ABSTRACT
An extremely rare renal hybrid tumor composed of papillary renal cell carcinoma (PRCC) and renal oncocytoma (RO) within the same tumor is described. Only eight previous cases are documented in the literature.A 44-year-old man showed a 3.5 cm renal mass composed by areas with tubulo-papillary structures made up with small cells with scanty cytoplasm adjacent to polygonal cells forming solid sheet and tubules with abundant eosinophilic cytoplasm and uniform, round central nuclei without mitoses. Complete immunohistochemical panel suggested a diagnosis of type 1 PRCC combined with RO. Contrary to previous cases of hybrid renal tumors reported in the literature, no pseudocapsule divided the two histotypes of tumors. Our patient is the youngest among the previous reports being 44.Collision tumours have previously been described, although mixed renal tumours composed of oncocytoma and PRCC is extremely rare. There is no evidence to suggest a relationship between oncocytoma and papillary RCC since they originate from different cells and have different prognoses.Given the possibility of oncocytomas to harbour other tumours, we suggest careful examination of the samples to exclude the presence of an associated malignant neoplasm, which might have a significantly worse prognosis than oncocytoma. Differential diagnosis is needed, and immunohistochemical stains are of great help in distinguishing between the two histological components.
Subject(s)
Adenoma, Oxyphilic , Carcinoma, Renal Cell , Kidney Neoplasms , Neoplasms, Multiple Primary , Adenoma, Oxyphilic/diagnosis , Adenoma, Oxyphilic/pathology , Adult , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/pathology , Diagnosis, Differential , Humans , Immunohistochemistry , Kidney Neoplasms/diagnosis , Kidney Neoplasms/pathology , Male , PrognosisABSTRACT
Los trastornos de la conducta alimentaria (TCA) son patologías de salud mental complejas, caracterizados por una alteración persistente del comer o del comportamiento relacionado con la alimentación. El objetivo de este estudio fue determinar el riesgo de TCA en adolescentes de diferentes tipos de establecimientos educacionales de la ciudad de Concepción, Chile. La muestra fue constituida por estudiantes de 7mo año básico a 4to año de enseñanza media, cuyo rango de edad fue de 13 a 18 años, pertenecientes a establecimientos educacionales municipalizados, particular subvencionados y particular, de la ciudad de Concepción. Para determinar riesgo de TCA, se empleó el instrumento de Test de Actitudes Alimentarias (EAT-40), junto a ello se realizaron mediciones de peso y talla para calcular el Índice de Masa Corporal. La muestra final comprendió 1056 estudiantes, de los cuales 37,5% eran hombres y 62,5% eran mujeres. El riesgo de desarrollar un TAC fue de 16,1%, siendo mayor en mujeres (21,8%) en relación con los hombres (6,6%) (p<0.001). Se evidenció mayor riesgo de TCA en mujeres con estado nutricional con sobrepeso (27,7%) y en hombres con estado nutricional de obesidad (14,7%). Al evaluar riesgo de TCA por tipo de establecimientos educacionales, se observan diferencias, pero sin resultados significativos (p 0,2008). Es relevante contar con políticas públicas que permitan abordar y acompañar a los adolescentes en riesgo de desarrollar un TCA(AU)
Eating disorders are complex mental health illnesses, characterized by irregular eating habits or behavior related to food. The purpose of this study was to determine the risk of eating disorders in adolescents from different educational establishments in the city of Concepción. The sample was constituted by students of seventh grade of basic education to fourth year of secondary, whose age range was from 13 to 18, belonging to public, subsidized and private educational establishments in the city of Concepción. To determine the risk of eating disorder, the Eating Attitudes (EAT-40) was used, and weight and height were measured to calculate body mass index. The final sample was composed of 1056 students, of which 37,5% were men and 62,5% women. The risk of developing an eating disorder was 16,1%, being higher in women (21,8%) in relation to men (6,6%) (p <0,001). It was demonstrated a higher risk of TCA in overweight women (27, 7%) and men with obesity (14, 7%). In assessing risks of TCA per type of educational establishments there were some differences but without significant results (p 0, 2008). It is essential to have public policies that allow the approach and accompany adolescents at risk of developing a disorder of eating behavior(AU)
