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Aim Laparoscopic adrenalectomy is the gold standard for benign lesions. So far only a few studies have compared the transperitoneal (TLA) and retroperitoneal (RLA) adrenalectomy. We present the results of our experiences on 189 cases comparing TLA and RLA. Materials and methods Between 1995 and 2005 121 TLA and 68 RLA procedures were performed. Three equal time periods were analyzed. Mann Whitney U test or two tailed Fisher exact test were used, where appropriate, by using SPSS for Windows 13.0. Statistical significance was set at P < 0.05. Results Period I Twenty-nine patients were recorded. Mean operative time was 185.6 ± 37.2 min and 125.7 ± 37.7 min in the RLA and TLA subgroup (P < 0.005). Two procedures were converted in the TLA (splenic lesion and haemorrhage). The time of first oral intake was 1.25 ± 0.4 days after the RLA, and 2.76 ± 1.5 days after the TLA (P < 0.005). The mean hospital stay in the RLA subgroup was 3.8 ± 1.1 days versus 6.3 ± 2.7 days in the TLA subgroup (P < 0.005). Period II One hundred seven patients were recorded. Mean operative time was of 145.3 ± 47.1 min and 114 ± 51.6 min in the RLA and TLA respectively (P < 0.005). Intraoperative blood loss was 443. 4 ± 236 cc in the RLA group and 279.5 ± 637 cc in the TLA group (P < 0.005). The time of first oral intake was of 1.3 ± 0.6 days and 1.6 ± 0.9 days in the RLA and TLA respectively (P < 0.005). The conversion rate 5% and 6% in the RLA and TLA respectively. Period III Fifty-three patients were recorded. Mean operative time was of 139 ± 35 min and 97.8 ± 32 min in the RLA and TLA group respectively (P < 0.001). Intraoperative blood loss was 438 ± 177 cc in the RLA group and 144 ± 166 cc in the TLA group (P < 0.005). The time of first oral intake was of 1.1 ± 0.3 days and 1.6 ± 0.7 days in the RLA and TLA respectively (P < 0.005). Conclusion TLA and RLA have different advantages, but the latter requires more experience. We found a significant advantage in TLA about operative time and blood loss, in RLA for hospital stay and first oral intake, significant improvement were recorded in the RLA access between period I vs. II and I vs. III in the mean operative time, hospital stay and first oral intake. [ABSTRACT FROM AUTHOR]

Introduction Esophageal liposarcomas are extremely rare soft tissue tumors that account for only 1.2-1.5% of all gastrointestinal liposarcomas. We report a case of liposarcoma of esophagus and the literature was reviewed. Case Report A 65-year-old man was admitted to our hospital complaining of progressive dysphagia and important weight loss occurred in the last 5 months. His past medical history was significant for distal gastrectomy for benign ulcer 20 years before and a cardiac pacemaker placement 4 years ago after a diagnosis of dilatative cardiomyopathy. Physical examimination and laboratory tests resulted to be within normal limits. A barium swallow study demonstrated a contrast-filling defect of the cervical esophagus. The esophagogastroduodenoscopy showed a submucosal polypoid mass protruding into the entire esophagus and the biopsy of the lesion showed normal mucosa. The CT scan with a hydrosoluble oral contrast showed a polypoid lesion of 5 cm in diameter and 21 cm in length occupying the entire esophageal lumen. Due to the patient's status of malnutrition and the unknown nature of the lesion the esophagectomy was ruled out. It was performed a left side cervical approach with a right thoracotomy from which the mass was taken out. Histological examination showed a liposarcoma. The patient had an uneventful postoperative course and was discharged in after 12 days. The patient was disease free at 12- and 18-month endoscopic follow-up. Discussion Esophageal liposarcomas are very rare entities and the present case represents the 21st described in the literature to date. In the present case, neither barium swallow nor esophagogastroscopy were helpful diagnostic tools. Only CT scan with contrast swallow allowed to define the anatomic relationships of the mass with the esophageal wall. Almost all cases in the literature were approached by cervicotomy, but in 15 cases a second access such as a laparotomy or thoracolaparotomy was necessary to remove the tumor. Only 4 patients underwent esophagectomy (1-4). Unfortunately avoiding esophagectomy the risk of an R1 resection increases. Esophageal liposarcoma management remain vague and therapeutic options range from less invasive endoscopic excision to radical esophagectomy. [ABSTRACT FROM AUTHOR]

Abstract: Steroid-resistant acute cellular rejection (ACR) and chronic rejection (CR) are still major concerns after intestinal transplantation. We report our experience from a single center on 48 adults recipients using 49 grafts from 2001 to 2011, immunosuppressing them initially with daclizumab initially and later Alemtuzumab. Overall patient survival was 41.9% at 10 years while graft survival was 38.5%. The steroid-resistant ACR population of 14 recipients (28.5%) experienced 50% mortality mainly due to sepsis, while the five (8%) CR recipients, included two survivors. All but 1 graft was placed without a liver. CR was often preceded by ACR episodes. Mortality related to steroid-resistant ACR and CR still affects the intestinal transplant population despite induction/preconditioning, especially in the absence of a protective liver effect of the liver. New immunosuppressive strategies are needed. [Copyright &y& Elsevier]