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1.
Ann Ital Chir ; 92: 130-134, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35342097

RESUMO

BACKGROUND: Hartmann's Procedure (HP) is performed for cancer, trauma or benign diseases of the left colon. It is regarded as a solution to avoid a risky anastomosis with the intent to reverse after the diseased colon is given time to recover. This reversal has been associated with a potential morbidity and mortality. OBJECTIVES: Our objective was to investigate the complications and morbidities associated with HP reversal. METHODS: The Hartmann reversal operations performed in the general surgery department were reviewed between January 2014 and January 2018 in the Istanbul Haseki Training and Research Hospital. RESULTS: During the evaluation period, 41 patients underwent a HP reversal with the mean age of 57.45 ± 15.75 The majority of the patients were male (73%; n = 30). The overall complication rate was 44%. There were seven (17%) cases of reoperation with high-grade complications, and four (9.8%) of the patients were re-hospitalized due to complications. CONCLUSIONS: HP reversal can be considered a relatively safe operation for a selected group of patients including those with preoperative comorbidities, yielding an anastomotic leakage rate of 7.3% and a hospital readmission rate of less than 10%. The repair of an incisional hernia at the same time does not increase the complication rate. KEY WORDS: Complications, Colostomy, Clavien-Dindo classification, Hartmann's procedure reversal, Hartmann's system procedure reversal.


Assuntos
Colostomia , Proctocolectomia Restauradora , Adulto , Idoso , Anastomose Cirúrgica/métodos , Colostomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Proctocolectomia Restauradora/efeitos adversos , Reto/cirurgia
2.
Exp Clin Transplant ; 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34387147

RESUMO

OBJECTIVES: Liver function is affected by ischemiareperfusion. Ischemia-reperfusion injury to the liver often follows hepatobiliary surgery. Here, we investigated biomarkers of liver ischemia-reperfusion injury using an animal model. MATERIALS AND METHODS: For this study, 24 male Sprague Dawley rats (146-188 g) were divided into 4 groups: group A was the control group, group B was the partial hepatic ischemia-reperfusion group, group C was the total hepatic ischemia-reperfusion group, and group D was the intermittent total hepatic ischemiareperfusion group. Laboratory liver function levels were measured before ischemia, after ischemia, and after reperfusion. We used liver and renal biopsies for histopathological examination at the end of the study. RESULTS: After clamping and reperfusion, alanine aminotransferase and cystatin C levels in groups B, C, and D were significantly higher than levels in group A. In group B, after clamping, neutrophil gelatinaseassociated lipocalin levels were higher than in groups A and D, with significantly higher level than in group D after reperfusion. Neutrophil gelatinase-associated lipocalin levels decreased significantly in groups B, C, and D after reperfusion. There was significantly greater hepatic damage in groups B, C, and D compared with group A but no significant differences in renal injury scores among the groups. There was a significant positive correlation between hepatic damage and renal injury. With regard to histopathological examination versus laboratory results, a statistically significant positive correlation was shown between grade of hepatic damage and serum alanine aminotransferase and cystatin C levels. Similarly, there was a positive correlation between renal damage score and alanine aminotransferase level. CONCLUSIONS: In our animal model, alanine amino - transferase and cystatin C levels tended to increase with ischemia-reperfusion injury levels but neutrophil gelatinase-associated lipocalin decreased during reperfusion. In liver ischemia, we suggest that neutrophil gelatinase-associated lipocalin may be an important biomarker for distinguishing the reperfusion phase.

