RESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.
Assuntos
Colo Sigmoide , Neoplasias do Colo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Idoso , Humanos , MasculinoRESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.
Assuntos
Colo Sigmoide , Neoplasias do Colo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Idoso , Humanos , MasculinoRESUMO
Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.
Assuntos
Colo Sigmoide , Intussuscepção/etiologia , Lipoma/complicações , Neoplasias do Colo/complicações , Humanos , Idoso , MasculinoRESUMO
In 1954, McKittrick and Wheelock described for the first time a syndrome presenting chronic lost of fluid and electrolytes secondary to chronic diarrhea, associated to large rectal villous adenomas. We report a case of a 75-year-old female who presented chronic diarrhea (3 to 4 depositions per day in the last year), accompanied by acute renal failure. In the rectal tact, we objective the presence of a mass of soft consistency with an irregular surface, occupying approximately two thirds of the circumference, at about 3 cm from the anal margin. It was confirmed by the colonoscopy and the patology was informed as villous adenoma, producing chronic diarrhea or McKittrick-Wheelock syndrome. We decide the surgical approach after the normalization of patient's general status and a proctectomy with coloanal anastomosis was performed. We conclude that we must think about this syndrome in aged patients with chronic diarrhea, alterations of the electrolyte balance and presence of renal failure. Surgery treatment after the replacement of water and electrolytes is the unique curative treatment. The absence of this can cause the death of these patients.
Assuntos
Injúria Renal Aguda/etiologia , Adenoma Viloso/complicações , Neoplasias do Colo/complicações , Diarreia/etiologia , Desequilíbrio Hidroeletrolítico/etiologia , Injúria Renal Aguda/cirurgia , Adenoma Viloso/cirurgia , Idoso , Neoplasias do Colo/cirurgia , Colonoscopia , Feminino , Humanos , Síndrome , Desequilíbrio Hidroeletrolítico/terapiaRESUMO
Este escrito tiene el propósito de presentar un conjunto de reflexiones en torno a la formación de un campo de investigación, la infancia anormal, y de intervención, la educación especial. En México, entre 1920 y 1940, se configuró un espacio de estudio en el que convergieron médicos, sociólogos, juristas y normalistas a fin de establecer «fronteras» y confluencias disciplinarias en torno a estos temas. Tal espacio favoreció una amplia circulación de ideas, delimitó contornos disciplinarios y contribuyó a crear o fortalecer«comunidades científicas», entre cuyos objetivos estuvieron el examen de la anormalidady el diseño de instituciones sociales y educativas que tendrían bajo su responsabilidad la atención de sectores de niños y niñas incluidos en dicha condición. (AU)
Assuntos
Criança , Saúde Pública/história , Crianças com Deficiência , Criança com Deficiência Intelectual , Educação Inclusiva/história , Ensino/história , MéxicoRESUMO
Lung cancer is the most prevalent malignancy in western countries and most of the patients present at advanced stages, but single splenic metastasis is exceptional instead. We report on a case of a seventy- three-year old male presenting with non-hemoptoic productive cough, constitutional syndrome and pain in the left lower quadrant. Physical examination and complementary radiological and histological procedures revealed the presence of an adenocarcinoma of the left lung with probable splenic metastasis. The patient underwent splenectomy, which confirmed the diagnose of splenic metastasis of lung adenocarcinoma and, secondly, lung resection was performed. Topics about lung cancer metastasis are discussed.
