RESUMEN
PURPOSE: To correlate the expression of E-cadherin and beta-catenin with alterations of expression of Smad4 in advanced colorectal cancer (CRC). METHODS: Tissue specimens from 75 colorectal cancer cases (Dukes stage C and D) were tested for Smad4, E-cadherin and beta-catenin by the Avidin-Biotin immunoperoxidase method. The results were correlated with patients' clinicopathological parameters. RESULTS: Smad4 expression was lost or reduced in roughly 1 out of every 3 Dukes C and D CRCs. Association of Smad4 expression with other clinicopathological parameters was not noted. Association of expression of E-cadherin with other clinicopathological parameters was not noted, apart from tumor location. Expression of beta-catenin was not associated with clinicopathological parameters. Lack of expression of Smad4 was associated with lack of expression of both E-cadherin (<0.000) and beta-catenin (p<0.000). As regards the relation between E-cadherin and beta-catenin, the expression of each seemed to parallel the expression of the other (p<0.000). Beta-catenin was overexpressed in 68.5% of the specimens studied. CONCLUSION: Clinically advanced CRC is associated with a reduced or complete lack of expression of Smad4. Ecadherin and beta-catenin are expressed in parallel with each other and also with Smad4. This tumor suppressor role of Smad4 by affecting both E-cadherin and beta-catenin may indicate a novel pathway for metastatic tumor via cellular reshaping. The precise underlined mechanism(s) and the clinical significance of these findings remain to be determined.
Asunto(s)
Cadherinas/análisis , Neoplasias Colorrectales/química , Proteína Smad4/análisis , beta Catenina/análisis , Anciano , Neoplasias Colorrectales/patología , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor of cutaneous origin of intermediate grade malignant potential. The incidence of DFSP is 0.1% of all cancers and 1% of all soft tissue sarcomas. We present the case of a 65years old female with a palpable, painful mass on the right thigh. A surgical excision of the lesion was done and the histopathology, as well as the immunohistochemical analysis with CD-34, confirmed the diagnosis of DFSP. Two years later, the patient is free of disease and no local recurrences or metastases have been found. Wide radical excision is the preferred surgical method for therapy of DFSP without distant metastasis. Furthermore, DFSP resists to conventional chemotherapy and radiation therapy, while, in cases of metastasis, therapy depends on cytogenesis and molecular biology of the tumor, so new therapeutic strategies are under research.
Asunto(s)
Dermatofibrosarcoma/patología , Dermatofibrosarcoma/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Anciano , Antígenos CD34/metabolismo , Biomarcadores de Tumor/metabolismo , Dermatofibrosarcoma/metabolismo , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Neoplasias de los Tejidos Blandos/metabolismo , Muslo , Resultado del TratamientoRESUMEN
Carcinoid tumors are malignancies originating from neuroendocrine cells, most commonly encountered in the gastrointestinal tract, in a rate of 64%, with the majority affecting the ileum. Certain genetic syndromes sometimes include carcinoid tumors in their phenotype. These malignancies may be rather asymptomatic, although occasionally they behave aggressively. They are typically diagnosed due to the effects of a locally advanced disease, or when producing symptoms because of hormone secretion (carcinoid syndrome). A better understanding of their molecular biology and behavior is demanded so that these tumors to be diagnosed precociously and managed effectively.
Asunto(s)
Tumor Carcinoide/diagnóstico , Tumor Carcinoide/terapia , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/terapia , Intestino Delgado/patología , Antineoplásicos Hormonales/uso terapéutico , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/metabolismo , Biomarcadores de Tumor/orina , Tumor Carcinoide/tratamiento farmacológico , Tumor Carcinoide/epidemiología , Tumor Carcinoide/cirugía , Diagnóstico Diferencial , Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias Gastrointestinales/tratamiento farmacológico , Neoplasias Gastrointestinales/epidemiología , Neoplasias Gastrointestinales/cirugía , Salud Global , Humanos , Incidencia , Síndrome Carcinoide Maligno/diagnóstico , Síndrome Carcinoide Maligno/terapia , Octreótido/uso terapéutico , Rumanía/epidemiologíaRESUMEN
BACKGROUND: The introduction of foreign bodies into the rectum is not an uncommon medical problem. The phenomenon has increased in the homosexual population. In a 25-year period we have encountered 34 patients with retained rectal foreign bodies. MATERIAL AND METHODS: We have performed five laparotomies due to perforation and a laparotomy in order to retrieve a large wooden object. RESULTS: We have observed only one complication in a woman who developed a retrovaginal fistula. CONCLUSIONS: In order to obtain successful extraction of the foreign body the surgeon, apart from the well-known techniques, must exercise a high degree of ingenuity. Finally, it should be emphasized that the appropriate respect should be shown to all patients who seek treatment for this problem.
