RESUMO
According to the World Health Organization, an increased ratio (more than 6%) of CPK-MB to total CPK may indicate the diagnosis of an acute infarction. But false elevation of CPK and CPK-MB levels after noncardiac operation, because of soft tissue damage, may confuse the clinicians in detecting myocardial infarction in early postoperative period. In order to determine the usefulness of CPK-MB to total CPK ratio in detecting myocardial infarction after open and laparoscopic cholecystectomy, we measured the serum levels of these markers in 135 patients, immediately after the operation and for the next five days. Patients were divided into four groups according to type of surgical procedure, as follows: Group I: a right oblique subcostal (Kocher's) incision was performed in 29 patients, Group II: a right paramedian transrectal incision was performed in 52 patients, Group III: a vertical high midline incision was performed in 17 patients, Group IV: laparoscopic cholecystectomy was performed in 37 patients. Although we found increased levels of CPK and CPK-MB after all the types of cholecystectomy, but in any case the CPK-MB exceeded more than 6% of total serum CPK. Furthermore we noticed that the patients who underwent open cholecystectomy with right oblique subcostal incision had the most elevated CPK and CPK-MB levels comparing to the other types of cholecystectomy. In conclusion, tissue damage after elective cholecystectomy is minimal and CPK-MB to total CPK ratio is a secure marker in detection of myocardial infarction during early post-operation period, after cholecystectomy.
Assuntos
Colecistectomia Laparoscópica , Creatina Quinase Forma MB/sangue , Creatina Quinase/sangue , Infarto do Miocárdio/enzimologia , Adolescente , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Período Pós-Operatório , Valores de Referência , Estudos RetrospectivosRESUMO
A variant of acute cholecystitis is emphysematous cholecystitis. Here in we reviewed useful clinical data of five cases of this entity. Clinical outcomes were uncomplicated for three patients who were treated with open cholecystectomy. But on the other hand we faced two septic musculoskeletal complications in two patients who were treated with percutaneous trans gallbladder drainage. We believe that we must be aware of musculoskeletal complications, whenever a patient with emphysematous cholecystitis is treated with percutaneous trans gallbladder drainage.
Assuntos
Artrite Infecciosa/etiologia , Drenagem/efeitos adversos , Colecistite Enfisematosa/complicações , Miosite/etiologia , Idoso , Colecistectomia/métodos , Drenagem/métodos , Colecistite Enfisematosa/mortalidade , Colecistite Enfisematosa/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Joelho , Perna (Membro) , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
Duodenal diverticula are usually incidental findings, but some times could be complicated with inflammatory or pressures effects to pancreas tissue. We present a rare case of pancreatic abscess caused by a perforated diverticulum, arising from the distal end of the second part of the duodenum.