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1.
J BUON ; 21(5): 1082-1089, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27837608

RESUMO

PURPOSE: Tumor cells can metastasize by entering existing vessels or new vessels actively recruited into the primary tumor. Invasion of the lymphatics and blood vessels in the periphery of the tumor seems to be a prerequisite step in the metastatic process. The aim of this study was to correlate peripheral lymphatic vessel infiltration (PLI) and peripheral blood vessel infiltration (PVI) in a cohort of patients with invasive ductal carcinoma of the breast with various other prognostic parameters and outcome. METHODS: The study population consisted of 236 female patients with invasive ductal breast carcinomas, who had been operated between 2011 and 2013. The registered data included age at diagnosis, histological subtype, tumor size, TNM stage, histological grade, estrogen (ER) and progesterone receptors (PR), HER-2, p53, and PLI and PVI. RESULTS: Pathological examination revealed that 22.5% of the patients had PVI and 37.3% had PLI at the tumor front. PVI correlated with younger age (p<0.05), higher histologic grade (p<0.05), advanced TNM stage (p<0.05), higher T stage (p<0.05), higher N stage (p<0.05) and positive Ki67 expression (p<0.05). Similarly, PLI correlated with higher histologic grade (p<0.05), advanced TNM stage (p<0.05), higher T stage (p<0.05) and higher N stage (p<0.05). Statistical analysis did not reveal significant correlation between the presence of tumor blood and lymphatic vessels with infiltration in overall (OS) and disease-free survival (DFS). CONCLUSIONS: PLI and PVI are important markers of worse clinical outcome as shown by their association with other established factors, but no association with recurrence and survival could be proven.


Assuntos
Vasos Sanguíneos/patologia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Vasos Linfáticos/patologia , Idoso , Biomarcadores Tumorais/análise , Vasos Sanguíneos/química , Neoplasias da Mama/química , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/química , Carcinoma Ductal de Mama/cirurgia , Bases de Dados Factuais , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Vasos Linfáticos/química , Mastectomia , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
2.
Ann Vasc Surg ; 27(4): 433-40, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23618591

RESUMO

BACKGROUND: We conducted a comparison of postoperative cardiac damage, defined as cardiac troponin I (cTn-I) elevation, after carotid endarterectomy in low- and high-risk patients. METHODS: The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) criteria for stratifying patients considered for carotid endarterectomy into low and high surgical risk groups were used prospectively. All patients had preoperative full cardiologic evaluations and cTn-I value assessments that were repeated on postoperative days 1, 3, and 7. Postoperative cTn-I values ranging from 0.05 to 0.5 ng/mL were classified as myocardial ischemia; values >0.5 ng/mL were classified as myocardial infarction. RESULTS: Mortality was 1.2%, the stroke rate was null, and symptomatic myocardial infarction was null. Among the 56 high-risk patients, 8 had cTn-I values>0.5 ng/mL. Among the 106 low-risk patients, 10 patients had cTn-I value >0.5 ng/mL and 4 patients had cTn-I values that were >0.05 ng/mL and ≤0.5 ng/mL. All patients with increased cTn-I levels were asymptomatic. Concerning all patients, the mean preoperative cTn-I value was 0.007 ng/mL, which increased to 0.438 ng/mL on postoperative day 1 (P=0.017), 0.168 ng/mL on postoperative day 3 (P=0.06), and 0.019 ng/mL on postoperative day 7 (P=0.02). In the high-risk group, the mean preoperative cTn-I value was 0.008 ng/mL, which increased to 0.829 ng/mL on postoperative day 1, 0.270 ng/mL on postoperative day 3, and 0.030 ng/mL on postoperative day 7. In the low-risk group, the mean preoperative cTn-I value was 0.007 ng/mL, which increased to 0.198 ng/mL on postoperative day 1, 0.119 ng/mL on postoperative day 3, and 0.013 ng/mL on postoperative day 7. Patients without cardiac damage showed analogous tendencies in their troponin values. Comparison of troponin values between high- and low-risk patients on each day showed no statistical difference. Electrocardiogram alterations were seen in 20 of the 22 patients with asymptomatic troponin elevation but in none without troponin elevation. CONCLUSIONS: Carotid endarterectomy is followed by an increase in cTn-I value>0.5 ng/mL in 14% of all cases, although symptomatic cardiac ischemia is very low. However, high-risk patients as defined by the SAPPHIRE criteria do not show an increased risk of cardiac damage compared to low-risk patients. Larger studies using cTn-I as a marker of postoperative cardiac damage, after carotid endarterectomy or stenting, are needed.


