RESUMO
During the past ten years a diagnosis of biliary-enteric fistula was made in thirty-five patients. Six were entirely asymptomatic and another seven patients had suffered only mild symptoms for a short period of time. This indicates that the gallbladder can undergo recurrent episodes of inflammation to the point of fistula formation, with little or no clinical signs of symptoms. An aggressive surgical approach is therefore warranted in patients with cholelithiasis, even when silent stones are involved.
Assuntos
Ductos Biliares , Fístula Biliar/etiologia , Colelitíase/complicações , Doenças da Vesícula Biliar/etiologia , Fístula Intestinal/etiologia , Adulto , Idoso , Colelitíase/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Ductos Biliares Intra-Hepáticos/anormalidades , Doenças Biliares/complicações , Cistos/complicações , Sepse/complicações , Adulto , Antibacterianos/uso terapêutico , Doenças Biliares/diagnóstico , Colangiografia , Colangite/diagnóstico , Colecistectomia , Cistos/diagnóstico , Diagnóstico Diferencial , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/tratamento farmacológico , Febre de Causa Desconhecida/tratamento farmacológico , Humanos , Masculino , Sepse/tratamento farmacológico , Sepse/etiologiaAssuntos
Hérnia Diafragmática/diagnóstico , Adulto , Dispneia/etiologia , Feminino , Hérnia Diafragmática/complicações , Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/cirurgia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Dor , Esforço Físico , Radiografia Torácica , Infecções Respiratórias/etiologia , Vômito/etiologiaRESUMO
The conventional excretory urogram may provide valuable information in the diagnosis of polyarteritis nodosa. A finding of imprints on the ureteral wall or a nodular appearance of the ureter simulating a string of pearls would seem to be pathognomonic for this disorder. Two cases with these manifestations are presented and the differential diagnosis is discussed.
Assuntos
Poliarterite Nodosa/diagnóstico por imagem , Ureter/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Masculino , RadiografiaRESUMO
Long-term follow-up of leiomyomas in the oesophagus is discussed from the radiological point of view. It is the authors' impression that surgical intervention is not a matter of urgency in the treatment of these tumours as their tendency to undergo malignant change is very rare. Nine cases of leiomyoma of the oesophagus were followed for periods ranging from 1 to 15 years. None showed malignant degeneration.
Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Adulto , Neoplasias Esofágicas/cirurgia , Feminino , Seguimentos , Humanos , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
We studied the incidence of myelosuppression and renal function in 33 patients treated by repeated resections of bladder tumors and thiotepa instillations for at least 26 months in the presence of vesicoureteral reflux. Of the 33 patients 28 had unilateral and 5 had bilateral reflux. Transient myelosuppression occurred in 5 patients (15.1 per cent), including 2 with bilateral reflux. Renal function remained stable in all but 2 patients who had decreased renal function when thiotepa was started. Our experience has shown that long-term thiotepa instillation in the presence of vesicoureteral reflux is relatively safe, with no significantly increased incidence of myelosuppression and no detrimental effect on renal function.
Assuntos
Carcinoma de Células de Transição/tratamento farmacológico , Tiotepa/efeitos adversos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Refluxo Vesicoureteral/etiologia , Idoso , Medula Óssea/efeitos dos fármacos , Carcinoma de Células de Transição/cirurgia , Terapia Combinada , Feminino , Seguimentos , Humanos , Testes de Função Renal , Masculino , Complicações Pós-Operatórias , Tiotepa/administração & dosagem , Tiotepa/uso terapêutico , Fatores de Tempo , Ureter/cirurgia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
A 60-year old male with a history of rectal bleeding was operated upon because of the finding of a filling defect on barium enema examination. At operation it was found that the defect was produced by the fusion of two epiploic appendages. Following release of the adhesion the colon regained its normal appearance and postoperative barium enema showed no pathological findings.
Assuntos
Tecido Adiposo/diagnóstico por imagem , Colo/diagnóstico por imagem , Neoplasias do Colo/diagnóstico por imagem , Sulfato de Bário , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Aderências TeciduaisRESUMO
In a 77-year-old man with dysphagia, x-rays demonstrated an irregular stenotic process in the lower third of the esophagus, suggesting malignancy. Endoscopy disclosed moderate narrowing of the lumen and several ulcers separated by bulges. Serial biopsies revealed Barrett's mucosa. Cimetidine 1 g/day led to prompt improvement and endoscopically there was a disappearance of the lesions after 3 months of therapy. Reduction of the drug to 400 mg/day 3 months later with supplements of antacids and metoclopramide was followed by reappearance of symptoms and recurrence of a deep ulcer. Raising the dose of cimetidine to 1 g/day again resulted in healing and since then a maintenance dose of 600 mg cimetidine with antacids and metoclopramide has been successful in preventing recurrence. This long-term study in a patient with Barrett's esophagus showed 1) that cimetidine can be effective in treating such patients; 2) the prophylactic value of multitherapy as a maintenance regimen, and 3) the importance of careful follow-up.
