Effect of exercise while utilizing a device with an arm compression sleeve to reduce lymphedema.

BACKGROUND: Lymphedema is one complication of breast cancer treatment and there is no consensus that identified one single therapy in the treatment of lymphedema; therfore an association of methods is recommended and one of these is exercising. The aim of this study was to evaluate the utilization of exercising with a facilitating device along with an arm compression sleeve to reduce the size of lymphedematous arms. MATERIALS AND METHODS: Thirty women from a rehabilitation group with arm lymphedema resulting from the surgical, chemotherapeutic, and radiotherapeutic treatment of breast cancer were enrolled sequentially on arriving in the clinic. While sitting in an upright position and wearing an arm compression sleeve, patients were submitted to a one-hour session of active exercising consisting of four 12-minute stints with three-minute intervals to rest. The change in lymphedema was evaluated by water volumetry before and immediately after the session. The active exercising device is similar to the pedaling system of a bicycle. The paired t-test was employed for statistical analysis. An alpha error of 5% (p-value < 0.05) was considered acceptable. RESULTS: A statistically significant reduction (p-value < 0.004) was noted in the size of the arm. CONCLUSION: Active exercising using a facilitating device and under supervision may reduce the size of lymphedematous arms.

Micrometastasis in regional lymph nodes of extirpated colorectal carcinoma: immunohistochemical study using anti-cytokeratin antibodies AE1/AE3.

OBJECTIVE: The main objectives of this study were to identify, by immunohistochemistry, possible micrometastasis in the regional lymph nodes previously considered free by conventional histopathological examination, and to assess their influence on the survival of patients with colorectal cancer that had been extirpated in a radical manner. PATIENTS AND METHODS: From 38 patients with Dukes B staging (Colorectal Carcinoma Stage II (T3 N0 M0 or T4 N0 M0)) colorectal carcinoma, 383 lymph nodes were studied in paraffin blocks that had previously been considered free by conventional histopathological examination. These were submitted to immunohistochemical study using AE1/AE3 anti-cytokeratin monoclonal antibodies to identify neoplastic epithelial cells. RESULTS: Seven lymph nodes (1.82%) in six patients (15.78%) contained micrometastasis. The survival of the patients with extirpated colorectal carcinoma staged as Dukes B who had lymph node metastasis was less than in the group of patients without micrometastasis, although these values were not statistically significant. CONCLUSION: This immunohistochemical method can be employed successfully in the detection of neoplastic cells in lymph nodes previously considered free. In this study, there was a trend towards lower survival in node-positive patients but this did not reach statistical significance.

[Isolated ileocecal tuberculosis simulating malignant neoplasia and Crohn's disease]. / Tuberculose ileocecal isolada simulando neoplasia maligna e doença de Crohn.

BACKGROUND: Isolated ileocecal involvement by tuberculosis in the absence of pulmonar disease is rare in Brasil, therefore causes a diagnostic dilemma as it mimics colonic malignancy and Crohn's disease. METHODS: Between 1969 and 1989, eight patients with isolated hypertrophic ileocecal tuberculosis were treated by surgery in the Gastroenterology Surgery Department of the HSPE-FMO. The most common complaint among them was abdominal pain (100%) with associated symptoms of weight loss (62.5%); nausea, vomiting, fever and general weekness appeared in half of the patients. A right iliac fossa mass was present in seven (87.5% ) of them. The mean duration of symptoms was 14.7 month (range 5-36 months). In all eight patients chest x-rays were negative for tuberculosis. Barium contrast studies showed abnormalities in all cases, but these could not be distinguished from carcinoma. Colonoscopy was helpful in establishing the diagnosis of suboclusive lesions of the ileocecal regions in three patients. Tuberculosis diagnosis was suspected in two of them because ofr the presence of granulomas in colonic biopsy material. RESULTS: Six patients were submitted to elective right hemicolectomy. The two remaining with suspect of tuberculosis were operated with signals of intestinal occlusion, and underwent a limited ileocaecal resection. The positive diagnosis of intestinal tuberculosis was made in all the patients by identification of acid-fast bacilli and by the presence of caseating granulomas in intestinal or lymph node tissue on histological examination. The outcome in all of them was favorable. They received treatment with three antituberculosis drugs over a twelve month period. CONCLUSION: Hypertrophic ileocecal tuberculosis must still be considered in the differential diagnosis of abdominal pathology localized in the right lower quadrant.

