Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
1.
J. coloproctol. (Rio J., Impr.) ; 40(4): 334-338, Oct.-Dec. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1143178

RESUMO

ABSTRACT Objective: To describe and analyze the cases of Fournier's Gangrene caused by perianal abscess treated in a tertiary hospital in western Paraná, correlating possible factors that influence mortality, with emphasis on late diagnosis and therapy. Methods: A retrospective and descriptive case series was carried out based on the analysis of medical records of patients with Fournier's Gangrene due to perianal abscess from January 2012 to December 2017. Results: Thirty-one patients with Fournier's Gangrene due to perianal abscess were treated in the period: 26 men and 5 women. Mean age was 53.51 ± 14.5 years. The most prevalent comorbidity in this group was type 2 diabetes mellitus, showing a strong correlation with mortality. The mean time from disease progression, from the initial symptom to the admission at the service, was 9.6 ± 6.81 days. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 3.25 ± 2.89 procedures/patient. Seven (22.58%) patients died and all of them showed signs of sepsis on admission; only 2 patients with sepsis did not die. Conclusion: The presence of sepsis on admission and type 2 diabetes mellitus were strongly correlated with mortality.


RESUMO Objetivo: Descrever e analisar os casos de gangrena de Fournier por abscesso perianal atendidos em hospital terciário do oeste do Paraná, correlacionando possíveis fatores que influenciem a mortalidade, com ênfase ao diagnóstico e terapêuticas tardias. Métodos: Realizou-se um estudo de série de casos, retrospectivo e descritivo baseado na análise de prontuários de pacientes portadores de gangrena de Fournier devido a abscesso perianal no período de Janeiro de 2012 à Dezembro de 2017. Resultados: Foram tratados 31 pacientes com gangrena de Fournier por abscesso perianal no período, sendo 26 homens e 5 mulheres. A média de idade foi de 53,51 ± 14,5 anos. A comorbidade de maior prevalência neste grupo foi diabete melitus tipo 2, demonstrando forte correlação com mortalidade. A média do tempo de evolução da doença, do sintoma inicial até entrada no serviço, foi de 9,6 ± 6,81 dias. Todos os pacientes foram submetidos à antibioticoterapia e tratamento cirúrgico com média de 3,25 ± 2,89 procedimentos/paciente. Sete (22,58%) pacientes evoluíram para óbito e todos estes apresentavam sinais de sepse na admissão; apenas 2 pacientes com sepse não evoluíram a óbito. Conclusão: Presença de sepse a admissão e diabete melitus tipo 2 foram fortemente correlacionadas com mortalidade.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Gangrena de Fournier/complicações , Abscesso/complicações , Abscesso/mortalidade , Fasciite Necrosante
2.
Rev Col Bras Cir ; 47: e20202530, 2020 Sep 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32901707

RESUMO

INTRODUCTION: simulation based teaching is a powerful tool in medical education, allowing hands on practice under a controlled environment and with repeated maneuvers. Central venous access venipuncture is one of the most frequent procedures carried out in the hospital setting, due to its various clinical indications and, when performed with the help of ultrasonography, the risk of adverse events is minimized. Aim: to develop, to describe and to test a porcine model that simulates the central venous access puncture aided by ultrasonography. METHOD: a low cost porcine model was developed to train medical students and residents on central venous access guided by ultrasonography. Both students and medical residents underwent a theoretical training regarding the model, followed by a hands-on training session. Afterwards, the participants assessed the model by answering a questionnaire. RESULTS: there were 51 participants. The average score regarding the similarity between the model and the human anatomy was 9.15. When the characteristics were separately assessed, the mean scores regarding the similarity of the vessels, anatomic disposition and ultrasonographic characteristics as well as the venipuncture were, respectively, 9.27; 9.31; 9.54 and 8.86. CONCLUSION: The model was approved and considered appropriate for the training of central venous venipuncture by all the participants. Furthermore, it is a low cost, simple and reproducible model, that presents high similarity with the human anatomy. Therefore, it may be used as an aid to train people on ultrasonography guided central venous access.


