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3.
Surg Endosc ; 36(9): 6535-6542, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35041052

RESUMO

BACKGROUND: Common bile duct stones (CBDSs) occasionally cause serious diseases, and endoscopic extraction is the standard procedure for CBDS. To prevent biliary complications, cholecystectomy is recommended for patients who present with gallbladder (GB) stones after endoscopic CBDS extraction. However, CBDS can occasionally recur. To date, the occurrence of CBDS after endoscopic CBDS extraction and subsequent cholecystectomy is not fully understood. Hence, the current study aimed to evaluate the incidence of postoperative CBDSs. METHODS: This retrospective observational study included consecutive patients who underwent postoperative endoscopic retrograde cholangiography after endoscopic CBDS extraction and subsequent cholecystectomy between April 2012 and June 2021 at our institution. After endoscopic CBDS extraction, a biliary plastic stent was inserted to prevent obstructive cholangitis. Endoscopic retrograde cholangiography was performed to evaluate postoperative CBDSs after cholecystectomy until hospital discharge. The outcomes were the incidence of postoperative CBDSs and CBDSs/sludge. Moreover, the predictive factors for postoperative CBDSs were evaluated via univariate and multivariate analyses. RESULTS: Of eligible 204 patients, 52 patients (25.5%) presented with postoperative CBDSs. The incidence rate of CBDS/sludge was 36.8% (n = 75). Based on the univariate analysis, the significant predictive factors for postoperative CBDSs were ≥ 6 CBDSs, presence of cystic duct stones, and ≥ 10 GB stones (P < 0.05). Moreover, male sex and < 60-mm minor axis in GB might be predictive factors (P < 0.10). Based on the multivariate analysis, ≥ 6 CBDSs (odds ratio = 6.65, P < 0.01), presence of cystic duct stones (odds ratio = 4.39, P < 0.01), and ≥ 10 GB stones (odds ratio = 2.55, P = 0.01) were independent predictive factors for postoperative CBDSs. CONCLUSIONS: The incidence of postoperative CBDS was relatively high. Hence, patients with predictive factors for postoperative CBDS must undergo imaging tests or additional endoscopic procedure after cholecystectomy.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia/efeitos adversos , Ducto Colédoco , Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Esgotos , Esfinterotomia Endoscópica/métodos
4.
Nihon Shokakibyo Gakkai Zasshi ; 118(3): 251-257, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33692259

RESUMO

In a 67-year-old man, colonoscopy confirmed the presence of a 5-6mm submucosal tumor in the upper rectum (Ra);the tumor showed a tendency to grow with the size appearing to be 9-10mm at re-examination that was performed 1 year thereafter. No findings on computed tomography indicated metastasis. A neuroendocrine tumor (NET) was suspected, and endoscopic submucosal dissection was performed. The patient was pathologically diagnosed with coexistence of NETG1 and a well-differentiated adenocarcinoma. Few reports have described the coexistence of relatively low-grade NETG1 and an adenocarcinoma in the Ra, and such an occurrence is considered rare. The patient has shown no recurrence at 3 years and 2 months postoperatively.


Assuntos
Adenocarcinoma , Ressecção Endoscópica de Mucosa , Tumores Neuroendócrinos , Neoplasias Retais , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Humanos , Masculino , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia
5.
Pathol Int ; 70(10): 786-792, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32803839

RESUMO

We describe an extremely rare case of simultaneous double melanoma of the stomach with no other obvious primary source. The patient has survived for more than 12 years post-complete gastrectomy. The patient was a woman in her seventies who was referred for anemia by another clinic. Esophagogastroscopy revealed an ulcerated gastric tumor that was diagnosed as a gastrointestinal stromal tumor (GIST) by endoscopic biopsy. She was admitted to our hospital for further examination and treatment. Gastroscopy at our institution revealed two submucosal tumors in the gastric wall. Since no metastatic lesions were detected after systemic exploration, multiple GIST of the stomach was diagnosed, and a total gastrectomy was performed. Malignant melanoma was diagnosed in both lesions by a histopathological study of the resected stomach. The patient's postoperative progress was good, and thorough examination of the skin did not result in the discovery of any systemic neoplastic lesions which could be regarded as the source for the primary tumor. No anticancer treatments were used. The patient has survived, with no recurrence for over ten years postsurgery. Strong evidence is presented in this case for the diagnosis and treatment of gastric malignant melanoma.


