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2.
Scott Med J ; 64(2): 49-55, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30630393

RESUMO

BACKGROUND AND AIMS: Diagnostic laparoscopy is commonly performed for diagnosis of right lower abdominal pain and its use is increasing in the emergency setting. Some studies have reported that diagnostic laparoscopy and laparoscopic appendicectomy have advantages over conventional surgery. Many emergency surgeons now perform diagnostic laparoscopy for both clinically diagnosed appendicitis and when the diagnosis is in doubt. The aim of the present study was to assess whether the use of diagnostic laparoscopy is justified and safe for those admitted with right lower abdominal pain. METHODS AND RESULTS: Data were collected prospectively on consecutive patients attending the acute surgical receiving unit with right iliac fossa pain or a suspected diagnosis of acute appendicitis. A total of 284 patients underwent diagnostic laparoscopy. Of them 233 (82%) had a positive finding at laparoscopy, 207 (88%) underwent appendicectomy, the majority of which were carried out laparoscopically. Surgical trainees performed the majority of operations and this did not have a negative impact on operative findings (p 0.856), operation performed (0.642), or operative duration (0.831). No intra-operative complications were sustained. Ultrasound examination was carried out in 49 patients, while CT was carried out in 24. CONCLUSION: The results of the present study highlight the utility of early diagnostic laparoscopy as both a diagnostic and therapeutic tool in the acute setting.


Assuntos
Dor Abdominal/etiologia , Apendicite/diagnóstico , Técnicas de Diagnóstico por Cirurgia , Laparoscopia , Dor Abdominal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/métodos , Apendicite/complicações , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Técnicas de Diagnóstico por Cirurgia/efeitos adversos , Feminino , Cirurgia Geral/educação , Humanos , Internato e Residência/estatística & dados numéricos , Laparoscopia/efeitos adversos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Adulto Jovem
3.
Am J Surg ; 217(1): 78-82, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29880389

RESUMO

BACKGROUND: The purpose of this study was to describe the diagnostic value and therapeutic benefit of diagnostic splenectomy. METHODS: Retrospective review was performed of patients undergoing splenectomy with an unknown diagnosis (UD), a hematologic malignancy (HM) or idiopathic thrombocytopenic purpura. Surgical indications and postoperative outcomes were evaluated. RESULTS: 113 splenectomy patients were identified. Of the UD patients undergoing splenectomy, 46% (n = 16) received a definitive diagnosis postoperatively. A change in diagnosis occurred in 12% (n = 4) of HM patients. Complete symptom relief was observed more often in UD patients who received a definitive diagnosis after splenectomy 69% (n = 11), compared to the 47% (n = 9) who did not receive definitive diagnosis postoperatively. CONCLUSIONS: The diagnostic ability of splenectomy was 46% when the diagnosis was unknown preoperatively. Additionally, a majority of patients experienced relief of symptoms postoperatively. Splenectomy may be a useful diagnostic and therapeutic tool in select UD and HM patients.


Assuntos
Técnicas de Diagnóstico por Cirurgia , Neoplasias Hematológicas/diagnóstico , Linfoma/diagnóstico , Púrpura Trombocitopênica Idiopática/diagnóstico , Esplenectomia , Feminino , Neoplasias Hematológicas/etiologia , Neoplasias Hematológicas/cirurgia , Humanos , Linfoma/complicações , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/etiologia , Púrpura Trombocitopênica Idiopática/cirurgia , Estudos Retrospectivos , Esplenomegalia , Avaliação de Sintomas
4.
J Glaucoma ; 28(2): e21-e23, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30300308

