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1.
Rev. méd. Urug ; 37(3): e37313, set. 2021. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1341561

ABSTRACT

Resumen: Introducción: si bien la esplenectomía laparoscópica en esplenomegalias masivas y supramasivas constituye un desafío técnico, su realización es factible y segura en centros con equipos con experiencia en cirugía laparoscópica. Objetivo: presentar el primer caso de esplenectomía laparoscópica en esplenomegalia masiva realizada en Uruguay. Caso clínico: se trata de una paciente de 70 años portadora de una pancitopenia periférica, esplenomegalia masiva y diagnóstico realizado por punción de médula ósea de neoplasia linfoproliferativa tipo B de bajo grado, a quien se le indicó la esplenectomía con fines diagnósticos y terapéuticos. La paciente se operó en decúbito lateral derecho a 15 grados, los trócares se colocaron bajo visión directa adaptados al tamaño del bazo que se extendía desde el diafragma hasta el estrecho superior de la pelvis. Se realizó la esplenectomía en un tiempo de 220 minutos, extrayéndose la pieza íntegra y sin haberla colocado en bolsa a través de un hemi Pfannenstiel, protegiendo la pared con un retractor de heridas quirúrgicas. No presentó complicaciones, fue dada de alta a las 48 horas. El hemograma realizado a las 24 horas demostró un aumento de las cifras de todas las series celulares y el informe anatomopatológico diagnosticó un linfoma no Hodgkin de zona marginal. Discusión: la esplenectomía laparoscópica en esplenomegalias masivas requiere de un mayor tiempo quirúrgico, aunque las pérdidas sanguíneas y la estadía hospitalaria son menores en comparación a los procedimientos convencionales, presentando una morbilidad similar. En la experiencia inicial de los equipos quirúrgicos se reporta un porcentaje de conversiones y reingresos cercanos al 30%.


Abstract: Introduction: despite the fact that laparoscopic splenectomy for massive and supramassive splenomegaly constitutes a technical challenge, it is a feasible and safe procedure in the context of institutions with experienced teams in laparoscopic surgery. Objective: to present the first case of laparoscopic splenectomy for massive splenomegaly in Uruguay. Clinical case: the study presents the case of a 70-year-old patient carrier of peripheral pancytopenia, massive splenomegaly and a diagnosis of type B lymphoproliferative neoplasm based on bone marrow aspiration and biopsy, who underwent diagnostic and therapeutic splenectomy. The patient was operated in supine position with a 15-degree tilt, the trocars were placed under direct view, adapted to the size of the spleen which went from the diaphragm until the superior pelvic outlet. Splenectomy was performed in 220 minutes, the entire piece was removed through a hemi Pfannenstiel incision, without placing it in a bag, the wall being protected with a surgical wound retractor. There were no complications and the patient was discharged from hospital 48 hours. The blood count performed after 24 hours evidenced increase in all cell series and the pathology report confirmed diagnosis of marginal zone non- Hodgkin lymphoma. Discussion: laparoscoppic splenectomy in massive splenomegaly requires of a greater surgical time, although blood loss and hospital star are lower when compared to conventional procedures and evidence similar morbility. The initial experience of surgical teams reports 30% of conversions and readmissions.


Resumo: Introdução: embora a esplenectomia laparoscópica em esplenomegalias massivas e supremassivas seja um desafio técnico, sua realização é viável e segura em centros com equipes com experiência em cirurgia laparoscópica. Objetivo: apresentar o primeiro caso de esplenectomia laparoscópica em esplenomegalia maciça realizada no Uruguai. Caso clínico: paciente de 70 anos com pancitopenia periférica, esplenomegalia maciça e diagnóstico feito por punção de medula óssea de neoplasia linfoproliferativa tipo B de baixo grau, com indicação de esplenectomia para fins diagnósticos e terapêuticos. A paciente foi operada em decúbito lateral direito a 15 graus, os trocartes foram colocados sob visão direta adaptados ao tamanho do baço que se estendia do diafragma ao estreito superior da pelve. A esplenectomia foi realizada em um tempo de 220 minutos, retirando-se toda a peça e sem colocá-la em bolsa por meio de uma hemi Pfannenstiel, protegendo a parede com afastador de ferida operatória. Sem apresentar complicações a paciente teve alta após 48 horas. O hemograma realizado 24 horas depois da cirurgia mostrou um aumento no número de todas as séries de células e o laudo anatomopatológico diagnosticou linfoma não Hodgkin de zona marginal. Discussão: a esplenectomia laparoscópica nas esplenomegalias maciças requer um tempo cirúrgico maior, embora as perdas sanguíneas e a permanência hospitalar sejam menores em comparação aos procedimentos convencionais, apresentando morbidade semelhante. Na experiência inicial das equipes cirúrgicas, é relatado um percentual de conversões e readmissões próximo a 30%.