Assuntos
Cateteres Venosos Centrais , Educação Médica , Treinamento por Simulação , Estudantes de Medicina/psicologia , Ultrassonografia de Intervenção/métodos , Animais , Humanos , Modelos Animais , Suínos
3.
Rev. Col. Bras. Cir ; 47: e20202530, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1136531

RESUMO

ABSTRACT Introduction: simulation based teaching is a powerful tool in medical education, allowing hands on practice under a controlled environment and with repeated maneuvers. Central venous access venipuncture is one of the most frequent procedures carried out in the hospital setting, due to its various clinical indications and, when performed with the help of ultrasonography, the risk of adverse events is minimized. Aim: to develop, to describe and to test a porcine model that simulates the central venous access puncture aided by ultrasonography. Method: a low cost porcine model was developed to train medical students and residents on central venous access guided by ultrasonography. Both students and medical residents underwent a theoretical training regarding the model, followed by a hands-on training session. Afterwards, the participants assessed the model by answering a questionnaire. Results: there were 51 participants. The average score regarding the similarity between the model and the human anatomy was 9.15. When the characteristics were separately assessed, the mean scores regarding the similarity of the vessels, anatomic disposition and ultrasonographic characteristics as well as the venipuncture were, respectively, 9.27; 9.31; 9.54 and 8.86. Conclusion: The model was approved and considered appropriate for the training of central venous venipuncture by all the participants. Furthermore, it is a low cost, simple and reproducible model, that presents high similarity with the human anatomy. Therefore, it may be used as an aid to train people on ultrasonography guided central venous access.


RESUMO Introdução: o ensino baseado em simulação é poderosa ferramenta para o aprendizado na educação médica, permitindo a prática de procedimentos em ambientes controlados e por repetidas vezes. A realização de acesso venoso central é um dos procedimentos médicos mais realizados em ambiente hospitalar, tendo várias indicações e, quando realizada com o auxilio da ultrassonografia, os riscos das complicações do procedimento são minimizados. Objetivo: desenvolver, descrever e aplicar um modelo porcino para simulação de acesso venoso central guiado por ultrassonografia. Métodos: modelo porcino de baixo custo foi desenvolvido para treinamento de acesso venoso central guiado por ultrassonografia. Estudantes de medicina e médicos residentes receberam treinamento teórico em relação ao procedimento, seguido de treinamento prático no modelo. Posteriormente, os participantes avaliaram o modelo desenvolvido por meio de um questionário. Resultados: o estudo contou com 51 participantes. O escore médio de semelhança geral do modelo com a realidade foi 9,15. Quando separadas por características, as médias dos escores de semelhança da imagem dos vasos, da disposição anatômica das estruturas, das características ultrassonográficas e da punção foram, respectivamente, 9,27; 9,31; 9,54 e 8,86. Conclusão: o modelo foi aprovado e considerado útil para treinamento do procedimento por todos os participantes, além de ter baixo custo, ser simples, reprodutível e apresentar alta semelhança com a realidade, podendo ser utilizado como adjunto no treinamento de acesso venoso central guiado por ultrassonografia.


Assuntos
Humanos , Estudantes de Medicina/psicologia , Ultrassonografia de Intervenção/métodos , Educação Médica , Cateteres Venosos Centrais , Suínos , Modelos Animais , Treinamento por Simulação
4.
Rev Col Bras Cir ; 45(1): e1430, 2018.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29451646

RESUMO

OBJECTIVE: to analyze the profile of patients with Fournier's gangrene treated in a public tertiary hospital in western Paraná State. METHODS: we conducted a cross-sectional, retrospective and descriptive study of patients with Fournier's gangrene treated between January 2012 and November 2016. RESULTS: there were 40 patients with Fournier's gangrene treated in the period, 29 (72.5%) men and 11 (27.5%) women. The mean age was 51.7±16.3 years. The mean time of disease progression, from the initial symptom to hospitalization, was 10.5±1.2 days. All patients had clinical signs such as pain, bulging, erythema, among others, and 38 (95%) had associated comorbidities, the most common being type 2 diabetes mellitus and systemic arterial hypertension. The majority (30 patients - 75%) had perianal abscess as the probable etiology. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 1.8±1.1 surgeries per patient. Nine (22.5%) patients died. There was a strong correlation between the presence of sepsis on admission and mortality. CONCLUSION: Fournier's gangrene patients in this series had a long disease duration and a high prevalence of comorbidities, with a high mortality rate.