Subject(s)
Humans , Male , Female , Adolescent , Feeding and Eating Disorders/parasitology , Affective Symptoms , Adolescent Nutrition , Diet, Food, and Nutrition , Diet, HealthySubject(s)
Leprosy/history , Leprosy/pathology , History, Medieval , Humans , Italy , Leprosy/mortality , Mycobacterium leprae/pathogenicitySubject(s)
Aorta, Abdominal/surgery , Blood Vessel Prosthesis/adverse effects , Femoral Artery/surgery , Ileum/injuries , Vascular Surgical Procedures/adverse effects , Humans , Ileum/diagnostic imaging , Iliac Artery/surgery , Male , Middle Aged , Tomography, X-Ray Computed , Vascular Grafting/adverse effects , Vascular Grafting/instrumentation , Vascular Grafting/methods , Vascular Surgical Procedures/methodsABSTRACT
Sterile haemorrhagic cystitis (SHC) is a known risk of cyclophosphamide treatment; however, most canine reports are case series. This case-control study examined risk factors for SHC in dogs with lymphoma receiving oral cyclophosphamide. Twenty-two dogs with SHC and 66 control dogs were identified. On univariate analysis, SHC risk factors included age (P = 0.041), induction protocol (P = 0.021) and cumulative cyclophosphamide dose (P = 0.002). On multivariate analysis, increasing cumulative cyclophosphamide dose was associated with increased risk of SHC and the 'short' induction protocol (protocol 1) was associated with decreased risk. Controlling for age and induction protocol, odds of SHC increased by 2.21 per 750 mg m(-2) increase in cyclophosphamide dose (P = 0.001). SHC from oral cyclophosphamide is a predominately delayed toxicity resulting from high cumulative doses.
Subject(s)
Antineoplastic Agents, Alkylating/adverse effects , Cyclophosphamide/adverse effects , Cystitis/veterinary , Dog Diseases/drug therapy , Dog Diseases/etiology , Hemorrhage/veterinary , Administration, Oral , Animals , Antineoplastic Agents, Alkylating/therapeutic use , Case-Control Studies , Cyclophosphamide/therapeutic use , Cystitis/chemically induced , Dogs , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Hemorrhage/chemically induced , Lymphoma/drug therapy , Lymphoma/veterinary , Male , Multivariate Analysis , Pennsylvania , Risk Factors , Schools, VeterinaryABSTRACT
Near-infrared spectroscopy (NIRS) is an optical imaging technique for medical applications, able to monitor the variation of hemoglobin saturation into the tissues. The NIR photon passes through the biological tissue following a path similar to a more or less complex split. The NIR absorption of photons is proportional to the concentration of chromophores (pigments that absorb the light in the spectral region of interest). NIRS probes are used as the light source on the same side of the source receiver, being this last able to capture the photons after their journey into the tissues. The NIRS methodology may be applied as an imaging technique for various organs. In this review the authors describe the use of NIRS for the continuous monitoring of regional cerebral oxygen saturation in the course of cardiovascular surgical procedures. Thanks to the NIRS technique, changes in cerebral oximetry can be monitored continuously during cardiovascular surgery. A desaturation greater than 20% of baseline or an rSO2 absolute value less than 50%, are associated with a reduction of the cortical somatosensory evoked potentials and an increase of neurological damage and / or cognitive impairment. During carotid surgery, reduction and / or asymmetries of rSO2 value are encountered in the course of intraoperative clamping causing cerebral hypoperfusion. Instead, rSO2 increase may predict hyperperfusion syndrome after carotid stenting or endarterectomy. Cerebral hyperperfusion syndrome is rare, but often fatal once it has established. The NIRS may represent an added value in those patients. The NIRS is also applied during surgery performed with cardiopulmonary bypass, including aortic arch surgery with cardiocirculatory arrest. Continuous monitoring of any changes in cerebral rSO2 allows a rapid treatment in the aim to improve the psycho-neurological outcome of patients undergoing this type of surgery.
