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1.
Urology ; 136: 245-250, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31751624

RESUMO

OBJECTIVE: To compare the outcomes of patients who underwent early repair (≤7 days) of iatrogenic ureteral injury with ureteroneocystostomy and compare them to those repaired in a delayed fashion (>7 days). METHODS: A retrospective review of billing data between 2012 and 2018 identified patients who underwent ureteroneocystostomy for a benign ureteral disease. Inclusion criteria included all ureteral injuries related to a laparoscopic, robotic, or open surgical injury. Patients with ureteral injury related to radiation, stones, or reconstructive surgery were excluded. Patients undergoing reconstruction during the initial injury or within ≤7 days were designated as having undergone early repair, while the remaining were considered delayed repair. Demographics, as well as inpatient and postdischarge data were acquired, and statistical analysis was performed comparing the 2 groups. RESULTS: Sixty-seven patients met inclusion criteria. Early repair was performed on 12 patients, while 55 underwent delayed repair. No significant difference in age, gender, Charlson Comorbidity Score, laterality, stricture location, or history of pelvic/abdominal radiation was noted. Inpatient complications were significantly higher in the immediate group (58 vs 18%, P =.004). Thirty- and 90-day complications were similar. Two patients in the delayed group and none in the immediate group demonstrated stricture recurrence (P =.710). A higher rate of Boari flap ureteral reconstruction was performed in the delayed cohort (P =.001). CONCLUSION: In this cohort, there was no detectable difference in outcomes when comparing early and delayed ureteroneocystostomy for iatrogenic ureteral injuries.


Assuntos
Cistostomia , Complicações Intraoperatórias/cirurgia , Ureter/lesões , Ureter/cirurgia , Ureterostomia , Adulto , Cistostomia/métodos , Intervenção Médica Precoce , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ureterostomia/métodos
2.
World Neurosurg ; 133: e275-e280, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31518747

RESUMO

BACKGROUND: The acellular dermal matrix (ADM) and turbinate flap (TF) have been widely used in the reconstruction of skull base defects. However, owing to the lack of reported data, the therapeutic effects have been controversial. The purpose of the present study was to compare the effect of the ADM and TF on cerebrospinal fluid (CSF) rhinorrhea after nasal endoscopic resection of a skull base tumor. METHODS: The data from 46 patients who had undergone nasal endoscopic resection of a skull base tumor and repair of CSF rhinorrhea were retrospectively analyzed. The patients were divided into ADM and TF groups according to the difference in repair materials used. We compared and analyzed the intraoperative information and postoperative outcomes. RESULTS: The operation time, blood loss, defect area, and need for blood transfusion were not significantly different between the ALT and TF groups. The postoperative length of hospital stay (14.33 ± 3.66 vs. 16.76 ± 5.51 days; P = 0.669) and the incidence of complications, including wound infection (1 vs. 0; P = 0.270), intracranial infection (1 vs. 1; P = 0.900), hemorrhage (2 vs. 3; P = 0.788), 15-day CSF leak (1 vs. 2; P = 0.658), and respiratory infection (2 vs. 1; P = 0.450) were comparable between the 2 groups. The 6-month (0 vs. 0; P = 1.000) and 12-month (0 vs. 0; P = 1.000) incidence of recurrence also showed no significant differences. CONCLUSION: The use of the ADM for patients with CSF rhinorrhea showed comparable results in terms of postoperative outcomes compared with the use of TF. ADM could serve as a safe and feasible alternative for endoscopic repair of CSF rhinorrhea after nasal endoscopic resection of skull base tumors.


