RESUMO
The authors report their experience with hiatus hernia surgery (9 cases of large hernia with severe gastroesophageal reflux). The fundamental role of instrumental diagnostics in establishing both a clear indication for surgical correction and the quality of the results obtained is emphasized. Technical details of the surgical treatment are report as well. On the basis of their experience and in accordance with other authors the Nissen fundoplication is considered a valid antireflux procedure. Furthermore, the abdominal approach used for this procedure allows to treat other abdominal pathologies often associated with hiatal hernia.
Assuntos
Hérnia Hiatal/cirurgia , Feminino , Seguimentos , Fundoplicatura/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/cirurgia , Gastroscopia , Hérnia Hiatal/diagnóstico , Humanos , Masculino , Radiografia , Estômago/diagnóstico por imagemRESUMO
Based on their personal experience in hepatic resective surgery the authors dwell upon details of surgical technique which, well combined and sustained by advanced technological supports (ultrasonic dissector, laser-argon clotter, intraoperative echography), allow to perform wide parenchymal resections sheltered from dangerous complications. The safety achieved in such a surgery--now routinely performed--derives not only from improved diagnostic techniques (US, CT, MNR, angiography) and advances in anaesthesia-reanimation but, above all, from precise knowledge of organon segmental anatomy and close vascular correlations between the two hepatic hemisystems.
Assuntos
Hepatectomia/métodos , Equinococose Hepática/patologia , Equinococose Hepática/cirurgia , Humanos , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgiaRESUMO
The authors report their experience, from 1983 to 1992, in the treatment of portal vein thrombosis and discuss various aetiological factor of obstruction also underlining the frequent and important association with portal hypertension. The authors emphasize the crucial role of the modern diagnostic techniques such as endoscopy and imaging radiology (U.S., C.T., angiography). Although these techniques not always allow a conclusive evidence in relation to aetiology, however, it is possible to have a rationale for the treatment, i.e. medical, sclerotherapeutic or surgical. As related to the surgical procedures, the authors--based on their personal experience--believe the best are the non-derivative ones.
Assuntos
Veia Porta , Trombose/diagnóstico , Antibacterianos/uso terapêutico , Fibrinolíticos/uso terapêutico , Seguimentos , Heparina/uso terapêutico , Humanos , Cuidados Paliativos , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Terapia Trombolítica , Trombose/etiologia , Trombose/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoRESUMO
The Authors report their limited series of neoplasms of the adrenal cortex, and underline the decisive role of the modern diagnostics based on imaging techniques (US--TC--NMR). These, in fact, often allow a good definition also in the non-functioning adrenal masses incidentally discovered (incidentalomas). The authors emphasize the high quality of such diagnostic methods offering a good reliability in discriminating the nature of the adrenal mass. These undeniable diagnostic advantages have a positive impact on the surgical strategy, allowing together with a careful morphological study of the lesion, to program in detail possible demolitive operations. The authors finally underline the importance of the surgical access: they are persuaded the best is the bilateral under-rib incision. This surgical approach assures a complete exploration of the abdominal and pelvic cavity; moreover, it allows to face every complication.
Assuntos
Adenoma/diagnóstico , Neoplasias do Córtex Suprarrenal/diagnóstico , Lipoma/diagnóstico , Adenoma/cirurgia , Córtex Suprarrenal/diagnóstico por imagem , Córtex Suprarrenal/patologia , Neoplasias do Córtex Suprarrenal/cirurgia , Adrenalectomia , Adulto , Idoso , Feminino , Humanos , Lipoma/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The authors report their personal experience in the treatment of bleeding gastroesophageal varices related to portal hypertension. The excellent results of the esophagogastric devascularization observed in the middle-term follow-up (5 years) reinforced authors' opinion on this surgical procedure as the most valid alternative to derivative surgery. Furthermore, they emphasize esophagogastric devascularization can often replace, on principle, derivative surgery.
Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Esôfago/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hipertensão Portal/cirurgia , Estômago/cirurgia , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/etiologia , Esôfago/irrigação sanguínea , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Estômago/irrigação sanguíneaRESUMO
The authors report their experience in the management of hepatocellular carcinoma, describing a right hepatectomy extended to the left medial segment (IV segment). They also emphasize the treatment of the remaining part of the liver and pay attention to the retrieval of blood.
Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Pessoa de Meia-Idade , RadiografiaRESUMO
The authors report their experience with the treatment of mechanical jaundice in inoperable malignant neoplasms of the bile ducts and pancreas. They emphasize the importance of intrahepatic peripheral biliodigestive derivations (Soupault and Couinaud operation). After a review of the international literature, the authors consider the value of on accurate surgical strategy even in the presence of pathological and clinical features which may limit a radical choice.
Assuntos
Neoplasias do Sistema Biliar/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cuidados Paliativos/métodos , Neoplasias Pancreáticas/cirurgia , Adulto , Neoplasias do Sistema Biliar/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnósticoRESUMO
The Authors report their experience in 4 cases of involvement of the inferior vena cava by hepatic and renal neoplastic and non neoplastic lesions. They describe the modern diagnostic technics and consider the surgical approaches in such cases.