RESUMO
The authors report a case of cystic dilatation of the choledochus associated with narrow stenosis at the confluence of the left and right hepatic ducts which was found to be inflammatory on histological examination. This pathology is becoming an increasingly more commonplace clinical finding. The case reported here is particularly interesting owing to the onset of the disease and the way in which it was treated. An attempt was made to treat the patient using a simple operation which was to the least radical possible. The authors take this opportunity of reviewing the literature on the subject.
Assuntos
Cisto do Colédoco/diagnóstico , Ducto Hepático Comum/patologia , Idoso , Doenças dos Ductos Biliares/diagnóstico , Doenças dos Ductos Biliares/cirurgia , Cisto do Colédoco/cirurgia , Constrição Patológica/diagnóstico , Constrição Patológica/cirurgia , Feminino , Ducto Hepático Comum/cirurgia , HumanosRESUMO
The authors report their experience of the posterior rectal access route. They used this route to operate 7 patients with rectal carcinoma during the period February 1989-October 1994; 3 patients were affected by villous adenoma, 3 by adenocarcinoma, and 1 by pelvic recidivation. Of the 3 patients suffering from adenocarcinoma, two underwent palliative treatment owing to their poor general conditions and the systemic nature of the base pathology, consisting in the exeresis of the tumour using a posterior route. The third patient was treated using a combined abdominal-posterior route; the site of the tumour and the presence of a narrow pelvis would in fact have made an "ultra low" front resection highly risky, whereas coloanal anastomosis (pull through) might have jeopardized efficacious anal continence. On the basis of their experience the authors indicate the posterior access route as a therapeutic possibility in the treatment of medium-low rectal tumours at an early or very advanced stage. The posterior approach is only justified in other forms if combined with laparotomic access. An oncologically correct operation is therefore guaranteed in full respect of sphincteric function.
Assuntos
Reto/cirurgia , Adenocarcinoma/cirurgia , Adenoma Viloso/cirurgia , Anastomose Cirúrgica/métodos , Colo/cirurgia , Humanos , Cuidados Paliativos , Neoplasias Retais/cirurgia , Grampeamento CirúrgicoRESUMO
The authors report 2 cases of amebic hepatic abscess, through to their observation with a little interval of time one from another and both coming from the same small town. Transmission modalities, the diagnostic approach and the therapeutic possibilities are discussed on the basis of personal experience.
Assuntos
Abscesso Hepático Amebiano/diagnóstico , Adulto , Idoso , Drenagem , Feminino , Hepatectomia , Humanos , Itália/epidemiologia , Abscesso Hepático Amebiano/tratamento farmacológico , Abscesso Hepático Amebiano/cirurgia , Abscesso Hepático Amebiano/transmissão , Masculino , Metronidazol/uso terapêutico , PrevalênciaRESUMO
The authors analyse and evaluate the clinical records of 45 patients treated in the last 4 years for pancreatic cancer and neoplasm of the bilioduodenapancreatic area, comparing the results with data available in the literature. In the group of patients treated with resection (12 cases), postoperative morbidity and mortality were respectively 28% and 6%, and three-years survival was 22%. The authors discuss particularly about reconstruction ways after duodenopancreatectomy, showing good results after reconstruction by Y loop sec. Roux and pancreato-jejunal anastomosis.
Assuntos
Adenocarcinoma/cirurgia , Ampola Hepatopancreática , Carcinoma Ductal de Mama/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Cistadenocarcinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/mortalidade , Idoso , Idoso de 80 Anos ou mais , Anastomose em-Y de Roux , Carcinoma Ductal de Mama/mortalidade , Neoplasias do Ducto Colédoco/mortalidade , Cistadenocarcinoma/mortalidade , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia , Pancreaticojejunostomia , Complicações Pós-Operatórias , Fatores de TempoRESUMO
The authors report a case recently brought to their observation: T.A., a 77 year old patient, operated on in July 1990, for aortic aneurysm with axillo femoral by-pass. The patient was reoperated on the 5th day for ischaemic necrosis of the descending colon. In 1992 he was operated in another hospital for right iliac branch removal of the by-pass and performing of extra-anatomic bifemoral by-pass for right iliac branch infection of anatomic prosthesis. He was brought to our observation in March 1993, after the patient was refused in other Centres because of purulent abscess located near the aortic prosthesis and in the right iliac fossa, with a fistula to right superior anterior iliac crista. The patient was operated on in April 1993, with an explorative laparatomy to drain the abscess and to remove the aortic prosthesis. The aorta was sutured with closed bottom by means of delayed points. The postoperative course was regular and an arteriography performed three months after confirms the good running of the axillo-femoral by-pass and of the bifemoral one previously performed. The authors because of their experience and the bibliographical data underline the goodness of the axillo-femoral by-pass in serious infections of an aortic prosthesis.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Artéria Axilar/cirurgia , Prótese Vascular , Artéria Femoral/cirurgia , Complicações Pós-Operatórias/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Idoso , Prótese Vascular/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Infecções Relacionadas à Prótese/etiologia , ReoperaçãoRESUMO
The authors present their personal experience in the surgical treatment of 256 cases of patients suffering from inguinal hernia, using the Shouldice technique in local anaesthesia. Minor incidence intra and postoperative complications compared with other types of anaesthesia, the possibility to converse with the patient during the operation and if necessary to invite him to cough in order to exclude the presence of other associated hernias or to assay the robustness and the resistance of the plastic, minor frequency of relapses compared with other operating techniques (1.5% in the Shouldice against 3% of the Bassini), and last but not least the possibility of early discharge from hospital and more swift resumption of work, confirm the full validity of this hernial plastic surgery.
