RESUMO
BACKGROUND: Carotid artery stenting (CAS) is a reasonable alternative to carotid endarterectomy (CEA), especially in patients at high risk for surgery. Carotid artery thrombosis of the treated segment is a rare, early but potentially devastating complication of this endovascular procedure. The aim of this article is to identify and critically review cases of acute stent thrombosis reported in the literature. MATERIALS AND METHODS: Previous trials that compared CEA with CAS were rather heterogeneous and not large enough to allow reliable conclusions. Furthermore, because there is limited follow-up information to date, the long-term effect of CAS remains unclear. Acute carotid thrombosis after angioplasty and stenting is a very rare but potentially fatal complication, and there are very few reports in the literature. This article reviews twelve cases of acute carotid thrombosis published in the English literature from eight different Vascular and Radiology Departments around the world. RESULTS: The different ways of immediate treatment of this rare complication of acute carotid thrombosis after CAS are, open surgical procedure with thrombus removal and thromboendarterectomy with or without removing of the stent, selective local or facilitated thrombolysis with the rescue use of GPIs (glycoprotein IIb/IIIa receptor inhibitors), recanalization by instent percutaneous transluminal angioplasty with distal protection and additional stent placement on the stented portion of the internal carotid artery (ICA) in conjunction with the intravenous administration of recombinant tissue plasminogen activator (rtPA: 1300,000 IU). CONCLUSION: Carotid artery stenting has to be performed under specific pro- and post procedure protocol from experienced endovascular specialists. The treatment of acute carotid thrombosis after CAS must be urgent and immediate in order to regain restoration of blood flow and avoid major neurological adverse events.
Assuntos
Trombose das Artérias Carótidas/etiologia , Stents/efeitos adversos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Trombose das Artérias Carótidas/diagnóstico por imagem , Trombose das Artérias Carótidas/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Ultrassonografia Doppler DuplaRESUMO
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor of cutaneous origin of intermediate grade malignant potential. The incidence of DFSP is 0.1% of all cancers and 1% of all soft tissue sarcomas. We present the case of a 65years old female with a palpable, painful mass on the right thigh. A surgical excision of the lesion was done and the histopathology, as well as the immunohistochemical analysis with CD-34, confirmed the diagnosis of DFSP. Two years later, the patient is free of disease and no local recurrences or metastases have been found. Wide radical excision is the preferred surgical method for therapy of DFSP without distant metastasis. Furthermore, DFSP resists to conventional chemotherapy and radiation therapy, while, in cases of metastasis, therapy depends on cytogenesis and molecular biology of the tumor, so new therapeutic strategies are under research.
Assuntos
Dermatofibrossarcoma/patologia , Dermatofibrossarcoma/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Idoso , Antígenos CD34/metabolismo , Biomarcadores Tumorais/metabolismo , Dermatofibrossarcoma/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Neoplasias de Tecidos Moles/metabolismo , Coxa da Perna , Resultado do TratamentoRESUMO
Usually, wherever breast STAT5a is present, PRLR is reduced; without STAT5a PRLR becomes abundant. Five breast lesions essentially lacking both were tested immunohistochemically for PRLR isoforms. The intermediate isoform was essentially only detected in these lesions. In some breast lesions PRLR isoforms may be involved in JAK/STAT pathway disturbances.
Assuntos
Neoplasias da Mama/metabolismo , Janus Quinases/metabolismo , Receptores da Prolactina/metabolismo , Fator de Transcrição STAT5/metabolismo , Proteínas Supressoras de Tumor/metabolismo , Neoplasias da Mama/enzimologia , Feminino , Humanos , Imuno-Histoquímica , Janus Quinases/biossíntese , Isoformas de Proteínas , Transdução de SinaisRESUMO
Carcinoid tumors are malignancies originating from neuroendocrine cells, most commonly encountered in the gastrointestinal tract, in a rate of 64%, with the majority affecting the ileum. Certain genetic syndromes sometimes include carcinoid tumors in their phenotype. These malignancies may be rather asymptomatic, although occasionally they behave aggressively. They are typically diagnosed due to the effects of a locally advanced disease, or when producing symptoms because of hormone secretion (carcinoid syndrome). A better understanding of their molecular biology and behavior is demanded so that these tumors to be diagnosed precociously and managed effectively.
