RESUMEN
Anastomotic leak after gastrointestinal surgery is a severe complication associated with relevant short and long-term sequelae. Most of the anastomoses are currently performed with a surgical stapler that is required to have appropriate characteristics in order to guarantee good performances. The aim of our study was to evaluate, ex vivo, pressure resistance and tensile strength of anastomosis performed with different circular staplers available in the market. We studied 7 circular staplers of 3 different companies, 3 of them used for gastrointestinal anastomosis and 4 staplers for hemorrhoidal prolapse excision. A total of 350 anastomoses, 50 for each of the 7 staplers, were performed using healthy pig fresh intestine, then injected saline solution and recorded the leaking pressure. There were no statistically significant differences between the mean pressure necessary to induce an anastomotic leak in the various instruments (p>0.05). For studying tensile strength, we performed a total of 350 anastomoses with 7 different circular staplers on a special strong paper (Tyvek), and then recorded the maximal tensile force that could open the anastomosis. There were statistically significant differences between one brand stapler vs other 2 companies staplers about the strength necessary to open the staple line (p<0.05). In conclusion, we demonstrated that different circular staplers of three companies available in the market give comparable anastomotic pressure resistance but different tensile strengths. This is probably due to different technical characteristics.
Asunto(s)
Anastomosis Quirúrgica/instrumentación , Engrapadoras Quirúrgicas , Resistencia a la Tracción , Animales , Procedimientos Quirúrgicos del Sistema Digestivo , Masculino , Presión , PorcinosAsunto(s)
Antibacterianos/uso terapéutico , Desbridamiento/métodos , Elefantiasis/complicaciones , Meningomielocele/complicaciones , Choque Séptico/terapia , Adulto , Angiografía , Elefantiasis/diagnóstico , Humanos , Masculino , Meningomielocele/diagnóstico , Pronóstico , Choque Séptico/diagnóstico , Choque Séptico/etiología , Tomografía Computarizada por Rayos XRESUMEN
Gold nanoshells, with a silica core and different core and shell dimensions, have been extensively investigated. Optical far-field properties, namely extinction and absorption, have been separately determined by means of spectrophotometry and photoacoustic spectroscopy, respectively, in the 440-900 nm range. The enhancement factor for surface-enhanced Raman scattering, which is related to near-field effects, has been measured from 568 to 920 nm. The absorption contribution to extinction decreases as the overall diameter increases. Moreover, absorption and scattering display different spectral distributions, the latter being red shifted. The Surface Enhanced Raman Scattering enhancement profile, measured using thiobenzoic acid as a Raman probe, is further shifted to the red. The latter result suggests that the enhancement is dominated by the presence of hot spots, which are possibly related to the surface roughness of gold nanoshell particles.
Asunto(s)
Oro/química , Nanocáscaras/química , Técnicas Fotoacústicas , Espectrometría Raman , Ácido Benzoico/química , Nanocáscaras/ultraestructuraRESUMEN
PURPOSE: Procalcitonin (PCT) is a biomarker used to help sepsis diagnosing and monitoring and guide antibiotic therapy. Anastomotic leak (AL) after colorectal surgery is a severe complication associated with relevant short- and long-term sequelae. The aim of our study is to assess the predictive value of PCT levels to early diagnose AL after colorectal surgery. METHODS: Between September 2011 and September 2012, a series of 99 patients underwent colorectal surgery in our institution. In all cases, white blood cell (WBC) count, C-reactive protein (CRP), and PCT levels were measured in first, third, and fifth postoperative day (POD). Anastomotic leaks and all other postoperative complications were recorded. RESULTS: We registered 7 ALs (7.1%). Decreased PCT levels had a significant negative predictive value (NPV) for AL in third and fifth POD (96.7% and 96.7%, respectively), compared with CRP and WBC. The best diagnostic performance was obtained with the combination of PCT and CRP measurements in third and fifth POD (area under the curve, 0.87 and 0.94, respectively). In 5th POD, PCT improves diagnosis, but not in a statistically significant way (area under the curve, 0.86). CONCLUSIONS: Compared with more established biochemical values such as CRP and WBC, PCT is an earlier, more sensitive, and reliable marker of AL. Increased PCT levels in early PODs after colorectal surgery may provide a more effective way to detect AL, before clinical symptoms appear. Moreover, normal PCT values might be also a useful marker to facilitate a safe and early discharge of selected patients after colorectal surgery.
