RESUMO
Isolated aneurysms of the iliac arteries are rare. The diagnoses of these aneurysms become easier with non-invasive radiologic investigations. The development of endovascular treatment is a recent alternative to surgical treatment. We report our experience in the management of 8 cases of isolated iliac aneurysms in the department of cardiovascular and thoracic surgery of the Habib Bourguiba Hospital of Sfax.
Assuntos
Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , TunísiaRESUMO
The neck, being not protected by skeleton, is vulnerable to external trauma and injury which can involve blood vessels, muscles, nerves, and trachea. Carotid injuries can be potentially life-threatening by hemorrhage and stroke. We present a case of a 26-year-old manual worker who presented a neck injury caused by a metallic projectile. The injury involved the right common carotid artery with an internal jugular vein fistula, and tracheal damage. The patient was managed with surgical repair of the tracheal lesion, reconstruction of the carotid section using a PTFE graft bypass, and ligation of the internal jugular vein. In the immediate postoperative period, the patient presented with no neurological deficits, but he did develop a pulmonary infection that resolved with antibiotic therapy. The follow-up is now 3months. The patient is doing well without any neurological disorder.
Assuntos
Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas/complicações , Veias Jugulares/lesões , Traumatismos Ocupacionais/complicações , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/cirurgia , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/cirurgia , Masculino , Traumatismos Ocupacionais/diagnóstico por imagem , Traumatismos Ocupacionais/cirurgiaRESUMO
Non-infectious aortitis is usually due to giant-cell arteritis, Takayasu disease or Behçet disease. The main aortic lesions are stenoses, occlusions and aneurysms in the Takayasu disease and aneurysms in the Behçet disease and giant-cell arteritis. Treatment is based on corticosteroid therapy and surgery. Endoluminal management is now the rule. We report a retrospective descriptive study of 10 patients who underwent surgical or endoluminal management of inflammatory lesions of the aorta between January 2000 and December 2015. There were 4 cases of Takayasu disease and 6 cases of Behçet disease. The aortic lesions were aneurysmal in all of the patients with Behçet disease. In the patients with Takayasu disease, aortic occlusions predominated, associated with other arterial lesions. Four patients with Behçet disease were managed surgically, and 2 patients underwent endovascular repair. All of the patients with Takayasu disease underwent surgery. Two patients died in the postoperative period, and two patients died during long-term follow-up. Systematic screening, as well as regular monitoring of the entire aorta during the follow-up, is necessary due to the frequency of aortic aneurysms.
Assuntos
Aortite/cirurgia , Síndrome de Behçet/cirurgia , Arterite de Células Gigantes/cirurgia , Arterite de Takayasu/cirurgia , Adulto , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tunísia , Adulto JovemRESUMO
Exostoses, or osteochondromas are benign bone tumors that have developed on the bone surface. These benign tumors can be asymptomatic or lead to complications, for instance arterial pseudoaneurysm. We report a case of a pseudoaneurysm of the popliteal artery treated surgically in a 17-year-old girl with a solitary exostosis of the right femur. Surgery was closure of the pseudoaneurysm and a bypass using a venous graft.
Assuntos
Falso Aneurisma/etiologia , Neoplasias Femorais/complicações , Osteocondroma/complicações , Artéria Poplítea , Adolescente , Anastomose Cirúrgica , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Veia Safena , Ultrassonografia DopplerRESUMO
BACKGROUND: The survival of patients with a metastatic colon cancer has improved with palliative chemotherapy, targeted therapies and surgery. Several prognostic factors influencing the survival of these patients were identified in the literature represented mainly by clinical factors: general condition, number and site of metastases, rate of white blood cells, initial carcinoembryonic antigen (CEA) rate, hemoglobin level, and therapeutic factors mainly represented by resection of metastases. AIM: To evaluate within a Tunisian retrospective study the significant prognostic factors on survival of metastatic colorectal cancer (MCRC). METHODS: We collected retrospectively 130 patients with MCRC treated in Sfax from january 2000 to December 2007. Uni and multivariate analysis were performed according to cox model for the following factors : Age or > 40 years, gender, synchronous vs metachronous metastases, disease-free survival (DFI) 1 > 1year, tumor site(colon vs rectum), performance status or PS ( 0-1or 2-3), white blood cells count (< or > 103/ml3 , haemoglobin rate (Hb) or > 11g/dl, seric carcinoembryonic antigen rate (CEA) < vs > 10 ng/ml, number of metastatic sites (single vs multiple), site of metastatic site (liver vs extrahepatic) and resection or not of the metastatic localizations. RESULTS: Statistical analysis showed for univariate analysis the positive impact of : PS 1, (Hb) rate > 11 g/dl, CEA) < 10 ng/ml and resection of metastases, while in in multivariate analysis, they were : a good PS and Hb > 11 g/dl. CONCLUSION: Our retrospective study confirmed the known prognostic impact of simple clinical tools like a good performance Status and Hb > 11 g/dl, a (CEA) rate lower than 10 ng/ml and resection of metastases which were identified by several other series such as predictive factors of a better survival in patients with metastatic colorectal cancer.