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/normas , Isquemia Miocárdica/epidemiologia , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Diagnóstico por Imagem , Eletrocardiografia , Endarterectomia das Carótidas/métodos , Feminino , Seguimentos , Grécia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/etiologia , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento , Troponina I
3.
JSLS ; 16(4): 663-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23484583

RESUMO

BACKGROUND AND OBJECTIVES: Schwannomas are tumors originating from Schwann cells of the peripheral nerve sheath (neurilemma) of the neuroectoderm. Rarely, schwannomas can arise from the retroperitoneum and adrenal medulla. We describe a case of a 71-y-old woman who presented with an incidentally discovered adrenal tumor. METHODS: Ultrasound and computed tomography scans revealed a lesion with solid and cystic areas originating from the left adrenal gland. The patient underwent complete laparoscopic resection of the tumor and the left adrenal gland. RESULTS: Histopathological examination and immunohistochemical staining of the excised specimen revealed a benign schwannoma measuring 5.5×5 3.7 cm. To our knowledge, few other cases of laparoscopic resection of adrenal schwannomas have been reported. CONCLUSION: Because preoperative diagnosis of adrenal tumors is inconclusive, complete laparoscopic excision allows for definitive diagnosis with histological evaluation and represents the treatment of choice.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Neurilemoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Neurilemoma/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia
4.
Tumori ; 97(1): 74-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21528668

RESUMO

INTRODUCTION: Adequate lymph node evaluation is an important determinant of prognosis in patients with colorectal cancer. Current guidelines recommend evaluation of at least 12 lymph nodes; however, a significant number of patients fail to meet these criteria. AIM: To investigate the factors that influence adequate recovery and evaluation of lymph nodes in colorectal cancer. METHODS: We retrospectively analyzed 454 consecutive cases of colorectal cancer surgically treated from September 2000 to September 2006. Univariate and multivariate linear and logistic regression analysis was used to study the effect of various factors in lymph node recovery. RESULTS: The number of lymph nodes retrieved ranged from 0 to 62 with a median of 13 nodes. Overall, 189 (41.6%) patients had fewer than 12 nodes removed. Patient age, tumor stage, location and size were associated with lymph node retrieval. Multivariable regression revealed that the aforementioned variables, including gender and hospital type, explained 17% of the observed variance of the lymph node number. CONCLUSION: Patient and tumor characteristics, although important, are only partly responsible for the variation of lymph node yield. Quality of surgical resection and/or the thoroughness of examination of the tissue by the pathologist might explain the wider proportion of this variance. Training in colorectal node evaluation could help to improve the quality of cancer care.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Adulto , Idoso , Feminino , Humanos , Metástase Linfática/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Prognóstico
5.
JSLS ; 15(2): 248-51, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21902986

RESUMO

The increasing use of laparoscopic cholecystectomy has led to an increased frequency of gallbladder perforation and subsequent gallstone spillage in the abdominal cavity. Occasionally unretrieved gallstones can cause infection, adhesions, and obstruction. Furthermore, spilt stones can cause erosion into adjacent organs and can migrate to distant sites, causing a variety of complications. We report the unusual case of a patient who presented with spontaneous erosion of gallstones through Grynfeltt's triangle, 1 year after laparoscopic cholecystectomy and review the current literature.