Asunto(s)
Fuga Anastomótica/diagnóstico , Calcitonina/sangre , Precursores de Proteínas/sangre , Anciano , Área Bajo la Curva , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Péptido Relacionado con Gen de Calcitonina , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Recuento de Leucocitos , Masculino , Periodo Posoperatorio , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: The subendocardial viability ratio (SEVR), calculated by pulse wave analysis, is an index of myocardial oxygen supply and demand. Here we analyze the relation between SEVR and cardiovascular mortality in the chronic kidney disease (CKD) population of a post hoc analysis of a multicenter, prospective, randomized, nonblinded study. METHODS: We studied 212 consecutive asymptomatic outpatients receiving care at 12 nephrology clinics in south Italy. Inclusion criteria were age >18 years, 6 months of follow-up before the enrollment and stage 3-4 CKD. RESULTS: During follow-up, 34 subjects died, 29 of them for cardiovascular causes. SEVR correlated inversely with vascular calcifications (r = -0.37) and myocardial mass (r = -0.45); SEVR changed from 1.33 ± 0.24 to 1.36 ± 0.16 (p = NS; baseline and final values, respectively) in living patients, and from 1.16 ± 0.31 to 0.68 ± 0.26 in deceased patients (p < 0.001). Kaplan-Meier curves show that that a greater reduction of SEVR values during the study (third tertile) significantly predicts cardiovascular mortality (p < 0.0001). CONCLUSIONS: This post hoc analysis shows that a reduction of SEVR values impacts cardiovascular mortality in CKD patients.
Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Análisis de la Onda del Pulso , Insuficiencia Renal Crónica/complicaciones , Anciano , Enfermedades Cardiovasculares/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
OBJECTIVE: Advanced glycation end-products (AGEs) and pulse wave velocity (PWV) are pivotal indices of the processes of arterial ageing and damage accumulation. The aim of the present study was to investigate the impact of AGEs, as measured by a non-invasive skin autofluorescence method, on arterial stiffness, estimated by PWV, in two different age groups of non-diabetic subjects. METHODS AND PATIENTS: A total of 116 non-diabetic subjects were classified into two groups, with 55 subjects in the group aged < 65 years and 61 in the group aged ≥ 65 years. AGEs were measured by skin autofluorescence while carotid-femoral PWV was assessed by tonometry. RESULTS: A significant (positive) association was observed between PWV and AGE skin autofluorescence in the younger age group (r = 0.51; P < 0.0001). However, this association was no longer significant after further adjustments for age and other factors on multiple regression analyses. In contrast, this correlation was not found in the elderly group (r = 0.098; P = 0.454). CONCLUSION: Younger non-diabetic subjects exhibit a different correlation profile between AGEs accumulated in skin and cfPWV as an index of arterial stiffness compared with elderly subjects. AGEs were significantly associated with cfPWV in younger individuals, but not in the elderly. A further study with a larger number of subjects is proposed to confirm the contribution of AGEs, the formation of which is manageable, as a determinant of arterial stiffness in younger subjects.
Asunto(s)
Arterias/fisiopatología , Productos Finales de Glicación Avanzada/análisis , Imagen Óptica , Piel/patología , Rigidez Vascular , Factores de Edad , Anciano , Análisis de Varianza , Elasticidad , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Flujo Pulsátil , Piel/irrigación sanguínea , Piel/química , Estadísticas no Paramétricas , Resistencia VascularRESUMEN
PURPOSE: To investigate pain and other complications following inguinal hernioplasty performed by the Lichtenstein technique with mesh fixation by fibrin glue or sutures. METHODS: Five hundred and twenty patients were enrolled in this 12-month observational multicenter study and received either sutures or fibrin glue (Tissucol(®)/Tisseel(®)) based on the preference of the surgeon. Pain, numbness, discomfort, recurrence, and other complications were assessed postoperatively and at 1, 3, 6, and 12 months. Pain intensity was assessed by a visual analog scale (VAS; 0 [no pain] to 10 [worst pain]). RESULTS: One hundred and seventy-one patients received sutures and 349 received fibrin glue. During the early postoperative phase, 87.4% of patients in the fibrin glue group and 76.6% of patients in the sutures group were complication-free (P = 0.001). Patients who received fibrin glue were also less likely to experience hematoma/ecchymosis than those in the suture group (both P = 0.001). The mean pain score was significantly lower in the fibrin group than the sutures group (2.5 vs. 3.2, P < 0.001). At 1 month, significantly fewer patients in the fibrin glue group reported pain, numbness, and discomfort compared with patients in the sutures group (all P < 0.05). Fibrin glue patients also experienced less intense pain (0.6 vs. 1.2; P = 0.001). By 3 months, the between-group differences had disappeared, except for numbness, which was more prevalent in the sutures group. By 12 months, very few patients reported complications. CONCLUSIONS: Tissucol fibrin glue for mesh fixation in the Lichtenstein repair of inguinal hernia shows advantages over sutures, including lower incidence of complications such as pain, numbness, and discomfort, and should be considered as a first-line option for mesh fixation in hernioplasty.
