RESUMO
Granular cell tumours are rare neoplasms that may occur anywhere in the body. The most common locations are the oral cavity, skin and subcutaneous tissue, with only 8% of these tumours occurring at a gastrointestinal site. In the specific case of gastric granular cell tumours, only a few cases have been published until today. Granular cell tumours are usually benign; however, some malignant forms have been reported. Both endoscopic and surgical resection represent the treatment of choice. The authors report a new clinical case of a gastric granular cell tumour, treated with laparoscopic surgical resection, describing some endoscopic, imagiological and anatomopathological features.
Assuntos
Endoscopia Gastrointestinal/métodos , Tumor de Células Granulares/patologia , Laparoscopia , Neoplasias Gástricas/patologia , Diagnóstico por Imagem/instrumentação , Feminino , Tumor de Células Granulares/diagnóstico por imagem , Tumor de Células Granulares/cirurgia , Humanos , Pessoa de Meia-Idade , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
Colonoscopy is being widely used since the 1980s and is the leading diagnostic procedure for colorectal cancer. For many colorectal diseases, it is also a therapeutic tool. Like many other procedures in Medicine, it has its drawbacks and complications, some of which if not readily diagnosed can represent a serious risk to the patient's health and well-being. We describe a case of colon perforation during diagnostic colonoscopy in a patient, resulting in exuberant pneumoretroperitoneum, pneumoperitoneum, pneumomediastinum and subcutaneous emphysema, who successfully underwent laparoscopic colonic resection with primary anastomosis. There are only a few cases of combined intraperitoneal and retroperitoneal perforations described in the literature.
Assuntos
Colonoscopia/efeitos adversos , Perfuração Intestinal/etiologia , Enfisema Mediastínico/etiologia , Pneumoperitônio/etiologia , Retropneumoperitônio/etiologia , Enfisema Subcutâneo/etiologia , Idoso , Anastomose Cirúrgica , Colo Sigmoide/cirurgia , Feminino , Humanos , Laparoscopia , Enfisema Mediastínico/diagnóstico por imagem , Pneumoperitônio/diagnóstico por imagem , Espaço Retroperitoneal , Retropneumoperitônio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Most ovarian inguinal hernias occur in children and are frequently associated with congenital genitalia defects. The authors present the case of a multiparous 89-year-old woman, without any genitalia defect, who was brought to the emergency department with an irreducible inguinal hernia. The patient was proposed for emergency surgery during which we encountered an ovary and a fallopian tube inside the hernial sac. An oophorosalpingectomy and a Lichtenstein procedure were carried out and the postoperative period was uneventful. This case shows that, even though it is rare, a hernial sac may contain almost any intra-abdominal organ, including those least frequent such as the appendix, an ovary or the fallopian tubes.
Assuntos
Tubas Uterinas/patologia , Hérnia Inguinal/patologia , Hérnia Inguinal/cirurgia , Ovário/patologia , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
Monitoring antibiotic consumption is a valuable tool which has been increasingly used in the last years due to the current concern with the emergence of resistant microbial strains. The present study aimed at monitoring antibiotic consumption, evaluating the economic impact of hospital antibiotic prescription and assessing the relationship between the prescribed antibiotics and the indications for either prophylactic or therapeutic use. This was a longitudinal pilot-study for which data were collected in six privately managed public hospital units during the month of May 2004, with a resulting sample of 1,122 admitted patients. We observed a prescription incidence rate of 76.9%, corresponding to a total of 1,154 dispensed antimicrobials, with a mean 71.2% of these antimicrobials being dispensed for the prophylaxis of surgical site infection (SSI). The mean cost of antibiotic courses was higher in cases of "suspected infection" (9.09 euro) or "confirmed infection" (8.74 euro) and lower in cases of "prophylaxis" (5.67 euro), a finding which is explained by the shorter mean duration of the later. There was a considerable variation among the different hospital units regarding the type of antibiotic compound that was used for SSI prophylaxis, with a mean duration of antibiotic use of 2.61 days for this indication and about half of the prophylactic regimens lasting longer than 24 hours, a fact that suggests an insufficient observation of the current recommendations for antibiotic use in SSI prophylaxis. This finding indicates the need for an investigation on the actual existence of local recommendations for SSI prophylaxis in individual hospital units and also for the evaluation of the compliance of practicing surgeons with eventually existing recommendations.