RESUMO
Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominal pain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis.
Assuntos
Traumatismos Abdominais/complicações , Duodeno/lesões , Perfuração Intestinal/cirurgia , Ferimentos não Penetrantes/complicações , Abdome Agudo/diagnóstico , Abdome Agudo/cirurgia , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/cirurgia , Traumatismos Abdominais/cirurgia , Anastomose em-Y de Roux , Diagnóstico Diferencial , Duodeno/cirurgia , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Espaço Retroperitoneal/cirurgia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/cirurgiaRESUMO
BACKGROUND: Intestinal metaplasia of the distal esophagus frequently cannot be detected in patients with esophageal adenocarcinoma. It has therefore been questioned whether Barrett's esophagus is the primary precursor lesion of such lesions. We hypothesized that the underlying Barrett's mucosa may be masked by tumor overgrowth in the majority of these patients. METHODS: The pretherapeutic endoscopy and biopsy records of 79 patients with locally advanced esophageal adenocarcinoma who had undergone preoperative chemotherapy were reviewed and compared to findings on restaging endoscopy/biopsy and subsequent resection and histopathologic analysis of the resected specimen. RESULTS: Pretherapeutic endoscopy and biopsy showed associated Barrett's esophagus in 59/79 patients, whereas there was no evidence of associated intestinal metaplasia in 20/79 patients on extensive biopsies. Following neoadjuvant chemotherapy, Barrett's mucosa was unmasked and later documented by biopsy or histopathologic assessment of the resected specimen in 18 of the latter 20 patients. This resulted in an overall association of Barrett's mucosa with adenocarcinoma in the distal esophagus of 97.4% CONCLUSION: Underlying Barrett's mucosa is frequently masked by tumor overgrowth in patients with locally advanced adenocarcinoma of the distal esophagus.
Assuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Esôfago de Barrett/diagnóstico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Diagnóstico Diferencial , Endoscopia/métodos , Junção Esofagogástrica/efeitos dos fármacos , Junção Esofagogástrica/patologia , Junção Esofagogástrica/cirurgia , Esôfago/efeitos dos fármacos , Esôfago/patologia , Esôfago/cirurgia , Feminino , Humanos , Masculino , Metaplasia/diagnóstico , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias/métodos , Tomografia Computadorizada por Raios X , Ultrassonografia de IntervençãoRESUMO
AIMS: Therapeutic options for advanced hepatocellular carcinoma (HCC) are limited. Bendamustine, a bifunctional cytostatic agent with mainly alkylating effect may be an alternative. METHODS: Five HCC cell lines were incubated in vitro with five different concentrations of bendamustine. In addition, cell lines Huh-7 and HepG2 were tested in a chimeric mouse model. RESULTS: In vitro treatment with bendamustine resulted in an IC( 50 )<6 microg/mL in two, <12 microg/mL in one, and 12-23 microg/mL in two cell lines. In vivo, bendamustine reduced significantly tumor volume in chimeric mice. CONCLUSION: Bendamustine demonstrated significant tumor growth inhibition both in vitro and in vivo at concentrations that can be reached in the plasma. The potential role of bendamustine therapy for HCC and its tolerability in impaired liver function is currently subject of a phase II study.