RESUMEN
Although their overall incidence is low, GISTs are distinctive subgroup of gastrointestinal mesenchymal tumors which express CD117 or platelet derived growth factor receptor alpha (PDGFRA). Considered as rare digestive cancers, tumors like schwannomas, neurofibromas, gastrointestinal leiomiomas are now reclassified as GIST based on immunohistochemistry studies. GIST are more frequent in stomach (40-70%), small bowel (20-40%), colon (5-15%), meanwhile locations such as mesentery, omentum, retro peritoneum in less of 5%. 10 GIST patients were surgically managed during 2004-2009. 5 gastric and 5 small bowel GIST. Most with symptomatic disease: palpable tumor, abdominal pain, anemia, fatigue, superior digestive hemorrhage or occlusion. Imagistic diagnosis consisted of: barium swallow, abdominal sonography, CT and PET-CT. Confirmation was made by hystopathological exam and immunohistochemistry. All patients had more or less wide surgical resections. For some patients there was also a specific adjuvant treatment. All patients survived after surgery. The principle of surgery for GIST is RO resection of the tumor. Tumor rupture or R1 resection of the primary tumor has a negative impact on disease free survival. Some patients (great volume tumors, R1 or R2 resection) had adjuvant treatment. Imatinib mesylate and derivates showed a significant improvement of recurrence free survival with one condition: permanent treatment. Surgery remains the mainstay of treatment in patients with localized, resectable GIST. Recurrence rate of 17-21% and 5 years survival rate of 48-70%, even in resectable GIST, impose an adjuvant treatment.
Asunto(s)
Neoplasias Duodenales , Tumores del Estroma Gastrointestinal , Neoplasias del Íleon , Neoplasias del Yeyuno , Recurrencia Local de Neoplasia , Neoplasias Gástricas , Anciano , Antineoplásicos/uso terapéutico , Benzamidas , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/terapia , Femenino , Gastrectomía , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/terapia , Humanos , Neoplasias del Íleon/diagnóstico , Neoplasias del Íleon/terapia , Mesilato de Imatinib , Neoplasias del Yeyuno/diagnóstico , Neoplasias del Yeyuno/terapia , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/terapia , Pancreatectomía , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Enfermedades Raras , Estudios Retrospectivos , Esplenectomía , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Resultado del TratamientoRESUMEN
For some patients, reflux disease means also duodenogastric, as well as gastroesophageal reflux; they may suffer because of duodenoesophageal reflux. For these patients, a simple surgical restoration of the cardial competence may prove to be insufficient; on the contrary, an indirect approach, using vagotomy and duodenal diversion may be a good therapeutical option in selected cases. In our hands, total duodenal diversion has already proven to be a good technical solution for the surgical treatment of the postoperative reflux disease, so we decided to expand its first choice indications to hiatal hernia cases, in the presence of duodenoesophageal reflux. Therefore, our study presents the results of the first 7 cases, operated on since 1995. No case had been gastric operated before, but 4/7 had already suffered a cholecystectomy. Duodenoesophageal reflux is discussed: etiopathogenesis related to surgical approach, using standard antireflux surgery (failures of the hiatal techniques and their causes) or total duodenal diversion (technical aspects, antireflux efficiency, secondary functional effects, pros and cons, therapeutical indications).
Asunto(s)
Reflujo Duodenogástrico/cirugía , Duodeno/cirugía , Reflujo Gastroesofágico/cirugía , Hernia Hiatal/cirugía , Adulto , Anciano , Reflujo Duodenogástrico/diagnóstico , Femenino , Fundoplicación/métodos , Reflujo Gastroesofágico/diagnóstico , Hernia Hiatal/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Pseudomyxoma peritonei (PMP) is an uncommon clinical entity, lacking a precisely defined etiopathogenesis. Its clinical features are not specific and diagnosis is difficult. We analysed 10 patients, all of them women, whom we had treated surgically in combination with intraperitoneal chemotherapy. Postoperative complications had been minimal and no death had occurred. 5 patients were followed up in time, 4 of them presenting a favourable evolution (2 required reintervention), and 1 patient decreased. We analysed up-to-date therapeutic approaches and the benefit of their combinations in order to identify the optimal therapeutic strategy. We consider that the combinations surgery + intraperitoneal chemotherapy or surgery + intracavitary radiotherapy are the most effective up to date.
Asunto(s)
Neoplasias Peritoneales/diagnóstico , Seudomixoma Peritoneal/diagnóstico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Femenino , Humanos , Cuidados Intraoperatorios , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/cirugía , Seudomixoma Peritoneal/tratamiento farmacológico , Seudomixoma Peritoneal/patología , Seudomixoma Peritoneal/cirugía , Estudios RetrospectivosRESUMEN
Primary repair of the abdominal wall and the cure of incisional hernias using the relon mono-filamentous fibres (N.I. 2402/76) Confronted with long lasting parietal suppurations which are entertained by the classic nylon poly-filamentous fibres, suppurations that cannot be avoided unless the above fibres are removed on one hand assuming the risk of a possible subsequent incisional hernias and on the other hand because of the relative elevated price of the mono-filamentous fibres brought from abroad, within the last years (from 1982) we have utilised the relon mono-filamentous fibre (N.I. 2402/76) in abdominal wall reconstruction (initially for the surgical cure of the incisional hernias and there after in primary abdominal wall reconstruction when there were factors predisposing to a possible subsequent parietal for septic contamination, in overweight patients, immune-compromised patients, in patients following steroid therapy, chemotherapy, etc. Our present experience extends over more than 1000 patients who have undertook a surgical procedure.
Asunto(s)
Músculos Abdominales/cirugía , Caprolactama/análogos & derivados , Hernia Umbilical/cirugía , Hernia Ventral/cirugía , Polímeros , Complicaciones Posoperatorias/cirugía , Suturas , Adulto , Apendicitis/complicaciones , Apendicitis/cirugía , Femenino , Humanos , Persona de Mediana Edad , Peritonitis/complicaciones , Peritonitis/cirugía , Recurrencia , ReoperaciónRESUMEN
Two cases of abdominal fibromatosis are followed-up in two brothers patients development, each of them having a peculiar development. First of them underwent operation for a huge abdominal tumor with a retroperitoneal origin and intraperitoneal development which needed a complex partial resection with first jejunal loop enterectomy. The other patient had first surgery for fibrosarcoma of nuchal area and after that he underwent an operation for superior digestive haemorrhagia as a result of antral gastric fibroid tumor with transverse colic and mezocolic extension, which needed gastro-colectomy. The patients father was followed up for tangible abdominal tumors, but he rejected the proposed coeliotomia. The two brothers patients had a good postoperative development. The examination of the charriotype showed anomalies of the short branch of the 21st and 22nd chromosome (which are still normal).