RESUMEN
This study was carried out on 11 infants and children, ranging in age between 26 days and 8 years, with localized benign splenic lesion or splenic disorder indicated for splenectomy. They were one case of wandering spleen, 3 cases of traumatic rupture of the spleen, four cases of thalassemia, one case of Gaucher's disease and one case of splenic cyst. They were treated by partial splenectomy. Lower polar splenectomy was performed in 10 cases while upper polar splenectomy was performed in one case of splenic cyst. All patients passed a smooth post-operative course with no bleeding or life threatening infection. Complications occurred in only 3 cases, one case of traumatic rupture of the spleen suffered in the early post-operative period from atelectasis and left pleural effusion and was treated conservatively while two cases of thalassemia suffered from intra-abdominal collection. In the later two cases, the dexon mesh used to wrap the remaining part of the spleen was accused to invite infection. The platelet count was significantly higher in the early post-operative period [P< 0.001]. Three months later, the platelet count was comparable with preoperative value [P> 0.05]. There was no increase in the number of pitted cells, Howel-Jolly bodies or Heinz bodies in the early or late post-operative period. The pre-operative serum IgM and IgG levels did not significantly differ from their levels in the early and late postoperative periods [P> 0.05]. Tha-lassemic children showed post-operative decrease in transfusion requirements and increased hemoglobin levels. Thus the immunological and hematological functions of the spleen are preserved after partial splenectomy and hence partial splenectomy is considered safe and better alternative to total splenectomy in the treatment of splenic disorders and benign lesions to avoid life threatening infections
Asunto(s)
Humanos , Masculino , Femenino , /métodos , Lactante , Niño , Periodo PosoperatorioRESUMEN
The study was an attempt to answer the question: What is the therapeutic value of surgery in advanced neuroblastoma = Twenty prospective patients with advanced adrenal neuroblastoma were studied in this report. All children were subjected to firs-look exploration in an attempt of gross complete surgical resection of the primary tumour or to gain a biopsy specimen for histopathological study from irresectable tumours. Chemotherapy was then given for all cases. Patients who showed regression of the size of previously irresectable tumours were re-explored via a second-look operation. The second-look surgery was aiming at total or subtotal eradication of the residual primary tumour. Follow up of all patients following all modalities of treatment was carried out by clinical examination, imaging by U.S and CT, and monitoring by VMA. The two years overall survival was recorded. Moreover analysis of the survival and its correlation with the stage, as well as with the therapeutic value of surgery was also discussed. Twenty patients with advanced neuroblastoma were reported in this study. They were 3 [15%] of stage III and 17 [85%] of stage IV, and with a mean age 3.55 +/- 2.2 years. All children were explored as the first-look operation during which gross complete resection of the primary tumour was achieved in one patient only and in the remaining 19 patients a biopsy specimen was excised. Five of these 19 patients showed regression of the tumour size as a favorable response to chemotherapy. These 5 patients were then subjected to a second-look operation, during which gross complete resection of the primary tumour was successful in 3 patients and gross subtotal resection in 2 patients. These 5 patients survived for 2 years. 3 had disease free survival and 2 were alive with disease. Of the remaining 14 patients who were maintained on chemotherapy alone, one patient only had 2 years survival but with residual tumour and the remaining 13 patients died before 2 years from the start of treatment. Thus the overal survival was 35% [7 patients], 4 of them had disease free survival and 3 were alive with disease. Of these 6 patients were treated by surgical resection of the primary tumour [complete or incomplete] and one patient only was treated by chemotherapy alone, all patients treated by surgical resection of the primary tumour, whether complete or incomplete, had better survival than those treated by chemotherapy alone, and this was statistically significant. This is why gross complete resection of the primary tumour in advanced neuroblastoma should be encouraged whenever feasible
Asunto(s)
Humanos , Masculino , Femenino , Neuroblastoma/cirugía , Quimioterapia , Neoplasias de las Glándulas SuprarrenalesAsunto(s)
Humanos , Femenino , Genética , Pediatría , Pronóstico , Cuidados Posoperatorios , Ultrasonografía Prenatal , Cirugía GeneralRESUMEN
This study was conducted on 121 patients with abdominal lymphoma. Non-Hodgkin's lymphoma was encountered in 103 cases [85.9%] and Hodgkin's lymphoma in 18 cases [14.1%]. The study included analysis of clinical presentation, histological types, staging and the effect of multimodality treatment on the survival