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1.
Pan Afr Med J ; 35: 9, 2020.
Artículo en Francés | MEDLINE | ID: mdl-32117524

RESUMEN

Lesions of the inferior laryngeal nerve are the most devastating complications of thyroid surgery. Identifying the inferior laryngeal nerve is all the more difficult when its path is atypical. We report a case of right non-recurrent inferior laryngeal nerve detected during thyroidectomy.


Asunto(s)
Complicaciones Posoperatorias/diagnóstico , Traumatismos del Nervio Laríngeo Recurrente/diagnóstico , Tiroidectomía/efectos adversos , Adulto , Femenino , Humanos , Glándula Tiroides/cirugía , Tiroidectomía/métodos
2.
Am Surg ; 86(2): 95-103, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167059

RESUMEN

Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Preoperative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality (P < 0.0001) and Clavien-Dindo grade IV complications (P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.


Asunto(s)
Cistectomía/efectos adversos , Fragilidad/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Proctectomía/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Cistectomía/mortalidad , Cistectomía/estadística & datos numéricos , Bases de Datos Factuales , Femenino , Fragilidad/complicaciones , Fragilidad/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Pelvis/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Proctectomía/mortalidad , Proctectomía/estadística & datos numéricos , Curva ROC , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
3.
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
4.
Medicine (Baltimore) ; 99(9): e19331, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118765

RESUMEN

BACKGROUND: Cricothyroidotomy is the final strategy in the "cannot intubate, cannot oxygenate" scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates. METHODS: The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25 mm. We made long stopper to shorten the length by 5 mm (net 20 mm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an ex-vivo porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13 mm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (P < .05 was statistically significant). RESULTS: Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45/45) and the shorter needle (91%, 41/45, P = .12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15/45) with the commercial kit and 5% (2/43) with the shorter needle (P < .01). CONCLUSION: During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.


Asunto(s)
Cartílago Cricoides/cirugía , Agujas/efectos adversos , Tráquea/lesiones , Animales , Estudios Cruzados , Modelos Animales de Enfermedad , Diseño de Equipo/métodos , Diseño de Equipo/normas , Agujas/tendencias , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Porcinos/lesiones , Enseñanza
5.
Medicine (Baltimore) ; 99(10): e19447, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150098

RESUMEN

Antiplatelet agents have been administered to patients with acute ischemic stroke after endovascular therapy. This study was designed to provide initial data to compare thromboelastography (TEG) with the conventional coagulation test (CCT) to analyze the coagulation function of antiplatelet drugs in such patients.The present retrospective cohort study included 240 patients who received endovascular therapy from September 2012 to December 2017. The baseline and clinical characteristics of these patients were collected with respect to TEG (parameters: R, K, maximal amplitude (MA), and α angle) and CCT (parameters: PT, activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR), and platelet count (PLT)) on day 5 after aspirin and clopidogrel post-endovascular interventions. The correlation and agreement of these 2 detecting methods were analyzed. Additionally, the area under the receiver operating characteristic curve (AUROC) was used to analyze the effectiveness of these 2 methods in detecting unfavorable clinical outcomes, including symptomatic intracranial hemorrhage and early neurological deterioration.The 3 pairs of parameters (R and APTT, K and APTT, and α angle and FIB) were in agreement for identifying hypercoagulability, while R and APTT, K and APTT, K and PLT, and α angle and PLT were in agreement for identifying hypocoagulability. The AUROC of parameter R for detecting symptomatic intracranial hemorrhage was 0.817, while that of parameter FIB for predicting early neurological deterioration was 0.887.Parameter FIB derived from CCT might be advantageous for evaluating early neurological deterioration, while parameter R detected by TEG might be superior for evaluating symptomatic intracranial hemorrhage.


Asunto(s)
Pruebas de Coagulación Sanguínea , Isquemia Encefálica/terapia , Hemorragias Intracraneales/diagnóstico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/terapia , Tromboelastografía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Estudios de Cohortes , Procedimientos Endovasculares , Femenino , Humanos , Relación Normalizada Internacional , Hemorragias Intracraneales/sangre , Hemorragias Intracraneales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven
6.
Medicine (Baltimore) ; 99(5): e18656, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000371

