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2.
Chirurgia (Bucur) ; 115(1): 95-101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155404

RESUMO

Introduction: Diverting ostomy is a commonly perfomed procedure but may be associated to its own morbidity (early or late complications). Colostomy-related evisceration is a rare but potentially life threatening condition (requiring emergency surgery), relatively undocumented for its mechanisms. Case report: A male aged 84 was admited for chronic low digestive occlusion due to a locally advanced, stenosing, rectal adenocarcinoma. Prior to neoadjuvant therapy, a loop sigmoidostomy was indicated using a left iliac open aproach, with no preparation of the colic content. The sigmoid was loaded with hard stools. The parietal breach was reaproximated by 2 monofilament nylon sutures, fascial and colocutaneus fixation. Colostomy was opened two days later, but was not functional (postoperative paralytic ileus). Parastomal evisceration of ileum in day 3, dehiscence of parietal suture. Emergency operation, using the same aproach. Results: Favourable outcome. Thoraco-abdominal CT scan: N0,M0. Pelvic MRI: proliferative mass of inferior and middle rectum, involving mesorectum fascia, levator ani and a few regional lymphatic nodes. Radio-chemotherapy and abdomino-perineal resection. Pathologic result: colorectal adenocarcinoma, G2, ypT1ypN0, ICD-O: 8140/3. Conclusions: We rewiewed 8 case reports published since 2011, equally distributed as late or early complications. There was no connection with the princeps indication (colorectal cancer in half of cases); neither related to topography (transverse or sigmoid) or type of colostomy (loop or end). Occurence of the complication is not time-dependent (5 to18 months in late, 3 to 12 days for early eviscerations). The main premise is colostomy itself (a place of reduced parieto-abdominal resistence), stressed by increassed intra-abdominal pressure (eg. bronchopulmonary disease, digestive obstruction). Predisposing factors for late evisceration seems to be related to spontaneous rupture of parastomal hernia/colostomy prolapse. As for early evisceration, both technical details and surgical strategy must be considered (indequate fixation; creation of a larger than necessary colostomy aperture).


Assuntos
Adenocarcinoma/cirurgia , Colostomia/efeitos adversos , Hérnia Ventral/cirurgia , Hérnia Incisional/cirurgia , Obstrução Intestinal/cirurgia , Neoplasias Retais/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Obstrução Intestinal/etiologia , Pseudo-Obstrução Intestinal/etiologia , Masculino , Protectomia , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico por imagem , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Tomografia Computadorizada por Raios X
3.
Wiad Lek ; 73(1): 83-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32124812

RESUMO

OBJECTIVE: The aim: To study the possibilities of ultrasound in adhesive ileus obstruction diagnosis and indications for surgical treatment determination. PATIENTS AND METHODS: Materials and methods: The results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction with comparative use of X-ray and ultrasound methods were analyzed. RESULTS: Results: The use of a standard X-ray examination of the abdominal organs upon admission to the hospital allowed the diagnosis of acute adhesions of small bowel obstruction in only 32 (53.3%) patients. Transabdominal ultrasonography allowed the establishment of adhesive ileus during hospitalization in 53 (88.3%) patients and also in 7 (11.7%) during a dynamic examination 2-3 hours after admission. Due to the lack of positive effect from the conducted conservative therapy relying on the data of ultrasound studies, 33 (55%) patients were operated on. During X-ray examination, only 10 (30.3%) of these patients demonstrated negative X-ray dynamics, and with an ultrasound study, deterioration of echo pictures was observed in all 33 (100%) patients. CONCLUSION: Conclusions: Compared with the X-ray method, transabdominal ultrasonography is established to be safe, affordable, simpler, non-invasive and highly informative method for the study of acute adhesions of the small intestinal obstruction. The method allows the assessment of the ongoing conservative therapy dynamics and determination for surgical treatment indications.


