RESUMO
HISTORY: An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis. INVESTIGATIONS AND DIAGNOSIS: The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings. TREATMENT AND COURSE: A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication. CONCLUSION: After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.
Assuntos
Estenose das Carótidas , Pneumopatias , Marca-Passo Artificial , Pneumonectomia/efeitos adversos , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Feminino , Hemoptise , Humanos , Pulmão , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Testes de Função Respiratória , Veia Subclávia , Resultado do Tratamento , VenostomiaRESUMO
The current S3 guidelines on the surgical treatment of colorectal cancer note that with a suitable patient selection and expertise of the surgeon the same oncological results can be achieved laparoscopically as with the open procedure. This requires that the same quality requirements have to be provided for both methods. The most important quality parameters of right sided (extended) hemicolectomy are central ligation of the supplying arteries (ileocolic artery, right branch of the middle colic artery and middle colic artery) flush to the central origin of the vessel (superior mesenteric artery or middle colic artery) and the sharp dissection of the mesocolon without any preparation tears. The photographic documentation of the fresh surgical specimens for categorizing the preparation quality as well as to determine the pedicle of the vessel can capture this quality well and is also currently the best surrogate parameter to evaluate the oncological quality of the operation. At present, there are still considerable widespread deficits not only with the laparoscopic approach but also in open surgery which must be urgently fixed.
Assuntos
Colectomia/normas , Neoplasias do Colo/cirurgia , Laparoscopia/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Artérias/cirurgia , Colectomia/métodos , Colo/irrigação sanguínea , Alemanha , Fidelidade a Diretrizes , Humanos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normasRESUMO
The new German S3 guideline "Colorectal Carcinoma" was created as part of the German Guideline Program in Oncology of the Association of the Scientific Medical Societies in Germany, the German Cancer Society and the German Cancer Aid under the auspices of the German Society for Digestive and Metabolic Diseases and replaces the guideline from 2008. With its evidence-based treatment recommendations, the guideline contains numerous updates and detailed definitions regarding the diagnosis and treatment of colon and rectal cancer. In particular, consensus-based recommendations regarding early detection, preoperative diagnostic method selection, and the use of interventional radiological treatment methods are detailed. The guideline also includes quality indicators so that standardized quality assurance methods can be used to optimize patient-related processes.The present article discusses the significance of the current recommendations for radiological diagnosis and treatment and is intended to enhance the quality of patient information and care by increasing distribution.
Assuntos
Colonografia Tomográfica Computadorizada , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Medicina Baseada em Evidências , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Neoplasias Colorretais/patologia , Terapia Combinada , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Metástase Linfática/patologia , Imagem Multimodal , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
Colorectal carcinoma is a common malignant tumor which shows a standard behavior for lymphogenic metastasis. Depending on the localization of the primary tumor the corresponding lymphatic area also has to be removed because lymph node metastases can already be present by every tumor even if there is no obvious intraoperative evidence. Lymphatic drainage is essentially oriented to the supplying arteries of the corresponding intestinal segment. The anatomy of arterial supply is individually variable and often deviates from the usual textbook presentation. In this review the oncological requirements of an adequate lymph node dissection in colorectal carcinoma are described with emphasis on the technical aspects to obtain an optimal specimen.
Assuntos
Neoplasias Colorretais/cirurgia , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Artérias/cirurgia , Colectomia/métodos , Neoplasias Colorretais/irrigação sanguínea , Neoplasias Colorretais/patologia , Humanos , Linfonodos/irrigação sanguínea , Estadiamento de Neoplasias , Reto/patologia , Reto/cirurgia , Veias/cirurgiaRESUMO
Evidence-based analysis of the influence of lymph node dissection on the prognosis of colorectal cancer patients is complicated by the now well-established multimodal treatment strategies. In addition surgical quality criteria, such as exact preparation along the mesenterial fascia and avoiding tears have a major influence on the prognosis.Nevertheless, the overall evidence for the need of lymph node dissection in the treatment of colorectal carcinoma is high. However, there are still some questions remaining concerning the extent of pericolic lymph node dissection, inclusion of the lymph nodes along the greater curvature of the stomach and the inferior aspect of the left pancreas in carcinomas of the transverse colon and the flexures. In particular the definitive central ligation of the supplying arteries in right-sided colon carcinoma is not adequately implemented worldwide.
