ABSTRACT
Interactions among human beings are very complex. Using only an ethical code as reference to deal with moral conflicts is hardly ever enough. Responsibility ethics demand such a profound reflection as well as a discussion about human essence and its role in society. The responsibility of a surgeon is inherent in a profession based since its origin, not only on altruism and humanity, but also on compassion, courage and tolerance. The studies and the comprehension of these qualities as well as the transmission of these values to the students and to the surgery residents are essential for human education of these individuals. This essay offers to show that these essential virtues are strongly connected to the work the surgeon develops whereas his/her responsibility starts before the surgery - when one intends to act.
Subject(s)
Empathy , General Surgery , Physician-Patient Relations , Virtues , Education, Medical , General Surgery/education , HumansABSTRACT
As interações entre os seres humanos são muito complexas. A abordagem de um conflito moral utilizando apenas como referencial um código de ética é quase sempre insuficiente. A ética da responsabilidade demanda uma reflexão muito mais profunda, uma discussão sobre a essência do homem e seu papel na sociedade. A responsabilidade do cirurgião é inerente a uma profissão construída desde sua origem não somente sobre o altruísmo e a humanidade, mas também compaixão, coragem e tolerância. O estudo e a compreensão destas qualidades, assim como a transmissão destes valores aos alunos e residentes de cirurgia são fundamentais para formação humana destes indivíduos. Este ensaio se propõe a mostrar que estas virtudes essenciais estão indissoluvelmente ligadas ao trabalho que o cirurgião faz, conquanto sua responsabilidade se inicia antes do ato operatório, já na intenção de agir.
Interactions among human beings are very complex. Using only an ethical code as reference to deal with moral conflicts is hardly ever enough. Responsibility ethics demand such a profound reflection as well as a discussion about human essence and its role in society. The responsibility of a surgeon is inherent in a profession based since its origin, not only on altruism and humanity, but also on compassion, courage and tolerance. The studies and the comprehension of these qualities as well as the transmission of these values to the students and to the surgery residents are essential for human education of these individuals. This essay offers to show that these essential virtues are strongly connected to the work the surgeon develops whereas his/her responsibility starts before the surgery - when one intends to act.
Subject(s)
Humans , Empathy , General Surgery , Physician-Patient Relations , Virtues , Education, Medical , General Surgery/educationABSTRACT
The Merkel cell carcinoma is a rare, serious, neuroendocrine, malignant skin cancer with lymph node involvement in half of patients and disseminated metastases in 20% of cases at the time of pathological diagnosis. Its treatment is not fully established, though the sentinel lymph node has been considered essential and may bring benefits to the therapeutic armamentarium of patients.
Subject(s)
Carcinoma, Merkel Cell/diagnostic imaging , Lymphoscintigraphy , Skin Neoplasms/diagnostic imaging , Algorithms , Carcinoma, Merkel Cell/therapy , Female , Humans , Middle Aged , Skin Neoplasms/therapyABSTRACT
O carcinoma de Células de Merkel constitui neoplasia cutânea maligna, rara e grave, de origem neuroendócrina, com comprometimento linfonodal em metade dos pacientes e metástases disseminadas em 20 por cento quando do diagnóstico anatomopatológico. Seu tratamento não está completamente estabelecido, entretanto a pesquisa do linfonodo sentinela vem sendo considerada indispensável e pode trazer benefícios na condução terapêutica dos pacientes.
The Merkel cell carcinoma is a rare, serious, neuroendocrine, malignant skin cancer with lymph node involvement in half of patients and disseminated metastases in 20 percent of cases at the time of pathological diagnosis. Its treatment is not fully established, though the sentinel lymph node has been considered essential and may bring benefits to the therapeutic armamentarium of patients.
