Asunto(s)
Hamartoma/patología , Obstrucción Intestinal/patología , Enfermedades del Yeyuno/patología , Adulto , Femenino , Hamartoma/complicaciones , Hamartoma/cirugía , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Enfermedades del Yeyuno/complicaciones , Enfermedades del Yeyuno/cirugía , Resultado del TratamientoRESUMEN
The Authors report a case al retractile mesenteritis. The disease is a chronic inflammation of the mesentery with the developement of fibrosis. The mesenteritis is a benign disease and sometimes it is related to urogenital neoplasm. The CT fìndings of mesenteritis are non specific and often is necessary a laparotomic or laparoscopic biopsy. The therapy in uncomplicated cases is steroid treatment.
Asunto(s)
Paniculitis Peritoneal/etiología , Complicaciones Posoperatorias/etiología , Adenocarcinoma/complicaciones , Adenocarcinoma/terapia , Adenocarcinoma de Células Claras/cirugía , Antiinflamatorios/uso terapéutico , Antimetabolitos Antineoplásicos/uso terapéutico , Terapia Combinada , Diagnóstico Diferencial , Fluorouracilo/uso terapéutico , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Neoplasias Renales/cirugía , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Terapia Neoadyuvante , Neoplasias Primarias Múltiples/terapia , Paniculitis/diagnóstico , Paniculitis/etiología , Paniculitis/terapia , Paniculitis Peritoneal/diagnóstico , Paniculitis Peritoneal/terapia , Nutrición Parenteral , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Neoplasias del Recto/complicaciones , Neoplasias del Recto/terapiaRESUMEN
Liver metastases of colorectal cancer is present in more than 20% of new diagnosed patients and in 40-60% of relapsed patients. It is a life-threatening prognostic aspect. Hepatic resection, when possible, is the best therapeutic modality, although the overall survival rate is still low (30%). Angiography and intraoperative ultrasonography are useful for resection. The number of hepatic metastases and the surgical margin are probably the most significant prognostic factors. Colorectal cancer may spread predominantly to the liver making regional treatment strategies viable options. Subtotal hepatic resections and segmentectomies are potentially curable procedures for single or small numbers of hepatic metastases without other sites of disease. However, there have been no prospective randomized trials comparing patients with unresected liver metastases and resected metastases. Regional chemotherapy with floxuridine seems usefull combined with hepatic resection or as palliative therapy. Gastric ulcer and biliary sclerosis are the main related toxicities. Patients with localized, unresectable hepatic metastases or concomitant bad medical condition may be candidates for radiation, percutaneous ethanol injection, cryosurgery, percutaneous radiofrequency, hypoxic flow-stop perfusions with bioreductive alkylating agents, hepatic arterial ligation, embolization and chemoembolization. These new hepatic-directed modalities of treatment are being investigated and may offer new approaches to providing palliation and prolonging survival. This review will report the possibilities of intra-arterial chemotherapy and other novel hepatic-directed approaches to the treatment of liver metastases from colorectal cancer.
Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Antineoplásicos/administración & dosificación , Terapia Combinada , Criocirugía , Embolización Terapéutica , Etanol/administración & dosificación , Arteria Hepática , Humanos , Infusiones Intraarteriales , Inyecciones Intralesiones , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Pronóstico , Resultado del TratamientoRESUMEN
Hepatic abscess is a serious surgical problem with a high mortality rate. The Authors report a case of a liver abscess following the migration of a toothpick from the stomach into the hepatic left lobe. Percutaneous abscess drainage combined with endoscopical removal of the foreign body were the goal treatment. The Authors stress importance of the laparoscopy-guided drainage with placement of intra-hepatic drains.
Asunto(s)
Cuerpos Extraños/complicaciones , Absceso Hepático/etiología , Drenaje , Endoscopía , Femenino , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Humanos , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
The authors report 30 cases of adenocarcinoma of the pancreas treated with palliative surgery at the 2nd Department of Surgery of S. Maria delle Croci Hospital in Ravenna, in the period 1985-1991. Biliary bypass or gastroenterostomy were performed because of severe jaundice and duodenal obstruction, and not with prophylactic intent. According to Fortner's classification 60% of the neoplasias were stage 3, 36.7% stage 2, and 3, 3% stage 1 tumors. The hospitalization mean time was 15 days, perioperative mortality was 6.6% and mean survival rate was 6.5 months. The authors conclude that palliative surgical treatment is useful in case of neoplastic biliary and duodenal stenoses, with no liver or lung metastases, and also whenever an histological evaluation of the tumor is necessary to evaluate resection chances.