Assuntos
Tumores do Estroma Gastrointestinal/secundário , Melanoma/secundário , Neoplasias Primárias Desconhecidas , Neoplasias Gástricas/secundário , Idoso , Sobreviventes de Câncer , Feminino , Gastrectomia , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Melanoma/diagnóstico , Melanoma/cirurgia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
6.
Anaesth Intensive Care ; 47(2): 175-182, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31112037

RESUMO

Avoiding hypoxaemia is considered crucial in cardiac surgery patients admitted to the intensive care unit (ICU). However, avoiding hyperoxaemia may also be important. A conservative approach to oxygen therapy may reduce exposure to hyperoxaemia without increasing the risk of hypoxaemia. Using a before-and-after design, we evaluated the introduction of conservative oxygen therapy (target SpO2 88%-92% using the lowest FiO2) for cardiac surgical patients admitted to the ICU. We studied 9041 arterial blood gas (ABG) datasets: 4298 ABGs from 245 'conventional' and 4743 ABGs from 298 'conservative' oxygen therapy patients. During mechanical ventilation (MV) and while in the ICU, compared to the conventional group, conservative group patients had significantly lower FiO2 exposure and PaO2 values ( P < 0.001 for each). Accordingly, using the mean PaO2 during MV, more conservative group patients were classified as normoxaemic (226 versus 62 patients, P < 0.01), fewer as hyperoxaemic (66 versus 178 patients, P < 0.01) and no patient in either group as hypoxaemic or severely hypoxaemic. Moreover, more ABG samples were hyperoxaemic or severely hyperoxaemic during conventional treatment ( P < 0.001). Finally, there was no difference in ICU or hospital length of stay, ICU or hospital mortality or 30-day mortality between the groups. Our findings support the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU after cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Oxigenoterapia , Oxigênio , Humanos , Hipóxia , Unidades de Terapia Intensiva , Oxigenoterapia/métodos , Respiração Artificial
7.
Crit Care Med ; 46(6): 935-942, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29509570

RESUMO

OBJECTIVES: To assess the feasibility, biochemical efficacy, and safety of liberal versus conventional glucose control in ICU patients with diabetes. DESIGN: Prospective, open-label, sequential period study. SETTING: A 22-bed mixed ICU of a tertiary hospital in Australia. PATIENTS: We compared 350 consecutive patients with diabetes admitted over 15 months who received liberal glucose control with a preintervention control population of 350 consecutive patients with diabetes who received conventional glucose control. INTERVENTIONS: Liberal control patients received insulin therapy if glucose was greater than 14 mmol/L (target: 10-14 mmol/L [180-252 mg/dL]). Conventional control patients received insulin therapy if glucose was greater than 10 mmol/L (target: 6-10 mmol/L [108-180 mg/dL]). MEASUREMENTS AND MAIN RESULTS: We assessed separation in blood glucose, insulin requirements, occurrence of hypoglycemia (blood glucose ≤ 3.9 mmol/L [70 mg/dL]), creatinine and white cell count levels, and clinical outcomes. The median (interquartile range) time-weighted average blood glucose concentration was significantly higher in the liberal control group (11.0 mmol/L [8.7-12.0 mmol/L]; 198 mg/dL [157-216 mg/dL]) than in the conventional control group (9.6 mmol/L [8.5-11.0 mmol/L]; 173 mg/dL [153-198 mg/dL]; p < 0.001). Overall, 132 liberal control patients (37.7%) and 188 conventional control patients (53.7%) received insulin in ICU (p < 0.001). Hypoglycemia occurred in 6.6% and 8.6%, respectively (p = 0.32). Among 314 patients with glycated hemoglobin A1c greater than or equal to 7%, hypoglycemia occurred in 4.1% and 9.6%, respectively (p = 0.053). Trajectories of creatinine and white cell count were similar in the groups. In multivariable analyses, we found no independent association between glucose control and mortality, duration of mechanical ventilation, or ICU-free days to day 30. CONCLUSIONS: In ICU patients with diabetes, during a period of liberal glucose control, insulin administration, and among patients with hemoglobin A1c greater than or equal to 7%, the prevalence of hypoglycemia was reduced, without negatively affecting serum creatinine, the white cell count response, or other clinical outcomes. (Trial Registration: Australian New Zealand Clinical Trials Registry; ACTRN12615000216516).


