RESUMEN
BACKGROUND: Several scores have been developed to evaluate surgical unit mortality and morbidity. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and derivatives use preoperative and intraoperative factors, whereas the Surgical Risk Scale (SRS) and Association Française de Chirurgie (AFC) score use four simple factors. To allow for advanced age in patients undergoing colorectal surgery, a dedicated score-the Elderly (E) POSSUM-has been developed and its accuracy compared with these scores. METHODS: From 2002 to 2004, 1186 elderly patients, at least 65 years old, undergoing major colorectal surgery in France were enrolled. Accuracy was assessed by calculating the area under the receiver operating characteristic curve (AUC) (discrimination) and calibration. RESULTS: The mortality and morbidity rates were 9 and 41 per cent respectively. The E-POSSUM had both a good discrimination (AUC = 0.86) and good calibration (P = 0.178) in predicting mortality and a reasonable discrimination (AUC = 0.77) and good calibration (P = 0.166) in predicting morbidity. The E-POSSUM was significantly better at predicting mortality and morbidity than the AFC score (P(c) = 0.014 and P(c) < 0.001 respectively). CONCLUSION: The E-POSSUM is a good tool for predicting mortality, and the only efficient scoring system for predicting morbidity after major colorectal surgery in the elderly.
Asunto(s)
Neoplasias Colorrectales/cirugía , Índice de Severidad de la Enfermedad , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Mortalidad Hospitalaria , Humanos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Mesenteric cysts are rare intraabdominal tumors in surgical pathology. Their etiology has been subject to much discussion. Symptoms are variable and depend on specific complications. Localisation in the gastro-hepatic mesentery is uncommon and has been reported only in two previous issues. We describe a new case with literature review.
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Quiste Mesentérico/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Humanos , Masculino , Quiste Mesentérico/patología , Quiste Mesentérico/cirugía , RadiografíaRESUMEN
Schwannomas as neurofibromas are neurogenic mesenchymal tumors of the stomach. They arise from the Schwann cells of nerves of th gastric wall and are usually benign. The incidence of malignant schwannomas is uncertain because of the variable pathologic criteria used. Immunohistochemistry is a diagnostic tool used to distinguish between schwannomas and leiomyomas both constituted by spindle-cells. In this issue we report a case of malignant schwannoma with lymph node involvement. The clinical and histological features of gastric schwannomas are discussed with evaluation of their diagnostic and therapeutic modalities.
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Neurilemoma/patología , Neoplasias Gástricas/patología , Humanos , Inmunohistoquímica , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Pronóstico , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Blunt abdominal trauma and delayed colon perforations are not common and usually occur in patients sustaining other injuries, but also as isolated event. We report a case of delayed perforation of sigmoid colon, three days after a blunt abdominal trauma in a male adult. It was caused by disinsertion of sigmoid colon mesentery for about ten centimeters. This condition is discussed with literature review.
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Traumatismos Abdominales/complicaciones , Colon Sigmoide/lesiones , Perforación Intestinal/etiología , Heridas no Penetrantes/complicaciones , Adulto , Colon Sigmoide/cirugía , Humanos , Perforación Intestinal/cirugía , MasculinoRESUMEN
The authors report a preliminary series assessing the feasibility of duodenal stenting using a surgical approach. The study included 16 patients with a malignant duodenal outlet obstruction for whom a biliaryobstruction necessitated a laparotomyor following an endoscopic stenting failure. The stent was efficient in 15 patients with a complete relieve of obstruction. These patients could have oral intake at the end of the first postoperative week. No stent obstruction occurred. The duodenal stenting by laparotomy could be a good alternative to palliative gastroenteral anasotomosis.
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Neoplasias Duodenales/complicaciones , Obstrucción Duodenal/etiología , Obstrucción Duodenal/cirugía , Laparotomía/métodos , Cuidados Paliativos/métodos , Implantación de Prótesis/métodos , Stents , Duodenoscopía , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Resultado del TratamientoRESUMEN
Authors have described 2 cases of benign schwannomas of pelvian origin and with abdominal extension. The diagnosis is often late because of the absence of early clinical signs and of specific investigations. The reliability of the diagnosis is based on the mobid anatomy of the surgical pieces, the hypervascularization. Schwannomes with bone adherences complicate the surgical treatment. These tumors very seldom degenerate. The pronostic is related to the risk seldom degenerate. The pronostic is related to the risk of recurrence if their ablation is incomplete.
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Neuroma/cirugía , Neoplasias Retroperitoneales/cirugía , Adulto , Humanos , Masculino , Persona de Mediana Edad , Neuroma/diagnóstico por imagen , Neoplasias Pélvicas , Pronóstico , Neoplasias Retroperitoneales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Retrospective analysis of a consecutive series of 285 cholecystectomies carried out by laparoscopy showed that 47 patients (17.5%) required conversion laparotomy. In 55% of these cases the conversion was due to difficulty in dissecting the gallbladder or cystic duct. Peri-operative cholangiography should be performed routinely, not only to verify the vacuity of the common bile duct (13% of the conversions) but, more particularly, to ensure the integrity of the principal biliary pathway during the dissection (8.5% of the conversions). Cholecystectomy under celioscopy is a proven and safe technique, on the condition that all stages of classical surgery can be carried out under good conditions.