Assuntos
Derme Acelular , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Complicações Intraoperatórias/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Retalhos Cirúrgicos , Conchas Nasais/transplante , Adulto , Idoso , Perda Sanguínea Cirúrgica , Rinorreia de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Neuroimagem , Duração da Cirurgia , Estudos Retrospectivos
3.
Urology ; 137: 146-151, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887351

RESUMO

OBJECTIVE: To explore a series of classic bladder exstrophy (CBE) cases referred to the authors' institution where primary closure with penile disassembly epispadias repair was complicated by penile injury. The penile disassembly technique is frequently combined with bladder closure in patients with CBE undergoing the complete primary repair of exstrophy (CPRE). Penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. METHODS: A prospectively-maintained institutional database of 1337 exstrophy-epispadias complex patients was reviewed for CPRE cases referred to the authors' institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. RESULTS: One hundred and thirteen male CBE patients were referred after prior CPRE. Twenty-six (20%) were identified with penile loss and reviewed. Eighty-one percent were closed in the neonatal period, and 54% had a pelvic osteotomy. Median follow-up time was 9.9 years (range 0.6-21.3). Of 26 patients with penile loss, 77% had unilateral loss and in 23% had bilateral loss involving the glans and/or one or both corpora cavernosa. Three patients were successfully managed with myocutaneous neophalloplasty. CONCLUSION: Complete penile disassembly during bladder exstrophy closure may lead to penile injury. This major complication questions the continued application of complete penile disassembly in the reconstruction of bladder exstrophy.


Assuntos
Extrofia Vesical/cirurgia , Epispadia/cirurgia , Complicações Intraoperatórias , Doenças do Pênis , Pênis , Procedimentos Cirúrgicos Urológicos , Atrofia , Criança , Humanos , Recém-Nascido , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/irrigação sanguínea , Pênis/lesões , Pênis/patologia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
5.
Surgery ; 166(4): 698-702, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31439402

RESUMO

BACKGROUND: Bile duct injury during laparoscopic cholecystectomy persists as a significant problem in general surgery, resulting in complex injuries, arterial damage, and post repair strictures. METHODS: We performed a retrospective analysis between 2 eras of bile duct injury repairs: 1987 to 2001 (n = 58) and 2002 to 2016 (n = 52) using logistic regression analyses to assess presentation, repair complexity, and outcomes. RESULTS: No differences in demographics, incidence of cholecystitis, conversion, time to presentation, level of injury, or arterial injury were identified. The second era had an increase in patient age, transhepatic catheter use, prior repair, and utilization of complex repairs. This approach resulted in equivalent complications and mortality rates with increased resource utilization but a lesser incidence of post-repair strictures (P = .004). Regression modeling correlated strictures to prior operative repairs (OR 4.25; P = .016) and a protective effect of repairs performed in the second era (OR 0.23; P = .045). CONCLUSION: The second era identified a decreasing trend of attempted repairs by referring surgeons but an increase in transhepatic catheters and complex repairs resulting in lesser rates of post-repair stricture. Final regression modeling confirmed increased operative experience decreased post-repair stricture reaffirming the benefits of early identification and referral of bile duct injuries to an experienced hepatobiliary surgeon at a specialty center.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Doença Iatrogênica/epidemiologia , Complicações Intraoperatórias/cirurgia , Adulto , Idoso , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/métodos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
Gastrointest Endosc Clin N Am ; 29(4): 705-719, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31445692

RESUMO

Large and complex colon polyps are frequently referred to surgery for fear of perforation that may need emergency surgery. During the last 15 years, advances in clip and suturing devices allowed us to close perforations and avoid surgery. In addition, we have made substantial progress in our understanding of the lesions at risk for either immediate or delayed perforation. This article focuses on the colonoscopic closure of resection defects and perforations and the prevention and treatment of colon perforations after endoscopic resection.