Asunto(s)
Cuerpos Extraños/cirugía , Laparotomía/métodos , Recto , Adulto , Anciano , Tacto Rectal , Femenino , Cuerpos Extraños/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Radiografía Abdominal , Estudios Retrospectivos , Sigmoidoscopía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
Adenocarcinoid arising in the vermiform appendix is a rarity. The diagnosis of appendiceal adenocarcinoma has never been made preoperatively and is frequently an incidental finding at the time of operation for unrelated conditions. Because of the rarity of the disease, its natural history is poorly understood. Benefits from adjuvant radiation, chemotherapy, or a combination have not been reported. Most studies emphasize survival outcome based on surgical technique. There are few data and, consequently, much debate on the appropriate management of these lesions. The aim of this article is to review this entity and to assess and report new data, through a study of the literature.
Asunto(s)
Adenocarcinoma , Apendicectomía , Neoplasias del Apéndice , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Adenocarcinoma/cirugía , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/epidemiología , Neoplasias del Apéndice/cirugía , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/epidemiología , Tumor Carcinoide/cirugía , Humanos , Hallazgos Incidentales , Pronóstico , Resultado del TratamientoRESUMEN
Superior mesenteric artery syndrome is extremely rare and is characterized by postprandial epigastric pain, nausea, vomiting and loss of appetite, with subsequent weight loss, which aggravates the condition of the patients. The syndrome is caused by compression of the third part of the duodenum in the angle between the aorta and the superior mesenteric artery. This review updates etiology, epidemiology, diagnosis, treatment and outcome of the superior mesenteric artery syndrome. Superior mesenteric artery syndrome is clearly defined and frequently associated with a wide range of predisposing conditions and surgical procedures.
Asunto(s)
Síndrome de la Arteria Mesentérica Superior , Dolor Abdominal/etiología , Anorexia/etiología , Diagnóstico Diferencial , Duodenostomía , Nutrición Enteral/métodos , Humanos , Yeyunostomía , Náusea/etiología , Síndrome de la Arteria Mesentérica Superior/diagnóstico , Síndrome de la Arteria Mesentérica Superior/etiología , Síndrome de la Arteria Mesentérica Superior/terapia , Resultado del Tratamiento , Vómitos/etiología , Pérdida de PesoRESUMEN
The main goal of the paper is to clarify anthelminthic treatment as an alternative hydatic cyst therapy, its indications and contraindications. Chemotherapy constitutes a non-invasive treatment and is less limited by the patient's status than surgery or PAIR. Many investigators have employed benzoimidazole carbonates for the management of human hydatid disease. Both, albendazole and mebendazole have, a favourable effect in patients suffering from multiorgan and multicystic disease, in inoperable primary liver or lung echinococcosis, and they can also prevent secondary echinococcosis. Chemotherapy is contraindicated for large cysts that are at risk to rupture and for inactive or calcified cysts. The main adverse events are related to changes in liver enzyme levels. The best efficacy is observed with liver, lung, and peritoneal cysts. Certain various factors influence the therapeutic results of medical treatment. The vast majority of the recurring cysts show good susceptibility to re-treatment.