RESUMO
OBJECTIVES: The aim of this study was to review our experience in the management of traumatic rupture of the aortic isthmus, to evaluate the results of surgery and endovascular exclusion and to develop an adequate therapeutic strategy based on the existence and severity of associated injuries. MATERIAL: A series of 37 patients presenting posttraumatic aortic rupture associated with other severe lesions was collected from 2000 to 2012. There were 33 males and four females, mean age 38 years. In this series, 25 patients underwent surgical treatment and 12 endovascular exclusion. RESULTS: Six patients died during or after surgery. Overall mortality was 16% (24% in the surgery group). The postoperative period was uneventful in all patients treated with the endovascular procedure. Postoperative computed tomography controls at one week, 1 month and 12 months showed good positioning of the stent without endoleakage. CONCLUSION: Traumatic aortic rupture is often the result of a severe high-energy chest trauma. Other serious injuries are often associated. Results of immediate surgical repair are associated with high morbidity and mortality. The advent of endovascular treatment has revolutionized the treatment of traumatic aortic rupture, especially in patients with a high surgical risk.
Assuntos
Aorta Torácica/lesões , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Acidentes de Trânsito , Adolescente , Adulto , Aorta Torácica/cirurgia , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Aortografia , Transfusão de Sangue/estatística & dados numéricos , Prótese Vascular , Implante de Prótese Vascular/estatística & dados numéricos , Árvores de Decisões , Gerenciamento Clínico , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/mortalidade , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , Complicações Intraoperatórias/mortalidade , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Choque Hemorrágico/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
Mediastinitis are among the most dreadful infectious complications following cardiac surgery. Their prognosis depends essentially on the precociousness of the diagnosis. In most of the cases, the medical treatment associated with an irrigation drainage is sufficient. But in case of severe sternal dehiscence, plastic surgery becomes necessary in order to fill up the loss with a well-vascularized tissue. We report the case of a 78-year-old patient, chronic bronchitic who presented, after a coronary artery bypass, an aseptic sternal dehiscence necessitating an osteosynthesis, then a Klebsiella pneumoniae mediastinitis with an enlarged sternal necrosis which was treated by bone resection and a myoplasty via reversal of the right pectoris major muscle. The postsurgery course was favourable. Now, after one-year remote, cicatrisation is complete and we have not noticed any infectious recurrence.
Assuntos
Ponte de Artéria Coronária , Mediastinite/cirurgia , Músculos Peitorais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Esternotomia , Retalhos Cirúrgicos/cirurgia , Idoso , Fixação Interna de Fraturas , Humanos , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae , Masculino , Mediastinite/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Reoperação , Esterno/lesões , Infecção da Ferida Cirúrgica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Aortic coarctation is rarely associated with an aneurysm of the ascending aorta and an aortic coronary fistula. In this study, we report the case of a 52-year-old man undergoing surgery for an isthmic coarctation who also had an aneurysm of the initial portion of the aorta and an aortic coronary fistula. The diagnosis was clinically suspected and confirmed by vascular catheterism. The first operative stage consisted of treating the coarctation. The second stage was performed two months later to remove the aneurysm and replace the ascending aorta and the aortic valve with a prosthesis. The coronary arteries were then reimplanted. The postoperative results were quite favourable.
