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1.
Radiol Clin North Am ; 58(3): 549-568, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32276703

RESUMEN

End-stage organ failure is commonly treated with transplantation of the respective failing organ. Although outcomes have progressively improved over the decades, early and late complications do occur, and are often diagnosed by imaging. Given the increasing survival rates of transplant patients, the general radiologist may encounter these patients in the outpatient setting. Awareness of the normal radiologic findings after transplantation, and imaging findings of the more common complications, is therefore important. We review and illustrate the imaging assessment of complications from lung, liver, and renal transplantation, highlighting the key similarities and differences between pediatric and adult patients.


Asunto(s)
Diagnóstico por Imagen/métodos , Trasplante de Órganos/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Factores de Riesgo , Tasa de Supervivencia
2.
Radiol Clin North Am ; 58(3): 569-582, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32276704

RESUMEN

Hematopoietic stem cell transplantation is an intravenous transfusion of pluripotent stem cells to repopulate the marrow and restore immunocompetence. However, before transplantation, the patient undergoes a conditioning regimen to eradicate the underlying disease, subsequently resulting in an immunocompromised state. Serious and some life-threatening complications involving any organ can occur. Currently, with advances in hematopoietic stem cell transplantation techniques and posttransplant management, more pediatric patients are now living longer and into their adulthood. The goal of this review article is to discuss the common neurologic, pulmonary, and abdominal complications associated with hematopoietic stem cell transplantation with emphasis on their imaging characteristics.


Asunto(s)
Diagnóstico por Imagen/métodos , Trasplante de Células Madre Hematopoyéticas/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Adulto , Niño , Humanos
3.
Isr Med Assoc J ; 22(4): 241-243, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32286028

RESUMEN

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.


Asunto(s)
Cistoscopía/métodos , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Uretra/diagnóstico por imagen , Estrechez Uretral/diagnóstico , Urografía/métodos , Anciano , Estudios de Cohortes , Cistografía/métodos , Estudios de Seguimiento , Humanos , Israel , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Resección Transuretral de la Próstata/efectos adversos , Resultado del Tratamiento , Estrechez Uretral/etiología , Estrechez Uretral/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/cirugía
4.
Bone Joint J ; 102-B(4): 539-544, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228071

RESUMEN

AIMS: Heterotopic ossification (HO) is a potentially devastating complication of the surgical treatment of a proximal humeral fracture. The literature on the rate and risk factors for the development of HO under these circumstances is lacking. The aim of this study was to determine the incidence and risk factors for the development of HO in these patients. METHODS: A retrospective analysis of 170 patients who underwent operative treatment for a proximal humeral fracture between 2005 and 2016, in a single institution, was undertaken. The mean follow-up was 18.2 months (1.5 to 140). The presence of HO was identified on follow-up radiographs. RESULTS: The incidence of HO was 15% (n = 26). Our multivariate model revealed that male sex (odds ratio (OR) 3.57, 95% confidence interval (CI) 1.30 to 9.80 compared to female) and dislocation as the initial injury (OR 5.01, 95% CI 1.31 to 19.22) were significantly associated with the formation of HO (p < 0.05) while no significant associations were seen for the age of the patient, the characteristics of the injury, or the type of operative treatment. CONCLUSION: This retrospective radiological study is the first to investigate the association between the method of surgical treatment for a proximal humeral fracture and the formation of HO postoperatively. We found that male sex and dislocation as the initial injury were risk factors for HO formation, whereas the method of surgical treatment, the age of the patient, and the pattern of the fracture were not predictive of HO formation. While additional studies are needed, these findings can help to identify those at an increased risk for HO formation under these circumstances. Cite this article: Bone Joint J 2020;102-B(4):539-544.


