Subject(s)
Humans , Male , Female , Antibiotic Prophylaxis/methods , Antibiotic Prophylaxis/trends , Thromboembolism/epidemiology , Thromboembolism/prevention & control , Venous Thromboembolism/epidemiology , Venous Thromboembolism/prevention & control , Venous Thromboembolism/physiopathology , Postoperative Complications/prevention & control , Postoperative Complications/physiopathologySubject(s)
Duodenal Ulcer/complications , Mediastinal Emphysema/etiology , Peptic Ulcer Perforation/complications , Subcutaneous Emphysema/etiology , Duodenal Ulcer/diagnosis , Duodenal Ulcer/surgery , Humans , Laparotomy , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/therapy , Middle Aged , Peptic Ulcer Perforation/diagnosis , Peptic Ulcer Perforation/surgery , Pneumoperitoneum/diagnostic imaging , Pneumoperitoneum/etiology , Pneumoperitoneum/therapy , Radiography , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/therapy , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Mediastinal Emphysema/etiology , Subcutaneous Emphysema/etiology , Duodenal Ulcer/complications , Peptic Ulcer Perforation/complications , Laparotomy , Mediastinal Emphysema , Mediastinal Emphysema/therapy , Pneumoperitoneum/etiology , Pneumoperitoneum , Pneumoperitoneum/therapy , Subcutaneous Emphysema , Subcutaneous Emphysema/therapy , Duodenal Ulcer/diagnosis , Duodenal Ulcer/surgery , Peptic Ulcer Perforation/diagnosis , Peptic Ulcer Perforation/surgeryABSTRACT
Thrombosis of the portal-mesenteric axis is an infrequent cause of intestinal ischemia or infarction. In addition to the multiple acquired factors that contribute to the development of this entity, hereditary risk factors, especially the factor V Leiden mutation and the G20210A mutation of the prothrombin gene, have been implicated. The G20210A mutation of the prothrombin gene is found in up to 40% of patients with splenic-portal-mesenteric thrombosis. The present case illustrates the unusual and nonspecific presentation of this mutation in the form of diarrhea and images of thrombosis of the superior mesenteric-portal vein and cavernous transformation of the portal vein. Delayed diagnosis is highly frequent since the clinical signs, laboratory investigations and radiological tests do not suggest the diagnosis. The patient received anticoagulant treatment and showed clinical improvement with complete portal-mesenteric recanalization. Currently the diagnostic technique of choice is magnetic resonance angiography or computerized tomography angiography and treatment consists of indefinite anticoagulation. This case illustrates that an unusual or atypical localization of venous thrombosis may be a manifestation of thrombophilia, emphasizing the importance of genetic screening in these cases.
Subject(s)
3' Untranslated Regions/genetics , Mesenteric Veins , Mutation , Portal Vein , Prothrombin/genetics , Splenic Vein , Thrombophilia/genetics , Venous Thrombosis/etiology , Acenocoumarol/therapeutic use , Angiography , Anticoagulants/therapeutic use , Colonoscopy , Diarrhea/etiology , Heparin/therapeutic use , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapyABSTRACT
La trombosis del eje portomesaraico es una causa infrecuente de isquemia o infarto intestinal. Además de múltiples factores adquiridos que contribuyen al desarrollo de este cuadro, recientemente se han implicado factores de riesgo hereditario, especialmente la mutación del factor V de Leiden y la mutación G20210A del gen de la protrombina. La mutación G20210A del gen de la protrombina se encuentra hasta en el 40% de los pacientes con trombosis portoesplenomesaraica. El presente caso ilustra la presentación inusual e inespecífica de dicha mutación, en forma de diarreas e imágenes de trombosis de la vena mesentérica superior y porta y cavernomatosis portal. Es muy frecuente el retraso en el diagnóstico ya que los signos clínicos, analíticos y la radiología no apuntan el diagnóstico. El paciente recibió tratamiento anticoagulante y mejoró clínicamente, con una repermeabilización completa portomesaraica. En la actualidad la técnica diagnóstica de elección es la angiorresonancia magnética o la angiotomografía computarizada, y el tratamiento, la anticoagulación de manera indefinida. Nuestro caso ilustra que una localización inusual o atípica de trombosis venosa puede ser la manifestación de una trombofilia, lo que recalca la importancia del cribado genético en estos casos
Thrombosis of the portal-mesenteric axis is an infrequent cause of intestinal ischemia or infarction. In addition to the multiple acquired factors that contribute to the development of this entity, hereditary risk factors, especially the factor V Leiden mutation and the G20210A mutation of the prothrombin gene, have been implicated. The G20210A mutation of the prothrombin gene is found in up to 40% of patients with splenic-portal-mesenteric thrombosis. The present case illustrates the unusual and nonspecific presentation of this mutation in the form of diarrhea and images of thrombosis of the superior mesenteric-portal vein and cavernous transformation of the portal vein. Delayed diagnosis is highly frequent since the clinical signs, laboratory investigations and radiological tests do not suggest the diagnosis. The patient received anticoagulant treatment and showed clinical improvement with complete portal-mesenteric recanalization. Currently the diagnostic technique of choice is magnetic resonance angiography or computerized tomography angiography and treatment consists of indefinite anticoagulation. This case illustrates that an unusual or atypical localization of venous thrombosis may be a manifestation of thrombophilia, emphasizing the importance of genetic screening in these cases