Assuntos
Abscesso/etiologia , Colecistectomia Laparoscópica/efeitos adversos , Colecistolitíase/cirurgia , Migração de Corpo Estranho/cirurgia , Complicações Intraoperatórias , Migração de Corpo Estranho/etiologia , Vesícula Biliar/lesões , Humanos , Complicações Intraoperatórias/diagnóstico , Masculino , Pessoa de Meia-Idade , Radiografia , Espaço Retroperitoneal/diagnóstico por imagem , Gordura Subcutânea/diagnóstico por imagem
6.
J Surg Oncol ; 102(6): 604-7, 2010 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-20607758

RESUMO

BACKGROUND: E-selectin, an intercellular adhesion molecule that plays important roles in metastasis of tumor cells, has a polymorphism in exon 4 that results in the substitution of a serine by an arginine within the extracellular domain of the receptor, which increases its affinity for ligands. No evidence exist on the role of E-selectin polymorphism in pancreatic cancer. METHODS: Eighty pancreatic cancer patients and 160 cases of normal healthy control subjects were investigated for genotype and allelic frequencies of S128R polymorphism of E-selectin gene by PCR-RFLPs. RESULTS: The frequencies for "AA," "CA," and "CC" genotypes were 46.25%, 50%, and 3.75% in patients, and 63.75%, 26.9%, and 9.4% in healthy subjects, respectively. The "C" carriers group of patients ("CA + CC" genotype) and the "C" allele were over-represented among the pancreatic cancer cases (P = 0.012 and 0.096, respectively). Advanced T stage, the presence of lymph node and other adverse pathologic characteristics were not significantly correlated with either the "CA + CC" genotype group of patients or the presence of "C" allele. CONCLUSIONS: E-selectin S128R "C" allele may confer an increased susceptibility to pancreatic cancer development, while its carriage status does not appear to be related to the aggressive features of this malignancy.


Assuntos
Adenocarcinoma/genética , Selectina E/genética , Neoplasias Pancreáticas/genética , Polimorfismo Genético , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade
7.
South Med J ; 103(7): 674-5, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20531063

RESUMO

A 78-year-old euthyroid patient presented for evaluation of a symptomatic, slowly growing neck mass. Ultrasound scan revealed a multinodular goiter and a hypoechoic nodule of the right thyroid lobe. Total thyroidectomy was performed and the lesion was completely excised. Definite diagnosis was obtained after histological examination of the surgical specimen. Cavernous hemangiomas of the thyroid gland are infrequent lesions which may escape diagnosis preoperatively. An effort should be made not to rupture these lesions in order to ensure a bloodless procedure.


Assuntos
Hemangioma Cavernoso/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Idoso , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/patologia , Hemangioma Cavernoso/cirurgia , Humanos , Masculino , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Ultrassonografia
8.
Am J Stem Cells ; 9(3): 36-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32699656

RESUMO

INTRODUCTION: Drug-induced liver injury (DILI) is a leading cause of acute liver injury (ALI). Acetaminophen (also termed paracetamol), can often be found in drugs that may be abused (i.e., prescription for pain relief). Animal experiments have shown that mesenchymal stem cell transplantation can ameliorate or even reverse hepatic injury. MATERIAL AND METHODS: ALI was induced in Wistar rats using paracetamol. ATSCs were transplanted via the intravenous, portal vein, or intrahepatic route directly onto the liver parenchyma. Histological evaluation was conducted to assess drug-induced injury following transplantation. Fluorescence in situ hybridization (FISH) was used to verify the location of stem cells on the liver parenchyma. The effect of those cells on liver regeneration was tested by immunohistochemistry for hepatic growth factor (HGF). In addition, reverse transcription-quantitative PCR (qRT-PCR) was used to assess hepatic growth factor (HGF), hepatic nuclear factor 4α (HNF4α), cytochrome P450 1A2 (CYP1A2) and α-fetoprotein (AFP) mRNA expression. RESULTS: Immunohistochemical staining for HGF was stronger in the transplanted groups than that in the control group (P<0.001). HNF4α and HGF mRNA levels were increased on day 7 following transplantation (P<0.001 and P=0.009, respectively). CYP1A2 mRNA levels were also increased (P=0.013) in the intravenous groups, while AFP levels were higher in the intrahepatic groups (P=0.006). ATSC transplantation attenuates ALI injury and promotes liver regeneration. Furthermore, expression of specific hepatic enzymes points to ATSC hepatic differentiation. CONCLUSION: The study showed the positive effects of transplanted adipose tissue stem cells (ATSCs) on liver regeneration (LG) through hepatotrophic factors. Furthermore, increased expression of hepatic specific proteins was recorded in ATSC transplanted groups that indicate stem cells differentiation into hepatic cells.

