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1.
Surg Clin North Am ; 99(6): 1197-1207, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676058

RESUMO

Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract driven by an exaggerated immune response to luminal microbiota in susceptible individuals. It presents with a heterogenous pattern of clinical disease severity, location, and behavior. Understanding the interaction between the host genome, gut microbiome, and further environmental exposures in the development of IBD is in the early stages, and factors that trigger onset of disease in susceptible individuals remain unknown. This article addresses the genetic, microbial, and environmental influences on development of inflammatory bowel disease and the ability to manipulate these factors through surgery and medical therapy.


Assuntos
Microbioma Gastrointestinal/genética , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/cirurgia , Pouchite/terapia , Proctocolectomia Restauradora/métodos , Meio Ambiente , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Pouchite/microbiologia , Proctocolectomia Restauradora/efeitos adversos , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Rev Med Suisse ; 15(670): 2021-2026, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696676

RESUMO

Proximal femur fractures in the elderly are still a major event in the functional trajectory of patients. In order to optimize their care, a pilot orthogeriatric unit was created in 2018 at the Valais Hospital. This innovative unit, managed by the internist-geriatrician within the orthopedic department, allows the early and standardized management of geriatric syndromes and postoperative complications. This article describes the practical operation of the unit, presents the preliminary results, and develops suggestions for improvement.


Assuntos
Fraturas Ósseas/cirurgia , Geriatras , Cirurgiões Ortopédicos , Idoso , Fêmur/cirurgia , Humanos , Complicações Pós-Operatórias/terapia
3.
Undersea Hyperb Med ; 46(5): 695-699, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683369

RESUMO

Successful penile replantations are rarely reported in the literature and are associated with significant complications. We present a case of a patient who auto-amputated his penis. Delayed microvascular replantation was performed approximately 14 hours following injury. He was treated with a phosphodiesterase inhibitor postoperatively, and adjuvant hyperbaric oxygen (HBO2) therapy was started 58 hours after replantation; 20 treatments at 2.4 atmospheres absolute (ATA), twice daily for eight days, followed by once daily for four days. Perfusion of the replanted penis was serially assessed using fluorescent angiography. With some additional surgical procedures including a split- thickness skin graft to the shaft due to skin necrosis he has made a complete recovery with return of normal urinary and sexual function. This unusual case illustrates the potential benefit of HBO2 therapy in preserving viability of a severed body part. Fluorescent angiography may have potential utility in monitoring efficacy of HBO2.


Assuntos
Oxigenação Hiperbárica , Pênis/cirurgia , Complicações Pós-Operatórias/terapia , Reimplante/métodos , Automutilação/cirurgia , Terapia Combinada , Desbridamento , Humanos , Masculino , Necrose , Pênis/irrigação sanguínea , Pênis/patologia , Fotografação , Adulto Jovem
4.
Undersea Hyperb Med ; 46(5): 701-707, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683370

RESUMO

Purpose: To report the successful treatment of postoperative posterior ischemic optic neuropathy (PION) with hyperbaric oxygen therapy and to review the current literature on the pathogenesis and treatment of PION. Observations: During an angiographic procedure at a community hospital, an elderly woman had a transient drop in blood pressure after receiving an intravenous dose of hydralazine. During recovery, the patient experienced bilateral vision loss. She was transferred to our specialty referral center for treatment with hyperbaric oxygen. We followed Table 5 in the U.S. Navy Diving Manual, the protocol for decompression sickness. Our patient's vision improved markedly immediately after the first session and continued to improve throughout the course of treatment to its completion. Follow-up ophthalmology visits found the patient's vision to be close to baseline. Conclusions and importance: PION is a rare condition. It has been difficult to determine a successful therapeutic approach because of the lack of large case-controlled studies. Hyperbaric oxygen has been used to treat other ischemic ophthalmic conditions, but there are only few reports of its use in patients with PION. Systemic steroids and antiplatelet therapy have also been used, with mixed success. In our patient, the combination of hyperbaric oxygen therapy and steroids was successful in restoring vision after postoperative PION.