Subject(s)
Humans , Female , Aged , Splenectomy , Splenomegaly/surgery , Laparoscopy , Lymphoma, Non-Hodgkin
2.
Article in Chinese | WPRIM | ID: wpr-880179

ABSTRACT

Primary immune thrombocytopenia (ITP) is a blood system disease mediated by autoimmune mechanism. Currently, the goal of treatment for primary ITP is to keep patients' peripheral platelet count at a safe level to prevent severe bleeding. Recently, avatrombopag and fostamatinib have been approved by the FDA for the treatment of primary ITP in adults, while new drugs such as rozanolixizumab, efgartigimod, PRTX-100, decitabine and atorvastatin have shown efficacy in early clinical trials. This review summarizes the current accepted therapies for the clinical treatment of primary ITP in adults, and briefly discuss the progress of new therapies.


Subject(s)
Adult , Hemorrhage , Humans , Platelet Count , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Splenectomy
3.
Article in Chinese | WPRIM | ID: wpr-880115

ABSTRACT

OBJECTIVE@#To investigate the factors affecting the chronicity of childhood primary immune thrombo-cytopenia (ITP) and compare the efficiency of different first-line treatment regimens.@*METHODS@#Children with ITP hospitalized in our hospital from September 2013 to October 2018 were retrospectively analyzed.@*RESULTS@#Three hundred and one children (150 males and 151 females) were included in this study, with a median age of 8 (0.17-17) years old, and 110 (36.5%), 92 (30.6%), and 99 (32.9%) cases were grouped into newly diagnosed, persistent, and chronic ITP, respectively. The median of follow-up was 41.92 (1.07-74.03) months. At the end of the follow-up (October 2019), among the 202 newly diagnosed/persistent ITP children, 79 cases (59 newly diagnosed and 20 persistent ITP) achieved remission within 1 year after initial diagnosis, with a remission rate of 39.3%; 122 cases (50 newly diagnosed and 72 persistent ITP) developed chronic disease, with a chronicity rate of 60.7%; one case underwent splenectomy. In 99 cases with chronic ITP, 5 cases underwent splenectomy. Multivariable logistic regression analysis showed that, the insidious onset of symptoms (OR=3.754, 95%CI: 1.882-7.488, P=0.000) increased the risk of chronicity, while the positive antibody to anti-platelet membrane glycoprotein (OR=0.446, 95%CI: 0.224-0.888, P=0.021) might reduce the risk of chronicity. And no difference was found by the analysis of subtype of anti-platelet membrane glycoprotein (P=0.305). The efficacy of the first-line treatment of intravenous immunoglobulin (IVIG) alone or combined with steroid was better than that of steroid alone (P=0.028, 0.028), however, the efficiency was not significantly different between IVIG alone and combined with steroid (P=0.086).@*CONCLUSION@#Insidious onset of symptoms in pediatric ITP increases the risk of chronicity, while the positive titer of anti-platelet membrane glycoprotein may reduce the risk. In the first-line treatment for the newly diagnosed/persistent children. The efficacy of IVIG alone or combined with steroid is better than that of steroid alone.


Subject(s)
Adolescent , Child , Child, Hospitalized , Female , Humans , Immunoglobulins, Intravenous , Male , Purpura, Thrombocytopenic, Idiopathic , Retrospective Studies , Splenectomy
4.
ABCD arq. bras. cir. dig ; 34(2): e1581, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1345002

ABSTRACT

ABSTRACT Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.


RESUMO Racional: O tratamento de escolha para pacientes com hipertensão portal esquistossomótica com sangramento de varizes é a desconexão ázigo-portal mais esplenectomia (DAPE) associada à terapia endoscópica. Porém, estudos mostram aumento do calibre das varizes em alguns pacientes durante o seguimento em longo prazo. Objetivo: Avaliar o impacto da DAPE e tratamento endoscópico pós-operatório no comportamento das varizes esofágicas e recidiva hemorrágica, de pacientes esquistossomóticos. Métodos: Foram estudados 36 pacientes com seguimento superior a cinco anos, distribuídos em dois grupos: queda da pressão portal abaixo de 30% e acima de 30% comparados com o calibre das varizes esofágicas no pós-operatório precoce e tardio além do índice de recidiva hemorrágica. Resultados: Após a DAPE houve diminuição significativa no calibre das varizes esofágicas que, durante o seguimento aumentaram de calibre e foram controladas com tratamento endoscópico. A queda da pressão portal não influenciou significativamente o comportamento do calibre das varizes no pós-operatório precoce nem tardio nem os índices de recidiva hemorrágica. Conclusão: A queda na pressão portal não influenciou significativamente a variação dos calibres das varizes ao comparar os diâmetros pré e pós-operatórios precoces ou tardios. A comparação entre a queda de pressão do portal e as taxas de ressangramento também não foi significativa.


