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Article in Chinese | WPRIM | ID: wpr-878695


Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.

Abdominal Neoplasms/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Humans , Retrospective Studies , Risk Factors , Treatment Outcome
ABCD arq. bras. cir. dig ; 32(3): e1455, 2019. graf
Article in English | LILACS | ID: biblio-1038026


ABSTRACT Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

RESUMO Racional: Pancreatoduodenectomia consiste no procedimento cirúrgico usual para tratamento curativo de neoplasias periampulares e apresenta mortalidade significativa. Variações arteriais do tronco celíaco não são incomuns e podem favorecer lesões iatrogênicas ou exigirem realização de ressecção/reconstrução arterial durante pancreatoduodenectomia. Objetivo: Determinar a prevalência de variações arteriais que apresentam implicações durante pancreatoduodenectomia. Métodos: A anatomia do tronco celíaco e sistema arterial hepático foi investigada retrospectivamente em 200 exames tomográficos contrastados do abdome. Resultados: Anatomia normal do sistema arterial hepático foi observada em 87% dos casos. Presença de uma artéria hepática direita anômala foi identificada em 13%. Em 12 casos houve uma artéria hepática direita substituta originária da artéria mesentérica superior, em dois uma artéria hepática direita acessória com origem similar. Tronco hepaticomesentérico foi identificado em sete casos e em cinco houve uma artéria hepática direita originária diretamente do tronco celíaco. Em todos casos de artéria hepática direita anômala seu curso foi por trás da cabeça do pâncreas e com trajeto passando posteriormente ao tronco da veia porta e após percorrendo sua face lateral direita antes de alcançar o fígado. Conclusões: Variações arteriais hepáticas, como artéria hepática direita anômala com trajeto posterior à veia porta, são frequentes (13%). Nestes pacientes, quando submetidos à pancreatoduodenectomia, pode ser necessária alteração na abordagem cirúrgica para ressecção adequada. Exames de imagem pré-operatórios podem claramente identificar estas variações e auxiliar na realização de dissecção segura da cabeça do pâncreas com adequado planejamento cirúrgico.

Humans , Male , Female , Pancreaticoduodenectomy , Hepatic Artery/anatomy & histology , Abdominal Neoplasms/surgery , Celiac Artery/anatomy & histology , Tomography Scanners, X-Ray Computed , Prevalence , Retrospective Studies , Dissection , Anatomic Variation , Hepatic Artery/abnormalities , Hepatic Artery/diagnostic imaging
Medicina (B.Aires) ; 78(6): 440-442, Dec. 2018. ilus
Article in Spanish | LILACS | ID: biblio-976143


La condición de inmunosuprimido aumenta el riesgo de cáncer en trasplantados renales, en comparación a la población general. La mejor supervivencia de esta población en los últimos años ha convertido a las neoplasias y a la enfermedad cardiovascular en las principales causas de morbi-mortalidad. Presentamos el caso de un paciente trasplantado renal que desarrolló cuatro años después del trasplante una forma inusual de tumor mesenquimatoso, el angiomixoma agresivo, que requirió resección quirúrgica amplia.

The condition of immunosuppressed increases the risk of cancer in kidney transplant patients, as compared to the general population. The best survival of inmunosupressed patients in recent years has turned both neoplasms and cardiovascular diseases into the main causes of morbidity and mortality. We present the case of a renal transplanted patient who developed an unusual form of mesenchymal tumor such as the aggressive angiomyxoma, four years after the implant and requiring wide surgical resection.

Humans , Male , Adult , Kidney Transplantation/adverse effects , Immunocompetence , Mesenchymoma/etiology , Myxoma/etiology , Magnetic Resonance Spectroscopy , Risk Factors , Immunosuppressive Agents/adverse effects , Mesenchymoma/surgery , Mesenchymoma/pathology , Abdominal Neoplasms/surgery , Abdominal Neoplasms/etiology , Abdominal Neoplasms/pathology , Myxoma/surgery , Myxoma/pathology
Säo Paulo med. j ; 136(6): 586-590, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-991690


ABSTRACT BACKGROUND: Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT: We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannenstiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pelvis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdominal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirming the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION: Resection of the mass along with the abdominal wall, with wall margins, is the most effective treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postoperatively for eight months, without any evidence of disease to date.

Humans , Female , Adult , Cell Transformation, Neoplastic/pathology , Adenocarcinoma, Clear Cell/etiology , Endometriosis/complications , Lymphatic Metastasis/pathology , Abdominal Neoplasms/etiology , Tomography, X-Ray Computed , Adenocarcinoma, Clear Cell/surgery , Adenocarcinoma, Clear Cell/pathology , Neoadjuvant Therapy , Abdominal Wall/surgery , Lymph Node Excision , Abdominal Neoplasms/surgery , Abdominal Neoplasms/pathology
Int. braz. j. urol ; 44(3): 483-490, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-954036


ABSTRACT Background and Purpose: Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.