Assuntos
Obstrução Intestinal , Adesivos , Humanos , Intestino Delgado , Aderências Teciduais , Ultrassonografia
6.
Zhonghua Zhong Liu Za Zhi ; 42(1): 61-64, 2020 Jan 23.
Artigo em Chinês | MEDLINE | ID: mdl-32023771

RESUMO

Objective: To explore the method of relieving intestinal obstruction in patients with recurrent cervical cancer accompanied with intestinal obstruction after radical radiotherapy. Methods: The data of 10 recurrent cervical cancer patients accompanied with high risk weak constitution and intestinal obstruction after radical radiotherapy from May 2012 to May 2018 were retrospectively analyzed, including preoperative radiotherapy dose, physique and obstruction status, operation time, operation blood loss, postoperative digestive tract patency and diet. All of the 10 patients with cervical cancer recurrence accompanied with intestinal obstruction and disturbance of independent walking after radical radiotherapy. Results: The median fasting time of the 10 patients was 21 days, the median weight was 35.5 kg, the median body mass index (BMI) was 13.3 kg/m(2,) the median value of hemoglobin was 67 g/L, and the median value of platelet was 44×10(9) /L. All of the patients underwent enterostomy. the median operation time was 6.0 min and the median amount of bleeding was 5.0 ml. All of the patients defecated after operation, fed on the first day after operation, and were able to walk on their own 5 days after operation. Conclusions: Although the cervical cancer patients with recurrent intestinal obstruction after radical radiotherapy are extremely weak, some patients still have the opportunity to relieve intestinal obstruction if the treatment strategy and surgical method are appropriate.


Assuntos
Enterostomia , Obstrução Intestinal , Neoplasias do Colo do Útero , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/cirurgia
7.
Medicine (Baltimore) ; 99(2): e18623, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914042

RESUMO

BACKGROUND: The surgical management of acute malignant left-sided bowel obstruction is associated with high morbidity and mortality. Recently, transanal drainage tubes (DTs) and metallic stents (MSs) used as a "bridge to surgery" have become widely used decompression methods compared with emergency surgery. This study aims to evaluate the efficacy and safety of DTs and MSs for the decompression of acute left-sided malignant colorectal obstruction. METHODS: All studies were acquired from PubMed, Medline, Embase, CNKI and the Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed with RevMan5.3. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the risk of bias. RESULTS: Eleven studies, which included three randomized controlled trials (RCTs) and 8 observational studies, were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of the technical success rate showed that the difference was not statistically significant between the2 devises. The differences in clinical success rate, operative time and complications were statistically significant between MSs and DTs, and MSs were associated with a better clinical success rate, increased operative time and fewer complications. Sensitivity analysis proved the stability of the pooled results, and the publication bias was low. CONCLUSION: MS insertion for acute left-sided malignant bowel obstruction is effective and safe with a better technical success rate and with fewer complications than decompression using a DT, and MS insertion can avoid stoma formation. Moreover, MS insertion appears to be a useful treatment strategy for malignant colonic obstruction even if the lesion is located in the right colon. More large-sample, multicenter, high-quality RCTs are needed to verify the outcomes of this meta-analysis.


Assuntos
Neoplasias Colorretais/complicações , Drenagem/instrumentação , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia
8.
J Comput Assist Tomogr ; 44(1): 131-137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939894

RESUMO

OBJECTIVE: To identify multidetector computed tomography (MDCT) findings of surgically confirmed adhesive internal hernias (IHs). METHODS: Two gastrointestinal radiologists performed blinded, independent, and retrospective reviews of MDCT findings from a consecutive cohort of 35 adhesive IH and 41 adhesive small-bowel obstruction cases that had undergone surgery within 48 hours after MDCT. Univariate statistical analyses were performed to assess CT signs of adhesive IHs and CT findings of intestinal necrosis in patients presenting with adhesive IHs. RESULTS: Dislocated cluster of the intestine (P = 0.005), 2 transitional zones (P = 0.002), and presence of fat in the center sign (P = 0.001) were key CT outcomes that were significantly associated with adhesive IHs. Additionally, intramural hemorrhage was found the MDCT feature indicative of intestinal necrosis (P = 0.028). CONCLUSIONS: This study illustrates specific MDCT findings of IHs, and these observations may help guide early clinical management of the condition.


