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1.
Gan To Kagaku Ryoho ; 50(1): 110-112, 2023 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-36760003

RESUMO

The patient underwent partial sigmoid colon resection for sigmoid colon cancer with hyper CEA blood(1,110.6 ng/mL) and concurrent liver metastases mostly in the right lobe of the liver, followed by systemic chemotherapy(SOX plus BEV). Seven courses of chemotherapy resulted in PR on imaging, and CEA was reduced to 5.0 ng/mL, which was within reference values. As he continued chemotherapy, frequent hematologic toxicities and adverse events forced frequent dose reductions and changes in the chemotherapy schedule. About 2 years after surgery(19 courses of SOX plus BEV), the liver metastases became slightly enlarged on imaging, and the CEA was also increasing. The patient did not wish to undergo systemic chemotherapy and requested hepatic arterial infusion chemotherapy(HAIC), which has relatively few side effects and adverse events. HAIC with pyrimidine fluoride alone is ongoing for 22 courses, and tumor markers have decreased again with PR on imaging. Performance status has been good without hematologic toxicity or adverse events for approximately 1 year during the course of HAIC. HAIC is a weakly recommended therapy in the colorectal cancer treatment guidelines, but it is considered one of the most effective therapies with relatively few side effects.


Assuntos
Neoplasias Colorretais , Neoplasias Hepáticas , Neoplasias do Colo Sigmoide , Masculino , Humanos , Fluoruracila , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Infusões Intra-Arteriais , Neoplasias do Colo Sigmoide/tratamento farmacológico , Neoplasias do Colo Sigmoide/cirurgia , Neoplasias do Colo Sigmoide/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/secundário , Artéria Hepática/patologia , Neoplasias Colorretais/cirurgia
2.
J Nippon Med Sch ; 90(1): 64-68, 2023 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-36436915

RESUMO

BACKGROUND: Leakage at the esophagojejunal anastomosis site is an important postoperative complication of total gastrectomy. We analyzed our surgical cases to determine the risk factors for esophagojejunal anastomotic leakage. METHODS: This study included 309 patients who underwent total gastrectomy and esophagojejunal anastomosis. The onset of esophagojejunal anastomotic leakage according to age, gender, performance status, American Society of Anesthesiologists classification, body mass index, presence or absence of diabetes, invasion depth, lymph node metastasis, histological type, presence or absence of esophageal infiltration, operative duration, amount of blood loss, experience of blood transfusion, procedural approach, and the prognostic nutritional index was analyzed. RESULTS: Univariate analyses revealed a significant difference in the rate of esophagojejunal anastomotic leakage due to advanced age, male gender, the presence of diabetes, the presence of esophageal infiltration, and blood loss ≥1,100 g. In the multivariate analysis, which included factors identified in the univariate analyses, advanced age, male gender, the presence of diabetes, and blood loss ≥1,100 g were identified as independent risk factors for esophagojejunal anastomotic leakage. CONCLUSIONS: Advanced age (≥68 years), male gender, diabetes, and massive blood loss are risk factors for esophagojejunal anastomotic leakage.


Assuntos
Fístula Anastomótica , Neoplasias Gástricas , Humanos , Masculino , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Neoplasias Gástricas/cirurgia , Jejuno/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fatores de Risco , Gastrectomia/efeitos adversos , Estudos Retrospectivos
3.
Gan To Kagaku Ryoho ; 50(13): 1459-1461, 2023 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-38303307

RESUMO

The patient is a 74-year-old woman. She had breast cancer(invasive ductal carcinoma, ER[+], PgR[+], HER2[-], Ki-67: 30-40%)and primary right lung cancer with lumbar metastasis, which led to the diagnosis synchronous double cancers of the breast and the lung. We decided to precede surgery for lung cancer because breast cancer was indicated hormonal receptor positive. Breast cancer is treated with anastrozole, thoracoscopic right upper lobectomy was performed for the lung cancer. Radiation therapy was performed for metastatic bone tumors. 13 months later, partial mastectomy sentinel lymph node biopsy performed. The histopathological diagnosis of breast cancer was pT2, pN0, cM0, pStage ⅡA, and histological response was Grade 2a. The remaining breast was treated radiation therapy. The breast cancer has not recurred and is doing well 6 months after surgery. As for primary lung cancer, 19 months have passed since surgery, and the patient is in complete remission without recurrence.


