RESUMO
BACKGROUND: To evaluate the efficacy of the tension free surgical technique for the treatment inguinal hernia. METHODS: The authors propose personal experience of 172 patients, treated for inguinal hernia in the period from 1986 to 1993, selecting two patients groups. In the first group the patients (80 cases) were treated with traditional hernioplasty, in the second group (92 cases) hernioplasty tension-free was performed. RESULTS: In the first group 6 cases of recurrence (6.7%), have been observed and in the second group only one case. CONCLUSIONS: The results obtained, and literature survey show the advantages of hernioplasty tension-free.
Assuntos
Hérnia Inguinal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors report a case of adrenal ganglioneuroma which was incidentally diagnosed performing preoperative examination for a sigmoid carcinoma. The authors took this finding as a starting point to underline the rarity of this condition and its chance discovery, this being due to the rare presence of signs and symptoms and its frequent association with other synchronous neoplasms; all this makes differential diagnosis rather difficult.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Ganglioneuroma/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Diagnóstico Diferencial , Ganglioneuroma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Isolated intestinal neurofibromatosis of the colon is a most unusual disease: from 1937 to 1999 only 12 cases have been reported. The differential diagnosis and treatment of this lesion are very difficult. A review of the literature is made and personal experience in the diagnosis and treatment of a case in a 68-year-old female is described.
Assuntos
Neoplasias do Colo/diagnóstico , Neurofibromatoses/diagnóstico , Idoso , Neoplasias do Colo/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Neurofibromatoses/cirurgiaRESUMO
The problems concerning surgical goiter treatment are discussed, particularly the morbidity of total thyroidectomy and possible injury to recurrent nerves in comparison to the partial resection of the gland. We discuss our case material and review the literature. We conclude that total thyroidectomy seems to be the most effective surgical procedure with lower morbidity than subtotal thyroidectomy.
Assuntos
Bócio Nodular/cirurgia , Nervo Laríngeo Recorrente/patologia , Tireoidectomia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Endoscopic ultrasonography (EUS) is a diagnostic method of considerable value for the local staging of esophageal cancer, in particular for T and N evaluation. After an extensive review of the literature, the authors underline the possibility of using EUS to improve the treatment and prognosis of esophageal neoplasms based on the use of various stage-dependent therapeutic strategies. EUS is regarded as a gold-standard technique for esophageal cancer staging in order to select appropriate treatment options, but is currently hampered by the intrinsic difficulty and subjectivity of interpreting ultrasonographic images. In order to ensure safe and reliable data, EUS must be carried out by operators who have undergone suitable training at a specialised centre.
Assuntos
Carcinoma/diagnóstico por imagem , Endossonografia , Neoplasias Esofágicas/diagnóstico por imagem , Carcinoma/patologia , Diagnóstico Diferencial , Endossonografia/estatística & dados numéricos , Neoplasias Esofágicas/patologia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Humanos , Metástase Linfática , Estadiamento de Neoplasias , Reprodutibilidade dos TestesRESUMO
The histological and diagnostic features of a thymoma case observed recently have been investigated in the present study. Comparing the case under investigation with the literature, the Authors conclude that the proper surgical approach is that indicated by Jaretsky. By means of a longitudinal sternotomy associated with minimal cervical incision, the whole mediastinal cellular tissue together with that of the thyroid inferior poles is easily removed. Moreover oncological and myastenic recurrences have a very low incidence in cases surgically treated with this procedure.
Assuntos
Timoma/cirurgia , Neoplasias do Timo/cirurgia , Idoso , Humanos , Masculino , Radiografia Torácica , Timoma/diagnóstico , Timoma/patologia , Timo/patologia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios XRESUMO
The authors take the case of a neuroendocrine tumour of the cecum as the starting point for an analysis of the anatomopathological and diagnostic-therapeutic aspects of these neoplasms. Furthermore, the authors underline that neuroendocrine tumours (NET) of the colon represent an extremely rare nosological entity and that they are heterogeneous from a clinical and biochemical point of view, thus making a reliable preoperative diagnosis a problem that is still difficult to resolve today.
