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1.
Rev Assoc Med Bras (1992) ; 65(5): 678-681, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166445

RESUMO

OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.


Assuntos
Complicações do Diabetes/cirurgia , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae/patogenicidade , Osteomielite/cirurgia , Abscesso do Psoas/cirurgia , Doenças da Coluna Vertebral/cirurgia , Complicações do Diabetes/microbiologia , Drenagem/métodos , Feminino , Gases/metabolismo , Humanos , Infecções por Klebsiella/microbiologia , Pessoa de Meia-Idade , Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Reprodutibilidade dos Testes , Doenças da Coluna Vertebral/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Acta Med Port ; 32(5): 368-374, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31166897

RESUMO

INTRODUCTION: Fournier gangrene is a polymicrobial life threatening infection of perineal subcutaneous soft tissues with its point of origin in urologic, colorectal or skin diseases. Although more frequent in elderly and men, it can affect all genders and age groups. Perianal abscess, diabetes mellitus and Escherichia coli are the most frequent cause, predisposing comorbidity, and microorganism found in tissue culture analysis respectively. The objective of this study was to describe the experience of a Plastic Surgery Department of a tertiary Hospital in reconstructing Fournier's gangrene perineal defects and its detailed demography. MATERIAL AND METHODS: The sample is composed of all patients with Fournier gangrene admitted in the Plastic Surgery and Burns Department. The authors retrospectively collected and analyzed demographic and clinical data during a period of 10 years including gender, age, length of stay, cause, number of debridements, predisposing factors, microbial culture results, surgical reconstructive techniques and its associated complications, additional surgical procedures and outcomes. RESULTS: Fifteen patients were identified: 14 males (93%) and one female (7%); mean age was 66.9 years (range: 46 - 86); mean, length of stay was 46.8 days (range: 20 - 71 days) and mean number of debridements was 3.3 (range: 1 - 4). The most frequent predisposing factor was diabetes mellitus, the major cause was perianal (n = 2) and skin abscess (n = 2). Eight (53.3%) patients had no identifiable source of Fournier gangrene. Various types of reconstructive techniques were employed; and 5 additional surgical interventions (33.3%) were undertaken (one cystostomy, two orchidectomy, two ileostomy); six patients (40%) presented reconstructive technique complications with adequate final outcome. DISCUSSION: In contrast with the literature, where Escherichia coli was the most frequently isolated agent, Staphylococcus aureus was the most frequent microorganism found in tissue biopsy/pus collection analysis. A higher than expected number of patients (n = 8) had no identifiable source of Fournier gangrene. This findings can be explained by the retrospective non-multicentre study limitation, with a potencial source of bias patients that were transferred from other hospitals in advanced stage, without point of origin of Fournier's gangrene identified. CONCLUSION: Early recognition and extensive necrotic tissue debridement, along with prompt and adequate antimicrobial treatment, are the mainstay of Fournier gangrene management, thus reducing morbidity and mortality in these patients. Surgical reconstruction challenges derived from this condition should be addressed by specialized teams due to the risk of dysfunctional sequelae and conspicuous deformities. Taking in account the single-center and retrospective observational character of the present study, these premises require proper validation from a multicenter prospective study.


Assuntos
Gangrena de Fournier/cirurgia , Idoso , Idoso de 80 Anos ou mais , Desbridamento/estatística & dados numéricos , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Complicações do Diabetes/cirurgia , Feminino , Gangrena de Fournier/etiologia , Gangrena de Fournier/microbiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Períneo , Estudos Retrospectivos , Fatores de Risco , Cirurgia Plástica/estatística & dados numéricos , Centros de Atenção Terciária
3.
Medicine (Baltimore) ; 98(23): e15935, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169714

