ABSTRACT
Desmoids are rare tumors of the connective tissue. It develops about 1:1000 times more in patients with familial adenomatous polyposis (FAP, Gardner syndrome) compared to normal population. It has been shown in molecular genetic examinations, that different mutations of the APC gene are responsible for desmoid tumors in FAP. It means, that this disease is one of the extraintestinal manifestations of Gardner syndrome. This tumor has high recurrence rate and is growing rapidly, and as a result it is the second most common cause of death in FAP patients. That is why genetic examination for FAP patients is advised to decide if the patient has higher risk for desmoid formation. If the result of the genetic test is positive, it is advisable to try to slow the progression of polyposis with medical treatment, and so to delay the date of the colectomy because the surgical intervention--and connective tissue damage--can induce desmoid formation in these patients. At the same time it is reasonable to examine and regularly control patients with sporadic desmoid tumors searching for other manifestations of Gardner syndrome (colon, stomach and duodenum polyposis, tumor of papilla Vateri, retinopathy, etc.). Palliative surgery is not indicated in patients with inoperable intraabdominal desmoid tumors, because partial resections (R1, R2, debulking) result in further tumor progression. In these patients medical treatment (sulindac, tamoxifen), chemotherapy (doxorubicin, dacarbazin) and radiotherapy or combination of them can result tumor remission. We describe our three patients (an abdominal wall desmoid four years following Cesarean section; a desmoid tumor in the retroperitoneum and in the pelvis diagnosed three years after total colectomy; and a retroperitoneal and abdominal wall desmoid one year after total colectomy) and etiology, diagnosis and therapy of desmoid tumors are discussed.
Subject(s)
Fibromatosis, Aggressive , Abdominal Muscles , Adult , Female , Fibromatosis, Aggressive/diagnosis , Fibromatosis, Aggressive/etiology , Fibromatosis, Aggressive/therapy , Humans , Male , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Neoplasms/etiology , Retroperitoneal Neoplasms/therapyABSTRACT
The history of a 45 year old man is reviewed who was treated with acute exacerbations of chronic mediastinitis. During one and a half year the patient was examined in different departments of internal medicine, he underwent into surgical interventions and several histological and microbiological examinations have been done. On the third occasion the bacterium of Actinomyces Israeli proved to be the etiologic factor of the disease. Some diagnostic and therapeutic points of view of different localization of the illness are discussed.
Subject(s)
Actinomycosis/diagnosis , Actinomycosis/microbiology , Mediastinitis/diagnosis , Mediastinitis/microbiology , Actinomycosis/diagnostic imaging , Actinomycosis/drug therapy , Actinomycosis/pathology , Diagnosis, Differential , Humans , Male , Mediastinitis/diagnostic imaging , Mediastinitis/drug therapy , Mediastinitis/pathology , Middle Aged , RadiographyABSTRACT
The authors review two cases of small bowel tumor. The first patient was operated electively with small bowel carcinoid causing multiplex liver metastases. The second patient was admitted because of massive gastrointestinal bleeding. After some diagnostic procedures bleeding of the small intestine was diagnosed. Urgent operation was performed and a bleeding jejunal tumor was removed. Gastrointestinal stroma cell tumor of the small bowel was found at histology. In connection with the patients some points about malignant small intestine tumors are analysed based on literature.
Subject(s)
Intestinal Neoplasms , Intestine, Small , Aged , Carcinoid Tumor/diagnosis , Carcinoid Tumor/surgery , Gastrointestinal Hemorrhage/etiology , Humans , Intestinal Neoplasms/classification , Intestinal Neoplasms/complications , Intestinal Neoplasms/diagnosis , Intestinal Neoplasms/etiology , Intestinal Neoplasms/therapy , Intestinal Obstruction/etiology , Male , Middle Aged , Stromal Cells/pathologyABSTRACT
Sixty-two children (13 days to 11 years old) with 1-12% dehydration due to acute watery diarrhoea were rehydrated in an Emergency Room Setting by means of intravenous fluid therapy in 6.34 +/- 0.57 hr. Mean duration of hospital stay was reduced and 87% of patients stayed 24 hrs. or less as compared to 36% in previous studies at this hospital. The correction of dehydration and its electrolyte imbalance was done in a shorter time; recovery of the patients was better and the complications were less; the method allowed a more rational use of beds in the Emergency Room Setting.
Subject(s)
Dehydration/therapy , Diarrhea, Infantile/therapy , Diarrhea/therapy , Solutions , Acute Disease , Child , Child, Preschool , Dehydration/etiology , Diarrhea, Infantile/complications , Female , Humans , Infant , Infant, Newborn , Injections, Intravenous , Male , Water-Electrolyte BalanceABSTRACT
The parastomal hernia is a continuing challenge, because of the disappointing results of the different procedures available to repair it. The mesh implantation seems to be the best, but not optimal method with 8-22 % recurrence rate and about 15-20% other complications. The PHSL (Polypropylene hernia system large; Ethicon inc. Johnson and Johnson, USA) device proved to be an acceptable solution in correction the medium and large parastomal hernia with low recurrence and complication rate. The device enforces the abdominal wall with double mesh layer connected with a tube. The sigmoid colostomy is lifted trough the tube to the abdominal surface. The device was implanted with preventive intent in 14 cases, without any parastomal hernia formation in the first postoperative year. The preventive PHSL mesh implantation at the Miles operation seems to be an useful method for prevention of parastomal hernias.