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1.
Sao Paulo Med J ; 137(2): 132-136, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31314873

RESUMO

BACKGROUND: Despite advances in surgical approaches, emergency colorectal surgery has high mortality and morbidity. OBJECTIVE: We aimed to create a simple and distinctive scoring system, for predicting mortality among patients undergoing emergency colorectal surgery. DESIGN AND SETTING: Prediction model development study based on retrospective data-gathering. METHODS: Patients who underwent emergency colorectal surgery between March 2014 and December 2016 at a single tertiary-level referral center were included in our study. Patient demographics, comorbidities, type of surgery, etiology and laboratory and radiological findings were collected retrospectively and analyzed. A new clinical score (named the Numune emergency colorectal resection score) was constructed from the last logistic regression model, in which one point was assigned for the presence of each predictive factor. RESULTS: 138 patients underwent emergency colorectal surgery. These comprised 64 males (46.4%) and 74 females (53.6%), with a mean age of 64 years. Multivariate analysis revealed that blood urea nitrogen level > 65 mg/dl (odds ratio, OR: 8.03; 95% confidence interval, CI: 2.16-15.77), albumin level < 0.7 -mg/-dl (OR: 4.43; 95% CI: 1.96-14.39) and American Society of Anesthesiologists score ≥ 3 (OR: 3.47; 95% CI: 0.81-9.18) were associated with postoperative complications. The Numune score was graded from I to III. The risk of mortality was found to be 63.2% in the group with grade III, which accounted for 35.2% of the subjects. There were 37 postoperative deaths. CONCLUSIONS: Surgeons need scoring systems, especially to predict postoperative mortality. We propose the Numune emergency colorectal resection score for emergency surgical procedures as a practical, usable and effective system for predicting postoperative morbidity.


Assuntos
Doenças do Colo/cirurgia , Cirurgia Colorretal/mortalidade , Tratamento de Emergência/mortalidade , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
2.
Säo Paulo med. j ; 137(2): 132-136, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1014629

RESUMO

ABSTRACT BACKGROUND: Despite advances in surgical approaches, emergency colorectal surgery has high mortality and morbidity. OBJECTIVE: We aimed to create a simple and distinctive scoring system, for predicting mortality among patients undergoing emergency colorectal surgery. DESIGN AND SETTING: Prediction model development study based on retrospective data-gathering. METHODS: Patients who underwent emergency colorectal surgery between March 2014 and December 2016 at a single tertiary-level referral center were included in our study. Patient demographics, comorbidities, type of surgery, etiology and laboratory and radiological findings were collected retrospectively and analyzed. A new clinical score (named the Numune emergency colorectal resection score) was constructed from the last logistic regression model, in which one point was assigned for the presence of each predictive factor. RESULTS: 138 patients underwent emergency colorectal surgery. These comprised 64 males (46.4%) and 74 females (53.6%), with a mean age of 64 years. Multivariate analysis revealed that blood urea nitrogen level > 65 mg/dl (odds ratio, OR: 8.03; 95% confidence interval, CI: 2.16-15.77), albumin level < 0.7 ­mg/­dl (OR: 4.43; 95% CI: 1.96-14.39) and American Society of Anesthesiologists score ≥ 3 (OR: 3.47; 95% CI: 0.81-9.18) were associated with postoperative complications. The Numune score was graded from I to III. The risk of mortality was found to be 63.2% in the group with grade III, which accounted for 35.2% of the subjects. There were 37 postoperative deaths. CONCLUSIONS: Surgeons need scoring systems, especially to predict postoperative mortality. We propose the Numune emergency colorectal resection score for emergency surgical procedures as a practical, usable and effective system for predicting postoperative morbidity.

3.
Ulus Travma Acil Cerrahi Derg ; 25(2): 137-141, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30892682

RESUMO

BACKGROUND: The clinical approach to back/flank wounds has evolved over the years. The aim of this study was to discuss the potential of computed tomography tractography in patients with a stab wound to the back or flank. METHODS: A total of 25 stable patients with stab wounds confined to the back/flank region were enrolled in this retrospective study. After initial resuscitation and physical examination, tractography was performed at the site of the stab wound. The patients subsequently underwent computed tomography with intravenous contrast. RESULTS: Computed tomography tractography helped avoid a laparotomy in 15 (60%) patients and accurately revealed a peritoneal breach in 10 (40%) patients. No missed injuries were reported in the conservatively followed patients. CONCLUSION: The addition of tractography to computed tomography is a safe, fast, and cost- and time-effective technique to evaluate back/flank stab wounds.


