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BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis. The outcomes of patients with cancer are determined not only by tumor-related factors but also by systemic inflammatory response. The objective of the study was to identify whether the preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with the prognosis of PDAC of the pancreas head after curative pancreatoduodenectomy. MATERIALS AND METHODS: Seventy-six patients were enrolled in this prospective, observational clinical study. The optimal NLR and PLR cut-off values were calculated using a receiver operating characteristic (ROC) curve analysis. ROC curve analysis revealed an optimal NLR and PLR cut-off point of 5.41 and 205.56, respectively. Consequently, the NLR and PRL scores were classified as NLR <5.41 or ≥5.41 and PLR <205.56 or ≥205.56. The clinical outcomes of overall survival (OS) and disease-free survival (DFS) were calculated by Kaplan-Meier survival curves. Univariate and multivariate analyses were performed to analyze the prognostic value of NLR and PLR. RESULTS: Low preoperative NLR and PLR levels both correlated with better pathological features, including decreased depth of invasion (p < 0.001), less lymph node metastasis (p < 0.001), earlier stage (p < 0.001), and lymphovascular invasion (p = 0.004). Kaplan-Meier plots illustrated that higher preoperative NLR and PLR had does not influence OS and DFS. Univariate analysis revealed that depth of invasion, lymph node metastasis, stage, PLR, and NLR are risk factors affecting OS and DFS. Multivariate analysis revealed that only stage was independently associated with OS and DFS. CONCLUSIONS: NLR and PLR measurements cannot provide important prognostic results in patients with resectable PDAC.
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Adenocarcinoma , Neutrófilos , Humanos , Neutrófilos/patología , Recuento de Linfocitos , Metástasis Linfática , Estudios Prospectivos , Recuento de Plaquetas , Estudios Retrospectivos , Linfocitos/patología , Plaquetas , Pronóstico , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Neoplasias PancreáticasRESUMEN
BACKGROUND: Esophago-jejunostomy leakage (EJL) it the most dreaded septic complication after total gastrectomy for gastric cancer. Early detection and treatment of this complication may improve outcomes. Systemic Inflammation Response Index (SIRI) is a marker that reflects systemic inflammation. METHODS: The SIRI was developed in a training cohort of 180 patients who underwent elective open total gastrectomy with esophago-jejunal anastomosis for gastric cancer from January 2009 to December 2013. To verify the prognostic value of SIRI score we recruited 192 patients treated from January 2014 to December 2021 as the validation cohort. The optimal cut-off value of SIRI was determined by receiver operating characteristic curve. Univariate and multivariate analysis was performed. RESULTS: An optimal cut-off point for the SIRI of 0.82 divided the patients into a low SIRI group and high SIRI group in the training cohort. Patients with a SIRI ≥0.82 was found to be significantly associated with EJL. Univariable analysis showed that NLR, PLR, MLR, SII, and SIRI were prognostic factors for EJL in the training cohort. In multivariable analysis, EJL high level of SIRI was identified as independent prognostic factor. CONCLUSIONS: Preoperative SIRI may be helpful in identifying patients at greater risk for developing EJL after total gastrectomy.
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Neoplasias Gástricas , Fuga Anastomótica/diagnóstico , Fuga Anastomótica/etiología , Gastrectomía/efectos adversos , Humanos , Inflamación/etiología , Estudios Retrospectivos , Neoplasias Gástricas/cirugíaRESUMEN
AIM: Rectal GIST is a rare tumor of the gastrointestinal tract. The few literature cases didn't show significant evidence about diagnostic and therapeutic management. We present a rare case of rectal GIST treated with laparoscopic anterior rectal resection (RARLs) preceded by neoadjuvant therapy with Imatinib Mesylate (IM). CASE REPORT: A 68-year-old woman with abdominal pain, rectal bleeding and palpable mass on rectal exam has been subjected to computerized tomography (CT) of the abdomen and pelvis and magnetic resonance imaging (MRI) that revealed a rectal GIST of 5x4x2 cm at 3 cm from anal verge. The diagnosis was confirmed with colonoscopy. After 3- mounts neoadjuvant therapy with IM, which allowed to down-stage the neoformation, the patient underwent RARLs without intraoperative or postoperative complications. Immunohistochemistry revealed cluster of differentiation CD 117 positive, HPF 5/50, Ki 67overexpressed. PDGF mutation was detected. The patient was therefore taken in charge by the oncologist. DISCUSSION AND CONCLUSION: Resection appear curative for rectal GIST. Extensive resections aren't necessary because of downstaging after IM therapy. However, the appropriate surgical technique is still debated. Further studies are necessary for a correct surgical standardization. KEY WORDS: Rectal GIST, Cajal cell, Laparoscopic rectal resection, Imatinib.
