RESUMO
Two young women presenting Budd-Chiari syndrome as the primary manifestation of hepatocellular carcinoma with intracardiac extension were treated by debulking of the atrium and inferior vena cava under extracorporeal circulation and major hepatectomy. The first patient who was treated in a single procedure died during the immediate postoperative period. The second patient who was treated in two steps died of meningeal and pulmonary metastases 12 months later. Clinical findings and surgical strategy for this rare condition are discussed in the light of 6 previously reported surgical cases.
Assuntos
Síndrome de Budd-Chiari/etiologia , Carcinoma Hepatocelular/secundário , Neoplasias Cardíacas/secundário , Neoplasias Hepáticas/diagnóstico , Adulto , Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/mortalidade , Síndrome de Budd-Chiari/cirurgia , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/cirurgia , Diagnóstico por Imagem , Evolução Fatal , Feminino , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/mortalidade , Neoplasias Cardíacas/cirurgia , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Células Neoplásicas Circulantes , Taxa de Sobrevida , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgiaRESUMO
OBJECTIVES: It is empirically accepted that certain foods play a role in the pathogenesis of hemorrhoids or their acute exacerbation. The aim of this work was to determine whether there is a relationship between hemorrhoids and certain food-related or common toxin-related factors. PATIENTS AND METHODS: Two groups of 50 subjects were compared. Group I was composed of 50 patients with hemorrhoid symptoms. Fifty volunteers with no proctologic abnormality were included in group II. We used a diet survey to compare total calorie, protein, carbohydrate, fat, food fiber, water, alcohol, salt, pepper, pimento, tea, and coffee intake was well as smoking habits. Episodes of constipation were also noted. RESULTS: Overall calorie intake, as well as protein, carbohydrate and fiber intake were similar in the two groups as were use of salt, coffee and tea. Dietary intake in group I was higher for fat (p = 0.02), alcohol (p = 0.01), pepper (p = 0.04, and pimento (p = 0.001). Subjects in group I drank less water (p = 0.008), smoked more (p = 0.01) and were more often constipated (p < 0.001) than those in group II. CONCLUSION: Our findings provide further arguments suggesting that dietary imbalance or smoking could be involved in the development of hemorrhoids. These factors should be evaluated in appropriate dietary inquiries. Epidemiological surveys would be required to confirm their possible causal effect.