The present study was performed to identify tumor cells in lymph nodes from colorectal adenocarcinomas considered free of disease by the classic hematoxylin-eosin stain, based on the detection of the carcinoembryonic antigen (CEA) and cytokeratins in neoplastic epithelial cells. For this purpose, 603 lymph nodes from 46 lesions were stained by the peroxidase-antiperoxidase technique. Tumor cells were detected in 22 nodes from 12 patients, mainly in the subcapsular sinuses, permitting a restaging of these patients into two groups: those now considered to have metastatic disease and those free of metastases. However, the 5-year follow-up showed no statistical differences in survival between the two groups.
RACIONAL: O tratamento de escolha para as doenças da vesícula biliar é a colecistectomia, cujo objetivo é o alívio de sintomas e o tratamento e/ou prevenção das complicações. OBJETIVO: Identificar as principais complicações da cirurgia videolaparoscópica no tratamento das doenças da vesícula biliar e vias biliares. MÉTODO: Realizou-se busca eletrônica na base de dados LILACS e Medline desde o ano de 1981 a agosto de 2007; foram encontrados 57 artigos, sendo utilizados para o estudo 31 e três capítulos de livros. RESULTADOS: A produção científica submetida à análise de conteúdo evidenciou os seguintes núcleos temáticos: variações anatômicas (3 artigos), iatrogenias (5 artigos), síndrome pós-colecistectomia (1 artigo), complicações raras (3 artigos), síndrome de Mirizzi (1 artigo), complicações pulmonares (2 artigos) e tratamento (1 capítulo de livro e três artigos). CONCLUSÕES: As complicações que podem ocorrer na cirurgia videolaparoscópica da vesícula biliar e das vias biliares têm basicamente duas vertentes: uma é a inexperiência dos cirurgiões com o método laparoscópico (curva de aprendizado) e outra, as variações anatômicas com as quais os cirurgiões, mesmo os mais experientes, podem se deparar.
From 1968 to 1975, 201 women had prophylactic oophorectomy at the time of definitive large-bowel resection, while in 134 patients oophorectomy was not performed. Oophorectomy was performed more commonly in women with cancer of the rectum and rectosigmoid. More patients undergoing oophorectomy had Dukes' C primary carcinoma. Four patients undergoing synchronous oophorectomy (2.0 per cent) had ovarian involvement or metastases from large-bowel cancer. Three patients (2.2 per cent) developed subsequent ovarian disease: two cases of ovarian carcinoma and one case of ovarian metastases from primary breast cancer. No late ovarian recurrences of large-bowel cancer were seen during this study. No patient with ovarian involvement or metastases from large-bowel cancer survived five years nor was the overall survival of the group of women undergoing oophorectomy materially affected. While stage and site significantly influenced survival, oophorectomy, menopausal status, preoperative irradiation, tumor size, and degree of differentiation had no influence. The prevention of primary ovarian cancer in postmenopausal women is considered to be the main benefit of bilateral prophylactic oophorectomy. Selective recommendations for oophorectomy under other circumstances are discussed.
The hamartomatous polyps of Peutz-Jeghers Syndrome (PJS) can cause repeated episodes of rectal bleeding and intestinal subocclusion. Laparoscopic treatment of intussusception is rarely reported and must be considered for this clinical condition. We described a 35-year-old male with PJS who presented with rectal bleeding and abdominal pain. One duodenal polyp and two others in the jejunum, which caused intussusception, were visualized on preoperative investigation. Polyps were identified by laparoscopy and removed extracorporeally through enterotomies. All lesions were hamartomas. The patient was discharged on the third postoperative day and has been asymptomatic for more than 2 years. Laparoscopy allows an adequate access to explore and treat small bowel polyps and avoid the classic laparotomy.
Chagas' disease is an endemic clinical entity caused by Trypanosoma cruzi, a parasite that is transmitted to humans by the hematophagic Triatominae insects. It affects several million persons in Latin America, mostly in Brazil, Argentina, Chile, Paraguay, and Bolivia. Megacolon, the most common complication of intestinal trypanosomiasis, results in severe constipation, for which surgery is indicated. A variety of procedures have been proposed for the correction of this disabling condition including sigmoidectomy, abdominal rectosigmoidectomy, left colectomy, and subtotal colectomy. On long-term follow-up, however, these operations have proved to be inadequate in a significant number of cases, apparently due to preservation of the dyskinetic rectum which continues to act as a functional obstacle to the progression of the fecal bolus. On the other hand, pull-through operations, which include the removal of all or almost all of the dyskinetic rectum, or the exclusion of the rectum, as in the Duhamel-Haddad operation, have been demonstrated to be superior. The abdominoperineal endoanal pull-through resection with delayed colorectal anastomosis and the Duhamel-Haddad operation are the most accepted procedures in Brazil and other Latin American countries; their technical details are illustrated. Functional results are satisfactory. Anal continence is normal in the vast majority of cases and sexual disturbances are rare. Routine treatment of 2 main complications--fecaloma and volvulus of the sigmoid colon--are discussed.
-Background -Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. Aim -To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. Methods -Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. Results -Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. Conclusion -Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea. HEADINGS -Acquired immunodeficiency syndrome. Colitis. Cytomegalovirus infections. Diarrhea. Colonoscopy.
Although the interobserver reproducibility of the colonic pit pattern is good for experienced endoscopists, MC must not be used to replace the histopathological analysis, since it does not differentiate with the necessary safety neoplastic from nonneoplastic lesions.
Abdominoperineal endoanal pull-through resection with colorectal anastomosis was performed on 728 patients--primarily those with chagasic megacolon and cancer of the rectum. Intestinal continuity was reestablished through immediate anastomosis (Swenson procedure) in 229 patients and through delayed anastomosis (Cutait-Turnbull procedure) in 499. Comparative studies showed: that the incidence of leakage was 31.9 percent in immediate and only 2.2 percent in delayed anastomosis; that presacral infection occurred in 27.9 percent in immediate and in 6.8 percent in delayed anastomosis; that stenosis was observed in 4.4 percent in immediate and 1.8 percent in delayed anastomosis; that mortality was 6.1 percent in immediate and 2.2 percent in delayed anastomosis; that anal continence was good in both procedures and that sexual disturbances were rare in benign and frequent in malignant lesions in both procedures. The final conclusion is that, in abdominoperineal endoanal pull-through resection with colorectal anastomosis, complications and mortality are less frequent in delayed than in immediate anastomosis and that continence and sexual behavior are identical in both procedures.
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