Humans , Male , Female , Adult , Aged , Carcinoma/surgery , Laparoscopy/methods , Abdominal Neoplasms/surgery , Neoplasms, Multiple Primary/surgery , Postoperative Complications , Prostatectomy/methods , Time Factors , Brazil , Reproducibility of Results , Retrospective Studies , Blood Loss, Surgical , Treatment Outcome , Operative Time , Tertiary Care Centers , Length of Stay , Middle Aged , Nephrectomy/methods
ABCD arq. bras. cir. dig ; 30(2): 88-92, Apr.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-885719


ABSTRACT Background: The treatment of neuroblastoma is dependent on exquisite staging; is performed postoperatively and is dependent on the surgeon's expertise. The use of risk factors through imaging on diagnosis appears as predictive of resectability, complications and homogeneity in staging. Aim: To evaluate the traditional resectability criteria with the risk factors for resectability, through the radiological images, in two moments: on diagnosis and in pre-surgical phase. Were analyzed the resectability, surgical complications and relapse rate. Methods: Retrospective study of 27 children with abdominal and pelvic neuroblastoma stage 3 and 4, with tomography and/or resonance on the diagnosis and pre-surgical, identifying the presence of risk factors. Results: The mean age of the children was 2.5 years at diagnosis, where 55.6% were older than 18 months, 51.9% were girls and 66.7% were in stage 4. There was concordance on resectability of the tumor by both methods (INSS and IDRFs) at both moments of the evaluation, at diagnosis (p=0.007) and post-chemotherapy (p=0.019); In this way, all resectable patients by IDRFs in the post-chemotherapy had complete resection, and the unresectable ones, 87.5% incomplete. There was remission in 77.8%, 18.5% relapsed and 33.3% died. Conclusions: Resectability was similar in both methods at both pre-surgical and preoperative chemotherapy; preoperative chemotherapy increased resectability and decreased number of risk factors, where the presence of at least one IDRF was associated with incomplete resections and surgical complications; relapses were irrelevant.

RESUMO Racional: O tratamento do neuroblastoma é dependente de estadiamento primoroso, realizado no pós-cirúrgico e dependente da expertise do cirurgião. O uso de fatores de risco através da imagem ao diagnóstico surge como preditivo de ressecabilidade, complicações e homogeneidade no estadiamento. Objetivos: Avaliar o critério de ressecabilidade tradicional com os fatores de risco para ressecabilidade, através das imagens radiológicas, em dois momentos no diagnóstico e no pré-cirúrgico analisando a ressecabilidade, complicações cirúrgicas e índice de recidiva. Métodos: Estudo retrospectivo em 27 crianças com neuroblastoma estádios 3 e 4 em abdome e pelve, e com tomografia e/ou ressonância no diagnóstico e pré-cirúrgico, identificando-se a presença de fatores de risco. Resultados: A idade média das crianças foi de 2,5 anos ao diagnóstico, onde 55,6% estavam acima dos 18 meses, 51,9% eram meninas e 66,7% tinham estádio 4. Houve concordância da ressecabilidade do tumor pelos dois métodos avaliados (INSS e IDRFs) e em ambos os momentos da avaliação, ao diagnóstico (p=0,007) e pós-quimioterapia (p=0,019). Desta forma todos pacientes ressecáveis por IDRFs no pós-quimioterapia tiveram ressecção completa; já nos irressecáveis, 87,5% tiveram ressecção incompleta. Houve remissão em 77,8%, 18,5% recaíram e 33,3% morreram. Conclusões: Aressecabilidade foi semelhante em ambos os métodos tanto no diagnóstico como no pré-cirúrgico. A quimioterapia pré-operatória aumentou a ressecabilidade e diminuição do número de fatores de risco, onde a presença de ao menos um IDRF associou-se às ressecções incompletas e complicações cirúrgicas. As recidivas foram irrelevantes.

Humans , Male , Female , Infant , Child, Preschool , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Abdominal Neoplasms/surgery , Abdominal Neoplasms/diagnostic imaging , Neuroblastoma/surgery , Neuroblastoma/diagnostic imaging , Postoperative Complications/etiology , Prognosis , Retrospective Studies , Risk Factors , Risk Assessment , Neoplasm Recurrence, Local/diagnostic imaging
Rev. bras. anestesiol ; 67(2): 210-213, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-843373


Abstract Neuroblastoma is the most common, non-central nervous system tumor of childhood. It has the potential to synthesize catecholamines. However, the presences of hypertension are uncommon. We report the perioperative management of a 15-month-old infant with giant abdominal neuroblastoma who presented severe hypertension. The pathophysiological alterations of neuroblastoma are reviewed and perioperative management presented.

