RESUMO
AIM: The purpose of this study is to determine the anatomical aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy. CLINICAL CASE: We report a case of an accidental bowel wall injury during diagnostic colonoscopic with consequent pneumoperitoneum; this was followed by expansion of gas through diaphragmatic fenestration perhaps congenital, in right pleural cavity causing pneumothorax. DISCUSSION: Rarely, colonic perforation during colonoscopy can occur into the extraperitoneal space, thus leading to the passage and diffusion of air along the fascial planes and large vessels, possibly causing pneumoretroperitoneum, pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. The combination of intraperitoneal and extraperitoneal perforation has also been reported. Pneumothorax following a colonoscopy sigmoid perforation is an extremely rare but severe and often lifethreatening complication. CONCLUSION: If the patient develops dyspnea and pneumoderma during or after this procedure, a chest radiogram or thoracoabdominal CT should be taken for diagnostic purposes. Urgent treatment, starting with chest tube insertion(s) and laparotomy or laparoscopy could be lifesaving.
Assuntos
Colo Sigmoide/lesões , Colonoscopia/efeitos adversos , Perfuração Intestinal/etiologia , Pneumotórax/etiologia , Abdome Agudo/etiologia , Diafragma/patologia , Emergências , Feminino , Humanos , Pessoa de Meia-Idade , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Although the intervention of knee arthroplasty became routine, there is no standard reference on the densitometric characteristics of the patella before and after surgery. Scope of this work is the evaluation of patellar bone density before and after unilateral knee arthroplasty. PATIENTS AND METHODS: BMD was assessed by DEXA examination in 146 individuals, who have been divided into three distinct groups. Group I: 68 subjects with a mean age of 70.6 years, with an unilateral femoral-tibial knee prothesis. Group II: healthy subjects of similar age (average: 64) and without implants. Group III: healthy adults with a mean age of 26.6 years. The follow-up was performed at 6 months to a maximum of 2 years post surgery. RESULTS: The results were obtained from 68 subjects examined with the DEXA software dedicated to the forearm, which turned out to be the most appropriate for our purpose. The follow-up performed every 6 months after surgery showed a reduction of the density values in the operated knee in the 1st control with a return to the pre-surgiucal situation in the control performed after 1 year. In subsequent checks there was a further increase of the patellar density of the operated knee. CONCLUSION: Patellar DEXA examination is recommended as an addition to the clinical and radiological standard examination.
Assuntos
Artroplastia do Joelho , Patela/química , Absorciometria de Fóton , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Remodelação Óssea/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Osteoporose/complicações , Período Pós-Operatório , Período Pré-Operatório , Recuperação de Função Fisiológica , Adulto JovemRESUMO
The improvement of the socio-economic conditions and the progress of medicine have extended the life span of the world's population and as a result, the number of patients with malignant neoplasms has increased. Gastric cancer is the third most common cancer (after lung and prostate) and the second leading cause of death caused by cancer (after lung bronchogenic cell carcinoma) in males; while it's the fifth cancer by frequency and the fourth cause of cancer death in females. It presents a peculiar geographical distribution with a lower incidence in Western Europe and North America, and higher incidence in the Far East, South America and Eastern Europe. Its incidence in Italy is 122 cases per 100000 inhabitants in males and 83 cases per 100000 inhabitants in females (in Italy). It occurs more frequently in old age, is quite rare in individuals under the age of 45. The aim of this work is to analyze the clinical and pathological characteristics of gastric carcinoma and the feasibility of curative surgery in patients over 75, identifying the factors affecting mortality, morbidity, survival and quality of life after surgery. These data have been compared with those of younger patients to assess the correct type of surgery.
