ABSTRACT
ABSTRACT Peritoneal carcinomatosis (PC) indicates advanced stage cancer, which is generally associated with a poor outcome and a 6 to 12 months. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an option for treating patients with primary PC, such as mesothelioma, or secondary PC, such as colorectal cancer (CRC) or pseudomixoma. Until recently, such patients were deemed untreatable. Objective: The purpose of this study was to assess the results of CRS + HIPEC in patients with PC. Postoperative complications, mortality and survival rates were evaluated according to the diagnosis. Results: Fifty-six patients with PC, undergoing full CRS + HIPEC between October 2004 and January 2020, were enrolled. The mortality rate was 3.8% and the morbidity rate was 61.5%. Complications were significantly higher in proportion to the duration of surgery (p<0.001). The overall survival rates, as shown in the Kaplan-Meyer curve, were respectively 81%, 74% and 53% at 12, 24 and 60 months. Survival rates according to each diagnosis for the same periods were 87%, 82% and 47% in patients with pseudomixoma, and 77%, 72% and 57% in patients with CRC (log-rank 0.371, p=0.543). Conclusion: CRS with HIPEC is an option for pacients with primary or secondary PC. Although complication rates are high, a longer survival rate may be attained compared to those seen in previously published results; in some cases, patients may even be cured.
RESUMO O diagnóstico de carcinomatose peritoneal (CP), indica um estágio avançado do câncer e em geral está associado a um mau prognóstico com sobrevida média variando de 6 a 12 meses. A cirurgia citorredutora (CRS) associada à quimioterapia intraperitoneal hipertérmica (HIPEC) tem sido descrita como uma opção de tratamento para os pacientes portadores de CP primária como nos portadores de mesotelioma, ou secundária como em portadores de cancer colorretal ou pseudomixoma, até recentemente considerados sem possibilidade terapêutica. Objetivo: Avaliar os resultados do tratamento de pacientes portadores de CP submetidos a CRS + HIPEC. Foram analisadas as taxas complicações pós-operatórias, mortalidade e a sobrevida desses pacientes. Resultados: Foram incluídos 56 pacientes com CP, submetidos a c CRS + HIPEC, no período de Outubro 2004 a Janeiro 2020. A taxa de mortalidade foi de 3,8% e taxa de morbidade de 61,5%, sendo a ocorrência de complicações significativamente maior quanto maior o tempo cirúrgico (p<0,001). A sobrevida global pela curva de Kaplan-Meyer foi de 81%, 74% e 53% em 12, 24 e 60 meses respectivamente. Já a sobrevida por diagnóstico nos mesmos períodos foi de 87%, 82%, 47% para os pacientes portadores de pseudomixoma e de 77%, 72% e 57% para pacientes portadores de câncer colorretal (Log -RANK 0,371, p=0,543). Conclusão: A CRS + HIPEC é uma opção de tratamento para pacientes portadores de CP primária ou secundária. Embora com taxa de complicações elevadas, pode proporcionar aumento da sobrevida quando comparado com resultados prévios da literatura e em alguns casos até a cura.
ABSTRACT
La hidatidosis es una zoonosis causada por los Echinococcus granulosus y Echinococcus multilocularis de forma más frecuente. La localización primaria peri apendicular es sumamente rara. Se presenta el caso de una paciente de 63 años. Procedente de zona alto andina del Cusco. Destaca la crianza de ganado vacuno, ovino y canes. Presentó síntomas de enfermedad por un lapso de 10 años aproximadamente. La sintomatología predominante era dolor abdominal en hemi-abdomen derecho. Al examen médico se localizó masa tumoral móvil en fosa iliaca derecha. La ecografía evidenció litiasis vesicular y masa quística compleja en hemi-abdomen inferior derecho, sugerente de hidatidosis peritoneal. Se realizó colecistectomía y quistectomía total (con adherencia al apéndice cecal). El resultado histopatológico confirmó el diagnóstico de quiste hidatídico peri apendicular de 10 x 8 cm, y apendicitis catarral aguda. La importancia de este caso se basa en la infrecuente localización peri apendicular del quiste hidatídico a nivel mundial y nacional.
Hydatid disease is a zoonotic disease caused most frequently by Echinococcus granulosus and Echinococcus multilocularis. A periappendiceal primary location is extremely rare. The case of a 63-year-old patient is presented. She is from a high Andean region in Cusco. She has had contact with cattle, sheep, and dogs. She had symptoms of disease for a period of approximately 10 years. The predominant symptoms were abdominal pain in the right hemi-abdomen. The physical examination revealed a mobile tumor mass in the right iliac area. The ultrasound scan evidenced cholelithiasis and complex cystic mass in the lower right hemi-abdomen, suggesting peritoneal hydatidosis. A total cholecystectomy and cystectomy was performed (with adherence to cecal appendix). Histopathological results confirmed the diagnosis of a periappendiceal hydatid cyst measuring 3.94 x 3.15 inches, and acute catarrhal appendicitis. The importance of this case is based on the unusual location of a primary hydatid cyst.