Subject(s)
Female , Humans , Middle Aged , Carcinoma, Merkel Cell , Lymphoscintigraphy , Skin Neoplasms , Algorithms , Carcinoma, Merkel Cell/therapy , Skin Neoplasms/therapySubject(s)
Humans , Female , Aged , Foreign Bodies , Intestinal Perforation , Intestinal Perforation/surgery , IntestinesABSTRACT
INTRODUÇÃO: Apesar dos refinamentos em cirurgia gastrointestinal, vazamentos anastomóticos persistem como grave problema, associados à morbidade e mortalidade elevadas e constituem a complicação mais temida. Na tentativa de prevenir e reduzir estas complicações, diversidade de técnicas de reforço anastomótico tem sido investigada e diversas medidas auxiliares têm sido desenvolvidas. OBJETIVO: Revisar os dados associados a aplicação de adesivos em cirurgia digestiva. MÉTODO: Revisão bibliográfica de artigos disponíveis no Medline/Pubmed utilizando-se os descritores: adesivo, trato gastrointestinal, anastomose cirúrgica e fístula. Foram selecionados os artigos mais atualizados sobre o assunto os quais utilizaram adesivos como estratégia para reduzir a morbidade e mortalidade relacionada à cirurgia digestiva. CONCLUSÃO: Adesivos teciduais parecem seguros na prática clínica e têm sido utilizados com crescente frequência em várias especialidades cirúrgicas em decorrência de suas propriedades hemostáticas e selante, ganhando cada vez maior aceitação por parte dos cirurgiões. Estudos sugerem que adesivos cirúrgicos podem reforçar e melhorar a cicatrização de anastomoses intestinais, elevando a pressão de ruptura e aumentando a força tênsil. Os potenciais efeitos deletérios teciduais destas substâncias podem limitar sua utilização. Em decorrência da heterogeneidade dos estudos e falta de evidência forte, novas pesquisas deverão ser desenvolvidas.
BACKGROUND: Despite refinements in the field of gastrointestinal surgery, anastomotic leakage still remains a serious problem associated with substantial morbidity and mortality and is the fearest life threatening complication in digestive surgery. To prevent or reduce these complications, a diversity of line reinforcement techniques have been investigated and several adjunctive measures have been developed. AIM: To review the data associated with the application of adhesives in digestive surgery procedures. METHOD: Review of papers available at Medline/Pubmed database using the follow headings: adhesive, gastrointestinal tract, surgical anastomosis, fistula. It was chosen recent articles on the subject which showed adhesives as strategy to reduce morbidity and mortality related to digestive surgery. CONCLUSION: Tissue adhesives appears to be safe in the clinical setting and are been used with increasing frequency in a variety of surgical field for its unique hemostatic and adhesive abilities, gaining increasing acceptance among surgeons. Studies suggest that surgical adhesive can be useful to reinforce and improve intestinal anastomotic healing, increase anastomotic bursting pressures and tensile strength. The potentially harmful tissue effects of the preparations might compromise the use of these substances. Because of the heterogeneity and lack of high level evidence, new studies have to be performed.
Subject(s)
Tissue Adhesives , Anastomosis, Surgical , FistulaABSTRACT
BACKGROUND: Solid papillary-cystic pancreatic tumors have been recognized as a distinct neoplastic disease, whose incidence has increased in recent years with advancements in imaging technology. CASE REPORT: Woman 17-year-old consulted with a symptomatic giant homogeneous solid-cystic mass in the pancreatic tail, undergone a spleen preserving distal pancreatectomy, with excision of the splenic vessels. Histopathology revealed epithelium-lined pseudopapillary protrusions, without malignant change. The patient's postoperative course was uneventful. CONCLUSION: Solid papillary-cystic pancreatic tumor has uncommon incidence and silent presentation, a high degree of suspicion on the part of the surgeon is warranted. In early diagnosis, complete resection is curative. The spleen should be preserved, if feasible.
INTRODUÇÃO: Tumores sólido-cístico papilares têm sido reconhecidos como uma doença neoplásica distinta, cuja incidência tem aumentado atualmente em decorrências dos avanços em imaginologia. RELATO DO CASO: Mulher de 17 anos, procurou atendimento médico em virtude de uma massa homogênea sólido-cística em cauda pancreática, e foi submetida a pancreatectomia distal com preservação do baço, apesar da excisão dos vasos esplênicos. Avaliação histológica revelou protrusões pseudopapilares revestidas de epitélio, sem degeneração maligna. A evolução clínica pós-operatória ocorreu sem complicações. CONCLUSÃO: Estes tumores têm que ser reconhecidos pelos clínicos, patologistas e radiologistas, e cirurgicamente ressecados com preservação do baço, conquanto apresentam prognóstico favorável.
