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
The Authors describe four cases of gastrointestinal stromal tumours (GIST) two of them were localized in the stomach, the others in the ileum. GIST are neoplasms of mesenchymal origin which develop inside the wall of the digestive tract. The most frequent site is the stomach, followed by the small bowel; less commonly these tumors can affect the oesophagus, the colon and the rectum. GIST originate from precursors of the interstitial cells of Cajal, which are localized in the gastro-intestinal wall and are involved in the regulation of the peristalsis. The treatment is surgical resection. For advanced disease there is a new interesting treatment based on the imatinib, a tyrosine kinase inhibitor.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias do Íleo/cirurgia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Benzamidas , Quimioterapia Adjuvante , Corpos Enovelados , Feminino , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Neoplasias do Íleo/tratamento farmacológico , Mesilato de Imatinib , Masculino , Pessoa de Meia-Idade , Piperazinas/uso terapêutico , Proteínas Tirosina Quinases/antagonistas & inibidores , Pirimidinas/uso terapêutico , Neoplasias Gástricas/tratamento farmacológicoRESUMO
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.
Assuntos
Terapia a Laser , Veia Safena/cirurgia , Varizes/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Fatores de TempoRESUMO
The Authors report three cases of appendiceal carcinoids, found during appendectomy for acute appendicitis during the last 15 years. Appendiceal carcinoid is a rare neoplasm, more frequent in females age ranging between 20 and 29 years. Lack of symptoms explains the occasional diagnosis of this disease. The prognosis is related mostly to the size of the tumor, local and lymphatic invasion, presence of metastases, localization inside the appendix, histological type and age of the patient. Therapy is mainly surgical and consists of appendectomy and right colectomy according to different criteria which are being discussed in this article.
Assuntos
Neoplasias do Apêndice , Tumor Carcinoide , Adulto , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Feminino , Humanos , MasculinoRESUMO
The Authors report a case of intestinal occlusion due to a colo-colonic intussusception arising from a lipoma of trasverse colon and, by a review of the cases in the Literature, they discuss diagnostic and therapeutic procedures in emergency.
Assuntos
Abdome Agudo/etiologia , Doenças do Colo/etiologia , Neoplasias do Colo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Neoplasias do Colo/diagnóstico , Feminino , Humanos , Lipoma/diagnóstico , Pessoa de Meia-IdadeRESUMO
The Authors describe three cases of Familial Adenomatous Polyposis, (FAP), in patients of the same family, mother and two daughters, with different stages of the disease. Familial adenomatous polyposis is a mendelian dominant inherited syndrome with an incidence of 1:11,000, caused by an alteration of APC gene, which causes multiple disorders of the development ecto-, endo- and mesoderma. The syndrome is characterized by the presence of adenomatous polyps in the gastroenteric tract, mostly in colon-rectum and duodenum with demonstrated adenoma-carcinoma sequence. In the family here reported a case of familial adenomatous polyposis at the adenomatous stage and two of cancer of colon-rectum are registered. In the first case surgery had a preventive aim, and ileo-rectal anastomosis was performed; in the other two cases the treatment was Miles operation with radical intention.
Assuntos
Polipose Adenomatosa do Colo , Polipose Adenomatosa do Colo/diagnóstico , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/cirurgia , Adolescente , Adulto , Canal Anal/cirurgia , Anastomose Cirúrgica , Criança , Colostomia , Diagnóstico Diferencial , Feminino , Humanos , Íleo/cirurgia , Reto/cirurgiaRESUMO
MALT-lymphomas are tumors of the mucosa associated lymphoid tissue, without primitive involvement of lympho nodes and spleen. They are located preferentially in the gastroenteric tract specially in the stomach (27%), but they may occur also in the respiratory and urinary tracts. There is a very well known link between MALT-omas and Hp infection, not only in the gastroenteric tract, but also in other sites. Moreover eradication of Helicobacter pylori can, in some cases, contribute to achieve the complete remission of the tumor. In this article the Authors report three cases of MALT-lymphomas: two of the stomach and one of the jejunum-ileum. Diagnosis is based on instrumental tests according to the involved tract and endoscopy of the upper digestive tract associated with biopsies more specific in case of gastric involvement; yet bioptic samples show a more significative incidence of false negative due to the extramucosal site of tumor. In these cases, a correct diagnosis will be obtained only through histologic examination of the surgical specimen. Surgery obtains good results in early stages, playing also a central role in palliation in association with radio- and chemotherapy. In case of low-grade B MALT-lymphomas of the stomach and in IE stages, eradication of Helicobacter pylori can, in 70-90% of cases, reduce the extension of the lymphocytic infiltration.