Assuntos
Oxigenação Hiperbárica , Neuropatia Óptica Isquêmica/terapia , Complicações Pós-Operatórias/terapia , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Feminino , Humanos , Hidralazina/efeitos adversos , Hipotensão/induzido quimicamente , Neuropatia Óptica Isquêmica/etiologia , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica
5.
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
6.
Zhonghua Zhong Liu Za Zhi ; 41(10): 771-774, 2019 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-31648500

RESUMO

Objective: To compare the efficiency of saline irrigation, antibiotics irrigation and high-concentration antibiotics perfusion with tube drainage in the treatment of infectious effusion. Methods: Clinical and sonographic features of abdominal and pelvic infectious effusion of 64 patients with malignant tumor collected from September 2013 to September 2017 were retrospectively analyzed. The changes of effusion size and temperature, catheterization time were evaluated in saline irrigation group and antibiotics irrigation group. The catheterization time was compared between antibiotics irrigation group and high-concentration antibiotics perfusion group. Results: The effective rates of the saline irrigation group and the antibiotics irrigation group were 68.6% and 86.8%, respectively, and the times of catheterization were 11.9±8.4 days and 7.8±4.8 days, respectively, with significantly statistical difference (both P<0.05). However, the effective rates of the antibiotics irrigation group and the high concentration antibiotic perfusion group were 86.8% and 100.0%, respectively (P=0.067), while the times of catheterization were 7.8±4.8 days and 3.6±3.1 days, respectively (P<0.001). Conclusion: The antibiotic irrigation with tube drainage, especially the high concentration perfusion is more effective than saline in the treatment of abdominal and pelvic infection effusion.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/terapia , Drenagem , Infecção Pélvica/terapia , Cloreto de Sódio/uso terapêutico , Irrigação Terapêutica , Infecções Bacterianas/complicações , Humanos , Infecção Pélvica/microbiologia , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(42): e17338, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626090

RESUMO

RATIONALE: Unicompartmental knee arthroplasty (UKA) is an effective method to treat single compartment disease of the knee joint. Report about the complications of UKA, especially tibial plateau fractures, is rare. Given its rarity, its pathogenesis is not well described, and a standard of treatment is still not established. Therefore, relevant studies and analysis of this complication have a significant effect on helping physicians avoid risks and guide clinical diagnosis and treatment. PATIENT CONCERNS: The 1st case corresponds to a 70-year-old male patient who complained of knee pain, difficulty walking, nocturnal rest pain, and elevated skin temperature at 3 weeks after the left knee arthroplasty. The second case is a 72-year-old female patient who complained of left knee pain and swelling during movement at 2 weeks after the left knee arthroplasty. DIAGNOSIS: The 1st case showed a fracture of the medial malleolus of the left knee and a secondary depression of the medial tibial plateau in X-rays and the second case showed a fracture of the medial malleolus of the left knee in computed tomography (CT) and X-rays. INTERVENTIONS: The 1st case was treated with plate and screw fixation and the second case was treated conservatively and immobilized using brace and remained nonweight bearing for 6 weeks. OUTCOMES: After 1 year, both patients have good joint activity, and there was no pain or loosening of the prosthesis and fragment displacement. LESSONS: The incidence of tibial plateau fractures (TPF) related to UKA might be low, but fatal and difficult to treat. Its pathogenesis determines procedure-related factors; when fracture develops, treatment should be based on the degree of displacement, stability of implant fixation, etc.


Assuntos
Artroplastia do Joelho/efeitos adversos , Tratamento Conservador/métodos , Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/terapia , Fraturas da Tíbia/terapia , Idoso , Idoso de 80 Anos ou mais , Braquetes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Niger J Clin Pract ; 22(9): 1189-1195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489852