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Tumores del Estroma Gastrointestinal , Neoplasias del Recto , Anciano , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Femenino , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Mesilato de Imatinib/administración & dosificación , Mesilato de Imatinib/uso terapéutico , Laparoscopía , Terapia Neoadyuvante , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Recto/diagnóstico por imagen , Recto/cirugíaRESUMEN
AIM: Primary small bowel melanoma is a very rare clinical entity with a paucity of publications in literature. Most cases of gastrointestinal melanomas are metastatic lesions arising generally from primary lesion of the skin, eyes, or anus. We present a case of a small bowel intussusception with primary malignant melanoma as lead point and a gluteal melanoma metastasis after four years free from disease. CASE REPORT: A 77-year-old female has come to our attention with signs and symptoms of intestinal occlusion. She was subjected to a computerized tomography (CT) of the abdomen and pelvis that revealed small bowel intussusception caused by intestinal polypoid lesion. She was treated with a bowel resection. The histological exam has shown the presence of an amelanocytic malignant melanoma. The examination of skin, eyes, esophagus, colon and anus, a tot al body contrast- enhanced CT and a bone scintigraphy were negative for primary melanoma. So, the final diagnosis was primary melanoma of the ileum. After four-years disease-free survival, the patient came back to our attention for a gluteal melanoma metastasis, that was surgically removed. Afterwards she started immunotherapy, that is still ongoing. DISCUSSION AND CONCLUSION: The diagnosis and the treatment of primary intestinal melanoma is a challenging due to the lack of scientific indications. Our case shows how an early diagnosis, although accidental, can offer a good survival free from disease. Moreover, a careful follow-up of our patients allows us to promptly identify neoplasm recurrence or distant metastasis that can be treated with surgery and systematic therapy. KEY WORDS: Intussusception, Primary bowel melanoma.
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Obstrucción Intestinal , Intususcepción , Melanoma , Neoplasias Cutáneas , Anciano , Femenino , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado , Intususcepción/etiología , Intususcepción/cirugía , Melanoma/complicaciones , Melanoma/diagnóstico , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
The presence of pancreatic lesions in patients with autoimmune pancreatitis requires histological diagnosis (percutaneous or endoscopic biopsy) to exclude malignancy. A nonspecific histology after endoscopic or percutaneous biopsy of a pancreatic lesion may require surgical excision and definite histology.
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BACKGROUND: Delayed diagnosis in case of acute appendicitis (AA) could lead to complicated intra-abdominal sepsis (IAS). Grading systems are not commonly employed in the clinical practice, because they are too complicated or too specific. Therefore, we suggest grading the severity of complicated IAS after AA with a simple system: TNM, an acronym borrowed by cancer staging where T indicates temperature, N neutrophils, and M multiple organ failure (MOF). This prospective observational study evaluates the predictive value of the TNM score on mortality of patients with complicated IAS after AA. METHODS: Sixty-eight patients with complicated IAS after AA were treated. Three classes of attributes were chosen: temperature (T), neutrophils count (N), and MOF (M). After defining the categories T (T0-T4), N (N0-N3) and M (M0-M2), these were grouped in stages (0-IV). Variables analyzed for their possible relation to death were age, sex, temperature, neutrophils count, preoperative organ failure, immunocompromised status, stage (0-IV). Odds ratios were calculated in a univariate and multivariate analysis. RESULTS: TNM staging was: one patient stage 0; 16 patients at stage I; 26 patients at stage II; 16 patients at stage III; nine patients at stage IV. Death occurred in 15 patients (22%). Neutrophil count, preoperative organ failure, immunocompromised status, stages III-IV were potential predictors of postoperative death in univariate analysis; only stage IV was significant independent predictor of postoperative mortality in multivariate analysis. CONCLUSIONS: TNM classification is very easy to use; it helps to define the mortality risk and is useful to objectively compare patients with sepsis.
