RESUMO
Abdominal aortic aneurysm (AAA) is an age related disease, so the aging of the population has meant to more elderly people undergoing AAA repair. The authors conducted a systematic review of the literature to analyze the perioperative mortality and complication rates and long-term survival of elderly people after AAA repair. The literature was searched using the Embase, Cochrane library and Medline databases as at May 2008. All studies reporting on the perioperative and long-term outcomes of patients aged 80 years or more undergoing elective open (OAR) or endovascular AAA repair (EVAR) were considered. The risk of perioperative mortality and morbidity were calculated using the odds ratio (OR), with 95% confidence intervals (CIs), and the chi(2) test. Thirty-five studies on OAR, five on EVAR and four on both were considered. In the OAR group, the mortality rate (38 studies, 1793 patients) was 5.6% (95% CI, 4.5 to 6.7) and the morbidity rate (18 studies, 725 patients) was 26.9% (95% CI, 23.7 to 30.1). Twenty studies reported a median 5-year survival rate of 60% (range, 14% to 86%). In the EVAR group, the mortality rate (9 studies, 1159 patients) was 4.5% (95% CI, 3.3 to 5.7) and the morbidity rate (8 studies, 1078 patients) was 16.5% (95% CI, 14.3 to 18.7). The follow-up data covered less than 5 years in five studies. Although the perioperative death rate was higher after OAR than after EVAR, the difference was not statistically significant (P=0.170; 95% CI, 0.90 to 1.78). The major systemic morbidity rate was significantly higher after OAR (P<0.001; 95% CI, 1.47 to 2.34). Although the perioperative mortality rate was comparable between the two surgical procedures, the marked selection bias cannot be ignored and may well mean that the mortality rates are actually higher for both procedures. Although the mid- and long-term survival rates after OAR and EVAR could seem acceptable, more information is needed on the long-term outcome after EVAR in larger samples in order to assess the durability of this less invasive procedure.
Assuntos
Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos/mortalidade , Idoso de 80 Anos ou mais , Intervalos de Confiança , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Complicações Intraoperatórias/mortalidade , Masculino , Razão de Chances , Taxa de SobrevidaRESUMO
Poor survival rate of elderly patients affected by locally advanced or metastatic gastric cancer is related to primary tumour complications. Bleeding is the most important adverse event, other major complications are gastric outlet obstruction and nutritional deprivation. Rarely the patients will perforate the stomach cancer and there is a sudden end to their life; contamination of the ascites result in a rapid death. Thus, an aggressive approach toward palliation of this condition is resection: in this manner the expected survival is approximately one year. Derivation techniques or endoscopic treatments are applied in those patients whose operative risk is inacceptable; in these cases poor median survival is expected. The aim of this report in to refer about the experience in palliative surgery for gastric cancer in the Department of Geriatric Surgery of the University of Padua.
Assuntos
Cuidados Paliativos , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , MasculinoRESUMO
The Authors, on the base of their experience by the Institutes of Surgical Semeiotics at the Trieste University and of Surgical Pathology at the Padua University, report 30 cases of malignant neoplasms of the anus and the anal canal. 17 patients were males and 13 females. Pathological, clinical and diagnostic problems are discussed. The Authors stress the value of surgical therapy, consisting in a simple local excision or in a wide abdominoperineal resection in conformity with the distinctive features of every single neoplasm. The surgical strategy against nodal metastases is proposed, and the results which are obtained by combining surgery and irradiation are analysed. It is opinion of the Authors that surgical therapy is the most suitable approach for radical treatment of these neoplasms, even if early experience with multimodality therapy is promising to be a great success.
Assuntos
Neoplasias do Ânus/cirurgia , Adenocarcinoma/cirurgia , Adulto , Idoso , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
Local recurrences of rectal cancer after surgical therapy are a mainly diagnostic and therapeutic problem. The Authors report their experience in local recurrences of rectal cancer. They consider anterior resection versus abdomino-perineal resection, the type of anastomosis and the stage of primary disease. Follow-up is discussed emphasizing early diagnosis for local recurrences.
Assuntos
Recidiva Local de Neoplasia , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Masculino , Métodos , Pessoa de Meia-Idade , Neoplasias Retais/patologiaRESUMO
The Authors present their experience with anal fistulas with recess above the levators. They mainly analyze the diagnostic, clinical, instrumental and therapeutic problems which this type of anal fistula may present.
Assuntos
Fístula Retal , Humanos , Fístula Retal/diagnóstico , Fístula Retal/cirurgiaRESUMO
Rectal injuries during barium enema are uncommon but not unusual complications. Radiologists and surgeons must be able to recognize them, as early diagnosis is essential for effective treatment. The Authors discuss various aspects of problems arising from rectal perforation, and report their experience on seven cases.
