RESUMEN
INTRODUCTION: The bladder-Exstrophy-Epispadias complex (BEEC) contains a wide spectrum of congenital malformations. A treatment naïve refugee was referred to our center with what was identified as BEEC. MATERIALS AND METHODS: A 27-year-old female patient was referred for total incontinence since birth by the general practitioner from the refugee center. An exstrophic bladder with blind ending ureteral orifices and a second non-exstrophic bladder with two orthotopic ureters was identified, demonstrating the bladder duplication in the sagittal plane. Laparotomy was performed, dissecting the exstrophic bladder plate caudally and using it as a ventral onlay to augment the non-exstrophic bladder. A Mitchell-type bladder neck reconstruction was performed with an autologous fascia sling around the bladder neck to obtain continence. As the patient had never voluntarily voided, chances of spontaneous voiding after surgery were low. Therefore creation of a continent Mitrofanoff-type vesicostomy was additionally realized and genital reconstruction was achieved. RESULTS: 12 months post operatively, the patient was completely continent, had a bladder capacity of 250 ml, and performed self-catheterization 5 times a day. No post-operative complications were observed. CONCLUSION: Admission of political refugees can implicate challenging surgeries for congenital malformations in adults, such as BEEC. This demonstrates the importance of multidisciplinary transitional care.
Asunto(s)
Extrofia de la Vejiga , Epispadias , Incontinencia Urinaria , Femenino , Adulto , Humanos , Vejiga Urinaria/cirugía , Extrofia de la Vejiga/cirugía , Extrofia de la Vejiga/complicaciones , Incontinencia Urinaria/etiología , Epispadias/diagnóstico , Epispadias/cirugía , Epispadias/complicacionesRESUMEN
Although percutaneous endoscopic gastrostomy (PEG) for feeding purposes has been in use for the past 10-12 years, many practitioners are unaware of this option. We describe 10 patients who underwent PEG with only 1 major, but nonfatal, complication. We stress that PEG is indicated for those who cannot swallow, and is safe, easy to perform, and a relatively cheap procedure. It is therefore a useful substitute for surgical gastrostomy.
Asunto(s)
Gastroscopía/métodos , Gastrostomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Nutrición Enteral , Gastroscopía/efectos adversos , Gastrostomía/efectos adversos , Humanos , Persona de Mediana EdadRESUMEN
A retrospective study was done of 132 patients with desmoid fibromatosis (fibrosarcoma grade I desmoid type [FIDT]). Eight patients with tumor in the extremities demonstrated abnormalities in the adjacent bones. Bone erosion and a "frondlike" periosteal reaction were the radiological patterns identified. A local recurrence occurred in 5 of the 8 patients, indicating the locally aggressive behavior of this tumor.