Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
Más filtros












Base de datos
Intervalo de año de publicación
1.
Obes Surg ; 31(6): 2529-2536, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33725296

RESUMEN

BACKGROUND: Despite the recognised advantages of bariatric and metabolic surgery, only a small proportion of patients receive this intervention. In the UK, weight management systems are divided into four tiers. Tier 3 is a clinician-lead weight loss service while tier 4 considers surgery. While there is little evidence that tier 3 has any long-term benefits for weight loss, this study aims to determine whether tier 3 improves the uptake of surgery. METHOD: A retrospective cohort study of all referrals to our unit between 2013 and 2016 was categorised according to source-tier 3, directly from the general practitioner (GP) or from another speciality. The likelihood of surgery was calculated using a regression model after considering patient demographics, comorbidities and distance from our hospital. RESULTS: Of the 399 patients, 69.2% were referred directly from the GP, 21.3% from tier 3, and 9.5% from another speciality of which 69.4%, 56.2%, and 36.8% progressed to surgery (p = 0.01). On regression analysis, patients from another speciality or GP were more likely to decide against surgery (OR 2.44 CI 1.13-6.80 p = 0.03 and OR 1.65 CI 1.10-3.12 p = 0.04 respectively) and more likely to be deemed not suitable for surgery by the MDT (OR 6.42 CI 1.25-33.1 p = 0.02 and OR 3.47 CI 1.11-12.9 p = 0.03) compared with tier 3 referrals. CONCLUSION: As patients from tier 3 were more likely to undergo bariatric and metabolic surgery, this intervention remains a relevant step in the pathway. Such patients are likely to be better informed about the benefits of surgery and risks of severe obesity.


Asunto(s)
Cirugía Bariátrica , Obesidad Mórbida , Comorbilidad , Humanos , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Pérdida de Peso
2.
BMJ Case Rep ; 20172017 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-28596200

RESUMEN

We report a case of chronic infection caused by Salmonella and cured by a laparoscopic cholecystectomy after Roux-en-Y gastric bypass (RYGB) surgery for obesity. This patient presented with a 2-year history of chronic abdominal pain, loose stools and excessive weight loss. Her stool and urine cultures were positive for Salmonella Despite multiple courses of antibiotics, she remained positive.After undergoing a laparoscopic cholecystectomy, the patient became asymptomatic and stools remained negative. In chronic carriers for Salmonella, the gall bladder is the common reservoir for the bacteria and removing it is usually curative.The possibility that the source of the may be in the biliary limb of her bariatric procedure and not in the gall bladder remained a concern.In patients who have had a RYGB, cholecystectomy is an effective treatment.All patients presenting with abdominal symptoms following RYGB should have stool and urine cultures taken as part of their work up.


Asunto(s)
Colecistectomía Laparoscópica/métodos , Enfermedades de la Vesícula Biliar/microbiología , Derivación Gástrica/efectos adversos , Infecciones por Salmonella/complicaciones , Infecciones por Salmonella/cirugía , Dolor Abdominal/etiología , Diagnóstico Diferencial , Heces/química , Femenino , Enfermedades de la Vesícula Biliar/patología , Enfermedades de la Vesícula Biliar/cirugía , Humanos , Persona de Mediana Edad , Salmonella/aislamiento & purificación , Infecciones por Salmonella/microbiología , Resultado del Tratamiento , Pérdida de Peso
3.
BMJ Case Rep ; 20172017 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-28630240

RESUMEN

Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic endometriosis 6 months previously and presented with a swelling around her umbilical port site scar associated with cyclical pain during menses. Ultrasound scan reported a well-defined lesion in the umbilicus and MRI scanning excluded other pathology. As she was symptomatic, she underwent an exploration of the scar and excision of the endometrioma with resolution of her symptoms. Precautions should be taken to reduce the risk of endometrial seeding during laparoscopic surgery. All tissues should be removed in an appropriate retrieval bag and the pneumoperitoneum should be deflated completely before removing ports to reduce the chimney effect of tissue being forced through the port site. The diagnosis should be considered in all women of reproductive age presenting with a painful port site scar.