RESUMO

Aim: The aim of the present study was to determine whether the use of advanced platelet rich fibrin based on the low speed+ centrifugation concept (A-PRF+) might improve the pain management and healing of delayed wound healing among cases of alveolar osteitis following mandibular third molar extraction. Materials and Methods: The patients (N = 40) with a complaint of alveolar osteitis following third molar extractions were divided into two groups: Group I (control; saline only); and Group II (use of A-PRF+). Pain was evaluated using the visual analogue scale (VAS). Soft tissue healing was assessed by the modified Index of Landry, Turnbull and Howley and bone density was assessed with the i-Dixel 2.1.8.2 software. Inter-group comparisons were analyzed by means of a student t-test and the Mann Whitney U test to identify group samples. Analysis of variance and the Friedman test were applied for repeated measurements. The Wilcoxon test and Bonferroni's test for multiple comparisons were conducted at the time-factor level. Yates Correction was used to compare qualitative data. Results: In regard to pain, A-PRF+ application demonstrated rapidly and continually reduced pain intensity at each respective time in comparison to the control. Statistically, the healing rates of epithelium and hard tissue were significantly faster in the A-PRF+ application group (p: 0.000, P < 0.05). Conclusions: The results show that A-PRF+ might represent an improved and accelerating therapeutic development for hard and soft tissue healing in management of alveolar osteitis that is also effective in reducing pain.


Assuntos
Alvéolo Seco/terapia , Adesivo Tecidual de Fibrina/administração & dosagem , Dente Serotino/cirurgia , Fibrina Rica em Plaquetas , Complicações Pós-Operatórias/terapia , Extração Dentária/efeitos adversos , Cicatrização/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Mandíbula , Manejo da Dor , Estudos Prospectivos , Extração Dentária/métodos , Escala Visual Analógica
10.
Undersea Hyperb Med ; 46(4): 461-465, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509902

RESUMO

Introduction: Mastectomy skin flap necrosis represents a significant complication of breast reconstructive procedures and is reported to occur in 30%-52% of patients undergoing breast reconstruction. Early identification of ischemia and early initiation of hyperbaric oxygen (HBO2) therapy can mitigate the effects of ischemia and rescue otherwise non-viable breast flap tissue. Methods: We retrospectively examined the outcomes of HBO2 therapy in eight breasts with compromised mastectomy skin flaps between September 2015 and January 2017. Indocyanine green angiography (ICGA) was used to assess perfusion intraoperatively and post-HBO2 administration. Results: Seven patients were referred for HBO2 within 24 hours of mastectomy. One patient failed to improve despite starting hyperbaric treatment within 24 hours. All other patients manifested successful healing of their mastectomy skin flaps with acceptable cosmesis after 10 HBO2 treatments. The mean relative perfusion of the at-risk area was 13.8% (±3.7%) pre-HBO2 and 101.6% (±37.3%) post-HBO2. The average area at-risk pre-HBO2 was 17.1 cm2 and reduced to zero post-HBO2. Relative perfusion values after HBO2 were found to be 6.8 (±3.4) times greater than those measured prior to HBO2. Conclusions: A short course of HBO2 may be sufficient to successfully rescue at risk post-mastectomy breast flaps. ICGA is a useful adjunct for evaluating post-mastectomy breast flap perfusion before and after HBO2 therapy.


Assuntos
Oxigenação Hiperbárica , Isquemia/terapia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/terapia , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Angiografia/métodos , Neoplasias da Mama/cirurgia , Corantes , Feminino , Humanos , Verde de Indocianina , Isquemia/etiologia , Mastectomia , Pessoa de Meia-Idade , Necrose/terapia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Terapia de Salvação/métodos , Retalhos Cirúrgicos/patologia , Cicatrização
11.
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
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 742-747, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422612

