RESUMO
Objetive: Self-expandable plastic stents (SEPS) are increasingly being used for treatment of postoperative esophageal leak. This complication occurs in 4-27% of patients after radical gastrectomy, and has a high mortality rate up to 60%. The aim of this study is to evaluate the efficacy of SEPS (Polyflex®) for treatment of post-operative eshopago-jejuno anastomosis leak after radical gastrectomy for gastric cancer. Material and methods: During one year period patients who underwent a radical gastrectomy in our hospital for gastric cancer and developed a postoperative anastomotic leak were prospectively included in the study after signing a consent form, and treated with SEPS placement under endoscopic and fluoroscopic control for leak occlusion. Results: Four patients were included (3 men/1 woman). The mean interval between operation and SEPS placement was 16 days (range: 4-34). SEPS deployment was easily performed in all patients with complete occlusion of esophageal lumen in three patients. In the fourth patient we needed to deploy a second coaxial stent to achieve a complete occlusion of the fistula. SEPS migration did not happen in our series. One patient had already developed a mediastinitis by the time we placed the SEPS and he died 3 days later. Extraction of the SEPS was easily performed 4-8 weeks after deployment. Conclusion: We achieved a complete healing of the anastomotic fistula after radical gastrectomy in 3 out of 4 patients, without major complications related to SEPS. Placement of SEPS is an appealing minimally invasive alternative to surgical repair for patients with postoperative anastomotic leak(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica , Stents Farmacológicos/normas , Stents Farmacológicos , Endoscopia , Endoscopia do Sistema Digestório/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Gastrectomia/mortalidade , Gastrectomia , Síndromes Pós-Gastrectomia/complicações , Esôfago/patologia , Esôfago/cirurgia , Esôfago , Estudos ProspectivosRESUMO
We report a case of spontaneous bilateral polydactylyon the upper limbs of a Macropus giganteus(Grey kangaroo). The specimen was anadult male (11 years), and had died from naturalcauses. The occurrence of polydactyly isexceptional in this species and have not foundany other case in the scientific literature. In our specimen there was a supernumerary finger on the anterior side of both forepaws (preaxial polydactyly), a duplicated thumb, inserted between the 1st and the 2nd fingers, with two phalanges, and its correspondingmetacarpal bone perfectly ossified, with theproximal articulate surface perfectly flat butshowing no contact with the trapezium bone.The space between both bones was occupied by soft tissues. The supernumerary digits of both hands were virtually identical (AU)
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Assuntos
Animais , Macropodidae/anormalidades , Polidactilia , Deformidades Congênitas das Extremidades SuperioresRESUMO
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