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1.
Medicine (Baltimore) ; 99(1): e18541, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895792

RESUMO

Perioperative hypertension is a common occurrence in the neurosurgical population, where 60% to 90% of the patients require treatment for blood pressure (BP) control. Nicardipine and clevidipine have been commonly used in neurocritical settings. This retrospective, observational study assessed the effectivity of the administration of clevidipine after nicardipine treatment failure in neurosurgical patients.We retrospectively reviewed the medical charts of adult patients who were admitted to our neurosurgical department and received clevidipine after nicardipine treatment failure for the control of BP. The primary effectivity outcome was the comparison of the percentage of time spent at targeted SBP goals during nicardipine and clevidipine administration, respectively.A total of 12 adult patients treated with clevidipine after nicardipine treatment failure and were included for data analysis. The median number of events that required dose-titration was 20.5 vs 17 during the administration of nicardipine and clevidipine, respectively (P = .534). The median percentage of time spent at targeted SBP goal was 76.2% during the administration of nicardipine and 93.4% during the administration of clevidipine (P = .123).Our study suggests that clevidipine could be an alternative effective drug with an acceptable benefit/risk ratio in the neurosurgical population that fails to achieve BP control with nicardipine treatment.


Assuntos
Bloqueadores dos Canais de Cálcio/administração & dosagem , Hipertensão/tratamento farmacológico , Complicações Intraoperatórias/tratamento farmacológico , Procedimentos Neurocirúrgicos/efeitos adversos , Piridinas/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Hipertensão/etiologia , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Nicardipino/uso terapêutico , Estudos Retrospectivos , Falha de Tratamento , Resultado do Tratamento
2.
Urology ; 135: 171-172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589882

RESUMO

OBJECTIVE: To demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely. METHODS: Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. RESULTS: The distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder. CONCLUSION: This video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Terapia a Laser/métodos , Morcelação/métodos , Prostatectomia/métodos , Bexiga Urinária/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/etiologia , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Masculino , Morcelação/efeitos adversos , Morcelação/instrumentação , Estudo de Prova de Conceito , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/cirurgia , Ultrassonografia , Bexiga Urinária/lesões
3.
World Neurosurg ; 133: e68-e75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31465851

RESUMO

BACKGROUND: Horner syndrome is an infrequently seen complication of anterior cervical discectomy and fusion (ACDF). Multicenter studies have reported a very low incidence, less than 0.1%. OBJECTIVE: To identify the incidence in, characteristics of, and postoperative course in patients in whom postoperative Horner syndrome developed after ACDF. METHODS: We performed a retrospective review of all patients who experienced Horner syndrome after ACDF for cervical degenerative disease at a single tertiary care institution between 2017 and 2018. A systematic review was then performed to identify studies investigating prevalence, diagnosis, and treatment of postoperative Horner syndrome after ACDF. RESULTS: Of 1116 patients at our institution who underwent ACDF, the incidence of Horner syndrome was 0.45%. C4/5 and C5/6 were the 2 most common surgical levels. The complication was noted to occur immediately after surgery, and at least partial improvement was identified in all patients an average 3.5 months after surgery (range, 10 days to 6 months). These findings were consistent with our systematic review of 21 studies that showed an incidence of 0.6% (range, 0.02% to 4.0%), the most common surgical level C5/6 (64%), and 82% of patients experiencing at least partial resolution of symptoms within 1 year (60.7% complete, 21.4% partial resolution). CONCLUSION: Horner syndrome occurs in 0.6% of patients undergoing ACDF. Careful postoperative examination should reveal this complication, which may be underdiagnosed or underreported in larger multicenter case series. The majority of patients experience complete resolution of symptoms within 6 months to 1 year and can be treated conservatively and expectantly.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Síndrome de Horner/etiologia , Degeneração do Disco Intervertebral/cirurgia , Complicações Intraoperatórias/etiologia , Fusão Vertebral/efeitos adversos , Idoso , Feminino , Síndrome de Horner/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sistema Nervoso Simpático/lesões , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento
4.
BJOG ; 127(1): 28-35, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31541614

