ABSTRACT
Surgical resection is the only potentially curative option in the treatment of pancreatic ductal adenocarcinoma. Preoperative radiological imaging allows to rule out the presence of metastases. Three resectability categories are established based on the radiological findings depending on the degree of contact between the tumor and the blood vessels. Histological confirmation of malignancy is only required in cases of borderline or non-resectable tumors, prior to neoadjuvant treatment initiation. Diagnostic laparoscopy is recommended in the presence of large tumors of the body or tail and in borderline tumors to explore the possibility of resection and to apply treatment with curative intent, as well as in those cases with high level of biomarkers to rule out peritoneal involvement. Prior to surgery preoperative nutritional measures as well as endoscopic biliary drainage can be applied to optimize patients conditions. Cephalic pancreaticoduodenectomy is the recommended surgical technique in tumors located in the head of the pancreas. The benefits from pyloric preservation, type or reconstruction (one vs. two loops), type of anastomosis (pancreaticojejunostomy vs. pancreaticogastrostomy), intraoperative biopsy of the pancreatic resection margin or the use of intraperitoneal drainages are inconclusive. Total pancreatectomy and/or portal resection should only be performed in particular cases; however, arterial resections have shown no benefits. Radical antegrade modular pancreaticosplenectomy, that can be performed laparoscopically, is the technique used for those tumors located in the pancreatic body-tail (AU)
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Subject(s)
Humans , Carcinoma, Pancreatic Ductal/drug therapy , Carcinoma, Pancreatic Ductal/surgery , Pancreatectomy/methods , Anastomosis, Surgical/methods , Pancreatic Neoplasms/surgery , Retrospective Studies , Preoperative Period , Nutritional Support/methods , Laparoscopy/methodsABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Lupus Nephritis/complications , Antiphospholipid Syndrome/complications , Hypertension/complications , Platelet Aggregation Inhibitors/therapeutic use , Anticoagulants/therapeutic useABSTRACT
El objetivo de la presente investigación fue estudiar los efectos de un gel de tetraciclina al 5 por ciento sobre los niveles de 3 microorganismos asociados al desarrollo de la periodontitis rápidamente progresiva (PRP). En un total de 20 pacientes con PRP se seleccionaron 5 dientes por paciente con bolsas periodontales >= a 5 mm. con sangrado al sondaje periodontal en los cuales se efectuaron los siguientes tratamientos: 1. Control. 2. Aplicación de un gel de tetraciclina al 5 por ciento (T). 3. Placebo (P1). 4. Raspado y alisado radicular (RA). 5. T + RA. De forma previa, en cada sitio seleccionado, se tomaron muestras de placa subgingival con un cono de papel estéril para detectar y cuantificar la presencia de P. Gingivalis, P. Intermedia y A. Actinomycetemcomitans, mediante el uso de sondas DNA (OMNIGENE, U.S.A.). Se dieron instrucciones de higiene oral, y se efectuó un nuevo control microbiológico a los 60 días. El análisis estadístico de los resultados demostró lo siguiente: 1. Ninguno de los tratamientos redujo significativamente los niveles de A. Actinomycetemcomitans. 2. Se detectó una reducción significativa de P. gingivalis en los sitios tratados con (R.A). (p<0,02) o cuando este último tratamiento se asoció a (T). (p<0,05). 3. Todos los tratamientos redujeron significativamente los niveles de P. intermedia. Aunque las tetraciclinas incluyen en su espectro de acción a las bacterias estudiadas, y alcanzan altas concentración después de su aplicación en los sitios respectivos, los reducidos efectos microbiológicos encontrados podrían explicarse por su rápida remoción por el fluido gingival desde su sitio de aplicación en las localizaciones estudiadas (AU)
The purpose of this investigation was to study the effects of local delivery of a tetracycline 5% gel on the levels of 3 bacteria associated to development of rapidly progressive periodontitis. In a sample of 20 patients, five teeth were selected from each patient with periodontal pockets > 5 mm and bleeding upon probing. One of the following treatments were done at each selected site: 1. Control (no treatment). 2. Local delivery of a 5% tetracycline gel. 3. Placebo gel. 4. Scaling and root planing. 5. Scaling and root planing + local application of tetracycline gel. Previously, at each selected site samples of subgingival plaque were taken with sterile paper points in order to detecte and quantify the presence of P.gingivalis, P.intermedia and A. actinomycetemcomitans, by using DNA probe technology (OMNIGENE, U.S.A.). Oral hygiene instructions were given to each patient and new samples of subgingival plaque were obtained at 60 days. Statistical analysis of results showed the following 1. No significant reductions of A. actinomycetemcomitans were found with performed treatments. 2. Scaling and root planing reduced the levels of P. gingivalis (p 0.02) or when the later was combined with tetracycline (p <0.05). 3. All treatments significantly reduced levels of P.intermedia. Although bacteria studied has shown sensitivity to tetracyclines and despite high levels of antibiotic that are obtained following its local delivery in a gel, the reduced microbiologic effects that were seen could be ascribed to rapid removal of gel by the gingival crevicular fluid from studied sites (AU)
