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1.
Br J Anaesth ; 113(3): 410-5, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24833727

RESUMO

BACKGROUND: Anaesthesia care in developed countries involves sophisticated technology and experienced providers. However, advanced machines may be inoperable or fail frequently when placed into the austere medical environment of a developing country. Failure mode and effects analysis (FMEA) is a method for engaging local staff in identifying real or potential breakdowns in processes or work systems and to develop strategies to mitigate risks. METHODS: Nurse anaesthetists from the two tertiary care hospitals in Freetown, Sierra Leone, participated in three sessions moderated by a human factors specialist and an anaesthesiologist. Sessions were audio recorded, and group discussion graphically mapped by the session facilitator for analysis and commentary. These sessions sought to identify potential barriers to implementing an anaesthesia machine designed for austere medical environments-the universal anaesthesia machine (UAM)--and also engaging local nurse anaesthetists in identifying potential solutions to these barriers. RESULTS: Participating Sierra Leonean clinicians identified five main categories of failure modes (resource availability, environmental issues, staff knowledge and attitudes, and workload and staffing issues) and four categories of mitigation strategies (resource management plans, engaging and educating stakeholders, peer support for new machine use, and collectively advocating for needed resources). CONCLUSIONS: We identified factors that may limit the impact of a UAM and devised likely effective strategies for mitigating those risks.


Assuntos
Anestesiologia/instrumentação , Análise de Falha de Equipamento/métodos , Ergonomia/métodos , Centros de Atenção Terciária , Atitude do Pessoal de Saúde , Competência Clínica , Países em Desenvolvimento , Humanos , Enfermeiras e Enfermeiros , Recursos Humanos em Hospital , Medição de Risco/métodos , Serra Leoa , Carga de Trabalho
2.
G Ital Med Lav Ergon ; 34(3 Suppl): 534-6, 2012.
Artigo em Italiano | MEDLINE | ID: mdl-23405709

RESUMO

This paper describes the experience of the School of Occupational Medicine of the University of Brescia at the current edition of the New York and New Jersey Education and Research Center--Historical Perspectives Tour on Occupational Safety and Health, that involved 5 different industrial and environmental sites, appropriate for understanding the complex occupational health and safety problems. In every site, the participants have interacted with workers and professionals and discussed about the specific work processes, to better understand the risk faced by the workers, occupational pathologies that can occur, personal protective equipment used and preventive measures adopted. This experience has been successful in provide interdisciplinary educations to occupational safety and health professionals in training in order to prepare them for the collaboration and cooperation required to solve the complex occupational health and safety problems they will face in their future careers.


Assuntos
Estudos Interdisciplinares , Internato e Residência , Medicina do Trabalho/educação , Humanos
3.
Bioresour Technol ; 102(18): 8466-74, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21724387

RESUMO

In this paper, a novel biomass-based hydrogen production plant is investigated. The system uses oil palm shell as a feedstock. The main plant processes are biomass gasification, steam methane reforming and shift reaction. The modeling of the gasifier uses the Gibbs free energy minimization approach and chemical equilibrium considerations. The plant, with modifications, is simulated and analyzed thermodynamically using the Aspen Plus process simulation code (version 11.1). Exergy analysis, a useful tool for understanding and improving efficiency, is used throughout the investigation, in addition to energy analysis. The overall performance of the system is evaluated, and its efficiencies become 19% for exergy efficiency and 22% energy efficiency while the gasifier cold gas efficiency is 18%.


Assuntos
Biomassa , Biotecnologia/métodos , Hidrogênio/metabolismo , Simulação por Computador , Óleo de Palmeira , Óleos de Plantas/metabolismo , Termodinâmica
4.
Yonsei Med J ; 42(6): 669-80, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11754150