Asunto(s)
Fijación Interna de Fracturas/efectos adversos , Osificación Heterotópica/etiología , Fracturas del Hombro/cirugía , Anciano , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Radiografía , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
5.
Medicine (Baltimore) ; 99(9): e19328, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118764

RESUMEN

We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean (±SD) age at injury of 12.0 ±â€Š2.2 years. Mean maximum fracture displacements were 6.6 ±â€Š6.5 mm initially, 2.7 ±â€Š2.0 mm postreduction, and 0.4 ±â€Š0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement ≥4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 ±â€Š2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.Level of Evidence: Level IV, case series.


Asunto(s)
Fijación de Fractura/normas , Fracturas de Salter-Harris/terapia , Adolescente , Niño , Femenino , Fijación de Fractura/métodos , Fijación de Fractura/estadística & datos numéricos , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Tibia/anatomía & histología , Tibia/lesiones , Tibia/fisiopatología , Resultado del Tratamiento
6.
J Comput Assist Tomogr ; 44(3): 314-327, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32176159

RESUMEN

Airway complications (ACs) after lung transplant remain a challenge and include bronchial dehiscence, bronchial stenosis, tracheobronchomalacia, infections, and bronchial fistulas. The spectrum of complications may coexist along a continuum and can be classified as early (<1 month after transplant) or late (>1 month), and anastomotic or nonanastomotic. Bronchiolitis obliterans is the most common form of chronic lung allograft rejection. Airway compromise is seen in rare instances of lung torsion, and imaging may provide helpful diagnostic clues. Computed tomography (CT) and bronchoscopy play major roles in the diagnosis and treatment of ACs after lung transplant. Chest CT with advanced postprocessing techniques is a valuable tool in evaluating for airways complications, for initial bronchoscopic treatment planning and subsequent posttreatment assessment. Various bronchoscopic treatment options may be explored to maintain airway patency. The goal of this article is to review imaging findings of ACs after lung transplantation, with emphasis on chest CT and bronchoscopic correlation.


Asunto(s)
Trasplante de Pulmón/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía Torácica , Enfermedades Respiratorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Humanos , Pulmón/diagnóstico por imagen , Dehiscencia de la Herida Operatoria/diagnóstico por imagen
7.
World Neurosurg ; 136: e690-e694, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32006735

RESUMEN

OBJECTIVE: The risk for developing posttraumatic hydrocephalus (PTH) is higher when patients undergo decompressive craniectomy as part of their treatment. The purpose of this study is to determine the prevalence of PTH after decompressive craniectomy in pediatric patients and determine associated risk factors that may lead to PTH. METHODS: A retrospective analysis was conducted by searching the Puerto Rico neurologic surgery database from 2010 to 2019. All pediatric patients (1-18 years old) at the University Pediatric Hospital of the Puerto Rico Medical Center who had traumatic brain injury and had a decompressive craniectomy were included in the study. Data were reviewed to determine if time to decompressive craniectomy, side of decompressive craniectomy, gender, mechanism of trauma, amount of subarachnoid hemorrhage, and time to cranioplasty were risk factors for the development of PTH. RESULTS: Incidence of PTH after decompressive craniectomy was 21%. Neither gender, side of decompressive craniectomy, mechanism of trauma, amount of subarachnoid hemorrhage, time from trauma to decompressive craniectomy, nor cranioplasty intervention had statistical significance for developing PTH. Time from decompressive craniectomy to cranioplasty was significant for development of PTH. CONCLUSIONS: Longer time to cranioplasty was associated with an increased likelihood of PTH. We recommend performing cranioplasty as soon as possible to reduce hydrocephalus development.


