RESUMEN
Single or multiple thyroid metastases from extra-thyroid primary tumors are reported to be rare. Malignancies that metastasize to the thyroid include cancers originating from lung, breast and kidney. We report our experience with a case of thyroid metastases, which were detected 18 years after curative kidney surgery for renal cell carcinoma. After 18 years, the patients noted the sudden appearance of a lump in the neck. Ultrasonography showed the presence of a multinodular goiter, all nodules being "cold" at scintiscan. Total thyroidectomy was performed; histology of all nodules revealed a metastatic thyroid cancer from renal cell carcinoma. The patient was still alive and in good health 16 months after thyroidectomy. History of patients with thyroid nodules should include inquiring about extra-thyroid malignancies, especially renal cell carcinoma, that may have been diagnosed even many years earlier. As a corollary, follow-up of such patients should include periodic thyroid exploration or at least a physical examination.
Asunto(s)
Carcinoma de Células Renales/secundario , Neoplasias Renales/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/secundario , Anciano , Carcinoma de Células Renales/cirugía , Humanos , Neoplasias Renales/cirugía , Masculino , Nefrectomía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Resultado del TratamientoRESUMEN
BACKGROUND: Our goal was to support the emerging opinion that laparoscopic cholecystectomy is safe and well tolerated in selected cirrhotic patients with indications for surgery. We present our experience with 50 laparoscopic cholecystectomies performed on patients with mild cirrhosis. METHODS: We retrospectively reviewed and analyzed the outcomes of 50 laparoscopic cholecystectomies performed between January 1995 and May 2006 in patients with Child-Pugh A and B cirrhosis. RESULTS: Laparoscopic cholecystectomy was uneventful for 35 cirrhotic patients. Conversion to an open procedure was necessary in two Child-Pugh B patients with chronic cholelcystitis. One Child-Pugh B cirrhotic patient required blood transfusion. Postoperative complications occurred in 12 patients, including hemorrhage, wound infection, intra-abdominal collection, and cardiopulmonary complications. The mean postoperative stay was 5 days (range, 3 to 13). No deaths occurred. CONCLUSIONS: Laparoscopic cholecystectomy is a safe procedure in well-selected Child-Pugh A and B cirrhotic patients and should be the gold standard for patients with mild cirrhosis and symptomatic cholelithiasis.
Asunto(s)
Colecistectomía/métodos , Colelitiasis/complicaciones , Colelitiasis/cirugía , Laparoscopía/métodos , Cirrosis Hepática/complicaciones , Colelitiasis/etiología , Humanos , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Seguridad , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of this study was to evaluate whether the outcome in children with chronic hemolytic anemia (CHA) and cholelithiasis undergoing laparoscopic cholecystectomy (LC) is related to the operation timing. METHODS: From June 1995 to December 2004, 46 children with CHA were referred to our division of surgery for cholelithiasis. All 46 children were asymptomatic at the time of the first visit, and an elective LC was proposed to all of them before the onset of symptoms. The operation was accepted in the period of study by 24 children and refused by 22. The patients were divided into three groups (group A, asymptomatic; group B, symptomatic; and group C, emergency admitted) depending on clinical presentation and operation timing, and the respective outcomes were compared. RESULTS: Elective LC in asymptomatic children (group A) is safe with no major complications reported. In children who refused surgery (groups B and C), we observed four sickle cell crises, four acute cholecystitis, and two choledocholithiasis, and all these complications were related to waiting. Two sickle cell crises occurred in symptomatic children waiting for surgery during biliary colic. The risk of emergency admission in children with cholelithiasis and CHA awaiting surgery was found to be high: 28% of the children admitted in emergency after a mean of 32 months (range, 22-36). Morbidity rate and postoperative stay increased when children with hemoglobinopathies underwent emergency LC. CONCLUSIONS: Elective LC should be the gold standard in children with CHA and asymptomatic cholelithiasis in order to prevent the potential complications of cholecystitis and choledocholithiasis, which lead to major risks, discomfort, and longer hospital stay.