RESUMO

BACKGROUND: Patients requiring posterior lumbar surgery have increased annually. Incision infection after lumbar surgery has serious consequences for patients. However, data on the related factors of incision infection after lumbar surgery in diabetic patients are limited. Therefore, this study aimed to analyze diabetic patients who underwent lumbar surgery and to explore the risk factors of perioperative incision infection to provide a scientific basis for perioperative intervention of lumbar spine surgery and reduce risk of incision infection in such patients. METHODS: We retrospectively reviewed data of diabetic patients who underwent posterior lumbar surgery from 2011 to 2016. A total of 523 diabetic patients undergoing posterior lumbar surgery were analyzed for the influence of various risk factors on postoperative incision infection. Univariate and multivariate logistic regression was performed. The test level was α=.05, and P < .05 was considered statistically significant. RESULTS: In the past 6 years, among the 523 diabetic patients, the incidence of incision infection after posterior lumbar surgery was approximately 7.1%, of which the shallow incision infection rate was 4.2% and the deep incision infection rate was 2.9%. Incision infection of posterior lumbar surgery in diabetic patients is related to smoking, preoperative glycosylated hemoglobin A1c, postoperative albumin (Alb), surgical segment, operation time, and intraoperative blood loss, especially on postoperative fasting blood glucose, postoperative postprandial blood glucose, local subcutaneous fat thickness, and operation sequence (odds ratio >5.00). Meanwhile, sex, age, body mass index (BMI), preoperative Alb, and newly diagnosed diabetes were not highly correlated with incision infection after posterior lumbar surgery. CONCLUSION: Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery.


Assuntos
Complicações do Diabetes/cirurgia , Diabetes Mellitus/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Idoso , Glicemia , Índice de Massa Corporal , Complicações do Diabetes/sangue , Complicações do Diabetes/patologia , Diabetes Mellitus/sangue , Diabetes Mellitus/patologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Fatores de Risco , Gordura Subcutânea/patologia , Infecção da Ferida Cirúrgica/sangue , Infecção da Ferida Cirúrgica/epidemiologia
4.
Int J Med Sci ; 16(5): 665-674, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31217734

RESUMO

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


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/cirurgia , Hiperglicemia/epidemiologia , Complicações Intraoperatórias/epidemiologia , Idoso , Glicemia/metabolismo , Complicações do Diabetes/patologia , Complicações do Diabetes/cirurgia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Feminino , Humanos , Hiperglicemia/etiologia , Hiperglicemia/patologia , Hiperglicemia/cirurgia , Insulina/metabolismo , Resistência à Insulina/genética , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Masculino , Fatores de Risco
5.
Curr Gastroenterol Rep ; 21(6): 26, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31025126

RESUMO

PURPOSE OF REVIEW: Transplantation of the islets of Langerhans or the pancreas aims to restore blood sugar control. We review both forms of transplantation in children. RECENT FINDINGS: Allogenic islet transplantation typically in to the liver via the portal vein may be a potential alternative to pancreas transplantation in the future. Autologous islet transplantation after total pancreatectomy is effective for debilitating symptoms of recurrent and chronic pancreatitis. Chronic pancreatitis in children is most often related to genetic mutations but is otherwise similar to adults with eventual exocrine and endocrine failure. Removal of the pancreas ameliorates pain, and islet transplantation preserves endocrine function to the extent allowed by the damage sustained by the pancreas from chronic inflammation. Despite the complexity of the operative procedure, the outcome of total pancreatectomy and autologous islet transplantation in children has been excellent including quality of life.


Assuntos
Complicações do Diabetes/cirurgia , Hiperglicemia/cirurgia , Transplante das Ilhotas Pancreáticas , Transplante de Pâncreas , Pancreatopatias/cirurgia , Criança , Complicações do Diabetes/etiologia , Humanos , Hiperglicemia/etiologia , Transplante das Ilhotas Pancreáticas/métodos , Pancreatectomia , Pancreatopatias/complicações , Pancreatite Crônica/etiologia , Pancreatite Crônica/cirurgia
7.
Gastroenterol Hepatol ; 42(7): 413-422, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30954320

RESUMO

INTRODUCTION: To assess the efficacy and safety of gastric peroral endoscopic myotomy for the treatment of gastroparesis. METHODS: PubMed, Embase, Cochrane Library and Web of Science databases were searched from their earliest records to May 2018. The evaluation of clinical efficacy and safety was based on gastric emptying scintigraphy normalization, the improvement in clinical symptoms and adverse event rate. R 3.5.0 software was used to calculate the pooled estimate rates by meta-analysis. The improvement rate of the Gastroparesis Cardinal Symptom Index score was analyzed at different follow-up times. RESULTS: Fourteen studies with a total of 276 patients were included in this systematic review. The pooled gastric emptying scintigraphy normalization rate was 61.3% (95% CI, 51.5-70.8%) and clinical symptom improvement rate was 88.2% (95% CI, 83.6-93.1%). Intra-operative complications were found in about 3.2% (95% CI, 0.1-4.2%) of all included patients, and postoperative adverse events in 2.1% (95% CI, 0.3-4.8%). The mean Gastroparesis Cardinal Symptom Index score improvement rate was about 90.2% at one month follow-up, 83.3% at three months, 70.3% at six months, 52.4% at twelve months and 57.1% at eighteen months. DISCUSSION: Our systematic review demonstrates that gastric peroral endoscopic myotomy is a safe and effective treatment for gastroparesis. Though the short-term outcomes are promising, prospective, randomized, controlled studies with large sample size and long-term follow-up are required to further confirm these results.