Subject(s)
Female , Adolescent , Cysts/surgery , Pancreatic Neoplasms/surgery , Pancreatectomy , Tomography, X-Ray ComputedABSTRACT
A busca pela anastomose impermeável é preocupação constante nas cirurgias abdominais. A deiscência anastomótica representa a complicação mais temida a que está sujeito o paciente submetido a esse tipo de operação. O processo de cicatrização do aparelho digestivo é similar àquele que ocorre em outros tecidos, apresentando os mesmo princípios básicos no que concerne às alterações celulares e bioquímicas, sendo o colágeno o principal fator determinante no processo cicatricial. Existem, entretanto, nuanças fisiológicas que diferenciam os tecidos gastrointestinais dos demais e diversos fatores estão implicados nesse processo. As técnicas e materiais empregados nas suturas, assim como as particularidades de cada órgão, interferem na cicatrização. Diversos parâmetros podem ser utilizados para analisar as anastomoses, seja clínica ou experimentalmente. Entre estes se destacam os clínicos, histopatológicos, mecânicos, bioquímicos e microbiológicos. Este artigo contém revisão sobre o processo cicatricial, com ênfase no trato digestivo. São apresentadas alterações citocínicas, assim como as mudanças do colágeno durante a evolução da ferida operatória. O conhecimento e o entendimento dos métodos de avaliação das anastomoses são fundamentais para a formação médica, notadamente para o cirurgião.
The search for impermeable anastomosis is a constant concern in abdominal surgery. Anastomotic dehiscence is the most feared complication to which the patient undergoing this type of operation is subjected. The healing of the digestive system is similar to that occurring in other tissues, presenting the same basic principles with respect to the cellular and biochemical alterations, the collagen being the main determining factor in the healing process. However, there are physiological nuances that make the gastrointestinal tissue different from the others and several factors are implied in this process. The techniques and materials used in the sutures, as well as each organ particularities interfere in the healing. Different parameters can be used to analyze the anastomoses, either clinically or experimentally. Among these we highlight the clinical, histopathological, mechanical, biochemical and microbiological tests. This article contains reviews on the healing process, with emphasis on the digestive tract. Cytokine changes are presented, as well as changes of collagen during the development of the surgical wound. The knowledge and understanding of anastomosis evaluation methods are crucial for medical training, especially for surgeons.
Subject(s)
Humans , Anastomosis, Surgical , Gastrointestinal Tract/surgery , Wound Healing , Collagen/therapeutic useABSTRACT
OBJECTIVE: To compare the effect of 2-octyl cyanoacrylate tissue adhesive with polypropylene suture on the healing of colonic anastomosis in Wistar rats. METHODS: Thirty two animals, divided in four groups of eight, were established concerning suture with Polypropylene or Cyanoacrylate application, and the day chose for euthanasia: third or seventh day following operation. In the control group, the anastomosis was done in a single layer with 5.0 polypropylene suture. In the adhesive group, the anastomosis was performed by using 2-octyl cyanoacrylate. Operative time, integrity and gross anastomotic healing, bursting pressure, intestinal obstruction, adhesions formation, histological healing and inflammatory process were recorded. RESULTS: Adhesion formation was more extensive in the cyanoacrylate group on the seventh postoperative day comparing with suture group (p=0.007). Mechanical strength of the anastomosis assessed on the seventh postoperative day was lower in 2-octyl cyanoacrylate group (p=0.002). Partial intestinal obstruction rate were more frequent in anastomosis using 2-octyl cyanoacrylate compared to those with polypropylene suture on the seventh postoperative day (p=0.029). Operative time were longer in groups with adhesive (p=0.004). The wound healing process, and inflammatory process did not differ statistically between groups (p>0.05). CONCLUSION: The application of 2-octyl cyanoacrylate, under experimental conditions seems to be detrimental at the seventh day of the healing, causing intense adhesion formation, colonic obstruction; and impairment healing with less mechanical strength resistance.
