RESUMO
OBJECTIVES: The liver is the most frequent anatomic location of hydatid disease. Imaging modality nowadays are numerous and increasingly efficient. The objective of our study is to precise the correlation between Ultrasonography, computed tomography and intraoperative findings on the different characteristics of hepatic hydatid cyst. PATIENTS AND METHODS: We conducted a prospective study including all hepatic hydatid cyst operated in 2015. We evaluated statistically, by calculating the coefficient K or the intraclass correlation coefficient, the concordance between Ultrasonography, computed tomography (CT) and intraoperative findings on the different characteristics of hepatic hydatid cyst. RESULTS: In our study, we included 48 patients with 79 hepatic hydatid cysts. It was concluded that Ultrasonography performs better than CT in the study of type of cyst, pericyst, relationships with portal vein and main bile duct. While CT is better than echography in terms of number, localizations of cyst, relationship with the vena cava inferior, other localizations and the remaining liver, both examinations remain limited in the determination of pericyst characteristics and the identification of biliary fistula. CONCLUSION: Ultrasonography and CT cannot provide accurate data for the study of pericyst and biliary fistula, hence requiring prospective studies of the place of MRI and intraoperative echography in this domain. KEY WORDS: Diagnostic, Imaging, Echinococcosis, Hepatic, Intraoperative Care.
Assuntos
Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Correlação de Dados , Humanos , Cuidados Intraoperatórios , Estudos Prospectivos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Internal hernias of the abdomen are uncommun. They represent less than 1% of bowel obstruction cases. The left paraduodenal hernia is the most frequent type of internal hernias. We report a case of 77 year-old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal paraduodenal hernia by showing incarcerated jejunal loops in a paraduodenal hernia through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities. KEY WORDS: Computer tomography Internal hernia, Paraduodenal hernia, Small bowel obstruction.
Assuntos
Hérnia/complicações , Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Doença Aguda , Idoso , Duodeno , Feminino , Hérnia/diagnóstico por imagem , Herniorrafia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Germline mutations in the base excision repair gene MUTYH have been associated with recessive inheritance of multiple colorectal adenomas. Screening of the MUTYH gene was carried on index cases of 10 unrelated Tunisian families and on available DNA samples from some members. Three germline mutations: c.536A > G (p.Y179C), c.1187 G > A (p.G396D) and c.1227_1228dup (p.Glu410GlyfsX43), were identified in the homozygous or compound heterozygous state in 8 out of 10 families. The c.1227_1228dup (p.Glu410GlyfsX43) mutation was the most frequent, since it was found in biallelic homozygous in 7 probands and 2 members of family F1 and in compound heterozygous associated with the c.536 A > G (p.Y179C) or c.1187 G > A (p.G396D) in family F2. Haplotype analysis revealed that the 8 families are unrelated. Moreover, in sporadic colorectal cancer, the c.1227_1228dup (p.Glu410GlyfsX43) mutation was identified in 13 % of patients compared to the p.G396D and p.Y179C found in 1.2 and 2.12 % respectively. Our data shows the high prevalence of the p.Glu410GlyfsX43 mutation in Tunisian families affected with MUTYH associated polyposis as well as in sporadic colorectal carcinoma.
Assuntos
Polipose Adenomatosa do Colo/genética , Neoplasias Colorretais/genética , DNA Glicosilases/genética , Mutação em Linhagem Germinativa , Adulto , Idoso , Idoso de 80 Anos ou mais , Família , Feminino , Haplótipos/genética , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Prevalência , TunísiaRESUMO
Internal hernias of the abdomen are uncommon. They represent less than 1% of bowel obstruction cases. The left Paraduodenal hernia (PH) is the most frequent type of internal hernias. We report a case of 77 year-â old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal PH by showing incarcerated jejunal loops in a PH through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities.
