RESUMO
A series of sixteen patients with supra-ampullary tumours of the biliary tree is reviewed. There was no sex difference and 9 from 16 were more than 60 years old. The clinical picture was insidious in 10 patients with dyspeptic symptoms; and started suddenly in 6; jaundice was the first symptom in 3, and was always present at admission. The delay for a correct diagnosis was 5 months since the beginning of the symptoms, and it was obtained by direct visualization of the biliary tree (PTC or/and ERCP). Surgical removal of the tumour was possible only in 3 patients. Microscopic diagnosis was obtained in 12 patients: 11 carcinomas (6 non-differentiated) and 1 lymphoma. Local metastasis were found only in 5 cases, with a mean evolution longer than 6 months. Until now, surgery has been disappointing; a more aggressive diagnostic approach conducting to earlier surgical treatment can probably improve the results.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Colangiografia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Apresenta-se uma serie de 16 doentes com neoplasia das vias biliares supra-ampulares (NVB), entre 60 com tumores das vias biliares observados num Servico de Medicina Interna no periodo de cinco anos (19751979). A distribuicao foi igual nos dois sexos e nove dos 16 doentes tinham mais de 60 anos. O quadro clinico iniciou-se gradualmente, por sintomas inespecificos, em 10 doentes; foi subito em seis. Ictericia foi o primeiro sinal em tres, mas estava sempre presente a data do internamento. O diagnostico foi, em geral, feito cerca de cinco meses apos o inicio das queixas e foi obtido por visualizacao direta das vias biliares: colangiografia percutanea transhepatica (CPT) e/ou colangiografia endoscopica retrogada (CPRE). Foi possivel a resseccao do tumor apenas em tres doentes. O tipo histologico dos tumores foi conhecido em 12: 11 adenocarcinomas (seis indeferenciados) e um linfoma. Encontraram-se metastases regionais apenas em cinco casos, com um tempo medio de evolucao superior a seis meses. A lenta evolucao destes tumores justifica uma atitude diagnostica mais agressiva para antecipar a terapeutica cirurgica
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Neoplasias dos Ductos Biliares , ColangiografiaRESUMO
From 388 patients with upper G.I. bleeding investigated by endoscopy, radiology or emergent surgery, one third bled from duodenal ulcer, one third oesophageal varices, and from the remain the most frequent were gastric ulcer (14%) and gastric cancer (9%). From a sample of 53 patients with liver cirrhosis, 66% bled from varices and 34% from other lesions. The proportion of patients who bled from oesophageal varices is higher under 60 yrs. The mortality was higher after 60 yrs, except when there was associated chronic liver disease or renal or cardio-respiratory failure. In this group of patients, near half in our series, the mortality is the same under and above 60 years.