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Colecistectomía Laparoscópica/métodos , Laparotomía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Colangiografía , Colecistitis/cirugía , Cólico/cirugía , Femenino , Humanos , Hepatopatías/cirugía , Masculino , Persona de Mediana Edad , Pancreatitis/cirugía , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
OBJECTIVES: The aim of this retrospective study was to evaluate the feasibility and the morbidity of laparoscopic cholecystectomy for acute cholecystitis in elderly patients. METHODS: Among 891 consecutive patients who underwent cholecystectomy, 151 had acute cholecystitis. Fifty three patients of > or = 70 years of age (group 1) were compared to 98 younger patients (group 2). Analysis was made in "intention to treat" so directly open cholecystectomies during the same period were also included. RESULTS: Elderly patients had a lower success rate of laparoscopic treatment (52.8% versus 70.4%; p < 0.05). This difference was due to higher rate of directly open cholecystectomy in the elderly (17% versus 2%). There was no difference between both groups in conversion rate to laparotomy (30.2% versus 26.5%). Surgical morbidity was 7.5% in group 1 and 4% in group 2 (NS). General complications were more frequent in the elderly (p < 0.05). Five patients in group 1 (9.4%) died of general complications of which 3 were operated on directly by open cholecystectomy. There was no mortality in group 2. CONCLUSION: Acute cholecystitis in the elderly remains a severe disease in which laparoscopic treatment is only possible in about fifty percent.
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Colecistectomía Laparoscópica , Colecistitis/cirugía , Enfermedad Aguda , Anciano , Arritmias Cardíacas/complicaciones , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Colecistectomía Laparoscópica/efectos adversos , Colecistitis/patología , Contraindicaciones , Estudios de Evaluación como Asunto , Estudios de Factibilidad , Gangrena , Humanos , Complicaciones Intraoperatorias , Laparotomía , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Esfinterotomía Endoscópica , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Adenocarcinoma of the appendix is rarely encountered and is usually discovered fortuitously at pathology examination of the surgical specimen. Six years after surgery for degenerative villous tumor of the appendix, local and parietal recurrence led to surgery in our patient. We present here the indications for complementary hemicolectomy and management of parietal scars resulting from the initial appendectomy.
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Adenocarcinoma Mucinoso , Neoplasias del Apéndice/complicaciones , Neoplasias del Ciego/secundario , Neoplasias de los Músculos/secundario , Recurrencia Local de Neoplasia , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/secundario , Adenocarcinoma Mucinoso/cirugía , Neoplasias del Apéndice/patología , Neoplasias del Apéndice/cirugía , Neoplasias del Ciego/patología , Neoplasias del Ciego/cirugía , Cicatriz/patología , Colectomía/métodos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de los Músculos/patología , Neoplasias de los Músculos/cirugía , Siembra Neoplásica , RecurrenciaRESUMEN
BACKGROUND: Undernutrition causes a reduction of body-fat mass and a decrease in the circulating concentration of leptin which impairs the production of proinflammatory cytokines and increases the incidence of infectious diseases. The main objective of this study was to determine whether leptin deficiency is a risk factor for ventilator-associated pneumonia (VAP). METHODS: This prospective observational case-control study was conducted in a university ICU during a 2-year period. Patients with VAP (cases) were matched (1:1) to patients without VAP (controls) according to all the following criteria: age, gender, SAPS II, and duration of ICU stay before VAP occurrence. In all patients leptin, C-reactive protein (CRP) and procalcitonin (PCT) were measured at ICU admission, and twice a week. In addition, in cases, leptin, CRP and PCT were also measured on the day of VAP diagnosis. RESULTS: Eighty-six cases were matched with 86 controls. No significant difference was found in leptin and PCT levels between cases and controls. CRP level was significantly higher on the day of VAP in cases compared with controls (99 vs. 48 mg/L, P=0.001). Combination of CRP-leptin (CRP ≥78 mg/L and leptin ≥6.2 ng/mL on the day of VAP) was significantly (P=0.009) associated with VAP in univariate analysis. Multivariate analysis identified the combination of CRP-leptin (OR [95% CI] 3.08 [1.18-8.04], P=0.003), LOD score (1.27 [1.08-1.48], P=0.003), neuromuscular-blockers use (6.6 [2.03-21.7], P=0.002), and reintubation (3.3 [1.14-9.6], P=0.027) as independent risk factors for VAP. CONCLUSION: In our study, leptin level was not associated with VAP occurrence. Further studies are needed to confirm our results, and to define the exact inflammatory role of leptin, and its interest as a biomarker in ICU patients.
