RESUMO
OBJECTIVE: Although pulmonary involvement represents the primary and most characteristic presentation of Sars-Cov-2 infection, due to its innate tropism for endothelium, it is also associated with systemic pro-coagulative changes and thromboses. This paper describes a COVID-19 atypical presentation with massive thrombotic occlusion of the splenoportal-mesenteric axis and the splenic artery in the absence of clinical or radiological manifestation of pulmonary involvement. PATIENTS AND METHODS: Female patient, with no history of disease, trauma or fever in the last 30 days, was admitted to ER for persistent left subcostal pain. Laboratory exams, including inflammation, coagulation markers and Sars-CoV-2 serology, were requested. Whole-body CT with contrast media injection was performed. RESULTS: Laboratory exams showed elevated reactive C-protein, bilirubin, γ-GT and D-dimer. Whole-body CT showed: splenic artery occlusion, thrombosis of splenic, mesenteric and portal veins with portal intra-hepatic branches ectasia, juxta-hilar portal cavernomatosis of probable acute onset (absence of signs of chronic hepatopathy and of varices), a hypodense area in the spleen indicating ischemic parenchymal suffering. The patient resulted positive for Sars-CoV-2 IgG, thus in the absence of typical clinics or pulmonary parenchymal abnormality at chest CT. CONCLUSIONS: A case of acute venous thrombosis and arterial occlusion as primary manifestations of COVID-19.
Assuntos
COVID-19/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , SARS-CoV-2 , Baço/irrigação sanguínea , Artéria Esplênica/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , COVID-19/sangue , COVID-19/complicações , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Oclusão Vascular Mesentérica/sangue , Oclusão Vascular Mesentérica/etiologia , Baço/diagnóstico por imagem , Trombose/sangue , Trombose/etiologia , Tomografia Computadorizada por Raios XRESUMO
Sentinel lymph node biopsy and intraoperatory radiolocalization (RLI) are fast becoming the standard surgical treatment for invasive breast cancer. Actually, it seems, they have the same rule in "high risk" DCIS of the breast.
Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/secundário , Cuidados Intraoperatórios , Metástase Linfática/diagnóstico por imagem , Mastectomia , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela , Agregado de Albumina Marcado com Tecnécio Tc 99m , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , CintilografiaRESUMO
AIMS AND BACKGROUND: In the last ten years validation of the sentinel lymph node (SLN) concept has led to modification of the surgical approach for patients with intermediate-risk cutaneous melanoma. METHODS AND STUDY DESIGN: Forty-eight patients affected by cutaneous melanoma with a Breslow thickness between 0.65 and 4 mm were enrolled in the study. Approximately 2 mCi of radiotracer and 1 mL of vital blue dye were injected in each patient around the site of the primary lesion. Lymphoscintigraphy was performed until the lymphatic basin and the respective SLN were localized. The whole surgical procedure consisted of enlargement of the surgical margins followed by localization and excision of the SLN(s) by using both radiotracer and vital dye. Whenever the SLN proved to be histologically positive for metastasis, complete regional lymphadenectomy was performed. RESULTS: Within 15 minutes of radiotracer administration the lymphatic basin was localized in all 4 patients by lymphoscintigraphy. Vital dye and radiotracer successfully allowed SLN localization and excision in 46 of 48 patients (97%); in one case the SLN was detected by radiotracer alone. The SLN proved to be metastatic in six (13%) of 46 evaluable patients; interestingly, in three of them the presence of metastatic cells was revealed only by immunohistochemistry. All patients with tumor-positive SLNs had primary lesions with a Breslow thickness = 2 mm. CONCLUSIONS: Sentinel lymphadenectomy is able to identify lymph node involvement in patients with cutaneous melanoma with a Breslow thickness > 1 mm, thus avoiding the risks associated with radical regional lymphadenectomy. Lymphoscintigraphy proved to be an important tool to obtain correct preoperative localization of the drainage basin, especially for melanomas located on the face and trunk.