RESUMO

BACKGROUND: Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh-related complications. OBJECTIVE: To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline 'Urinary incontinence (update) and pelvic organ prolapse in women: management'. SEARCH STRATEGY: Search strategies were developed for each indication for referral. SELECTION CRITERIA: Relevant interventions included complete or partial mesh removal, mesh division, and non-surgical treatments such as vaginal estrogen. DATA COLLECTION AND ANALYSIS: Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted. MAIN RESULTS: Twenty-four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely. CONCLUSIONS: The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh-related complications. Robust data are needed so that mesh complications can be managed effectively in the future. TWEETABLE ABSTRACT: Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica , Dispareunia/etiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Recidiva , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Adulto Jovem
5.
BJOG ; 127(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31544327

RESUMO

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colposcopia/efeitos adversos , Colposcopia/mortalidade , Colposcopia/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Sistema de Registros , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
6.
Bone Joint J ; 101-B(12): 1489-1497, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31786989

RESUMO

AIMS: The aim of this meta-analysis was to compare the outcome of total elbow arthroplasty (TEA) undertaken for rheumatoid arthritis (RA) with TEA performed for post-traumatic conditions with regard to implant failure, functional outcome, and perioperative complications. MATERIALS AND METHODS: We completed a comprehensive literature search on PubMed, Web of Science, Embase, and the Cochrane Library and conducted a systematic review and meta-analysis. Nine cohort studies investigated the outcome of TEA between RA and post-traumatic conditions. The preferred reporting items for systematic reviews and meta-analysis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) guidelines and Newcastle-Ottawa scale were applied to assess the quality of the included studies. We assessed three major outcome domains: implant failures (including aseptic loosening, septic loosening, bushing wear, axle failure, component disassembly, or component fracture); functional outcomes (including arc of range of movement, Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), and perioperative complications (including deep infection, intraoperative fracture, postoperative fracture, and ulnar neuropathy). RESULTS: This study included a total of 679 TEAs for RA (n = 482) or post-traumatic conditions (n = 197). After exclusion, all of the TEAs included in this meta-analysis were cemented with linked components. Our analysis demonstrated that the RA group was associated with a higher risk of septic loosening after TEA (odds ratio (OR) 3.96, 95% confidence interval (CI) 1.11 to 14.12), while there was an increased risk of bushing wear, axle failure, component disassembly, or component fracture in the post-traumatic group (OR 4.72, 95% CI 2.37 to 9.35). A higher MEPS (standardized mean difference 0.634, 95% CI 0.379 to 0.890) was found in the RA group. There were no significant differences in arc of range of movement, DASH questionnaire, and risk of aseptic loosening, deep infection, perioperative fracture, or ulnar neuropathy. CONCLUSION: The aetiology of TEA surgery appears to have an impact on the outcome in terms of specific modes of implant failures. RA patients might have a better functional outcome after TEA surgery. Cite this article: Bone Joint J 2019;101-B:1489-1497.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Substituição do Cotovelo , Articulação do Cotovelo/lesões , Artroplastia de Substituição do Cotovelo/reabilitação , Articulação do Cotovelo/cirurgia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Falha de Prótese/etiologia , Recuperação de Função Fisiológica , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
8.
Arq Bras Cir Dig ; 32(3): e1454, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644674

RESUMO

BACKGROUND: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. AIM: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. METHODS: : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. RESULTS: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. CONCLUSION: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.


Assuntos
Perda Sanguínea Cirúrgica , Colestase/cirurgia , Drenagem/efeitos adversos , Hemostasia , Complicações Intraoperatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres , Colestase/sangue , Estudos Transversais , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punções , Fatores de Risco , Adulto Jovem
9.
Am Surg ; 85(10): 1146-1149, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657312