Assuntos
Colonoscópios , Colonoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Perfuração Intestinal/cirurgia , Complicações Intraoperatórias/cirurgia , Idoso , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Prognóstico , Instrumentos Cirúrgicos , Técnicas de Sutura , Técnicas de Fechamento de Ferimentos/instrumentação
7.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31427852

RESUMO

Background: Laparoscopic surgery is safe in pregnancy, but is not without risk. Inadvertent uterine perforation of the gravid uterus is a rare complication. Cases: Three pregnant women had inadvertent uterine perforation during laparoscopic surgery. All patients were counseled regarding the risks of an "incidental fetoscopy" and elected to continue the pregnancy. Two delivered after preterm premature rupture of membranes at 32 and 36 weeks' gestation, and one twin pregnancy delivered at 30 weeks due to preeclampsia. Conclusion: Surgical planning of the gravid patient undergoing laparoscopic surgery should include demarcation of the most superior aspect of the uterine fundus, either via physical examination or, if not conclusive, via preoperative or intraoperative ultrasound.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Complicações na Gravidez/etiologia , Perfuração Uterina/etiologia , Útero/lesões , Adulto , Apendicite/cirurgia , Cesárea , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Recém-Nascido , Complicações Intraoperatórias/cirurgia , Trabalho de Parto Prematuro/etiologia , Pré-Eclâmpsia/etiologia , Gravidez , Complicações na Gravidez/cirurgia , Resultado da Gravidez , Gravidez Múltipla , Perfuração Uterina/cirurgia
8.
Medicine (Baltimore) ; 98(28): e16385, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305442

RESUMO

RATIONALE: Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS: A 40-year-old woman presented with repeated chest pain. DIAGNOSIS: Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS: The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES: The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS: Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.


Assuntos
Complicações Intraoperatórias , Embolia Pulmonar/etiologia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Reoperação , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia
9.
Int J Med Sci ; 16(5): 665-674, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31217734

RESUMO

BACKGROUNDː Dysglycemia is associated with adverse outcome including increased morbidity and mortality in surgical patients. Acute insulin resistance due to the surgical stress response is seen as a major cause of so-called stress hyperglycemia. However, understanding of factors determining blood glucose (BG) during surgery is limited. Therefore, we investigated risk factors contributing to intraoperative dysglycemia. METHODSː In this subgroup investigation of the BIOCOG study, we analyzed 87 patients of ≥ 65 years with tight intraoperative BG measurement every 20 min during elective surgery. Dysglycemia was defined as at least one intraoperative BG measurement outside the recommended target range of 80-150 mg/dL. Additionally, all postoperative BG measurements in the ICU were obtained. Multivariable logistic regression analysis adjusted for age, sex, American Society of Anesthesiologists (ASA) status, diabetes, type and duration of surgery, minimum Hemoglobin (Hb) and mean intraoperative norepinephrine use was performed to identify risk factors of intraoperative dysglycemia. RESULTSː 46 (52.9%) out of 87 patients developed intraoperative dysglycemia. 31.8% of all intraoperative BG measurements were detected outside the target range. Diabetes [OR 9.263 (95% CI 2.492, 34.433); p=0.001] and duration of surgery [OR 1.005 (1.000, 1.010); p=0.036] were independently associated with the development of intraoperative dysglycemia. Patients who experienced intraoperative dysglycemia had significantly elevated postoperative mean (p<0.001) and maximum BG levels (p=0.001). Length of ICU (p=0.007) as well as hospital stay (p=0.012) were longer in patients with dysglycemia. CONCLUSIONSː Diabetes and duration of surgery were confirmed as independent risk factors for intraoperative dysglycemia, which was associated with adverse outcome. These patients, therefore, might require intensified glycemic control. Increased awareness and management of intraoperative dysglycemia is warranted.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/cirurgia , Hiperglicemia/epidemiologia , Complicações Intraoperatórias/epidemiologia , Idoso , Glicemia/metabolismo , Complicações do Diabetes/patologia , Complicações do Diabetes/cirurgia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Feminino , Humanos , Hiperglicemia/etiologia , Hiperglicemia/patologia , Hiperglicemia/cirurgia , Insulina/metabolismo , Resistência à Insulina/genética , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Masculino , Fatores de Risco
10.
Eur J Orthop Surg Traumatol ; 29(7): 1549-1557, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31154509

RESUMO

Management of chronic neglected patellar tendon rupture represents a challenging condition for the orthopedic surgeons to deal with due to many factors such as quadriceps muscle atrophy, superior migration of the patella, e.g., patella alta, peri-patellar adhesions and patellar tendon atrophy. Such difficulties might be further complicated by intra-operative patellar fracture during patellar tendon reconstruction. In the current article, the authors report (1) a salvage procedure for such devastating intra-operative complication, based on bypassing the patella and gaining the advantage of the quadriceps tendon for structural and functional restoration of the knee extensor mechanism, and (2) prophylactically a technical modification of patellar tendon reconstruction guarding against such inadvertent patellar fracture.