RESUMO

Many of the anesthetic considerations for fetal procedures and surgery are identical to those for nonobstetric surgery during pregnancy, including concern for maternal safety, avoidance of both teratogenic drugs and fetal asphyxia, and the prevention of preterm labor and delivery. Anesthesia is required for the mother and quite often the fetus to perform many fetal procedures. Fetal procedures and surgery can be divided into subgroups according to their anesthetic requirements. For example: procedures that only require a needle insertion into the uterus but not into the fetus, such as intrauterine infusions; laser surgical photocoagulation of the communicating placental circulation for twin-twin transfusion syndrome (TTTS) and radio-frequency umbilical cord ablation for managing twin reversed arterial perfusion (TRAP), which are not really fetal procedures, rather they are placental or cord procedures; surgical procedures performed directly on the fetus; and the EX-utero Intrapartum Treatment (EXIT) procedure. Anesthetic considerations also depend on other factors, such as the location of the placenta. Unlike maternal surgery, for fetal procedures, the fetus is not an innocent bystander for whom the least anesthetic interference is used. Instead, the fetus can be the primary patient and may benefit from anesthesia, with close monitoring of the anesthetic effects to ensure well-being. Fetal asphyxia, hypoxia, or distress can be most effectively recognized, predicted, and avoided by fetal monitoring. Monitoring is also crucial for assessing the fetal response to corrective maneuvers.


Assuntos
Anestesia , Doenças Fetais/diagnóstico , Doenças Fetais/terapia , Feto/cirurgia , Diagnóstico Pré-Natal , Animais , Feminino , Humanos , Gravidez
5.
Cancer Res ; 61(16): 6064-72, 2001 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-11507055

RESUMO

The effects of stromal and hormonal environment on the immortalized but nontumorigenic human prostatic epithelial cell line BPH-1 were investigated in an in vivo model. BPH-1 cells were recombined with rat urogenital sinus mesenchyme (UGM), and the tissue recombinants were grafted to the renal capsule of adult male athymic mouse hosts. BPH-1 + UGM recombinants formed solid branching epithelial cords with a well-defined basement membrane. The cords canalized to form ductal structures. The mesenchymal cells formed thick sheets of well-differentiated smooth muscle surrounding the epithelium, reinforcing the idea that the epithelium dictates the patterning of prostatic stromal cells. When hosts carrying BPH-1 + UGM tissue recombinants were exposed to testosterone propionate and 17-beta-estradiol (T + E2), the tissue recombinants responded by forming invasive carcinomas, demonstrating mixed, predominantly squamous as well as adenocarcinomatous (small acinar and mucinous) differentiation. When either untreated or T + E2-treated hosts were castrated, epithelial apoptosis was observed in the grafts. When tumors were removed and regrafted to fresh hosts they grew rapidly. Tumors were serially regrafted through six generations. Histologically these tumors consisted largely of focally keratinizing squamous cell carcinoma with high-grade malignant cytological features. BPH-1 cells grown in the absence of UGM survived at the graft site but did not form tumors or organized structures. This behavior was not influenced by the presence or absence of T + E2 stimulation. These data show that an immortalized, nontumorigenic human prostatic epithelial cell line can undergo hormonal carcinogenesis in response to T + E2 stimulation. In addition, the data demonstrate that the stromal environment plays an important role in mediating hormonal carcinogenesis.


Assuntos
Transformação Celular Neoplásica/efeitos dos fármacos , Estradiol/toxicidade , Neoplasias da Próstata/induzido quimicamente , Testosterona/toxicidade , Animais , Antígenos Transformantes de Poliomavirus/fisiologia , Apoptose/fisiologia , Divisão Celular/efeitos dos fármacos , Linhagem Celular , Transformação Celular Neoplásica/patologia , Células Epiteliais/patologia , Feminino , Humanos , Masculino , Mesoderma/citologia , Mesoderma/fisiologia , Camundongos , Camundongos Nus , Orquiectomia , Gravidez , Neoplasias da Próstata/patologia , Ratos , Ensaio de Cápsula Sub-Renal , Sistema Urogenital/citologia , Sistema Urogenital/embriologia , Sistema Urogenital/fisiologia
6.
Semin Liver Dis ; 21(1): 71-80, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11296698

RESUMO

Hepatic steatosis is a common finding encountered during cross-sectional imaging examinations. This article reviews the imaging findings of hepatic steatosis as revealed by sonography, computed tomography, magnetic resonance imaging, and magnetic resonance spectroscopy. Focal fatty sparing and focal hepatic steatosis are conditions that can create potential diagnostic challenges for the radiologist. The typical findings, distribution, and etiology of these focal processes are presented. In the setting of diffuse hepatic steatosis, hepatic mass lesions can be difficult to discern on both computed tomography and sonography, with reported decreased sensitivity and specificity of lesion detection. In such cases, magnetic resonance imaging may be the imaging procedure of choice for the detection and characterization of both hepatic steatosis and coexistent hepatic masses. Some hepatocellular neoplasms, particularly hepatic adenoma and well-differentiated hepatocellular carcinoma, can have intratumoral lipid. By demonstrating the lipid content of these masses, imaging can add specificity in characterizing them as hepatocellular in origin because nonhepatocellular neoplasms in general do not contain intracellular lipid.


