RESUMO
BACKGROUND/AIMS: Living donor liver transplantations (LDLT) is a definitive treatment for patients with end-stage liver disease (ESLD), especially in the countries with donation problem. Between April 2007 and April 2010, we performed LDLT in 289 patients. Fifteen of the cases required re-transplantations. This study evaluates these 304 consecutive LDLTs donor and recipient outcomes. METHODOLOGY: Complication rates and survival data of the recipients and donors of 304 LDLT cases were analyzed. RESULTS: All donors are alive and well. Overall complication rate was 27%. Early postoperative recipient complication rate was 51%. Most frequent complication was infection. In the long-term there were 57 biliary stricture and 5 chronic bile fistula cases. Chronic and acute rejection attacks developed in 7 and 103 patients, respectively. Hepatic artery thrombosis rate was 8%. One, two and three year survival rates were 82%, 79% and 75%, respectively. Recipient mortality was 25%, mostly due to vascular complications, septic complications, liver dysfunction and chronic rejection. CONCLUSIONS: More than 150 liver tranplantations per year in a single center is a challenge in Turkey, where there is a shortage of deceased donor grafts. LDLT is a safe procedure for donors and effective for ESLD. Improvement in surgical technique would provide better outcomes.
Assuntos
Transplante de Fígado , Doadores Vivos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Lactente , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Pessoa de Meia-IdadeRESUMO
BACKGROUND: This study aimed at analyzing the effect on coagulation of head trauma and other local traumas in patients exposed to multiple traumas in the early stage, and also the relations of Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) with coagulation parameters in these patients. METHODS: Fifty consecutive patients (9 women, 41 men) with multiple traumas were included in this study. The GCS, ISS and coagulation parameter levels were measured. Presence of a correlation between GCS and ISS with coagulation parameters was analyzed. Patients exposed to multiple traumas were assessed in four categories as the patients with no significant traumas (A), only head traumas (B), head trauma and other local traumas (c), and no head traumas but other local traumas (D). RESULTS: A marked relationship was found between ISS and international normalized ratio (INR), activated partial thromboplastin time (aPTT), D-dimer, fibrin degradation product (FDP), antithrombin (AT), and fibrinogen (p<0.05). There was a statistically significant difference between Group C and the other groups in INR, D-dimer, fibrinogen, aPTT, and AT parameters (p<0.05). There was also a statistically significant difference between the groups with and without head trauma in INR, D-dimer and fibrinogen (p<0.05). CONCLUSION: The coagulation parameters were observed to diverge in patients with head trauma, but in cases with head injuries accompanying other local traumas, more coagulation parameters became abnormal.
Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Traumatismo Múltiplo/complicações , Adolescente , Adulto , Idoso , Transtornos da Coagulação Sanguínea/epidemiologia , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
The correlation between matrix metalloproteinase (MMP)-2, MMP-9, and MMP-14 expression on the prognostic parameters of gallbladder carcinoma (GBC) and their role in carcinogenesis were evaluated. Carcinomas of the gallbladder (n=20) and chronic cholecystitis (n=10) were studied for the expression of MMP-2, MMP-9, and MMP-14 by immunohistochemistry. In all of the cases, metaplastic and dysplastic epithelial alterations, and (in GBC histologic type, grade of differentiation, level of infiltration, perineural and angiolymphatic invasion, liver invasion, and lymph node involvement were noted. MMP-2, MMP-9, MMP-14 were expressed in tumor epithelium in 9 (45%), 20 (100%), and 20 (100%) of the cases, respectively. MMP stromal expression including muscle layer, vascular endothelium, fibroblasts, and lymphoid cells were detected in all cases. MMP-2 was not expressed in normal, metaplastic, and dysplastic epithelia. In contrast, MMP-9 and MMP-14 immunoreactivities were present in antral-type metaplastic areas as moderate (grade 2) and strong in dysplastic epithelia (grade 3). Only in mucinous-type GBC was the expression of the MMPs lower than in the other types. No significant correlation was detected with the grade of differentiation, level of infiltration, perineural and angiolymphatic invasion, liver invasion, or lymph node involvement. These data suggest that MMP-9 and MMP-14 overexpression may have an important role in tumorigenesis. MMP-2, MMP-9, and MMP-14 were expressed in GBC epithelium but also the expression in the stromal component may be essential for the malignant potential of GBC.