Assuntos
Tumor Carcinoide/diagnóstico , Tumor Carcinoide/terapia , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/terapia , Intestino Delgado/patologia , Antineoplásicos Hormonais/uso terapêutico , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/metabolismo , Biomarcadores Tumorais/urina , Tumor Carcinoide/tratamento farmacológico , Tumor Carcinoide/epidemiologia , Tumor Carcinoide/cirurgia , Diagnóstico Diferencial , Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/cirurgia , Saúde Global , Humanos , Incidência , Síndrome do Carcinoide Maligno/diagnóstico , Síndrome do Carcinoide Maligno/terapia , Octreotida/uso terapêutico , Romênia/epidemiologiaRESUMO
BACKGROUND: The introduction of foreign bodies into the rectum is not an uncommon medical problem. The phenomenon has increased in the homosexual population. In a 25-year period we have encountered 34 patients with retained rectal foreign bodies. MATERIAL AND METHODS: We have performed five laparotomies due to perforation and a laparotomy in order to retrieve a large wooden object. RESULTS: We have observed only one complication in a woman who developed a retrovaginal fistula. CONCLUSIONS: In order to obtain successful extraction of the foreign body the surgeon, apart from the well-known techniques, must exercise a high degree of ingenuity. Finally, it should be emphasized that the appropriate respect should be shown to all patients who seek treatment for this problem.
Assuntos
Corpos Estranhos/cirurgia , Laparotomia/métodos , Reto , Adulto , Idoso , Exame Retal Digital , Feminino , Corpos Estranhos/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Abdominal , Estudos Retrospectivos , Sigmoidoscopia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
Adenocarcinoid arising in the vermiform appendix is a rarity. The diagnosis of appendiceal adenocarcinoma has never been made preoperatively and is frequently an incidental finding at the time of operation for unrelated conditions. Because of the rarity of the disease, its natural history is poorly understood. Benefits from adjuvant radiation, chemotherapy, or a combination have not been reported. Most studies emphasize survival outcome based on surgical technique. There are few data and, consequently, much debate on the appropriate management of these lesions. The aim of this article is to review this entity and to assess and report new data, through a study of the literature.
Assuntos
Adenocarcinoma , Apendicectomia , Neoplasias do Apêndice , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Adenocarcinoma/cirurgia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/epidemiologia , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/epidemiologia , Tumor Carcinoide/cirurgia , Humanos , Achados Incidentais , Prognóstico , Resultado do TratamentoRESUMO
Superior mesenteric artery syndrome is extremely rare and is characterized by postprandial epigastric pain, nausea, vomiting and loss of appetite, with subsequent weight loss, which aggravates the condition of the patients. The syndrome is caused by compression of the third part of the duodenum in the angle between the aorta and the superior mesenteric artery. This review updates etiology, epidemiology, diagnosis, treatment and outcome of the superior mesenteric artery syndrome. Superior mesenteric artery syndrome is clearly defined and frequently associated with a wide range of predisposing conditions and surgical procedures.
Assuntos
Síndrome da Artéria Mesentérica Superior , Dor Abdominal/etiologia , Anorexia/etiologia , Diagnóstico Diferencial , Duodenostomia , Nutrição Enteral/métodos , Humanos , Jejunostomia , Náusea/etiologia , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/etiologia , Síndrome da Artéria Mesentérica Superior/terapia , Resultado do Tratamento , Vômito/etiologia , Redução de PesoRESUMO
The main goal of the paper is to clarify anthelminthic treatment as an alternative hydatic cyst therapy, its indications and contraindications. Chemotherapy constitutes a non-invasive treatment and is less limited by the patient's status than surgery or PAIR. Many investigators have employed benzoimidazole carbonates for the management of human hydatid disease. Both, albendazole and mebendazole have, a favourable effect in patients suffering from multiorgan and multicystic disease, in inoperable primary liver or lung echinococcosis, and they can also prevent secondary echinococcosis. Chemotherapy is contraindicated for large cysts that are at risk to rupture and for inactive or calcified cysts. The main adverse events are related to changes in liver enzyme levels. The best efficacy is observed with liver, lung, and peritoneal cysts. Certain various factors influence the therapeutic results of medical treatment. The vast majority of the recurring cysts show good susceptibility to re-treatment.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos , Equinococose/tratamento farmacológico , Echinococcus granulosus/efeitos dos fármacos , Mebendazol , Albendazol/administração & dosagem , Albendazol/efeitos adversos , Animais , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/efeitos adversos , Anti-Helmínticos/uso terapêutico , Equinococose/parasitologia , Humanos , Mebendazol/administração & dosagem , Mebendazol/efeitos adversos , Mebendazol/uso terapêutico , Prevenção Secundária , Resultado do TratamentoRESUMO
Insulinomas are functional endocrine tumors originating from the pancreatic b-cells. In 1902 Nicholls described the first adenoma of pancreatic islets, while the first insulinoma was described in 1927 in Mayo Clinic, which was dissected two years later in 1929 in Toronto. The first enucleation of insulinoma took place in a St. Jouis hospital in 1931, and after four years, in 1935, Whipple described the classic diagnostic triad: symptoms of fasting hypoglycemia or fatigue, blood glucose levels under 50 mg/dl and disappearance of symptoms after glucose administration.