Tuberculose ileocecal isolada simulando neoplasia maligna e doença de Crohn / Isolated ileocecal tuberculosis simulating malignant neoplasia and Crohn's disease

OBJETIVO: No Brasil, a tuberculose ileocecal isolada, na ausência de tuberculose pulmonar ativa ou cicatrizada, é rara, sendo freqüentemente confundida com neoplasia e a doença de Crohn. MÉTODOS: Os autores apresentam oito doentes com essas características, tratados por cirurgia, em período de 20 anos. A dor abdominal na fossa ilíaca direita foi o principal sintoma (100 por cento), seguido da presença de perda de peso (62,5 por cento), febre, náuseas e vômitos e fadiga em 50 por cento dos doentes. Sete enfermos (87,5 por cento) apresentaram massa palpável na fossa ilíaca direita. A duraçäo média dos sintomas foi de 14,7 meses, variando de 5 a 36 meses. Todas as lesöes foram detectadas pelo enema opaco e mimetizavam aspecto neoplásico. A colonoscopia foi realizada em três doentes, evidenciando lesöes sub-oclusivas da regiäo íleo-cecal em dois; as biópsias foram sugestivas de tuberculose, näo sendo possível diferenciá-las da doença de Crohn. RESULTADOS: Seis enfermos com diagnóstico presuntivo de neoplasia foram submetidos a cirurgia eletiva, realizando-se neles a colectomia direita clássica. Os outros dois, com suspeita de tuberculose, foram operados na vigência de obstruçäo intestinal, sendo submetidos a ressecçäo limitada (ileocecectomia). O estudo anatomopatológico estabeleceu o diagnóstico final pelo encontro de necrose caseosa e de bacilos álcool ácido-resistentes no intestino ou nos linfonodos. A evoluçäo pós-operatória foi satisfatória, com pequena morbidade resolvida clinicamente. Posteriormente, todos os doentes receberam o esquema tríplice por 12 meses, variando a droga de acordo com a época do tratamento. CONCLUSÄO: Apesar de rara, a tuberculose hipertrófica ileocecal isolada freqüentemente é confundida com neoplasias e com a doença de Crohn, devendo ser lembrada no diagnóstico diferencial das lesöes localizadas no quadrante inferior direito do abdome

Primary non-Hodgkin lymphoma of the right colon: a retrospective clinical-pathological study.

The objective of this study was to analyze the results of surgical treatment of primary non-Hodgkin lymphomas of the right colon. Ten patients were operated on with curative intention. Dawson's criteria were used to characterize the colonic lymphoma as a primary lymphomas. In the staging of the tumor, the Ann Arbor classification for gastrointestinal lymphomas modified by Musshoff and Schmidt-Vollmer was used. The histological classification was made by using the International Working Formulation Group system. All patients were submitted to radical right colectomy and 6 of them received postoperative chemotherapy. The overall average survival was 39.2 months. Four of the patients are still alive, without active disease, with an average survival of 85.2 months. Six patients died due to relapse in the abdomen, with an average survival of 8.2 months. These results suggest that it is advantageous to patient survival to have them submitted for resection of their lesions at an initial stage of the disease (IE and IIE1). Chemotherapy must be used as a complementary treatment in locally advanced lesions, in an attempt to control the residual microscopic disease.

The role of surgery in the treatment of primary gastric lymphoma.

The present retrospective study of 23 patients with primary gastric lymphoma had the objective of determining the role of surgical treatment on survival. All patients were submitted to gastric resection with regional lymph node removal. Nine patients (39.1%) received supplementary treatment (chemotherapy and/or radiotherapy). According to the Kiel classification, the most frequent histological type was the centroblastic (29.1%), and most patients (60.9%) had a low-grade lymphoma. According to the Ann Arbor classification, modified by Musshoff and Schmidt-Vollmer, stages were IE in 52.1%, II1E in 8.7%, II2E in 13.1%, and IV in 26.1% of the cases. Mean survival was 29.3 months. The variables that influenced survival rates were age, advanced stage tumor, and receiving postoperative adjuvant therapy. Analysis of our cases suggests that complete lesion resection along with adjacent lymph nodes, and supplementary postoperative treatment is the best approach for a resectable primary gastric lymphoma.

Surgical treatment for colorectal endometriosis.

