ABSTRACT
OBJECTIVES: We analyzed long-term morbidity and bowel function alteration after postoperative radiotherapy for rectal cancer following resection with anastomosis. PATIENTS AND METHODS: Thirty-seven patients who underwent surgery with intention to cure and a minimal follow-up period of 3 years were included. These patients were divided into two groups: in the first group, 14 patients received postoperative chemo-radiotherapy, 5-fluorouracil plus folinic acid, and 45 Gy plus 5 Gy boost. In the second group, there were 23 patients regarded as controls. We designed a questionnaire about their bowel function and analyzed the morbidity detected in their follow-up. RESULTS: The group that was treated with postoperative chemo-radiotherapy had more daily bowel movements (p = 0.03) and night-time movements (p = 0.04); incontinence (69.2 vs. 17.4% in the control group; p = 0.002), and perianal skin irritation (p = 0.04) versus the control group. Although without meaningful differences, the group under treatment wore a pad more often, had more defecatory urgency, could distinguish worse gas from stool, and needed more frequently antidiarrheal measures. Major complications were present in 28.6% of the under-treatment group: three intestinal resections were performed due to actinic stenosis; one patient had a residual stercoral fistula; another had several occlusive crises solved with medical treatment. CONCLUSIONS: Postoperative chemo-radiotherapy had a high morbidity rate, which determined a significant alteration in quality of life. Accuracy in indication is therefore necessary, as well as a consideration of other alternatives for treatment, such as preoperative chemo-radiotherapy and total mesorectal excision.
Subject(s)
Postoperative Complications , Radiation Injuries/etiology , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Female , Humans , Male , Middle Aged , Morbidity , Neoplasm Staging , Quality of Life , Radiation Injuries/physiopathology , Radiotherapy, Adjuvant , Rectal Neoplasms/physiopathology , Retrospective Studies , Surveys and QuestionnairesABSTRACT
Objetivos. Describir los episodios adversos (complicaciones postoperatorias, mortalidad, reintervenciones y reingresos) tras la cirugía biliar y analizar las asociaciones entre estos resultados y determinadas características del paciente y del ingreso hospitalario. Material y métodos. Cohorte de 692 pacientes intervenidos de cirugía biliar -no oncológica- entre 1992 y 1996 en un hospital comarcal, en la que se registraron prospectivamente las complicaciones postoperatorias, las reintervenciones y otros resultados de interés, y se identificaron retrospectivamente los reingresos en el período de estudio. Además del análisis descriptivo y bivariante, se utilizó la regresión logística para valorar las asociaciones entre complicaciones y características de los pacientes, y un modelo de regresión de riesgos proporcionales respecto al riesgo de reingreso. Resultados. El 19,5 por ciento de los pacientes desarrolló alguna complicación posquirúrgica (herida: 6,9 por ciento; intraabdominales: 3,6 por ciento; insuficiencias orgánicas: 3,0 por ciento), un 0,7 por ciento fueron reintervenidos en el ingreso, un 1,4 por ciento requirieron ingreso en cuidados intensivos y el 0,6 por ciento fallecieron intrahospitalariamente. El 4,2 por ciento de los pacientes reingresaron en el servicio de cirugía, en el año siguiente a la intervención, por un problema relacionado con la cirugía previa, y un 1,7 por ciento por coledocolitiasis residual (en todo el período de seguimiento). Las complicaciones posquirúrgicas se asociaron al sexo masculino (OR: 1,69; p < 0,05), al ingreso urgente (OR: 2,09; p < 0,05), a la cirugía urgente (OR: 6,59; p < 0,05), a los procedimientos de colecistectomía abierta simple (OR: 2,56; p < 0,05) y cirugía de la vía biliar principal (OR: 3,53; p < 0,05) respecto a la colecistectomía laparoscópica. Los casos complicados duplicaron en cuanto a la estancia media a los no complicados. El reingreso relacionado con el episodio previo tan sólo se asoció con la presencia de complicaciones durante el ingreso (OR: 3,44; p < 0,001).Conclusiones. Las tasas de acontecimientos adversos en la serie analizada, similares a otras series publicadas, señalan la importancia de las complicaciones en esta enfermedad y su impacto sobre la estancia media y los reingresos. Aunque la mayor parte de los factores de riesgo identificados quedan fuera del control del cirujano, configuran un subgrupo de pacientes de alto riesgo en los que debería incrementarse la vigilancia (AU)
Subject(s)
Biliary Tract Surgical Procedures/adverse effects , Postoperative Complications/epidemiology , Cholecystectomy/adverse effects , Cholecystectomy/mortality , Length of Stay/statistics & numerical data , Reoperation/adverse effectsABSTRACT