Asunto(s)
Lesiones Traumáticas del Encéfalo/complicaciones , Craniectomía Descompresiva/efectos adversos , Hidrocefalia/etiología , Adolescente , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Niño , Preescolar , Femenino , Humanos , Hidrocefalia/diagnóstico por imagen , Lactante , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X
8.
Zhonghua Yi Xue Za Zhi ; 100(3): 220-224, 2020 Jan 21.
Artículo en Chino | MEDLINE | ID: mdl-32008290

RESUMEN

Objective: To investigate the value of bedside pulmonary ultrasound in the diagnosis and treatment of atelectasis in patients after cardiac surgery. Methods: A total of 45 patients developed respiratory failure within 1 week after cardiovascular surgery from April 2017 to April 2018 were enrolled in this study. Among them, 27 were male and 18 were female, mean age was (47±5) years. The postoperative pulmonary ultrasound and chest CT findings were collected, and the consistency, efficacy evaluation, timeliness and safety value of pulmonary ultrasound and chest CT diagnosis were compared. The consistency of the two diagnostic methods was checked based on the Kappa consistency test. Results: A total of 87 foci of atelectasis were diagnosed in 45 patients, including 29 foci of complete atelectasis and 58 foci of incomplete atelectasis. Thoracic CT examination confirmed 44 cases of atelectasis (positive rate 97.8%), and 42 cases (93.3%) were found with atelectasis with ultrasound test. The two methods were consistent in the diagnosis of atelectasis (Kappa value was 0.741, P<0.05). In the evaluation of the atelectasis, the results of the two examination methods were completely consistent, and the pulmonary ultrasound couldcheck the lung recruitment in real time. Ultrasound examination after lung recruitment showed that the total ventilation score of 42 patients decreased significantly when compared with that before treatment ((18.3±3.6) vs (26.6±3.8), t=10.229, P<0.05). There was no significant difference in the safety between the two examination methods. The time the bedside pulmonary ultrasound used was significantly shorter than that in the chest CT. Conclusions: The accuracy of bedside pulmonary ultrasound in assessing atelectasis after cardiovascular surgery is consistent with chest CT, it brings dynamic monitoring of lung status and assessment of lung recruitment by changes in lung ventilation scores. The inspection takes a short time and is worth promoting.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Atelectasia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Adulto , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Atelectasia Pulmonar/patología , Atelectasia Pulmonar/terapia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
9.
Ann R Coll Surg Engl ; 102(5): e97-e99, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32081032

RESUMEN

Laparoscopic Heller myotomy is the mainstay surgical treatment of oesophageal achalasia and has proven to be safe and effective over the course of time. Oesophageal perforation after myotomy can be a serious complication with devastating outcomes. Most commonly, mucosal perforation are detected intraoperatively or early postoperatively. We present an extremely rare case of late oesophageal perforation in a 28-year-old man treated with laparoscopic Heller myotomy for type II oesophageal achalasia, and its successful minimally invasive repair with laparoscopic primary suturing.


Asunto(s)
Acalasia del Esófago/cirugía , Perforación del Esófago/cirugía , Miotomía de Heller/efectos adversos , Hiperfagia/complicaciones , Complicaciones Posoperatorias/cirugía , Adulto , Perforación del Esófago/diagnóstico por imagen , Perforación del Esófago/etiología , Humanos , Laparoscopía , Masculino , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/etiología , Neumoperitoneo/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Técnicas de Sutura , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
10.
Sports Health ; 12(3): 271-278, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32091298