RESUMO

PURPOSE: The main purpose of this study was to report a case of panscleritis after gonioscopy-assisted transluminal trabeculotomy (GATT). METHODS: We describe the case of a 33-year-old man with a history of unilateral anterior uveitis and glaucoma, who developed panscleritis after GATT surgery. RESULTS: Uneventful GATT surgery was performed in a glaucomatous left eye. On the second postoperative day, the patient developed tenderness on palpation of the eye. Ophthalmic examination revealed significant diffuse hyperemia, elongated and tortuous upper bulbar conjunctival/scleral vessels, and exudative retinal detachment at the superior nasal quadrant, with diffuse scleral thickening. The patient was diagnosed as having panscleritis, which was attributed to the GATT surgery. Although the scleritis resolved completely with intravenous and oral methylprednisolone treatment, localized retinal detachment persisted. CONCLUSIONS: Surgery-induced posterior scleritis may occur following minimally invasive glaucoma surgeries such as GATT. Control of uveitis for at least 3 months before surgery is indicated in patients with uveitis if GATT surgery is planned.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Gonioscopia , Esclerite/etiologia , Trabeculectomia/efeitos adversos , Adulto , Antialérgicos/uso terapêutico , Técnicas de Diagnóstico por Cirurgia , Combinação de Medicamentos , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Pressão Intraocular/fisiologia , Etabonato de Loteprednol/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Período Pós-Operatório , Estudos Retrospectivos , Esclerite/tratamento farmacológico , Resultado do Tratamento , Acuidade Visual
5.
J Laparoendosc Adv Surg Tech A ; 29(2): 184-191, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30585754

RESUMO

PURPOSE: Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS: A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS: Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS: Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Apendicite/terapia , Técnicas de Apoio para a Decisão , Conduta Expectante , Doença Aguda , Adolescente , Adulto , Apendicectomia/métodos , Técnicas de Diagnóstico por Cirurgia , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos Retrospectivos , Adulto Jovem
7.
Int J Pediatr Otorhinolaryngol ; 110: 57-60, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29859588

RESUMO

INTRODUCTION: Diagnostic tonsillectomy is performed to exclude malignancy. It is associated with a post-operative hemorrhage rate of 3.5%, (1) which is more dangerous in small children. No previous case series for asymmetrical tonsils have detected tonsil lymphoma.(2-6) We aimed to review our local diagnostic tonsillectomy practice. METHOD: The authors reviewed the clinical notes and histological results for all diagnostic tonsillectomies carried out from June 2013 to June 2016. RESULTS: We recorded data for 168 patients. There were four post-operative bleeds and one return to theatre. Bilateral tonsillectomies accounted for 152 operations (90.5%). Lymphoid hyperplasia accounted for 95% of histological diagnosis with no malignancies found. Pre-operative tonsil grading demonstrated no statistically significant association with histological tonsil weight difference (ANOVA p = 0.10). Actinomyces colonisation had little affect on tonsil weight difference when we compared patients with bilateral colonisation and no colonisation (t-test p = 0.540) and between tonsils in patients with unilateral tonsil Actinomyces colonisation (paired t-test p = 0.448). Recurrent tonsillitis was more prevalent in patients with Actinomyces colonisation than OSA/sleep disordered breathing (39% vs 15%). CONCLUSION: A literature search yielded five smaller case series of palatine tonsil asymmetry in children with no malignancy found.(2-6) Case-control studies report tonsillar asymmetry as the most common presenting symptom (73%) in tonsillar lymphoma.(7) This enlargement usually occurs rapidly within 6 weeks with new obstructive or systemic B-type symptoms.(3) A Turkish epidemiological study found asymmetrical tonsils in 1.7% of the healthy paediatric population.(8) We therefore estimate there to be over 210,000 children with asymmetrical tonsils in the UK. With an unreliable grading system, we believe asymmetrical tonsils in isolation, unchanged for over 6 weeks may not warrant tonsillectomy.


