RESUMEN
BACKGROUND/AIMS: Anastomotic leak is a life threatening complication following surgery for rectal cancer below peritoneal reflection. Colostomy or ileostomy following colorectal or coloanal anastomosis protect the patients from general peritonitis or sepsis secondary to anastomotic leak. METHODOLOGY: In this paper the experience of the last 100 cases of rectal cancer below the peritoneal reflection treated from 2004 to 2010 was reviewed. RESULTS: In 79 cases, primary anastomosis was performed. In 44/79 cases virtual ileostomy was prepared and in 35/79 cases, based on risk factors and intraoperative decision of the surgeon, an open ileostomy was performed. In 8/44 cases virtual ileostomy was opened, thus avoiding in 35/79 cases a second operation. CONCLUSIONS: The goal for a good clinical outcome of patients with virtual ileostomy is a strict postoperative follow-up focused on fever onset and quality of drainage discharge. In our experience virtual ileostomy is a good tool to avoid open ostomy at time of primary colorectal or coloanal anastomosis in a good number of cases.
Asunto(s)
Fuga Anastomótica/prevención & control , Ileostomía/métodos , Complicaciones Posoperatorias/prevención & control , Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/radioterapia , Factores de Riesgo , Resultado del TratamientoRESUMEN
We report a case of rectus sheath haematoma (RSH) in a patient undergoing laparoscopic right hemicolectomy and anticoagulant prophylaxis of a pulmonary thromboembolism (PTE) with low molecular weight heparin. This pathological condition is rare and could be a cause of misdiagnosis in patients with acute abdominal pain. It can be a serious complication in the course of anticoagulant therapy. A rapid, correct diagnosis may lead to better treatment which must be timely, aggressive and ultimately curative. Our patient, with acute onset and swift worsening of his general condition, benefited from an immediate surgical procedure, with ligature of the epigastric artery stumps and drainage of the haematoma.
Asunto(s)
Colectomía/efectos adversos , Colectomía/métodos , Hematoma/etiología , Laparoscopía/efectos adversos , Enfermedades Musculares/etiología , Recto del Abdomen , Anciano , Humanos , MasculinoRESUMEN
In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique. No mortality occurred with either technique. None of the cases submitted to laparoscopy presented anastomotic dehiscence or severe intraoperative bleeding. In the group submitted to open surgery, 3 cases of severe complications occurred (10.3%), consisting in acute faecal peritonitis due to immediate dehiscence of the colorectal anastomosis; angulation of the intestinal loop with microdehiscence of the ileo-colic anastomosis; and pulmonary embolism. In the group submitted to laparoscopic surgery, 2 cases of severe complications occurred (9.5%), consisting in enterorrhagia due to haemoperitoneum; and intrafascial haematoma due to haemorrhage of the epigastric artery. The overall complication rate was 10%, corresponding to the minimum values reported in the literature. No statistically significant difference was observed in the incidence of these complications with the two methods employed. A very low incidence of minor complications was observed, limited to repercussions on the postoperative course. Furthermore, the laparoscopic technique led to early canalisation, a reduction in hospital stay, less need of drugs (antibiotics and pain killers) and better aesthetic results. The advantages obtained with the laparoscopic technique, with no significant differences in severe complications, indicate that this approach is preferable to the traditional technique in colorectal surgery for cancer.
Asunto(s)
Colectomía/efectos adversos , Colectomía/métodos , Neoplasias Colorrectales/cirugía , Laparoscopía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
Physicochemical characterization of particulate matter fractionated into eight samples by size from 10 to 0.43 microm was performed by HS-SPME/GC-MS for the organic (semi-)volatile components and SEM X-ray microanalysis (SEM/EDX) for analysis of the elemental composition. The HS-SPME technique was shown to be efficient with respect to requiring an extremely low amount of material, being selective and clean and avoiding use of any solvents. Particulate matter was collected at four sites characterized by particular environmental locations and different pollution levels around the city of L'Aquila in central Italy. The results reveal a tight correlation between the particle composition, size, and the emission source. The analyses show also that the finer the particle, the higher its content of elemental carbon and organic compounds. Well-known carcinogens such as PAHs were detected among the identified organic compounds from both the rural and highly polluted sites.
