RESUMO
We report a case of spinal epidural hematoma after removal of an epidural catheter. The patient had no background of anticoagulant therapy or coagulopathy; sudden severe back pain occurred immediately after removal of the catheter. The chance of this occurring is estimated to be between 1:150,000 and 1:190,000. We studied 40 previous reports from 1952 to 2000, and we also investigated anticoagulant therapy and pathologic states, puncture difficulties and bleeding at the point of insertion, and its onset. In 23 cases (57.5%), anticoagulant therapy had been performed, and in 5 cases (12.5%), coagulopathy or liver dysfunction had been recognized. In 20 cases (50%), the initial symptoms were recognized within 24 hours after removal of the epidural catheter. Although spinal epidural hematoma is a very rare condition, it is a serious complication of continuous epidural anesthesia.
Assuntos
Anestesia Epidural/efeitos adversos , Cateterismo/efeitos adversos , Hematoma Epidural Espinal/diagnóstico , Hematoma Epidural Espinal/etiologia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/etiologia , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Hematoma Epidural Espinal/terapia , Humanos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/terapia , Ferimentos Penetrantes/terapiaRESUMO
We treated 15 patients with malignant bone and soft-tissue tumours of the shoulder girdle using limb salvage operations involving resection of the proximal humerus, scapula and clavicle. The oncological and functional outcomes were evaluated in all patients after an average of 5 (1-13) years. Oncological evaluation revealed that in 11 patients with adequate surgical margins six were continuously disease free and two had no evidence of disease. Three patients with marginal surgical margins had all died. We suggest that only where adequate surgical margins can be obtained should operations be performed. Forequarter amputation is still indicated in patients with complicated neurovascular involvement. Functional evaluation showed that scapular resections, especially glenoid resections, provided poor results (mean score 54%) in comparison with patients without such resection (mean score 82%).
Assuntos
Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Articulação do Ombro , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/mortalidade , Quimioterapia Adjuvante , Criança , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Procedimentos Ortopédicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Neoplasias de Tecidos Moles/mortalidade , Taxa de Sobrevida , Resultado do TratamentoRESUMO
We report on a patient with lipoma arising from flexor tenosynovium at the level of the wrist who had snapping of the middle finger and carpal tunnel syndrome. She was relieved of these symptoms after excising the lipoma.