Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes

Abstract Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

Hydroperitoneum: A unique complication of Supine Percutaneous Nephrolithotomy on an Ectopic Solitary Pelvic Kidney

@#A 47-year-old male complained of anuria for 2 days with elevated creatinine of 14 mg/dL on admission. Patient underwent emergent hemodialysis. Non-contrast CT showed a solitary ectopic pelvic kidney with a 2 cm. pelvolithiasis and a 1 cm upper pole calyceal stone with obstructive hydronephrosis. He therefore underwent ultrasound-guided nephrostomy tube placement. Once clinically stable, the patient underwent a multi-tract supine PCNL. Intraoperatively, the authors noted tense abdominal distention accompanied by hypotension during the procedure. A diagnosis of compartment syndrome secondary to hydroperitoneum was considered. An indwelling stent and a nephrostomy tube were placed. An abdominal pigtail drain was placed removing three liters of fluid. The patient remained intubated for 3 days. He underwent blood transfusion. He required two 2 sessions of hemodialysis postoperatively. The patient was discharged in stable condition on postoperative day 22. Hydroperitoneum is a potential complication of PCNL in ectopic pelvic kidneys. Its prompt recognition, followed by immediate aspiration of intraabdominal fluid and drain placement is life-saving.

Epifisiolisis tibial proximal tipo IV-A de Ryu y Debenham. A propósito de un caso / Ryu and Debenham type IV-A proximal tibia epiphysiolysis. A case report

Las epifisiólisis tibiales proximales son un cuadro poco frecuente debido a la protección que aportan las estructuras circundantes de dicha zona. Por el desplazamiento que se origina es necesario realizar una exploración vascular junto a una reducción urgente para prevenir la lesión de la arteria poplítea y la aparición de un síndrome compartimental. Presentamos a un varón de 10 años con epifisiólisis de tibia proximal tipo I de Salter-Harris. Nivel de Evidencia: IV

Epiphysiolysis of the proximal tibia is a rare injury due to the surrounding structures that protect the area. In displaced fractures, the evaluation of vascular structures is mandatory to detect injury to the popliteal artery or the presence of compartment syndrome. We present a Salter & Harris type I epiphyseal injury of the proximal tibia in a 10-year-old boy Level of Evidence: IV

Presión intracompartimental y signos clínicos en pacientes con fracturas diafisarias en miembros inferiores ingresados en el IAHULA / Intracompartimental pressure and clinical Signs in patiens with diaphyseal fractures of the lower limbs admitted at IAHULA hospital

Las fracturas diafisarias del fémur y la tibia son las lesiones traumáticas más comunes a nivel mundial, afectan principalmente a la población joven y económicamente activa como consecuencia de traumatismos de alta energía, en su mayoría accidentes viales. Las complicaciones de estas lesiones han sido ampliamente descritas y las implicaciones médico-legales son importantes cuando estas no son detectadas a tiempo. Por lo que resulta relevante estudiar como se comportan las presiones intracompartimentales en las fracturas cerradas y su evolución en el tiempo, así como las manifestaciones clínicas durante las primeras 12 horas de evolución. Se realizó un estudio observacional transversal en 65 pacientes con fracturas cerradas diafisarias de fémur y tibia, evaluando las cifras de presión intracompartimental y las variables clínicas al momento de su ingreso y a las 12 horas de evolución intrahospitalaria. Encontramos que el compartimento más afectado es el anterior con un promedio de presión al ingreso de 22,26±6,90 mmHg. Asimismo, se demostró una relación directa entre el mecanismo y energía del trauma con respecto a las cifras de presión intracompartimental. Los resultados del estudio demostraron que el parámetro clínico más importante fue el dolor, el cual está relacionado con la energía del trauma(AU)

Diaphyseal fractures of the femur and tibia are the most common traumatic injuries worldwide, mainly affecting the young and economically active population as a consequence of high-energy trauma, mostly traffic related accidents. The complications of these injuries have been widely described and the legal implications are important when they are not detected early enough. Therefore, its relevant to study how intracompartmental pressures behave in closed fractures and their evolution, as well as the clinical manifestations during the first 12 hours. A cross-sectional observational study was made. 65 patients with closed diaphyseal fractures of the femur and tibia were included. The intracompartmental pressure numbers and the clinical variables at the time of admission and at 12 hours of in-hospital evolution were evaluated. As results, the most affected compartment is the anterior one with an average pressure at admission of 22.26 ± 6.90 mmHg. A direct relationship between the mechanism and energy of the trauma was also demonstrated with respect to the intracompartmental pressure levels reported. The most important clinical parameter was the pain, related to the energy of the trauma(AU)

