Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
1.
Chirurgia (Bucur) ; 109(6): 843-5, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25560511

RESUMEN

INTRODUCTION: Mucinous cystadenoma is the most common of benign neoplasms of the appendix and carcinoid is the most common type of primary malignant lesions of the appendix.We report a rare case of a 57-year-old female with combined mucinous cystadenoma and carcinoid tumor of the appendix.Dual carcinoid and epithelial neoplasia is a rare occurrence in the appendix. CASE REPORT: A 57-year-old Caucasian woman presented after incidentally palpating a mass on her right iliac fossa. Imaging modalities revealed a cystic tumor in the right iliac fossa with a diameter of about 8 cm, originating either from the right ovary or the appendix. She underwent laparoscopic surgical exploration, which revealed appendiceal mucocele and appendicectomy was finally performed as well as excision of a right ovarian cyst. Pathological examination showed acollision tumor consisting of mucinous cystadenoma and carcinoid tumor of the appendix. Because of the size and extension of the carcinoid tumor, which the pathology report revealed, she underwent re-exploration and laparoscopic right colectomy. DISCUSSION: Mucinous cystadenoma is rare, but it is the commonest of benign appendiceal tumours accounting for 0.6% of appendectomy specimens. It can present as appendicitis,mucocele or if the tumour ruptures, as pseudomyxomaperitonei. On the other hand, carcinoid is the most common type of primary malignant lesion of the appendix and 0.3-0.9%of appendectomy specimens, with small predominance in female patients. Rare cases of mucinous cystadenomas of the appendix coexisting with carcinoid tumors were reported before, but in our case it was a collision tumor with no transitional zone between them. Also, the clinical presentation of our patient and the differential diagnosis of ovarian lesions from appendiceal tumors is worth being mentioned.


Asunto(s)
Neoplasias del Apéndice/diagnóstico , Tumor Carcinoide/diagnóstico , Cistoadenoma Mucinoso/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Apendicectomía , Neoplasias del Apéndice/cirugía , Tumor Carcinoide/cirugía , Colectomía , Cistoadenoma Mucinoso/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Hallazgos Incidentales , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Quistes Ováricos/cirugía , Factores de Riesgo , Resultado del Tratamiento
2.
J BUON ; 18(3): 703-7, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24065486

RESUMEN

PURPOSE: Liver failure is a major cause of early mortality following hepatectomy. The future-remnant liver function is an important factor when assessing the risk for postoperative liver functional impairment. Several techniques have been established for this evaluation, including the indocyanine green (ICG) test. The aim of this study was to evaluate the ICG clearance in patients scheduled for liver resection regarding perioperative and postoperative risk factors. METHODS: Thirty-one patients, scheduled for liver resection, underwent the ICG test. Peri-operative and postoperative variables were recorded and analyzed using non-parametric tests. RESULTS: Procedures extended from wedge excisions to extended hepatectomies. Plasma disappearance rate (PDR) was found positively correlated with total blood loss, transfusion and operation duration. There were 11 primary hepatic malignancies, including hepatocellular carcinomas and cholangiocarcinomas, 13 metastatic carcinomas, mainly of colorectal origin, and 7 benign lesions. The uninvolved liver parenchyma was normal in 20 (64. 5%) cases. Two patients died due to myocardial infarction and postoperative liver failure, respectively. CONCLUSION: The role of residual liver function and particularly the hepatic reserve assessment on liver surgery may be of most benefit in the routine stratification of risk, enabling surgical procedures to be performed with safety. The ICG clearance markers were found significantly correlated with perioperative risk factors in histologically "normal" liver parenchyma. In addition to computed tomographic (CT) volumetry, functional assessment of the hepatic reserve with the ICG test may persuade the preoperative planning and prevent postoperative liver failure.


Asunto(s)
Hepatectomía/efectos adversos , Verde de Indocianina , Fallo Hepático/diagnóstico , Neoplasias Hepáticas/complicaciones , Complicaciones Posoperatorias , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/patología , Conductos Biliares Intrahepáticos/cirugía , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Colangiocarcinoma/complicaciones , Colangiocarcinoma/patología , Colangiocarcinoma/cirugía , Colorantes , Femenino , Estudios de Seguimiento , Humanos , Fallo Hepático/etiología , Pruebas de Función Hepática , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Factores de Riesgo
3.
J BUON ; 18(4): 1026-31, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24344033

