RESUMO
Glomus tumor is an uncommon perivascular lesion usually located in the dermis of the extremities. It rarely involves the respiratory tract or the lungs. We present the clinical and pathological features of a 39-year-old man who was evaluated for an incidental radiological finding of a pulmonary nodule. A chest computed tomography (CT) confirmed the presence of an upper left lobe coin lesion. Bronchoscopy and 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) were negative. An intraoperative frozen section examination was interpreted as a neuroendocrine tumor; therefore a left upper lobectomy with lymphadenectomy was performed. An immunohistochemical examination supported the diagnosis of a primary pulmonary glomangioma. The patient was free of disease at the 51-month follow-up. Due to its uncertain behavior we stress the usefulness of typical lung resection, lymph node dissection, and accurate follow-up.
Assuntos
Tumor Glômico/diagnóstico , Neoplasias Pulmonares/diagnóstico , Tomografia por Emissão de Pósitrons , Nódulo Pulmonar Solitário/diagnóstico , Adulto , Biópsia , Broncoscopia , Tumor Glômico/diagnóstico por imagem , Tumor Glômico/cirurgia , Humanos , Imuno-Histoquímica , Achados Incidentais , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Masculino , Pneumonectomia , Valor Preditivo dos Testes , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Ar , Colo/anormalidades , Diafragma/anormalidades , Infecções por Helicobacter/complicações , Fígado/anormalidades , Idoso , Antibacterianos/uso terapêutico , Colo/diagnóstico por imagem , Diagnóstico Diferencial , Diafragma/diagnóstico por imagem , Quimioterapia Combinada , Dispepsia/microbiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Fígado/diagnóstico por imagem , Masculino , Náusea/microbiologia , Inibidores da Bomba de Prótons/uso terapêutico , Radiografia , Síndrome , Resultado do Tratamento , UltrassonografiaAssuntos
Doenças do Esôfago/cirurgia , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/diagnóstico por imagem , Fluoroscopia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Síndrome , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Takayasu's arteritis is rarely reported associated with Crohn's disease in the English world literature. A case of Takayasu's arteritis type V in a young female affected by Crohn's disease is presented and the pathophysiology mechanism, and the clinical and diagnostic aspects are underlined. Surgical strategy is discussed.
Assuntos
Doença de Crohn/complicações , Arterite de Takayasu/complicações , Adulto , Angiografia , Angioplastia/métodos , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/cirurgia , Feminino , Seguimentos , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/cirurgia , Ileostomia , Obstrução Intestinal/complicações , Obstrução Intestinal/cirurgia , Artéria Renal/diagnóstico por imagem , Artéria Subclávia/diagnóstico por imagem , Arterite de Takayasu/diagnóstico por imagem , Arterite de Takayasu/terapia , Fatores de Tempo , Artéria Vertebral/diagnóstico por imagemRESUMO
PURPOSE: The aim of this study was to determine whether the use of multidetector computed tomography (MDCT) is associated with decreased sedation, frequency of motion artefacts and conventional angiograms compared with single-detector CT (SDCT). MATERIALS AND METHODS: CT examinations performed in young children between January 1993 and June 2005 were reviewed retrospectively. Prior to September 2000, SDCT was used; after that period, MDCT was used. The examinations obtained during these two periods were compared for the frequency of sedation, motion artefacts, and conventional angiograms. Statistical comparison between the two groups was determined by using the chi(2) test. RESULTS: A total of 126 infants and children younger than 6 years of age underwent 134 CT examinations. Eighty-eight were obtained with a SDCT (65%) (group 1) and 46 with a MDCT (35%) (group 2). Sedation was required in 31/88 (35%) CT examinations in group 1 and in 6/46 (13%) in group 2. Conventional angiography was performed in 20/88 (22%) cases in group 1 and in 6/46 (13%) in group 2. Motion artefacts were present in 8/88 (9%) CT examinations in group 1 and in 4/46 (8%) in group 2. There was significant statistical difference with regard to sedation and angiography rates between the two groups (p<0.001) whereas there was no significant difference with regard to motion artefacts (p>1). CONCLUSIONS: MDCT can reduce the need for sedation and conventional angiography in children after liver transplantation. There is no effect on patient motion artefacts.
