Malfunción valvular intermitente por migración del catéter peritoneal a escroto / Shunt dysfunction secondary to peritoneal catheter migration to the scrotum

Introducción. La malfunción valvular por obstrucción del catéter proximal es un hecho relativamente frecuente en el servicio de urgencias de los grandes hospitales, pero la obstrucción distal de causa no infecciosa es excepcional. Caso clínico. Presentamos un varón de 6 años con malfunción valvular aguda, por migración del catéter distal al hemiescroto derecho. Para resolver el cuadro completamente se realizó un cierre del conducto peritoneo-vaginal de urgencia. Discusión. La permeabilidad del conducto peritoneo-vaginal (existente en hasta el 60% de los varones menores de 1 año) es la causante de los hidroceles en los pacientes portadores de una derivación ventrículo-peritoneal. Pero la migración del catéter es muy infrecuente, sobre todo en mayores de un año. Si este hecho conlleva el aumento de la presión intracraneal con disfunción valvular, el cierre de urgencia de dicho conducto debe ser prioritario.

Introduction. Valvular dysfunction secondary to obstruction of proximal catheter is relatively frequent at emergency room. However non-infectius obstruction of distal catheter is exceptional. Case report. A 6-year-old boy with dysfunction shunt due to migration of the abdominal catheter into the right scrotum. The patient was operated urgently for peritoneum-vaginal processus closure. Discussion. Permeability of the peritoneum-vaginal processus (until 60% of boys younger than one year) causes hydrocele in patients with ventricle-peritoneal shunt. However migration of the peritoneal cateter is very infrequent specially in patients older than one year. In the case of this event with increased intracraneal pressure levels and shunt malfunction, emergency closure of the duct should be a priority.

Bilateral spontaneous dislocation of posterior chamber intraocular lens in a patient with gyrate atrophy.

We report a patient with gyrate atrophy, a rare metabolic disease, who had bilateral late spontaneous posterior dislocation of in-the-bag posterior chamber intraocular lens (PCIOL). He underwent pars plana vitrectomy, PCIOL retrieval and anterior chamber intraocular lens implantation in both eyes. This report may imply that patients with gyrate atrophy are at risk for spontaneous dislocation of intraocular lenses.

Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20-mm Diameter Stents

OBJECTIVE: To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction. MATERIALS AND METHODS: The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients. RESULTS: A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement. CONCLUSION: The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.

Táticas e técnicas endovasculares para retirada de corpos estranhos intravenosos / Endovascular techniques and procedures, methods for removal of intravascular foreign bodies

INTRODUÇÃO: A incidência da embolização de cateteres intravenosos, na literatura mundial, é de 1 por cento dentre todas as complicações descritas. Porém, possui taxa de mortalidade podendo variar de 24 a 60 por cento. O não funcionamento do cateter é a suspeita diagnóstica principal da embolização, visto que, habitualmente, os pacientes são assintomáticos. OBJETIVO: Relatar o manejo na extração de corpos estranhos intravenosos, com o uso de táticas e técnicas endovasculares diversas. MÉTODOS: Estudo retrospectivo com 12 pacientes, no período de dois anos. Sete pacientes eram do sexo feminino e cinco do sexo masculino, com média de idade de 29 anos (dois meses a 65 anos). RESULTADOS: Sucesso técnico foi obtido em 100 por cento dos casos. Foram extraídos 10 port-a-caths, um intra-cath e um PICC. Os locais mais frequentes de alojamento de uma das extremidades dos corpos estranhos intravenosos foram o átrio direito (41,6 por cento) e o ventrículo direito (33,3 por cento). Em 100 por cento dos casos se utilizou um único acesso venoso. O acesso femoral foi o mais utilizado, em 91,6 por cento dos casos (11 cateteres). Utilizou-se o laço (loop-snare) em 10 (83,3 por cento) casos. O motivo mais frequente da presença do corpo estranho intravascular foi a fratura do cateter, que ocorreu em 66,6 por cento dos casos (oito pacientes). Houve uma complicação, fibrilação atrial (8,3 por cento), relacionada à extração de corpo estranho intravenoso. A taxa de mortalidade em 30 dias foi igual a zero. CONCLUSÃO: A retirada de corpos estranhos intravenosos por via percutânea é considerada tratamento padrão ouro, por se tratar de procedimento minimamente invasivo, relativamente simples, seguro e com baixas taxas de complicações quando comparada ao tratamento cirúrgico convencional.