Subject(s)
Cardiac Surgical Procedures , Cerebrovascular Circulation , Monitoring, Intraoperative/methods , Oximetry/methods , Spectroscopy, Near-Infrared , Brain Chemistry , Brain Damage, Chronic/prevention & control , Evoked Potentials, Somatosensory , Humans , Hypoxia-Ischemia, Brain/diagnosis , Hypoxia-Ischemia, Brain/prevention & control , Intraoperative Complications/diagnosis , Intraoperative Complications/prevention & control , Oxyhemoglobins/analysis , Postoperative Complications/prevention & control , Spectroscopy, Near-Infrared/instrumentation , Spectroscopy, Near-Infrared/methodsSubject(s)
Blood Vessel Prosthesis Implantation , Coronary Artery Bypass , Coronary Artery Disease/surgery , Lower Extremity/blood supply , Peripheral Vascular Diseases/surgery , Aorta/surgery , Coronary Artery Disease/complications , Femoral Artery/surgery , Humans , Peripheral Vascular Diseases/complications , Sternotomy , Treatment OutcomeABSTRACT
Treatment of ascending aortic aneurysm, without involvement of aortic sinuses of Valsalva, is usually treated by tube graft interposition. Nowadays, many alternative techniques were described. The technique of resection and end-to-end anastomosis has been already described both by our group and by other authors as well. This report will focus on some surgical details of this technique based on a ten-year-experience. The preoperative study of candidates amenable to undergo this technique has to be completed by a computed tomography-scan of thoracic aorta. The ideal candidate has an elongated aorta in the antero-lateral wall. As a consequence, the heart is usually displaced inferiorly and toward a more horizontal plane. The aortotomy is done circumferentially one and half cm above the aortic commissures. A wide wedge resection of the aortic wall is performed. The resected aortic wall is wider in the anterior part than in the posterior. A very accurate hemostasis of the fat tissue close to the pulmonary artery is achieved by diathermy. The amount of wedge resection is mainly dictated by the elongation of the aortic wall. In authors' experience it usually ranges between 4 and 6 cm anteriorly and 1 cm posteriorly. The suture of the two stumps is performed by a running suture. The technique described has extensively been used; up today 136 patients undergo. According to authors' opinion this technique can be a useful alternative to the tube graft interposition in selected patients.
Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Anastomosis, Surgical , Humans , Vascular Surgical Procedures/methodsABSTRACT
We present images of a chest CT scan of an 89-year-old man, showing an area of localised dissection in the convexity of the aortic arch. The ascending and descending aorta were not involved in the disease. The patient suffered a stroke, with severe neurological impairment. Differential diagnosis was undertaken.
Subject(s)
Aorta, Thoracic , Aortic Aneurysm/complications , Aortic Dissection/complications , Stroke/etiology , Acute Disease , Aged, 80 and over , Aortic Dissection/diagnosis , Aortic Aneurysm/diagnosis , Diagnosis, Differential , Humans , Male , Stroke/diagnosis , Tomography, X-Ray ComputedABSTRACT
Chest wall fractures, including injuries of the sternum, usually heal spontaneously without specific treatment. However sometimes, they need surgical treatment. To treat these patients the selection criteria often are subjective in spite of many surgical devices for sternal osteosynthesis are available nowadays. One of the most recent device is the Synthes-Titanium Sternal Fixing System, usually used to treat post-sternotomy dehiscence. We describe the case of a 67-year-old man with previous history of chest trauma presenting to our institution with chronic transverse sternal fracture. We describe the pre-operative study, stressing the particular role of the CT scan and a surgical approach by an alternative use of the Synthes.
