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Dis Colon Rectum ; 65(1): 108-116, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34538832


BACKGROUND: Fecal management systems have become ubiquitous in hospitalized patients with fecal incontinence or severe diarrhea, especially in the setting of perianal wounds. Although fecal management system use has been shown to be safe and effective in initial series, case reports of rectal ulceration and severe bleeding have been reported, with a relative paucity of clinical safety data in the literature. OBJECTIVE: The purpose of this study was to determine the rate of rectal complications attributable to fecal management systems, as well as to characterize possible risk factors and appropriate management strategies for such complications. DESIGN: This was a retrospective cohort study. SETTINGS: The study was conducted at a large academic medical center. PATIENTS: All medical and surgical patients who underwent fecal management system placement from December 2014 to March 2017 were included. MAIN OUTCOME MEASURES: We measured any rectal complication associated with fecal management system use, defined as any rectal injury identified after fecal management system use confirmed by lower endoscopy. RESULTS: A total of 629 patients were captured, with a median duration of fecal management system use of 4 days. Overall, 8 patients (1.3%) experienced a rectal injury associated with fecal management system use. All of the patients who experienced a rectal complication had severe underlying comorbidities, including 2 patients on dialysis, 1 patient with cirrhosis, and 3 patients with a recent history of emergent cardiac surgery. In 3 patients the bleeding resolved spontaneously, whereas the remaining 5 patients required intervention: transanal suture ligation (n = 2), endoscopic clip placement (n = 1), rectal packing (n = 1), and proctectomy in 1 patient with a history of pelvic radiotherapy. LIMITATIONS: The study was limited by its retrospective design and single institution. CONCLUSIONS: This is the largest study to date evaluating rectal complications from fecal management system use. Although rectal injury rates are low, they can lead to serious morbidity. Advanced age, severe comorbidities, pelvic radiotherapy, and anticoagulation status or coagulopathy are important factors to consider before fecal management system placement. See Video Abstract at INCIDENCIA Y CARACTERIZACIN DE LAS COMPLICACIONES RECTALES DE LOS SISTEMAS DE MANEJO FECAL: ANTECEDENTES:Los sistemas de manejo fecal se han vuelto omnipresentes en pacientes hospitalizados con incontinencia fecal o diarrea severa, especialmente en el contexto de heridas perianales. Aunque se ha demostrado que el uso del sistema de tratamiento fecal es seguro y eficaz en la serie inicial, se han notificado casos de ulceración rectal y hemorragia grave, con una relativa escasez de datos de seguridad clínica en la literatura.OBJETIVO:Determinar la tasa de complicaciones rectales atribuibles a los sistemas de manejo fecal. Caracterizar los posibles factores de riesgo y las estrategias de manejo adecuadas para tales complicaciones.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:Centro médico académico de mayor volumen.PACIENTES:Todos los pacientes médicos y quirúrgicos que se sometieron a la colocación del sistema de manejo fecal desde diciembre de 2014 hasta marzo de 2017.PRINCIPALES MEDIDAS DE VALORACION:Cualquier complicación rectal asociada con el uso del sistema de manejo fecal, definida como cualquier lesión rectal identificada después del uso del sistema de manejo fecal confirmada por endoscopia baja.RESULTADOS:Se identificaron un total de 629 pacientes, con una duración media del uso del sistema de manejo fecal de 4,0 días. En general, 8 (1,3%) pacientes desarrollaron una lesión rectal asociada con el uso del sistema de manejo fecal. Todos los pacientes que mostraron una complicación rectal tenían comorbilidades subyacentes graves, incluidos dos pacientes en diálisis, un paciente con cirrosis y tres pacientes con antecedentes recientes de cirugía cardíaca emergente. En tres pacientes el sangrado se resolvió espontáneamente, mientras que los cinco pacientes restantes requirieron intervención: ligadura de sutura transanal (2), colocación de clip endoscópico (1), taponamiento rectal (1) y proctectomía en un paciente con antecedentes de radioterapia pélvica.LIMITACIONES:Diseño retrospectivo, institución única.CONCLUSIONES:Este es el estudio más grande hasta la fecha que evalúa las complicaciones rectales del uso del sistema de manejo fecal. Si bien las tasas de lesión rectal son bajas, pueden provocar una morbilidad grave. La edad avanzada, las comorbilidades graves, la radioterapia pélvica y el estado de anticoagulación o coagulopatía son factores importantes a considerar antes de la colocación del sistema de manejo fecal. Consulte Video Resumen en

Incontinência Fecal/terapia , Fissura Anal/diagnóstico , Hemorragia/diagnóstico , Doenças Retais/patologia , Reto/lesões , Idoso , Comorbidade/tendências , Gerenciamento Clínico , Endoscopia do Sistema Digestório/métodos , Incontinência Fecal/epidemiologia , Feminino , Fissura Anal/epidemiologia , Fissura Anal/cirurgia , Hemorragia/epidemiologia , Hemorragia/cirurgia , Humanos , Incidência , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pelve/patologia , Pelve/efeitos da radiação , Protectomia/métodos , Doenças Retais/cirurgia , Reto/diagnóstico por imagem , Reto/patologia , Estudos Retrospectivos , Fatores de Risco , Segurança , Suturas , Cirurgia Endoscópica Transanal/métodos
Pediatr Surg Int ; 37(5): 627-630, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33423100