Subject(s)
Humans , Schistosomiasis , Esophageal and Gastric Varices/surgery , Hypertension, Portal/surgery , Recurrence , Splenectomy , Follow-Up Studies , Portal Pressure , Gastrointestinal Hemorrhage/surgery , Gastrointestinal Hemorrhage/etiology
5.
Article in English, Portuguese | LILACS | ID: biblio-1369690

ABSTRACT

Introdução: Tanto o angiossarcoma esplênico quanto o linfoma não Hodgkin (LNH) de células B não só são raros como apresentam desafios diagnósticos. Relato do caso: Paciente do sexo masculino, 45 anos, obeso, sudorese noturna há um ano, e dor abdominal cíclica há dois, com clínica inicial de angiossarcoma, contudo, sob o exame histopatológico e imuno-histoquímico, mostrou tratar-se de LNH de células B com apresentação atípica. A ultrassonografia (US) de abdome total realizada ao início do sintoma de sudorese noturna não teve alterações. Após um ano, a US apresentou massa esplênica. Na ressonância magnética da região abdominal, constatou-se tumoração esplênica expansiva heterogênea no aspecto anterior, suspeita de angiossarcoma esplênico. Após esplenectomia total, pancreatectomia caudal e linfadenectomia retroperitoneal, o exame histopatológico mostrou neoplasia maligna pouco diferenciada extensamente necrótica substituindo o parênquima esplênico. O estudo imuno-histoquímico foi positivo para os marcadores CD20 em diversos focos, para o BCL2 e para o KI67 (em 95% dos núcleos das células neoplásicas). A histopatologia e a imuno-histoquímica foram compatíveis com o diagnóstico de LNH difuso de alto grau, com imunofenótipo B do baço, sem sinal de infiltração de tecidos adjacentes. Após a esplenectomia total e quatro ciclos de quimioterapia, o paciente estava livre do linfoma e sem sintomas. Conclusão: É de suma importância o reconhecimento do diagnóstico correto de neoplasias raras como a relatada. Tanto a clínica quanto os exames de imagem, mesmo que fundamentais, podem ser imprecisos, reiterando a importância dos exames histológico e imuno-histoquímico complementares


Introduction: Both the splenic angiosarcoma and the B-cell non-Hodgkin's lymphoma (NHL) are not only rare but are challenging to diagnose. Case report: Male patient, 45 years old, obese, night sweats for one year, and cyclic abdominal pain for two years, with an initial angiosarcoma clinic, however after immunohistochemistry test, it was revealed a B-cell NHL with atypical presentation. The total abdomen ultrasound (US) performed at the onset of the night sweating symptom showed no alterations. After one year, the US showed a splenic mass. Magnetic resonance imaging of the abdominal region revealed a heterogeneous expansive splenic lesion in the anterior aspect with suspected splenic angiosarcoma. After full splenectomy, caudal pancreatectomy, and retroperitoneal lymphadenectomy, histological analysis showed an area of poorly differentiated necrotic malignancy infiltrated in the splenic parenchyma. Immunohistochemical analysis was positive for CD20 reagents in several foci, BCL2, and for KI67 (in ninety percent of the neoplastic cell nucleus). Histopathology and immunohistochemistry are consistent with high-grade, diffuse, NHL of immunophenotype B in the spleen, with no sign of metastasis to adjacent tissues. After total splenectomy and four rounds of chemotherapy, the patient had remission of the tumor and was asymptomatic. Conclusion: It is extremely important to recognize the relevance of the correct diagnosis of rare neoplasms such as the one reported. Both clinical and imaging tests, although important, can be inaccurate, reiterating the importance of complementary histologic and immunohistochemical tests


Introducción: El angiosarcoma esplénico e el linfoma no Hodgkin (LNH) de células B no solo son raros sino que presentan un reto diagnóstico. Relato del caso: Paciente masculino de 45 años, obeso, con sudoración nocturna durante un año y dolor abdominal cíclico durante dos años, con clínica inicial de angiosarcoma, pero bajo inmunohistoquímica mostró LNH de células B con presentación atípica. En la ecografía de abdomen total realizada al comienzo del síntoma de sudoración nocturna no hubo cambios. Después de un año, la ecografía enseñó una masa esplénica. La resonancia magnética de la región abdominal reveló una lesión esplénica expansiva heterogénea en la cara anterior, sospechosa de angiosarcoma esplénico. Tras la esplenectomía total, la pancreatectomía caudal y la linfadenectomía retroperitoneal, el análisis histológico mostró un área de neoplasia maligna necrótica poco diferenciada infiltrada en el parénquima esplénico. El análisis inmunohistoquímico fue positivo para los reactivos CD20 en varios focos, BCL2 y KI67 en el 95% del núcleo celular, la histología y la inmunohistoquímica son consistentes con LNH difuso de alto grado de inmunofenotipo B en el bazo, sin signos de metástasis. Tras esplenectomía total y cuatro rondas de quimioterapia, el paciente presentó remisión del tumor, así como disminución de síntomas. Conclusión: Es de suma importancia reconocer el diagnóstico de neoplasias raras como la reportada. Tanto las pruebas clínicas como las de imagen, aunque fundamentales, pueden ser inexactas, reiterando la importancia de las pruebas histopatológicas e inmunohistológicas


Subject(s)
Humans , Male , Splenectomy , Splenic Neoplasms/diagnostic imaging , Lymphoma, Non-Hodgkin/diagnostic imaging , Ultrasonography , Drug Therapy , Case Reports
7.
Rev. Soc. Bras. Med. Trop ; 54: e0748-2020, 2021. graf
Article in English | LILACS | ID: biblio-1155522

ABSTRACT

Abstract Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania spp. The recurrence of the disease occurs, in general, in patients with decreased or loss of T-cell function, whether due to the use of corticosteroids, immunosuppressive disease, or another cause. In some cases, splenectomy may be a therapeutic option. However, the effectiveness of splenectomy is not well defined. This report describes the evolution of a pediatric patient with seven recurrences of VL, who relapsed post-surgery after drug therapy and splenectomy.