RESUMEN

RATIONALE: The De Winter electrocardiogram (ECG) pattern is considered as a ST elevated myocardial infarction (STEMI)-equivalent pattern. Due to its rare nature, it is unclear whether this ECG pattern suggests the presence of some other condition. PATIENT CONCERNS: We reported a 47-year-old man with new-onset chest discomfort several hours after the second-stage percutaneous coronary intervention (PCI). DIAGNOSES: An emergency coronary angiogram (CAG) did not show any abnormality. However, the dynamic changes in the ECG and myocardial biomarkers indicated perioperative myocardial infarction. INTERVENTION: The patient was monitored in the cardiac care unite (CCU), and was administered an intravenous infusion of diltiazem and subcutaneous injection of low molecular weight heparin. OUTCOMES: After a few hours, his symptoms were alleviated. The patient was discharged after 6 days of hospitalization without any complications. LESSONS: The De Winter ECG pattern can be observed in patients without significantly coronary arteries occlusion. The newly onset De Winter ECG pattern after PCI procedure may indicate perioperative myocardial infarction caused by impaired microvascular perfusion.


Asunto(s)
Electrocardiografía , Infarto del Miocardio/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Complicaciones Posoperatorias/etiología
7.
Isr Med Assoc J ; 22(2): 89-93, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043325

RESUMEN

BACKGROUND: There are several ways to remove silicone oil (SO) from the vitreous cavity. OBJECTIVES: To describe a simple, safe and inexpensive method of 2-port SO removal. METHODS: Medical charts of 33 patients who underwent SO removal combined with cataract extraction were retrospectively reviewed, from a cohort of 119 patients who had silicone oil removal. The primary outcome was the rate of re-detachment, secondary outcomes included visual acuity (VA) and intraoperative and postoperative complications. RESULTS: Mean follow-up time was 27.6 months (0.25-147 ± 33.1), and mean tamponade duration prior to SO removal was 16.77 months (4-51.5 ± 14.6). The re-detachment rate was 3% (one patient). Postoperatively, seven patients (20%) had epiretinal membrane (ERM), eight patients had posterior capsule opacification (24%), and proliferative vitreoretinopathy (PVR) was diagnosed in two patients (6%). Compared to the mean VA (logarithm of the minimum angle of resolution [LogMAR]) at the preoperative examination, the mean VA (LogMAR) improved significantly at the last visit when including all ranges of VA (n=32, LogMAR 1.52 vs. 1.05 P = 0.0002 [Student's t-test] and P = 0.001 [Wilcoxon test]). CONCLUSIONS: The technique described is fast and simple, keeping the posterior capsule intact in pseudophakic patients, which is advantageous in the event of future re-detachment necessitating SO reinjection. Rates of re-detachment and postoperative ERM and PVR were low. Furthermore, our method does not require the use of a surgical microscope with posterior segment viewing systems, or opening a full disposable vitrectomy set, thus drastically reducing the procedure's cost.


Asunto(s)
Endotaponamiento/métodos , Complicaciones Posoperatorias , Desprendimiento de Retina , Aceites de Silicona/uso terapéutico , Succión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación/métodos , Reoperación/estadística & datos numéricos , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/fisiopatología , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Succión/efectos adversos , Succión/métodos , Resultado del Tratamiento , Agudeza Visual , Cirugía Vitreorretiniana/métodos
9.
Medicine (Baltimore) ; 99(3): e18798, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011483

RESUMEN

RATIONALE: Renal hemosiderosis is a disease in which hemosiderin deposits in the renal cortex as a form of iron overload. However, cases of renal hemosiderosis due to intravascular hemolysis following mitral valve repair have been rarely reported. PATIENT CONCERNS: We present the case of a 62-year-old woman who developed asymptomatic urinary abnormalities including microscopic hematuria and proteinuria due to renal hemosiderosis following a mitral valve repair surgery performed two years earlier. DIAGNOSES: A percutaneous renal biopsy showed no specific glomerular abnormality, tubular atrophy, or interstitial fibrosis but extensive deposition of hemosiderin in the proximal tubule. The patient was diagnosed with renal hemosiderosis and chronic intravascular hemolysis following mitral valve repair. INTERVENTIONS: Our patient refused a mitral valve repeat surgery and hence was treated with oral iron preparations, N-acetylcysteine, and a ß-receptor blocker. OUTCOMES: Moderate mitral regurgitation with the regurgitant blood striking against the annuloplasty ring was confirmed on follow-up echocardiography. After the 24-month follow-up period, hemolytic anemia persisted, but there was no significant decline of renal function. LESSONS: For cases of chronic intravascular hemolysis accompanied with asymptomatic urinary abnormalities, a renal biopsy is required to exclude underlying kidney pathology and predict potential renal insufficiency.


Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Hemólisis , Hemosiderosis/diagnóstico , Enfermedades Renales/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Femenino , Hemosiderosis/etiología , Hemosiderosis/patología , Humanos , Enfermedades Renales/etiología , Enfermedades Renales/patología , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/cirugía , Complicaciones Posoperatorias/patología
10.
Urology ; 137: 183-189, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31926195

RESUMEN

OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (n = 14; mean age = 62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (n = 7; mean age = 60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, P = .0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, P = .9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, P = .76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, P = .2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.


Asunto(s)
Enfermedades del Pene , Pene , Complicaciones Posoperatorias , Uretra , Estrechez Uretral , Procedimientos Quirúrgicos Urológicos , Pesos y Medidas Corporales/métodos , Brasil , Constricción Patológica , Correlación de Datos , Diagnóstico por Imagen de Elasticidad/métodos , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Enfermedades del Pene/diagnóstico , Enfermedades del Pene/etiología , Pene/patología , Pene/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/patología , Procedimientos Quirúrgicos Reconstructivos/métodos , Uretra/irrigación sanguínea , Uretra/inervación , Uretra/patología , Uretra/cirugía , Estrechez Uretral/diagnóstico , Estrechez Uretral/epidemiología , Estrechez Uretral/etiología , Estrechez Uretral/patología , Procedimientos Quirúrgicos Urológicos/efectos adversos , Procedimientos Quirúrgicos Urológicos/métodos
13.
J Surg Res ; 246: 379-383, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31676146

RESUMEN

BACKGROUND: Lymphocytes have become the target of cancer interventions through engineering or immune checkpoint antibodies. We previously found decreased lymphocyte counts to be a predictor of mortality and complications in trauma and cardiac surgery patients. We hypothesized lack of lymphocyte count recovery postoperatively would predict outcomes in esophagectomy patients. METHODS: A retrospective review of all patients undergoing esophagectomy for adenocarcinoma performed over 13 y at our center by a single surgeon after institutional review board approval was performed. Patients were grouped by postoperative lymphocytes counts: never low, low with recovery, and low without recovery. Resolution of lymphopenia was assessed by day 4. Primary end points were overall and recurrence-free survival. RESULTS: In total, 198 patients were included with a minimum 6-mo follow-up. Collectively the 5-y recurrence and overall survival rates were 36% and 50%, respectively. Recurrence was significantly higher at 5 y in patients with persistent lymphopenia (43%) compared with those who recovered (14% P = 0.0017) and those who never dropped (0% P = 0.0009). The persistent lymphopenia group had significantly lower survival (45%) compared with the two other groups (67% P = 0.0232). CONCLUSIONS: There is a significant decrease in the overall and recurrence-free survival in those patients whose lymphocyte count drops without recovery after their esophagectomy. These data imply differences in immune responses to the stress of surgery that can be measured with routine postoperative laboratory values and are indicative of overall outcomes.


Asunto(s)
Neoplasias Esofágicas/mortalidad , Esofagectomía/efectos adversos , Linfocitos , Linfopenia/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Supervivencia sin Enfermedad , Neoplasias Esofágicas/sangre , Neoplasias Esofágicas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Recuento de Linfocitos , Linfopenia/sangre , Linfopenia/etiología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/epidemiología , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
14.
Ann Hematol ; 99(2): 385-388, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31773213

Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad de Hodgkin/tratamiento farmacológico , Terapia Molecular Dirigida , Neoplasias Primarias Secundarias/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Aloinjertos , Anticuerpos Monoclonales Humanizados/administración & dosificación , Antineoplásicos Inmunológicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Infecciones por Virus de Epstein-Barr/diagnóstico , Infecciones por Virus de Epstein-Barr/etiología , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Enfermedad Injerto contra Huésped/etiología , Enfermedad de Hodgkin/diagnóstico , Enfermedad de Hodgkin/etiología , Humanos , Inmunosupresores/efectos adversos , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/etiología , Leucemia Mieloide Aguda/terapia , Masculino , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Protoporfiria Eritropoyética/terapia , Recurrencia , Inducción de Remisión , Activación Viral , Adulto Joven
16.
Oncology ; 98(2): 117-122, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31715614

