Primary placement of a voice prosthesis on transposed colon after total pharyngolaryngoesophagectomy.

BACKGROUND: Primary placement of a voice prosthesis may aid rehabilitation after total laryngectomy. METHODS: We present a rare clinical situation of a T4 NO MO squamous cell carcinoma of the hypopharynx and esophagus in a patient who had previously undergone a transmesocolic Billroth II gastrectomy. RESULTS: The patient benefited from a total pharyngolaryngoesophagectomy, with reconstruction using a transverse-descending colon transposition, and primary placement of a low-pressure voice prosthesis. CONCLUSION: Primary placement of a voice prosthesis may be successful even in a patient who requires extensive pharyngoesophageal reconstruction using transposed colon. To our knowledge, there has been no previous report of primary placement of a voice prosthesis on a colon autograft.

Laparoscopic colorectal procedures: a multicenter Brazilian experience.

An evaluation of the results of the Brazilian experience in colorectal laparoscopic procedures in a multicenter prospective protocol done by the Brazilian Society of Colo-Proctology is presented. From December 1991 to August 1998, 1,161 patients (583 men and 578 women; mean age, 49.8 years), were operated on laparoscopically. Most of the procedures (40.5%) were for cancer, and the most common procedure was anterior resection (22.5%). The mean operative time was 189 minutes (3.1 hours). There were 42 (3.6%) perioperative complications; visceral injuries were the most common (1.4%). Conversions occurred in 122 (10.5%) cases. There were 148 (12.7%) postoperative complications; wound infections were the most common (5.2%). A liquid diet was started at a mean time of 1.4 days after the operation, and the mean hospitalization period was 6.4 days.

[Colorectal diseases in AIDS patients and endoscopic findings]. / Afecções colorretais em portadores da síndrome da imunodeficiência adquirida e suas manifestações endoscópicas.

In order to establish which are the most frequent endoscopic detectable colorectal disorders in AIDS patients with intestinal complaints we analysed 236 colonoscopies in a series of 186 patients. The colonoscopic procedure was always followed by biopsies, even in the absence of macroscopic lesions. The most frequent diagnosis was colitis due to citomegalovirus infection observed in 64 exams (27.1%) and presented with an inflammatory pattern with ulcers, followed by Cryptosporidium sp., found in 31 exams (13.1%). This infection, conversely, presented as an inflammatory non-ulcerative lesion. Others pathogens found in lower frequency were: Mycobacterium sp., Histoplasma capsulatum, Herpes simplex, Isospora sp., Giardia sp., Candida sp. and Campilobacter sp.. Neoplastic lesions, mostly Kaposy's sarcoma, were detected in 10 of the colonoscopies (4.2%). The most frequent colorectal disorders in AIDS patients detected by endoscopic procedures are citomegalovirus and Cryptosporidium infection. Biopsies are always necessary to confirm the endoscopic diagnosis and to identify the presence of associated pathogens.

Transureterocalicostomy: an alternative internal diversion technique.

We report a case of an infiltrating retroperitoneal tumor that completely enveloped and obstructed the mid third of the left ureter. After resection of the tumor, including a 10 cm. long segment of ureter, the upper left ureter was successfully diverted to the upper calix of the right ectopic kidney (transureterocalicostomy). To our knowledge our report represents the first case of such surgery.

[Multicentric osteosarcoma: report of a case with synchronous lesions]. / Osteossarcoma multicêntrico: relato de um caso com lesões sincrônicas.

A case of multicentric synchronous osteosarcoma occurring in a 9 year old girl is reported. Some particular features of this rare disease namely its rapid progression despite intensive drug therapy is stressed. Current hypothesis for the occurrence of this unusual form of neoplasm are here discussed.

Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins.

The present study was performed to identify tumor cells in lymph nodes from colorectal adenocarcinomas considered free of disease by the classic hematoxylin-eosin stain, based on the detection of the carcinoembryonic antigen (CEA) and cytokeratins in neoplastic epithelial cells. For this purpose, 603 lymph nodes from 46 lesions were stained by the peroxidase-antiperoxidase technique. Tumor cells were detected in 22 nodes from 12 patients, mainly in the subcapsular sinuses, permitting a restaging of these patients into two groups: those now considered to have metastatic disease and those free of metastases. However, the 5-year follow-up showed no statistical differences in survival between the two groups.

Surgery of chagasic megacolon.

Chagas' disease is an endemic clinical entity caused by Trypanosoma cruzi, a parasite that is transmitted to humans by the hematophagic Triatominae insects. It affects several million persons in Latin America, mostly in Brazil, Argentina, Chile, Paraguay, and Bolivia. Megacolon, the most common complication of intestinal trypanosomiasis, results in severe constipation, for which surgery is indicated. A variety of procedures have been proposed for the correction of this disabling condition including sigmoidectomy, abdominal rectosigmoidectomy, left colectomy, and subtotal colectomy. On long-term follow-up, however, these operations have proved to be inadequate in a significant number of cases, apparently due to preservation of the dyskinetic rectum which continues to act as a functional obstacle to the progression of the fecal bolus. On the other hand, pull-through operations, which include the removal of all or almost all of the dyskinetic rectum, or the exclusion of the rectum, as in the Duhamel-Haddad operation, have been demonstrated to be superior. The abdominoperineal endoanal pull-through resection with delayed colorectal anastomosis and the Duhamel-Haddad operation are the most accepted procedures in Brazil and other Latin American countries; their technical details are illustrated. Functional results are satisfactory. Anal continence is normal in the vast majority of cases and sexual disturbances are rare. Routine treatment of 2 main complications--fecaloma and volvulus of the sigmoid colon--are discussed.