Assuntos
Hérnia Abdominal/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Intestinos/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Omento/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Adulto Jovem
9.
Anaesthesia ; 75(3): 313-322, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31667827

RESUMO

Pulmonary aspiration of gastric content is a significant cause of anaesthesia-related morbidity and mortality. High-quality prospective randomised evidence to support prevention strategies, such as rapid sequence intubation, is difficult to generate due to well-described practical, ethical and methodological barriers. We aimed to generate an understanding of worldwide practice through surveying clinically practicing anaesthetists and airway experts. Our survey was designed to assess the influence of: departmental standards; patient factors; socio-economic factors; training; and supervision. We surveyed 10,003 anaesthetists who responded to an invitation to participate on LinkedIn. We then surveyed 16 international airway experts on the same content. When asked about a hypothetical patient with intestinal obstruction, respondents expressed preferences for [OR (95%CI)]: the head-up or -down position 4.26 (3.98-4.55), p < 0.001; nasogastric tube insertion 29.5 (26.9-32.3), p < 0.001; and the use of cricoid force 2.80 (2.62-3.00), p < 0.001, as compared with a hypothetical patient without intestinal obstruction also requiring rapid sequence intubation. Respondents from lower income countries were more likely to prefer [OR (95%CI]: the supine position 2.33 (2.00-2.63), p < 0.001; nasogastric tube insertion 1.29 (1.09-1.51), p = 0.002; and cricoid force application 2.54 (2.09-3.09), p < 0.001 as compared with respondents from higher income countries for a hypothetical patient with intestinal obstruction. This survey, which we believe is the largest of its kind, demonstrates that preferences for positioning, nasogastric tube use and cricoid force application during rapid sequence intubation vary substantially. Achieving agreed consensus may yield better training in the principles of rapid sequence intubation.


Assuntos
Intubação Intratraqueal/métodos , /métodos , Manuseio das Vias Aéreas , Anestesiologistas/educação , Anestesistas , Cartilagem Cricoide , Estudos Transversais , Humanos , Obstrução Intestinal/diagnóstico , Posicionamento do Paciente , Pobreza , Estudos Prospectivos , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Ann R Coll Surg Engl ; 102(2): 141-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31660754

RESUMO

INTRODUCTION: Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery. METHODS: Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent. RESULTS: Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention. CONCLUSIONS: Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.


Assuntos
Doenças do Colo/cirurgia , Descompressão Cirúrgica/instrumentação , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Stents , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Retratamento/instrumentação , Falha de Tratamento , Resultado do Tratamento
11.
Med Klin Intensivmed Notfmed ; 115(1): 22-28, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31792558

RESUMO

BACKGROUND: Mechanical bowel obstruction is a common condition in geriatric patients in the emergency department. It accounts for up to 50% of all emergency surgeries in the elderly. In recent years, diagnosis and treatment of mechanical bowel obstruction has improved, but little is known whether elderly patients benefit from modern treatment approaches. OBJECTIVE: The aim of the work is to generate knowledge about possible improvement of diagnosis and treatment of mechanical bowel obstruction in the elderly. METHODS: A retrospective review of 132 patients was performed comparing geriatric (>80 years of age) and nongeriatric patients (50-70 years of age) admitted with mechanical bowel obstruction. Etiology, time from first contact to operation, bowel resection rate and morbidity/mortality were compared. Data analysis included Fisher's test and Student t­test. RESULTS: In patients under 70 years of age it took 18.23 ± 0.79 h from first contact until laparotomy in the operating room (OR) vs. 43.38 ± 12.08 h in patients above 80 years of age (p = 0.0111). In 58.9% of geriatric patients, resection of bowel was necessary, while only 35.3% of <70-year-old patients needed bowel resection (p = 0.0401). In all, 50% of geriatric patients experienced major complications (Dindo/Clavien >IIIB) vs. only 12.7% of 50- to 70-year-old patients (p = 0.0002). Postoperative stay in the intensive care unit was significantly prolonged in geriatric patients compared to younger patients (93.97 ± 17.36 h vs. 26.11 ± 3.73 h, p < 0.0001). CONCLUSIONS: Time from first contact in the emergency department until laparotomy in the OR is prolonged in geriatric patients, leading to a higher probability of bowel resection with greater morbidity and mortality. Diagnostics should be intensified and accelerated in geriatric patients. Emergency surgery should be considered earlier.


