ABSTRACT
A ascite quilosa é uma complicação rara após procedimentos cirúrgicos e trauma abdominal, apresentando elevada morbidade e difícil manejo. Nos casos refratários ao tratamento clínico habitual, o tratamento cirúrgico se impõe, apesar da baixa taxa de sucesso. Dois casos são apresentados: o primeiro paciente foi vítima de trauma abdominal contuso e o segundo foi submetido a hernioplastia hiatal a Nissen videolaparoscópica, ambos evoluindo com ascite quilosa que necessitou de tratamento cirúrgico através da ligadura do ducto torácico, junto aos pilares diafragmáticos. Os pacientes evoluíram com melhora clínica e ausência de ascite após 24 meses de seguimento.
Chylous ascites is a rare complication after abdominal procedures and blunt abdominal trauma, associated with high morbidity and difficult management. When clinical treatment fails, surgical intervention is necessary, despite the limited success rate. Two cases are reported: the first patient had a blunt abdominal trauma and the second patient underwent laparoscopic Nissen fundoplication; both developed chylous ascites and required surgical treatment with suture repair of the thoracic duct, close to the diaphragm. There was clinical improvement and ascites was absent at a 24-month follow-up.
Subject(s)
Humans , Female , Adult , Middle Aged , Chylous Ascites/surgery , Chylous Ascites/complications , Chylous Ascites/diagnosis , Lymphatic Diseases/surgery , Lymphatic Diseases/diagnosis , Laparoscopy/methods , LaparoscopyABSTRACT
Supranumerary or ectopic parathyroid glands are the main cause of persistent hyperparathyroidism (HPT) in patients with end stage renal disease (ESRD) submitted to parathyroidectomy (PTx). PURPOSE: To evaluate the prevalence and location of parathyroid glands in these patients. METHODS: Thirty-five patients with ESRD and severe secondary hyperparathyroidism (HPT2) had been submitted to total PTx at HUCFF from December 2001 to July 2005. Surgery was always performed by the same surgeon, who described in details the location of the glands. RESULTS: Sixteen patients (45.7 percent) had ectopic glands, which were also extranumerary in five of them (14.3 percent). The most common locations were the thyroid parenchyma (33.3 percent), thyroid-thymus conduit (18.5 percent), and thymus (14.8 percent). Before PTx, the sensibility of ultrasonography and scintigraphy with technetium-99m Sestamibi was low (48.3 percent and 35.3 percent, respectively). Moreover, 51.4 percent of the nodules found at US were thyroid nodules. However, 99mTc-Sestamibi was useful to identify ectopic glands in those two patients with persistent HPT after PTx. CONCLUSION: The presence of extranumerary and ectopic parathyroid glands in HPT2 is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location.
A principal causa cirúrgica de persistência da doença após paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica (HPT2) é a existência de paratireóides supranumerárias e/ou ectópicas. OBJETIVO: Avaliar o número, prevalência de ectopia e localizações mais comuns das paratireóides nestes pacientes. MÉTODOS: Acompanhamos prospectivamente pacientes com HPT2, submetidos à paratireoidectomia no HUCFF, entre dezembro/2001 e julho/2005. Todos foram operados pelo mesmo cirurgião, que descreveu detalhadamente a localização das paratireóides encontradas. RESULTADOS: Foram avaliados 35 pacientes: em cinco (14,3 por cento) foi encontrada uma quinta glândula, supranumerária; dezesseis (45,7 por cento) possuíam glândulas ectópicas; as localizações mais comuns foram parênquima intratireoidiano (33,3 por cento), trajeto conduto tireotímico (18,5 por cento) e timo (14,8 por cento). As principais glândulas ausentes na presença de ectopia foram as inferiores esquerdas (29,6 por cento) e direitas (25,9 por cento). A sensibilidade da ultra-sonografia e da cintigrafia com sestamibi na detecção dos nódulos foi baixa (48,3 por cento e 35,3 por cento, respectivamente). Além disso, 51,4 por cento das ultra-sonografias mostraram incidentalomas tireoidianos. CONCLUSÃO: A presença de paratireóides supranumerárias e ectópicas no HPT2 é suficientemente relevante para justificar sua procura exaustiva. Como os exames de imagem pré-operatórios contribuem muito pouco para localizá-los, é necessário que se desenvolva uma rotina de exploração abrangendo as localizações mais comuns.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Choristoma/diagnosis , Hyperparathyroidism, Secondary/surgery , Kidney Failure, Chronic/complications , Lymphatic Diseases/diagnosis , Parathyroid Glands , Thyroid Diseases/diagnosis , Choristoma , Choristoma/surgery , Hyperparathyroidism, Secondary , Lymphatic Diseases , Lymphatic Diseases/surgery , Parathyroidectomy , Prospective Studies , Parathyroid Hormone/blood , Radiopharmaceuticals , Thymus Gland , Thyroid Diseases , Thyroid Diseases/surgeryABSTRACT
To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria. Twenty patients [12 men and 8 women, age 32-65 years] with severe chyluria of variable duration [5 months to 4 years], underwent surgical disconnection of the lymphorenal communication after confirming the diagnosis of chyluria by urine examination for fat globules. All patients were either failed minimally invasive treatment with intrarenal pelvic instillation of sclerosing material [8 patients], or presented with severe chyluria [12 patients]. Cystoscopy was performed in all patients before treatment. Chyluria was seen to spurt from the ureteral orifice unilaterally in 16 patients and bilaterally in 4 patients. The areolar tissue containing dilated lymphatics traveling to the kidney in the perirenal and hilar regions was dissected and divided between ligatures, thus stripping these structures completely. Only one side was operated at a time. All patients were available for a minimum follow-up of 1 year, with the longest follow-up 3 years. With unilateral surgery, clearance was achieved in 15 patients [93.7%] immediately, with final success in 14 [87.5%] patients. Of the four patients who underwent bilateral surgery a clearance rate of 75% was achieved. In three cases of failure, instillation of sclerotherapy was successful in two patients but failed in one patients who cured by repeated surgery. Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications. Salvage sclerotherapy is usually effective for the minority of patients who fail surgical stripping
Subject(s)
Humans , Male , Female , Lymphatic Diseases/surgery , Follow-Up StudiesABSTRACT
Lymphocytoma cutis is rare pathology affecting mainly the head and neck. Because of its rarity, the authors describe a clinical case in which the face was severely affected, as well as the histological examination and surgical management for functional eyelid improvement.
Subject(s)
Humans , Female , Adult , Eyelid Diseases , Lymphatic Diseases , Skin Diseases , Lymphatic Diseases/surgery , Lymphatic Diseases/diagnosis , Eyelid Diseases/surgery , Eyelid Diseases/diagnosis , Skin Diseases/diagnosis , Skin Diseases/surgeryABSTRACT
Os autores apresentam o relato de caso de uma paciente de 52 anos com linfadenopatia axilar com tumor primário desconhecido. Essa forma de apresentaçao de câncer de mama, sem evidência clínica ou mamográfica da lesao é rara, perfazendo ao redor de 1 por cento dos casos. Enfatiza-se a necessidade de uma minuciosa investigaçao clínica e laboratorial com o intuito de descartar outras neoplasias que podem apresentar-se com massa axilar palpável. Sao discutidos também, os métodos diagnósticos e a conduta a ser adotada nesta caso.