Assuntos
Gangrena de Fournier , Estudos Transversais , Feminino , Gangrena de Fournier/complicações , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Rev. Col. Bras. Cir ; 45(1): e1430, fev. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-956548

RESUMO

ABSTRACT Objective: to analyze the profile of patients with Fournier's gangrene treated in a public tertiary hospital in western Paraná State. Methods: we conducted a cross-sectional, retrospective and descriptive study of patients with Fournier's gangrene treated between January 2012 and November 2016. Results: there were 40 patients with Fournier's gangrene treated in the period, 29 (72.5%) men and 11 (27.5%) women. The mean age was 51.7±16.3 years. The mean time of disease progression, from the initial symptom to hospitalization, was 10.5±1.2 days. All patients had clinical signs such as pain, bulging, erythema, among others, and 38 (95%) had associated comorbidities, the most common being type 2 diabetes mellitus and systemic arterial hypertension. The majority (30 patients - 75%) had perianal abscess as the probable etiology. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 1.8±1.1 surgeries per patient. Nine (22.5%) patients died. There was a strong correlation between the presence of sepsis on admission and mortality. Conclusion: Fournier's gangrene patients in this series had a long disease duration and a high prevalence of comorbidities, with a high mortality rate.


ABSTRACT Objetivo: analisar o perfil dos pacientes com gangrena de Fournier tratados em um hospital público terciário do oeste do Paraná. Métodos: estudo transversal, retrospectivo e descritivo de pacientes portadores de gangrena de Fournier atendidos no período de janeiro de 2012 a novembro de 2016. Resultados: foram tratados 40 pacientes com gangrena de Fournier no período: 29 (72,5%) homens e 11 (27,5%) mulheres. A média de idade foi de 51,7±16,3 anos. A média de tempo de evolução da doença, do sintoma inicial até a internação, foi de 10,5±1,2 dias. Todos os pacientes apresentaram algum sinal clínico como dor, abaulamento, eritema, entre outros, e 38 (95%) tinham comorbidades associadas, sendo as mais comuns diabetes mellitus tipo 2 e hipertensão arterial sistêmica. A maioria (30 pacientes -75%) apresentava como etiologia provável abscesso perianal. Todos os pacientes foram submetidos à antibioticoterapia e tratamento cirúrgico com média de 1,8±1,1 cirurgias por paciente. Nove (22,5%) pacientes morreram. Houve forte correlação entre a presença de sepse na admissão e mortalidade. Conclusão: pacientes portadores de gangrena de Fournier, nesta casuística, apresentavam longo tempo de doença e elevada prevalência de comorbidades com alto índice de mortalidade.


Assuntos
Humanos , Masculino , Feminino , Gangrena de Fournier/cirurgia , Gangrena de Fournier/complicações , Gangrena de Fournier/diagnóstico , Estudos Transversais , Estudos Retrospectivos , Pessoa de Meia-Idade
6.
Acta cir. bras ; 30(12): 844-851, Dec. 2015. tab
Artigo em Inglês | LILACS | ID: lil-769503

RESUMO

ABSTRACT PURPOSE: To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS: A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS: The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION: The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Drenagem/métodos , Herniorrafia/reabilitação , Hérnia Incisional/cirurgia , Seroma/etiologia , Infecção da Ferida Cirúrgica/etiologia , Drenagem/efeitos adversos , Seguimentos , Hérnia Ventral/cirurgia , Hérnia Incisional/complicações , Reoperação , Seroma , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura/efeitos adversos
7.
J. coloproctol. (Rio J., Impr.) ; 35(3): 175-177, July-Sept. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-761641

RESUMO

ABSTRACT: Pilonidal sinus is a term first used by Hodges in 1880 to describe granulomatous lesions containing hairs in its interior. The presence of endoanal pilonidal sinus is rare and only nine cases have been reported in medical literature. This article describes a male, 42 years, initially submitted to fistulotomy with seton placement that four years later evolved with complaints of anal purulent discharge associated with painful anal groin. During the first evaluation a small endoanal tumor was found. It was located in posterolateral anus position and contained hair in its interior, without purulent discharge at that moment. Underwent surgery that confirmed the presence of endoanal pilonidal sinus. The sinus was opened and left to heal by secondary intention. The patient had good outcome with no signs of recurrence. (AU)


