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1.
Georgian Med News ; (294): 83-87, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687955

RESUMO

The aim of the research was to investigate the relationship between cerebral microembolization and the development of postoperative cognitive impairment in patients after coronary artery bypass grafting with and without prophylactic administration of nitroglycerin at the end of artificial blood circulation. The study included 72 patients (43 male and 29 female) who had ACBPS using an ABCA. The patients were randomized into two clinical groups. The number of patients in the control group was 34 patients, in the study group - 38 patients. The study of the cognitive sphere was performed using a battery of clinical tests that included MSA and MMSE scales, Trail-making test, Grooved Pageboard, fine hands-motor test, 10 words test by AR Luria, Wexler's test, Schultz tables. The assessment was carried out on a day before the intervention and on the fifth day after the surgical intervention. It was shown that by all patients undergoing aorto-coronary bypass syrgery microembolization within the cerebral blood flow had been determined. The vast majority of microemboli is formed at the beginning of artificial blood circulation, at the moment of clamping aorta, as well as during the restoration of effective cardiac activity. Intraoperative microembolization of cerebral blood flow in excess of 750 microemboli leads to clinically significant deterioration of the brain functions in the early postoperative period. When used as a peripheral vasodilator, nitroglycerin, at a dose of 8-10 µg/kg*min in high (120-130%) volume perfusion rate, decreases the number of microemboluses in the basin of СМА by 2.4%.


Assuntos
Aorta/diagnóstico por imagem , Substitutos Sanguíneos , Ponte Cardiopulmonar/efeitos adversos , Disfunção Cognitiva/etiologia , Ponte de Artéria Coronária/efeitos adversos , Embolia Intracraniana/psicologia , Infarto do Miocárdio/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar/métodos , Circulação Cerebrovascular , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Avaliação de Processos e Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
2.
Anticancer Res ; 39(11): 6283-6290, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704858

RESUMO

BACKGROUND/AIM: The usefulness of C-reactive protein-to-albumin ratio (CAR) as a predictive indicator for clinically-relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) is unclear. We performed a retrospective analysis to identify reliable inflammatory indicators for prediction of CR-POPF after PD. PATIENTS AND METHODS: We enrolled 160 consecutive patients who underwent PD. Multivariate logistic regression analysis was performed. The areas under curves (AUCs) were compared with the discriminatory ability of inflammatory indicators, namely, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet count multiplied by C-reactive protein (P-CRP), and CAR. RESULTS: The AUC for CAR on POD 3 to predict CR-POPF was 0.782 (p<0.001) and higher than that for CRP (0.773), NLR (0.652), PLR (0.504), and P-CRP (0.703). Multivariate analysis revealed that CAR on POD 3 was an independent predictive indicator of CR-POPF. CONCLUSION: CAR on POD 3 is a reliable predictor of CR-POPF after PD.


Assuntos
Proteína C-Reativa/análise , Fístula Pancreática/sangue , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/sangue , Albumina Sérica/análise , Idoso , Amilases/análise , Biomarcadores/sangue , Feminino , Humanos , Modelos Logísticos , Contagem de Linfócitos , Masculino , Neutrófilos/citologia , Pâncreas/patologia , Ductos Pancreáticos/patologia , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiologia , Contagem de Plaquetas , Complicações Pós-Operatórias/diagnóstico , Curva ROC , Estudos Retrospectivos
3.
Br J Anaesth ; 123(6): 877-886, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31627890

RESUMO

BACKGROUND: Rapid, preoperative identification of patients with the highest risk for medical complications is necessary to ensure that limited infrastructure and human resources are directed towards those most likely to benefit. Existing risk scores either lack specificity at the patient level or utilise the American Society of Anesthesiologists (ASA) physical status classification, which requires a clinician to review the chart. METHODS: We report on the use of machine learning algorithms, specifically random forests, to create a fully automated score that predicts postoperative in-hospital mortality based solely on structured data available at the time of surgery. Electronic health record data from 53 097 surgical patients (2.01% mortality rate) who underwent general anaesthesia between April 1, 2013 and December 10, 2018 in a large US academic medical centre were used to extract 58 preoperative features. RESULTS: Using a random forest classifier we found that automatically obtained preoperative features (area under the curve [AUC] of 0.932, 95% confidence interval [CI] 0.910-0.951) outperforms Preoperative Score to Predict Postoperative Mortality (POSPOM) scores (AUC of 0.660, 95% CI 0.598-0.722), Charlson comorbidity scores (AUC of 0.742, 95% CI 0.658-0.812), and ASA physical status (AUC of 0.866, 95% CI 0.829-0.897). Including the ASA physical status with the preoperative features achieves an AUC of 0.936 (95% CI 0.917-0.955). CONCLUSIONS: This automated score outperforms the ASA physical status score, the Charlson comorbidity score, and the POSPOM score for predicting in-hospital mortality. Additionally, we integrate this score with a previously published postoperative score to demonstrate the extent to which patient risk changes during the perioperative period.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Nível de Saúde , Mortalidade Hospitalar , Aprendizado de Máquina , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Medição de Risco , Fatores de Risco , Adulto Jovem
4.
Urol Clin North Am ; 46(4): 605-618, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582033