RESUMEN

BACKGROUND: Reductions in muscle size are common after anterior cruciate ligament reconstruction (ACLR) and may contribute to suboptimal patient outcomes. However, few studies have quantified postoperative alterations in muscle quality and evaluated its associations with patient-reported function. HYPOTHESES: Rectus femoris cross-sectional area (CSA) will decrease postoperatively but improve at return to activity (RTA), rectus femoris muscle quality (percentage fat [PF]) will increase postoperatively and be greater at RTA compared with preoperative values, and rectus femoris CSA and PF will be associated with International Knee Documentation Committee (IKDC) scores at both postoperative time points. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 26 individuals who sustained an ACL injury and underwent reconstructive surgery were evaluated preoperatively (T0), 9 weeks post-ACLR (T1), and at RTA. Rectus femoris CSA and PF were evaluated bilaterally via ultrasound imaging, and patient-reported function was assessed using the IKDC score. RESULTS: Bilateral reductions in rectus femoris CSA were noted from T0 to T1 (P < 0.01). Only the uninvolved limb returned to preoperative CSA (P = 0.80), as the involved limb failed to return to preoperative levels at RTA (P = 0.04). No significant changes in rectus femoris PF were observed across time points (P > 0.05). Lesser PF (P < 0.01) but not CSA (P = 0.75) was associated with higher IKDC score at T1. Lesser PF (P = 0.04) and greater CSA (P = 0.05) was associated with higher IKDC score at RTA. CONCLUSION: Substantial atrophy occurs bilaterally after ACLR, and the involved limb does not return to preoperative muscle size despite the patient completing rehabilitation. Quadriceps muscle morphology is associated with patient-reported function and may be an important rehabilitation target after ACLR. CLINICAL RELEVANCE: Quadriceps atrophy and poor muscle quality may contribute to suboptimal patient functioning and quadriceps dysfunction and may be important in RTA decision making. Assessing muscle morphology using ultrasound may be a feasible and clinically beneficial tool in patients after ACLR.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/patología , Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior , Medición de Resultados Informados por el Paciente , Músculo Cuádriceps/patología , Adolescente , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Reconstrucción del Ligamento Cruzado Anterior/rehabilitación , Humanos , Debilidad Muscular/diagnóstico por imagen , Debilidad Muscular/etiología , Atrofia Muscular/diagnóstico por imagen , Atrofia Muscular/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Músculo Cuádriceps/diagnóstico por imagen , Ultrasonografía
11.
PLoS One ; 15(2): e0228628, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32097419

RESUMEN

We reviewed charts and radiologic studies of 30 patients operated upon by ADR with Mobi-C® in single level since 2006. All patients had healthy cervical facet joints (less than or equal to grade 1 according to grading systems for cervical facet joint degeneration) preoperatively. We assessed clinical outcomes with NDI and VAS on neck and arm over follow-up and also measured ROM at implanted segment on dynamic radiographs during follow-up. The mean follow-up period was 42.4 ± 15.9 months. We then assessed the linearity of changes in ROM at implanted segment through linear mixed model. All patients showed significantly improved clinical outcomes. ROMs at implanted segment were maintained at slightly increased levels until 24 months postoperatively (P = 0.529). However, after 24 months, ROMs at implanted segment decreased significantly until last follow-up (P = 0.001). In addition, the decreasing pattern after 24 months showed a regular regression (P = 0.001). This decline was correlated with decline of extension angle at implanted segment. Based on this regular regression, we estimated that ROMs at implanted segments would be less than 2 degrees at 10.24 years postoperatively. Even though implanted segment maintains its motion for some length of time, we could assume that an artificial disc would have limited life expectancy correlated with the decline of extension angle.


Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Rango del Movimiento Articular , Reeemplazo Total de Disco/efectos adversos , Adulto , Vértebras Cervicales/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía
12.
Eur J Vasc Endovasc Surg ; 59(4): 526-534, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32033871