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Apendicitis/complicaciones , Temperatura Corporal , Insuficiencia Multiorgánica/epidemiología , Neutrófilos , Sepsis/clasificación , Abdomen , Absceso Abdominal/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Apendicitis/diagnóstico , Diagnóstico Tardío/efectos adversos , Femenino , Fiebre/diagnóstico , Humanos , Huésped Inmunocomprometido , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Peritonitis/epidemiología , Estudios Prospectivos , Sepsis/complicaciones , Sepsis/mortalidad , Factores Sexuales , Adulto JovenRESUMEN
The incidence of anal cancer has increased during the second half of the 20th century, with an incidence rate over 2.9% greater than in the decade of 1992-2001. Yet, it still constitutes a small percentage, about 4%, of all anorectal tumours. Its risk factors are human papillomavirus infection, a history of sexually transmitted diseases, a history of vulvar or cervical carcinoma, immunosuppression related to human immunodeficiency virus infection or after organ transplantation, haematological or immunological disorders, and smoking. The most frequent symptom is rectal bleeding (45%), followed by anal pain, and sensation of a rectal mass. The diagnosis requires clinical examination, palpation of the inguinal lymph nodes, high resolution anoscopy followed by fine-needle aspiration biopsy or core biopsy. Subsequent histologic diagnosis is necessary, as well as computed tomography or magnetic resonance imaging evaluation of the pelvic lymph nodes. Since 1980, patients with a diagnosis of anal cancer have shown a significant improvement in survival. In Europe during the years 1983-1994, 1-year survival increased from 78% to 81%, and the improvement over 5 years was between 48% and 54%. Prior to 1974, patients with invasive cancer were routinely scheduled for abdominoperineal amputation, after which it was demonstrated that treatment with 5-fluorouracil and radiotherapy associated with mitomycin or capecitabine could be adequate to treat the tumour without surgery. Today, numerous studies have confirmed that combined multimodal treatment is effective and sufficient.
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BACKGROUND: Laparoscopic anti-reflux surgery could be of benefit in a subset of elderly patients with gastroesophageal reflux disease. However, there are few reports that have evaluated the long-term results. This study examined the effects of age on the short- and long-term (for at least 5 years) outcomes after laparoscopic Nissen fundoplication (LNF). PATIENTS AND METHODS: Patients were divided into four groups as follows: young (18-49); adult (50-69); and elderly (70-84), and very elderly (85-91). The database (recorded prospectively) included operating duration, conversion, intra- and early post-operative complication and late outcomes. Mean follow-up was 14.5 years (range 5-24 years). RESULTS: Five hundred and sixty-nine patients met the inclusion criteria: young n = 219 (38.4%); adult n = 248 (43.5%); elderly n = 91 (16.0%) and very elderly n = 11 (1.9%). Hiatal hernia (type I and III) was significantly less frequent in young and adult patients (P < 0.0001). The operation was significantly longer in elderly and very elderly patients (P < 0.001); the use of drains (P < 0.001) and grafts (P < 0.0001) for hiatal hernia repair was less in young and adult patients. The hospital stay, conversion (5.4%), intra-operative and early post-operative complications were not influenced by age. Dysphagia was evenly distributed among the groups. Forty-eight (8.4%) patients had recurrence: 15 in the young group (6.8%), 18 in the adult group (7.2%), 11 in the elderly group (12%) and 4 in the very elderly group (36.3%) (P < 0.0001). CONCLUSIONS: Age does not influence short- and long-term outcomes following LNF. Control of reflux in the elderly is worse than adult patients. Therefore, ageing is a relative contraindication to LNF.
