Background. Mature cystic teratomas (dermoid cysts) are the most common germ cell tumours with 10–25% incidence of adult and 50% of paediatric ovarian tumours. The aetiology of dermoid cysts is still unclear, although currently the parthenogenic theory is most widely accepted. The tumour is slow-growing and in the majority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. The main complication of a dermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1–2%), infection (1%), and rupture (0.3–2%). Prolonged pressure during pregnancy, torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. The diagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. Materials and methods. We present a report of a clinical case of a 35-years-old female, who was referred to the hospital due to abdominal pain spreading to her feet for three successive days. She had a history of a normal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed a multiloculated cystic mass measuring 16 × 10 cm in the pelvis. In the absence of urgency, planned surgical treatment was recommended. The next day the patient was referred to the hospital again, with a complaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. The ultrasound scan differed from the previous one. This time, the transvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was a large amount of free fluid in the abdominal cavity. The patient was operated on – left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of the thromboembolism were administered. The patient was discharged from the hospital on the seventh postoperative day and was sent for outpatient observation. Results and conclusions. Ultrasound is the imaging modality of choice for a dermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once a rupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of the spontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.
Background. Uterine sarcomas are rare gynaecologic tumours representing 3–7% of all uterine malignancies. The aetiology of sarcomas is still unclear: it is thought, that chromosomal translocations have influence on wide histological variety of sarcomas. Presenting symptoms are vague and nonspecific. Usually sarcoma causes abnormal vaginal bleeding, can cause abdominal or pelvic pain, or manifests as a rapidly growing uterine tumour. The diagnosis of sarcoma is often made retrospectively after surgical removal of a presumed benign uterine neoplasm, because imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign leiomyoma and malignant pathology. If there are certain clinical features that raise a suspicion of malignancy in the uterus, it is recommended to avoid the use of power morcellation through laparoscopic surgery in order to prevent disease dissemination. Materials and methods. We present a clinical case of a 64-year-old patient, who was referred to hospital due to abdominal pain and tenesmus that lasted for two days. From a past medical history it was known that previously the patient had been diagnosed with uterine myoma. Transvaginal ultrasonography showed a 10.4 cm × 9.8 cm uterine tumour of nonhomogeneous structure with signs of necrosis and good vascularization. The patient refused urgent hysterectomy, that was advised to her. The patient was operated on one month later and total hysterectomy with bilateral salpingooforectomy was performed. Postoperative histological evaluation showed undifferentiated sarcoma uterus pT1b L/V0. Imaging modalities were made to evaluate possible dissemination of the disease. In the absence of signs of disease progression, the patient received radiotherapy and brachytherapy and was followed-up by doctors. Results and conclusions. Uterine sarcomas are highly malignant tumours that originate from smooth muscles and connective tissue elements of the uterus and make up 1% of all malignant gynaecological tumours and about 3–7% of all malignant uterine tumours. Imaging modalities cannot yet reliably distinguish benign myomas from malignant sarcomas. It is important not to damage the wholeness of uterus during operation in order to prevent dissemination of the disease in the abdominal cavity. The low-grade endometrial stromal sarcoma has the best survival prognosis, while carcinosarcoma and undifferentiated uterine sarcoma have the lowest survival rates.
