Mucinous biliary cystadenoma (MBC) is a very rare cystic tumour of the liver usually occurring in middleaged women. This condition is difficult to diagnose before surgery; differential diagnosis with hydatid disease of the liver has to be done and is difficult to distinguish from mucinous biliary cystadenocarcinoma. We report two diagnosed and treated cases of intrahepatic MBC.
a marked improvement in survival (between 50% and 62%), largely attributed to lymph node resection known as "D2 lymphadenectomy" [1]. The randomized prospective studies made by the Dutch Gastric Cancer Group and the Medical Research Council, comparing patients submitted to D2 lymphadenectomy with those submitted to D1 gastrectomy, concluded that D2 lymphadenectomy caused greater morbidity and mortality, without benefi t in terms of survival. The procedure therefore was not recommended on a routine basis [2,3].These conclusions have been repeatedly questioned, however, for methodological reasons, among others. This and the publication of studies showing the advantages of D2 lymphadenectomy have generated uncertainty regarding an ideal lymphadenectomy for the management of these patients [4][5][6][7][8][9][10][11][12][13][14][15][16][17].Moreover, other studies suggest that surgeon expertise not only plays an important role in reducing surgical morbidity and mortality but also contributes substantially to improving survival [18].Gastric cancer mortality is largely attributable to relapse of the disease, manifesting in different ways or in more than one location simultaneously [19].Some authors consider gastric cancer relapse and patient survival to depend on both the stage of the disease at the time of diagnosis and on the extent of surgery [4].The present study examined whether D2 lymphadenectomy associated with surgery for gastric cancer can be performed with morbidity and mortality outcomes that justify the procedure, and, moreover, whether the procedure offers benefi t in terms of patient survival.The study presents the results obtained with gastrectomy and D2 lymphadenectomy performed over a period of time at the Department of General and Digestive Surgery (Esophagogastric Unit) of the Virgen del Camino Hospital (Pamplona, Navarre, Spain). AbstractBackground. In the surgical management of gastric cancer, D2 lymphadenectomy aims to reduce the incidence of locoregional relapse, and to increase patient survival. Methods. A prospective study was made of 126 consecutive patients operated upon for gastric cancer, with gastrectomy and D2 lymphadenectomy. Hospital morbidity and mortality, relapses, and patient survival after 5 years were studied. Results. The overall hospital mortality rate was 1.6%, with a mortality of 2.1% in the patients submitted to total gastrectomy. The overall morbidity rate was 29.4%. Dehiscence of the esophagojejunal anastomosis was recorded in 1.6%. The median follow-up was 73.6 months. Relapses were observed in 37% of the patients (76% in the fi rst 2 years). Overall actuarial survival after 5 years was 52.3%, and 5-year survival in the patients with R0 resection with positive N2 lymph nodes according to the Japanese classifi cation was 26.5%. Conclusion. Our results show that D2 lymphadenectomy can be performed with low morbidity-mortality, and a 5-year survival of more than 50%. The procedure offers benefi t in terms of survival for a certain percentage of patients with positive level N2...
There is evidence in the literature that psychosocial aspects affect the symptoms and results of surgery for gastroesophageal reflux. The purpose of this study was to estimate the prevalence of psychopathological disorders measured using the General Health Questionnaire (GHQ-28) in a sample of patients with gastroesophageal reflux, and to assess the influence of such disorders on their quality of life. A prospective study was conducted in 74 consecutive patients before gastroesophageal reflux surgery; patients answered the GHQ-28, the health questionnaire SF-36, and the Gastrointestinal Quality of Life Index (GIQLI). The convergent validity of the GHQ-28 questionnaire as compared to the other two questionnaires and preoperative quality of life was tested. A pathological result of the GHQ-28 questionnaire was found in 38.3% of patients. A correlation was seen between the results of the GHQ-28 questionnaire and all categories of the SF-36 and GIQLI questionnaires. Patients with pathological results in the GHQ-28 questionnaire had poorer results in all dimensions of the SF-36 and GIQLI quality of life questionnaires as compared to patients with a normal result in the GHQ-28 questionnaire. In conclusion, 38.3% of patients with gastroesophageal reflux showed psychopathological disorders when administered the GHQ-28 questionnaire. These patients also had poorer results in quality of life studies.
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