RESUMO
Between 1987 and 2000, 111 patients with epidermoid anal cancer (T1-T4 Nx M0) were assigned to primary simultaneous radiochemotherapy (RCT) with a radiation dose of 45 Gy, performed either as a split course with 2-Gy single fractions (schedule A, 1987-1996, n = 65 patients) or continuously with fractions of 1.8 Gy (schedule B, 1996-2000; n = 38 patients). The chemotherapy consisted of continuous infusions of 5-fluorouracil (5-FU; 800/1,000 mg/m(2)/day, on 4/5 consecutive days, during weeks 1 and 5) together with one (schedule A) or two (schedule B) short infusions of mitomycin C (10 mg/m(2)) during the first course of 5-FU. Associations between clinical outcome and various prognostic factors were assessed in 103 patients who completed these schedules. For both patient groups combined, 5-year local control rate was 67% and 5-year survival rate 71%. Advanced tumor stage, size, and nodal status significantly decreased the 5-year local control rate as well as the overall treatment time (OTT) >41 days (58% for OTT >41 days vs. 79% for OTT < or =41 days; p = 0.04). However, we did not find a correlation with the prescribed radiotherapy schedule (A or B). In conclusion, in patients with anal carcinomas treated with RCT with a radiation dose of 45 Gy, the predominant determinant of local control is the resulting OTT and not the administration schedule (split course or continuous radiotherapy).
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Ânus/mortalidade , Carcinoma Adenoescamoso/mortalidade , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células de Transição/mortalidade , Recidiva Local de Neoplasia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Ânus/tratamento farmacológico , Neoplasias do Ânus/patologia , Neoplasias do Ânus/radioterapia , Carcinoma Adenoescamoso/tratamento farmacológico , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/radioterapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/radioterapia , Terapia Combinada , Intervalo Livre de Doença , Esquema de Medicação , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Doses de Radiação , Análise de Sobrevida , Suíça , Resultado do TratamentoAssuntos
Ampola Hepatopancreática/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Duodenopatias/diagnóstico , Cálculos Biliares/cirurgia , Perfuração Intestinal/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Abscesso/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Masculino , Reoperação , Espaço Retroperitoneal , Tomografia Computadorizada por Raios XRESUMO
New methods of visualisation of the cysts like ultrasonography, computertomography and endoscopy make a praeoperative diagnosis possible. Because of the malignant potential of the cyst resection is now the treatment of choice instead of cystenterostomy which was formerly used.
Assuntos
Doenças do Ducto Colédoco/congênito , Cistos/congênito , Adulto , Anastomose em-Y de Roux , Colangiopancreatografia Retrógrada Endoscópica , Doenças do Ducto Colédoco/cirurgia , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Jejuno/cirurgia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Thirty-six patients were treated for severe acne conglobata. Wide and deep excision of the affected area should be followed by wound closure, primary or secondary, depending on the body region involved.
Assuntos
Acne Vulgar/cirurgia , Adolescente , Adulto , Drenagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Técnicas de Sutura , CicatrizaçãoRESUMO
After ligation of the mesenteric arteries an intestinal ischaemia was obtained. Endotoxin was measured from the peritoneal cavity, the portal und the peripheral blood. The limulus test for Endotoxin was used after phenol-water-extraction of the plasma. Microbiological investigations were done simultaneously. The endotoxin concentrations correlated to the clinical state of gram negative sepsis.
Assuntos
Endotoxinas/análise , Bactérias Gram-Negativas/isolamento & purificação , Infarto/microbiologia , Mesentério/irrigação sanguínea , Sepse/microbiologia , Animais , Cães , Endotoxinas/sangue , Feminino , Ligadura , Teste do Limulus , Masculino , Artérias Mesentéricas , Cavidade Peritoneal/análiseRESUMO
Fecal peritonitis was produced by a sphincter-system leading to intestinal perforation. In 10 beagle dogs endotoxin was measured with the Limulus test. There was a correlation between endotoxin appearance and microbiological findings in the peritoneal cavity and in the blood. Endotoxinaemia correlated with the clinical severity of peritonitis.
Assuntos
Infecções Bacterianas/microbiologia , Endotoxinas/sangue , Peritonite/microbiologia , Choque Séptico/microbiologia , Animais , Líquido Ascítico/microbiologia , Bactérias/isolamento & purificação , Cães , Fezes/microbiologia , Perfuração Intestinal/microbiologia , Teste do LimulusRESUMO
Experience obtained from acid burns in 60 adult patients is reported in this paper. Twelve of them died, while 48 received conservative treatment, and twelve underwent surgery. Attempted suicide accounted for the highest number and severity of those accidental injuries. The therapeutic approach should be chosen on earliest possible endoscopy. Trends towards exploratory laparotomy and blind oesophagus stripping are described, and the problem of conservative therapy is discussed.
Assuntos
Ácidos/intoxicação , Álcalis/intoxicação , Queimaduras Químicas/patologia , Esôfago/lesões , Estômago/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagoscopia , Esôfago/patologia , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estômago/patologiaRESUMO
Between 1980 to 1985 in ten patients with complete anal incontinence the autologous muscle graft introduced by Schmidt has been used. The operative results obtained were good for satisfactory in nine patients whereas in one patient the operation failed.
Assuntos
Incontinência Fecal/cirurgia , Retalhos Cirúrgicos , Adulto , Incontinência Fecal/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnósticoRESUMO
Endotoxin has been measured in the blood and peritoneal fluid from 28 patients with diffuse peritonitis after intestinal perforation, intestinal obstruction or mesenteric infarction. Phenol-Water-Extraction for plasma preparation has been used. Endotoxin in correlated with the clinical state in these patients.
