RESUMO
Thrombocytopenic patients with chronic hepatitis C virus (HCV) infection are poor candidates for antiviral treatment with interferon (IFN), but no standard treatment for thrombocytopenia has yet been established. We evaluated the safety of splenectomy and its efficacy for the initiation and continuation of antiviral therapy. From March 2003 to April 2006, 10 patients (mean age 62.5 years) with HCV-related cirrhosis, low platelet count (<==106 000/mm(3)) and splenomegaly (spleen size >==10 cm) underwent splenectomy. Platelet counts significantly increased at 4-8 weeks after splenectomy [pre: 64 200 +/- 6900/mm(3)vs post 209 000 +/- 40 600/mm(3) (P = 0.004)]. No severe operative complications were observed. All patients subsequently received antiviral therapy. Of the eight patients who were infected with HCV genotype 1 and had a high viral load (>==100 KIU/mL), four received combination therapy with pegylated IFNalpha-2b plus ribavirin, and the other four received standard IFNalpha-2b plus ribavirin. One patient infected with HCV genotype 2 and another with HCV genotype 1 and a low viral load (<100 KIU/mL) were treated with pegylated IFNalpha-2a. Six patients achieved sustained virologic response (SVR). Among four patients who failed to achieve SVR, one was given retreatment with pegylated IFN plus ribavirin, and the other three received low-dose long-term IFN therapy. Although this study was small, the treatment results were similar to those for patients without thrombocytopenia and suggested that splenectomy would not reduce the antiviral efficacy of IFNalpha-based treatment.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Esplenectomia , Esplenomegalia/cirurgia , Trombocitopenia/terapia , Idoso , Feminino , Humanos , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/uso terapêutico , Proteínas Recombinantes , Ribavirina/uso terapêutico , Resultado do Tratamento , Carga ViralRESUMO
BACKGROUND: With the technical advances of recent years, the number of operative manipulations in the abdominal cavity by laparoscopic surgery is now considered to be the same as that using classical open surgery. The question has been raised whether laparoscopic colorectal surgery with lymphadenectomy improves the recovery compared to open surgery. METHODS: We compared patients' physical activity for 7 days postoperatively as measured with an accelerometer between laparoscopic-assisted colorectal resection (LAC, n = 32) and classical open colorectal surgery (OC, n = 30). RESULTS: Physical activity expressed as cumulative acceleration was significantly higher in the LAC than in the OC group on each postoperative day. The recovery time, defined as the day on which the cumulative acceleration recovered to 90% of the preoperative level, was significantly shorter (p < 0.05) in the LAC (3.4 +/- 1.2 days) than in the OC group (6.8 +/- 1.7 days). CONCLUSION: Our results showed that the duration of convalescence with LAC was significantly shorter than that with the OC procedure. Laparoscopic colorectal surgery appears to allow an earlier recovery after the operation than the classical open procedure, and it is less invasive as assessed by convalescence.
Assuntos
Aceleração , Neoplasias Colorretais/cirurgia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Monitorização Fisiológica/instrumentação , Atividade Motora , Recuperação de Função Fisiológica , Idoso , Convalescença , Defecação , Feminino , Humanos , Tempo de Internação , Excisão de Linfonodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Período Pós-Operatório , Resultado do Tratamento , CaminhadaRESUMO
Pancreatic islet cell tumors are rarely associated with intra-abdominal hemorrhage. We report herein a rare case of nonfunctioning islet cell carcinoma associated with massive hemorrhage into the abdominal cavity caused by spontaneous rupture of the tumor. A 44-year-old man presenting with sudden upper abdominal pain was admitted to his local hospital on April 18, 1994. On April 19, a laparotomy was performed with the diagnosis of peritonitis. Massive hemorrhage of unknown origin occurred, and he was transferred to our hospital in a state of hypovolemic shock. Imaging findings revealed massive hematoma in the abdominal cavity and a hypervascular tumor arising from the body of the pancreas. Because the hemorrhage was life-threatening, an emergent re-laparotomy was performed on April 20. Apart from the massive hemorrhage, a pancreatic tumor (60 x 35 x 30 mm in size) with spontaneous rupture was noted. Distal pancreatectomy, combined with splenectomy and removal of the hematoma, was performed. Histological findings revealed an islet cell carcinoma of the pancreas with venous invasion. Peritoneal dissemination, liver metastasis, and lymph node metastasis were not observed. The patient is alive without recurrence 6 years and 5 months after the operation.