Assuntos
Linfoma/diagnóstico , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Hemorragia Pós-Operatória/etiologia , Neoplasias Tonsilares/diagnóstico , Tonsilectomia , Tonsilite/diagnóstico , Actinomyces/isolamento & purificação , Adolescente , Portador Sadio/microbiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Diagnóstico Diferencial , Técnicas de Diagnóstico por Cirurgia , Humanos , Hiperplasia/diagnóstico , Hiperplasia/etiologia , Hiperplasia/patologia , Tamanho do Órgão , Estudos Retrospectivos , Síndromes da Apneia do Sono/complicações , Tonsilectomia/efeitos adversos , Tonsilite/complicações , Tonsilite/microbiologia
8.
Int J Gynaecol Obstet ; 142(2): 131-142, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29729099

RESUMO

Challenges intrinsic to the accurate diagnosis of endometriosis contribute to an extended delay between the onset of symptoms and clinical confirmation. Intraoperative visualization, preferably with histologic verification, is considered by many professional organizations to be the gold standard by which endometriosis is diagnosed. Clinical diagnosis of symptomatic endometriosis via patient history, physical examination, and noninvasive tests, though more easily executed, is generally viewed as less accurate than surgical diagnosis. Technological advances and increased understanding of the pathophysiology of endometriosis warrant continuing reevaluation of the standard method for diagnosing symptomatic disease. A review of the published literature was therefore performed with the goal of comparing the accuracy of clinical diagnostic measures with that of surgical diagnosis. The current body of evidence suggests that clinical diagnosis of symptomatic endometriosis is more reliable than previously recognized and that surgical diagnosis has limitations that could be underappreciated. Regardless of the methodology used, women with suspected symptomatic endometriosis would be well served by a diagnostic paradigm that is reliable, conveys minimal risk of under- or over-diagnosis, lessens the time from symptom development to diagnosis, and guides the appropriate use of medical and surgical management strategies.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Técnicas de Diagnóstico por Cirurgia/normas , Endometriose/diagnóstico , Medicina Baseada em Evidências , Avaliação de Sintomas/métodos , Endometriose/cirurgia , Feminino , Humanos , Reprodutibilidade dos Testes , Avaliação de Sintomas/normas
9.
J Trauma Acute Care Surg ; 85(4): 659-664, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29554039

RESUMO

BACKGROUND: Expediting evaluation and intervention for severely injured patients has remained a mainstay of advanced trauma care. One technique, direct to operating room (DOR) resuscitation, for selective adult patients has demonstrated decreased mortality. We sought to investigate the application of this protocol in children. METHODS: All DOR pediatric patients from 2009 to 2016 at a pediatric Level I trauma center were identified. Direct to OR criteria included penetrating injury, chest injuries, amputations, significant blood loss, cardiopulmonary resuscitation, and surgeon discretion. Demographics, injury patterns, interventions, and outcomes were analyzed. Observed mortality was compared with expected mortality, calculated using Trauma Injury Severity Score methodology, with two-tailed t tests, and a p value less than 0.5 was considered significant. RESULTS: Of 2,956 total pediatric trauma activations, 82 (2.8%) patients (age range, 1 month to 17 years) received DOR resuscitation during the study period. The most common indications for DOR were penetrating injuries (62%) and chest injuries (32%). Forty-four percent had Injury Severity Score (ISS) greater than 15, 33% had Glasgow Coma Scale (GCS) score of 8 or less, and 9% were hypotensive. The most commonly injured body regions were external (66%), head (34%), chest (30%), and abdomen (27%). Sixty-seven (82%) patients required emergent procedural intervention, most commonly wound exploration/repair (35%), central venous access (22%), tube thoracostomy (19%), and laparotomy (18%). Predictors of intervention were ISS greater than 15 (odds ratio, 14; p = 0.013) and GCS < 9 (odds ratio = 8.5, p = 0.044). The survival rate to discharge for DOR patients was 84% compared with an expected survival of 79% (Trauma Injury Severity Score) (p = 0.4). The greatest improvement relative to expected mortality was seen in the subgroup with penetrating trauma (84.5% vs 74.4%; p = 0.002). CONCLUSION: A selective policy of resuscitating the most severely injured children in the OR can decrease mortality. Patients suffering penetrating trauma with the highest ISS, and diminished GCS scores have the greatest benefit. Trauma centers with appropriate resources should evaluate implementing similar policies. LEVEL OF EVIDENCE: Diagnostic tests or criteria, level II.