Assuntos
Endotoxinas/metabolismo , Bactérias Gram-Negativas , Peritonite/metabolismo , Adolescente , Adulto , Idoso , Técnicas Bacteriológicas , Criança , Feminino , Humanos , Obstrução Intestinal/complicações , Perfuração Intestinal/complicações , Teste do Limulus , Masculino , Oclusão Vascular Mesentérica/complicações , Pessoa de Meia-Idade , Peritonite/cirurgia , Infecção da Ferida Cirúrgica/metabolismoRESUMO
A sphincter system for intermittent intestinal occlusion in conscious dogs is presented. The system consists of a hydropneumatic system and a percutaneous lead implanted in the neck of the animal. In 14 long-time experiments (24-40 days) the system was well tolerated by the dogs and no failure was accounted.
Assuntos
Obstrução Intestinal/fisiopatologia , Próteses e Implantes , Animais , Estado de Consciência , Modelos Animais de Doenças , Cães , Chumbo , Elastômeros de SiliconeRESUMO
Tests for the presence of endotoxin in blood and peritoneal fluid were performed at short intervals in 19 patients with peritonitis, 9 following gastric perforation, and 10 with perforation of the large bowel. A highly sensitive precipitation technique (LAL test) was used. Endotoxin was demonstrated in peritoneal fluid during the early stage of peritonitis in 15 of 19 patients (79%), while blood determination revealed endotoxin in 7 of 19 cases within the first 48 h. During the clinical course circulating endotoxin was recovered in 12 of 19 patients, which implies endotoxinemia in 63% of the cases. The prognostic significance of endotoxin determinations was high, since circulating endotoxin was demonstrated within the first 72 h in 8 of 9 patients with a fatal course. Demonstration of circulating endotoxin is a time-consuming and complicated procedure with great clinical significance in patients with gram-negative peritonitis.
Assuntos
Infecções Bacterianas/microbiologia , Endotoxinas/sangue , Peritonite/microbiologia , Adulto , Idoso , Líquido Ascítico/análise , Infecções Bacterianas/patologia , Temperatura Corporal , Endotoxinas/análise , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Peritonite/patologia , PrognósticoAssuntos
Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Pancreatite/cirurgia , Adulto , Doença Crônica , Doenças do Ducto Colédoco/etiologia , Doenças do Ducto Colédoco/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicaçõesAssuntos
Neoplasias Retais/radioterapia , Idoso , Feminino , Humanos , Masculino , Prognóstico , Dosagem Radioterapêutica , Neoplasias Retais/cirurgiaRESUMO
A case of fatal cervical dislocation in a front seat passenger restrained by a retractable three-point belt is described. A biomechanical and technical analysis is given.
Assuntos
Vértebras Cervicais/lesões , Luxações Articulares/etiologia , Cintos de Segurança/efeitos adversos , Acidentes de Trânsito , Adolescente , Adulto , Desaceleração/efeitos adversos , Feminino , Humanos , MasculinoAssuntos
Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Anestesia Local , Berlim , Criança , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidadeRESUMO
1. Depending on the operative trauma, insulin secretion is decreased until the 10th day after abdominal surgery. 2. The decreased insulin release is caused by a diminished discharge from the pancreatic beta cell during the second phase of insulin secretion (partially newly synthesized insulin). Insulin release during the early phase of insulin secretion (prestored insulin) is unchanged or even accelerated. 3. The glucose tolerance level is pathologically diminished until the 10th postoperative day.
Assuntos
Glicemia/análise , Hiperglicemia/etiologia , Insulina/metabolismo , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Feminino , Humanos , Hiperglicemia/metabolismo , Insulina/biossíntese , Secreção de Insulina , Masculino , Veia Porta , Período Pós-Operatório , VeiasRESUMO
In this study it is reported about operative mortality and long-term results of surgery of gastric carcinoma in patients over the age of 70 years. The operative mortality in 50 patients with a distal partial gastrectomy was 16%, the mortality in 24 patients with total gastrectomy was 33.3% and in 14 patients with a proximal gastrectomy the mortality was 28%. The main cause of death (40%) was a pneumonia. There was no correlation between frequency of pneumonia and preoperative results of measurement of lung function. Only advanced arteriosclerotic disease in the heart and brain has a fatal influence on mortality rate. In the old patients the long-term results are determined by the staging of the tumor at the time of operation, too. In the 60 patients, who had left the hospital and who are in our control, the half year survival rate was 78.3%, the 1-year survival rate was 58.3% and the 2-years survival rate is exceeding 41.6%. 14 patients of the 17, who are still alive and who are after 2 1/2 years again explored, are in a very good condition. In comparison with the literature it is to conclude that for the indication to surgery of gastric carcinoma there is important not only the real age of the patient but rather the biological and mental condition of the patient.
Assuntos
Neoplasias Gástricas/cirurgia , Fatores Etários , Idoso , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pneumonia/mortalidade , Complicações Pós-Operatórias/mortalidade , Prognóstico , Fatores de TempoRESUMO
Three cases of benign liver tumors in young women are reported in addition to 58 cases in the literature. Uncharacteristic pains in the upper abdomen and general weakness were the main symptoms. The most valuable diagnostic examination is selective angiography. Liver resection was successful in these cases. Elective surgery is advocated because massive bleeding with high lethality may occur. Histologically focal nodular hyperplasia was found and all three had taken oral contraceptives.