INTRODUCTION: The incidence of intravascular embolization of venous catheters reported in the world medical literature corresponds to 1 percent of all the described complications. However, its mortality rate may vary between 24 to 60 percent. Catheter malfunction is the most likely signal of embolization, since patients are usually asymptomatic. OBJECTIVE: To report the method of removing intravascular foreign bodies, catheters with the use of various endovascular techniques and procedures. METHODS: This is a two-year retrospective study of 12 patients: seven women and five men. The average age was 29 years (ranging from two months to 65 years). RESULTS: Technical performance was 100 percent successful. Ten port-a-caths, one intra-cath and one PICC were extracted. The most common sites for the lodging of one of the ends of the intravascular foreign bodies were the right atrium (41.6 percent) and the right ventricle (33.3 percent). In 100 percent of the cases, only one venous access was used for extraction of foreign bodies, and in 91.6 percent of the cases (11 catheters) the femoral access was used. The loop-snare was used in 10 cases (83.3 percent). The most common cause of intravascular foreign body insertion was a catheter fracture, which occurred in 66.6 percent of the cases (eight cases). One major complication, the atrial fibrillation, occurred (8.3 percent), which was related to the intravascular foreign body extraction. The mortality rate in 30 days was zero. CONCLUSION: Percutaneous retrieval of intravascular foreign bodies is considered gold standard treatment because it is a minimally invasive, relatively simple, safe procedure, with low complication rates compared to conventional surgical treatment.

Lipoid pneumonia: An uncommon entity.

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids.

Repeated fracture of pacemaker leads with migration into the pulmonary circulation and temporary pacemaker wire insertion via the azygous vein.

Repeated implantation of pacemaker in the same patient is a common occurrence because of the increased longevity of patients. However, repeated lead fracture in the same patient and migration of the pacemaker lead into the pulmonary circulation is rare. We describe a 56-year-old gentleman who had undergone pacemaker implantations thrice due to repeated lead fractures (thrice) and also had migration of the pacemaker lead into the pulmonary circulation. He also had an azygous vein which was noticed while placing the temporary pacemaker wire.

Umbilical perforation: a rare complication of entriculoperitoneal shunt

A female baby of one-and-a-half-year old presented with extrusion of ventriculoperitoneal [VP] shunt through umbilicus. On exploration, the urachal remnant was found perforated by VP shunt and the tube exteriorized through umbilicus. Child was managed successfully with excision of urachal remnant, removal of VP shunt, antibiotic treatment and re-insertion of shunt

Spontaneously Migrated Tip of an Implantable Port Catheter into the Axillary Vein in a Patient with Severe Cough and the Subsequent Intervention to Reposition It

Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear. We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough. Coughing was suggested for this case as the cause of the catheter tip migration. We corrected the position of the catheter tip via transfemoral snaring.

Extrusão dos implantes em portadores de cavidade anoftálmica / Anophthalmic cavity and implant extrusion

OBJETIVO: Avaliar as características dos portadores de cavidades anoftálmicas que desenvolveram extrusão do implante. MÉTODOS: Estudo retrospectivo, observacional, tendo sido avaliados 37 portadores de cavidade anoftálmica que tiveram extrusão do implante de cavidade, na Faculdade de Medicina de Botucatu-UNESP. RESULTADOS: As extrusões ocorreram em cavidades enucleadas ou evisceradas, a maioria delas submetidas a cirurgia em decorrência de phthisis bulbi ou trauma, em geral de 1 a 2 anos após a cirurgia inicial. A deiscência precedeu a extrusão em todos os casos, tendo a extrusão ocorrido com todos os tipos de implantes empregados. CONCLUSÃO: Após a colocação de implantes de cavidade podem ocorrer complicações. A deiscência e extrusão das esferas são possibilidades que podem requerer nova intervenção cirúrgica, para a qual o paciente e o oftalmologista devem estar preparados.

PURPOSE: To evaluate the characteristics of patients with anophthalmic cavity who developed sphere extrusion. METHODS: A retrospective observational study was done evaluating 37 patients with anophthalmic cavity and sphere extrusion at the "Faculdade de Medicina de Botucatu-UNESP". RESULTS: Extrusion was observed in enucleated and eviscerated cavities. The majority of the patients had the eye removed because of phthisis bulbi or trauma and the extrusion happened 1 or 2 years after the surgery. Extrusion was preceded by conjunctival dehiscence and exposure of the sphere and occurred with all used implants. CONCLUSION: Complications after orbital implant placement are a possibility. Dehiscence and sphere extrusion may happen and another surgery would be necessary. The patient and the ophthalmologist have to be prepared for this.

Endoprótese auto-expansível de malha de poliéster revestida por silicone (Polyflex®) no tratamento de estenoses traqueais não-cirúrgicas / Self-expanding stent made of polyester mesh with silicon coating (Polyflex®) in the treatment of inoperable tracheal stenoses

