RESUMO
The aim of this study was to evaluate the ability of intravascular ultrasound to diagnose tumor involvement of the portal and the superior mesenteric veins using the preoperative percutaneous, transhepatic approach, and to compare the findings with those made at concomitant direct portography, surgery, and histopathological examination. Ten patients with a preoperative diagnosis of a resectable tumor in the pancreatic head region were examined with percutaneous transhepatic portography (PTP) and intravascular ultrasound (IVUS). The surgeon's intraoperative evaluation and the histopathological examination in combination revealed tumor involvement of the portal or superior mesenteric veins in six of the ten patients. Percutaneous transhepatic portography suggested tumor involvement of the veins in six patients but two of the examinations were false positive and another two were false negative. Intravascular ultrasound showed signs of tumor involvement in eight patients. The examination was, however, false positive in two patients, but there were no false negatives. Complications of the percutaneous transhepatic procedure occurred in six patients including severe pain, bleeding, and related death. Percutaneous transhepatic IVUS of the portal vein may be a useful tool in the preoperative selection of the subgroup of patients with tumor of the pancreatic head region that could benefit from surgery. There is a need for technical improvement as well as studies with larger patient series to definitely decide the role of the technique.
Assuntos
Neoplasias Pancreáticas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Adulto , Idoso , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Veias Mesentéricas/patologia , Veias Mesentéricas/ultraestrutura , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Veia Porta/patologia , Portografia , Ultrassonografia de IntervençãoRESUMO
We report a case of congenital absence of the portal vein (CAPV) in an adult male who underwent resection for hepatocellular carcinoma. CAPV is a rare anomaly; only 29 cases, mostly in children, have been presented to date. An association between CAPV and cardiac abnormalities, polysplenia syndrome, skeletal abnormalities and liver tumors has been seen in children. To the best of our knowledge this is the first case of CAPV in an adult male resected for hepatocellular carcinoma. However, since CAPV can be without symptoms, the number of undiagnosed cases is not known.
Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Veia Porta/anormalidades , Carcinoma Hepatocelular/complicações , Humanos , Fígado , Neoplasias Hepáticas/complicações , Pessoa de Meia-IdadeRESUMO
During recent years new concepts and methods have been introduced in the management of acute pancreatitis. Severity and risk of complications show wide variation. Outcome is also dependent on the physician's experience and on his local resources. In this light the Swedish Society of Upper Abdominal Surgery has elaborated national guidelines for management. Attention is paid to diagnosis, severity assessment and etiology. Furthermore, guidelines are offered for treatment of mild and severe pancreatitis, as well as for the management of pseudocysts. The role of multidisciplinary intensive care specialist teams in the management of severe disease is emphasized. The guidelines are supported by the Swedish Society of Gastroenterology, the Swedish Society of Gastroenterology, the Swedish Society of Anesthesiology and Intensive Care and by experts from other Nordic countries.
Assuntos
Pancreatite , APACHE , Doença Aguda , Antibacterianos/administração & dosagem , Drenagem , Nutrição Enteral , Medicina Baseada em Evidências , Humanos , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite/terapia , Nutrição Parenteral , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Sociedades Médicas , Suécia , Resultado do TratamentoRESUMO
Twenty cases of cystic pancreatic neoplasms were examined over a 10-year period by the Department of Radiology, University Hospital, Lund, Sweden. Four patients had serous cystadenoma, seven had mucinous cystadenoma, and seven had mucinous cystadenocarcinoma. One patient had a mucin-producing ductal carcinoma, and one patient had a benign mucus cyst. The various types of tumor are illustrated, and the difficulty in differentiating the subtypes is stressed.
Assuntos
Cistadenocarcinoma Mucinoso/diagnóstico por imagem , Cistadenoma Mucinoso/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Serviços de Saúde Comunitária/história , Medicina de Família e Comunidade/história , Serviços de Saúde Comunitária/legislação & jurisprudência , Serviços de Saúde Comunitária/organização & administração , Dinamarca , Medicina de Família e Comunidade/legislação & jurisprudência , Medicina de Família e Comunidade/organização & administração , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Médicos de Família/históriaRESUMO
BACKGROUND/AIMS: Preliminary clinical trials have suggested that dearterialization (interruption of arterial blood supply) is beneficial to patients with liver tumours. The aim of this report was to review the outcome of all patients undergoing dearterialization for colorectal liver metastases and to analyze whether refinement of the technique was followed by improvement in outcome. METHODS: Retrospective review of 57 patients undergoing temporary (16 h) dearterialization during 1972-1984 (n = 24) or repeated transient dearterialization (1-2 h once or twice daily) during 1985-1995 (n = 33). RESULTS: The median survival after start of treatment was 1.1 years, and the 5-year survival rate was 0%. There was no significant difference in survival between temporary and repeated transient dearterialization. Liver tumour volume and extrahepatic metastases varied negatively with survival. The temporary dearterialization procedure was followed by hepatic or intra-abdominal abscess formation in 6 patients (24%), leading to postoperative death in 2 patients (operative mortality 8%). Complications after repeated transient dearterialization were related mainly to technical problems with the occluder device. CONCLUSION: Although this was not a randomized study, it appears that dearterialization is of no benefit in colorectal liver cancer.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/secundário , Cateterismo , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de SobrevidaAssuntos
Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Saúde Global , Animais , Manipulação de Alimentos , Inspeção de Alimentos , Doenças Transmitidas por Alimentos/complicações , Doenças Transmitidas por Alimentos/mortalidade , Humanos , Fatores de Risco , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/epidemiologia , Intoxicação Alimentar por Salmonella/mortalidadeAssuntos
Diagnóstico por Imagem/tendências , Processamento de Imagem Assistida por Computador/tendências , Radiologia/tendências , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/patologia , Cardiopatias/diagnóstico , Cardiopatias/diagnóstico por imagem , Cardiopatias/patologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética , Masculino , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/patologia , Radiologia/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
Of 99 patients operated on with subtotal pancreatectomy due to ampullary carcinoma, five had a local recurrence in the pancreatic bed at the ligament of Treitz. The patients all had distinct symptoms: recurrent bouts of fever, general malaise, and rapid loss of weight. They had little pain, but all were jaundiced in spite of absence of marked compression of the bile ducts. Computed tomography or ultrasound could not detect the small, local recurrence that was obstructing the jejunal loop 10-15 cm distal to the hepaticojejunostomy, but as an indirect sign of the recurrence, the distended small bowel loop proximal to the ligament of Treitz was clearly seen in all patients.