RESUMEN

OBJECTIVE: Intra-operative haemodynamic instability during carotid endarterectomy (CEA) has been associated with an increased risk of procedural stroke. Diffusion weighted imaging (DWI) lesions have been proposed as a surrogate marker for peri-operative silent cerebral ischaemia. This study aimed to investigate the relationship between peri-operative blood pressure (BP) and presence of post-operative DWI lesions in patients undergoing CEA. METHODS: A retrospective analysis was performed based on patients with symptomatic CEA included in the MRI substudy of the International Carotid Stenting Study. Relative intra-operative hypotension was defined as a decrease of intra-operative systolic BP ≥ 20% compared with pre-operative ('baseline') BP, absolute hypotension was defined as a drop in systolic BP < 80  mmHg. The primary endpoint was the presence of any new DWI lesions on post-operative MRI (DWI positive). The occurrence and duration of intra-operative hypotension was compared between DWI positive and DWI negative patients as was the magnitude of the difference between pre- and intra-operative BP. RESULTS: Fifty-five patients with symptomatic CEA were included, of whom eight were DWI positive. DWI positive patients had a significantly higher baseline systolic (186 ± 31 vs. 158 ± 27 mmHg, p = .011) and diastolic BP (95 ± 15 vs. 84 ± 13 mmHg, p = .046) compared with DWI negative patients. Other pre-operative characteristics did not differ. Relative intra-operative hypotension compared with baseline occurred in 53/55 patients (median duration 34 min; range 0-174). Duration of hypotension did not differ significantly between the groups (p = .088). Mean systolic intra-operative BP compared with baseline revealed a larger drop in BP (-37 ± 29 mmHg) in DWI positive compared with DWI negative patients (-14 ± 26 mmHg, p = .024). Absolute intra-operative systolic BP values did not differ between the groups. CONCLUSION: In this exploratory study, high pre-operative BP and a larger drop of intra-operative BP were associated with peri-procedural cerebral ischaemia as documented with DWI. These results call for confirmation in an adequately sized prospective study, as they suggest important consequences for peri-operative haemodynamic management in carotid revascularisation.


Asunto(s)
Infarto Encefálico/epidemiología , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Hipertensión/diagnóstico , Hipotensión/diagnóstico , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Anciano , Enfermedades Asintomáticas/epidemiología , Determinación de la Presión Sanguínea/estadística & datos numéricos , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Infarto Encefálico/diagnóstico por imagen , Infarto Encefálico/etiología , Estenosis Carotídea/complicaciones , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Hipertensión/complicaciones , Hipotensión/etiología , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
13.
Ann Otol Rhinol Laryngol ; 129(6): 633-636, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31975610

RESUMEN

OBJECTIVE: A nasal septal abscess after placement of a dental implant is seldom seen and is usually caused by an infection around the implant. A septal haematoma following dental implantation leading to septal abscess formation has never been reported. METHODS AND RESULTS: We present a case of a patient who developed a septal abscess after dental implantation without accompanying signs of infection around the implant. On the computed tomography scan we found the implant protruding the nasopalatine duct which led to bilateral septal hemorrhage, resulting in abscess formation. The patient underwent reconstructive nasal septum surgery, using an autologous auricular cartilage graft. This resulted in a good nasal function and cosmetic outcome. CONCLUSIONS: Medical health care professionals should be aware of a septal abscess in case of an acute blocked nose even without prior nasal or facial trauma or nasal surgery. Reconstruction of the septal nasal cartilage using autologous conchal cartilage is a good solution to preserve nasal function as well as tip support.


Asunto(s)
Absceso/cirugía , Implantación Dental/efectos adversos , Implantes Dentales/efectos adversos , Deformidades Adquiridas Nasales/cirugía , Complicaciones Posoperatorias/cirugía , Rinoplastia/métodos , Traumatismos de los Dientes/cirugía , Absceso/diagnóstico por imagen , Absceso/etiología , Humanos , Masculino , Cartílagos Nasales/cirugía , Obstrucción Nasal/etiología , Tabique Nasal , Deformidades Adquiridas Nasales/diagnóstico por imagen , Deformidades Adquiridas Nasales/etiología , Paladar Duro , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Hemorragia Posoperatoria , Procedimientos Quirúrgicos Reconstructivos , Tomografía Computarizada por Rayos X , Cornetes Nasales/trasplante , Adulto Joven
14.
J Comput Assist Tomogr ; 44(1): 124-130, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939893

