ABSTRACT
INTRODUCTION: Inflammatory pseudotumor (IP) is an uncommon benign neoplasm. It was first described in the lung but it has been recognized in several somatic and visceral locations. Mesenteric presentation is rare and its clinical presentation is variable but patients can be completely asymptomatic. Complete surgical resection is the only curable treatment. Rational follow-up protocols have not been established yet. PRESENTATION OF CASE: A 57 years-old man, with no relevant comorbidities and completely asymptomatic, apart from a lump on the right hypochondrium, was submitted to surgical resection of a large mesenteric mass. The preoperative Computed Tomography suggested gastrointestinal stromal tumor as the most probable diagnosis. Definitive histological examination of the completely resected surgical specimen confirmed the diagnosis of IP. The patient has been on follow-up for four years, without no evidence of recurrence. DISCUSSION: The preoperative diagnosis of IP may be difficult to establish mainly due to the lack of a typical clinical presentation. It is a rare entity, particularly in the adult population. These two aspects make it easier to neglect this entity in the differential diagnosis of an abdominal mass on asymptomatic adults. Although there are no formal guidelines on follow-up, close follow-up seems to be advisable in these patients as recurrence is frequent. CONCLUSION: IP should be present as a possible differential diagnosis in an abdominal mass. Complete excision of the lesion can be curable but close follow-up seems to be required.
ABSTRACT
OBJECTIVES: We aimed to assess the outcome of endovascular revascularization in Diabetic patients with Fontaine stage IV chronic ischaemia, at our Diabetic Foot Clinic. Primary outcomes were ulcer healing, major amputation and limb salvage. METHODS: Retrospective single center analysis of patients treated between January 2009 and May 2015. Time-dependent event rates were estimated by the Kaplan-Meier method. The differences between groups were evaluated with the chi-square test. A P value below 0,05 was considered statistically significant. RESULTS: There were 106 limbs (93 patients) revascularized during the study. The average age was 71 years, and PEDIS 3 or 4 infection was present in 45.3% on admission. 56.6% were treated for femoropopliteal injurie only, 17% infrapopliteal, and 26.4% for both levels. Technical success was achieved in 77.4%, and haemodynamic success in 58.3%. Ulcer healing was attained in 53.8%, with an average healing time of 8.4 months. The major amputation rate was 7.5%, with a limb salvage rate of 90.4% at 6, 12 and 24 months. Chronic pulmo- nary disease decreased the likelihood of healing (p=0,012). Restenosis was more likely to occur in patients with nephropathy (p=0,008) or insulin-treated diabetes (p=0,033). CONCLUSIONS: Dedicated multidisciplinary teams are key to successful treatment in diabetic foot disease. The good results achieved in our series arise from best medical treatment combined with timely revascularization in those ischemic.
Objetivos: Avaliar os resultados da revascularização endovascular em diabéticos com isquemia crónica grau IV de Lériche- -Fontaine, seguidos em Consulta Multidisciplinar de Pé Diabético na nossa instituição, relativamente a taxa de cicatrização, amputação major e salvamento de membro. Material e Métodos: Análise retrospetiva dos doentes tratados no período de janeiro de 2009 até maio de 2015. As taxas de eventos dependentes do tempo foram estimadas com recurso a curvas de Kaplan-Meier e as diferenças entre grupos investigadas pelo teste de qui-quadrado. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: No período analisado foram revascularizados 106 membros (93 doentes). A idade média foi 71 anos, sendo que 45,3% apresentavam infeção PEDIS 3 ou 4 na apresentação. Das lesões intervencionadas, 56,6% eram suprageniculares, 17% infrageniculares, e 26,4% foram intervencionados nos dois setores. Foi obtido sucesso técnico em 77,4% e sucesso hemodinâmico em 58,3%. Foi conseguido o encerramento da úlcera em 53,8%, com tempo médio de cicatrização de 8,4 meses. A taxa de amputação major foi de 7,5%, verificando-se uma taxa de salvamento de membro de 90,4% aos 6, 12 e 24 meses. A doença pulmonar crónica influenciou negativamente a probabilidade de cicatrização (p=0,012). A reestenose foi mais frequente em doentes com nefropatia (p=0,008) ou DM insulino-tratada (p=0,033). Conclusões: A existência de equipas multidisciplinares dedicadas ao Pé Diabético são fundamentais para o sucesso do tratamento. Os bons resultados obtidos resultam da melhor otimização do tratamento médico combinada com a revasculari- zação no doente isquémico, associado a um seguimento apertado e à reintervenção precoce quando clinicamente justificado.