Assuntos
Lesões nas Costas , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes , Lesões nas Costas/diagnóstico por imagem , Lesões nas Costas/epidemiologia , Lesões nas Costas/cirurgia , Humanos , Estudos Retrospectivos , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia
5.
J Vasc Surg Venous Lymphat Disord ; 6(1): 57-65, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29248109

RESUMO

BACKGROUND: The role of cutaneous microvascular dysfunction is well known in the development of chronic venous disease. However, the effects of venous obstruction on microcirculation have not been well investigated. The aim of this study was to assess cutaneous microvascular function in patients with iliocaval venous obstruction (ICVO) before and after venous stent placement. METHODS: Endothelium-dependent and endothelium-independent vasodilator responses to iontophoretic administration of incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP) were evaluated using a laser Doppler scanner in the perimalleolar region in the supine and sitting positions in patients with ICVO (n = 11) and in healthy control subjects (n = 15). Cutaneous microvascular function, the Venous Clinical Severity Score (VCSS), and the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class were re-evaluated 3 months after stent placement in patients with ICVO. RESULTS: The vasodilatory responses to ACh and SNP in the cutaneous microcirculation were lower in patients with ICVO than in healthy subjects in the sitting position (P < .05). Recanalization and stent placement were successful in all patients in the evaluation of VCSS and clinical class, and a significant decrease was determined in the signs and symptoms of the venous disease (P < .01). Stent placement resulted in a significant increase in vasodilation response to both ACh and SNP in the supine position and no improvement in the sitting position in patients with ICVO. CONCLUSIONS: ICVO impairs endothelium-dependent and endothelium-independent vasodilation in the perimalleolar region. Iliocaval venous stent placement may recover microvascular dysfunction at different levels.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca , Microcirculação , Pele/irrigação sanguínea , Stents , Vasodilatação , Veia Cava Inferior , Insuficiência Venosa/terapia , Trombose Venosa/terapia , Administração Cutânea , Adulto , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Endotélio Vascular/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Iontoforese , Masculino , Microcirculação/efeitos dos fármacos , Pessoa de Meia-Idade , Posicionamento do Paciente , Flebografia/métodos , Estudos Prospectivos , Fluxo Sanguíneo Regional , Decúbito Dorsal , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular , Vasodilatação/efeitos dos fármacos , Vasodilatadores/administração & dosagem , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
6.
Turk J Surg ; 33(4): 294-295, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29260137

RESUMO

Hamartoma is a rare benign tumor of the spleen. It is often asymptomatic and diagnosed incidentally. In this study, we report the case of a 51-year-old female patient who was admitted to our department for intermittent epigastric pain since the last 6 months and left upper quadrant fullness. She was diagnosed with splenic hamartoma histopathologically after splenectomy. Although splenic hamartoma is very rare, it must be included in the differential diagnosis of splenic mass-forming lesions.

7.
World J Gastrointest Endosc ; 9(4): 149-152, 2017 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-28465780

RESUMO

Crohn's disease (CD) is a chronic inflammatory disease of digestive tract. Approximately 70% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However, laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD, which are also complicating laparoscopic treatments. Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.

8.
Am J Case Rep ; 18: 72-75, 2017 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-28104902

RESUMO

BACKGROUND Toothpick ingestion is implicated in bowel injuries that may cause violent complications, mimicking diseases causing acute abdomen. CASE REPORT A 18-year-old man was admitted with a 3-day history of a swallowed wooden toothpick. The patient had tenderness in the left flank area. Computed tomography indicated toothpick impaction at the splenic flexura of the colon. It was successfully removed with colonoscopy. After the procedure, abdominal radiography showed free air as a sign of perforation. Along with conservative management, the patient was discharged without surgery. CONCLUSIONS There is need for greater awareness of the hazardous of an ingested toothpick. Endoscopic approach should be considered in the first-line management of toothpick perforations.


Assuntos
Colo/lesões , Endoscopia do Sistema Digestório/métodos , Corpos Estranhos/complicações , Perfuração Intestinal/cirurgia , Adolescente , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Masculino , Tomografia Computadorizada por Raios X
9.
World J Gastrointest Surg ; 8(9): 621-626, 2016 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-27721925

RESUMO

Anastomotic leakage is an unfortunate complication of colorectal surgery. This distressing situation can cause severe morbidity and significantly affects the patient's quality of life. Additional interventions may cause further morbidity and mortality. Parenteral nutrition and temporary diverting ostomy are the standard treatments of anastomotic leaks. However, technological developments in minimally invasive treatment modalities for anastomotic dehiscence have caused them to be used widely. These modalities include laparoscopic repair, endoscopic self-expandable metallic stents, endoscopic clips, over the scope clips, endoanal repair and endoanal sponges. The review aimed to provide an overview of the current knowledge on the minimally invasive management of anastomotic leaks.