Asunto(s)
Anemia Hemolítica/complicaciones , Colecistectomía Laparoscópica , Colelitiasis/complicaciones , Colelitiasis/cirugía , Adolescente , Anemia de Células Falciformes/epidemiología , Anemia de Células Falciformes/etiología , Anemia de Células Falciformes/prevención & control , Niño , Colecistectomía Laparoscópica/efectos adversos , Colecistitis Aguda/epidemiología , Colecistitis Aguda/etiología , Colecistitis Aguda/prevención & control , Coledocolitiasis/epidemiología , Coledocolitiasis/etiología , Coledocolitiasis/prevención & control , Enfermedad Crónica , Servicios Médicos de Urgencia , Humanos , Incidencia , Estudios Retrospectivos , Riesgo , Factores de Tiempo , Resultado del Tratamiento , Negativa del Paciente al TratamientoRESUMEN
BACKGROUND: This study aimed to evaluate the safety of laparoscopic cholecystectomy for patients with cirrhosis. METHODS: The records of 22 laparoscopic cholecystectomies performed in patients with cirrhosis Child-Pugh A and B, from January 1995 to July 2001 were retrospectively reviewed. RESULTS: No deaths occurred. Conversion to open cholecystectomy was necessary in two cases. The average operative time was 115 min, which was significantly shorter than that for patients undergoing open cholecystectomy. None of the patients required blood transfusion. Intraoperative problems occurred in two patients who experienced liver bed bleeding. Postoperative morbidity occurred in 36% of the patients and included hemorrhage, wound complications, intraabdominal collections, and cardiopulmonary complications, but all were controlled. The patients were dismissed after an average of 4 days. CONCLUSION: The authors believe laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child-Pugh A and B who manifest indication for surgery. Laparoscopic cholecystectomy offers several advantages over open cholecystectomy: lower morbidity, shorter operative time, and reduced hospital stay.
Asunto(s)
Colecistectomía Laparoscópica , Colelitiasis/cirugía , Cirrosis Hepática/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Colelitiasis/complicaciones , Circulación Colateral , Comorbilidad , Femenino , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , OmbligoRESUMEN
BACKGROUND: Several laboratory and clinical studies have raised the concern that laparoscopic procedures might worsen the prognosis of patient with malignant disease due to premature intraperitoneal cancer cell dissemination. The aim of the study was to examine the risk of the dissemination in patients with unsuspected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC). METHODS: A retrospective clinicopathologic study was performed on 5 patients with unsuspected gallbladder cancer without preoperatively diagnosis among 1280 patients that underwent LC in the period 1993-2002. The possible neoplastic dissemination was compared to that reported in 8 patients affected from unsuspected gallbladder cancer diagnosed after open cholecystectomy. RESULTS: Two patients with unsuspected gallbladder cancer (T1a-T2) presented a port-site recurrence after respectively six and four months. There was not statistically significant difference between types of cholecystectomy (LC or OC). Survival rate did not change according to whether the operation was carried out using LC or OC. CONCLUSION: After an accurate checking of the factors indicated to explain the early neoplastic dissemination frequently observed in the patients undergone LC and an analysis of their own experience the Authors conclude that LC does not worsen the prognosis of unsuspected gallbladder cancer.
Asunto(s)
Carcinoma/secundario , Colecistectomía Laparoscópica/efectos adversos , Neoplasias de la Vesícula Biliar/patología , Siembra Neoplásica , Neoplasias Peritoneales/secundario , Anciano , Carcinoma/mortalidad , Carcinoma/cirugía , Colecistectomía , Colecistectomía Laparoscópica/instrumentación , Femenino , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias Peritoneales/mortalidad , Pronóstico , Estudios Retrospectivos , Riesgo , Tasa de SupervivenciaRESUMEN
A critical revision of the data in the literature regarding mixed allogeneic systemic chimerism by transplantation permits to perceive the aspects of undoubted interest in the immunological and clinical field. The usefulness of the cellular exchange, with the aim of the acceptance of the transplantation, that is carried out between recipient and the transplanted organ and which constitutes a completely peculiar immunological situation, comparable to the immunotolerance of the fetal period even though with same not totally identificable is pointed out.
Asunto(s)
Quimera por Trasplante , Inmunología del Trasplante , Enfermedad Injerto contra Huésped/inmunología , HumanosRESUMEN
Authors, considering the increasing of the middle duration of life and the increasing of geriatric population, examine various surgical problems in the elderly. They took in consideration not only the age, but all the other markers of surgical risk related to the surgical illness, to the associate illness and to the type of operation. After reporting their experience in the treatment of geriatric patients, they conclude that a scrupulous surgical preparation, a correct indication to the operation and an accurate overseeing after surgery are necessary to do that the elderly patient faces surgical intervention with the same capability of success of the young.
Asunto(s)
Anciano , Procedimientos Quirúrgicos Operativos , Factores de Edad , Anciano de 80 o más Años , Urgencias Médicas , Humanos , Factores de RiesgoRESUMEN
The Authors confirm how the advent of mechanical suture has directed the management of rectal carcinoma to an increasingly conservative attitude. In reporting their experience--which consists of about twenty years (222 patients) they specify how not only an increased incidence of recurrence has not appeared, but they have also observed a reduction of theirs (-5.2%). They then attempt to outline basic moments which have characterized the history of rectal carcinoma surgery and they state how today, 80 years since it was conceived, Miles' intervention maintains its validity, even if with more restrictive indications.