Síndrome compartimental bilateral de pierna tras posición de litotomía prolongada: presentación de un caso clínico / Bilateral leg compartment syndrome after prolonged lithotomy position: clinical case report

INTRODUCCIÓN: El síndrome compartimental es una complicación infrecuente pero severa que puede aparecer ante una posición de litotomía prolongada y el uso de perneras. OBJETIVO: Presentar un caso de síndrome compartimental bilateral tras posición de litotomía prolongada asociada con el uso de perneras. MATERIAL Y MÉTODOS: Paciente varón de 43 años sometido a una cirugía urológica en posición habitual de litotomía durante un periodo de 6 horas. A las 2 horas de finalizar la cirugía, el paciente presentó dolor intenso y endurecimiento de compartimento anterior y lateral de ambas piernas, junto con una elevación de la creatina quinasa sérica (valor inicial de 109 U/L que se elevó hasta 7.689 U/L a las 12 horas) y una imposibilidad para la flexión dorsal pasiva de ambos tobillos. El paciente no sentía dolor en el resto de los compartimentos. RESULTADOS: Ante la sospecha de un síndrome compartimental anterolateral, se realizó fasciotomía bilateral urgente, y se observó una disminución de la perfusión muscular y mejoría de la misma tras apertura de la fascia. Se realizaron curas periódicas cada 48 horas, y se observó viabilidad del tejido hasta su cierre definitivo a los 4 días. A las 2 semanas, el paciente presentó fatiga ligera para la deambulación sin ayuda, con tumefacción en el compartimento lateral de ambas piernas. A los 10 meses de evolución, el paciente caminaba sin ayuda y con función muscular completa. CONCLUSIONES: El conocimiento de la asociación del síndrome compartimental y la cirugía laparoscópica prolongada es esencial para un diagnóstico precoz y un tratamiento quirúrgico inmediato, para evitar graves secuelas. Los buenos resultados de nuestro paciente se deben a la rápida actuación, ya que normalmente se suele demorar. Para evitar su aparición o disminuir su incidencia, la posición de litotomía debería limitarse a aquellos momentos de la cirugía en los que sea imprescindible, modificando la posición de las piernas cada dos horas en caso de cirugías prolongadas, para prevenir dicha complicación.

Compartment syndrome is a rare but severe complication resulting from a prolonged lithotomy position and the use of leg loops. PURPOSE: To present a case of bilateral compartment syndrome after prolonged lithotomy position associated with the use of leg loops. METHODS: A 43-year-old man underwent urological surgery in the usual lithotomy position for a 6-hour period. Two hours after the end of the surgery, the patient presented severe pain and stiffening of the anterior and lateral compartments of both legs, elevated serum creatine kinase levels (the baseline value of 109 U/L increased to 7,689 U/L at 12 hours), and inability for passive dorsiflexion of both ankles. The patient reported no pain in the other compartments. RESULTS: Suspicion of an anterolateral compartment syndrome resulted in an urgent bilateral fasciotomy; muscle perfusion was decreased, and it improved after fascial opening. Dressings were changed every 48 hours, and tissue viability was observed until the final closure at 4 days. At two weeks, the patient presented slight fatigue when walking with no assistance, in addition to swelling in the lateral compartment of both legs. Ten months after surgery, the patient walked with no assistance and with complete muscle function. CONCLUSION: Knowledge of the association between compartment syndrome and prolonged laparoscopic surgery is essential for an early diagnosis and immediate surgical treatment to avoid serious sequelae. In our patient, the good outcomes resulted from quick action, since diagnosis is often delayed. Limiting the lithotomy position to those surgical moments in which it is essential and changing the position of the legs every 2 hours during prolonged procedures can reduce the occurrence and incidence of compartment syndrome, preventing this complication.