RESUMO
Cyclo-oxygenase 2 (COX-2) and E-cadherin are promising biomarkers for cancer diagnosis and therapy. The aim of this study was to examine the expression of these two proteins in primary colorectal adenocarcinomas and to investigate their association with clinicopathological characteristics including survival of patients. Immunostaining of E-cadherin and COX-2 was assessed in 70 primary colorectal adenocarcinomas from Tunisian patients. Membranous E-cadherin immunostaining and cytoplasmic COX-2 expression were observed in 74.3% and 68.6% of cases respectively. A significant association was found between COX-2 expression and age at diagnosis (P=0.02), and vessel invasion (P=0.037). The expression of E-cadherin correlated with age at diagnosis (P=0.01), and tumor size (P=0.02). In addition, by multivariate analysis, we revealed a significant association with 1-year disease free survival and a tendency with distant metastasis (P=0.017 and P=0.065 respectively). On the other hand, tumors exhibiting COX-2+/E-cadherin-profile were larger (P=0.006), and in an advanced stage (P=0.001). Survival analysis showed that COX-2 over-expression confers a reduced overall survival rate (Plog rank=0.036) and is an independent factor predictive for prognosis.
Assuntos
Adenocarcinoma/metabolismo , Caderinas/biossíntese , Neoplasias Colorretais/metabolismo , Ciclo-Oxigenase 2/biossíntese , Adenocarcinoma/química , Adenocarcinoma/diagnóstico , Caderinas/análise , Neoplasias Colorretais/química , Neoplasias Colorretais/diagnóstico , Ciclo-Oxigenase 2/análise , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida , Taxa de Sobrevida , TunísiaRESUMO
BACKGROUND: Upper gastrointestinal bleeding is a frequent cause for emergency hospital admission. Most severity scores include in their computation the endoscopic findings. The Glasgow-Blatchford score is a validated score that is easy to calculate based on simple clinical and biological variables that can identify patients with a low or a high risk of needing a therapeutic (interventional endoscopy, surgery and/ or transfusions). AIM: To validate retrospectively the Glasgow-Blatchford Score (GBS). METHODS: The study examined all patients admitted in both the general surgery department as of Anesthesiology of the Regional Hospital of Sidi Bouzid. There were 50 patients, which the mean age was 58 years and divided into 35 men and 15 women. In all these patients, we calculated the GBS. Series were divided into 2 groups, 26 cases received only medical treatment and 24 cases required transfusion and / or surgery. Univariate analysis was performed for comparison of these two groups then the ROC curve was used to identify the 'Cut off point' of GBS. Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) with confidence interval 95% were calculated. RESULTS: The SGB was significantly different between the two groups (p <0.0001). Using the ROC curve, it was determined that for the threshold of GBS ³ 7, Se = 96% (88-100%), Sp = 69% (51-87%), PPV = 74% (59 -90%) and NPV = 95% (85-100%). This threshold is interesting as to its VPN. Indeed, if GBS <7, we must opt for medical treatment to the risk of being wrong in only 5% of cases. CONCLUSION: The Glasgow-Blatchford score is based on simple clinical and laboratory variables. It can recognize in the emergency department the cases that require medical treatment and those whose support could need blood transfusions and / or surgical treatment.
Assuntos
Técnicas de Diagnóstico do Sistema Digestório , Hemorragia Gastrointestinal/terapia , Projetos de Pesquisa , Idoso , Estudos de Coortes , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Trato Gastrointestinal Superior/patologiaAssuntos
Colite Isquêmica/diagnóstico , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colite Isquêmica/diagnóstico por imagem , Colite Isquêmica/patologia , Colo/patologia , Colonoscopia , Feminino , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , UltrassonografiaRESUMO
INTRODUCTION: Alterations in different signaling pathways are involved in initiation and progression of colorectal carcinoma, such as those related to p53, MLH1, p16INK4a, Kras, etc. AIM: This study was conducted with the aim to investigate the expression of p16INK4a and p53 in colorectal cancer (CRC) and evaluated their correlation with major clinicopathologic features and patients' survival. MATERIALS AND METHODS: The expression of p16INK4a and p53 were analyzed by immunohistochemistry on 70 paraffin specimens of CRC. RESULTS: Positive immunostaining for p16INK4a and p53 was observed in 27 (38.6%) and 53 (80%) cases, respectively. Significant correlation between loss of p16INK4a expression and tumor size was found (P=0.008), whereas overexpression of p16INK4a correlated with favorable prognosis parameters, such as absence of lymph node metastasis (P=0.029) and early stage of CRC (P=0.027). Furthermore, p53 overexpression significantly correlated with distal tumor location (P=0.022) and was related to a better overall survival in the group of patients with distal colon carcinomas (P=0.002). Patients with p16INK4a-positive tumors had a significant longer overall survival time than patients with p16INK4a-negative carcinomas (P=0.033). In addition, Cox regression model showed that overexpression of p16INK4a is an independent factor for prognosis with depth of invasion, p53 accumulation, and coincident abnormal expression of p16INK4a or p53. CONCLUSION: Our data suggest that the assessment of both p53 and p16INK4a expression might be helpful in predicting prognosis in patients with colorectal cancer.