Assuntos
Colecistite/diagnóstico , Neoplasias da Vesícula Biliar/enzimologia , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Adulto , Idoso , Colecistite/enzimologia , Colecistite/patologia , Doença Crônica , Feminino , Vesícula Biliar/enzimologia , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/patologia , Humanos , Imuno-Histoquímica , Masculino , Metaloproteinase 14 da Matriz/metabolismo , Pessoa de Meia-IdadeRESUMO
AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus. METHODS: From March 2000 to September 2007, 77 patients with acute sigmoid volvulus were treated. A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy. Twenty-five patients received RPA (Group A), and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B). The clinical course and postoperative complications of the two groups were compared. RESULTS: The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a rate of 6.3%. The difference was numerically impressive but was statistically not significant. CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results. It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus.
Assuntos
Colectomia , Colostomia , Volvo Intestinal/cirurgia , Doenças do Colo Sigmoide/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Colectomia/efeitos adversos , Colostomia/efeitos adversos , Feminino , Humanos , Volvo Intestinal/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Doenças do Colo Sigmoide/mortalidade , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
When compared with open splenectomy, laparoscopic splenectomy was associated with fewer complications, however, with more hemorrhagic complications. Furthermore, the mean operative time for laparoscopy was significantly longer than for the open procedure. Vessel sealing systems are represented as decreasing operative time and blood loss in several surgical procedures. The aim of this study is to evaluate the blood loss and operating time of laparoscopic splenectomy with a vessel sealing system. We evaluated 19 laparoscopic splenectomies with a vessel sealing device, particularly focusing on operative blood loss and operating time. Patients were operated in the right lateral decubitus position usually with three ports. In all cases, dissection of the spleen and sealing of hilar vessels and short gastric vessels were performed with a vessel sealing system. No clips, sutures, or monopolar-bipolar diathermy were used. Mean operative blood loss was 88 ml (range 20-400 ml) and mean operative time was 107 minutes (range 45-230 minutes). Both results were better than those of most series of laparoscopic splenectomy performed with endostaplers or endoclips. Laparoscopic splenectomy with a vessel sealing system is safe for all vascular controls in laparoscopic splenectomy and can lead to less blood loss. This technique removes the disadvantage of longer operating times for laparoscopic as compared to open splenectomy.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Laparoscopia/métodos , Esplenectomia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Postura , Esplenectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The objective of this study is to evaluate the incidence of Enterobius vermicularis in the appendices of the adult population and a possible relationship between E. vermicularis and acute appendicitis. E. vermicularis was identified in 18 (2%) of 890 patients. Six hundred sixty-five operations were performed for presumptive diagnosis of acute appendicitis, and E. vermicularis was found in 12 (2%) patients. The histopathological examination revealed acute inflammatory cells in four cases (33%). Three of these four specimens included luminal ova and one E. vermicularis. Histopathological examination of six cases revealed E. vermicularis in 225 incidental appendectomies with no evidence of either acute or chronic inflammatory cells. This study suggests a relationship between the presence of E. vermicularis ova and acute inflammation, but the presence of the pinworm in the lumen of the appendix is coincidental. On the other hand E. vermicularis in the appendix lumen can cause symptoms of acute appendicitis.
Assuntos
Apendicite/parasitologia , Apendicite/cirurgia , Apêndice/parasitologia , Enterobíase/cirurgia , Enterobius/isolamento & purificação , Adolescente , Adulto , Idoso , Animais , Apendicectomia , Apendicite/epidemiologia , Diagnóstico Diferencial , Enterobíase/diagnóstico , Enterobíase/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Turquia/epidemiologiaRESUMO
OBJECTIVES: The purpose of the study was to determine the diagnostic value of computed tomography densitometry in the quantification of hepatosteatosis. MATERIALS AND METHODS: Fifty-one potential liver donors, ranging in age from 19 to 52 years (mean age: 32.4 years ± 10.2), participated in the study. The mean hepatic attenuation and mean splenic attenuation were determined using regions of interest measurements. The difference between the mean hepatic attenuation and mean splenic attenuation (or liver attenuation index), with liver attenuation index = mean hepatic attenuation - mean splenic attenuation were calculated. Computed tomography densitometric parameters were correlated with histopathologic results. RESULTS: From the histopathologic analysis, the degree of macrovesicular hepatosteatosis was 0% to 8% (mean: 1.1% ± 2%). Seven donors (13.7%) had a degree of macrovesicular steatosis of > 5%, and 12 donors (23.5%) had ≥ 2%. Of the 29 normal donors with histopathologic verification, computed tomography densitometry predicted ≤ 5% of the hepatosteatosis in 27 donors, and ≤ 2% hepatosteatosis in 2 subjects. The liver attenuation index was significantly correlated to the histopathologic results. The mathematical relation between liver attenuation index and the degree of histopathologic hepatosteatosis was calculated using the least-squares methods, which provided quadratic polynomials. CONCLUSIONS: Computed tomography densitometry is a rapid, robust, noninvasive technique for the assessment of hepatosteatosis. When used in conjunction with clinically stable reference measurements of spleen, the density measurements of liver correctly predicted the presence of fatty infiltration with significant sensitivity (77%) and specificity (75%). This technique, which was refined during the course of our liver transplant program, minimizes the need for highly invasive percutaneous liver biopsies.