Assuntos
Artefatos , Hipnóticos e Sedativos/uso terapêutico , Transplante de Fígado/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Administração Oral , Angiografia/estatística & dados numéricos , Criança , Pré-Escolar , Hidrato de Cloral/administração & dosagem , Hidrato de Cloral/uso terapêutico , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Processamento de Imagem Assistida por Computador , Lactente , Injeções Intravenosas , Masculino , Movimento (Física) , Pentobarbital/administração & dosagem , Pentobarbital/uso terapêutico , Estudos RetrospectivosRESUMO
In non small cell lung cancer (NSCLC) patients undergoing surgery after induction chemotherapy, all mediastinal lymphnodes potentially involved by tumor should be resected whenever possible. Paratracheal bilateral lymphadenectomy for left sided tumors can be disabling, i.e. median sternotomy plus a thoracotomy to reach the subcarinal region. From the right side, an extensive ipsilateral dissection is feasible through a standard thoracotomy, but contralateral lymphnodes, especially in the left hilum and aortopulmonary window are considered inaccessible. A technical tip is shown to reach and dissect the left paratracheal and aortopulmonary window nodes through a simple right thoracotomy in right-lung cancer. The procedure has been carried out in 3 cases and proved to be technically feasible. The value of such a procedure as to staging accuracy, local disease control and survival should be evaluated in a clinical trial setting.
Assuntos
Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo/métodos , Mediastino/cirurgia , Pneumonectomia/métodos , Toracotomia/métodos , HumanosRESUMO
Tracheobronchial injury (TBI) after blunt trauma of the chest is a rare life-threatening entity that can be successfully managed by surgery if there is an early diagnosis. A 18-year-old man was injured in a motocycle accident. Three consecutive flexible bronchoscopies risulted negative for tracheo-bronchial lesions. Then, the patient was submitted to a spiral CT-scan of the chest with 3-dimensional reconstruction of the tracheobronchial tree that showed a rupture of the right main bronchus from the trachea. The lesion was successfully treated by surgery. Bronchoscopic findings in TBI may be unclear also for an experienced thoracic surgeon.
Assuntos
Brônquios/lesões , Broncografia/métodos , Tomografia Computadorizada Espiral , Acidentes de Trânsito , Articulação Acromioclavicular , Adolescente , Anastomose Cirúrgica , Brônquios/cirurgia , Humanos , Luxações Articulares/etiologia , Pulmão/diagnóstico por imagem , Lesão Pulmonar , Masculino , Enfisema Mediastínico/etiologia , Motocicletas , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologiaRESUMO
BACKGROUND: The aim of this study was to confirm some selection criteria for the transrectal repair of the anterior rectocele and to compare our surgical results with those reported in the literature. METHODS: From January 1992 to December 1999, 30 females (mean age 52.9 years, range 28-70 yrs) affected by anterior rectocele were prospectively evaluated with a standard questionnaire, clinical examination, proctosigmoidoscopy, colonic transit time, dynamic defecography, anal EMG, anal manometry. Then, they were submitted to transrectal repair of rectocele with anterior plication of the rectal muscular wall. Fourteen (46.6%) of them were also submitted to perineal levatorplasty. Patients were followed postoperatively (mean 25.7 months) with the same standard questionnaire, clinical examination, defecography, and manometry. Results were tested by Fisher's Exact text, Wilcoxon's test, and "t"-test. RESULTS: Rectal dyschezia, incomplete evacuation, digital help in defecating, mean stool frequency, and rectal bleeding significantly improved. After 3 months, 30% of patients had no complaints, 40% had only 1-2 episodes/month complaints, 13.3% had evacuation only using laxatives, and 16.6% were unchanged. Defecography showed a significant reduction of the rectocele in 70% of patients after 3 months. Manometric parameters were not significantly modified. Four (28.6%) out of 14 patients submitted to perineal levatorplasty complained of dyspareunia. CONCLUSIONS: Our surgical results were comparable with those reported in the literature, with more than 80% of successful outcome. Preoperative clinical data and defecography were confirmed to be basic parameters in selecting patients for surgery. Colonic transit time, anal EMG, and anorectal manometry demonstrated to be useful to recognize conditions as slow colonic transit time, peripheral denervation, and reduced voluntary contraction that could lead to a less satisfactory outcome after surgery, and might benefit with a postoperative perineal rehabilitation by biofeedback and anal electrostimulations. The perineal levatorplasty is not suitable in young females, due to the risk of dyspareunia.