Assuntos
Carcinoma/cirurgia , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Carcinoma/epidemiologia , Comorbidade , Feminino , Humanos , Hipoalbuminemia/epidemiologia , Hipoalbuminemia/etiologia , Incidência , Itália/epidemiologia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Indução de Remissão , Neoplasias Gástricas/epidemiologia , Análise de Sobrevida , Carga TumoralRESUMO
Pancreas divisum is a genetic defect associated with recurrent acute pancreatitis due to insufficient drainage of the accessory pancreatic duct. Seven young patients diagnosed with pancreatic divisum and thickening of the gallbladder bile as shown on magnetic resonance cholangio-pancreatography without pancreatic ductal changes underwent laparoscopic cholecystectomy. During the mean follow-up of 32 months no episode of pancreatitis was reported. There is an association between PD and higher concentration of bile in the gallbladder. Cholecystectomy can be considered curative in patients with PD in the absence of indications for major surgery.
Assuntos
Colangiopancreatografia por Ressonância Magnética , Colecistectomia , Cálculos Biliares/etiologia , Cálculos Biliares/cirurgia , Pâncreas/anormalidades , Pancreatite/etiologia , Adulto , Colangiopancreatografia por Ressonância Magnética/métodos , Feminino , Seguimentos , Cálculos Biliares/diagnóstico , Humanos , Masculino , Estudos Prospectivos , Recidiva , Resultado do TratamentoRESUMO
The presence of sarcoid-type granulomata in peripheral lymph nodes, with no evidence of other typical lesions, doesn't allow to diagnose sarcoidosis. In fact, sarcoidosis is a systemic disease and two or more organs must be affected to reach a definitive diagnosis. However this involvement could happen even several years later, thus making a correct diagnosis really difficult. In the absence of other organ involvement, an "idiopathic granulomatous disease" of peripheral lymph nodes is identified. Patients must anyway undergo a careful, long-term follow-up in order to detect clinical or radiologic variations that may confirm a diagnosis of sarcoidosis. After presenting a case-report of monolateral adenopathy of the axilla as an idiopathic granulomatous disease, the Authors review the international literature about sarcoidosis and its extra-pulmonar presentation, underlining the importance of considering sarcoidosis among possible diagnosis when peripheral adenopathies occur.
Assuntos
Granuloma/diagnóstico , Doenças Linfáticas/diagnóstico , Sarcoidose/diagnóstico , Axila , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The Authors presents a case of post-cholecystectomy intrahepatic lithiasis. They focalized their attention to the complications of multimodal treatment.
Assuntos
Ductos Biliares Intra-Hepáticos , Colecistectomia/efeitos adversos , Colelitíase/etiologia , Colelitíase/terapia , Terapia Combinada/efeitos adversos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Aim of the study was to evaluate the role of echo color/power Doppler and magnetic resonance imaging in the diagnosis of space occupying parotid lesions, in the attempt to establish criteria for differential diagnosis between benign and malignant types. The study population comprised 49 patients (23 male, 26 female), age range 30-85 years, with a space occupying lesion of the parotid gland. Each lesion was carefully studied with ultrasound integrated with colour/power doppler and magnetic resonance imaging; patients were then submitted to echo-guided needle-biopsy and surgical excision. A preliminary evaluation by means of ultrasound revealed the site, size of lesion, echostructure and borders. Echo colour/power Doppler and magnetic resonance imaging can play a very important role both in diagnosis and pre-operative surgical planning of parotid lesions, although cost and availability, the former to be recommended vs. magnetic resonance imaging, which is poorly accessible, expensive, and not always accepted by the patients.
Assuntos
Imageamento por Ressonância Magnética , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Ultrassonografia Doppler em Cores , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Ultrassonografia Doppler em Cores/métodosRESUMO
Primary sclerosing cholangitis (PSC) is an idiopathic chronic inflammatory condition affecting intra- and extra-hepatic biliary system. The aim of this study is to stress the importance of cholecystectomy in patients with PSC. Consideration should be given to performing a cholecystectomy in PSC patients with gallbladder adenomyomas or calculi, even asymptomatic; this happens in approximately 15% of cases.