Assuntos
Gastroparesia/cirurgia , Gastroscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Piloro/cirurgia , Esfincterotomia/métodos , Complicações do Diabetes/cirurgia , Estudos de Avaliação como Assunto , Seguimentos , Esvaziamento Gástrico , Humanos , Complicações Intraoperatórias/etiologia , Boca , Complicações Pós-Operatórias/etiologia , Projetos de Pesquisa , Estudos Retrospectivos , Resultado do Tratamento
8.
Ulster Med J ; 88(1): 30-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30675076

RESUMO

Background: Major lower limb amputation remains a common treatment for patients with peripheral vascular disease (PVD) in whom other measures have failed. It has been associated with high morbidity and mortality, including risks from venous thromboembolism (VTE). Methods: A two-year retrospective cohort study was conducted involving 79 patients who underwent major lower limb amputation (below- or above-knee amputation) between January 2014 and December 2015 in a single tertiary referral centre. Amputation procedures were performed for reasons relating to complications of PVD and/or diabetes mellitus. Patients were followed-up to investigate all-cause mortality rates and VTE events using the Northern Ireland Electronic Care Record database (mean follow-up time 17 months). Results: Of the 79 patients, there were 52 male and 27 female. Mean age at time of surgery was 72 years (range 34-99 years). Forty-six patients (58%) suffered from diabetes mellitus, 29 (35%) heart failure, 31 (39%) chronic kidney disease (CKD) and 10 (13%) chronic obstructive pulmonary disease (COPD). Twenty patients (25%) were on anticoagulant therapy, and 53 (67%) were on antiplatelet therapy.Thirty-five patients (44%) died during follow-up; mean age at death was 74 years. No statistically significant association was found between mortality rate and the level of amputation (p=0.3702), gender (p=0.3507), or comorbid diabetic mellitus (p=0.1127), heart failure (p=0.1028), CKD (p=0.0643) or COPD (p=0.4987).Two patients experienced radiologically-confirmed non-fatal pulmonary emboli and two patients developed radiologically-confirmed deep vein thrombosis. Conclusions: The results are in agreement with current literature that amputation is associated with significant mortality, with almost half of the study population dying during follow-up. Further work should explore measures by which mortality rates may be reduced.


Assuntos
Amputação/mortalidade , Complicações do Diabetes/cirurgia , Extremidade Inferior/cirurgia , Doenças Vasculares Periféricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Causas de Morte , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Irlanda do Norte/epidemiologia , Doenças Vasculares Periféricas/complicações , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Tromboembolia Venosa/etiologia
9.
Wound Repair Regen ; 27(3): 249-256, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30663823

RESUMO

The effect of diabetes on postoperative outcomes following surgical management of pressure ulcers is poorly defined despite evidence showing that patients with diabetes are at increased risk for developing pressure ulcers, as well as postoperative wound complications including delayed healing and infection. This study aimed to examine the impact of diabetes on postoperative outcomes following surgical management of pressure ulcers using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. In this retrospective analysis all CPT codes with ICD-9 diagnoses of pressure ulcers were reviewed. A total of 3,274 patients who underwent surgical management of pressure ulcers were identified, of which 1,040 (31.8%) had diabetes. Overall primary outcomes showed rates of superficial and deep incisional surgical site infection (SSI) were 2.0 and 4.2%, respectively, while the rate of wound dehiscence was 2.1%. Univariate analysis of primary outcomes stratified by diabetes status showed that patients with diabetes had significantly higher rates of superficial incisional SSI (3.9 vs. 2.3%; p = 0.01), deep incisional SSI (7.0 vs. 4.3%; p = 0.001), wound dehiscence (5.2 vs. 2.7%; p < 0.001), as well as significantly higher rates of readmission (12.8 vs. 8.9%; p = 0.001). Multivariate analysis for significant outcomes between groups on univariate analysis demonstrated that diabetes was an independent risk factor for superficial incisional SSI (OR = 2.7; 95% CI: 1.59-4.62; p < 0.001), deep incisional SSI (OR = 1.85; 95% CI: 1.26-2.70; p = 0.002), wound dehiscence (OR = 4.09; 95% CI: 2.49-6.74; p < 0.001), and readmission within 30 days (OR = 1.38; 95% CI: 1.05-1.82; p = 0.02). These findings emphasize the importance of preoperative prevention, and vigilant postoperative wound care and monitoring in patients with diabetes to minimize morbidity and optimize outcomes. Future prospective studies are needed to establish causality between diabetes and these outcomes.