Assuntos
Seleção de Pacientes , Retocele/cirurgia , Adulto , Idoso , Defecação , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Retocele/complicaçõesRESUMO
BACKGROUND: Increasing numbers of intestinal carcinomas in patients affected by Crohn's disease have been reported by several authors, even if the strength of this associations (age, longstanding of the disease, its characteristics and distribution) still has to be elucidated. METHODS: From January 1992 to July 2000, 130 patients with Crohn's disease were submitted to surgery. RESULTS: Four patients showed an associated intestinal carcinoma at operation, in 3 cases located in the ileum, and in 1 case in the colon. Patients' mean age was 54 years. Mean duration time of the Crohn's disease was 7 years. One patient died 3 months after surgery for disseminated peritoneal carcinomatosis, whereas 3 patients are still alive with malignancy free at 5, 8, and 11 years after the tumor resection. CONCLUSIONS: These results suggest the difficulty in recognizing patients with Crohn's disease who are at risk for intestinal carcinoma. Longstanding disease, previous intestinal exclusion surgery, enterocutaneous or other types of fistulas should be considered for the development of cancer. Therefore, the prognosis may be good if early diagnosis and treatment are made.
Assuntos
Neoplasias do Colo/etiologia , Doença de Crohn/complicações , Neoplasias do Íleo/etiologia , Idoso , Criança , Neoplasias do Colo/cirurgia , Feminino , Humanos , Neoplasias do Íleo/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: This randomized prospective study compared the outcome of circular hemorrhoidectomy according to the Hospital Leopold Bellan (HLB) technique (Paris) with Longo stapled circumferential mucosectomy (LSCM) in two homogeneous groups of patients affected by circular fourth-degree hemorrhoids with external mucosal prolapse. METHODS: From December 1996 to December 1999, 80 consecutive patients with fourth-degree hemorrhoids and external mucosal prolapse were randomly assigned to two groups. Forty patients (group A: 18 men, 22 women, mean age 50.5 years, range 21 to 82) underwent HLB hemorrhoidectomy, and 40 patients (group B: 15 men, 25 women, mean age 51.0 years, range 29 to 92) underwent LSCM. Before surgery, all patients were selected with a standard questionnaire for symptom evaluation, full proctological examination, flexible rectosigmoidoscopy, dynamic defecography, and anorectal manometry. No significant differences among the two groups were found. All patients were controlled with follow-up questionnaire and with clinical examination at 1, 2, 4, 12, and 54 weeks after the operation. A postoperative manometry was performed 3 months after surgery. RESULTS: The length of the operation was significantly lower in group B (25 +/- 3.1 SD versus 50 +/- 5.3 minutes, P <0.001). Mean hospital stay was 3 +/- 0.4 days in group A and 2 +/- 0.5 days in group B (P <0.01). Mean duration of inability to work was 8 +/- 0.9 days in group B and 15 +/- 1.4 days in group A (P <0.001). Postoperative pain was significantly lower in group B (P <0.001). Mean length of follow-up was 20 +/- 8.0 months in group A and 20 +/- 7.8 months in group B. Late complications were similar in the two groups, with 0%, at present, recurrence rate. CONCLUSIONS: Our results confirm that both operations are safe, easy to perform, and effective in the treatment of advanced hemorrhoids with external mucosal prolapse. However, the LSCM seems to be preferable owing to the fewer postoperative complications, easier postoperative management, and shorter time to return to work. A longer follow-up is required to confirm the true efficacy of this surgical method.
