RESUMO
Anatomical modifications implemented during bariatric surgery not only result in weight loss, but also lead to metabolic corrections that translate into better glycemia stability and improvement in cardiovascular and liver disorders. The logical extension of surgical indications beyond mere reduction of the body mass index (BMI) (i.e. patients with<35kg/m2) is a hot topic today in France and worldwide. Metabolic surgeries make use of multiple modalities (endoscopic, mini-invasive, invasive) that should be carried out by trained physicians and within the same type of multidisciplinary formation as that for bariatric surgery. The aim of this update is to describe the physiological mechanisms that result in the benefits of bariatric surgery, the various procedures currently available and the perspectives for this new field in visceral and digestive surgery.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Humanos , Cirurgia Bariátrica/métodos , Índice de Massa Corporal , França , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Redução de Peso/fisiologiaRESUMO
Cataract surgery has become the most frequent surgical procedure performed every year in Western countries. Perioperative patient circuit has to be adapted to the important medical needs and progress. Hence, a secure short circuit (SSC) for surgeries of the anterior segment of the eye under topical anaesthesia was created. Patients included in the circuit are selected first by surgeons and answer a medical questionnaire, they do not have any preoperative evaluation by anaesthesiologist, are monitored during surgery by the surgical team and in case of problem an intraoperative medical action (IMA) can be performed. We conducted a retrospective observational incidence study of the occurrence of the IMA, followed by a case control study. The primary outcome was to identify risk factors of IMA among the patients' medical history. Out of 2744 screened patients, 1592 patients were included during the period of November 2015 to November 2017. The rate of IMA was 5%, 81% of them presenting with intraoperative high blood pressure (HBP). In the case control study part, stepwise regression analysis revealed that a history of HBP and insulin-dependent diabetes (IDD) was significantly correlated with IMA (respectively, adjusted odds ratio 1.7, P=0.005 and 2.6, P=0.002). The low incidence of IMA showed that the SSC is a safe tool thanks to a selection and an optimised and secure pathway. A history of HBP and IDD was significantly associated with the occurrence of IMA. Therefore, an optimisation of the perioperative period would be beneficial in these cases.
Assuntos
Extração de Catarata , Catarata , Estudos de Casos e Controles , Humanos , Incidência , Estudos Retrospectivos , Fatores de RiscoAssuntos
Coriorretinite/diagnóstico , Toxoplasma , Toxoplasmose Ocular/diagnóstico , Toxoplasmose Ocular/etiologia , Toxoplasmose/complicações , Aciclovir/uso terapêutico , Adulto , Alprazolam/administração & dosagem , Antimaláricos/uso terapêutico , Aripiprazol/administração & dosagem , Coriorretinite/tratamento farmacológico , Coriorretinite/parasitologia , Humanos , Imunocompetência , Masculino , Pirimetamina/uso terapêutico , Tentativa de Suicídio/prevenção & controle , Toxoplasma/isolamento & purificação , Toxoplasmose/diagnóstico , Toxoplasmose/tratamento farmacológico , Toxoplasmose Ocular/tratamento farmacológicoRESUMO
Immune-related adverse events (IRAEs) are rare but serious adverse events that may be associated with inhibitors of few immune control points. The purpose here is to report the case of an inflammatory ocular disease, potentially linked to the immunity and use of nivolumab, a new immunological agent used for the treatment of a solid tumor. In spite of the involvement of this treatment in the onset of inflammation, we must always seek another cause. It is possible to continue this treatment by considering the benefit/risk balance for each patient. Close collaboration between oncologists and ophthalmologists is necessary in the diagnosis and rapid management of these IRAE ocular related to these new emerging therapies.