Assuntos
Ressuscitação/métodos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/cirurgia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Adolescente , Cateterismo Venoso Central , Criança , Pré-Escolar , Protocolos Clínicos , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/cirurgia , Técnicas de Diagnóstico por Cirurgia , Tratamento de Emergência , Feminino , Escala de Coma de Glasgow , Humanos , Hipotensão/etiologia , Lactente , Escala de Gravidade do Ferimento , Masculino , Salas Cirúrgicas , Taxa de Sobrevida , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/cirurgia , Toracostomia , Triagem , Ferimentos e Lesões/complicações , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgia
10.
J Laparoendosc Adv Surg Tech A ; 28(5): 506-513, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29293406

RESUMO

INTRODUCTION: Diagnostic laparoscopy (DL) is a well-accepted approach for penetrating abdominal trauma (PAT). However, the steps of procedure and the systematic laparoscopic examination are not clearly defined in the literature. The aim of this study was to clarify the definition of DL in trauma surgery by auditing DL performed for PAT at our institution, and to describe the strategies on how to avoid missed injuries. METHODS: The data of patients managed with laparoscopy for PAT from January 2012 to December 2015 were retrospectively analyzed. The details of operative technique and strategies on how to avoid missed injuries were discussed. RESULTS: Out of 250 patients managed with laparoscopy for PAT, 113 (45%) patients underwent DL. Stab wounds sustained 94 (83%) patients. The penetration of the peritoneal cavity or retroperitoneum was documented in 67 (59%) of patients. Organ evisceration was present in 21 (19%) patients. Multiple injuries were present in 22% of cases. The chest was the most common associated injury. Two (1.8%) iatrogenic injuries were recorded. The conversion rate was 1.7% (2/115). The mean length of hospital stay was 4 days. There were no missed injuries. In the therapeutic laparoscopy (TL) group, DL was performed as the initial part and identified all injuries. There were no missed injuries in the TL group. The predetermined sequential steps of DL and the standard systematic examination of intraabdominal organs were described. CONCLUSIONS: DL is a feasible and safe procedure. It accurately identifies intraabdominal injuries. The selected use of preoperative imaging, adherence to the predetermined steps of procedure and the standard systematic laparoscopic examination will minimize the rate of missed injuries.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Técnicas de Diagnóstico por Cirurgia , Laparoscopia/métodos , Traumatismo Múltiplo/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Conversão para Cirurgia Aberta , Erros de Diagnóstico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Peritoneal/lesões , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/lesões , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Ferimentos Perfurantes/cirurgia , Adulto Jovem
11.
J Surg Res ; 221: 328-335, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29229147

RESUMO

BACKGROUND: Before primary oral tumors are treated, various prophylactic procedures that require tissue repair are often necessary (e.g. biopsies, tooth extractions, radiation, and tracheotomies). Wound healing and tumor growth harness similar immune/inflammatory mechanisms. Our previous work indicates that tumors impair wound healing, although the extent to which tissue repair conversely influences tumor growth is poorly understood. Here, we test the hypothesis that dermal wound healing exacerbates primary tumor growth and influences tumor immunobiology. MATERIALS AND METHODS: Female, immunocompetent mice were inoculated subcutaneously with murine oral cancer cells (AT-84) to induce flank tumors. Half of the mice received dermal excisional wounds (4 × 3.5 mm diameter) on their dorsum 16 days later, whereas the skin of controls remained intact. Tumor and blood tissues were harvested 1 and 5 days post wounding, and tumor myeloid cell populations and inflammatory gene expression were measured. Circulating myeloid cells, cytokines, and corticosterone were also quantified. RESULTS: Wounding increased tumor mass, early tumor infiltration of macrophages, and tumor inflammatory gene expression. While wounding attenuated tumor growth-induced increases in circulating myeloid cells, no effects of wounding on circulating cytokine/endocrine measures were observed. CONCLUSIONS: These results indicate that modest skin immune/inflammatory processes can enhance distal tumor growth and alter innate tumor immunity. The implication for this work is that, in the presence of a tumor, the benefits of tissue-damaging procedures that occur clinically must be weighed against the potential consequences for tumor biology.