Assuntos
Colangite Esclerosante/cirurgia , Colecistectomia , Adenoma/complicações , Adenoma/patologia , Ductos Biliares/patologia , Colangite Esclerosante/complicações , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/patologia , Colecistite/complicações , Colecistolitíase/complicações , Colecistolitíase/patologia , Doença Crônica , Seguimentos , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
AIM: To study the spine alterations in alcaptonuria with traditional radiology and magnetic resonance (MR), comparing the results of the two techniques. PATIENTS AND METHODS: Five patients (4 males, 1 female, mean age 51 years) underwent the examinations. For the study with X-rays we performed anteroposterior and lateral scan and the images have been studied making reference to a radiographic score; it examines the alterations of the joint space and the presence of calcifications. MR scan, oriented in the three spatial planes, were performed using spin echo T1-weighted and spin echo T2-weighted sequences. RESULTS: Both MR and X-rays pointed out, in the cases with known diagnosis, the typical alterations of the ochronosis: narrowing of the articular spaces, even osseous ankylosis, calcifications of the discs, osteophytosis, multiple disc protrusions and reactive sclerosis of the articular surfaces, evident above all to dorso-lumbar tract; nevertheless MR has been more accurate than X-rays for individualizing the lesions and recognizing alterations, such as the thickness of the anterior longitudinal ligament. In the case of new diagnosis, the MR is fundamental to recognize typical signs of the ochronotic arthropathy not well detected by X-rays. CONCLUSIONS: Imaging techniques, first of all the MR, are essential in the differential diagnosis of ochronosis vertebral lesions with other articular diseases.
Assuntos
Alcaptonúria/diagnóstico , Vértebras Cervicais/patologia , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Osteofitose Vertebral/diagnóstico , Vértebras Torácicas/patologia , Adulto , Idoso , Alcaptonúria/complicações , Alcaptonúria/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Ligamentos Longitudinais/patologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ocronose/complicações , Ocronose/diagnóstico , Radiografia , Osteofitose Vertebral/diagnóstico por imagem , Osteofitose Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagemRESUMO
The BIS-index data show that an opiate as Fentanyl is advisable with associations Cisatracurium/Propofol or Vecuronium/Propofol. It is possible to use in these cases a drip infusion to avoid the risk of awareness during intubation.
Assuntos
Anestesia Geral/métodos , Atracúrio/análogos & derivados , Conscientização , Monitorização Intraoperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Atracúrio/administração & dosagem , Quimioterapia Combinada , Eletroencefalografia/efeitos dos fármacos , Potenciais Evocados Auditivos/efeitos dos fármacos , Feminino , Fentanila/administração & dosagem , Humanos , Infusões Intravenosas , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/administração & dosagem , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Propofol/administração & dosagem , Brometo de Vecurônio/administração & dosagemRESUMO
Although rare, injuries of the duodenum increased in frequency during the past ten years. Careful attention must be paid to them, especially in blunt trauma of the abdomen and lower thoracic regions. Often they occur along with lesions of other related structures in polytraumatized patients. X-rays are the most important mean used in diagnosis. Early diagnosis and surgical treatment are conditio sine qua non for successful results. Complete intraoperative inspection of the duodenum, careful suture of the perforation and a correct placement of drainage are essential for the prevention of postoperative complications. If the duodenal wall had lost its vitality, a gastrojejunal or duodenojejunal anastomosis or gastrostomy are performed; the duodenum is decompressed and drainage of the peritoneal cavity is established. In cases of associated injury of the pancreas or choledochus, the drainage of the extrahepatic bile duct is recommended. The Authors report a case of spontaneous rupture of duodenum in which all of the above mentioned procedures were used; they stress that only suspicion of a duodenum's rupture indicates an immediate laparotomy.
Assuntos
Duodenopatias , Diagnóstico Diferencial , Duodenopatias/diagnóstico , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Duodeno/lesões , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Abdominal , Ruptura , Ruptura Espontânea , Técnicas de Sutura , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The Authors report an interesting case of liposarcoma of the leg and review the international Literature. Moreover, a particular analysis of different aspects such as anatomy, clinic, diagnosis and treatment has been carried out.