Subject(s)
Male , Humans , 3' Untranslated Regions/genetics , Mesenteric Veins , Mutation , Portal Vein , Prothrombin/genetics , Splenic Vein , Thrombophilia/genetics , Venous Thrombosis/etiology , Acenocoumarol/therapeutic use , Angiography , Anticoagulants/therapeutic use , Colonoscopy , Diarrhea/etiology , Heparin/therapeutic use , Tomography, X-Ray Computed , Venous Thrombosis/drug therapy , Venous ThrombosisABSTRACT
BACKGROUND: This study aimed to evaluate a program of training in laparoscopic surgery based on clinical practice in the emergency room, in which laparoscopic appendectomy is the first technique that residents perform as surgeons. METHODS: A prospective nonrandomized study was conducted involving all the laparoscopies performed in emergencies with a diagnosis of acute abdomen, appendicular in origin, during the period between June 1991 and December 1997. RESULTS: There were no statistically significant differences between residents and assistants in terms of conversion rates (22/242 vs 15/158), mean hospital stay for each type of surgeon (5.2 days for residents and 5.1 days for assistants), and complications (12.8% for residents and 13.7% for assistants). Operating time, was significantly longer (p < 0.05) for residents (52.2 min) than for assistants (48 min). CONCLUSIONS: Apprenticeship in laparoscopic appendectomy can be accomplished with gradual clinical training and without the need for resort to animal experimentation laboratories.
Subject(s)
Abdomen, Acute/surgery , Ambulatory Surgical Procedures/education , Appendectomy/education , Internship and Residency/statistics & numerical data , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures/statistics & numerical data , Appendectomy/methods , Child , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Program Evaluation , WorkforceABSTRACT
El tubo en "T" de Kehr es un instrumento que se viene utilizando desde hace más de un siglo como drenaje biliar después de la cirugía sobre la vía biliar principal. Muchos cirujanos lo consideran una herramienta imprescindible después de hacer una coledocotomía supraduodenal, aunque otros asocian su uso con un alto índice de complicaciones. El objetivo del presente artículo de revisión consiste en estudiar las distintas complicaciones asociadas a la utilización del tubo en "T", así como las causas a las que se atribuyen, planteando las soluciones alternativas que publican los diversos autores que han trabajado sobre el tema. El artículo comienza con una introducción histórica de la utilización del tubo en "T"; a continuación se exponen las diversas complicaciones relacionadas con su utilización. Posteriormente se explican las causas que encuentran los diversos autores de estas complicaciones, y por último las alternativas que muchos autores plantean a la utilización sistemática del tubo en "T" (AU)
Subject(s)
Female , Male , Humans , Biliary Fistula/complications , Biliary Fistula/surgery , Ascites/complications , Choledochostomy/instrumentation , Choledochostomy/adverse effects , Drainage/methods , Drainage , Drainage/instrumentation , Peritonitis/complications , Peritonitis/surgery , Intraoperative Complications/epidemiology , Postoperative Complications/epidemiology , Adrenal Cortex Hormones/therapeutic use , Adrenal Cortex Hormones , Sphincterotomy, Endoscopic/methods , Sphincterotomy, Endoscopic , Prospective Studies , Biliary Tract Surgical Procedures/complicationsABSTRACT
AIM: To evaluate the results of treatment of retroperitoneal sarcomas. PATIENTS AND METHODS: We evaluated clinical, diagnostic, surgical and histological parameters as well as adjuvant therapy and evolution in 15 patients with retroperitoneal sarcoma. RESULTS: All patients presented abdominal tumors at diagnosis. Imaging revealed retroperitoneal origin. Complete surgical resection was carried out in seven patients (47%), reduction in size of tumor mass in five (33%) and exploratory laparotomy in three (20%). Histological analysis revealed 12 liposarcoma (80%), two leiomyosarcoma (13%) and one fibrosarcoma. Adjuvant therapy was given to two patients. Of the patients who underwent complete surgical resection, four survived without relapse (1, 2, 5 and 5 years respectively). With the other treatments, there were no survivals at 2 years. Adjuvant therapy did not influence survival. CONCLUSIONS: Retroperitoneal sarcoma is diagnosed late. Prognosis is poor due to tumor relapse and only complete surgical removal produces a "cure".