Factores de riesgo para amputación en pacientes manejados con fasciotomía de miembro inferior en un centro de alta complejidad / Risk factors for amputation in patients managed with lower limb fasciotomy in a high complexity center

Resumen Introducción: El síndrome compartimental del miembro inferior tiene el potencial de causar morbilidad devastadora en los pacientes y altos riesgos médico-legales para los médicos involucrados en su tratamiento. Una vez instaurado, la fasciotomía se constituye como el único tratamiento efectivo. La pérdida de la extremidad afectada es su complicación con mayor carga de enfermedad. Existen pocas descripciones sobre factores de riesgo para la necesidad de amputación de miembro inferior luego de haber sido sometido a fasciotomía en pacientes con lesiones traumáticas. Materiales y Método: Se realizó un estudio retrospectivo, observacional, analítico en el cual se recolectó información de pacientes con traumatismo de miembro inferior que requirieron fasciotomía de muslo o pierna durante un periodo de 10 años en busca de factores que pudieron influir en la pérdida de la extremidad. Resultados: 21 pacientes cumplían los criterios de inclusión de los cuales 6 (28,57%) fueron amputados y 2 fallecieron (9,52%). La mayoría de los individuos fueron menores de 30 años y casi la totalidad del sexo masculino. Encontramos que el porcentaje de amputación parece verse afectado de manera estadísticamente significativa por factores como un International Severity Score (ISS) elevado (media de 24), las parestesias al ingreso, la realización de fasciotomía tardía (> 6 h), la reactividad muscular al momento de la cirugía, la infección del sitio operatorio y la reintervención por trombosis del injerto vascular. Conclusiones: Existen factores de riesgo que pueden indicar la pérdida de la extremidad inferior luego de ser sometido a fasciotomía en el contexto de trauma. Un seguimiento prospectivo y un mayor número de pacientes podrían permitir dilucidar más de dichos factores.

Introduction: The lower limb compartment syndrome has the potential to cause devastating morbidity in patients and high legal medical risks for doctors involved in its treatment. Once established, fasciotomy is the only effective treatment. The loss of the affected limb is the complication with a greater burden of disease. There are few descriptions of risk factors for the need for lower limb amputation after having undergone fasciotomy in patients with traumatic injuries. Materials and Method: A retrospective, observational, analytical study was conducted in which information was collected from patients with lower limb trauma that required thigh or leg fasciotomy for a period of 10 years in search of factors that could influence limb loss. Results: 21 patients met the inclusion criteria of which 6 (28.57%) were amputated and 2 died (9.52%). The majority of the individuals were under 30 years old and almost all of the male sex. We found that the percentage of amputation seems to be affected statistically significantly by factors such as a high ISS (mean of 24), paresthesia at admission, performing late fasciotomy (> 6 h), muscle reactivity at the time of surgery, postoperative SSI and reintervention by vascular graft thrombosis. Conclusions: We found risk factors that may indicate the loss of the lower limb after being subjected to fasciotomy in the context of trauma. A prospective follow-up and a greater number of patients could make it possible to elucidate more of these factors.

Síndrome compartimental agudo del miembro inferior: estado actual / Acute compartment syndrome of the lower extremity: An update

El síndrome compartimental agudo del miembro inferior es una urgencia médica, que puede conllevar una importante morbilidad para el paciente y que puede tener implicaciones medico legales para el personal médico. Afecta cerca de 3,1 por 100.000 habitantes en el mundo occidental, con predominio de hombres y jóvenes. Debido a una alteración de la perfusión tisular, por la disposición de los músculos de las extremidades en compartimientos compactos, con poca tolerancia a variaciones en la presión, puede causar isquemia, con cambios irreversibles a nivel muscular y nervioso, falla multiorgánica y la muerte, de no tratarse oportunamente. El trauma de la extremidad inferior asociado a fractura es la principal causa del síndrome compartimental agudo. El diagnóstico puede realizarse por evaluación clínica, mediante las clásicas seis "P" de la isquemia, o de manera objetiva, al medir la presión intracompartimental con dispositivos especializados. La fasciotomía descompresiva es un procedimiento quirúrgico mediante el cual se inciden las fascias de los compartimientos musculares, permitiendo la disminución de las presiones a ese nivel, y se constituye en el único tratamiento eficaz para el síndrome compartimental agudo. Las complicaciones posquirúrgicas no son infrecuentes, siendo la perdida de la extremidad la más grave de todas. Un correcto conocimiento y aplicación de la técnica quirúrgica evitará procedimientos inadecuados, que impliquen mayor riesgo de resultados adversos. Presentamos una revisión de los aspectos fundamentales de esta patología potencialmente catastrófica