Assuntos
Neoplasias Colorretais/cirurgia , Medicina Baseada em Evidências , Excisão de Linfonodo/métodos , Colectomia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Fidelidade a Diretrizes , Humanos , Excisão de Linfonodo/mortalidade , Linfonodos/patologia , Metástase Linfática/patologia , Estadiamento de Neoplasias/mortalidade , Prognóstico , Reoperação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
This study prospectively examined nine human volunteers who underwent unilateral cementless total knee arthroplasty and had 600 mg of tobramycin powder added to their wound just prior to fascial closure. Serum levels of tobramycin were measured at 30 minutes, 4 hours, 8 hours, and 12 hours after surgery. Tobramycin levels in the reinfused whole blood were measured with each reinfusion. Patients were reinfused up to 12 hours after surgery and then the reservoir was left to suction drainage. All patients had significant levels of serum tobramycin 30 minutes after surgery. The average serum level was 5.5 micrograms/ml (range, 3.0-10.6 micrograms/ml). This level was achieved prior to any reinfusion and represented systemic absorption of tobramycin from the bleeding surfaces of the muscle and bone. All patients received at least one reinfusion of 400 ml of whole blood in the first 8 hours after surgery. Two thirds of the patients received a second reinfusion within the same time frame. Serum tobramycin levels measured post-reinfusion indicated that the risk of attaining potential toxic levels of aminoglycoside was not dependent on reinfusion, but on absorption from the wound. The dose of tobramycin in the drain was measured and found to be excessive and potentially toxic (range, 27-312 mg; average, 132 mg). Despite this fact, reinfusion was not as likely to produce toxic serum levels as was local uptake of the antibiotic. Although no patient in this series had any complaints relating to the high dose of tobramycin (deafness or renal failure), caution should be exercised when using antibiotics in a reinfusion system.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Transfusão de Sangue Autóloga , Articulação do Joelho/cirurgia , Prótese do Joelho , Tobramicina/administração & dosagem , Administração Tópica , Humanos , Cuidados Intraoperatórios , Estudos Prospectivos , Tobramicina/farmacocinéticaRESUMO
Because of its proven effectiveness in reducing the need for banked blood transfusions following total joint arthroplasty, the indications for postoperative blood retrieval were expanded to include seven cases of infected total knee or hip arthroplasties where a one-stage exchange procedure was performed. Each joint had been aspirated after surgery and had positive cultures but no gross pus at the time of revision surgery. Each of the operations included debridement with reimplantation of a cementless prosthesis under cover of intravenous antibiotics for 48 hours followed by oral treatment until discharge. Antibiotic-soaked morselized bone graft was used in all patients to restore deficient nonstructural bone. Wound drainage blood was retrieved and reinfused during the first 8 hours after surgery, averaging 958 cc. Banked blood usage averaged 2.4 U (88% homologous) with an average blood loss of 1,974 cc. One patient experienced shaking chills during a second reinfusion of 600 cc of blood without stoppage of the transfusion. Wound hematoma occurred in one patient but did not require surgical evacuation. No patient developed evidence of septicemia.
Assuntos
Transfusão de Sangue Autóloga/métodos , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Infecções Estafilocócicas/cirurgia , Staphylococcus epidermidis , Infecções Estreptocócicas/cirurgia , Transfusão de Sangue , Drenagem , Humanos , Estudos Prospectivos , Infecções Relacionadas à Prótese/epidemiologia , ReoperaçãoRESUMO
A series of mono- and geminal difluorinated analogues of spermidine (4-azaoctane-1,8-diamine) have been tested as potential substrates of partially purified rat hepatoma (HTC) cell or pure bovine spleen spermine synthase (EC 2.5.1.22). Substitution of the hydrogen atoms of the methylene group at position 7 by one or two fluorine atoms decreases 8-fold and 160-fold the apparent Km values for the HTC cell enzyme respectively. Similarly, the Km values of 7-monofluoro and 7,7-difluorospermidine for the pure bovine enzyme are reduced 8-fold and 100-fold respectively, in comparison with spermidine. Di-, but not monofluoro substitution, in the 6-position causes a 5-fold reduction in the affinity for the HTC cell enzyme. Gem-fluorine substitution in the 2-position abolishes substrate capability. In addition to their high affinity for spermine synthase, 7-monofluorospermidine and 7,7-difluorospermidine cause substrate inhibition. This phenomenon, which is more pronounced in the case of the difluorinated analogues is pH-dependent. These enzymatic findings are discussed with regard to the protonation sites of the spermidine analogues, determined by potentiometric titration, which vary as a function of the number and position of the fluorine substituents relative to the basic amino groups.
Assuntos
Espermidina/análogos & derivados , Espermina Sintase/metabolismo , Transferases/metabolismo , Animais , Bovinos , Fenômenos Químicos , Química , Flúor/metabolismo , Concentração de Íons de Hidrogênio , Cinética , Neoplasias Hepáticas Experimentais/enzimologia , Prótons , Ratos , Espermidina/metabolismo , Baço/enzimologia , Células Tumorais CultivadasRESUMO
The time course of revascularization of nonvascularized and vascularized nerve grafts was followed histologically and quantitatively using microspheres in the saphenous nerve of dogs. Nonvascularized and vascularized nerve grafts were created in opposite hindlimbs of each dog. The intravascular presence of India ink was not observed until the third day postoperatively in the nonvascularized grafts, while it was demonstrated in vascularized grafts on the first postoperative day. Control blood flow in undisturbed nerves ranged from 0.06 to 0.16 ml/min/gm dry weight. On postoperative day 1, flow was not detectable in any of the nonvascularized grafts, while vascularized grafts all had increased flow with a mean of 0.73 ml/min/gm dry weight. By day 3, two of six dogs had some measurable flow in the nonvascularized grafts, while flow in vascularized grafts had reached a mean of 1.88 ml/min/gm dry weight. By day 6, blood flow rate had increased to 7.63 and 4.72 ml/min/gm dry weight for nonvascularized and vascularized grafts, respectively. By this avoidance of up to 3 days of warm ischemia, there may be some advantage to vascularized nerve grafts even in a well-vascularized bed.