10.
Niger Med J ; 57(2): 77-80, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27226679

RESUMO

BACKGROUND: The modern approach to palpable breast masses is to get cytopathologic diagnosis before definitive surgery. We aimed to compare fine needle aspiration cytology (FNAC) with core biopsy in histopathologic diagnosis of palpable breast masses. MATERIALS AND METHODS: Data were collected on 123 women who have suspicious palpable breast masses from 2007 to 2010. RESULTS: Of the 123 patients, core biopsies were performed on 64 patients (Group 1) and FNAC on 59 patients (Group 2). Malignancy was confirmed in 25 out of 32 clinically suspicious patients in Group 1 (78.1%), and 20 out of 21 participants in Group 2 (95.2%). Among the clinically suspicious patients, 81.8% of 33 patients in Group 1, and 90.3% of 31 patients in Group 2 were identified malignancy. Sensitivity was 100% for core biopsy and 95% for FNAC. Specificity was 100% in both procedures. False negativity rate in FNAC were 5%. CONCLUSION: Sensitivity and specificity showed that in the case of true histopathologic classification, core biopsy is superior to FNAC. Nevertheless, FNAC's role as a fast, simple and cheap diagnosis cannot be ignored. It is an effective diagnostic tool in most patients, in comparison to the correct and specific typing of core biopsies in benign lesions which protect patients from the open biopsy.

11.
Medicine (Baltimore) ; 94(31): e1078, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26252271

RESUMO

Renal angiomyolipoma (AML) is a rare benign tumor of the kidney. Occasionally, it may extend into the renal vein or the inferior vena cava (IVC), but so far of pulmonary embolism in patients with renal AML was rarely reported. Here, a case of symptomatic pulmonary embolism secondary to AML that was placed IVC filter before the operation and then treated with radical nephrectomy is reported.This case highlights the rare possibility of renal vein and IVC involvement with symptomatic pulmonary fat embolism in renal AML, which may potentially result in fatal complications if not appropriately and cautiously managed with surgical intervention.


Assuntos
Angiomiolipoma/diagnóstico , Embolia Gordurosa/etiologia , Neoplasias Renais/diagnóstico , Embolia Pulmonar/etiologia , Veia Cava Inferior/patologia , Adulto , Angiomiolipoma/complicações , Embolia Gordurosa/diagnóstico , Feminino , Humanos , Neoplasias Renais/complicações , Invasividade Neoplásica , Embolia Pulmonar/diagnóstico
12.
Ann Surg Treat Res ; 89(1): 17-22, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26131440

RESUMO

PURPOSE: The aim of our study is to evaluate the effects of administration of perioperative supplemental oxygen on anastomoses. METHODS: Forty male Wistar albino rats were used in the study and randomized into 4 groups. Ischemia-reperfusion models were built in groups 3 and 4. Jejunojejunostomy was performed in all rats and assigned to an oxygen/nitrous oxide mixture with a fraction of inspired oxygen of 30% in groups 1 and 3 and 80% in groups 2 and 4. The measurements of perianastomotic tissue oxygen pressure, bursting pressure, level of hydroxyproline were evaluated and compared in all groups. RESULTS: The perianastomotic tissue oxygen pressures, bursting pressures and levels of hydroxyproline were identified as significantly high in groups 2 and 4, administered a fraction of inspired oxygen of 80%, compared to groups 1 and 3, administered a fraction of inspired oxygen of 30%. CONCLUSION: Perioperative supplemental oxygen contributes positively to the anastomotic healing.

13.
Am J Emerg Med ; 33(9): 1188-90, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26093799

RESUMO

INTRODUCTION: The study aimed to identify the presence of peritoneal penetration in management of anterior abdominal stab wound by using computed tomography (CT) tractography. MATERIAL AND METHODS: Hemodynamically stabile, CT tractography-performed patients who were admitted to our emergency clinic with anterior abdominal stab wounds between the years 2012 and 2014 were included in this study, and all images were evaluated in terms of peritoneal penetration and possible intra-abdominal injury. RESULTS: In the study CT tractography identified necessity of laparotomy accurately in 90% of the patients, and none of the patients without peritoneal penetration needed surgical treatment in their follow-up. CONCLUSION: The procedure may be used for some selected cases of hemodynamically stable patient with anterior abdominal stab wounds to abstain from local wound exploration.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Peritônio/diagnóstico por imagem , Peritônio/lesões , Tomografia Computadorizada por Raios X/métodos , Ferimentos Perfurantes/diagnóstico por imagem , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Mesentério/diagnóstico por imagem , Mesentério/lesões , Reto do Abdome/diagnóstico por imagem , Reto do Abdome/lesões
14.
Clinics (Sao Paulo) ; 70(4): 247-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26017790

RESUMO

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy.


