RESUMEN
An ingested foreign body often passes the gastrointestinal tract without any complications. Foreign bodies, such as fish bones, chicken bones and toothpicks, have been known to cause perforation of the gastrointestinal tract. We present 4 cases: the first 2 of a 27-year-old male and a 48-years-old female respectively, with acute abdomen, diffuse purulent peritonitis, with ileum perforation, both caused by accidentally ingesting a wire, 1 case of a 64-year-old male with sigmoid perforation, caused by accidentally ingesting a toothpick and 1 case of a 52-year-old female presented with left buttock painful swelling for 1 week associated with fever,physical examination revealed an ischiorectal abscess.During incision and drainage a 3 cm chicken bone was found inside the abscess cavity. Evolution was favorable in all 4 cases.
Asunto(s)
Abdomen Agudo/diagnóstico , Absceso/diagnóstico , Enfermedades del Ano/diagnóstico , Colon Sigmoide , Migración de Cuerpo Extraño/diagnóstico , Íleon , Perforación Intestinal/diagnóstico , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Absceso/etiología , Absceso/cirugía , Adulto , Enfermedades del Ano/etiología , Enfermedades del Ano/cirugía , Diagnóstico Diferencial , Drenaje , Ingestión de Alimentos , Femenino , Migración de Cuerpo Extraño/complicaciones , Migración de Cuerpo Extraño/cirugía , Humanos , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Pancreatic true cysts represent a rare, heterogeneous group of pancreatic tumors; therapeutic strategy is based on patient's general status, cyst topography, and especially the estimated risk of malignancy. This paper aim is to present 7 cases of pancreatic true cysts, operated on a six years period (January 2004-January 2010) in our surgical clinic: 2 men and 5 women, aged between 24-61 years old; cyst diameter varies between 3.5-15 cm, tumor location being pancreatic head in two cases and the distal pancreas in 5 cases. Surgical treatment consisted in cyst enucleation (two cases), splenopancreatectomy (three cases), duodenopancreatectomy (one case), and subtotal splenopancreatectomy (one case). Histology was represented by serous cystadenoma (one case), mucinous cystadenoma (2 cases), intraductal papillary mucinous cystadenoma (one case), and papillary cystadenocarcinoma (3 cases).Postoperative results were good in all cases, with 3 postoperative pancreatic external fistulas, resolved conservatory; no case of post-pancreatectomy diabetes mellitus was registered. In conclusion, surgical removal of the pancreatic cystic tumors is necessary, especially due to the risk of malignancy, at least in the absence of rigorous histological proofs of benignancy. Postoperative results are favorable in terms of postoperative morbidity and mortality.
Asunto(s)
Cistoadenoma/diagnóstico , Cistoadenoma/cirugía , Quiste Pancreático/diagnóstico , Quiste Pancreático/cirugía , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirugía , Adulto , Cistadenocarcinoma Papilar/diagnóstico , Cistadenocarcinoma Papilar/cirugía , Cistoadenoma/patología , Cistoadenoma Mucinoso/diagnóstico , Cistoadenoma Mucinoso/cirugía , Cistoadenoma Papilar/diagnóstico , Cistoadenoma Papilar/cirugía , Cistadenoma Seroso/diagnóstico , Cistadenoma Seroso/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatectomía , Quiste Pancreático/patología , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía , Esplenectomía , Resultado del Tratamiento , Adulto JovenRESUMEN
Carcinoids (neuroendocrine tumours) are considered the most common primary appendiceal neoplasm. Primary appendiceal tumours are uncommon. Routine histopathological examination of appendicectomy specimens is justified given the not infrequent incidental finding of appendiceal tumours. In cases of appendicitis in the elderly, the index of suspicion for epithelial tumours of the appendix should be raised. Moreover, once the diagnosis of an adenomatous lesion is made, colonoscopic examination of the entire large bowel is mandatory given the frequency of synchronous colorectal neoplasia in our population. In our study, we review 3 cases of carcinoid tumor of the appendix and describe their presentation, treatment and outcome. They are often diagnosed incidentally after histopathological examination of the vermiform appendix submitted in the course of the management of another clinical diagnosis. Appendectomy is appropriate for lesions < 1 cm but for lesions over 2 cm in diameter there is a significant increase in metastatic spread and thus right hemicolectomy is required in such cases. Appendiceal carcinoid tumours are found in 0,3 - 0,9 per cent of patients undergoing appendicectomy. Controversy exists over the management following appendicectomy, especially with regard to the role of right hemicolectomy in patients with tumours smaller than 2 cm in diameter.