Assuntos
Hemorroidas/cirurgia , Prolapso Retal/cirurgia , Suturas , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
PURPOSE: In 1993, prolapse reduction using the circular stapler for the treatment of hemorrhoidal disease was proposed. The procedure is characterized by minimal postoperative pain. In this study we evaluated the above technique using regional anesthesia to identify the advantages and feasibility of stapled hemorrhoidectomy, with special focus on the efficacy of same-day discharge. METHODS: From December 1997 to November 1999, we performed 70 consecutive reduction corrections of mucosal hemorrhoidal prolapse using the circular stapler with regional anesthesia (a technical modification of Marti's posterior perineal block). Our series included 41 males and 29 females with a mean age of 43.4 (range, 25-74) years. Three patients were affected by second-degree hemorrhoids and 67 by third-degree hemorrhoids. RESULTS: Sixty-two patients were discharged three hours after the operation in good general condition and without pain, whereas eight patients were discharged the day after for early complications, consisting of two cases of early bleeding, three cases of urinary retention, and three cases of persistent severe pain requiring prolonged medical treatment. CONCLUSION: Our study shows that, in selected cases, it is possible to perform day surgery for patients with hemorrhoidal disease using a circular stapler device when combined with regional anesthesia.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia por Condução , Hemorroidas/cirurgia , Suturas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa , Dor , Complicações Pós-Operatórias , Prolapso , Resultado do TratamentoRESUMO
We report the first case known to us of a synchronous isolated splenic metastasis from colon carcinoma in a 52-year-old woman operated on splenectomy, left colectomy, and ileal resection. The patient died of diffuse carcinomatosis 1 year after the operation. Splenectomy for isolated splenic metastasis from colon carcinoma is justified, and serum tumor markers are useful to detect metastases early during the follow-up, as in our report.
Assuntos
Adenocarcinoma/secundário , Neoplasias do Colo/patologia , Neoplasias Esplênicas/secundário , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
PURPOSE: The aim of this study was to evaluate the advantages and feasibility of hemorrhoidectomy using regional anesthesia (posterior perineal block). METHODS: From March 1994 to December 1998 we performed 400 hemorrhoidectomies with regional anesthesia in an overnight-stay regimen in our department (Colo-Rectal Unit). Posterior perineal block involves anesthesia of the deep plains (infiltration of the inferior hemorrhoidal nerves, the posterior branch of the internal pudendal nerves, and the anococcygeal nerves) and anesthesia of the superficial plains (block of the inferior gluteal nerves and of perineal branches of minor nerves from the sacral plexus). RESULTS: Posterior perineal block was always effective; optimal to satisfactory intraoperative analgesia was obtained in 379 patients (95.2 percent), whereas in 17 cases (4.2 percent) intravenous analgesic drugs were administered. No conversion to general anesthesia was needed. Urinary retention was 7.8 percent. In our study most of patients (70 percent) reported no pain at all for five to ten hours. Ninety-two percent of patients were discharged in the first 24 hours. CONCLUSIONS: Posterior perineal block allows the surgeon to perform radical hemorrhoidectomies in an overnight-stay regimen with safe and effective intraoperative and postoperative analgesia, sphincter relaxation, and low incidence of urinary retention. Experience of the surgeon combined with careful surgical handling are of great importance for success in this technique.
Assuntos
Anestesia por Condução , Hemorroidas/cirurgia , Bloqueio Nervoso , Adulto , Idoso , Analgésicos Opioides , Buprenorfina , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report two cases of an isolated splenic metastasis, occurring 5 and 3 years, respectively, after gastrectomy for gastric carcinoma. Serum carcinoembryonic antigen and CA 19-9 levels were evaluated preoperatively, postoperatively, and during the oncologic follow-up. The patients underwent splenectomy for solitary splenic metastasis. We conclude that the use of serum carcinoembryonic and CA 19-9 values may help in the early diagnosis of these recurrences and splenectomy allows radical treatment in patients with no evidence of disseminated disease.