RESUMEN

OBJECTIVE: To review and describe imaging findings on multidetector computed tomography in the early postoperative period after cytoreductive surgery with concomitant hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). METHODS: This was a retrospective review of consecutive patients undergoing early (≤60 days) postoperative abdominopelvic multidetector computed tomography scans after CRS + HIPEC from 2014 to 2018 at a single institution. Two radiologists separately assessed bowel wall thickening, bowel wall enhancement, bowel dilation, ascites, and pleural effusion(s) and identified any other significant finding(s). RESULTS: Thirty-two patients met the inclusion criteria. The majority of patients demonstrated bowel wall thickening (53%; n = 17) and ascites (72%; n = 23), whereas postoperative ileus (35%; n = 10), pleural effusion(s) (24%; n = 7), and bowel wall hyperenhancement (6%; n = 1) were less common. Significant findings included anastomotic leak/perforation (13%; n = 4), fistula (13%; n = 4), abscess (13%; n = 4), and bladder leak (6%; n = 2). CONCLUSIONS: Multidetector computed tomography is an excellent imaging modality to identify common postoperative findings as well as complications following CRS + HIPEC.


Asunto(s)
Terapia Combinada/métodos , Tomografía Computarizada Multidetector/métodos , Neoplasias Peritoneales/terapia , Complicaciones Posoperatorias/diagnóstico por imagen , Adulto , Anciano , Procedimientos Quirúrgicos de Citorreducción , Femenino , Humanos , Hipertermia Inducida , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos , Resultado del Tratamiento
17.
Br J Anaesth ; 124(3): 336-344, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31918847

RESUMEN

BACKGROUND: General anaesthesia is increasingly common in elderly and obese patients. Greater age and body mass index (BMI) worsen gas exchange. We assessed whether this is related to increasing atelectasis during general anaesthesia. METHODS: This primary analysis included pooled data from previously published studies of 243 subjects aged 18-78 yr, with BMI of 18-52 kg m-2. The subjects had no clinical signs of cardiopulmonary disease, and they underwent computed tomography (CT) awake and during anaesthesia before surgery after preoxygenation with an inspired oxygen fraction (FIO2) of >0.8, followed by mechanical ventilation with FIO2 of 0.3 or higher with no PEEP. Atelectasis was assessed by CT. RESULTS: Atelectasis area of up to 39 cm2 in a transverse scan near the diaphragm was seen in 90% of the subjects during anaesthesia. The log of atelectasis area was related to a quadratic function of (age+age2) with the most atelectasis at ∼50 yr (r2=0.08; P<0.001). Log atelectasis area was also related to a broken-line function of the BMI with the knee at 30 kg m-2 (r2=0.06; P<0.001). Greater atelectasis was seen in the subjects receiving FIO2 of 1.0 than FIO2 of 0.3-0.5 (12.8 vs 8.1 cm2; P<0.001). A multiple regression analysis, including a quadratic function of age, a broken-line function of the BMI, and dichotomised FIO2 (0.3-0.5/1.0) adjusting for ventilatory frequency, strengthened the association (r2=0.23; P<0.001). PaO2 decreased with both age and BMI. CONCLUSIONS: Atelectasis during general anaesthesia increased with age up to 50 yr and decreased beyond that. Atelectasis increased with BMI in normal and overweight patients, but showed no further increase in obese subjects (BMI ≥30 kg m-2). Therefore, greater age and obesity appear to limit atelectasis formation during general anaesthesia.


Asunto(s)
Anestesia General/efectos adversos , Obesidad/complicaciones , Complicaciones Posoperatorias/prevención & control , Atelectasia Pulmonar/etiología , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anestesia General/métodos , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/fisiopatología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/fisiopatología , Atelectasia Pulmonar/prevención & control , Intercambio Gaseoso Pulmonar/fisiología , Respiración Artificial/métodos , Fumar/efectos adversos , Volumen de Ventilación Pulmonar/fisiología , Tomografía Computarizada por Rayos X , Adulto Joven
18.
J Cardiothorac Surg ; 15(1): 8, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915025

RESUMEN

BACKGROUND: Bleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare. CASE PRESENTATION: A 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space. CONCLUSIONS: This report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.