Assuntos
Esôfago de Barrett/tratamento farmacológico , Cimetidina/uso terapêutico , Doenças do Esôfago/tratamento farmacológico , Idoso , Hidróxido de Alumínio/administração & dosagem , Esôfago de Barrett/patologia , Combinação de Medicamentos/administração & dosagem , Quimioterapia Combinada , Esofagoscopia , Esôfago/patologia , Humanos , Assistência de Longa Duração , Hidróxido de Magnésio/administração & dosagem , Masculino , Metoclopramida/administração & dosagem , Úlcera/tratamento farmacológicoRESUMO
27 patients with recurrent low-grade, low-stage transitional cell carcinoma (TCC) of the bladder and uni- or bilateral vesico-ureteral reflux were followed for up to 18 years in order to study a possible higher incidence of TCC of the upper tract. None of the patients developed tumours of the upper collecting system during the follow-up period. Routine bladder instillations with Thiotepa may be one explanation of such a finding.
Assuntos
Carcinoma de Células de Transição/secundário , Neoplasias Renais/secundário , Recidiva Local de Neoplasia/patologia , Neoplasias Ureterais/secundário , Neoplasias da Bexiga Urinária/patologia , Refluxo Vesicoureteral/complicações , Idoso , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/terapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Neoplasias da Bexiga Urinária/terapiaRESUMO
In the diagnosis of multiple myeloma (MM), the radiological skeletal survey (RSS) was proven to be most useful for the detection of bone lesions. Since 1961, a new technique radioisotopic bone scan (RIBS), for the detection of such lesions, using 85Sr and 99mTc, has been shown to be highly sensitive for the detection of skeletal metastases of epithelial tumors. We have studied 30 patients with plasma cell dyscrasia (PCD) by both methods and concluded that RSS is clearly superior to RIBS in PCD. As RIBS detected less than 50% of the lesions demonstrated by RSS there seems to be no indication for a routine RIBS in the initial work-up of patients suspected to have PCD. However, due to the fact that RIBS is useful for the detection of new bone formation it has a certain value in the localization of pathological fractures in MM, mainly in vertebral compression.
Assuntos
Osso e Ossos/diagnóstico por imagem , Difosfonatos , Mieloma Múltiplo/diagnóstico por imagem , Tecnécio , Adulto , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Plasmocitoma/diagnóstico por imagem , Radiografia , Cintilografia , Costelas/diagnóstico por imagem , Crânio/diagnóstico por imagem , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Medronato de Tecnécio Tc 99mRESUMO
Vesicoureteral reflux was studied by retrograde cystograms in 75 patients with recurrent transitional cell carcinoma of the bladder. Unilateral reflux was detected in 6 of the 14 patients (42.8 per cent) treated by transurethral resection of the bladder tumors. Five of these cases of reflux were anticipated and 1 was unanticipated. Among 61 patients treated by tumor resection and adjuvant instillations of thio-tepa reflux was found in 33 ureters of 25 patients (41.0 per cent). Of the 33 cases of reflux 15 were anticipated, while 18 were unanticipated. All the anticipated cases of reflux resulted from the direct effect of tumor resection on the ureteral orifice. The effect of thio-tepa on bladder mucosa and the ureteral orifices is suggested as a possible cause of the unanticipated cases of reflux.
Assuntos
Carcinoma de Células de Transição/terapia , Tiotepa/efeitos adversos , Neoplasias da Bexiga Urinária/terapia , Refluxo Vesicoureteral/induzido quimicamente , Feminino , Humanos , Masculino , Mucosa/efeitos dos fármacos , Tiotepa/administração & dosagem , Uretra/cirurgia , Refluxo Vesicoureteral/etiologiaRESUMO
Postoperative phytobezoars (duration from 2 months to 46 years) after surgery for duodenal ulcer disappeared in seven patients, by both x-ray and gastroscopy, on conservative approach aimed at the major role of delayed gastric emptying in phytobezoar formation. During a 3-day period, metoclopramide was given by drip infusion, 40 mg/24 hours, and the patient received only a copious clear diet, with no solid food. In one patient, two courses of treatment were necessary for complete elimination of the phytobezoar. None of the patients had any underlying disease. All but one had good dentition. "Disruption" of the bezoars allowed the discovery upon endoscopy of unusual etiological features such as carcinoma of the stoma and stomal polypoid hypertrophic gastritis (so-called gastritis cystica polyposa ) in one patient, and a retained suture narrowing the stoma in another.