Subject(s)
Retroperitoneal Neoplasms/therapy , Sarcoma/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Neoplasms/mortality , Sarcoma/diagnosis , Sarcoma/mortalitySubject(s)
Intestinal Perforation/diagnosis , Abdomen, Acute/diagnostic imaging , Adolescent , Female , Humans , Laparoscopy , RadiographyABSTRACT
Currently, the vena cava superior syndrome (VCSS) is mainly of oncologic origin. We report here four cases of this syndrome caused by intrathoracic multinodular goiter. All patients had compressive symptoms, particularly of the oesophagus and trachea. Axial CT was the imaging technique that delineated the intrathoracic multinodular goiter compressing brachiocephalic vessels. Surgery (total thyroidectomy) was used and all compressive symptoms resolved.
Subject(s)
Goiter, Substernal/complications , Superior Vena Cava Syndrome/etiology , Aged , Aged, 80 and over , Female , Goiter, Substernal/surgery , Humans , Middle Aged , Superior Vena Cava Syndrome/surgeryABSTRACT
OBJECTIVE: To present our experience of patients who presented with intestinal perforation by foreign bodies to our hospital between 1980 and 1998. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 21 patients who presented with intestinal perforation by foreign bodies. MAIN OUTCOME MEASURES: Size of perforations, nature of foreign bodies, clinical symptoms, radiological findings, treatment and outcome. RESULTS: The most common location was the terminal ileum (n = 11), followed by the rectosigmoid junction (n = 5). The objects were mainly bone fragments and toothpicks. The diagnosis was generally made at operation, and only 4 of the 21 patients had signs of pneumoperitoneum on the preoperative abdominal film. The most common treatment was simple suture of the defect. CONCLUSIONS: Intestinal perforation by a foreign body is uncommon, and normally affects the ileocaecal and rectosigmoid regions, in which it is unusual to find pneumoperitoneum preoperatively. It must be considered in the differential diagnosis of such conditions as acute appendicitis and diverticulitis.
