RESUMO
OBJECTIVE: To review the experience with ileal pouch-anal anastomosis surgery for ulcerative colitis at the University Hospital. BACKGROUND: As many as 40 of patients with ulcerative colitis (UC) and 75 with Crohn's disease (CD) require some surgery for their disease. The number of patients referred to our clinics for evaluation and management of Inflammatory Bowel Disease (IBD) has risen in the past seven years. A multidisciplinary IBD service has been created at the University Hospital for the care of these patients, leading to a dramatic increase in the number of surgeries performed for IBD. Over the past decade the ileal pouch-anal anastomosis (IPAA) has emerged as the procedure of choice in most patients with ulcerative colitis requiring total colectomy for management of their disease. Even though the procedure is associated with a considerable morbidity rate, it has become very popular since it avoids the need for a permanent stoma and presumably rids the patient of disease and subsequent cancer risk. RESULTS: Twenty-five patients were identified as having IPAA for ulcerative colitis between 1993-2000. Indications for surgery were intractability and toxic megacolon. Complications were pouchitis in 11/25 (44), anastomotic stricture in 6/25 (24), small bowel obstruction in 4/25 (16), and pouch failure in 2/25 (8). Other complications included wound abscess in 1/25 (4), and sexual dysfunction in 1/25 (4) patients. There was no mortality; the patients' quality of life was rated as greatly improved in 14 of 17 patients interviewed (82.4) and 16 of 17 said they would recommend the surgery to others (94.1). CONCLUSIONS: The results of IPAA surgery, morbidity, mortality, and patient satisfaction in our series were similar to other centers around the world.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Colite Ulcerativa , Proctocolectomia Restauradora , Satisfação do Paciente , Complicações Pós-Operatórias , Pouchite , Porto Rico , Qualidade de VidaRESUMO
La localización superficial de las masas en la región cervical alta las hace con facilidad accesibles a la exploración mediante equipos de ultrasonido. Con ello podemos caracterizar la textura de la masa. Conocer sus dimensiones e inclusive guiar la punción biopsia para estudio histopatológico. Los patrones ecográficos resultan bastante confiables para sospechar el diagnóstico. Así las masas benignas se comportan como lesiones quísticas, de bordes nítidos, con algunos ecos finos internos de acuerdo al tipo específico de tumor. Las masas malignas son lesiones ecogénicas, con ecos irregulares en su interior y márgenes difusos. Se menciona la experiencia con 35 enfermos, entre los culaes se incluyen glándulas salivales, ganglios cervicales, quistes tiroglosos y una tumoración irregular, probable histiocitoma o neurofibroma.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Gânglios/anormalidades , Glândula Submandibular/anormalidades , Glândulas Salivares/anormalidades , Neoplasias de Cabeça e Pescoço/classificação , Neoplasias Parotídeas , Neoplasias Parotídeas/classificação , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/história , Gânglios , Glândula Submandibular , Glândulas Salivares , Neoplasias de Cabeça e Pescoço , Neoplasias de Cabeça e Pescoço/diagnósticoRESUMO
Las duplicaciones del tracto digestivo son alteraciones poco frecuentes en el desarrollo embrionario, las cuales suelen manifestarse como una masa en tórax o abdomen, con predilección por el sexo femenino y detectándose generalmente en etapa pediátrica temprana. Cobran interés al tenerlas en mente dentro del diagnóstico diferencial de tumoraciones, especialmente en niños. Se presentan dos casos de duplicación; el primero una duplicación del esófago distal en un hombre de 51 años; el otro en una niña de 5 años con una duplicación quística del estómago. Se revisa el tema y se presentan comentarios