ABSTRACT
AIM: The authors signal a case of gastric polypoid signet ring cell carcinoma, of particular interest for its rarity like show from the review of the literature, which is the first to have been described after Tabaru's citation. METHODS: The study has been carried out at the Department of Surgical and Oncological Sciences of the University of Palermo. It has been based on 2000 cases analysed from June 2001 to December 2003. RESULTS: The authors advance some and emphasizes the diagnostic flow chart and therapeutic choices adopted. CONCLUSIONS: We agree that the endoscopic polypectomy is surgical procedure of first approach, but modifying the therapeutic guideline in relation to histologic examination, like happened in the case in issue.
Subject(s)
Carcinoma, Signet Ring Cell , Polyps , Stomach Neoplasms , Adult , Age Factors , Aged , Aged, 80 and over , Biopsy , Carcinoma, Signet Ring Cell/diagnosis , Carcinoma, Signet Ring Cell/epidemiology , Carcinoma, Signet Ring Cell/pathology , Carcinoma, Signet Ring Cell/surgery , Chi-Square Distribution , Endoscopy , Female , Humans , Immunohistochemistry , Male , Middle Aged , Polyps/diagnosis , Polyps/epidemiology , Polyps/pathology , Polyps/surgery , Practice Guidelines as Topic , Prevalence , Sex Factors , Stomach Neoplasms/diagnosis , Stomach Neoplasms/epidemiology , Stomach Neoplasms/pathology , Stomach Neoplasms/surgeryABSTRACT
BACKGROUND: The surgical approach to a cirrhotic patient is conditioned by a number of variables depending on the emergency and kind of the intervention. It is also related to the evolutionary stage of the liver pathology (evaluated following Child-Pugh score). The present study will explore the physiopathologic mechanisms which should be correlated with the preoperative risk factors responsible for the variation of morbidity and mortality of the hepatopathic patient addressed to an extrahepatic surgical intervention. METHODS: This study includes a retrospective analysis (from 1992 to 1999) of 40 patients with cirrhosis (80% HCV correlated cirrhosis, 15.5% alcoholic cirrhosis, 2.5% cryptogenic cirrhosis), who underwent such procedures as: colon resection (5), gastrectomy (4), hernioplasty (11), cholecystectomy (14), ulcorraphy (3), laparotomy (3). Patients with hepatic resection and portal shunt are excluded from this study. A pre- and postoperative evaluation of ascites, PT, APTT, albumin, bilirubin and protein value, number of leukocytes and Child-Pugh score was performed on all patients. Their follow-up was 30 days. RESULTS: The presence of tensive ascites, low albumin value, PT, APTT, together with the emergency of the operation, proved to be significant (p<0.001), in correlation with a mortality of 7.1% in Child's class A, of 23% in class B, and of 84% in class C. CONCLUSIONS: Cirrhotic patients undergoing elective or emergency surgery can incur significant preoperative risks and postoperative complications, increasing their mortality rate. An accurate preoperative predictive factor is Child's class.
Subject(s)
Digestive System Surgical Procedures/statistics & numerical data , Intraoperative Complications/etiology , Liver Cirrhosis/complications , Postoperative Complications/etiology , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/mortality , Elective Surgical Procedures/statistics & numerical data , Emergencies , Female , Hernia, Inguinal/surgery , Humans , Intraoperative Complications/epidemiology , Intraoperative Complications/prevention & control , Male , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Preoperative Care , Prognosis , Severity of Illness IndexABSTRACT
Three case reports are presented concerning permanent maxillary molars with fusion of two buccal roots. The morphology is peculiar because it is characterized by the mesiobuccal canal merging into the distobuccal canal in their apical one-third. A thorough review of the literature failed to reveal any previously reported description of permanent maxillary molars with this arrangement of canals, with the exception of a recently reported epidemiological study.
