RESUMO
Hepatocellular carcinoma (HCC) is a complex and heterogeneous tumor with multiple genetic aberrations. Several molecular pathways involved in the regulation of proliferation and cell death are implicated in the hepatocarcinogenesis. The major etiological factors for HCC are both hepatitis B virus (HBV) and hepatitis C virus infection (HCV). Continuous oxidative stress, which results from the generation of reactive oxygen species (ROS) by environmental factors or cellular mitochondrial dysfunction, has recently been associated with hepatocarcinogenesis. On the other hand, a distinctive pathological hallmark of HCC is a dramatic down-regulation of oxido-reductive enzymes that constitute the most important free radical scavenger systems represented by catalase, superoxide dismutase and glutathione peroxidase. The multikinase inhibitor sorafenib represents the most promising target agent that has undergone extensive investigation up to phase III clinical trials in patients with advanced HCC. The combination with other target-based agents could potentiate the clinical benefits obtained by sorafenib alone. In fact, a phase II multicenter study has demonstrated that the combination between sorafenib and octreotide LAR (So.LAR protocol) was active and well tolerated in advanced HCC patients. The detection of molecular factors predictive of response to anti-cancer agents such as sorafenib and the identification of mechanisms of resistance to anti-cancer agents may probably represent the direction to improve the treatment of HCC.
Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Hepatocelular/metabolismo , Neoplasias Hepáticas/metabolismo , Estresse Oxidativo , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Humanos , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapiaRESUMO
INTRODUCTION: Intraperitoneal sepsis due to anastomotic leakage significantly affects the outcomes of intestinal surgery. The aim of this retrospective review is to examine retrospectively general and local factors involved in anastomotic leakage and their prognostic value. MATERIALS AND METHODS: Between April 1998 and April 2008, 367 patients underwent elective (217=59%) or emergency (150=41%) primary colonic resection for benignan (77=21%) or malignant (290=79%) disease in our department. We performed the following operations; 124 right colon resections with immediate anastomoses (primary resection), 65 (52.4%) of which were emergency and 59 (47.6%) elective procedures; 171 left colon resections, 73 (42.7%) of which were emergency and 98 (57.3%) elective procedures, and 72 primary rectal resections, 12 (16.7%) of which were emergency and 60 (83.3%) elective procedures. The considered variables were stapled or manual anastomoses, protective stomas and medical comorbidities. RESULTS: The perioperative mortality rate was 6.6% for emergency and 3.6% for elective procedures. The leak rate was 8.7% (32/367), 13.3% for emergency and 5.5% for elective procedures. Fistula was observed in 7/124 (5.6%) ileocolic, 13/171 (7.6%) colo-colic and 12/72 (16.6%) colo-rectal anastomoses, 8 of which were fashioned during emergency surgery. Twenty-one patients with anastomotic dehiscence were treated conservatively (3 underwent reoperation), while 11, with severe dehiscence, in all cases in the left colon, underwent an emergency Hartmann's procedure, with a perioperative mortality rate of 35.7%. CONCLUSIONS: In our experience, the site of colonic anastomosis represents the risk factor most strictly related to the anastomotic leak rate, while other technical factors seem weakly associated with leakage. A significantly high percentage of patients (65.6%) with anastomotic fistulas have medical comorbidities.