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Background: The grading systems for intra-abdominal sepsis (IAS) are not employed commonly in clinical practice because they are too complicated or too specific. We propose to grade IAS with a simple grading system: the TNM system, which is an acronym borrowed from cancer staging, where T indicates Temperature, N indicates Neutrophils, and M indicates Multiple organ failure (MOF). The aim of this prospective observational study is to assess the predictive value of the TNM score on deaths of patients with complicated IAS. Patients and Methods: We considered 147 patients with complicated IAS. Three classes of attribute were chosen: Temperature (T), Neutrophil count (N), and MOF (M). After defining the categories T (T0-T4), N (N0-N3), and M (M0-M2), they were grouped in stages (0-IV). We analyzed specific variables for their possible relation to death: Age, gender, blood transfusion, causes of IAS, T, N, pre-operative organ failure, immunocompromised status, stage 0, I, II, III, and IV. Odds ratios were calculated in a uni-variable and multi-variable analysis. Results: This was the distribution in classes, based on TNM stages: One patient was in stage 0; 15 patients in stage I; 47 patients in stage II; 56 patients in stage III; 28 patients in stage IV. Death occurred in 45 (30.6%) patients. The N, pre-operative organ failure, immunocompromised status, stage III-IV were potential predictors of post-operative death in uni-variable analysis. Only pre-operative organ failure and stage IV were significant independent predictors of post-operative death in multi-variable analysis. Conclusions: The TNM classification is an easy system that could be considered to define the death risk of patients with IAS and to compare patients with sepsis.
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Temperatura Corporal , Clasificación , Infecciones Intraabdominales/clasificación , Infecciones Intraabdominales/diagnóstico , Insuficiencia Multiorgánica/clasificación , Insuficiencia Multiorgánica/diagnóstico , Neutrófilos/clasificación , Sepsis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Infecciones Intraabdominales/complicaciones , Infecciones Intraabdominales/fisiopatología , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/fisiopatología , Oportunidad Relativa , Estudios Prospectivos , Estudios Retrospectivos , Sepsis/fisiopatología , Adulto JovenRESUMEN
OBJECTIVES: The prevalence of morbid obesity has dramatically increased over the last several decades worldwide, currently reaching epidemic proportions. Gastric leak (GL) remains the potentially fatal main complication after sleeve gastrectomy (SG) for morbid obesity. To our knowledge, there are no standardized guidelines for GL treatment after laparoscopic sleeve gastrectomy (LSG) yet. The aim of this study was to represent our institutional preliminary experience using the endoscopic double-pigtail catheter (EDPC) as the method of internal drainage and propose it as first-line treatment in case of GL after LSG. METHODS: One hundred and seventeen patients were admitted to our surgical department and underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity from March 2014 to June 2019. In 5 patients (4.3%) of our series, GL occurred as a complication of LSG. EPDC was the stand-alone procedure of internal drainage and GL first-line treatment. The internal pig tail was endoscopically removed from 30th to 40th POD in all cases. RESULTS: Present data (clinical, biochemical, and instrumental tests) showed a complete resolution of GL, with promotion of a pseudodiverticula and complete re-epithelialization of leak. Follow-up was more strict than usual (clinical visit and biochemical test on 7th, 14th, and 21st day after discharge; a CT scan with gastrografin on 30th day from discharge if clinical visit and exams were normal). CONCLUSION: This was a preliminary retrospective observational study, conducted on 5 patients affected by GL as a complication of LSG for morbid obesity. EDPC maintains the safety, efficacy, and nonexpensive characteristic and may be proposed as better first-line treatment in case of GL after bariatric surgery.
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A young lady complained of the sudden onset of intense chest pain, in consequence of an extreme hyperextension of the back in a yoga position. At endoscopy a large lesion of the esophageal epithelium was detected, involving the middle third of the anterior wall of the esophagus. Other symptoms reported by the patient were dysphagia and odynophagia, depicting the typical features of intramural hematoma, also known as intramural dissection or intramural perforation of the oesophagus. The patient was managed conservatively and symptoms disappeared within a week. A barium swallow at six months reported normal findings. Different types of accidents occurring during yoga practice are reported in the literature, mainly involving musculoskeletal or nervous systems. Visceral lesions are exceptional and no similar cases have been reported in the literature. KEYWORDS: Acute chest pain, Esophageal lesion, Intramural hematoma, Management of esophageal lesion.
