12 research outputs found
Spontaneous regression of a true splenic cyst: a case report and review of the literature
Splenic cysts are rare clinical findings, detected due to derivative symptoms or as a random discovery in abdominal imaging. Although there still remains controversy as to their optimal treatment, bigger secondary cysts should be treated surgically. However, spontaneous regression may be observed in cysts with a diameter smaller than 4 cm. In these cases, expectant treatment is preferable. We report, herein, a single case of a splenic cyst in an adult woman, who reported minor symptoms despite the size of the lesion and who demonstrated a possible almost total regression of the cyst within a ten-year period, accompanying with review of the most recent literature
Diffuse anorectal melanoma; review of the current diagnostic and treatment aspects based on a case report
Primary anorectal melanoma is a rare and aggressive disease. Patients commonly complain for changes in bowel habits and rectal bleeding, and proctoscopically they mostly appear as non pigmented or lightly pigmented polypoid lesions. Such a lesion should always raise a high index of suspicion in any gastroenterologist or surgeon to prompt surgery, since early radical excision is the only treatment option
Surgical treatment of giant mesenteric fibromatosis presenting as a gastrointestinal stromal tumor: a case report
<p>Abstract</p> <p>Introduction</p> <p>Intra-abdominal fibromatosis, usually located at the mesenteric level, is a locally invasive tumor of fibrous origin, with no ability to metastasize, but a tendency to recur. Certain non-typical cases of intra-abdominal fibromatosis with involvement of the bowel wall can be misdiagnosed because of their different biological behavior.</p> <p>Case presentation</p> <p>We describe the case of a 64-year-old Caucasian man presenting with mesenteric fibromatosis and involvement of the bowel wall, who was treated surgically. The macroscopic and microscopic appearance of the lesion mimicked a gastrointestinal stromal tumor, a tumor with potential malignant behavior.</p> <p>Conclusion</p> <p>It is essential to make an early and correct diagnosis in such equivocal cases, so that the appropriate treatment can be chosen and suitable patients admitted to clinical trials if appropriate. New and reliable criteria for discriminating between intra-abdominal fibromatosis and gastrointestinal stromal tumor should be proposed and established because novel sophisticated therapeutic strategies have been introduced in the international literature.</p
Antioxidant Properties of Probiotics and Their Protective Effects in the Pathogenesis of Radiation-Induced Enteritis and Colitis
Radiation therapy has become one of the most important treatment
modalities for human malignancy, but certain immediate and delayed
side-effects on the normal surrounding tissues limit the amount of
effective radiation that can be administered. After exposure of the
abdominal region to ionizing radiation, nearly all patients experience
transient symptoms of irradiation of the bowel. Acute-phase symptoms may
persist for a short time, yet long-term complications can represent
significant clinical conditions with high morbidity. Data from both
experimental studies and clinical trials suggest the potential benefit
for probiotics in radiation-induced enteritis and colitis. On the other
hand, it is well evidenced that both useful and harmful effects of
therapeutic applications of ionizing radiation upon living systems are
ascribed to free-radical production. Therefore, the hypothesis that
probiotics reinforce antioxidant defense systems of normal mucosal cells
exposed to ionizing radiation may explain to an extent their beneficial
action. The aim of this review is threefold: First, to make a short
brief into the natural history of radiation injury to the intestinal
tract. Second, to describe the primary interaction of ionizing radiation
at the cellular level and demonstrate the participation of free radicals
in the mechanisms of injury and, third, to try a more profound
investigation into the antioxidant abilities of probiotics and
prebiotics based on the available experimental and clinical data
Temporal Changes of Low Anterior Resection Syndrome Score after Sphincter Preservation: A Prospective Cohort Study on Repetitive Assessment of Rectal Cancer Patients
Background: There is a relative shortage of studies directly addressing the postoperative rectal cancer patients’ evacuatory dysfunction, as estimated by the low anterior resection syndrome (LARS) score at repeated assessment time-points. The aim of the present study was to prospectively evaluate the incidence of LARS at predefined time intervals during the first 3 years after sphincter preserving rectal cancer surgery and to enlighten the effect of identified risk factors. Materials and methods: Seventy-eight patients, who remained alive and recurrence-free 2 years after (ultra-) low anterior resection were prospectively assessed at 6, 12, 18, 24, 30 and 36 months postoperatively, using the LARS score as bowel dysfunction outcome measure. All patients have completed the 2-year follow-up functional assessment, while 56 and 37 of them have been evaluated up to the 30th and the 36th postoperative month, respectively. Results: The proportion of patients with “major and minor” LARS significantly decreased during the first 3 evaluations (up to 18 months) (74% vs 62% vs 35%, p = 0.0001). The tumor distance from the anal verge and the neoadjuvant radiotherapy were identified as risk factors for high LARS score at 6 months (p < 0.03). The tumor distance remained as risk factor throughout the entire follow-up. All patients with high tumors were alleviated from symptoms reflecting “major” or “minor” LARS at 18 months. Most patients (90%) after radiotherapy showed a high LARS score in the first semester, but improved afterwards. Conclusion: Overall, the LARS score improves in the majority of patients after 18 months, with low tumor height and radiation adversely affecting them. Our results may be useful in more accurately define the postoperative “functional course” of rectal cancer patients and in aiding their consultation on expected functional outcome
A prospective longitudinal evaluation and affecting factors of health related quality of life after appendectomy
Background: The aim of the present study was to longitudinally evaluate
the pattern of Health-Related Quality of Life (HRQoL) alterations, as an
indirect convalescence index after appendectomy, to assess the timing of
its restoration to the healthy population levels and to attempt a
profound investigation into factors determining HRQoL outcomes.