Asunto(s)
Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , MasculinoRESUMEN
The authors report their experience on synthetic prosthesis used in 36 patients with abdominal hernias. Thirty six cases of incisional hernias have been analyzed by Institute of General Surgery of Messina University from 1992 to 1998. Among the 33 cases with median parietal defect, in 7 cases concerning great incisional hernias group a PTEF-e prosthesis, which was positioned in an intraperitoneal site, was employed. In 21 cases of medium size incisional hernias they used a polypropylene prosthesis, which was positioned in an intraparietal or preperitoneal site. In 5 cases of small size incisional hernias, polypropylene prosthesis was placed in a superfascial site. In the 3 cases of medium size lateral laparocele++, polypropylene prosthesis was positioned in a intraparietal site. There was no operative mortality. Among postoperative complications, 4 seromas, 1 parietal and 1 subcutaneous haematoma and 2 haematomas in retroperitoneal site appeared. Clinical-instrumental controls, which have continued until two or three years after the operation were performed which pointed out a recurrence in just one case where the prosthesis was positioned in a superfascial site. To conclude, we consider that nowadays the use of synthetic prosthesis lets us face and solve problems concerning surgical treatment of incisional hernias with confidence.
Asunto(s)
Hernia Ventral/cirugía , Mallas Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polipropilenos , Politetrafluoroetileno , Prótesis e ImplantesRESUMEN
Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. AEF develop progressively from the esophageal perforation caused by foreign body. Clinically, there is a medial chest pain, followed by hematemesis and finally terminal exsanguination. Diagnosis must be achieved during the free intervals in this triad of often rapidly succeeding signs.
Asunto(s)
Enfermedades de la Aorta/etiología , Fístula Esofágica/etiología , Cuerpos Extraños/complicaciones , Fístula Vascular/etiología , Aorta Torácica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A series of 8 patients with spontaneous rupture of the esophagus is analysed. Correct diagnosis is difficult. The time lapse between the rupture and diagnosis nevertheless seems to be the most important single factor in the outlook for treatment of spontaneous rupture of the esophagus. Early primary closure of the tear and good drainage of the mediastinum and pleural cavity give the best results in such cases. Sometimes a conservative management should be advocated for the treatment of esophageal perforations.
Asunto(s)
Enfermedades del Esófago , Enfermedades del Esófago/diagnóstico , Enfermedades del Esófago/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rotura Espontánea , Síndrome , Factores de TiempoRESUMEN
Bone-remodeling markers have been proposed to monitor antiosteoporotic therapy, as substantial changes in these markers usually occur in a relatively short time interval. In this study we have evaluated the short term effects of two bisphosphonates on bone-remodeling markers with the aim of 1) defining the shortest reliable time interval after which markers should be measured, and 2) comparing the effects of different bisphophonates. To do so, 74 postmenopausal women with a lumbar spine t score of at least -1 were randomly allocated to 4 different treatments: calcium carbonate (500 mg/day; n = 18), 5 mg/day alendronate (A5; n = 18), 10 mg/day alendronate (A10; n = 20), and cyclical etidronate (CE; n = 18). Serum and 24-h urine samples were collected at baseline and 14, 28, 56, and 84 days after the beginning of therapy. Type I collagen N-terminal (NTx) and C-terminal (CTx) telopeptides and total deoxypyridinoline (tDPD) were measured in urine and normalized for urinary creatinine excretion. Osteocalcin and bone alkaline phosphatase in serum were measured. Alendronate (at both doses) and CE significantly decreased bone-remodeling markers, whereas calcium carbonate did not. Bone resorption markers reduction reached a plateau 14 (A10) or 28 (A5 and CE) days after the beginning of treatment, whereas osteocalcin and bone alkaline phosphatase were significantly reduced at 56 (A10) and 84 (CE) days. The global effects of alendronate and CE on NTx and CTx (calculated as the area under the curve) were significantly different from those of calcium (P < 0.05), but were not significantly different from each other. The percent change from baseline obtained with tDPD, NTx, or CTx during bisphosphonate treatment were significantly different (P < 0.05), but this difference disappeared when the variability in the calcium carbonate group was taken into account. In conclusion, this study shows that 1) etidronate and alendronate induce a significant and rapid reduction in bone-remodeling markers; 2) the changes in NTx, CTx, and tDPD urinary excretions reach a plateau after 2-4 wk of treatment; and 3) short term treatments with CE or alendronate induce similar changes in the urinary excretion of NTx and CTx.