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Unidades de Terapia Intensiva , Idoso , Estudos Controlados Antes e Depois , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
8.
Nihon Shokakibyo Gakkai Zasshi ; 109(4): 615-23, 2012 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-22481263

RESUMO

Computed tomography colonography (CTC) was performed in 5 patients with pneumatosis cystoides intestinalis (PCI). The virtual colonoscopy view of CTC as well as total colonoscopy (TCS) findings showed polypoid lesions in the colon, and multiplanar reconstruction images of the colon revealed in the polypoid lesions of the colon. We confirmed the diagnosis of PCI in all cases. CTC also detected the PCI lesions in the subserosa of the colonic wall which were not detected by TCS. Accurate evaluation of the extent of PCI involvement was obtained by CT air-contrast enema images. CTC is useful for detection of PCI lesions, assessment of the exact site and final diagnosis for PCI.


Assuntos
Colonografia Tomográfica Computadorizada , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Adolescente , Idoso , Humanos , Masculino , Pessoa de Meia-Idade
9.
Case Rep Gastroenterol ; 6(3): 754-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23341797

RESUMO

A 56-year-old woman with a history of gynecological surgery for cervical cancer 18 years previously was referred to our hospital for colicky abdominal pain, nausea and vomiting. Intestinal obstruction was diagnosed by contrast-enhanced computed tomography (CT) which showed dilation of the small intestine and suggested obstruction in the terminal ileum. In addition, CT showed a thick-walled cavitary lesion communicating with the proximal jejunum. (18)F-fluorodeoxyglucose positron emission tomography showed abnormal uptake at the same location as the cavitary lesion revealed by CT. The patient underwent laparotomy for the ileus and resection of the cavitary lesion. At laparotomy, we found a retained surgical sponge in the ileum 60 cm from the ileocecal valve. The cavitary tumor had two fistulae communicating with the proximal jejunum. The tumor was resected en bloc together with the transverse colon, part of the jejunum and the duodenum. Microscopic examination revealed fibrous encapsulation and foreign body giant cell reaction. Since a retained surgical sponge without radiopaque markers is extremely difficult to diagnose, retained surgical sponge should be considered in the differential diagnosis of intestinal obstruction in patients who have undergone previous abdominal surgery.

