Thandor Die Invasion Windows 7 15
Thandor Die Invasion Windows 7 15
It is necessary to analyze the intestinal wall to diagnose the possibility of tumour invasion to the diaphragm, or to take out the pancreatic tail. This technique is simple, safe, and safe for the patient, a minimum of blood loss and no need for conversion to laparotomy. The recurrence of the tumour was 6.5% in this study and a more aggressive treatment is necessary to these patients.
Conclusion: Surgical procedure was low anterior resection / intersphincteric resection / abdominoperineal resection: 190/23/4, and Conversion to open surgery was needed for 6 (2.8%) patients. Sphincter-preserving procedures were performed in 204 (97.2%) patients. There were no perioperative mortalities and positive resection margin. The mean length of hospital stay was 10.5days. Complications beyond Clavien-Dindo Grade III occurred in 14 (6.4%) patients,the anastomotic leakage rate was 3.6% (8/217). The positive lymph node metastasis rate was 12.9% (28/217). High tumor budding (p=0.006), lymphatic invasion (p<0.0001), and mucinous /poor histological differentiation (p=0.01) were significantly associated with lymph node metastasis on univariate analysis. On multivariate analysis, only lymphatic invasion was associated with lymph node metastasis (p<0.001).The median follow-up time was 50months (range, 6-151months), recurrence free survival rates was 96.3% (209/217).
Clinical case: we present a 65year old patient with constitutional syndrome and severe hypercortisolism and hypokalemia reason why she was admitted to ICU for episodes of ventricular fibrillation. No other medical history of interest except refractory hypertension to treatment. The TC showed a left adrenal mass of 6.5 4.5 5cm with microcalcifications, areas of necrosis and hemorrhage, no infiltrating, without disease to distance. The surgery was a laparoscopic left adrenalectomy with no evidence of infiltration and no lymph nodes. The histopathology lesion presented a dense proliferation cellular of cortical type, with incomplete fibrous, without vascular or capsular invasion, with a 30% ki67; positivity vimentin and CD56. All epithelial markers, were negative. All this leads to the diagnosis of a neoplasm of uncertain malignancy potential adrenocortical. During the postoperative period, the patient presents a crisis of adrenal insufficiency that was treated with intravenous replenishment corticoidea and later orally with good clinical response.
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