RESUMO

As more transgender patients undergo gender-affirming genital reconstructive surgery, such as vaginoplasty and phalloplasty, it is imperative for health care providers, including urologists, to understand the new anatomy and most common complications to diagnose and treat patients effectively. Although there have been several modifications to prior techniques as well as development of new techniques over the years, complications are still common after vaginoplasty and phalloplasty. This article focuses on the most common complications as well as the evaluation and management of those complications.


Assuntos
Disforia de Gênero/cirurgia , Pênis/cirurgia , Complicações Pós-Operatórias/terapia , Cirurgia de Readequação Sexual/efeitos adversos , Transexualismo , Vagina/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/métodos
5.
Medicine (Baltimore) ; 98(39): e17307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574859

RESUMO

To investigate the cognitive and psychological outcomes of pediatric allogeneic HSCT survivors in China.A total of 135 3 to 18 years old children and adolescents who underwent allo-HSCT and survived at least 3 months post-HSCT were recruited and completed the assessments. Cognitive and psychological functions were assessed via age-appropriate standardized measures. Clinical information was extracted from the medical records.Forty one 3 to 6 years old children completed Psychological Questionnaires for 3 to 6 years Children. The scores of 21(51.2%) children in cognitive development dimension, 18(43.9%) in motor development dimension, 16(39.0%) in language development and social development dimension, 15(36.6%) in emotion and will dimension and 14(34.1%) in living habits dimension were less than the standard. Fifty six 8 to 16 years old children and adolescents completed the Depression Self-rating Scale for Children and 9 (16.1%) of these met the criteria of depression. Sixty nine 7 to 16 years old children and adolescents completed the screening for Child Anxiety Related Disorders and 7 (10.1%) of these met the criteria of anxiety, especially social phobia and school phobia. Eighty nine 6 to 18 years old children and adolescents completed the Symptom Checklist-90 and 43.8% to 77.5% of these experienced mild symptoms like obsession-compulsion (77.5%), hostility (64%), and interpersonal sensitivity (60.7%). Children treated with total body irradiation (TBI) showed more cognitive impairments like motor deficits than those without TBI. Also older children and adolescents had more symptoms like psychoticism.These findings demonstrated cognitive and psychological late effects of pediatric allo-HSCT survivors in a single center in China and highlighted that the survivors conditioned with TBI had more cognitive impairments and older children and adolescents had more symptoms. Early intervention in these children and adolescents might minimize the cognitive losses and psychological effects.


Assuntos
Ansiedade , Disfunção Cognitiva , Depressão , Transplante de Células-Tronco Hematopoéticas , Complicações Pós-Operatórias , Qualidade de Vida , Adolescente , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Criança , Pré-Escolar , China/epidemiologia , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Intervenção Médica Precoce/métodos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Destreza Motora , Avaliação de Processos e Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Técnicas Psicológicas , Sobreviventes/psicologia
6.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(3): 429-432, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31631613