Resumo Neuroblastoma é o tumor mais comum do sistema nervoso não central na infância. Esse tumor tem o potencial de sintetizar catecolaminas; entretanto, a presença de hipertensão é rara. Relatamos o manejo perioperatório de uma criança de cinco meses com neuroblastoma abdominal gigante que apresentou hipertensão grave. As alterações fisiopatológicas do neuroblastoma foram revistas e o manejo perioperatório é apresentado.

Humans , Male , Infant , Anesthesia , Abdominal Neoplasms/surgery , Abdominal Neoplasms/pathology , Neuroblastoma/surgery , Neuroblastoma/pathology
Rev. medica electron ; 39(supl.1): 781-790, 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902257


Los tumores estromales gastrointestinales son neoplasias que se originan en el tejido mesenquimal de la pared del tracto gastrointestinal. Se ha postulado que las células que originan estos tumores son las células intersticiales de Cajal, las cuales constituyen el marcapaso del tracto digestivo, se hallan en el plexo mientérico de Auerbach y responden al oncogén CD117, c-KIT. Pueden presentarse a cualquier edad pero tienen un pico de incidencia durante la sexta década de la vida. La localización más frecuente es en estómago. Tienen variedad de tamaños desde pocos milímetros hasta 20 cm o más. En este trabajo se presenta un paciente de 56 años de edad que fue ingresado en el centro hospitalario del territorio de Colón por presentar un cuadro de sangrado digestivo alto en forma de melena. Se le realizaron exámenes de laboratorio, estudios imagenológicos (Rx contrastado de estómago-duodeno, ultrasonido y TAC abdominal) y endoscopia digestiva superior. Se comprobó la presencia de una tumoración polipoide de 5 cm de diámetro en la región prepilórica gástrica. Fue sometido a operación quirúrgica y los resultados definitivos de Anatomía Patológica arrojaron un tumor del estroma gastrointestinal de bajo grado de malignidad (AU).

Gastrointestinal stromal tumors are neoplasias originated in the mesenchymal tissue of the gastrointestinal tract wall. It has been stated that cells originating these tumors are the Cajal´s interstitial cells, the digestive tract pacemaker, that are located in he Auerbach´s myoenteric plexus and answer to CD117, c-KIT oncogen. They may occur at any age but have an incidence peak during the sixth decade of life. The most common location is the stomach. There is a variety of sizes, from few millimeters to 20 cm or more. The case of a 56-years-old patient is presented in this work; he was admitted in the territorial hospital of Colon for presenting a high digestive bleeding in a melena form. Laboratory tests, imagine studies (contrasted Rx of stomach and duodena, abdominal ultrasound and CAT) and high digestive endoscopy were made. It was proved the presence of a 5 cm polypoid tumor in the gastric pre-pyloric region. It was surgically operated and the final results of Pathologic Anatomy showed a gastrointestinal stromal tumor of low level malignancy (AU).

Humans , Male , Female , Biopsy , Gastrointestinal Stromal Tumors/epidemiology , Ultrasonics/methods , Gastrointestinal Stromal Tumors/surgery , Gastrointestinal Stromal Tumors/complications , Gastrointestinal Stromal Tumors/diagnosis , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/therapy , Drug Therapy/methods , Abdominal Neoplasms/surgery , Abdominal Neoplasms/diagnosis , Abdominal Neoplasms/epidemiology
Rev. bras. cir. plást ; 31(2): 252-256, 2016. ilus
Article in English, Portuguese | LILACS | ID: biblio-1570


As opções reconstrutivas para defeitos da parede anterior do tórax podem ser desafiadoras especialmente quando o defeito é extenso e sujeito a radioterapia pré-operatória. Apresenta-se caso de paciente com carcinoma ductal invasivo de mama não tratado que realizou radioterapia e quimioterapia incompleta no pré-operatória. O exame patológico revelou carcinoma ductal invasivo de 11,5 cm, grau III, com invasão linfovascular e linfonodos axilares positivos (20/20). Após a mastectomia, defeitos estendidos seguido de longa excisão de pele mediram 25 x 20 cm, sendo esses cobertos imediatamente com retalhos em abdominoplastia reversa tensionada. Trata-se do primeiro caso relatado de excisão larga de mastectomia reconstruída exclusivamente com retalhos avançados em abdominoplastia reversa e alta tensão progressiva de pontos de adesão demostrando que nos pacientes selecionados, a pele abdominal pode ser avançada superiormente com segurança e facilidade para atingir a área superior do tórax e cobrir a área com defeito significante.

Reconstructive options for anterior chest wall defects can be challenging especially when the defect is large and has been subject for preoperative radiotherapy. We report a case of a patient with a neglected large invasive ductal carcinoma of the breast who had received incomplete preoperative radiotherapy and chemotherapy. The pathology examination revealed an 11.5 cm invasive ductal carcinoma, grade III, with lymphovascular invasion and positive axillary lymph nodes (20/20). The post mastectomy large defect following wide skin excision measured 25 x 20 cm and it was immediately covered with a tensioned reverse abdominoplasty flap. To our knowledge, this is the first case reported of a wide skin excision mastectomy reconstructed solely with a reverse abdominoplasty advancement flap and progressive high-tension with quilting sutures demonstrating that, in the selected patients, abdominal skin can be safely and easily advanced superiorly to reach the upper chest area and cover an area of significant defect.

