RESUMO
INTRODUCTION: Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS: This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS: The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS: According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
Assuntos
Fístula Anastomótica/epidemiologia , Colectomia/métodos , Colo Transverso/cirurgia , Neoplasias do Colo/cirurgia , Tempo de Internação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Colo Transverso/patologia , Neoplasias do Colo/patologia , Intervalo Livre de Doença , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de TempoRESUMO
The short term or acute intravenous administration of nifedipine has been reported to increase urine flow rate and sodium clearance but does not significantly alter the patient's serum or urine electrolytes as other vasodilators. Still comparatively little is known, however, about the effects of antihypertensive drugs on calcium metabolism. Our data, on 15 hypertensive patients with normal renal function, don't show significative changes in plasma or urine levels of calcium in short term treatment; moreover there isn't water and salt retention. Thus nifedipine is confirmed as a prime choice drug in hypertensive patients with normal renal function.
Assuntos
Cálcio/metabolismo , Hipertensão/metabolismo , Nifedipino/uso terapêutico , Eletrólitos/urina , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/urina , Masculino , Pessoa de Meia-IdadeAssuntos
Glomerulonefrite Membranoproliferativa/etiologia , Tuberculose Pulmonar/complicações , Adulto , Antituberculosos/uso terapêutico , Feminino , Seguimentos , Glomerulonefrite Membranoproliferativa/patologia , Glomerulonefrite Membranoproliferativa/terapia , Humanos , Transplante de Rim , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/tratamento farmacológico , Urina/microbiologiaAssuntos
Angioedema/etiologia , Nefropatias/etiologia , Pneumopatias/etiologia , Dedos do Pé/irrigação sanguínea , Vasculite/etiologia , Angioedema/patologia , Proteínas Inativadoras do Complemento 1/deficiência , Feminino , Humanos , Pneumopatias/patologia , Pessoa de Meia-Idade , Necrose , Vasculite/patologiaRESUMO
A case is told with osseous fractures occurred during uremia in a periodically dialyzed man treated with phosphate-binding substances in excessive doses. The healing time is studied to value the effectiveness of normalized phosphatemia and the vitamin D treatment necessity.
Assuntos
Quelantes/efeitos adversos , Osteomalacia/induzido quimicamente , Fósforo/sangue , Uremia/tratamento farmacológico , Adulto , Hidróxido de Alumínio/efeitos adversos , Hidróxido de Alumínio/uso terapêutico , Androgênios/uso terapêutico , Sítios de Ligação , Humanos , Ferro/uso terapêutico , Magnésio/uso terapêutico , Masculino , Diálise Renal , Uremia/sangue , Uremia/complicaçõesRESUMO
The Authors describe one case of acute renal insufficiency in a patient treated with high doses of gentamicin over a period of three weeks. The documentation includes electron microscope observations of needle biopsy material revealing the presence of electron-dense masses (cytosegregosomes) in the epithelial cells of the proximal renal tubules, such as had previously been described only in animal experiments and human autopsy studies. The clinical course and favorable outcome of this case of gentamicin-induced renal failuse afford the opportunity for some interesting considerations concerning the kinetics and toxic proclivities of this aminoglycoside antibiotic.
Assuntos
Injúria Renal Aguda/patologia , Gentamicinas/efeitos adversos , Túbulos Renais/patologia , Injúria Renal Aguda/induzido quimicamente , Epitélio/patologia , Gentamicinas/uso terapêutico , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Pneumonia/prevenção & controle , Cuidados Pós-OperatóriosRESUMO
Cutaneous syndrome called porphyria tarda-like of dialyzed patients may involve risk of infections besides aesthetic complications. We have described a very serious case of which the therapeutic problem has become oppressive inducing various attempts, already used for porphyria cutanea tarda or completely new. The only treatment which brought improvement in symptomatology was repeated venesection. Aminoacidic loss during dialysis appears as possible pathogenetic hypothesis for this syndrome.
Assuntos
Sangria , Porfirias/terapia , Diálise Renal/efeitos adversos , Dermatopatias/terapia , Aminoácidos/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Porfirias/etiologia , Dermatopatias/etiologiaRESUMO
A case of 66-years-old woman with mild renal failure due to deposition of K light chains on glomerular nodules, is reported. Monoclonal K light chains were found by immunofixation in serum and concentrated urine. Bone marrow examination showed a moderate increase of plasma cells, all stained for K light chains. Amyloid was not identified. No chemotherapy was started. Despite this, in the 15-months follow-up, renal function was preserved; no signs of myeloma, nor of extrarenal involvement were found. Careful follow-up is emphasized. The reason why light chains form amyloidoses or nodular deposits, like diabetic glomerulosclerosis of Kimmelstiel-Wilson, is briefly discussed, together with the differential diagnosis from other nephropathies.
Assuntos
Glomerulonefrite/etiologia , Hipergamaglobulinemia/patologia , Cadeias kappa de Imunoglobulina , Idoso , Amiloidose/diagnóstico , Medula Óssea/patologia , Diagnóstico Diferencial , Feminino , Humanos , Glomérulos Renais/patologia , Mieloma Múltiplo/diagnósticoRESUMO
Acquired bilateral cystic transformation of kidneys in patients on chronic dialysis has been increasingly noted by morphological and clinical studies. Our study aims to identify a group of high-risk patients for incidence and extent of such disease. We studied with ultrasonography 87 patients on maintenance hemodialysis (60 men and 27 women), median age 58 years (range 18 to 81), mean duration of hemodialysis 75 months (range 2-256). The presence of cysts was divided into five grades from 0 no cysts to 4 more than 15 cysts detected for each kidney. 74 patients 85% of our dialytic population had acquired cystic disease; cysts varied in size from 0.5 to 4.5 cm in diameter. The cysts were found in 97% of patients dialyzed for more than 8 years and in 73% of patients on hemodialysis for less than 3 years. The incidence of cystic disease was highly and significantly correlated with the duration of dialysis, the grade correlated with duration of chronic renal failure and hemodialysis. The extent of disease appears to be increased in males. Because of high incidence of disease in long term dialysis patients ultrasonography monitoring is recommended for patients on dialysis for more than 3 years with more attention for males.