RESUMO

Objective: To evaluate the clinical predictive ability of POSSUM and P-POSSUM scoring system in laparoscopic pancreatoduodenectomy (LPD). Methods: There were 132 consecutive LPD performed in West China Hospital of Sichuan University from February 2014 to July 2017. The clinical data were retrospective collected, including 12 preoperative physiological variables, 6 operative severity variables, and complications and mortality The postoperative expected mortality and morbidity were calculated by POSSUM and P-POSSUM score, and compared with measured morbidity and mortality. The clinical predictive ability of POSSUM and P-POSSUM system was evaluated by the receiver operating characteristic (ROC) curve and hierarchical analysis. Results: The area under ROC curve ( AUC) was 0.83. The preoperative physiological score (PS) and POSSUM score of the patients with complications were higher, and the difference was statistically significant ( P<0.01). For the prediction of complications after LPD, the expected value was the most accurate to the measured value when POSSUM score was >0.4-0.6. POSSUM scoring system had no significant difference in predicting the incidence of complications for benign and malignant lesions ( P>0.05), with a higher predictive value for malignant tumors. It was valuable in predicting the incidence of complications in male and female, and there was no significant difference in expected value between the sexes. Expected morbidity rate by POSSUM scoring system was 36.6% and measured morbidity rate was 33.3%. The expected and measured morbidities had no significantly differences. The expected mortality was 7.0% and measured mortality rate was 1.5%. The expected and measured mortality had no significantly differences. Expected mortality by P-POSSUM system was 1.6%, the expected and measured mortality had no significantly differences. Conclusion: POSSUM and P-POSSUM scoring system had high value for predicting LPD postoperative morbidity and mortality of LPD patients.


Assuntos
Laparoscopia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , China , Feminino , Humanos , Masculino , Morbidade , Mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença
7.
Niger J Clin Pract ; 22(10): 1372-1377, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607726

RESUMO

Objectives: The aim of the study is to compare the pre- and post-operative symptomatology, endoscopic findings, and nasal patency and to evaluate the postoperative outcomes of conventional compared to endoscopic septoplasty (ES). Materials and Methods: This prospective study was conducted at Rajindra Hospital, Patiala, Punjab, India, on 50 patients aged between 18 and 60 years having symptomatic deviated nasal septum and refractory to medical treatment. The patients were divided into two groups: Group A, which included 25 patients in whom conventional septoplasty (CS) was performed, and Group B, which included 25 patients in whom ES was conducted. The postoperative assessment was carried out at once weekly for 1 month and twice weekly for another 2 months. Results: Nasal obstruction was relieved in 79.1% cases belonging to Group A and 91.3% cases to Group B. Headache was relieved in 62.5% cases belonging to Group A and 93.3% cases to Group B. Postnasal drip was relieved in 73.3% cases in Group A and 94.1% cases in Group B. The results were found to be statistically significant. An improvement in visual analog scale score was observed in both groups, but statistically significant difference was seen at 2nd and 4th week. Postoperative nasal patency improvement was observed in both groups by the Gertner plate, and the results were found to be statistically significant. Postoperative hemorrhage was observed in 24% cases in Group A and 12% cases in Group B. Septal perforation, septal hematoma, and mucosal tear were observed in 4%, 4%, and 8% of cases, respectively, in Group A. No such complication was reported in Group B. Conclusion: ES is more effective in terms of relief of symptoms and improvement of nasal patency. It is best for isolated spur, posterior deviation, and revision surgery, but anterior caudal dislocation is best handled with CS. Both these techniques should be taken as an adjuvant to each other.


Assuntos
Endoscopia/métodos , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Adulto , Endoscopia/efeitos adversos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/epidemiologia , Deformidades Adquiridas Nasais/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Período Pós-Operatório , Estudos Prospectivos , Rinoplastia/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
9.
Medicine (Baltimore) ; 98(38): e17247, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567991

RESUMO

RATIONALE: Retropharyngeal hematoma (RH) is an infrequent but potentially life-threatening complication of anterior cervical spine surgeries (ACSS). Challenging situations might be confronted and catastrophic events or even deaths still occurred occasionally during the treatment. Currently, no widely accepted protocol has been developed. PATIENT CONCERNS: A 55 years old male underwent ACSS due to cervical myelopathy. Thirty-three hours after surgery the patient presented cervical swelling and obstructive dysphagia. Conservative treatment resulted in no recovery and cervical swelling progressed. DIAGNOSES: Emergent magnetic resonance imaging and plain radiograph established massive incisional and RHs. RH was shown to extend from the base of the skull to T1. INTERVENTIONS: An emergent surgery was performed under local anesthesia and cervical hematoma was evacuated. Nonetheless, evacuation of the blood clots in the vision field resulted into incomplete recovery of throat blockage. A gloved finger was used to explore the retropharyngeal space and some hidden blood clots were found and evacuated, then the patient obtained complete relief of the symptoms. OUTCOMES: Normal respiration and swallowing functions were obtained after the surgery. Obviously, recovery of motor function was noted while no other complication was found at 3-month follow-up LESSONS:: Our case illustrated that dysphagia was an early symptom of RH. Posterior compression from RH could cause obstruction of the pharyngeal airway and lead to difficulty of intubation. Hematoma could spread through the retropharyngeal space, a hematoma exploration beyond the visual range might be necessary in some cases for fear of the hidden hematoma.