RESUMEN

PURPOSE: The aim of this study was to review the clinical features, diagnostic modalities, treatment options and pathological characteristics of various types of hepatic vascular tumors treated in our Institution over the last 20 years. METHODS: From 1991 to 2011, 761 cases of various hepatic lesions, benign and malignant, were surgically treated in our hospital. Among these, 56 (7.35%) hepatectomy specimens referred to vascular tumors. The records of these patients were retrieved and demographics , tumor characteristics, treatment, and actuarial survival were analyzed. The various therapeutic procedures, postoperative complications, follow-up data and the pre-and postoperative diagnostic difficulties were registered and analyzed. RESULTS: Pathological examination showed: hepatic hemangiomas in 35 (62.5%) patients (80% females), hepatic angiosarcomas in 7 patients (12.5%; males 71.4%), hepatic epithelioid hemangioendotheliomas in 9 (16%; females 50%) and hepatic angiomyolipomas in 5 patients (9%; females 60%). CONCLUSIONS: Vascular tumors of the liver comprise a heterogeneous group of neoplasms, benign, malignant and of intermediate degree of malignant behavior. These lesions can create great diagnostic difficulties, pre- and postoperative considerations, but the correct pathological diagnosis and classification of vascular hepatic tumors are most of the times mandatory in order to choose the proper therapeutic actions.


Asunto(s)
Hepatectomía , Hospitales Universitarios , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Neoplasias de Tejido Vascular/patología , Neoplasias de Tejido Vascular/cirugía , Adulto , Femenino , Grecia , Hemangioendotelioma Epitelioide/patología , Hemangioendotelioma Epitelioide/cirugía , Hemangioma/patología , Hemangioma/cirugía , Hemangiosarcoma/patología , Hemangiosarcoma/cirugía , Hepatectomía/efectos adversos , Hepatectomía/mortalidad , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Neoplasias de Tejido Vascular/mortalidad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
4.
World J Surg ; 36(3): 659-66, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22270986

RESUMEN

BACKGROUND: The surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, when acute sclerotherapy fails, and in cases where no further treatment is accessible, emergency surgery may be life saving. In the present study we retrospectively analyzed the results of the modified Sugiura procedure, performed as emergency and semi-elective treatment in the patient with bleeding esophageal varices. METHODS: Ninety patients with cirrhosis and portal hypertension were managed in our department for variceal esophageal bleeding between January 1985 and December 1992. The modified Sugiura procedure was performed in 46 patients on an emergency (25 patients) or semi-elective (21 patients) basis. Liver cirrhosis stage according to Child classification was A in 4 patients, B in 16 patients, and C in 26 patients. RESULTS: Acute bleeding was controlled in all patients. Postoperative mortality was 23.9% (11 of 46 patients). The mortality rate was 34.6% in Child class C patients (9 of 26 patients), and 12.5% in Child class B patients (2 of 16 patients). Twenty-four patients had long-term follow-up extending from 14 months to 22 years (mean 83.1 months). Ten of 24 patients (41.6%) did not develop rebleeding for 5-22 years (mean 10.3 years). Overall 5-year survival in these 24 patients was 62.5%. CONCLUSIONS: The modified Sugiura procedure remains an effective rescue therapy for patients with bleeding esophageal varices when alternative treatments fail or are not indicated. Moreover, it can be a life-saving procedure in patients with anatomy unsuitable for shunt surgery or for patients treated in nonspecialized centers where surgical expertise for a shunt operation is not available.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Várices Esofágicas y Gástricas/cirugía , Hemorragia Gastrointestinal/cirugía , Adulto , Anciano , Anastomosis Quirúrgica , Procedimientos Quirúrgicos Electivos , Servicios Médicos de Urgencia , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/mortalidad , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/mortalidad , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
5.
J BUON ; 17(1): 138-42, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22517708

RESUMEN

PURPOSE: Retroperitoneal sarcomas (RPs) are characterized by slow indolent growth and metastasize at a late point in their natural course. The purpose of this study was to review our experience in the management of RSs and identify prognostic factors for local control and survival. METHODS: Between January 1990 and December 2010, the hospital records of 75 patients with RSs were retrospectively studied. Sixty-four (85.3%) patients had undergone surgical resection in our hospital for primary RS, whereas 11 (14.7%) were referred to our department for recurrent disease. RESULTS: The patient median age was 57 years. Median tumor size was 18.5 cm. The most common histologic type was liposarcoma (44%) followed by leiomyosarcoma (17%), paraganglioma (10%), malignant fibrous histiocytoma (6.5%) and rare tumors such as 2 chondrosarcomas and 1 pecoma. Complete initial resection with negative macroscopic margins (R0) was achieved in 39 (60.9%) patients. En bloc resection of adjacent organs was required in 8 (12.5%) patients with primary RS and in 8 (72.9%) with recurrent disease. Mortality rate was 4%. For the group of patients initially treated in our hospital, 1-year recurrence rate was 34.3%. The 3- and 5-year overall survival rates were 56.2% and 53.1%, respectively. Satellite tumors were recognised in 13 (20.3%) patients treated for primary RS, from whom 11 (84%) recurred within one year. Seven patients received adjuvant chemotherapy. CONCLUSION: Radical surgical resection is the treatment of choice for patients with primary and locally recurrent RSs.