10.
Gastrointest Endosc ; 72(2): 255-64, 264.e1-2, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20541198

RESUMO

BACKGROUND: Endoscopic submucosal dissection (ESD) was originally developed in Japan for en bloc resection of gastric neoplasms. OBJECTIVE: To clarify whether the novel ESD procedure is feasible and gives results that justify the pursuit of integrated minimally invasive procedures aimed at curing early squamous cell carcinoma of the esophagus (SCCE). DESIGN: Retrospective cohort study. SETTING: A single-institution trial by experienced endoscopists. PATIENTS: This study involved 300 consecutively enrolled patients with SCCE (Tumor, Nodes, Metastasis classification T1, N0) who underwent either EMR (n = 184) or ESD (n = 116) from March 1994 to July 2007. INTERVENTION: The patients underwent endoscopic resection and then were followed by periodic endoscopy for 8 to 174 months (mean 65 months). MAIN OUTCOME MEASUREMENTS: Resectability, cure rates, complications, disease-free survival of the two groups, and risk factors for local recurrence were explored. RESULTS: En bloc resection and the local recurrence rate were significantly better in the ESD group (P = .0009 and .065, respectively). The frequency of perforation was not significantly different between the two groups (P = .68). Four independent risk factors for local recurrence were identified by the Cox regression model: EMR, deep cancer invasion, upper esophagus location, and family history of esophageal cancer. Radical cure is mostly obtained by successful endoscopic retreatment of local recurrence after previous endoscopic resection. Disease-free survival was significantly better with ESD. LIMITATIONS: The study's retrospective nature prevents definitive conclusions. CONCLUSIONS: We provide evidence that ESD gives a higher cure rate and is safer than conventional endoscopic resection when applied to early SCCE. ESD warrants prospective comparative studies with conventional endoscopic resection.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Dissecação/métodos , Diagnóstico Precoce , Endoscopia Gastrointestinal/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Mucosa Intestinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidade , Intervalo Livre de Doença , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Gravação em Vídeo
11.
Nihon Shokakibyo Gakkai Zasshi ; 107(5): 750-9, 2010 May.
Artigo em Japonês | MEDLINE | ID: mdl-20460849

RESUMO

A 59-year-old woman, who was given a diagnosis of portal vein aneurysm at another hospital 2 years previously, visited our institution complaining of abdominal pain in November 2005. Abdominal imaging including computed tomography and ultrasonography demonstrated that the portal vasculature had dilated to 5 cm in maximum dimension and its center was at the junction of the superior mesenteric vein and the splenic vein. Moreover, a large thrombus was seen in the portal vein, the superior mesenteric vein and the splenic vein. She was conservatively followed-up with warfarin. After 6 months, angiography revealed cavernous transformation around the portal vein was found with collateral flow toward the liver. At the time of writing the patient's condition is stable with neither extension of the thrombus nor constriction of the esophageal varices.


Assuntos
Aneurisma/complicações , Veia Porta , Trombose/complicações , Feminino , Humanos , Pessoa de Meia-Idade
12.
Nihon Shokakibyo Gakkai Zasshi ; 105(6): 847-53, 2008 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-18525192

RESUMO

A tumor, which was 10 cm in diameter, was found in the lateral segment of the liver of a 42-year-old man in October, 2004. The lesion was clinically diagnosed as focal nodular hyperplasia (FNH). In March, 2006, the patient admitted our hospital complaining epigastralgia, back pain, and fever. Hemorrhage and necrotic region was revealed within the tumor, hence lateral segmentectomy was carried out. The lesion was pathologically diagnosed as a telangiectatic FNH (T-FNH). A possibility that hemorrhage or necrosis may be induced within a T-FNH during its progress should be taken into consideration.


Assuntos
Hiperplasia Nodular Focal do Fígado/complicações , Hiperplasia Nodular Focal do Fígado/patologia , Hemorragia/etiologia , Hepatopatias/etiologia , Telangiectasia/complicações , Telangiectasia/patologia , Adulto , Diagnóstico por Imagem , Hiperplasia Nodular Focal do Fígado/diagnóstico , Hiperplasia Nodular Focal do Fígado/cirurgia , Humanos , Masculino , Necrose , Telangiectasia/diagnóstico , Telangiectasia/cirurgia
13.
Am J Clin Oncol ; 27(6): 644-5, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15577449

RESUMO

Ectopic (heterotopic) gastric mucosa (EGM) of the upper esophagus, referred as inlet patch, is an asymptomatic benign lesion that is often detected during endoscopic examination. Although it is considered a source of adenocarcinoma in the upper esophagus, only 17 cases of adenocarcinoma have been reported previously. We report a rare case of adenocarcinoma arising in EGM of the cervical esophagus.


Assuntos
Adenocarcinoma/diagnóstico , Coristoma/diagnóstico , Neoplasias Esofágicas/diagnóstico , Mucosa Gástrica , Humanos , Masculino , Pessoa de Meia-Idade
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