Assuntos
Complicações do Diabetes/cirurgia , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Lesão por Pressão/patologia , Infecção da Ferida Cirúrgica/patologia , Cicatrização/fisiologia , Adulto , Idoso , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Cuidados Pré-Operatórios/métodos , Lesão por Pressão/etiologia , Lesão por Pressão/cirurgia , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/cirurgia
10.
Microsurgery ; 39(1): 14-23, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29719063

RESUMO

BACKGROUND: Diabetes affects a significant proportion of the population in the United States. Microsurgical procedures are common in this patient population, and despite many conflicting reports in the literature, there are no large studies evaluating the direct association between diabetes and outcomes, specifically failure, following free flap reconstruction. In this study, we sought to determine the impact of diabetes on postoperative outcomes following free flap reconstruction using a national multi-institutional database. METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patients undergoing free flap reconstruction from 2010 to 2015. Preoperative variables and outcomes were compared between diabetic and nondiabetic patients. Univariate and multivariate analyses were performed to control for confounders. RESULTS: We identified 6030 eligible patients. No significant difference in flap failure rates was observed. However, diabetic patients presented significantly higher rates of wound complications, including deep incisional surgical site infection (SSI) (OR = 1.35; P = .01) and wound dehiscence (OR = 1.17; P = .03). Diabetic patients also presented a significantly longer hospital length of stay (LOS) (ß = .62; P < .001). CONCLUSIONS: Our study evaluated the largest national cohort of free flap procedures. These results suggest that diabetes is not associated with increased rates of flap failure. However, diabetic patients are at significantly higher risk of postoperative deep incisional SSI, wound dehiscence, and longer LOS. Our findings provide the most concrete evidence to date in support of free flap reconstruction in diabetic patients, but highlight the need for heightened clinical vigilance and wound care for optimal outcomes.


Assuntos
Complicações do Diabetes/complicações , Retalhos de Tecido Biológico , Microcirurgia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Bases de Dados Factuais , Complicações do Diabetes/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos
11.
Endocrine ; 63(1): 27-35, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30238327

RESUMO

PURPOSE: The surgical outcome on glucose metabolism in acromegaly patients is not fully understood. We aimed to investigate the impact of surgery on glucose metabolism and identify key factors that influence alterations of glucose metabolic status in acromegaly patients. METHODS: Oral glucose tolerance test was performed in 151 newly diagnosed acromegaly patients before and 3-12 months after surgery. Insulin resistance and insulin secretion was assessed. Patients were grouped as cured, discordant, and having active disease according to postoperative growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels. Receiver-operating characteristic curves were generated to determine the optimal cut-off points to predict the impact of surgery on glucose metabolism. RESULTS: At baseline, 32.5%, 41.7%, and 25.8% patients were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM), respectively. After surgery, improved glucose tolerance was observed in 87.3% patients with IGT and 66.7% patients with DM. Deterioration was observed in 14.3% patients with NGT. Glucose tolerance improved in patients with lower preoperative FBG, 2 h-BG, and HbA1c and higher HOMA-ß and IGI/IR. The proportion of NGT was significantly increased in surgically cured patients (28.3% vs. 79.2%, P < 0.001) and those with normal GH but elevated IGF-1 levels (25.6% vs. 79.5%, P < 0.001), but not in patients with active disease (42.9% vs. 57.1%, P = 0.131). Baseline FBG < 6.35 mmol/l predicted improved glucose metabolism after surgery. CONCLUSIONS: Glucose metabolic status improved in patients with preserved ß-cell function. Preoperative FBG was an independent predictor for improved glucose tolerance status after surgery.