Assuntos
Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Melanoma/cirurgia , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática , Masculino , Melanoma/diagnóstico por imagem , Melanoma/patologia , Pessoa de Meia-Idade , Cintilografia , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Agregado de Albumina Marcado com Tecnécio Tc 99mRESUMO
The authors present a case of PPD, stressing the importance to distinguish "true" PPD from pagetoid spread, for correct diagnosis and appropriate treatment. This distinction is possible by using immunohistochemical stains, with particular regarding Ab-GCDFP-15, considered specific marker for Paget's cell.
Assuntos
Neoplasias do Ânus/patologia , Doença de Paget Extramamária/patologia , Idoso , Humanos , MasculinoRESUMO
A case of subtotal colectomy cecoproctostomy for multiple lesions of the colon is introduced. This procedure has advantages over ileoproctostomy because it spares the terminal ileum, ileocecal junction and cecum. Due to the high incidence of bowel movements after the ileoproctostomy operation, the authors recommend cecoproctostomy as a valid choice in a selectioned group of patients with multiple or extended lesions that spares cecum and rectum.
Assuntos
Ceco/cirurgia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Reto/cirurgia , Idoso , Anastomose Cirúrgica , Feminino , HumanosRESUMO
The authors present a case of ileocecocolic intussusception by carcinoma of the caecum. They stress the most peculiar aspects of this condition: rare etiology; complete invagination of caecum appendix and ileum; typical clinical presentation characterized by variable dimensions of the mass and symptoms not ascribing to occlusion, no lesions at endoscopy; evidence of a typical "target mass" visualized at T.C.
Assuntos
Doenças do Ceco/etiologia , Neoplasias do Ceco/complicações , Valva Ileocecal , Intussuscepção/etiologia , Humanos , Doenças do Íleo/etiologia , Masculino , Pessoa de Meia-IdadeRESUMO
According to a clinic case, the authors pointed out the role of histological diagnosis in the therapeutic approach of large intestinal adenomas. In order to identify those lesions which can metastasize, having exceeded the muscularis mucosae and having invaded the submucosa, rigorous histological standards must be performed. Intestinal resection versus polypectomy is determined only according to the involvement or not of the muscularis mucosae.
Assuntos
Adenoma/patologia , Carcinoma/patologia , Transformação Celular Neoplásica/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Adenoma/cirurgia , Carcinoma/cirurgia , Pólipos do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-IdadeRESUMO
The authors, on the basis of 3 cases of complicated diverticular disease, discuss the indications to surgery, considering the advantages and disadvantages of the various surgical techniques and examining in particular the rules for a correct operation with resection and primary or secondary anastomosis. As they performed a rectosigmoidectomy with primary high colorectal anastomosis, they report the reasons why they adopted the preservation and peeling of the inferior mesenteric artery (IMA).
Assuntos
Divertículo do Colo/complicações , Divertículo do Colo/cirurgia , Artéria Mesentérica Inferior/cirurgia , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Colo Sigmoide/cirurgia , Divertículo do Colo/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Reto/cirurgia , Doenças do Colo Sigmoide/classificaçãoRESUMO
Carcinoid tumours of the anorectum are rare (0.7% of malignant rectal tumours). Because of this rarity several aspects of the management of these tumours remain controversial. Diagnosis may be delayed because of failure to recognize their morphological characteristics and histological appearance may not reflect their biological behaviour. Immunocytochemistry for neuroendocrine-cells are essential to identify different types of carcinoid tumours and to do differential diagnosis from other malignant tumours. All that allow an exact therapeutic approach to these tumours. The tumours less than cm 1 in diameter can be safely treated by local excision; the tumours more than cm 1 in diameter are treated by radical surgery (AAP).
