ABSTRACT
BACKGROUND: Curettage mastectomy is indicated as a palliative treatment in locally advanced breast cancer. We present our experience with the use of a DIEP flap reconstruction following extensive mastectomy. METHODS: We report the case of a patient with very advanced local breast cancer that was subsidiary to aggressive palliative surgery after chemotherapy. RESULTS: It was considered that the closure that could be performed with the latissimus dorsi muscle was unsuitable, therefore a DIEP flap was performed. The patient was discharged uneventfully. CONCLUSION: The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment.
Subject(s)
Breast Neoplasms/surgery , Mammaplasty/methods , Perforator Flap , Breast Neoplasms/pathology , Curettage , Epigastric Arteries , Female , Humans , Middle Aged , Neoplasm Staging , Palliative CareABSTRACT
Fundamento. La mastectomía de limpieza está indicada con carácter paliativo en el cáncer de mama localmente avanzado. Para cerrar el defecto cutáneo puede ser necesario el empleo de un injerto. Mostramos nuestra experiencia con el uso de un colgajo DIEP (Deep Inferior Epigastric artery Perforators) de cobertura tras la realización de una mastectomía de gran extensión. Material y métodos. Se muestra el caso de una paciente con un tumor de mama muy avanzado localmente, que era subsidiaria de un tratamiento quirúrgico agresivo tras la administración de quimioterapia. Resultados. Se consideró que el cierre que puede ofrecer un colgajo realizado con el músculo dorsal ancho esta insuficiente, por lo que se realizó un DIEP. La paciente presentó una evolución postoperatoria satisfactoria. Conclusiones. El colgajo DIEP de cobertura ofrece una gran extensión cutánea. Puede ser un recurso en casos muy seleccionados de tumores de mama localmente avanzados, en los que la cirugía se convierte en la principal arma terapéutica (AU)
Background. Curettage mastectomy is indicated as a palliative treatment in locally advanced breast cancer. We present our experience with the use of a DIEP flap reconstruction following extensive mastectomy. Methods. We report the case of a patient with very advanced local breast cancer that was subsidiary to aggressive palliative surgery after chemotherapy. Results. It was considered that the closure that could be performed with the latissimus dorsi muscle was unsuitable, therefore a DIEP flap was performed. The patient was discharged uneventfully. Conclusion. The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment (AU)
Subject(s)
Humans , Mastectomy/methods , Breast Neoplasms/surgery , Mammaplasty/methods , Epigastric Arteries/transplantation , Surgical FlapsABSTRACT
The use of the laparoscopic approach in managing early liver transplant complications has been shown to be safe and feasible in various settings with the advantages of shorter recovery period, decreased postoperative pain, and rapid functional recovery. The laparoscopic approach has been used to resolve postoperative complications in kidney and pancreas recipients and less often in orthotopic liver transplantation (OLT) recipients, most of them in the late period (> 1 month posttransplantation). We herein describe our experience with the laparoscopic management of early complications after liver transplantation. From May 2009 to May 2011, we successfully treated three patients with early abdominal complications after OLT using a laparoscopic approach. Three patients-two with intraabdominal bleedings and one with a small bowel obstruction were treated successfully, thereby avoiding risks of a relaparotomy. In addition to these benefits, the laparoscopic approach causes less tissue injury and consequently evokes a minor innate immune response.
Subject(s)
Intestinal Obstruction/surgery , Jejunal Diseases/surgery , Laparoscopy , Liver Transplantation/adverse effects , Postoperative Hemorrhage/surgery , Adult , Drainage , Humans , Intestinal Obstruction/etiology , Jejunal Diseases/etiology , Male , Middle Aged , Postoperative Hemorrhage/etiology , Reoperation , Time Factors , Treatment OutcomeSubject(s)
Humans , Male , Female , Pneumatosis Cystoides Intestinalis/complications , Pneumatosis Cystoides Intestinalis/diagnosis , Ischemia/complications , Ischemia/diagnosis , /methods , Gastroenteritis/complications , Gastroenteritis/diagnosis , Ischemia , Gastroenteritis/drug therapy , Gastroenteritis/radiotherapy , GastroenteritisSubject(s)
Humans , Male , Female , Adult , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/physiopathology , Prognosis , Pancreatectomy/methods , Immunohistochemistry/methods , Pancreaticoduodenectomy/methods , Retrospective Studies , Pancreas/cytology , Pancreas/pathology , Pancreatic Neoplasms , ImmunohistochemistryABSTRACT
BACKGROUND: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. AIM: To analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. MATERIAL AND METHODS: A retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. RESULTS: 6 Patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation) and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved) in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ) was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. CONCLUSIONS: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial.