The authors studied the surgical treatment of patients with intestinal endometriosis. A total of 10 patients, with a median age range of 43 years, underwent an operation. Cramp abdominal pain (100%), diarrhea (30%), constipation and enterorrhagia (20%) dominated the clinical picture. At the time of surgery, four patients presented intestinal obstructive symptoms. Five (50%) patients reported gynecological complaints. Four patients were infertile and five had prior surgical gynaecological events. Seven cases presented sigmoid involvement, and three had involvement of the cecal appendix. Pre-operative diagnosis was carried out in two patients only. Surgical indications were due to suspicion of cancer (4 patients), appendicitis (3 patients), diverticular disease (1 patient) and unmanageable pain (2 patients). The following procedures were performed: left colectomy (2 cases), rectosigmoidectomy (3 cases), sigmoidectomy (3 cases), colostomy (2 cases) and three appendicectomy cases associated with concomitant gynecological interventions. No postoperative complications or deaths were observed. The authors emphasize that intestinal stenotic lesions should be treated by means of extirpation while the parietal nodule should be treated by exeresis. Intestinal endometriosis should be suspected in cases of lower abdomen recurrent pain in premenopausal infertile women or with previous surgical, gynecological events associated with intestinal symptoms or distal colon stenosis.

Spontaneous perforations of the small intestine.

BACKGROUND AND METHODS: The present study describes the procedures used by the authors in the management of 34 patients with spontaneous perforation of the small intestine. RESULTS: Only one (2.9%) of the patients had the perforation cause diagnosed before laparotomy; 27 (80%) cases showed ileal perforative lesions while seven (20%) had jejunal lesions; 31 (91.1%) patients presented single perforations and three (8.8%) had multiple ones. Intestinal resection followed by anastomosis or ileostomy and colostomy, was carried out in 21 (61.7%) cases, and 13 (38.2%) patients were submitted to exeresis with edge restoration and lesion suture. The cause of perforation could be identified in 29 (86.3%) cases while in five (14.7%) patients the cause was considered idiopathic. Eighteen (53%) patients recovered from surgery and were discharged; there were 16 (47%) deaths resulting from a number of complications. CONCLUSIONS: Since the prognosis regarding this disease depends on the peritoneal infection severity level, the patient's organic resistance, and most of all, the time interval spent until the treatment is initiated, the authors emphasize the need to have a laparotomy performed as early as possible considering that this procedure provides the best chances of survival and health recovery.

Lipomas colorretais: correlaçäo anatomoclínica de 29 casos / Colorectal lipomas: anatomoclinical study of 29 cases

Objetivo. Avaliar a ocorrência de lipomas colorretais, métodos diagnósticos e conduta terapêutica, com o intuito de estabelecer normas no atendimento dos portadores desta afecçäo. Casuística e Métodos. Revisadas autópsias feitas em período de 6 anos e estudados os prontuários de portadores de lipomas colorretais tratados entre 1965 e 1993, com ênfase ao quadro clínico, conduta diagnóstica e terapêutica. Os 29 portadores de lipomas intestinais submucosos foram distribuídos em três grupos. O grupo I, cujos lipomas foram detetados em necrópsias; o grupo II, com doentes sintomáticos, e um terceiro grupo de enfermos assintomáticos, com lipomas encontrados acidentalmente em peças cirúrgicas ressecadas por neoplasias ou durante procedimentos diagnósticos. Resultados. 0,6 por cento dos autopsiados apresentaram lipomas colorretais, situados, preferencialmente, no cólon direito, predominando em mulheres (70,0 por cento). No grupo II, a enterorragia foi o sintoma mais freqüente (54,5 por cento), seguida pela dor abdominal em cólica e por alteraçöes do hábito intestinal. A intussuscepçäo ocorreu em três doentes (27,3 por cento). Ao contrário da literatura, os lipomas sintomáticos localizaram-se, preferencialmente, no cólon esquerdo, sendo seu tamanho médio de 6,1cm. Os diagnósticos foram realizados por meio do enema opaco e, mais recentemente, pela colofibroscopia e tomografia computadorizada. Neste grupo, foram realizadas ressecçöes em dez doentes, sendo cinco amplas, três locais e duas endoscópicas. Um paciente eliminou, espontaneamente, seu lipoma. Lipomas múltiplos foram detetados em 30 por cento dos autopsiados e em 25 por cento do grupo assintomático. Nestes dois grupos, nenhum dos tumores era maior que 2,0cm de diâmetro. Conclusöes. Lipomas colorretais säo raros, quer na clínica diária, quer em autópsias. Antes do advento da colofibroscopia e da tomografia, a maioria dos doentes era submetida a ressecçäo extensa, na suposiçäo de doença maligna. Posteriormente, a polipectomia endoscópica e a ressecçäo local passaram a ser nossa conduta preferencial.

[Colorectal lipomas: anatomoclinical study of 29 cases]. / Lipomas colorretais: correlação anatomoclínica de 29 casos.