Assuntos
Antineoplásicos/efeitos adversos , Nivolumabe/efeitos adversos , Uveíte/induzido quimicamente , Carcinoma Broncogênico/tratamento farmacológico , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Pessoa de Meia-Idade , Nivolumabe/administração & dosagem , Uveíte/diagnósticoRESUMO
New anticancer therapies, immune pathway inhibitors, may cause immune-related adverse events (IRAE). Immune-related ocular toxicities are rare but are potentially serious adverse events. The purpose of this article is to report a case of ocular inflammatory involvement potentially related to the immune response and the use of nivolumab, a new immunologic agent used for the treatment of a solid tumor. Despite the implication of this therapy in the occurrence of inflammation, other causes must always be ruled out. It is possible to continue this therapy in consideration of the risk/benefit ratio for each patient. Close collaboration between oncologists and ophthalmologists is necessary in the diagnosis and timely management of IRAE related to these new emerging therapies.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos/efeitos adversos , Imunossupressores/efeitos adversos , Uveíte Anterior/induzido quimicamente , Adenocarcinoma/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/farmacologia , Antineoplásicos/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Infecções Oculares Virais/diagnóstico , Feminino , Granuloma/induzido quimicamente , Granuloma/tratamento farmacológico , Granuloma/imunologia , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/farmacologia , Neoplasias Pulmonares/tratamento farmacológico , Pessoa de Meia-Idade , Nivolumabe , Receptor de Morte Celular Programada 1/efeitos dos fármacos , Receptor de Morte Celular Programada 1/imunologia , Subpopulações de Linfócitos T/efeitos dos fármacos , Subpopulações de Linfócitos T/imunologia , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/imunologiaRESUMO
PURPOSE: This study aimed to evaluate the safety and efficacy of anakinra for severe and refractory scleritis. METHODS: Ten patients with severe (i.e. at least 2 ocular relapses per year despite treatment) and refractory [i.e. at least to one disease modifying antirheumatic drugs (DMARDS)] scleritis were treated with anakinra (100 mg/day subcutaneously). Scleritis was associated with inflammatory systemic diseases in 60% of cases. The remission rate defined the primary outcome. RESULTS: Ninety percent of patients were complete responders with a mean follow-up of 19.4 months after starting anakinra. The corticosteroids daily dose decreased from 18.3 ± 4.1 mg to 4.2 ± 4.9 mg, (p < 0.05), at initiation of anakinra and at end of follow-up, respectively. Associated immunosuppressants were stopped in all cases except one. Side effects were observed in 4 patients who did not need anakinra withdrawal. CONCLUSIONS: This pilot study suggests the efficacy of anakinra in patients with refractory scleritis.
Assuntos
Proteína Antagonista do Receptor de Interleucina 1/administração & dosagem , Esclera/diagnóstico por imagem , Esclerite/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Esclera/efeitos dos fármacos , Esclerite/diagnóstico , Fatores de Tempo , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVE: The purpose of this study was to present the role of embolization in the treatment of kidney angiomyolipomas (AML), for preventive care or in case of bleeding. METHODS: From March 1995 to March 2007, 22 AML in 21 patients (16 women and five men, mean age 38 years) were embolized: five AML were treated for hemorrhagic shock emergency and 16 were preventive embolization. Eight AML were discovered incidentally and nine patients had pain or hematuria. The average size of AML was 70 mm (20 to 130 mm). The embolization was performed with coils or embospheres. RESULTS: Three patients have not been embolized because of renal failure catheterization. The embolization was effective in 100% of patients treated in emergency. The six patients cared for gross hematuria and pain were asymptomatic after embolization. The average tumor size reduction was 32% with a mean time of 53.2 months (five to 101 months). Three patients (14%) have benefited from surgery remotely. CONCLUSION: Embolization is the best technique for treating bleeding secondary to AML. In preventive treatment or symptomatic, AML embolization is a treatment to offer before considering surgery.
Assuntos
Angiomiolipoma/terapia , Embolização Terapêutica , Neoplasias Renais/terapia , Adulto , Angiomiolipoma/complicações , Feminino , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Neoplasias Renais/complicações , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Laparoscopic mesh repair of ventral abdominal wall hernias is routinely performed. Mesh detachment and migration within the abdominal cavity is a late complication of this procedure. Symptoms are non-specific and imaging diagnosis is difficult to achieve because this complication is rare and overlooked.
Assuntos
Parede Abdominal/cirurgia , Migração de Corpo Estranho/diagnóstico , Hérnia Inguinal/cirurgia , Processamento de Imagem Assistida por Computador , Laparoscopia , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/cirurgia , Idoso , Colo/patologia , Colo/cirurgia , Doenças do Colo/diagnóstico , Doenças do Colo/cirurgia , Feminino , Migração de Corpo Estranho/cirurgia , Hérnia Abdominal/cirurgia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/cirurgia , Fístula Urinária/diagnóstico , Fístula Urinária/cirurgiaAssuntos
Perfuração Intestinal/etiologia , Pneumatose Cistoide Intestinal/complicações , Doenças do Colo Sigmoide/etiologia , Feminino , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/cirurgia , Radiografia , Doenças do Colo Sigmoide/diagnóstico por imagem , Doenças do Colo Sigmoide/cirurgiaAssuntos
Coxa da Perna , Angiografia , Biópsia , Humanos , Imuno-Histoquímica , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sarcoma Alveolar de Partes Moles/diagnóstico , Sarcoma Alveolar de Partes Moles/diagnóstico por imagem , Sarcoma Alveolar de Partes Moles/genética , Sarcoma Alveolar de Partes Moles/patologia , Sarcoma Alveolar de Partes Moles/cirurgia , Coxa da Perna/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Adulto JovemRESUMO
Currently, multidetector row CT (MDCT) is routinely used for cardiac imaging, especially for detection of coronary artery disease and morphological and functional evaluation. Recent advances in MDCT with cardiac gating and improved spatial and temporal resolution allow non-invasive evaluation of cardiac valves with significant reduction in artifacts traditionally associated with valvular prostheses. Postsurgical follow-up of mechanical aortic valvular prostheses requires knowledge of the functioning mechanism of different valve types and related complications, some potentially lethal and sometimes of insidious onset. The most frequently used non-invasive imaging modalities to evaluate morphology and function of prosthetic heart valves are echocardiography and fluoroscopy. We present the CT imaging features of three mechanical aortic valvular prostheses and the value of CT for diagnosis of related complications as a complement to standard imaging modalities.