Humans , Female , Middle Aged , History, 21st Century , Surgical Flaps , Abdominal Muscles , Reconstructive Surgical Procedures , Thoracic Wall , Carcinoma, Ductal , Diffusion of Innovation , Abdomen , Mastectomy , Surgical Flaps/surgery , Abdominal Muscles/surgery , Abdominal Muscles/pathology , Reconstructive Surgical Procedures/methods , Thoracic Wall/surgery , Thoracic Wall/pathology , Carcinoma, Ductal/surgery , Carcinoma, Ductal/pathology , Abdomen/surgery , Abdomen/pathology , Abdominal Neoplasms , Mastectomy/methods , Abdominal Neoplasms/surgery , Abdominal Neoplasms/complications
Braz. j. med. biol. res ; 47(11): 1003-1007, 11/2014. tab
Article in English | LILACS | ID: lil-723896


Deep venous thrombosis (DVT) is a common surgical complication in cancer patients and evidence that inflammation plays a role in the occurrence of DVT is increasing. We studied a population of cancer patients with abdominal malignancies with the aim of investigating whether the levels of circulating inflammatory cytokines were associated with postoperative DVT, and to determine the levels in DVT diagnoses. The serum levels of C-reactive protein (CRP), interleukins (IL)-6 and IL-10, nuclear transcription factor-κB (NF-κB) and E-selectin (E-Sel) were determined in 120 individuals, who were divided into 3 groups: healthy controls, patients with and patients without DVT after surgery for an abdominal malignancy. Data were analyzed by ANOVA, Dunnet's T3 test, chi-square test, and univariate and multivariate logistic regression as needed. The CRP, IL-6, NF-κB, and E-Sel levels in patients with DVT were significantly higher than those in the other groups (P<0.05). The IL-10 level was higher in patients with DVT than in controls but lower than in patients without DVT. Univariate analysis revealed that CRP, IL-6, NF-κB, and E-Sel were statistically associated with the risk of DVT (OR=1.98, P=0.002; OR=1.17, P=0.000; OR=1.03, P=0.042; and OR=1.38, P=0.003; respectively), whereas IL-10 had a protective effect (OR=0.94, P=0.011). Multivariate analysis showed that E-Sel was an independent risk factor (OR=1.41, P=0.000). Thus, this study indicated that an increased serum level of E-Sel was associated with increased DVT risk in postoperative patients with abdominal malignancy, indicating that E-Sel may be a useful predictor of diagnosis of DVT.

Adult , Female , Humans , Male , Middle Aged , Abdominal Neoplasms/surgery , Inflammation Mediators/metabolism , Venous Thrombosis/etiology , Abdominal Neoplasms/blood , C-Reactive Protein/analysis , Case-Control Studies , Cytokines/blood , E-Selectin/blood , /blood , /blood , NF-kappa B/blood , Postoperative Period , Risk Assessment , Risk Factors
São Paulo; s.n; 2014. 143 p. ilus, tab, graf.
Thesis in Portuguese | LILACS | ID: lil-720623


Objetivos: O propósito do estudo foi avaliar se uma estratégia restritiva de transfusão de hemácias era superior a uma estratégia liberal em reduzir a incidência de morte ou complicações graves em 30 dias em pacientes submetidos à cirurgia abdominal de grande porte para tratamento do câncer. Desenho: Estudo fase III de superioridade, unicêntrico, randomisado e controlado. Local: Unidade de Terapia Intensiva do Instituto do Câncer do Estado de São Paulo, Brasil. Participantes: Pacientes adultos com câncer submetidos à cirurgia abdominal de grande porte que necessitaram de cuidados pós-operatórios na unidade de terapia intesiva imediatamente após a cirurgia. Intervenção: Os pacientes foram aleatoriamente alocados durante a internação na unidade de terapia intensiva para uma estratégia liberal de transfusão de hemácias (eram transfundidos se a hemoglobina fosse inferior a 9 g/dL) ou para uma estratégia liberal (eram transfundidos se a hemoglobina fosse inferior a 7 g/dL). Desfecho primário: Desfecho composto de morte por qualquer causa ou complicações graves (cardiovasculares, síndrome do desconforto respiratório agudo, insuficiência renal com necessidade de diálise, choque séptico e reoperação) em 30 dias. Resultados: Foram incluídos 198 pacientes na análise final; 101 alocados no grupo restritivo e 97 no grupo liberal. A concentração de hemoblobina foi maior nos pacientes do grupo liberal durante o periodo do estudo. Também houve uma maior incidência de transfusão de hemácias neste grupo. O desfecho primário ocorreu em 19,6% (95% Intervalo de confiança [IC] 12,9 a 28,6) dos pacientes da estratégia liberal e em 35,6% (95% IC 27,0 a 45,4) dos pacientes da estratégia restrictiva (p= 0,012). Comparada com a estratégia restritiva, a estratégia liberal resultou em redução do risco absoluto do desfecho primário em 16% (95% IC 3,8 a 28,1) e um número necessário para tratar de 6,2 (95% IC 3,5 a 26,0). Conclusões: Uma estratégia liberal de...

