ABSTRACT
BACKGROUND/AIMS: Our aim is to present our experience with acute emphysematous cholecystitis (AEC), a severe variety of acute cholecystitis characterized by early gangrene and perforation of the gallbladder. METHODOLOGY: We reviewed the clinical records of 20 patients with AEC, analyzing age, sex, past medical history, symptoms, laboratory tests, X-rays, ultrasounds, operative and microbiological findings, morbidity and mortality. RESULTS: Our study included 13 men and 7 women (mean age 59 years). Associated factors were diabetes mellitus (11 cases) and gallstones (6 cases, 3 of them with common bile duct stones). Clinical symptom presentation included: right hypochondrial pain and fever in all cases, vomiting in 9, septic shock in 3, jaundice in 7, and peritonitis in 8. Hyperbilirubinemia was present in 7 cases. Plain abdominal X-rays or ultrasounds led to diagnosis in 95% of the cases. Surgical findings were AEC in all cases, pericholecystic abscess in 8, gallbladder necrosis in 7 and bile peritonitis in 3. C perfringens, E coli and B fragilis were the most frequent pathogens. Mortality rate was 25%, and morbidity 50%. CONCLUSIONS: AEC predominantly affects elderly diabetic men. Abdominal X-rays or ultrasounds are good diagnostic techniques, and emergency surgery is needed due to the high incidence of gangrene and perforation Despite all the efforts made, morbidity and mortality are still high.
Subject(s)
Cholecystitis , Emphysema , Acute Disease , Adult , Aged , Aged, 80 and over , Cholecystitis/diagnosis , Cholecystitis/mortality , Cholecystitis/surgery , Emphysema/diagnosis , Emphysema/mortality , Emphysema/surgery , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: The purpose of this paper is to expose our experience in malignant stromal tumors of the stomach. METHODOLOGY: We present 16 cases of malignant stromal tumors of the stomach, operated on in our hospital from 1977 to 1995. Age, sex, symptoms and signs, standard laboratory tests, diagnostic methods, location, size, infiltration of other organs, proliferating activity, treatment and survival rate are analyzed. Immune staining was performed using the avidin-biotin-peroxidase method, with the S-100 1/8000 and muscular actin 1/50 antiserum. All patients underwent surgical treatment, and neither chemotherapy nor radiotherapy were used. RESULTS: Thirteen patients died 5 to 78 months after surgery, and the other 3 are alive and free of disease 74, 48 and 38 months after resection, respectively. Five year survival rate was 37.5%. The most important prognostic factors were tumor size, infiltration of neighboring organs and high mitotic index. CONCLUSION: All the clinical data, survival rates and prognostic factors are similar to other published cases. Surgery is the first step in the treatment of these tumors, as the role of other therapeutic options is not well known yet.