Assuntos
Anestesia Local , Hérnia Inguinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Inguinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Procedimentos Cirúrgicos Operatórios/métodos , Inquéritos e QuestionáriosRESUMO
The authors report about a case of celiac axis obliteration, noticed during an operation of pancreaticoduodenectomy for pancreatic formation. The arterial flux of sovramesocolic district took place completely through the gastroduodenal artery. To complete the operation the authors were obliged to stop the circulation of the pancreaticoduodenal artery and to rivascular the common hepatic through bypass with aorta. The authors confirm the importance of arteriography for the study of expansive lesions of the pancreas, liable to surgical treatment as well to avoid treating urgently similar cases or due to anatomic variants.
Assuntos
Arteriopatias Oclusivas/diagnóstico , Artéria Celíaca , Pancreaticoduodenectomia , Idoso , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/cirurgia , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/cirurgia , Colecistectomia , Emergências , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Humanos , Cuidados Intraoperatórios , Masculino , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia , RadiografiaRESUMO
The authors report their experience of the treatment of 43 cases of perforated colonic diverticula. The operations were: 12 primary resections-anastomoses; 7 resections-anastomoses with protective colostomy; 2 operations of suture and drainage; 22 Hartmann's resections. The authors believe that Hartmann's resection is the operation of first choice in cases of diffuse or stercoraceous peritonitis. This operation another the removal of the sick part of intestines without exposing the patient to the possible complications of an operation "at risk", and allows a late recanalization destitute of risk: in our experience 13 cases of 22 (59%).
Assuntos
Divertículo do Colo/cirurgia , Perfuração Intestinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia , Colostomia , Divertículo do Colo/complicações , Divertículo do Colo/mortalidade , Drenagem , Emergências , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/mortalidade , Peritonite/cirurgiaRESUMO
Pulmonary mucormycosis (phycomycosis) is an uncommon infection occurring in immunodepressed or debilitated patients. Mortality is very high. Recovery depends upon underlying disease and upon early diagnosis, although difficult to obtain. Aggressive medical therapy is requested and surgical treatment in some instances is indicated. The following is a report of pulmonary mucormycosis occurring in a man with lymphocytic leukemia under chemotherapy treatment. Surgical treatment was considered as medical treatment had been unsuccessful. No success has been achieved, as also diffuse bone metastases showed up.
Assuntos
Pneumopatias Fúngicas/cirurgia , Mucormicose/cirurgia , Infecções Oportunistas/cirurgia , Candida albicans/isolamento & purificação , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Masculino , Pessoa de Meia-Idade , Mucor/isolamento & purificação , Mucormicose/diagnóstico , Mucormicose/microbiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
The paper reports the Authors' experience during the period 1989-91 and refers to 80 operated cases of rectum-sigma cancer. Given that data reported in the literature affirm that the limit of oncological safety is 1.5-2 centimetres distal from the tumour, and owing to their use of mechanical staplers, the Authors were able to use the preferred anterior section followed by low or very low colo-rectal anastomosis in 96% of cases. Miles' technique for abdomino-perineal amputation was only resorted to in 4% of cases. Tumours parameters, short- and medium-term complications and the results of a short-term follow-up are all discussed. The Authors compare their experience with that of other researchers reported in the literature.
Assuntos
Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Operatórios/métodos , Grampeadores CirúrgicosRESUMO
The Authors report a case of familial mediterranean fever with pseudo-acute abdomen recently observed and emphasize how a careful anamnesis can avoid unnecessary surgical intervention.