Assuntos
Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/patologia , Transplante de Fígado/métodos , Fígado/diagnóstico por imagem , Fígado/patologia , Tomografia Computadorizada por Raios X , Adulto , Área Sob a Curva , Biópsia , Feminino , Humanos , Análise dos Mínimos Quadrados , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Índice de Gravidade de Doença , Adulto JovemRESUMO
Intestinal tuberculosis is a major problem in many regions of the world. The incidence of it is rising in Western countries due to immigration from Third World countries and human immunodeficiency virus infection. The difference between the simple closure and resection and anastomosis was evaluated in this study. Retrospectively, 12 patients with intestinal tuberculosis diagnosed histopathologically among 50 patients with free intestinal perforations operated on between 1995 and 2003 at Turgut Ozal Medical Center were evaluated. Each patient underwent routine laboratory tests and radiologic studies. The most common symptoms of patients were abdominal pain, night sweats, and weight loss. Sites of perforation were ileum in 10 patients (multiple perforation in 4) and jejunum in 2 patients (both had multiple perforations). The perforation was closed by primary closure in 7 patients. Resection-anastomosis was performed in 5 patients. Leaks occurred in overall 3 of 7 patients with primary closure. Three of the 7 patients with leaks due to septicemia died. The mortality rate among all patients was 25%. Intestinal tuberculosis should be kept in mind as a cause in free intestinal perforations. Because of high mortality rate, the resection of the affected area and anastomosis may be the treatment of choice rather than primary closure.
Assuntos
Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Tuberculose Gastrointestinal/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
This experimental study was designed to evaluate the degree of adhesion formation and peritoneal tissue levels of malondialdehyde (MDA), reduced glutathione (GSH) and nitric oxide (NO) and the effect of melatonin on these metabolites in a postoperative intraperitoneal adhesion formation model in rats. Thirty adult female Wistar albino rats were subjected to standardized lesions by cecal and uterine horn abrasion and were randomly divided into three groups. Control rats were treated with 5% ethanol. Melatonin treated rats received 4 mg/kg melatonin before closure and for 10 consecutive days intraperitoneally after surgery. Rats in the sham operation group underwent a surgical procedure similar to the other groups however the peritoneal abrasion was not performed. On postoperative day 10 relaparatomy was performed. After the assessment of the adhesions, the rats in each group were sacrificed and peritoneal tissues were harvested to determine the tissue levels of MDA, GSH and NO activity. Adhesion formation scores in the melatonin group were significantly lower than that of control and sham group (p<0.01 and p<0.02, respectively). Tissue levels of MDA and NO were significantly lower in the melatonin treated rats when compared with control and sham groups. The levels of GSH in the melatonin treated rats were significantly higher than those of control and sham groups (p<0.01). The results demonstrate that in this experimental model, intraperitoneal administration of melatonin decreases the extent of peritoneal adhesions and causes a decrease in MDA and NO and an increase in GSH levels.