Acute compartment syndrome of the lower limb is a medical emergency, which can entail significant morbidity for the patient and which may have medico-legal implications for medical personnel. It affects about 3.1 per 100,000 inhabitants in the Western world, with a predominance of men and young people. Ischemia can be caused after an alteration of tissue perfusion, due to the arrangement of the muscles of the extremities in compact compartments, with little tolerance to variations in pressure, with irreversible changes at the muscular and nervous level, and multiorgan failure and death if not treated promptly. Trauma to the lower extremity associated with fracture is the main cause of acute compartment syndrome. Diagnosis can be made by clinical evaluation, using the classic six "P" of ischemia, or objectively by measuring intracompartmental pressure with specialized devices. Decompressive fasciotomy is a surgical procedure by which the fasciae of the muscle compartments are incised, allowing the pressure to be reduced at that level, and it is the only effective treatment for acute compartment syndrome. Postoperative complications are not uncommon, limb loss being the most serious of all. A correct knowledge and application of the surgical technique will avoid inappropriate procedures, which imply a greater risk of adverse results. We present a review of the fundamental aspects of this potentially catastrophic pathology

Early incision, decompression and screw fixation for the treatment of Lisfranc injuries with foot osteofascial compartment syndrome / 中国骨伤

OBJECTIVE@#To explore clinical effect of early incision and decompression combined with screw fixation in treating Lisfranc injury and foot osteofascial compartment syndrome.@*METHODS@#Clinical data of 5 patients with Lisfranc injury and foot osteofascial compartment syndrome were retrospective analysized from January 2017 to December 2018, including 4 males and 1 female, aged from 19 to 62 years old. All patients were suffered from closed injuries. The time from injury to treatment ranged from 1 to 14 h. According to Myerson classification, 1 patient was type A, 1 patient was type B, and 3 patients were type C. All patients were performed early incision decompression and screw fixation. Maryland foot functional scoring standard at 12 months after opertaion was used to evaluate clinical effect.@*RESULTS@#All patients were followed up for 10 to 48 months. All fractures were achieved bone union, and healing time ranged from 3 to 9 months. All metatarsal and tarsal joints were reached to anatomical reduction. No infection, osteomyelitis, loosening or breaking of internal fixation occurred. Postopertaive Maryland foot function score at 12 months was from 44 to 97, and 2 patients got excellent result, 2 good, and 1 poor.@*CONCLUSION@#Early incision and decompression with screw fixation for the treatment of Lisfranc injury and foot osteofascial compartment syndrome, which has advantages of simple opertaion, thoroughly decompression, screw fixation does not occupy space, stable decompression and fixation, and could receive satisfied clinical effect.

Síndrome compartimental no primeiro interósseo dorsal: relato de caso / Compartment syndrome in the first dorsal interosseous compartment: case report

Resumo O diagnóstico da síndrome compartimental em regiões que não são frequentemente afetadas, por possuírem uma boa relação continente-conteúdo, pode se tornar difícil, uma vez que o cirurgião terá dificuldades em alcançar um diagnóstico apenas por um sinal ou sintoma isolado. Assim, muitas vezes, pode-se protelar a conduta adequada, desencadeando danos ao paciente. A paciente era uma mulher, de 29 anos, que foi atendida com dor em mão esquerda por queimadura, com lesão em região anterior à tabaqueira anatômica de tamanho significativo. A paciente já havia sido submetida a cirurgia na sua cidade de origem com desbridamento de pele e tecido subcutâneo há 30 dias, com evolução sem melhora do quadro doloroso. Estava em uso de antibioticoterapia (ceftriaxona 1 g de 12 em 12 horas) e analgesia com dose terapêutica de morfina de 8 em 8 horas.

