RESUMO
OBJECTIVES: The present study investigates the outcome of Fowler-Stephens operation in prepubertal Wistar rats focused on microlithiasis and Leydig cell hyperplasia development. METHODS: Thirty-eight (38) animals underwent laparoscopic Fowler-Stephens operation on the right testis (8 of them formed the control group) and 6 of them additional contra-lateral orchectomy. The testes were examined histological 9,30,70 and 90 days later, while ultrasound study was perfomed a day earlier. RESULTS: Initially, atrophic signs were visible as early as 9 days after the operation. Signs of intratubular calcification were obvious 30 days after the operation, in severe atrophic testes. Another important point was that in the animals that underwent orchectomy, testicular microlithiasis co-existed with lesions of Leydig cell hyperplasia. CONCLUSIONS: Microlithiasis and Leydig cell hyperplasia seem to have causative relation in operated undescended testis and present serious postoperative complications, with a review in the literature.
Assuntos
Cálculos/etiologia , Cálculos/cirurgia , Criptorquidismo/cirurgia , Laparoscopia/efeitos adversos , Células Intersticiais do Testículo/patologia , Orquiectomia/efeitos adversos , Doenças Testiculares/etiologia , Doenças Testiculares/cirurgia , Animais , Cálculos/diagnóstico por imagem , Cálculos/patologia , Proliferação de Células , Criptorquidismo/complicações , Criptorquidismo/diagnóstico por imagem , Criptorquidismo/patologia , Modelos Animais de Doenças , Hiperplasia , Masculino , Ratos , Ratos Wistar , Doenças Testiculares/diagnóstico por imagem , Doenças Testiculares/patologia , Ultrassonografia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversosRESUMO
The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The 'Asclepeion' of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1,000,000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the 'Asclepeion' of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 - 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at 'Asclepeion' of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.
Assuntos
Acidentes de Trânsito/tendências , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , Grécia/epidemiologia , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Ferimentos e Lesões/classificaçãoRESUMO
BACKGROUND AND AIMS: This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test. PATIENTS AND METHODS: 717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation. RESULTS: 598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11% of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions. CONCLUSIONS: Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.
Assuntos
Apendicite/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Apendicite/cirurgia , Criança , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Exame Físico , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Forgetting a foreign body in the abdominal cavity is an unpleasant and avoidable situation. It usually occurs when the preventive protocols are not followed precisely. In such a case clinical consequences are unpredictable and relaparotomy may become necessary. CASE PRESENTATION: We present the case of a temporary intestinal obstruction six months after a transabdominal hysterectomy. Diagnostic workup revealed a laparotomy-gauze left in the abdominal cavity at the previous operation. Exploration showed that the gauze was actually located in the intestinal lumen. The inflammatory reaction elicited by the foreign body eroded the intestinal wall and allowed its intraluminal migration. The gauze moved distally due to peristalsis until it became trapped in the ileocecal valve causing obstruction. When it finally passed through the valve the obstruction was relieved. Intraoperative maneuvers advanced the foreign body further forward until it was removed transanally. CONCLUSION: The formal processes - counting the gauzes continually and double crossing the counting - must be kept in every laparotomy to avoid the unpleasant experience of gauze remaining in the peritoneal cavity. In such an unfortunate case traditional open surgery provides a safe solution to the patient's problem.
Assuntos
Migração de Corpo Estranho/complicações , Granuloma de Corpo Estranho/etiologia , Histerectomia , Doenças do Íleo/etiologia , Pseudo-Obstrução Intestinal/etiologia , Leiomioma/cirurgia , Complicações Pós-Operatórias/etiologia , Tampões de Gaze Cirúrgicos , Neoplasias Uterinas/cirurgia , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Granuloma de Corpo Estranho/diagnóstico por imagem , Granuloma de Corpo Estranho/cirurgia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Pseudo-Obstrução Intestinal/diagnóstico por imagem , Pseudo-Obstrução Intestinal/cirurgia , Pessoa de Meia-Idade , Omento/cirurgia , Complicações Pós-Operatórias/cirurgia , Radiografia , ReoperaçãoRESUMO
A new technique for the restoration of the continuity of the colon with preservation of an existing colostomy is described here. A 75-year-old male with a three-year history of abdominal-perineal resection and a well functioning end colostomy was admitted to our department for a second primary cancer of the descending colon. At operation the colon was divided close to the abdominal wall; the colostomy was left in situ while the descending colon and mesocolon were radically resected. The viability of the colostomy was being continuously inspected. An EEA stapler was then inserted through the colostomy and an anastomosis was created. Shortening the length of the operation and avoiding the possible complications that follow the creation of a new stoma are the major benefits of the technique. Still, the viability of the colostomy after its separation of the rest of the colon and mesocolon has to be ensured before proceeding.
Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Colostomia/métodos , Segunda Neoplasia Primária/cirurgia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Colonoscopia/métodos , Humanos , Masculino , Reoperação , Grampeadores CirúrgicosRESUMO
The purpose of this study was to examine the usefulness and the validity of spiral computerized tomography (CT) in assessing acute segmental intestinal ischemia. We present the spiral CT imaging findings in surgically proven cases of intestinal ischemia. 46 patients were admitted to our facility over a five-year period with suspicion of acute enteric ischemia. 34 were first examined with spiral CT and underwent surgery. In 24 of the 34 patients (sensitivity 70.6%), at least one imaging finding specific for segmental intestinal ischemia was recognised (true positive examinations). Spiral-CT examination demonstrated non-specific or normal findings in 7 out of 34 patients with proven intestinal ischemia (20.6% false negative studies). In conclusion, spiral CT can be used in the investigation of patients with suspected acute intestinal ischemia to confirm or suggest the diagnosis or exclude other potential diagnoses.