Assuntos
Adenocarcinoma/sangue , Adenocarcinoma/secundário , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Neoplasias Esplênicas/sangue , Neoplasias Esplênicas/secundário , Neoplasias Gástricas/sangue , Neoplasias Gástricas/patologia , Adenocarcinoma/diagnóstico , Idoso , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Esplênicas/diagnóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgiaRESUMO
BACKGROUND: In this retrospective investigation the symptoms, signs, and laboratory findings collected in 2 groups of patients with simple and complicated acute appendicitis, respectively, have been observed in order to give some indication for a correct diagnosis and surgical treatment. METHODS: A total of 103 consecutive patients affected by simple and complicated acute appendicitis submitted to surgical operation have been studied. RESULTS: Data collected show statistically significant differences between clinical presentation of simple and complicated acute appendicitis. CONCLUSIONS: The conclusion is draws in that anamnesis and clinical examination of the patients affected by acute appendicitis are the best indications for an exact diagnosis and to select patients who need an immediate operation.
RESUMO
This retrospective study reports the results of our 5-year experience in the diagnosis and treatment of rectal prolapse with fecal incontinence by the abdominal (laparotomy or laparoscopy) and perineal approaches. Twenty-five patients (group A; 22 women and 3 men; mean age 57.3 years; range 22-76 years) were operated on by the abdominal approach and ten (group B; 8 women and 2 men; mean age 68.9 years; range 58-84 years) by the perineal approach. All patients were evaluated by clinical examination, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry, and anal electromyography preparatory to surgery. In patients of group A, we performed an abdominal rectopexy in 19 cases (7 by laparoscopy) and in the remaining 6 cases, a sigmoid resection-rectopexy (3 of which were by laparoscopy). All patients of group B were treated by a perineal operation using Delorme's mucosectomy in 4 cases and Altemeier's rectosigmoidectomy with total perineoplasty in 6 cases. The mean follow-up was 38.8 months in group A and 25.7 months in group B. The postoperative complication rate was 8% (two cases) in group A, whereas no significant complications occurred in group B. Dyschezia and fecal incontinence improved significantly in both groups (P < 0.05 in group A and P < 0.005 in group B), whereas anoperineal pain was not significantly reduced. At 1-year follow-up, the recurrences rates were 8% in group A and 30% in group B. Rectopexy or resection-rectopexy proved to be a safe and effective procedure for external prolapse, without a discernible difference between the laparotomic and laparoscopic techniques. In selected cases, the perineal approach gives good results regarding fecal incontinence without complications, even if in these patients, the likelihood of recurrence is high.
Assuntos
Laparoscopia/métodos , Laparotomia/métodos , Prolapso Retal/cirurgia , Adulto , Idoso , Colo Sigmoide/cirurgia , Feminino , Seguimentos , Motilidade Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Pressão , Reto/cirurgia , Reflexo , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Thoracic hemangiomatosis is an extremely rare condition of the thorax of unknown origin: thin-walled capillary blood vessels infiltrate the lung parenchyma, blood vessels, interlobular septa, bronchiolar walls and pleura. The infiltration of pulmonary veins and venules induces secondary pulmonary veno-occlusive disease and pulmonary hypertension with a slowly progressive clinical course. This condition can be associated with vascular dementia and disseminated intravascular coagulation (DIC).
Assuntos
Hemangioma Capilar/diagnóstico , Neoplasias Pulmonares/diagnóstico , Idoso , Feminino , Hemangioma Capilar/diagnóstico por imagem , Hemangioma Capilar/patologia , Hemangioma Capilar/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , RadiografiaRESUMO
Castleman's disease is rare and can be present in many sites and with a variety of symptoms. Surgery is always recommended for localized lesions to remove the mass as completely as possible, reserving other treatment modalities for unresectable cases.