Subject(s)
Foreign Bodies/complications , Intestinal Perforation/etiology , Intestines , Adolescent , Adult , Aged , Aged, 80 and over , Appendicitis/diagnosis , Cholecystitis/diagnosis , Female , Foreign Bodies/surgery , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Introducción. Desde que se introdujo la laparoscopia en nuestro hospital ha ido variando la categoría del cirujano que realiza la apendicectomía laparoscópica. El objetivo de nuestro trabajo es analizar la evolución de la categoría del cirujano que efectúa esta técnica. Pacientes y método. Hemos estudiado las 400 apendicecto mías laparoscópicas realizadas entre junio de 1991 y diciembre de 1997, dividiéndolas en 4 grupos de 100. Analizamos los hallazgos operatorios, el tiempo quirúrgico, la tasa de conversiones, las complicaciones, la estancia hospitalaria y la categoría del cirujano en cada grupo. Resultados. Inicialmente, los adjuntos realizaban casi la totalidad de intervenciones, siendo actualmente los residentes los que llevan a cabo más del 85 por ciento de las apendicectomías laparoscópicas. No existen diferencias en el tiempo quirúrgico, complicaciones y estancia hospitalaria en los 4 grupos. Ha aumentado de forma significativa la tasa de conversiones y ha disminuido el número de apendicitis perforadas conforme avanza la serie. Conclusiones. La apendicectomía laparoscópica es una técnica ampliamente asimilada por los residentes de nuestro servicio, que realizan en estos momentos la mayoría de intervenciones (AU)
Subject(s)
Adult , Female , Male , Middle Aged , Humans , Laparoscopy , Appendectomy , Appendectomy/methods , Appendicitis/complications , Length of Stay/statistics & numerical data , Length of Stay/trends , Learning , Appendix/pathology , Appendix/surgeryABSTRACT
El síndrome de vena cava superior (SVCS) es hoy un problema principalmente oncológico. En este trabajo presentamos cuatro casos de este síndrome causado por bocio multinodular intratorácico. Todos los pacientes presentaban otros síndromes compresivos, sobre todo esofágico y traqueal. La tomografía axial computadorizada (TAC) fue la técnica de imagen que objetivó el bocio multinodular intratorácico comprimiendo los troncos braquiocefálicos. El tratamiento fue quirúrgico (tiroidectomía total), revirtiendo todos los síntomas compresivos. (AU)
Subject(s)
Middle Aged , Aged , Aged, 80 and over , Female , Humans , Superior Vena Cava Syndrome , Goiter, SubsternalABSTRACT
Introducción. La apendicectomía laparoscópica se introdujo en nuestro servicio de manos de cirujanos con experiencia previa en colecistectomía laparoscópica. Progresivamente, los residentes se iniciaron en la técnica, realizando hoy día la mayor parte de estas intervenciones. El objetivo del estudio es analizar si el grado de experiencia del cirujano influye en el pronóstico del paciente con apendicitis aguda intervenido por laparoscopia. Pacientes y método. Se estudian 400 pacientes con sospecha de apendicitis aguda intervenidos por laparoscopia. Analizamos los hallazgos, el tiempo quirúrgico, las conversiones, las complicaciones y la estancia hospitalaria según el cirujano (adjunto o residente, y año de formación). Resultados. No existen diferencias en cuanto al tiempo quirúrgico, tasa de conversión, complicaciones y estancia hospitalaria entre los pacientes intervenidos por adjuntos o residentes. No obstante, los adjuntos han operado un mayor porcentaje de apendicitis complicadas que los residentes. Conclusión. Los residentes de cirugía deben iniciarse en laparoscopia a través de la apendicectomía laparoscópica, aunque las formas complicadas deben ser operadas por cirujanos con experiencia (AU)
Subject(s)
Adult , Female , Male , Middle Aged , Humans , Acute Disease/therapy , Education, Medical, Continuing/methods , Appendectomy , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/surgery , Appendicitis , Prognosis , Emergencies/epidemiology , Laparotomy , Laparotomy/statistics & numerical data , Postoperative ComplicationsSubject(s)
Lymphoma, Mantle-Cell/diagnosis , Splenic Rupture/etiology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow Transplantation , Diabetes Mellitus, Type 2/complications , Diagnosis, Differential , Humans , Hypercholesterolemia/complications , Lymphoma, Mantle-Cell/complications , Lymphoma, Mantle-Cell/therapy , Male , Middle Aged , Rupture, Spontaneous , Splenectomy , Splenic Rupture/diagnosis , Splenic Rupture/surgerySubject(s)
Ischemia/etiology , Pancreatitis/complications , Spleen/blood supply , Stomach/blood supply , Acute Disease , Aged , Fatal Outcome , Gastric Fundus/blood supply , Gastric Fundus/pathology , Humans , Ischemia/pathology , Male , Necrosis , Pancreatitis/pathology , Spleen/pathology , Stomach/pathologyABSTRACT
Idiopathic intestinal invagination is a relatively frequent process in children in comparison with cases of intestinal obstruction/subocclusion by invagination secondary to a tumor in adults which is unusual and more often observed in patients over the age of 60 years. Two clinical cases of intestinal obstruction in young adult males due to intestinal invagination by a tumor of the small intestine are presented. One case was due to a submucosal lipoma which lead to ileo-ileal intussusception and an ileo-cecal invagination by a terminal ileum lymphoma. The clinical and diagnostic aspects of this infrequent disease are discussed.