3.
Surg Res Pract ; 2021: 5542619, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34056058

RESUMO

INTRODUCTION: Peptic ulcer is an important health problem worldwide with a prevalence of around 5%. Peptic ulcer perforation is a potentially mortal complication of peptic ulcer disease. We aimed to investigate the potential use of red cell distribution width as a prognostic marker in peptic ulcer perforation. METHODS: The files, operation notes, biochemical and hematological parameters, and prognosis of patients who were operated for a peptic ulcer perforation were reviewed in a retrospective cohort study. The relation of red cell distribution width (RDW) to main outcome in-hospital mortality was assessed. RESULTS: The mean age of the 172 patients was 40 ± 17.89. There were 158 (92%) males and 14 (8%) females. The in-hospital mortality was 8.7% (15/172). The median RDW in the group with mortality was 15.00 (interquartile range (IQR): 14.30-17.20) compared with the median RDW in the group with no mortality as 13.2 (IQR: 12.80-14.00, p ≤ 0.001). Receiver operator characteristic curves were plotted for RDW to identify nonsurvivors and yielded a significant area under the curve as 0.812 (95% confidence interval: 0.682-0.942). The sensitivity and specificity of RDW at a cutoff value of 14.25% were calculated with an accuracy of 81.98 (95% confidence interval: 75.40-87.41) as 80.00 (51.91-95.67) and 82.17 (75.27-87.81), respectively. CONCLUSION: Increased RDW may be of use to interpret mortality in patients with peptic ulcer perforation.

4.
Int J Appl Basic Med Res ; 10(3): 200-204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33088744

RESUMO

INTRODUCTION: Red cell distribution width (RDW) has predictive properties in different benign and malignant diseases. AIM: Our aim was to evaluate the predictive value of RDW for malignant gastric lesions by upper gastrointestinal screening. MATERIALS AND METHODS: Data of 91 male patients (Group A) who underwent upper gastrointestinal endoscopy and subsequent surgery for gastric malignancy and age-matched 91 healthy male patients (Group B) with benign disorders were reviewed in this retrospective cohort study. The pathology reports, laboratory parameters, and demographics of the patients were recorded for comparison. Receiver operating characteristic curves were plotted for RDW, and a threshold for prediction of malignancy was calculated. RESULTS: The average age of the patients with gastric cancer was 62 (interquartile range [IQR]: 53-70) years. The difference in RDW levels between Group A and Group B was found to be significant: 14.40% (IQR: 13.40-16.40) versus 13.10% (IQR: 12.55-13.50) for the malignant and benign groups, respectively, P = 0.000. The area under the curve was 0.81 (95% confidence interval [CI]: 0.76-0.86), P = 0.000. For the threshold of 13.45%, the positive predictive value (PPV) for malignancy was found to be 69.15 (95% CI: 61.77-75.67) and negative predictive value (NPV) was 70.45 (95% CI: 62.60-77.26). CONCLUSION: RDW was found to have a PPV for malignancy in nearly two-thirds of the patients and had a similar NPV.

5.
Medeni Med J ; 35(3): 181-187, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33110669

RESUMO

OBJECTIVE: Whipple's procedure for periampullary tumors has significant risks and complications. Delayed gastric emptying has the highest rate. Although the International Study Group of Pancreatic Surgery defined (ISGPS) this entity, multiple definitions still exist among authors. This study aims to revise the definition. METHOD: Seventy-three consecutive patients were analyzed for complications, particularly delayed gastric emptying. All patients underwent a standardized surgery. Procedures used for total pancreatectomies and benign diseases were excluded. RESULTS: A total of 73 patients were included in the study. Intra-abdominal complications were observed in 15 (20.6%) patients. Grade C delayed gastric emptying was observed in only one (1.4%) patient. Grade A and B disease were observed in three (4.1%) patients. However, they responded well to conservative methods, causing no extra morbidity. CONCLUSION: Grade A and B delayed gastric emptying can be observed after any gastrointestinal surgery. These patients respond well to simple conservative methods with nasogastric intubation. Drainage of the intra-abdominal collection resolves the emptying problem (if any). Only grade C disease without other intra-abdominal complications can be accepted as a complication of this procedure. ISGPS definition does not include the cause. Thus, the definition and grading can be revised.