9.
J Surg Res ; 155(2): 183-90, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19645077

RESUMO

BACKGROUND: The detection of epithelial-specific mRNA correlates well with the presence of cancer cells in the peripheral blood and provides a rational explanation for subsequent metastasis. MATERIAL AND METHODS: Forty-two, patients with colorectal cancer and 14 controls were included in our study. Peripheral blood samples were acquired at 24 h before and 48 h after laparotomy. Tissue samples were also acquired from the primary lesion. All samples were examined for the expression profile of CEA, CK20, and TEM-8. RESULTS: Tissue samples expressed CEA in every specimen, CK20 in 30, and TEM-8 in 41. CEA and CK20 were not identified in the control blood samples while TEM-8 was detected in 4. CEA was detected in 17, CK20 in 28 and TEM-8 in 23, of the preoperative blood samples. CEA mRNA expression in preoperative blood sample and TNM stage were found independently associated with increased tumor size. Positive CEA, CK20, and TEM-8 signals were found in 25, 25, and 23 of the postoperative blood samples respectively. CONCLUSIONS: CK20 and CEA are significantly more frequently detected in colon cancer patients than in healthy controls and can serve as markers. Cancer cell mRNA is commonly detected in the preoperative and postoperative peripheral blood samples. Tumor size was independently associated with the preoperative detection of CEA mRNA. Although TEM-8 mRNA detection in the peripheral blood showed no specificity for cancer patients or correlation with clinical stage, identification and validation of genes and proteins implicated in metastatic process needs to be further investigated.


Assuntos
Biomarcadores Tumorais/metabolismo , Antígeno Carcinoembrionário/metabolismo , Neoplasias Colorretais/metabolismo , Células Epiteliais/metabolismo , Queratina-20/metabolismo , Proteínas de Neoplasias/metabolismo , Receptores de Superfície Celular/metabolismo , Idoso , Antígeno Carcinoembrionário/genética , Estudos de Casos e Controles , Centrifugação com Gradiente de Concentração/métodos , Neoplasias Colorretais/patologia , Células Epiteliais/patologia , Estudos de Viabilidade , Feminino , Humanos , Queratina-20/genética , Masculino , Proteínas dos Microfilamentos , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , RNA Mensageiro/sangue , Receptores de Superfície Celular/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Sensibilidade e Especificidade
10.
JSLS ; 13(2): 273-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19660232

RESUMO

A left-sided gallbladder is a gallbladder located on the left side of the round ligament. It constitutes an uncommon anatomic abnormality. We report on a case of left-sided gallbladder discovered incidentally during laparoscopic cholecystectomy, and we discuss the different forms of this anatomic anomaly and its surgical relevance.