Assuntos
Abdome Agudo/diagnóstico , Febre Familiar do Mediterrâneo/diagnóstico , Anamnese , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
The Authors on the basis of their own experience and scientific literature, study the indications to the surgical treatment of pulmonary metastasis. Surgical treatment usually produces a palliative result, bettering the quality of life. For some other Authors, surgical treatment if there are no local recurrences and metastasis, could produce complete healing.
Assuntos
Neoplasias Pulmonares/secundário , Adulto , Feminino , Humanos , Perna (Membro) , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Masculino , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Sarcoma/diagnóstico , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/cirurgiaRESUMO
The authors analyze data of 100 consecutive mediastinoscopies, performed for diagnostic and/or staging purposes in suspected or known bronchogenic carcinomas. They confirm once again how mediastinoscopy is, in many cases, the only diagnostic procedure that can give, at the same time, a preoperative histological diagnosis and a quite accurate staging, thus avoiding useless exploratory thoracotomies.
Assuntos
Carcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Mediastinoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
The authors discuss the role of surgical treatment in patients with highly malignant soft tissue sarcomas in the limbs. A careful analysis is made of different therapies on the basis of the results obtained by the authors and those reported in the literature. The anatomic classification of lesions is based on functional anatomic compartments, defined as intra- or extracompartmental. If a lesion was within an intrafascial compartment, all the muscles with intact fascial sheaths have up till now been removed "en bloc" to obtain radical margins. Many authors now think that all manifest disease be removed with a generous soft tissue margin on all sides to ensure adequate local treatment. Amputation has commonly been performed for extracompartmental lesions, but a multinodal treatment programme, including limb-sparing resection and tumour-bed radiation, should now be considered if possible in the management of these tumours.
Assuntos
Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Terapia Combinada , Humanos , Perna (Membro) , Masculino , Fatores de Risco , Sarcoma/diagnóstico , Sarcoma/patologia , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/patologia , Sarcoma Sinovial/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/patologiaRESUMO
The results obtained after short-term surgical prophylaxis with ceftriaxone in 443 patients of whom 361 operated of choice are reported. In all, only 3 failures were encountered. The drug also proved to be well tolerated and there were no noteworthy side-effects in the treated patients. The effectiveness of prophylactic treatment is attributed to the long half-life of the molecule (about 8 hours) guaranteeing efficient antibacterial cover with just one administration for the whole period that is critical for surgical infections, during and after operation.
Assuntos
Ceftriaxona/uso terapêutico , Pré-Medicação , Infecções Bacterianas/prevenção & controle , Humanos , Fatores de TempoRESUMO
The paper describes a recent case of neurilemmoma of the stomach. Following a review of the literature, the Authors focus their attention on the diagnostic difficulties and the choice of therapy. Tomography, arteriography and gastroscopy with multiple biopsies may at times be misleading depending on the development of the tumour. Most Authors agree that local resection or, when possible, enucleation are the most appropriate forms of therapy.
Assuntos
Neurilemoma/cirurgia , Neoplasias Gástricas/cirurgia , Idoso , Humanos , Masculino , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Estômago/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios XRESUMO
Early peritoneal dialysis is proposed for the early treatment of acute necrotic haemorrhagic pancreatitis on the basis of experimental and clinical studies. The results obtained in 53 cases so treated in the past 8 years are reported.
Assuntos
Hemorragia/terapia , Pancreatite/terapia , Diálise Peritoneal/métodos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia/etiologia , Humanos , Pessoa de Meia-Idade , Necrose , Pancreatopatias/etiologia , Pancreatopatias/terapia , Pancreatite/complicações , Pancreatite/patologia , Fatores de TempoRESUMO
On the basis of the literature and of personal experience, the problem of the extent of demolition time, total gastrectomy or subtotal gastrectomy for patients suffering from stomach cancer is analysed. It is considered that total gastrectomy does not always lead to longer survival by comparison with subtotal gastrectomy and that in certain cases the latter, after careful consideration of a series of variables, may be the operation of choice.
Assuntos
Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Humanos , Estadiamento de Neoplasias , Neoplasias Gástricas/patologiaRESUMO
Personal experience of a fairly rare disease is reported and it is stressed that the decisive factor in opting for surgery is the diameter of the colon, particularly the cecum, on the basis of direct X-ray of the abdomen. It is considered that cecostomy is not only the simplest operation but is also the one that offers the best possibilities of success.