RESUMO
The authors report a case of a 3 cm hepatocellular carcinoma at the junction of segments VI and VII with double bile duct tumoral thrombi (Types I and III). The type I thrombus was suspected during the pre-operative workup, but the type III bile duct tumoral thrombus (BDTT) was an intra-operative additional finding on cholangiography. The patient underwent a bisegmental posterolateral resection to remove the primary tumour and the first tumoral thrombus located in the posterolateral intrahepatic duct. A choledocotomy was also performed to remove, by balloon catheter, the floating thrombus located in the common bile duct just over the papilla. The authors discuss their diagnostic and therapeutic approach and review the literature.
Assuntos
Neoplasias dos Ductos Biliares/patologia , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Células Neoplásicas Circulantes/patologia , Idoso de 80 Anos ou mais , Humanos , MasculinoRESUMO
BACKGROUND: Case series suggest a possible association between bariatric surgery and incident IBD. AIM: The aim of this study was to evaluate the association between bariatric surgery and new-onset IBD. METHODS: We first conducted a multi-institutional case series of patients with a history of IBD and bariatric surgery. We next conducted a matched case-control study using medical and pharmacy claims from 2008 to 2012 in a US national database from Source Healthcare Analytics LLC. Bariatric surgery was defined by ICD-9 or CPT code. Bariatric surgery was evaluated as recent (code in database timeframe), past (past history V code) or no history. Conditional logistic regression was used to estimate odds ratios (OR) and 95% CI for new-onset IBD, CD and UC. RESULTS: A total of 15 cases of IBD (10 CD, 4 UC, 1 IBD, type unclassified) with a prior history of bariatric surgery were identified. Most cases were women, had Roux-en-Y surgery years prior to diagnosis and few IBD-related complications. A total of 8980 cases and 43 059 controls were included in our database analysis. Adjusting for confounders, a past history of bariatric surgery was associated with an increased risk of new-onset IBD (OR 1.93, 95% CI 1.34-2.79). However, patients who had recent bariatric surgery did not appear to be at shorter term risk of IBD (OR 0.94, 95% CI 0.58-1.52). CONCLUSION: New-onset IBD was significantly associated with a past history of bariatric surgery. This potential association needs to be confirmed in future prospective studies.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Doenças Inflamatórias Intestinais/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de ChancesRESUMO
Bowel rest during treatment of acute pancreatitis deprives the gut of nutrients and affects its structure and function. Enteral feeding is usually performed late in the course of acute pancreatitis and therefore cannot prevent intestinal barrier dysfunction and possible bacterial translocation. To assess the effect of early enteral nutrition we performed a prospective study on 21 patients (11 males/10 females) presenting with severe acute pancreatitis (13 biliary, 6 alcoholic, and 2 miscellaneous). Severity was established by a mean Ranson score of 3.57. All but one patient could be fed through a double-lumen nasogastrojejunal tube within 60 h after admission. No significant complication of the technique was observed. We conclude that early jejunal feeding can be used safely in severe acute pancreatitis. Further comparative studies are necessary to demonstrate any superiority to total parenteral nutrition.
Assuntos
Nutrição Enteral , Pancreatite/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Translocação Bacteriana/fisiologia , Proteína C-Reativa/análise , Endoscopia do Sistema Digestório/métodos , Estudos de Viabilidade , Feminino , Humanos , Intubação Gastrointestinal , Jejunostomia , Masculino , Pessoa de Meia-Idade , Pancreatite/patologia , Estudos ProspectivosRESUMO
The aim of this study was to evaluate the quality of life of 31 patients presenting with gastroesophageal reflux (GORD) and operated on by Nissen fundoplication. The series consisted of 23 men and 8 women; the median age was 39 years (range 22-65) and the median follow-up 36 months (range 18-74). We used a new questionnaire: the Gastrointestinal Quality of Life Index (GIQLI) that includes 36 items and uses a five-graded Likert scale (from 0 to 4) giving a maximum score of 144. This score includes five dimensions: symptoms, emotions, vitality, social relations and medical treatment. The pre- and postoperative GIQLI scores observed in the Nissen group and the score of a control group of 110 healthy patients were compared with each other. The preoperative score (71 +/- 21) was greatly impaired compared to the score (123 +/- 13) of the control group (p < 0.0001). The postoperative score (109 +/- 21) increased significantly (p < 0.0001) but remained statistically inferior to the score of the control group (p < 0.005). The analysis of the dimensions showed that the postoperative score of the symptoms was lower in the Nissen group: 56 +/- 9 versus 66 +/- 6 in the control group (p < 0.0005) whereas no statistical difference was found for the four other dimensions. This lower symptoms score was not due to recurrence of GORD symptoms but to the occurrence of flatulence and to the persistence of gurgling noises and gas bloating. In conclusion, the quality of life of the patients requiring surgery for gastroesophageal reflux was greatly impaired, it largely improved after Nissen fundoplication but did not reach the level of healthy patients because of unrelated GORD gastrointestinal symptoms.
