ABSTRACT
Two cases of diffuse malignant mesothelioma of abdominal cavity were analysed. These tumors arise from the peritoneum and are also found in the parietal and visceral pleura, pericardium and in vaginal tunic. All of them, infra or supra-diaphragmatic, are associated with asbestos exposure in at least 80% of cases. It is difficult to explain how inhaled asbestos induces peritoneal neoplasms. This aspects become very important in the diagnostic, basically why it is done at laparotomy or laparoscopy. When was proceed the biopsy of the lesions, and occasionally by identification of malignant mesothelial cells in ascitic fluid. In this two cases exposed considerations about the advanced phase of diagnostic are made, the diagnostic was performed in the majority of the collected cells, showing the advanced stage of the disease. At that time of diagnosis we observed poor evolution. We call attention to the importance of precancer diagnosis, the best chance to treatment options, always based on surgical resections, radiation or chemotherapy alone or combined. If the radical surgery is not possible, this patients must be treated by chemotherapy or radiotherapy, defined after complete staging of the disease.
Subject(s)
Mesothelioma/diagnosis , Peritoneal Neoplasms/diagnosis , Aged , Asbestos/adverse effects , Carcinogens/adverse effects , Humans , Magnetic Resonance Imaging , Male , Mesothelioma/chemically induced , Middle Aged , Peritoneal Neoplasms/chemically induced , Tomography, X-Ray ComputedABSTRACT
The authors report two rare pancreatic tumor cases (Frantz's tumor), which were in different evolutionary stages, emphasizing the complexity of a precise anatomopathologic diagnosis and an aggressive surgical approach, whenever possible because the excellent prognosis. They also discuss the clinical manifestation and histological origin, as well as the prognosis factors and a new approach for the liver metastasis.
Subject(s)
Pancreatic Neoplasms , Adolescent , Female , Humans , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/therapy , PrognosisABSTRACT
Hepatorenal syndrome was observed in 25% of the patients with end stage liver disease. In this situation they stayed longer time in intensive unit treatment, hemodialysis. This evolution was observed in 67% of them with this complication after surgery. In this report we describe three patients with hepatorenal syndrome reversible after liver transplant. We define the form of management of these patients after surgery, regard treatment with cyclosporine A, only 72 h after surgery, without administration of aminoglycosides and amphoterycin. This good evaluation also depends of absence of arterial hypotension or infection episodes during and after surgery. It also depends of the good conditions of the implanted liver.
Subject(s)
Cyclosporine/therapeutic use , Hepatorenal Syndrome/surgery , Liver Cirrhosis/complications , Liver Transplantation , Adult , Female , Hepatorenal Syndrome/blood , Hepatorenal Syndrome/etiology , Humans , Male , Middle Aged , Postoperative CareABSTRACT
Transjugular intrahepatic portosystemic shunts (TIPS) represents a new surgical technique minimally invasive utilized in the treatment of portal hypertension. Such technique avoid the risks of general anesthesia, and major surgery like portocava anastomosis, reducing the hepatic-portal gradient, and help bleeding esophagogastric varices, hemorrhagic congestive gastropathy and refractary ascites. Certainly diminishes the intensity of intraperitoneal colorectal circulation and the necessity of blood transfusion during surgery for liver transplantation. In this report we reported the first case in Brazil of the implant of TIPS like preparation for liver transplantation in cirrhotic alcoholic patient. We made consideration about techniques aspects and surgery evolution. This new interesting technique applied for this type of patients is indicated as a bridge for candidates for liver transplantation.
Subject(s)
Liver Cirrhosis, Alcoholic/surgery , Liver Transplantation , Portasystemic Shunt, Transjugular Intrahepatic , Adult , Humans , Intraoperative Care , Male , Postoperative PeriodABSTRACT
Infected pancreatic necrosis was diagnosed clinically and radiologically in a patient admitted for acute pancreatitis. As free gas in the pancreatic area was recognized, antibiotic therapy (ceftriaxone) was empirically introduced, while surgical drainage was being planned. After the second week, the patient rapidly started to improve, to the point that he could be discharged home without operation. Control CT-scans and general laboratory tests, at this phase and later on, confirmed a still enlarged gland but free of infection or ongoing inflammation. Cholelithiasis, which had been identified in an early ultrasound scan, was electively treated by cholecystectomy 2 mo after the onset of pancreatitis, in the absence of sepsis, and with uneventful recovery. This case illustrates the rare possibility of spontaneous regression of infected necrotic pancreatitis, without any type of operation or nonoperative drainage.
Subject(s)
Bacterial Infections/physiopathology , Ceftriaxone/therapeutic use , Pancreas/pathology , Pancreatitis/physiopathology , Acute Disease , Aged , Bacterial Infections/pathology , Humans , Male , Necrosis , Pancreatitis/drug therapy , Pancreatitis/pathology , Remission, Spontaneous , Tomography, X-Ray ComputedABSTRACT
O numero de opcoes para derivacao do esofago obstruido e grande, talvez porque nenhuma delas preenche totalmente os requisitos necessarios para cada caso. E analisada uma destas opcoes, que e o tubo gastrico isoperistaltico (TGI), sendo salientado, entre suas qualidades, a manutencao da continuidade esofago-gastrica, a facil cicatrizacao de seus tecidos e a extensao que podem alcancar. Considera-se, por estes motivos, o TGI em derivacao bem indicado para pacientes com neoplasias obstrutivas do terco medio e superior do esofago toracico, consideradas irresecaveis, que mantem condicoes minimas de operabilidade. Sao descritos os pormenores tecnicos adotados na sua execucao e as operacoes complementares necessarias.