Asunto(s)
Neoplasias Retroperitoneales/cirugía , Sarcoma/cirugía , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Pronóstico , Neoplasias Retroperitoneales/mortalidad , Neoplasias Retroperitoneales/patología , Sarcoma/mortalidad , Sarcoma/patología
6.
J BUON ; 16(4): 697-700, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22331724

RESUMEN

PURPOSE: The standard therapeutic approach to epidermoid anal canal cancer consists of combined radiation therapy and chemotherapy. Although disease control has been reported to have excellent results, as many as 40% of patients will develop locoregional disease progression. The treatment of choice for patients with persistent (PD) or recurrent disease (RD) is salvage abdominoperineal resection (APR). The purpose of this study was to review our experience with salvage surgery in this group of patients. METHODS: The medical records of all patients with epidermoid anal canal cancer treated from 1997 to 2010 in our department were retrospectively reviewed. Nine patients who presented with persistent or locally recurrent anal canal cancer were subjected to salvage APR. Before surgery, all of the patients had received chemoradiation therapy (CRT). RESULTS: There were 9 patients (7 women, 2 men) with a median age of 59 years (range 40-79). Six patients underwent radical salvage APR for persistent disease and 3 patients for recurrent disease. There were no deaths attributable to operation. The median follow-up time was 31.75 months (range 3-108) after salvage surgery. Two patients died of disease progression, with a median survival time of 24 months (range 12-36). At the time of last follow-up, 6 patients were alive without evidence of recurrent disease, and one patient was lost to follow-up. The median follow-up time for survivors was 34.3 months (range 3-108). CONCLUSION: Long-term survival can be achieved in the majority of patients who undergo radical salvage APR after failed CRT for epidermoid carcinoma of the anal canal.


Asunto(s)
Neoplasias del Ano/cirugía , Carcinoma de Células Escamosas/cirugía , Terapia Recuperativa/métodos , Abdomen/patología , Abdomen/cirugía , Adulto , Anciano , Neoplasias del Ano/radioterapia , Neoplasias del Ano/terapia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/terapia , Quimioradioterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perineo/patología , Perineo/cirugía , Estudios Retrospectivos , Tasa de Supervivencia , Insuficiencia del Tratamiento
7.
Case Rep Surg ; 2019: 4891512, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31815031

RESUMEN

INTRODUCTION: Secondary pancreatic metastasis from other solid organ malignancy is rare and accounts for less than 2% of all pancreatic tumors. The aim of this study is to highlight that colorectal metastatic disease in the pancreas could be in selected cases an indication for surgery rather than for palliative chemotherapy. CASE PRESENTATION: We present a case of a 62-year-old Caucasian female with a history of rectal adenocarcinoma. Four years ago, the patient underwent low anterior resection of the rectosigmoid, post neoadjuvant chemoradiotherapy, with adjuvant chemotherapy. During her follow-up, imaging examinations revealed a lesion in the pancreatic neck with features indicating primary pancreatic cancer. Near-total distal pancreatectomy with en bloc splenectomy was performed. Histopathology revealed metastatic disease compatible with colorectal adenocarcinoma as the primary cancer. Second-line chemotherapy was decided from the institutional tumor board. The patient remains disease free one year later. CONCLUSION: Pancreatic lesions in patients with a history of extrapancreatic malignancy should raise suspicions of metastatic disease. Surgical intervention is a legitimate treatment option for these pancreatic lesions, since they represent solitary disease deposits and of course in the context of multidisciplinary meeting decisions, and after proper and extensive staging investigations.

8.
Scand J Surg ; 102(2): 61-8, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23820678

RESUMEN

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.


Asunto(s)
Abdomen/cirugía , Técnicas de Cierre de Herida Abdominal , Fístula Intestinal/cirugía , Complicaciones Posoperatorias/cirugía , Humanos , Fístula Intestinal/etiología , Fístula Intestinal/terapia , Terapia de Presión Negativa para Heridas/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia
9.
Case Rep Med ; 2011: 487875, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22028724

RESUMEN

Introduction. In patients with extra-adrenal malignancy, an adrenal mass necessitates investigating the possibility of metastatic tumor. Curable adrenal metastasis are considered as a rare event. Case report. A 52-year-old male suffering from lower esophageal adenocarcinoma with a solitary left adrenal metastasis is presented herein, who underwent concomitant transhiatal esophagectomy and left adrenalectomy. The patient remains disease-free 18 months later. Discussion. Adrenal metastases mostly occur in patients with lung, kidney, breast, and gastrointestinal carcinomas. Primary esophageal adenocarcinoma gives adrenal metastatic deposits according to autopsy series with an incidence of about 3%-12%. When no other evidence of metastatic disease in cancer patients exists, several authors advocate adrenalectomy with curative intent. Isolated cases of long-term survival after resection of solitary adrenal metastasis from esophageal adenocarcinoma, like in our case, have been reported only as case reports. Conclusion. This study concludes that surgical resection may result in survival benefit in selected patients with solitary adrenal metastasis from esophageal adenocarcinoma.