Assuntos
Adenocarcinoma/diagnóstico , Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/diagnóstico , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Colorretais/fisiopatologia , Progressão da Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Transdução de Sinais , Análise de Sobrevida , Carga Tumoral , TunísiaRESUMO
The methylation of CpG islands in the promoters is associated with loss of protein via repression of gene transcription. Several studies have demonstrated that tumour suppressor and DNA repair genes are often aberrantly hypermethylated in colorectal cancer. The present study was conducted to examine whether the methylation profile of p16INK4a and hMLH1 (human mutL homologue 1) promoters was associated with clinical features and patients' survival in CRC (colorectal carcinoma). Aberrant methylation of p16INK4a and hMLH1 promoters was found in 47.2 and 53.4% of tumours respectively. For adjacent non-tumoral mucosa, p16INK4a was fully unmethylated in 30% of the cases, whereas hMLH1 was predominantly unmethylated (76%). Methylation of p16INK4a correlated with gender and tumour size (P=0.005 and 0.035 respectively), whereas those of hMLH1 significantly correlated with overall survival (P log rank=0.007). Concomitant methylation of p16INK4a and hMLH1 was associated with TNM (tumour, lymph node and metastases) stage and tumour size (P=0.024 and 0.021 respectively). Our data show that loss of hMLH1 expression through aberrant methylation could be used as a marker of poor prognosis in CRC.
Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Adenocarcinoma/genética , Neoplasias Colorretais/genética , Inibidor p16 de Quinase Dependente de Ciclina/genética , Proteínas Nucleares/genética , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Adenocarcinoma/metabolismo , Idoso , Neoplasias Colorretais/metabolismo , Ilhas de CpG , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Metilação de DNA , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Proteínas Nucleares/metabolismo , Regiões Promotoras Genéticas , Proteínas Proto-Oncogênicas B-raf/metabolismo , TunísiaRESUMO
Silencing of gene expression by aberrant methylation at the CpG islands is common in human tumors, including colorectal cancer. This epigenetic alteration affects promoter of genes having crucial cellular functions such as tumor suppressor, DNA repair, apoptosis, cell adhesion, etc. We investigated the methylation status in the promoter regions of the RARß2, RASSF1A, DAPKinase, and CDH1 genes in 73 colorectal carcinoma and 43 paired normal tissues of Tunisian patients using methylation-specific PCR assays. The association between methylation status and the clinicopathological features was evaluated. To determine whether aberrant methylation affects gene expression, we performed immunohistochemistry analysis for E-cadherin and COX-2, a target gene of RARß2. The methylation frequencies vary from 80.8% for RARß2 to 35.6% for RASSF1A while in non-tumor-paired samples; the frequencies of methylation are significantly lower for all the fourth genes tested. The methylation status did not correlate with any of the clinical features considered; however, aberrant methylation of RARß2 was associated with a shortened overall patients' survival (p log rank = 0.026); nevertheless, it needs to be confirmed on larger sample size. Moreover, a significant inverse association was observed between methylation status of RARß2 and COX-2 protein expression in tumor specimen (p = 0.014). On the other hand, we found that loss of E-cadherin expression was significantly associated with aberrant methylation of the CDH1 promoter (p = 0.005). Our findings showed that RARß2 was frequently methylated in colorectal cancer and correlated with a worse prognosis and high expression of COX-2 suggesting a link between these two proteins in colorectal carcinogenesis. We also showed that epigenetic alteration of CDH1 is a major mechanism of the loss of E-cadherin protein expression in primary colorectal tumors.