Assuntos
Diagnóstico por Imagem , Fígado Gorduroso/diagnóstico , Previsões , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X
7.
Drug Alcohol Depend ; 59(2): 153-63, 2000 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-10891628

RESUMO

Because clozapine may be prescribed to cocaine abusing patients with schizophrenia, we studied cocaine-clozapine interactions in a controlled setting. Eight male cocaine addicts underwent four oral challenges with ascending doses of clozapine (12.5, 25 and 50 mg) and placebo followed 2 h later by a 2-mg/kg dose of intranasal cocaine. Subjective and physiological responses, and serum cocaine levels were measured over a total 4-h period. Clozapine pretreatment increased cocaine levels during the study and significantly increased the peak serum cocaine levels in a dose dependent manner. In spite of this elevation in blood levels, clozapine pretreatment had a significant diminishing effect upon subjective responses to cocaine, including 'expected high', 'high' and 'rush', notably at the 50 mg dose. There was also a significant effect upon 'sleepiness', 'paranoia' and 'nervous'. Clozapine caused a significant near-syncopal episode in one subject in the study, requiring his removal from the study. Clozapine had no significant effect on baseline pulse rate and systolic blood pressure, but it attenuated the significant pressor effects of the single dose of intranasal cocaine. These data suggested a possible therapeutic role for clozapine in the treatment of cocaine addiction in humans, but also suggests caution due to the near-syncopal event and the increase in serum cocaine levels.


Assuntos
Clozapina/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/reabilitação , Cocaína/efeitos adversos , Esquizofrenia/reabilitação , Adulto , Nível de Alerta/efeitos dos fármacos , Clozapina/efeitos adversos , Cocaína/farmacocinética , Comorbidade , Relação Dose-Resposta a Droga , Interações Medicamentosas , Euforia/efeitos dos fármacos , Humanos , Masculino , Fatores de Risco , Síncope/induzido quimicamente
9.
Differentiation ; 63(3): 131-40, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9697307

RESUMO

Tissue recombinants composed of adult human prostatic epithelium (hPrE) and rat urogenital sinus mesenchyme (rUGM) were grafted beneath the renal capsule of athymic rodent hosts. The pseudostratified human epithelium initially became multilayered, solid epithelial cords emerged, grew into the surrounding mesenchyme and canalized to regenerate a pseudostratified epithelium. Basal cells expressed cytokeratins 5 and 14, while luminal cells expressed cytokeratins 8 and 18, prostate specific antigen and prostatic acid phosphatase. The rat mesenchymal component differentiated into thick sheets of smooth muscle, characteristic of the human but not the rat prostate. These findings indicate that epithelial-mesenchymal interactions were reciprocal. Rat UGM induced adult hPrE to form new ductal-acinar tissue, involving epithelial proliferation, ductal branching morphogenesis and functional cytodifferentiation. Concurrently the epithelium dictated smooth muscle differentiation and patterning. Species-specific reverse transcriptase polymerase chain reaction SC (RT-PCR) analysis of the tissue recombinants was performed to separately examine the expression of epidermal growth factor (EGF), transforming growth factor-alpha (TGF-alpha), epidermal growth factor receptor (EGFR), TGF-beta 1, and TGF-beta 3 in the epithelium, stroma and host components of the graft. All of these genes, except TGF-beta 1, were expressed in all three tissues. Human TGF-beta 1 was not detected, indicating that this gene was not expressed in human prostatic epithelium but was present in stroma.