RESUMO

Cirrhosis is associated with adverse outcomes after emergency general surgery (EGS). The objective of this study was to determine the safety of laparoscopic cholecystectomy (LC) in EGS patients with cirrhosis. We performed a two-year retrospective cohort analysis of adult patients who underwent LC for symptomatic gallstones. The primary outcome was the incidence of intraoperative complications. Of 796 patients, 59 (7.4%) were cirrhotic, with a median model for end-stage liver disease (MELD) score of 15 (IQR, 7). On unadjusted analysis, patients with cirrhosis were older, more likely to be male (both P < 0.01), diabetic (P < 0.001), had a higher incidence of preadmission antithrombotic therapy use (P < 0.02), and experienced a longer time to surgery (3.2 vs 1.8 days, P < 0.001). Coarsened exact matching revealed no difference in intra- or postoperative complications between groups (P = 0.67). Operative duration was longer in patients with cirrhosis (162 vs 114 minutes, P = 0.001), who also had a nonsignificant increase in the rate of conversion to an open cholecystectomy (14% vs 4%, P = 0.07). The results of this study indicate that LC may be safely performed in EGS patients with cirrhosis.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Tratamento de Emergência/efeitos adversos , Cálculos Biliares/cirurgia , Complicações Intraoperatórias/epidemiologia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Fatores Etários , Ductos Biliares/lesões , Conversão para Cirurgia Aberta/estatística & dados numéricos , Tratamento de Emergência/métodos , Feminino , Fibrinolíticos/uso terapêutico , Cálculos Biliares/etiologia , Hemorragia/epidemiologia , Humanos , Incidência , Intestinos/lesões , Complicações Intraoperatórias/etiologia , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Segurança , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos
10.
Medicine (Baltimore) ; 98(42): e17611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626138

RESUMO

There is no consensus regarding the references to determine the exact location of the skin incision to minimize iatrogenic sural nerve injury in the sinus tarsi approach for calcaneal fracture.The purpose of this cadaveric study was to describe the anatomical course of the sural nerve in relation to easily identifiable landmarks during the sinus tarsi approach and to provide a more practical reference for surgeons to avoid sural nerve injury.Twenty-four foot and ankle specimens were dissected. The bony landmarks used in the following reference points were the tip of the lateral malleolus (point A), lateral border of the Achilles tendon on the collinear line with point A (point B), posteroinferior apex of the calcaneus (point C), inferior margin of the calcaneus on the plumb line through point A (point D), and tip of the fifth metatarsal base (point E). After careful dissection, the distances of the sural nerve to points A and B in the horizontal direction (lines D1 and D2), points A and C in the diagonal direction (lines D3 and D4), points A and D in the vertical direction (lines D5 and D6), and points A and E in the diagonal direction (lines D7 and D8) were measured.The median ratio of D1 to D1+D2, D3 to D3+D4, D5 to D5+D6, and D7 to D7+D8 were 0.37 (range, 0.26-0.50), 0.23 (range, 016-0.33), 0.35 (range, 0.25-0.45), and 0.32 (range, 0.20-0.45), respectively.The distance ratios from this study can be helpful to avoid sural nerve injury during the sinus tarsi approach for calcaneal fractures. Established standard incision may have to be modified to minimize sural nerve injury.


Assuntos
Traumatismos do Tornozelo/cirurgia , Calcâneo/lesões , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Complicações Intraoperatórias/prevenção & controle , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Sural/lesões , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/diagnóstico , Cadáver , Calcâneo/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Ossos do Tarso/cirurgia
11.
Urology ; 134: 66-71, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487511

RESUMO

OBJECTIVE: To analyze the outcomes of upper pole access during percutaneous nephrolithotomy (PCNL), an option pole often avoided due to the concern for pleural injury. METHODS: We retrospectively collected data on patients undergoing PCNL at our institution. Patients were divided into 3 groups according to access: supracostal upper calyx (group 1), subcostal upper calyx (group 2), and nonupper calyx (group 3). Preoperative imaging was reviewed to assess stone burden, Hounsfield units (HU), location, and Guy's Stone Score. Patients were considered stone-free if residual fragments were 3 mm or smaller on CT scan. RESULTS: We analyzed 329 PCNLs (left: 174; right: 155). Stones had a median size of 32 mm, 800 HU, and Guy's Stone Score of 2. Groups 1, 2, and 3 had 119, 108, and 102 patients, respectively. The 90-day complication rate was 20.4% (7.9% Clavien 3-4). Group 1 patients, with higher BMI and larger stones, had higher SFR than group 3 (89.9% vs 79.4%, P = .038), but with a significantly higher risk of complications (P = .001). Within group 1, left PCNL (7.0% vs 24.2%, P = .016) and BMI ≥30 (6.9% vs 25.0%, P = .013) carried a lower risk of chest tube insertion. There was no difference in complications between groups 2 and 3 (1.9% vs 2.9%). CONCLUSION: Upper pole access is safe and effective, particularly if done below the ribs. Supracostal access is an effective option to achieve higher stone-free rates in complex stones, while carrying a risk of significant hydrothorax, particularly on the right side and in nonobese patients.


