightforward in 92% of cases (n = 69). Conclusion: Appendicular abscess is a frequent medico-surgical emergency, the prognosis of which depends greatly on early diagnosis and adequate and immediate management.

Function and Gene Expression of Islets Experimentally Transplanted to Muscle and Omentum

Islet transplantation to the liver is a potential curative treatment for patients with type 1 diabetes. Muscle and the greater omentum are two alternative implantation sites, which can provide excellent engraftment and hold potential as future sites for stem-cell-derived beta-cell replacement. We evaluated the functional outcome after islet transplantation to muscle and omentum and found that alloxan-diabetic animals were cured with a low number of islets (200) at both sites. The cured animals had a normal area under the curve blood glucose response to intravenous glucose, albeit animals with intramuscular islet grafts had increased 120-min blood glucose levels. They also demonstrated an exaggerated counter regulatory response to hypoglycemia. The expression of genes important for beta-cell function was, at both implantation sites, comparable to that in native pancreatic islets. The gene expression of insulin (INS1 and INS2) and glucose transporter-2 was even increased, and the expression of lactate dehydrogenase decreased, at both sites when compared to native islets. We conclude that muscle and omentum provide excellent conditions for engraftment of transplanted islets. When compared to control, 200 islets implanted to the omentum displayed a restored glucose tolerance, whereas animals with intramuscular islet grafts of similar size displayed mild glucose intolerance.

Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report

ABSTRACT Chronic septic bone nonunion requires a well-designed therapeutic planning, demanding a multimodal treatment to achieve bone consolidation and elimination of infection. A successful case of an association of the major omentum flap with surgical stabilization with an interlocking nail for treatment of a femoral septic nonunion in dog is reported. The patient had partial functional return of the limb 30 days after surgery, negative bacterial culture with radiographic signs of bone healing and total functional return of the limb at 90th days after the surgical procedure.

Anomalous Course of Accessory Splenic Arteries in Gastrosplenic Ligament: Case Report and Clinico-Embryological Basis

Accessory splenic arteries in the gastrosplenic ligament constitute one of the extremely sub-component of abdominal vasculature variations and it is imperative to recognize this anomaly while planning for complex surgeries in the supra-colic compartment. We report the case of accessory splenic arteries in an approximately 50-year-old male cadaver encountered during routine educational dissection. One of them arising from left gastroepiploic artery supplies the spleen in addition to splenic artery. Another variant vessel bifurcated to enter greater omentum and anterior pole of spleen, as discrete branches. The anatomical vascular variation, if recognized during the imaging work-ups for elective surgical procedures could avoid potential iatrogenic blood loss.

Study of the effect of selective inhibitor of Arginase II KUD 975 and of low doses of Acetylsalicylic acid on the functional parameters of the cardiovascular system In experimental preeclampsia

Introduction: Over the past decade, preeclampsia has been the subject of an increased attention, as this complication is the most common cause of maternal mortality, triggering every third case of obstetric morbidity and taking lives of up to 50.000 young women worldwide each year. Despite a large number of ongoing studies, no clear algorithm for monitoring pregnant women with this pathology has been developed yet.
 Materials and methods: The study was conducted on 220 female Wistar rats weighing 250–300 g. In the experiment, ADMA-like preeclampsia model was used.
 Results and discussion: The introduction of L-NAME to the animals from the 14th till the 20th day of pregnancy causes the following disturbances: a rise in systolic and diastolic blood pressure in 1.4 and 1.5 times, an increase in proteinuria in 3.3 times and an increase in the content of fluid in the greater omentum from 44.39 ± 1.62% to 55.02 ± 1.74%, all of which correspond to the disorders in pregnant women in case of preeclampsia. The use of the selective inhibitor of arginase II KUD 975 (3mg/kg/day) in combination with acetylsalicylic acid (10mg/ kg/day) leads to a pronounced correction in the emerging changes: a decrease in systolic and diastolic blood pressure in 1.2 and 1.3 times, a decrease in proteinuria in 1.9 times and a decrease in the fluid content in the greater omentum.
 Conclusion: Selective inhibitor of arginase II KUD 975 and small doses of acetylsalicylic acid have a pronounced positive effect in the correction of morphofunctional disorders in animals with ADMA-like preeclampsia.