Assuntos
Adenocarcinoma/genética , Neoplasias Colorretais/genética , Ciclo-Oxigenase 2/biossíntese , Metilação de DNA , Receptores do Ácido Retinoico/genética , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD , Caderinas/biossíntese , Caderinas/genética , Neoplasias Colorretais/mortalidade , Ilhas de CpG/genética , Epigênese Genética/genética , Feminino , Inativação Gênica , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prognóstico , Regiões Promotoras Genéticas/genética , Proteínas Supressoras de Tumor/genéticaRESUMO
Undifferentiated (embryonal) sarcoma (UES) of the liver is a very rare pediatric neoplasm with an aggressive behavior. Multimodal treatment including complete surgical resection and chemotherapy has improved survival. We report a case of UES occurring in a 15-year-old female. Radiographic findings showed a multicystic mass appearance. The diagnosis of hydatid cyst was initially presumed. A complete tumor resection after 3 cycles of chemotherapy was performed. Histologically, only 20% of tumor necrosis was noted. Adjuvant chemotherapy was instituted. She remained well at 11 months of follow-up. Cystic appearance is a usual finding in UES. Differential diagnosis with hydatid cyst may be problematic in endemic hydatidosis areas.
Assuntos
Equinococose Hepática/patologia , Neoplasias Hepáticas/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Sarcoma/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adolescente , Biópsia por Agulha , Quimioterapia Adjuvante , Terapia Combinada , Diagnóstico Diferencial , Equinococose Hepática/diagnóstico , Doenças Endêmicas , Endossonografia/métodos , Feminino , Seguimentos , Hepatectomia/métodos , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/terapia , Medição de Risco , Sarcoma/diagnóstico , Sarcoma/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , TunísiaRESUMO
Sarcoma of the stomach is a rare histological entity. These differentiated mesenchymal tumors do not differ clinically from other gastric cancers. Endoscopic ultrasonography is the preferred means of exploration because it determines the existence of a submucosal lesion and provides guidance in determining its type. Certainty of diagnosis requires pathologic and immunohistochemical examinations of the surgical specimen. Malignant gastric stromal tumors are the first differential diagnosis of sarcoma of the stomach. They can be better characterized by testing their expression of the c-kit protein. Histological confirmation of malignancy sometimes remains difficult. Locoregional invasion and distant metastases confirm malignancy. Treatment is essentially surgical. Prognosis depends on tumor size, extension, rupture and histological grade.
Assuntos
Sarcoma , Neoplasias Gástricas , Humanos , Sarcoma/diagnóstico , Sarcoma/terapia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapiaRESUMO
UNLABELLED: THE AIM of this work was to study the clinical and therapeutic features of this affection. CASE REPORT: Our retrospective study concerned two cases of hyperlipemic pancreatitis treated during 6 years from 1998 to 2003. The incidence of this affection was 1.42%. Our patients were respectively a man aged 32 years without any significant history and a pregnant woman aged 24 years with a positive history of dyslipidemia. Clinical, biologic and radiological data didn't differ from those of other causes of acute pancreatitis. The hyperlipemic origin was confirmed by a lactescent serum and a rate of triglycerides greater than 10 g/l. The course was characterized by the recurrence of pancreatitis related to the increased triglycerid serum level over 10 g/l. Plasmapheresis and administration of heparin and/or insulin seem to be efficient in reducing the serum level of triglyceride and in improving the course. Hygieno-dietary measures and hypolipemiant treatment were necessary for the level of triglyceirdes in serum below 10 g/l. We in the absence of comolicatons, surgery seemed umnecessry in the two cases. CONCLUSION: the clinical pattern of acute hyperlipemic pancreatitis doesn't include any specific elements, but its treatment and prevention must take into account the associated hyperlipidemia.
