RESUMEN
Lung expansion after pneumonectomy is well documented in animal models like dogs or mice. We present a lung expansion case after left pneumonectomy for an advanced carcinoid tumor in a 16-year-old patient with hemoptysis and acute dyspnea. This tumor was localized in the left upper lobe (LUL) invading the left main bronchus. During the follow-up we noticed a real growth of the remaining lung.
Asunto(s)
Tumor Carcinoide/cirugía , Neoplasias Pulmonares/cirugía , Pulmón/crecimiento & desarrollo , Neumonectomía , Adolescente , Femenino , Humanos , Mediciones del Volumen Pulmonar , Tamaño de los Órganos , Periodo PosoperatorioRESUMEN
OBJECTIVES: To study the impact of conversion on postoperative recovery, morbidity and mortality in laparoscopic aortobifemoral bypass surgery for aorto-iliac occlusive disease (AIOD). DESIGN: Retrospective analysis of a prospectively maintained database. METHODS: Between November 2002 and December 2006, 139 patients were treated for severe AIOD with a laparoscopic aortobifemoral bypass at one community and one university hospital. Demographic data, operative data, postoperative recovery data, morbidity and mortality were recorded and analysed according to a conversion and a non-conversion group. RESULTS: Conversion was needed in 13.7% of the patients. Morbidity was 16.5%-14.2% in the non-conversion group and 31.8% in the conversion group. Systemic morbidity was significantly higher in the conversion group (31.6% vs.10%; p=0.002), but only one patient had incomplete recovery; local morbidity was comparable in both groups (10.5% vs. 5.8%; p=0.337). Mortality rate was 2.2%. CONCLUSION: Laparoscopic aortobifemoral bypass surgery is a safe procedure for the treatment of AIOD. The outcome of patients after conversion is not affected in the way that it could be an impediment to start a laparoscopic procedure. Conversion in time is a safe way to overcome the learning curve.
Asunto(s)
Aorta Abdominal/cirugía , Arteriopatías Oclusivas/cirugía , Distribución de Chi-Cuadrado , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Laparoscopía , Enfermedades Vasculares Periféricas/cirugía , Adulto , Anciano , Análisis de Varianza , Aorta Abdominal/diagnóstico por imagen , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/mortalidad , Bélgica/epidemiología , Femenino , Arteria Femoral/diagnóstico por imagen , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/mortalidad , Complicaciones Posoperatorias , Radiografía , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
AIM: To assess the feasibility of aortobifemoral bypass by a laparoscopic approach. MATERIAL AND METHODS: During November 2002 through July 2003 a total of 21 patients with aorto-iliac occlusive disease underwent total laparoscopic aortobifemoral bypass surgery. RESULTS: The median operative time was 240 (range 150-420) min with a median aortic cross-clamp time of 60 (30-120) min. Operating time was reduced with experience. The median blood loss was 500 (100-2500) ml. One conversion to open surgery for acute dilation of the small bowel was necessary. Post-operative complications occurred in five patients (coagulation problems, disseminated intravascular coagulation secondary to thrombosis of the left limb, cerebro-vascular accident, dyspnoea, lymph leak) and there was no peri-operative death. Median hospital stay was 7 (5-30) days. CONCLUSION: Aorto-bifemoral bypass using a total laparoscopic approach can be performed safely. As all new techniques, a learning curve is observed. This new technique should be evaluated in a larger randomised trial to assess its clinical value in comparison to conventional surgery.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular/métodos , Adulto , Anciano , Aorta/cirugía , Estudios de Factibilidad , Femenino , Arteria Femoral/cirugía , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: Since a few years vascular surgeons are developing laparoscopic vascular techniques. We report our preliminary results in this area, using the hand-assisted technique. MATERIALS AND METHODS: Twenty-five patients were operated between February and December 2001 using the HandPort-system. Indications were occlusive aortoiliac disease or infrarenal aortoiliac aneurysmal disease. RESULTS: Mean operating time was 180'; mean aortic clamping time was 37'; mean blood loss was 521 mL. Mean laparotomy length was 7.9 cm. A conversion to a larger laparotomy was necessary in two patients. Mean hospital stay was seven days. Operative mortality was 4% (one postoperative death). CONCLUSIONS: Hand-assisted laparoscopic aortoiliac surgery is feasible in community hospital settings.
Asunto(s)
Aorta , Aneurisma de la Aorta Abdominal/cirugía , Arteriopatías Oclusivas/cirugía , Arteria Ilíaca , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Bélgica , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoAsunto(s)
Cocaína/análogos & derivados , Neostriado/diagnóstico por imagen , Enfermedad de Parkinson/diagnóstico por imagen , Radiofármacos , Sustancia Negra/diagnóstico por imagen , Dihidroxifenilalanina/metabolismo , Distonía/diagnóstico por imagen , Distonía/etiología , Humanos , Radioisótopos de Yodo , Neostriado/patología , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Cintigrafía , Sustancia Negra/patologíaRESUMEN
Functional imaging is mainly used for clinical research. However, if available, this technique could help the clinical diagnosis. First, because it is possible to confirm the loss of nigrostriatal Dopaminergic neurons using [(18)F]-L-Dopa with PET or [(123)I]-FP-CIT with SPECT. Second, distinguishing idiopathic from atypical parkinsonism might be possible using the assessment of striatal Dopaminergic D2 receptors or the measurement of brain metabolism. However, there has been no prospective study to confirm this hypothesis and functional imaging is only performed to exclude patients with atypical parkinsonism from the waiting list for neurosurgical treatments.