Subject(s)
Humans , Child , Leishmania , Leishmaniasis, Visceral/drug therapy , Recurrence , Splenectomy
8.
Arq. gastroenterol ; 57(4): 459-465, Oct.-Dec. 2020. tab
Article in English | LILACS | ID: biblio-1142337

ABSTRACT

ABSTRACT BACKGROUND: There are quite a few studies examining prognostic factors in non-traumatic splenectomies compared to traumatic ones. OBJECTIVE: This study aimed to evaluate the predictors of mortality in patients who underwent splenectomy for non-traumatic spleen diseases. METHODS: Medical records of the patients, who had undergone total splenectomy for non-traumatic spleen diseases at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. Exclusion criteria included patients younger than 18 years of age, partial splenectomies, splenectomies applied to facilitate surgery for malignancy on contiguous organs, and splenectomies performed during liver transplantation. Iatrogenic splenic injuries were regarded as trauma and these cases were also excluded. RESULTS: The current study included 98 patients. Nine (9.2%) patients died. In univariate analysis, age, the presence of hematological neoplasia, hematocrit, hemoglobin, white blood cell counts, neutrophil-to-lymphocyte ratio, indications for splenectomy, application of emergency surgery, surgical technique, and transfusion of blood components were all significantly associated with mortality. In multivariate analysis, the presence of hematological malignancy [P=0.072; OR=7.17; (CI: 0.386-61.56)], the application of emergency surgery [P=0.035; OR=8.33; (CI: 1.165-59.595)] and leukocytosis [P=0.057; OR=1.136; (CI: 0.996-1.296)] were found to be positively associated with mortality. CONCLUSION: Hematologic neoplasia, emergency surgery, and leukocytosis were the independent predictors of mortality in patients, who were operated on for non-traumatic spleen diseases. A thorough preoperative evaluation, early therapeutic intervention, and advanced surgical techniques are important and can serve to minimize complications and mortality in case of inevitable splenectomy. Immunological research can provide new therapeutic opportunities that may impact positively on patients by minimizing morbidity and mortality.


RESUMO CONTEXTO: Há alguns estudos que examinam fatores prognósticos em esplenectomias não traumáticas em comparação com os traumáticos. OBJETIVO: Este estudo teve como objetivo avaliar os preditores de mortalidade em pacientes submetidos à esplenectomia para doenças do baço não traumático. MÉTODOS: Os prontuários dos pacientes, submetidos à esplenectomia total não traumática para doenças do baço em um centro terciário entre janeiro de 2009 e dezembro de 2019, foram revisados retrospectivamente. Os critérios de exclusão incluíram pacientes menores de 18 anos, esplenectomias parciais, esplenectomias aplicadas para facilitar a cirurgia para a malignidade em órgãos contíguos e esplenectomias realizadas durante o transplante hepático. As lesões esplênicas iatrogênicas foram consideradas trauma e esses casos também foram excluídos. RESULTADOS: O presente estudo incluiu 98 pacientes. Nove (9,2%) pacientes morreram. Na análise univariada, idade, presença de neoplasia hematológica, hematócrito, hemoglobina, contagem de glóbulos brancos, razão entre neutrófilos-linfócitos, indicações de esplenectomia, aplicação de cirurgia de emergência, técnica cirúrgica e transfusão de componentes sanguíneos foram significativamente associadas à mortalidade. Na análise multivariada, a presença de malignidade hematológica [P=0,072; OR=7,17; (IC: 0,386-61,56)], aplicação de cirurgia de emergência [P=0,035; OR=8,33; (IC: 1,165-59,595)] e leucocitose [P=0,057; OR=1,136; (IC: 0,996-1,296)] verificou-se que estão positivamente associados à mortalidade. CONCLUSÃO: Neoplasia hematológica, cirurgia de emergência e leucocitose foram os preditores independentes da mortalidade em pacientes, operados por doenças não traumáticas do baço. Uma avaliação pré-operatória minuciosa, intervenção terapêutica precoce e técnicas cirúrgicas avançadas são importantes e podem servir para minimizar complicações e mortalidade em caso de inevitável esplenectomia. Pesquisas imunológicas podem fornecer novas oportunidades terapêuticas que podem impactar positivamente nos pacientes, minimizando a morbidade e a mortalidade.