Methods: Uncomplicated cases of histologically verified acute
appendicitis (AA) were enrolled in a prospective cohort study. HRQoL
indices were collected at baseline, 15 days, 1 and 3 months using EQ-5D,
SF-36 and, GIQLI questionnaires. Data were processed with non-parametric
tests and logistic regression analysis.
Results: For the 147 patients eventually included, significant
improvements compared to baseline at EQ-5D and SF-36 general health and
physical function domains were noted at 15 days, while bodily pain was
worse. The majority HRQoL parameters were significantly better at the
1st and the 3rd-month compared to baseline and the 15th-day assessments.
General health, physical and emotional function were restored at the
general population levels between 15 days and 1 month, while bodily
pain, social function and EQ-5D indices between the 1st and 3rd month.
Logistic regression analysis indicated that high Alvarado score was the
most powerful predictor of HRQoL impairment with older age coming
second.
Conclusions: Post-appendectomy HRQoL disturbances predominate and the
burden of AA should not be underestimated. Convalescence period as
translated by HRQoL restoration may be extended beyond the second week
and up to the first month. Degree of inflammation and patient’s age
emerged as key mediators of HRQoL outcomes. (C) 2014 Surgical Associates
Ltd. Published by Elsevier Ltd. All rights reserved
Do Anastomotic Leaks Impair Postoperative Health-related Quality of Life After Rectal Cancer Surgery? A Case-matched Study
BACKGROUND: Anastomotic leaks after colorectal resections for cancer are
a leading cause of postoperative morbidity, mortality, and long hospital
stay. Few data exist on the potentially deleterious effect of the
anastomotic leaks after proctectomy for cancer on patient health-related
quality of life.
OBJECTIVE: The aim of this study was to explore the effect of clinically
evident anastomotic leaks on health-related quality of life after rectal
cancer excision.
DESIGN: This is a case-matched study.
SETTINGS: This study was conducted in a Greek academic surgical
department.
PATIENTS: Included were 25 patients undergoing low anterior resection
complicated by an anastomotic leak (Clavien classification II, n = 14,
and III, n = 11) and 50 patients undergoing low anterior resection with
an uncomplicated course.
MAIN OUTCOME MEASURES: Health-related quality-of-life data were
prospectively collected at fixed assessment time points (baseline, 3, 6,
and 12 months postoperatively) by the use of validated questionnaires
(Medical Outcomes Study Short Form 36, Gastrointestinal Quality of Life
Index, European Organization of Research and Treatment of Cancer Quality
of Life Questionnaire-C30, and European Organization of Research and
Treatment of Cancer Quality of Life Questionnaire-CR29).
RESULTS: Leak patients required a longer hospitalization. Although the
numbers of initially constructed defunctioning loop ileostomies were not
significantly different between cases and controls, leak patients were
required to remain with a stoma significantly more often at all
postoperative assessment time points. No differences were observed in
the baseline scores between the 2 groups. Physical function of leak
patients was significantly worse at all postoperative assessment time
points. At 6 and 12 months, their emotional and social function and
overall quality-of-life scores were significantly decreased in
comparison with the patients with an uncomplicated course. Leak patients
experienced significantly more stoma-related problems and sore skin
around the stoma site.
LIMITATIONS: Limited number of patients, restriction of follow-up to the
end of the first year, and heterogeneity in terms of the presentation,
severity, and management of anastomotic leaks were the limitations of
this study.
CONCLUSIONS: Anastomotic leaks have an adverse effect on postoperative
health-related quality of life
Diffuse anorectal melanoma; review of the current diagnostic and treatment aspects based on a case report
Primary anorectal melanoma is a rare and aggressive disease. Patients
commonly complain for changes in bowel habits and rectal bleeding, and
proctoscopically they mostly appear as non pigmented or lightly
pigmented polypoid lesions. Such a lesion should always raise a high
index of suspicion in any gastroenterologist or surgeon to prompt
surgery, since early radical excision is the only treatment option.
Herein, we report a case of a 57-year-old man with a diffuse anal canal
melanoma and give reference to the current diagnostic and treatment
options