Assuntos
Fraturas Ósseas/cirurgia , Patela/lesões , Ligamento Patelar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Terapia de Salvação/métodos , Adolescente , Doença Crônica , Fraturas Ósseas/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Masculino , Patela/cirurgia , Ligamento Patelar/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ruptura/cirurgia
11.
World Neurosurg ; 129: 242-244, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207372

RESUMO

BACKGROUND: Acute stent thrombosis is a rare adverse event following endovascular treatment of carotid artery. Experience on the topic is scarce, making the therapeutic approach a clinical challenge. In cases of intraprocedural acute carotid stent thrombosis, thromboaspiration, thrombectomy, and thrombolysis have been used as successful modalities for achieving recanalization. CASE DESCRIPTION: We describe a case of carotid artery dissection treated endovascularly and complicated by intraprocedural stent thrombosis, which was ultimately managed by emergent extracranial-intracranial bypass with radial artery graft connecting the external carotid artery to the ipsilateral middle cerebral artery. CONCLUSIONS: Neurosurgical management may represent a rescue option for otherwise unmanageable acute carotid stent thrombosis.


Assuntos
Trombose das Artérias Carótidas/etiologia , Estenose das Carótidas/cirurgia , Revascularização Cerebral/métodos , Procedimentos Endovasculares/efeitos adversos , Complicações Intraoperatórias/cirurgia , Stents/efeitos adversos , Trombose das Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade
12.
Rev. bras. cir. plást ; 34(2): 264-267, apr.-jun. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1015987

RESUMO

A hidradenite supurativa (HS) é uma doença inflamatória crônica da pele caracterizada por apresentar nodulações subcutâneas, dolorosas e com sinais flogísticos, inicialmente enrijecidas e que evoluem para consistência amolecida. Ocorre em 1 a 4% da população mundial. A sua etiologia ainda é pouco conhecida, sugere-se que aconteça devido à oclusão do ducto apócrino dos folículos pilosos por fatores precipitantes como fricção de tecido adiposo, higiene precária, entre outras. Seu diagnóstico é eminentemente clínico, pela identificação de lesões típicas recorrentes em forma de nodularidades, abcessos, tratos fistulosos ou cicatrizes. Não há testes patognomônicos. Sua evolução é variável e de difícil manejo, o qual pode ser feito com terapia tópica, sistêmica ou por exérese cirúrgica. Este trabalho revisa a avaliação por imagem da hidroadenite supurativa e demonstra imagens de um caso avaliado por ressonância magnética. A avaliação por exames de imagem, apesar de pouco específica para firmar diagnóstico, é muito útil na determinação da extensão da doença, assim como na exclusão de diagnósticos diferenciais, destacando-se o papel da ressonância magnética na avaliação das lesões anogenitais, com potencial de reduzir recorrências.


Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful deep-seated skin nodules with phlogistic signs, which are initially hard and progress to have a soft consistency. It occurs in 1­4% of the world population. Etiology of HS is still poorly understood and is suggested to occur due to occlusion of the apocrine duct of the hair follicles by triggering factors such as friction of the adipose tissue and poor hygiene, among others. Diagnosis is eminently clinical, through the identification of typical recurrent lesions that include nodules, abscesses, sinus tracts, or scars. There are no pathognomonic tests used to confirm its presence. Progression is variable and difficult to manage, which can be done with topical or systemic therapy or surgical excision. This work reviews the imaging assessment of HS and shows images of a case assessed by magnetic resonance imaging. Imaging assessment, although not specific enough for a diagnosis, is useful to determine the extent of the disease and to exclude differential diagnoses. Moreover, magnetic resonance imaging has an important role in the assessment of anogenital lesions and a potential to reduce recurrences.