Abstract In areas that are not commonly affected by compartment syndrome because they have a good content/container ratio, diagnosis of the condition can be a challenge, since surgeons will find it difficult to make a diagnosis on the basis of an isolated sign or symptom. As a result, the correct treatment can very often be delayed, causing harm to the patient. In this case, the patient was a 29-year-old woman who was seen for a painful left hand secondary to a large burn injury to the area anterior of the anatomical snuffbox. She had already undergone surgery in her home town 30 days previously, with debridement of skin and subcutaneous tissue, but the pain had not improved. She was on antibiotic therapy (ceftriaxone, 1g every 12 hours) and analgesia, with therapeutic morphine doses every 8 hours.

The Role of Magnetic Resonance in the Diagnosis of Chronic Exertional Compartment Syndrome / O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício

Abstract Chronic compartment syndrome is a common and often underdiagnosed exercise-induced condition, accounting on average for a quarter of cases of chronic exertional pain in the leg, second only to the fracture/tibial stress syndrome spectrum. It traditionally occurs in young runner athletes, although more recent studies have demonstrated a considerable prevalence in low-performance practitioners of physical activity, even in middle-aged or elderly patients. The list of differential diagnoses is extensive, and sometimes it is difficult to distinguish them only by the clinical data, and subsidiary examinations are required. The diagnosis is classically made by the clinical picture, by exclusion of the differential diagnoses, and through the measurement of the intracompartmental pressure. Although needle manometry is considered the gold standard in the diagnosis, its use is not universally accepted, since there are some important limitations, apart from the restricted availability of the needle equipment in Brazil. New protocols of manometry have recently been proposed to overcome the deficiency of the traditional ones, and some of them recommend the systematic use of magnetic resonance imaging (MRI) in the exclusion of differential diagnoses. The use of post-effort liquid-sensitive MRI sequences is a good noninvasive option instead of needle manometry in the diagnosis of chronic compartment syndrome, since the increase in post-exercise signal intensity is statistically significant when compared with manometry pressure values in asymptomatic patients and in those with the syndrome; hence, the test can be used in the diagnostic criteria. The definitive treatment is fasciotomy, although there are less effective alternatives.

Resumo A síndrome compartimental crônica é uma condição comum e frequentemente subdiagnosticada, induzida pelo exercício, que corresponde em média a um quarto dos casos de dor crônica na perna relacionada ao exercício, e que perde em frequência apenas para o espectro fratura/reação ao estresse tibial. Tradicionalmente ocorre em jovens atletas corredores, embora estudos mais recentes tenham demonstrado uma prevalência considerável em praticantes de atividade física de baixo rendimento, mesmo em pacientes de meia-idade ou idosos. A lista de diagnósticos diferenciais é extensa, e por vezes é difícil fazer a distinção apenas pelos dados clínicos, sendo necessários exames subsidiários. Classicamente, o diagnóstico é feito pelo quadro clínico, pela exclusão dos diferenciais, e pela medida pressórica intracompartimental. Embora a manometria por agulha seja considerada o padrão-ouro no diagnóstico, seu uso não é universalmente aceito, visto que existem algumas limitações importantes, além da disponibilidade restrita do equipamento com agulha no Brasil. Recentemente, novos protocolos de manometria têm sido propostos a fim suplantar a deficiência dos tradicionais, com algum deles inclusive recomendando o uso sistemático da ressonância magnética (RM) na exclusão dos diagnósticos diferenciais. O uso de sequências de RM sensíveis a líquido pós-esforço é uma ótima opção não invasiva à manometria por agulha no diagnóstico da síndrome compartimental crônica, uma vez que o aumento da intensidade de sinal pós-exercício é estatisticamente relevante quando comparados os valores pressóricos de manometria em pacientes com a síndrome e assintomáticos; portanto, o exame pode ser usado no critério diagnóstico. O tratamento definitivo é a fasciotomia, embora existam alternativas menos eficazes.