Assuntos
Abdome/cirurgia , Carcinoma de Células das Ilhotas Pancreáticas/complicações , Hemorragia/etiologia , Neoplasias Pancreáticas/complicações , Abdome/patologia , Adulto , Carcinoma de Células das Ilhotas Pancreáticas/diagnóstico por imagem , Carcinoma de Células das Ilhotas Pancreáticas/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Radiografia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgiaRESUMO
To review the practice of concurrent chronic ambulatory peritoneal dialysis catheter insertion and arteriovenous fistula formation in patients needing dialysis, we retrospectively assessed the results of arteriovenous fistula procedures, the risk factors for fistula failure, and the selection strategy used to choose which patients with end-stage renal disease would be given dialysis. We analysed the medical records of 136 patients who had first-time arteriovenous fistulae created between 1 July 1986 and 1 May 1994 at a public hospital in Sydney, Australia. As many as 36% of fistulae were never used (24.5% due to primary failure) and 30.1% of the fistulae used had to be abandoned for various reasons. In addition, 22.8% of patients experienced complications, the most common being thrombosis and stenosis. None of the factors associated with fistula formation were significant in terms of fistula patency rates, but smokers and female patients had inferior fistula patency rates. Whereas the overall results were satisfactory, the practice of concurrent chronic ambulatory peritoneal dialysis catheter insertion and arteriovenous fistula formation to give vascular access for dialysis is questionable.
Assuntos
Derivação Arteriovenosa Cirúrgica , Cateterismo Venoso Central , Diálise Peritoneal Ambulatorial Contínua/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , Diálise Renal , Reoperação , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
Laparoscopic intragastric surgery (LIGS) has become more widely established in Japan as a therapy for early gastric cancers and some types of submucosal gastric tumors. However, there have been some technical difficulties with the original method of LIGS. Certain complicated procedures to access the gastric lumen are required, along with repair of the gastric wall after endoluminal procedures. Using a 5-mm radially expandable sleeve (RES) for the working ports in LIGS, it becomes easier to establish access to the gastric lumen, and repair of the port sites on the gastric wall is not required. Using RES makes LIGS a simpler, less invasive procedure.
Assuntos
Laparoscopia/métodos , Estômago/cirurgia , Adenocarcinoma/cirurgia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/cirurgiaRESUMO
Graft recurrence of insulin-dependent diabetes mellitus (IDDM) was examined. Islet transplantation or pancreas-alone transplantation excluding the duodenum and peripancreatic lymph nodes was compared with whole pancreaticoduodenal transplantation. A Wistar Furth (WF; RT1(u), RT6.2) to major histocompatibility complex (MHC)-compatible diabetes-prone (DP; RT1(u), RT6.1 gene carrier)-biobreeding (BB) rat transplantation model was used. Only DP recipients that had been transplanted with whole pancreaticoduodenal grafts were free from IDDM recurrence (>60 days postgrafting) when treated with anti-intercellular adhesion moluecule-1 (ICAM)-1/leukocyte function-associated antigen-1 (LFA-1) monoclonal antibodies (mAbs). In the spleen cells of the DP rats that had accepted pancreatic grafts (60 days postgrafting), flow cytometric analysis showed that NKR-P1(+)TCRalphabeta(+) (NKT) cells had proliferated markedly, with the proportion of 12.8 +/- 1.7% in the total splenic T cells, most of which (86.2%) were derived from the donor (RT6.2(+)). By enzyme-linked immunonosorbent assay (ELISA), serum interferon gamma (IFN-gamma) was not detected (<13 pg/ml) in all rats. However, interleukin-4 (IL-4) was detected as 158.8 +/- 28.0 pg/ml in the nonrecurrent DP recipients. These data suggested that to prevent IDDM recurrence in the pancreatic graft, the lymphocytes in the pancreaticoduodenal grafts are necessary. Also, the donor-derived NKT cells might have some immunoregulatory functions with a Th2 deviation.
