RESUMO
Schwannoma is a rare tumor that develops from the Schwann cells in the nerve sheath. A 42 years old woman was found incidentally to have a bulky mass in epigastric region. Abdominal ultrasonography CT and MRI have been of aid to know the position and size of the tumor. A massive capsulated retroperitoneal lesion was identified. It moved forward the hepatoduodenal ligament, inferior vena cava laterally and aorta medially. The mass is exte-riorized and detached from adhesions. There were no complications after the operation and the patient was discharged on the fourth post-operative day. The microscopically examina-tion showed features suggestive of Cellular Schwannoma. After 8 months during follow-up, the patient did not report any neurological deficit and control CT did not suggest the presence of recurrent disease.
Assuntos
Neurilemoma/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/cirurgiaRESUMO
Thyroid hemiagenesis is a rare congenital abnormality in which one of the thyroid lobes is not developed. It can be associated with various thyroid diseases, such as Grave's disease, nodular goiter and thyroid neoplasm, rarely with hyperparathyroidism. We report a case of a 50-year old woman with left thyroid lobe agenesis diagnosed by ultrasonography and scintigraphy. Right thyroidectomy was performed and the histopathological examination showed diffuse hyperplasia, multinodular goiter and Hashimoto's thyroiditis. To our knowledge, this is the first description of multinodular goiter and Hashimoto's thyroiditis in a patient with thyroid hemiagenesis.
Assuntos
Bócio Nodular/complicações , Doença de Hashimoto/complicações , Glândula Tireoide/anormalidades , Feminino , Bócio Nodular/cirurgia , Doença de Hashimoto/cirurgia , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Glândula Tireoide/cirurgiaRESUMO
AIM: To verify the involvement of free radicals in tumor progression and to investigate the effects of an ethanolic extract of Ruta Chalepensis L. and of rutin in blood of patients with colon cancer. MATERIALS AND METHODS: Leaves of Ruta Chalepensis L. were collected in the area around Catania (Italy). For the preparation of the ethanol extract of leaves, an exhaustive extraction of 100 g of the drug was carried out in Soxhlet with 800 ml of 95% ethanol. Fifty-six patients with colorectal cancer were randomly selected for this study; among these, 34 were affected by an early stage (T1 N0 M0 according to scale), while 22 were affected by an advanced stage (T4, N1-2, M0) of cancer. Data obtained from these patients were compared with those of a control group consisting of 20 healthy subjects. Plasma of each sample was used for determining non-proteic antioxidant capacity, thiol groups, lipid hydroperoxides and nitrite/nitrate levels, evaluated by spectrophotometric tests. In addition, percentage of haemolysis was evaluated incubating (for 2 hours at 37 degrees C) erythrocyte suspension with a free radical donor (50 mM 2,2'-azobis-amidino propane chloridrate), in the presence or absence of ethanolic extract of Ruta Chalepensis L. (250 microg/ml) or rutin (1 mM). RESULTS: Non-proteic antioxidant capacity was significantly lower in cancerous patients than in healthy subjects (p < 0.001). This decrease was stage-related. In fact, non-proteic antioxidant capacity resulted lower in advanced than in early colorectal cancer (p < 0.001). The same significant stage-related decrease was observed in plasma thiol groups (p < 0.001). Coherently with the decrease in non-proteic antioxidant capacity and thiol groups, higher levels of lipid hydroperoxides and nitrite/nitrate were observed in patients with colorectal cancer with respect to healthy subjects (p < 0.001) and the increase in these markers of oxidative stress was related to the cancer stadiation. Neoplastic patients also showed an increased percentage of oxidative hemolysis respect to controls and the haemolytic damage was correlated with the stage of colon cancer. Both the extract of Ruta Chalepensis L. and rutin were able to protect erythrocytes from oxidative stress induced by the free radical donor, but the extract of Ruta Chalepensis L. was more effective than rutin. This protective effect was significant only in erythrocytes from patients with early colorectal group, whereas no significant modification was induced by Ruta Chalepensis L. or rutin in red blood cells from advanced colorectal cancer patients exposed to the same experimental conditions. CONCLUSION: Oxidative stress correlates with colon cancer stadiation and both the extract of Ruta chalepensis and rutin are able to protect red blood cells from radical-induced damage. However, their effects are significant in early stages of cancer. So these natural antioxidants might be usefull to prevent carcinogenesis and/or tumor progression.
