RESUMO
BACKGROUND: Recent data regarding the impact of biologics and new surgical techniques on the indications and outcomes of colectomy for ulcerative colitis (UC) are limited. AIMS: The present study aimed at determining the trend of colectomy in UC by comparing colectomy indications and outcomes between 2000 and 2010 and 2011-2020. METHODS: This observational retrospective study was conducted in two tertiary hospitals, including consecutive patients who underwent colectomy between 2000 and 2020. All data concerning UC history, treatment and surgeries were collected. RESULTS: Among the 286 patients included, 87 underwent colectomy in 2001-2010 and 199 in 2011-2020. Patients' characteristics were similar between groups, except for prior biologic exposure (50.6 % vs. 74.9%; p<0.001). The indications of colectomy significantly decreased for refractory UC (50.6 % vs. 37.7%; p = 0.042), but were similar for acute severe UC (36.8 % vs. 42.2%; p = 0.390) and (pre)neoplastic lesions (12.6 % vs. 20.1%; p = 0.130). A widespread use of laparoscopy (47.7 % vs. 81.4%; p<0.001) was associated with fewer early complications (12.6 % vs. 5.5%; p = 0.038). CONCLUSION: Over the last two decades, the proportion of surgery for refractory UC significantly decreased compared to other surgical indications while surgical outcomes improved despite larger exposure to biologics.
Assuntos
Produtos Biológicos , Colite Ulcerativa , Laparoscopia , Humanos , Estudos Retrospectivos , Colite Ulcerativa/cirurgia , Colectomia/métodos , Produtos Biológicos/uso terapêuticoRESUMO
Introduction: Lipomas are the most common benign mesenchymal tumors which can be found in any part of the body. Nevertheless, their etiology and pathogenesis remain unknown. It is hypothesized that some of these lesions could result from an acute or chronic trauma. Patients and methods: We report a case of a 54-year-old man presenting a perineal lipoma which volume grew rapidly after he fell on his buttock, in the context of inaugural epileptic seizure. Pelvic MRI showed a voluminous fatty mass, measuring 6.6 × 5 × 9 cm without any signs of local invasion. Furthermore, we review the latest research on lipomas originating from traumatic lesion. Results: The mass was completely excised in one block under general anesthaesia, using an elliptical incision and a deep dissection. We did not close the skin incision in view of the cutaneous defect. Post-operative recovery was uneventful and the patient was discharged from hospital two days after the operation. Histopathology indicated a reorganised lipoma with no evidence of malignancy. Conclusion: Perineal lipomas are extremely rare, pathological examination of imaging guided biopsies are needed to exclude malignancy especially a well-differentiated liposarcoma. MRI remains the first option and radical surgical excision is the gold standard treatment.
Assuntos
Neoplasias do Ânus/etiologia , Lipoma/etiologia , Neoplasias Pélvicas/etiologia , Períneo/lesões , Lesões dos Tecidos Moles/complicações , Acidentes por Quedas , Neoplasias do Ânus/cirurgia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/cirurgia , Períneo/diagnóstico por imagem , Períneo/cirurgia , Convulsões/complicaçõesAssuntos
Endoscopia/métodos , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Transtornos Linfoproliferativos/diagnóstico , Diagnóstico Diferencial , Gastroenteropatias/patologia , Humanos , Linfoma/diagnóstico , Linfoma/patologia , Transtornos Linfoproliferativos/patologia , Plasmocitoma/diagnóstico , Plasmocitoma/patologiaRESUMO
BACKGROUND: Patients with clinically active Crohn's disease (CD), defined by a Crohn's Disease Activity Index (CDAI)>150, may have normal C-reactive protein (CRP) serum levels. In such cases, it is difficult to know whether these patients have really active disease or rather functional symptoms. This distinction is important to decide the most appropriate treatment. The aim of our work was to assess intestinal and colonic lesions in such patients and to look for biological markers potentially associated with endoscopic activity of the disease. METHODS: We included 28 consecutive CD patients with CDAI>150 and a normal CRP level. These patients underwent a full colonoscopy with Crohn's Disease Endoscopy Index of Severity (CDEIS) calculation, fecal calprotectin, blood fibrinogen, acid alpha-1 glycoprotein, and erythrocyte sedimentation rate measurement. The Harvey-Bradshaw score was also calculated. Serum IL1 beta, IL6, IL8, sIL2R, and sTNFR2 were measured. RESULTS: The median CDAI was 181 (151-485). Almost all (92.9%) these patients had endoscopic lesions, but the majority had only mild lesions (CDEIS
Assuntos
Proteína C-Reativa/biossíntese , Doença de Crohn/sangue , Doença de Crohn/terapia , Endoscopia Gastrointestinal/métodos , Adulto , Idoso , Biomarcadores , Doença de Crohn/diagnóstico , Citocinas/metabolismo , Estudos de Avaliação como Assunto , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Pseudo-papillary tumors of the pancreas are rare and usually occur in young women. We report a case with a very rare presentation (rupture of esogastric varices complicating biliary cirrhosis secondary to bile duct compression by a pancreatic tumor). After biological and radiological explorations, a duodenopancreatectomy was performed. Diagnosis was confirmed by conventional histology and immunohistochemistry. One year later, the patient remained asymptomatic.