Assuntos
Obstrução Intestinal , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Intestinos , Laparotomia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos
12.
Ann R Coll Surg Engl ; 102(2): e39-e41, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31532226

RESUMO

Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The management of caecal herniation remains challenging due to the lack of literature highlighting this pathology. A 66-year-old woman was admitted with a 24-hour history of epigastric pain radiating to the back. The pain was associated with nausea and vomiting of gastric contents. On examination, the abdomen was soft with mild tenderness but no signs of peritonism or distension. The abdominal x-ray and a computed tomography were in keeping with caecal volvulus and confirmed that the caecum was not in the right iliac fossa. In a midline laparotomy procedure, the ileum, caecum and ascending colon were noted to be herniating into the foramen of Winslow. A right hemicolectomy with a handsewn anastomosis was performed. The foramen of Winslow was not closed. No postoperative complications occurred. A literature review showed a lack of similar cases with no agreed management consensus. The laparotomy approach is comparable to the laparoscopic approach and no caecal herniation recurrence after open/laparoscopic surgical procedures were identified. Awareness of caecal herniation allows early diagnosis and timely surgical management is needed in prevent patient morbidity and mortality.


Assuntos
Ceco/diagnóstico por imagem , Colo Ascendente/diagnóstico por imagem , Hérnia Abdominal/diagnóstico por imagem , Idoso , Doenças do Ceco/diagnóstico por imagem , Doenças do Ceco/cirurgia , Ceco/cirurgia , Colo Ascendente/cirurgia , Feminino , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Radiografia Abdominal , Tomografia Computadorizada por Raios X
13.
Ann R Coll Surg Engl ; 102(1): e12-e14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31859525

RESUMO

Malrotation is part of a spectrum of small and large bowel positional and fixational abnormalities caused by the failure of the fetal intestine to complete a 270-degree rotation around the superior mesenteric artery axis. Rarely, it presents in the adult as a cause of acute small bowel obstruction. Chronic symptoms of malrotation in adults are subtle, and include intermittent abdominal pain, nausea and vomiting. We present two cases of malrotation in octogenarian men presenting acutely with small bowel obstruction. Both patients were treated with emergency surgery. In one case the chronic symptoms resolved postoperatively. Malrotation and midgut volvulus should be considered as a rare differential diagnosis for small bowel obstruction in adults. Suspicions should be increased when there is a history of recurrent presentations with similar symptoms.


Assuntos
Obstrução Intestinal/cirurgia , Volvo Intestinal/congênito , Intestino Delgado/cirurgia , Idoso de 80 Anos ou mais , Constipação Intestinal/etiologia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Volvo Intestinal/diagnóstico por imagem , Volvo Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Masculino , Náusea/etiologia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologia
14.
Dis Colon Rectum ; 63(1): 101-112, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31804272

RESUMO

BACKGROUND: Incisional hernia and adhesional intestinal obstruction are important complications of laparoscopic and open resection for colorectal cancer. This is the largest systematic review of comparative studies on this topic. OBJECTIVE: This study aimed to investigate whether laparoscopic surgery decreases the incidence of incisional hernia and adhesional intestinal obstruction compared to open surgery for colorectal cancer. DATA SOURCES: Online databases PubMed, EMBASE, and the Cochrane Library were searched. Abstracts from the annual meetings of the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology were performed to cover gray literature. STUDY SELECTION: We included both randomized and nonrandomized comparative studies. INTERVENTIONS: Laparoscopic resection was compared to open resection for patients with colorectal cancer. MAIN OUTCOMES MEASURES: The primary outcomes measured were incisional hernia and adhesional intestinal obstruction. RESULTS: Fifteen studies met inclusion criteria (6 randomized comparative studies/9 nonrandomized comparative studies); 84,172 patients. Meta-analysis showed decreased odds of developing incisional hernia in the laparoscopic cohort (OR, 0.79; 95% CI, 0.66-0.95; p = 0.01) but no difference in requirement for surgery (OR, 1.07; 95% CI, 0.64-1.79; p = 0.79). Similarly, there were decreased odds of developing adhesional intestinal obstruction in the laparoscopic cohort (OR, 0.81; 95% CI, 0.72-0.92, p = 0.001), but no difference in requirement for surgery (OR, 0.84; 95% CI, 0.53-1.35; p = 0.48). LIMITATIONS: Incisional hernia and adhesional intestinal obstruction were poorly defined in many studies. CONCLUSION: Laparoscopic surgery is associated with decreased odds of incisional hernias and adhesional intestinal obstructions compared with open surgery for colorectal cancer.