Asunto(s)
Embolización Terapéutica , Hematoma/etiología , Hematoma/terapia , Neumotórax/cirugía , Arteria Subclavia , Adherencias Tisulares/complicaciones , Anciano , Angiografía , Circulación Colateral , Hematoma/diagnóstico por imagen , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia
19.
Acta Orthop ; 91(2): 159-164, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928120

RESUMEN

Background and purpose - The uncemented Symax hip stem has shown early proximal ingrowth as result of the BONIT-hydroxyapatite (HA) coating and the distal DOTIZE surface treatment. We evaluated 2-year postoperative radiostereometric analysis (RSA) migration of the Symax hip stem in THA patients. We also investigated the correlation between migration at 4 weeks and clinical outcomes after 2 years.Patients and methods - Patients in a 2-year clinical follow-up single-centre RSA randomized controlled trial were randomized to 2 different cup designs. All 45 patients received a Symax hip stem. RSA migration patterns of the Symax hip stem is presented here as a single cohort. RSA examinations were performed postoperatively, but before weight-bearing, and subsequently after 1, 3, 6, 12, and 24 months. Clinical outcomes and radiographic evaluations were assessed 3, 6, 12, and 24 months postoperatively.Results - During the first 4 weeks, the Symax hip stem subsided, rotated into retroversion, and translated posteriorly, after which the migration ceased and the prosthesis stabilized. All clinical outcomes improved from preoperatively to 2 years. There was no clinically or statistically significant correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years.Interpretation - RSA evaluation of the uncemented Symax hip stem confirms that the design principles and coating properties lead to early stabilization of the stem, as early as 4 weeks postoperatively. There was no correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Based on the predictive potential of the RSA technique, we anticipate excellent long-term survival of this hip stem.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/efectos adversos , Falla de Prótesis/etiología , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Materiales Biocompatibles Revestidos , Durapatita , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Diseño de Prótesis , Radiografía , Análisis Radioestereométrico , Rotación , Resultado del Tratamiento
20.
Acta Orthop ; 91(2): 171-176, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31960731

RESUMEN

Background and purpose - Compressive osseointegration fixation is an alternative to intramedullary fixation for endoprosthetic reconstruction. Mechanical failure of compressive osseointegration presents differently on radiographs than stemmed implants, therefore we aimed to develop a reliable radiographic method to determine stable integration.Patients and methods - 8 reviewers evaluated 11 radiographic parameters from 29 patients twice, 2 months apart. Interclass correlation coefficients (ICCs) were used to assess test-retest and inter-rater reliability. We constructed a fast and frugal decision tree using radiographic parameters with substantial test-retest agreement, and then tested using radiographs from a new cohort of 49 patients. The model's predictions were compared with clinical outcomes and a confusion matrix was generated.Results - 6 of 8 reviewers had non-significant intra-rater ICCs for ≥ one parameter; all inter-rater ICCs were highly reliable (p < 0.001). Change in length between the top of the spindle sleeve and bottom of the anchor plug (ICC 0.98), bone cortex hypertrophy (ICC 0.86), and bone pin hypertrophy (ICC 0.81) were used to create the decision tree. The sensitivity and specificity of the training cohort were 100% (95% CI 52-100) and 87% (CI 74-94) respectively. The decision tree demonstrated 100% (CI 40-100) sensitivity and 89% (CI 75-96) specificity with the test cohort.Interpretation - A stable spindle length and at least 3 cortices with bone hypertrophy at the implant interface predicts stable osseointegration; failure is predicted in the absence of bone hypertrophy at the implant interface if the pin sites show hypertrophy. Thus, our decision tree can guide clinicians as they follow patients with compressive osseo-integration implants.


Asunto(s)
Interfase Hueso-Implante/diagnóstico por imagen , Árboles de Decisión , Extremidad Inferior/cirugía , Oseointegración , Falla de Prótesis/etiología , Estudios de Cohortes , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Hiperostosis , Extremidad Inferior/diagnóstico por imagen , Variaciones Dependientes del Observador , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Pronóstico , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Radiografía/métodos , Sensibilidad y Especificidad , Estrés Mecánico
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