Assuntos
Vértebras Cervicais/cirurgia , Hematoma/etiologia , Transtornos de Deglutição/etiologia , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia , Doenças da Medula Espinal/cirurgia
10.
Medicine (Baltimore) ; 98(39): e17043, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574801

RESUMO

RATIONALE: Post-hysterectomy collision tumors of the vulva has rarely been reported. Though long-term HPV infection may induce vulva tumor, but the relationship between HPV infection and collision vulva tumor is not clear. And there are no clear rules of the post-hysterectomy cancer surveillance for human papilloma virus (HPV) long-term infections. So here we first report a case of post-hysterectomy rare collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland and hope to bring new direction to our future research. PATIENT CONCERNS: A 48-year-old woman with long-term HPV infection, 3 years after hysterectomy, gravida 3, para 2, was admitted to our hospital with complaints of a 4-month history of an itching vulva ulceration. An anabrosis was located on the surface of the solid mass of the bartholin gland at the posterior part of the right labium and the right inguinal lymph nodes were palpable. Result of the incisional biopsy of the ulcer area at local hospital was atypical squamous cells couldn't exclude high-grade squamous intraepithelial lesion (ASC-H). Subsequently more authoritative pathological consultation results suggested squamous cell carcinoma of the vulva. DIAGNOSES: Post-hysterectomy collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland. INTERVENTIONS: The extensive excision of the vulva, bilateral inguinal lymph nodes dissection, and local skin flap transposition surgeon was done to this patient. The final certificate diagnosis was: vulvar tumor T1bM0N0 composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland; HPV infection; post hysterectomy, and bilateral salpingectomy. OUTCOMES: The patient recovered well after surgery, and consequently received 6 courses of TC (paclitaxel + carboplatin) chemotherapy, and 9 months and 13 days followed up. So far patient recorded as complete response (CR). LESSONS: Collision vulva tumor occurred post-hysterectomy is extremely rare. It is most likely related to long-term HPV infection, which suggests us should to modify the manner of the post-hysterectomy cancer surveillance for HPV long-term infections. For patients with high-risk HPV infection, even if the cytology results are negative, we may should perform colposcopy and vulva biopsy more positively to prevent the disease from progressing into cancer. And the pathogenesis of relationship between HPV infection and collision vulva tumor is still need further investigation.


Assuntos
Glândulas Vestibulares Maiores , Carcinoma Adenoescamoso/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Histerectomia , Neoplasias Primárias Múltiplas/diagnóstico , Infecções por Papillomavirus/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Neoplasias Vulvares/diagnóstico , Glândulas Vestibulares Maiores/patologia , Biópsia , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/virologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Colposcopia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/virologia , Infecções por Papillomavirus/patologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/virologia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/virologia
11.
Int Heart J ; 60(5): 1222-1225, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484879

RESUMO

Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no abnormal findings. Right heart catheterization showed that the cardiac index (CI) was 1.9 L/minute/m2. Continuous intravenous infusion of isoproterenol (0.003 µg/kg/minute) increased the HR to 80 bpm and CI to 2.7 L/minute/m2 and improved his symptoms. Isoproterenol was switched to oral administration of cilostazol (100 mg, twice a day), which maintained the HR at around 80 bpm and CI of 2.5 L/minute/m2. The patient's HR gradually recovered and cilostazol could be discontinued three months after the HT. Oral administration of cilostazol can be a therapeutic option for patients with sinus bradycardia following HT, who need positive chronotropic support.


Assuntos
Bradicardia/tratamento farmacológico , Cilostazol/uso terapêutico , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Bradicardia/diagnóstico por imagem , Bradicardia/etiologia , Débito Cardíaco/efeitos dos fármacos , Eletrocardiografia/métodos , Seguimentos , Insuficiência Cardíaca/diagnóstico , Transplante de Coração/métodos , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Fatores de Tempo , Resultado do Tratamento
12.
BMC Infect Dis ; 19(1): 763, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477035

