RESUMEN
Rhabdomyolysis is an uncommon event in bariatric surgery. It can be caused by ischemia, crush injury, alcohol ingestion and drug intake, and as a consequence renal failure can develop. A few reports indicate that patients undergoing bariatric surgical intervention are at risk for rhabdomyolysis. A super-obese male (BMI 52 kg/m2) is reported, who underwent laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS). Operative time was 265 minutes, and the BPD/DS operation was uneventful. Post-operatively, the patient complained of pain in both hips and the left shoulder, and suffered oliguria. He was treated with fluids (isotonic saline), bicarbonate, and mannitol. Despite this, he developed renal failure, which subsequently required hemodialysis. The patient died from arrhythmia and cardiac arrest on the 8th postoperative day. Obese patients undergoing bariatric surgery are at risk of rhabdomyolysis. Prolonged compression of the muscles during the surgical intervention, in long laparoscopic procedures, predisposes to this complication.
Asunto(s)
Desviación Biliopancreática/efectos adversos , Duodeno/cirugía , Laparoscopía , Obesidad Mórbida/cirugía , Rabdomiólisis/etiología , Adulto , Resultado Fatal , Humanos , Masculino , Rabdomiólisis/prevención & control , Factores de RiesgoRESUMEN
A 35-years old gravida IV and para II underwent caesarean section because of fetal distress following induction of labour. During operation the patient developed disseminated intravascular coagulation (DIC), severe haemorrhage and shock necessitating massive blood transfusion,hysterectomy with pelvic packing, and high-dose catecholamines. Ultimately, recombinant factor VIIa was given to control bleeding. During the first 24 hours after operation, both clinical and laboratory findings showed that the severe DIC was on the course to recovery.However, the patient subsequently developed multiple organ dysfunction syndrome with respiratory and renal failure requiring mechanical ventilation and haemodialysis.All therapeutical efforts could not help that the patient passed away due to an inevitable multiple organ failure on the 12th day after the operation. Given the constellation of diagnostic and clinical findings, the most likely diagnosis was amniotic fluid embolism (AFE), a rare complication of pregnancy. The following differential diagnoses were less likely or excluded in this reported patient: pre-eclampsia/pregnancy-induced hypertension,HELLP syndrome,anaphylaxis,uterine rupture, transfusion reactions,pulmonary embolism. AFE occurs rarely, and because studies in animal models cannot reproduce accurately the pathophysiological and clinical alterations seen in humans, its pathogenesis remains unclear. It has been proposed that the clinical syndrome of AFE occurs when fetal antigens pass the maternal immunological barrier in susceptible mothers. The recognition of fetal antigens by maternal immune system subsequently triggers the release of endogenous mediators that are responsible for dramatic pathophysiological disturbances.Furthermore, the components of amniotic fluid initiate the DIC. These events are more consistent with septic shock and anaphylactic shock than with an embolic process and it was proposed that the term "amniotic fluid embolism" be changed to "anaphylactoid syndrome of pregnancy". At present, no therapy has been found to consistently improve outcomes in women with AFE.Patients who survive the initial insult are at high risk for multiple organ failure. The mortality of AFE remains high.
Asunto(s)
Anafilaxia/fisiopatología , Embolia de Líquido Amniótico/fisiopatología , Complicaciones del Embarazo/fisiopatología , Adulto , Anafilaxia/tratamiento farmacológico , Anafilaxia/terapia , Transfusión Sanguínea , Catecolaminas/uso terapéutico , Cesárea , Coagulación Intravascular Diseminada/fisiopatología , Embolia de Líquido Amniótico/tratamiento farmacológico , Embolia de Líquido Amniótico/terapia , Resultado Fatal , Femenino , Humanos , Insuficiencia Multiorgánica/complicaciones , Insuficiencia Multiorgánica/fisiopatología , Hemorragia Posparto , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/terapiaAsunto(s)
Linfoma Cutáneo de Células T/patología , Neoplasias del Pene/patología , Neoplasias Cutáneas/patología , Biomarcadores de Tumor/metabolismo , División Celular , Circuncisión Masculina , Histocitoquímica , Humanos , Linfoma Cutáneo de Células T/metabolismo , Linfoma Cutáneo de Células T/cirugía , Masculino , Persona de Mediana Edad , Neoplasias del Pene/metabolismo , Neoplasias del Pene/cirugía , Neoplasias Cutáneas/metabolismo , Neoplasias Cutáneas/cirugía , Resultado del TratamientoRESUMEN
A series of six cases of chondroid lipoma is reported in this paper. The age of the patients, four women and two men, ranged from 34 to 75 years. Four tumours arose in the lower and two in the upper extremities between 4.5 and 8 cm in size. Whereas two neoplasms were located in the subcutis, four lesions were seen in perifascial or intramuscular tissues. Histologically, all neoplasms were encapsulated and characterized by a somewhat lobular growth pattern. The neoplasms were composed of mature adipocytes, uni - and multivacuolated lipoblasts, and nests and strands of cells reminiscent to hibernoma cells or chondrocytes. Immunohistochemically and ultrastructurally the lipogenic nature of the latter type of cells was confirmed. Interestingly, focal immunopositivity of tumour cells for cytokeratin was found in two cases. Tumour cells were set in a myxohyaline matrix showing different degrees of degeneration. Chondroid lipoma represents a distinct entity in the spectrum of lipomatous lesions and has to be distinguished from benign and malignant neoplasms (extraskeletal chondroma, hibernoma, lipoblastoma, chondrolipoangioma, myoepithelioma, myxoid/round cell liposarcoma, and extraskeletal myxoid chondrosarcoma). Because they are easily misdiagnosed as malignant tumours, familiarity with the features of chondroid lipoma is of practical importance to avoid an overtreatment.