Levels of neoangiogenesis factors in pathological tissues of gastric cancer patients

The aim was to study levels of VEGFA, VEGFC, sVEGFR1, sVEGFR3 and TGFβ1 in malignant gastric, peritoneal and omental tissues. Materials and methods. 62 patients were enrolled in the study: 21 (10, 11) -stomach cancer T 3-4а N 0-3 M 1 and metastases to the peritoneum; 24 (15, 9) - stomach cancer T 3-4а N 0-3 M 0 without metastasis; 17 (6, 11) - non-cancer patients (controls). Levels of growth factors and their receptors were measured by ELISA in tissues of the peritoneum, greater omentum, gastric tumors (GT) and their perifocal tissues (PT). Results. All patients had elevated GT and PT levels of VEGFА and VEGFR1, but not VEGFСand VEGFR3; GT tissues contained more VEGFR1, and PT - more VEGFА. Only metastatic peritoneum and omentum showed increased levels of VEGFs: in the omentum -VEGFА (by 2.8 times), VEGFС (by 2.7 times), VEGFR1 (by 2.3 times), VEGFR3 (by 1.6 times (p<0.05)); in the peritoneum - VEGFА (by 4.2 times0, VEGFС (by 3.5 times), VEGFR1 (by 2.5 times), VEGFR3 (by 2.3 times). The TGF-β1 level increased in GT, PT and omentum tissues in all patients despite metastases, while peritoneal TGF-β1 levels sharply increased - by 3.1 times with metastases and decreased - by 1.8 times (p<0.05) without ones. Conclusion. The role of VEGFА and TGFβ1 in omental and peritoneal metastasis from gastric cancer was confirmed.

Morphological changes of a great omentum at implantation of polypropylene and composite prostheses at allohernioplasty

To date, allohernioplasty of giant postoperative ventral hernias retains high postoperative mortality and a significant number of postoperative complications. The purpose of the study is to investigate the possibility of intraperitoneal use of polypropylene and composite implants in allohernioplasty of postoperative giant ventral hernias by studying the morphological changes of the great omentum. The results of surgical treatment of 146 patients with postoperative giant ventral hernias were investigated. To this group of patients with allohernioplasty by the method onlay was performed 22 (15.1%) patients, by the method sublay – 46 (31.5%), by the method inlay – 52 (35.6%), with intra-abdominal placement of the mesh by the method onlay (intraperitoneal onlay mesh) – 26 (17.8%). 32 (21.9%) patients who underwent surgery using the sublay method polypropylene implant was fenced off from the abdominal organs with a great omentum, 22 (15.1%) patients operated on by the intraperitoneal onlay mesh method composite implant was also fenced off from the abdominal organs by a great omentum. In 8 (5.5%) patients from the group of patients who were operated on by the sublay method and in 6 (4.1%) – operated by the intraperitoneal onlay mesh method for 14-18 days patients developed signs of chronic intestinal obstruction, where the cause was postoperative adhesive illness. The study of the effect of polypropylene prosthesis on a great omentum was performed on 8 outbred dogs and 6 outbred mature dogs, who were implanted with a composite mesh unilaterally covered with oxycellulose. The polypropylene implant has been shown to have a greater capacity for the development of adhesive processes. However, if a great omentum to protect this prosthesis from the abdominal cavity then the first zone (active inflammation) spread in 155 microns (increase in the number of blood capillaries of the microcirculatory bed, thickening of the arterioles wall, venous full blood flow, diapedesis of leukocytes through the wall of the blood cells), the second zone (sclerosis) – up to 40 microns (increase in the number of macrophages and lymphocytes. proliferation of fibroblasts). In the future, the structure of the omentum was almost indistinguishable, so with allohernioplasty by the developed method, it was possible to prevent the development of adhesive disease on the intestine. This study confirmed the limited spread of the inflammatory response, which allows the implant of a polypropylene mesh on a great omentum. In the composite mesh, the composite mesh was spliced with surrounding tissues from the side where there was no gel coating, and from the side of the salivary coating, the “readiness” to spread the inflammatory process (vasculitis with pronounced lympho-plasmocytic infiltration of the vessel walls and perivascular ductus), therefore, left it is also necessary to enclose it with a large omentum from intestium.

A Case of Castleman's Disease Located in the Greater Omentum with Epigastric Pain

A Case of Castleman's Disease Located in the Greater Omentum with Epigastric Pain

Pericardial hernias in adults: a systematic review of the literature.