Subject(s)
Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Papilloma, Intraductal/pathology , Papilloma, Intraductal/surgery , Adult , Aged , Cohort Studies , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Pancreas/pathology , Pancreas/surgery , Pancreatic Neoplasms/mortality , Pancreaticoduodenectomy , Papilloma, Intraductal/mortality , Postoperative Period , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Introducción: la neoplasia papilar mucinosa intraductal(NPMI) del páncreas comprende una serie de lesiones que evolucionandesde lesiones benignas (adenoma) hasta carcinoma ductalinvasivo.Objetivo: analizar los resultados clínicos y patológicos de 15pacientes diagnosticados de NPMI e intervenidos según las recomendacionesde conferencia de consenso.Material y métodos: análisis retrospectivo de 15 pacientescon NPMI, intervenidos entre marzo de 1993 y septiembre de2009; según pautas de conferencias de consenso internacionales.Se recogieron datos demográficos, pruebas diagnósticas, tipo deintervención, histopatología y supervivencia actuarial con un seguimientoentre mes y medio y nueve años.Resultados: se realizaron 6 duodenopancreatectomías cefálicas,4 pancreatectomías totales, 2 pancreatectomías centrales,2 pancreatectomías parciales y una pancreatectomía distal. Se registróuna morbilidad del 40%, sin mortalidad operatoria, con unaestancia media de 10 días. En 5 casos la NPMI fue de tipo mixto,en 4 afectaba al conducto pancreático y en los 6 restantes a ramasaccesorias. Dos pacientes presentaron carcinoma in situ y 3carcinoma invasivo con ganglios negativos. Un paciente, sin carcinomainvasivo, falleció a los 66 meses por adenocarcinoma depáncreas. La supervivencia actuarial hasta recidiva o muerte fuede 105,133 meses; con un rango de seguimiento entre mes y medioy 9 años.Conclusiones: la NPMI tipo ductal y mixto exige la reseccióncompleta debido a la elevada incidencia de carcinoma invasivo ode lesiones precursoras de malignidad. Por su carácter multifocallos enfermos deben ser revisados a largo plazo. Existen controversiasen las NPMI tipo accesorio asintomáticas y menores de 3 cm(AU)
Background: intraductal papillary mucinous neoplasm(IPMN) shows a series of lesions which evolve from benign lesionsadenoma to invasive carcinoma.Aim: to analyze the clinical and pathological results of 15 patientsdiagnosed of IPMN, and surgically treated according to theguidelines of International Consensus Conference.Material and method: a retrospective analysis of 15 patientssurgically treated between March 1993 and September 2009, accordingto the International Consensus recommendation. Demographic,diagnostic tools, surgical report, pathologic database andactuarial survival were analyzed with a follow-up from one and ahalf month through nine years.Results: 6 patients underwent pancreaticoduodenectomies,4 total pancreatectomies, 2 body or central pancreatectomies, 2 partialpancreatectomies (enucleation) and 1 distal pancreatectomy.A morbidity of 46 and 0% hospital mortality were assessed, witha median length hospital stay of 10 days. In five cases, the IPMNwas combined type (both main and branch pancreatic ducts involved)in four main duct-type and branch duct-type in the anothersix as well. Several atypia (IPMN carcinoma in situ) wasobserved in 2 patients and invasive carcinoma with negativelymph nodes was identified in 3 patients. A patient without invasivecarcinoma died at 66 months of follow-up for pancreas adenocarcinoma.The actuarial survival up to recurrence or deathwas 105,133 months with a range of follow-up from 1 monthand a half until 9 years.Conclusions: IPMN main duct or mixed type warrants completeresection due to its incidence of invasive carcinoma or precursorlesions of malignancy as well. Due to its multifocal pattern,patients should be followed in long-term surveillance. The managementof asymptomatic IPMN type branch less than 3 cm iscontroversial(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Neoplasms, Cystic, Mucinous, and Serous/epidemiology , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/methods , Pancreaticoduodenectomy/trends , Pancreatectomy/methods , Pancreatic Neoplasms , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Confidence IntervalsABSTRACT
The celiac axis compression syndrome (CACS) due to median arcuate ligament (MAL) was first described by Harjola in 1963; originating postpandrial abdominal pain, weight loss, epigastric bruit and celiac axis stenosis > 75% in angiographic studies. This clinical condition has been the origin of controversies about its pathogenesis, diagnosis and its long term clinical results. Advances in diagnostic imaging as 64 multidetector-row CT (MDCT), 3-D reconstruction, magnetic resonance (MR) and color duplex ultrasonography, provide better understanding of the syndrome and allow to identify the best candidates for surgical division of MAL fibers. Since the introduction of laparoscopic approach, and also endovascular procedures, in 2000, a new perspective has established in this challenging syndrome. With the occasion of our own experience, a critical review of the syndrome is presented.