Assuntos
Colecistectomia Laparoscópica/métodos , Vesícula Biliar/anormalidades , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade
11.
World J Gastroenterol ; 14(20): 3266-8, 2008 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-18506938

RESUMO

Cysts of the liver ligaments are extremely rare and cysts of the ligamentum teres of the liver have been sporadically reported in the literature during the last century. The present report describes a case of a symptomatic patient with a cyst of the ligamentum teres of the liver. The patient presented with right upper quadrant pain and indigestion during the last 2 years. Ultrasound and computed tomography scans revealed a water-density mass attached to the anterior abdominal wall, but definite diagnosis could not be reached. The cyst was completely excised during laparotomy. Cysts of the ligamentum teres of the liver, although infrequent, may produce clinical symptoms and require excision. Ultrasound and computed tomography scan preoperatively cannot rule out malignancy, thus exploratory laparotomy and total resection of these lesions are necessary.


Assuntos
Cistos/patologia , Ligamentos/patologia , Hepatopatias/patologia , Dor Abdominal/etiologia , Dor Abdominal/patologia , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Humanos , Ligamentos/cirurgia , Hepatopatias/complicações , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Vômito/etiologia , Vômito/patologia
12.
World J Gastroenterol ; 14(22): 3583-6, 2008 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-18567091

RESUMO

Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.


Assuntos
Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/etiologia , Transplante de Coração-Pulmão , Perfuração Intestinal/complicações , Perfuração Intestinal/etiologia , Peritonite/etiologia , Complicações Pós-Operatórias , Adulto , Colo Sigmoide/cirurgia , Doença Diverticular do Colo/diagnóstico , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Peritonite/diagnóstico
13.
Surg Infect (Larchmt) ; 9(3): 377-88, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18570579

RESUMO

BACKGROUND AND PURPOSE: Renal dysfunction attributable to sepsis was long considered a result of hemodynamic instability and subsequent local ischemia. Recent data show that apoptosis may be implicated also. The purpose of this study was to evaluate the role of apoptosis and the expression of the bax, bcl-2, caspase-8, and cytochrome c proteins in the renal parenchymal cells of rats with sepsis. METHODS: Sepsis was induced using cecal ligation and puncture (CLP) in 62 male Wistar rats, which were euthanized 6, 12, 24, 36, 48, or 60 h later. Ten sham-treated animals served as a control group. Another group of 50 animals were subjected to CLP and then supervised for 60 h. Renal apoptosis was evaluated using light and transmission electron microscopy, in situ nick-end labeling (TUNEL), and flow cytometry using 7-amino-actinomycin D (7-AAD). Caspase-mediated apoptosis was assessed using M30 antibody. The expression of the apoptosis-regulator proteins B-cell lymphoma 2 (bcl-2), bcl-2-associated x protein (bax), caspase-8, and cytochrome c was detected immunohistochemically. RESULTS: Sepsis increased inflammatory infiltration (p < 0.001) and necrosis (p < 0.001) in renal parenchyma. Apoptosis was significantly more common than in the kidneys of control animals (p = 0.02). Nuclei stained by the TUNEL technique were predominant in the tubular cells of non-survivors (p = 0.05). The time distribution of all types of cell death was increased significantly 6 h after the induction of sepsis, and declined subsequently. Caspase-generated cytokeratin 18 (CK18) new epitope (M30) was significantly more abundant in the kidneys of animals with sepsis than in control rats, with peaks at 6 h and 60 h post-procedure (p < 0.001). In addition, cells initiating apoptosis were significantly more common at 6 h than at 48 h post-CLP (p = 0.014). Caspase-8 protein immunodetection followed the same time pattern as cell death, increasing as early as 6 h post-CLP and decreasing thereafter (p = 0.013). Bax protein expression was elevated significantly early in the course of sepsis (p = 0.037), whereas the other members of the mitochondrial-dependent pathway remained constant. Animals dying from sepsis had a significantly greater prevalence of bax- (p = 0.037) and caspase-8- (p = 0.031) immunoreactive renal cells. CONCLUSION: Apoptosis in renal tissue was significantly more common in animals with sepsis than in controls. The time distribution of cell death markers showed a consistent pattern, making early sepsis the likely initiator of the apoptotic events.