Asunto(s)
Adhesivo de Tejido de Fibrina/efectos adversos , Hernia Inguinal/cirugía , Hipoestesia/etiología , Dolor Postoperatorio/etiología , Mallas Quirúrgicas , Suturas/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Adhesivo de Tejido de Fibrina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Recurrencia , Estadísticas no Paramétricas , Adulto JovenRESUMEN
BACKGROUND: The aim of the present study was to establish whether elevated carotid-femoral pulse wave velocity (c-fPWV), an indicator of aortic stiffness, assessed before surgery, is correlated with variations in arterial pressure (AP) during induction of anaesthesia in elderly patients undergoing non-cardiovascular surgery. METHODS: c-fPWV was measured with the PulsePen(®) device during pre-surgical anaesthetic evaluation. Monitoring included electrocardiography, pulse oximetry, non-invasive AP, heart rate, bispectral index (BIS), and oxygen concentration during induction of anaesthesia with propofol and remifentanil. Anaesthesia was induced so as to maintain BIS values between 40 and 50. RESULTS: Forty-five patients, aged [mean (sd)] 71.1 (5.8) yr, were studied. The mean value of c-fPWV was 12.1 (3.9) m s⻹. There was no correlation between hypotension during anaesthesia induction and total dosage or rate of administration of propofol or remifentanil. In univariate analysis, only age and PWV significantly correlated with the decreases in AP, and the association between c-fPWV and a decrease in AP was also seen in multivariate analysis (r = 0.36, P< 0.05). Patients classified as having 'high stiffness' (c-fPWV ≥ 12.9 m s⻹) had 25% further decrease in systolic AP during anaesthesia induction than those with lower PWV [75.2 (5.7) vs 60.2 (4.2) mm Hg, P < 0.05]. CONCLUSIONS: Increased aortic stiffness, as assessed by PWV measured during preoperative anaesthetic evaluation, is associated with more pronounced hypotension during induction of anaesthesia. Measurement of aortic stiffness in the elderly may thus represent a valid indicator of the risk of hypotension during anaesthesia induction.
Asunto(s)
Aorta/fisiopatología , Hipotensión/diagnóstico , Complicaciones Intraoperatorias/diagnóstico , Resistencia Vascular/fisiología , Anciano , Anestesia General/métodos , Artroplastia de Reemplazo de Cadera , Velocidad del Flujo Sanguíneo/fisiología , Arteria Carótida Común/fisiopatología , Femenino , Arteria Femoral/fisiopatología , Humanos , Masculino , Manometría/métodos , Persona de Mediana Edad , Monitoreo Intraoperatorio/métodos , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Flujo Pulsátil/fisiología , Factores de RiesgoRESUMEN
Arterial stiffness, estimated by pulse wave velocity (PWV), is an independent predictor of cardiovascular mortality and morbidity. However, the clinical applicability of these measurements and the elaboration of reference PWV values are difficult due to differences between the various devices used. In a population of 50 subjects aged 20-84 years, we compared PWV measurements with three frequently used devices: the Complior and the PulsePen, both of which determine aortic PWV as the delay between carotid and femoral pressure wave and the PulseTrace, which estimates the Stiffness Index (SI) by analyzing photoplethysmographic waves acquired on the fingertip. PWV was measured twice by each device. Coefficient of variation of PWV was 12.3, 12.4 and 14.5% for PulsePen, Complior and PulseTrace, respectively. These measurements were compared with the reference method, that is, a simultaneous acquisition of pressure waves using two tonometers. High correlation coefficients with the reference method were observed for PulsePen (r = 0.99) and Complior (r = 0.83), whereas for PulseTrace correlation with the reference method was much lower (r = 0.55). Upon Bland-Altman analysis, mean differences of values +/- 2s.d. versus the reference method were -0.15 +/- 0.62 m/s, 2.09 +/- 2.68 m/s and -1.12 +/- 4.92 m/s, for PulsePen, Complior and Pulse-Trace, respectively. This study confirms the reliability of Complior and PulsePen devices in estimating PWV, while the SI determined by the PulseTrace device was found to be inappropriate as a surrogate of PWV. The present results indicate the urgent need for evaluation and comparison of the different devices to standardize PWV measurements and establish reference values.
Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Enfermedades Cardiovasculares/fisiopatología , Manometría/instrumentación , Fotopletismografía/instrumentación , Pulso Arterial/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Aorta/fisiopatología , Enfermedades Cardiovasculares/complicaciones , Elasticidad/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flujo Pulsátil/fisiología , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
The Authors report their experience in surgical management of sacrococcygeal fistulas treated by radical excision and subcutaneous/cutaneous rhomboid flap. This is a simple, safe surgical technique and the patients can be treated in day surgery by spinal anesthesia.
Asunto(s)
Fístula Cutánea/cirugía , Seno Pilonidal/cirugía , Colgajos Quirúrgicos , Fístula Cutánea/etiología , Humanos , Seno Pilonidal/complicaciones , Región SacrococcígeaRESUMEN
Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.4+/-5.0 years), who had a standard health check-up at the 'Centre de Médecine Préventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women (9.99+/-2.56 vs 8.66+/-2.56, P<0.001). In univariate analysis, PWV was correlated with age (r=0.26, P<0.001) and mean arterial pressure (MAP) (r=0.40, P<0.001), and these relationships were similar in men and women. Subjects with hypertension (P<0.001), diabetes mellitus (P<0.001) and obesity (P<0.01) had higher values of PWV. In multiple regression analysis, PWV correlated positively and independently with age, male gender, MAP and diabetes mellitus. In conclusion, in an apparently healthy elderly population, the main determinants of arterial stiffness are the age, MAP, diabetes and gender. Our study also shows that the gender-related differences in arterial stiffness observed in middle-aged subjects are maintained in the elderly.
Asunto(s)
Velocidad del Flujo Sanguíneo , Presión Sanguínea , Arterias Carótidas , Arteria Femoral , Resistencia Vascular , Factores de Edad , Anciano , Diabetes Mellitus/mortalidad , Diabetes Mellitus/fisiopatología , Femenino , Estudios de Seguimiento , Francia , Humanos , Hipertensión/mortalidad , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Pulso Arterial , Factores SexualesRESUMEN
Diverticulitis of the right colon is a rare disease in the Western countries, so that the diagnosis still remains very difficult and frequently indistinguishable from acute appendicitis preoperatively. In presence of acute abdominal discomfort with pain referred to the right lower quadrant region, fever and hyperleukocytosis, nausea and vomiting, surgeons operate with a margin of uncertainty, because of the increased morbidity and mortality associated with delay in diagnosis and consequent perforation of acute appendicitis. Moreover the unexpected inflammatory colonic mass of uncertain etiology is sometimes mistaken for carcinoma at laparotomy and consequently a right hemicolectomy is performed. In these cases it should be better that right-sided colonic diverticulitis should be taken into account allowing a more correct surgical approach and even conservative treatment alone. Therefore, in case of suspected appendicitis, since our experience and literature data indicate that the mean age for right diverticulitis is over 40 years, also in presence of a significative Alvarado's score, computed tomography is strongly recommended, if the age is over 40 years.
Asunto(s)
Diverticulitis del Colon/diagnóstico , Adulto , Apendicitis/diagnóstico , Apendicitis/cirugía , Diagnóstico Diferencial , Diverticulitis del Colon/cirugía , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The aim of this paper is to describe a typical clinical case of tuberous sclerosis complex (Bourneville disease) and discuss controversial issues about the management of this rare condition, with a short revision of the literature. Particularly, we define which is the role of the surgeon in the treatment of this very rare condition, that should be primary approached conservatively.