Assuntos
Adenoma/metabolismo , Adenoma/cirurgia , Glucose/metabolismo , Adenoma Hipofisário Secretor de Hormônio do Crescimento/metabolismo , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Acromegalia/metabolismo , Acromegalia/cirurgia , Adulto , Complicações do Diabetes/cirurgia , Feminino , Teste de Tolerância a Glucose , Hormônio do Crescimento Humano/sangue , Humanos , Insulina/metabolismo , Resistência à Insulina , Fator de Crescimento Insulin-Like I/análise , Masculino , Pessoa de Meia-Idade , Valores de Referência , Resultado do Tratamento , Adulto Jovem
12.
Endocrinol Diabetes Nutr ; 66(1): 56-61, 2019 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30392998

RESUMO

OBJECTIVES: To assess remission of type 2 diabetes mellitus (T2DM) after bariatric surgery, to analyze potential conditioning factors, and to compare Spanish and American remission criteria. MATERIAL AND METHODS: A retrospective study of diabetic patients undergoing Roux-en-Y gastric bypass from 2009 to 2015. Data collected included age, sex, time since T2DM diagnosis, antidiabetic drugs, insulin (type and dose), weight and BMI, percent excess weight lost, HbA1c, blood glucose levels, and course of T2DM after surgery according to Spanish and American criteria, including a descriptive analysis and correlation between both. RESULTS: The study sample consisted of 106 patients. Outcomes one year after surgery was as follows (Spanish criteria): complete remission 65.9%, partial remission 5.5%, improvement 18.9%, no change 9.7% (at 5 years: 68.4, 5.3, 10.5, and 15.8%, respectively). Outcomes according to ADA criteria were as follows: complete remission 61.5%, partial remission 5.3%, and no remission 28.6% (after 5 years, complete remission 68.4%). There was a good correlation between both classifications (Rho=0.974; P<.001). Mean HbA1c levels: 7.3±1.8% at baseline; 5.7±1% at one year; 6.3±1.2% at 5 years. Chance of remission was lower in patients aged over 50 years (54.4 vs. 88.2%; P=.001), with T2DM diagnosed more than 10 years before (26.3 vs. 81.8%; P<.001), on insulin treatment (31.3 vs. 87.9%; P<.001), and with HbA1c levels≥8% (40 vs. 77%; P=.001). CONCLUSIONS: At our hospital, bariatric surgery is associated to a high remission rate of T2DM in patients with morbid obesity, with a good correlation between Spanish and American criteria. Age over 50 years old, long T2DM duration, poorer baseline metabolic control, and previous insulin treatment are markers of poorer response.


Assuntos
Cirurgia Bariátrica , Complicações do Diabetes/cirurgia , Diabetes Mellitus Tipo 2/cirurgia , Obesidade Mórbida/cirurgia , Complicações do Diabetes/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento
13.
Biomed Res Int ; 2018: 3050537, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30515389

RESUMO

Objective: To explore whether it is safe to change from transecting excision and primary anastomosis (tEPA) towards nontransecting excision and primary anastomosis (ntEPA) in the treatment of short bulbar urethral strictures and to evaluate whether surgical outcomes are not negatively affected after introduction of ntEPA. Materials and Methods: Two-hundred patients with short bulbar strictures were treated by tEPA (n=112) or ntEPA (n=88) between 2001 and 2017 in a single institution. Failure rate and other surgical outcomes (complications, operation time, hospital stay, catheterization time, and extravasation at first cystography) were calculated for both groups. Potentially predictive factors for failure (including ntEPA) were analyzed using Cox regression analysis. Results: Median follow-up for the entire cohort was 76 months, 118 months, and 32 months for, respectively, tEPA and ntEPA (p<0.001). Nineteen (9.5%) patients suffered a failure, 13 (11.6%) with tEPA and 6 (6.8%) with ntEPA (p=0.333). High-grade (grade ≥3) complication rate was low (1%) and not higher with ntEPA. Median operation time, hospital stay, and catheterization time with tEPA and ntEPA were, respectively, 98 and 87 minutes, 3 and 2 days, and 14 and 9 days. None of these outcomes were negatively affected by the use of ntEPA. Diabetes and previous urethroplasty were significant predictors for failure (Hazard ratio resp. 0.165 and 0.355), whereas ntEPA was not. Conclusions: Introduction of ntEPA did not negatively affect short-term failure rate, high-grade complication rate, operation time, catheterization time, and hospital stay in the treatment of short bulbar strictures. Diabetes and previous urethroplasty are predictive factors for failure.


