RESUMO
O tumor de Buschke-Lowestein, também conhecido como condiloma acuminado gigante é uma lesão de aspecto verrucoso, extensa, envolvendo a região ano-genital. Não representa uma lesão maligna por critérios histológicos, embora exista claramente um potencial de malignização, e tenha um comportamento agressivo. Não existe um consenso sobre o seu tratamento, aventando-se o uso de drogas quimioterápicas aplicadas local ou sistematicamente, uso de imunoterapia, radioterapia e ressecções cirúrgicas amplas isoladas ou em combinação com outras terapias. Relatamos um caso onde a opção de tratamento foi o imiquimod creme 5 por cento. A lesão envolvia musculatura esfincteriana e, sendo assim, a cirurgia acarretaria perda da continência fecal, causando ao paciente o ônus de um estoma definitivo. Após tratamento durante 20 semanas, o tumor apresentou regressão significativa de tamanho, sendo realizado excisão local da lesão residual com preservação esfincteriana.
Buschke-Lowestein tumor or giant condyloma acuminatum is a verrucous, large lesion in the anorectal and perianal regions. It is not a malignant lesion in histopathologic findings. However, there is a risk of malignancy and trends an aggressive behavior. There is not a gold standard therapy, with the use of topical or systemic chemotherapy, immunotherapy, radiation therapy and large surgical resections. These surgical resections can be doing alone or in combinations with others therapies (multimodality therapy). The authors describe a case that the treatment option was the imiquimod cream 5 percent. The lesion invades in the anal sphincters, so fecal incontinence will result after surgery and a colostomy was mandatory. After 20 weeks treatment, the tumor presented a great regression, and it was treated with local excision and avoided a mutilating procedure.
RESUMO
Racional - A videolaparocolecistectomia já é condiderada na literatura, como a melhor opção de tratamento da doença calculosa da vesícula biliar. Atualmente a maioria dos pacientes submetidos a colecistectomia laparoscópica permanecem internados por aproximadamente 24 horas, podendo até mesmo ser operados em sistema de hospital-dia...
Background - Laparoscopic cholecystectomy is considered in the literature, the best option as a treatment of gallblader stones. Currently the medium hospital stay of patients submitted to laparoscopic cholecystetomy is 24 hours. Although it can be made as day hospital, there are some situations...
Assuntos
Humanos , Colecistectomia , Colecistite/cirurgia , Laparoscopia , Análise Multivariada , Colelitíase/cirurgia , Doença Aguda , Tempo de InternaçãoRESUMO
BACKGROUND: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. METHOD: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. RESULTS: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (< or =65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P = 1). CONCLUSION: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age.