Assuntos
Humanos , Masculino , Feminino , Adulto , Imagem por Ressonância Magnética/métodos , Ultrassonografia/métodos , Hidradenite Supurativa/cirurgia , Hidradenite Supurativa/etiologia , Hidradenite Supurativa/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Análise de Frequência de Ressonância/métodos , Complicações Intraoperatórias/cirurgia , Doença Nodular Cutânea/cirurgia , Doença Nodular Cutânea/etiologia , Doença Nodular Cutânea/diagnóstico por imagem
13.
Rev. bras. cir. plást ; 34(2): 283-286, apr.-jun. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1015992

RESUMO

Defeitos parciais de orelha podem ser tratados de diversas formas, dentre elas o fechamento primário, cicatrização por segunda intenção ou retalhos. Diversas opções técnicas foram descritas para a sua reconstrução de modo a manter o contorno natural da orelha, sem sacrificar tecido sadio ou alterar sua estética e função. Apresentamos neste artigo dois casos atendidos no Instituto do Câncer do Hospital de Base de São José do Rio Preto de reconstrução de defeitos condrocutâneos de orelha após ressecção de carcinoma basocelular em região central da orelha, com a confecção de retalho retroauricular ilhado transposto através de uma janela cartilaginosa e com o pedículo desepidermizado. Área doadora com fechamento primário. Tal procedimento constitui técnica segura, pois a região retroauricular é ricamente vascularizada, é de fácil execução, em único estágio e com resultado estético e funcional satisfatório.


Partial ear defects can be treated in several ways, including primary closure, healing by secondary intention, or flaps. Several surgical options have been described for reconstruction in order to maintain the natural contour of the ear, without sacrificing healthy tissues or changing the aesthetics and function. In this article, we present two cases of reconstruction of chondrocutaneous defects of the ear after resection of basal cell carcinoma in the central region of the ear, with the production of a retroauricular island flap transposed through a cartilaginous window with the de-epidermized pedicle. The donor area healed following a primary closure. This procedure can be performed in a single stage, yields satisfactory aesthetic and functional results, and is safe because the retroauricular region is richly vascularized.


Assuntos
Humanos , Masculino , Adulto , Idoso , Retalhos Cirúrgicos/cirurgia , Retalhos Cirúrgicos/efeitos adversos , Neoplasias da Orelha/cirurgia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cartilagem da Orelha/anormalidades , Cartilagem da Orelha/cirurgia , Cartilagem da Orelha/crescimento & desenvolvimento , Deformidades Adquiridas da Orelha/cirurgia , Orelha Externa/anatomia & histologia , Orelha Externa/anormalidades , Orelha Externa/cirurgia , Complicações Intraoperatórias/cirurgia , Complicações Intraoperatórias/prevenção & controle
15.
J Shoulder Elbow Surg ; 28(7): e226-e231, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31085033

RESUMO

BACKGROUND: The Latarjet procedure is the preferred method to treat recurrent anterior shoulder instability with glenoid deficiency. An iatrogenic fracture of the transferred coracoid process is one possible intraoperative complication. METHODS: We propose a rescue technique using double-row suture bridge fixation. Double-loaded 4.5-mm suture anchors were placed medially in the scapular neck. These sutures were then brought over the top of the coracoid fragment, placed around the bony fragment, and fixated to the glenoid face with knotless suture anchors. RESULTS: Radiologic evidence of bone graft healing was observed in the desired position. CONCLUSIONS: We present a salvage procedure that will assist surgeons if an intraoperative fracture of the coracoid bone graft occurs during fixation when performing the Latarjet procedure.