Assuntos
Neoplasias da Mama , Neoplasias Pulmonares , Feminino , Humanos , Idoso , Neoplasias da Mama/cirurgia , Neoplasias da Mama/diagnóstico , Mastectomia , Biópsia de Linfonodo Sentinela , Pulmão/patologia , Neoplasias Pulmonares/cirurgia
4.
Gan To Kagaku Ryoho ; 50(13): 1540-1542, 2023 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-38303334

RESUMO

An 88-year-old man underwent thoracoscopic lower lobectomy for left lung cancer at the age of 87. Ten months later, he was examined closely for abdominal distention, frequent constipation, and anemia with a decreased Hb of 6.1 g/dL. The CT scan revealed an irregular tumor with contrast effect. The patient was diagnosed with malignant tumor of small intestine. At laparotomy, a tumor of 5 cm in diameter was found in the jejunum, and small bowel resection was done. Pathological examination revealed that the tumor was a metastasis of lung cancer. Seven months later, the patient is currently an outpatient, with no evidence of cancer recurrence.


Assuntos
Neoplasias Pulmonares , Masculino , Humanos , Idoso de 80 Anos ou mais , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Recidiva Local de Neoplasia , Intestino Delgado/cirurgia , Intestino Delgado/patologia , Jejuno
5.
J Nippon Med Sch ; 89(5): 487-493, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-35644550

RESUMO

BACKGROUND: Gastric cancer can recur soon after treatment. We evaluated the prognostic nutritional index (PNI), a predictor of postoperative complications, and examined the association of PNI with progression and recurrence of gastric cancer. METHODS: We retrospectively investigated data from 697 patients who had undergone surgery for gastric carcinoma (excluding those with stage IV disease) and analyzed associations of age, sex, performance status (PS), American Society of Anesthesiologists (ASA) classification, diabetes, depth of main tumor (T), lymph node metastasis, postoperative complications, recurrence, and survival with PNI. We also performed multivariate analysis to identify factors associated with survival. RESULTS: PNI significantly decreased with age and was significantly lower in women. PNI was significantly positively correlated with PS. PNI was significantly lower for ≥T2 cancers and in patients with lymph node metastasis. There was no association between postoperative complications and PNI. PNI was significantly lower for patients who developed recurrence than for those who did not. The survival rate was examined for groups with a PNI of ≥45 (high PNI) and <45 (low PNI). Both 5-year overall survival (OS) and cancer-specific survival (CS) were significantly worse for the low PNI group. Multivariate analysis showed that PNI was an independent predictor of OS and CS. CONCLUSIONS: PNI was associated with progression and recurrence of gastric cancer.


Assuntos
Avaliação Nutricional , Neoplasias Gástricas , Humanos , Feminino , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Gastrectomia/efeitos adversos , Metástase Linfática , Prognóstico , Estudos Retrospectivos , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Estado Nutricional
6.
J Nippon Med Sch ; 89(2): 215-221, 2022 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34526465

RESUMO

BACKGROUND: A recent increase in the number of surgeries performed on obese patents has raised several issues. In this study, we examined the effects of obesity on laparoscopic and open distal gastrectomy. METHODS: A total of 262 patients with gastric cancer (cStage I) who underwent distal gastrectomy were classified into open distal gastrectomy (ODG) (145 patients) and laparoscopic distal gastrectomy (LDG) (117 patients) groups. According to their body mass index (BMI), they were subdivided into obese (BMI ≥ 25) and non-obese patients (BMI < 25) to examine the duration of surgery, blood loss, the number of lymph node dissections, postoperative hospital stay, and incidence of postoperative complications. RESULTS: The duration of surgery was longer and blood loss was higher for obese patients than for non-obese patients in both groups. The results for these two endpoints were significantly reduced in the LDG group than in the ODG group both in obese and non-obese patients. Furthermore, the number of lymph nodes dissected tended to be higher in the LDG group than in the ODG group in obese patients. Postoperative hospital stay was not significantly different between obese and non-obese patients in both groups, but was significantly shorter in the LDG group than in the ODG group regardless of the body weight. The incidence of postoperative complications was significantly higher in obese patients than in non-obese patients, although the difference between the groups was not significant. CONCLUSIONS: These findings indicate that LDG may be useful for obese patients with cStage I gastric cancer.