RESUMO

Objective: To investigate the morbidity and treatment of early postoperative complications after laparoscopic D2 radical gastrectomy for gastric cancer, and to explore the risk factors. Methods: A case-control study was performed to retrospectively collect clinicopathological data of 764 patients undergoing laparoscopic D2 radical gastrectomy for gastric cancer at our department between January 2015 and December 2017. Patient inclusion criteria: (1) gastric cancer diagnosed by preoperative electronic gastroscopy and biopsy, and confirmed by postoperative pathology; (2) without invasion into adjacent organs by preoperative evaluation of tumors; (3) tumors without definite liver and distant metastasis; (4) R0 resection of gastric cancer and standard D2 lymph node dissection; (5) patients with informed consent. Exclusion criteria: (1) unperformed laparoscopic D2 radical resection; (2) other types of gastric tumor confirmed by pathology; (3) cases with incomplete clinical data. Complication occurring within two weeks after laparoscopic D2 gastrectomy was defined as early postoperative complication. Patients were divided into two groups: non-complication group (693 cases) and complication group (71 cases) according to the occurrence of complications after operation. The clinicopathological data of two groups were analyzed and compared with t test and χ(2) test, and the factors of P < 0.2 were included in the multivariate logistic regression model to analyze the risk factors of postoperative complications. Results: Of 764 patients, 71 (9.3%) developed early postoperative complications, with median onset time of 3 (1 to 11) days. Surgical complications accounted for 7.9% (60/764), including 13 cases (1.7%) of abdominal hemorrhage, 12 cases (1.6%) of anastomotic leakage, 10 cases (1.3%) of incision infection, 8 cases (1.0%) of anastomotic bleeding, 7 cases (0.9%) of gastric stump weakness, 4 cases (0.5%) of abdominal infection, 4 cases (0.5%) of duodenal stump leakage and 2 cases (0.3%) of small intestinal obstruction. Non-surgical complications accounted for 1.4% (11/764), including 6 cases (0.8%) of pulmonary infection and 5 cases (0.7%) of cardiovascular disease. Two cases (0.3%) died of sepsis caused by severe abdominal infection; 9 cases (1.2%) recovered after receiving the second operation, among whom 5 cases were abdominal hemorrhage, 2 cases were anastomotic leakage and 2 cases were duodenal stump leakage; the remaining patients were healed with conservative treatment. Compared with patients without complications, patients with complications had higher proportions of BMI ≥24 kg/m(2) [42.3% (30/71) vs. 24.2%(168/693), χ(2)=10.881, P=0.001], comorbity [64.8% (46/71) vs. 33.5% (232/693), χ(2)=27.277, P<0.001], combined organ resection [70.4% (50/71) vs. 20.5% (142/693), χ(2)=85.338, P<0.001], and pTNM stage of III [70.4% (50/71) vs. 40.1% (278/693), χ(2)=24.196, P<0.001], meanwhile had longer time to postoperative flatus [(4.2±2.1) days vs. (2.9±1.2) days, t=4.621, P=0.023], longer hospital stay [(34.6±12.6) days vs. (14.2±6.2) days, t=9.862, P<0.001] and higher hospitalization cost [(126.8±64.5) thousand yuan vs. (85.2±35.8) thousand yuan, t=11.235, P<0.001]. Multivariate analysis showed that BMI ≥24 kg/m(2) (OR=3.762, 95% CI: 1.960-8.783, P=0.035), accompanying disease (OR=8.620, 95% CI: 1.862-29.752, P<0.001), combined organ resection (OR=6.210, 95% CI: 1.357-21.568, P=0.026), and pTNM stage (OR=4.752, 95% CI: 1.214-12.658, P<0.001) were the independent risk factors of postoperative complications. Conclusions: Laparoscopic D2 radical gastrectomy is a safe and effective approach for gastric cancer. Most early postoperative complications can obtain satisfactory efficacy after conservative treatment. Perioperative management should be strengthened for those patients with high BMI, accompanying diseases, combined organ resection, and advanced pTNM stage.


Assuntos
Gastrectomia/efeitos adversos , Neoplasias Gástricas/cirurgia , Humanos , Laparoscopia , Excisão de Linfonodo , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco
13.
Ann Otol Rhinol Laryngol ; 128(12): 1194-1197, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31364384

RESUMO

OBJECTIVES: To describe a case of open airway surgery with postoperative respiratory complications in a paraplegic woman and to review the unique respiratory physiology seen in patients with a history of cervical or thoracic spinal cord injury (SCI). METHODS: Case report and literature review. RESULTS: We describe the case of a 25-year-old paraplegic who developed tracheal stenosis after tracheotomy, eventually requiring tracheal resection and re-anastomosis. Her postoperative course was complicated by mucus plugging and severe atelectasis, necessitating reintubation. After extubation, the patient reported difficulty expectorating secretions ever since her SCI, requiring manual abdominal pressure from her family members to assist her when she needed to cough. CONCLUSION: This first report of cricotracheal resection in a patient with paraplegia following SCI highlights the importance of an adequate cough and demonstrates the unique respiratory management necessary for patients with SCI.