Assuntos
Técnicas de Diagnóstico por Cirurgia/efeitos adversos , Neoplasias/imunologia , Cicatrização/imunologia , Animais , Feminino , Citometria de Fluxo , Camundongos Endogâmicos C3H , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/cirurgia , Reação em Cadeia da Polimerase
12.
Indian J Tuberc ; 64(3): 167-172, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28709483

RESUMO

BACKGROUND: Tuberculosis (TB) is a common endemic disease in Tunisia. Abdominal location is rare. Early diagnosis of abdominal TB remains difficult due to its non-specific clinical presentations. The aim of our study is to highlight the characteristics of the different presentations, to characterize tools contributing to a positive preoperative diagnosis, and finally to assess the role of surgery in the management of this entity. MATERIALS AND METHODS: A retrospective review from 2005 to 2015 identified 90 cases of confirmed abdominal TB managed in the Department of General Surgery of the Habib Thameur Hospital. The diagnosis was established by histopathology examination for all cases. This study was approved by the ethical committee. RESULTS: The mean age of the patient was 44.13 years with a sex ratio (M/F) of 0.34. We collected 56 cases of peritoneal TB, 12 cases of abdominal lymph node TB, 10 cases of intestinal TB, four cases of hepatic TB, and two cases of gallbladder's TB. For six patients, an association of many localizations was noted. The diagnosis was suspected on clinical, biological, and morphological arguments, but the confirmation was always made by surgical exploration and pathological examination of removed specimens. Surgical management was urgent in complicated cases (13.3%). Laparoscopy was performed in 71 cases (78.9%). Laparoscopic features of peritoneal TB were specific and always confirmed by histological examination. CONCLUSION: Despite the wide range of examination available for the preoperative exploration of abdominal TB, diagnosis is usually late and difficult. TB is a medical condition. However, surgical exploration is frequently needed in the management.


Assuntos
Técnicas de Diagnóstico por Cirurgia , Tuberculose/diagnóstico , Tuberculose/cirurgia , Abdome , Adolescente , Adulto , Idoso , Doenças Endêmicas , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/epidemiologia , Peritonite Tuberculosa/cirurgia , Radiologia , Estudos Retrospectivos , Tuberculose/epidemiologia , Tuberculose/patologia , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Gastrointestinal/epidemiologia , Tuberculose Gastrointestinal/cirurgia , Tuberculose Hepática/diagnóstico , Tuberculose Hepática/epidemiologia , Tuberculose Hepática/cirurgia , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/epidemiologia , Tuberculose dos Linfonodos/cirurgia , Tunísia/epidemiologia , Adulto Jovem
13.
Gynecol Oncol ; 146(3): 449-456, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28645428

RESUMO

OBJECTIVE: To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. METHODS: An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. RESULTS: We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses. CONCLUSION: In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.


Assuntos
Procedimentos Cirúrgicos de Citorredução/economia , Custos de Cuidados de Saúde , Laparoscopia/economia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Quimioterapia Adjuvante/economia , Análise Custo-Benefício , Técnicas de Diagnóstico por Cirurgia/economia , Feminino , Humanos , Futilidade Médica , Pessoa de Meia-Idade , Terapia Neoadjuvante/economia , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
14.
Taiwan J Obstet Gynecol ; 56(2): 181-183, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28420504

