7 research outputs found

    TEM in the treatment of recurrent rectal cancer in elderly

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    INTRODUCTION: Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. PATIENTS AND METHODS: During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months. RESULTS: The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies. DISCUSSION: The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy. CONCLUSION: In selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results

    TEM in the treatment of recurrent rectal cancer in elderly

    Get PDF
    INTRODUCTION: Transanal microscopic surgery is an important application of minimally invasive surgery of rectum, allowing realization of complex transanal intervention. PATIENTS AND METHODS: During the period between January 2002 and December 2010, seven patients, five men and two women, average age 75 years, with early rectal cancer recurrence were selected for this type of surgical palliative procedure. The selection of the patients is made by: transrectal ultrasonografy, colonoscopy and abdominal ultrasonografy, to rule out liver metastases, CT with and without enema, PET CT. Follow-up is approximately 12-30 months. RESULTS: The pathologic staging confirms the complete excision of recurrences. Then patients are referred for more complementary therapies. DISCUSSION: The significance of conservative treatment for local recurrence of rectum adenocarcinoma is still controversial because the recurrence is an expression of tumor spread not controlled by oncological surgical and radio/chemo therapy. CONCLUSION: In selected subjects such as the elderly, based on equal oncological treatment, the reduction of surgical trauma, preservation of anatomical integrity and resolution of symptoms are important results

    Minimally invasive ileocecal valve resection in ileocecal Crohn's disease

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    Aim: Considering ileocolic resection as a surgical standard for the treatment of ileocecal valve Crohn's disease, we propose a limited resection of the terminal ileum and ileocecal valve with ileocecal anastomosis. Material of study: Three patiens between 20 and 37 years of age, diagnosed with Crohn's disease unresponsive to medical therapy, who have stenoses or fissures confined to the terminal ileum and ileocecal valve, seen during instrumental investigations. Results: The proposed procedure allowed us to perform a minimal resection and reconstruction of a new ileocecal valve. Once the symptoms have resolved, at endoscopic follow ups, at 6 and 12 months after surgery, there were no changes in the mucosa of the ileocecal neo-anastomosis. Discussion: Since Crohn's disease is a systemic disease with a chronic relapsing course complicated by a high rate of post-surgical relapses, it is essential to limit the extension of resections to the macroscopically involved tissues and reduce the anastomotic surfaces. The proposed surgical procedure allows to preserve the caecum and the colon with an optimal postoperative course. Conclusion: We believe that, with specific clinical and endoscopic conditions, the treatment we illustrated can be proposed to other patients as an alternative to the standard VL ileocolic resection. Key words: Crohn's Disease, Ileocaecal Valve, Ileocaecal Anastomosis

    Adrenocortical carcinoma: What the surgeon needs to know. Case report and literature review

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    AbstractAdrenocortical carcinoma is a rare and aggressive cancer and its prognosis is frequently unsatisfactory. Due to its rarity there's a lack of prospective randomized studies. Without experience in the approach of this kind of tumor, managing becomes challenging and, moreover, we have only few recommendations, based on weak evidence. We report a case that has some peculiarities and is an excellent food for thought. Then we deal with a literature review to highlight and summarize most significant aspects of epidemiology, clinic, diagnosis, therapy and prognosis in an exquisitely surgical point of view

    Imipenem/cilastatin (1.5 g daily) versus meropenem (3.0 g daily) in patients with intra-abdominal infections: Results of a prospective, randomized, multicentre trial

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    An open-label prospective, randomized, parallel multicentre study was undertaken to compare the efficacy and tolerability of 1.5 g/day intravenous imipenem/cilastatin with 3 g/day intravenous meropenem in the treatment of intra-abdominal infections, A total of 287 patients mere enrolled; 201 patients, divided between the 2 treatment groups, were evaluable. Clinical outcome, bacteriological outcome, untoward microbiological effects, and clinical and laboratory adverse experiences mere evaluated, 98% of patients receiving imipenem/cilastatin therapy mere cured, with 96% showing eradication of infection, 95% of those on meropenem mere cured, with 98% showing eradication. These differences in clinical and bacteriological outcome between the 2 treatments were not statistically significant, Two patients receiving imipenem/cilastatin and 5 receiving meropenem had untoward microbiological effects. There mas a 0.7% frequency (1/139 patients) of possibly or probably drug-related clinical or laboratory adverse experiences with imipenem/cilastatin and a 2.7% frequency (4/148) with meropenem, The mean time to defervescence was significantly less for patients in the imipenem/cilastatin treatment group than for those receiving meropenem. This study shows that 1.5 g/day of imipenem/cilastatin is equivalent to 3.0 g/day meropenem in clinical and bacteriological outcome, as well as in incidence of side effects
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