Asunto(s)
Atmósfera/química , Tamaño de la Partícula , Material Particulado/análisis , Material Particulado/química , Emisiones de Vehículos/análisis , Microanálisis por Sonda Electrónica , Salud , Compuestos Inorgánicos/química , Microscopía Electrónica de Rastreo , Compuestos Orgánicos/química , Material Particulado/toxicidad , VolatilizaciónRESUMEN
Surgical management of rectal cancer has undergone a significant change during the past two decades. Low anterior resection (LAR) with total mesorectal excision (TME) is, at the moment, the "gold standard" for carcinoma of the mid or lower rectum. Because the most specific complication following rectal resection with anastomosis is symptomatic leakage, which is associated with 18% mortality rate, routine formation of a temporary stoma is suitable after sphincter-saving resection for anastomoses situated at or less than 5cm from the anal verge. Actually the preferred modes of fecal diversion following LAR with TME are loop ileostomy or loop transverse colostomy. Low anastomosis, preoperative radiation or chemoradiation, presence of intraoperative adverse events and male gender are independent risk factors for symptomatic anastomotic leakage. A defunctioning loop ileostomy or the classical "protective" colostomy requires subsequent reconstructive surgery with a significant postoperative morbidity. For these reasons we use an alternative to protect a high risk anastomosis with fashioning a proximal intraabdominal closed loop ileostomy called "virtual ileostomy". In a seven-year period from 1999 to 2005 a total of 107 patients underwent elective anterior resection of the rectum for carcinoma, in all cases was fashioned a virtual ileostomy. The incidence of symptomatic clinically evident anastomotic leakage was 13%; in all the cases (14 pts) the closed loop ileostomy was opened with a reduction of the originally planned number of ileostomies by over 80%. The procedure is easy to perform and well accepted by the patients. It avoids a second operation.
Asunto(s)
Canal Anal/cirugía , Ileostomía/instrumentación , Ileostomía/métodos , Neoplasias del Recto/cirugía , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/métodos , Carcinoma , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
Recent studies support a participation of fine airborne particulate matter (PM) with an aerodynamic diameter less than 2.5 microm in the effects of air pollutants on health. Particulate matter was collected in an urban area of L'Aquila during the winter 2004. Fine particulate samples were analyzed by X-ray photoelectron spectroscopy (XPS) to determine the chemical inventory of the aerosol particle surfaces and to evaluate the weight of characteristic functional groups of the most frequent carbon-containing organic pollutant compounds (C-C/C-H, C-O/C-N, C=O, COOH). The most important contributor to the mass of fine particulate matter was carbon. The overall purpose of this work was to determine the in vitro toxicity and genotoxicity of fine PM in cultured macrophages (RAW 264.7 cells) since the biological target of inhaled PM are the pulmonary epithelium and resident macrophages. In parallel in vitro toxicity assays were used including cell viability and apoptosis. Genotoxicity was evaluated by the micronucleus (MN) assay. The viability of macrophages was assessed by the MTT method; apoptosis by an ELISA test for programmed cell death (PCD) was determined after RAW 264.7 cells treatment. Concentration of 1, 3 and 10 microg/cm2 of fine particles induced micronuclei in a dose-dependent manner. We also compared the effects of fine PM with those of fine carbon black particles (CB) in similar doses. Fine carbon black particles were consistently less genotoxic than the fine atmospheric particles, suggesting that the contaminants adsorbed on them (i.e. carbon-containing organic compounds in addition to metal oxides and metal salts) are involved in genotoxicity. Fine PM reduced cellular proliferation. Overall, the results presented here demonstrate the utility of in vitro tests in mouse cells for testing genotoxicity of urban air particulate matter.
Asunto(s)
Contaminantes Atmosféricos/toxicidad , Macrófagos/efectos de los fármacos , Pruebas de Mutagenicidad/métodos , Animales , Apoptosis/efectos de los fármacos , Línea Celular , Supervivencia Celular/efectos de los fármacos , Microanálisis por Sonda Electrónica , Ensayo de Inmunoadsorción Enzimática , Ratones , Pruebas de MicronúcleosRESUMEN
Increased incidence of mortality and sickness due to cardiopulmonary complications has been associated with elevated levels of urban air particles (UAP), with an aerodynamic diameter of 10 microm (PM 10) and 2.5 microm (PM 2.5). In the present report alternative plant systems and human cells in vitro are associated with human hazard and genotoxic risk assessment of UAP. The genotoxic activities associated with the coarse (PM 10) and the fine fraction (PM 2.5) of airborne particulates have been analyzed by evaluating micronuclei induction and/or sister-chromatid exchange (SCE) using in vitro models of Daucus carota and HS 27 human fibroblast cell suspensions and Zea mays root meristems. Results show variability in the response of the test systems and indicate that the mutagenicity trend in both plant and human cell cultures was directly correlated to the concentration of carbon-rich particles in the fraction of the PM 2.5 airborne particulates. Moreover, in plant tissues, the frequency of micronuclei and SCE was related to an enhancement of the specific activity of the stress-related enzyme peroxidase.