Subject(s)
Colon/surgery , Cyanoacrylates , Polypropylenes , Sutures , Tissue Adhesives , Anastomosis, Surgical , Animals , Cyanoacrylates/adverse effects , Male , Materials Testing , Polypropylenes/adverse effects , Rats , Rats, Wistar , Sutures/adverse effects , Tissue Adhesives/adverse effectsABSTRACT
A obesidade, considerada um dos grandes problemas de saúde pública, é uma doença crônica, caracterizada pelo acúmulo excessivo de gordura corporal. O seu tratamento envolve uma abordagem multifatorial, tornando-se necessária,em determinados casos, a cirurgia bariátrica, a qual tem se mostrado uma possibilidade de melhora da qualidade devida. Este estudo objetivou avaliar a qualidade de vida e a satisfação dos pacientes submetidos à cirurgia bariátrica,bem como investigar variáveis como pressão arterial, glicemia e dislipidemia. Este estudo transversal é constituído por uma amostra de 36 pacientes classificados pela OMS como obesos grau II, com morbidades associadas, e como obesos grau III, ambos os grupos submetidos à cirurgia bariátrica pela mesma equipe médica, num hospital privado de Juiz de Fora, no período de agosto de 2001 a agostode 2005. Foi utilizado o questionário sobre qualidade devida WHOQOL - abreviado. As análises estatísticas foram realizadas com o programa SPSS. 11.0., considerando-seum intervalo de confiança de 95% e utilizando-se o testet de Student. Os resultados mostraram que a maioria erado sexo feminino (66,7%), com idade entre 30 e 49 anos(66,6%), branca (83,3%) e com 2º grau completo (44,4%).Quanto aos benefícios, 63,9% apresentaram redução dosníveis pressóricos, 52,8% apresentaram diminuição da glicemia e 63,9% obtiveram redução dos níveis lipidêmicos.Observou-se que os pacientes do sexo masculino apresentaram valores superiores na questão: ?Como você avaliaria sua qualidade de vida??. Já os pacientes do sexo feminino apresentaram valores superiores na questão:?Quão satisfeito(a) você está com sua saúde??, referentes ao questionário WHOQOL. Nos indivíduos estudados, a cirurgia bariátrica mostrou-se eficaz na qualidade de vida,na satisfação dos pacientes, no controle da obesidade ediminuição das comorbidades associadas, proporcionando um melhor controle dos níveis glicêmicos, valor pressóricoe lipidemia.
Obesity, a major health problem, is a chronic disease characterized by the excessive accumulation of body fat.Treatment is multifactorial, but sometimes bariatric surgeryis the only possibility to improve the quality of life. The purpose of this study was to assess the quality of life and satisfactionof patients who underwent bariatric surgery, and investigate variables such as blood pressure, blood glucoseand dyslipidemia. This cross-sectional study has 36 WHOclasses II (with related morbidity) and III obese patients,who had undergone bariatric surgery, performed by thesame surgical team of a private hospital from the city of Juizde Fora, MG, Brazil, in the period August 2001 through August 2005. The abbreviated WHOQOL questionnaire was used. The 11.0 SPSS software was used for statisticalanalysis, with 95% confidence intervals and Student`s t test.The results showed that most subjects (66.7%) were female,aged between 30 and 49 years (66.6%), white (83.3%) andwith complete secondary education (44.4%). As for thebenefits, 63.9% had reductions in their blood pressure,52.8% had reductions in their blood glucose and 63.9% hadreductions in their blood lipids. Males had higher values inthe question: ?How would you rate your quality of life??Females had higher values in the question: ?How satisfiedare you with your health??. Bariatric surgery was effective to improve the quality of life, control obesity and reduce related comorbidities, with better control of blood glucose,lipids and pressure.
