RESUMO
INTRODUCTION: Spontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy. METHODS: A retrospective analysis of a prospectively maintained database of all patients with a diagnosis of spontaneous hematoma of the abdominal rectus muscle between March 2003 and December 2014. RESULTS: The study included 34 patients, of whom 28 were women, with an average age of 80 years old. All the patients showed a unilateral infraumbilical haematoma. Twenty- 8 patients had received long-term anticoagulant treatment (26 with acenocumarol and 2 low molecular weight heparin); and 6 patients were under anticoagulant prophylaxis with low molecular weight heparin. The diagnosis was performed with ultrasound in 7 cases, computed tomography angiography in 27 patients, and with both methods in 6 cases. The treatment consisted of stopping the anticoagulant drug, correcting haemostasis parameters and blood transfusion when required. Ten patients displayed active bleeding in the computed tomography angiography, and 8 underwent selective arterial embolization. The evolution was successful in 34 patients, however, 2 patients required surgery and, finally, died due to persistent haemorrhage. CONCLUSION: Spontaneous haematoma of the rectus abdominis muscle is more frequent in elderly women under oral anticoagulant treatment. Non-operative treatment is successful in most cases. Computed tomography angiography is useful to determine which patients could benefit from selective arterial embolization.
Assuntos
Hematoma , Reto do Abdome , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION AND OBJECTIVES: Since different PET/CT (Positron Emission Tomography/Computed Tomography) scanners give different qualitative readings, a program for clinical trial qualification (CTQ) is mandatory to guarantee a reliable and reproducible use of PET/CT in prospective multi-centre clinical trials. Within this work we will show the results carried out in performing CTQ in Spain. MATERIALS AND METHODS: We set up, under the auspices of Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GELTAMO), a CTQ program consisting of the acquisition and analysis of 18F uniformity and image quality phantoms for the reduction of inter-scanner variability (ISV). The ISV was estimated on background activity concentration (BAC) and sphere to background ratio (SBR) and defined as their 95% confidence level. RESULTS: Twenty-six out of 27 (96%) scanners fulfilled the CTQ requirements. The CTQ was fulfilled at the first round in 27% of the cases, while in 38%, 15% and 20%, two, three or more than three iterations, were required, respectively. The mean CTQ time was (1.8 ± 1.4) months (range: 0.3-4.6). The ISV in BAC and SBR were 20.3% and 67.7%. CONCLUSIONS: The CTQ proven to be a reliable tool to reduce ISV. This enabled to set-up clinical trials in which PET/CT was used to evaluate different clinical endpoints.
RESUMO
BACKGROUND: Many procedures have been described in the search for the ideal mastopexy technique, ranging from simple cutaneous reduction, with or without glandular remodelling, to the use of dermal flaps fixed to the pectoral fascia, or even the use of silicone mesh or sheets. OBJECTIVE: We describe a technique that uses a dermoglandular hammock flap to achieve optimal position and shape of the breast; well located, good quality scars that are as short as possible; and satisfactory early- and long-term results. METHODS: A superior pedicle dermoglandular flap was raised from the lower pole of the breast and transposed to the upper pole. The flap is fixed like a hammock to the pectoral fascia and the wedge-shaped donor defect is closed by approximation and fixation of the medial and lateral pillars with absorbable sutures, thus releasing the tension in the skin suture line. RESULTS: Twenty-eight patients aged 19 to 58 years underwent the procedure. Adequate shape and projection were achieved in all cases. Partial dehiscence of the suture line developed in 1 patient. The scar quality was excellent, except in 2 cases in which some degree of temporary hypertrophy occurred. CONCLUSIONS: In our experience with this technique, we obtained satisfactory position and shape; good quality, well-placed scars; long-lasting results; and preservation of the patient's ability to breast feed. The technique is simple to perform and is indicated in cases of moderate ptosis.
Assuntos
Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Protrombina/genética , Tromboembolia/genética , Feminino , Humanos , Pessoa de Meia-Idade , Mutação , Dor Pós-Operatória/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Ritidoplastia , Ultrassonografia DopplerRESUMO
En primer lugar se hace un análisis de las condiciones ideales que debería reunir una técnica para reconstrucción mamaria, señalando que ninguna de las técnicas hasta ahora diseñadas cumplen todas las condiciones y no es tampoco aplicable a todos los casos. La técnica del colgajo abdominomamario está basada en tres principios: 1- Utilización de la piel en excesso del abdómen que es traccionada hacia arriba. 2- Utilización de la piel sobrante de la mamma sana cuando se necesario hacer una reducción o corregir la ptosis. 3- Transposición del exceso de piel y tejido celular subcutáneo del abdomen y la mama sana como un colgajo contralateral (colgajo abdominomamario), pero con pedículo homo y contralateral. Se hace la descripción de la técnica describiendo los detalles y aplicaciones de las cuatro variantes, según la magnitud del defecto cutáneo y la posición de la cicatriz de la mastectomía. Variante I- Desepitelización completa del colgajo y utilización exclusiva de la piel tóraco-abdominal del lado afecto para la cobertura externa. Variante II- Desepitelización de la mitad o dos tercios distales del colgajo y utilización de la porción proximal para la cobertura externa. Variante III- Desepitelización subtotal o total del colgajo y plastia asociada. Variante IV- Desepitelización selectiva del colgajo. La opinión del autor es que si bien no es tampoco un método ideal, sí constituye una alternativa interesante en el campo de la reconstrucción mamaria