RESUMO

OBJECTIVE: Endometriosis has been increasingly recognized as the cause of severe dysmenorrhea among younger women including adolescents, often with significant delay from time of presentation to diagnosis. Data on the South East Asian women is scarce. This study aims to describe the disease pattern in a group of young Asian women with histological diagnosis of endometriosis in our center. MATERIALS AND METHODS: A total of 709 laparoscopic operations were performed for endometriosis in our center between 2000 and 2007. Women aged 25 years old and below were included in this study. Details regarding clinical presentation and severity of disease were retrospectively reviewed and described. RESULTS: A total of 45 women were included in this study, aged between 14 years and 25 years. Thirty seven patients (82.3%) were aged between 21 years and 25 years. Racial distribution was as follows: 57.8% Chinese, 26.7% Malay, and 15.6% Indian. Dysmenorrhea was the commonest symptom (84.4%); 44.4% of which were described as mild. Eleven patients (24.4%) presented with severe symptoms resulting in absence from school or work. Severity of endometriosis during laparoscopy was staged using the rAFS staging system, and was 11.1%, 17.8%, 28.9%, and 42.2% for disease Stage I, Stage II, Stage III, and Stage IV, respectively. CONCLUSION: Endometriosis can cause severe disease even in adolescents and young females. Increased awareness among patients and healthcare providers would raise a higher index of suspicion for endometriosis in these women, with consequent early treatment which may result in better functional and fertility outcomes.


Assuntos
Endometriose/diagnóstico , Endometriose/cirurgia , Atividades Cotidianas , Adolescente , Adulto , Técnicas de Diagnóstico por Cirurgia , Dismenorreia/etiologia , Endometriose/complicações , Endometriose/tratamento farmacológico , Feminino , Humanos , Laparoscopia , Estudos Retrospectivos , Índice de Gravidade de Doença , Singapura , Centros de Atenção Terciária , Fatores de Tempo , Ultrassonografia , Adulto Jovem
15.
Ann Surg Oncol ; 24(5): 1214-1220, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27904972

RESUMO

BACKGROUND: Small intestinal neuroendocrine tumors (SI-NETs) are uncommon tumors with an annual incidence of about 1 per 100,000. Usually, SI-NETs have a slow progression, and patients often present with generalized disease. Many patients do well, and the disease has a relatively favorable 5-year survival rate. Some SI-NETs, however, have a more negative prognosis. This study aimed to establish prognostic factors for death identifiable at primary surgery. METHODS: A nested case-control study investigated 1150 patients from the cohort of all patients with a diagnosis of SI-NETs in Sweden between 1961 and 2001. The study cases consisted of all patients who died of SI-NETs during the study period. Each case was assigned a control subject matched by age at diagnosis and calendar period. Possible prognostic factors [gender, degree of symptoms, indication for surgery, World Health Organization (WHO) stage] were evaluated in uni- and multivariable analyses. RESULTS: The patients with symptomatic disease had an increased risk of dying. The indication for primary surgery influenced survival, showing a more negative prognosis for elective surgery. The WHO stage influenced survival, and stage 4 patients had an almost threefold risk of dying compared with stages 1 to 3b patients. CONCLUSIONS: This study showed that preoperative symptoms are important in prognostication for SI-NETs. Hormonal symptoms generally signify a patient with a more advanced disease stage and a worse prognosis. Including symptomatic disease together with the WHO stage and grade could possibly increase the accuracy of prognostication.


Assuntos
Neoplasias Intestinais/mortalidade , Síndrome do Carcinoide Maligno/mortalidade , Idoso , Estudos de Casos e Controles , Técnicas de Diagnóstico por Cirurgia/estatística & dados numéricos , Diarreia/etiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Rubor/etiologia , Humanos , Achados Incidentais , Neoplasias Intestinais/complicações , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado , Masculino , Síndrome do Carcinoide Maligno/complicações , Síndrome do Carcinoide Maligno/patologia , Síndrome do Carcinoide Maligno/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Sons Respiratórios/etiologia , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Suécia/epidemiologia , Avaliação de Sintomas
16.
Eur J Gynaecol Oncol ; 38(2): 232-235, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29953786