ĮvadasLietuvoje kasmet diagnozuojama apie 1500 kolorektalinio vėžio atvejų ir sergamumas šia liga kiekvienais metais didėja. Radi kalus chirurginis gydymo būdas taikomas siekiant pašalinti vėžį ir taip pailginti pacientų išgyvenamumą. Po operacijos profi laktinių patikrų metu suvėžėjusias pilvaplėvės ląsteles yra sunku diagnozuoti dėl klinikinių simptomų stokos ir nepakankamo vaizdinių tyrimų jautrumo. Todėl pacientams, turintiems rizikos veiksnius recidyvui atsirasti, tikslinga taikyti diagnostinę rela parotomiją, kurios metu būtų atliekama HIPEC procedūra. Ligoniai ir metodaiAtliktas retrospektyvusis tyrimas VULSK Pilvo chirurgijos centre. Tirti 321 pacientai, kuriems 2011-2014 m. diagnozuotas kolo rektalinis T3-T4 stadijos neišplitęs navikas ir taikytas radikalus chirurginis gydymas. Į tyrimą įtraukti 208 pacientai. Analizuoti operacijų protokolai bei histologiniai navikų aprašai. Rezultatai Analizuoti 208 pacientų duomenys. 34 (16,3 %) pacientams buvo nustatyti pirminio naviko recidyvai. Recidyvavo 15 (26,8 %) T4 histologinio tipo navikų ir 19 (12,5 %) T3 navikų (p=0,013). Recidyvavimas pagal išplitimą į regioninius limfmazgius buvo 10 (9,8 %) N0, 12 (18,2 %) N1 ir 12 (30 %) N2 grupėse (p=0,012). Iš žarnos spindį užkimšusių navikų recidyvavo 7 (46,7%) (p=0,003). Statistiškai reikšmingo ryšio tarp recidyvų dažnio ir pirminio naviko lokalizacijos, histologinio tipo ir pirminio navi ko perforacijos nenustatėme. Penkerių metų išgyvenamumas nenustačius ligos recidyvo buvo 24,65 %, o recidyvavus -0 %. Išvados Atlikus radikalią kolorektalinio naviko šalinimo operaciją, svarbu šiuos pacientus stebėtis dėl galimo ligos recidyvavimo. Paci entams, turintiems didelę riziką recidyvui atsirasti, yra tikslinga svarstyti relaparotomijos su CRS ir HIPEC galimybę. Reikšminiai žodžiai: kolorektalinis vėžys, recidyvas, rizikos veiksniai 45Recidyvo rizikos veiksniai po radikalios kolorektalinio vėžio operacijos Introduction Each year about 1,500 cases of colorectal cancer is diagnosed in Lithuania and the incidence of this disease is increasing every year. Radical surgery removal is the first choice treatment of the cancer that presents the best longterm results. Recurrence of the disease after surgery is difficult to diagnose due to the lack of clinical symptoms and insufficient sensitivity of imag ing study. The aim of the study was to evaluate risk factors for secondlook surgery of colorectal cancer following complete cytoreductive surgery. Materials and methodsBetween 2011 and 2014 in 321 cases radical T3T4 stage colorectal cancer surgery was performed. 208 of 321 patients were involved to study. In a single centre retrospective study we analyzed operation records and pathophysiological protocols. Results A total 34 (16.3%) patients had recurrence of the disease in 14 year. In 15 (26,8%) T4 stage and 19 (12.5%) T3 stage cases colorectal cancer relapsed (p=0,013). Lymph node invasion impacts recurrence: N0 -10 (9.8%), N1 -12 (18.2%) N1, N2 -12 (30%) (p=0.012). 7 (46.7%) occlusive colorectal cancer cases had recurrence (p=0.00...
[straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba] Įvadas. Anastomozės nesandarumas yra viena iš pavojingiausių komplikacijų, kylančių po storosios žarnos rezekcinių operacijų. Dėl šios pooperaciniu laikotarpiu pasireiškiančios komplikacijos pacientams didėja sergamumo ir mirtingumo rizika. Be komplikacijų ir pacientui sukeliamų klinikinių simptomų, anastomozės nesandarumas yra didelė finansinė našta ligoninei dėl atliekamų pakartotinių operacijų, didelio lovadienių skaičiaus, instrumentinių tyrimų ir kitų veiksnių, susijusių su anastomozės nesandarumo gydymu.Ligoniai ir metodai. Atliktas retrospektyvinis tyrimas. Tirti 39 pacientai, kuriems pooperaciniu laikotarpiu po storosios žarnos rezekcinės operacijos pasireiškė anastomozės nesandarumas. Analizuoti duomenys rinkti iš ligos istorijų protokolų ir naudojantis ligoninės elektronine sistema. Gydymo išlaidos skaičiuotos bendradarbiaujant su Vilniaus universiteto ligoninės Santaros klinikų Ekonomikos skyriumi. Anastomozės nesandarumo gydymo kaina lyginta su įprasto nekomplikuoto gydymo kaina ir su lėšomis, skirtomis pacientams gydyti, iš Valstybinės ligonių kasos.Rezultatai. Analizuoti 26 vyrų (66,7 %) ir 13 moterų (33,3 %) duomenys. Tiriamųjų amžiaus vidurkis – 69,5±13,6 metų, kūno masės indekso (KMI) vidurkis – 28,3. Ligoninės išlaidos šių pacientų anastomozės nesandarumui gydyti buvo didesnės negu lėšos, skirtos iš Valstybinės ligonių kasos (8 373,2±3 709,27 Eur vs. 4 097,1±1254,66 Eur) (p < 0,001). Ligonių, kuriems nustatytas anastomozės nesandarumas, gydymas kainavo keturis kartus daugiau negu nekomplikuotas poopercinis gydymas (8 373,2±3 709,27 Eur vs. 2 041,51±146,53 Eur), truko ilgiau (25,7±18,48 dienų vs. 7,5 dienų) ir buvo dešimt kartų nuostolingesnis (4 275,6±2 967,84 Eur vs. 389,0±146,08 Eur). 2014–2016 m. bendras ligoninės nuostolis, gydant anastomozės nesandarumą, siekė 166 769,74 Eur. Gydymo metu mirė 10 (25,6 %) tiriamųjų.Išvados. Storosios žarnos anastomozių nesandarumo gydymas kelia ligoninei didelę finansinę naštą. Būtina ieškoti sprendimų šiai problemai spręsti.
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