Assuntos
Hidrotórax , Complicações Intraoperatórias , Cálculos Renais , Nefrolitotomia Percutânea , Pleura/lesões , Cuidados Pré-Operatórios/métodos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Hidrotórax/etiologia , Hidrotórax/prevenção & controle , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Estados Unidos
12.
Bone Joint J ; 101-B(9): 1115-1121, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474138

RESUMO

AIMS: The aim of this study was to explore risk factors for complications associated with dural tear (DT), including the types of DT, and the intra- and postoperative management of DT. PATIENTS AND METHODS: Between 2012 and 2017, 12 171 patients with degenerative lumbar diseases underwent primary lumbar spine surgery. We investigated five categories of potential predictors: patient factors (sex, age, body mass index, and primary disease), surgical factors (surgical procedures, operative time, and estimated blood loss), types of DT (inaccessible for suturing/clipping and the presence of cauda equina/nerve root herniation), repair techniques (suturing, clipping, fibrin glue, polyethylene glycol (PEG) hydrogel, and polyglycolic acid sheet), and postoperative management (drainage duration). Postoperative complications were evaluated in terms of dural leak, prolonged bed rest, headache, nausea/vomiting, delayed wound healing, postoperative neurological deficit, surgical site infection (SSI), and reoperation for DT. We performed multivariable regression analyses to evaluate the predictors of postoperative complications associated with DT. RESULTS: In total, 429/12 171 patients (3.5%) had a DT. Multivariable analysis revealed that PEG hydrogel significantly reduced the incidence of dural leak and prolonged bed rest, and that patients treated with sealants (fibrin glue and PEG hydrogel) significantly less frequently suffered from headache. A longer drainage duration significantly increased the incidence of headache, nausea/vomiting, and delayed wound healing. Headache and nausea/vomiting were significantly more prevalent in younger female patients. Postoperative neurological deficit and reoperation for DT significantly depended on the presence of cauda equina/nerve root herniation. A longer operative time was the sole independent risk factor for SSI and was also a risk factor for dural leak, prolonged bed rest, and nausea/vomiting. CONCLUSION: Sealants, particularly PEG hydrogel, may be useful in reducing symptoms related to cerebrospinal fluid leakage, whereas prolonged drainage may be unnecessary. Younger female patients should be carefully treated when DT occurs. Cite this article: Bone Joint J 2019;101-B:1115-1121.


Assuntos
Vazamento de Líquido Cefalorraquidiano/terapia , Dura-Máter/lesões , Dura-Máter/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/etiologia , Drenagem , Feminino , Adesivo Tecidual de Fibrina/administração & dosagem , Humanos , Hidrogel de Polietilenoglicol-Dimetacrilato/administração & dosagem , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Polietilenoglicóis/administração & dosagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Reoperação , Estudos Retrospectivos , Fatores de Risco , Técnicas de Sutura , Adesivos Teciduais/administração & dosagem , Adulto Jovem
13.
Bone Joint J ; 101-B(9): 1129-1137, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474142

RESUMO

AIMS: The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). PATIENTS AND METHODS: A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. RESULTS: Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. CONCLUSION: Hospitals should operate on patients within 48 hours after fracture to reduce mortality and intraoperative complications. Cite this article: Bone Joint J 2019;101-B:1129-1137.