Assuntos
Carcinoma Neuroendócrino/diagnóstico , Neoplasias Retais/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Six cases of anal canal squamous carcinoma are presented. The authors precise the present view about pathological, epidemiological, clinical and therapeutical aspects of these lesions. They stress, also, the primary role of embryology and anatomy in the oncogenesis of such tumours; the importance to single out specific population at risk, absolutely different from the typical one for rectal adenocarcinoma and the role of chemoradiation therapy as treatment of choice of these neoplasms. Particular importance is given to modern histologic and histogenetic classification of these tumours, stressing the difficulties to distinguish the various histologic types.
Assuntos
Neoplasias do Ânus/patologia , Carcinoma de Células Escamosas/patologia , Idoso , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/terapia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , PrognósticoRESUMO
Authors analyze 256 patients admitted in III Clinica Chirurgica of University of Rome "La Sapienza" for breast cancer, from 1982 to 1992; 16 of them had later developed another neoplasm in the opposite breast. After a retrospective study of the clinical history of all patients they came to the conclusion that bilateral neoplasm frequency is similar to that reported in world literature (1-18%) (23, 9, 2). Moreover, are analyzed the primary risk factors for a bilateral carcinoma, and they consider the utility of the prophylactic surgical treatment of the opposite breast.
Assuntos
Neoplasias da Mama/cirurgia , Carcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/prevenção & controle , Carcinoma/prevenção & controle , Feminino , Humanos , Mastectomia Radical Modificada , Mastectomia Radical , Mastectomia Segmentar , Mastectomia Simples , Pessoa de Meia-IdadeRESUMO
The authors on the base of two cases of Gardner's syndrome recently observed, proceed to a wide review of literature on this subject so as to stress the peculiar aspects of this syndrome, so complex and uncommon. The greatest emphasis is given to the role of genetics as regarding to diagnosis and screening programs, as well as to the more recent acquisitions about diagnosis, therapy and follow up of risk lesions, such as colorectal and duodenal adenomas, as well as of intrabdominal desmoid tumours, which, although not histologically malignant, may often influence prognosis negatively, because of their remarkable local invasiveness and tendency to recurrence.
Assuntos
Síndrome de Gardner , Adulto , Feminino , Síndrome de Gardner/diagnóstico , Síndrome de Gardner/genética , Genótipo , Humanos , Masculino , Linhagem , Fenótipo , Tomografia Computadorizada por Raios XRESUMO
The authors, o the basis of a retrospective analysis of a series of 13 cases of chronic periaortitis, after a review of the literature about the subject, discuss about the most recent theories about pathogenesis, pathological anatomy, diagnosis and treatment of this condition. At first the authors stress the importance of adopting the term chronic periaortitis to describe any idiopathic fibrotic retroperitoneal process, as a consequence of the well established relationship between the atherosclerotic abdominal aorta an the development of this condition. Histological, immunohistochemical and immunological studies, consented to clarify the pathogenesis o the lesion. CT or MRI currently makes the diagnosis but histological confirmation is desiderable. Surgical therapy plays still a fundamental role in the management of chronic periaortitis, but the use of immunosuppressive drugs is to be considered extremely promising.
Assuntos
Fibrose Retroperitoneal/diagnóstico , Aorta Abdominal/patologia , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Imuno-Histoquímica , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Fibrose Retroperitoneal/tratamento farmacológico , Fibrose Retroperitoneal/imunologia , Fibrose Retroperitoneal/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
The Authors report a case of ovarian endometriosis causing an "Ab extrinseco" sigmoid stenosis. The histogenesis as well as different possibilities of treatment, i.e. medical and surgical, are discussed.
