RESUMEN
OBJECTIVES: To review the short-term outcome of endoscopic resection of superficial upper gastro-intestinal lesions in Hong Kong. DESIGN: Historical cohort study. SETTING: All Hospital Authority hospitals in Hong Kong. PATIENTS: This was a multicentre retrospective study of all patients who underwent endoscopic resection of superficial upper gastro-intestinal lesions between January 2010 and June 2013 in all government-funded hospitals in Hong Kong. MAIN OUTCOME MEASURES: Indication of the procedures, peri-procedural and procedural parameters, oncological outcomes, morbidity, and mortality. RESULTS: During the study period, 187 lesions in 168 patients were resected. Endoscopic mucosal resection was performed in 34 (18.2%) lesions and endoscopic submucosal dissection in 153 (81.8%) lesions. The mean size of the lesions was 2.6 (standard deviation, 1.8) cm. The 30-day morbidity rate was 14.4%, and perforations and severe bleeding occurred in 4.3% and 3.2% of the patients, respectively. Among patients who had dysplasia or carcinoma, R0 resection was achieved in 78% and the piecemeal resection rate was 11.8%. Lateral margin involvement was 14% and vertical margin involvement was 8%. Local recurrence occurred in 9% of patients and 15% had residual disease. The 2-year overall survival rate and disease-specific survival rate was 90.6% and 100%, respectively. CONCLUSION: Endoscopic mucosal resection and endoscopic submucosal dissection were introduced in low-to-moderate-volume hospitals with acceptable morbidity rates. The short-term survival was excellent. However, other oncological outcomes were higher than those observed in high-volume centres and more secondary procedures were required.
Asunto(s)
Adenoma/cirugía , Carcinoma/cirugía , Neoplasias Duodenales/cirugía , Neoplasias Esofágicas/cirugía , Perforación Intestinal/etiología , Hemorragia Posoperatoria/etiología , Neoplasias Gástricas/cirugía , Adenoma/patología , Anciano , Pérdida de Sangre Quirúrgica , Carcinoma/patología , Disección/efectos adversos , Neoplasias Duodenales/patología , Endoscopía Gastrointestinal , Neoplasias Esofágicas/patología , Femenino , Mucosa Gástrica/cirugía , Hong Kong , Humanos , Mucosa Intestinal/cirugía , Masculino , Auditoría Médica , Persona de Mediana Edad , Neoplasia Residual , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Adenocarcinoma of the duodenum is an exceedingly rare disorder. Its vague and non-specific symptoms often lead clinicians and patients to suspect other more benign differential diagnoses. Improved endoscopy and radiology have enabled more of these cases to be unearthed. Definitive surgery is the only means of potential cure, with the prognosis being significantly better for node-negative patients. We present a case of a 52-year-old man who underwent a Whipple's operation for this uncommon disease and a literature review of the subject.
Asunto(s)
Adenocarcinoma/diagnóstico , Anorexia/etiología , Neoplasias Duodenales/diagnóstico , Adenocarcinoma/complicaciones , Adenocarcinoma/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/cirugía , Humanos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Pérdida de PesoAsunto(s)
Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Conjuntiva/patología , Córnea/patología , Hiperparatiroidismo Secundario/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Adulto , Biomarcadores/sangre , Calcinosis/patología , Conjuntiva/diagnóstico por imagen , Córnea/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Hiperparatiroidismo Secundario/sangre , Hiperparatiroidismo Secundario/cirugía , Paratiroidectomía , Diálisis Renal , Tomografía Computarizada por Rayos XRESUMEN
Laparoscopy under total intravenous anesthesia (TIVA) with spontaneous respiration is a commonly encountered procedure in ambulatory gynecologic surgery. The purpose of this study was to evaluate the efficacy of TIVA using propofol and ketamine, compared with endotracheal inhalational general anesthesia (EIGA) for ambulatory gynecologic laparoscopy. Fifty-eight female patients, aged 17-48 years, were randomly allocated into two groups. Group 1 (TIVA) (n = 28) received propofol at the induction of anesthesia followed by propofol infusion for maintenance. Intravenous ketamine 0.5 mg/kg was administered before operation for anesthetic effect. Natural airway and spontaneous breathing were then maintained in patients. Group 2 (n = 30) received EIGA with isoflurane under controlled ventilation. We found that the two groups demonstrated similar trend characters of pH and PaCO2 during operation and in recovery room. The incidence of postoperative vomiting was higher in group 2 than in group 1 (30% vs. 7%; p < 0.05). The incidence of intraoperative arrhythmia was higher in group 2 than in group 1 (40% vs. 3%; p < 0.001). Furthermore, the incidence of sore throat was higher in group 2 than in group 1 (47% vs. 7%; p < 0.001). We conclude that TIVA with spontaneous respiration is suitable for ambulatory gynecologic laparoscopy.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Anestesia Intravenosa , Ketamina/farmacología , Laparoscopía , Propofol/farmacología , Adolescente , Adulto , Femenino , Humanos , Máscaras Laríngeas , Persona de Mediana EdadAsunto(s)
Suero Antilinfocítico/farmacología , Inmunosupresores/farmacología , Trasplante de Riñón , Inmunología del Trasplante/efectos de los fármacos , Pruebas de Aglutinación , Animales , Rechazo de Injerto/efectos de los fármacos , Caballos/inmunología , Ganglios Linfáticos/citología , Mesenterio , Trasplante de Neoplasias , Porcinos , Trasplante Heterólogo , Trasplante HomólogoRESUMEN
The three-dimensional orientation of a maxillary cast mounting from a simulated-kinematic facebow transfer was evaluated in multiple trials among three operators on a single subject. The anterior and posterior anatomic facial reference points were marked on the subject. Each operator performed a separate series of trials to reset the anterior facebow component, the two posterior facebow components, and a control series with no resetting of any facebow components relative to the subject. The x, y, and z coordinates of three reference points on the maxillary cast were determined with a machinist microscope relative to a fixed reference after each facebow transfer. A range of differences between mountings of the maxillary cast were found between trials with all three methods used. These mounting errors were due to setting of the instrument and would be expected in routine clinical use of this instrument.