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Dolor Agudo/etiología , Enfermedades de la Aorta/etiología , Dolor en el Pecho/etiología , Mucosa Esofágica/lesiones , Hematoma/etiología , Yoga , Técnicas de Ejercicio con Movimientos/efectos adversos , Femenino , HumanosRESUMEN
BACKGROUND: A number of studies have been reported on the effects of high-concentration oxygen (HCO) on cytokine synthesis, with controversial results. We assessed the effect of administration of perioperative HCO on systemic inflammatory and immune response in patients undergoing laparoscopic Nissen fundoplication (LNF). MATERIALS AND METHODS: Patients (n = 117) were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 58) or 80% (n = 59). Administration was commenced after induction of anaesthesia and maintained for 6 h after surgery. White blood cells, peripheral lymphocytes subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-1 and IL-6 and C-reactive protein (CRP) were investigated. RESULTS: A significantly higher concentration of neutrophil elastase, IL-1, IL-6 and CRP was detected post-operatively in the 30% FiO2group patients in comparison with the 80% FiO2group (P < 0.05). A statistically significant change in HLA-DR expression was recorded post-operatively at 24 h, as a reduction of this antigen expressed on monocyte surface in patients from 30% FiO2group; no changes were noted in 80% FiO2group (P < 0.05). CONCLUSIONS: This study demonstrated that perioperative HCO (80%), during LNF, can lead to a reduction in post-operative inflammatory response, and possibly, avoid post-operative immunosuppression.
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BACKGROUND: Some studies suggested that after abdominal trauma, postoperative infections are associated with bacterial translocation, whereas others have not replicated these findings. We have assessed the bacterial translocation and postoperative infections in patients undergoing splenectomy after abdominal trauma, using a very homogeneous study population. METHODS: We consecutively studied, in a prospective observational clinical study, 125 patients who required urgent surgical treatment (splenectomy) following blunt abdominal trauma. For bacterial translocation identification, tissue samples were taken from liver, spleen and mesenteric lymph nodes (MLNs). Postoperative infectious complications in these patients were registered, confirmed by a positive culture obtained from the septic focus. Associations between clinical variables, bacterial translocation presence, and postoperative infection development were established. RESULTS: Bacterial translocation was detected in 47 (37.6%) patients. Postoperative infections were present in 29 (23.2%) patients. A significant statistical difference was found between postoperative infections in patients with bacterial translocation evidence (22 of 47 patients: 46.8%) in comparison with patients without bacterial translocation (7 of 78 patients: 8.9%) (P < 0.05). After multivariate adjustment analysis: a) the bleeding ≥ 1500 mL was significantly associated with the risk of bacterial translocation and, b) bacterial translocation was significantly associated with the risk of postoperative infections. Bacterial strains isolated from infection sites were the same as those cultured in MLNs in 48.3% of the cases (n = 14 of 29). CONCLUSIONS: There is higher risk of bacterial translocation in patients who required urgent surgical treatment (splenectomy) following blunt abdominal trauma and it is associated with a significant higher number of postoperative infections.
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Traumatismos Abdominales/complicaciones , Traslocación Bacteriana , Infecciones/etiología , Esplenectomía/efectos adversos , Traumatismos Abdominales/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infección de la Herida Quirúrgica , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Adulto JovenRESUMEN
BACKGROUND: The focus of this study was to understand the relationship between the failure of gut barrier function, inflammatory markers and septic complications after resection for extraperitoneal rectal cancer. METHODS: One hundred seven patients were enrolled into this prospective observational study and underwent open colorectal resection for extraperitoneal cancer. All patients underwent an assessment of intestinal permeability (L/M ratio), endotoxemia, interleukin-1ß (IL-1ß), interleukin-6 (IL-6), C-reactive protein (CRP) and elastase levels before surgery and on postoperative days 1, 3, and 7. RESULTS: Septic complications developed in 23.3% of patients. There were no significant differences in preoperative L/M ratio, endotoxine, CRP, interleukin-1 (IL-1), IL-6, and elastase levels between septic and non-septic groups. All patients showed a significant increase in intestinal permeability, endotoxemia, IL-1, IL-6, CRP, and elastase on the first postoperative day. At postoperative day 7, the septic group continued to demonstrate an increase in intestinal permeability, endotoxemia and elastase and significant difference was observed between the 2 groups (p < 0.05), whereas there was no significant difference in IL-1, IL-6, and CRP levels. CONCLUSION: The pattern of change in the postoperative period of intestinal permeability, systemic endotoxemia and elastase concentration is significantly higher in patients in whom sepsis develops, while the concentration of IL-1ß, IL-6, and CRP does not permit to distinguish infection from inflammation.