Asunto(s)
Apendicectomía , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/cirugía , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Colectomía , Adolescente , Adulto , Anciano , Femenino , Humanos , Hallazgos Incidentales , Masculino , Invasividad Neoplásica , Resultado del TratamientoRESUMEN
Primary varices pathogenesis is still unclear about the trigger event and the disease progression. Throughout time, a lot of hypotheses were created, each with a certain degree of veracity, to explain the aforementioned dilemmas. Present day investigation technologies allowed the undeniable progress in deciphering venous mechanics and biochemistry. Objectifying venous hemodynamic and valvular-parietal changes, their dynamic progression as well, lead to important clarifications in primary varicose disease physiopathogenesis. The importance of establishing a complete, unitary pathogenic model implies the practical possibility of immediately applying the right therapy addressing the pathogenic mechanism of this disease (i.e. correcting the "pressure escape" gateway) correlated with the progression stage (reflux degree) and the type of primary varices (gravitational, non-gravitational, or "suspended" varices). Initially, our study produces a critical evaluation of the classic pathogenic hypotheses and, later on, based on our long time experience in this field, it presents a complete and unitary, evolutive and pathogenic model in primary varices. The proposed model details a pathogenesis and a progression far more nuanced in primary varices, based on solid evidence, having obvious therapeutic implications and predictable results.
Asunto(s)
Várices/etiología , Progresión de la Enfermedad , Hemodinámica , Humanos , Índice de Severidad de la Enfermedad , Várices/clasificación , Várices/diagnóstico , Várices/fisiopatología , Várices/terapiaRESUMEN
Synchronous development of a second primary cancer in patients with esophageal squamous cell carcinoma was reported in 2.73%-11% of the cases. Although the synchronous association between esophageal and renal cancer is very rare, an increasingly number of cases is reported in medical literature. This study's aim is to report a case of synchronous esophageal squamous cell carcinoma and an urothelial carcinoma of the right kidney. Patient G.D. was admitted in our clinic with esophageal cancer diagnosis; during the preoperative work-up protocol, an asymptomatic right renal mass was discovered. A nephroureteroscopy with biopsy was performed and the urothelial renal cancer diagnosis was established. The patient is proposed for seriate surgery: nephroureterectomy on the first stage, then esophagectomy with gastric reconstruction was performed. Postoperative evolution was unfavourable, patient being finally discharged, on his request, with severely altered status.
Asunto(s)
Carcinoma/diagnóstico , Neoplasias Esofágicas/diagnóstico , Neoplasias Renales/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Carcinoma/cirugía , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Humanos , Hallazgos Incidentales , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Nefrectomía , Cuidados Paliativos , Procedimientos de Cirugía Plástica , Estómago/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Urotelio/patologíaRESUMEN
This paper aim is to discuss the advantages of enteral postoperative feeding on patients submitted to surgery finalized through an eso-digestive anastomosis; in these cases enteral feeding is often delayed 5-8 days after the surgery, and in case of an anastomotic dehiscence may be even impossible. Also, the paper promotes duodenostomy as an important enteral feeding way, and discusses the indications and contraindications of different enteral nutrition pathways in such cases. There were studied 230 cases, 149 cases submitted to cancer surgery and 81 cases with benign condition surgery followed by an eso-digestive anastomosis, in which the following enteral nutrition pathways was practiced: nasogastric or naso-esojejunal feeding tube (55 cases); Witzel jejunostomy (28 cases); gastrostomy (79 cases); duodenostomy (68 cases). Postoperative morbidity induced exclusively by the enteral nutrition pathway was encountered in 36% of patients. On patients with an eso-gastric cervical anastomosis or esogastric thoracic anastomosis we used jejunostomy as enteral feeding path and a gastric tube passed by pyloric canal for gastric decompression. In cases of esophageal reconstruction for benign esophageal strictures gastrostomy remains the best feeding method. Duodenostomy was practiced as a feeding pathway in cases of total gastrectomy with esojejunal anastomosis, with closure of the duodenal stump.