6.
Wideochir Inne Tech Maloinwazyjne ; 13(4): 469-476, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30524617

RESUMO

INTRODUCTION: Endoscopic hernia repair integrates the advantages of tension-free preperitoneal mesh support of the groin with the advantages of minimally invasive surgery procedures. AIM: To compare outcomes between slit mesh (SM) and nonslit mesh (NSM) placement in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. MATERIAL AND METHODS: This is a retrospective study of 353 patients who underwent TEP inguinal hernia repair between January 2010 and December 2011. One hundred forty-nine and 154 hernias were operated on in the SM and NSM groups, respectively. Postoperative complications, recurrence, early postoperative pain, and chronic pain levels were evaluated. RESULTS: In a total of 303 patients, hernia repair was performed as 395 direct and indirect hernias. Nonslit mesh was converted from TEP to transabdominal preperitoneal patch plasty (TAPP) in 4 patients in the group and 6 patients in the slit mesh group. The average operation time of the SM group was significantly higher than that of the NSM group (p < 0.001). In the evaluation of early postoperative pain, VAS levels of the NSM group were statistically significantly lower than those of the SR group in all evaluations (p = 0.001). The pain rate of the SM group after 3 months of chronic pain was significantly higher than that of the NSM group (p = 0.004). There was no difference in recurrence rate, 6th month chronic pain, wound infection or wound hematoma. CONCLUSIONS: The use of SM and NSM in TEP operations is not different in terms of recurrence and complications. However, the use of NSM gives better results in terms of early postoperative pain and chronic pain.

7.
Iran J Parasitol ; 11(4): 574-579, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28127370

RESUMO

BACKGROUND: Vast majority of complaints and physical examination findings of hydatid disease are common in emergency room patients. Different emergency presentations of hydatid cyst disease and their treatment are evaluated. We studied preoperative laboratory findings of these patients to identify any parameters to predict hydatid cyst-biliary system communication. METHODS: We reviewed the files of patients who underwent emergency surgery due to liver hydatid cysts and related conditions between March 2010 and March 2014 in Ankara Numune Research and Training Hospital, Turkey, retrospectively. Patients were grouped, regarding to the presence of biliary system involvement. RESULTS: Twelve patients (9 males, 3 females) were included. We identified two groups. Biliary system involved group (n=9) had significantly higher pre-operative gamma glutamine transferase and alkaline phosphatase levels (P=0.036). No significant difference was noted regarding other pre-operative laboratory findings. Mortality rate was 17%. CONCLUSION: Medical literature lacks sufficient information about hydatid disease related non-traumatic emergency surgeries. Preoperative elevated gamma glutamyl transferase and alkaline phosphatase levels may be questioned as a warning about cyst-biliary communication in hydatid cyst patients with abdominal pain in the emergency room. Future studies with larger sample sizes are needed. In addition, prolongation of the time before diagnosis in these patients may result in life threatening complications.

8.
Indian J Surg ; 77(Suppl 3): 1219-21, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27011540

RESUMO

Rectus sheath hematoma is a clinical entity characterized by the presence of blood within rectus abdominis muscle sheath. The aim of this study was to analyze clinical characteristics, diagnostic approach, treatment strategy, and outcomes of patients with rectus sheath hematoma. Patients diagnosed and treated for spontaneous rectus sheath hematoma between March 2010 and March 2014 were included in the study. A total of 10 patients were diagnosed as spontaneous rectus sheath hematoma. The mean age was 66.5 ± 16.9 years, and the mean hospital stay was 4.4 ± 1.8 days. There was no mortality. Six patients were using anticoagulant or antiplatelet agents. Eight patients recovered after conservative treatment. Two patients underwent surgery. Spontaneous rectus sheath hematoma is associated with anticoagulant therapy. Cases with abdominal pain and a non-pulsatile abdominal mass particularly in elderly women should be kept in mind. Treatment is mostly based on supportive care to preserve hemodynamic stability.

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