RESUMO
INTRODUCTION: The prognosis of patients with cutaneous melanoma is greatly influenced by the presence of lymph node metastases. One of the most innovative and fascinating concepts to emerge in the field of oncology in recent years is the use of sentinel lymph node biopsy (SLNB). AIM: The aim of this study was to determine what SPECT-CT images contribute to the search for sentinel nodes in patients with melanoma. METHODS: From March 2007 to October 2008, 18 patients were examined for sentinel nodes using dynamic scintigraphy, planar images, and SPECT-CT in the Nuclear Medicine Department of San Carlos University Hospital. The group contained 10 women and 8 men, age range 14-83 years, mean age 57 years (57+/-20.1). RESULTS: The sentinel node was located by conventional imaging techniques (dynamic scintigraphy and planar images) in 16 of 18 patients (88.88%). SPECT-CT identified the sentinel node in 18 of 18 patients (100%) and detected clinically relevant findings in 6 of 18 patients (33.33%) CONCLUSIONS: SPECT-CT imaging contributed clinically relevant information on sentinel nodes of melanoma, which is particularly important in patients with melanoma of the trunk or head and neck.
Assuntos
Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Adenoma Viloso/complicações , Neoplasias Retais/complicações , Desequilíbrio Hidroeletrolítico/etiologia , Adenoma Viloso/diagnóstico , Adenoma Viloso/diagnóstico por imagem , Adenoma Viloso/fisiopatologia , Adenoma Viloso/cirurgia , Idoso , Colonoscopia , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Neoplasias Retais/diagnóstico , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , UltrassonografiaRESUMO
Intestinal pneumatosis is an infrequent disease of difficult clinical and radiologic diagnosis. It may be accompanied by pneumoperitoneum in up to 30% of the cases leading to differential diagnosis with pictures of visceral perforation. We herein present 4 cases of intestinal pneumatosis in whom pneumoperitoneum was associated in 3 patients. Diagnosis was intraoperative in 2 patients submitted to emergency surgery because of an associated acute gastrointestinal event (intestinal volvulus and acute cholecystitis). The other 2 cases were diagnosed by computerized tomography and colonoscopy, respectively, and given their satisfactory clinical evolution they received conservative treatment. The course of the disease was favorable in all the patients with the radiologic signs of pneumatosis disappearing.
Assuntos
Pneumatose Cistoide Intestinal/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Gangrene of the stomach is a rare and catastrophic event, usually attributed to local pathologic conditions. Although there are no cases documented in the literature, non-occlusive arterial ischemia is sometimes listed among the causes of necrotizing gastritis. We report a case of necrotizing gastroenteritis associated with a low flow state secondary to an episode of fulminant colitis, fecal peritonitis and septic shock. The patient recovered after staged resection of the involved segments of the gastrointestinal tract.
Assuntos
Enterocolite Pseudomembranosa/complicações , Gastrite/complicações , Doenças Inflamatórias Intestinais/complicações , Adulto , Terapia Combinada , Procedimentos Cirúrgicos do Sistema Digestório , Emergências , Enterocolite Pseudomembranosa/cirurgia , Feminino , Gastrite/cirurgia , Humanos , Doenças Inflamatórias Intestinais/cirurgia , Necrose , Peritonite/etiologia , Peritonite/cirurgia , Reoperação , Choque Séptico/etiologia , Choque Séptico/cirurgiaRESUMO
Laparoscopic antireflux surgery has quickly developed since Bernard Dallemagne carried out the first laparoscopic fundoplication in 1991. However, only preliminary results from institutional series are available. The authors review the indications for laparoscopic antireflux surgery. In addition, technical aspects of several reported laparoscopic antireflux procedures are evaluated. Data from institutional series show that morbidity and mortality rates after laparoscopic antireflux surgery are similar to those reported for open surgery, with a perioperative morbidity rate ranging between 4% and 26% and a mortality rate under 0.6%. Endoscopic dilation for postoperative dysphagia is required in 7%-11% of the cases. In summary, preliminary data show that laparoscopic antireflux surgery may play a predominant role in the treatment of complicated gastroesophageal reflux. Meanwhile, controlled trials with open surgery and medical therapy should be done before the laparoscopic approach is generalized.