Asunto(s)
Alendronato/administración & dosificación , Remodelación Ósea/fisiología , Ácido Etidrónico/administración & dosificación , Adulto , Alendronato/uso terapéutico , Fosfatasa Alcalina/sangre , Aminoácidos/orina , Biomarcadores , Huesos/enzimología , Carbonato de Calcio/uso terapéutico , Colágeno/orina , Colágeno Tipo I , Difosfonatos/administración & dosificación , Difosfonatos/uso terapéutico , Esquema de Medicación , Ácido Etidrónico/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Osteocalcina/sangre , Péptidos/orina , Factores de TiempoRESUMEN
We evaluated the clinical performances of the immunoenzymometric assays for type I collagen N-terminal and C-terminal telopeptides and the HPLC assay for total deoxypyridinoline, in distinguishing between subjects with a moderately increased bone resorption rate (women in postmenopause) and subjects with normal bone resorption rate (women in premenopause). The postmenopausal group consisted of 61 women who had been in menopause for no more than 10 years, while the premenopausal group consisted of 52 healthy women with normal menstrual cycles. The biochemical markers were measured in a 24 hour urine sample and the results expressed as the molar ratio with urinary creatinine. The clinical performances were estimated by calculating the accuracy (as the area under a Receiver Operated Characteristic (ROC) curve: mean +/- SEM) and the discriminating power (as score) of each assay in distinguishing postmenopausal subjects from premenopausal subjects. Type I collagen C-terminal telopeptide, type I collagen N-terminal telopeptide and total deoxypyridinoline were significantly higher in the postmenopausal than in the premenopausal group (p < 0.01). Accuracies of these three markers ranged from 66.8 +/- 5.1% to 76.8 +/- 4.3%, while Z scores ranged from 3.54 to 5.67. Type I collagen C-terminal telopeptide, type I collagen N-terminal telopeptide and total deoxypyridinoline were not significantly different in their accuracy or discriminating power. All markers were highly correlated with coefficients of correlation ranging from 0.61 to 0.77. In summary, this study shows that 1) the immunoenzymometric assays for type I collagen N-terminal telopeptide and type I collagen C-terminal telopeptide show a high accuracy and discriminating power in distinguishing subjects with different bone resorption rate; 2) the results obtained with these immunoenzymometric assays are comparable to those obtained with the HPLC assay for total deoxypyridinoline. In conclusion our data support the use of the immunoenzymometric assays for type I collagen N-terminal telopeptide and type I collagen C-terminal telopeptide for estimating bone resorption.
Asunto(s)
Cromatografía Líquida de Alta Presión/métodos , Colágeno/orina , Técnicas para Inmunoenzimas , Péptidos/orina , Adulto , Biomarcadores/orina , Resorción Ósea/orina , Colágeno/química , Colágeno Tipo I , Creatinina/orina , Reactivos de Enlaces Cruzados , Femenino , Humanos , Técnicas para Inmunoenzimas/estadística & datos numéricos , Menopausia , Persona de Mediana Edad , Péptidos/química , Compuestos de Piridinio/análisis , Sensibilidad y EspecificidadRESUMEN
From 1990 to 1996, a total of 223 patients, with breast cancer, were treated. Out of these patients, 7 (3.04%) developed a second primary carcinoma in the controlateral breast. Two (28.5%) had a synchronous manifestation while the remaining 5 (71.5%) had a metachronous manifestation. The seven patients were followed up for periods between 4-8 years: 80% of the metachronous tumours occur within 5 years of follow-up. The 7-year actuarial survival was 100% in the two synchronous tumours and 60% in the five metachronous tumours (two patients died on account of intervening diseases). The prognosis does not depend on the length of the interval between the development of the two carcinomas but it is in relation with the anatomo-clinical state, to the adequate treatment of each primary tumour and to the rigorous clinical-instrumental follow-up, in which the mammography plays a fundamental role.
Asunto(s)
Neoplasias de la Mama , Carcinoma Ductal de Mama , Carcinoma Lobular , Neoplasias Primarias Múltiples , Neoplasias Primarias Secundarias , Análisis Actuarial , Adulto , Factores de Edad , Anciano , Mama/patología , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/mortalidad , Carcinoma Lobular/patología , Femenino , Estudios de Seguimiento , Humanos , Mamografía , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/mortalidad , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Secundarias/diagnóstico por imagen , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Primarias Secundarias/patología , Pronóstico , Factores de TiempoRESUMEN
Authors discuss ethiopathogenus of pilonidal disease after a historical background and support acquired-congenital theory. Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method. Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Seno Pilonidal/cirugía , Adolescente , Adulto , Drenaje , Electrocoagulación , Femenino , Estudios de Seguimiento , Humanos , Terapia por Láser , Masculino , Recurrencia , Instrumentos Quirúrgicos , Factores de TiempoRESUMEN
Adenocarcinoma of the duodenum represents a rare neoplasia characterized by an indefinite symptomatology, at least early, and deceitful, that, therefore, arrives at surgeon, almost always, in advanced stage. The Authors, taking from a clinical case, recently observed, as a starting point, review the literature, referring the etiopathogenetic hypothesis that explain the relative rarity of this neoplasia. They therefore report the diagnostic and therapeutic procedure to carry out in these patients.