Assuntos
Antioxidantes/farmacologia , Ceco/patologia , Melatonina/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Aderências Teciduais/prevenção & controle , Útero/patologia , Animais , Feminino , Glutationa/metabolismo , Mucosa Intestinal/patologia , Malondialdeído/metabolismo , Óxido Nítrico/metabolismo , Ratos , Ratos WistarRESUMO
BACKGROUND/AIMS: Carcinomas of the biliary tree are rare tumors of the gastrointestinal tract, with an increasing incidence in recent years. Biliary neoplasms are classified into intra- and extrahepatic cholangiocarcinoma (Klatskin tumor, middle and distal extrahepatic tumors), gallbladder adenocarcinoma, and ampullary carcinoma. We aimed to determine the expression profile of matrix metalloproteinase (MMP)-2, MMP-9 and MMP-14 in the biliary neoplasms classified according to their localization and the relation with the prognosis. METHODS: Ten gallbladder adenocarcinoma, 8 distal bile duct carcinomas (distal cholangiocarcinoma), 8 Klatskin tumors, 8 intrahepatic cholangiocarcinomas and 10 ampullary carcinomas were included in the study. The immunohistochemical expression of MMP-2, MMP-9 and MMP-14 was detected in the nontumoral, metaplastic, dysplastic and tumoral epithelia. The tumor differentiation, angiolymphatic and perineural invasion of the tumor, and presence of lymph node and distant metastasis were determined. Survey of the patients was noted from the patient follow-up data. RESULTS: The nontumoral epithelia of the gallbladder, intrahepatic ducts, and Klatskin tumor did not express MMP-2. MMP-2 expression was detected in the distal part of the biliary ducts, in 75% (6/18) of cases and in the nontumoral epithelia of the ampullary region in 50% (5/10) of cases. The metaplastic and dysplastic epithelia were positively stained in all of the gallbladder adenocarcinoma, distal cholangiocarcinoma and ampullary tumors. In the intrahepatic cholangiocarcinoma, the hepatocytes were positively stained but the infiltrative tumors were spared. Klatskin tumors were also not stained with MMP-2. The gallbladder adenocarcinoma, distal cholangiocarcinoma and ampullary carcinomas expressed MMP-2 in 30%, 37% and 40% of the cases, respectively. MMP-9 and MMP-14 were expressed in normal, metaplastic, and dysplastic epithelium and tumoral cells in all of the cases of the groups. Expressions of MMPs were higher in subjects with neural invasion, but there was no correlation between MMP expression and tumor differentiation or angiolymphatic invasion. CONCLUSIONS: When tumors of the biliary system are divided as intrahepatic and extrahepatic cholangiocarcinomas, MMP-2 expression was present in the extrahepatic cholangiocarcinomas including gallbladder carcinomas. Like the intrahepatic cholangiocarcinoma, Klatskin tumors also did not express MMP-2. This can be related with its characteristic growth pattern. MMP-9 and MMP- 14 were present in metaplasia, dysplasia carcinoma sequence in all of the bile tract tumors, suggesting that MMPs play an important role in carcinogenesis. The higher expression of the MMPs with neural invasion suggests the significant role of those tumors in the invasion activity.
Assuntos
Neoplasias dos Ductos Biliares/metabolismo , Ductos Biliares Intra-Hepáticos/enzimologia , Colangiocarcinoma/metabolismo , Metaloproteinases da Matriz/metabolismo , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Ampola Hepatopancreática/enzimologia , Ampola Hepatopancreática/patologia , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/patologia , Progressão da Doença , Neoplasias da Vesícula Biliar/metabolismo , Neoplasias da Vesícula Biliar/patologia , Ducto Hepático Comum/enzimologia , Ducto Hepático Comum/patologia , Humanos , Imuno-Histoquímica , Tumor de Klatskin/metabolismo , Tumor de Klatskin/patologia , Metaloproteinase 14 da Matriz/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Invasividade Neoplásica , PrognósticoRESUMO
INTRODUCTION: Hydatid cyst disease is common in some regions of the world and is usually located in the liver and lungs. This report presents two cases of primary hydatid cysts located subcutaneously: one in the medial thigh and one in the left palm between the index and middle fingers. CASE PRESENTATIONS: A 64-year-old male farmer visited our hospital because a swelling on the right medial thigh had grown during the last year. Superficial ultrasound and computed tomography revealed a lesion resembling a hydatid cyst. A germinative membrane was encountered during surgical excision. Pathological examination was compatible with a hydatid cyst. The second case involved a 67-year-old male farmer who complained of a swelling that had grown in his left palm in the last year. The preliminary diagnosis was a lipoma. However, a hydatid cyst was diagnosed during surgical excision and after the pathological examination. The patient did not have a history of hydatid cyst disease and hydatid cysts were not detected in other organs. There has been no disease recurrence after following both patients for 3 years. CONCLUSION: A hydatid cyst should be considered in the differential diagnosis of subcutaneous cystic lesions in regions where hydatid cysts are endemic, and should be excised totally, with an intact wall, to avoid recurrence.