Asunto(s)
Duodenostomía/métodos , Nutrición Enteral/métodos , Cuidados Posoperatorios , Anastomosis Quirúrgica/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Nutrición Enteral/efectos adversos , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Gastrectomía/métodos , Humanos , Yeyunostomía/métodos , Factores de Riesgo , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
Soft tissue sarcomas are a rare group of cancers compromising 1% of all malignancies and there has been a slight increase in incidence. We present 3 cases of soft tissue sarcomas (the tumors were located to the right axilary region, perianal and dorsale face of the left leg) hospitalized in 2nd Surgical Clinic of Emergency Hospital of Craiova and we discuss the difficulties of diagnosis and treatment. The classification and characterization of soft-tissue sarcomas have evolved as the information supplied by histologic analysis has been supplemented with that provided by immunohistochemical analysis. Surgical resection involving wide margins, with or without radiotherapy, offers the best chance of cure in the absence of metastatic disease. There is little evidence that local recurrence increases the likelihood of metastatic spread, although debate on this point continues. Except for rhabdomyosarcomas and Ewing's sarcomas, the use of adjuvant chemotherapy generally does little to influence the natural history of the disease. In conclusion surgical treatment is mainstay of treatment for soft-tissue sarcomas and is usefull the prompt diagnosis for decrease the risk of local recurrence and metastatic disease.
Asunto(s)
Sarcoma/diagnóstico , Sarcoma/cirugía , Anciano , Canal Anal/patología , Canal Anal/cirugía , Axila/patología , Axila/cirugía , Femenino , Humanos , Pierna/patología , Pierna/cirugía , Masculino , Persona de Mediana Edad , Sarcoma/patología , Resultado del TratamientoRESUMEN
The valvular segment is a distinct venous structure, which, from a morphological point of view, is comprised of the following components: the valvular insertion, the valvular gorge entrance orifice, the valvular defile, the valvular gorge exit orifice, the valvular sinus. Endoscopic and echo Doppler examinations are used to identify the normal and the pathological morphology of the valvular segment, and the hemodynamic phenomena occurring at this level. Cusps' integrity and size as well as valvular dynamics are key elements directly involved in shaping the valvular segment in general, and the valvular sinus in particular. The valvular sinus shows an obvious hemodynamic determinism. Valvular segment pathology is the outcome either of a progressively long evolving process initialized by gravitational venous pressure overcharges, or of a rapidly evolving process such as the hemodynamic shock following intense physical efforts. Valvular defunctionalisation implies a different mechanism and a different type of cusp lesion.
Asunto(s)
Extremidad Inferior/irrigación sanguínea , Válvulas Venosas/anatomía & histología , Válvulas Venosas/patología , Válvulas Venosas/fisiología , Endosonografía , Hemodinámica , Humanos , Extremidad Inferior/diagnóstico por imagen , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/patología , Enfermedades Vasculares Periféricas/fisiopatología , Ultrasonografía Doppler Dúplex , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/patología , Insuficiencia Venosa/fisiopatología , Válvulas Venosas/diagnóstico por imagenRESUMEN
Soft tissue leiomyosarcoma is a relatively rare malignant tumor. It may be difficult to be distinguished from gastrointestinal stromal tumors and Schwann cell neoplasms. To make a correct identification of soft tissue leiomyosarcoma, immunostaining with several smooth muscle differentiation markers (actin, calponin and desmin), and negative staining results with S100 (to rule out Schwann cell neoplasm), c-kit and CD34 (to rule out gastrointestinal stromal tumors) is needed. Prompt diagnosis and referral are desirable, since the size of the tumor at presentation is a continuous variable for the risk of local recurrence and metastatic disease. Chemosensitivity varies according to the tumor subtype, and the tumor grade, the patient's age, performance status, and the timing of metastatic disease further influence the likelihood of a response and survival. Chemotherapy is palliative for most patients with unresectable or metastatic disease. Ifosfamide and doxorubicin are routinely used in this setting; doxorubicin as a single agent is considered the drug of choice.
