Hiatal hernia is a rare postoperative complication of esophagectomy in the treatment of esophageal cancer. Although rare, its incidence increased after the establishment of minimally invasive surgical techniques. The patient is usually oligosymptomatic, and the diagnosis is made in the late postoperative period, during outpatient follow-up. The initial presentation of hiatus hernia with hemodynamic instability is a rare condition that has never been described in the literature before. In the following report, we address the clinical picture, diagnosis, and treatment for this condition, discussing the main nuances of the literature.
Objective: To assess the predictive value of preoperative serum laboratory test results for identifying choledocholithiasis and reduce the use of cholangioresonance and its inherent costs. Methods: Patients aged 21-69 years who underwent preoperative cholangioresonance examination at our institute were included. Patients with a history of fluctuating jaundice or biliary pancreatitis, bile duct dilatation on ultrasonography, and elevated levels of canalicular enzymes (alkaline phosphatase >100U/L and gamma-glutamyl transferase >50U/L) underwent cholangioresonance-guided surgery. Cases of choledocholithiasis confirmed by cholangioresonance were compared with those without choledocholithiasis. Serum laboratory data were evaluated and the diagnostic capabilities of these examinations were analyzed. Results: A total of 104 patients were included. For detecting choledocholithiasis using alkaline phosphatase, the cut-off point was 78U/L, sensitivity was 97.6% (95%CI: 87.4-99.9), and specificity was 72.6% (95%CI: 59.8-83.1). In the binary logistic regression analysis, age (OR= 0.92; 95%CI: 0.86-0.98) and alkaline phosphatase level (OR= 1.02; 95%CI: 1.01-1.05) were selected for the final model. Conclusion: Serum alkaline phosphatase levels may aid preoperative diagnosis of asymptomatic choledocholithiasis. After a global clinical assessment of the patient, serum laboratory findings may contribute to a reduction in cholangioresonancerelated heathcare costs.
RESUMOIntrodução: O gliossarcoma apresenta componentes gliais e sarcomatosos em sua constituição e uma média de sobrevida entre 6 e 14,8 meses. Relato do Caso: Paciente de 32 anos que recebeu, em 2012, o diagnóstico de meningioma e realizou a ressecção cirúrgica. Em 2013, após quadro de cefaleia intensa e crises convulsivas tônico-clônicas, a paciente foi submetida à tomografia computadorizada (TC) e à ressonância magnética (RM), que sugeriram a recidiva do meningioma. Uma nova cirurgia foi efetuada e a análise anatomopatológica confirmou tratar-se de um gliossarcoma, optando-se, portanto, pela radioterapia como conduta adjuvante. Após o tratamento, a paciente recebeu alta e indicação para realizar RM de controle. Em 2015, fraturou o fêmur direito e os exames de imagem indicaram lesão sugestiva de metástase, o que foi confirmado após análise anatomopatológica, instituindo-se tratamento quimioterápico. Mesmo após a conclusão da terapêutica, outros focos de metástase foram confirmados na crista ilíaca, na coluna vertebral e nos pulmões. A paciente, devido ao acometimento sistêmico, veio a óbito 26 meses após o diagnóstico inicial de gliossarcoma. Discussão e Conclusão: Quanto às metástases sistêmicas envolvendo o gliossarcoma, a revisão da literatura evidenciou que as metástases ósseas são incomuns e que, apesar disso, a paciente do caso apresentou sobrevida maior do que a esperada. ABSTRACT Introduction:Gliosarcoma presents glial and sarcomatous components in its constitution and an average survival between 6 and 14.8 months. Case Report: A 32-year-old patient who, in 2012, had meningioma diagnosis and underwent surgical resection. In 2013, after a severe headache and convulsive tonic-clonic seizures, the patient was submitted to computed tomography (CT) and magnetic resonance imaging (MRI), which suggested a relapse of the meningioma. A new surgery was performed and anatomical pathology analysis confirmed gliosarcoma, therefore, radiotherapy was chosen as adjuvant behavior. After treatment, the patient was discharged and indicated to perform control MRI. In 2015, she fractured the right femur and the imaging tests indicated lesions suggestive of metastasis, which was confirmed after anatomical pathology analysis, and chemotherapy treatment was instituted. Even after completion of therapy, other foci of metastasis were confirmed in the iliac crest, spine and lungs. The patient, due to systemic involvement, died 26 months after the initial diagnosis of gliosarcoma. Discussion and Conclusion: Regarding the systemic metastases involving gliosarcoma, a review of the literature has shown that bone metastases are uncommon and that, despite this, our patient had a survival rate higher than expected. IntroduçãoOs meningiomas correspondem de 13 a 26% dos tumores intracranianos 1,2 . São mais comuns em adultos com mais de 60 anos, e sua incidência aumenta com a idade, acometendo duas vezes mais mulheres do que homens 3 . De acordo com a classificação dos tumores do sistema nervoso central (SNC), elaborada pela Organização M...
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