Assuntos
Anastomose Cirúrgica/métodos , Complicações do Diabetes/cirurgia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Cateterismo , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento , Uretra/fisiopatologia , Estreitamento Uretral/fisiopatologia
14.
Tunis Med ; 96(8-9): 520-523, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30430532

RESUMO

INTRODUCTION: necrotizing fasciitis of the chest wall is a rare condition in subcutaneous tissues and deep fascia. Primary thoracic involvement is exceptional and is a diagnostic and therapeutic emergency. AIM: To report our experience in the management of this rare pathology of which clinical picture is unknown by most practitioners. METHODS: This is a retrospective study carried out over a period of 07 years, compiling 07 cases of primitive necrotizing fasciitis of the thoracic wall at the department of thoracic surgery at the CHU Hassan II in Fez. RESULTS: Patients were five men and two women, with an average age of 58 years. All our patients were known to have poorly balanced diabetes. The reason for consultation was a swelling of the chest wall with fever in all patients. On the results of thoracic computed tomography (CT), the presence of a deep collection of soft tissue was found   in all patients. The treatment was a large necrosectomy, taking away the skin as well as the adjacent muscle. Postoperative follow-up was favorable in five patients. We noted two deceased patients due to postoperaive septic shock. CONCLUSION: Necrotizing chest wall fasciitis is a medical and surgical emergency, requiring early diagnosis and rapid and appropriate management which will determine the prognosis.


Assuntos
Complicações do Diabetes/diagnóstico , Complicações do Diabetes/cirurgia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/cirurgia , Parede Torácica/microbiologia , Idoso , Fasciite Necrosante/microbiologia , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia Torácica , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos , Parede Torácica/patologia , Tomografia Computadorizada por Raios X
16.
Cir Cir ; 86(5): 399-403, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30226498

RESUMO

Antecedentes: Una de las principales complicaciones de la diabetes mellitus es la amputación de alguna extremidad. En todo el mundo, la prevalencia de amputaciones asociadas a la diabetes es muy variada y tiene un impacto considerable en la calidad de vida del paciente. Objetivo: Analizar la frecuencia de las amputaciones en el Hospital Universitario Dr. José E. González y evaluar si se presenta un patrón estacional. Método: Se realizó un estudio retrospectivo de 2009 a 2012, en el que se revisaron los expedientes de pacientes diabéticos que se sometieron a amputación. La estacionalidad se analizó con la bondad de ajuste de ji al cuadrado. Resultados: Se analizaron 456 amputaciones. Los resultados muestran que febrero es el mes que presenta la mayor frecuencia de amputaciones. La estación anual con mayor número de amputaciones fue el invierno. Conclusiones: Las amputaciones en pacientes diabéticos del área metropolitana de Monterrey presentan un patrón estacional, siendo los meses de invierno los de mayor frecuencia. Background: The amputation of an extremity is a main complication of Diabetes mellitus. Worldwide the prevalence of amputations associated with diabetes mellitus is variable and had a considerable impact in the quality of life. Objective: Analyze the frequency of amputations in the University Hospital, Dr José E González and evaluate if a seasonal pattern is present. Method: A retrospective analysis from 2009 to 2012 was carried out. Clinical files of diabetic patients undergoing to amputation were studied. The seasonality was evaluated with a chi square goodness of fit. Results: A total of 456 amputations were studied. Results shown that February was the month with highest frequency of amputations while winter was the annual season with highest frequency of amputations. Conclusions: Amputations of diabetic patients from Metropolitan Monterrey Mexico show a seasonal pattern being the winter months those that present highest frequency.


Assuntos
Amputação/estatística & dados numéricos , Idoso , Complicações do Diabetes/cirurgia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , México , Pessoa de Meia-Idade , Razão de Chances , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Estudos Retrospectivos , Estações do Ano , Fatores Socioeconômicos
17.
Wiad Lek ; 71(5): 1076-1079, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30176644

RESUMO

Summarizing the review of literary sources, one can conclude that, despite a significant number of scientific papers devoted to the problem of pyoinflammatory complications of diabetes, there remain issues that require further study and solution. Taking into account the above facts, it becomes obvious that it is necessary to seek for more effective and advanced methods of complex treatment of pyoinflammatory complications of soft tissues, with an emphasis of search efforts on the introduction of effective therapeutic methods of conservative correction into the medical practice, methods of activation of reparative processes, aimed at restriction of invalidizating limb amputations, combined with further improvement of minimally invasive operational and technical innovations in the surgical direction.