RESUMO

BACKGROUND: Actinomycetes can rarely cause intracranial infection and may cause a variety of complications. We describe a fatal case of intracranial and intra-orbital actinomycosis of odontogenic origin with a unique presentation and route of dissemination. Also, we provide a review of the current literature. CASE PRESENTATION: A 58-year-old man presented with diplopia and progressive pain behind his left eye. Six weeks earlier he had undergone a dental extraction, followed by clindamycin treatment for a presumed maxillary infection. The diplopia responded to steroids but recurred after cessation. The diplopia was thought to result from myositis of the left medial rectus muscle, possibly related to a defect in the lamina papyracea. During exploration there was no abnormal tissue for biopsy. The medial wall was reconstructed and the myositis responded again to steroids. Within weeks a myositis on the right side occurred, with CT evidence of muscle swelling. Several months later he presented with right hemiparesis and dysarthria. Despite treatment the patient deteriorated, developed extensive intracranial hemorrhage, and died. Autopsy showed bacterial aggregates suggestive of actinomycotic meningoencephalitis with septic thromboembolism. Retrospectively, imaging studies showed abnormalities in the left infratemporal fossa and skull base and bilateral cavernous sinus. CONCLUSIONS: In conclusion, intracranial actinomycosis is difficult to diagnose, with potentially fatal outcome. An accurate diagnosis can often only be established by means of histology and biopsy should be performed whenever feasible. This is the first report of actinomycotic orbital involvement of odontogenic origin, presenting initially as bilateral orbital myositis rather than as orbital abscess. Infection from the upper left jaw extended to the left infratemporal fossa, skull base and meninges and subsequently to the cavernous sinus and the orbits.


Assuntos
Actinomicose/diagnóstico , Doenças Autoimunes/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Doenças Maxilares/microbiologia , Miosite Orbital/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/microbiologia , Diagnóstico Diferencial , Diplopia/diagnóstico , Diplopia/microbiologia , Evolução Fatal , Humanos , Masculino , Doenças Maxilares/complicações , Doenças Maxilares/diagnóstico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Extração Dentária/efeitos adversos
13.
Medicine (Baltimore) ; 98(36): e16995, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490381

RESUMO

RATIONALE: Active tuberculosis constitutes a relevant risk for kidney transplant recipients. In contrast to immunocompetent hosts, kidney transplant recipients often show atypical presentation and course of the disease impeding diagnosis. Especially extrapulmonary or disseminated infection is more frequent and can resemble malignant processes. However, reactivation of tuberculosis mostly develops within the early post-transplant course, whereas malignancies are predominantly long-term complications. We report a case of disseminated abdominal tuberculosis developing 10 years after kidney transplantation and review the underlying literature. PATIENT CONCERNS AND DIAGNOSES: A 51-year-old lady presented with epigastric pain, diarrhea, weight loss and night sweats 10 years after deceased-donor kidney transplantation. An epigastric as well as multiple peritoneal masses were found suspicious of a cancer of unknown primary. Colonoscopy revealed a colon tumor with the biopsy showing no dysplasia but histiocytic and granulomatous infiltration with acid-fast bacilli. Mycobacterium tuberculosis was detected in the biopsy and stool and disseminated abdominal tuberculosi was diagnosed. INTERVENTIONS AND OUTCOMES: With anti-tuberculosis therapy, the masses regressed, and all cultures became sterile, sparing graft function. LESSONS: This case emphasizes how variable and unspecific the presentation of tuberculosis in kidney transplant recipients may be and that tuberculosis constitutes a relevant risk also in the long-term post-transplant course.


Assuntos
Neoplasias do Colo/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Transplante de Rim , Pessoa de Meia-Idade , Tuberculose Gastrointestinal/tratamento farmacológico
14.
Medicine (Baltimore) ; 98(37): e17006, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517819

RESUMO

CD200 is an immunoglobulin superfamily membrane protein that binds to a myeloid cell-specific receptor and induces inhibitory signaling. The aim of this study was to investigate the role of CD200 and its receptor (CD200R1) on kidney transplant (KTx) outcome. In a collective of 125 kidney recipients (University hospital, Heidelberg, Germany), CD200 and CD200R1 concentrations were evaluated immediately before transplantation. Recipient baseline and clinical characteristics and KTx outcome, including acute rejection (AR), acute tubular necrosis, delayed graft function, cytomegalovirus (CMV) and human polyomaviridae (BK) virus infections, and graft loss were evaluated during the first post-transplant year. The association of CD200 and CD200R1 concentrations and CD200R1/CD200 ratios with the outcome of KTx was investigated for the first time in a clinical setting in a prospective cohort. There was a positive association between pre-transplant CD200R1 concentrations and CMV (re)activation (P = .041). Also, increased CD200R1 concentration was associated with a longer duration of CMV infection (P = .049). Both the frequency of AR and levels of creatinine (3 and 6 months after KTx) were significantly higher in patients with an increased CD200R1/CD200 ratio (median: 126 vs 78, P = .008). Increased pre-transplant CD200R1/CD200 ratios predict immunocompetence and risk of AR, whereas high CD200R1 concentrations predict immunosuppression and high risk of severe CMV (re)activation after KTx.