Assuntos
Carcinoma/cirurgia , Excisão de Linfonodo/métodos , Neoplasias das Paratireoides/cirurgia , Adulto , Fatores Etários , Idoso , Carcinoma/patologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica , Neoplasias das Paratireoides/patologia , Paratireoidectomia/métodos , Estudos Retrospectivos , Tireoidectomia/métodos , Resultado do Tratamento
15.
J Laparoendosc Adv Surg Tech A ; 25(5): 401-5, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25918952

RESUMO

Sleeve gastrectomy is an effective and single stand-alone surgical procedure for the treatment of morbid obesity. One of the most frequent and serious complications of this procedure is staple-line leak. It can usually be treated with self-expandable stents. If this process results in failure and gastrocutaneous fistula occurs, a challenging period starts for the patient and the surgeon. We describe a new, relatively simple and quick endoscopic technique for closing a chronic gastrocutaneous fistula. A plug prepared with porcine acellular dermal matrix was used for this purpose. Gastrocutaneous fistula following an obesity surgery can be successfully treated endoscopically with this technique. This method can prevent the need for aggressive reconstructive surgery following a gastrocutaneous fistula and can prompt rapid improvement while decreasing the average hospital stay for this condition.


Assuntos
Derme Acelular , Fístula Cutânea/cirurgia , Gastrectomia/efeitos adversos , Fístula Gástrica/cirurgia , Laparoscopia/efeitos adversos , Adulto , Animais , Fístula Cutânea/etiologia , Endoscopia Gastrointestinal , Gastrectomia/métodos , Fístula Gástrica/etiologia , Humanos , Masculino , Suínos
16.
Clinics ; 70(4): 247-249, 04/2015. tab
Artigo em Inglês | LILACS | ID: lil-747118

RESUMO

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy. .


Assuntos
Pré-Escolar , Feminino , Humanos , Masculino , Multilinguismo , Fonética , Comparação Transcultural , Diagnóstico Diferencial , Terapia da Linguagem , Singapura , Testes de Articulação da Fala , Medida da Produção da Fala , Fonoterapia , Distúrbios da Fala/diagnóstico , Distúrbios da Fala/terapia
17.
Int J Clin Exp Med ; 8(10): 18813-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26770500

RESUMO

OBJECTIVE: Postoperative iPTH assay may predict significant hypocalcemia after thyroid surgery. The present study aimed to evaluate the ability of iPTH assay to monitor parathyroid function and to identify the risk of postoperative hypocalcemia in patients underwent thyroid surgery. MATERIALS AND METHODS: One hundred patients participated in the study (7 male and 93 female). Hypocalcemia was defined as a serum calcium concentration less than 8.0 mg/dL and symptoms of hypocalcemia. Concomitant serum calcium and iPTH levels were measured before operation and at 1(st) h for iPTH, 24(th) h for calcium after thyroidectomy. RESULTS: Postoperative hypocalcemia was observed in 31 patients. The mean postoperative serum calcium concentration in normocalcemic patients was 8.8 ± 0.5 mg/dL, whereas it was 7.6 ± 0.3 mg/dL in hypocalcemic patients. The mean postoperative 1(st) hour iPTH of patients in the hypocalcemia group was 9.1 ± 4.9 pg/mL, whereas patients of the normocalcemia group had a mean postoperative iPTH of 35.8 ± 20.2 pg/mL. CONCLUSION: Postoperative 1(st) hour iPTH < 8 pg/mL with drop in iPTH level ≥ 81.5% together showed the highest diagnostic accuracy in predicting postoperative hypocalcemia.