Assuntos
Insulinoma/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Doenças Raras , Diagnóstico Diferencial , História do Século XX , Humanos , Hipoglicemia/etiologia , Insulinoma/epidemiologia , Insulinoma/história , Insulinoma/cirurgia , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/história , Tumores Neuroendócrinos/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/história , Neoplasias Pancreáticas/cirurgia , Prevalência , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Doenças Raras/história , Doenças Raras/cirurgia , Romênia/epidemiologia , Resultado do TratamentoRESUMO
The modern tendency of surgery is to perform a constantly rising number of operations under local anaesthesia. Superficial parotidectomy under local anaesthesia has not been widely attempted. However only few reports show that this kind of procedure could be feasible. If this is the case, standard assessment of benign parotid tumors will change radically.
Assuntos
Anestesia Local/métodos , Procedimentos Cirúrgicos Bucais/métodos , Doenças Parotídeas/cirurgia , Adenoma Pleomorfo/cirurgia , Adolescente , Adulto , Idoso , Anestésicos Locais/farmacologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/cirurgia , Satisfação do Paciente , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Gallstone ileus representing 1-4% of all bowel obstructions cholelithiasis. Impaction of a gallstone in the human of the bowel is a surgical emergency. Relief of the obstruction is the treatment of choice, but controversy exists regarding the repair of the fistula and cholecystectomy. Our experience in the management of gallstone ileus is presented in the following article.
Assuntos
Fístula Biliar/cirurgia , Cálculos Biliares/cirurgia , Íleus/cirurgia , Laparoscopia , Idoso , Idoso de 80 Anos ou mais , Fístula Biliar/diagnóstico , Fístula Biliar/etiologia , Colecistectomia Laparoscópica/métodos , Feminino , Seguimentos , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Humanos , Íleus/diagnóstico , Íleus/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The case of a patient, victim of a car accident, with rupture of the left adrenal gland associated with splenic rupture and liver laceration is reported. Injury of the adrenal glands is most frequently caused by blunt abdominal trauma and is usually associated with injuries of other abdominal organs. Careful exploration of the upper retroperitoneal space where adrenals are located is considered necessary during laparotomy for severe blunt abdominal trauma. If adrenal lesion has been overlooked continuous hemorrhage may occur, which could be lethal if not promptly treated.
Assuntos
Traumatismos Abdominais/cirurgia , Glândulas Suprarrenais/lesões , Hemorragia/etiologia , Traumatismo Múltiplo/cirurgia , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , Feminino , Humanos , Fígado/lesões , Fígado/cirurgia , Ruptura , Ruptura Esplênica/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Vibrio vulnificus is a Gram-negative pathogen which is found in seawater and shellfish during warm months and can cause local infections in healthy individuals or septicemia in patients with chronic liver disease. MATERIALS-METHODS: Clinical and laboratory records of four complicated cases are presented, with a 4.2 mean year follow-up. RESULTS: Three patients underwent urgent leg amputation because of of irreversible necrotic changes with septic complications and failure of incisional drainage to control the infection. Another one patient underwent only excision of necrotic soft tissue but he developed calcaneus osteomyelitis after three years of the initial fish bone injury. DISCUSSION: Clinicians must maintain a high index of suspicion, especially in regions endemic for vibrio necrotising fasciitis and antibiotic prophylaxis must be given to swimmers before or during bathing.
Assuntos
Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Pé , Vibrioses/diagnóstico , Vibrioses/terapia , Vibrio vulnificus/isolamento & purificação , Adolescente , Adulto , Idoso , Amputação Cirúrgica , Animais , Antibacterianos/uso terapêutico , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/microbiologia , Fasciite Necrosante/cirurgia , Feminino , Peixes , Grécia/epidemiologia , Humanos , Perna (Membro) , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Vibrioses/tratamento farmacológico , Vibrioses/epidemiologia , Vibrioses/cirurgiaRESUMO
Hydatid disease is an endemic zoonosis caused by the cestode Echinococcus granulosus. The most common affected organs are the liver and the lungs. Echinococcal cyst located in the subcutaneous tissue constitutes an extremely rare manifestation of the hydatid disease. Here we present a case report with a cystic mass in the subcutaneous tissue of the left gluteal area, diagnosed as being a hydatid cyst.
