ABSTRACT
There are no approved therapeutic regimes for adrenal carcinoma following progression to a first line of chemotherapy/mitotane although a high percentage of patients are candidates to receive them. In the present article we review the possible therapeutic alternatives after the progression to a first line of treatment in patients with adrenal carcinoma and we report a case in which a prolonged overall survival is achieved, much higher than expected, probably in relation to the multidisciplinary management of the case and the use of most of the therapeutic arsenal available.
En el carcinoma suprarrenal metastásico no existen esquemas de tratamiento aprobados tras la progresión a una primera línea de quimioterapia/mitotane, si bien un alto porcentaje de pacientes son candidatos a recibirlos. En este artículo realizamos una revisión sobre las posibles alternativas terapéuticas tras la progresión a una primera línea de tratamiento en pacientes con carcinoma suprarrenal metastásico. A propósito de la misma, se presenta un caso clínico en el que se consigue una prolongada supervivencia global, mucho mayor de la esperable, probablemente debido al manejo multidisciplinario del caso y a la utilización de la mayor parte del arsenal terapéutico disponible.
Subject(s)
Adrenal Cortex Neoplasms/drug therapy , Adrenocortical Carcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Adrenal Cortex Neoplasms/pathology , Adrenocortical Carcinoma/pathology , Adult , Humans , Male , Mitotane/administration & dosage , Palliative Care/methods , Patient Care Team/organization & administration , Survival RateABSTRACT
INTRODUCTION: Appendectomy is performed on almost 700 000 patients per year in the European Community, rendering it the most common acute surgical procedure. Since the introduction of laparoscopic surgery, there has been increased interest in carrying out procedures with fewer incisions and less ports. MATERIALS AND METHODS: After the inception of single-port access, it is possible to insert into the abdominal cavity multiple instruments through a single device. A total of 15 patients--mean age 22 years and mean body mass index 27 kg/m(2)--with acute appendicitis were included in this study. RESULTS: Mean operative time was 35 minutes with no conversions. Local suction drain was needed in 2 patients. Mean hospital stay was less than 24 hours with no complications. CONCLUSION: Single-port suprapubic appendectomy is feasible and safe, and can allow a more direct vision of the operating field depending on the position of the appendix and presents good cosmetic and postoperative outcomes.
Subject(s)
Appendectomy/methods , Appendicitis/surgery , Laparoscopy/methods , Adolescent , Adult , Drainage , Female , Humans , Length of Stay/statistics & numerical data , Male , Treatment OutcomeABSTRACT
El tumor de células granulares es una neoplasia infrecuente, generalmente benigna, que suele afectar cara y cuello. Aparece entre la segunda y la sexta década, más frecuentemente en la raza negra y en mujeres. El 25% de los casos presenta lesiones múltiples. El único tratamiento es quirúrgico. Un varón de 17 años presentó una lesión nodular única epitroclear en el codo derecho. Se realizó una escisión amplia y el resultado anatomopatológico fue un tumor de células granulares. Tras un seguimiento de seis meses no hay evidencia de recidiva. La patogénesis debe ser claramente establecida, aunque la literatura sostiene la hipótesis de que tiene su origen en las células de Schwann. Los autores subrayan la peculiaridad de la localización epitroclear y discuten la clasifi cación, fi siopatología y el tratamiento del tumor con una revisión de la literatura.
Granular cell tumor is an infrequent neoplasm, benign in most of the cases, that usually affects head and neck. It develops between the second and sixth decades of life, more frequently among women and black people. 25% of the cases occur as multiple lesions. The only treatment is surgery. A 17- year old male presented a nodular, single and fi rm epithroclear lesion in his right elbow. A wide surgical excision was performed and the fi nal pathologic diagnosis was granular cell tumor. During follow-up of six months there is no evidence of tumour recurrence. The pathogenesis of the tumor has still to be clearly established, although literature sustains the hypothesis that it has origin in the Schwann ́s cells. The authors underscore the peculiarity of the epithroclear localization and discuss the classifi cation, pathophysiology and the treatment of Abrikossoff ́s tumor through a review of the literature.