Assuntos
Artroplastia de Quadril/mortalidade , Fixação Interna de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Complicações Intraoperatórias/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Hemiartroplastia/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Masculino , Noruega/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco
14.
Transplant Proc ; 51(7): 2228-2231, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474289

RESUMO

BACKGROUND: The aim of this study is to investigate the frequency and risk factors of new-onset diabetes after donation in kidney donors without diabetes. METHODS: Living donors of kidney transplants between 1998 and 2016 were evaluated. To detect the blood glucose profile of the donors, preoperative fasting glucose (pro-G), nephrectomy evening glucose (nG), and postoperative day 1 fasting glucose (post-G) values were measured. RESULTS: A total of 195 cases were included in the study. The mean follow-up time in months ± SD (range) was 56 ± 45 (12-215). Of these, 28 (14.3%) donors developed diabetes. The pro-G (103 ± 7.6 vs 93 ± 9.0), nG (208 ± 122 vs 163 ± 67) and post-G (121 ± 25 vs 111 ± 21) values of the donors with new-onset diabetes were higher. Nineteen donors (9.7%) had normal pro-G, nG, and post-G values (group A). However, there were 153 (78.5%) cases with at least 1 abnormal value (group B) and 25 (12.8%) cases that had abnormal values in all (pro-G, nG, and post-G) measurements (group C). The incidence of new-onset diabetes was 0 (0%) in group A, 11% in group B, and 48% in group C (P < .001). In multiple regression analysis, pro-G (Exp[B], 1.08; 95% CI, 1.04-1.13; P < .001) and basal glomerular filtration rate (Exp[B], 0.96; 95% CI, 0.94-0.99; P < .01) independently associated with new-onset diabetes. CONCLUSIONS: In kidney donors without a history of diabetes, the development of diabetes after donor nephrectomy is an important problem. Pre- and postoperative blood glucose levels provide important information to predict these cases.


Assuntos
Diabetes Mellitus/etiologia , Hiperglicemia/etiologia , Complicações Intraoperatórias/etiologia , Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Glicemia/análise , Diabetes Mellitus/sangue , Jejum/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Hiperglicemia/sangue , Complicações Intraoperatórias/sangue , Rim/cirurgia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Fatores de Risco
15.
Transplant Proc ; 51(6): 1913-1919, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399175

RESUMO

AIM: To investigate the impact of circadian rhythms on the outcomes of liver transplantation on patients suffering from hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed data of patients who underwent liver transplantation from 2012 to 2017 in our center. Based on the begin time of transplantation, these patients were separated into 2 groups: day group and night group. The intraoperative and postoperative clinical variables were analyzed to find out the impact of the circadian rhythms. Multivariate analysis was performed to examine strength associations between the begin time of operation and surgical outcomes. RESULTS: A total of 147 patients were included in this study: 102 patients in the day group and 45 patients in the night group. Compared with the day group, patients in the night group had higher incidence of intraoperative massive hemorrhage (11.1% vs 2.0%, P = .048), more intraoperative blood loss (2168.00 ± 2324.20 mL vs 1405.88 ± 1037.69 mL, P = .040), and more requirement of red blood cells (RBC) suspension (8.59 ± 7.11 u vs 6.37 ± 5.78 u, P = .048). In addition, total operation time in the night group was longer than that in the day group (8.90 ± 1.65 hours vs 8.26 ± 1.69 hours, P = .034), as well as the cold ischemia time (9.35 ± 5.03 hours vs 7.21 ± 3.93 hours, P = .014). Furthermore, the night group had higher incidence of other intraoperative complications (13.3% vs 2.9%, P = .038), postoperative abdominal infection (20.0% vs 6.9%, P = .038), and more hospital cost (37,357.96 ± 6779.96 dollars vs 33,551.75 ± 11,683.38 dollars, P = .045). Moreover, patients in the night group needed longer time to restore hepatic function to normal (21.77 ± 10.91 days vs 17.54 ± 10.80 days, P = .033). Multivariate analysis showed that begin time of operation was the independent risk factor of longer operation time, more blood loss during operation, higher incidence of massive hemorrhage and other intraoperative complications, longer time for restoration of hepatic function to normal, higher incidence of abdominal infection at the early stage after transplantation, and more hospital cost (all P value ≤ .05). CONCLUSION: Liver transplantation performed at night was associated with higher incidence of intraoperative and early postoperative complications, as well as higher hospital cost. And these worsened outcomes all could be explained by the influence that circadian rhythms had on patients or medical workers.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ritmo Circadiano/fisiologia , Complicações Intraoperatórias/etiologia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Carcinoma Hepatocelular/fisiopatologia , Feminino , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Neoplasias Hepáticas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Int J Pediatr Otorhinolaryngol ; 126: 109601, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369970