Objectives: The purpose of this study was to evaluate whether a restrictive strategy of red blood cell (RBC) transfusion was superior to a liberal one for reducing mortality or severe clinical complications among patients undergoing major abdominal cancer surgery. Design: Phase III, randomised, unicentric, controlled, parallel-group, superiority trial. Setting: Intensive care unit (ICU) of Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, a tertiary oncology university hospital in Sao Paulo, Brazil Participants: All adult patients with cancer who were undergoing major abdominal surgery requiring postoperative care in the ICU were included. Interventions: Patients were randomly allocated during intensive care unit stay to treatment with either a liberal RBC transfusion strategy (transfusion when haemoglobin concentration decreased below 9 g/dL) or a restrictive RBC transfusion strategy (transfusion when haemoglobin concentration decreased below 7 g/dL). Main outcome measures: The primary outcome was a composite endpoint of all cause mortality or severe complications (cardiovascular complications, acute respiratory distress syndrome, acute kidney injury requiring renal replacement therapy, septic shock and reoperation) at 30 days. Results: A total of 198 patients were included in the final analysis; 101 randomised to the restrictive group and 97 to the liberal group. Haemoglobin concentrations were higher during the study period in the liberal group with a greater use of RBC transfusions. The primary composite endpoint occurred in 19.6% (95% confidence interval [CI] 12.9 to 28.6) of patients in the liberal strategy group and in 35.6% (95%CI 27.0 to 45.4) of patients in the restrictive strategy group (p=.012). Compared to the restrictive strategy, the liberal transfusion strategy resulted in an absolute risk reduction for the composite outcome of 16% (95%CI 3.8 to 28.1) and a number needed to treat of 6.2...

Humans , Male , Adult , Anemia , Critical Care , Erythrocyte Transfusion , Abdominal Neoplasms/surgery , Postoperative Complications , Randomized Controlled Trial
Rev. bras. ginecol. obstet ; 34(6): 278-284, jun. 2012. tab
Article in Portuguese | LILACS | ID: lil-641696


OBJETIVO: Avaliar a distribuição anatômica das lesões de endometriose profunda infiltrativa (EPI) em uma amostra de mulheres do Sul do Brasil. MÉTODOS: Foi conduzida uma análise prospectiva das mulheres submetidas a tratamento cirúrgico de EPI durante o período entre janeiro de 2010 e janeiro de 2012. As lesões foram classificadas em oito localizações principais, da menos para a mais grave: ligamento redondo, serosa uterina anterior/reflexão peritonial vesicouterina, ligamento uterossacro, região retrocervical, vagina, bexiga, intestino e ureter. O número e a localização das lesões de EPI foram estudados para cada paciente de acordo com os critérios acima e, também, de acordo com o acometimento isolado ou múltiplo. A análise estatística foi conduzida com o programa Statistica versão 8.0. Os valores p<0,05 foram considerados estatisticamente significativos. RESULTADOS: Durante o período de estudo, um total de 143 mulheres apresentaram 577 lesões de EPI: ligamento uterossacro (n=239; 41,4%), retrocervical (n=91; 15,7%), vagina (n=50; 8,7%), ligamento redondo (n=50; 8,7%), septo vesicouterino (n=41; 7,1%), bexiga (n=12; 2,1%), intestino (n=83; 14,4%), ureter (n=11; 1,9%). Doença multifocal foi observada na maioria das pacientes (p<0,0001), sendo que o número médio de lesões por paciente foi de 4. Endometrioma foi identificado em 57 mulheres (39,9%). Sessenta e cinco pacientes (45,4%) apresentaram infiltração intestinal comprovada histologicamente, totalizando 83 lesões assim distribuídas: apêndice (n=7), ceco (n=1) e retossigmoide (n=75). O número médio de lesões intestinais por paciente foi de 1,3. CONCLUSÕES: a EPI tem um padrão de distribuição multifocal, o que tem importância fundamental quando se define o tratamento cirúrgico completo da doença.