A pericardial hernia is defined as the protrusion of abdominal viscera through the central tendon of the diaphragm into the pericardial sac. It is a rare clinical entity whose symptoms vary considerably. The objective of this study was to evaluate the clinical manifestations of and the optimal surgical treatments for pericardial hernias. PubMed and the Cochrane bibliographical databases were searched (last search: 20 April 2019) for studies on pericardial diaphragmatic hernias in the adult population. Eighty studies met our inclusion criteria and reported on 85 patients (62 men and 23 women) with a mean age of 55.86 ± 15.79 years (mean ± standard deviation) presenting with a pericardial hernia at health care facilities. The leading aetiology was trauma (56.5%) followed by iatrogenic interventions (30.6%). The most common herniated organs were the transverse colon (49.4%) and the greater omentum (48.2%). Seventy-one patients (83.5%) underwent an open surgical repair, whereas 14 (16.5%) had a laparoscopic approach. Mesh or a patch was applied in 41.9% of cases. A postoperative morbidity rate of 16.9% was recorded, whereas the mortality rate reached 2.4%. Pericardial hernia is a rare disease characterized by abdominal organs herniating into the pericardium. It requires a high degree of suspicion for early diagnosis, and all medical professionals should be encouraged to report such cases to clarify the best available therapeutic approach.

Laparoscopic-assisted management of paediatric intra-abdominal lymphatic malformations

Lymphatic malformations (LMs) are low-flow vascular anomalies with treatment modalities that include conservative, sclerotherapy, oral therapeutic agents and surgical excision. The use of laparoscopy combined with interventional radiology has not previously been described. We report our multidisciplinary (MDT) approach to the management of these lesions. All complex paediatric LM referrals are discussed at our vascular MDT that spans across general paediatric surgery, interventional radiology (IR), plastics, orthopaedics, ENT, and dermatology. Intra-abdominal LM’s undergo an initial USS followed by contrast-enhanced MRI to confirm diagnosis and delineate the nature of the lesion. Our first-line treatment has previously been US-guided sclerotherapy. More recently, we have changed our approach to perform an intra-operative assessment of these lesions combined with IR to confirm the diagnosis and assess their resectability. Four patients have undergone combined assessment with our IR team in the last 24 months ranging from 1 to 7 years of age. Two lesions were found to involve the distal ileum, one proximal jejunum and one greater omentum. In all cases, the lesions were excised following initial laparoscopic assessment combined with IR-guided drainage. There have been no complications encountered in these four patients and none have had a recurrence till date. Primary laparoscopic assessment of an intra-abdominal LM is feasible and enables the confirmation of the diagnosis and assessment of resectability. Morbidity from the use of sclerosant agents and the repeated use of general anaesthesia can also potentially be avoided using this technique.

Emergent laparoscopic dome resection and omental suturing to the splenic parenchymal edge for a spontaneously ruptured non-parasitic large splenic cyst in a pediatric patient: a case report

BackgroundSpontaneously ruptured large splenic cyst is a rare in children, and traditionally total or partial splenectomy has been performed for treating an emergent case. We herein present a first case with spontaneously ruptured pediatric splenic cyst treated with emergent laparoscopic dome resection with omental suturing to the parenchymal edge of the spleen.Case presentationA 12-year-old girl with a spontaneously ruptured large non-parasitic splenic cyst (SC) was successfully treated by emergent laparoscopic dome resection with omental suturing to the edge of the splenic parenchyma. The patient presented with acute abdominal pain and was diagnosed with a ruptured non-parasitic SC and peritonitis by contrast-enhanced computed tomography (CT). Emergent laparoscopic dome resection of the SC and omental suturing to the splenic parenchymal edge were then performed. The protruding part of the cyst wall was completely resected using an ultrasonically activated device (USAD), and the greater omentum was then sutured to the anterior edge of the splenic parenchyma under a laparoscopic view. No complications were observed during the operation. A histological examination revealed a congenital splenic cyst lined by epithelial cells. The postoperative course was uneventful, and an ultrasound scan showed no evidence of cyst recurrence at 3 years after the operation.ConclusionsThis minimally invasive laparoscopic procedure was feasible and effective for treating a ruptured large splenic cyst in an emergent pediatric patient.

Secondary debulking for ovarian carcinoma relapse: The R-R dilemma – is the prognosis different for residual or recurrent disease?