Assuntos
Antioxidantes/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Ruta , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse OxidativoRESUMO
We report unusual but severe complication after Longo recto-anopexy for hemorrhoidal prolapse, i.e. large intramural hematoma of the rectum and subsequent hemoperitoneum. We make some assessment about the technique.
Assuntos
Canal Anal/cirurgia , Hemoperitônio/etiologia , Hemorroidas/cirurgia , Reto/cirurgia , Grampeamento Cirúrgico/efeitos adversos , Adulto , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
UNLABELLED: GIST are a group of quite rare neoplastic pathologies. This type of pathology is currently the subject of discussion as for their origin and treatment. It is generally difficult to determine if they are to be considered as a benign or malignant neoplastic disease. We present the case of a patient with recurrence of anal GIST who was examined 8 years after the first treatment. CASE REPORT: C.M., female, 81 years old, came to our Clinic in March 2001 complaining of rectal haemorrhage and abdominal pain in the lower quadrants; she had also suffered from constipation for 1 month. During rectal exploration we found a mass spreading inside the lumen 3 cm from the anal verge. Colonoscopy showed that the tumour, which was 7 x 5 cm in size, was inside the wall with normal mucosa. EUS revealed that the origin was within the muscular layer; therefore we chose transanal excision as surgical treatment. The patient was discharged 5 days after surgery and is alive; she only showed a small local recurrence of disease 30 months after treatment. Histological examination confirmed that the tumour was a GIST This case provides the basis for a discussion about characteristics and the evolution of this group of pathologies.
Assuntos
Neoplasias do Ânus/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Recidiva Local de Neoplasia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Ânus/diagnóstico , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Estadiamento de Neoplasias , Resultado do TratamentoRESUMO
AIM OF THE STUDY: To evaluate if percutaneous ethanol injection treatment, introduced twelve years ago as palliative therapy for inoperable hepatocellular carcinoma, can be used with curative intent to treat biliary cysts with good results. MATERIALS AND METHODS: For the study were observed 13 symptomatic patients (M 4; F 9 - age 38-71, medium 54 years). All the patients were treated by percutaneous alcoholization under ultrasonographic control. RESULTS: Better technique and protocol standardisation give us the possibility to utilise percutaneous ethanol injection like a good treatment for symptomatic patients. CONCLUSIONS: Easy technique, low cost and very small number of complications gives to percutaneous ethanol injection the possibility to become the gold standard for the treatment of biliary cysts.
Assuntos
Cistos/terapia , Etanol/administração & dosagem , Hepatopatias/terapia , Escleroterapia/métodos , Adulto , Idoso , Cistos/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Injeções Intradérmicas , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Escleroterapia/economia , Fatores de Tempo , Resultado do Tratamento , UltrassonografiaRESUMO
The authors present a case of carcinoid of the ileocaecal valve. The patient complained for over one year of mild pain in the right lower quadrant of the abdomen. Colonoscopy had shown hyperaemia on the colic side of the ileocaecal valve which appeared substenotic and biopsy revealed micronodules formed by chromogranin-A-positive neuroendocrine cells. Roentgenography of the small bowel and barium enema revealed a specular filling defect in the caecum and in the terminal ileum near the ileocaecal valve. Right hemicolectomy was performed and the definitive diagnosis was carcinoid of the ileocaecal valve. The tumour had spread to all layers of the intestinal wall and 4/19 lymph nodes were metastatic. The patient refused an oncological examination; however, three years after surgery there are no signs of recurrence. Carcinoids have been included in the APUD system and usually present endocrine activity. The 5-year survival of patients with gastrointestinal carcinoids is 80% when located in the appendix and rectum as against 50% in the stomach, jejunum and colon, because the localisation in the appendix and rectum is marked by clinical signs of appendicitis and rectal bleeding, which suggest diagnostic examinations useful for an early diagnosis. Radical operations according to the rules of oncologically correct surgery are the treatment of choice, while complementary treatments have yet to be codified.
Assuntos
Tumor Carcinoide/cirurgia , Neoplasias do Íleo/cirurgia , Valva Ileocecal , Idoso , Feminino , HumanosRESUMO
The Authors report a case of adrenal pseudocyst surgically treated (complete resection) in a 42 years old symptomatic woman. They discuss the pathological and clinical features of the adrenal cysts and pseudocysts and stress the peculiarity of the case observed.