18.
Ann Vasc Surg ; 28(8): 1869-77, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25108093

RESUMO

BACKGROUND: The aim of our study was to assess the effects of venous stripping on microvascular functions in isolated great saphenous vein insufficiency. METHODS: Two groups of participants were prospectively evaluated. The first group included 15 healthy participants without any evidence of venous insufficiency. The second group included 20 patients with varicose veins because of great saphenous vein insufficiency. The demographics, venous clinical severity scores, and CEAP classifications of the patients were recorded. Next, all individuals underwent evaluations for microvascular vasoreactivity using an iontophoretic laser Doppler imager, and the outcomes were recorded. Patients with varicose veins underwent stripping surgeries, and microvascular vasoreactivity evaluations were repeated 6 weeks postoperatively. RESULTS: There was a statistically significant decrease in the patients with varicose veins compared with the control group in response to nitroprusside (SNP) applied at 4 mC in the supine position. Furthermore, there was also a significant difference in the response to acetylcholine (ACh) in patient group in the sitting position (P < 0.05). We also observed a statistically significant decrease in the responses to SNP applied for 1, 2, and 4 mC (P < 0.05) in the patients in the sitting position. The relief of pain and edema after surgery was found to be significant (P < 0,001). In the subgroup in which ACh was applied for 1 and 4 mC in the supine position, postoperative microvascular flow was significantly increased (P < 0.005). Moreover, based on the measurements taken in the supine position, the patients in the subgroup in which SNP was applied for 1, 2, or 4 mC exhibited significantly increased postoperative microvascular dilatation (P < 0.005). CONCLUSIONS: Saphenous vein insufficiency impairs the endothelium-dependent vasodilatation response in the perimalleolar region, and partial recoveries in microvascular function were observed after surgical treatment.


Assuntos
Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Feminino , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares , Insuficiência Venosa/diagnóstico por imagem
19.
Clinics (Sao Paulo) ; 69(8): 515-23, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25141109

RESUMO

OBJECTIVES: Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses. The pathogenesis is still poorly understood and breast hamartoma is not a well-known disorder, so its diagnosis is underestimated by clinicians and pathologists. This study was designed to present our experience with breast hamartoma, along with a literature review. METHOD: We reviewed the demographic data, pathologic analyses and imaging and results of patients diagnosed with breast hamartoma between December 2003 and September 2013. RESULTS: In total, 27 cases of breast hamartoma operated in the Ankara University Medicine Faculty's Department of General Surgery were included in the study. All patients were female and the mean age was 41.8±10.8 years. The mean tumor size was 3.9±2.7 cm. Breast ultrasound was performed on all patients before surgery. The most common additional lesion was epithelial hyperplasia (22.2%). Furthermore, lobular carcinoma in situ was identified in one case and invasive ductal carcinoma was observed in another case. Immunohistochemical staining revealed myoid hamartoma in one case (3.7%). CONCLUSION: Breast hamartomas are rare benign lesions that may be underdiagnosed because of the categorization of hamartomas as fibroadenomas by pathologists. Pathologic examinations can show variability from one case to another. Thus, the true incidence may be higher than the literature indicates.


Assuntos
Angiomatose/patologia , Doenças Mamárias/patologia , Hamartoma/patologia , Hiperplasia/patologia , Adulto , Angiomatose/diagnóstico por imagem , Doenças Mamárias/diagnóstico por imagem , Feminino , Hamartoma/diagnóstico por imagem , Humanos , Hiperplasia/diagnóstico por imagem , Mamografia , Pessoa de Meia-Idade , Turquia , Ultrassonografia , Adulto Jovem
20.
Clinics ; 69(8): 515-523, 8/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-718193

RESUMO

OBJECTIVES: Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses. The pathogenesis is still poorly understood and breast hamartoma is not a well-known disorder, so its diagnosis is underestimated by clinicians and pathologists. This study was designed to present our experience with breast hamartoma, along with a literature review. METHOD: We reviewed the demographic data, pathologic analyses and imaging and results of patients diagnosed with breast hamartoma between December 2003 and September 2013. RESULTS: In total, 27 cases of breast hamartoma operated in the Ankara University Medicine Faculty's Department of General Surgery were included in the study. All patients were female and the mean age was 41.8±10.8 years. The mean tumor size was 3.9±2.7 cm. Breast ultrasound was performed on all patients before surgery. The most common additional lesion was epithelial hyperplasia (22.2%). Furthermore, lobular carcinoma in situ was identified in one case and invasive ductal carcinoma was observed in another case. Immunohistochemical staining revealed myoid hamartoma in one case (3.7%). CONCLUSION: Breast hamartomas are rare benign lesions that may be underdiagnosed because of the categorization of hamartomas as fibroadenomas by pathologists. Pathologic examinations can show variability from one case to another. Thus, the true incidence may be higher than the literature indicates. .


Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Angiomatose/patologia , Doenças Mamárias/patologia , Hamartoma/patologia , Hiperplasia/patologia , Angiomatose , Doenças Mamárias , Hamartoma , Hiperplasia , Mamografia , Turquia
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