Assuntos
Nádegas/diagnóstico por imagem , Doenças do Tecido Conjuntivo/parasitologia , Equinococose/parasitologia , Tela Subcutânea/parasitologia , Idoso , Nádegas/parasitologia , Nádegas/cirurgia , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Doenças do Tecido Conjuntivo/cirurgia , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Humanos , Masculino , Tela Subcutânea/diagnóstico por imagem , Tela Subcutânea/patologia , Tela Subcutânea/cirurgia , UltrassonografiaRESUMO
Hydatid disease constitutes an endemic zoonosis caused by different species of the cestode Echinococcus. The main organs affected are the liver and the lungs. Echinococcosis of the urinary tract is an extremely rare medical condition, met in 2-4% of cases. This pathologic entity has to be included in the differential diagnosis of occupying lesions of the urinary tract at any age, especially among patients in endemic areas. Meticulous laboratory and imaging control when taking into consideration the suspicion for the disease, can guarantee an accurate diagnosis and successful outcome.
Assuntos
Equinococose/diagnóstico , Equinococose/terapia , Echinococcus , Infecções Urinárias/parasitologia , Animais , Antinematódeos/uso terapêutico , Diagnóstico Diferencial , Equinococose/tratamento farmacológico , Equinococose/cirurgia , Echinococcus/classificação , Humanos , Nefropatias/parasitologia , Nefrectomia , Resultado do Tratamento , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapiaRESUMO
Fractures of the clavicle and acute dislocations of the acromioclavicular joint are common seen in the emergency room. Displaced or comminuted clavicle fractures and acromioclavicular joint ruptures (types III-VI) are associated with complications, such as subclavian vessels injury, hemopneumothorax, scapula-thoracic dissociation or brachial plexus paresis. Herein we discuss the usually complications seen after these injuries and underline whatever a trauma surgeon should know in order to avoid fatal situations.
Assuntos
Articulação Acromioclavicular/lesões , Clavícula/lesões , Fraturas Ósseas/complicações , Plexo Braquial , Humanos , Paresia/etiologia , Pneumotórax/etiologia , Ruptura , Escápula/lesões , Artéria Subclávia/lesões , Veia Subclávia/lesões , Traumatismos Torácicos/etiologiaRESUMO
Mammary candidiasis is a disease with significant impact on breast feeding. Early diagnosis and treatment is essential for successful long-term breastfeeding. It constitutes however a significantly rare breast inflammatory entity. A case of a young woman with breast candidiasis properly diagnosed and treated in our clinic is reported.
Assuntos
Doenças Mamárias/microbiologia , Doenças Mamárias/terapia , Aleitamento Materno , Candidíase/diagnóstico , Candidíase/terapia , Adulto , Antifúngicos/uso terapêutico , Doenças Mamárias/diagnóstico , Doenças Mamárias/tratamento farmacológico , Doenças Mamárias/cirurgia , Candidíase/tratamento farmacológico , Candidíase/cirurgia , Feminino , Fluconazol/uso terapêutico , Humanos , Mamilos/microbiologia , Resultado do TratamentoRESUMO
Cytomegalovirus infection of the gastrointestinal tract of normal hosts is very rare. On the other hand, this is a common cause of morbidity in immunocompromised hosts. Herein we describe the case of a 52-year-old male who underwent a gastrectomy due to a severe gastrointestinal hemorrhage. Histological examination showed the characteristic cytomegalovirus inclusion bodies. The diagnosis was confirmed with immunohistochemistry and his immune system revealed no abnormality. We believe that, although it is very rare, cytomegalovirus infection should be kept in mind for non-immunocompromised patients with upper gastrointestinal bleeding or multiple gastric ulcers.
Assuntos
Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/metabolismo , Hemorragia Gastrointestinal/diagnóstico , Trato Gastrointestinal/microbiologia , Antivirais/uso terapêutico , Infecções por Citomegalovirus/complicações , Gastrectomia/métodos , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Imunoglobulina G/química , Imuno-Histoquímica/métodos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Spigelian hernia is a relatively rare defect of the abdominal wall. Due to its unspecific and variable clinical presentation, presents a difficult diagnostic challenge. We present a rare case of bilateral Spigelian hernia that was diagnosed and successfully treated with open surgery and hernioplasty. Also we present our experience in management of the disease. In our department the last fifteen years, 12 cases of Spigelian hernia have been treated surgically, using direct reconstruction with excellent results.
Assuntos
Hérnia Ventral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Ventral/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
We present a rare case of bilateral subcapital hip fracture as a first sign of multiple myeloma in a young man. Right femoral neck fracture was treated by three Asnis screws and the left one by hemiarthroplasty. In order to avoid implant failure, we used zoledronic acid, a bisphosphonate compound, instead of methacrylate cement. After an 18-month follow-up, there was no evidence of avascular necrosis, no implant failure and no periprothetic fracture.