RESUMO
The transplantation of organs from donors who have undergone shunt surgery or craniotomy for a malignant central nervous system (CNS) tumor is controversial. We report a case of Kaposi's sarcoma (KS) developing as a result of immunosuppression in the recipient of a liver transplant from a donor who underwent craniotomy and ventriculoperitoneal shunt surgery for primary CNS lymphoma. Polymerase chain reaction assay did not isolate human herpes virus-8 in the Kaposi lesions. To our knowledge, this is the only case ever reported of KS developing after liver transplantation from a donor with lymphoma. Thus, with appropriate screening to exclude possible dissemination, patients with a history of high-grade primary CNS lymphoma treated by ventriculoperitoneal shunt and craniotomy may be accepted as donors.
Assuntos
Neoplasias do Sistema Nervoso Central/cirurgia , Craniotomia/métodos , Terapia de Imunossupressão/efeitos adversos , Transplante de Fígado/patologia , Linfoma/cirurgia , Sarcoma de Kaposi/etiologia , Doadores de Tecidos , Derivação Ventriculoperitoneal/métodos , Biópsia , Neoplasias do Sistema Nervoso Central/diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Linfoma/diagnóstico , Pessoa de Meia-Idade , Sarcoma de Kaposi/patologiaRESUMO
Primary intestinal lymphoma with spontaneous perforation and after systemic chemotherapy is rare. The present study summarizes retrospectively the outcome of eight free intestinal perforated patients diagnosed with intestinal non-Hodgkin's lymphoma. Two patients had a history of systemic chemotherapy before perforation. The most common symptoms of the patients were abdominal pain, nausea, vomiting, weight loss, and fever. Sites of perforation were ileum in four, jejunum in two, cecum in one, and sigmoid colon in one patient. Synchronous lymphoma was present in three patients. The perforation was closed by primary closure in three patients. Resection/anastomosis was performed in four patients and sigmoid colostomy was performed in one patient. Three patients were lost due to leakage or septicemia. Intestinal lymphoma might be kept in mind as a cause in free intestinal perforations. Because of the high mortality rate early diagnosis and treatment are important to improve the prognosis of bowel perforation in patients with non-Hodgkin's lymphoma.
Assuntos
Neoplasias Intestinais/complicações , Perfuração Intestinal/etiologia , Linfoma não Hodgkin/complicações , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Hydatid disease should be considered in the differential diagnosis of any cystic mass in endemic areas. The symptoms due to bulk effect, usually occurring over a certain period of time, depend on the site and size of the cyst. We report an unusual presentation of retroperitoneal hydatid cyst with rapidly developing uremia and acute intestinal obstruction.
Assuntos
Equinococose/complicações , Obstrução Intestinal/etiologia , Doenças Retais/etiologia , Espaço Retroperitoneal , Uremia/etiologia , Obstrução Ureteral/etiologia , Doença Aguda , Adulto , Equinococose/cirurgia , Humanos , Obstrução Intestinal/cirurgia , Masculino , Doenças Retais/cirurgia , Obstrução Ureteral/cirurgia , Adulto JovemRESUMO
PURPOSE: Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far only limited data have been reported. The objective of this retrospective study was to evaluate the outcome of patients presenting with a complicated Morgagni hernia and who undergo a transabdominal repair. METHODS: Between September 1999 and October 2005, 11 patients with Morgagni hernia were operated on in our department. Eight of them had acute presentations because of a complicated Morgagni hernia. The patient demographics, presenting symptoms, operative approach, and complications were collected. The postoperative course was evaluated for morbidity and mortality. RESULTS: The patients' ages ranged from 42 to 85 years (mean 69.4). Two (18.2%) patients were male and nine (81.8%) patients were female. Chest roentgenograms, computed tomography, and contrast meal studies were used as diagnostic utilities. A transabdominal approach was used for all patients. One patient died due to pulmonary failure. The mean follow-up was 2.8 years. There was no recurrence or symptoms regarding the operation in the remaining patients. CONCLUSION: We recommend the transabdominal approach in patients with Morgagni hernia as it makes it easy to reduce the hernia contents and repair of the hernia sac. Moreover, when complicated with strangulation, incarceration or perforation, a surgical repair through a transabdominal approach is mandatory.