OBJECT: To evaluate the incidence of colorectal lipomas, its diagnostic methodology and therapeutic management. CASUISTIC AND METHODS: The reviewed necropsies performed in a six years period and the patients' records from colorectal lipomas cases treated up to 1965 until 1993 were studied enhancing the clinical presentation, their diagnosis and therapy. The 29 cases of submucosal intestinal lipomas were disposed in three groups. The first group with ten patients lipomas were detected at necropsies. The second group with 11 symptomatic patients and group three with 8 asymptomatic patients which lipomas were discovered accidentally in surgical specimens resected due to neoplasm or in the course of diagnostical procedure. RESULTS: 0.56% of patients who were submitted to necropsy disclosed colorectal lipomas situated preferentially in right colon and in female. Enterourhage was the most often symptom (54.5%) in the group two, followed by cramp abdominal pain. Intussusception appeared in three patients (27.3%). Contrary to the medical literature, the symptomatic lipomas were preferentially situated in left colon and its mean size was 6.1 cm. The diagnosis were performed through opaque enema and more recently by colofibroscopy and CT scan. Resections were performed in all patients: five were enlarged, three were local and other three were endoscopic resections. Multiple lipomas were detected in 30% of patients who were submitted to necropsy and in 25% of asymptomatic group. In both groups no tumor was larger than 2.0 cm of diameter. CONCLUSIONS: Colorectal lipomas are rare in both clinical presentation and necropsy. Before the advent of CT scan and colofibroscopy the majority of the patients were submitted to wide resections, in the assumption of malignancy. Afterwards the endoscopic polipectomy and local resection became our preferential management.

[Multiple retroperitoneal neurofibroma. Report of a case]. / Neurofibroma múltiplo retroperitoneal. Relato de um caso.

Tumors of nervous origin in the retroperitoneum are rare without specific symptoms which diagnosis is usually very difficult. The authors report a case of an asymptomatic patient with two benign retroperitoneal neurofibromas, one of them calcified and located near the inferior pole of the left kidney; the other tumor was closely adhered to the pancreatic tail in the supramesocolic region. Both were resected with appropriated surgical margins. The histopathologic and immunohistochemical studies established the correct diagnosis of the lesions. The authors comment the diagnostic tests of these tumors, their possible malignant degeneration and their surgical treatment.

[Carcinoid tumors of the gastrointestinal tract. Analysis of 21 cases]. / Tumores carcinóides do trato gastrointestinal. Análise de 21 casos.

Twenty-one patients with carcinoid tumors have been analysed. Out of 18 patients the diagnostic was made at operation and out of 3 by autopsy. The most frequent sites of the primary tumors were the appendix (38.1%), ileum (23.8%) and colon (19.9%). Asymptomatic tumors were found incidentally in 10 patients (55.5%). The symptomatic neoplasms were more common in the ileum. No one patients in this series obtained the diagnostic of carcinoid tumors before operation or autopsy. It was not observed the malignant carcinoid syndrome. Sixteen patients (88.8%) were submitted to resection and the mean survival was 10.7 years. Two patients (11.1%) were submitted to palliative operations and the mean survival was 3.5 months. The incidence of metastases in cases with carcinoid greater than 2.0 cm in diameter was 71.4%; on the other hand, the patients with carcinoids 2.0 cm in diameter or smaller than this size disclosed metastases in 7.6%. No patients with appendix carcinoid showed metastases and all patients with metastases presented ileum or colon carcinoids. In this series, the prognostic was related with the lesion's size, the localization of the tumor in the gastrointestinal tract and with the resection or not of the primary neoplasm.

Tratamento cirurgico do cancer colorretal. Valor das provas cutaneas de competencia imunologica na avaliacao prognostica e imunoterapica. / Surgical treatment of colon and rectal cancer.Value of immunologic competence skin tests in the prognostic and immunotherapic evaluation

Os autores analisam o valor de provas de competencia imunologica na avaliacao prognostica e imunoterapica no tratamento cirurgico do cancer colorretal. Foram estudados 76 pacientes, incluidos na classificacao de Dukes: no grupo A, um paciente: no grupo B, 46 pacientes e 29 no grupo C.Todos os doentes submeteram-se a avaliacao de imunidade celular por testes cutaneos de varios antigenos, cujas respostas foram estimadas por pontos. Concluiram os autores que o perfil imunologico celular tem valor prognostico em pacientes do grupo B, o que nao ocorre com os pacientes do grupo C. As respostas foram fracas nos doentes dos grupos A e B, estimulados, melhoraram as respostas e tiveram evolucao superior