Assuntos
Neoplasias do Ceco/patologia , Tumores Neuroendócrinos/patologia , Neoplasias do Ceco/cirurgia , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgiaRESUMO
The authors take the case of a neuroendocrine tumour of the cecum as the starting point for an analysis of the anatomopathological and diagnostic-therapeutic aspects of these neoplasms. Furthermore, the authors underline that neuroendocrine tumours (NET) of the colon represent an extremely rare nosological entity and that they are heterogeneous from a clinical and biochemical point of view, thus making a reliable preoperative diagnosis a problem that is still difficult to resolve today.
Assuntos
Neoplasias do Ceco/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias do Ceco/cirurgia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgiaRESUMO
Based of a personal series of 206 patients, the authors evaluate their personal experience of an outpatient surgery ward for thyroid pathologies. The paper reports the diagnostic and therapeutic approaches both in patients undergoing surgery and those who do not. Attention is focused on the importance of the multidisciplinary team and the quality of the results of a homogeneous follow-up.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Doenças da Glândula Tireoide/cirurgia , Adulto , Idoso , Instituições de Assistência Ambulatorial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Doenças da Glândula Tireoide/tratamento farmacológico , Tireoidectomia , Fatores de TempoRESUMO
The rarity of primary non-Hodgkin lymphomas of the parotid gland triggers this report on a case treated and now in the fourth year of follow-up, which offers the opportunity for a review of the literature on the subject. The paper also describes the criteria for accurate classification, the diagnostic tools available and the problems of differential diagnosis. Treatment protocols and survival are also considered.
Assuntos
Linfoma não Hodgkin/patologia , Neoplasias Parotídeas/patologia , Feminino , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/terapia , Pessoa de Meia-Idade , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/terapiaRESUMO
The paper discusses the indications, limits and basic technical principles of laparoscopic appendicectomy, comparing the costs and benefits to the laparotomic method. The authors review the Literature on this subject and report their personal experience of 11 cases with a nil morbidity and mortality rate.
Assuntos
Apendicectomia/métodos , Apendicectomia/normas , Ceco/cirurgia , Laparoscopia , Adulto , Apendicectomia/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
The treatment of postoperative chronic thoracic fistulas with fibrin glue can be the non-operative ideal solution for the relative simplicity of the execution technique.
Assuntos
Fístula Brônquica/terapia , Fístula Cutânea/terapia , Adesivo Tecidual de Fibrina , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Starting from the study of a personal case, the authors underline that adrenal cysts are a very rare pathology, occasionally observed and without symptoms. Moreover they point out diagnostic methods, don't permit a certain diagnosis and therapies are not univocal.
Assuntos
Doenças das Glândulas Suprarrenais/diagnóstico , Cistos/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , HumanosRESUMO
The authors report two cases of malignant fibrous histiocytoma localised in the gluteus maximus and re-evaluate some clinical and biological aspects of the neoplasia. Although its histiogenesis is still unsure, the tumour can be classified into various isotopes: the vorticoid-polymorphous variety (70%), and the myxoid, giant cell, angiomatous and inflammatory varieties. It is the most common soft tissue sarcoma in adults and onset is most frequently observed on the trunk and limbs. Biological behaviour shows a marked tendency to local recidivation, with metastatic diffusion occurring mainly late. The choice of therapy consists of more or less radical surgical removal with or without ratio- and immunotherapy. The results of surgery are influenced by the technique used, and the biological and clinical behaviour of the tumour; in view of the numerous case reports of anomalous behaviour, these factors are only indicative. Therapeutic efficacy is on the whole greater in cases of tumours with diameters of less than 5 cm and more superficial localisations compared to the deep muscular fascia.
Assuntos
Histiocitoma Fibroso Benigno , Músculo Esquelético , Idoso , Nádegas , Feminino , Histiocitoma Fibroso Benigno/diagnóstico , Histiocitoma Fibroso Benigno/cirurgia , Humanos , Pessoa de Meia-IdadeAssuntos
Pancreatite/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Amilases/sangue , Antibacterianos/uso terapêutico , Colagogos e Coleréticos/uso terapêutico , Colecistectomia , Ensaios Enzimáticos Clínicos , Endoscopia , Feminino , Fármacos Gastrointestinais/uso terapêutico , Antagonistas de Hormônios/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Pancreatite/diagnóstico , Pancreatite/cirurgia , Inibidores de Proteases/uso terapêutico , Somatostatina/uso terapêuticoRESUMO
From March 1992 to September 1994, 281 patients were submitted to laparoscopic cholecystectomy for cholelithiasis. 27 patients were admitted with diagnosis of acute cholecystitis and in 17 patients common duct stones were discovered and managed by ERCP before laparoscopic procedure. Surgical procedure was the standard one described by Cox. The mean duration of the operation was 60 minutes and was significantly related to the surgeon's experience; the incedence of conversion to open procedure was 5.7%. There was no postoperative mortality; the total morbility rate was 2.8%, with 3 major complications, and 5 minor complications.