Assuntos
Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 1/prevenção & controle , Diabetes Mellitus Tipo 1/fisiopatologia , Duodeno/transplante , Tecido Linfoide/fisiologia , Transplante de Pâncreas , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/fisiopatologia , Animais , Células Matadoras Naturais/fisiologia , Masculino , Ratos , Ratos Endogâmicos , Ratos Endogâmicos WF , RecidivaAssuntos
Antígenos de Superfície/análise , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Lectinas Tipo C , Transplante de Fígado/imunologia , Receptores de Antígenos de Linfócitos T alfa-beta/análise , Linfócitos T/imunologia , Animais , Rejeição de Enxerto/patologia , Interferon gama/sangue , Interleucina-4/sangue , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/patologia , Transplante de Fígado/patologia , Masculino , Subfamília B de Receptores Semelhantes a Lectina de Células NK , Ratos , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Linfócitos T/patologia , Transplante HomólogoAssuntos
Antígenos de Superfície/análise , Diabetes Mellitus Tipo 1/cirurgia , Duodeno/transplante , Células Matadoras Naturais/imunologia , Lectinas Tipo C , Transplante de Pâncreas/imunologia , Receptores de Antígenos de Linfócitos T alfa-beta/análise , Linfócitos T/imunologia , Transplante Homólogo/imunologia , Animais , Anticorpos Monoclonais/uso terapêutico , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/imunologia , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Insulina/uso terapêutico , Molécula 1 de Adesão Intercelular/imunologia , Fígado/imunologia , Subfamília B de Receptores Semelhantes a Lectina de Células NK , Ratos , Ratos Endogâmicos BB , Ratos Endogâmicos WF , Baço/imunologiaAssuntos
Diabetes Mellitus Experimental/cirurgia , Sobrevivência de Enxerto/imunologia , Transplante das Ilhotas Pancreáticas/imunologia , Complexo Principal de Histocompatibilidade , Animais , Diabetes Mellitus Experimental/imunologia , Rejeição de Enxerto/imunologia , Teste de Histocompatibilidade , Ratos , Ratos Endogâmicos BUF , Ratos Endogâmicos , Transplante de Pele/imunologia , Fatores de Tempo , Transplante HomólogoAssuntos
Sobrevivência de Enxerto/imunologia , Transplante de Coração/imunologia , Terapia de Imunossupressão/métodos , Animais , Soro Antilinfocitário , Transplante de Coração/patologia , Período Intraoperatório , Masculino , Ratos , Ratos Endogâmicos ACI , Ratos Endogâmicos BUF , Ratos Endogâmicos Lew , Tacrolimo/uso terapêutico , Timo , Transplante Homólogo/imunologiaAssuntos
Compostos de Bifenilo/uso terapêutico , Sobrevivência de Enxerto/efeitos dos fármacos , Transplante de Coração/imunologia , Imunossupressores/uso terapêutico , Animais , Teste de Cultura Mista de Linfócitos , Masculino , Ratos , Ratos Endogâmicos BUF , Ratos Endogâmicos Lew , Transplante HomólogoAssuntos
Sobrevivência de Enxerto/imunologia , Antígenos de Histocompatibilidade/imunologia , Terapia de Imunossupressão/métodos , Transplante das Ilhotas Pancreáticas/imunologia , Transfusão de Linfócitos , Transplante de Pele/imunologia , Animais , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Experimental/cirurgia , Rejeição de Enxerto/imunologia , Antígenos de Histocompatibilidade Classe I/imunologia , Teste de Histocompatibilidade , Transplante das Ilhotas Pancreáticas/métodos , Linfonodos/citologia , Linfonodos/imunologia , Transfusão de Linfócitos/métodos , Ratos , Ratos Endogâmicos BUF , Ratos Endogâmicos , Fatores de TempoRESUMO
Microangiopathic hemolytic anemia (MAHA) is a term which describes the association of hemolytic anemia with red cell fragmentation caused by microangiopathy mechanically. This paper reports a 45-year-old woman with bone metastases from breast cancer. She developed MAHA and disseminated intravascular coagulation (DIC). Although the prognosis of MAHA associated with malignant tumor has been very poor, she achieved remission of the syndrome after chemoendocrine therapy.
