48 research outputs found
Role of the extended lymphadenectomy in gastric cancer surgery: experience
Although curative resection is the treatment of choice for gastric
cancer, controversy exists about the adequate extent of lymph node dissection
when resection is performed. METHODS: We retrospectively assessed 85 patients who
underwent a limited lymphadenectomy (D1) and 71 who had an extended lymph node
dissection (D2) in a single institution between 1990 and 1998 (median follow-up,
37.3 months). Prognostic factors were assessed by Cox proportional hazard models
adjusted for potential confounders. RESULTS: We found no significant difference
in the length of hospital stay (median, 12.1 and 13.1 days), overall morbidity
(48.2% and 53.5%), or operative mortality (2.3% and 0%) between D1 and D2,
respectively. Five-year survival in the D2 group was longer (50.6%) than in the
D1 group (41.4%) for tumor stages (tumor-node-metastasis) >I. In multivariate
analysis, tumor-node-metastasis stage (hazard ratio for stages >I vs. 0-I, 11.6),
the ratio between invaded and removed lymph nodes, the presence of distant
metastases, Lauren classification, and the extent of lymphadenectomy (hazard
ratio for D1 vs. D2, 2.3; 95% confidence interval, 1.25-4.30) were the only
significant prognostic factors. CONCLUSIONS: Our experience shows that extended
(D2) lymph node dissection improves survival in patients with resected gastric
cancer
Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy A Consecutive Nine-case Series at a Single Institution
To present the results of a series of laparoscopic middle
pancreatectomies with roux-en-Y duct-to-mucosa pancreaticojejunostomy. SUMMARY OF
BACKGROUND DATA: Middle pancreatectomy makes it possible to preserve pancreatic
parenchyma in the resection of lesions that traditionally have been treated by
distal splenopancreatectomy or cephalic duodenopancreatectomy. The laparoscopic
approach could minimize the invasiveness of the procedure and enhance the
benefits of middle pancreatectomy. METHODS: From March 2005 to October 2007, 9
consecutive patients with benign or low malignant potential lesions in the
pancreatic neck or body underwent surgery. Laparoscopic middle pancreatectomy
with a roux-en-Y duct-to-mucosa pancreaticojejunostomy was planned on all of
them. In the first 2 patients, the pancreas was transected by endostapler; in the
last 7, the staple line was reinforced with absorbable polymer membrane. RESULTS:
The intervention was concluded laparoscopically in every case except 1
(laparoscopic-assisted) in which pancreaticojejunostomy was performed by means of
minilaparotomy. Mortality was 0% and perioperative morbidity was 33%, (fistula of
the cephalic stump in the first 2 patients (22%)). The pancreaticojejunostomy
fistula rate was 0%. The median postoperative hospital stay was 5 days (range,
3-41). In the last 7 patients, in which pancreas was transected with staple line
reinforcement material there were no stump fistulas; morbidity decreased to 14%
and the median hospital stay was 4 days (range, 3-30). CONCLUSIONS: Laparoscopic
middle pancreatectomy is feasible and safe. Duct-to-mucosa pancreaticojejunostomy
can be performed safely using this approach. The method of pancreatic transection
seems to be decisive in the incidence of cephalic stump fistulas
Novedades en el tratamiento quirúrgico del cáncer de mama
Adecuate surgical treatment is mandatory in order to achieve cure in patients with breast cancer. Breast surgeons have to choice the best surgical technique over the breast and over the axillary nodes. Two new surgical aproaches have been implemented in the last decade: oncoplastic conservative surgery and sentinel lymph node biopsy. Oncoplastic surgery provides oncologic safety results and good cosmetic outcome. In this paper the technical steps and indications of different oncoplastic techniques in conservative breast surgery are review. Concerning to axillary surgery sentinel lymph node biopsy is the gold standard. However there are several controversial points in sentinel node biopsy referring to indications, identification and histological findings
Sistemas de acceso venoso central (SAVC) en pacientes pediátricos. Experiencia de seis años
The need for an access to the venous system, in order to infuse chemotherapeutic treatments or parenteral nutrition, has increased the number of central venous access systems (CVAS) implanted in the past years. Between February 1985 and December 1990, 87 devices were implanted in 76 patients (from 11 months to 15 years of age), with a median function time of 349 days (range: 7 to 1887 days). The overall incidence of complications was 0.10 per 10 days of catheterization, with complication rates for infection and thrombosis of 0.02 and 0.03, respectively. Nineteen systems were removed because of complications and 11 because of completion of the treatment. Of the cases, 97.7% included a follow-up period. The present study confirms the advantages of these devices, with a long working life and a low complication rate, being a good alternative for chronically ill children requiring long-term and/or cyclic intravenous therapy
Secuelas tras inyección ilegal de silicona líquida como técnica de aumento mamario: presentación de 2 casos
The use of liquid silicone for breast augmentation
was widespread in the 1960s but was abandoned at
the end of the decade due to numerous studies describing
the development of a large number of local
complications, as well as remote migration of small
amounts of silicone. The use of liquid silicone also leads
to enormous difficulty in the early diagnosis of
breast cancer; these patients are precluded from routine
screening programs and must undergo exhaustive
periodic examinations. Magnetic resonance imaging
has become the most effective test for the early
detection of breast cancer in these patients. Indications
for subcutaneous mastectomy are the presence
of local complications, suspicion of a malignant lesion,
or the patient’s desire to prevent both these potential
problems
Comparison Between Two Warm Ischemic Models in Experimental Liver Transplantation in Pigs
Experimental models of warm ischemia in liver transplantation have
been employed to study the mechanisms and treatment of ischemia reperfusion
injury. METHODS: We compared a control group without (group A, n = 10) versus two
models of warm ischemia of liver transplants in pigs: namely, occlusion of the
hepatic artery and portal vein for 30 minutes (group B, n = 23) and extraction of
the liver 60 minutes after cardiac arrest (group C, n = 5). Liver function tests,
coagulation studies, and liver biopsies were performed during the first 24 hours
post-liver transplant. RESULTS: Clamping of the hepatic vasculature in group B
produced a significant liver injury compared with the control group: elevation of
the ALT and an abnormal 1-hour post-revascularization biopsy similar to that
observed in the cardiac arrest group C. The transaminase levels were lower among
group A animals (P <.05). But the hepatic synthetic functions as reflected in the
protrombin time (PT) were not affected in group B versus group A. The alteration
in PT with respect to the initial value was similar among group A and group B
animals, which were significantly less than that in group C (P <.05).
CONCLUSIONS: Occlusion of the hepatic artery and portal vein, a simple surgical
maneuver, causes moderate damage to a liver graft but less alteration of hepatic
synthetic function. Clamping of the hepatic vasculture obtains more long-term
survivors after OLT than cardiac arrest