Asunto(s)
Albendazol/uso terapéutico , Antihelmínticos , Equinococosis/tratamiento farmacológico , Echinococcus granulosus/efectos de los fármacos , Mebendazol , Albendazol/administración & dosificación , Albendazol/efectos adversos , Animales , Antihelmínticos/administración & dosificación , Antihelmínticos/efectos adversos , Antihelmínticos/uso terapéutico , Equinococosis/parasitología , Humanos , Mebendazol/administración & dosificación , Mebendazol/efectos adversos , Mebendazol/uso terapéutico , Prevención Secundaria , Resultado del TratamientoRESUMEN
Insulinomas are functional endocrine tumors originating from the pancreatic b-cells. In 1902 Nicholls described the first adenoma of pancreatic islets, while the first insulinoma was described in 1927 in Mayo Clinic, which was dissected two years later in 1929 in Toronto. The first enucleation of insulinoma took place in a St. Jouis hospital in 1931, and after four years, in 1935, Whipple described the classic diagnostic triad: symptoms of fasting hypoglycemia or fatigue, blood glucose levels under 50 mg/dl and disappearance of symptoms after glucose administration.
Asunto(s)
Insulinoma/diagnóstico , Tumores Neuroendocrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Enfermedades Raras , Diagnóstico Diferencial , Historia del Siglo XX , Humanos , Hipoglucemia/etiología , Insulinoma/epidemiología , Insulinoma/historia , Insulinoma/cirugía , Tumores Neuroendocrinos/epidemiología , Tumores Neuroendocrinos/historia , Tumores Neuroendocrinos/cirugía , Pancreatectomía , Neoplasias Pancreáticas/epidemiología , Neoplasias Pancreáticas/historia , Neoplasias Pancreáticas/cirugía , Prevalencia , Enfermedades Raras/diagnóstico , Enfermedades Raras/epidemiología , Enfermedades Raras/historia , Enfermedades Raras/cirugía , Rumanía/epidemiología , Resultado del TratamientoRESUMEN
The anatomophysiological integrity of the pelvic floor and anorectum contributes to the important function of continence and defecation. A variety of causes can cause damage in the anatomy and/or the innervation of the pelvic floor muscles as well as in anorectal sensitivity or stool consistency leading to anorectal continence disorder and incontinence. The most common cause of anorectal incontinence is related to injury of the sphincter muscles after delivery, or anorectal surgery. Anorectal incontinence is a complex problem, often of multifactorial origin. The exact cause of its incidence is unknown. However, the incidence is approximately 2% in the general population and 25-60% in the elderly. Although the condition is considered a problem in the elderly, it is becoming apparent that people are frequently affected from a much younger age. Anorectal incontinence is a severe disability and a major social problem as it produces a feeling of insecurity and pushes the patient towards social isolation. Management of the incontinent patient may be conservative (medicinal, biofeedback training), surgical (sphincter repair, pelvic floor repair, neosphincter formation, artificial sphincter or stoma) or use sacral nerve stimulation. The successful treatment of anorectal incontinence depends on accurate diagnosis of its cause, which is achieved by a thorough patient assessment including patient history, physical examination and selective specialized investigations. A stoma is the final resort when all other therapeutic attempts have failed.
Asunto(s)
Incontinencia Fecal/etiología , Incontinencia Fecal/cirugía , Canal Anal/cirugía , Terapia por Estimulación Eléctrica , Incontinencia Fecal/fisiopatología , Humanos , Diafragma Pélvico/cirugíaRESUMEN
The modern tendency of surgery is to perform a constantly rising number of operations under local anaesthesia. Superficial parotidectomy under local anaesthesia has not been widely attempted. However only few reports show that this kind of procedure could be feasible. If this is the case, standard assessment of benign parotid tumors will change radically.
Asunto(s)
Anestesia Local/métodos , Procedimientos Quirúrgicos Orales/métodos , Enfermedades de las Parótidas/cirugía , Adenoma Pleomórfico/cirugía , Adolescente , Adulto , Anciano , Anestésicos Locales/farmacología , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Parótida/cirugía , Satisfacción del Paciente , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Gallstone ileus representing 1-4% of all bowel obstructions cholelithiasis. Impaction of a gallstone in the human of the bowel is a surgical emergency. Relief of the obstruction is the treatment of choice, but controversy exists regarding the repair of the fistula and cholecystectomy. Our experience in the management of gallstone ileus is presented in the following article.
