RESUMO
Three cases of biliary tract serious lesions during videolaparoscopic cholecystectomy are reported. They were executed in other hospitals and presented big technical restoring difficulties, not easily resolvable. In 2 cases of lithiasic cholecystitis there was a complete damage of common biliary duct, in the third one there was a double main biliary duct binding with removal of a biliary tract segment. In all cases a biliary confluence-jejunal anastomosis with Roux en y loop was made up. In all cases the operation was difficult because of main bile duct fragility and modest expansion. In the third one the presence of a secondary biliary duct in gallbladder fossa not recognized but drained outside with a common drainage placed during the operation has prevented appearance of jaundice with dilatation of biliary ducts. It has heavily conditioned confluence-jejunal anastomosis with Roux en Y loop. In all cases tubes were left in the biliary duct for few months in order to calibrate it. In 2 patients postoperative course was characterized by the appearance of an external biliary fistula which has spontaneously disappeared. One year later both patients don't present any stenosis or cholangitis problem.
Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Ducto Colédoco/lesões , Ducto Colédoco/cirurgia , Ducto Hepático Comum/lesões , Ducto Hepático Comum/cirurgia , Adulto , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco/diagnóstico por imagem , Feminino , Seguimentos , Ducto Hepático Comum/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
The Author reports the experience of the III Surgical Department of the University of Milan on stapling devices in bariatric surgery. The use of stapling devices is now almost irreplaceable for some surgical interventions like gastroplasty, jejuno-ileal bypass, and intestinal bypass revision because staplers simplify and shorten operating procedures, also reducing surgical risk.
Assuntos
Obesidade Mórbida/cirurgia , Grampeadores Cirúrgicos , Estudos de Avaliação como Assunto , Gastroplastia/instrumentação , Humanos , Derivação Jejunoileal/instrumentaçãoRESUMO
An association of 5-fluoruracyl (or methotrexate) and cyclophosphamide was used in the treatment of 20 cases of hormone-resistant breast cancer. Five objective regressions were obtained. Mean survival here was 28.25 (S.D. 2.87) months, as opposed to 12.75 (S.D. 6.93) months in the remainder. Side-effects of various kinds were noted in 9 patients.