Assuntos
Tosse , Paraplegia/complicações , Complicações Pós-Operatórias/terapia , Traumatismos da Medula Espinal/complicações , Estenose Traqueal/cirurgia , Adulto , Extubação , Feminino , Humanos , Muco , Complicações Pós-Operatórias/etiologia , Estenose Traqueal/etiologia , Traqueotomia/efeitos adversos
14.
Niger J Clin Pract ; 22(8): 1115-1119, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417055

RESUMO

Background: A new approach for prosthesis-based breast reconstruction is the use of a titanium-coated polypropylene mesh TiLOOP® Bra. However, the safety and outcomes are currently unclear in Chinese breast cancer patients. Methods: A retrospective study of patients undergoing prosthesis-based breast reconstruction using TiLOOP® Bra was carried out. Complications were divided into minor complications (require conservative treatment) and major complications (require surgical intervention). The influence of patient- and surgery-related characteristics on complications was analyzed. Results: Postoperative hematoma and seroma were respectively found in one and two breasts and could be treated conservatively. In three breasts skin infection occurred immediately after surgery resulting in skin necrosis of two breasts and wound dehiscence of one breast. These three breasts were treated with mesh removal, and revisionary surgery. Increased risk of mesh removal and implant explantation were observed in case of skin infection (P = 0.011) and skin necrosis (P = 0.033). Neither patient-related characteristics including age >50 years, BMI >25 kg/m2, and postoperative radiotherapy/chemotherapy, nor surgery-related characteristics including sentinel lymph node biopsy or axillary dissection alone, and curative/prophylactic surgery were significantly correlated with minor and major complications. Ultrasound evaluation showed a well-incorporated mesh into surrounding tissue. Conclusion: This titanium-coated polypropylene mesh showed acceptable complications and could be used safely in prosthesis-based breast reconstruction by stabilizing the implant pocket. Longer follow-up data and more randomized trials are necessary to determine the clinical use of this mesh.


Assuntos
Implantes de Mama , Materiais Revestidos Biocompatíveis , Mamoplastia/métodos , Polipropilenos , Telas Cirúrgicas , Titânio , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mastectomia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
15.
Br J Anaesth ; 123(4): 421-429, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256916

RESUMO

BACKGROUND: The National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) calculator and the Revised Cardiac Risk Index (RCRI) were derived using currently outdated methods of diagnosing perioperative myocardial infarctions. We tested the external validity of these tools in a setting of a systematic perioperative cardiac biomarker measurement. METHODS: Analysis of routinely collected data nested in the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study. A consecutive sample of patients ≥45 yr old undergoing in-hospital noncardiac surgery in a single tertiary care centre was enrolled. The predictive performance of the models was tested in terms of the occurrence of major cardiac complications defined as a composite of a nonfatal myocardial infarction, a nonfatal cardiac arrest, or a cardiac death within 30 days after surgery. The plasma concentration of high-sensitivity troponin T was measured before surgery, 6-12 h after operation, and on the first, second, and third days after surgery. Myocardial infarction was diagnosed according to the Third Universal Definition. RESULTS: The median age was 65 (59-72) yr, and 704/870 (80.9%) subjects were male. The primary outcome occurred in 76/870 (8.7%; 95% confidence interval [CI], 6.9-10.8%) patients. The c-statistic was 0.64 (95% CI, 0.57-0.70) for the NSQIP MICA and 0.60 (95% CI, 0.54-0.65) for the RCRI. Predicted risks were systematically underestimated in calibration belts (P<0.001). The RCRI and the NSQIP MICA showed no clinical utility before recalibration. CONCLUSIONS: The NSQIP and RCRI models had limited predictive performance in this at-risk population. The recently updated version of the RCRI was more reliable than the original index.