[Totally implantable vascular reservoir for chemotherapy: initial experience]. / Reservatório vascular totalmente implantável para quimioterapia: experiência inicial.

The authors present their experience with the totally implanted vascular reservoirs for chemotherapy. Thirty-one reservoirs were implanted in 29 patients. Complications were observed in 19.3% of the cases imposing the removal of 12.9% of them. No reservoir have been lately removed because of infection or obstruction. Based on their results, the authors conclude that the totally implanted reservoir is extremely helpful for patients submitted to chemotherapy for long periods.

Abdominoperineal endoanal pull-through resection. A comparative study between immediate and delayed colorectal anastomosis.

Abdominoperineal endoanal pull-through resection with colorectal anastomosis was performed on 728 patients--primarily those with chagasic megacolon and cancer of the rectum. Intestinal continuity was reestablished through immediate anastomosis (Swenson procedure) in 229 patients and through delayed anastomosis (Cutait-Turnbull procedure) in 499. Comparative studies showed: that the incidence of leakage was 31.9 percent in immediate and only 2.2 percent in delayed anastomosis; that presacral infection occurred in 27.9 percent in immediate and in 6.8 percent in delayed anastomosis; that stenosis was observed in 4.4 percent in immediate and 1.8 percent in delayed anastomosis; that mortality was 6.1 percent in immediate and 2.2 percent in delayed anastomosis; that anal continence was good in both procedures and that sexual disturbances were rare in benign and frequent in malignant lesions in both procedures. The final conclusion is that, in abdominoperineal endoanal pull-through resection with colorectal anastomosis, complications and mortality are less frequent in delayed than in immediate anastomosis and that continence and sexual behavior are identical in both procedures.

Lesoes arteriais actinicas: efeitos de uma dose de 2000 rads em arteria iliaca de coelho. / Actinic arterial lesions: effects of a dose of 2000 rads on the iliac artery of rabbits

Os autores estabelecem um metodo de se avaliar os efeitos da irradiacao pela telecobaltoterapia nas arterias iliacas de coelhos. Foram utilizados 20 animais divididos em dois grupos de dez cada.O primeiro foi submetido a dose de 2000 rads em quatro sessoes diarias e consecutivas de 500 rads. O segundo grupo foi submetido a simulacao da irradiacao com os animais anestesiados e colocados no aparelho, sem que este fosse ligado. No 14o. dia os animais de ambos os grupos foram sacrificados e as arterias iliacas foram retiradas e submetidas a exame anatomo-patologico com tres diferentes coloracoes - Hematoxilinaesoina, Tricromico de Masson e Verhoeff.Em quatro coelhos do grupo exposto e irradiacao foram encontradas pontos de fragmentacao da lamina elastica interna. Correlaciona-se estes achados com outros da literatura

Endocardite por estreptococo do grupo D (S. bovis e S. faecalis) e tumor de colon. Apresentação de dois casos / Endocarditis due to group D Streptococcus (Sbovis and S faecalis) and tumor of the colon.Report of 2 cases

Sao relatados 2 casos de pacientes com endocardite infecciosa e tumor de tubo digestivo. No primeiro caso, um paciente de 50 anos, o agente etiologico foi o Steptococcus bovis e foram identificados multiplos adenomas vilosos a partir do enema opaco, realizado por ser este o agente etiologico. No outro caso, um paciente de 55 anos de idade apresentou endocardite por S. faecalis e insuficiencia cardiaca severa, necessitando de implante de bioprotese mitral e aortica.A persistencia de anemia prolongada apos a operacao levou a realizacao de enema opaco identificando-se falha de enchimento no angulo hepatico de colon, sendo o paciente submetido a hemicolectomia direita por adenocarminoma tubular, bem diferenciado. Os autores sublinham a necessidade de identificar os estreptococos ate a especie e a necessidade de investigacao do tubo digestivo no caso de identificacao de Streptococcus bovis, mesmo na ausencia de sintomas do tubo digestivo

Prophylactic oophorectomy in surgery for large-bowel cancer.

From 1968 to 1975, 201 women had prophylactic oophorectomy at the time of definitive large-bowel resection, while in 134 patients oophorectomy was not performed. Oophorectomy was performed more commonly in women with cancer of the rectum and rectosigmoid. More patients undergoing oophorectomy had Dukes' C primary carcinoma. Four patients undergoing synchronous oophorectomy (2.0 per cent) had ovarian involvement or metastases from large-bowel cancer. Three patients (2.2 per cent) developed subsequent ovarian disease: two cases of ovarian carcinoma and one case of ovarian metastases from primary breast cancer. No late ovarian recurrences of large-bowel cancer were seen during this study. No patient with ovarian involvement or metastases from large-bowel cancer survived five years nor was the overall survival of the group of women undergoing oophorectomy materially affected. While stage and site significantly influenced survival, oophorectomy, menopausal status, preoperative irradiation, tumor size, and degree of differentiation had no influence. The prevention of primary ovarian cancer in postmenopausal women is considered to be the main benefit of bilateral prophylactic oophorectomy. Selective recommendations for oophorectomy under other circumstances are discussed.