Thoracoabdominal compartment syndrome complicating right-sided diaphragmatic eventration with co-existent unilateral renal agenesis

Diaphragmatic eventration (DE) associated with intestinal malrotation and renal agenesis is a rare entity. The authors report a case of a 69-year-old man who had symptoms of heart failure. He had a previous imaging diagnosis of right diaphragmatic eventration and dilated cardiomyopathy. He died on the second day after the hospital admission and had a post mortem examination that confirmed complete right diaphragmatic eventration, intestinal malrotation, left renal agenesis, dilated cardiomyopathy, and anteriorly rotated right kidney and had findings suggestive of a thoracoabdominal compartment syndrome. Thoracoabdominal compartment syndrome is described as transmission of abdominal pressure through a defective diaphragm causing compression of the hemithorax viscera and mediastinal shift with a hemodynamic alteration. The association of these anomalies is rare, and the possibility of this finding in a patient with eventration should always be considered.

Síndrome compartimental agudo como complicación de un loxoscelismo cutáneo edematoso / Acute compartment syndrome as a complication of cutaneous loxoscelism mainly edematous

Resumen El síndrome compartimental agudo (SCA) es el aumento de la presión en un espacio osteofascial cerrado. Esto reduce la presión capilar bajo el nivel necesario para la viabilidad de los tejidos del compartimento. El SCA de mano como complicación de un loxoscelismo cutáneo (LC) de predominio edematoso es muy poco frecuente. Presentamos el caso de una mujer de 22 años que presentó un SCA de la mano secundario a un LC y que requirió tratamiento quirúrgico de urgencia mediante una fasciotomía dorsal y palmar.

Abstract Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not performed. Hand ACS secondary to cutaneous loxoscelism with edematous predominance is extremely infrequent. We present a clinical case of a 22-year-old patient who started a hand compartment syndrome secondary to cutaneous loxoscelism (CL), requiring emergency surgical treatment with dorsal and palmar fasciotomy.

Hipertensión intraabdominal y síndrome compartimental abdominal en el paciente grave / Intra-abdominal hypertension and abdominal compartment syndrome in the severe patient / Hipertensão intra-abdominal e síndrome do compartimento abdominal no paciente grave

RESUMEN Introducción: La hipertensión intraabdominal y el síndrome compartimental abdominal implican un grave pronóstico. Objetivo: Sistematizar contenidos esenciales relacionados con el diagnóstico y el tratamiento de estas emergencias médicas. Método: En la Facultad de Ciencias Médicas Guantánamo, entre enero y julio de 2019 se hizo una revisión narrativa sobre el tema a través de una búsqueda en bases de datos electrónicas (Biblioteca Virtual en Salud): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Resultados: Se localizaron 125 documentos, y se eligieron 25 relevantes para el objetivo de la revisión. La información se estructuró en los siguientes aspectos: definición, fisiopatología, etiología, diagnóstico y tratamiento. Conclusiones: Se elaboró un referente teórico útil a estudiantes y médicos generales para prepararse sobre el tema. Se identificaron controversias sobre la efectividad del uso de fármacos sedantes, analgésicos, procinéticos, albúmina y diuréticos, la terapia de reemplazo renal y la descompresión gástrica y colónica para el tratamiento médico, el impacto de los tratamientos quirúrgicos en la supervivencia de pacientes y el efecto de la comorbilidad del paciente, la enfermedad causal, la ventana temporal diagnóstico-tratamiento en los resultados terapéuticos de estas emergencias médicas.

ABSTRACT Introduction: Intra-abdominal hypertension and abdominal compartment syndrome imply a serious prognosis. Objective: Systematize essential contents related to the diagnosis and treatment of these medical emergencies. Method: In the Faculty of Medical Sciences Guantanamo, between January and July 2019, a narrative review on the subject was made through a search in electronic databases (Virtual Health Library): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Results: 125 documents were located, and 25 relevant for the purpose of the review were chosen. The information was structured in the following aspects: definition, pathophysiology, etiology, diagnosis and treatment. Conclusions: A useful theoretical reference to students and general practitioners was prepared to prepare on the subject. Controversies were identified about the effectiveness of the use of sedative, analgesic, prokinetic, albumin and diuretic drugs, renal replacement therapy and gastric and colonic decompression for medical treatment, the impact of surgical treatments on patient survival and the effect of the patient's comorbidity, the causative disease, the diagnostic-treatment time window in the therapeutic results of these medical emergencies.