Assuntos
Doenças Renais Císticas/etiologia , Diálise Renal/efeitos adversos , Adolescente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Ultrassonografia , Uremia/complicações , Uremia/terapiaRESUMO
To evaluate the long-term results of parathyroidectomy (PTX) on parathyroid function, blood pressure and anemia, data of 45 patients with secondary Hyperparathyroidism in dialysis who had undergone PTX were collected retrospectively from 8 different dialysis units. The patients, 25 M and 20 F, mean age 56 +/- 11 years, who were followed up for an average period of 3.3 +/- 2.3 years, were divided into four groups according to the surgical procedure: 19 patients had had a subtotal PTX; 10 patients had undergone total PTX with autotransplantation (AT); 10 patients had had total PTX without AT, and 6 patients had undergone partial PTX. Taking a reduction in intact PTH > 50% as sign of successful PTX, only 5 patients did not attain this result. Considering values of PTH between 20 and 200 pg/ml at the mid-term observation (1-2 years) as the optimal result, values under 20 pg/ml as an expression of permanent hypoparathyroidism, and those above 200 pg/ml as indicating persistent/recurrent hyperparathyroidism, 65.5% of patients operated with subtotal PTX and total PTX + AT had a therapeutic success, versus 31.2% of patients in the other two groups, due to excess permanent hypoparathyroidism and persistent/recurrent hyperparathyroidism; 20 of 45 patients with preoperative hypertension experienced a statistically and clinically significant decrease in blood pressure levels. An increase in serum hemoglobin was also observed, despite a reduction of administered erythropoietin. In conclusion, the results of PTX obtained from this multicenter study are comparable to those reported by single leading centers. Recommended surgical procedures are subtotal PTX and total PTX with AT. The fall in blood pressure in hypertensive patients is clinically significant, and improvement in anemia is also observed with a reduction in erythropoietin dosage.
Assuntos
Anemia/prevenção & controle , Pressão Sanguínea/fisiologia , Hiperparatireoidismo Secundário/cirurgia , Falência Renal Crônica/complicações , Glândulas Paratireoides/fisiopatologia , Paratireoidectomia , Diálise Renal/efeitos adversos , Idoso , Anemia/sangue , Feminino , Hemoglobinas/metabolismo , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Estudos RetrospectivosRESUMO
BACKGROUND: Anaemia is one of the major clinical characteristics of patients with chronic renal failure, and has a considerable effect on morbidity and mortality. Adequate dialysis is of paramount importance in correcting anaemia by removing small and medium-sized molecules, which may inhibit erythropoiesis. However, high-molecular-weight inhibitors cleared only by means of highly porous membranes have also been found in uraemic serum and it has been claimed from uncontrolled studies that high-flux dialysis could improve anaemia in haemodialysis patients. METHODS: We therefore planned this multicentre randomized controlled trial with the aim of testing whether the use of a large-pore biocompatible membrane for a fixed 12-week follow-up improves anaemia in haemodialysis patients in comparison with the use of a conventional cellulose membrane. Eighty-four (5.3%) of a total of 1576 adult haemodialysed patients attending 13 Dialysis Units fulfilled the entry criteria and were randomly assigned to the experimental treatment (42 patients) or conventional treatment (42 patients). RESULTS: Haemoglobin levels increased non-significantly from 9.5+/-0.8 to 9.8+/-1.3 g/dl (dP=0. 069) in the population as a whole, with no significant difference between the two groups (P:=0.485). Erythropoietin therapy was given to 32/39 patients (82%) in the conventional group, and 26/35 (74%) in the experimental group (P:=0.783) with subcutaneous administration to 26/32 patients in conventional and to 23/26 patients in experimental group, P:=0.495. Dialysis dose (Kt/V) remained constant in both groups (from 1.30+/-0.17 to 1.33+/-0.20 in the conventional group and from 1.28+/-0.26 to 1.26+/-0.21 in the experimental group, P:=0.242). Median pre- and post-dialysis beta(2)-microglobulin levels remained constant in the conventional group (31.9 and 34.1 mg/dl at baseline) and decreased in the experimental group (pre-dialysis values from 31.1 to 24.7 mg/dl, P:=0.004 and post-dialysis values from 24.8 to 20.8 mg/dl, P:=0.002). Median erythropoietin doses were not different at baseline (70 IU/kg/week in conventional treatment and 90 IU/kg/week in experimental treatment, P:=0.628) and remained constant during follow-up (from 70 to 69 IU/kg/week in the conventional group and from 90 to 91 IU/kg/week in the experimental group, P:=0.410). Median erythropoietin plasma levels were in the normal range and remained constant (from 12.1 to 12.9 mU/ml in the conventional group and from 13.2 to 14.0 mU/ml in the experimental group, P:=0.550). CONCLUSIONS: This study showed no difference in haemoglobin level increase between patients treated for 3 months with a high-flux biocompatible membrane in comparison with those treated with a standard membrane. When patients are highly selected, adequately dialysed, and have no iron or vitamin depletion, the effect of a high-flux membrane is much less than might be expected from the results of uncontrolled studies.