ABSTRACT
Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.
Subject(s)
Celiac Artery/abnormalities , Constriction, Pathologic/diagnosis , Aged , Celiac Artery/surgery , Constriction, Pathologic/surgery , Female , Humans , Laparoscopy , Median Arcuate Ligament SyndromeABSTRACT
El síndrome del ligamento arcuato medio (SLAM), o síndrome de compresión del tronco celíaco, es causado por la compresión extrínseca del ligamento arcuato medio, bandas fibrosas prominentes y tejido ganglionar periaórtico. En muchas ocasiones es asintomático, pero puede manifestarse con síntomas como dolor abdominal postprandial o durante el ejercicio, náuseas, vómitos y pérdida de peso. Mediante técnicas poco invasivas, como la ecografía doppler color y la angiotomografía preoperatoria, es posible obtener resultados diagnósticos comparables a los de la arteriografía. La cirugía constituye el tratamiento de elección, siendo la vía laparoscópica una técnica segura y eficaz Se presenta un caso sintomático atípico que requirió tratamiento quirúrgico laparoscópico, con mejoría clínica e imagenológica luego del procedimiento.(AU)
Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.(AU)
ABSTRACT
El síndrome del ligamento arcuato medio (SLAM), o síndrome de compresión del tronco celíaco, es causado por la compresión extrínseca del ligamento arcuato medio, bandas fibrosas prominentes y tejido ganglionar periaórtico. En muchas ocasiones es asintomático, pero puede manifestarse con síntomas como dolor abdominal postprandial o durante el ejercicio, náuseas, vómitos y pérdida de peso. Mediante técnicas poco invasivas, como la ecografía doppler color y la angiotomografía preoperatoria, es posible obtener resultados diagnósticos comparables a los de la arteriografía. La cirugía constituye el tratamiento de elección, siendo la vía laparoscópica una técnica segura y eficaz Se presenta un caso sintomático atípico que requirió tratamiento quirúrgico laparoscópico, con mejoría clínica e imagenológica luego del procedimiento.
Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.
Subject(s)
Aged , Female , Humans , Celiac Artery/abnormalities , Constriction, Pathologic/diagnosis , Celiac Artery/surgery , Constriction, Pathologic/surgery , LaparoscopyABSTRACT
BACKGROUND: Due to the fact that different biological parameters play a key role in colonic malignant behavior, with nuclear morphometry being a prognostic marker in many malignancies, then predictive approaches in colorectal cancer (CRC) carried out on histologically well-defined groups may prevent interpretative errors. Subsequently, in the present study, CRC patients were screened according to the morphometric features of tumor cell nuclei, using an accurate histotechnical approach, to analyze their clinical evolution according to Dukes' stratification. MATERIALS AND METHODS: A total of 66 cases were grouped according to Dukes' classification (5 y of follow-up). The perimeter, nuclear area, and shape factor of 50 interphase carcinoma nuclei were recorded through microphotographs obtained from each subject. Nuclei boundaries were drawn by an electronic pencil and examined by a computerized system. Data were submitted to a variance analysis, and a multi-regression model compared results. RESULTS: The sample was made up of 44 males (66.67%) and 22 females (33.33%) aged 59.7 +/- 6 y old. Forty-nine patients (74.24%) were classified as stage B, and 17 (25.76%) as stage C. Nuclear homogeneity was confirmed by analysis of variance. The nuclear parameters were (mean +/- SD): area (3.17 +/- 1.74), perimeter (6.72 +/- 1.83), and shape factor (0.82 +/- 0.03). A multiple logistic regression model showed that stage C subjects had a higher risk of developing a worse clinical evolution than those at stage B (P < 0.02), independent of sex and age. CONCLUSIONS: Dukes' classification remains the best predictor of evolution. Although nucleomorphometric suitability is still controversial, this technique has become an additional tool to establish CRC prognosis.