Assuntos
Mesoderma/fisiologia , Próstata/anatomia & histologia , Sistema Urogenital/anatomia & histologia , Adulto , Animais , Colagenases/metabolismo , Epitélio/anatomia & histologia , Epitélio/fisiologia , Feminino , Humanos , Hialuronoglucosaminidase/metabolismo , Hibridização in Situ Fluorescente , Masculino , Camundongos , Camundongos Nus , Reação em Cadeia da Polimerase , Gravidez , Próstata/fisiologia , Ratos , Transdução de Sinais/fisiologia , Especificidade da Espécie , Ensaio de Cápsula Sub-Renal , Transcrição Gênica , Sistema Urogenital/fisiologia
10.
Anesthesiology ; 88(6): 1467-74, 1998 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9637638

RESUMO

BACKGROUND: Remifentanil has not been studied in obstetric patients. This study evaluates the placental transfer of remifentanil and the neonatal effects when administered as an intravenous infusion. METHODS: Nineteen parturients underwent nonemergent cesarean section with epidural anesthesia and received 0.1 microg kg(-1) x min(-1) remifentanil intravenously, which was continued until skin closure. Maternal arterial (MA), umbilical arterial (UA), and umbilical venous (UV) blood samples were obtained at delivery for analysis of drug concentrations of remifentanil, its metabolite, and blood gases. Maternal vital signs were monitored continuously, and pain and sedation levels were assessed intermittently. Apgar scores were obtained at 1, 5, 10, and 20 min, and Neonatal and Adaptive Capacity Scores were noted 30 and 60 min after delivery. Parturients and newborns were observed for at least 24 h after surgery for side effects. RESULTS: The means and SDs of UV:MA and UA:UV ratios for remifentanil were 0.88+/-0.78 and 0.29+/-0.07, respectively. Mean clearance was 93 ml x min(-1) kg(-1). The mean UV:MA and UA:MV ratios for remifentanil acid were 0.56+/-0.29 and 1.23+/-0.89, respectively. The mean MA (remifentanil acid):MA (remifentanil) ratio was 2.92+/-3.65. There were no adverse effects on the neonates, but there was a sedative effect and respiratory depressant effect on the mothers. CONCLUSIONS: Remifentanil crosses the placenta but appears to be rapidly metabolized, redistributed, or both. Maternal sedation and respiratory changes occur, but without adverse neonatal or maternal effects.


Assuntos
Anestesia Obstétrica , Anestésicos Intravenosos , Cesárea , Piperidinas , Adolescente , Adulto , Anestésicos Intravenosos/farmacocinética , Índice de Apgar , Gasometria , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Troca Materno-Fetal , Piperidinas/farmacocinética , Gravidez , Remifentanil
11.
Int J Obstet Anesth ; 7(1): 18-22, 1998 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15321241

RESUMO

Hypotension commonly accompanies induction of spinal anesthesia for cesarean section. To determine whether intravenous ephedrine prophylaxis would benefit prehydrated obstetrical patients presenting for elective cesarean section, we studied 30 patients randomly assigned to one of three experimental groups. All patients were preloaded with crystalloid (15 ml/kg), given spinal anesthesia and positioned with left uterine displacement (LUD). During induction, all patients received a 2 ml intravenous bolus and intravenous infusion of the study drug or placebo. The control group (n=10) received a saline bolus and saline infusion, the bolus group (n=10) received an ephedrine bolus (10 mg) and a saline infusion and the infusion group (n=10) received a saline bolus and a two-stage ephedrine infusion (20 mg over 12 min). After induction of anesthesia, systolic blood pressure decreased in the first 5 min in all groups. Hypotension occurred in 6/10 control patients, 5/10 bolus patients and 5/10 infusion patients. The amount of supplemental ephedrine required to treat hypotension did not differ among groups. Although the efficacy of ephedrine prophylaxis for hypotension associated with spinal anesthesia for elective cesarean section cannot be established by the small number of patients studied, this practice does not appear to be clinically relevant at the doses studied.