RESUMEN

BACKGROUND: The treatment of kidney cancer usually involves surgery, and in some cases systemic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to control postsurgical pain in patients undergoing nephrectomy for renal cancer. Nevertheless, the association between these drugs and adverse postsurgical outcomes, including deterioration of renal function, is not fully established. METHODS: This retrospective cohort study included patients >18 years old with kidney cancer undergoing nephrectomy between January 2006 and January 2018. The primary endpoint was to determine the impact of postsurgical analgesic therapy (NSAIDs vs. acetaminophen) on renal function and postsurgical complications. This study was approved by our scientific and bioethical committee. RESULTS: One hundred patients were included in the final analysis. Clear-cell renal-cell carcinoma was the most frequent histologic subtype. Adequate acute pain control was accomplished in 91% of the patients during hospitalization. Twenty percent of the patients presented postsurgical complications. Bleeding-related complications were the most frequent (9%), followed by surgical-site infection (6%) and acute renal injury (6%). The administration of NSAIDs was not related to any postsurgical complication in comparison with the use of acetaminophen (21.3 vs. 17.9%, respectively). The length of hospital stay did not differ between patients treated with NSAIDs and those treated with acetaminophen (the average stay was 4 days for both groups, p = 0.32). CONCLUSION: The use of NSAIDs was not related to acute kidney injury, postsurgical complications, or prolonged hospital stay in patients with renal cancer undergoing nephrectomy.


Asunto(s)
Analgésicos/efectos adversos , Neoplasias Renales/complicaciones , Nefrectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Anciano , Analgésicos/administración & dosificación , Biomarcadores , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Nefrectomía/métodos , Cuidados Posoperatorios , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/metabolismo , Pronóstico , Resultado del Tratamiento
17.
Ann R Coll Surg Engl ; 102(1): e7-e11, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31530171

RESUMEN

Ehlers-Danlos syndrome is a hereditary connective tissue disorder that has gastrointestinal manifestations in over 50% of its cases. We present the first case of bariatric surgery in a patient with Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for morbid obesity. His comorbidity included type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks later, he presented with 43.9% excess weight loss and improved glycaemic control. Three months postoperatively, however, he complained of dysphagia, regurgitation and postprandial pain. A barium meal and gastroscopy suggested the presence of a gastric diverticulum. A surgical exploration was planned. Intraoperative gastroscopy demonstrated an asymmetrical gastric pouch dilatation and the pouch was therefore refashioned laparoscopically. Despite the initial symptomatic relief, two months later he experienced retrosternal pain with progressive dysphagia. Since then, multiple endoscopic dilatations of the gastro-oesophageal junction have been performed for recurrence of symptoms. Finally, a laparoscopic hiatus hernia repair and adhesiolysis was performed resulting in complete relief of patient's symptoms. Bariatric management of patients with Ehlers-Danlos syndrome can prove challenging. The bariatric team must implement a careful management plan including a detailed consent process, a tailored surgical intervention and a follow-up focused on potential gastrointestinal manifestations.


Asunto(s)
Síndrome de Ehlers-Danlos/complicaciones , Obesidad Mórbida/cirugía , Trastornos de Deglución/etiología , Diabetes Mellitus Tipo 2/complicaciones , Endoscopía del Sistema Digestivo/métodos , Derivación Gástrica/métodos , Hernia Hiatal/diagnóstico , Hernia Hiatal/etiología , Hernia Hiatal/cirugía , Herniorrafia/métodos , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación
20.
Eur J Ophthalmol ; 30(1): 162-167, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30301386

RESUMEN

PURPOSE: To analyze the risk factors associated with early and late failure after goniotomy for primary pediatric glaucoma. METHODS: A retrospective study was done on infants who underwent goniotomy as the initial surgical procedure for primary pediatric glaucoma, and had a follow-up period ⩾48 months after surgery. Early and late failures were defined as intraocular pressure ⩾18 mmHg or signs of glaucoma progression before and after the end of first year, respectively. RESULTS: A total of 81 eyes of 47 children were included. The mean age at the time of surgery was 6.1 ± 6.7 months, 34 children (72.3%) were bilateral. The mean follow-up was 5.9 ± 2.8 years. Of the included eyes, 41 eyes (50.6%) showed success, 25 eyes (30.9%) showed an early failure, and 15 eyes (18.5%) showed a late failure. The mean survival time was 43 months. However, only surgery before the end of the first month and positive consanguinity of the parents (P < 0.01 for both) were independent risk factors for early and late failure of goniotomy for primary pediatric glaucoma. Patients with late failure showed a statistically significant lower preoperative intraocular pressure (P = 0.02). A larger preoperative corneal diameter and a male gender were associated with higher but statistically insignificant failure rates. There were no differences in the early or late failure rates between unilateral and bilateral cases. CONCLUSION: A positive consanguinity of the parents and surgery before the end of the first month are the major predictors of failure of goniotomy.


Asunto(s)
Predicción , Glaucoma/cirugía , Presión Intraocular/fisiología , Complicaciones Posoperatorias/diagnóstico , Trabeculectomía/efectos adversos , Preescolar , Femenino , Estudios de Seguimiento , Glaucoma/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Tonometría Ocular , Resultado del Tratamiento
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