Asunto(s)
Fístula Biliar/cirugía , Cálculos Biliares/cirugía , Ileus/cirugía , Laparoscopía , Anciano , Anciano de 80 o más Años , Fístula Biliar/diagnóstico , Fístula Biliar/etiología , Colecistectomía Laparoscópica/métodos , Femenino , Estudios de Seguimiento , Cálculos Biliares/complicaciones , Cálculos Biliares/diagnóstico , Humanos , Ileus/diagnóstico , Ileus/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The case of a patient, victim of a car accident, with rupture of the left adrenal gland associated with splenic rupture and liver laceration is reported. Injury of the adrenal glands is most frequently caused by blunt abdominal trauma and is usually associated with injuries of other abdominal organs. Careful exploration of the upper retroperitoneal space where adrenals are located is considered necessary during laparotomy for severe blunt abdominal trauma. If adrenal lesion has been overlooked continuous hemorrhage may occur, which could be lethal if not promptly treated.
Asunto(s)
Traumatismos Abdominales/cirugía , Glándulas Suprarrenales/lesiones , Hemorragia/etiología , Traumatismo Múltiple/cirugía , Heridas no Penetrantes/cirugía , Accidentes de Tránsito , Glándulas Suprarrenales/cirugía , Adrenalectomía , Adulto , Femenino , Humanos , Hígado/lesiones , Hígado/cirugía , Rotura , Rotura del Bazo/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Vibrio vulnificus is a Gram-negative pathogen which is found in seawater and shellfish during warm months and can cause local infections in healthy individuals or septicemia in patients with chronic liver disease. MATERIALS-METHODS: Clinical and laboratory records of four complicated cases are presented, with a 4.2 mean year follow-up. RESULTS: Three patients underwent urgent leg amputation because of of irreversible necrotic changes with septic complications and failure of incisional drainage to control the infection. Another one patient underwent only excision of necrotic soft tissue but he developed calcaneus osteomyelitis after three years of the initial fish bone injury. DISCUSSION: Clinicians must maintain a high index of suspicion, especially in regions endemic for vibrio necrotising fasciitis and antibiotic prophylaxis must be given to swimmers before or during bathing.
Asunto(s)
Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Pie , Vibriosis/diagnóstico , Vibriosis/terapia , Vibrio vulnificus/aislamiento & purificación , Adolescente , Adulto , Anciano , Amputación Quirúrgica , Animales , Antibacterianos/uso terapéutico , Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/epidemiología , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/cirugía , Femenino , Peces , Grecia/epidemiología , Humanos , Pierna , Extremidad Inferior , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Vibriosis/tratamiento farmacológico , Vibriosis/epidemiología , Vibriosis/cirugíaRESUMEN
Hydatid disease is an endemic zoonosis caused by the cestode Echinococcus granulosus. The most common affected organs are the liver and the lungs. Echinococcal cyst located in the subcutaneous tissue constitutes an extremely rare manifestation of the hydatid disease. Here we present a case report with a cystic mass in the subcutaneous tissue of the left gluteal area, diagnosed as being a hydatid cyst.
Asunto(s)
Nalgas/diagnóstico por imagen , Enfermedades del Tejido Conjuntivo/parasitología , Equinococosis/parasitología , Tejido Subcutáneo/parasitología , Anciano , Nalgas/parasitología , Nalgas/cirugía , Enfermedades del Tejido Conjuntivo/diagnóstico por imagen , Enfermedades del Tejido Conjuntivo/cirugía , Equinococosis/diagnóstico por imagen , Equinococosis/cirugía , Humanos , Masculino , Tejido Subcutáneo/diagnóstico por imagen , Tejido Subcutáneo/patología , Tejido Subcutáneo/cirugía , UltrasonografíaRESUMEN
Hydatid disease constitutes an endemic zoonosis caused by different species of the cestode Echinococcus. The main organs affected are the liver and the lungs. Echinococcosis of the urinary tract is an extremely rare medical condition, met in 2-4% of cases. This pathologic entity has to be included in the differential diagnosis of occupying lesions of the urinary tract at any age, especially among patients in endemic areas. Meticulous laboratory and imaging control when taking into consideration the suspicion for the disease, can guarantee an accurate diagnosis and successful outcome.