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Endotoxemia/sangre , Mucosa Intestinal/metabolismo , Lactulosa/metabolismo , Manitol/metabolismo , Neoplasias del Recto/cirugía , Sepsis/sangre , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Endotoxemia/etiología , Endotoxinas/sangre , Femenino , Humanos , Interleucina-1beta/sangre , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Elastasa Pancreática/sangre , Permeabilidad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Prospectivos , Sepsis/etiología , Sepsis/metabolismoRESUMEN
POURPOSE: The aim was to evaluate the relationship between failure of gut barrier function, inflammatory markers and septic complications after pancreatoduodenectomy for pancreatic adenocarcinoma. METHODOLOGY: 44 patients were enrolled in this prospective observational clinical study and underwent curative open pancreatoduodenectomy for adenocarcinoma of the head of the pancreas. All patients underwent assessment of intestinal permeability using the lactulose/manitol excretions ratios (L/M ratio), endotoxemia, IL-1ß, IL-6, CRP, and elastase levels before surgery and on postoperative days 1, 3 and 7. Septic complication was defined as a specific clinical condition related to infection by bacterium, virus, or fungus in a specific organ/compartment with positive culture. RESULTS: Septic complications developed in 25% of patients. There were no significant differences in preoperative L/M ratio, endotoxine, CRP, IL-1ß, IL-6, and elastase levels between sepsis-positive and sepsis-negative groups. All patients showed a significant increase in intestinal permeability, endotoxemia, IL-1, IL-6, CRP and elastase on the first postoperative day. At postoperative day 7, the sepsis-positive group continued to demonstrate an increase in intestinal permeability, endotoxemia and elastase; a significant difference was observed between the two groups (P = 0.02), whereas there was no significant difference in IL-1, IL-6, and CRP levels. CONCLUSION: The pattern of change of intestinal permeability, systemic endotoxemia, and elastase concentration in the postoperative period is significantly higher in patients in whom sepsis develops, while the concentration of IL-1ß, IL-6 and CRP do not permit to distinguish infection from inflammation.
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Endotoxemia/etiología , Inflamación/sangre , Intestinos/patología , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Sepsis/etiología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Citocinas/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Permeabilidad , Neoplasias PancreáticasRESUMEN
PURPOSE: We conducted a prospective, randomized study to evaluate the necessity of drainage after thyroid surgery. METHODS: The patients (n = 215) were randomly assigned to be treated with suction drains (group 1; n = 108) or not (group 2; n = 107). RESULTS: The postoperative pain scores were significantly lower in the non-drained group than in the drained group of patients at postoperative days 0 and at 1. Hematomas, seromas, wound infections, transient biochemical hypoparathyroidism, and transient damage of the recurrent laryngeal nerve occurred more frequently in the drained group than in the non-drained group. The mean hospital stay was significantly shorter in the non-drained group than in the drained group. CONCLUSIONS: Routine drain emplacement after thyroidectomy is unnecessary.
