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1.
Br J Haematol ; 112(3): 637-40, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11260065

RESUMEN

Sixty-one consecutive patients undergoing splenectomy for chronic immune thrombocytopenia were retrospectively evaluated. Platelet response was considered as complete (CR) when platelet count rose to > 100 x 109/l, partial (PR) when 30-100 x 109/l or absent (NR) if otherwise. Follow-up (mean time 7.6 years) was possible in 54 patients. Forty-eight patients (88%) had an immediate response to splenectomy (39 CR, 9 PR) whereas six (12%) were NR. Thirty-six responders (67%) had sustained remission (31 CR; 5 PR) without further treatment; thrombocytopenia recurred in 12 patients (33%). The probability curve of continued remission showed a constant relapse-rate during the first 36 months; a further step of relapse was observed beginning 70 months after surgery. The only positive predictive factor for the long-term response to splenectomy was age < 40 (P < 0.005). Neither duration of thrombocytopenia nor previous response to medical treatment (steroids and/or intravenous immunoglobulins) were related to splenectomy response.


Asunto(s)
Púrpura Trombocitopénica Idiopática/cirugía , Esplenectomía , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/sangre , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
2.
Chir Ital ; 53(6): 821-6, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11824057

RESUMEN

The aim of this study was to evaluate the use of laparostomy in the management of patients with severe abdominal infections. From June 1992 to December 2000 sixty patients with severe peritonitis were treated with laparostomy and studied retrospectively. Thirty-eight had post-operative peritonitis. Twelve patients had necrotic pancreatitis. Five patients had peritonitis due to ischemic colitis. Two patients had hemoperitoneum following multiple abdominal operations, and three patientshad severe wound dehiscence. The APACHE II score was used to determine the severity of patients' condition. The median age was 46 years, the mean APACHE II score was 19.7, and the observed mortality was 38.3%. The incidence of spontaneous fistulation of the exposed loop of intestine was 13.3%. In 11 patients abdominal wall closure was accomplished by primary intention. Incisional hernias were inevitable in the rest of patient and were repaired 1 years after surgery. Laparostomy is a good way to manage patients with severe peritonitis but it should be performed before irreversible septic shock and subsequent multi organ failure develop.


Asunto(s)
Peritonitis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritoneo/cirugía , Complicaciones Posoperatorias/epidemiología , Índice de Severidad de la Enfermedad , Procedimientos Quirúrgicos Operativos
3.
Tumori ; 83(4): 779-82, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9349322

RESUMEN

We report the case of a 65-year-old man who developed a symptomatic splenomegaly due to spleen metastasis from thyroid follicular carcinoma. In 1982, at the age of 53, the patient had undergone a thyroid lobectomy for a cold node, followed one year later by a second intervention for a microfollicular adenoma. He was subsequently administered thyroid suppressive therapy with no further follow-up. The diagnosis of spleen metastases from thyroid cancer was first suspected on the basis of history, high serum thyroglobulin (Tg) levels, and the presence of pulmonary 99Tc uptake. The patient underwent a splenectomy, during which vast infiltration involving the diaphragm, spleen, stomach, colon and pancreas, was found. Histological and immunohistochemical results showed that the spleen and diaphragm metastases derived from thyroid follicular carcinoma. Radioiodine uptake by the pulmonary metastases confirmed the thyroid source. Retrospective re-evaluation of the thyroid tissue removed in 1983 revealed a histological pattern consistent with follicular carcinoma, which could not be unequivocally attributed to the widely or minimally invasive form. To our knowledge this is the first report of splenomegaly as the first manifestation of thyroid cancer metastases. In this paper cases of splenomegaly due to metastatic spread are reviewed and the management of the present case is discussed.


Asunto(s)
Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/secundario , Neoplasias del Bazo/diagnóstico , Neoplasias del Bazo/secundario , Esplenomegalia/etiología , Neoplasias de la Tiroides/patología , Adenocarcinoma Folicular/patología , Anciano , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias del Bazo/patología , Esplenomegalia/patología
4.
Minerva Chir ; 52(9): 1053-5, 1997 Sep.
Artículo en Italiano | MEDLINE | ID: mdl-9432579

RESUMEN

The incidence of lipomas of the colon is difficult to evaluate due to lack of symptoms. They are often discovered by chance during endoscopic or radiological examination and sometimes display only obstructive symptoms. A barium enema may be useful for the preoperative diagnosis of lipoma of the colon. The difficulty of obtaining a clear preoperative diagnosis influences the type of surgical treatment undertaken. Thus, a resection is often preferred to the simple removal of the lipoma by colotomy or endoscopy.


Asunto(s)
Neoplasias del Colon/cirugía , Lipoma/cirugía , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/diagnóstico por imagen , Colonoscopía , Colostomía , Femenino , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía
5.
Ital J Gastroenterol ; 28(4): 220-4, 1996 May.
Artículo en Inglés | MEDLINE | ID: mdl-8842838

RESUMEN

A 60-year-old female with a history of chronic pancreatitis and previous pancreaticojejunostomy has been submitted to distal gastric resection for recurrent perforating ulcers. A carcinoid tumour was identified in the surgical specimen. Hypergastrinaemia was subsequently diagnosed and tumour localization was carried out by a new scintigraphic technique with 111In-Pentetreotide. The tumour was found to be a metastasis confined to a peripancreatic lymph node. Surgery was successful, and 6 months later the patient is still eugastrinaemic. The different imaging methods for the identification of gastrinomas are discussed together with the current therapeutic options.


Asunto(s)
Neoplasias Duodenales/diagnóstico por imagen , Gastrinoma/diagnóstico por imagen , Gastrinoma/secundario , Radioisótopos de Indio , Neoplasias Pancreáticas/diagnóstico por imagen , Somatostatina/análogos & derivados , Tomografía Computarizada de Emisión de Fotón Único , Neoplasias Duodenales/secundario , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Neoplasias Pancreáticas/patología
8.
Dis Colon Rectum ; 30(8): 647-9, 1987 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-3622172

RESUMEN

The papillotomy knife, introduced by an endoscope, was employed to treat stenosis following stapler anastomosis, and to cut the stenotic ring in three points along its circumference.


Asunto(s)
Enfermedades del Colon/cirugía , Endoscopía , Enfermedades del Recto/cirugía , Engrapadoras Quirúrgicas/efectos adversos , Constricción Patológica/cirugía , Humanos
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