Assuntos
Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Coartação Aórtica/cirurgia , Fístula Artério-Arterial/cirurgia , Doença da Artéria Coronariana/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico , Aortografia , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/diagnóstico , Implante de Prótese Vascular , Cateterismo Cardíaco , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Ecocardiografia , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Papillary fibroelastoma is a benign primitive cardiac tumour, which can be associated with serious embolic complications. We report on a 37-year-old woman admitted for a cerebrovascular accident. Transthoracic and transesophageal echocardiography revealed a small and pedunculated mass attached to the anterior mitral leaflet. Because of the severity of its symptoms and its high embolic potential, the tumour was surgically excised and histologically diagnosed as a papillary fibroelastoma. The postoperative period was uneventful and the patient was discharged at the third day. Papillary fibroelastoma must be surgically treated because of its high embolic potential and its severe prognosis.
Assuntos
Fibroelastose Endocárdica/complicações , Neoplasias Cardíacas/complicações , Valva Mitral , Músculos Papilares , Acidente Vascular Cerebral/etiologia , Adulto , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Transesofagiana , Fibroelastose Endocárdica/diagnóstico por imagem , Fibroelastose Endocárdica/cirurgia , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Resultado do TratamentoRESUMO
The development of a lung cancer in young patients with emphysematous bullae is a classical, albeit rare, event. These patients can however be operated upon for the resection of a giant bulla causing respiratory distress. We report the case of a 41 year old male patient who was submitted to the resection of a giant right apical emphysematous bulla. The histopathological examination of the fragment revealed an undifferentiated lung carcinoma the diameter of which was less than one centimeter. This observation underlines the need for a systematic examination of the resected material and for a careful radiological follow-up of such patients.
Assuntos
Carcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Enfisema Pulmonar/diagnóstico , Adulto , Vesícula/diagnóstico , Diagnóstico Diferencial , Seguimentos , Humanos , Imuno-Histoquímica , Masculino , Pneumonectomia , Tomografia Computadorizada por Raios XRESUMO
Massive hemoptysis is a clinical entity characterized by its unpredictable and potential lethal course. We studied retrospectively the observations of 25 patients hospitalized in our surgical unit. We collected all the demographic, clinical and surgical data. A male predominance with a sex-ratio of 2,1 was noted. The average age was 45 years, with extremes of 17 and 75. The dominant cause was bronchiectasis. Twenty patients were operated on. The surgery consisted of a pulmonary resection in 9 cases (45%), an atypical lung resection in 4 cases (20%), a resection of an aspergilloma in 2 cases (10%), a kystectomy of hydatic cyst in 4 cases (20%) and one arterial ligature (5%). Five patients (25%) had emergent surgery, and 15 (75%) delayed surgery. Hospital mortality was 20% in the first group and 6.66% in the second. No recurrence of bleeding was observed after an average follow-up of 7 months. Surgery remains a therapy of choice for massive hemopysis. It must as far as possible be avoided during active bleeding.
Assuntos
Hemoptise/etiologia , Hemoptise/cirurgia , Adolescente , Adulto , Idoso , Feminino , Hemoptise/mortalidade , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
AIM: The aim of this study was to assess the influence of drainage with a Redon drain versus a conventional drain on postoperative pain and blood loss after valve replacements. METHODS: After approval by the local Ethics Committee and written informed consent, 30 patients, 20-60 years of age, scheduled for first elective valve replacement were included. After standardized anaesthetic regimens, cardiopulmonary bypass and coagulation therapy procedures and at the end of the operation, the patients were randomly assigned to 1 of 2 groups: (GI, n=15): drainage with 4 Redon drains; (GII, n=15): drainage with 2 conventional drains. Postoperative pain intensity at rest (VAS-R), during coughing and mobilization (VAS-M) in bed was independently evaluated using a visual analogue scale (VAS 100 mm) at 6 hourly intervals until 48 h after admission to the ICU (Ho). All patients received 2 g of paracetamol after obtaining the VAS score (8 g/24 h). No other analgesic agents were used. All patients were submitted to 2D echocardiography to verify the presence of pericardial effusion 24 h after surgery. Values are expressed as means. Pearson's chi squared and ANOVA (for repeated measurements) were used for statistical analysis. P<0.05 was considered significant. RESULTS: There was no statistically significant difference in the mean postoperative VAS-R and VAS-M, and in the mean postoperative total blood drainage 822.3 ml in GI, versus 704.3 ml in GII. Non pericardial effusion was found, and we did not see side-effects in any of the patients. CONCLUSIONS: We have shown that drainage with a Redon drains versus a conventional drain does not influence postoperative pain intensity and blood loss after valve replacements.
Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Sucção/instrumentação , Adulto , Valva Aórtica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Medição da Dor , Dor Pós-Operatória/etiologia , Hemorragia Pós-Operatória/etiologiaRESUMO
Traumatic lung hernia of the chest wall is unusual in pediatric patients. Most acquired traumatic lung hernia occur at the site of injury or on the anterior parasternal chest wall because the external intercostal muscle is absent from the cost cartilaginous junction to the sternum. A five-year-old girl presented with such a hernia after severe blunt trauma to her right torso. A chest radiograph, immediately after the injury and a CT scan showed lung herniation. She was treated surgically by direct repair of the chest wall defect. The recovery proceeded without complications. With early identification and appropriate surgical or video-assisted repair, symptomatic pulmonary hernia can have an excellent prognosis and very low probability of recurrence.
Assuntos
Pneumopatias/etiologia , Lesão Pulmonar , Pré-Escolar , Feminino , Hérnia/etiologia , Humanos , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicaçõesRESUMO
Recently the TMPRSS3 gene, which encodes a transmembrane serine protease, was found to be responsible for two non-syndromic recessive deafness loci located on human chromosome 21q22.3, DFNB8 and DFNB10. We found evidence for linkage to the DFNB8/10 locus in two unrelated consanguineous Tunisian families segregating congenital autosomal recessive sensorineural deafness. The audiometric tests showed a loss of hearing greater than 70 dB, in all affected individuals of both families. Mutation screening of TMPRSS3 revealed two novel missense mutations, W251C and P404L, altering highly conserved amino acids of the serine protease domain. Both mutations were not found in 200 control Tunisian chromosomes. The detection of naturally-occurring TMPRSS3 missense mutations in deafness families identifies functionally important amino acids. Comparative protein modeling of the TMPRSS3 protease domain predicted that W251C might lead to a structural rearrangement affecting the active site H257 and that P404L might alter the geometry of the active site loop and therefore affect the serine protease activity.
Assuntos
Perda Auditiva Neurossensorial/genética , Proteínas de Membrana , Mutação de Sentido Incorreto/genética , Proteínas de Neoplasias , Serina Endopeptidases/genética , Sequência de Aminoácidos , Audiometria , Sequência de Bases , Sítios de Ligação , Mapeamento Cromossômico , Cromossomos Humanos Par 21/genética , Consanguinidade , Sequência Conservada/genética , Análise Mutacional de DNA , Feminino , Genes Recessivos/genética , Ligação Genética/genética , Genótipo , Perda Auditiva Neurossensorial/congênito , Humanos , Masculino , Modelos Moleculares , Dados de Sequência Molecular , Linhagem , Estrutura Terciária de Proteína , Serina Endopeptidases/química , TunísiaAssuntos
Perda Auditiva Neurossensorial/genética , Retinose Pigmentar/genética , Adolescente , Adulto , Idoso , Criança , Dineínas , Feminino , Seguimentos , Perda Auditiva Neurossensorial/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Miosina VIIa , Miosinas/genética , Retinose Pigmentar/patologiaRESUMO
INTRODUCTION: The aneurysm of the descending aorta complicating a pseudocoarctation, itself due to a congenital elongation with kinking of the aorta is a rare entity. OBSERVATION: We report a case of aortic aneurysm discovered in a 72 years old woman without notable antecedents, which was referred for recurrent bronchitis. The X-ray showed a calcified opacity of the upper mediastinum, 5 cm of large. A thoracic CT-scan evoked the presence of a circulating sacciform aneurysm with calcified walls, developing on the final part of the aortic arch, which was with abnormally ascending way going up to the cervico-thoracic orifice and carrying out an aspect of aortic kinking. The assessment was complemented by a RMI as well as an aortic opacification. A thoracic scintigraphy showed an hypoperfusion of the left lung. The remainder of the cardiac assessment was normal. The patient was operated under femoro-femoral extracorporeal circulation through a left posterolateral thoracotomy of the 4th intercostal space. The examination showed a 7 cm diameter calcified aneurysm of the descending thoracic aorta complicating a tight stenosis in connection with an elongation and a kinking. The upper section of the aorta was shifted towards the pleural dome. The aortic section above aneurism was of normal size whereas the lower section was dilated. The aneurism was excised and a prosthetic graft was carried out. The surgery follow-up was marked by an hemodynamic stability, without neurological deficit. A ventilatory assistance was necessary during 5 days. Currently with 8 months follow-up, the patient goes well. COMMENTS: A prosthetic replacement in front of this type of aneurism is legitimate given the risk of the occurrence of complications secondary to the pseudocoarctation (arterial hypertension, aortic insufficiency) or to the aneurism itself, dissection or compression of vicinity (pulmonary artery).