Assuntos
Doenças das Glândulas Suprarrenais/cirurgia , Cistos/cirurgia , Adulto , Feminino , HumanosRESUMO
Inflammation of the myenteric plexus of the gastrointestinal tract is a very rare pathological condition, with few reports in the medical literature. This pathological condition causes atonic gut motor dysfunction and is principally secondary to other diseases, being reported nearly solely as a paraneoplastic phenomenon in neuroendocrine lung tumors, including small cell carcinomas or neuroblastomas. In addition it can also be associated with disorders of the central nervous system, although it has rarely been described in Chagas disease. It has been named 'idiopathic myenteric ganglionitis' because no apparent causes can be demonstrated. We report the clinicopathologic findings of an exceptional case of a young woman affected by severe chronic constipation suddenly changing into acute intestinal pseudoobstruction with dramatic evolution. Relationships between ganglionitis, idiopathic constipation and acute intestinal pseudoobstruction as well as therapeutic implications are discussed.
RESUMO
In performing experimental liver surgery, it is difficult to prolong anhepatic time because the animals do not tolerate prolonged portal and caval clamping. To counteract prolonged venous stasis, the authors previously developed a simple porto-intracaval shunt. The shunt consists of a self-constructed inverted Y silicone tube. The effectiveness of this shunt was studied comparing two groups of 10 rabbits with shunt (S) versus those with clamped portal and inferior caval vein (C). In the group of rabbits that underwent porto-intracaval shunt, the results concerning intraoperative mortality, intraoperative increase in distal portal vein pressure, and incidence of the histologic signs of gut damage were clearly improved. The proposed porto-intracaval shunt was therefore effective in reducing some principal negative effects of portal and caval clamping. This type of porto-intracaval shunt can be therefore useful allowing improvement of experimental models concerning liver surgery in little animals.
Assuntos
Cateteres de Demora , Fígado/cirurgia , Microcirurgia/instrumentação , Derivação Portocava Cirúrgica/instrumentação , Silicones , Instrumentos Cirúrgicos , Animais , Modelos Animais de Doenças , Intestinos/irrigação sanguínea , Intestinos/patologia , Isquemia/patologia , Fígado/irrigação sanguínea , Masculino , Pressão na Veia Porta/fisiologia , CoelhosRESUMO
BACKGROUND AND AIMS: The notable success of stapled prolapsectomy in recent years led us to compare this technique with Milligan-Morgan hemorrhoidectomy in terms of the results obtained both in the immediate postoperative period and in the long term. PATIENTS AND METHODS: We performed conventional hemorrhoidectomy on 50 randomly selected patients and operated on a further 50 using the stapler technique. The patients were monitored over the immediate postoperative period (e.g., type of anesthesia, mean duration of operation, mean hospitalization time, analgesic administration, time before returning to work) and over a long-term follow-up period of 48 months (later complications such as prolapse relapse, bleeding, stenosis, incontinence). RESULTS: The stapled group experienced significantly less pain (mean number of analgesic tablets 2.60 vs. 15.9) and returned to normal activity sooner (8.04 vs. 16.9 days), as reported by other authors. In the long-term follow-up at 48 months, stapled hemorrhoidectomy was found to control prolapse, discharge, and bleeding, with no stenosis or significant incontinence, in 94% of cases. CONCLUSION: Our conclusions confirm the excellent advantages of stapled hemorrhoidectomy which allows the rapid recovery of patients and also promises the complete resolution of hemorrhoidal prolapse in the long term.
Assuntos
Hemorroidas/cirurgia , Prolapso Retal/cirurgia , Grampeadores Cirúrgicos , Atividades Cotidianas , Adulto , Idoso , Canal Anal/fisiopatologia , Canal Anal/cirurgia , Incontinência Fecal/etiologia , Feminino , Fissura Anal/etiologia , Fissura Anal/cirurgia , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Complicações Pós-Operatórias , Recuperação de Função Fisiológica/fisiologia , Resultado do TratamentoRESUMO
This study reports a simplified, low-cost, easily performed chemico-mechanical isolation method of the islets of Langerhans. The experimental study was carried out on 15 adult pigs. Our method used collagenase and a digestion chamber for islet isolation and yielded 2,240 +/- 613 islets per g treated pancreas after purification. This demonstrates that the method is reliable and can give satisfactory results.