RESUMO Introdução: Hipertensão intra-abdominal e síndrome do compartimento abdominal implicam um prognóstico sério. Objetivo: Sistematizar conteúdos essenciais relacionados ao diagnóstico e tratamento dessas emergências médicas. Método: Na Faculdade de Ciências Médicas de Guantánamo, entre janeiro e julho de 2019, foi realizada uma revisão narrativa sobre o assunto, através de uma busca em bases de dados eletrônicas (Biblioteca Virtual em Saúde): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Resultados: Foram localizados 125 documentos e escolhidos 25 relevantes para a finalidade da revisão. As informações foram estruturadas nos seguintes aspectos: definição, fisiopatologia, etiologia, diagnóstico e tratamento. Conclusões: Foi preparado um referencial teórico útil para estudantes e médicos de clínica geral para se preparar sobre o assunto. Foram identificadas controvérsias sobre a eficácia do uso de medicamentos sedativos, analgésicos, procinéticos, albumina e diuréticos, terapia de reposição renal e descompressão gástrica e colônica para tratamento médico, o impacto dos tratamentos cirúrgicos na sobrevida dos pacientes e o efeito da comorbidade do paciente, da doença causadora, da janela do tempo de diagnóstico e tratamento nos resultados terapêuticos dessas emergências médicas.

Actualización en fracturas supracondíleas del codo en la infancia / Update in suprancondylar elbow fractures in children / Atualização em fraturas supracondilares do cotovelo na infância

Las supracondíleas son el tipo más común de fracturas en la articulación del codo durante la infancia, con un pico de presentación entre los cinco y siete años. Además constituyen el segundo tipo de fracturas más frecuente en la población pediátrica en general. El mecanismo típico de la lesión es una caída desde la altura del paciente sobre la palma de la mano con el codo en hiperextensión. El diagnóstico se basa en la sospecha clínica, según el mecanismo de la lesión y la edad del paciente, además de la radiografía simple del codo en dos proyecciones. La clasificación de Gartland es la más usada para establecer la gravedad de la fractura y guiar el tratamiento, que puede ser ortopédico en fracturas no desplazadas. El método de elección para corrección de las desplazadas es la reducción cerrada y fijación con pines percutáneos. La complicación más común es la neuropraxia del nervio mediano. Otras complicaciones son la lesión de la arteria braquial, el síndrome compartimental, la isquemia de Volkmann, el deslizamiento de los pines y el cúbito varo.

Supracondylar are the most common fractures in the elbow joint during childhood with a peak between the ages five to seven. Besides, they are the second most common type of fracture in the pediatric population in general. The typical cause of the injury is the patient falling from their own height on the palm of the hand with the elbow in hyperextension. The diagnosis is based on the clinical suspicion according to the injury mechanism and the age of the patient, in addition to a standard elbow X-ray from two views. The Gartland classification is the most used instrument to establish the severity of the fracture and to guide the treatment, which can be orthopedic in non-displaced fracture, whereas the method of choice for correction of displaced fractures is closed reduction and percutaneous fixation. The most common complication is the neuropraxia of the median nerve. Others are the brachial artery injury, compartment syndrome, Volkamm ischemic contracture, sliding of the pins and ulna varus.

As supracondilares são o tipo mais comum de fraturas na articulação do cotovelo durante a infância, com um pico de apresentação entre os cinco e sete anos. Ademais constituem o segundo tipo de fraturas mais frequente na população pediátrica em geral. O mecanismo típico da lesão é uma queda desde a altura do paciente sobre a palma da mão com o cotovelo em hiperextensão. O diagnóstico se baseia na suspeita clínica, segundo o mecanismo da lesão e a idade do paciente, ademais da radiografia simples do cotovelo em duas projeções. A classificação de Gartland é a mais usada para estabelecer a gravidade da fratura e guiar o tratamento, que pode ser ortopédico em fraturas não deslocadas. O método de eleição para correção das deslocadas é a redução fechada e fixação com pinos percutâneos. A complicação mais comum é a neuropraxia do nervo mediano. Outras complicações são a lesão da artéria braquial, a síndrome compartimental, a isquemia de Volkmann, o deslizamento dos pinos e o cúbito varo.

Does a staged treatment of high energy tibial plateau fractures affect functional results and bony union? A case series / 中华创伤杂志(英文版)

PURPOSE@#Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.@*METHODS@#Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.@*RESULTS@#Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554).@*CONCLUSION@#A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.