Assuntos
Processo Coracoide/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Complicações Intraoperatórias/cirurgia , Instabilidade Articular/cirurgia , Articulação do Ombro , Adulto , Artroplastia/efeitos adversos , Transplante Ósseo/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Âncoras de Sutura , Tomografia Computadorizada por Raios X
16.
World Neurosurg ; 128: 314-319, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31125771

RESUMO

BACKGROUND: Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. CASE DESCRIPTION: Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. CONCLUSION: Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Artérias Temporais/cirurgia , Adulto , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Revascularização Cerebral/métodos , Feminino , Humanos
17.
Ann Surg Oncol ; 26(8): 2579, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31065963

RESUMO

BACKGROUND: The intraoperative air cholangiogram, or "air leak test" (ALT), at the time of hepatectomy can significantly reduce the rates of bile leak and symptomatic fluid collection after high-risk procedures.1,2 Because a bile leak in the setting of an en bloc diaphragm resection and mesh reconstruction would be a particularly dreaded complication, this video shows the technique for resection, reconstruction, and ALT. PRESENTATION: The video presents the case of a 29-year-old woman who had metastatic teratoma with an 8 × 7-cm liver metastasis in segment 7 and diaphragm invasion to the level of the right hepatic vein. OPERATION: The authors performed a formal right posterior sectionectomy with en bloc diaphragm resection. The 12 × 8-cm diaphragmatic defect was reconstructed using biologic mesh (Surgimend, Integra LifeSciences, Plainsboro, NJ). An intraoperative ALT (air injection into the cystic duct with finger compression of the distal bile duct) identified several areas of bubbles from biliary radicles on the cut surface of the liver, which were ligated with 4-0 polypropylene. The ALT was repeated until no bubbles remained. Because no evidence of bubbles was observed, no surgical drain was needed. The patient did well postoperatively with no complications. CONCLUSION: In cases of combined liver and diaphragmatic resection, prevention of bile leak, with subsequent contamination of the diaphragm repair and even the thoracic cavity, is particularly vital. An easily replicated intraoperative air leak test can mitigate the risk of bile leak and organ-space infection, as well as associated sequelae on quality of life, return to intended oncologic therapy, and oncologic outcomes.


Assuntos
Fístula Anastomótica/diagnóstico , Ducto Colédoco/lesões , Hepatectomia/métodos , Complicações Intraoperatórias/diagnóstico , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Teratoma/cirurgia , Adulto , Fístula Anastomótica/cirurgia , Ducto Colédoco/cirurgia , Feminino , Humanos , Complicações Intraoperatórias/cirurgia , Neoplasias Hepáticas/patologia , Prognóstico , Teratoma/patologia
18.
World Neurosurg ; 128: e454-e460, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051305

RESUMO

BACKGROUND: Endovascular coiling is generally considered as an effective treatment option for ruptured intracranial aneurysms. Increasing operator experience and quality of tools determined an improvement of endovascular cerebral aneurysms' treatment. However, procedure-related complications still occur. The purpose of this study is to report a series of rescue stenting procedures with the Neuroform Atlas (NA) open-cell stent, for intraprocedural complications during coil embolization in patients with ruptured intracranial aneurysms. METHODS: Between April 2016 and January 2018, 12 consecutive coil protrusions that occurred during ruptured aneurysms' embolizations were rescued using NA stenting together with tirofiban therapy. Follow-up was performed with initial magnetic resonance angiography (MRA) at 1 month and then MRA plus standard digital subtraction angiography at 11-13 months after the procedure. RESULTS: Technical success was achieved in 100% of patients. No NA stent delivery/deployment complication occurred. Initial MRA showed complete occlusion of the aneurysm, with evidence of blood flow into parent vessels in 12 out of 12 cases. At 11-13 months, MRA and digital subtraction angiography showed 10 complete occlusion cases and 1 partial occlusion case. At 2 months, 1 death occurred due to subarachnoid hemorrhage. CONCLUSIONS: The open-cell NA stent represents a rescue option for coil protrusion during endovascular treatment of ruptured intracranial aneurysms allowing regular restoration of blood flow and minimizing thromboembolic events.