Assuntos
Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Tomografia Computadorizada por Raios X , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Desenho de PróteseRESUMO
MATERIALS AND METHODS: Thirty-one patients underwent stent placement between June 1998 and October 2006 for superior vena cava obstruction. The initial effectiveness of the metallic stent therapy and the follow-up results were studied at one, six and 12 months. PURPOSE: We retrospectively studied the utility of metallic stent placement for the treatment of malignant superior vena cava obstruction in 31 patients (SVCO) on the basis of long-term follow-up data. RESULTS: The initial clinical success rate was 100% (31 out of 31), the primary clinical patency rate was 93% (26 out of 28) at six months. The obstruction rate of the stent was 7% (two out of 28) at six months. There was no additional stent used for recurrence. At 12 months, 27 out of 31 patients were deceased in whom there was no recurrence of SVCO until death. CONCLUSION: Stent therapy is an effective treatment for SVCO. Adjuvant therapy must to be evaluated in association with stent therapy.
Assuntos
Implante de Prótese Vascular , Stents , Síndrome da Veia Cava Superior/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
The persistence of a left superior vena cava (LSVC) is an intrinsically cardiac anomaly, which can lead to serious complications during catheterization via the subclavian or internal jugular vein. We found this anomaly during dissection associated with an abnormal origin of the vertebral artery originating from the aortic arch between the left common carotid and subclavian arteries. The LSVC coursed towards the right atrium through a very dilated coronary sinus ostium. No abnormality of the azygos system was found. A thorough anatomic description was then made with external and internal morphology. The embryonic development and variations are described. Radiological and clinical implications are discussed.
Assuntos
Veia Cava Superior/anormalidades , Artéria Vertebral/anormalidades , Idoso , Cadáver , Feminino , Humanos , Ilustração MédicaRESUMO
We report a case of postoperative inferior mesenteric arteriovenous fistula. Arteriovenous fistula represents a rare disease. Symptoms are due to portal hypertension and distal ischemy. Treatment of these fistulas is embolization. Surgery is possible by ligature or excision of the fistula because vascularisation is obtained by Riolan arcade and hypogastric artery.
Assuntos
Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Artérias Mesentéricas/patologia , Veias Mesentéricas/patologia , Complicações Pós-Operatórias , Fístula Arteriovenosa/complicações , Humanos , Hipertensão Portal/etiologiaRESUMO
The duplication of the inferior vena cava is often incidentally discovered during radiological studies. The presence of this anomaly can be mistaken for retroperitoneal adenopathy. Its knowledge allows to avoid hemorrhagic complications during retroperitoneal surgery. An anatomical dissection of a duplication of the inferior vena cava is presented. Embryogenesis and variations are described. Radiological and clinical implications are discussed.
Assuntos
Veia Cava Inferior/anormalidades , Veia Cava Inferior/anatomia & histologia , Aorta Abdominal/anormalidades , Aorta Abdominal/anatomia & histologia , Aorta Abdominal/cirurgia , Dissecação/métodos , Humanos , Artéria Ilíaca/anatomia & histologia , Processamento de Imagem Assistida por ComputadorRESUMO
INTRODUCTION: A primary antiphospholipid syndrome is a very rare cause of adrenal haemorrhage. OBSERVATION: A 51 year-old man presented with a unilateral adrenal haemorrhage, enhanced by the prescription of Synacthène during the 4 days that preceded. There was no adrenal deficiency but the immunological control revealed the presence of anti-phospholipid antibodies. After 2 years of follow-up, adrenal controls have not shown any underlying tumour or endocrine insufficiency. COMMENTS: Adrenal involvement is described in the anti-phospholipid syndrome and may present in the form of adrenal deficiency in the case of occasionally only microscopic bilateral haemorrhages. Furthermore, Synacthène is known to induce adrenal haemorrhages although this complication remains rare. Moreover, any unilateral adrenal haemorrhage requires subsequent follow-up for several months or even years in order to eliminate any underlying tumour and to control the absence of any adrenal deficiency if the involvement is bilateral.