Assuntos
Antígenos CD/sangue , Antígenos de Superfície/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/cirurgia , Transplante de Rim , Complicações Pós-Operatórias/diagnóstico , Receptores de Superfície Celular/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Adulto Jovem
15.
J Pediatr Orthop ; 39(8): 411-415, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393301

RESUMO

BACKGROUND: The modified Dunn procedure (open subcapital realignment via a surgical dislocation approach) has been shown to be a safe and effective way of treating acute, unstable slipped capital femoral epiphysis (SCFE). There is a paucity of literature comparing the modified Dunn procedure in stable SCFE. The purpose of this study was to compare acute, unstable versus chronic, stable SCFE managed with the modified Dunn procedure. METHODS: A retrospective chart review was performed on 44 skeletally immature patients who underwent the modified Dunn procedure for SCFE. Patients were divided into stable or unstable based on clinical presentation and intraoperative findings. Demographics, radiographic measurements, and complications were recorded and compared. χ and t tests were used to compare variables. RESULTS: In total, 31 consecutive hips (29 patients) with acute, unstable slips, and 17 consecutive hips (15 patients) with chronic, stable slips were reviewed. Average age was 12.5 and 13.8 years for acute and chronic, respectively (P=0.05). Mean follow-up was 27.9 months (unstable) and 35.5 months (stable). Average postoperative Southwick angle was 14.2 degrees; (unstable) and 25.3 degrees (stable) (P=0.001). Greater trochanteric height averaged 6.2 mm below the center of the femoral head in the acute group and 6.2 mm above center in the chronic group (P<0.001). Average femoral neck length measured 34.1 mm (unstable) and 27.1 mm (stable) (P<0.001). Two patients (6%) developed avascular necrosis (AVN) in the unstable group, with 5 patients (29.4%) in the stable group (P=0.027). All patients with hip instability (N=3) developed AVN. CONCLUSIONS: Although both acute, unstable and chronic, stable SCFE can be successfully treated with the modified Dunn procedure, the complication rate is statistically higher in patients with stable SCFE, specifically both AVN rate and postoperative instability. In addition, it is more difficult to establish normal anatomic indexes with regard to greater trochanteric height and femoral neck length. This procedure has great utility in the correction of the anatomic deformity associated with SCFE, but should be used with caution in patients with chronic, stable SCFE. LEVEL OF EVIDENCE: Level III-retrospective review.


Assuntos
Cabeça do Fêmur/cirurgia , Articulação do Quadril/fisiopatologia , Instabilidade Articular , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Escorregamento das Epífises Proximais do Fêmur , Adolescente , Criança , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/epidemiologia , Instabilidade Articular/etiologia , Masculino , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico , Escorregamento das Epífises Proximais do Fêmur/fisiopatologia , Escorregamento das Epífises Proximais do Fêmur/cirurgia , Resultado do Tratamento
16.
J Pediatr Orthop ; 39(8): 422-428, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393303

RESUMO

PURPOSE: To examine the efficacy, safety, and clinical outcomes of distraction osteogenesis through the physis (PDO) or through subphyseal osteotomy (SPDO) in patients with atrophic-type congenital pseudarthrosis of tibia with proximal tibial dysplasia. METHODS: To validate the efficacy and safety of PDO and SPDO, radiographic and clinical parameters were compared between 5 patients who underwent proximal tibial metaphyseal or metadiaphyseal lengthening as a control (group 1) and 7 patients who underwent PDO or SPDO (group 2). Postoperative complication was also compared between the groups. RESULTS: A significant difference in terms of healing index (group 1, 83.3±24.7 d/cm; group 2, 35.0±11.1 d/cm; P=0.001) and percentage increase (11.0%±3.7% vs. 23.1%±10.5%, P=0.034) was observed between the 2 groups. According to the Paley classification, group 1 included 1 "problems" case and 3 "obstacles" cases, whereas group 2 included 2 "problems" cases and 1 "obstacles" case. According to the Lascombes classification, group 1 included 2 grade IIIb cases and 3 grade IV cases, whereas group 2 included 6 grade I cases and 1 grade IIa case. Severe complications were significantly higher in group 1 compared with the group 2 (P=0.007). CONCLUSIONS: This study demonstrated that PDO or SPDO can be effectively and safely performed for tibial lengthening in atrophic-type congenital pseudarthrosis of tibia patients with proximal tibial dysplasia. LEVEL OF EVIDENCE: Level III.