RESUMO
Six patients who underwent segmental autotransplantation of the caudal pancreas (SAT) following total pancreatectomy for pancreatic cancer were investigated. The graft was transplanted to the left groin, and pancreatic juice was diverted outside through a polyethylene tube indwelled into the main pancreatic duct. In these SAT patients, the responses of insulin (IRIS) in terms of plasma levels and pancreatic secretion to subcutaneous injections of somatostatin octreotide (Sandostatin: SMS201-995) were simultaneously observed. Four doses (0.039, 0.156, 0.625 and 2.5 micrograms/kg) of SMS201-995 were given on separate days. As a control, saline was injected subcutaneously. Standard liquid test meal was given 1 h after the subcutaneous injection. The basal plasma IRI were significantly decreased with doses greater than 0.156 microgram/kg. The postprandial responses of IRI was also significantly suppressed with the same doses. On the other hand, the basal pancreatic exocrine secretion was significantly suppressed with doses greater than 0.625 microgram/kg. The postprandial pancreatic exocrine secretion was also significantly suppressed with doses greater than 0.625 microgram/kg. Those suppressions were dose-dependent. The postprandial CCK secretion was also significantly suppressed in dose-dependent manner with SMS201-995. The CCK suppression was significantly correlated with the suppression of pancreatic exocrine secretion. This clinical study under the setting of SAT demonstrated not only the direct inhibitory effect of somatostatin on both the islet and acinar cells but also, probably, the indirect inhibitory effect on the acinal cells via suppression of CCK release in humans.
Assuntos
Octreotida/farmacologia , Pâncreas/efeitos dos fármacos , Somatostatina/farmacologia , Idoso , Amilases , Glicemia/metabolismo , Colecistocinina/sangue , Feminino , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Pâncreas/metabolismo , Transplante de Pâncreas , Secretina/sangueAssuntos
Terapia de Imunossupressão/métodos , Transplante das Ilhotas Pancreáticas/métodos , Tacrolimo/uso terapêutico , Animais , Diabetes Mellitus Experimental/cirurgia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto/efeitos dos fármacos , Terapia de Imunossupressão/efeitos adversos , Transplante das Ilhotas Pancreáticas/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Ratos , Ratos Wistar , Transplante HeterólogoAssuntos
Glicemia/metabolismo , Transplante de Pâncreas/métodos , Animais , Cães , Estudos de Avaliação como Assunto , Sobrevivência de Enxerto/fisiologia , Insulina/sangue , Transplante das Ilhotas Pancreáticas/métodos , Transplante das Ilhotas Pancreáticas/fisiologia , Transplante de Pâncreas/fisiologia , Pancreatectomia , Veia Esplênica , Transplante AutólogoAssuntos
Diabetes Mellitus Experimental/cirurgia , Insulina/metabolismo , Transplante das Ilhotas Pancreáticas/fisiologia , Animais , Diabetes Mellitus Experimental/tratamento farmacológico , Cães , Glucose/farmacologia , Insulina/uso terapêutico , Secreção de Insulina , Ilhotas Pancreáticas/efeitos dos fármacos , Ilhotas Pancreáticas/metabolismo , Cinética , Pancreatectomia , Baço , Transplante Autólogo , Transplante Heterotópico/fisiologiaAssuntos
Transplante das Ilhotas Pancreáticas , Baço/metabolismo , Animais , Glicemia/metabolismo , Cães , Insulina/sangue , Insulina/metabolismo , Secreção de Insulina , Ilhotas Pancreáticas/metabolismo , Modelos Biológicos , Consumo de Oxigênio , Perfusão , Valores de Referência , Transplante Autólogo , Transplante HeterotópicoRESUMO
Adenomatosis coli is recently regarded as a systemic disease with a predisposition to multiple tumor formation. We report siblings of familial adenomatosis coli with gastric cancers. Case 1 was a 58 year-old elder brother. His diagnosis was familial adenomatosis coli accompanied with colon cancer and simultaneous early gastric cancer. Total colectomy and partial gastrectomy were carried out on Mar. 13, 1984 at our hospital. Numerous polyps over the whole colon and an ulcerative tumor in the hepatic flexure were found in the resected colon. Histologically tubular adenocarcinoma were demonstrated in the ulcerative tumor, and all other polyps were adenomas. In the resected gastric specimen, there were two shallow, depressed lesions on the each anterior and posterior wall of the antrum. Histologically both of them were adenocarcinoma confined within the mucosa. Postoperative course was satisfactory and he is quite healthy 2 and a half years after surgery. Case 2 was a 56 year-old younger brother. He received a partial gastrectomy for advanced gastric cancer at another hospital on May 20, 1982. In one and a half year from the surgery, a large lung tumor (probably metastasis of the gastric cancer) was found and he received chemotherapy. He also received radiation therapy in June, 1984 and during this admission barium enema study was performed. It revealed numerous polyps over the whole colon. No cancerous lesions were found. He died of lung tumor on Dec. 8, 1985. The similar siblings were first reported by Kokaji et al. in 1984, and our cases seem to be the second ones.