RESUMEN
Acute pancreatitis can complicate non-selective transcatheter arterial embolization of hepatocellular carcinoma with an incidence ranging from 1,7% (acute clinical pancreatitis) to 40% (biological pancreatitis). This complication is thought to be related to embolization of extrahepatic arterial collaterals. We report herein a case of acute clinical pancreatitis developing within 24 hours after a second course of selective transcatheter arterial chemo-embolization into the proper hepatic artery. Neither anatomical arterial variation nor particular risk factor for acute pancreatitis could be identified. This complication is unusual after selective arterial embolization. Because it may clinically mimick a postembolization syndrome, dosage of serum pancreatic enzymes should be performed systematically in case of abdominal pain following chemoembolization.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/efectos adversos , Neoplasias Hepáticas/terapia , Pancreatitis/etiología , Enfermedad Aguda , Arteria Hepática , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/patologíaRESUMEN
STUDY AIM: Esophageal squamous cell carcinomas are frequently associated with head and neck cancers. This retrospective study was conducted to compare the long-term outcome of the patients with a double cancer and of the patients with a solitary esophageal cancer after curative management. PATIENTS AND METHODS: From 1989 to 1999, 114 patients with an esophageal carcinoma were included in the study. Among them, 52 had an associated head and neck cancer (metachronous: n = 17 and synchronous: n = 35). Curative treatment was achieved in all patients. The patients were divided in "solitary" and "associated" group. RESULTS: Age, sex distribution, tumor location and histological findings were similar in the two groups. The esophageal resection was an esopharyngolaryngectomy (n = 13), a subtotal esophagectomy with cervical anastomosis (n = 92) and a Lewis-Santy esophagectomy with thoracic anastomosis (n = 9). Operative mortality (8 versus 7.7%), anastomotic leaks rate (14.5 versus 21%) and pneumonia rate (21 versus 9.6%) were not significantly different in the two groups. The mean hospital stay was 27 days. The mean follow-up was 85 +/- 50 months. Five-year survival rates were not significantly different in the two groups (p = 0.6411). In univariate survival analysis the only significant predictive factors were the depth of esophageal tumor invasion (p = 0.0002) and node involvement (p = 0.0373). The presence of head and neck cancer did not affect survival after esophagectomy. CONCLUSION: With an aggressive therapeutic plan, the survival of patients with an esophageal cancer associated to head and neck cancer was similar to the survival of patients with an isolated esophageal carcinoma. Long term esophageal survey seems to be useful to detect more superficial esophageal carcinomas in patients with head and neck cancer.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Primarias Múltiples/cirugía , Neoplasias Primarias Secundarias/cirugía , Anciano , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Tiempo de Internación , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Secundarias/patología , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/métodos , Infecciones Relacionadas con Prótesis/cirugía , Antibacterianos/uso terapéutico , Artroplastia/métodos , Terapia Combinada , Desbridamiento/métodos , Estudios de Seguimiento , Humanos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , Recurrencia , Reoperación/métodos , Irrigación Terapéutica/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Treatment of multiple primary squamous cell carcinomas of the head and neck and oesophagus is controversial. The poor prognosis of these 2 types of carcinoma taken individually and their anatomic proximity complicate the therapeutic strategy and limit the treatment choices for each location. METHODS: From 1986 to 1998, 43 patients received curative treatment for multiple synchronous (n = 30) or metachronous (n = 13) primary neoplasms of the oesophagus and head and neck. For synchronous cancers, the therapeutic strategy consisted of first curing the head and neck cancer and then planning oesophagectomy according to the type of head and neck cancer therapy. RESULTS: Ten total oesopharyngolaryngectomies and 33 subtotal oesophagectomies were performed. The postoperative mortality rate was 9.3% (4/43). The rate of anastomotic leakage was 30% (13/43), and all such leaks were cervical. Pulmonary infection occurred in 19% of cases (8/43). A past history of cervical radiation therapy or cervicotomy did not appear to be a significant risk factor for anastomotic leakage or pulmonary complications. Oesophagectomy did not affect the functional results in the 31 patients whose larynx could be preserved. CONCLUSIONS: Oesophagectomy after head and neck cancer treatment is possible with a low mortality rate and acceptable morbidity.
Asunto(s)
Neoplasias Esofágicas/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Primarias Múltiples/cirugía , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esofagectomía , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Laringectomía , Masculino , Persona de Mediana Edad , Morbilidad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/mortalidad , Faringectomía , Análisis de SupervivenciaRESUMEN
BACKGROUND: Esophageal squamous cell carcinomas are frequently associated with head and neck cancers. The poor prognosis of each cancer, and their proximity, often limit the treatment options. This study was conducted to determine the characteristics and long-term outcome of such dual cancers. PATIENTS AND METHODS: We included 75 patients with esophageal carcinoma, of whom 25 had a synchronous head and neck malignancy. Curative treatment was possible in every case. The patients were divided into "solitary cancer" and "synchronous cancer" groups. RESULTS: The gender distribution, tumor location, and histological findings were similar in the two groups. Patients in the synchronous cancer group were younger than those in the solitary group (P < 0.0042). The operative mortality and pulmonary morbidity rates were not significantly different in the two groups. The rate of cervical anastomotic leaks was higher in the synchronous group (P < 0.05). The mean follow-up was 83 +/- 50 months. Five-year survival rates were not significantly different in the two groups (14.3% +/- 5.7% in the solitary group and 17.5% +/- 7.9% in the synchronous group). CONCLUSIONS: With aggressive treatment, the survival of patients with synchronous esophageal and head and neck cancers was similar to that of patients with isolated esophageal cancer.
Asunto(s)
Carcinoma de Células Escamosas/mortalidad , Neoplasias Esofágicas/mortalidad , Esofagectomía , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias Primarias Múltiples/mortalidad , Carcinoma de Células Escamosas/cirugía , Estudios de Casos y Controles , Neoplasias Esofágicas/cirugía , Esofagectomía/mortalidad , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Análisis de Supervivencia , Tasa de Supervivencia , Factores de TiempoAsunto(s)
Carcinoma de Células Escamosas/diagnóstico , Quiste Pancreático/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/patología , Humanos , Masculino , Persona de Mediana Edad , Quiste Pancreático/complicaciones , Quiste Pancreático/patología , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/patología , Tomografía Computarizada por Rayos XRESUMEN
Cystic dystrophy of the duodenal wall developing in heterotopic pancreas is rare. Pancreaticoduodenectomy is usually advocated in cases of symptomatic cystic dystrophy without chronic pancreatitis but little is known about long-term results. We report a case of cystic dystrophy of the duodenum wall developing in heterotopic pancreas responsible for abdominal pain and duodenal obstruction associated with chronic pancreatitis. Pancreaticoduodenectomy allowed complete relief of symptoms. Chronic pancreatitis associated with cystic dystrophy may complicate the choice of appropriate therapy.