OBJETIVO: Avaliar a prótese Polyflex® quanto à sua eficácia, facilidade de implantação e complicações em pacientes com afecções traqueobrônquicas. MÉTODOS: Foram acompanhados, prospectivamente, dezesseis pacientes com estenoses traqueais secundárias à intubação orotraqueal (n = 12), neoplasia (n = 3) e granulomatose de Wegener (n = 1), não candidatos a tratamento cirúrgico. Desses, onze eram mulheres e cinco eram homens, com idade média de 42,8 anos (intervalo de 21 a 72 anos). Os pacientes foram submetidos à implantação de um total de 21 próteses Polyflex®. Os procedimentos foram realizados no centro cirúrgico, sob anestesia geral e as próteses implantadas através de laringoscopia de suspensão e aplicador próprio. RESULTADOS: Em todos os casos foi possível implantar a prótese e observamos resolução de sintomas. Os pacientes permaneceram com a prótese por tempo médio de 7,45 meses, variando entre 2 e 18 meses. As complicações pós-operatórias imediatas observadas foram disfonia em dois pacientes (12,5 por cento) e odinofagia em dois pacientes (12,5 por cento). As complicações tardias foram tosse em dez pacientes (62,5 por cento), migração em sete pacientes (43,75 por cento), formação de granulomas em dois pacientes (12,5 por cento) e pneumonia em um paciente (6,25 por cento). CONCLUSÃO: A prótese Polyflex® é fácil de implantar e retirar, é bem tolerada e efetiva na resolução dos sintomas, porém, está associada a alto índice de migração, principalmente em estenoses pós-intubação orotraqueal.

OBJECTIVE: To evaluate the Polyflex® stent in terms of its efficacy, ease of implantation, and complications in patients with tracheobronchial affections. METHODS: This was a prospective study, in which sixteen patients with inoperable tracheal stenosis secondary to orotracheal intubation (n = 12), neoplasia (n = 3), or Wegener's granulomatosis (n = 1) were monitored. Of these patients, eleven were women, and five were men. The mean age was 42.8 years (range, 21-72 years). Patients were submitted to implantation of a total of 21 Polyflex® stents. All procedures were carried out in the operating room under general anesthesia, and the stents were implanted via suspension laryngoscopy using the stent applicator. RESULTS: Stents were implanted and symptoms were resolved in all cases. The stents remained in place for a mean period of 7.45 months, ranging from 2 to 18 months. The complications observed in the immediate postoperative period were dysphonia (in two patients, 12.5 percent) and odynophagia (in two patients, 12.5 percent). Late complications were cough (in ten patients, 62.5 percent), migration (in seven patients, 43.75 percent), granuloma formation (in two patients, 12.5 percent), and pneumonia (in one patient, 6.25 percent). CONCLUSION: The Polyflex® stent is easily implanted, easily removed, well tolerated by patients and effective in resolving symptoms. However, its use is associated with a high rate of migration, especially in patients with post-orotracheal intubation stenosis.

Removal of central venous catheter fragment embolus in a young male.

A 22 years male admitted with severe pancreatitis with central venous catheter implanted for central venous pressure monitoring and for providing total parental nutrition developed catheter fragment embolus due to accidental fracture of the same while manipulating it. Non surgical retrieval of the same was done by radiological intervention without any complication.

Transmural Migration of Surgical Sponge Evacuated by Defecation: Mimicking an Intraperitoneal Gossypiboma

The spontaneous defecation of the surpical retained sponge is very rare. Here, we report a case of migrating surgical sponge that was retained in the colon and it was evacuated by defecation.

Migración recurrente del botón de gastrostomía: "síndrome de Buried Bumper" / Recurrent migration of internal bumper gastrostomy: Buried bumper syndrome

Introducción: En la actualidad la gastrostomía ha cambiado el manejo de los niños para el soporte nutricional ambulatorio, así como el soporte nutricional a largo plazo en pacientes con patología crónica. La gastrostomía endoscópica percutánea (GEP) es la técnica de elección hoy en día principalmente por ser segura y porque constituye un procedimiento mínimamente invasivo. Sin embargo, como toda técnica quirúrgica no está libre de complicaciones, siendo una de ellas la migración del botón de gastrostomía en la pared abdominal o gástrica, conocido como Síndrome de Buried Bumper. Caso clínico: Con el fin de ilustrar esta complicación, hasta ahora poco descrita en niños, se presenta el caso de un preescolar a quien se le realizan dos gastrostomías percutáneas por vía endoscópica, en distintos sitios del estómago, complicándose en ambas oportunidades con este síndrome. Conclusión: Creemos que si bien es cierto la PEG puede brindar una serie de ventajas al constituir un acceso seguro a la vía digestiva, ésta es una técnica invasiva, con complicaciones no despreciables desde infección de herida operatoria hasta el Buried Bumper, lo cual hace necesario revisar en detalle cada caso en particular con el fin de no agregar morbilidad a nuestro paciente.

Spontaneous antegrade enteral migration of feeding jejunostomy tube.

Spontaneous migration of enteral feeding tubes is unusual. We report an 18-year-old man with corrosive stricture of the upper esophagus in whom feeding jejunostomy was performed using an 18F Levine's tube. Thirteen months later, he presented with absence of the tube. The patient was tolerating liquid diet and was managed conservatively. Serial radiographs and colonoscopy showed a steady progress of the tube through the gut. The tube was passed out spontaneously after 20 days.