Assuntos
Laparoscopia , Neoplasias Gástricas , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
7.
Gan To Kagaku Ryoho ; 49(13): 1426-1428, 2022 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-36733090

RESUMO

We compared laparoscopic gastrectomy and open gastrectomy for the early gastric cancer. Laparoscopic surgery was comparable to laparotomy in terms of operation time and number of lymph node dissections, significantly less bleeding volume, postoperative hospital stay, and lower postoperative complication rate. As a result of E-PASS, surgical invasion was significantly low and the overall risk score was also significantly low. There was no difference in cancer-specific survival, and overall survival was significantly better with laparoscopic distal gastrectomy. Based on the above, laparoscopic gastrectomy is considered to be superior to open gastrectomy as a surgical technique for the early gastric cancer.


Assuntos
Laparoscopia , Neoplasias Gástricas , Humanos , Resultado do Tratamento , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Excisão de Linfonodo/métodos , Laparoscopia/métodos , Gastrectomia/métodos , Complicações Pós-Operatórias
8.
Gan To Kagaku Ryoho ; 49(13): 1470-1472, 2022 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-36733105

RESUMO

The patient was a 79-year-old man with complaints of defecation difficulties and constipation. CT scan showed a 7.5 cm diameter mass in the lower rectum, and biopsy revealed GIST. MRI findings suggested prostate invasion, and the patient was started treatment with imatinib. Six months later, the tumor shrank to 4.5 cm in diameter. However, the patient refused surgery and continued taking Imatinib. The tumor continued to shrink gradually. Currently, 7 years later at the age of 86, it is only 2 cm in diameter and its inside has almost completely been replaced with calcifications.


Assuntos
Antineoplásicos , Tumores do Estroma Gastrointestinal , Neoplasias Retais , Masculino , Humanos , Idoso , Mesilato de Imatinib/uso terapêutico , Antineoplásicos/uso terapêutico , Reto/patologia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/patologia , Seguimentos , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Benzamidas/uso terapêutico , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia
9.
Gan To Kagaku Ryoho ; 48(1): 115-117, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33468739

RESUMO

A 68-year-old man having a descending colon cancer with multiple metastases of up to 9.5 cm in the right lobe of the liver(T3, N0, M1a)underwent laparoscopic colon resection for anemia control. Chemotherapy with mFOLFOX6 plus Bmab was administered postoperatively. Because this treatment had little effect, FOLFIRI plus Pmab was initiated 3 months later. A significant reduction in the tumor size was observed. Therefore, we performed laparotomy. However, the liver metastasis had invaded the inferior vena cava, which was not resectable. After the second surgery, we introduced the 5-FU hepatic arterial injection port ia plus Pmab iv, which was effective for 8 months. We then restarted chemotherapy with FOLFIRI plus Pmab. However, the tumor became more enlarged; therefore, we changed the chemotherapy regimen to SOX plus Bmab. Partial reduction in the tumor size was observed again, and the effects lasted for a while. The patient continued visiting the outpatient clinic with almost no symptoms for more than 1 year. He died of the primary cancer 3 years and 8 months after the first visit. We report a case of liver metastasis of colon cancer that could have been controlled successfully by repeatedly using the same pharmacotherapy.


Assuntos
Neoplasias do Colo , Neoplasias Hepáticas , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colectomia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Fluoruracila/uso terapêutico , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Masculino
10.
Gan To Kagaku Ryoho ; 48(13): 2058-2060, 2021 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-35045492

RESUMO

The patient was a 29-year-old female with a chief complaint of transient right-sided abdominal pain. A CT scan revealed homogenously contrasted tumor of 4 cm in diameter with smooth margins and clear borders in the lower part of the pancreatic head. The tumor was contrast-enhanced on MRI and stained on abdominal angiography using the proximal branch of the right colonic artery as a feeding vessel. PET scan showed moderate accumulation. Malignancy could not be ruled out, and tumor resection including the ascending colon was performed. The pathological diagnosis was hyaline vascular-type Castleman's disease in the mesentery of the colon.


