RESUMEN
Helical computed tomography with arterioportography (CTAP) and intraoperative sonography (IOUS) are both recognized to be extremely sensitive in the detection of liver metastases measuring <2 cm in diameter. As sensitivity and specificity values for both techniques differ significantly in the literature and in default of sufficient published data regarding this subject, a lesion-by-lesion analysis was considered necessary. Accuracy of IOUS was compared with helical computed tomography (CT) and portal-phase contrast enhancement (CTAP) in the preoperative detection of liver metastases from colorectal carcinoma projected as a prospective blinded study. Cost efficiency should be determined. Liver CTAP and IOUS were evaluated in 33 patients with colorectal carcinoma. Metastases were resected in 10 cases, and the remaining 23 patients were observed for follow-up with CT investigations every 3 months for a period of 1 year. CTAP and IOUS detected all 13 lesions measuring 5-10 mm (13/13). One metastasis measuring >10 mm was missed by IOUS. CTAP presented an ideal sensitivity of 100%, but specificity was as low as 68%. IOUS sensitivity was 98% and specificity was 95%. IOUS and CTAP are of comparable value regarding the detection of liver metastases <10 mm. Both techniques may be used if resections of synchronous or metachronous metastases are planned in order not to miss limiting small lesions and to prevent superfluous liver surgery. Helical CT scan with dynamic intravenous contrast enhancement is considered the most cost-effective preoperative staging method, although local staging may not be achieved because of insufficient intraabdominal survey.
Asunto(s)
Neoplasias Colorrectales/patología , Cuidados Intraoperatorios/métodos , Neoplasias Hepáticas/secundario , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Anciano de 80 o más Años , Angiografía/métodos , Angiografía/estadística & datos numéricos , Femenino , Hepatectomía , Humanos , Cuidados Intraoperatorios/estadística & datos numéricos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Portografía/métodos , Portografía/estadística & datos numéricos , Estudios Prospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/estadística & datos numéricosRESUMEN
Laparoscopic partial pericystectomy is a promising new therapeutical approach in surgery of hydatid liver disease. In combination with a review of the published results of laparoscopic therapy for hydatid disease the actual relevance of this technique should be defined. Together with our own experience with this technique we evaluated all patients with hydatid liver disease from Echinococcus granulosus published in literature operated either by pericystectomy or by partial pericystectomy. The review was projected as a search over DIMDI data access. This technique is practicable without increasing the risk of intraabdominal spillage of scolices if well-known security criteria are respected. Additional training is not necessary. Laparoscopic treatment of Echinococcus multilocularis is not possible yet, as complicated liver resections may be required for these patients. Hydatid hepatic cysts of E. granulosus however may be operated upon laparoscopically and do not necessarily require open surgery. While working under visual control minimal invasiveness is achievable and post-operative hospital stay can be reduced. This new technique is a feasible method, especially regarding obese patients, but on the other hand it is limited by a laparoscopically inaccessible intrahepatic localization (Segments IVa, VII, VIII and small centrally located cysts).
Asunto(s)
Equinococosis Hepática/cirugía , Laparoscopía , Femenino , Humanos , MasculinoRESUMEN
We report a case of postoperative paraplegia resembling an anterior spinal artery syndrome after curative esophagectomy in a patient with carcinoma of esophagus and clinical stage III (UICC). Neurologic deficit was characterized by loss of sensibility at the level of T12/L1 together with paraparesis of both lower extremities. Furthermore, dissociated sensorimotor depletion at C6/C7 (right-sided) and at T5 (left-sided) was noted. This severe complication was most probably caused by peeling of an arteriosclerotic plaque of the thoracic aorta due to preexisting advanced arteriosclerosis, leading to a partial occlusion of the great radicular artery of Adamkiewicz. Even though anterior spinal artery syndrome is a well-known problem in the operative management of thoracic aortic aneurysms, this complication has not previously been reported after esophagectomy.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Isquemia/etiología , Paraplejía/etiología , Complicaciones Posoperatorias/etiología , Médula Espinal/irrigación sanguínea , Adulto , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Estudios de Seguimiento , Humanos , Laparotomía , Escisión del Ganglio Linfático , Masculino , Estadificación de Neoplasias , Examen Neurológico , ToracotomíaRESUMEN
We report on a case of malignant gastrinoma located on the posterior surface of the descending duodenum, presenting with Zollinger-Ellison syndrome. The tumor was not evident on preoperative imaging studies, metastasis was not present and there was no coincidence with multiple endocrine neoplasia type-I. As the gastrinoma was located on the posterior surface of the pancreatic head, to obtain a sufficient safety margin, partial excision of this region was necessary. Under preservation of the Oddi's sphincter, the reconstruction was completed by direct suturing of the duodenal wall to the pancreatic surface without need for enteral diversion procedures. This technique represents a possible non-invasive resection modality for benign and malignant duodenal gastrinomas located close to the pancreatic head region.
Asunto(s)
Neoplasias Duodenales/cirugía , Gastrinoma/cirugía , Pancreaticoduodenectomía/métodos , Síndrome de Zollinger-Ellison/cirugía , Adulto , Neoplasias Duodenales/patología , Duodeno/patología , Femenino , Gastrinoma/patología , Humanos , Escisión del Ganglio Linfático , Estadificación de Neoplasias , Páncreas/patología , Técnicas de Sutura , Síndrome de Zollinger-Ellison/patologíaRESUMEN
Lithium chloride (LiCl) has been shown to decrease gastric acid secretion and protect against ethanol-induced hemorrhagic gastritis in the rat. To further investigate these properties, two sets of experiments were performed in dogs with chronic Heidenhain pouches to study the effect of LiCl on histamine-stimulated gastric acid secretion and bile-induced disruption of the gastric mucosal barrier. In the first experiments the effect of LiCl on intravenous histamine-stimulated gastric secretion (40 micrograms/kg . hr) was determined. LiCl (30 mg/kg . hr) significantly reduced gastric acid secretion when compared to normal saline control (457 +/- 87 mueq H+/10 min versus 637 +/- 112 mueq H+/10 min, P less than 0.05). Serum and gastric lithium levels were determined and a significant inverse linear correlation existed between acid output and serum and gastric lithium levels. In the second set of experiments the effect of LiCl on bile-induced disruption of the gastric mucosal barrier was determined. Heidenhain pouches were continuously perfused with a pH 2 acid test solution and indices of mucosal barrier function (net acid back-diffusion and potential difference) were determined. LiCl (30 mg/kg . hr) significantly reduced both the increase in acid-back diffusion and the fall in potential difference with bile injury (5 mM taurodeoxycholate). In conclusion, these studies indicate that LiCl (1) decreases histamine-stimulated gastric acid secretion, and (2) diminishes bile-induced disruption of the gastric mucosal barrier in the canine Heidenhain pouch.