Assuntos
Osteogênese por Distração , Osteotomia , Complicações Pós-Operatórias , Pseudoartrose/congênito , Tíbia , Adolescente , Criança , Pré-Escolar , Feminino , Lâmina de Crescimento , Humanos , Masculino , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/métodos , Osteotomia/efeitos adversos , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Pseudoartrose/diagnóstico , Pseudoartrose/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/cirurgia , Resultado do Tratamento
17.
Transplant Proc ; 51(6): 1699-1705, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399160

RESUMO

BACKGROUND: Rejection and infection are 2 major complications affecting the health and survival of patients receiving an allograft organ transplantation. We describe a diagnostic assay that simultaneously monitors for rejection and infection in recipients of kidney transplant by sequencing of cell-free DNA (cfDNA) in plasma. METHODS: By using cfDNA in plasma, we established a noninvasive method that simultaneously monitors rejection and infection in patients with a history of organ transplant. A total of 6200 single-nucleotide polymorphisms were captured by liquid hybridization and sequenced by next-generation sequencing. The donor-derived cfDNA (ddcfDNA) level was calculated based on maximum likelihood estimation, without relying on the donor's genotype. We also analyzed the nonhuman cfDNA to test for infections in the patients' plasma. RESULTS: Artificial ddcfDNA levels quantified by a donor-dependent and donor-independent algorithm were significantly correlated, with the multivariate coefficient of determination, or R2 value, of 0.999. This technique was applied on 30 patients (32 samples) after kidney transplantation, and a significant difference was observed on the ddcfdNA levels between nonrejection and rejection. Furthermore, 1 BK virus infection and 1 cytomegalovirus infection were revealed by this method, and the enrichment efficiency of the viral sequences was 114 and 489 times, respectively, which are consistent with clinical results. CONCLUSION: This method can be used to simultaneously monitor for acute rejection as well as a broad spectrum of infections for patients of allograft organ transplant because it provides comprehensive information for clinicians to optimize immunosuppression therapy.


Assuntos
Ácidos Nucleicos Livres/sangue , Rejeição de Enxerto/diagnóstico , Infecção/diagnóstico , Transplante de Órgãos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Adulto , Algoritmos , Feminino , Rejeição de Enxerto/sangue , Humanos , Hospedeiro Imunocomprometido , Infecção/sangue , Infecção/imunologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue
18.
Transplant Proc ; 51(6): 1706-1716, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399161

RESUMO

BACKGROUND: Living kidney donors (LKDs) are at high risk of renal dysfunction after undergoing a donor nephrectomy (DN), resulting in poor prognosis associated with the development of cardiovascular or cerebrovascular disease. Decreasing this risk can improve the survival rate of LKDs. We investigated the effects of preoperative conditions in LKDs on renal dysfunction after DN using abdominal adipose tissue, inflammation, nutritional status, and muscle mass as markers for this assessment. METHODS: Our retrospective study included 79 LKDs. Body composition markers were assessed using preoperative unenhanced computed tomographic images. Inflammation- and nutritional status-based markers were assessed using preoperative laboratory blood tests. The association between each marker was investigated, and prognostic markers for renal dysfunction after DN were identified. RESULTS: The LKDs in this cohort comprised 30 men and 49 women. The median age at the time of DN and the preoperative estimated glomerular filtration rate were 58 years and 81.9 mL/min/1.73 m2, respectively. Abdominal subcutaneous adipose tissue and muscle mass significantly differed between the sexes. Each adipose tissue-, inflammation-, nutritional status-, and muscle mass-based marker showed an association with each other. Abdominal visceral adipose tissue and nutritional status could be independent prognostic markers for renal dysfunction after DN. CONCLUSIONS: Our findings suggest that the preoperative condition of LKDs (assessed using specific markers such as abdominal visceral adipose tissue mass per volume and nutritional status) could affect renal dysfunction after DN. Optimal preoperative management can lead to better outcomes in LKDs. Further research is needed to establish appropriate exercise programs and nutritional interventions.