Subject(s)
Humans , Male , Female , Bariatric Surgery , Quality of Life , Postoperative Care , ObesityABSTRACT
A fragmentação e "compartimentalização" do conhecimento médico não são as únicas causas das dificuldades encontradas na formação de cirurgiões. O abandono do ensino médico vinculado às ciências humanas (sociais) tem levado a formação de profissionais que entendem as ciências biológicas sem entender as ciências da vida. O afastamento da realidade cotidiana, cultural e individual cria condições para o não entendimento da singularidade e subjetividade de cada ser humano. O cirurgião tem, frequentemente, sido erroneamente descrito como portador de qualidades negativas, mas que na verdade remetem a um caráter mais firme e resoluto. De outra forma não é preciso dom para operar, mas empenho, esforço e determinação. O ensino problematizador possibilita a construção de um conhecimento crítico que leva o indivíduo a intervir na realidade que vivencia, de forma transformadora, objetiva e consciente. Esta construção crítica e humanística do conhecimento só poderá se instituir por intermédio de um ensino contextualizado sociocultural e historicamente, não apenas técnico, biocêntrico e hospitalocêntrico.
The fragments and compartments of medical knowledge are not the only causes of difficulty found to form surgeons. The abandon of medical education associated with human science (social science) has formed professionals that understand biological science but don't understand life science. The distance from individual and cultural everyday reality enables one to not understand uniqueness and differences of each human being. Surgeons frequently have been described as someone endowed with bad qualities which actually just represent a tough and daring aspect. In other words, you don't need to be gifted to operate. All you need is effort, hard work and determination. Education built with problems produces a critical knowledge that makes an individual intervene in reality that physicians lives in a transformer, conscious and objective way. The critical and humanistic construction of knowledge will only be possible if teaching includes historical and socio-cultural characteristics and not only bio-centric and hospital-centric ones.
Subject(s)
General Surgery/education , HumanismABSTRACT
OBJETIVO: Comparar os resultados das anastomoses colônicas realizadas com o adesivo 2-octil cianoacrilato e as feitas com fio de polipropileno 5.0. MÉTODOS: Selecionaram-se 32 ratos Wistar machos distruibuidos em quatro grupos de oito animais tendo em conta o tipo de sutura - polipropileno ou aplicação de cianoacrilato -, e os dias para eutanásia - terceiro ou sétimo do pós-operatório. Nos animais dos grupos controle, as anastomoses foram realizadas em plano único com fio de polipropileno 5.0. Nos dos grupos com adesivo, elas foram executadas com 2-octil cianoacrilato. Avaliaram-se o tempo operatório, a integridade, o aspecto macroscópico das anastomoses, a pressão de ruptura à distensão, obstrução intestinal, formação de aderências e histologicamente o processo cicatricial e inflamatório. RESULTADOS: O tempo operatório foi significativamente maior nos grupos em que se aplicou adesivo tanto no terceiro quanto no sétimo dias (p=0,004). A formação de aderências foi mais extensa no grupo 2-octil cianoacrilato estudado no sétimo dia de pós-operatório em comparação com o grupo polipropileno (p=0,007). Os valores obtidos no estudo tensiométrico da anastomose, no sétimo dia de pós-operatório, mostraram-se menores no grupo 2-octil cianoacrilato (p=0,002). A frequência de obstrução intestinal parcial foi maior no grupo em que se aplicou adesivo quando avaliado no sétimo dia (0,029). O processo cicatricial e inflamatório não diferiu entre os grupos, seja no terceiro ou sétimo dias (p>0,05). CONCLUSÃO: Em condições experimentais, o uso do 2-octil cianoacrilato, avaliado no sétimo dia revelou-se deletério, levando a intensa formação de aderências, obstrução parcial da luz colônica, e menor resistência mecânica da anastomose.