Assuntos
Neoplasias do Íleo , Neoplasias do Jejuno , Linfoma de Zona Marginal Tipo Células B , Neoplasias Gástricas , Idoso , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Neoplasias do Jejuno/diagnóstico , Neoplasias do Jejuno/cirurgia , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgiaRESUMO
A rare case of primary adenocarcinoma of the vermiform appendix (less than 250 cases described in the literature) in a 36 year-old female patient presenting signs and symptoms of an acute appendicitis is reported. Adeno-carcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract with an incidence of about 0,01-0,2%. Usually the diagnosis of adenocarcinoma of the vermiform appendix is difficult because symptoms and signs are not pathognomonic. In the case described, the diagnosis was intra and postoperative and confirmed by the pathological examination of the surgical specimens. At laparotomy, performed under suspicion of an acute appendicitis, disseminated disease was discovered, characterized by the involvement of the two ovaries, the left colon, the cecum, the vermiform appendix, with a peritoneal carcinosis and a hydroureteronephrosis. According to the dissemination of the disease, the surgical treatment was right hemicolectomy, anterior resection of left colon, bilateral oophorectomy and omentectomy. The post-operative course was regular. Adjuvant therapy was performed for 6 cycles, with 5FU and oxaliplatinum. The patient is still alive after 6 months and there is no sign of progression of the disease. A mild left hydroureteronephrosis is persistent.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Apêndice/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adulto , Apendicectomia , Neoplasias do Apêndice/tratamento farmacológico , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/cirurgia , Apendicite/diagnóstico , Neoplasias do Ceco/tratamento farmacológico , Neoplasias do Ceco/secundário , Neoplasias do Ceco/cirurgia , Quimioterapia Adjuvante , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/secundário , Neoplasias do Colo/cirurgia , Diagnóstico Diferencial , Feminino , Fluoruracila/administração & dosagem , Humanos , Hidronefrose/etiologia , Laparotomia , Compostos Organoplatínicos/administração & dosagem , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/cirurgia , Oxaliplatina , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgiaRESUMO
In this case report the Authors describe a case of primary gastric lymphoma in a 62 years old patient who presented with dyspepsia and weigh loss. Primary gastric lymphoma is a rare neoplasm which of 1-10% of the malignant gastric neoplasms in the gastroenteric tract. The clinic presentation is usually aspecific. The infection by H. pylori is a factor of predisposition for this kind of disease. The diagnostic pathway consists in x-ray examination of the gastrointestinal tract, the endoscopy with biopsies, the computerized tomography and the echo-endoscopy. However obtaining a preoperative diagnosis is often difficult because of the submucosal localization of the lymphoma. There is not a common strategy among the Authors for the treatment of the disease, which can be surgical, radiotherapic or chemotherapic.
Assuntos
Linfoma/diagnóstico , Neoplasias Gástricas/diagnóstico , Diagnóstico Diferencial , Infecções por Helicobacter/complicações , Helicobacter pylori , Humanos , Linfoma/microbiologia , Linfoma/terapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/terapiaRESUMO
The Authors report a case of retroperitoneal sarcoma, in the histological subtype "liposarcoma", occasionally diagnosed in a 57 year old woman, who presented aspecific symptoms, characterized by dry cough, vomiting and chest pain. Chest TC showed a neoplasm of the retroperitoneum, close to liver, right colon, duodenum and right kidney. The arteriography of the right renal artery showed a neovascolarization inside the mass. A surgical resection was performed. The histological examination confirmed the diagnosis of liposarcoma. Liposarcomas account for 30% of the retroperitoneal soft tissue sarcomas; symptoms and diagnosis are late and the surgical resection of primary neoplasm, metastases and local recurrences representing the only therapeutic choice.
Assuntos
Lipossarcoma , Neoplasias Retroperitoneais , Feminino , Humanos , Lipossarcoma/diagnóstico , Lipossarcoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgiaRESUMO
In this case report, the Authors describe a case of stromal gastric tumour, in a male 65 years old, who presented gastrointestinal bleeding. Gastro-Intestinal Stromal Tumors (GISTs) are neoplasm with an incidence of 1-3 per cent of the digestive tract malignant neoplasms. The rarity of this disease, its visceral wall localization, the histopathological characteristics make the diagnosis difficult. Moreover there is no correlation between the behaviour of these neoplasms and the histologic features. Surgery represents the main treatment for GISTs based on complete resection, followed by a long-term follow-up. Chemotherapy and radiotherapy don't seem to play a crucial role in the treatment of these neoplasms. A new treatment with inhibitors of the tyrosinekinase is under discussion. Follow-up represents the only way to evaluate the effective behaviour of the disease, due to the lack of classic prognostic factors impact.
Assuntos
Neoplasias Gástricas , Idoso , Humanos , Masculino , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Células EstromaisRESUMO
When considering urogenital complaints occurring during diabetic autonomous neurotherapy , three clinical situations are important due to their frequency and the clinical situation, the considerable effect they have on quality of life. In addition they may also be responsible for severe complications as in the case of diabetic cystopathy . This syndrome is the cause of considerable subjective disturbances even though it may be diagnosed instrumentally in its early, completely asymptomatic stage. The complaint evolves inevitably towards bladder denervation, chronic urinary retention and more or less severe septic complications. Retrograde ejaculation may lead to the loss of procreative ability as in the case of neurogenic impotence in diabetics. These three autonomous neuropathic situations occur quite frequently, especially in older subjects who have suffered from diabetes for more than ten years. Often the three syndromes are interconnected or linked to autonomous or peripheric neuropathic complaints affecting other areas. The few therapeutic measures practised have not proved very conclusive. Only a diligent examination of signs and symptoms with the aim of early diagnosis and the maintenance of good glycometabolic balance are considered to be at all effective as preventive measures.