ABSTRACT
Acute appendicitis is a frequent abdominal pathology, more frequent in the childhood. The pathophysiology of acute appendicitis is obstruction of the appendix lumen and distension due to continued mucosal secretion. The second step is a rapid multiplication of resident bacteria, excretion of toxine and wall inflammation. Causes of this processes are different: in most of cases there is an hyperplasia of intrinsic lymphoid tissue (60%) or hard stool. Another cause may be foreign body. But is there a relationship between abdominal trauma and appendicitis?
Subject(s)
Abdominal Injuries/complications , Appendicitis/etiology , Appendicitis/surgery , Wounds, Nonpenetrating/complications , Child , Female , HumansABSTRACT
The incidence of adenocarcinoma arising from Barrett's esophagus is dramatically increasing in Western countries. The purpose of this study was to report our experience in the surgical management of these patients. Between November 1992 and December 2000, 330 consecutive patients with adenocarcinoma of the esophagogastric junction were observed in our institution. Of these, 105 (31.8%) had Barrett's carcinoma. In 12 individuals (11.4%) adenocarcinoma was discovered during endoscopic surveillance for Barrett's esophagus. Twelve patients with doubtful cleavage planes at preoperative investigation were treated with neoadjuvant chemotherapy. Overall, 80 patients (76.2%) underwent esophagectomy without operative mortality. The Ivor Lewis approach was used in 70 patients; of these, 31 underwent extended mediastinal lymph node dissection. Seventy-four patients (92.5%) had R0 resection. The overall 5-year survival rate was 48%. Survival was significantly associated with stage, lymph node status, and completeness of resection. Early diagnosis remains the prerequisite for curative treatment of esophageal carcinoma. An extended mediastinal lymphadenectomy does not increase morbidity, allows precise tumor staging, and may prove effective in preventing local recurrences. Neoadjuvant therapy requires major improvement before it can be unconditionally recommended outside clinical trials.