RESUMO: O termo cisto pilonidal foi descrito pela primeira vez por Hodges em 1880 para descrever lesões granulomatosas contendo pêlos em seu interior. A presença de cisto pilonidal endoanal é rara e existem apenas nove casos relatados na literatura médica. Descreve-se um caso masculino, 42 anos, em acompanhamento há 5 anos no serviço. Submetido inicialmente à fistulostomia em dois tempos com sedenho, evoluindo 4 anos depois com queixas de secreção purulenta intermitente por via anal associada a presença de tumoração dolorosa. No exame físico constatou-se presença de orifício contendo pêlos em seu interior, sem secreção purulenta no momento do exame. Foi encaminhado para tratamento cirúrgico que confirmou diagnóstico de cisto pilonidal endoanal. No procedimento foi realizada abertura do cisto que foi deixado para cicatrizar por segunda intenção. O paciente apresentou boa evolução, sem sinais de recidiva local. (AU)


Assuntos
Humanos , Masculino , Adulto , Canal Anal , Seio Pilonidal/diagnóstico
8.
Int J Surg Case Rep ; 8C: 35-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25622240

RESUMO

INTRODUCTION: Rene De Garengeot, a French surgeon, was the first to describe the presence of the appendix inside a femoral hernia sac in 1731. It is a rare entity that has fewer than 100 cases reported in literature. PRESENTATION OF CASE: An 86 years-old male patient, comes to Emergency Department complaining of painful bulging in the right inguinal region, associated with local inflammatory signs. He was initially diagnosed as incarcerated femoral hernia and underwent emergency open surgery. Inguinotomy was performed and after hernia sac dissection it was possible to observe the presence of the appendix incarcerated in its interior, without clinical signs of appendicitis. Surgeons performed appendectomy and inguinal repair of the femoral hernia with placement of a polypropylene mesh. DISCUSSION: De Garengeot hernia is a rare entity that requires early treatment in order to avoid possible complications. When facing a patient with incarcerated hernia emergency surgery must be indicated even if it is not possible to determine the contents of the hernia. CONCLUSION: This paper presents a case report of a De Garengeot hernia patient who presented a good evolution after surgery.

9.
Acta Cir Bras ; 30(12): 844-51, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26735057

RESUMO

PURPOSE: To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS: A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS: The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION: The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.


Assuntos
Drenagem/métodos , Herniorrafia/reabilitação , Hérnia Incisional/cirurgia , Seroma/etiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Drenagem/efeitos adversos , Feminino , Seguimentos , Hérnia Ventral/cirurgia , Humanos , Hérnia Incisional/complicações , Masculino , Pessoa de Meia-Idade , Reoperação , Seroma/diagnóstico por imagem , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura/efeitos adversos , Ultrassonografia
10.
J. bras. ginecol ; 109(1/4): 41-9, jan.-abr. 1999. ilus, tab, graf
Artigo em Português | LILACS | ID: lil-275790

RESUMO

Os autores apresentam uma revisäo sobre as propriedades farmacológicas do ibuprofeno, droga antiinflamatória-näo-esteroidal (AINE), e seu emprego na dismenorréia primária (DP), enfermidade de importante aspecto sócio-econômico devido a seus sintomas incapacitantes quando na forma severa. Säo abordados aspectos sobre farmacocinética, farmacodinâmica, indicaçöes clínicas, interaçöes medicamentosas e efeitos adversos da droga, revelando-se o ibuprofeno como o AINE que apresenta, na vigência de seu uso, a menor incidência de distúrbios gastrointestinais quando comparado aos demais AINE. Em relaçäo a seu uso na DP, säo analisados estudos onde compara-se a eficácia do ibuprofeno à eficácia de outros AINES em relaçäo ao alívio dos sintomas dismenorreícos. Conclui-se ser o ibuprofeno, devido à sua ótima eficácia no alívio da dor e sua baixíssima incidência efeitos adversos, e a droga de escolha no tratamento da DP, tendo nesta sua grande indicaçäo


Assuntos
Humanos , Feminino , Dismenorreia/tratamento farmacológico , Dismenorreia/fisiopatologia , Ibuprofeno/efeitos adversos , Ibuprofeno/farmacocinética , Ibuprofeno/uso terapêutico , Anti-Inflamatórios não Esteroides/farmacocinética , Anti-Inflamatórios não Esteroides/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...