ABSTRACT
PURPOSE: To evaluate the effects of copaiba oil as a prophylactic and/or therapeutic substance on survival of rats subjected to cecal ligation and puncture, describing histopathological and oxidative stress findings.METHODS:Forty rats (Ratus norvegicus) were distributed into five study groups (N=8): Sham group (ShG): normal standard animals; Sepse group (SepG): submitted a cecal ligation and puncture (CLP); Pre group (PreG): administered copaiba oil once daily by subcutaneous injection for five days before carrying out CLP; Post CLP group (PostG): administered copaiba oil once daily by subcutaneous injection from the first day of CLP until death by sepsis; and Pre/Post group (Pre/PostG): administered copaiba oil once daily by subcutaneous injection for five days before carrying out CLP and from the first day of CLP until de death by sepsis. After the death of the animals, blood was collected for assessment of oxidative stress and histological analysis were performed. The Kaplan-Meier curves of surviving time were realized.RESULTS: Survival analysis demonstrated that animals treated with copaiba oil prior to the execution of the CLP (PreG and Pre/Post groups) had longer survival compared to the sepsis group (p<0.0001) whereas animals receiving copaiba only after the completion of CLP (PostG) showed no statistically significant difference compared to the sepsis group. However, when comparing the two groups in which was administered copaiba previously (PreG and Pre/PostG groups), there was no statistical significance between the groups (p=0.4672). There was no statistical difference between histopathological findings or the levels of oxidative stress.CONCLUSION: Prophylactic subcutaneous administration of copaiba increases survival of rats subjected to severe sepsis by cecal ligation and puncture.
Subject(s)
Animals , Male , Fabaceae/chemistry , Peritonitis/drug therapy , Plant Oils/therapeutic use , Sepsis/drug therapy , Cecum/surgery , Disease Models, Animal , Feces , Injections, Subcutaneous , Ligation , Malondialdehyde/blood , Oxidative Stress/drug effects , Punctures , Peritonitis/etiology , Peritonitis/prevention & control , Plant Oils/pharmacology , Post-Exposure Prophylaxis/methods , Random Allocation , Rats, Wistar , Reproducibility of Results , Survival Analysis , Sepsis/prevention & control , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the effects of copaiba oil administered by different routes on survival of mices subjected to cecal ligation and puncture. METHODS: Thirty two mice were distributed into four study groups (N=8): Sham group: normal standard animals; Control group: submitted a cecal ligation and puncture (CLP); Gavage group: submitted a CLP, and treat with copaiba oil by gavage; and Subcutaneous group: submitted a CLP, and treat with copaiba oil by subcutaneous injection. After the death of the histological analysis were performed. The Kaplan-Meier curves of surviving time were realized. RESULTS: All animals that received copaiba, regardless of the route used, survived longer when compared to the control group (p<0.0001), whereas the survival time ranged from 20 hours for the control group up to 32 hours for the animals of gavage group and 52 for subcutaneous group. The animals that received gavage copaiba lived about and about 20 hours unless the subcutaneous group (p=0.0042). There was no statistical difference when compared the intensity of inflammatory response (p>0.05) CONCLUSION: Prophylactic subcutaneous administration of copaiba in mice subjected to severe sepsis by cecal ligation and puncture, resulted in a survival time higher than non-use or use of this oil by gavage. .
Subject(s)
Animals , Male , Mice , Balsams/administration & dosage , Sepsis/drug therapy , Balsams/therapeutic use , Cecum/surgery , Injections, Subcutaneous/methods , Intubation, Gastrointestinal/methods , Ligation , Lung/pathology , Models, Animal , Necrosis/pathology , Punctures , Peritoneal Diseases/drug therapy , Random Allocation , Survival Analysis , Time FactorsABSTRACT
Objective To investigate the CT manifestations of inflammatory and tumorous diseases in peritoneum, and to improve the abilities of diagnosis and differential diagnosis. Methods Conventional non-enhanced and enhanced CT were performed in 63 patients. The mean value of peritoneal structures in normal persons and patients were measured and calculated. The CT features of abnormal peritoneum were divided into 5 classes that were collated with their pathological changes. The numbers of each CT class appeared in inflammatory and tumorous diseases were countered. The data were treated with statistical methods for comparing the differences.Results (1) In normal persons, the non-enhanced and enhanced mean CT values were (-88.60?18.30) and (-78.73?16.90) HU, respectively, while in patients, they were(-38.63?15.64) and (-1.42?14.42) HU, respectively. CT value of abnormal peritoneum was significantly higher than that of normal group. (2) There were 183 places of abnormal peritoneum in five classes: firstly, fine and blur attenuation in 65 places (56 inflammations and 9 tumors); secondly, linear or strip thickening of peritoneum in 25 places (12 inflammations and 13 tumors); thirdly, attenuation of disorganized strip and piece or nodus in 50 places (8 inflammations and 42 tumors); fourthly, soft tissue mass in 28 places (5 inflammations and 23 tumors); and fifthly, cake peritoneum in 15 places ((2 inflammations) and 13 tumors). The data showed statistical differences (P
ABSTRACT
The results suggest that the root cause of formation of peritoneal adhesions is cong-cllation. produced by exudation of fibrin. Extensive adhesions are associated with multi-factors.The principal measures to prevent peritoneal adhesions are removing of exudate and foreign bodies during abdominal operations.Granulation composed mainly of spin die-shaped fibroblasts and capillaries forms by 72 hours, indicating that congelation caused by multi-factors can result in peritoneal adhesions at the initial stage.The effccient precautions against adhesions within three days need further research.There were no normal mesothelial cells, which have fibrinolytic activity, to be found in the study.The reason may be that plasminogen activating factor in the blood vessels beneath mesothelium is inhibited by ischemia,injury,infection,foreign bodies and hemorrhage. This is worth notice in the prevention and treatment.