Subject(s)
Humans , Splenectomy , Spleen/surgery , Blood Transfusion , Retrospective Studies , Abdominal Injuries
10.
Rev. ecuat. pediatr ; 21(2): 1-7, 31 de agosto del 2020.
Article in Spanish | LILACS | ID: biblio-1140935

ABSTRACT

Introducción: La esplenectomía es un tratamiento estandarizado en niños con trombocitopenia. El método de laparoscopía, en este tratamiento, minimiza los procesos post-operatorios y se ha difundido su aplicación en la comunidad científica. El objetivo del presente estudio es realizar una descripción de la casuística y utilidad de la esplenectomía laparoscópica en los niños con patología hematológica. Métodos: El presente estudio observacional, retrospectivo se realizó en el Hospital Pediátrico Baca Ortiz. Se revisaron expedientes clínicos de los últimos 10 años de pacientes con indicación de esplenectomía quirúrgica. Se analizan variables demográficas, clínicas y de resultados. Se utiliza estadística descriptiva. Resultados: Ingresaron al estudio 14 pacientes que tuvieron una esplenectomía quirúrgica vía laparoscópica. La mayoría de estos pacientes son del sexo femenino, con patologías hematológicas como esferocitosis y púrpura trombocitopénica idiopática (PTI). En el 50% se realizó colecistectomía además de esplenectomía. El tiempo quirúrgico varió de 60 a 120 minutos. Conclusiones: La esplenectomía laparoscópica es considerada una técnica compleja dentro de los procedimientos de laparoscopia, pero es ideal para los pacientes con patología hematológica, por lo que es la técnica de elección. Una ventaja de la esplenectomía laparoscópica es el menor tiempo de recuperación y hospitalización, con heridas quirúrgicas más pequeñas.


Introduction: Splenectomy is a standardized treatment in children with thrombocytopenia. The laparoscopic method, in this treatment, minimizes post-operative processes and its application has become widespread in the scientific community. The objective of this study is to describe the casuistry and usefulness of laparoscopic splenectomy in children with hematological pathology. Methods: This retrospective, observational study was conducted at Baca Ortiz Pediatric Hospital. Medical records of the last 10 years of patients with an indication for surgical splenectomy were reviewed. Demographic, clinical and outcome variables are analyzed. Descriptive statistics are used. Results: Fourteen patients who had a laparoscopic surgical splenectomy entered the study. Most of these patients are female, with hematological pathologies such as spherocytosis and idiopathic thrombocytopenic purpura (ITP). In 50% a cholecystectomy was performed in addition to splenectomy. The surgical time ranged from 60 to 120 minutes. Conclusions: Laparoscopic splenectomy is considered a complex technique within laparoscopic procedures, but it is ideal for patients with hematological pathology, so it is the technique of choice. An advantage of laparoscopic splenectomy is the shorter recovery time and hospitalization, with smaller surgical wounds


Subject(s)
Humans , Splenectomy , Hematologic Diseases
11.
Rev. argent. cir ; 112(3): 333-336, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1279748

ABSTRACT

RESUMEN Las metástasis pancreáticas por carcinoma renal de células claras son excepcionales; en general, se presentan como tumores asintomáticos de diagnóstico incidental. Caso clínico: hombre de 61 años, nefrectomizado hace 10 años; durante el seguimiento se detecta una masa pancreática distal de 3 cm, hipervascular. Se realiza pancreatectomía corporocaudal laparoscópica, confirmándose la presencia de una metástasis de carcinoma renal. Las metástasis pancreáticas del carcinoma renal suelen apare cer en forma asintomática y metacrónica. La resección quirúrgica logra buenos resultados oncológicos y debe intentarse siempre que sea posible. En este caso destacamos que se pudo realizar una exéresis radical mediante abordaje mínimamente invasivo.


ABSTRACT Pancreatic metastases from clear cell renal carcinoma are very rare, and generally present as incidental asymptomatic tumors. Case report: a 61-year-old male patient with a history of nephrectomy 10 years before presented a 3-cm hypervascular mass in the distal pancreas during follow-up. A laparoscopic distal pancreatectomy was performed, confirming the presence of metastasis from a renal cell carci noma. Pancreatic metastases from renal cell carcinoma are usually metachronous and asymptomatic. Surgical resection is associated with favorable oncological results and, if possible, should be attempted. In our case, a successful oncological resection could be performed through a minimally invasive ap proach.


Subject(s)
Humans , Male , Middle Aged , Pancreatectomy , Carcinoma, Renal Cell/surgery , Neoplasms, Second Primary/surgery , Pancreatic Neoplasms/surgery , Splenectomy/methods , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Neoplasm Metastasis/diagnosis
12.
Int. j. med. surg. sci. (Print) ; 7(2): 53-60, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1179272

ABSTRACT

Los linfomas primarios de bazo afectan al bazo y/o sus ganglios linfáticos inicialmente. Representan <1% de los linfomas e implican un reto diagnóstico, por baja prevalencia y sintomatología inusual. Por lo tanto, el objetivo de este trabajo fue describir el manejo y evolución de un paciente con VIH-SIDA y la presentación de un Linfoma primario de bazo.En este reporte presentamos el caso de un paciente masculino de 52 años con VIH sin apego a tratamiento debuta con dolor abdominal, fiebre y pérdida de peso de 2 meses de evolución. La tomografía computarizada properatoria revela esplenomegalia y lesiones hipodensas sospechosas de neoformación. Es intervenido, realizándose una laparotomía exploratoria, con esplenectomía. El estudio histopatológico reporta linfoma no Hodgkin.El linfoma primario de bazo es poco frecuente. Es necesario su conocimiento para su sospecha diagnóstica y un diagnóstico diferencial en pacientes con esplenomegalia.Primary splenic lymphomas involve the spleen and/or its lymph nodes. They represent <1% of lymphomas and they imply a diagnostic challenge due to its poor symptomatology and low prevalence.There for, the objects this work describe the management and evolution of a patient with HIV-AIDS and presentation of a primary lymphoma of the spleenIn this report we present the case of a 52-year-old male patient with HIV infection without treatment presented with abdominal pain, fever and a 2-month weight loss. The pre-operative computed tomography showed splenomegaly and hypodense lesions suspected to be tumoral. He was operated on, performing an exploratory laparotomy, performing an splenectomy. The histopathological study reported a non-Hodgkin lymphoma.Primary splenic lymphoma is a non frequent entity. It is necessary to be acquainted with it in order to suspect it.