OBJECTIVE: To compare the effect of 2-octyl cyanoacrylate tissue adhesive with polypropylene suture on the healing of colonic anastomosis in Wistar rats. METHODS: Thirty two animals, divided in four groups of eigth, were established concerning suture with Polypropylene or Cyanoacrylate application, and the day chose for euthanasia: third or seventh day following operation. In the control group, the anastomosis was done in a single layer with 5.0 polypropylene suture. In the adhesive group, the anastomosis was performed by using 2-octyl cyanoacrylate. Operative time, integrity and gross anastomotic healing, bursting pressure, intestinal obstruction, adhesions formation, histological healing and inflammatory process were recorded. RESULTS: Adhesion formation was more extensive in the cyanoacrylate group on the seventh postoperative day comparing with suture group (p=0.007). Mechanical strength of the anastomosis assessed on the seventh postoperative day was lower in 2-octyl cyanoacrylate group (p=0.002). Partial intestinal obstruction rate were more frequent in anastomosis using 2-octyl cyanoacrylate compared to those with polypropylene suture on the seventh postoperative day (p=0.029). Operative time were longer in groups with adhesive (p=0.004). The wound healing process, and inflammatory process did not differ statistically between groups (p>0.05). CONCLUSION: The application of 2-octyl cyanoacrylate, under experimental conditions seems to be detrimental at the seventh day of the healing, causing intense adhesion formation, colonic obstruction; and impairment healing with less mechanical strength resistance.
Subject(s)
Animals , Male , Rats , Cyanoacrylates , Colon/surgery , Polypropylenes , Sutures , Tissue Adhesives , Anastomosis, Surgical , Cyanoacrylates/adverse effects , Materials Testing , Polypropylenes/adverse effects , Rats, Wistar , Sutures/adverse effects , Tissue Adhesives/adverse effectsABSTRACT
CONTEXT: Squamous cell carcinoma arising from chronic lymphedema has only been reported in the literature 11 times (12 cases). Some aspects of its pathogenesis remain unclear and, for the first time, attention has been drawn to epidemiological data. CASE REPORT: A 90-year-old white female with chronic unilateral lower-limb lymphedema, secondary to trauma 20 years earlier, presented with a three-month history of a vegetating cutaneous lesion. There had not been any previous local ulceration. The tumor was completely excised and the histopathological analysis showed that it was an infiltrating squamous cell carcinoma. A literature review in the Medline (Medical Literature Analysis and Retrieval System Online) and Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) databases using the MeSH (Medical Subject Heading) terms "Carcinoma, Squamous Cell" AND "Lymphedema" identified 112 references and found 12 similar case reports.
CONTEXTO: O crescimento de carcinoma de células escamosas a partir de linfedema crônico foi relatado apenas 11 vezes na literatura (12 casos). Aspectos sobre sua patogênese ainda não foram completamente elucidados e pela primeira vez chama-se atenção para os dados epidemiológicos. RELATO DE CASO: Paciente do sexo feminino, branca, 90 anos de idade, portadora de linfedema crônico unilateral de membro inferior secundário a trauma sofrido há 20 anos, apresentou história de lesão cutânea vegetante de três meses. Não havia relato de lesão local prévia. O tumor foi completamente excisado e sua análise histopatológica mostrou tratar-se de carcinoma escamocelular infiltrante. Uma revisão da literatura nos bancos de dados Medline (Medical Literature Analysis and Retrieval System Online) e Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), utilizando-se dos termos MeSH (Medical Subject Heading) "Carcinoma, Squamous Cell" AND "Lymphedema", identificou 112 citações e encontrou relatos de 12 casos semelhantes.
Subject(s)
Aged, 80 and over , Female , Humans , Carcinoma, Squamous Cell/etiology , Lymphedema/complications , Skin Neoplasms/etiology , Carcinoma, Squamous Cell/surgery , Chronic Disease , Leg , Skin Neoplasms/surgeryABSTRACT
A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.
