RESUMO
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Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Estenose Esofágica/diagnóstico por imagem , Perfuração Esofágica/diagnóstico por imagem , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios X , EndoscopiaRESUMO
The management and prognosis of benign esophageal strictures differ from those of malignant strictures. Distinguishing between the two entities may occasionally be challenging, despite endoscopy and biopsies. The consequences of erroneous treatment may be fatal. We review this topic in a patient who required an emergency esophagectomy following a perforation after dilation due to a peptic stricture, which concealed an esophageal cancer.
Assuntos
Neoplasias Esofágicas , Perfuração Esofágica , Estenose Esofágica , Constrição Patológica , Dilatação , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/etiologia , Estenose Esofágica/cirurgia , Humanos , Recidiva Local de NeoplasiaRESUMO
BACKGROUND: Despite increases in knowledge and advances in the management of acute mesenteric ischemia syndrome (AMI), there have been no significant improvements in mortality in recent years. The objective of this study was to assess the changes in clinical characteristics and surgical outcomes in patients who underwent AMI over time. METHODS: A total of 323 consecutive patients who underwent acute mesenteric ischemia at our institution between 1990 and 2015 were examined. The occurrence of significant changes over this 25-year period in demographic data, comorbidity, clinical characteristics, laboratory results, operative findings, etiology of the AMI, and operative mortality were evaluated. The evolution mortality rates for the studied period were analyzed using the additive logistic regression, and the significant effect was determined using the Akaike Information Criterion (AIC). RESULTS: A significant increasing linear trend was observed in recent years in Charlson score values (p = 0.008), antiplatelet drug intake (p < 0.001), use of CT scan (p < 0.001), arterial thrombosis (p < 0.001), and intestinal resection (p = 0.047), while a decreasing linear trend was observed in digoxin intake (p < 0.001), angiography use (p = 0.004), and embolia (p < 0.001). The rest of the parameters did not present changes over time. Regarding the evolution of the adjusted surgical mortality, a significant decrease according the AIC criterion was observed. CONCLUSIONS: In recent years, the characteristics of patients with AMI requiring surgery have changed. Changes in operative mortality have also been detected, showing a tendency toward a progressive and significant decrease.