12.
J Pediatr Surg ; 32(11): 1637-42, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9396545

RESUMO

BACKGROUND: Congenital diaphragmatic hernia (CDH) remains an unsolved problem. Despite optimal postnatal care, up to 60% of CDH babies die. Experimental evidence and clinical experience have shown that in utero repair of CDH is feasible and can reverse pulmonary hypoplasia, but only in fetuses without liver herniation. For this subgroup, the safety and efficacy of repair before birth has not been compared with standard care after birth. METHODS: Four fetuses in whom CDH without liver herniation was diagnosed underwent open fetal surgery for repair of the CDH. Seven comparison fetuses were treated conventionally. Neonatal mortality was the principle outcome variable. Secondary outcome variables included death of all causes until 2 years of age, number of days of ventilatory support, length of hospital stay, requirement for extracorporeal membrane oxygenation (ECMO), and total hospital charges. RESULTS: There was no difference in survival between the fetal surgery group and the postnatally treated comparison group (75% v 86%). Fetal surgery patients were born more prematurely than the comparison group (32 weeks v 38 weeks' gestation). Length of ventilatory support and requirement for ECMO were equivalent in the fetal surgery group and the postnatally treated comparison group. Length of hospital stay and hospital charges did not differ between the groups. CONCLUSIONS: Open fetal surgery is physiologically sound and technically feasible, but does not improve survival over standard postnatal treatment in the subgroup of CDH fetuses without liver herniation, primarily because overall survival in this subgroup is favorable with or without prenatal intervention. These data suggest that fetuses who have prenatally diagnosed CDH and without evidence of liver herniation should be treated postnatally.


Assuntos
Feto/cirurgia , Hérnia Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas , California/epidemiologia , Feminino , Hérnia Diafragmática/mortalidade , Preços Hospitalares , Humanos , Recém-Nascido , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Cuidado Pós-Natal/economia , Gravidez , Taxa de Sobrevida
15.
Int J Obstet Anesth ; 6(2): 112-7, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15321292

RESUMO

Pheochromocytoma during pregnancy is unusual, with approximately 250 cases now reported in the literature. The current case describes the anesthetic management of a patient with a large extra-adrenal pheochromocytoma who underwent a combined cesarean section and tumor removal in which perioperative hemodynamic control was difficult despite high-dose a-adrenergic blockade. In this case it is believed that difficulty in perioperative hemodynamic management was related to mechanical stimulation of the tumor by the gravid uterus. Review of published case reports since 1980 reveals that a pheochromocytoma during pregnancy may be diagnosed in an extra-adrenal location relatively more commonly compared to non-pregnant patients. Established criteria exist for the adequacy of alpha- and beta-adrebergic blockade for the management of pheochromocytoma in the non-pregnant patient. We discuss how these criteria apply to pregnant patients with pheochromocytoma, and suggest possible modifications to the criteria.

16.
J Pediatr Surg ; 32(2): 227-30; discussion 230-1, 1997 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9044127

RESUMO

While treating eight fetuses with predictable airway obstruction, the authors developed a systematic approach, the ex utero intrapartum treatment procedure, to secure the airway during delivery. Six patients had their trachea plugged or clipped in utero for treatment of congenital diaphragmatic hernia, and two patients had prenatally diagnosed cystic hygroma of the neck and oropharynx. The ex utero intrapartum treatment procedure was performed by using high doses of inhaled halogenated agents to facilitate uterine relaxation during cesarean section, securing the fetal airway while feto-placental circulation remained intact, and then dividing the umbilical cord. A variety of procedures were performed during the ex utero intrapartum treatment procedure including bronchoscopy, orotracheal intubation, tracheostomy, tracheostomy with retrograde orotracheal intubation, tracheoplasty, removal of internal tracheal plug, removal of external tracheal clip, central line placement, and instillation of surfactant. There were minimal maternal or fetal complications during the procedure. This approach requires the coordinated efforts of pediatric surgeons, obstetricians, anesthesiologists, sonographers, and neonatologists. The combination of intensive maternal-fetal monitoring, cesarean section with maximal uterine relaxation, and maintenance of intact feto-placental circulation provides a controlled environment for securing the airway in babies with prenatally diagnosed airway obstruction.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Parto Obstétrico , Doenças Fetais/terapia , Feto/cirurgia , Obstrução das Vias Respiratórias/etiologia , Cesárea , Feminino , Hérnia Diafragmática/cirurgia , Hérnia Diafragmática/terapia , Hérnias Diafragmáticas Congênitas , Humanos , Recém-Nascido , Linfangioma Cístico/complicações , Linfangioma Cístico/cirurgia , Gravidez , Traqueia/cirurgia , Traqueostomia
17.
J Pediatr Surg ; 31(10): 1339-48, 1996 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8906657