Objective:To analyze the kind of ovarian cancer relapse by separating residual from recurrent disease and correlating them with patient survival.Material and Methods:This was a retrospective study of 200 women with ovarian carcinoma relapse between 2005 and 2017.Results:The main sites of residual disease included the great omentum, epiploic appendices, liver round ligament, gallbladder, and cervical/vaginal stump. The median survival for women with residual disease treated with cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) + systemic chemotherapy was 38 months compared with the control group, which reached 23.8 months. The morbidity rates were 18% vs 7%, respectively, and the mortality rates were 2.5% vs 1.3%. The main sites of recurrent disease included the mesenterium, pelvic floor, diaphragm, and Glisson’s capsule. Women with recurrent disease treated with CRS + HIPEC + systemic chemotherapy had median survival rates of 26 months vs 16 months in the control group. The morbidity rates were 22% vs 15%, respectively, and the mortality rates were 3.3% vs 0%.Conclusion:Patients undergoing secondary debulking plus HIPEC for ovarian carcinoma relapse have a different prognosis when compared with patients with residual and recurrent disease. A different prognosis is presented in women undergoing secondary debulking plus HIPEC for ovarian carcinoma relapse when comparing patients with residual and recurrent disease.

Imaging and treatment of idiopathic abdominal cocoon in 9 patients.

The aim of the current study was to investigate the imaging features of abdominal cocoon (AC), the methods of diagnosis and treatment of AC and improve understanding of AC. To do this, the current study retrospectively analyzed the clinical data and imaging findings of nine patients with AC. The clinical manifestations included intestinal obstruction in six out of the nine cases of AC, which included two cases of bowel strangulation and five cases of soft masses in the abdomen. Imaging features of AC included the following: i) Bowel loops were usually present in a fixed cluster; ii) bowel loops were encapsulated partially or totally by a thickening fibrous membrane-like ‘cocoon’; iii) bowel wall thickened in the ‘cocoon’, and the bowel loops and sac adhered; iv) loculated ascites in the ‘cocoon’; v) abnormal clustering of the mesenteric vasculature, hypoplasia of the omentum majus was present or absent; and vi) Ileus occurred in some cases. The features of a plain abdominal X-ray, a gastrointestinal barium meal series and ultrasonography lacked specificity. The results of CT in eight out of nine cases of AC were consistent with the surgical findings. Surgery was the first choice of therapy. All cases were treated surgically, showing that the bowel loops were encapsulated partially or totally by a thickened fibrous membrane. All cases received operations including partial or total excision of the membrane and enterolysis. In conclusion, CT may be highly valuable in the preoperative diagnosis of AC.

In silico comparison of the dosimetric impacts of a greater omentum spacer for abdominal and pelvic tumors in carbon-ion, proton and photon radiotherapy

PurposeThe purpose of this study was to compare carbon-ion (C-ion), proton and photon radiotherapy (RT) plans with regard to dose reduction of the gastrointestinal (GI) tract by using a greater omentum spacer (GO spacer).MethodsWe retrospectively retrieved data for ten patients who received the GO spacer as surgical spacer placement for abdominal and pelvic tumors. Simulation plans were created on pre-spacer Computed Tomography (CT) and post-spacer CT for C-ion RT, proton RT and photon RT to compare the dose of the GI tract. The plans were normalized so that at least 95% of the planning target volume (PTV) received 70 Gy (relative biological effectiveness equivalent) delivered in 35 fractions. All plans were created with the lowest possible dose to the GI tract under conditions that meet the dose constraints for the PTV and spinal cord (maximum dose < 45 Gy). The part of the GI tract to be evaluated was defined as that most adjacent to the PTV. C-ion RT plans and proton RT plans were calculated by a spot scanning technique, and photon RT plans were calculated employing by fixed-field intensity-modulated radiation therapy.ResultsD2 cc and V10–70 of the GI tract were significantly lower on post-spacer plans than on pre-spacer plans for all three RT modalities. Regarding post-spacer plans, D2 cc of the GI tract was significantly lower on C-ion RT plans and proton RT plans than on photon RT plans (C-ion vs photon p = 0.001, proton vs photon p = 0.002). However, there was no significant difference between C-ion RT plans and proton RT plans for D2 cc of the GI tract (C-ion vs proton p = 0.992). In the photon RT plan for one patient, D2 cc of the GI tract did not meet < 50 Gy.ConclusionsThe GO spacer shows a significant dose reduction effect on the GI tract.

Target region resection in patients undergoing cytoreductive surgery for peritoneal metastases-is it necessary in absence of visible disease?