Assuntos
Apoptose , Túbulos Renais/citologia , Túbulos Renais/metabolismo , Sepse/fisiopatologia , Animais , Caspase 8/metabolismo , Citocromos c/metabolismo , Citometria de Fluxo , Imuno-Histoquímica , Marcação In Situ das Extremidades Cortadas , Queratina-18/metabolismo , Túbulos Renais/fisiologia , Masculino , Microscopia Eletrônica , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Ratos Wistar , Sepse/mortalidade , Sepse/patologia , Organismos Livres de Patógenos Específicos , Proteína X Associada a bcl-2/metabolismo
14.
Ann Vasc Surg ; 22(3): 449-52, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18362063

RESUMO

Femoral and popliteal artery aneurysms constitute the majority of peripheral arterial aneurysms. However, aneurysm of the profunda femoral artery is highly uncommon, being mainly of traumatic and mycotic origin. Diagnosis is usually straightforward with clinical and radiological examination, and such aneurysms are only rarely misdiagnosed as tumors. We herein report a case of preoperatively diagnosed pseudoaneurysm of the profunda femoral artery that was intraoperatively found to be a soft tissue tumor and finally revealed to be a schwannoma, by pathology. Our case's unusual presentation considerably confounded both diagnosis and management, thus providing a salutary clinical lesson.


Assuntos
Falso Aneurisma/patologia , Erros de Diagnóstico , Artéria Femoral/patologia , Neurilemoma/patologia , Neoplasias de Tecidos Moles/patologia , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia , Coxa da Perna , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Expert Rev Med Devices ; 5(4): 447-66, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18573045

RESUMO

Accurate and efficient hemostasis is one of the first priorities of the thyroid surgeon to prevent or minimize complications, including injury to the laryngeal nerves or parathyroid glands, perioperative hemorrhage and the potentially life-threatening hematoma. Means to prevent and control intra- or postoperative bleeding therefore remain a topic of utmost importance. Although thyroidectomy is one of the most common surgical procedures, the safest, most efficient and cost-effective way to achieve hemostasis is debated by endocrine surgeons and otorhinolaryngologists. In our opinion, there is no substitute for meticulous surgical technique and hemostasis, while experience in such operations is essential for the best outcome with the fewest complications. Ties, suture-ligations, monopolar/bipolar diathermy, clips, and hemostatic agents/sealants or tissue adhesives have been used. Over the last 10 years, innovative hemostatic devices, such as the electrothermal bipolar vessel sealing system and ultrasonically activated shears, have been developed and have been welcome adjuncts to the thyroid surgeon's armamentarium. In this review we aim to cover both novel and well-established traditional techniques of hemostasis in thyroid surgery, with specific focus on the bipolar vessel sealer and harmonic scalpel.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Diatermia/instrumentação , Eletrocoagulação/instrumentação , Hemostasia Cirúrgica/instrumentação , Glândula Tireoide/cirurgia , Tireoidectomia , Desenho de Equipamento , Hemostasia Cirúrgica/métodos , Hemostáticos/uso terapêutico , Humanos , Ligadura , Pressão , Instrumentos Cirúrgicos , Suturas , Tireoidectomia/efeitos adversos , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento , Terapia por Ultrassom/instrumentação
16.
Expert Rev Med Devices ; 5(5): 567-72, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18803467

RESUMO

The AO Hook plate has been used for stabilization of acromioclavicular joint dislocations. We present our experience of this newly introduced device in a general hospital, since there are not many papers in the literature reporting on this. A total of 16 patients were treated with the AO Hook plate between November 2001 and November 2003 at Princess Alexandra Hospital in Harlow, UK. For functional assessment 6 months after removal of the plate, the constant score and the pain visual analogue score were used. The pain visual analogue score ranged from 0 to 6 (mean: 0.87) and the constant score ranged from 78 to 100 (mean: 96.4). In one instance, a patient developed instability after removal of the plate. The use of this device results in excellent functional outcome for the treatment of acromioclavicular joint dislocations.