Asunto(s)
Adenocarcinoma/cirugía , Cuidados Paliativos , Neoplasias Pancreáticas/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pancreatectomía , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía , Estudios RetrospectivosRESUMEN
The authors report their experience of 14 cases of hepatic trauma that underwent surgical treatment. During the period 1987-1990, 42 patients were admitted with diagnosis of hepatic injuries to the surgical department of Ravenna Hospital. 28 of the 42 patients were subjected to repeated abdominal echography and didn't undergo surgical treatment. The authors consider the importance of the abdominal echography whether of the surgical treatment or nonoperative management. Prognosis is always serious, and it is influenced by three factors: the kind of trauma, the concomitant lesions and the general conditions of the patient. The authors, in conclusion, report the per cent of survive and of complications that they have found.
Asunto(s)
Hígado/lesiones , Hígado/cirugía , Adulto , Femenino , Humanos , MasculinoRESUMEN
The authors report their experience with the mostly used technique of hernioplasty. They compare the Shouldice hernioplasty, development of the traditional Bassini, with the Trabucco and Lichtenstein techniques in which synthetic prosthesis are used. The two surgical departments participating to this study present 234 patients who underwent hernioplasty with the above mentioned techniques. The authors consider local and general complications during the postoperative time and after a 6-month follow-up. Results indicate that the surgical techniques used are efficient in terms of low complication rates and reduced hospitalization.
Asunto(s)
Hernia Inguinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Italia/epidemiología , Masculino , Métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Recurrencia , Mallas QuirúrgicasRESUMEN
The authors report a rare case of cystic lymphangioma of the colon. Cystic lymphangioma is a benign neoplasm, that originate from lymphatic structures; it unusually involves the large bowel. This tumor has some original features: big dimension, intracystic sepiments, bad demarcation from surroundings structures. Diagnostic examinations are aspecific, showing only a generic mass, which structure is assessable with abdominal echography or TC. A definite diagnosis is only possible with surgical resection.
Asunto(s)
Neoplasias del Colon/cirugía , Linfangioma Quístico/cirugía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
The Authors report their experience on the incidence of anastomotic recurrence in 122 patients surgically treated with colorectal resection for cancer. The number of local recurrences (3 cases, that is 2.5%) is in the inferior range of what reported in Literature. Parameters that influence the local failure are: depth of tumor invasion, extension to adjacent organs and structures, presence of lymph node metastases (valuable with Dukes' modified staging). Type of operation and histologic grade do not seem to influence local recurrence. The Authors report the therapeutic choices adopted in the cases considered.
Asunto(s)
Neoplasias Colorrectales/cirugía , Recurrencia Local de Neoplasia/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/patología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
The authors report their experience concerning the cultural study of bile samples taken during elective biliary surgery. All the operations were carried out after a randomized preoperative antibiotic prophylaxis. Among the 138 cases examined the presence of surgical infections (wound infection) was taken into account. A lack of correlation between the germs present in the bile and those isolated from samples of complicated cases, was registered. However, the Authors emphasize that, although antibiotic prophylaxis gives a reduced percentage of postoperative infections, it is unable to sterilize the bile.
Asunto(s)
Bilis/microbiología , Procedimientos Quirúrgicos del Sistema Biliar , Infección de la Herida Quirúrgica/microbiología , Antibacterianos/uso terapéutico , Evaluación de Medicamentos , Humanos , Premedicación , Distribución Aleatoria , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
The Authors studied the effects of a short-term prophylaxis (Aztreonam + Clindamycin) administered to 259 patients operated on for colo-rectal diseases. Thirteen wound sepsis (5.15%) and 49 different infections (19.44%) occurred in this group of patients. The study confirms the link between P.N.I. greater than 50 and the incidence of wound infections. The incidence of urogenital sepsis was correlated with the catheterization period (greater than 6 days), operative time (greater than 200 min.), hospitalization (greater than 12 days) and age (greater than 70 years). General tolerance to the antibiotics was good.
Asunto(s)
Aztreonam/uso terapéutico , Clindamicina/uso terapéutico , Colon/cirugía , Premedicación , Recto/cirugía , Adolescente , Adulto , Factores de Edad , Anciano , Infecciones Bacterianas/epidemiología , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Factores Sexuales , Infección de la Herida Quirúrgica/epidemiologíaRESUMEN
The Authors report their experience from 1984 to 1989 with surgery in the elderly. Patients aged 75 years were considered as geriatric and entered the study. Mortality and morbidity rates were analysed in 476 cases operated. Pre-existent diseases were related to postoperative complications. The Authors conclude underlining the feasibility of geriatric surgery as well as the acceptable risk rate.