La pancreatitis crónica puede complicarse en su evolución con la formación de seudoquistes pancreáticos que serán intraglandulares, a diferencia de lo que ocurre en las pancreatitis agudas; en su evolución pueden acabar provocando la erosión y destrucción de los elementos anatómicos circundantes. Entre los de mayor importancia por el riesgo vital para el paciente se encuentra la afectación de las arterias peripancreáticas. Se presenta un caso de seudoaneurisma esplénico secundario a un seudoquiste pancreático que se fistulizó al colon transverso, produciendo una hemorragia digestiva baja que obligó a una esplenopancreatectomía distal asociada a una colectomía segmentaria de urgencia. El diagnóstico se realizó mediante eco-Doppler, TAC y endoscopia. Se comenta la utilidad de las diversas opciones diagnósticas y terapéuticas existentes, en función de la urgencia, gravedad y condiciones generales del paciente, ya que esta enfermedad está gravada con una alta mortalidad (AU)
Subject(s)
Male , Middle Aged , Humans , Aneurysm/complications , Aneurysm/diagnosis , Pancreatitis/complications , Pancreatitis/diagnosis , Pancreatitis/etiology , Pancreatitis/pathology , Pancreatic Fistula/surgery , Pancreatic Fistula/physiopathology , Pancreatic Fistula/pathology , Pancreatectomy/methods , Pancreatectomy , Echocardiography, Doppler/instrumentation , Echocardiography, Doppler/methods , Echocardiography, Doppler , Endoscopy/methods , Endoscopy , Colonoscopy , Colonoscopy/methods , Pancreatic Pseudocyst/surgery , Pancreatic Pseudocyst/complications , Pancreatic Pseudocyst/diagnosis , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/mortality , Splenic Artery/surgery , Splenic Artery/pathology , Tomography Scanners, X-Ray Computed , Abdomen , Abdomen/pathology , Insulin/therapeutic use , Diabetes Mellitus/drug therapy , Angiography/methods , Angiography , Stomach/pathology , Stomach/surgery , Spleen/surgery , Spleen/pathologyABSTRACT
UNLABELLED: The aim of the study which we present is to analyze the incidence of late complications, clinical and sub-clinical, of venous reservoirs implanted through two access routes, subclavian (group A), and brachial (group B). It is a multi-centric clinical study, initiated in 1992, in which the general surgery departments of three general hospitals of the Valencian Community were involved. It is made up of 87 patients, 48 men and 39 women, with a mean age (SD) of 57.1 (12.6) years, of whom we made a late review of 41 patients (29 from group A and 12 from group B). They were subjected to a physical examination, bacterial cultures of the entrance, and phlebograms of the upper extremities through the dorsal veins of the hands. RESULTS: The incidence of clinical complications was 39% in group A and 77% in group B (p = 0.0507). The main clinical complications were minimally symptomatic venous thrombosis, catheter thrombosis, infection, and miscellaneous (migration, paresthesias, articular movement alterations, etc.). And the prevalence of phlebographic venous thrombosis was 18% in group A and 40% in group B (p = 0.051). CONCLUSIONS: The subclavian access for the implantation of venous reservoirs has a lower incidence (with a tendency towards clinical significance) of clinical complications and subclinical venous thrombosis (Phlebogram) than the brachial access.
Subject(s)
Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Catheters, Indwelling/adverse effects , Analysis of Variance , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/methods , Catheterization, Central Venous/statistics & numerical data , Catheterization, Peripheral/instrumentation , Catheterization, Peripheral/methods , Catheterization, Peripheral/statistics & numerical data , Catheters, Indwelling/statistics & numerical data , Chi-Square Distribution , Female , Forearm/blood supply , Humans , Male , Middle Aged , Spain , Subclavian Vein , Time Factors , VeinsABSTRACT
UNLABELLED: A multicentric clinical trial was performed to evaluate two routes of access for implantable subcutaneous central venous devices: by way of the subclavian vein (group A) and peripheral access by way of the veins of the flexion side of the elbow (group B). The indications for implantation were: antineoplastic treatment of solid tumors, myelo- and lymphoproliferative syndromes, antiviral treatment, and parenteral nutrition at home. The study was composed of 87 patients, 48 men and 39 women, with a mean age of 57.1 years (SD = 12.6). Group A was made up of 48 patients, and group B of 39. RESULTS: Implantation failure was 8.3% in group A and 5.1% in group B (p = n.s.). Complications of implantation were 23.4% in group A and 15.4% in group B (p = n.s.). The complications of permanence were diagnosed at 27.6% in group A and at 15.4% in group B (p = n.s.). CONCLUSIONS: We have not been able to find significant differences between the two groups, probably due to the fact that the series is still short. Nevertheless, the manageability, comfort for the nursing staff and for the patients, appears to be greater with the devices implanted in the infraclavicular region, by means of a subclavian vein puncture.