Assuntos
Adenocarcinoma/secundário , Neoplasias Pulmonares/patologia , Neoplasias Esplênicas/secundário , Adenocarcinoma/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Masculino , Esplenectomia , Neoplasias Esplênicas/diagnóstico por imagem , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Neurocutaneous melanosis is a rare congenital neurocutaneous syndrome in which benign and malignant melanocytic tumors of the leptomeninges with large or numerous congenital melanocytic nevi develop. The Dandy-Walker malformation occurs as a broad posterior fossa with high insertion of the tentorium, hypoplasia or aplasia of the cerebellar vermis, and cystic dilation of the fourth ventricle communicating with the posterior fossa. Association of these entities is very unusual and only 10 previous reports were found in the literature. Our patient had multiple, medium-size to small melanocytic nevi present since birth. At 5 years of age the patient has intracranial pressure secondary to hydrocephalus. A diagnosis of Dandy-Walker malformation and suspected neurocutaneous melanosis was established after a skull computed tomography (CT) scan. Three months later the patient developed a right frontal tumor shown on the CT scan. The histologic finding was nevomelanocytic infiltration with strong pleomorphism. The tumor grew rapidly, producing neurogenic shock and death. The postmortem report indicated malignant melanoma.
Assuntos
Neoplasias Encefálicas/complicações , Síndrome de Dandy-Walker/complicações , Melanoma/complicações , Melanose/complicações , Neoplasias Encefálicas/patologia , Pré-Escolar , Síndrome de Dandy-Walker/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Melanoma/patologia , Tomografia Computadorizada por Raios XRESUMO
Introducción. El hepatoblastoma (HB) es la neoplasia maligna de hígado más frecuente en pediatría. Antes de la década de los noventas, la sobrevida de los pacientes con HB era inferior al 25 por ciento. La introducción de quimioterapia neoadyuvante (QTN) en el tratamiento del HB ha facilitado su manejo quirúrgico, disminuyendo la mortalidad perioperatoria e incrementando la sobrevida a más de 70 por ciento. Material y métodos. Siete pacientes con diagnóstico histológico de HB fueron incluidos en el estudio para evaluar el papel de la QTN como parte esencial del tratamiento y valorar la utilidad de la alfafetoproteína (AFP) y colesterol como indicadores de respuesta, al correlacionarlos con la respuesta clínica, tomográfica e histopatológica. Se administraron 4 ciclos de QTN con cisplatino, 5 fluoracilo y vincristina, seguidos de resección quirúrgica del tumor primario y 2 ciclos de quimioterapia posterior a ésta. Resultados. Se obtuvo respuesta en todos los casos. La resección completa fue posible en 5. En 2 pacientes con grandes tumores sólo hubo respuesta parcial, siendo necesario modificar el esquema de tratamiento; la mala respuesta se correlacionó con niveles séricos persistentemente elevados de AFP y colesterol. Conclusión. La QTN demostró ser el tratamiento de elección para los tumores primarios de hígado, ya que permite obtener resecciones completas en tumores inicialmente irresecables, controlar metástasis y evaluar quimiosensibilidad. El colesterol se relacionó con la respuesta obtenida a QTN. Hepatoblastoma; quimioterapia neoadyuvante; indicadores de respuesta.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Vincristina/uso terapêutico , Cisplatino/uso terapêutico , Hepatoblastoma/tratamento farmacológico , Fluoruracila/uso terapêutico , Quimioterapia AdjuvanteRESUMO
Introducción. La ciclofosfamida a dosis escaladas incrementó su citotoxicidad en tumores sensibles a ésta, sin aumento de sus efectos tóxicos. Material y métodos. Se evaluaron 50 pacientes con tumores sólidos, en los que se utilizó ciclofosfamida en dosis escaladas de 2.5 g hasta 4.5 g/m² de superficie corporal como esquema de primera línea o de rescate, con uroprotector y factor estimulante de colonia en cada ciclo. La toxicidad y la respuesta fueron basadas en criterios de la Organización Mundial de la Salud. Resultados. Los diagnósticos más frecuentes fueron tumores del sistema nervioso central y retinoblastoma con 18 y 9 pacientes respectivamente. Cuarenta y cinco pacientes (90 por ciento) presentaron respuesta a quimioterapia, ya sea completa (72 por ciento) o parcial. Sólo en 5 pacientes no hubo respuesta. Se presentaron 3 episodios de cistitis hemorrágica. Conclusiones. Se comprobó que la ciclofosfamida a dosis escalada es activa en un grupo heterogéneo de pacientes con tumores sólidos y que esta modalidad terapéutica no incrementa el riesgo de toxicidad