PURPOSE: To evaluate the anatomical distribution of deep infiltrating endometriosis (DIE) lesions in a sample of women from the South of Brazil. METHODS: A prospective study was conducted on women undergoing surgical treatment for DIE from January 2010 to January 2012. The lesions were classified according to eight main locations, from least serious to worst: round ligament, anterior uterine serosa/vesicouterine peitoneal reflection, utero-sacral ligament, retrocervical area, vagina, bladder, intestine, ureter. The number and location of the DIE lesions were studied for each patient according to the above-mentioned criteria and also according to uni- or multifocality. The statistical analysis was performed using Statistica version 8.0. The values p<0.05 were considered statistically significant. RESULTS: During the study period, a total of 143 women presented 577 DIE lesions: uterosacral ligament (n=239; 41.4%), retrocervical (n=91; 15.7%), vagina (n=50; 8.7%), round ligament (n=50; 8,7%), vesico-uterine septum (n=41; 7.1%), bladder (n=12; 2.1%), and intestine (n=83; 14.4%), ureter (n=11; 1.9%). Multifocal disease was observed in the majority of patients (p<0.0001), and the mean number of DIE lesions per patient was 4. Ovarian endometrioma was present in 57 women (39.9%). Sixty-five patients (45.4%) presented intestinal infiltration on histological examination. A total of 83 DIE intestinal lesions were distributed as follows: appendix (n=7), cecum (n=1) and rectosigmoid (n=75). The mean number of intestinal lesions per patient was 1.3. CONCLUSIONS: DIE has a multifocal pattern of distribution, a fact of fundamental importance for the definition of the complete surgical treatment of the disease.

Adult , Female , Humans , Middle Aged , Young Adult , Abdominal Neoplasms/pathology , Abdominal Neoplasms/surgery , Endometriosis/pathology , Endometriosis/surgery , Prospective Studies
Rev. chil. pediatr ; 83(1): 68-72, feb. 2012. ilus
Article in Spanish | LILACS | ID: lil-627469


Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics, more frequent in pediatrics. Objective: To report a case with unusual clinical presentation of lymphangioma. Clinical Case: A two-year old boy previously health who presented with abdominal pain, lipothymia, and generalized pallor ensuing an abdominal massage. Abnormal findings included an abdominal mass and Ht of 17.3 percent. Sonogram showed a large retroperitoneal mass with anechogenic areas and vasculari-zed septi. CT scans showed similar results. Surgical removal and biopsy confirmed the diagnosis. Discusion: Abdominal lymphangioma is uncommon in children, presentation varies from asymptomatic to acute abdomen. Images are essential in diagnosis and pre-op studies.

El linfangioma abdominal es una patología poco frecuente, benigna que corresponde a una malformación congénita del desarrollo linfático mesentérico y/o retroperitoneal. Es más frecuente en población infantil. Objetivo: Reportar un caso con presentación atípica de linfangioma. Caso clínico: Paciente de 2 años varón, previamente sano, que se presenta con dolor abdominal, luego lipotimia y palidez generalizada tras recibir un masaje abdominal. Al examen físico se encontró una masa abdominal, sin hepatomegalia, esplenomegalia ni adenopatías palpables. Presentaba un hematocrito de 17,3 por ciento. La Ecografía mostró una gran masa retrope-ritoneal con áreas anecogénicas y septos vascularizados. La TAC mostró hallazgos similares: masa quísti-ca, lobulada probablemente determinada por linfangioma abdominal. Se realizó extirpación quirúrgica y la biopsia confirma el diagnóstico. Discusión: El linfangioma abdominal es una patología infrecuente en niños. La presentación clínica es variable, puede ser desde asintomático hasta presentarse con abdomen agudo. Se requiere estudio imagenológico para su evaluación preoperatoria. La ecografía y TAC tienen un importante rol diagnóstico, en localización, tamaño, anatomía circundante y posibles complicaciones.

Humans , Male , Child, Preschool , Lymphangioma, Cystic/surgery , Lymphangioma, Cystic/diagnosis , Abdominal Neoplasms/surgery , Abdominal Neoplasms/diagnosis , Abdomen, Acute/etiology , Biopsy , Lymphangioma, Cystic/pathology , Abdominal Neoplasms/pathology , Retroperitoneal Space , Tomography, X-Ray Computed , Ultrasonography
Iranian Journal of Pediatrics. 2011; 21 (4): 543-548
in English | IMEMR | ID: emr-137376


The Abdominal Inflammatory Myofibroblastic Tumor [AIMT] is a rare tumor with unknown etiology which usually occurs in children and adolescents. It is composed of myofibroblastic spindle cells intermixed with inflammatory cells. We present four cases of AIMT. We herein present four cases of AIMT in different ages [range: 3.5 to 13 years] and in different organs [stomach, periduodenal, mesenteric, and colon]. There were two females and two males. The main symptoms were abdominal pain/mass/obstruction, vomiting, and weight loss. In all four patients, diagnosis was made by laparatomy and pathologic examination of excised mass lesion. Three patients underwent complete excision and no residual disease was present, one patient received chemotherapy due to tumor recurrences. The patients were followed up in average for four years. As the imaging and laboratory tests are non-specific, the diagnosis of AIMT is rarely made before surgery. AIMT should, therefore, be considered when a mass arises in an unusual location in the pediatric age group. Complete surgical resection should be performed whenever possible and the child should be kept on long-term follow-up