Assuntos
Fundoplicatura/psicologia , Refluxo Gastroesofágico/cirurgia , Complicações Pós-Operatórias/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Refluxo Gastroesofágico/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Perfil de Impacto da DoençaRESUMO
BACKGROUND AND STUDY AIMS: Complicated Acute Colonic Diverticulitis (ACD) is usually treated by parenteral way thus keeping the bowel at rest. To date there are no clear recommendations regarding the route of nutrition administration. We study the safety of early feeding by oral energetic fiber-free liquid diet in non-surgical complicated ACD patients. PATIENTS AND METHODS: From February 2008 to October 2011, 25 patients were admitted with complicated ACD and took part in this prospective study. Surgical and medical assessments were performed at admission. Initial treatment was given with perfusion, intravenous antibiotics and hydric diet. Within 72 hours of admission, antibiotic therapy was switched to oral administration for 5 up to 15 days depending on the progression of the disease. At the same time the patient received oral liquid fiber-free feeding. Solid but fiber-free diet was introduced 24h hours before discharge. RESULTS: 25 cases of ACD were complicated with covered perforation and/or abscess. Mean hospitalisation time was 10A.4 days. 23 cases had good recovery and discharged, while 1 case progressed to colonic stenosis during hospitalisation, requiring a sigmoidectomy with a one-time anastomosis with good recovery. One patient relapsed his abscess during hospitalisation despite CT guided drainage and required sigmoidectomy with transient ileostomy. The mean daily treatment and nutrition cost for the non-surgical 23 patients was 30 euros. CONCLUSIONS: Early enteral nutrition in complicated ACD is feasible, not harmful, and reduce both, mean hospitalization time and treatment cost. Further studies comparing enteral with parenteral nutrition are necessary to confirm our hypothesis.
Assuntos
Doença Diverticular do Colo/dietoterapia , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibras na Dieta , Doença Diverticular do Colo/diagnóstico , Nutrição Enteral/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
A 52-year-old man, having been treated for 4 months with chlorpropamide for diabetes mellitus type II, developed severe cholestatic hepatitis following a short course of erythromycin ethylsuccinate. Despite prompt withdrawal of both drugs, the cholestatic picture worsened and was associated with morphological evidence of disappearing interlobular bile ducts. After a 2-year course of profound cholestasis complicated by steatorrhea and striking hyperlipidemia, the patient died of ischemic cardiomyopathy. It is believed that this is the first published case of irreversible cholestasis with disappearance of ducts potentially related to a metabolic interaction between erythromycin ethylsuccinate and chlorpropamide.
Assuntos
Ductos Biliares Intra-Hepáticos/efeitos dos fármacos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Clorpropamida/efeitos adversos , Colestase Intra-Hepática/induzido quimicamente , Eritromicina/análogos & derivados , Clorpropamida/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Interações Medicamentosas , Eritromicina/efeitos adversos , Eritromicina/uso terapêutico , Etilsuccinato de Eritromicina , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
High levels of serum amylase and CA19.9 were noted in a patient with papillary serous cystadenocarcinoma of the ovary. Electrophoresis identified isoamylases of salivary type. Both markers decreased rapidly after removal of the ovarian tumour. These considerations argue in favor of the early detection of amylase isoenzymes in patients in whom history, objective signs, and routine diagnostic studies fail to disclose a pancreatic disease.
Assuntos
Amilases/sangue , Cistadenocarcinoma/sangue , Neoplasias Ovarianas/sangue , Idoso , Amilases/metabolismo , Cistadenocarcinoma/metabolismo , Feminino , Humanos , Neoplasias Ovarianas/metabolismoRESUMO
We report the case of a patient with "lymphocytic gastritis" surprisingly associated with an intestinal lymphoma which was treated after intestinal resection by corticosteroids and a combination of antimitotic agents. Comparing gastric mucosa before and 3 months after therapy, we observed a striking reduction of inflammation. Such a case suggests the possibility of a beneficial effect of immunosuppressive therapy on "lymphocytic gastritis" and favors the hypothesis of an immunological disorder.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gastrite/tratamento farmacológico , Doença de Hodgkin/cirurgia , Neoplasias do Íleo/cirurgia , Linfócitos , Bleomicina/administração & dosagem , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Gastrite/etiologia , Doença de Hodgkin/tratamento farmacológico , Humanos , Neoplasias do Íleo/tratamento farmacológico , Leucovorina/administração & dosagem , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Vincristina/administração & dosagemRESUMO
Serum CA 19-9 has been proposed as a tumour marker for pancreatic cancer (PC). However, false positive results are seen in sera of patients with benign jaundice. The CA 19-9 assay was performed by a solid state radioimmunoassay in 86 icteric patients (total bilirubin greater than 2 mg/dl). 24/86 had PC (12 men, 12 women, mean age 74 years) and 62/86 had benign jaundice (29 men, 33 women, mean age 56 years; cirrhosis: n = 20, angiocholitis: n = 21, hepatitis: n = 21). At a cut-off level of 60 U./ml, for detecting icteric PC, sensitivity was 83%, and specificity was 79%. At 120 U./ml, sensitivity was 79%, but specificity was increased to 92%. We conclude that 21% of patients with benign jaundice had a CA 19-9 level greater than 60 U./ml, and using a CA 19-9 level of 120 U./ml, the specificity of the test to detect icteric PC was increased, with little decrease in the sensitivity.