Primary splenic lymphomas involve the spleen and/or its lymph nodes. They represent <1% of lymphomas and they imply a diagnostic challenge due to its poor symptomatology and low prevalence.There for, the objects this work describe the management and evolution of a patient with HIV-AIDS and presentation of a primary lymphoma of the spleenIn this report we present the case of a 52-year-old male patient with HIV infection without treatment presented with abdominal pain, fever and a 2-month weight loss. The pre-operative computed tomography showed splenomegaly and hypodense lesions suspected to be tumoral. He was operated on, performing an exploratory laparotomy, performing an splenectomy. The histopathological study reported a non-Hodgkin lymphoma.Primary splenic lymphoma is a non frequent entity. It is necessary to be acquainted with it in order to suspect it.


Subject(s)
Humans , Male , Middle Aged , Splenic Neoplasms/surgery , Splenic Neoplasms/diagnostic imaging , Lymphoma, AIDS-Related , Splenectomy , Tomography, X-Ray Computed , Acquired Immunodeficiency Syndrome
13.
Rev. cuba. anestesiol. reanim ; 19(1): e539, ene.-abr. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093131

ABSTRACT

Introducción: La esferocitosis hereditaria (ESH) es una anemia hemolítica de observación frecuente, en la cual existen defectos cualitativos o cuantitativos de algunas proteínas de la membrana eritrocitaria que llevan a la formación de hematíes de forma esférica, osmóticamente frágiles, que son atrapados de formas selectiva y destruidos en el bazo, con incidencia variable y más frecuente en pacientes con descendencia europea. Objetivo: Describir la conducta clínica y anestesiológica de un paciente pediátrico con diagnóstico de micro esferocitosis hereditaria programado de forma electiva para procedimiento quirúrgico. Desarrollo: Se presenta un caso clínico de un paciente escolar con diagnóstico de micro esferocitosis hereditaria al cual se le realizó esplenectomía total electiva convencional. Con principal signo dolor a la palpación en hipocondrio izquierdo. Se condujo con anestesia total intravenosa con buenos resultados clínicos quirúrgicos, utilizando propofol a razón de 3 mcg/mL y ketamina a 0,2 mg/mL. La estrategia estuvo basada en cinco aspectos claves: evitar la hipoxia, la hipotermia, la acidosis, reducir la pérdida de sangre, así como un correcto control del dolor postoperatorio. Asociado a lo anterior es indispensable una estrecha vigilancia ya que estos pacientes pueden manifestar crisis hemolítica y aplásica. Conclusiones: El manejo perioperatorio del paciente con esferocitosis hereditaria depende de la severidad del cuadro clínico, de la anemia y su repercusión y del grado de hemólisis. La anestesia total intravenosa es una técnica segura para el tratamiento de pacientes con esferocitosis hereditaria(AU)


Introduction: Hereditary spherocytosis (HS) is a hemolytic anemia of frequent occurrence, in which there are qualitative or quantitative defects of some erythrocyte membrane proteins that lead to the formation of sphere-shaped red blood cells, which are osmotically fragile, and that are selectively trapped and destroyed in the spleen, with variable and more frequent incidence in patients with European descent. Objective: To describe the clinical and anesthesiological behavior of a pediatric patient with a diagnosis of hereditary microspherocytosis electively programmed for a surgical procedure. Development: A clinical case of a school-age patient with a diagnosis of hereditary microspherocytosis was presented. The patient underwent conventional elective total splenectomy. Pain was as the main sign on palpation to the left hypochondrium. The case was conducted with total intravenous anesthesia, with good surgical clinical results, using propofol at a rate of 3 mcg/mL and ketamine at 0.2 mg/mL. The strategy was based on five key aspects: avoid hypoxia, hypothermia, acidosis, reduce blood loss, as well as proper control of postoperative pain. Associated with the above-mentioned, close monitoring is essential, as these patients may manifest hemolytic and aplastic crisis. Conclusions: The perioperative management of the patient with hereditary spherocytosis depends on the severity of the clinical status, the anemia and its repercussion, and the degree of hemolysis. Total intravenous anesthesia is a safe technique for the treatment of patients with hereditary spherocytosis(AU)


Subject(s)
Humans , Male , Child , Spherocytosis, Hereditary/surgery , Spherocytosis, Hereditary/diagnosis , Splenectomy/methods , Anesthesia, Intravenous/methods
14.
Article in English | WPRIM | ID: wpr-880596