Assuntos
Refluxo Gastroesofágico/cirurgia , Laparoscopia , Transtornos de Deglutição/etiologia , Estudos de Avaliação como Assunto , Fundoplicatura , Refluxo Gastroesofágico/complicações , Humanos , Complicações Pós-Operatórias , ReoperaçãoRESUMO
The results of an enteral nutritional pattern used in 40 seriously ill patients who underwent gastrointestinal tract surgery, are described. The most frequently used route of administration (97.5% of the cases) was a jejunal catheter. We review the types of formula used, the method and time of perfusion, and the association with parenteral nutrition. The mean time of perfusion was 8.6 (5) days and the morbidity rate due to enteral nutrition was 20%. In all cases the complications were minor (externalization of the catheter in 2 cases, proximal reflux of the formula in 1 patient, a catheter break, which was eliminated through the stool without any consequences, in 1 case, diarrhoea in 2 patients, and catheter obstruction in 2 cases). The nutritional results, evaluated by means of clinical chemistry (total proteins, albumin, prealbumin, and transferrin), showed a stabilization of the catabolic process in patients with a poor preoperative nutritional state under severe surgical stress. It can be concluded that enteral nutrition is a useful manner of postoperative feeding in seriously ill patients who undergo gastrointestinal surgery, and that it must often be added to parenteral nutrition to ensure an adequate caloric intake.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Nutrição Enteral , Cuidados Pós-Operatórios , Doença Aguda , Idoso , Terapia Combinada , Doenças do Sistema Digestório/terapia , Nutrição Enteral/efeitos adversos , Nutrição Enteral/instrumentação , Nutrição Enteral/métodos , Feminino , Humanos , Masculino , Estado Nutricional , Nutrição Parenteral , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos ProspectivosRESUMO
Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cholelithiasis. However, the indication of the laparoscopic approach for acute inflammation of the gallbladder in unclear and further analysis of the results is required. The aim of our study was to compare the results of laparoscopic cholecystectomy after uncomplicated cholelithiasis and after acute cholecystitis. Data from 201 patients who underwent laparoscopic cholecystectomy were collected prospectively. Uncomplicated cholelithiasis was present in 149 patients and 52 individuals had acute cholecystitis. No differences in age, sex distribution or associated diseases were observed between groups. The mean operative time was significantly higher in patients with acute cholecystitis. However, no difference was observed regarding conversion rate (7.3%-7.6%) and morbidity rate (8.7%-9.6%). No mortality has occurred in any group. The average hospital stay after laparoscopic cholecystectomy was greater when acute cholecystitis was present (2.6 days-4.9 days; p < 0.01). But in this case hospitalization was shorter than after elective conversion (8 days; p < 0.001 and p < 0.05). We conclude that patients with acute cholecystitis can undergo laparoscopic cholecystectomy safely, with low morbidity and mortality rates and reduced hospital stay.
Assuntos
Colecistectomia Laparoscópica , Colecistite/etiologia , Colelitíase/complicações , Colelitíase/cirurgia , Doença Aguda , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
We analyse the first 174 patients treated with laparoscopic cholecystectomy (LC) and their follow-up results. Average age was 57 years. Intraoperative cholangiography was not done in anyone. Conversion rate into other forms of intervention was 6.3%. The rate of common bile duct injury has been null. Total morbidity was 6.3%. Two cases of pulmonary embolism and two biliary leakages stand out in the postoperative morbidity. There was no death. After a follow-up period of up to 36 months, only 1 case of residual choledocholithiasis was registered, and it was cured with endoscopy. In this series morbid-mortality figures are low. LC is a safe procedure in the treatment of cholelithiasis, even in older patients.
Assuntos
Colecistectomia Laparoscópica , Hospitais Universitários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Colecistectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colelitíase/epidemiologia , Colelitíase/cirurgia , Feminino , Seguimentos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Estatísticas não ParamétricasRESUMO
We discuss the case of a right bronchial artery aneurysm in its intrapulmonary trajectory which manifested itself by repeated mild hemoptysis. Diagnosis was made through selective angiography of bronchial artery and during the same procedure it was treated through transcatheter embolization. We have reviewed the literature and found 17 cases of bronchial artery aneurysms with intrapulmonary or mediastinal localization.