Assuntos
Articulação Acromioclavicular/cirurgia , Placas Ósseas , Luxações Articulares/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Adulto , Placas Ósseas/efeitos adversos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Radiografia
17.
World J Gastroenterol ; 13(3): 432-7, 2007 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-17230614

RESUMO

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most common causes of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.


Assuntos
Obstrução Intestinal/etiologia , Perfuração Intestinal/etiologia , Intestinos/patologia , Isquemia/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Abdominal/complicações , Humanos , Neoplasias Intestinais/complicações , Obstrução Intestinal/patologia , Obstrução Intestinal/terapia , Intestinos/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Necrose/patologia , Estudos Prospectivos , Aderências Teciduais/complicações , Resultado do Tratamento
18.
World J Gastroenterol ; 13(26): 3641-4, 2007 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-17659719

RESUMO

Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is, therefore, elusive. The presence of a structural abnormality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity. The present report describes a case of jejunojejunal intussusception in an adult with a history of severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was suspected preoperatively but computed tomography scan could not rule out malignancy. Exploratory laparotomy revealed jejunojejunal intussusception secondary to a lipoma which was successfully treated with segmental intestinal resection.


Assuntos
Intussuscepção/etiologia , Doenças do Jejuno/etiologia , Neoplasias do Jejuno/complicações , Lipoma/complicações , Dor Abdominal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório , Hemorragia Gastrointestinal/etiologia , Humanos , Intussuscepção/cirurgia , Doenças do Jejuno/cirurgia , Neoplasias do Jejuno/cirurgia , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Can J Gastroenterol ; 21(4): 249-53, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17431515

RESUMO

Hydatid disease, although endemic mostly in sheep-farming countries, remains a public health issue worldwide, involving mainly the liver. Intrabiliary rupture is the most frequent complication of the hepatic hydatid cyst. Endoscopy is advocated, preoperatively, to alleviate obstructive jaundice caused by intracystic materials after a frank rupture and is also a useful and well-established adjunct in locating postoperative biliary fistulas. Endoscopic retrograde cholangiography with sphincterotomy has been successful as the sole and definitive means of treatment of intrabiliary ruptured hydatid cysts. A case of an elderly woman with frank rupture is presented, where the rupture was definitively managed endoscopically in conjunction with sphincterotomy to remove the intrabiliary obstructive daughter cysts and to achieve decontamination of the biliary tree. Endoscopic retrograde cholangiography provided an excellent diagnostic and therapeutic modality in the present case and, thus, it should be considered as definitive treatment in similar cases especially if surgical risk is anticipated to be high.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Equinococose Hepática/cirurgia , Esfinterotomia Endoscópica , Idoso de 80 Anos ou mais , Doenças dos Ductos Biliares/etiologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Equinococose Hepática/diagnóstico por imagem , Feminino , Humanos , Ruptura Espontânea
20.
Perit Dial Int ; 27(2): 136-41, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17299146

RESUMO

Nonocclusive mesenteric ischemia (NOMI) is a relatively uncommon disorder, seen primarily in elderly patients with cardiac disease, and is characterized by progressive intestinal ischemia leading to infarction, sepsis, and death. It is suspected of being the underlying cause in at least 20% - 30% of acute mesenteric ischemia patients. End-stage renal disease patients are among the highest risk populations for developing this lethal complication; however, NOMI is not unique to hemodialysis and can occur in peritoneal dialysis patients as well. Unfortunately, the presentation of NOMI is very similar to that of peritonitis. The key to correct diagnosis is a high index of suspicion in predisposed patients. The high mortality rate is a clear reflection of failure to recognize the syndrome at an earlier, treatable stage. We present our case experience and an extensive review of the literature regarding this dreadful complication that may be reversible if considered early as a possible etiology and the appropriate diagnostic maneuvers undertaken.


Assuntos
Colo/irrigação sanguínea , Isquemia/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Idoso , Evolução Fatal , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/terapia
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