ABSTRACT

Subphrenic splenic implantation is a rare disease, usually occurred followed the splenic trauma and splenectomy. Surgeries are often necessary for diagnosing and treating it. A 46-year-old male post-splenectomy patient, tolerating abdominal bloating and pain for more than 1 year, was admitted to the Second Xiangya Hospital, Central South University. Fundus bulge suggested a possibility of stromal tumors originating from the muscularispropria layer with endoscopic ultrasound. Slightly stomachic thickness was detected using enhanced computed tomography (CT). Without any improvement for symptoms after medication, the patient strongly requested to undergo an endoscopic therapy. Natural orifice transluminal endoscopic surgery (NOTES) result confirmed it as subphrenic splenic implantation with postoperative pathology. In this case, NOTES helped us to confirm the diagnosis, relieve the symptoms, as well as prevent secondary surgery injury, which would be helpful to other clinicians.


Subject(s)
Endoscopy , Gastric Fundus , Humans , Intraoperative Complications , Male , Middle Aged , Splenectomy/adverse effects , Tomography, X-Ray Computed
15.
Chinese Journal of Traumatology ; (6): 185-186, 2020.
Article in English | WPRIM | ID: wpr-827834

ABSTRACT

Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.


Subject(s)
Abdominal Injuries , Adult , Asymptomatic Diseases , Humans , Male , Spleen , Wounds and Injuries , Splenectomy , Splenosis , Diagnosis , Pathology , General Surgery , Thoracic Diseases , Diagnosis , Pathology , General Surgery , Thoracic Injuries , Thoracotomy , Unnecessary Procedures
17.
Rev Assoc Med Bras (1992) ; 66(5): 596-599, 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136257

ABSTRACT

SUMMARY AIMS Omentin is an adipokine primarily produced by visceral adipose tissue and its reduced levels have been shown to be associate with worse metabolic outcomes. We aimed to study the effects of preoperative ibuprofen on postoperative omentin levels in rats after surgery. METHODS Forty-eight albino Wistar rats, 6 in each of 8 groups according to the surgical procedure (laparotomy, laparotomy plus ibuprofen (IBU), nephrectomy, nephrectomy plus IBU, hepatectomy, hepatectomy plus IBU, splenectomy and splenectomy plus IBU). The Omentin levels of the groups were postoperatively analyzed. RESULTS The mean omentin was significantly higher in the laparotomy plus IBU group compared to the laparotomy group (p<0.001). Mean Omentin was significantly higher in the hepatectomy plus IBU group compared to the hepatectomy group (p=0.01). Mean Omentin was significantly higher in the nephrectomy plus IBU group compared to the nephrectomy group (p=0.001). CONCLUSION We suggest that preoperative ibuprofen may enhance circulating levels of Omentin, which has beneficial effects in trauma and inflammation settings in subjects that undergo minor or major abdominal surgery.


RESUMO OBJETIVOS A omentina é uma adipocina produzida principalmente pelo tecido adiposo visceral e níveis reduzidos dela foram associados a piores desfechos metabólicos. Nosso objetivo foi estudar os efeitos do uso pré-operatório do ibuprofeno nos níveis pós-operatórios da omentina em ratos. METODOLOGIA Quarenta e oito ratos Wistar albinos foram divididos em 8 grupos (6 em cada), de acordo com o procedimento cirúrgico: laparotomia, laparotomia e ibuprofeno (IBU), nefrectomia, nefrectomia e IBU, hepatectomia, hepatectomia e IBU, esplenectomia, e esplenectomia e IBU. Os níveis de omentina dos grupos foram analisados após a cirurgia. RESULTADOS A omentina média foi significativamente maior no grupo de laparotomia e IBU do que no grupo de laparotomia (p<0,001). A omentina média foi significativamente maior no grupo de hepatectomia e IBU do que no grupo de hepatectomia (p = 0,01). A omentina média foi significativamente maior no grupo de nefrectomia e IBU do que no grupo de nefrectomia (p = 0,001). CONCLUSÃO Sugerimos que o uso pré-operatório de ibuprofeno pode aumentar os níveis circulantes de omentina, que têm efeitos benéficos em um contexto de trauma e inflamação em indivíduos submetidos cirurgia abdominal.


Subject(s)
Humans , Rats , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Ibuprofen/pharmacology , Lectins/blood , Splenectomy , Cytokines/blood , Rats, Wistar , Adipokines , Inflammation
19.
Rev. venez. cir ; 73(1): 10-13, 2020. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1283939

ABSTRACT

La gastrectomía vertical laparoscópica es actualmente la cirugía bariátrica más empleada a nivel mundial. Aunque es un procedimiento seguro y efectivo pueden ocurrir complicaciones mayores. En el presente trabajo reportamos el caso de un infarto y absceso esplénico como una rara complicación de esta técnica, que requirió finalmente de esplenectomía como tratamiento definitivo. Caso clínico: Mujer de 22 años con obesidad grado I, a quien se le practicó gastrectomía vertical laparoscópica con buena evolución intrahospitalaria y egreso a las 48 horas. Al 4to día posoperatorio consultó por fiebre, dolor abdominal, taquipnea y taquicardia. Mediante tomografía computada de abdomen se diagnosticó infarto esplénico parcial. Recibió tratamiento médico con remisión inicial de los síntomas, los cuales reaparecieron a la 3era semana. Se reinició el tratamiento médico, esta vez sin respuesta, y con evolución al absceso esplénico. Se decidió esplenectomía como tratamiento definitivo logrando la recuperación completa de la paciente. Conclusión: El infarto esplénico es una complicación infrecuente de la gastrectomía vertical. Su tratamiento inicial es médico, reservando la esplenectomía para los casos que no responden(AU)