Subject(s)
Aged , Female , Humans , Abdomen, Acute/diagnosis , Urinary Bladder Diseases/diagnosis , Diagnosis, Differential , Fatal Outcome , Rupture, SpontaneousABSTRACT
Pâncreas heterotópico é uma alteração congênita que consiste na presença de tecido pancreático normal, localizado externamente a este órgão. Aproximadamente 75% de todos os pâncreas heterotópicos estão localizados no estômago, duodeno e jejuno. O diagnóstico diferencial inclui um número variado de tumores gástricos benignos e malignos. Este é um relato de caso de uma mulher de 43 anos com clínica de dor abdominal cujas ecoendoscopia e tomografia computadorizada abdominal sugeriram Tumor Gastrintestinal de Células Estromais (GIST) em parede anterior de antro gástrico. A paciente foi submetida a celiotomia e ressecção em cunha da lesão que se mostrou ser ao exame anátomo-patológico pâncreas heterotópico.
Heterotopic pancreas is a congenital situation that consists of normal pancreatic tissue in an abnormal location. Approximately 75% of all heterotopic pancreatic tissue is located in the stomach, duodenum and jejunum. Differential diagnosis includes a variety of benign and malignant gastric tumors. We report the case of a 43-year-old woman who presented with abdominal pain. Echoendoscopy and computed tomography of the abdomen suggested gastrointestinal stromal tumor (GIST) of the anterior wall of the gastric antrum. The patient underwent celiotomy and wedge resection of the lesion. Histopathology defined heterotopic pancreas.
Subject(s)
Pancreas , Stomach , Pancreas/surgery , Stomach/diagnostic imaging , Stomach NeoplasmsABSTRACT
A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.
Subject(s)
Abdomen, Acute/diagnosis , Urinary Bladder Diseases/diagnosis , Aged , Diagnosis, Differential , Fatal Outcome , Female , Humans , Rupture, SpontaneousABSTRACT
A colite pseudomembranosa é causa de diarréia associada ao uso de antibióticos, sendo provocada por reação inflamatória intestinal às toxinas do Clostridium difficile. Apresenta-se neste relato o caso de um paciente masculino de 76 anos que, após internações recorrentes devido a causas respiratórias, evoluiu com diarréia, febre e dor abdominal, com sinais de irritação peritoneal, simulando de abdômen agudo cirúrgico. A retossigmoidoscopia associada à biópsia foi o método que estabeleceu o diagnóstico de colite pseudomembranosa, possibilitando tratamento clínico bem-sucedido, evitando-se a intervenção cirúrgica.
Subject(s)
Humans , Male , Aged , Abdomen, Acute/surgery , Clostridioides difficile , Enterocolitis, Pseudomembranous/diagnosis , Biopsy , SigmoidoscopyABSTRACT
JUSTIFICATIVA E OBJETIVOS: A embolia pulmonar por líquido amniótico é uma complicação obstétrica rara, freqüentemente fatal, de fisiopatologia ainda não totalmente esclarecida e pouco conhecida pelo intensivista e obstetra. O objetivo deste relato foi enfatizar a necessidade de conhecimento desta entidade clínica e discutir a literatura pertinente de maior relevância. RELATO DO CASO: Paciente com 15 anos, primigesta, 34 semanas de gestação, foi admitida no serviço de emergência para tratamento de início de parto prematuro. Queixava-se de tosse e dispnéia. Ao exame clínico apresentava-se taquipneica (28 irm), ausculta pulmonar normal, sem outras anormalidades. Permaneceu em observação com uso de oxigênio através de máscara facial. Houve agravamento progressivo sendo transferida para a UTI. À admissão na UTI apresentava taquipnéia (28 irm), lúcida, pressão arterial (PA) de 104 x 56 mmHg e pressão arterial média (PAM) de 65 mmHg, SpO2 de 87 por cento com fluxo de oxigênio de 5 L/min. Devido à piora progressiva da mecânica ventilatória foi realizada intubação traqueal e instituída ventilação mecânica com pressão controlada e volume garantido. Radiograma de tórax evidenciou infiltrado pulmonar extenso e bilateral. O painel de coagulação evidenciou importante alargamento do tempo de tromboplastina parcial ativado de 34,7 seg na admissão para 57,4 seg, 10 horas após, com redução progressiva nos dias subsequentes. Foi submetida à cesariana na manhã seguinte. Apresentou importante hipotensão arterial no intra-operatório, apesar de utilização de cristalóides em volume aparentemente adequado, sendo iniciado administração de noradrenalina. Foi extubada no 3º dia, recebendo alta hospitalar 13 dias após a admissão, assintomática. CONCLUSÕES: A embolia por líquido amniótico é uma rara e catastrófica complicação da gestação. A síndrome se caracteriza por um quadro súbito de desconforto ventilatório, hipotensão arterial, sintomatologia neurológica e coagulopatia...