Asunto(s)
Angiomiolipoma , Neoplasias Renales , Esclerosis Tuberosa , Adulto , Angiomiolipoma/diagnóstico , Angiomiolipoma/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/diagnóstico , Neoplasias Renales/diagnóstico por imagen , Radiografía Abdominal , Factores de Tiempo , Tomografía Computarizada por Rayos X , Esclerosis Tuberosa/complicaciones , Esclerosis Tuberosa/diagnósticoRESUMEN
The use of self-expandable metallic stents in colorectal stenoses, both benign and malignant, is a recently born treatment, quickly widespread because of its simplicity and therapeutic efficacy. It is particulary useful, like emergency temporany treatment, in malignant colonic obstruction; in these cases the temporary endoprosthesis positioning allows the intestinal transit and to overcame the emergengy phase. After patient conditions improvement, he can be operated and the endoprosthesis removed within operating specimen. In some particularly serious cases, when only a derivative intervention is mandatory because of the general conditions of the patient or the advanced stadium of the illness, stenting can also represent definitive palliative treatment. In fact, it allows contemporary resolution of the occlusion and of the physiopathologic alterations, with hospital cost reduction and a quality life imprevement for the patient thanks to the colestomy absence. In benign pathologies, self-expandable stents are used for a long time in the superior gastrointestinal and biliary tract; now stents have found employment also for the treatment of the post-operative fistula, intestinal diverticular occlusion and for the treatment of post-anastomotic or radiotherapy strictures. The Authors report two cases observed in emergency with complication determinated by positioning of colonic endoprosthesis for previous occlusive episode. The first case, a 56 year-old woman with a decubitus perforation occurred by stent, previously positioned with only palliative intent for a sigma-rectal metastatic cancer: in the second case, a 75 year-old man, the endoprosthesis had been positioned for a postoperative benign stricture of colorectal anastomosis for neoplasm: in this case the stent had determined a vescico-rectal fistula and after a new intestinal occlusion.
Asunto(s)
Colon/lesiones , Perforación Intestinal/etiología , Stents/efectos adversos , Anciano , Colon Sigmoide/lesiones , Enfermedades del Colon/cirugía , Colostomía , Remoción de Dispositivos , Urgencias Médicas , Femenino , Humanos , Obstrucción Intestinal/cirugía , Perforación Intestinal/cirugía , Masculino , Persona de Mediana Edad , Cuidados PaliativosRESUMEN
Neurofibromatosis (NF) is a relatively common disorder characterized by cutaneous pigmented maculas, multiple neurofibromas and Lisch nodules (pigmented iris hamartomas). This disorder is retained being a neurocristopathy. Melanocytes are neural crest derivates too. Twenty-six patients with neurofibromatosis associated to cutaneous malignant melanoma have been reported till now, but data on association between these two pathologies are lacking. One more case of malignant cutaneous melanoma in a patient with neurofibromatosis is reported and the hypothesis of a more frequent association than usually believed of these two pathologies is discussed.
Asunto(s)
Melanoma , Neurofibromatosis 1 , Neoplasias Cutáneas , Humanos , Masculino , Melanoma/complicaciones , Melanoma/diagnóstico , Persona de Mediana Edad , Neurofibromatosis 1/complicaciones , Neurofibromatosis 1/diagnóstico , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/diagnósticoRESUMEN
The abdominal compartment syndrome is a high grade abdominal hypertension with clinical evidence of multiorgan failure (MOF). It is more and more frequently observed in intensive-care units as a complication in critical patients, but especially in traumatology and surgery. The incidence is highly variable according to the different trials but the severity of scores is the common factor. All the possible mechanical, haemorrhagical, inflammatory and traumatological causes act but do not enable the stability of the abdominal content, abdominal compliance and parietal tension. The initial triad of effects consists in diaphragm elevation and visceral and vascular compression and therefore triggers a physio-pathological way that leads to a respiratory, renal and cardiovascular dysfunction and to parietal, hepatic and intestinal ischaemia and consequent bacterial translocation: sepsis and MOF. Burch's classification (1996) reports four levels of gravity from low (<15 mmHg) to severe (>35 mmHg): both of the first grades should be managed in intensive-care units with conservative pharmacological procedures, while for the two others a surgical approach of laparotomy with drainage and temporaneous closure of the abdominal wall should be considered. As mortality is still very high (29-62%), especially when multiorgan failure is already set; bladder pressure of all critical patients should be monitorized to treat immediately any potential abdominal hypertension.