Subject(s)
Bone Plates , Fracture Fixation, Internal/methods , Fractures, Bone , Sternum/injuries , Tomography, X-Ray Computed/methods , Accidents, Traffic , Aged , Chronic Disease , Follow-Up Studies , Fracture Healing , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Humans , Imaging, Three-Dimensional , Male , Sternum/diagnostic imaging , Thoracic Injuries , Time Factors , TitaniumSubject(s)
Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Aorta , Heart Valve Prosthesis Implantation/methods , Polyethylene Terephthalates , Aged , Aneurysm, False/etiology , Cardiac Surgical Procedures/methods , Heart Valve Prosthesis Implantation/adverse effects , Humans , Male , Prosthesis Design , Radiography , Reoperation , Treatment OutcomeABSTRACT
Pericardial cysts are an uncommon benign congenital anomaly in the middle mediastinum. They are thought to result from failure of fusion of one of the mesenchymal lacunae that form the pericardial sac. The authors present the case of a 77-year-old-man with a large pericardial cyst, treated by surgical resection trough a median sternotomy. They analyze the different diagnostic alternatives and the various management options in this pathology. In the reported case the authors used a surgical resection trough a median sternotomy, to facilitate the exposure of all of the cyst, extending around the great vessels area, and on the other side of the chest.
Subject(s)
Mediastinal Cyst/surgery , Sternum/surgery , Aged , Humans , Incidental Findings , Male , Mediastinal Cyst/diagnosis , Treatment OutcomeABSTRACT
AIM: Trauma of the thoracic aorta for blunt trauma shows a very high incidence of mortality. Hospital mortality rate after aortic open surgery is between 15% and 30%. Endovascular management represents an alternative treatment Associated lesions are usually seen in those critical patients. Hemothorax may be present. The authors propose a combined treatment of endovascular repair for the aortic lesion and video-assisted thoracoscopy surgery (VATS) for the treatment of chest bleeding complications. METHODS: The authors report a series of three patients with post-traumatic aortic lesion and hemothorax. In two patients endovascular procedure was first performed, followed by VATS, few days later, for retained hemothorax. In the third patient the two procedures were performed at the same time because of the patient's critical conditions. RESULTS: There was technical success of stent-graft placement in all the treated cases. No postoperative mortality. No postoperative paraplegia. No VATS converted to thoracotomy. The postoperative follow-up time range between 10 and 19 months. CONCLUSION: Considering the relatively short procedural time and minimally invasive approach of both techniques, the concomitant use of them may represent an alternative to standard open surgery in cases of thoracic aorta lesions associated with hemothorax. Those procedures may be performed sequentially or together in emergency cases with intra-thoracic more active bleeding to exclude or to treat intra thoracic bleeding.
Subject(s)
Aorta, Thoracic/injuries , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Hemothorax/surgery , Stents , Thoracic Injuries/surgery , Thoracic Surgery, Video-Assisted , Accidental Falls , Accidents, Traffic , Adolescent , Aged , Angiography , Aortic Aneurysm, Thoracic/etiology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Image Processing, Computer-Assisted , Male , Minimally Invasive Surgical Procedures , Radiography, Thoracic , Thoracic Injuries/diagnostic imaging , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
AIM: The authors discuss tumor histological type, TNM staging and time of first occurrence of lung cancer, as well as related cardiovascular diseases, underlining type of treatment, surgical timing, surgical mortality, post-surgical complications and potentially additional therapies. METHODS: A total of 189 patients underwent surgery for non-small cell lung cancer (NSCLC) (Stage I-II), 35 (17.5%) of which presented with surgically relevant concurrent cardiovascular disease (8 coronary artery disease, 4 carotid stenosis, 8 obstructing artery disease, 15 aortic aneurysm). In most cases, surgical timing provides for cardiovascular disease treatment completion first, followed by lung resection only afterwards. Alternatively, concomitant cardiovascular and lung cancer treatment averts the need for repeated surgery, even though the intraoperative complications rate is higher, as long as patients are hemodynamically stabile. RESULTS: No remarkable surgical mortality was observed; stay in hospital ranged from 8 to 18 days. A 5-year follow-up was carried out in only 95/189 patients; 11/18 (61%) with concurrent cardiovascular disease and 46/77 (59%) with lung cancer alone are still alive. CONCLUSIONS: In 17% of cases, surgical treatment by the simultaneous and the differentiated approach for cancer and cardiovascular disease proved essential; comorbidity as an identifier of the strong correlation between the two diseases had a major impact on prognosis.