BACKGROUND AND OBJECTIVES: Amniotic fluid embolism is a rare complication of pregnancy whose physiopathology is not completely known and still not frequently remembered by intensive care physicians and obstetricians. The main aim of this case report was to emphasize the need of better knowledge of this disease by physicians. CASE REPORT: A 15 years old, primigravida, 35th week of gestation was admitted in our intensive care unit (ICU) with a sudden respiratory distress. Soon after admission she was intubated and put on mechanical ventilation. After stabilization she was transferred to the operating room and a cesarean section was undertaken. During the operation, instead of fluid reposition with crystalloids in large amounts, her hemodynamic status deteriorated and it was necessary to use vasoactive drugs. After three days on mechanical ventilation she was successfully weaned and discharged from the intensive care unit (ICU) after 6 days. She and her baby were discharged from hospital on13th day of hospitalization. CONCLUSIONS: Amniotic fluid embolism is a rare and catastrophic complication of pregnancy, at least in its classic presentation. It is characterized by acute respiratory distress, hemodynamic compromise and coagulopathy that occur during or within 30 min after labor. Diagnosis is by exclusion of other conditions of pregnancy or diseases that can be aggravated during pregnancy such as eclampsia, sepsis, pos-partum cardiomyopathy, anaphylaxis, pulmonary thromboembolism, transfusion reactions, anesthetic complications and mitral stenosis. There is growing evidence that we have a spectrum of manifestation which can be more common that in the classic ones. The treatment is supportive of vital functions, such as mechanical ventilation, fluid reposition, vasoactive drugs and fresh frozen plasma as necessary. The intensive care physicians and obstetricians should be aware of this disease in order to make early diagnosis and prompt treatment.
Subject(s)
Humans , Female , Pregnancy , Embolism, Amniotic FluidABSTRACT
BACKGROUND AND OBJECTIVES: Amniotic fluid embolism is a rare complication of pregnancy whose physiopathology is not completely known and still not frequently remembered by intensive care physicians and obstetricians. The main aim of this case report was to emphasize the need of better knowledge of this disease by physicians. CASE REPORT: A 15 years old, primigravida, 35th week of gestation was admitted in our intensive care unit (ICU) with a sudden respiratory distress. Soon after admission she was intubated and put on mechanical ventilation. After stabilization she was transferred to the operating room and a cesarean section was undertaken. During the operation, instead of fluid reposition with crystalloids in large amounts, her hemodynamic status deteriorated and it was necessary to use vasoactive drugs. After three days on mechanical ventilation she was successfully weaned and discharged from the intensive care unit (ICU) after 6 days. She and her baby were discharged from hospital on13th day of hospitalization. CONCLUSIONS: Amniotic fluid embolism is a rare and catastrophic complication of pregnancy, at least in its classic presentation. It is characterized by acute respiratory distress, hemodynamic compromise and coagulopathy that occur during or within 30 min after labor. Diagnosis is by exclusion of other conditions of pregnancy or diseases that can be aggravated during pregnancy such as eclampsia, sepsis, pos-partum cardiomyopathy, anaphylaxis, pulmonary thromboembolism, transfusion reactions, anesthetic complications and mitral stenosis. There is growing evidence that we have a spectrum of manifestation which can be more common that in the classic ones. The treatment is supportive of vital functions, such as mechanical ventilation, fluid reposition, vasoactive drugs and fresh frozen plasma as necessary. The intensive care physicians and obstetricians should be aware of this disease in order to make early diagnosis and prompt treatment.