ABSTRACT
Abstract Purpose: To evaluate the outcome of transhiatal esophagectomy without thoracotomy and with preservation of the vagal trunks for the treatment of advanced megaesophagus. Methods: Between March 2006 and September 2017, it was performed 136 transhiatal esophagectomies without thoracotomy by laparoscopy, with preservation of the vagus nerves. All patients were evaluated pre and postoperatively for respiratory and nutritional aspects Post operatively, some surgical aspects were evaluated like radiology and endoscopy of the digestive tract. Results: Follow-up for 7 months to 12 years by clinical, radiologic, endoscopic and pH monitoring revealed satisfactory and encouraging outcomes of the procedure. Conclusion: The laparoscopic transhiatal esophagectomy is a feasible and safe technique with good postoperative outcomes.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Vagus Nerve , Esophageal Achalasia/surgery , Laparoscopy/methods , Organ Sparing Treatments , Severity of Illness Index , Follow-Up Studies , Treatment Outcome , Esophagectomy/methodsABSTRACT
ABSTRACT Background: Cholelithiasis is one of the diseases with greater surgical indication. Currently, laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis. Aim: To analyze the culture of bile from patients with cholelithiasis, mainly in the occurrence of brown and mixed stones. Methods: Was carried out a prospective study with 246 cases with biliary lithiasis who underwent elective laparoscopic cholecystectomy. Bile culture was performed in all. During anesthetic induction the patients received a single dose of intravenous cefazolin 1 g. At the end of the surgery, the gallbladder was punctured, its contents extracted and immediately placed in a sterile 20 ml propylene flask and promptly sent to bacterioscopy with Maconkey and blood agars. Incubation at 37° C for 24 h was carried out. A protocol was elaborated to include the main factors potentially related to cholelithiasis and the possible presence of associated bacterial infection. Results: Of the 246 patients, 201 had negative bile culture and 45 positive. Of the 45 patients with bacteriobilia, 34 had growth of a single type of bacterium in bile culture and 11 more than one. Conclusions: It was observed a relationship between bacteriobilia and age, suggesting that age is a risk factor for bacteriobilia. The use of antibiotic prophylaxis in the elderly is therefore recommended.
RESUMO Racional: A colecistolitíase é uma das doenças que têm maior indicação cirúrgica. Atualmente a colecistectomia laparoscópica é o padrão-ouro no seu tratamento. Objetivo: Analisar a cultura da bile de pacientes portadores de colecistolitíase, principalmente na ocorrência de cálculos com pigmentos marrons e mistos. Métodos: Foi realizado estudo prospectivo de 246 casos de pacientes portadores de litíase biliar, submetidos à colecistectomia laparoscópica eletiva, sendo realizada cultura da bile. Durante a indução anestésica os pacientes receberam dose única de cefazolina 1 g, intravenosa. No final da operação foi puncionada a vesícula biliar, extraído seu conteúdo e imediata colocação em frasco estéril de propileno de 20 ml e prontamente encaminhado para bacterioscopia com semeadura do material coletado em ágar sangue e de Maconkey com posterior incubação em estufa de cultura a 37° C durante 24 h. Foi elaborado um protocolo capaz de englobar os principais fatores potencialmente relacionados à colecistolitíase e a possível presença de infecção bacteriana associada. Resultados: Dos 246 participantes, 201 tiveram cultura de bile negativa e 45 positiva. Dos 45 pacientes com bacteriobilia, 34 tiveram crescimento de um único tipo de bactéria e 11 mais de uma. Conclusões: Foi observada relação entre bacteriobilia e a idade, sugerindo que a idade é fator de risco para bacteriobilia. Recomenda-se assim o emprego de antibioticoprofilaxia nos idosos.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Bacteria/isolation & purification , Bile/microbiology , Cholelithiasis/surgery , Cholelithiasis/microbiology , Cholecystectomy, Laparoscopic , Prospective Studies , Elective Surgical ProceduresABSTRACT
O melanoma maligno corresponde a 5% de todas as neoplasias da pele. Apresenta elevada agressividade local e tendência à disseminação através de metástases. O aparelho digestivo não é sítio secundário comum de melanoma, e o estômago é raramente comprometido. Relatamos caso de paciente do sexo masculino, 64 anos, com quadro de astenia progressiva, anemia, episódio de síncope e história de exérese de melanoma maligno nível IV de Clark em asa nasal há 6 anos, com esvaziamento de cadeia linfonodal cervical ipsilateral. Durante a investigação, foi encontrada massa gástrica, sendo submetido à gastrectomia total com reconstrução em Y de Roux, com melhora substancial dos sintomas. O exame anatomopatológico da massa gástrica confirma o resultado de metástase de melanoma maligno pela biópsia endoscópica pré-operatória. O paciente segue em acompanhamento ambulatorial sem manifestações de novas metástases até o momento. (AU)
Malignant melanoma accounts for 5% of all skin cancers. It has high local aggressiveness and tendency to spread through metastases. The digestive tract is not common secondary site of melanoma, and the stomach is rarely compromised. We report the case of a male patient, 64, with progressive asthenia, anemia, syncope and previously excision of malignant melanoma Clark level IV in nasal wing for 6 years with ipsilateral cervical lymph node emptying. During the investigation we found gastric mass and underwent total gastrectomy and Roux-en-Y with substantial improvement in symptoms. The anatomopathological examination of the gastric mass confirms the result of malignant melanoma metastasis by the preoperative endoscopic biopsy. The patient is in outpatient treatment without signs of new metastases so far. (AU)