RESUMO
BACKGROUND: The procedure of radical peritonectomy followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard treatment for peritoneal cancers. AIMS: To evaluate various outcomes in a cohort of patients with peritoneal tumors treated with HIPEC. METHODS: Twenty-four patients consecutively treated with radical peritonectomy plus HIPEC within the time frame of November 2007 to July 2010 were enrolled; 15 (62%) had tumors of appendicular origin, 4 (16.7%) had primary peritoneal tumors, 2 had ovarian carcinomas and there was one case of colon cancer, one carcinosarcoma and one hemangioendothelioma. Mean age was 53 years (range: 26-68) and median follow-up was 14.2 months (range: 1-32). Demographic data, histology, peritoneal cancer index (PCI), surgical procedure characteristics, recurrence-free survival (RFS), and overall survival (OS) were all evaluated. Short-term morbidity and mortality were also determined. RESULTS: Complete cytoreduction was achieved in 18 patients (75%). Mean PCI was 15 (<10: 41% and >10: 58%), and the median (range) for surgery duration, length of stay in the Intensive Care Unit, parenteral nutritional support, and hospital stay were 12,5 (7-20) hours, 11,4 (2-74) days, 13,8 (12-65) days, and 29,1 (10-90) days, respectively. One patient (4%) died 6 months after the procedure, due to multiple associated complications. Considerable morbidity was seen in 52% of cases, including thromboembolic events (41%), catheter-related bacteremia (29%), fistulas (29%), and nephrotoxicity (25%). Six patients (25%) recurred after a median of 21 months of RFS. CONCLUSIONS: Cytoreductive surgery plus HIPEC in well-selected patients presenting with tumors that affect the peritoneum is a procedure that can be carried out in Colombia with an adequate safety and effectiveness profile. Mortality was similar to that reported in the international literature.
Assuntos
Antineoplásicos/uso terapêutico , Hipertermia Induzida , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Adulto , Terapia Combinada , Feminino , Hospitais de Ensino , Humanos , Tempo de Internação , Masculino , Neoplasias Peritoneais/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
Syringomyelia associated with posterior fossa tumours is a very infrequent combination of pathological entities. The few cases which have been reported generally were asymptomatic in respect of the spinal cavitations. The authors report on a 36-year-old woman with a large extradural posterior fossa epidermoid tumour with a concomitant holocord symptomatic syringomyelia. Some of her symptoms were clearly attributed to the intraspinal cavitation. The lesions were both diagnosed by magnetic resonance imaging (MR). The patient did well after surgery of the brain lesion, with an objective improvement in her neurological status and a complete resolution of the syrinx documented by the MR 7 months after tumour removal. Syringomyelia in this case could be explained by blockage of the cerebrospinal fluid (CSF) circulation at the foramen magnum which in turn resulted in cranio-spinal pressure dissociation. This led to an accumulation of extracellular fluid (ECF) in the central canal, starting cavitation. Consequently, the syrinx was slowly expanded by the long-standing "slosh" effect of the systolic pressure waves. However, also via a distortion mechanism within the posterior fossa a pathologically plugged obex could have contributed to syrinx formation by means of preventing drainage of fluid from the ventricular CSF system.