Assuntos
Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Cardiopatias/epidemiologia , Complicações Intraoperatórias/terapia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Complicações Pós-Operatórias/terapia , Medição de Risco/normas , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Estudos de Coortes , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Valor Preditivo dos Testes , Melhoria de Qualidade , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
16.
Br J Anaesth ; 123(3): 378-391, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331649

RESUMO

Respiratory depression is common in patients recovering from surgery and anaesthesia. Failure to recognise and lack of timely institution of intervention can lead to catastrophic cardiorespiratory arrest, anoxic brain injury, and mortality. Opioid-induced respiratory depression (OIRD) is a common and often under-diagnosed cause of postoperative respiratory depression. Other causes include residual anaesthesia, residual muscle paralysis, concurrent use of other sedatives, splinting from inadequate pain control, and obstructive sleep apnoea. Currently used methods to identify and monitor respiratory safety events in the post-surgical setting have serious limitations leading to lack of universal adoption. New tools and technologies currently under development are expected to improve the prediction of respiratory depression especially in patients requiring opioids to alleviate acute postoperative pain. In this narrative review, we discuss the various causes of postoperative respiratory depression, and highlight the advances in monitoring and early recognition of patients who develop this condition with an emphasis on OIRD.


Assuntos
Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Insuficiência Respiratória/diagnóstico , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Diagnóstico Precoce , Humanos , Monitorização Fisiológica/tendências , Dor Pós-Operatória/tratamento farmacológico , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
17.
Braz J Cardiovasc Surg ; 34(3): 352-360, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310475

RESUMO

Acute kidney injury (AKI) is a common and severe complication after cardiac surgery. Currently, a series of novel biomarkers have favored the assessment of AKI after cardiac surgery in addition to the conventional indicators. The biomartkers, such as urinary liver fatty acid binding protein (L-FABP), urinary neutrophil gelatinase-associated lipocalin (NGAL), serum L-FABP, heart-type FABP, kidney injury molecule 1 (KIM-1), and interleukin-18 were found to be significantly higher in patients who developed AKI after cardiac surgery than those who did not. Apart from urinary interleukin-18, the novel biomarkers have been recognized as reliable indicators for predicting the diagnosis, adverse outcome, and even mortality of AKI after cardiac surgery. The timing of the renal replacement therapy is a significant predictor relating to patients' prognoses. In patients with AKI after cardiac surgery, renal replacement therapy should be performed as early as possible in order to achieve promising outcomes. In children, AKI after cardiac surgery can be managed with peritoneal dialysis. AKI after cardiac surgery has received extensive attention as it may increase early mortality and impact long-term survival of patients as well. The purpose of this article was to analyze the changes of the pertinent biomarkers, to explore the related risk factors leading to the occurrence of AKI after cardiac surgery, and to provide a basis for the clinical prevention and reduction of AKI.


Assuntos
Lesão Renal Aguda/etiologia , Biomarcadores/análise , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Lesão Renal Aguda/terapia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
Medicine (Baltimore) ; 98(26): e16204, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31261567

RESUMO

Several prognostic indices have been employed to predict the outcome of surgical critically ill patients. Among them, acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS 3) are widely used. It seems that biological markers such as C-reactive protein (CRP), albumin, and blood lactate levels correlate with the degree of inflammation during the immediate postoperative phase and could be used as independent predictors. The objective of this study is to compare the different predictive values of prognostic indices and biological markers in the outcome of 847 surgical patients admitted to the intensive care unit (ICU) in the postoperative phase.The patients were divided into survivors (n = 765, 57.4% males, age 61, interquartile range 51-71) and nonsurvivors (n = 82, 57.3% males, age 70, interquartile range 58-79). APACHE II, APACHE II death probability (DP), SOFA, SAPS 3, SAPS 3 DP, CRP, albumin, and lactate were recorded on ICU admission (first 24 hours). The area under the ROC curve (AUROC) and 95% confidence interval (95% CI) were used to measure the index accuracy to predict mortality.The AUROC and 95% CI for APACHE II, APACHE II DP, SOFA, SAPS 3, SAPS 3 DP, CRP/albumin ratio, CRP, albumin, and lactate were 0.850 (0.824-0.873), 0.855 (0.829-0.878), 0.791 (0.762-0.818), 0.840 (0.813-0.864), 0.840 (0.813-0.864), 0.731 (0.700-0.761), 0.708 (0.676-0.739), 0.697 (0.665-0.728), and 0.601 (0.567-0.634), respectively. The ICU and overall in-hospital mortality were 6.6 and 9.7%, respectively. The APACHE II, APACHE II DP, SAPS 3, SAPS 3 DP, and SOFA scores showed a better performance than CRP/albumin ratio, CRP, albumin, or lactate to predict in-hospital mortality of surgical critically ill patients.Even though all indices were able to discriminate septic from nonseptic patients, only APACHE II, APACHE II DP, SOFA and to a lesser extent SAPS 3, SAPS 3 DP, and blood lactate levels could predict in the first 24-hour ICU admission surgical patients who have survived sepsis.