Subject(s)
Celiac Plexus , Nerve Compression Syndromes , Celiac Plexus/diagnostic imaging , Celiac Plexus/surgery , Humans , Laparoscopy , Ligaments , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/physiopathology , Nerve Compression Syndromes/surgery , Radiography , UltrasonographyABSTRACT
El síndrome de compresión del tronco celiaco fue descrito porHarjola en 1963 como la compresión extrínseca del tronco celiacopor las fibras tendinosas del ligamento arcuato; causando uncuadro de dolor intenso post-pandrial en epigastrio, pérdida depeso, soplo epigástrico y estenosis mayor del 75% en la angiografíaselectiva. Desde entonces, dicho síndrome ha sido motivo demúltiples controversias relacionadas con su patogenia y la variabilidadde los resultados obtenidos con la cirugía.Debido a la proliferación y accesibilidad de técnicas de imagenmás precisas y menos invasivas (angio-TAC multicorte, angio-RMN, eco-doppler), el diagnóstico de dicho síndrome puede realizarsecon mayor precisión y sentar las bases de la indicación quirúrgicacon mayor seguridad y eficacia.La introducción, en el año 2000, de técnicas laparoscópicasen la liberación del tronco celiaco, junto con procedimientos endovascularescomplementarios, ha representado un notable avanceen el tratamiento del síndrome.Basados en nuestra experiencia personal, presentamos una revisióncrítica y propuesta terapéutica del síndrome(AU)
The celiac axis compression syndrome (CACS) due to medianarcuate ligament (MAL) was first described by Harjola in 1963;originating postpandrial abdominal pain, weight loss, epigastricbruit and celiac axis stenosis > 75% in angiographic studies. Thisclinical condition has been the origin of controversies about itspathogenesis, diagnosis and its long term clinical results.Advances in diagnostic imaging as 64 multidetectorrow CT(MDCT), 3-D reconstruction, magnetic resonance (MR) and colorduplex ultrasonography, provide better understanding of the syndromeand allow to identify the best candidates for surgical divisionof MAL fibers.Since the introduction of laparoscopic approach, and also endovascularprocedures, in 2000, a new perspective has establishedin this challenging syndrome. With the occasion of our ownexperience, a critical review of the syndrome is presented(AU)
Subject(s)
Humans , Celiac Artery/physiopathology , Laparoscopy/methods , Peripheral Vascular Diseases/surgery , Diaphragm/physiopathology , Diagnosis, Differential , Abdominal Pain/etiologyABSTRACT
Solid pseudo-papillary tumor (SPPT) is a rare cystic tumor of the pancreas (1-3% of exocrine tumors of the pancreas) which shows an "enigmatic" behavior on the clinical and molecular pattern. A retrospective analysis of the cytological studies and resected specimens of pancreatic cystic tumors from May 1996 to February 2010 was carried out. Three cases of SPPT were found, which are the objective of this study. The diagnosis was established upon occasional finding in the abdominal CT, in spite of sizing between 3 and 6 cm of diameter. In the three cases the preoperative diagnosis was confirmed by cytology and specific immunohistochemical staining. Cases 2 and 3 showed strong immunoreactivity for Beta-Catenin and E-Cadherin staining. Radical resection (R0) was carried out in the three cases. A young male -21 years of age (case 1)- who had duodenal infiltration and two lymph nodes metastases died of hepatic and peritoneal recurrence 20 months following surgery. The other two cases are free of disease. The current review of the literature reports roughly 800 cases since the first report in 1959, and shows the enigmatic character of this tumor regarding the cellular origin, molecular pathways, prognostic factors and clinical behavior.