Subject(s)
Carcinoma, Non-Small-Cell Lung/epidemiology , Cardiovascular Diseases/complications , Lung Neoplasms/epidemiology , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/surgery , Cardiovascular Diseases/surgery , Comorbidity , Female , Humans , Italy/epidemiology , Length of Stay , Lung Neoplasms/complications , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
UNLABELLED: Lipomatous hypertrophy of the interatrial septum is a rare benign cardiac disorder characterised by the accumulation of adipose tissue; data from several post mortem surveys report how the disorder represents 0.6% of all benign cardiac tumours. Generally asymptomatic, it frequently constitutes an incidental post mortem finding. The disorder may at times lead to a pumping deficit associated to congestive heart failure or determine an abnormal heart rhythm leading even to sudden death. Lipomatous hypertrophy can at times lead to problems in differential diagnosis of the disorder from other tumours or heart diseases. Surgical removal produces excellent short and long-term RESULTS: We describe a case of lipomatous hypertrophy of the interatrial septum associated to coronary disease diagnosed by means of transesophageal echocardiography. The diagnostic and treatment techniques applied are discussed and a literature review is done.
Subject(s)
Heart Neoplasms/diagnosis , Heart Septum , Lipoma/diagnosis , Diagnosis, Differential , Echocardiography, Transesophageal , Heart Atria , Heart Neoplasms/surgery , Humans , Lipoma/surgery , Male , Middle Aged , Treatment OutcomeABSTRACT
In this study the anti-angiogenic action of a novel non-peptide RGDS-analog named RAM was tested in vitro and in vivo. RAM inhibited FGF-2-induced chemotaxis by 80% in an adhesion-independent way. Further, it induced HUVEC-apoptosis in collagen-seeded HUVEC, indicating that such pro-apoptotic effect was adhesion-independent. In vivo studies revealed that RAM inhibited FGF-2 induced angiogenesis by 60% in the mouse Matrigel-assay and in the chicken-egg chorion-allantoic membrane assay. Finally, RAM was markedly more stable in serum as compared to the template RGDS and after 24 h incubation in 100% serum was significantly more active than RGDS. Taken together these results show that RAM exerts anti-chemotactic and pro-apoptotic effects, by an unexpected adhesion-independent mechanism, as we have recently shown for the template RGDS molecule [Blood 103 (2004) 4180], and has in vivo relevant anti-angiogenic properties, with marked stability in serum; therefore, RAM represents a novel promising anti-angiogenic molecule.
Subject(s)
Angiogenesis Inhibitors/pharmacology , Neovascularization, Physiologic/drug effects , Oligopeptides/pharmacology , Angiogenesis Inhibitors/chemistry , Animals , Apoptosis/drug effects , Cell Adhesion/drug effects , Cell Movement/drug effects , Cells, Cultured , Chick Embryo , Drug Stability , Endothelium, Vascular/cytology , Endothelium, Vascular/drug effects , Humans , Male , Mice , Mice, Inbred C57BL , Oligopeptides/chemistryABSTRACT
Mexilitine is an anti-arrhythmic agent used to treat neuropathic pain. The drug has a low side-effect profile with gastritis as the predominant complaint. The following two cases suggest that mexilitine can potentially cause persistent ophthalmic changes and should be used with caution in chronic pain patients with preexisting ocular disease.