Asunto(s)
Equinococosis/diagnóstico , Equinococosis/terapia , Echinococcus , Infecciones Urinarias/parasitología , Animales , Antinematodos/uso terapéutico , Diagnóstico Diferencial , Equinococosis/tratamiento farmacológico , Equinococosis/cirugía , Echinococcus/clasificación , Humanos , Enfermedades Renales/parasitología , Nefrectomía , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapiaRESUMEN
Mammary candidiasis is a disease with significant impact on breast feeding. Early diagnosis and treatment is essential for successful long-term breastfeeding. It constitutes however a significantly rare breast inflammatory entity. A case of a young woman with breast candidiasis properly diagnosed and treated in our clinic is reported.
Asunto(s)
Enfermedades de la Mama/microbiología , Enfermedades de la Mama/terapia , Lactancia Materna , Candidiasis/diagnóstico , Candidiasis/terapia , Adulto , Antifúngicos/uso terapéutico , Enfermedades de la Mama/diagnóstico , Enfermedades de la Mama/tratamiento farmacológico , Enfermedades de la Mama/cirugía , Candidiasis/tratamiento farmacológico , Candidiasis/cirugía , Femenino , Fluconazol/uso terapéutico , Humanos , Pezones/microbiología , Resultado del TratamientoRESUMEN
Cytomegalovirus infection of the gastrointestinal tract of normal hosts is very rare. On the other hand, this is a common cause of morbidity in immunocompromised hosts. Herein we describe the case of a 52-year-old male who underwent a gastrectomy due to a severe gastrointestinal hemorrhage. Histological examination showed the characteristic cytomegalovirus inclusion bodies. The diagnosis was confirmed with immunohistochemistry and his immune system revealed no abnormality. We believe that, although it is very rare, cytomegalovirus infection should be kept in mind for non-immunocompromised patients with upper gastrointestinal bleeding or multiple gastric ulcers.
Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/metabolismo , Hemorragia Gastrointestinal/diagnóstico , Tracto Gastrointestinal/microbiología , Antivirales/uso terapéutico , Infecciones por Citomegalovirus/complicaciones , Gastrectomía/métodos , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Inmunoglobulina G/química , Inmunohistoquímica/métodos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Spigelian hernia is a relatively rare defect of the abdominal wall. Due to its unspecific and variable clinical presentation, presents a difficult diagnostic challenge. We present a rare case of bilateral Spigelian hernia that was diagnosed and successfully treated with open surgery and hernioplasty. Also we present our experience in management of the disease. In our department the last fifteen years, 12 cases of Spigelian hernia have been treated surgically, using direct reconstruction with excellent results.
Asunto(s)
Hernia Ventral/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hernia Ventral/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
In most cases of echinococcal disease the liver is the mainly affected organ. The clinical manifestations are defined by the size and the localization of the hydatid cyst. The appearance of complications, such as purulence and rupture of the cyst, aggravate the patients' clinical condition. Intrabiliary rupture, although rare, carries severe health risks; timely diagnosis and appropriate management of this entity are vital for the patient's survival.
Asunto(s)
Conductos Biliares Intrahepáticos , Enfermedades de las Vías Biliares/etiología , Equinococosis Hepática/complicaciones , Animales , Enfermedades de las Vías Biliares/diagnóstico , Enfermedades de las Vías Biliares/terapia , Procedimientos Quirúrgicos del Sistema Digestivo , Equinococosis Hepática/diagnóstico , Equinococosis Hepática/terapia , Humanos , Rotura Espontánea , Resultado del TratamientoRESUMEN
This article deals with the dilemma of the surgeon to choose the optimal surgical procedure in case of coexistence of ischiorectal abscess and a rectal carcinoma. The case of a patient suffering from ischiorectal abscess in association with rectal carcinoma is reported.