Humans , Male , Female , Abdominal Neoplasms/pathology , Abdominal Neoplasms/surgery , Granuloma, Plasma Cell/diagnosis , Review Literature as Topic
Arq. gastroenterol ; 47(4): 373-378, Oct.-Dec. 2010. ilus, tab
Article in English | LILACS | ID: lil-570525


CONTEXT: Desmoid tumors constitute one of the most important extraintestinal manifestations of familial adenomatous polyposis. The development of desmoids is responsible for increasing morbidity and mortality rates in cases of familial adenomatous polyposis. OBJECTIVES: To evaluate the occurrence of desmoid tumors in familial adenomatous polyposis cases following prophylactic colectomy and to present patient outcome. METHODS: Between 1984 and 2008, 68 patients underwent colectomy for familial adenomatous polyposis at the School of Medical Sciences Teaching Hospital, University of Campinas, SP, Brazil. Desmoid tumors were found in nine (13.2 percent) of these patients, who were studied retrospectively by consulting their medical charts with respect to clinical and surgical data. RESULTS: Of nine patients, seven (77.8 percent) were submitted to laparotomy for tumor resection. Median age at the time of surgery was 33.9 years (range 22-51 years). Desmoid tumors were found in the abdominal wall in 3/9 cases (33.3 percent) and in an intra-abdominal site in the remaining six cases (66.7 percent). Median time elapsed between ileal pouch-anal anastomosis and diagnosis of desmoid tumor was 37.5 months (range 14-60 months), while the median time between colectomy with ileorectal anastomosis and diagnosis was 63.7 months (range 25-116 months). In 6/9 (66.7 percent) patients with desmoid tumors, the disease was either under control or there was no evidence of tumor recurrence at a follow-up visit made a mean of 63.1 months later (range 12-240 months). CONCLUSIONS: Desmoid tumors were found in 13.2 percent of cases of familial adenomatous polyposis following colectomy; therefore, familial adenomatous polyposis patients should be followed-up and surveillance should include abdominal examination to detect signs and symptoms. Treatment options include surgery and clinical management with antiestrogens, antiinflammatory drugs or chemotherapy.

CONTEXTO: Os tumores desmóides representam uma das manifestações extraintestinais mais importantes na síndrome da polipose adenomatosa familiar. O aparecimento desta neoplasia está relacionada ao aumento da morbimortalidade nos doentes com polipose adenomatosa familiar. OBJETIVOS: Avaliar a ocorrência dos tumores desmóides nos casos de polipose adenomatosa familiar submetidos a colectomia profilática e avaliar o seguimento em ambulatório. MÉTODOS: Entre 1984 e 2008, 68 pacientes foram submetidos a colectomia por polipose adenomatosa familiar no Hospital das Clínicas da Faculdade de Ciências Médicas da Universidade de Campinas, SP. Os tumores desmóides ocorreram em nove pacientes (13.2 por cento), que foram estudados retrospectivamente, por meio da análise de prontuários, buscando dados clínicos e cirúrgicos. RESULTADOS: Dos nove pacientes, sete (77,8 por cento) foram submetidos a laparotomia para ressecção do tumor. A média de idade no momento da cirurgia foi de 33,9 anos (variando 22-51 anos). Os tumores desmóides da parede abdominal ocorreram em 3/9 casos (33.3 por cento) e os intra-abdominais em seis casos (66,7 por cento). O tempo médio entre a cirurgia do reservatório ileal e o diagnóstico do tumor desmóide foi de 37,5 meses (variando 14-60 meses), enquanto o tempo médio entre a cirurgia de colectomia com anastomose íleorretal e o diagnóstico foi de 63,7 meses (variando 25-116 meses). Em 6/9 (66,7 por cento) pacientes com tumor desmóide, a doença estava controlada ou não havia evidência de recidiva do tumor em 63,1 meses (variando de 12 a 240 meses) de tempo médio de seguimento. CONCLUSÃO: Os tumores desmóides ocorreram em 13,2 por cento dos casos de polipose adenomatosa familiar após a cirurgia do cólon; desta maneira, os pacientes com polipose adenomatosa familiar devem manter seguimento em ambulatório e o rastreamento deve incluir o exame abdominal minucioso a fim de identificar sinais e sintomas que possam conduzir ao diagnóstico de tumor desmóide. As opções de tratamento incluem cirurgia e manejo clínico com antiestrogênios, anti-inflamatórios ou quimioterapia.