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Drenaje , Complicaciones Posoperatorias/prevención & control , Enfermedades de la Tiroides/cirugía , Glándula Tiroides/cirugía , Tiroidectomía , Adulto , Drenaje/efectos adversos , Femenino , Humanos , Hipocalcemia/etiología , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Satisfacción del Paciente , Periodo Posoperatorio , Estudios Prospectivos , Infección de la Herida Quirúrgica/etiología , Parálisis de los Pliegues Vocales/etiologíaRESUMEN
Spontaneous hepatic rupture without underlying liver diseases is uncommon entity. We report a rare case of spontaneous rupture of liver hematoma in patient treated with warfarin end enoxaparin sodium because of pulmonary embolism. Two day after admission the patient complained generalized abdominal pain and hemodynamic instability. The abdominal US and TC scan revealed free fluid and lesion at right liver lobe. The patient, despite intravenous fluid support and blood transfusion, was hemodinamically instable and urgent laparotomy was needed. At laparotomy, it was found that a subcapsular haematoma, involving the diaphragmatic face of the right liver, had ruptured into peritoneum. Hepatic bleeding was stopped using a conservative approach by Pringle manoeuvre, parenchymal suture and fibrin sealant. There was no complication related to hepatic surgery but the patient died because of new massive pulmonary embolism 10 days after surgery. The absence of underlying liver pathology was confirmed by autopsy examination. This case report suggests that the possibility of spontaneous liver rupture should be considered in patients being treated with oral anticoagulants. Early diagnosis are critically important given the high morbidity and mortality. Aggressive resuscitation and immediate exploratory laparotomy is needed when hemodynamic instability occurs. In our case a quick, safe and effective control of bleeding was provided by partial vascular occlusion, parenchymal suture and topical haemostatic agent. KEY WORD: Anticoagulant therapy, Araumatic hemoperitoneum, Liver hematoma.
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Anticoagulantes/efectos adversos , Enoxaparina/efectos adversos , Hematoma/inducido químicamente , Hepatopatías/etiología , Embolia Pulmonar/tratamiento farmacológico , Warfarina/efectos adversos , Anticoagulantes/administración & dosificación , Quimioterapia Combinada , Enoxaparina/administración & dosificación , Resultado Fatal , Hematoma/diagnóstico , Hematoma/terapia , Hepatectomía , Humanos , Hepatopatías/diagnóstico , Hepatopatías/terapia , Recurrencia , Rotura Espontánea , Warfarina/administración & dosificaciónRESUMEN
BACKGROUND: Some studies suggest that obesity is associated with a poor outcome after Laparoscopic Nissen Fundoplication (LNF), whereas others have not replicated these findings. The effect of body mass index (BMI) on the short- and long-term results of LNF is investigated. METHODS: Inclusion criteria were only patients who undergone a LNF with at least 11-year follow-up data available, patients with preoperative weight and height data available for calculation of BMI (Kg/m2), and patients with a BMI up to a maximum of 34.9. RESULTS: 201 patients met the inclusion criteria: 43 (21.4%) had a normal BMI, 89 (44.2%) were overweight, and 69 (34.4%) were obese. The operation was significantly longer in obese patients; the use of drains and graft was less in the normal BMI group (p < 0.0001). The hospital stay, conversion (6,4%), and intraoperative and early postoperative complications were not influenced by BMI. CONCLUSIONS: BMI does not influence short-term outcomes following LNF, but long-term control of reflux in obese patients is worse than in normal weight subjects.
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Reflujo Gastroesofágico/cirugía , Obesidad Mórbida/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: This study assessed effect of administration of high-concentration supplemental perioperative oxygen on systemic inflammatory and immune response in patients undergoing elective laparoscopic cholecystectomy. MATERIALS AND METHODS: One hundred seventy-seven patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n=88) or 80% (n=89). White blood cells, peripheral lymphocytes subpopulation, human leukocyte antigen-DR, neutrophil elastase, interleukin (IL)-1 and IL-6, and C-reactive protein were investigated. RESULTS: Significantly higher concentration of neutrophil elastase, IL-1, IL-6 and C-reactive protein was detected postoperatively in the 30% FiO2 group patients in comparison with the 80% FiO2 group (P<0.05). Statistically significant change in human leukocyte antigen-DR expression was recorded postoperatively at 24 hours, as a reduction of this antigen expressed on monocyte surface in patients from 30% FiO2 group. CONCLUSIONS: This study demonstrated that high-concentration (80%) supplemental perioperative oxygen can lead to a reduction in postoperative inflammatory response and avoid postoperative immunosuppression.