Assuntos
Aneurisma Roto/cirurgia , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Complicações Intraoperatórias/cirurgia , Stents , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Angiografia Digital , Angiografia Cerebral , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Int Orthop ; 43(11): 2637-2647, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30968166

RESUMO

BACKGROUND: Cementless hemiarthroplasty is a widely used treatment for femoral neck fractures. Intra-operative femoral fracture occasionally occurs during the procedure, and the use of cerclage wire has been proposed to stabilize both the prosthesis and the bone. This study aimed to investigate the outcomes of cerclage wiring to manage intra-operative fractures occurring during cementless hemiarthroplasty in older patients with a femoral neck fracture. METHODS: Medical records and radiographs of older patients with femoral neck fractures who underwent hemiarthroplasty during 2009 to 2015 were retrospectively reviewed. Patients who received cerclage wiring were matched with a demographically matched control group that did not. Patients were followed for at least 12 months. Functional outcomes and health-related quality of life were evaluated by determining the distance of distal stem migration, Barthel Index, EuroQol-visual analog scale (VAS), and pain-VAS. RESULTS: Eighty-one patients were included, comprising 27 study group and 54 control group patients. A tapered wedge-shaped femoral prosthesis was implanted in all cases. No significant differences in distance of distal stem migration or rate of stem subsidence > 2 mm were observed between the case and control groups (subsidence rate 11.1 vs. 14.8%, respectively). There was also no significant difference in functional outcomes between groups. CONCLUSION: Our results revealed a low mean distance of distal stem migration and a low subsidence rate. Functional outcomes and quality of life were similar between the two groups. Cerclage wiring technique is safe, and it should be routinely performed when intra-operative femoral fracture occurs during cementless hemiarthroplasty.


Assuntos
Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Hemiartroplastia/efeitos adversos , Fraturas por Osteoporose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fios Ortopédicos , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fêmur/diagnóstico por imagem , Fêmur/lesões , Hemiartroplastia/métodos , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/etiologia , Estudos Retrospectivos , Resultado do Tratamento
20.
Gen Thorac Cardiovasc Surg ; 67(11): 969-975, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31004316

RESUMO

BACKGROUND: The aim of this study was to discuss indications and outcomes for conversion to thoracotomy during thoracoscopic lobectomy. MATERIALS AND METHODS: Patients who underwent lobectomy for non-small cell lung cancer between January 2012 and December 2016 were evaluated retrospectively. The study included 129 patients who underwent video-assisted thoracoscopic lobectomy (group-V) and 18 patients converted from thoracoscopic lobectomy to thoracotomy due to unexpected intraoperative complications (group-T). RESULTS: The two patient groups showed no statistical differences in terms of demographic characteristics. Causes of unexpected conversions to thoracotomy were hemorrhage in six patients, dense pleural adhesions in seven patients, fused fissure in one patient, and fibrocalcified lymph nodes around the vascular structures in four patients. Operative time was 180.37 ± 68.6 min in group-V and 235 ± 72.6 min in group-T (p = 0.003). Intraoperative blood loss was 263.9 ± 180.6 mL in group-V, compared to 562.7 ± 296.2 mL in group-T (p < 0.001). Patient age ≥ 70 years was a significant risk factor for conversion to thoracotomy (p = 0.015, odds ratio 4.73). The 5-year survival rate in group-V was 71.4% {mean: 65.2 months [95% confidence interval (CI) 59.6-70.8]}, while that in group-T was 80% [mean 54.9 months (95% CI 45.9-63.8)] (p = 0.548). CONCLUSION: Advanced age was identified as the main risk factor for conversion to thoracotomy. However, early- and long-term outcomes were similar in the two groups, indicating that video-assisted thoracoscopic surgery is a safe and applicable method.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Conversão para Cirurgia Aberta , Hemorragia/cirurgia , Neoplasias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida , Toracotomia , Fatores Etários , Idoso , Perda Sanguínea Cirúrgica , Calcinose/cirurgia , Feminino , Hemorragia/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Linfadenopatia/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/métodos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Cirurgia Torácica Vídeoassistida/efeitos adversos , Aderências Teciduais/cirurgia
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