ABSTRACT
BACKGROUND AND OBJECTIVES: Voltage-sensitive calcium channel conductance is essential for the nervous system to signal a painful event. However, intrathecal administration of L-type calcium channel blockers does not provide analgesia. The present investigation was designed to assess the safety and analgesic efficacy of ziconotide, a new N-type calcium channel blocker, when administered intrathecally to patients with acute postoperative pain. METHODS: This randomized, double-blind, pilot study included patients undergoing elective total abdominal hysterectomy, radical prostatectomy, or total hip replacement. After intrathecal injection of local anesthetic and before surgical incision, a continuous intrathecal infusion of either placebo or 1 of 2 doses of ziconotide (0.7 microg/h or 7.0 microg/h) was started and continued for 48 to 72 hours postoperatively. Primary and secondary efficacy variables were the mean daily patient controlled analgesia (PCA) morphine equivalent consumption and visual analog pain intensity (VASPI) scores, respectively. RESULTS: Thirty patients received study drug; 26 were evaluable for efficacy. Mean daily PCA morphine equivalent consumption was less in patients receiving ziconotide than in placebo-treated patients, and the difference was statistically significant between 24 and 48 hours (P = .040). VASPI scores during the first 8 hours postoperatively were markedly lower in ziconotide-treated than in placebo-treated patients. In 4 of 6 patients receiving the high-dose of ziconotide (7 microg/h), adverse events, such as dizziness, blurred vision, nystagmus, and sedation contributed to study drug being discontinued after 24 hours. After ziconotide discontinuation, these symptoms resolved. CONCLUSIONS: Ziconotide showed analgesic activity, as shown by decreased PCA morphine equivalent consumption and lower VASPI scores. Because of a favorable trend of decreased morphine consumption with an acceptable side-effect profile in the low-dose ziconotide group, 0.7 microg/h may be closer to the ideal dose than 7 microg/h. Large-scale studies are required to clarify this issue.
Subject(s)
Calcium Channel Blockers/therapeutic use , Calcium Channels, N-Type/metabolism , Pain, Postoperative/drug therapy , omega-Conotoxins/therapeutic use , Acute Disease , Adult , Aged , Aged, 80 and over , Analgesia, Patient-Controlled , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Arthroplasty, Replacement, Hip , Calcium Channel Blockers/administration & dosage , Calcium Channel Blockers/adverse effects , Calcium Channels, N-Type/drug effects , Double-Blind Method , Female , Humans , Injections, Spinal , Male , Middle Aged , Morphine/administration & dosage , Morphine/therapeutic use , Pain Measurement , Pilot Projects , omega-Conotoxins/administration & dosage , omega-Conotoxins/adverse effectsABSTRACT
Eight patients (4 men, 4 women), mean age 51 years, referred to our Institution for left atrial myxoma underwent removal of the tumor through a superior transseptal approach. All patients in sinus rhythm with normal conduction time. The myxomas were localized in the fossa ovalis (3 cases), interatrial septum (2 cases), left appendage (2 cases), and mitral annulus (1 case). One patient died in hospital after emergency operation for low-output syndrome complicated by septic shock. All other patients had an uneventful postoperative course. Atrial arrhythmias did not represent a major postoperative complication. Transient PR interval elongation was occasionally seen. Electrophysiological studies showed normal sinus node function. At 6 months following operation, patients were evaluated with transesophageal echocardiography. There was no tumor recurrence. There were no episodes of arrhythmia in 24-hour electrocardiographic monitoring, and all patients were in NYHA Class I. We believe that the superior transseptal approach gives optimal exposure of the left atrial cavity, overcoming all difficulties related to a small left atrium which is an usual pattern in left atrial myxomas.