ABSTRACT
Self-expanding metal stents are an established treatment for malignant colon strictures, either as palliative treatment or as a bridge to later surgery. Little data exist regarding the use of stents for benign obstructions and the rate of subsequent complications related to the procedure is high. After reviewing the existing literature, we found only one case of stent placement in an intestinal obstruction caused by endometriosis, as a bridge to surgery. The use of prostheses in benign disease has a higher rate of complications such as stent migration and gut perforation. Such complications are even more likely to happen when the stent has been placed as a bridge to surgery and it is delayed for more than 7 days. This is the case of a young woman presenting an acute intestinal obstruction related to endometrioma. Stent placement was used in this case as a bridge to surgery with successful results.
Subject(s)
Colectomy/methods , Colonic Diseases/diagnosis , Colonic Diseases/surgery , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Stents , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Adult , Colonic Diseases/etiology , Emergency Service, Hospital , Endometriosis/complications , Endometriosis/diagnosis , Female , Follow-Up Studies , Humans , Intestinal Obstruction/etiology , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
El neurotecoma celular es una tumoración cutáneabenigna poco frecuente de histogénesis incierta, que ocurrefundamentalmente en la parte superior del cuerpo de niñosy adultos jóvenes, con predominio femenino. Clásicamentese considera que los neurotecomas (variantes mixoide, celulary mixta) forman parte de un espectro de tumores consupuesto origen en la vaina nerviosa. Sin embargo, la faltade diferenciación neurosustentacular convincente tanto enel neurotecoma celular como en el mixto ha cuestionadoeste concepto, y numerosos autores afirman que se trata detumores diferentes que justifican una clasificación separada.Se presentan dos casos de neurotecoma celular, en unvarón de 24 años y en una niña de 9 años, con tumoracionesasintomáticas en el hombro derecho y en la rodilla izquierdarespectivamente. Histológicamente, ambos casos secaracterizan por una proliferación en la dermis reticular decélulas fusiformes y/o epitelioides dispuestas en nidos yfascículos, rodeados por un estroma colágeno denso. Unode los casos muestra importante atipia citológica y unpatrón marcadamente plexiforme. Inmunohistoquímicamente,ambos casos son positivos para vimentina, CD68,CD10, factor XIIIa y actina músculo-liso. En uno de loscasos también hay inmunorreactividad para enolasa neuronalespecífica. El resto de los marcadores realizados sonnegativos, entre ellos la proteína S-100. Los hallazgosinmunohistoquímicos sugieren diferenciación fibrohistiocitaria,lo que probablemente justifica la separación del neurotecomacelular del neurotecoma mixoide. En cuanto alneurotecoma mixto, éste probablemente representa unavariante mixoide del neurotecoma celular (AU)
Cellular neurothekeoma is a rare benign cutaneous neoplasmof uncertain histogenesis arising usually on the upperbody of children and young adults, with a female predominance.Neurothekeomas (myxoid, cellular and mixedvariants) are classically regarded as forming part of a spectrumof tumors of putative nerve sheath origin. The lack ofconvincing evidence of neurosustentacular differentiation incellular and mixed variants, however, has challenged thisconcept, and numerous authors state that they are differenttumors that warrant a separate classification. This is thereport of two cases of cellular neurothekeoma, in a 24-yearoldman and a 9-year-old girl, with asymptomatic tumorsoccurring on the right shoulder and left knee respectively.Histologically, both cases are characterized by a proliferationof spindle and/or epithelioid cells involving reticulardermis, arranged in fascicles and nests surrounded by scleroticcollagen. One of the two cases show significant cytologicatypia and a notably plexiform pattern. Immunohistochemically,both cases are positive for vimentin, CD68,CD10, factor XIIIa and smoth muscle actin. In one of thetwo cases there is also immunoreactivity for neuron-specificenolase. The remainder of immunomarkers are negative,S-100 protein included. The immunohistochemical findingssuggest fibrohistiocytic differentiation, so it probablywarrants the separation of cellular neurothekeoma frommyxoid neurothekeoma. In respect to the mixed neurothekeoma,this probably represents a myxoid variant of cellularneurothekeoma (AU)
Subject(s)
Humans , Male , Female , Child , Adult , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Neurothekeoma/diagnosis , Neurothekeoma/pathology , /analysis , ImmunohistochemistryABSTRACT
BACKGROUND AND OBJECTIVE: Pouchitis is the most frequent complication following total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Up to 15% of patients with pouchitis experience a chronic course, which can be resistant to antibiotic therapy and may lead to surgical excision of the pouch. Further therapeutic options are therefore needed. Oral budesonide, a corticosteroid with topical activity in the terminal ileum (controlled ileal release [CIR] capsules), may be an alternative. MATERIAL AND METHOD: We performed a prospective, open study of five patients with chronic refractory pouchitis. Patients were treated with 9 mg of budesonide capsules after other causes of the lack of treatment response were excluded. Assessments included clinical, endoscopic and histological evaluation at baseline and after 8 weeks of treatment. Efficacy was evaluated using the pouchitis disease activity index (PDAI) global scores as well as the clinical, endoscopic and histological subscores at baseline and 8 weeks. Remission was defined as a global score < 7. Variations in laboratory parameters and tolerance were also assessed. RESULTS: Four out of five patients went into remission at 8 weeks and a significant decrease was observed in the median total PDAI score from 14 (range, 12-15) to 4 (range, 4-11) (p = 0.0422) and in the three subscores: clinical from 4 (range, 4-5) to 1 (range, 0-4) (p = 0.0394), endoscopic from 5 (range, 4-6) to 2 (range, 1-5) (p = 0.0394), and histologic from 4 (range, 4-5) to 2 (range, 2-2) (p = 0.0339). No significant adverse effects were reported. CONCLUSIONS: Oral budesonide CIR capsules may be an option to induce remission in active chronic refractory pouchitis. Because tolerance is good, the use of enemas may be avoided.