Assuntos
Perna (Membro) , Lipossarcoma , Idoso , Feminino , Humanos , Lipossarcoma/diagnóstico , Lipossarcoma/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/cirurgiaRESUMO
Parotid tumours represent a wide group of tumours which are mostly localized in the major salivary glands. We report a case of a 69-year old female with a parotid tumour history who was referred to us with a prominent lump and swelling localized in the right parotid area. In the period between 1985-2002, she was operated 5 times elsewhere for a recurrent pleomorphic adenoma of the right parotid (mixed tumour until 1991), which was histologically confirmed. Sixteen years after the primitive tumour, she underwent mastectomy and axillary dissection for a ductal carcinoma. Routine follow-up has been conducted on both malignancies. Pleomorphic adenoma is the most frequent tumour of the parotid. The potential risk of a malignant transformation can increase over the years with an incidence of 1% to 7%. Management of these recurrences is complex and controversial because of the different treatment options advocated such as radical resection with possible facial nerve sacrifice, or postoperative radiotherapy in non radical cases.
Assuntos
Adenocarcinoma/diagnóstico , Adenoma Pleomorfo/patologia , Neoplasias Parotídeas/diagnóstico , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adenoma Pleomorfo/cirurgia , Idoso , Feminino , Humanos , Glândula Parótida/patologia , Neoplasias Parotídeas/secundário , Neoplasias Parotídeas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A clinical assessment of protective action of desmoplastic response by limiting tumor aggressiveness has been carried out in 171 patients with gastric carcinoma, surgically treated at the First Surgical Clinic of the University of Rome "La Sapienza" between 1988-1999. A univariate statistical analysis was performed using Kaplan-Meier method for: desmoplastic reaction, age, sex, histologic type, tumor size, stage, lymphonodal status and metastases. To determine the influence of these factors on prognosis, the Cox regression was applied. We found a significant association between desmoplastic reaction extent and presence or absence of metastases (p= 0.026), lymphonodal involvement (p = 0.05), stage (p = 0.036). In the univariate analysis, survival was significantly related to sex (p = 0.012), tumor size (p = 0.009), lymphonodal involvement (p = 0.000), metastases (p = 0.000), stage (p = 0.000), desmoplastic reaction extent (p = 0.05); age and histologic type showed no relationship (p = n.s.). The desmoplastic response extent is not a protective factor against tumor invasiveness in gastric carcinoma, on the contrary it may be considered a negative prognostic factor.
Assuntos
Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Matriz Extracelular/patologia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida , Fatores de TempoRESUMO
Pelvic perineal recurrence rate is the major therapeutic problem after curative surgery of extraperithoneal rectal cancer, after lower anterior resection as well as abdomino-perineal resection: local failure rate is high, particularly for stages B2-C. Radiotherapy alone or in combination with chemotherapy proved to be an useful adjunct to surgery. Postoperative radiotherapy, with 40 to 50 Gy doses, has shown local improvement, but causing intestinal damaging. There is now evidence that hyperthermia enthances radiation effects, by killing radioresistant acid tumor cells. In order to give high postoperative radiation doses, without intestinal damage, and to kill acid tumor cells by hyperthermia, we developed a device, able both to displace intestinal loops and to produce combined hyperthermia. From 1993 to 1995, four patients with Astler-Coller stages B2 (2 patients), C1 (1 patient) and C2 (1 patient) distal cancer, were operated by Hartmann's procedure and treated with postoperative radio-hyperthermia with our device. Overall radiation dose delivered in the pelvic area was of 65 Gy, associated with three heating sessions at 43 degrees C for 30 minutes. Pelvic infection occurred in one patient; all pelvic byopsies were negative and no bowel damage was found. Three patients underwent recanalization, one had anasthomotic leackage. The C1 and C2 stage patients died from hepatic metastasis, 18 and 11 months after recanalization; one B2 stage patient is still under treatment and the other is alive and disease free 13 months after recanalization. Our technique allows to give high postoperative radiation doses, without small intestine damage, and to give a good hyperthermia for better control of local failure.