Asunto(s)
Neoplasias del Ano/patología , Leiomiosarcoma/patología , Anciano , Neoplasias del Ano/tratamiento farmacológico , Axila/patología , Doxorrubicina/uso terapéutico , Femenino , Humanos , Leiomiosarcoma/tratamiento farmacológico , MasculinoRESUMEN
This paper aim is to discuss the main etiopathogenic aspects responsible for eso-digestive anastomotic leakage, as well as prophylactic and therapeutic measures of this postoperative complication. There were studied 173 consecutive eso-digestive anastomosis: 103 anastomosis performed for malignancy and 70 anastomosis for benign conditions. Surgical operations followed by an eso-digestive anastomosis were: esophageal reconstruction for benign esophageal caustic strictures (n=67); total gastrectomy (n=55); total esophagectomy (n=13); total esophagectomy plus total gastrectomy (one case); eso-gastrectomies (n=34); upper gastric pole resection (n=2); distal esophageal resection (n=1). Eso-digestive anastomosis topography were cervical (n=81), intrathoracic (n=37) and abdominal (n=57). There were 30 eso-gastrostomies, 81 eso-jejunostomies, and 62 eso-colostomies. There were recorded 24 eso-digestive anastomotic dehiscences (13.8%): 14 in the cervical region (17.2% out of 81 cervical anastomosis); 5 intrathoracic leakages (14.2% out of 35 anastomosis); 5 intraabdominal anastomotic dehiscences (8.7% out of 57 intraabdominal anastomosis). Four patients died as an anastomotic leakage consequence: two patients died after cervical eso-gastrostomy dehiscences, one patient died after an intrathoracic eso-jejunostomy leakage, and one patient died after intraabdominal eso-gastrostomy leakage. In conclusion, we analyze postoperative results, emphasizing the role of discovering and removal of predisposing factors which may lead to an eso-digestive anastomotic leakage.
Asunto(s)
Colon/cirugía , Enfermedades del Esófago/cirugía , Unión Esofagogástrica/cirugía , Esófago/cirugía , Yeyuno/cirugía , Dehiscencia de la Herida Operatoria/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Colostomía/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Enfermedades del Esófago/mortalidad , Esofagectomía/efectos adversos , Femenino , Gastrectomía/efectos adversos , Humanos , Yeyunostomía/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Dehiscencia de la Herida Operatoria/mortalidad , Dehiscencia de la Herida Operatoria/cirugía , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The authors present one case of acute mesenteric ischemia appeared to the patient 70 years old, with HTA and coronary heart disease with heart arrhythmia treated with angiotensin-converting-enzyme inhibitor, anti arrhythmia agents and antithrombin therapy (trombostop). Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus and nonocclusive mesenteric ischemia. These diseases have common clinical features caused by impaired blood perfusion of the intestine, bacterial translocation and systemic inflammatory response syndrome. Reperfusion injury is another important feature of nonocclusive mesenteric ischemia. We discuss about the nonocclusive mesenteric ischemia is the most lethal form of acute mesenteric ischemia because of the poor understanding of its pathophysiology and its nonspecific symptoms, which often delay its diagnosis. Although acute mesenteric ischemia is still lethal and in-hospital mortality rates have remained high over the last few decades, accumulated knowledge on this condition is expected to improve its prognosis.
Asunto(s)
Isquemia/diagnóstico , Isquemia/cirugía , Oclusión Vascular Mesentérica/diagnóstico , Oclusión Vascular Mesentérica/cirugía , Mesenterio/irrigación sanguínea , Enfermedad Aguda , Anciano , Humanos , Masculino , Resultado del TratamientoRESUMEN
Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus, and nonocclusive mesenteric ischemia. These diseases have common clinical features caused by impaired blood perfusion to the intestine, bacterial translocation, and systemic inflammatory response syndrome. There is substantial evidence that the mortality associated with acute mesenteric ischemia varies according to its trigger cause. Nonocclusive mesenteric ischemia is the most lethal form of the acute mesenteric ischemia, because of the poor understanding of its pathophysiology and its mild and nonspecific symptoms, which often delay its diagnosis. Mesenteric venous thrombosis is much less lethal than acute thromboembolism of the superior mesenteric artery and nonocclusive mesenteric ischemia. In this articles we presents an overview of acute mesenteric ischemia, based on the research. Although the mortality rates, in acute mesenteric ischemia, have remained high over the last few decades, accumulated knowledge on this condition is expected to improve its prognosis.