RESUMO

OBJECTIVES: Perilymph gusher (PLG), an uncommon complication of otologic surgery, has been attributed to communication between the cochlea and the internal auditory canal (IAC). Subtle osseous defects may be missed on routine review of computed tomography (CT). This study aimed to quantify cochlear basal turn patency not seen on axial CT in patients with PLG and compare those against patients without intraoperative PLG. METHODS: Ears that underwent cochlear implantation or stapedotomy with preoperative helical CT that was interpreted as "normal" at a tertiary referral center. An otologist and a radiologist independently and in a blinded fashion measured the dimensions of cochlear basal turn patency on CT images in oblique plane and parasagittal planes along the interface of the cochlea and IAC fundus. RESULTS: Sixty-one ears were reviewed, including 3 with surgically confirmed PLGs and 12 with apparent dehiscence without a PLG. Mean defect width with PLG was 0.83 mm (range 0.75-0.9 mm) and without PLG was 0.43 mm (range 0.3-0.65 mm, p = 0.011). A greater proportion of PLGs occurred in ears with defects (3 of 15) than in ears without (0 of 46, p = 0.013). Using a cutoff of 0.75 mm, a greater proportion of PLGs occurred with defect width >0.75 mm (3 of 3) than in defects <0.75 mm (0 of 12, p = 0.022). CONCLUSIONS: CT dehiscence between the IAC and cochlear basal turn, particularly with a width > 0.75 mm, should be considered a risk for PLG with stapedotomy or cochlear implantation.


Assuntos
Implante Coclear , Orelha Interna/anormalidades , Complicações Intraoperatórias/etiologia , Perilinfa , Cirurgia do Estribo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cóclea/anormalidades , Cóclea/diagnóstico por imagem , Orelha Interna/diagnóstico por imagem , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Método Simples-Cego , Tomografia Computadorizada Espiral , Adulto Jovem
17.
Klin Onkol ; 32(4): 306-309, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31426649

RESUMO

Gastrointestinal stromal tumors (GISTs), being the most common mesenchymal tumors of the gastrointestinal tract, arise most commonly in stomach (60-70%) and small intestine (20-25%) while other sites of origin are rare. In most cases, they are diagnosed accidentally due to their indolent clinical course; however, 10-30% have malignant potential. Gastric and esophageal GISTs carry a better prognosis than small bowel GISTs of similar size and mitotic rate. Complete surgical resection is the only potentially curative procedure, but despite its success, at least 50% of patients develop recurrence or metastases. Tyrosine kinase inhibitor imatinib gave positive results in treatment of unresectable, metastatic or recurrent GISTs. We present the case of a 69-year-old woman with a large unresectable GIST of esophago-gastric junction with multiple bilobar liver metastases who underwent an emergent palliative surgery due to diffuse bleeding from the tumor. Twelve months after the surgery, patient is still alive and stable under imatinib therapy with no signs of local recurrence of the disease. This example suggests that patients with locally advanced GISTs with distant metastases may benefit from surgery in terms of prolonged survival and quality of life.


Assuntos
Neoplasias Esofágicas/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Hérnia Hiatal/cirurgia , Idoso , Anastomose Cirúrgica , Antineoplásicos/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Feminino , Gastrectomia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/patologia , Hérnia Hiatal/etiologia , Humanos , Mesilato de Imatinib/uso terapêutico , Complicações Intraoperatórias/etiologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário
18.
Biomed Res Int ; 2019: 4572130, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467891

