RESUMEN
Emphysematous cholecystitis, a relatively rare variant of acute cholecystitis, is associated with high morbidity and mortality rates. In the presence of a concomitant pneumoperitoneum, these rates may be considered even higher, approaching those of perforation of the gallbladder. The first choice of treatment in cases presenting with pneumoperitoneum is emergency laparotomy. We performed a staged procedure as a second best alternative. In a 65 year-old female patient, initial percutaneous cholecystostomy with a strict intravenous antibiotics regimen, and subsequent cholecystectomy 6 months, later was carried out with successful outcome. A review of the literature revealed 13 other cases of this combination. Treatment modalities and outcome of these patients are discussed.
Asunto(s)
Colecistitis/cirugía , Colecistostomía , Drenaje , Quimioterapia Combinada/administración & dosificación , Urgencias Médicas , Enfisema/cirugía , Neumoperitoneo/cirugía , Enfermedad Aguda , Anciano , Colecistectomía , Colecistitis/diagnóstico por imagen , Enfisema/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Metronidazol/administración & dosificación , Neumoperitoneo/diagnóstico por imagen , Reoperación , Tobramicina/administración & dosificación , Tomografía Computarizada por Rayos XRESUMEN
A 46-year-old man with a second local recurrence of a myxoid liposarcoma in the fossa poplitea, after surgery and high-dose external beam radiotherapy, was successfully treated by a limb-sparing procedure combining marginal excision, intraoperative radiotherapy and reconstructive surgery. After a 48-month follow-up, there was no evidence of disease, and the function of the leg and knee was normal.
Asunto(s)
Cuidados Intraoperatorios/métodos , Pierna , Liposarcoma/radioterapia , Liposarcoma/cirugía , Recurrencia Local de Neoplasia , Radioisótopos de Cobalto/uso terapéutico , Estudios de Seguimiento , Humanos , Liposarcoma/epidemiología , Masculino , Persona de Mediana Edad , Teleterapia por Radioisótopo , Dosificación Radioterapéutica , Radioterapia de Alta Energía , Colgajos Quirúrgicos , Factores de TiempoAsunto(s)
Neoplasias Abdominales/radioterapia , Neoplasias Óseas/radioterapia , Condrosarcoma/radioterapia , Neoplasias Abdominales/cirugía , Adulto , Neoplasias Óseas/cirugía , Condrosarcoma/cirugía , Terapia Combinada , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Dosificación Radioterapéutica , Radioterapia de Alta EnergíaRESUMEN
Patients with locally advanced disease, considered incurable by conventional therapeutic options, were treated, if possible, with surgical resection, and intra-operative radiotherapy (IORT) with or without external beam radiotherapy (EBRT), with the aim of improving local control of disease. Twelve patients were selected for IORT and eight patients were subsequently submitted to IORT in order to achieve local control. There were no IORT related complications, and local tumor control was achieved in all cases with a median follow-up of 22 months. IORT is a new and experimental treatment modality with a potential advantage over conventional radiotherapy.
Asunto(s)
Neoplasias/radioterapia , Neoplasias/cirugía , Adulto , Anciano , Terapia Combinada , Arquitectura y Construcción de Instituciones de Salud , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Quirófanos , Proyectos Piloto , Radioterapia/métodosRESUMEN
Blood loss during partial hepatic resection is a major concern. Controlling haemorrhage by means of non-cutting compression sutures, without the risk of disrupting the liver tissue, was experimentally investigated. Twenty-two beagles underwent a partial resection of the right median liver lobe with this technique. Blood loss was negligible and no complications occurred during surgery or follow-up. There were no deaths. The method of using compression sutures is a simple, quick and efficient technique to prevent blood loss during and after partial hepatic resection.
Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Hemostasis Quirúrgica/métodos , Hígado/cirugía , Técnicas de Sutura , Animales , Perros , Técnicas de Sutura/instrumentaciónRESUMEN
It is hypothesized that heterotopic segmental pancreatic autotransplantation with removal of the remaining segment compromises glucose tolerance in dogs in the long run. In 10 dogs the left lobe of the pancreas was heterotopically autotransplanted, in 5 dogs the left lobe remained in situ, after denervation. Duct drainage was provided by a pancreaticoileostomy. Six months after transplantation, decreased beta-cell response, combined with increased insulin sensitivity was observed in the heterotopically transplanted dogs. Five dogs in this group developed an insulin dependent diabetes mellitus. These results are explicable by the diversion of insulin from the liver and the late effects of continuous endocrine pancreatic stimulation on the beta-cell function.