Asunto(s)
Isquemia/cirugía , Arterias Mesentéricas/cirugía , Oclusión Vascular Mesentérica/cirugía , Mesenterio/irrigación sanguínea , Enfermedad Aguda , Embolectomía , Humanos , Isquemia/diagnóstico , Isquemia/mortalidad , Isquemia/fisiopatología , Arterias Mesentéricas/patología , Arteria Mesentérica Superior/cirugía , Venas Mesentéricas/cirugía , PronósticoRESUMEN
The objective of this study is to analyze the main diagnostic and therapeutic aspects in locally advanced colorectal cancers, related to recent advances published in the medical literature. The paper analyzes 2nd Surgical Clinic cases of advanced colorectal cancers over a five year period: 224 such patients operated on, with 79.9% tumor resectability (64.4% with radical intent); in 12.94% extended resections were necessary in order to achieve primary tumor removal. Overall morbidity and mortality rate were 52.23% and 7.14%, respectively. In conclusion it has been emphasized that improvements are necessary to be made in order to achieve a good staging of disease and, as therapeutic feature, in locally advanced cases extended resections may be perform with acceptable risks for the patients.
Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Colectomía , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Adenocarcinoma/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Colectomía/métodos , Neoplasias Colorrectales/diagnóstico , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The venous system anatomy of the lower limbs and especially its functionality still presents half-lighted areas, fact easily qualified as incredible for the third millennium. Our dissections on fresh amputation segments, methylene blue injected in superficial veins or in deeper veins pointed out that venous circulation is much more complex than it seemed, that there are subdermal collectors connected to the saphene trunks which permit bidirectional transfer of blood mass to saphene venous roots or to derm. The dermal plexus has also a complex connection with the deep venous system by Delater perforators, by perforators, which drain saphene systems after having previously received dermal affluents, and by Delater equivalences (submillimetric perforators) that provide blood mass transfer from deep to surface under the conditions of a moderate and temporary venous hypertension. High- and long-term venous hypertension determines the valvular device deterioration of classical perforators making possible a pathological bi-directional flow.
Asunto(s)
Amputación Quirúrgica , Pierna/irrigación sanguínea , Venas/anatomía & histología , Humanos , Tibia/irrigación sanguínea , Venas/patología , Vénulas/anatomía & histología , Vénulas/patologíaRESUMEN
The authors present a study both upon eight crania of dead born fetuses having the vertex-coccis distance between 25-29 cm and a human embryocephalic extremity of 18 cm. The crania were examined in the lateral, vertical, frontal, occipital, basal norms. Sagittal sections were performed upon the embryo, and then those sections were microscopically examined after HE staining. We concluded that the cranial arch bones morphogenesis and the facial complex is a long-time development process, which initially started during the early embryogenesis, and it is completed as an adult. Determining factors of the flat bones osteogenesis are the following: vascular, muscle, extracell (mesenchyma) and neuronal factors (rhombencephalon presence).
Asunto(s)
Morfogénesis/fisiología , Cráneo/anatomía & histología , Cráneo/embriología , Feto/anatomía & histología , HumanosRESUMEN
Mesenteric inflammatory veno-occlusive disease is a rare but recognized cause of intestinal ischemia, who can be defined as phlebitis or venulitis affecting mesentery or the bowel, without any evidence of coexisting of an obvious predisposing cause or a coexisting arterial inflammatory involvement. We report the case of a male patient, 63 year old, admitted in the Emergency County Hospital of Craiova, who after presenting with an acute abdomen, underwent exploratory laparotomy and resection of the ischemic sigmoid, temporary colostomy and after four months we reintroduced descendent colon in the digestive transit. The resected specimen of the patient was examined histopathologically, and distinctive histopathological characteristics of the mesenteric inflammatory veno-occlusive disease were identified.