RESUMO

Purpose: Acute kidney injury (AKI) is a major and severe complication following donation-after-circulatory-death (DCD) liver transplantation (LT) and is associated with increased postoperative morbidity and mortality. However, the risk factors and the prognosis factors of AKI still need to be further explored, and the relativity of intraoperative hepatic blood inflow (HBI) and AKI following LT has not been discussed yet. The purpose of this study was to investigate the correlation between HBI and AKI and to construct a prediction model of early acute kidney injury (EAKI) following DCD LT with the combination of HBI and other clinical parameters. Methods: Clinical data of 132 patients who underwent DCD liver transplantation at the first hospital of China Medical University from April 2005 to March 2017 were analyzed. Data of 105 patients (the first ten years of patients) were used to develop the prediction model. Then we assessed the clinical usefulness of the prediction models in the validation cohort (27 patients). EAKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria based on serum creatinine increase during 7-day of postoperative follow-up. Results: After Least Absolute Shrinkage and Selection Operator (LASSO) regression and simplification, a simplified prediction model consisting of the Child-Turcotte-Pugh (CTP) score (p=0.033), anhepatic phase (p=0.014), packed red blood cell (pRBC) transfusion (p=0.027), and the HBI indexed by height (HBI/h) (p=0.002) was established. The C-indexes of the model in the development and validation cohort were 0.823 [95% CI, 0.738-0.908] and 0.921 [95% CI, 0.816-1.000], respectively. Conclusions: In this study, we demonstrated the utility of HBI/h as a predictor for EAKI following DCD LT, as well as the clinical usefulness of the prediction model through the combination of the CTP score, anhepatic phase, pRBC transfusion and HBI/h.


Assuntos
Lesão Renal Aguda/diagnóstico , Complicações Intraoperatórias/diagnóstico , Transplante de Fígado/efeitos adversos , Fígado/irrigação sanguínea , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Adulto , Creatinina/metabolismo , Feminino , Sobrevivência de Enxerto , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Obtenção de Tecidos e Órgãos
20.
BMC Musculoskelet Disord ; 20(1): 380, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421678

RESUMO

BACKGROUND: At present, bicortical pedicle screws (BPSs) are not used clinically because they carry the potential risk of damaging the prevertebral great vessels (PGVs). The authors observed the anatomical relationship between the PGVs and simulated BPSs at different transverse screw angles (TSAs), exploring the insertion method of the BPS. METHODS: Computed tomography angiography (CTA) images from 65 adults were collected. A total of 4-5 TSAs of the BPSs were simulated on the left and right sides of L1-L5 (L1-L3: 0°, 5°, 10°, 15°; L4-L5: 0°, 5°, 10°, 15°, 20°). There were three types of distances from the anterior vertebral cortex (AVC) to the PGVs (DAVC-PGV); DAVC-PGV < 0.50 cm, DAVC-PGV ≥ 0.50 cm, and DAVC-PGV↑; these distances represented close, distant, and noncontact PGV, respectively. RESULTS: The ratio of every type of PGV was calculated, and the appropriate TSA of the BPS was recommended. In L1, the recommended left TSA of the BPS was 0°, and the ratio of the close PGV was 7.69%, while the recommended right TSA was 0°-10°, and the ratio of the close PGV was 1.54-4.62%. In L2, the recommended left TSA of the BPS was 0° and the ratio of the close PGV was 1.54%, while the recommended right TSA was 0°-15° and the ratio of the close PGV was 3.08-9.23%. In L3, the recommended left TSA was 0°-5°, and the ratio of the close PGV was 1.54-4.62%. In L4, the recommended left TSA was 0°, and the ratio of the close PGV was 4.62%. BPS use was not recommended on the right side of either L3 or L4 or on the either side of L5. CONCLUSIONS: From the anatomical perspective of the PGVs, BPSs were not suitable for insertion into every lumbar vertebra. Furthermore, the recommended methods for inserting BPSs were different in L1-L4.


Assuntos
Vértebras Lombares/irrigação sanguínea , Parafusos Pediculares/efeitos adversos , Fusão Vertebral/métodos , Adulto , Idoso , Aorta Abdominal/anatomia & histologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Artéria Ilíaca/anatomia & histologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Veia Ilíaca/anatomia & histologia , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/lesões , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Veia Cava Inferior/anatomia & histologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Adulto Jovem
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