RESUMO
Introducción. La utilización de material protésico en el tratamiento de la hernia inguinal es cada vez más frecuente. Presentamos nuestra experiencia con la hernioplastia abierta sin tensión de Lichtenstein mediante malla de polipropileno. Pacientes y métodos. Se analizan 233 hernioplastias de Lichtenstein efectuadas en 189 pacientes. La técnica anestésica fue regional en el 95 por ciento de los pacientes, general en el 3 por ciento y local en un 2 por ciento.Al comienzo de la serie, se introdujo una pequeña variante técnica para reforzar la fascia transversalis en caso de observar debilidad de la misma. Resultados. No hubo mortalidad operatoria. El tiempo quirúrgico medio fue de 45 min y la estancia hospitalaria media de 3 días. La morbilidad global fue de un 9 por ciento. Han sido reintervenidos 3 pacientes (1,5 por ciento), dos por hematoma y uno para retirar la malla por infección persistente. No se ha detectado ninguna recidiva tras un período de seguimiento mínimo de 4 meses (4-17 meses) del 96 por ciento de los pacientes ni tampoco durante el mismo. La sutura continua de la fascia transversalis dificultó el inicio de la deambulación de los primeros pacientes de la serie. Conclusiones. La hernioplastia de Lichtenstein con malla de polipropileno es una técnica sencilla, que aporta unos excelentes resultados en morbilidad y recidiva, y proporciona una rápida recuperación de los pacientes por la ausencia de tensión en la línea de sutura. Reforzar la fascia transversalis con una sutura continua puede dificultar el inicio de la deambulación en los pacientes (AU)
Assuntos
Humanos , Hérnia Inguinal/cirurgia , Telas CirúrgicasRESUMO
A series of 13 patients with primary gastric lymphoma treated between 1981 and 1990 are presented. Primary gastric lymphoma made up 4.8% of all gastric tumors treated during this period of time. Histologically, there were 3 lymphoplasmocytoid and 3 centroblastic forms (according to Kiel's classification) followed by 2 lymphocytic and 2 centrocytic-centroblastic. According to Mushoff's classification. 4 patients belonged to stage I E, 3 to II E1, 3 to II E2, 2 to III E, and one patient to stage IV E. In all cases gastrectomy was performed (9 subtotal and 4 total) although 3 out the former were palliative (23%). The operative morbidity was 30.7% and the mortality 7.7%. Seven patients received additional treatment with chemotherapy. Survival after 2 years was 70%.
Assuntos
Linfoma não Hodgkin/patologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Feminino , Gastrectomia , Humanos , Metástase Linfática , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Espanha , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/terapiaAssuntos
Doenças do Colo/etiologia , Idoso , Idoso de 80 Anos ou mais , Fezes , Feminino , Humanos , Ruptura EspontâneaRESUMO
Presentation of 55 patients aged more than 65 years, appendectomized with the diagnosis of acute appendicitis. After histological study, we saw 6 normal cecal appendixes (10.9%), so the real number of acute appendicitis operated was 49 out of 435 (11.2%) interventions. The clinical history was typical in most of the patients and, nevertheless, we noticed a diagnostic delay greater than 24 hours in 31 (63.2%), and greater than 48 hours in 17 patients (34.6%). We verified the existence of a high percentage of perforated appendicitis (36.7%) closely related to a long evolution time, not being able to show, in the group studied, an increase of early appendix perforations in comparison with the rest. These results suggest that the high morbidity of acute appendicitis in old patients is due, to a great extent, to a delay in the performance of the appendectomy.
Assuntos
Apendicite/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Apendicite/complicações , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Ruptura Espontânea , Fatores de TempoAssuntos
Adenocarcinoma/patologia , Neoplasias dos Ductos Biliares/patologia , Ducto Hepático Comum , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/cirurgia , Terapia Combinada , Diagnóstico Diferencial , Drenagem/métodos , Hepatectomia , Ducto Hepático Comum/diagnóstico por imagem , Ducto Hepático Comum/patologia , Ducto Hepático Comum/cirurgia , Humanos , Transplante de Fígado , RadiografiaRESUMO
We present a case of extrahepatic biloma in a patient who was an emergency admission to the hospital and had a clinical pattern of obstructive jaundice secondary to choledocholithiasis. The diagnosis was made by echography and needle aspiration (PAAF). Due to the unfavorable evolution of the patient in the 48 hours after admission, she underwent surgery, which confirmed the diagnosis. Cholecystectomy was performed, with removal of the choledochal gallstone and side-to-side choledochoduodenostomy, and the postoperative evolution was satisfactory. We review the pathophysiologic characteristics of this entity and its etiology, symptomatology, diagnosis and treatment.
Assuntos
Bile , Cálculos Biliares/complicações , Idoso , Biópsia por Agulha , Colestase Extra-Hepática/etiologia , Cistos/etiologia , Feminino , Cálculos Biliares/cirurgia , Humanos , UltrassonografiaRESUMO
The authors present their experience with Spiegel's hernia and a series of seven cases, three of which debuted as intestinal occlusion. On four occasions the hernial content was appreciated, only one of which required resection. The diagnostic procedures most commonly used in this pathology are noted and it is concluded that sonography offers high resolution images and effectiveness in the differential diagnosis. In all the cases the hernia was located below the aponeurosis of the major oblique muscle. Herniorrhaphy was performed in every case, and there was no morbidity, mortality or recurrence of the hernia.