An atypical presentation of leiomyosarcoma causing extremity compartment syndrome of the crural region in a Dutch Warmblood mare: a case report

Compartment syndrome after distal biceps brachii tendon rupture in an athlete / Síndrome compartimental em paciente atleta após ruptura do tendão distal do músculo bíceps do braço

ABSTRACT This is a case report of a previously healthy athlete who did not use oral anticoagulant, suffered a rupture of the distal biceps brachii tendon, and evolved with arm compartment syndrome. An emergency fasciotomy and the repair of the tendon were performed. After surgery the patient had a good recovery of the paresthesia and sensibility. This complication is rare and, when reported, is usually associated with patients who use anticoagulant therapy. Due to growth of rupture of distal biceps tendon cases, physicians should be aware that this complication must be treated as an emergency.

RESUMO Relato de caso de paciente atleta, previamente hígido e que não utilizava anticoagulantes orais, com lesão do tendão distal do músculo bíceps braquial, que evoluiu com síndrome compartimental do braço. Realizaram-se fasciotomia de emergência e reparo cirúrgico do tendão, apresentando bom seguimento com recuperação da parestesia e sensibilidade. Essa complicação é bastante rara e, quando relatada, geralmente é associada a pacientes em uso de medicamentos anticoagulantes orais. Contudo, com o aumento da incidência de rupturas do tendão do músculo bíceps braquial, é preciso estar atento à tal complicação que deve ser conduzida como emergência.

Sundown syndrome in patients with Alzheimer's disease dementia / Síndrome do entardecer em pacientes portadores de demência da doença de alzheimer

ABSTRACT The sundown syndrome is a complex neurobehavioral disorder in patients with dementia associated with high financial cost and significant caregiver burden. It is a multifactorial phenomenon with unclear pathophysiology, characterized by the presence of neuropsychiatric symptoms in the evening period. Objective: To analyze the main neuropsychiatric symptoms, their correlation with one another, with comorbidities, and with time of day of greatest symptom intensity in patients with Alzheimer's disease dementia. Methods: This is a cross-sectional, observational and explanatory study in which caregivers/relatives of elderly patients with dementia were interviewed using a structured tool called the Neuropsychiatric Inventory (NPI). Results: The sample studied was composed of 38 patients, 60.5% female and 39.5% male, with mean age of 81±6 (67-94) years. A high frequency of neuropsychiatric symptoms in the evening period was observed, predominantly irritability (55.3%), nocturnal behavior (47.4%), and aggressiveness (42.1%). Only 36.8% of the family caregivers used non-pharmacological strategies. Conclusion: The frequency of neuropsychiatric symptoms was exacerbated in the evening among patients with Alzheimer's disease, especially for those behavioral symptoms that had a positive correlation with one another.

RESUMO A síndrome do entardecer ou "pôr do sol" - "sundown syndrome" - é uma alteração neurocomportamental complexa em pacientes portadores de demência que geram custos financeiros excessivos e desgaste importante a seus cuidadores. Trata-se de um fenômeno multifatorial com fisiopatologia incerta, que caracteriza-se pela presença de sintomas neuropsiquiátricos no período vespertino. Objetivo: Analisar os principais sintomas neuropsiquiátricos, sua correlação entre si, com comorbidades e o horário do dia de maior intensidade destes em pacientes portadores de demência da doença de Alzheimer. Métodos: Trata-se de um estudo analítico transversal, observacional e explanatório no qual foram entrevistados cuidadores/familiares de pacientes idosos portadores de demência utilizando uma ferramenta estruturada denominada Neuropsychiatric Inventory (NPI). Resultados: A amostra estudada foi de 38 pacientes, 60,5% feminino e 39,5% masculino, com 81±6 (67-94) anos de idade. Foi observada uma alta frequência de sintomas neuropsiquiátricos no período vespertino, principalmente irritabilidade (55,3%), comportamento noturno (47,4%), agressividade (42,1%). Apenas 36,8% dos cuidadores familiares empregavam estratégias não farmacológicas. Conclusão: A frequência dos sintomas neuropsiquiátricos são exacerbados ao entardecer em pacientes com doença de Alzheimer; principalmente os sintomas comportamentais com correlação positiva entre si.