PURPOSE: Pediatric surgeons at our institution are often asked by families about a theoretical increased risk of severe common upper respiratory infections in children status post lung resection. No data exist on this topic. We, therefore, aimed to examine the risk of severe respiratory infection in children after pulmonary resection. METHODS: A chart review was conducted on all pediatric patients who underwent pulmonary resection between August 1st, 2009 and January 31st, 2019. Collected data included patient characteristics, operation, complications and any admission for respiratory infection. RESULTS: Fifty-seven patients met inclusion criteria. Resections included lobectomy (45.6%), segmentectomy (14.0%), and wedge resection (40.4%). Twelve (21.1%) were immunocompromised and 6 (10.5%) had post-operative complications. Within 1 year of surgery, 2 (3.5%) patients were hospitalized for a viral upper respiratory illness (URI), 1 (1.8%) for bacterial pneumonia, and none due to influenza. CONCLUSION: In the general pediatric population, the risk of admission for respiratory illness is 3-21%. At this institution, overall risk of respiratory infection after lung resection appears comparable to baseline community risk. Our findings could aid counseling pediatric patients and their families regarding the 1-year risk of infection after lung resection.

Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias , Infecções Respiratórias/etiologia , Criança , Feminino , Humanos , Lactente , Pulmão/cirurgia , Masculino , Pediatria , Pneumonectomia
Biomed Mater ; 13(3): 035013, 2018 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-29362293


Controlling acidic degradation of biodegradable polyesters remains a major clinical challenge. This work presents a simple and effective strategy of developing polyester composites with biodegradable magnesium metal or alloys. PLGA samples with compositions of 1, 3, 5, and 10 wt% magnesium were produced using a simple solvent-casting method, which resulted in composite films with near uniform Mg metal/alloy particle dispersion. Degradation study of the composite films showed that all compositions higher than 1 wt% magnesium were able to extend the duration of degradation, and buffer acidic pH resulting from PLGA degradation. PLGA composite with 5 wt% of magnesium showed near-neutral degradation pattern under sink conditions. Magnesium addition also showed improved mechanical characteristics in terms of the tensile modulus. In vitro experiments conducted by seeding PLGA composites with MC3T3-E1 pre-osteoblasts demonstrated increased ALP expression and cellular mineralization. The established new biodegradable polymer-metal system provides a useful biomaterial platform with a wide range of applications in biomedical device development and scaffold-based tissue engineering.

Materiais Biocompatíveis/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Engenharia Tecidual/métodos , Células 3T3 , Fosfatase Alcalina/metabolismo , Ligas/química , Animais , Proliferação de Células , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/química , Magnésio/química , Camundongos , Osteoblastos/metabolismo , Tamanho da Partícula , Poliésteres/química , Ácido Poliglicólico/química , Estresse Mecânico , Resistência à Tração , Tecidos Suporte/química
Tissue Eng Part A ; 22(7-8): 610-20, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26914219


Despite recent progress, segmental bone defect repair is still a significant challenge in orthopedic surgery. While bone tissue engineering approaches using biodegradable matrices along with bone/blood vessel forming cells offered improved possibilities, current regenerative strategies lack the ability to achieve vascularized bone regeneration in critical-sized/segmental bone defects. In this study, we introduced and evaluated a two-pronged approach for vascularized bone regeneration in vivo. The goal was to demonstrate vascularized bone formation using oxygen tension-controlled (OTC) matrices seeded with bone and blood vessel forming cells. OTC matrices were coimplanted with rabbit mesenchymal stem cells (MSCs) and peripheral blood-derived endothelial progenitor cells (PB-EPCs) to demonstrate the osteogenic and vasculogenic differentiation of these cells, postseeding on a matrix, especially deep inside the matrix pore structure. Matrices coimplanted with varied rabbit MSC and PB-EPC ratios (1:4, 1:1, and 4:1) were assessed in a nude mouse subcutaneous implantation model to determine a coimplantation ratio with superior osteogenic as well as vasculogenic properties. The implants were analyzed, at week 8, for endothelial (CD31 and Von Willebrand factor [vWF]) and osteogenic marker (RunX2 and Col I) staining qualitatively and collagen deposition and number of vessel formation quantitatively. Results from these experiments established MSC-to-PB-EPC ratio 1:1 as the best coimplantation ratio. OTC matrix with 1:1 coimplantation ratio was assessed for segmental bone defect repair in a rabbit critical-sized bone defect model. The group under investigation was OTC matrix, and the matrix was seeded with MSCs, EPCs, or MSCs:EPCs in a 1:1 ratio. Explants at week 12 were evaluated for bone defect repair via micro-CT and histology. Results from rabbit in vivo experiments show enhanced mineralization and vascularization for the 1:1 coimplantation group. Overall, the study establishes a two-pronged approach involving OTC matrix and effective progenitors for large-area and vascularized bone regeneration.

Regeneração Óssea/efeitos dos fármacos , Células Endoteliais/citologia , Células-Tronco Mesenquimais/citologia , Neovascularização Fisiológica/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Oxigênio/farmacologia , Tecidos Suporte/química , Animais , Biomarcadores/metabolismo , Modelos Animais de Doenças , Células Endoteliais/efeitos dos fármacos , Imunofluorescência , Implantes Experimentais , Células-Tronco Mesenquimais/efeitos dos fármacos , Camundongos SCID , Coelhos , Ulna/diagnóstico por imagem , Ulna/efeitos dos fármacos , Ulna/patologia , Microtomografia por Raio-X