Assuntos
Sulfato de Bário , Enema/efeitos adversos , Perfuração Intestinal/diagnóstico por imagem , Reto/lesões , Idoso , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Feminino , Gastroenteropatias/diagnóstico por imagem , Humanos , Perfuração Intestinal/fisiopatologia , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , RupturaRESUMO
Surgery for the treatment of inguinal and femoral hernias has recent years acquired numerous increasingly modern, innovative techniques. This has been possible thanks modern, innovative techniques. This has been possible thanks to the introduction of prosthetic material which is better tolerated by the tissues and to the utilization of new ways of approach. A new method of hernia classification, no longer based on anatomical criteria but on a broader evaluation which takes multiple aspects into account, is now needed to decide on valid criteria for choice of operation, at the same time expressing themselves in a common language which will allow the results to the verified.
Assuntos
Hérnia Femoral/classificação , Hérnia Inguinal/classificação , Adulto , Procedimentos Cirúrgicos Eletivos , Emergências , Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Humanos , RecidivaRESUMO
Two personally observed cases of Castleman's benign lymphoma of the hyaline vascular type located in the mediastinum are described. The stages in the development of our knowledge of this tumour are traced and the various aetiopathogenic theories discussed. The difficulty of preoperative diagnosis is emphasised while the potential predictive value of calcifications combined with hypervascularization in an asymptomatic mass usually in the mediastinum and revealed by CT is pointed out.
Assuntos
Hiperplasia do Linfonodo Gigante , Adulto , Hiperplasia do Linfonodo Gigante/diagnóstico , Hiperplasia do Linfonodo Gigante/patologia , Diagnóstico Diferencial , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
A lot of mechanisms of healing of intestinal anastomoses has been explained. A leading role in the intestinal wall is made by the submucosal tunica, where collagen synthesis and degradation process take place, but local and systemic factors are present by a definite causal action. Technique of suture, materials and surgeon's experience are of fundamental importance for the success of operation, even if in some cases it is important to take in consideration the clinical situation: emergency or not, the patient's state and age, concomitant diseases, pharmacological or radiotherapeutic treatments. Nowadays surgical research tends towards biochemical and molecular field to identify the factors, that speed up the healing process to use them in suturing materials getting a quick healing as soon as possible.
Assuntos
Intestinos/fisiopatologia , Intestinos/cirurgia , Deiscência da Ferida Operatória/fisiopatologia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Breast cancer represents an important epidemiological and clinical problem, and the elderly age represents a large proportion of women with breast cancer. In patients older than 65-year, the frequency of breast cancer is 50% and more. Early diagnosis and adequate therapy may play an important role also in the elderly. We performed a retrospective analysis of 146 women older than 65-year to determine the effect of age in management of the disease.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Fatores Etários , Idoso , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/terapia , Feminino , Humanos , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
Peptic disease is even more described in the elderly patients. Is it different from the young people peptic disease? Is it a specific syndrome? These questions are debated by the authors from their experience about in the old age surgery. In 1997, out of 569 oesophago-gastro-duodenoscopies positive for peptic disease, about 2/5 of the patients were older than 65-year with a high percentage of hypersecretive patients. Also the incidence of complications is similar in the aged and young patients, but their course is much more serious in the elderly. NSAID therapy was not always demonstrated as a determining factor of complications in the elderly. The ulcer perforation is the most serious complication; in the over-70 year aged persons a very severe course is often demonstrated. In conclusion in the elderly a specific diagnostic and therapeutic care is recommended to avoid the high incidence of deadly complications.
Assuntos
Úlcera Péptica/complicações , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Úlcera Péptica/mortalidade , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/mortalidade , Úlcera Péptica Perfurada/etiologia , Úlcera Péptica Perfurada/mortalidade , Fatores de RiscoRESUMO
Gastric cancer often affect very old patients even if it is not a typical disease of the elderly. The Authors report their experience on 108 patients (mean age of 77.8 years) affected by gastric cancer; early diagnosis and surgical technique are discussed.
Assuntos
Neoplasias Gástricas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Humanos , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
Neuroendocrine gastroenteropancreatic tumor diagnosis is a very difficult and expensive procedure. This study compared Chromogranin A (CgA) to Neuron-specific enolase (NSE) in 55 patients affected by neuroendocrine tumors. Advanced local or metastatic neoplasia was found in 43 patients. Radical operation was performed in 12 patients. Seventeen cases of lung microcystoma, 23 cases of other intestinal tumors and 19 patients affected by irritable bowel syndrome were used as controls. CgA sampling demonstrated sensitivity of 73% and specificity of 66%, a positive predictive value of 77% and a negative predictive value of 61% while NSE sampling showed sensitivity of 100%, specificity of 36%, a positive predictive value of 15% and a negative predictive value of 100%. CgA values demonstrated a statistically significant difference between patients with neuroendocrine tumors and tumor-free resected patients (p = 0.0015), microcystoma patients (p = 0.0087), other types of neoplasia (p = 0.01) and irritable bowel syndrome patients (p = 0.0004). No significant difference was found among the same groups when NSE values were analyzed. The high diagnostic accuracy of CgA sampling renders it very useful in early neoplastic detection, even in cases of nonfunctioning neoplasms or absence of liver metastases. In addition, CgA sampling may be an effective screening test in patients with irritable bowel syndrome or with liver or lung metastases when there is no evidence of the primitive tumor.