Assuntos
Hiperplasia do Linfonodo Gigante , Adulto , Angiografia , Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/cirurgia , Feminino , Humanos , Hialina , Mesentério , Tomografia Computadorizada por Raios X
11.
Gan To Kagaku Ryoho ; 47(1): 189-191, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-32381901

RESUMO

We examined the occurrence of complications following gastric cancer surgery in the elderly and its influence on the prognosis of reduction surgery.The study included 805 surgical cases of gastric cancer; elderly, middle-aged, and young patients were examined.In the elderly patients, there was a tendency to undergo reduction surgery.According to the gastric cancer treatment guidelines, 28.9% of the elderly patients, 5.3% of the middle-aged patients, and 0% of the young patients did not satisfy the criteria for lymph node dissection. The incidences of postoperative complications were 25.6%, 23.0%, and 13.4%in the elderly, middle-aged, and young patients, respectively, with a higher tendency seen in elderly patients.In elderly patients, the survival rate was examined separately for each postoperative complication, but no significant difference was noted.Additionally, the survival rate was assessed for the limited surgery and standard surgery groups; however, no significant difference was noted.Therefore, it is recommended that the optimal lymph node dissection range be determined in the elderly with respect to the general condition.


Assuntos
Neoplasias Gástricas , Idoso , Gastrectomia , Humanos , Excisão de Linfonodo , Estadiamento de Neoplasias , Taxa de Sobrevida
12.
Gan To Kagaku Ryoho ; 47(13): 2135-2137, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33468885

RESUMO

In this study, we compared the outcomes of laparoscopic gastrectomy and open gastrectomy in the elderly. Laparoscopic surgery was comparable to laparotomy in terms of the operation time and number of lymph node dissections and was significantly associated with less bleeding volume, duration of postoperative hospital stay, and a lower postoperative complication rate. Surgical invasion and overall risk scores were significantly low as assessed by the Estimation of Physiologic Ability and Surgical Stress(E-PASS)system. Based on these findings, laparoscopic gastrectomy can be considered to be superior to open gastrectomy as a surgical technique for the elderly.


Assuntos
Laparoscopia , Neoplasias Gástricas , Idoso , Gastrectomia , Humanos , Tempo de Internação , Excisão de Linfonodo , Complicações Pós-Operatórias , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
13.
Gan To Kagaku Ryoho ; 46(13): 2482-2484, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-32156972

RESUMO

A 33-year-old man was diagnosed with bowel obstruction due to advanced sigmoid colon cancer and underwent an emergency laparotomy. The sigmoid colon cancer turned out to be unresectable because of firm invasion to the retroperitoneum with severe adhesions and diffuse dissemination. Therefore, unplanned jejunostomy was performed, which was complicated by high-output stoma and short bowel syndrome. His condition was stable enough to receive chemotherapy via parenteral nutrition and parenteral electrolyte solution infusion added to the diet. mFOLFOX6 plus cetuximab therapy was started 4 weeks postoperatively. Although oxaliplatin was discontinued because of worsening numbness, he was sustained without cancer progression by receiving chemotherapy for a year. Chemotherapy was interrupted by a Candida fungemia 13months postoperatively, and he died 4 months later. Patients with jejunostomy may have difficulty absorbing enough water and nutrients in the intestine; therefore, they are at risk of dehydration and electrolyte depletions due to high stomal output, and malnutrition due to the short bowel. These complications may prevent colorectal cancer patients with jejunostomy to be indicated for chemotherapy.


Assuntos
Neoplasias Peritoneais/secundário , Síndrome do Intestino Curto , Neoplasias do Colo Sigmoide , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cetuximab , Fluoruracila , Humanos , Jejunostomia , Leucovorina , Masculino , Compostos Organoplatínicos , Neoplasias Peritoneais/tratamento farmacológico , Síndrome do Intestino Curto/complicações , Neoplasias do Colo Sigmoide/tratamento farmacológico
14.
Gan To Kagaku Ryoho ; 46(13): 2589-2591, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-32157008

RESUMO

We report a case of breast cancer(T4b[skin], N1, M1[lung], ER-, PR-, HER2 3+)in a 63-year-old woman with liver dysfunction of unknown cause(T-Bil 3.6mg/dL, ALP 3,483 U/L, AST 214 U/L, ALT 320 U/L, g / -GTP 1,943 U/L). Further- more, serum CA19-9(4,670 U/mL)and HbA1c(8.8%)levels were both elevated. First, she underwent chemotherapy with trastuzumab and capecitabine. Subsequently, liver dysfunction relieved gradually. CA19-9 and HbA1c levels were also decreased, but the tumor size was NC. Subsequently, trastuzumab, pertuzumab, and docetaxel were administered, as liver function became normal. The tumor shrank significantly after this treatment. Finally, she underwent mastectomy. Five years after the first visit, she has continued chemotherapy, with lung metastases almost scarred(CR).