BackgroundThe aim was to study the patterns of target region (greater omentum, lesser omentum, falciform and umbilical round ligament) involvement in patients undergoing cytoreductive surgery (CRS) from various primary tumors, factors affecting involvement and implications on surgical practice. MethodsAll patients undergoing CRS from July 2018 to December 2018 were included in this prospective study. The incidence of target region involvement in presence and absence of visible disease and the impact of primary tumor site, PCI and other variables on target region involvement was evaluated. ResultsIn 191 patients, greater omentum was involved in over 15% of patients irrespective of the primary tumor type and in 15.7% in absence of visible disease. 75% of these had PCI <20. The involvement of the other three target regions was higher than 20% in ovarian cancer, appendiceal tumors and peritoneal mesothelioma. Involvement of these 3 regions was associated with a higher PCI (p < 0.001 for all) and omental involvement (p < 0.001for all). 2.1% of colorectal cancer patients had umbilical round ligament involvement, 4.2% had falciform ligament involvement and none had lesser omentum involvement. ConclusionsTarget region involvement varies according to primary tumour site and disease extent. Resection of the greater omentum should be performed during CRS for PM arising from all primary sites. Resection of other target organs may be performed for selected patients with ovarian cancer, peritoneal mesothelioma and mucinous appendiceal tumors in absence of visible disease. For other patients, it should be done only in presence of visible disease.

Contrast-enhanced ultrasound and tissue elastography in the differential diagnosis of primary and metastatic ovarian tumors in uterine cancer patients: our experience

Objective : to study the possibilities of tissue elastography and contrast-enhanced ultrasound in the differential diagnosis of primary and metastatic ovarian tumors in uterine cancer patients. Materials and methods. The results of observations of 8 patients were analyzed. Results. We identified 8 patients with ovarian tumors, of whom 4 had synchronous primary cancers of the endometrium (synchronous group) and ovary and 4 had endometrial cancer with ovarian metastasis (metastasis group). Ovarian tumors in the synchronous group were more often unilateral, the structure of the ovarian tumor is more often multilocular-solid with uneven, clear contours, the size of the ovaries exceeds 6 cm, and the ovaries were mapped with 4 types of elastograms during tissue elastography. In this group dissemination of the process was not detected. Ovarian tumors in metastasis group were both bilateral and unilateral, represented by solid formations with clear, even contours, ovarian size did not exceed 6 cm, disseminated process was revealed in half of the cases (metastases in the greater omentum and in the retroperitoneal lymph nodes). With tissue elastography solidformations in the structure of the ovaries were mapped mainly by type 5 elastograms. With contrast-enhanced ultrasound in areas of a solid structure a rapid accumulation of the contrast agent in the arterial phase and its rapid excretion into the venous phase was revealed, only the contours of the walls and septum were visualized in the late phase with the multilocularsolid structure of the ovary. Conclusions. When we conduct an ultrasound examination of patients with a uterine cancer, a thorough study of the structure of the ovaries is important for timely diagnosis of the tumor. Further development of differential diagnostic criteria for macrometastases and synchronous ovarian tumors using modern ultrasound technologies is a promising task, since this information is necessary to correct the volume of surgery in this category of patients.

GENERAL CHARACTERISTICS OF THE MAIN MORPHOMETRIC INDICATORS OF THE SHAPE AND ANGIOARCHITECTURE OF THE HUMAN GREATER OMENTUM

The review examines the age characteristics of the greater omentum, its metric and topographic parameters. It has been revealed that the shape of the greater omentum can be single-, two- and multi-lobular, which is determined by its loose part. The linear dimensions of the greater omentum are consistent with the stature type and age range. The length of the loose portion of the greater omentum varies widely and ranges from 20 to 43 cm (average 31.58 ± 0.8 cm); the area of the surface of the greater omentum in adults reaches an average of 0.81 m2, which is almost half the entire surface of the peritoneum and is on average 0.40 m2. The range of individual variability in the size of the greater omentum varies at different ages of the child's development. It is especially large at the end of the first year of life. In the next 2-4 years of life, the range of variability of the greater omentum narrows slightly, the largest growth of linear sizes of the greater omentum is observed during the first year of life of the child and they increase by 2 times, and the area – by 3 times. The asymmetry of the longitudinal dimensions of the greater omentum on the right and left also increases. The boundaries of the greater omentum are: liver, spleen, parietal peritoneum of anterior abdominal wall, small intestine, ascending and descending part of the colon. It has been revealed that the main source of blood supply of the human greater omentum is the abdominal and upper mesenteric arteries, the anterior duplication of the greater omentum receives nutrition from the short and long omental arteries, and numerous small arterial vessels are involved in the blood supply of the upper left part of the omentum; they are located in the thickness of the gastro-splenic ligament. Usually 5-13 branches ramify from the right gastrointestinal artery, and one branches off from the left one. The left gastrointestinal artery has a length of 7 to 21 cm and the right gastrointestinal artery – from 10 to 38 cm.