Assuntos
Colecistectomia Laparoscópica , Gravação em Vídeo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/efeitos adversos , Colecistite/diagnóstico por imagem , Colecistite/cirurgia , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
At the beginning of their experience the authors limited laparoscopic treatment to simple cholelithiasis. They then extended this method to acute cholecystitis. They report here 11 cases with no mortality and morbidity and a conversion rate equal to 18.18% (2 cases of new acute phase of chronic cholecystitis after deferred emergency surgical treatment). The postoperative stay in hospital never exceeded 72 hours for the 9 cases of laparoscopic cholecystectomy, while the 2 cases of laparotomic respectively on the VII and VIII days. In consideration of what is reported in the literature and of personal experience, even if limited, the authors acknowledge that laparoscopic cholecystectomy if it is practised by an expert surgeon in the presence of precise indications and with a low conversion rate.
Assuntos
Colecistectomia Laparoscópica , Colecistite/cirurgia , Doença Aguda , Colecistectomia Laparoscópica/métodos , Emergências , Humanos , Tempo de Internação , Resultado do Tratamento , Gravação em VídeoRESUMO
In eighty patients with obstructive jaundice treated with percutaneous or endoscopic drainage, the results of biochemical liver-function tests (serum bilirubin, transaminase, gamma-glutamyl transferase, alkaline phosphatase, and albumin) were analyzed to evaluate the return of liver function after biliary decompression. Before decompression all the patients had increased serum concentrations of all the liver-function indicators measured. Conjugated bilirubin normalized within 7 days in 67.5% of the patients and within 14 days in 94.5%. The other serum responses normalized as follows: glutamic oxaloacetic transaminase (7 days in 45%, 14 days in 100%); glutamic pyruvic transaminase (7 days in 46.2%, 14 days in 100%); gamma-glutamyl transferase (7 days in 56.2%, 14 days in 89.1%); alkaline phosphatase (7 days in 52.5%, 14 days in 90.4%); and albumin (7 days in 100%, 14 days in 90.4%). The low mortality and morbidity rates in this series of patients with obstructive jaundice: 0% and 7% after endoscopic and 2.1% and 10.4% after percutaneous drainage suggest that biliary drainage has a valuable place in the preparation of jaundiced patients for surgery and in some cases provides a definitive intervention.
Assuntos
Sistema Biliar , Colestase/terapia , Drenagem , Fígado/fisiopatologia , Adulto , Idoso , Cateteres de Demora , Endoscopia do Sistema Digestório , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The authors make a wide-ranging review of the literature, examine the epidemiological aspect of fail chest and underline the importance of its correct anatomopathological classification for a more qualified physiopathologist, diagnostic and therapeutic approach. They make a historical excursion on volet's treatment and underline the complementarity of surgical and resuscitation therapies.
Assuntos
Tórax Fundido/terapia , Tórax Fundido/cirurgia , Ventilação em Jatos de Alta Frequência , Humanos , Ortopedia , Respiração com Pressão Positiva , Respiração ArtificialRESUMO
A comparative study was performed on the efficacy, safety and tolerability of three different antibiotics (imipenem, ceftazidime, ceftriaxone) in the prevention of postoperative infection. Evaluations were made on the basis of the results obtained in a group of 90 patients subdivided into three matched groups each of which was treated with one of the three compounds. The trend of cutaneous temperature showed differences at the limit of significance (p congruent to 0.05). Variations in leucocyte concentrations showed an analogous pattern in all patients, although there were fewer and with a shorter duration in subjects treated with imipenem. The wound healing process was improved in patients receiving prophylactic antibiotic treatment in the form of imipenem (0.01 < p < 0.05) who also showed a greater respect for therapeutic protocols (80%), a higher percentage of remission of fever and a shorter mean hospital stay (9 days). In the light of these preliminary results the authors express their favourable judgement regarding the choice of imipenem for the prophylaxis of postoperative infection; however, each of the three protocols showed a considerable prophylactic capacity as well as good tolerability and ease of use.