Subject(s)
Budesonide/administration & dosage , Glucocorticoids/administration & dosage , Pouchitis/drug therapy , Administration, Oral , Adult , Chronic Disease , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
INTRODUCCIÓN Y OBJETIVO: La reservoritis es la principalcomplicación, tras la proctocolectomía total con anastomosisileoanal y reservorio, en la colitis ulcerosa. En un 15% de loscasos sigue un curso crónico y, a veces, refractario al tratamientoantibiótico, y puede terminar en exéresis del reservorio.Por ello, son necesarias otras opciones terapéuticas. Budesonidaes un corticoide de acción tópica que, en cápsulasorales de liberación en el íleon terminal (CIR), puede seruna posible alternativa terapéutica.MATERIAL Y MÉTODO: Estudio prospectivo, abierto, realizadoen 5 pacientes con reservoritis crónica refractaria. Descartadasotras causas de refractariedad, se trata a los pacientescon budesonida oral 9 mg/día. Se realiza unaevaluación clínica, endoscópica e histológica basal y tras 8semanas de tratamiento. La eficacia se evalúa mediante lacomparación del índice de actividad de reservoritis (PDAI) ysus subíndices clínico, endoscópico e histológico, antes y despuésdel tratamiento. Se establece como remisión un índice< 7. Se valora, asimismo, la modificación de diversos parámetrosanalíticos y la tolerancia.RESULTADOS: Cuatro de 5 pacientes logran la remisión tras 8semanas de tratamiento y se constata un descenso significativoen la mediana del PDAI global de 14 (rango, 12-15) a 4(rango, 4-11) (p = 0,0422), así como en sus 3 subíndices: clínicode 4 (rango, 4-5) a 1 (rango, 0-4) (p = 0,0394), endoscópicode 5 (rango, 4-6) a 2 (rango, 1-5) (p = 0,0394) e histológicode 4 (rango, 4-5) a 2 (rango, 2-2) (p = 0,0339). No seregistraron efectos secundarios.CONCLUSIONES: Budesonida oral en cápsulas de liberaciónileal controlada puede ser una opción terapéutica para inducirla remisión en la reservoritis activa, crónica y refractaria.La tolerancia es buena y se puede evitar su aplicación enforma de enemas
BACKGROUND AND OBJECTIVE: Pouchitis is the most frequentcomplication following total proctocolectomy with ilealpouch-anal anastomosis for ulcerative colitis. Up to 15% ofpatients with pouchitis experience a chronic course, whichcan be resistant to antibiotic therapy and may lead to surgicalexcision of the pouch. Further therapeutic options aretherefore needed. Oral budesonide, a corticosteroid with topicalactivity in the terminal ileum (controlled ileal release[CIR] capsules), may be an alternative.MATERIAL AND METHOD: We performed a prospective, openstudy of five patients with chronic refractory pouchitis. Patientswere treated with 9 mg of budesonide capsules afterother causes of the lack of treatment response were excluded.Assessments included clinical, endoscopic and histologicalevaluation at baseline and after 8 weeks of treatment. Efficacywas evaluated using the pouchitis disease activityindex (PDAI) global scores as well as the clinical, endoscopicand histological subscores at baseline and 8 weeks. Remissionwas defined as a global score < 7. Variations in laboratoryparameters and tolerance were also assessed.RESULTS: Four out of five patients went into remission at 8weeks and a significant decrease was observed in the mediantotal PDAI score from 14 (range, 12-15) to 4 (range, 4-11) (p= 0.0422) and in the three subscores: clinical from 4 (range,4-5) to 1 (range, 0-4) (p = 0.0394), endoscopic from 5 (range,4-6) to 2 (range, 1-5) (p = 0.0394), and histologic from 4(range, 4-5) to 2 (range, 2-2) (p = 0.0339). No significant adverseeffects were reported.CONCLUSIONS: Oral budesonide CIR capsules may be an optionto induce remission in active chronic refractory pouchitis.Because tolerance is good, the use of enemas may beavoided