RESUMO

PURPOSE: The objective of this study was to identify the lymph node involvement in apparently early ovarian cancer (OC) Materials and Methods: Patients with clinically apparent early OC who underwent staging surgery between August 2012 and August 2015 were prospectively identified. Patients' characteristics and tumor histopathology were evaluated. RESULTS: Twenty consecutive patients were operated for grossly apparent early ovarian carcinoma. All patients were surgically staged and underwent a systematic pelvic and para- aortic lymphadenectomy. There were eight patients (40%) with lymph node involvement. One of the eight lymph node metastasis was solely in para-aortic node, three patients had both positive-pelvic and aortic nodes, and the other metastasis was in ipsilateral pelvic lymph node. Positive lymph node involvement was significantly higher among patients with poorly differentiated tumor grade (62.5%) (p = 0.02). CONCLUSION: All patients diagnosed with early OC macroscopically confined to the ovaries should be considered for compre- hensive staging surgery including pelvic and para-aortic lymphadenectomy.


Assuntos
Carcinoma/secundário , Carcinoma/cirurgia , Excisão de Linfonodo , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Aorta , Técnicas de Diagnóstico por Cirurgia , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Pelve , Estudos Prospectivos
17.
Eur J Gynaecol Oncol ; 38(2): 314-318, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29953804

RESUMO

Primitive Neuroectodermal tumor belongs to the family of Ewing's tumor and is characterized by at (11;22) (q24;ql2) or at (21;22) (q22;ql2) translocation. Retroperitoneal primitive neuroectodermal tumor (PNET) are rare, usually affect young adults, and are often diagnosed late. There is no specific characteristics for imaging. The diagnosis is made on histological examination of the surgical spec- imen or biopsies. Radiotherapy and chemotherapy complete the treatment. The authors report the case of a 26-year-old patient who only had pelvic discomfort. Diagnostic laparoscopy showed a retroperitoneal and retrovesical mass of five centimeters. The patient benefited from adjuvant chemotherapy and radiotherapy. She is free of disease 30 months after treatment.


Assuntos
Tumores Neuroectodérmicos Primitivos/diagnóstico , Tumores Neuroectodérmicos Primitivos/terapia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/terapia , Adulto , Quimioterapia Adjuvante , Técnicas de Diagnóstico por Cirurgia , Feminino , Humanos , Laparoscopia , Tomografia por Emissão de Pósitrons , Radioterapia Adjuvante
18.
J Invest Surg ; 30(2): 88-94, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27690703

RESUMO

Purpose/Aim: Postoperative adhesions remain an undesirable and commonly symptomatic side effect of abdominopelvic surgeries. Animal models of postoperative adhesions typically yield heterogeneous adhesions throughout the abdominal cavity and are not easily quantified. Here we present a novel method of postoperative adhesion assessment and report its reliability and measurement error. MATERIALS AND METHODS: A model of cecal abrasion with partial sidewall attachment was performed on female rats. After 1, 2, 4, or 7 days of recovery, the rats were euthanized and their abdominopelvic cavities were systematically evaluated for postoperative adhesions. The necropsy was recorded through the surgical microscope. Four raters were trained to use a ballot to capture key factors of the adhesions as they viewed the recordings. Their ratings were compared for measurement error and reliability (using Bland-Altman plots and intraclass correlation coefficients, respectively) and for the ability to discriminate differences in experimental groups. A subset of the data was analyzed to determine practical utility. RESULTS: The rating system was shown to have low measurement error and high inter-rater reliability for all parameters measured. Applied practically, the system was able to discriminate groups in a manner that was expected. CONCLUSIONS: We have developed and validated a rating system for postoperative adhesions and shown that it can detect group differences. This method can be used to quantify postoperative adhesions in rodent models.