Assuntos
Adenocarcinoma/terapia , Hipertermia Induzida/métodos , Neoplasias Retais/terapia , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Adulto , Terapia Combinada , Feminino , Humanos , Hipertermia Induzida/instrumentação , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Proteção Radiológica , Radioterapia Adjuvante , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgiaRESUMO
The purpose of this research was to evaluate the role of Echo Colour/Power Doppler and Magnetic Resonance Imaging (MRI) in the diagnosis of expansive parotid lesions, and to establish criteria for differential diagnosis between benign and malignant forms. Forty nine patients (23 males and 26 females), aging from 30 to 85 years, with an expansive pathology of parotid gland were enrolled in our study from February 1999 through August 2004. Each patient was carefully assessed employing both ultrasonography integrated with Color/Power Doppler and MRI. Eventually, all patients received echo-guided needle-biopsy and surgical excision of the parotid lesion. Preliminary ultrasound assessed site, size, echoic appearance and margins of the lesion. In order to assess blood supply by means of Colour/Power Doppler, we divided the patients in four groups. Our MRI diagnostic criteria included site, size, intensity of signal, behaviour of the lesion after i.v. contrast, relationship with facial nerve and retromandibular vein, detection of margins and proximity to adjacent structures. On the basis of our results, the Authors concluded that both Echo Colour/Power Doppler and MRI play a very important role in the diagnosis and surgical planning of parotid gland lesions.
Assuntos
Carcinoma/patologia , Imagem Ecoplanar/métodos , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/patologia , Adenoma , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico , Carcinoma/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Radiografia , Fatores de TempoRESUMO
The faultless seal of the intestinal anastomosis makes up a very important event of abdominal surgery. This work proposes an original experimental method to reinforce the intestinal anastomosis and to prevent the complications due defective seal of the sutures. The results obtained show that this method reduces remarkably the possibility of peritonitis due to the filtration or dehiscence of reinforced anastomosis as regards a control group not treated with omental mesh graft.
Assuntos
Omento/transplante , Anastomose Cirúrgica/métodos , Animais , Feminino , Masculino , Peritonite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Coelhos , Telas Cirúrgicas , Deiscência da Ferida Operatória/prevenção & controleRESUMO
Liver resections pose a great variety of problems, not least repair of the cut. The various reconstruction modalities are reviewed and personal experience in twenty rats submitted to surgical removal of the median lobe of the liver with cover of the sectioned surface by means of omental mesh autograft is reported. The results were flattering for the absence of significant complications and for the haematological and haematochemical data obtained which confirm low easily the graft takes, its regenerative potential and the modulator action of peritoneal repair processes.
Assuntos
Fígado/cirurgia , Animais , Fígado/lesões , Regeneração Hepática , Masculino , Omento/transplante , RatosRESUMO
In general surgery, the advantages deriving from the utilisation of omental graft are attributable to the ease with which it takes, its regenerating potential and the modulator action on tissue repair. Personal experience regarding the peritoneization and covering of surgical liver surfaces is reported and the use in various sectors of surgery of omental mesh graft is recommended.
Assuntos
Omento/transplante , Animais , Intestinos/cirurgia , Fígado/cirurgia , Ortopedia , Coelhos , Cirurgia Plástica , Doenças Urológicas/cirurgiaRESUMO
A study relating to the preliminary results of the measurement of tumoral markers (TPA, GICA) in patients suffering from colorectal carcinoma is reported. It is possible to state, on the basis of this experience, that the use of the two tumoral markers is justified in the preoperative period above all as a prognostic indicator, while greater clinical utility would seem to derive from their use through serial determinations, in the postoperative follow-up and in the monitoring of patients undergoing antiblastic and radiation treatment.