Assuntos
Hérnia Diafragmática/cirurgia , Cavidade Abdominal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The most successful method of managing the difficult duodenum, including the stump leakage, has been the tube duodenostomy technique, but it has not gained wide acceptance and is rarely used. The purpose of this study is to describe the details of the procedure for indication, technical approach, and postoperative care. METHODS: During the period from 1998 to 2006, a tube duodenostomy was performed in 31 patients for possible insecure duodenal stump closure during gastric resection, postoperative duodenal stump leakage, duodenal leak after primary closure of duodenum for perforation or injury, or anostomotic leak after choledochoduodenostomy. All of the tube duodenostomies were performed through the open end of the duodenum. We also inserted a T-tube into the common bile duct in 19 of 31 patients (61.2 %) with tube duodenostomy. RESULTS: A tube duodenostomy was performed in the primary operation in 15 of 31 patients. None of those 15 patients required a second operation, and there were no leaks and no deaths. Among the larger group (31 patients), there was one (3.2 %) duodenal stump leak after tube duodenostomy, and it ceased spontaneously; one patient had a subhepatic collection after removal of the duodenostomy tube, and three patients had associated incisional infections. Two patients died; one after a myocardial infarction and the other from irreversible sepsis. The mean length of hospital stay was 26.9 days. CONCLUSIONS: We conclude that tube duodenostomy is a simple, effective, and safe method to prevent rupture of an insecure duodenal stump or to treat the leakage from the duodenal stump or primary repair on the duodenum.
Assuntos
Duodenopatias/terapia , Duodenostomia/instrumentação , Gastrectomia/efeitos adversos , Adulto , Idoso , Drenagem/métodos , Duodenostomia/métodos , Duodenostomia/mortalidade , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/terapia , Resultado do TratamentoRESUMO
Matrix metalloproteinases (MMPs) degregade and remodel the extracellular matrix. They are known to be overexpressed as normal mucosa progresses to adenomas and carcinomas. In our prospective study we measured the overexpression of MMP-7 immunohistochemically in various types of colonic adenomas. Although MMP-7 has already been shown to be overexpressed in various types of colonic adenomas, tubular versus villous adenomas had not been further seperated to date. Seventy-six patients had either normal mucosa (n=15) or tubular (n=32), tubulovillous (n=16), or villous (n=13) colonic adenoma. MMP-7 expression was classified into three categories, as negative, weakly stained, or strongly stained, depending on the percentage of cells stained. Each adenoma was graded according to the percentage of strongly stained areas in the adenoma as G0, G1, G2, or G3. Sixty-nine percent of villous adenomas showed grade 3 staining of MMP-7, versus none of the tubular adenomas. G0 and G1 staining was not detected in the villous adenomas. The results of the study show that the degrees of overexpression of the three subtypes of colonic adenomas were statistically significantly different. In conclusion, MMP-7 overexpression is thought to be an early event in the adenoma-carcinoma pathway.
Assuntos
Adenoma/enzimologia , Neoplasias Colorretais/enzimologia , Metaloproteinase 7 da Matriz/fisiologia , Adenoma/patologia , Adenoma Viloso/enzimologia , Adenoma Viloso/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/patologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Metaloproteinase 7 da Matriz/metabolismo , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
This experimental study was designed to determine the effects of resveratrol on the level of malondialdehyde (MDA), reduced glutathione (GSH), and nitric oxide (NO) in gastric tissue after bile duct ligation (BDL). Swiss albino rats were divided into three groups: Group 1, sham (n = 7); Group 2, BDL (BDL only group; n = 7); and Group 3, BDL plus resveratrol (n = 7). Animals in the resveratrol group were treated with 10 mg/kg resveratrol (i.p.) once a day throughout 28 days. In the resveratrol group, levels of MDA and NO in gastric tissue were significantly lower than in the BDL-only group (P < 0.001). The level of GSH in the resveratrol group was significantly higher than in the BDL-only group (P < 0.001). The present study demonstrates that intraperitoneal administration of resveratrol maintains antioxidant defenses and reduces oxidative gastric damage. This effect of resveratrol may be useful to preserve gastric tissue under oxidative stress due to cholestasis.