Assuntos
Aneurisma da Aorta Torácica/patologia , Coartação Aórtica/complicações , Implante de Prótese Vascular/métodos , Idoso , Aneurisma da Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Resultado do TratamentoRESUMO
Classical studies have demonstrated genetic heterogeneity for nonsyndromic autosomal recessive congenital neurosensory deafness. The first two DFNB1 and DFNB2 locations were found using two consanguineous Tunisian families respectively from north and south. We tested these loci for cosegregation with deafness in twenty four southern families with nonsyndromic presumed congenital sensorineural deafness and a pedigree structure consistent with autosomal recessive inheritance. Only in our families, did deafness cosegregate with DFNB1. Although our families are from the south, none of them showed linkage to DFNB2.
Assuntos
Conexinas/genética , Consanguinidade , Dineínas/genética , Perda Auditiva Neurossensorial/genética , Mutação/genética , Miosinas/genética , Segregação de Cromossomos/genética , Conexina 26 , Feminino , Frequência do Gene/genética , Genes Recessivos/genética , Heterogeneidade Genética , Ligação Genética/genética , Testes Genéticos , Genótipo , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/epidemiologia , Humanos , Padrões de Herança/genética , Escore Lod , Masculino , Repetições de Microssatélites/genética , Miosina VIIa , Linhagem , Penetrância , Polimorfismo Genético/genética , Características de Residência/estatística & dados numéricos , Tunísia/epidemiologiaAssuntos
Pneumopatias Fúngicas/diagnóstico , Nocardiose/diagnóstico , Adulto , Antibacterianos , Diagnóstico Diferencial , Drenagem , Quimioterapia Combinada/uso terapêutico , Humanos , Pneumopatias Fúngicas/cirurgia , Neoplasias Pulmonares/diagnóstico , Masculino , Nocardiose/tratamento farmacológico , Nocardiose/cirurgia , Pneumonectomia , Tomografia Computadorizada por Raios XAssuntos
Ferro/sangue , Gravidez em Diabéticas/sangue , Adulto , Feminino , Ferritinas/sangue , Hemoglobina A/análise , Humanos , GravidezRESUMO
Echography and/or chest radiograph in association with six serologic (immunologic) methods were tested for their ability to diagnose human hydatidosis. The immunologic techniques used were latex agglutination, counter immunoelectrophoresis, enzyme-linked immunosorbent assay (ELISA) with whole hydatid fluid and with antigen 5, a thermobabile lipoprotein that elicits the arc 5 precipitin line in immunoelectrophoresis. In this report, the results of examinations of 273 patients are presented. Of these, 243 cases were surgically proven to have hydatidosis, whereas 30 of the 273 that were strongly suspected of having hydatid cysts by radiology were shown to have other pathologies. The ELISA was more sensitive than the other methods, with 204 of 243 sera shown to be positive. The remaining 39 sera that gave false-negative results were tested using two recently developed methods, enzyme-linked immunoelectrodiffusion assay (ELIEDA) and immunoblotting (electrophoretic migration of hydatid fluid antigens under denaturing but nonreducing conditions, blotting, and immunoenzymatic assay). Immunoblotting, using our experimental conditions, had a greater sensitivity than the ELIEDA with this technique. Four of 37 sera showed one to three bands of 65, 12, and 8 kD. The sensitivity of the ELISA did not increase with either the size or type of cyst. Comparison of radiology with serology confirmed a good correlation between the two methods. Nevertheless, serology is more specific but less sensitive than imagery.