RESUMO
Metastasis of colorectal cancer (CRC) in an adrenal gland develops in 1.8% of cases (in synchrony or in metachrony) for patients with liver metastatic lesion and aggravates for certain prognosis for long-term survival. There are no data concerning colorectal metastasis in an adrenal gland with tumor thrombosis of inferior vena cava (IVC) in world-wide literature. A patient, 57 years old, on 04.29.11 underwent palliative distal sigmoid colectomy in respect of CRC pT3N2M1 (metastatic lesion of liver right lobe). Process stabilization was noticed after 4 courses of polychemotherapy. On 07.28.11 she underwent right-sided hemihepatectomy. She underwent further 4 courses in accordance with the same scheme. On 12.06.13 case-control USI and multi-layer spiral CT of abdominal cavity detected mass lesion in the right adrenal gland, it was estimated as metastatic lesion with compression of inferior vena cava and thrombosis in its lumen at retroliver segment level. Right-sided adrenalectomy. Thrombectomy of IVC was carried out in the condition of total vascular isolation. Taking into account metastasis respectability in an adrenal gland and small extent of a tumor thrombus we suppose the described surgical practice to be justified. The problem of neoadjuvant chemotherapy prescription is still controversial.
Assuntos
Adenocarcinoma , Neoplasias das Glândulas Suprarrenais , Adrenalectomia/métodos , Neoplasias Colorretais , Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Compostos Organoplatínicos/administração & dosagem , Trombectomia/métodos , Trombose , Veia Cava Inferior , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Antineoplásicos/administração & dosagem , Capecitabina , Colectomia/métodos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Terapia Combinada , Desoxicitidina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Oxaliplatina , Trombose/etiologia , Trombose/cirurgia , Resultado do Tratamento , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgiaRESUMO
This study included 500 patients who had undergone extensive liver resection and transplantation of whom 250 were treated with the use of remedial gymnastics, physiotherapeutic factors, and massage. The positive dynamics of objective characteristics of the patients' condition. None of the treated patients showed a negative response to the proposed program of medical rehabilitation and activation throughout the early postoperative period.
Assuntos
Terapia por Exercício , Transplante de Fígado/reabilitação , Massagem , Feminino , Humanos , Masculino , Período Pós-Operatório , Fatores de Tempo , Transplante HomólogoRESUMO
The condition of the major duodenal papilla and the periampullary region was studied in 1,113 patients with diseases of the biliary tract and pancreas. In 88.6% of cases complex examination revealed various pathological changes which were considered to be important etiological factors of the development of the diseases. These changes were found to be particularly significant in patients with the postcholecystectomy syndrome. The authors present the modern methods for correction of pathology of the major duodenal papilla, among which endoscopic interventions are most valuable.