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Capecitabina , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Receptor ErbB-2 , Trastuzumab
15.
Gan To Kagaku Ryoho ; 45(3): 563-565, 2018 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-29650939

RESUMO

A 61-year-old woman was introduced for consultation with a chief complaint of frequent vomiting. CT revealed a pancreatic body cancer approximately 40mm in size; an invading stenosis from the horizontal part of the duodenum to the jejunum, superior mesenteric artery, and portal vein, splenic vein obstruction, lymphadenopathy, and some ascitic fluid. We diagnosed a passage disorder due to the invasive stenosis from the horizontal part of the duodenum of the pancreatic body cancer to the jejunum, and subsequently performed a duodenum and jejunum bypass operation. We controlled cancer pain with opioid analgesia, and S-1 monotherapy was chosen as the primary chemotherapy. A tendency to increase and the cancer pain of the tumor was aggravated when 5 courses took effect, so gemcitabine plus nab-paclitaxel(GEM plus nab-PTX)therapy was chosen as the second-line chemotherapy because of adverse Grade 3 events due to difficulties with S-1 internal use. We tapered off the opioid analgesia dosage because the cancer pain was relieved after 1 course. The imaging top indicated stable disease at the end of 5 courses, but the pain was relieved so opioid pain killers were unnecessary. Foreign continuation is under treatment with 10-course GEM plus nab-PTX therapy after initial diagnosis. Currently, the patient has undergone 5 courses of S-1 for approximately 18 months, and has achieved stable disease. The only adverse events were nausea, fatigue, Grade 1 malaise, and Grade 2 alopecia, as detected with imaging.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pancreáticas/tratamento farmacológico , Albuminas/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Paclitaxel/administração & dosagem , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Resultado do Tratamento , Gencitabina
16.
Gan To Kagaku Ryoho ; 45(13): 1925-1927, 2018 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-30692399

RESUMO

The is a case involving a 55-year-old man with advanced rectal cancer(type 3). MRI showed urinary tract and regional lymph node metastases without distant metastasis. The tumor was reduced(PR)after neoadjuvant chemotherapy(mFOL FOX6 plus Bmab, 4 courses). The patient underwent an abdominoperineal resection. Because infiltration of the tumor into the lower urinary tract was deep, it was also resected and repaired. The clip was placed to mark the repaired region. Pathological examination revealed that excision stump at the anterior wall of the urethra was cancer positive without lymph node metastasis. He was then administered chemotherapy(mFOLFOX6 4 courses)and irradiated 60 Gy in both sides of the inguinal lymph node to prevent metastasis to the pelvicdomain. One year and 6 months postoperatively, as the left inguinal lymph node swelled at 3.7 cm irregularly, he further received chemotherapy(FOLFIRI 8 courses). The size of the lymph node became normal with a good response to FOLFIRI. Six years postoperatively, he remains alive and well with no evidence of recurrence.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Retais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia
17.
Surg Infect (Larchmt) ; 15(3): 256-61, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24810804

RESUMO

BACKGROUND: Since 2005, we have been conducting prospective surgical site infection (SSI) surveillance and infection control according to the U.S. Centers for Disease Control and Prevention guidelines for patients who undergo gastrointestinal surgery at our institution. Surgical site infection occurs with greater frequency in emergency than in elective surgery because of factors such as ill-conceived preoperative preparation and "dirty" operations. A large number of studies have been reported on risk factors for SSI in elective colorectal surgery; however, there are few papers on such factors in emergency colorectal surgery. The aim of this study was to identify risk factors for incisional SSI in emergency colorectal surgery. METHODS: Using our SSI surveillance database, we analyzed retrospectively 78 patients who underwent emergency colorectal surgery between 2005 and 2010. Univariable and multivariable analyses were used to identify risk factors for incisional SSI. Moreover, we subclassified dirty-infected operations (class IV) by the extent of contamination according to our own definition to study the incidence of incisional SSI at each degree. RESULTS: The incidence of incisional SSI was 32.1% (25/78 patients). By univariable analysis, seven parameters correlated with a higher risk of incisional SSI: Surgical incision class III-IV, obesity (body mass index ≥25 kg/m(2)), American Society of Anesthesiologists score 3 or 4 points, chronic kidney disease (serum creatinine concentration >1.2 mg/dL), blood loss ≥200 mL, blood transfusion, and ventilator support. Multivariable analyses showed that surgical incision class III-IV (odds ratio [OR] 5.9; 95% confidence interval [CI] 1.7, 25.2) and obesity (OR 11.9; 95% CI 2.1, 87.8) were independent risk factors for incisional SSI. The incidence of incisional SSI in colon perforation with generalized contamination was statistically higher than that in prepared colon perforation and colon perforation with localized contamination (82.4% vs. 25.0%; p<0.001). CONCLUSIONS: The risk factors for incisional SSI in emergency colorectal surgery were incision contamination and obesity. Moreover, the incidence of incisional SSI among the incision class IV operations increased significantly with increasing extents of contamination. As a tactic for management of dirty abdominal wounds, we suggest that primary skin closure is suitable in cases of perforation of a prepared colon or colon perforation with localized contamination. On the other hand, in cases of colon perforation with generalized contamination, delayed primary skin closure or leaving an incision open to heal by secondary intention should be considered.