Assuntos
Neoplasias Infratentoriais/complicações , Neoplasias Infratentoriais/cirurgia , Siringomielia/etiologia , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/etiologia , Pressão do Líquido Cefalorraquidiano , Feminino , Humanos , Imageamento por Ressonância Magnética , Siringomielia/patologia , Resultado do TratamentoRESUMO
The purpose of this study is to describe a single-center experience in primary coronary angioplasty in 304 consecutive patients with acute myocardial infarction. Sixty-seven percent were men and 33% women, the mean age was 69 years. The time from onset to treatment was 3.5 hours, 14% had previous bypass surgery and 23% prior myocardial infarction, 11% arrived in cardiogenic shock. Coronary angiography showed multivessel disease in 56% of patients, 73% had TIMI 0-1 flow. Successful PTCA occurred in 95% and in hospital mortality was 6.5%. Primary coronary angioplasty is a successful reperfusion method in acute myocardial infarction and it is associated with low mortality even in high risk groups. The rates of success and major complications in this series are similar to other publications.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/estatística & dados numéricos , Angiografia Coronária , Feminino , Mortalidade Hospitalar , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Estudos Prospectivos , Recidiva , Fatores de TempoRESUMO
Ventricular dysfunction is the most common cause of in-hospital death in patients with acute myocardial infarction. When cardiogenic shock is manifested the mortality is very high. Seven patients with cardiogenic shock complicating acute myocardial infarction were treated with emergency coronary angioplasty. Four patients required cardiopulmonary resuscitation (CPR), 2 intraaortic balloon pump support and one femoro-femoral bypass pump support during the coronary angioplasty. The angiography success rate was 86%. Two patients died, one in the catheterization laboratory and the other one 24 hours later. The hospital mortality was 29%. Of the patients who survived 4 are in functional class I and one in functional class II (NYHA). Coronary angioplasty therapy in patients with cardiogenic shock complicating acute myocardial infarction plays a decisive role in the reduction of mortality.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Choque Cardiogênico/terapia , Idoso , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/estatística & dados numéricos , Emergências , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Estudos Retrospectivos , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Fatores de TempoRESUMO
The records of 50 cerebellar haemorrhages were reviewed retrospectively. In this series the most important factor for clinical development, management and mortality was the presence of obstructive hydrocephalus (p < 0.01). Slowly progressive (type 1) and abruptly developing (type 2) deterioration of consciousness was significantly related to high mortality; this holds also true for the combination of hydrocephalus with an haematoma diameter > 3 cm. Larger haematomas had a higher mortality but this relation, analyzed alone, did not reach statistical significance (p > 0.05). In cases with hydrocephalus mortality could significantly be reduced by surgical evacuation of the haematoma (p < 0.01). The treatment of cerebellar haemorrhages must be directed at resolving obstructive hydrocephalus.
Assuntos
Doenças Cerebelares/cirurgia , Hemorragia Cerebral/cirurgia , Hidrocefalia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cerebelares/mortalidade , Hemorragia Cerebral/mortalidade , Feminino , Seguimentos , Humanos , Hidrocefalia/mortalidade , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Percutaneous transluminal coronary and renal angioplasty (PTA and Renal PTA) were performed during the same procedure in five of 100 patients who underwent PTCA between August 1989 and June 1990. All patients were male, with systemic hypertension (HT) with angina grade I to IV. The median age was 62 years (range 53 to 74). Three patients had controlled HT with 2 to 4 drugs and 2 were uncontrolled even after multiple antihypertensive treatment. Two patients were diabetic and the serum creatinine levels were normal except in one patient (1.9 mg/dL). Lesions more than 70% obstruction of luminal diameter were approached. Multivessel PTCA was done in one patient, multi-lesion in 2 and single lesion in other two. A total of 11 lesions were dilated, 4 in LAD, 5 in Cx and 2 in RCA (type A = 2, type B = 9). Complete revascularization was achieved in all cases. Five renal lesions were approached, 4 in the proximal third and one on the middle third. In 2 patients the blood pressure (BP) fell within normal limits without medication. In other 2 there was an improvement and were easily controlled with just one drug. One patient had no improvement and required multiple therapy to control it. The only complication observed was in a diabetic with previous abnormal serum creatinine who developed non-oliguric renal failure and returned to basal creatinine level at the third day post PTCA. In selected cases PTCA and renal PTA can be safely performed during the same procedure, with the advantage of cost reduction.
Assuntos
Angioplastia Coronária com Balão , Angioplastia com Balão , Artéria Renal , Idoso , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/métodos , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Doença das Coronárias/epidemiologia , Doença das Coronárias/terapia , Seguimentos , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Recidiva , Indução de Remissão , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/terapiaRESUMO
A select group of 26, class IV unstable angina patients that had multiple lesions or multivessel disease were treated with percutaneous transluminal coronary angioplasty (PTCA). Complete revascularization was the endpoint in all patients. Seventy lesions were dilated (mean = 2.6 lesions per patient). In the tandem multi-lesion group (13 patients) 2.23 lesions per patient were approached (Range 2-3) and in the multivessel disease group (13 patients) a mean of 3.15 lesions per patient were attempted (Range 2-6). An overall success rate of 96% per patient (25/26 patients) and 95.7% primary success per lesion were achieved with no mortality. We report the results of a select group of unstable angina patients with multi-lesion or multivessel disease who underwent PTCA. A careful performance was associated with high primary success in the high risk group achieving clinical and angiographic improvement.