Laparoscopic sleeve gastrectomy is currently the most performed bariatric surgery worldwide. Although it is an effective and safe procedure major complications can occur. In the present manuscript we report a case of splenic infarct and abscess as a rare complication of laparoscopic sleeve gastrectomy, finally requiring a splenectomy as a definitive treatment. Case report: A 22 years old woman with grade I obesity underwent laparoscopic sleeve gastrectomy with good hospital evolution and 48 hours discharge. On the 4th postoperative day she return because fever, abdominal pain, tachypnea and tachycardia. By means of a computed tomography a splenic infarct was diagnosed. She received medical treatment with initial remission of symptoms, which reappear at the third week. Medical treatment was restarted, this time without success, and with progression to splenic abscess. We decided a splenectomy as definitive treatment achieving a complete patient recovery. Conclusion: Splenic infarction is a rare complication after sleeve gastrectomy. The treatment is non surgical, reserving the splenectomy for the non responded cases(AU)


Subject(s)
Humans , Female , Adult , Young Adult , Splenic Infarction/etiology , Laparoscopy/adverse effects , Bariatric Surgery/adverse effects , Gastrectomy/adverse effects , Splenectomy , Splenic Infarction/surgery , Splenic Infarction/diagnosis , Laparoscopy/methods , Bariatric Surgery/methods , Gastrectomy/methods , Obesity/surgery
20.
Rev. colomb. cir ; 35(3): 464-471, 2020. fig, tab
Article in Spanish | LILACS | ID: biblio-1123206

ABSTRACT

Introducción. Es frecuente (46 %) que la lesión esplénica se acompañe de otra lesión visceral concomitante, con una alta tasa de morbimortalidad. La evolución de las técnicas para el abordaje de estas lesiones incluye procedimientos quirúrgicos, intervencionistas y de manejo expectante. Métodos. Se trata de un estudio con cohorte única retrospectiva y observacional. Se incluyeron pacientes mayores de 13 años de edad con trauma esplénico, atendidos entre enero de 2000 y diciembre de 2017. Se describieron las características relacionadas con el proceso de atención.Resultados. Se identificaron 116 pacientes con trauma esplénico, el 85,2 % de ellos hombres, con una edad promedio de 26 años. El 75,9 % de los pacientes presentaba lesiones concomitantes; las más frecuentes fueron de diafragma (31,0 %), de hígado (17,2 %) y de riñón (11,2 %). Los mecanismos de lesión más frecuentes fueron por arma corto-punzante (29,3 %), por arma de fuego (22,4 %) y por accidentes de tránsito (22,4 %). La gravedad fue clasificada como de grado V en el 24,1 % de los pacientes y de grado I en el 23,3 %. Se practicó esplenectomía total en el 39,7 % de los pacientes y el 15,2 % fue manejado de forma conservadora. La mortalidad fue del 4,3 %, tres casos en el posoperatorio inmediato (menos de 24 horas) y dos en la primera semana postoperatoria. Discusión. El manejo conservador de las lesiones esplénicas de poca gravedad es una estrategia segura y efectiva, con una tasa de fracaso de menos del 5 %. El abordaje quirúrgico se reserva para lesiones de mayor gravedad y su relación con otros órganos lesionados, con una mayor morbimortalidad (63 %)


Introduction. Splenic injuries are usually accompanied by another concomitant visceral lesion (46 %), with a high rate of morbidity and mortality. The evolution of techniques for approaching these injuries includes surgical, interventional and expectant management procedures.Methods. Retrospective, observational single cohort study. Patients older than 13 years of age with splenic trauma who were treated between January 2010 and December 2017 were included. The characteristics related to the care process were described.Results. 116 patients with splenic trauma were identified, 85,2 % were men and the average age was 26 years. Concomitant lesions were identified in 75,9% of patients, the most common were diaphragm (31 %), liver (17,2 %), and kidney (11,2 %). The most common mechanisms of injury were stab wounds (29,3 %), gunshot wounds (22,4 %), and motor vehicle collisions (22,4 %). Severity was classified as grade V in 24,1 % of patients and grade I in 23,3 %. Total splenectomy was performed in 39,7 % of patients and 15,2 % was conservatively managed. Mortality was 4,3 %, three cases in the immediate postoperative period (within 24 hours) and two in the first week postoperative week. Discussion. Conservative management of low-grade splenic injuries is a safe and effective strategy, with a failure rate of less than 5 %. Surgical approach is reserved for injuries with greater severity and their relationship with other injured organs, with greater morbidity and mortality (63 %)


Subject(s)
Humans , Abdominal Injuries , Splenectomy , Endovascular Procedures , Conservative Treatment
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