Assuntos
Neoplasias Colorretais/cirurgia , Hérnia Incisional/epidemiologia , Obstrução Intestinal/epidemiologia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Aderências Teciduais/epidemiologia , Saúde Global , Humanos , Incidência , Hérnia Incisional/etiologia , Obstrução Intestinal/etiologia , Aderências Teciduais/etiologia
15.
Georgian Med News ; (295): 123-126, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804213

RESUMO

The aim of our research was the elaboration of acute adhesive small bowel obstruction model and further study of pathomorphological changes of small bowel and peritoneum in experiment. The study was carried out on 40 rats which were done suturing of sero-serous small bowel stiches and modelling of angulations of small bowel with the use of mechanical and implantation factors of peritoneal adhesive disease development according to the worked out by us technique. The suggested experimental model allows modelling the acute adhesive small bowel obstruction just on the 3rd day of the experiment and specifying some aspects of adhesion formation in peritoneum under pathomorphological study.


Assuntos
Obstrução Intestinal , Aderências Teciduais , Doença Aguda , Animais , Modelos Animais de Doenças , Obstrução Intestinal/etiologia , Intestino Delgado , Ratos
16.
Medicine (Baltimore) ; 98(49): e18250, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804355

RESUMO

RATIONALE: Various types of internal hernias have been reported including paraduodenal, intersigmoidal, pericecal, foramen of Winslow, as well as transmesenteric and retroanastomotic hernias. However, small bowel obstruction secondary to an internal hernia caused by the ureter is rare, and only a few cases have been reported worldwide. We report a case of small bowel herniation caused by the ureter in a woman who underwent radical hysterectomy for cervical cancer. PATIENT CONCERNS: A 53-year-old woman presented with acute abdominal pain and vomiting and reported a history of radical hysterectomy for cervical cancer 6 years prior to presentation. DIAGNOSES: Computed tomography revealed segmental luminal dilatation of pelvic ileal loops, 2 transition zones with the beak sign in the left-sided pelvic cavity, and reduced enhancement of bowel loops. Hydronephrosis with abrupt luminal narrowing of the left distal ureter was also observed. INTERVENTIONS: Exploratory laparoscopy revealed incarcerated bowel segments beneath an adhesive band. We did not immediately cut the adhesive band and continued to trace the course of the small bowel and attempted reduction of the hernia. Reduction of the hernia was not difficult; therefore, the entire small bowel could be disentangled from the pelvic adhesions without any small bowel injury. After reduction of the herniated small bowel, we could confirm that the adhesive band was the left ureter (ureteral peristalsis was observed). The reduced segments of the small bowel appeared viable, and resection was not required. OUTCOMES: The patient was discharged 2 days postoperatively without any complication. LESSONS: Cutting band during adhesiolysis enables release of bowel obstruction. However, owing to the different types of internal hernias that are known to occur, it is essential to confirm the patient's history and preoperative CT findings to avoid complications.


Assuntos
Hérnia Abdominal/complicações , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado , Laparoscopia/métodos , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Aderências Teciduais/cirurgia
17.
Anticancer Res ; 39(12): 6781-6786, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810943

RESUMO

BACKGROUND/AIM: Patients affected with Stage IV colorectal cancer and unresectable metastases represent a heterogeneous group. Resection of the primary tumor or stent positioning followed by chemotherapy and/or targeted therapies still represent a difficult choice for surgeons. PATIENTS AND METHODS: From February 2013 to September 2019, 46 patients were enrolled into a prospective randomized open label parallel trial presenting with Stage IVA and IVB rectal cancer, unresectable metastases and symptoms of subacute large bowel obstruction. Our population was divided into two groups: Group 1 included 20 patients who underwent placement of a self-expandable metal stent and Group 2 included 26 patients in whom primary tumor resection was performed. RESULTS: One-year actuarial survival rate of Group 1 was significantly lower compared to Group 2. Overall 17 patients had survival longer than 1-year (3 in Group 1 and 14 in Group 2). Cox regression analysis showed that endoscopic stent positioning and the suspension of the chemotherapy because of deterioration of liver function tests were the two most important factors negatively influencing survival. CONCLUSION: Patients affected with stage IVA and IVB rectal cancer and symptoms of bowel obstruction had a significant longer survival rate when submitted to surgical rectal resection followed by chemotherapy.


