RESUMO
AIM: Can the tension-free suturless technique, used in the surgical treatment of inguinal hernia, to be the gold standard for treatment of inguinal hernia? METHODS: The tension-free suturless technique is often criticized as a fundamental principle: do not have suture. The criticism stems from concern that the mesh can migrate and cause damage to important anatomical structures. We conducted a study on the mobility of prosthesis on 33 patients, by using titanium clips that we have fixed on the meshes corner, X-rays over time, done at last, a follow-up of ten years. RESULTS: The study shows that the prosthesis moves together with the anatomical space in which there is the forces present in the inguinal canal: gravity, intra-abdominal pressure, reactive force ascending gait. Across thirty-three patients have relapsed in the first six months and two recurrences in ten years, in the reconstitution of the neo-orifice, through which passes the cord. In the remaining patients the mesh were relocated upward and medially (as identified by the clips of the increase of 10-15%). CONCLUSION: Our study shows that the mesh migrates upwards and medially. Migration is more or less, depending on the patient's age and quality of its tissue. Fix the prosthesis is good practice to secure at the flag on the inguinal ligament leads to two advantages: not to frustrate the principle tension-free, since the fixed prosthesis on one side does not create moments of tension, and prevent the prosthesis returns to the opening road to relapse.
Assuntos
Migração de Corpo Estranho/epidemiologia , Hérnia Inguinal/cirurgia , Implantação de Prótese/métodos , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Fenômenos Biomecânicos , Feminino , Seguimentos , Migração de Corpo Estranho/prevenção & controle , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/terapia , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , História Medieval , Humanos , Laparotomia/história , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Radiografia , Recidiva , Funda para Hérnia/históriaRESUMO
Mucinous cystadenomas of the appendix are rare tumours. In this article we describe the case of a young woman who presented with abdominal pain and a clinical pattern likely to a chronic appendicitis. At laparotomy we found a dilatation of the appendix which contained an abundant quantity of mucus. Histological examination showed a mucinous cystadenoma of the appendix. This neoplasm requires a surgical treatment, usually only appendectomy and right hemicolectomy in case of involvement of the caecum. During operation, the surgeon must take care in handling the appendix because of the risk of rupture with consequent dissemination of epithelial cells in the peritoneal cavity (pseudomyxoma peritonei).
Assuntos
Neoplasias do Apêndice/complicações , Cistadenoma Mucinoso/complicações , Mucocele/etiologia , Apendicectomia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Cistadenoma Mucinoso/diagnóstico , Cistadenoma Mucinoso/cirurgia , Feminino , Humanos , Laparotomia , Pessoa de Meia-Idade , Mucocele/diagnóstico , Mucocele/cirurgia , Resultado do TratamentoRESUMO
Inflammatory myofibroblastic pseudotumors (IPM) are very rare tumor characterized by unpredictable clinical behaviour. They arise in soft tissues of almost every organ and the most common site is the lung. Over 200 cases of inflammatory myofibroblastic pseudotumor of the lung have been described in literature. Intra-abdominal IMP are very rare. We describe a case of intra-abdominal IMP in a boy of 15 years old who presented symptoms and signs of acute appendicitis. Exploratory laparotomy revealed a mass in the peritoneal cavity. The mass was removed. The histologic examination showed that it was an IMP. Surgical treatment was the only therapy. Six months after the surgical operation the patient has no sign of illness.
Assuntos
Granuloma de Células Plasmáticas/cirurgia , Neoplasias de Tecido Muscular/cirurgia , Neoplasias Peritoneais/cirurgia , Adolescente , Diagnóstico Diferencial , Granuloma de Células Plasmáticas/patologia , Humanos , Masculino , Neoplasias de Tecido Muscular/patologia , Neoplasias Peritoneais/patologia , Resultado do TratamentoRESUMO
The pheochromocytoma is a very rare neoplasm, which originates in 98% of cases in the adrenal medulla; it is often bilateral in familial syndromes. It is more frequent in syndromes like MEN2, von Hippel-Lindau disease, and neuofribromatosis type 1. In this article the Authors report a case of a young woman with a large adrenal pheochromocytoma, that presented by an acute abdomen; the treatment was explorative laparotomy with unilateral adrenalectomy. Therapy of this tumour is founded on surgery, plus chemiotherapy radiotherapy or treatment with 131I-MIBG (iodine-131-metaiodobenzylguanidine in malignant cases (10%). According with the absence of a correlation between pathological findings and clinical behaviour, a long-term follow up is indispensable.
Assuntos
Abdome Agudo/etiologia , Neoplasias das Glândulas Suprarrenais/complicações , Feocromocitoma/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia , Radiografia Abdominal , Ruptura Espontânea , Fatores de Tempo , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Splenic marginal zone lymphomas are rare tumors which take origin from the B cells. More common in the elderly, often asymptomatic, they can present with abdominal pain, splenomegaly and cytopenia and have an indolent clinical course. We describe a case of a women 79 years old who presented with abdominal pain, fever and splenomegaly. Computed tomography demonstrated splenomegaly with an area of low density in the spleen. Only by laparotomy and splenectomy the correct diagnosis was possible. Because of the indolent course of this kind of lymphomas, splenectomy is the main treatment for patients with abdominal pain, splenomegaly and cytopenia. If there is no pain and no cytopenia, the treatment can be only wait and see. Only in case of progression of disease chemotherapy can be employed.
Assuntos
Linfoma , Neoplasias Esplênicas , Dor Abdominal/etiologia , Idoso , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica , Laparotomia , Linfoma/complicações , Linfoma/diagnóstico , Linfoma/diagnóstico por imagem , Linfoma/patologia , Linfoma/cirurgia , Prognóstico , Radiografia Abdominal , Baço/patologia , Esplenectomia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/diagnóstico por imagem , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/cirurgia , Esplenomegalia/diagnóstico por imagem , Esplenomegalia/etiologia , Esplenomegalia/patologia , Esplenomegalia/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Laser treatment of primary varicose veins of the legs is a new mini-invasive technique which represent an alternative to the safenectomy. Endovascular laser treatment is based on the employ of laser to destroying the vascular wall and inducing fibrosis. This technique is not without complications: burns, paraesthesias, haematomas, but most of all disappear in few days. Encouraged by the promising results reported in literature, we have performed 18 laser ablation of greater saphenous vein since 2003 till today. Our patients had a good post-operative course and a follow up without troubles (3-17 months). We think that laser treatment is effective in the treatment of the primary varicose veins of the legs. It requests attention and experience in dosing the laser energy for minimizing the complications. Today there isn't long term follow up in literature.