10.
Int J Surg Case Rep ; 2(5): 79-81, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22096689

RESUMEN

Rectus sheath hematoma (RSH) is an accumulation of blood in the rectus abdominis muscle sheath, secondary to several conditions which may cause the epigastric vessel rupture or muscular tear, but mostly affecting patients undergoing anticoagulation therapy.We present a rare case of a 67-year-old woman who underwent laparoscopic cholecystectomy and developed RSH on the 12th postoperative day. The patient was under anticoagulation therapy with acenocoumarole due to mitral valve replacement. The bleeding source was an arteriovenous malformation (AVM) rupture as indicated by the angiogram images and it was embolized succefully. The patient was discharged seven days later.

11.
Surg Endosc ; 15(1): 41-3, 2001 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-11178760

RESUMEN

BACKGROUND: There is little evidence in the literature to support a lower incidence of adhesion formation following laparoscopic surgery rather than laparotomy. Adhesion formation after laparotomy has been well studied, but we believe that the decrease or absence of adhesions following laparoscopic surgery is underreported. Therefore, we set out to evaluate adhesion formation following laparoscopic cholecystectomy (LC) compared with open cholecystectomy (OC). METHODS: Group A consisted of 18 patients who underwent a second laparoscopy due to various intraabdominal diseases after an LC had already been performed. Group B consisted of eight patients who underwent laparoscopy due to various intraabdominal diseases after an open cholecystectomy performed at an earlier date. In both groups, the frequency, extent, and thickness of adhesions were evaluated according to a standardized scoring system. RESULTS: Ten patients in group A (55.5%) had no adhesion formation either on the treated side of the previous LC or on the trocar entry sites. Three patients (16.6%) had minimal adhesions on the treated side of the previous LC, but no adhesions were observed at the trocar entry sites. Five patients (27.7%) had loose, easily separable adhesions on the treated site of the previous LC and at the trocar entry sites. All eight patients in group B (100%) had thick and extensive adhesions either on the treated side of the previous open cholecystectomy or the anterior abdominal wall below the surgical incision. CONCLUSION: This comparative clinical study suggests that LC results in less adhesion formation, either on the operative or at the trocar entry sites, than open cholecystectomy.


Asunto(s)
Colecistectomía Laparoscópica , Colecistectomía , Complicaciones Posoperatorias/etiología , Adherencias Tisulares/etiología , Abdomen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
Ann Oncol ; 14(3): 378-82, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12598341

RESUMEN

BACKGROUND: The aim of this study was to determine whether the efficacy of the combination of 5-fluorouracil (5-FU), leucovorin (LV) and radiation therapy (RT) could be improved by the addition of interferon-alpha2b (IFN-alpha) in patients who have had a 'curative' resection, for rectal adenocarcinoma (Dukes' B2/C; T3 N0, T4 N0, N1-3). PATIENTS AND METHODS: A total of 207 eligible patients with a performance status of 0 or 1 were randomized postoperatively between days 21 and 70 to one of the two treatment groups: group A, LV 20 mg/m2 i.v. bolus and 5-FU 425 mg/m2 i.v. days 1-5 and 29-33, LV 20 mg/m2 and 5-FU 400 mg/m2 days 57-60 and 85-88, LV 20 mg/m2 and 5-FU 380 mg/m2 days 1-5 and 29-33 with the second day 1 occurring 28 days after the completion of RT (45 Gy); group B, LV, 5-FU and RT as in group A, and IFN-alpha 5 x 10(6) IU s.c. three times during each week chemotherapy is given. RESULTS: 104 patients were randomized into group A and 103 into group B. There was no statistically significant difference in either disease-free survival or overall survival between the two groups. Toxicity was also the same, except for the flu-like syndrome associated with the IFN-alpha administration. CONCLUSIONS: There was no difference in efficacy between the two combinations. Toxicity was greater with the LV + 5-FU + IFN-alpha regimen because of the flu-like syndrome.


Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/radioterapia , Adenocarcinoma/cirugía , Adulto , Anciano , Quimioterapia Adyuvante , Supervivencia sin Enfermedad , Femenino , Fluorouracilo/administración & dosificación , Humanos , Infusiones Intravenosas , Inyecciones Intravenosas , Interferón alfa-2 , Interferón-alfa/administración & dosificación , Leucovorina/administración & dosificación , Masculino , Persona de Mediana Edad , Radioterapia Adyuvante , Proteínas Recombinantes , Neoplasias del Recto/cirugía , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA