RESUMO
AIM: The aim of our study was to evaluate, through prospective randomized study, the outcome and the immediate and late complications of the two types of surgery most widely used for degree III-IV haemorrhoids. METHODS: A total of 122 patients with degree III and IV hemorrhoids were elected for surgical intervention and, randomly, underwent surgery for PPH or THD. We assessed the most common immediate postoperative complications. The patients have been followed for three months with a mean follow-up at 1 month and 3 months after surgery. Parameters taken into consideration were: bleeding, pain at rest and after evacuation, soiling, constipation and tenesmus. RESULTS: Five patients in PPH group (7.9%) had a major postoperative bleeding, whereas no such episode occurred in THD group (P=ns). In percentage terms, VAS score was lower in THD group than in PPH group, although the difference was not statistically significant. Finally parameters values observed, during the follow-up, proved to be lower for THD group compared to PPH group. CONCLUSION: PPH and THD are two surgical treatments for degree III and IV haemorrhoids with low perioperative complications and good results in the short term. However, our experience shows that better results in terms of pain and fewer postoperative complications are obtained after THD surgery, such surgery is less invasive and more adaptable to the needs of day surgery.
Assuntos
Hemorroidectomia/métodos , Hemorroidas/cirurgia , Feminino , Hemorroidectomia/efeitos adversos , Hemorroidas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
Metronomic chemotherapy is an anticancer strategy which uses conventional cytotoxic drugs administered at very low dose in close intervals. We have designed a phase II trial to investigate the safety and antitumor activity of the newest metronomic chemo-hormonal-therapy with daily cyclophosphamide and twice daily megestrol acetate (mCM regimen) in patients with metastatic pretreated breast cancer.Twenty-nine pretreated post-menopausal patients with multiple metastatic sites were enrolled. four patients had a triple negative status, nineteen a positive hormonal ER and PgR status, and three ERB-B2 over-expression. Patients received treatment with cyclophosphamide (50 mg/daily day 1-21/q28) and fractionated megestrol acetate (80 mg twice a day). The overall objective response rate was 31.0%, disease control rate 41.3%, mean time to tumor progression 7.4 months (CI 95%, 3.8-10.88, range 1-48 months) and mean overall survival 13.4 months (CI 95%, 7.24-17.18, range 1-53 months). The mCM regimen was active and well tolerated.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/patologia , Ciclofosfamida/administração & dosagem , Feminino , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Acetato de Megestrol/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Although colonic diverticulum is a common disease, affecting about 35% of patients above the age of 60, giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature. We report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy. Resection of the diverticulum is a safe surgical procedure, provided that the colon section close to the lesion presents no sign of flogosis or diverticula; in addition, recurrences are not reported after 6-year follow-up.
RESUMO
Previous results suggest that GEM affects 5-fluorouracil (5-FU) metabolism and pharmacokinetics in cancer patients, while combined with oxaliplatin, levo-folinic acid, and 5-FU (GOLF regimen), at doses achievable in cancer patients, determines high cytotoxic and proapoptotic antitumour activity in colon cancer cells in vitro. On these bases we designed a phase I-II clinical trial testing the GOLF regimen in patients with metastatic colorectal carcinoma, who had received at least a prior line of chemotherapy. In total, 29 patients (20 males and nine females) enrolled in the study received every 2 weeks, gemcitabine (patients #1-3 received 600 mg m(-2); patients # 4-6 received 850 mg m(-2); while patients # 7-29 received 1000 mg m(-2)) on the day 1, levo-folinic acid (100 mg m(-2)) on the days 1 and 2; 5-fluorouracil (400 mg m(-2)) in bolus injection, followed by a 22-h continuous infusion (800 mg m(-2)) on the days 1 and 2, and oxaliplatin (85 mg m(-2)), 6 h after the 5-FU bolus on day 2. The most frequent side effect was grade I-II haematological toxicity. In total, 28 patients were evaluable for response: three achieved a complete response, nine a partial response, 10 had a stable disease, and six progressed. The average time to progression and overall survival of the patients was, respectively, 7.26 and 22 months. Our GOLF combination is well tolerated and seems promising for the treatment of advanced colorectal cancer.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Desoxicitidina/análogos & derivados , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Esquema de Medicação , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/efeitos adversos , Oxaliplatina , Taxa de Sobrevida , Resultado do Tratamento , GencitabinaAssuntos
Abdome/cirurgia , Glutamina/administração & dosagem , Nutrição Parenteral Total , Cuidados Pós-Operatórios , Idoso , Feminino , Glutamina/uso terapêutico , Humanos , Incidência , Tempo de Internação , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Nitrogênio/metabolismo , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
BACKGROUND: Late proximal pouch dilatation (LPPD) has occurred occasionally following gastric banding for morbid obesity. At present, laparoscopic conservative resetting and oversuturing of the band is considered the standard procedure for pouch dilatation without any important posterior component. METHODS: Two cases of LPPD are presented, which occurred in our initial experience with the Lap-Band, corrected via a laparoscopic approach. RESULTS: The reintervention was necessary in both patients, with conservative laparoscopic repositioning and oversuturing of the band in the first case and laparoscopic substitution of the gastric band in the second. We have not observed further complications, and weight loss has been maintained in a midterm outcome in both cases (30 and 18 months follow-up). CONCLUSIONS: LPPD can be corrected with a conservative laparoscopic surgical approach, without complications and negative functional effects on mid-term outcome.
Assuntos
Gastroplastia/efeitos adversos , Adulto , Dilatação Patológica , Feminino , Gastroplastia/métodos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Reoperação , Estômago/patologia , Técnicas de SuturaRESUMO
BACKGROUND: Bariatric surgery depends on complete preoperative study of morbid obesity, in order to obtain the treatment of choice. A multidisciplinary group was founded in 1998 at the University of Siena. METHODS: During 1998, 16 patients, with median weight 121.8 +/- 31 kg and median body mass index (BMI) 43 +/- 6, underwent bariatric surgery. A multidisciplinary assessment was used in order to evaluate psychological status, food intake problems and patient compliance, and hemodynamic, respiratory, metabolic and arthritic functions. 13 patients were submitted to laparoscopic surgery: in 11 adjustable gastric banding was performed and 2 were submitted to a vertical gastroplasty plus adjustable gastric banding. Three patients were operated via traditional laparotomy, due to previous abdominal surgery in 2 cases (submitted to an adjustable gastric banding) and one woman was submitted to a bilio-intestinal bypass according to the Hallberg technique, for her psychiatric troubles and coexisting systolic hypertension and uncontrolled diabetes. Monthly follow-up for each patient continues after 6 months. RESULTS: No morbidity or mortality has occurred. The median weight loss at three months, was 19.5 kg. Two cases required injection of 1 ml more of fluid into the port, respectively at 4 and 9 months. Fifteen days after surgery, seven patients (46%) had vomiting episodes, due to rapid food intake. All patients have shown an improvement of their comorbidities after surgery. CONCLUSION: Early results via the multidisciplinary team and laparoscopic banding have been satisfactory thus far.
Assuntos
Gastroplastia/métodos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Equipe de Assistência ao Paciente , Resultado do TratamentoRESUMO
About half of the carcinomas and polyps of the large intestine is placed in the descendent colon and in the sigma, where most frequently the diverticula are found. Literature refers to them as varying percentage of association diverticulosis-carcinoma between 2 to 8 percent. The increase of the frequency of neoplasms and diverticula in the same population classes may indicate common factors in their development. The study includes 1149 cases of colo-rectal neoplasms examined in the Department of Scienze Chirurgiche--University of Siena, from january 1981 to december 1993. The association of carcinomas and diverticula has been found in 8.96% of the cases (103 pts) and the tumours with stenosis in 59,2% of the cases. The colonoscopy is very important for a more precise differential diagnosis especially in occlusive forms, in which a multiple biopsy is indispensable. Referring to the data of literature, the authors consider that patients with symptomatic diverticular disease have a major general risk for cancer of the large intestine; the existence of certain common symptoms in either disease (especially the bleeding) may not exclude the presence of a tumor in patients with diverticular disease.
Assuntos
Neoplasias do Colo/complicações , Divertículo do Colo/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Colonoscopia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/cirurgia , Diagnóstico Diferencial , Divertículo do Colo/diagnóstico , Divertículo do Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/complicações , Neoplasias do Colo Sigmoide/diagnóstico , Neoplasias do Colo Sigmoide/cirurgiaRESUMO
The Authors report their experience in the surgical management of cancer in the aged (over 65 year old patients), during the period 1988-1992 at the Istituto Policattedra di Scienze Chirurgiche, University of Siena. They consider colon and rectum, breast, stomach, pancreas and biliary tract neoplasms in relation to site, staging, emergency or delayed surgical treatment, and early postoperative results. Finally, they outline the frequently encountered problems in treating old patients and the most appropriate surgical approach.
Assuntos
Neoplasias/cirurgia , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , PrognósticoRESUMO
Ischemic colitis shock-associated still is a not well-defined clinical entity. The authors describe symptoms, clinical course and treatment in a case recently observed. They outline the difficulties of preoperative diagnosis and the need of a not postponable surgical treatment due to shock and peritonitis.
Assuntos
Colite Isquêmica/patologia , Adenocarcinoma/patologia , Idoso , Colectomia , Colite Isquêmica/cirurgia , Colo/patologia , Humanos , Masculino , Necrose , Neoplasias Retais/patologia , Reoperação , Choque/patologia , Choque/cirurgiaRESUMO
The results of a ten-year experience are reported. According to the literature data, abdominoperineal resection for rectal cancers located 6-10 cm above the anal verge as well as anterior resection for upper locations confirmed to be the best therapeutical choice.
Assuntos
Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colectomia/métodos , Colo Sigmoide/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Estadiamento de Neoplasias , Cuidados Paliativos , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Reto/cirurgia , Neoplasias do Colo Sigmoide/mortalidade , Neoplasias do Colo Sigmoide/patologiaRESUMO
The authors report 11 consecutive partial or total pancreatectomies with preservation of the pylorus. They believe this technique is to be preferred because it allows a better digestion and reduces complication rate.
Assuntos
Pancreatectomia/métodos , Antro Pilórico/cirurgia , Piloro/cirurgia , Idoso , Duodeno/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgiaRESUMO
Personal experience in the treatment of 60 cases of cancer of the large bowel with left hemicolon and rectal localisation is reported. 20 manual double layer anastomoses (group I), 20 single layer (group II) and with mechanical stapler (EEA stapler) (group III) were carried out in consecutive series. The results are reported in terms of early local and general complications: specifically 13 cases of anastomotic dehiscence of which 69.2% were observed in group I, 15.4% in group II and 15.4% in group III. Total postoperative mortality was 5%, average hospitalisation was as follows: 19 days group I, 14 days group II, 17 days group III. The value of single layer anastomoses, which is comparable to results with the stapler whose use is essential in cases of real manual technical difficulty, is stressed.
Assuntos
Neoplasias do Colo/cirurgia , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Deiscência da Ferida Operatória , Técnicas de Sutura , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reto/cirurgiaRESUMO
CEA appears to be a good marker in the follow up of patients operated for colorectal cancer. The Authors analyse, on the base of literature data, the results of CEA test in their experience of colorectal cancers operated from 1978 to 1987. They confirm the importance of CEA as recurrence marker, however the test, by itself, is not sufficient to always identify a new onset of the disease.