RESUMO

Most fetuses with congenital diaphragmatic hernia (CDH) diagnosed before 24 weeks' gestation die despite optimal postnatal care. In fetuses with liver herniation into the chest, prenatal repair has not been successful. In the course of exploring the pathophysiology of CDH and its repair in fetal lambs, the authors found that obstructing the normal egress of fetal lung fluid enlarges developing fetal lungs, reduces the herniated viscera, and accelerates lung growth, resulting in improved pulmonary function after birth. They developed and tested experimentally a variety of methods to temporarily occlude the fetal trachea, allow fetal lung growth, and reverse the obstruction at birth. The authors applied this strategy of temporary tracheal occlusion in eight human fetuses with CDH and liver herniation at 25 to 28 weeks' gestation. With ongoing experimental and clinical experience, the technique of tracheal occlusion evolved from an internal plug (two patients) to an external clip (six patients), and a technique was developed for unplugging the trachea at the time of birth (Ex Utero Intrapartum Tracheoplasty [EXIT]). Two fetuses had a foam plug placed inside the trachea. The first showed dramatic lung growth in utero and survived; the second (who had a smaller plug to avoid tracheomalacia) showed no demonstrable lung growth and died at birth. Two fetuses had external spring-loaded aneurysm clips placed on the trachea; one was aborted due to tocolytic failure, and the other showed no lung growth (presumed leak) and died 3 months after birth. Four fetuses had metal clips placed on the trachea. All showed dramatic lung growth in utero, with reversal of pulmonary hypoplasia documented after birth. However, all died of nonpulmonary causes. Temporary occlusion of the fetal trachea accelerates fetal lung growth and ameliorates the often fatal pulmonary hypoplasia associated with severe CDH. Although the strategy is physiologically sound and technically feasible, complications encountered during the evolution of these techniques have limited the survival rate. Further evolution of this technique is required before it can be recommended as therapy for fetal pulmonary hypoplasia.


Assuntos
Doenças Fetais/terapia , Hérnia Diafragmática/terapia , Hérnias Diafragmáticas Congênitas , Pulmão/embriologia , Traqueia , Animais , Feminino , Doenças Fetais/diagnóstico por imagem , Maturidade dos Órgãos Fetais , Fetoscopia , Feto/cirurgia , Humanos , Recém-Nascido , Pulmão/diagnóstico por imagem , Masculino , Gravidez , Próteses e Implantes , Ovinos , Resultado do Tratamento , Ultrassonografia Pré-Natal
19.
J Urol ; 152(1): 22-5, 1994 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8201670

RESUMO

During a 15-year period we treated 38 patients with combined renal and pancreatic injuries (40 kidneys): 18 patients (19 kidneys) with renal contusion (89% from blunt trauma) and 20 with renal laceration or vascular injuries (90% from penetrating trauma). All patients with renal contusion were managed conservatively without complication, despite major pancreatic injury in a third. The 16 patients with significant renal and pancreatic injuries were classified as a high risk group: 3 underwent nephrectomy for vascular injuries that could not be repaired but all of the remaining kidneys were salvaged. Perinephric abscesses developed in 2 of these patients, for a major complication rate of 15%. No secondary nephrectomies were necessary, nor did urinary fistulas develop. We conclude that significant renal injuries in patients with major pancreatic injuries may be managed by renal repair with an increased but acceptable complication rate and that nephrectomy should be performed only if the degree of renal injury precludes repair.


Assuntos
Rim/lesões , Pâncreas/lesões , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia , Adulto , Contusões/epidemiologia , Contusões/terapia , Feminino , Humanos , Masculino , Nefrectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Artéria Renal/lesões , Veias Renais/lesões , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia
20.
Urology ; 43(2): 251-4, 1994 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8116126

RESUMO

Transitional cell carcinoma arising from the anterior portion of the male urethra is rare, with less than 10 cases reported in the literature. Our patient had a high-grade, highly invasive transitional cell carcinoma originating in the fossa navicularis and extending proximally along the corpus spongiosum, the corpora cavernosa, and blood and lymphatic vessels. In addition, the patient had a concurrent low-grade prostatic adenocarcinoma, a large basal cell carcinoma of the nose, and a squamous cell carcinoma of the penile skin. The previously reported cases are reviewed, with particular reference to the possible association of these tumors with human papillomavirus infection.


Assuntos
Adenocarcinoma/patologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células de Transição/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Penianas/patologia , Neoplasias da Próstata/patologia , Neoplasias Cutâneas/patologia , Neoplasias Uretrais/patologia , Idoso , Humanos , Masculino , Neoplasias Primárias Múltiplas/epidemiologia , Pênis/patologia , Próstata/patologia , Uretra/patologia
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