Assuntos
Adenocarcinoma/terapia , Obstrução Intestinal/terapia , Neoplasias Retais/terapia , Stents Metálicos Autoexpansíveis , Adenocarcinoma/complicações , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Terapia Combinada/métodos , Feminino , Fluoruracila/administração & dosagem , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular , Compostos Organoplatínicos/administração & dosagem , Estudos Prospectivos , Neoplasias Retais/complicações , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Taxa de Sobrevida
18.
PLoS One ; 14(12): e0219286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860649

RESUMO

Intussusception is one of the most common causes of intestinal obstruction in young children. We report a retrospective, observational study of the epidemiology of intussusception in South Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). A cohort of newborns born between 2002 and 2008 was selected. The primary objective was to assess the incidence of intussusception in the pediatric population of Korea. The secondary objectives were to describe the basic epidemiological characteristics of intussusception and to identify risk factors. A total of 362 children were identified. The highest incidence of intussusception (2.6 per 1,000) was observed in children aged 1-2 years. A total of 58.8% of the children were male, and there was no significant difference in incidence according to the birth year (P = 0.804). Most of the children diagnosed with intussusception underwent air reduction, while only 0.6% had surgery. In all, 82.3% of the children were admitted to the hospital, 0.8% of them had to be admitted to the ICU, and the 6-month mortality was only 0.3%. In this retrospective, observational study, the incidence of intussusception was highest among children between 1 and 2 years of age. Most of the children underwent air reduction.


Assuntos
Intussuscepção/epidemiologia , Pré-Escolar , Feminino , Hospitalização , Humanos , Incidência , Lactente , Recém-Nascido , Obstrução Intestinal/complicações , Intussuscepção/etiologia , Masculino , Programas Nacionais de Saúde , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Fatores Sexuais
19.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(6): 418-421, 2019 Nov 30.
Artigo em Chinês | MEDLINE | ID: mdl-31854526

RESUMO

This paper designs and implements a low power portable bowel sound monitor, which adopts bone conduction transducer to collect bowel sound continuously for long time and transmit to phone by Bluetooth. Then the phone application can record, play and analyse the bowel sound digital data in real time. This paper also designs an experiment to collect bowel sound from healthy people and patients with intestinal obstruction. It is verified by clinicians that this monitor can accurately record and preserve the bowel sound of the detected people, and is not disturbed by the external environment.


Assuntos
Monitorização Fisiológica , Humanos , Obstrução Intestinal
20.
Pan Afr Med J ; 33: 214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692747

RESUMO

Primary melanoma of the small bowel is a rare clinical entity with a paucity of published reports in literature. Most cases of gastrointestinal melanomas are metastatic lesions arising from skin or ocular origins. This is a case report of a 63 year old female with adult intussusception with jejunal melanoma as the lead point. The index patient had a long history of abdominal pain associated with significant weight loss and presented with features of intestinal obstruction. The possibility of a regressed or unidentified extra-intestinal site cannot be absolutely excluded as the patient did not have a PET scan. Due to the vague nature of clinical symptoms and signs, the diagnosis of small bowel melanoma is difficult, especially in patients with no obvious cutaneous pathology. A high index of suspicion for melanoma as a malignant lead point for adult intussusception should always be entertained.


Assuntos
Intussuscepção/etiologia , Neoplasias do Jejuno/diagnóstico , Melanoma/diagnóstico , Dor Abdominal/etiologia , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Intussuscepção/diagnóstico , Neoplasias do Jejuno/complicações , Melanoma/complicações , Pessoa de Meia-Idade
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