Assuntos
Colectomia/efeitos adversos , Fístula Intestinal/etiologia , Peritonite/etiologia , Deiscência da Ferida Operatória/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Doenças do Colo/cirurgia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Incidência , Fístula Intestinal/mortalidade , Fístula Intestinal/cirurgia , Itália , Masculino , Pessoa de Meia-Idade , Peritonite/microbiologia , Peritonite/mortalidade , Peritonite/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/mortalidade , Deiscência da Ferida Operatória/cirurgia , Análise de SobrevidaRESUMO
INTRODUCTION: There are a number of reports in the literature which describe the association of venous thrombosis with oral contraceptives. Venous thrombosis is a rare form of mesenteric ischemia which may be lethal if not diagnosed and treated quickly. Although the non specificity of clinical signs do not always permit an early diagnosis. MATERIALS AND METHODS: The patient, aged 52, with a case history characterized by alteration of the alvus with occasional emission of blood, and abdominal pain. She referred with metrorrhagia of about one year, and was being treated with Ethynylestradiol/Gestodene. A CAT scan with contrast showed the signs of thrombosis in the superior mesenteric vein. The patient underwent surgical laparotomy. On opening the peritoneum we found a large tumefaction formed of conglobate iliac loops together with intense inflammation. A resection of the tumefaction was performed "en bloc". DISCUSSION: Pharmacological contraception remains in various cases as the only identified risk factor and there are reports which also censure a relationship of greater risk with increased hormonal doses and even reports of mesenteric venous thrombosis in patients taking triphasic drugs. Thus, we may state with near certainty, that a relationship between pharmacological contraceptives and mesenteric venous thrombosis exists and is probably more than a simple risk factor in contrast to that which exists for tobacco smoking and obesity. CONCLUSIONS: Before the prescription of contraceptive therapy the examination of risk factors is necessary, compiled preferably by hematochemical screening to exclude haematological and/or coagulative pathologies, and not deriding the use of non-pharmalogical methods of contraception when possible. Considering the technological advancement of instrumentation (CAT scan, angiogram), even a diagnosis aimed at a suspected clinical history; starting from less invasive screening by ultrasonographic Doppler, might induce to a rapid intervention and thereby avoid sacrificing too much intestinal tissue if it is the case.
Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Veias Mesentéricas , Trombose/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Hepatitis B and C are endemic in the Campania region of Italy, and as a result there are many patients with hepatitis-related cirrhosis. The medical community is therefore faced with a series of issues which must be dealt with and which are especially relevant to various areas of surgery. Abdominal wall hernias occur very frequently in cirrhotic patients, and hepatic cirrhosis has always been the harbinger of a negative outcome in patients undergoing inguinal hernia repair. The aim of this study, conducted on 52 cirrhotic patients who underwent inguinal hernioplasty, was to evaluate the effectiveness and safety of surgical treatment when certain parasurgical measures are used. These measures and the notes we inserted in our surgical protocol include the following: short-term antibiotic prophylaxis, perioperative infusion of concentrated platelets, not opening the hernia sac, application of human fibrin glue, elastic compression. All patients were treated according to the same protocol and the data was analysed using the statistics software EPI INFO 3.5.
Assuntos
Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Cirrose Hepática/complicações , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
Usually, left colon cancer metastasis concerns liver, abdominal lymph nodes and lungs. Other localizations are quite rare occurrences. In spite of this, some uncommon metastasis sites are reported in literature, such as: peritoneum, ovaries, uterus, kidney testis, bones, thyroid, oral cavity and central nervous system. We report two cases of unusual localizations of left colon cancer metastasis localization, one into the retroperitoneal space and the other at the left axillary lynphnodes and between liver and pancreas. In the first reported case the diffusion pathway may have been the lymphatic mesocolic vessels, partially left in place from the previous surgery. In the second case the alleged metastatic lane may have been through the periumbilical lymph nodes to the parasternal lymph nodes and then to the internal mammary ones, finally reaching the axillary limph nodes.
Assuntos
Neoplasias do Colo/patologia , Linfonodos/patologia , Neoplasias Retroperitoneais/secundário , Axila , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-IdadeRESUMO
UNLABELLED: Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection (3-15%). The objective of this study was to evaluate the advantages antibiotic prophylaxis in patients undergoing breast surgery. A multicenter randomized controlled study was performed between January 2008 and November 2008. One thousand four hundred patients were enrolled in prospective randomized study; surgical wound infection was found in 41 patients (2.93%). In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection (17 patients, 2.42%, subjected to antibiotic prophylaxis vs 24 patients, 3.43%, without antibiotic prophylaxis) (P = 0.27). In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis (5 patients, 0.92%, subjected to antibiotic prophylaxis vs 14 patients, 3.09%, without antibiotic prophylaxis) (P = 0.02). CONCLUSION: This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant.
Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Doenças Mamárias/cirurgia , Neoplasias da Mama/cirurgia , Cefazolina/uso terapêutico , Mastectomia Radical , Mastectomia Segmentar , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Antibacterianos/administração & dosagem , Cefazolina/administração & dosagem , Ácido Clavulânico/administração & dosagem , Ácido Clavulânico/uso terapêutico , Interpretação Estatística de Dados , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Seleção de Pacientes , Infecção da Ferida Cirúrgica/tratamento farmacológico , Resultado do TratamentoRESUMO
In the early days of video-assisted laparoscopic cholecystectomy (VLC), obesity was considered a contraindication for the procedure. We reviewed charts from 304 patients undergoing VLC; 90 patients were obese, and among these, according to a classification currently used by medical nutritionists and based on BMI, 45 were overweight (BMI > or = 25 < or = 29.9), 27 were considered conventionally obese (BMI > or = 30 and < 40) and 18 morbidly obese (BMI > or = 40). In this study we considered only the morbidly obese patients (5 males and 13 females). The average age was 42.3 years (range: 21-65) and the average weight 275 Ib (range: 186-331 Ib). Six patients had previously undergone abdominal surgery. All patients were symptomatic for gallstones, and 5 of them were suffering from acute cholecystitis. Mean operative time was 20 minutes (range: 10-45 minutes) longer than that of non-obese patients. No open conversion was necessary. No major postoperative morbidity and no cases of mortality occurred. The mean hospital stay and resumption of normal diet were similar to those of non-obese patients. Regardless of the higher postoperative risks after open cholecystectomy in obese patients (pulmonary complications, thromboembolism, wound infections and cardiovascular complications), we suggest VLC as the procedure of choice for cholecystectomy in these patients.
Assuntos
Colecistectomia Laparoscópica , Obesidade Mórbida/complicações , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Fatores SexuaisRESUMO
A 62 y.o. male with tight fimosis, swelling, redness, pain on palpating and necrosis of the penis and scrotum was admitted in our clinic, (FGSI = 6) with periferic vasculopathy; and diabetes mellitus type II and he was in dialysis treatment before the hospitalization. The patient was HCV affected. In 24 hours he underwent radical surgical debridement with excision of all necrotic material from penis and scrotum up to the subdermal layer and tissue of doubtful viability for about 75% of the skin and circumcision. In third, fifth and seventh postoperative days he underwent to local infusion of autologous PLT growth factors. The patient was discharged in 9th postoperative day and FGSI was still 6; the skin and subdermal tissue was barely reskined, with low homogeneous granulation, edema was heavely reduced. In our case, deviation from homeostasis status at admission was the main worrying factor. We found that diabetes mellitus and renal dysfunction at admission was also important risk factor for FG. "E.Coli" was the most common organism isolated from patient wound cultures. The FGSI is an objective and easy to apply score method to quantify the metabolic status and can be used to evaluate therapeutic options and assess results.
Assuntos
Gangrena de Fournier/cirurgia , Infecções dos Tecidos Moles/cirurgia , Gangrena de Fournier/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Infecções dos Tecidos Moles/patologiaRESUMO
Based on the theory--which is now acknowledged-of a clinical difference between proximal and distal colon cancer and on the results of recent genetic and microbiological studies, a minority of authors have assumed that also in the sphere of right-sided colon cancer, tumors at three different locations, namely, the cecum and ascending and transverse colon, can be considered to be biologically different. These studies have provided the basis for a retrospective study carried out on 50 patients admitted to our department from 1996 to 2008 for tumor pathology of the right colon. The tumor was considered to be a unified biological entity and assessed in relation to the three above-mentioned locations. The results verify that the aggressive of the tumor increases from the cecum to the transverse, with a higher percentage of cecal tumors being in I stage, more tumors in the ascending colon being in II stage, and more transverse tumors, with the largest percentage of N+ and M+, in stages III and IV. This difference in biological behavior for the three tumor locations has been also found in terms of sensitiveness, both pre- and post-operation, of tumor markers CEA, TPA, and CA19-9. Clinical data revealed a binary relationship between the transverse, cecum, and ascending tumors, which ultimately affects patient mortality, which increases in a directly proportional way from the cecum to the transverse-in the case of a tumor at one of these locations.