Assuntos
Cromograninas/sangue , Neoplasias do Sistema Digestório/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Carcinoma de Células Pequenas/diagnóstico , Carcinoma de Células Pequenas/cirurgia , Cromogranina A , Doenças Funcionais do Colo/diagnóstico , Diagnóstico Diferencial , Neoplasias do Sistema Digestório/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Fosfopiruvato Hidratase/sangue , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Old people are continuously increasing in frequency but age is not a significant factor to value the operative risk in hernia surgery. From June 1985 to December 1996, 189 patients, aged > 80-year, were submitted to hernia surgery. No complications were noted when elective surgery was performed. Emergent procedure was undertaken in 7% of the patients major perioperative complications and one death were registered in this group of patients. Mean hospital stay has decreased in the period of the study: was 2.2 days in the last two years. Local anesthesia permitted a day surgery procedure in 60% of cases.
Assuntos
Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Anestesia Local , Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Humanos , Tempo de Internação , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
After a short historical outline, the advantages of, the indication for, and the contraindications for local anaesthesia in hernial surgery are considered. The principal pharmacological characteristics of the most widely-employed local anaesthetics are set out. Preoperative preparation of the patient, intraoperative monitoring and the technique of local anaesthesia employed by the authors are described in detail.
Assuntos
Anestesia Local , Herniorrafia , Anestesia Local/métodos , Anestésicos Locais/efeitos adversos , Contraindicações , Humanos , Cuidados Intraoperatórios , Medicação Pré-Anestésica , Cuidados Pré-OperatóriosRESUMO
In our Country 16% of population is over 65 years old and on 2010 a quarter of people will be over 70 years old. More over the percentage of patients over 70 years admitted in surgical departments is triple than 10 years ago and the percentage of octgenarian patients is ten times. In the last years new methods of diagnosis and care have been introduced to reduce morbility and mortality; the preoperative evaluation to define the risk factors is complex. The surgeon should respect some primary points: the patient interest, true surgical treatments, multimodal management, valid pain therapy, discharge as soon as possible, ambulatory or day hospital management, expecting and quality of life.
Assuntos
Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Comorbidade , Humanos , Itália , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Transtornos Respiratórios/epidemiologia , RiscoRESUMO
The sepsis is a bacterial invasion of the organism producing many manifestations which are able to amplify themselves. In the United States of America there are 100,000 death per year and the incidence is among 300,000-500,000 cases. The major surgery in the elder (especially if it is in emergency) has a great percental of risk because the preoperative study isn't often complete. Fever, agitation, panting, bullation, abdominal splinting, enteroplegia, are signals of evolving inflammatory situation. Moreover there are disorders of biochemical values: leukocytosis, thrombocytopenia, increased levels of VES, PCR, amylase and biliribinaemia. The more common radiological examinations are the straight radiography of abdomen and horax, abdomen ultrasonography, CT or MRI. In the last years pro-calcitonin, interleukin-6 , C-reactive protein, and nitric oxide from endothelial and muscularis cells have been evaluated as prognostic factors in the septic shock.
Assuntos
Complicações Pós-Operatórias/diagnóstico , Choque Séptico/diagnóstico , Idoso , Biomarcadores , Proteínas Sanguíneas/análise , Diagnóstico por Imagem , Humanos , Incidência , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Choque Séptico/sangue , Choque Séptico/epidemiologia , Choque Séptico/etiologia , Choque Séptico/terapiaRESUMO
The early rectal cancer which needs conservative surgical treatment should present some pathological characters: intramucosal site without muscularis invasion (pT1), high or moderate differentiated grading (GI-G2), no lymph node metastasis or vascular invasion. Total mesorectal excision is the gold standard for these neoplasms and permits very low resection or colo-anal anastomosis with sphincter function preserving. However, this type of surgery has still a high percentage of postoperative morbidity and mortality (some authors report respectively 40% and 5%). Therefore the local excision in selected cases is able to preserve the sphincter function and to reduce the postoperative complications with high probability of recovery.
Assuntos
Carcinoma/cirurgia , Neoplasias Retais/cirurgia , Idoso , Carcinoma/patologia , Humanos , Invasividade Neoplásica , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Retais/patologiaRESUMO
The bowel infarction is till affected by high mortality in spite of new diagnostic methods and therapy. In our experience was observed about 45 patients with bowel infarction by different etiology; fast diagnosis and therapy are necessary for a good prognosis. The arteriography, at the light of this experience, is the gold standard but it is still performed in a low number of patients. The laparoscopy, in the advanced pathologies, is able to avoid an ineffectual laparotomy and permits a better diagnosis in borderline cases.