Assuntos
Nefropatias/diagnóstico , Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Biomarcadores/análise , Feminino , Humanos , Inflamação , Gordura Intra-Abdominal , Nefropatias/etiologia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Complicações Pós-Operatórias/diagnóstico , Prognóstico , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 98(29): e16161, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335670

RESUMO

RATIONALE: Insignifificant, asymmetrical or lack of labial tubercle often occurs after cleft lip surgery due to improper treatment of vermilion tissue. Especially in the cases of bilateral cleft lip, because of short front lip and insuffificient vermilion tissue, the median vermilion depression often occurs after surgery, forming a "whistling" deformity. The object of this study is to verify the outcomes of patients with median labial tubercle detects after treatment with bilateral vermilion musculomucosal sliding flflaps (VMSF). PATIENT CONCERNS: Six patients with median labial tubercle defect after bilateral cleft lip repair from March 2015 to May 2017 were enrolled in our department and subjected to bilateral lip deformity correction under general anesthesia. DIAGNOSES: Secondary deformity of bilateral cleft lip forming a "whistling" deformity were diagnosed in all the patients. INTERVENTIONS: Bilateral VMSF were designed and used to reconstruct the median labial tubercles by sliding downward so as to eliminate the whistling deformity. OUTCOMES: During the 10 to 37 months of follow-up, the reconstructed vermilion tubercles had stable morphology showing no whistling deformity and the overall lip shapes were satisfactory. LESSONS: Reconstructing MVTD and eliminating whistling deformity using the scar tissues that need to be removed previously on the vermilion musculomucosa has achieved stable and satisfactory results and is worthy of clinical application.


Assuntos
Cicatriz , Fenda Labial/cirurgia , Procedimentos Cirúrgicos Bucais , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos , Reoperação/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Criança , China , Cicatriz/etiologia , Cicatriz/cirurgia , Feminino , Humanos , Lábio/cirurgia , Masculino , Procedimentos Cirúrgicos Bucais/efeitos adversos , Procedimentos Cirúrgicos Bucais/métodos , Avaliação de Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos
20.
Medicine (Baltimore) ; 98(29): e16303, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335676

RESUMO

To investigate the incidence, outcomes, and risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients undergoing surgical repair for acute type A aortic dissection.This retrospective study involved 270 patients who underwent surgical repair for acute type A aortic dissection between January 2009 and December 2015. Data on clinical characteristics and outcomes were collected. Patients who immediately died after surgery and with preoperative myocardial dysfunction were excluded. The included patients were divided into the ARDS (ARDS patients who met the Berlin definition) and non-ARDS groups. Primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS and was reviewed by 2 qualified physicians with expertise in critical care and cardiac surgery. Outcomes of interest were the incidence and severity of risk factors for ARDS in this population, and perioperative outcomes and survival rates were compared with patients with or without ARDS.A total of 233 adult patients were enrolled into this study; of these, 37 patients (15.9%) had ARDS. Three, 20, and 14 patients had mild, moderate, and severe ARDS, respectively, according to the Berlin definition, with no significant difference in age, sex, and underlying disease. The ARDS group had lower mean oxygenation index (OI) than the non-ARDS group in the first 3 days post-surgery and demonstrated an improvement in lung function after the fourth day. Postoperative complication risks were higher in the ARDS group than in the non-ARDS group. However, no significant difference was observed in in-hospital mortality between the 2 groups (10.8% vs 5.6%, P = .268). Additionally, there was also no significant difference in the 3-year mortality rate between the 2 groups (P of log-rank test = .274). Postoperative hemoglobin level (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.62-0.99) and perioperative blood transfusion volume (OR: 1.07; 95% CI: 1.03-1.12) were associated with ARDS risk.Postoperative ARDS after type A aortic dissection repair surgery was associated with risks of postoperative complications but not with risk of in-hospital mortality or 3-year mortality. A higher perioperative blood transfusion volume and a lower postoperative hemoglobin level may be risk factors for ARDS.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico , Transfusão de Sangue , Hemoglobinas/análise , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma Aórtico/complicações , Gasometria/métodos , Transfusão de Sangue/métodos , Transfusão de Sangue/estatística & dados numéricos , Cuidados Críticos , Análise Fatorial , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Testes de Função Respiratória/métodos , Medição de Risco/métodos , Fatores de Risco , Taxa de Sobrevida , Procedimentos Cirúrgicos Vasculares/métodos
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