Asunto(s)
Dolor Abdominal/diagnóstico por imagen , Pared Abdominal/patología , Cicatriz/diagnóstico por imagen , Endometriosis/diagnóstico por imagen , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Ombligo/diagnóstico por imagen , Dolor Abdominal/etiología , Pared Abdominal/diagnóstico por imagen , Adulto , Cicatriz/complicaciones , Cicatriz/cirugía , Endometriosis/complicaciones , Endometriosis/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento , Ultrasonografía , Ombligo/cirugía
4.
BMJ Case Rep ; 20152015 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-25762576

RESUMEN

Endometriosis is a common clinical presentation for gynaecologists. Occasionally it can present to general surgeons as a swelling in the groin or abdominal wall. This condition should be included in the differential diagnosis in female patients. A 32-year-old woman with a 2-year history of a painful persistent lump in her right groin was referred to the general surgeons by her general practitioner. She was referred with a diagnosis of a suspected inguinal hernia. MRI excluded a hernia and exploration of the groin and subsequent histology confirmed the lesion to be an endometrial deposit.


Asunto(s)
Endometriosis/diagnóstico , Ingle/patología , Hernia Inguinal/diagnóstico , Adulto , Diagnóstico Diferencial , Endometriosis/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética
6.
Br J Hosp Med (Lond) ; 72(10): 593-Unknown, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22041734

RESUMEN

Paragangliomas can be confused with adrenal incidentalomas because of their proximity to the adrenal glands. A 71-year-old man presented with left-sided abdominal pain. A computed tomography scan showed a large cystic mass with a solid component arising from the left adrenal gland (Figure 1).


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/cirugía , Paraganglioma/diagnóstico , Paraganglioma/cirugía , Anciano , Diagnóstico Diferencial , Humanos , Masculino
7.
Br J Hosp Med (Lond) ; 72(11): 653, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22083011

RESUMEN

Crohn's disease can cause abdominal pain and diarrhoea. A 33-year-old man presented with a 3-month history of recurrent abdominal pain and occasional diarrhoea.


Asunto(s)
Enfermedad de Crohn/complicaciones , Enfermedades del Íleon/etiología , Ileítis/complicaciones , Intususcepción/etiología , Adulto , Diagnóstico Diferencial , Humanos , Intususcepción/diagnóstico , Masculino , Tomografía Computarizada por Rayos X
11.
Nat Rev Urol ; 6(6): 335-7, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19498411

RESUMEN

BACKGROUND: A 15-year-old boy presented to hospital with tenderness in his left loin and hypochondrium, and frank hematuria; he was hemodynamically stable. The patient was overweight and had fallen onto his left flank from his bicycle 2 h previously. INVESTIGATIONS: Physical examination, routine blood tests, contrast-enhanced CT of the abdomen and pelvis, renal MRI and percutaneous transfemoral angiography. DIAGNOSIS: Grade V blunt renal trauma, grade IV splenic injury and left renal vein thrombosis. MANAGEMENT: The patient received conservative management with supportive measures followed by percutaneous transfemoral angiography and embolization of the injured left kidney. He recovered well and was able to resume normal activities.


Asunto(s)
Riñón/irrigación sanguínea , Riñón/lesiones , Venas Renales , Bazo/lesiones , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapia , Adolescente , Manejo de la Enfermedad , Humanos , Riñón/diagnóstico por imagen , Angiografía por Resonancia Magnética/métodos , Masculino , Radiografía , Bazo/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Heridas no Penetrantes/diagnóstico
12.
Ann R Coll Surg Engl ; 91(4): 340-3, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19344555

RESUMEN

INTRODUCTION: Isolated duodenal injury due to blunt abdominal trauma is extremely rare. We present a series of three such injuries due to go-karting accidents, which presented to our hospital over 5 months. CASE REPORTS: Between October 2007 and February 2008, three cases of D3/D4 duodenal rupture presented to our hospital after go-karting accidents. Trauma occurred as a result of the steering wheel impacting on the abdomen. All patients presented similarly with symptoms of epigastric and right upper quadrant pain. In all cases, computed tomography scanning was highly suggestive of duodenal injury and, in particular, demonstrated presence of retroperitoneal air centred around the duodenum. Treatment required laparotomy and operative repair in all cases. CONCLUSIONS: Duodenal injury presents insidiously due to its retroperitoneal position. A low threshold for investigating patients presenting with epigastric and right upper quadrant pain should be adopted along with active clinical vigilance to exclude serious and life-threatening trauma after go-karting accidents.


Asunto(s)
Traumatismos Abdominales/etiología , Duodeno/lesiones , Vehículos a Motor Todoterreno , Heridas no Penetrantes/etiología , Traumatismos Abdominales/diagnóstico por imagen , Accidentes , Adulto , Femenino , Humanos , Masculino , Rotura , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...