Assuntos
Endometriose/complicações , Obstrução Intestinal/etiologia , Doenças Ovarianas/complicações , Doenças do Colo Sigmoide/etiologia , Adulto , Endometriose/cirurgia , Feminino , Humanos , Obstrução Intestinal/cirurgia , Doenças Ovarianas/cirurgia , Doenças do Colo Sigmoide/cirurgiaRESUMO
From a retrospective analysis of 181 cases observed in a ten-year period (1980-1990), the authors registered a frequency of bilateral breast cancer comparable to that reported in the literature (1-12%). Early diagnosis is the only factor able to modify positively the prognosis, through an accurate follow up, based on blood and X-ray tests (low-density mammography).
Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Carcinoma/epidemiologia , Carcinoma/mortalidade , Carcinoma/cirurgia , Feminino , Humanos , Itália/epidemiologia , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/mortalidade , Segunda Neoplasia Primária/cirurgia , Prognóstico , Estudos RetrospectivosRESUMO
The authors report a case of juvenile vasculopathy in a homocystinuria patient. They point out that thromboembolism may be the only symptomatic expression of this genetically determined metabolic disease. Diagnostic approach and surgical therapy of the vascular lesions as well as medical therapy to prevent further complications are analysed. The opportunity to perform clinical tests for the diagnosis of homocystinuria in all those young patients presenting vascular lesions without other risk factors is finally stressed.
Assuntos
Homocistinúria/complicações , Artéria Ilíaca , Claudicação Intermitente/etiologia , Obstrução da Artéria Renal/etiologia , Artéria Renal , Tromboembolia/etiologia , Adulto , Angioplastia com Balão , Terapia Combinada , Homocistinúria/diagnóstico , Homocistinúria/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/cirurgia , Masculino , Artéria Mesentérica Inferior , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/etiologia , Oclusão Vascular Mesentérica/cirurgia , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/terapia , Tromboembolia/diagnóstico , Tromboembolia/cirurgiaRESUMO
A case of Tietze's syndrome is reported. A 55-year-old woman had experienced left anterior chest pain and tender swelling of the left second costosternal junction for one month. CT showed a focal enlargement of the left second costal cartilage with partial calcification. Six months later a complete recovery was registered and a second CT scan was negative. These clinical and CT findings are consistent with Tietze's syndrome.
Assuntos
Síndrome de Tietze/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Osso e Ossos/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , CintilografiaRESUMO
The Authors report a review of the Literature and their personal series to evaluate the role of total thyroidectomy in the surgical management of non-toxic multinodular goiter. On the basis of the data obtained, the Authors consider total thyroidectomy the therapy of choice for this pathology.
Assuntos
Bócio Nodular/cirurgia , Tireoidectomia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
The Authors, on the basis of their experience with 196 patients aged from 18 to 45, affected by relapsing varicose veins, stress the advantages of the outpatient treatment according to Muller's technique. For these lesions excellent aesthetic and functional results, easy surgical technique, low incidence of complications, prompt resumption to work were registered.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Varizes/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Counseling patients with DCIS in a rational manner can be extremely difficult when the range of treatment criteria results in diverse and confusing clinical recommendations. Surgeons need tools that quantify measurable prognostic factors to be used in conjunction with clinical experience for the complex decision-making process. Combination of statistically significant tumor recurrence predictors and lesion parameters obtained after initial excision suggests that patients with DCIS can be stratified into specific subsets allowing a scientifically based discussion. The goal is to choose the treatment regimen that will significantly benefit each patient group without subjecting the patients to unnecessary risks. Exploring the effectiveness of complete excision may offer a starting place in a new way of reasoning and conceiving surgical modalities in terms of "downscoring" or "upscoring" patient risk, perhaps changing clinical approach. Reexcison may lower the specific subsets' score and improve local recurrence-free survival also by revealing a larger tumor size, a higher nuclear grade, or an involved margin and so suggesting the best management. It seems, that the key could be identifying significant relapse predictive factors, according to validated risk investigation models, whose value is modifiable by the surgical approach which avails of different diagnostic and therapeutic potentials to be optimal. Certainly DCIS clinical question cannot have a single curative mode due to heterogeneity of pathological lesions and histologic classification.