Asunto(s)
Abdomen , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/cirugía , Síndromes Compartimentales , Hipertensión/complicaciones , Abdomen/fisiopatología , Síndromes Compartimentales/tratamiento farmacológico , Síndromes Compartimentales/etiología , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/cirugía , Enfermedad Crítica , Drenaje , Humanos , Unidades de Cuidados Intensivos , Laparotomía , Presión Negativa de la Región Corporal Inferior , Insuficiencia Multiorgánica/etiologíaRESUMEN
Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in damage control surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. Its possible too applying packs in organ-specific techniques (early abdominal packing). A wide review of the literature has allowed to emphasize the most common problem of this technique, the adequacy of the particular indications, their evolution, timing, the results in general and particular which multiple critical situations and not always predictable when an intensive diagnostic and methodological approach is necessary in. The principal indications are when complex anatomic lesions are diagnosed with not ruleable hemorrhages, in presence of metabolic failure (hypothermia < 35 degrees C, acidosis > 7.2, coagulopathy PTT > 16 seconds: These three derangements become established quickly in the exsanguinating trauma patient and, once established, form a vicious circle which may be impossible to overcome. The results are encouraging and we can evaluate a median survival of the 70%, certainly superior to the obtainable survival with immediate surgical repair. Immediate failures are substantially due to bleeding, especially in "underpacking" case, and remote: these last can be premises, fundamentally septic and bound at the time of stay (above the 72 hours) and associated by the coexistence of lesions: in these situations is possible a MOF syndrome due to excessive intra-abdominal pressure (overpacking) or to an Abdominal Compartment Syndrome.
Asunto(s)
Traumatismos Abdominales/terapia , Hemorragia/terapia , Técnicas Hemostáticas , Hígado/lesiones , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/cirugía , Síndromes Compartimentales/etiología , Síndromes Compartimentales/prevención & control , Hemorragia/etiología , Hemorragia/cirugía , Hemostasis Quirúrgica , Humanos , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/prevención & control , Factores de TiempoRESUMEN
The desmoid tumor (DT) is a soft tissue neoplasm most frequently localized in the anterior abdominal wall typically in females of childbearing age. Because its particular incidence in women who had recently been pregnant, it was correlated with delivery's trauma stimulating proliferation of muscolo-aponeurotic tissues. Complete surgical resection is the recommended treatment approach to prevent recurrence. Many authors emphasize the role of radiotherapy in regression of DT and in controlling local recurrence in patient who had incomplete resection. Many others emphasize the role of chemotherapy or antiestrogenic compounds, even though tumour does not express estrogen receptors. DT, otherwise, is neoplasm with high rates of recurrence after surgery but it never develops distant metastases, so that function and structure-sparing surgery may be a reasonable choice in young women when possible without leaving macroscopic residual disease. Furthermore literature data suggest that the presence of incomplete histological surgical resection does not correlate with local recurrence and that pregnancy does not represent a risk factor. In women of childbearing age, even after non radical histological DT primary resection, adjunctive radiotherapy, chemotherapy or antiestrogen therapy could be avoided and clinical observation alone may be considered.
Asunto(s)
Neoplasias Abdominales , Fibromatosis Abdominal , Fibromatosis Agresiva , Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/terapia , Adulto , Femenino , Fibromatosis Abdominal/diagnóstico , Fibromatosis Abdominal/terapia , Fibromatosis Agresiva/diagnóstico , Fibromatosis Agresiva/terapia , HumanosAsunto(s)
Colecistitis/diagnóstico por imagen , Colecistitis/patología , Tomografía Computarizada por Rayos X , Colecistectomía , Colecistitis/cirugía , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Vesícula Biliar/patología , Humanos , Persona de Mediana Edad , Necrosis , Tomografía Computarizada Espiral , Tomografía Computarizada por Rayos X/métodos , UltrasonografíaRESUMEN
Superior vena cava syndrome is due to an intrinsic or extrinsic caval obstruction that evolves in acute or subacute way with distinctive clinical feature such as respiratory symptoms and venous stasis. Since 1998 we have treated three cases of spontaneous superior vena cava thrombosis in neoplastic patients who underwent several infusion of chemotherapy, respectively for a breast, uterine and rectum cancer. All patients was female, 52, 58 and 70 years old. The first two cases was treated with locoregional thrombolysis by infusing Urokinase 50,000 UI/h during 24 hours and Urokinase 50,000 UI/h during 12 h the third one. After that, we have positioned a 16/9 wallstent: in the first two cases directly into the superior vena cava, in the third case in the subclavian-anonyma truncus. We had in all cases the complete opening of the stent within the first 48 hours without complications, enabling us to reach a free caval diameter of about 2 cm with resolution of the clinical signs. In patients with high surgical risk, the caval wall-stent is the first choice to solve the vein recanalization.