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Leptina/sangre , Neumonía Asociada al Ventilador/sangre , Anciano , Biomarcadores/sangre , Índice de Masa Corporal , Proteína C-Reactiva/análisis , Calcitonina/sangre , Péptido Relacionado con Gen de Calcitonina , Estudios de Casos y Controles , Femenino , Infecciones por Bacterias Gramnegativas/sangre , Infecciones por Bacterias Gramnegativas/etiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/etiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Hipoalbuminemia/sangre , Control de Infecciones , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Desnutrición/sangre , Persona de Mediana Edad , Neumonía Asociada al Ventilador/microbiología , Neumonía Asociada al Ventilador/prevención & control , Estudios Prospectivos , Precursores de Proteínas/sangre , Factores de Riesgo , Sensibilidad y Especificidad , Desconexión del VentiladorAsunto(s)
Adenocarcinoma/cirugía , Laparoscopía/métodos , Neoplasias del Colon Sigmoide/cirugía , Adenocarcinoma/patología , Anciano , Anciano de 80 o más Años , Colectomía , Femenino , Humanos , Masculino , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/cirugía , Neoplasias del Colon Sigmoide/patología , Grabación en VideoRESUMEN
The authors report the exceptional case of a young boy, 14 years old, affected by Crohn's disease, first treated medically. Extension and aggravation of injuries required right hemicolectomy. An obstruction of right ureter appeared, diagnosed by echography. The investigations showed up a stenosis of right ureter. A resection-suture was performed and the follow up at two years in good.
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Enfermedad de Crohn/complicaciones , Enfermedades Ureterales/etiología , Adolescente , Constricción Patológica/diagnóstico , Constricción Patológica/etiología , Constricción Patológica/cirugía , Enfermedad de Crohn/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/cirugíaRESUMEN
The authors report a case of pulmonary fibrosarcoma in a newborn. The respiratory distress imposed an urgent thoracotomy at the fifth hour of live. A lobectomy was performed. Three months later a relapse occurred. A second thoracotomy permitted an incomplete resection. The total involution was achieved after 6 months of chemotherapy. Actually no recidive is shown after 20 months of follow up. Its an exceptional case. A unique one was published in 1977.
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Fibrosarcoma/cirugía , Neoplasias Pulmonares/cirugía , Fibrosarcoma/diagnóstico , Fibrosarcoma/diagnóstico por imagen , Humanos , Recién Nacido , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Recurrencia Local de Neoplasia , Radiografía , Reoperación , Toracotomía , UltrasonografíaRESUMEN
We reported a series of 446 consecutive cholecystectomies performed laparoscopically between June 1990 and January 1993. There were 354 females and 92 men, mean age 53 +/- 17 years. Laparoscopic cholangiography was attempted in 410 cases (92%) and led to the discover of a stone in the main bile duct in 18 cases (4%) and an abnormal insertion of the bladder duct in 30% (6.7%). Conversion to laparotomy was required in 84 patients (18.8%) due to difficult dissection (52), peroperative incidents or accidents (15) and abnormal hepatogram (17). No accident inherent to the operation was encountered in this series. One death occurred after laparotomic conversion for acute angiocholitis. The rate of post-operative complications was 5.6% and reoperations were required in 7 patients (1.5%).
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Colecistectomía Laparoscópica/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Colangiografía , Colecistectomía Laparoscópica/métodos , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To focus attention on the management and outcome of patients with intraductal papillary mucinous tumours of the pancreas. DESIGN: Retrospective study and analysis of published reports. SETTING: University hospital, France. SUBJECTS: 111 patients (101 published cases and our own 10 cases) divided in two groups: the first including malignant tumours (n = 46), and the second group benign or in situ tumours (n = 61). In 4 patients the type of tumour was not known. MAIN OUTCOME MEASURE: Resectability, mortality and recurrence. RESULTS: More men had benign or in situ tumours [48/61 (79%) compared with 28/46 (61%), p = 0.054]. Pancreatitis was more common among benign than malignant tumours [34/61 (58%) compared with 21/46 (46%), p = 0.33]. In group I, 39 patients had diabetes. A total of 107 patients were operated on: pancreaticoduodenectomy (n = 54, 50%), distal pancreatectomy (n = 25, 23%), total pancreatectomy (n = 4,4%), bypass (n = 2,2%). The type of resection was not mentioned in 22 records (21%). Four patients were not operated on because of their poor general condition. The resectability rate was 98% (105/107). Eleven patients had died at the time of publication. Hospital mortality rate was 3% (n = 3), mainly because 2 of the 4 who had total pancreatectomy died. With a median follow-up of 37 months, recurrence was 5% (n = 5). CONCLUSION: Intraductal papillary mucinous tumours of the pancreas are well known distinctive pancreatic tumours that are usually intraductal but may develop into invasive carcinoma. They should be resected, and have a good prognosis and low recurrence rate.