Asunto(s)
Abdomen Agudo/etiología , Oclusión Vascular Mesentérica/complicaciones , Venas Mesentéricas/patología , Colon Sigmoide/irrigación sanguínea , Colon Sigmoide/patología , Humanos , Isquemia/etiología , Isquemia/patología , Masculino , Oclusión Vascular Mesentérica/patología , Persona de Mediana Edad , Necrosis , Flebitis/complicaciones , Flebitis/patologíaRESUMEN
This paper aim is to analyze the main diagnostic and therapeutic aspects in rectal cancer; for this purpose we analyzed the Craiova's Surgical II Clinic statistics and we report them to the present literature. There were 179 rectal cancers, diagnosed over 10 years period (between 1995 and 2004); 163 cases were operated on, in 62 cases (38.03%) the surgical intervention aim being curative; global resection of tumor was 84.66%. The operation was preceded by preoperative radiotherapy in 82 cases; all cases diagnosed in the last four years in curative stage of disease were treated by preoperative radiotherapy. The postoperative mortality was 3.68% (6 cases) and the morbidity rate (55 cases - 33.74%) is still important, mainly because of the associated diseases. In conclusion we emphasize the importance of untimely diagnosis and the obligatorily sequential treatment: preoperative radiotherapy curative surgical resection - postoperative adjuvant treatment.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/cirugía , Femenino , Humanos , Masculino , Registros Médicos , Estadificación de Neoplasias , Radioterapia Adyuvante , Neoplasias del Recto/mortalidad , Neoplasias del Recto/radioterapia , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The aim of this paper is to debate, on the basis of medical literature review, the importance of detection the sentinel nodes in surgery of breast cancer. The beginning of the paper emphasized the problems of the sentinel nodes definition, and then we discuss the dates related to the history and the importance of the sentinel nodes knowledge that consist in the avoidance of axillary lymph nodes dissection in patients with breast cancer N-. Afterwards, we present the indications for detecting the sentinel nodes and the criterion to exclude from the detection of the sentinel nodes. As a part of the results of surgery sentinel nodes, we present dates about the techniques of detection the sentinel nodes, the place of injection of the radiopharmaceuticals, the size of the radiocolloid. Finally, we come up in the conclusion that the identification of the sentinel nodes is useful and possible for majority of the patients with breast cancer T1 or T2N0M0.
Asunto(s)
Neoplasias de la Mama/patología , Biopsia del Ganglio Linfático Centinela , Axila , Neoplasias de la Mama/cirugía , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Cintigrafía , Radiofármacos , Renio , Compuestos de TecnecioRESUMEN
This paper presents the case of a male patient, 57 years old, admitted to the hospital for upper digestive bleeding revealed by melena stools. The upper digestive endoscopy has not discovered the source of bleeding. Conventional medical therapy, with hemostatics, proton pump blockers and transfusion, failed to stop the bleeding, requiring emergency surgery for stopping the bleeding. The intraoperative exploration discovered three submucosal formations with dimensions between 0,5 and 0,75 cm, who ulcerated the jejunal mucosa, situated at 20-25cm from the duodeno-jejunal angle. The pathologic report described haemorrhagic intestinal lymphangioma. The excision of the sub-mucosal haemangioma stopped the bleeding.
Asunto(s)
Neoplasias Duodenales/complicaciones , Hemangioma/complicaciones , Neoplasias del Yeyuno/complicaciones , Linfangioma/complicaciones , Melena/etiología , Neoplasias Duodenales/patología , Neoplasias Duodenales/cirugía , Hemangioma/patología , Hemangioma/cirugía , Humanos , Neoplasias del Yeyuno/patología , Neoplasias del Yeyuno/cirugía , Linfangioma/patología , Linfangioma/cirugía , Masculino , Melena/patología , Melena/cirugía , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The authors present the case of a patient with a large paraesophageal hiatal hernia complicated with organo-axial gastric volvulus. We discuss problems of diagnosis and therapeutical options.