Assuntos
Cuidados Críticos , Estado Terminal/mortalidade , Estado Terminal/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , APACHE , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Cuidados Críticos/métodos , Feminino , Mortalidade Hospitalar , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/mortalidade , Sepse/terapia , Albumina Sérica/metabolismo , Escala Psicológica Aguda Simplificada
19.
Lakartidningen ; 1162019 Jun 27.
Artigo em Sueco | MEDLINE | ID: mdl-31265115

RESUMO

Tracheal rupture is a rare but potentially lethal injury. There are several causes; traumatic, neck surgery, tracheal dilatation and association to intubation. We describe a case of tracheal injury where the patient developed subcutaneous emphysema while coughing in the recovery room. Our patient did initially not complain of any breathing difficulties but after further coughing the emphysema increased and the patient became dyspnoeic. Emergent CT-imaging showed a tracheal injury and our patient was transport to ENT for stent therapy. It is important to recall the risk for tracheal injury. Subcutaneous emphysema and breathing difficulties with debut following extubation should raise the suspicion.


Assuntos
Intubação Intratraqueal/efeitos adversos , Traqueia/lesões , Adulto , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Fatores de Risco , Enfisema Subcutâneo/etiologia , Enfisema Subcutâneo/terapia
20.
Medicine (Baltimore) ; 98(28): e16475, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305482

RESUMO

Afferent loop obstruction is an uncommon complication associated with Billroth-II distal gastrectomy. Inappropriate treatment may result in life-threatening events as perforation and peritonitis. For the benign afferent loop obstruction, Braun or Roux-en-Y reconstruction has been reported as the choice. However, the edematous afferent loop may result in anastomotic fistula. In this study, a less invasive technique was described for treatment of benign afferent loop obstruction. The aim of this study was to investigate the effectiveness and safety of endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction.We conducted a retrospective review of the data of 2548 gastric cancer patients who underwent distal gastrectomy from January 2002 to January 2018. Patients who developed benign afferent loop obstruction were treated by this procedure. Outcomes were recorded. Follow-up was scheduled at 3, 6, and 12 months after the treatment.Twenty-six patients (1.0%) developed afferent loop obstruction. The median age, consisting of 19 men and 7 women, was 60 years (range 36-69 years). Of these 26 patients, 23 underwent the endoscopic treatment. The obstructive symptoms had a rapid relief in all the 23 patients. No one died due to this procedure. However, 2 patients underwent surgical treatment due to intestinal obstruction because of adhesion at >4 and 7 months after the endoscopic drainage, respectively.Endoscopic nasogastric tube insertion is an effective and safe procedure for treatment of benign afferent loop obstruction. In addition, it could be considered as the first step in treatment, especially in high-surgical-risk patients.


Assuntos
Síndrome da Alça Aferente/terapia , Endoscopia Gastrointestinal , Gastrectomia , Intubação Gastrointestinal , Complicações Pós-Operatórias/terapia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/métodos , Endoscopia Gastrointestinal/métodos , Seguimentos , Humanos , Intubação Gastrointestinal/métodos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Estudos Retrospectivos , Resultado do Tratamento
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