Assuntos
Técnicas de Diagnóstico por Cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Índice de Gravidade de Doença , Animais , Materiais Biocompatíveis , Ceco/patologia , Modelos Animais de Doenças , Feminino , Complicações Pós-Operatórias/patologia , Ratos , Reprodutibilidade dos Testes , Aderências Teciduais/diagnóstico , Aderências Teciduais/patologia
19.
BMJ Case Rep ; 20162016 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-27873763

RESUMO

A 70-year-old man presented with recent onset, predominantly right-sided heart failure. Echocardiogram demonstrated features of hypertensive heart disease and was suggestive of, but non-diagnostic for, constrictive pericarditis (CP). CT demonstrated mild pericardial thickening. Right heart catheterisation showed elevation and equalisation of diastolic pressures in all cardiac chambers with early rapid filling, minimal ventricular interdependence, and no dissociation of intrathoracic and intracardiac pressures. While several features pointed towards CP, the minimal ventricular interdependence and no dissociation of intrathoracic and intracardiac pressures suggested other pathology. Diagnostic pericardiectomy was performed, after which the central venous pressure decreased from 22 to 12 mm Hg. Pathology revealed pericardial fibrosis. The patient experienced sustained resolution of his heart failure. A potential explanation for lack of CP criteria was the presence of hypertensive heart disease. CP needs to be considered when approaching patients with heart failure as diagnostic evaluation can be multifaceted and treatment curative.


Assuntos
Insuficiência Cardíaca/etiologia , Pericardiectomia , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/cirurgia , Idoso , Técnicas de Diagnóstico por Cirurgia , Humanos , Masculino , Pericardite Constritiva/complicações
20.
J Laparoendosc Adv Surg Tech A ; 26(9): 730-3, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27467856

RESUMO

INTRODUCTION: Disorder of sexual development (DSD) is a rare condition. The surgical treatment of these patients includes investigation of the internal genitalia, evaluation of the gonads, and if necessary gonadectomy. The prevention of germ cell tumors is the most important issue in the surgical treatment of this varied and special group of patients. This study aimed to evaluate the role of laparoscopy in the surgical treatment of patients with DSD. MATERIALS AND METHODS: Over a 4-year-period, all patients presenting with DSD who underwent laparoscopic surgery at our institution were retrospectively reviewed. Operative procedure, age at the time of surgery, and histopathological results were evaluated. In addition, karyotypes and phenotypes were investigated. RESULTS: Altogether, 12 patients undergoing 14 laparoscopic procedures were included. Median age at the time of surgery was 6 years with a range from 9 months to 17 years. Explorative laparoscopy was performed in all patients. In seven children, laparoscopic gonadectomy was necessary. Histopathologic examination revealed germ cell tumors in four children. In two patients, a gonadoblastoma was identified; in two patients, a dysgerminoma was found. Inguinal exploration was performed in four patients and led to removal of gonadal remnants in one case and gonadopexy in three cases. In two patients presenting with repeated urinary tract infections, laparoscopic removal of an utriculus was performed. CONCLUSIONS: Laparoscopic gonadal biopsy, gonadopexy, and gonadectomy can be performed successfully, even in patients with germ cell tumors. To define guidelines for the surgical treatment of patients with DSD, further prospective and multicenter studies are necessary.


Assuntos
Transtornos do Desenvolvimento Sexual/cirurgia , Disgerminoma/cirurgia , Gonadoblastoma/cirurgia , Laparoscopia/métodos , Neoplasias Embrionárias de Células Germinativas/cirurgia , Adolescente , Criança , Pré-Escolar , Técnicas de Diagnóstico por Cirurgia , Transtornos do Desenvolvimento Sexual/genética , Disgerminoma/diagnóstico , Disgerminoma/patologia , Feminino , Gonadoblastoma/diagnóstico , Gonadoblastoma/patologia , Humanos , Lactente , Cariótipo , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Orquiectomia , Ovariectomia , Fenótipo , Estudos Retrospectivos
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