Adult , Female , Humans , Male , Middle Aged , Young Adult , Abdominal Neoplasms/surgery , Colectomy , Fibromatosis, Abdominal/surgery , Fibromatosis, Aggressive/surgery , Anastomosis, Surgical , Abdominal Neoplasms/pathology , Abdominal Neoplasms/prevention & control , Abdominal Wall/surgery , Follow-Up Studies , Fibromatosis, Abdominal/pathology , Fibromatosis, Abdominal/prevention & control , Fibromatosis, Aggressive/pathology , Fibromatosis, Aggressive/prevention & control , Treatment Outcome
Rev. Col. Bras. Cir ; 37(2): 159-161, mar.-abr. 2010. ilus
Article in Portuguese | LILACS | ID: lil-550073


Paragangliomas is a pheochromocytoma of extra adrenal localization. The case report is a male, 55 years old who presented symptoms of adrenergic hyperstimulation associated to an abdominal mass diagnosed as paraganglioma by a biopsy. Because of its size, localization and vascularization, an aortography with embolization of the nutrient branches of the tumor was done pre-operatively. Four days later, a surgical ressection was performed, and the tumor was adhered to the duodenum, infra-renal aorta and inferior vena cava. We believe that an angiographic study pre-operatively with embolization makes possible an analysis of the anastomosis and arterial supplement, making the ressecability of the tumor safer, although it seems the surgical intervention should have been done earlier.

Humans , Male , Middle Aged , Abdominal Neoplasms/therapy , Embolization, Therapeutic , Paraganglioma/therapy , Abdominal Neoplasms/surgery , Preoperative Care , Paraganglioma/surgery
Rev. chil. obstet. ginecol ; 75(1): 42-46, 2010. ilus
Article in Spanish | LILACS | ID: lil-561831


Se presentan los casos de tres pacientes en su quinta década de vida que fueron sometidas a histerectomia por miomas uterinos sintomáticos. Caso 1: Paciente sometida a histerectomia supracervical laparoscópica. El cuerpo uterino fue extraído del abdomen mediante morcelación eléctrica. Cuatro años después presenta intenso dolor pélvico cíclico que requiere hospitalizaciones. La resonancia magnética sugiere nodulos vascularizados en pelvis. Se efectúa laparotomía diagnóstica resecándose implantes de tejido miometrial y endometrio en pelvis. Caso 2: Paciente sometida a histerectomia subtotal laparoscopica hace 12 años por miomatosis uterina. Consulta por dolor en fosa iliaca izquierda con exacerbación cólica de larga evolución. La tomografia helicoidal sin contraste (pielo TAC) muestro imagen hipodensa en fosa iliaca izquierda. Se realiza laparoscopia quirúrgica resecándose el tumor. La biopsia fue informada como muestra constituida por pared tipo corporal uterino. Caso 3: Paciente sometida a histerectomia total abdominal. Dos años después en ecotomografía vaginal de rutina se pesquisa tumor pelviano sólido de probable origen anexial izquierdo. La resonancia magnética sugiere leiomioma. La laparoscopia diagnóstica objetiva tumor sólido en relación a la cúpula vaginal compatible con mioma. Se reseca el tumor y el estudio anátomo patológico confirma el diagnóstico. Conclusión: La retención de fragmentos uterinos es una complicación infrecuente de la histerectomia supracervical laparoscópica que sería posible prevenir. La laparoscopia tiene un rol en la resolución de retención de fragmentos uterinos post histerectomia. La resonancia magnética aportó información relevante en estos casos.

We will present the cases of three patients in the fifth decade of their life, that had undergone an histerec-tomy with the diagnosis of uterine leiomyoma. Case 1: Pacient had undergone a supracevical laparocopic hysterectomy. The uterus had been extracted from the abdominal cavity by electrical morcellation. Four years after the procedure, she presents ciclic pelvic pain which requires hospitalization. The magnetic resonante suggests vascularized tumors in the pelvis. A diagnostic laparoscopy was done, removing miometrial and endometrial tissue. Case 2: Pacient had undergone a supracevical laparocopic hysterectomy twelve years ago with the diagnosis of leiomyoma. She requires medical attention because of a colic pain in the left ilac fossa. The unhenhanced helicoidal CT- Scan shows an hipodense image in the left iliac fossa. A diagnostic laparoscopy was done, removing the tumor. The biopsy showed a sample constituded of uterine corpus. Case 3: Pacient had undergone an abdominal histerectomy. Two years after the procedure, a vaginal ecotomography showed a solid pelvian tumor that was propably located in the left adnexa. The magnetic resonante suggests a leyomioma. The diagnostic laparoscopy shows a solid tumor in touch with the cúpula vaginalis, the tumor was removed. The biopsy confirms the diagnosis. Conclusion: The uterine fragments retention is an infrecuent complication of the supracervical laparoscopic hysterectomy that can be prevenible. The laparoscopy has a role in the resolution of the uterine fragments post histerectomy. The magnetic resonance contributed with relevant information in this cases.

Humans , Female , Middle Aged , Hysterectomy/adverse effects , Laparoscopy/adverse effects , Abdominal Neoplasms/surgery , Abdominal Neoplasms/etiology , Hysterectomy/methods , Pelvic Neoplasms/surgery , Pelvic Neoplasms/etiology