Assuntos
Hiperlipidemias/complicações , Pancreatite/etiologia , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Gravidez , Complicações na Gravidez/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. METHODS: We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy. RESULTS: We treated 44 hydatid cysts of segment I surgically in 10 men and 34 women, with a mean age of 40.6 years. Ten patients (22.7%) had a history of hydatid cysts. Symptoms or complications were noted at admission in 45% of cases. Only five cases (11.4%) required emergency surgery. Surgical examination confirmed vascular compression in 17 cases (38.6%) and a biliary fistula in 17 cases (38.6%). Surgical treatment consisted of deroofing in 37 cases (84,1%), with omentoplasty in 23 (54%), subtotal pericystectomy in 3 and simple drainage in 4. Large biliary fistulas (> 5 mm) were treated with bipolar drainage in 2 cases and internal transfistulary drainage in 3. Some hemorrhaging occurred during surgery in 5 cases, and one cyst ruptured in the peritoneal cavity. Albendazole was prescribed postoperatively for nine patients. There was one intraoperative death, secondary to hemorrhage resulting from erosion of the inferior vena cava. Morbidity was 25%. After a mean follow-up of 32 months, five patients had recurrences in the liver but outside segment I. CONCLUSION: Segment I of the liver is a rare site for hydatid disease, and a site where vascular and biliary complications are frequent. Its management requires a good knowledge of the vascular anatomy of the liver and wide experience of hydatid cyst surgery and especially of simple surgical procedures.
Assuntos
Equinococose Hepática , Adolescente , Adulto , Idoso , Albendazol/uso terapêutico , Anticestoides/uso terapêutico , Criança , Pré-Escolar , Colangiografia , Drenagem , Equinococose Hepática/complicações , Equinococose Hepática/diagnóstico , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/tratamento farmacológico , Equinococose Hepática/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Abdominal , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
OBJECTIVE: Our aim was to assess the epidemiological particularities, the circumstances of the diagnosis and the therapeutic indications of the cystic lymphangioma of the abdominal spaces. METHODS: Our retrospective and analytic survey concerns 11 cases of cystic lymphangioma of the abdominal spaces: mesentere 6 cases, epiploon 1 case, retroperitoneum 3 cases and under peritoneum 1 case. The incidence was of 1/2476 hospitalizations (0.04%). RESULTS: The median age was 28 years. The sex-ratio was of 1.2. The main circumstance of discovery of the cystic lymphangioma was an abdominal mass in 7 cases. The other circumstances were: a pseudoappendicular syndrome, an ascitis, a disembowelment and a direct traumatism of the abdomen. Total resection of the cystic lymphangioma was performed in 7 cases. In 4 cases a simple enucleation and in 3 cases a resection of a segment of the organ that supports the lymphangioma. Only a partial resection of the lymphangioma has been achieved for the remnant patient. A cystic lymphangioma relapsed 13 years after a total resection in one case. Mortality rate was nul. CONCLUSION: The circumstances of diagnosis of the cystic lymphangioma were in relation with the volume of the tumor or a mechanical, infectious or hemorrhagic complications. The recidivism after a total resection let evoke the possibility of multiple and diffuse cystic lymphangioma.
Assuntos
Neoplasias Abdominais/diagnóstico , Linfangioma Cístico/diagnóstico , Neoplasias Abdominais/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Linfangioma Cístico/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos RetrospectivosRESUMO
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure. It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains controversial. Its onset is often insidious: an increase in the abdominal perimeter may be the first sign noted. Preoperative diagnosis is facilitated by modern imaging techniques. Ultrasonography and computed tomography provide complementary signs: septa and scalloping of the liver margins, respectively. Effusion in the lesser peritoneal cavity suggests this diagnosis. Magnetic resonance imaging, by showing the gelatinous ascites, their septa and the scalloping of liver and spleen, can strengthen the probability of the diagnosis. Only laparotomy can confirm it, however. Appendectomy is required in all cases. Recurrence is more frequent in the forms associated with malignant or bipolar tumors. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the only therapy shown to be effective in cases of recurrence or malignant forms.
