RESUMO
The efficacy of surgery was evaluated in 32 patients with common bile duct stones. Twenty-two patients have not undergone a previous cholecystectomy. In 13 cases an endoscopic approach was attempted before surgery. In 13 patients biliary-intestinal anastomoses were performed for large stones or bile duct strictures. In 19 cases common bile exploration with biliary drainage insertion was performed for uncomplicated biliary stones. We had no mortality and morbidity was 9%. We conclude that surgery is the treatment of choice in patients with gallbladder in situ or in cases of endoscopic failure. Endoscopic sphincterectomy may be preferred in poor-risk patients.
Assuntos
Cálculos Biliares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
We here describe our experience of the treatment of "breast cancer" in the elderly. The results in this group of patients (37 over 75 years) are like the younger group if: the local control is done; hormonotherapy is prescribed; chemotherapy is done even in the 70-80-year-old group. If a radical mastectomy isn't impossible in the patients over 80, even a simple mastectomy is safe. In this patients a conservative local treatment of the breast is not mandatory. Our over-75-year-old patients have no psychological problem related to mastectomy. They often don't accept obligatory radiotherapy after the conservative treatment of breast cancer, and moreover the breast cancer in the elderly is usual smaller, fibrotic and bigger than 3 cm. Lymph nodal status isn't important for overall survival, but only for the eventual chemotherapeutic treatment, so in patients over 80 year-old simple mastectomy is sufficient because we don't use chemotherapy for the general conditions of the same. The local control of axillary lymph nodes is obtained with radiotherapy if necessary. Screening for breast cancer must also include 70-75-year-old patients. Why is the breast cancer in elderly like the others patients? Some authors have seen that the immuno-reaction around the cancer in elderly is less than the same reaction observed in younger patients. So in the elderly there is a smaller production of "growth factors" important for the growth of the tumor and of "angiogenesis factor", fundamental for the initial growth of the cancer.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Neoplasias da Mama/terapia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/patologia , Terapia Combinada , Feminino , Humanos , Metástase Linfática , Mastectomia/estatística & dados numéricos , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , RadioterapiaRESUMO
A clinical case of cloacogenic anal carcinoma is reported. These neoplasms, deriving from embryonal residuals at different levels of the ano-rectal junction, have a better prognosis than squamous carcinomas; the surgical alternative to abdomino-perineal resection is a simple local exeresis for small tumours that do not invade the muscular layer, with a good radical result as reported by the literature.
Assuntos
Neoplasias do Ânus/cirurgia , Carcinoma de Células de Transição/cirurgia , Idoso , Neoplasias do Ânus/patologia , Carcinoma de Células de Transição/patologia , Humanos , MasculinoRESUMO
The paper reports a rare case of malignant ileal schwannoma. A review of the most recent literature confirms the diagnostic and therapeutic procedures used by the authors. Minimal resection or necessary resection in relation to the site and local situation are the only real therapy apart from palliative surgery. It is vital to identify any possible polycentric manifestation since schwannoma is often associated with Recklinghausen's disease. Radiotherapy and chemotherapy are completely ineffective. Responses were obtained in around 30% of cases in the most common trials; the gastrointestinal localization also appears to be even less responsive. The most active drugs are decarbazine, doxorubicin and ifosfamide, associated with CIVADIC or MAID polychemotherapy protocols. It is often difficult to diagnose malignancy; the overall survival rate (taking grading into account) is 7-10% after 10 years and 50% after 5 years for those forms with the lowest degree of malignancy. Antoni classified schwannoma into: type A with a solid component, and type B with a microcystic component. Treatment and prognosis are identical.
Assuntos
Neoplasias do Íleo/terapia , Neurilemoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , PrognósticoRESUMO
The paper describes the authors' personal experience of internal pancreatic fistulas. This is an uncommon pathology which should however be taken into account in the presence of ascites or pleural effusion without a clear cause. Essential diagnostic tests are chemical and physical examination and the assay of amylase in ascitic or pleural fluids. Medical treatment is sometimes efficient leading to the disappearance of the fistula. If medical therapy fails, surgery is necessary, based on pancreatic resection or the drainage of the cyst or interrupted pancreatic duct.
Assuntos
Fístula Pancreática/diagnóstico , Doença Aguda , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Fístula Pancreática/etiologia , Fístula Pancreática/cirurgia , Pancreatite/complicações , EsplenectomiaRESUMO
The authors report their experience concerning 12 cases of extranodal lymphoma (6 gastric, 1 duodenal, 2 ileal, 1 rectal, 1 splenic, 1 mammary). Extranodal lymphomas are increasing because of the high number of patients with AIDS and new extra-European immigration. Surgery is important not only for diagnosis, but above all for therapy. The great majority of extranodal lymphomas is diffuse rather nodular. Diffuse histiocytic type is the most commun pathologic feature. Prognosis of gastroenteric lymphomas is better than adenocarcinomas of gastrointestinal tract. The surgical techniques are the same as those used for the others tumors, and combined-modality therapy appears superior to local therapy alone for patients with extranodal disease characterized by unfavorable histology, site or stage. The classification is that of Ann Arbor, but for many authors the TNM system was an useful predictor of survival in patients treated with surgery.
Assuntos
Linfoma não Hodgkin , Terapia Combinada , Diagnóstico Diferencial , Humanos , Linfografia , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/cirurgia , Linfoma não Hodgkin/terapia , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
The presence of candida and other fungi was investigated in 300 patients referred with anal problems of diverse aetiology. Candida was present in 13% and played a pathogenic role in about 50% of all positive cultures. It is concluded that cultural tests for fungal pathogens should always be performed in cases of anal itching or burning combined with other anal skin problems.
Assuntos
Candidíase/etiologia , Doenças Retais/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ânus/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The paper reports a case of carcinoma of the parathyroid associated with thyroid struma and underlines the difficulties of intraoperative diagnosis and the surgical approach which should be adopted on the basis of this finding. Often the diagnosis of the malignant nature of the neoplasia is based on the possible appearance of local or distant recurrence rather than histological examination.
Assuntos
Adenoma/complicações , Carcinoma/complicações , Bócio Nodular/complicações , Neoplasias das Paratireoides/complicações , Adenoma/diagnóstico , Idoso , Carcinoma/patologia , Carcinoma/cirurgia , Feminino , Bócio Nodular/diagnóstico , Humanos , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnósticoRESUMO
The authors describe an uncommon complication in a case of side-to-side portacaval shunt which was suppressed due to disabling portal-systemic encephalopathy; the patient was treated by esophageal transection with esophagogastric devascularization and nonoperative secondary occlusion of the shunt by external elastic traction on a Silastic catheter surrounding the anastomosis: a stenosis of the caval vein under traction required another operation in order to close the shunt.