Assuntos
Cirurgia Colorretal/efeitos adversos , Serviços Médicos de Emergência/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
18.
J Nippon Med Sch ; 80(6): 470-4, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24419721

RESUMO

True splenic cysts are uncommon and are associated with elevated serum and intracystic tumor marker CA 19-9 levels. A 33-year-old woman presented to our hospital with a chief complaint of epigastralgia. Computed tomography of the abdomen showed a 10-cm cystic lesion in the spleen. The serum carbohydrate antigen (CA) 19-9 level was 3,347 U/mL (normal, <37 U/mL). Total laparoscopic splenectomy was performed, and the serum level of CA 19-9 had normalized 2 weeks later. Pathological examination showed a benign true epidermal cyst of the spleen with strong immunohistological staining for CA 19-9. Splenic epidermoid cysts most often occur in young women, and laparoscopic surgery to remove cysts of this type is minimally invasive. Thus, laparoscopic surgery should be the method of first choice for most cases of splenic benign true cyst.


Assuntos
Antígeno CA-19-9/sangue , Cisto Epidérmico/sangue , Cisto Epidérmico/cirurgia , Laparoscopia , Baço/patologia , Baço/cirurgia , Adulto , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Feminino , Humanos , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
Med Sci Monit ; 18(7): CS53-6, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22739738

RESUMO

BACKGROUND: Late-onset and solitary recurrence of gastric signet ring cell (SRC) carcinoma is rare. We report a successful surgical resection of late solitary locoregional recurrence after curative gastrectomy for gastric SRC carcinoma. CASE REPORT: The patient underwent total gastrectomy for advanced gastric carcinoma at age 52. Seven years after the primary operation, he visited us again with sudden onset of abdominal pain and vomiting. We finally decided to perform an operation, based on a diagnosis of colon obstruction due to the recurrence of gastric cancer by clinical findings and instrumental examinations. The laparotomic intra-abdominal findings showed that the recurrent tumor existed in the region surrounded by the left diaphragm, colon of splenic flexure, and pancreas tail. There was no evidence of peritoneal dissemination, and peritoneal lavage fluid cytology was negative. We performed complete resection of the recurrent tumor with partial colectomy, distal pancreatectomy, and partial diaphragmectomy. Histological examination of the resected specimen revealed SRC carcinoma, identical in appearance to the previously resected gastric cancer. We confirmed that the intra-abdominal tumor was a locoregional gastric cancer recurrence in the stomach bed. The patient showed a long-term survival of 27 months after the second operation. CONCLUSIONS: In the absence of effective alternative treatment for recurrent gastric carcinoma, surgical options should be pursued, especially for late and solitary recurrence.


Assuntos
Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Estômago/patologia , Estômago/cirurgia , Enema , Gastrectomia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Mucinas/metabolismo , Fenótipo , Estômago/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Med Sci Monit ; 17(1): CS8-11, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21169914

RESUMO

BACKGROUND: Spontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively. CASE REPORT: A 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery. CONCLUSIONS: A more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient's general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.


Assuntos
Ductos Biliares Extra-Hepáticos/lesões , Drenagem/métodos , Idoso , Colecistectomia , Drenagem/instrumentação , Feminino , Humanos , Laparotomia , Ruptura Espontânea
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