Assuntos
Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/terapia , Pseudomixoma Peritoneal/diagnóstico , Pseudomixoma Peritoneal/terapia , Idoso , Antineoplásicos/uso terapêutico , Apendicectomia , Biópsia por Agulha , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Hipertermia Induzida , Laparotomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/terapia , Paracentese , Neoplasias Peritoneais/epidemiologia , Neoplasias Peritoneais/etiologia , Cuidados Pré-Operatórios , Pseudomixoma Peritoneal/epidemiologia , Pseudomixoma Peritoneal/etiologia , Doenças Raras , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
Linitis plastica accounts for 3-19% of gastric cancers. Its diagnosis requires morphology findings of an infiltrating stomach tumor and pathology findings including signet-ring cells and fibrous stroma. Its etiology is not known, and it has no particular features. Diagnostic sensitivity of endoscopy is poor because of the difficulty of biopsies: "Forceps slide on the infiltrated walls." Its characteristic radiologic appearance is due to the infiltration and stiffness that causes it to be known as "leather-bottle stomach". Endosonography is currently the reference examination and has made it possible to identify localized linitis. Unlike other stomach cancers, it frequently extends into the peritoneum and lymphatic system. Curative treatment remains radical surgical resection. Modern chemotherapy protocols based on oral derivatives of 5-FU (TS-1) and of paclitaxel appear promising. The severity of its prognosis is explained by the frequency of peritoneal dissemination, lymphatic invasion and extension toward neighboring organs.
Assuntos
Linite Plástica/diagnóstico , Linite Plástica/terapia , Diagnóstico Diferencial , Diagnóstico por Imagem , Humanos , Prognóstico , Neoplasias Gástricas/diagnósticoRESUMO
Breast cancer in men is rare and most often occurs at or after the age of 60 years. Prognosis is poor when it is discovered at a late stage, as it often is in men, although it should be easier to detect because men have so little breast tissue. The causal mechanism appears to depend on hormone metabolism abnormalities related to elevated estrogen or prolactin levels. A family history of breast cancer is found in 5-10% of cases. Infiltrating ductal carcinoma accounts for most cases (70-90%) of male breast cancers. In situ but not invasive carcinoma is exclusively ductal and accounts for 7% of cases. Spread to lymph nodes is observed in 50-75% of cases. Immunohistochemical analysis shows that tumors are positive for progesterone and estrogen receptors more frequently in men than women. Diagnosis is based on clinical examination, ultrasonography, and mammography. Aspiration cytology often makes it possible to confirm the malignancy. Excisional biopsy with an immediate intraoperative pathology examination confirms malignancy and makes wider excision possible during the same procedure. A modified radical mastectomy with removal of some lymph nodes (Patey's mastectomy) is the standard basic treatment. Locoregional radiotherapy is very often indicated. Hormone therapy is also a first-line treatment. Chemotherapy is reserved for young men with substantial lymph node invasion and negative for hormonal receptors. The prognosis of breast cancer in men remains uncertain because of the frequently late diagnosis, unpredictable course, and high potential for metastasis.
Assuntos
Neoplasias da Mama Masculina , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biópsia , Mama/patologia , Neoplasias da Mama Masculina/diagnóstico , Neoplasias da Mama Masculina/diagnóstico por imagem , Neoplasias da Mama Masculina/tratamento farmacológico , Neoplasias da Mama Masculina/epidemiologia , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia , Carcinoma Ductal de Mama/epidemiologia , Criança , Feminino , Humanos , Incidência , Masculino , Mamografia , Mastectomia Radical Modificada , Pessoa de Meia-Idade , Prognóstico , Ultrassonografia MamáriaRESUMO
BACKGROUND: Laparoscopic cholecystectomy is at present the gold standard treatment of gallbladder lithiasis. AIM: Assesment of Laparoscopic cholecystectomy METHODS: Through a retrospective series of 500 laparoscopic cholecystectomies during a period going from January 1996 to March 2000, we tried to evaluate our experience by comparing our results to the literature data. RESULTS: There were 420 women and 80 men with a sex ratio of 0.19. Average age was 50 years. 16.2% of our patients were obese. 13 patients had a history of respiratory disease and 122 history of a cardiovascular pathology essentially arterial hypertension. All our patients benefited from at least one hepato-biliary ultrasound examination before the intervention. Antibioprophylaxy was administrated in 93.8% of cases. In 23 cases (4.6%), a conversion was necessary for different causes. We noted 11 surgical complications (2.2%) among which 2 required a surgical resumption, and 11 medical complications dominated by broncho-pulmonary infections. We had no death.