Bilateral Krukenberg Tumor with Undetermined Origin during Pregnancy

Krukenberg tumor is a rare neoplasia and its occurrence during pregnancy is even more uncommon. In 80% of the cases, Krukenberg tumors are bilateral and the prognosis is poor, especially during pregnancy, which can mimic symptoms and delay diagnosis. We present the case of a 25-year-old woman with a gestational age of 15 weeks diagnosed with bilateral ovarian tumors in a routine ultrasound. Investigation with colonoscopy, esophagogastroduodenoscopy and breast ultrasound was negative. The MRI showed two expansive formations in the pelvic-abdominal region. The right-sided mass measured 12.6 x 12.8 x 14.0 cm with a volume of 1174 cc and the left-sized mass measured 6.0 x 6.8 x 5.1 cm with a volume of 108 cc. Neither side showed signs of invasion of adjacent structures. It was also observed a marked thickening of the greater omentum, minimal thickening of the iliac peritoneal surface, and a large amount of free fluid in the abdominal cavity. Ca – 125 levels were higher than 251, with normal Ca 19-9 and CEA levels. A diagnostic laparoscopy was firstly performed and further bilateral adnexectomy with omentectomy. Pathology report revealed both ovaries infiltrated by epithelioid cells with irregular nuclei consistent with signet-cells. Immunohistochemistry was positive for cytokeratin 20 (CK20), CDX2 and focally positive for cytokeratin 7 (CK7). Based on these findings, the final pathology report was mucinous adenocarcinoma with “signet ring” cells (Krukenberg tumor) favoring gastrointestinal tract origin (CK20, CDX2 and CK7 positive). Due to the need for systemic treatment, pregnancy was interrupted at 31 weeks and a C-section was performed, still showing ascites and multiple tumor implants. A viable female infant was born, weighting 1,715 g with Apgar scores 9 and 10. The infant was admitted to the neonatal intensive care unit for further care and was discharged home after five weeks in good conditions. The patient died one month after giving birth due to severe impairment of her general condition due to disease progression.

The results of the treatment of hand - Outcomes of the treatment of hand degloving injuries with greater omentum flaps.

Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.

Heterotopic vascularization and functionalization of implantable bio engineered hepatic tissue alleviates liver injury in rats.

The challenge of using bioengineered liver lies in sustaining the quantity of high-quality hepatocytes and the vasculature for blood perfusion. We characterized the heparinization of a porcine decellularized liver scaffold (DLS) as a carrier to support hepatocyte angiogenesis, thereby developing functional and vascularized hepatic tissue useful to treat liver injury. The porcine DLS was obtained by the removal of cellular components and then subjected to heparinization by the end-point attachment technique. The heparinized DLSs were recellularized with rat hepatocyte spheroids to construct engineered hepatic tissue. The hepatic tissue was heterotopically implanted in the omentum majus of a rat model with liver injury induced by carbon tetrachloride (CCl4 ). Hepatocyte spheroids in the heparinized DLS remained viable for at least 10weeks in vivo. The entire scaffold was populated with hepatocytes and arranged well. The volume of the heparinized DLS group was expanded over 400-fold. Liver-specific functions such as albumin synthesis, glycogen storage and cytochrome P 3A4 activity were highly expressed in the hepatic tissue. In addition, endothelial cells were recruited, as shown by CD31 staining, and new blood vessels formed, as visualized by fluorescein isothiocyanate-labelled dextran intravital confocal microscopy. The heparinized bioengineered hepatic tissue alleviated CCl4 -induced liver injury by regulating the deposition and degradation of the extracellular matrix. Primary hepatocyte spheroids survived for an extended time on the heparinized DLS and expanded to generate vascularized and functional bioengineered hepatic tissue that can alleviate liver injury in rats.