Assuntos
Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/cirurgia , Inflamação , Ozônio/uso terapêutico , Humanos
18.
J Mycol Med ; 28(3): 519-522, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30205883

RESUMO

Mucormycosis is a rare fungal infection and high mortality that commonly affects patients with the weakened immune system. We present an unusual case of tongue necrosis probably due to the healthcare-associated mucormycosis (HCM) in a diabetic patient. Although cannot be proved with certainty, we surmise that intubation as a risk factor in our case. The diagnosis was confirmed by histopathological examination (HPE) of the necrotic tissue specimen. The patient was responded well to lipid complex amphotericin B (250mg) regime after surgery. Subsequent follow up revealed that no signs of recurrence. Early, recognition, diagnosis, prompt treatment and awareness among clinician are representing the most effective way of managing the disease.


Assuntos
Complicações do Diabetes/microbiologia , Mucormicose/microbiologia , Língua/patologia , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Desbridamento , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/cirurgia , Cetoacidose Diabética/complicações , Feminino , Humanos , Hospedeiro Imunocomprometido , Intubação/efeitos adversos , Malásia , Pessoa de Meia-Idade , Mucormicose/complicações , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Necrose , Fatores de Risco , Língua/microbiologia , Língua/cirurgia , Resultado do Tratamento
19.
Surg Obes Relat Dis ; 14(10): 1516-1520, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30077665

RESUMO

BACKGROUND: For patients in whom laparoscopic adjustable gastric band has failed, conversion to Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are both options for further surgical treatment. There are limited data comparing these 2 procedures. The National Bariatric Surgery Registry is a comprehensive United Kingdom-wide database of bariatric procedures, in which preoperative demographic characteristics and clinical outcomes are prospectively recorded. OBJECTIVES: To compare perioperative complication rate and short-term outcomes of patients undergoing single-stage conversion of gastric band to Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. SETTING: United Kingdom national bariatric surgery database. METHODS: From the National Bariatric Surgical Registry data set, we identified 141 patients undergoing single-stage conversion from gastric band to either gastric bypass (113) or sleeve gastrectomy (28) between 2009 and 2014, and analyzed their clinical outcomes. RESULTS: With respect to perioperative outcomes gastric bypass was associated with a higher incidence of readmission or reintervention postoperatively (16 versus 0; P = .04). There was no difference in percentage excess weight loss between sleeve gastrectomy and gastric bypass at final follow-up at 1 year (52.1% versus 57.1% respectively; P = .4). CONCLUSIONS: Conversion from band to sleeve or bypass give comparable good early excess weight loss; however, conversion to sleeve is associated with a better perioperative safety profile.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Cirurgia Bariátrica/efeitos adversos , Complicações do Diabetes/cirurgia , Gastrectomia/efeitos adversos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Gastroplastia/efeitos adversos , Gastroplastia/métodos , Humanos , Hipertensão/complicações , Hipertensão/cirurgia , Tempo de Internação/estatística & dados numéricos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Sistema de Registros , Reoperação/estatística & dados numéricos , Falha de Tratamento , Resultado do Tratamento , Reino Unido , Ganho de Peso/fisiologia , Perda de Peso/fisiologia
20.
PLoS One ; 13(7): e0200365, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29995929

RESUMO

PURPOSE: We aimed to investigate biomarkers and predictive factors for visual and anatomical outcome in patients with naïve diabetic macular edema (DME) who underwent small gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling as a first line treatment. DESIGN: Multicenter, retrospective, interventional study. PARTICIPANTS: 120 eyes from 120 patients with naïve DME treated with PPV and ILM peeling with a follow up of 24 months. METHODS: Change in baseline best corrected visual acuity (BCVA) and central subfoveal thickness (CST) 1, 6, 12 and 24 months after surgery. Predictive value of baseline BCVA, CST, optical coherence tomography (OCT) features (presence of subretinal fluid (SRF) and photoreceptor damage), and time between DME diagnosis and surgery. Additional treatment for DME needed. Intra- and post-operative complications (cataract rate formation, increased intraocular pressure). MAIN OUTCOME MEASURES: The correlation between baseline characteristics and BCVA response (mean change from baseline; categorized improvement ≥5 or ≥10; Early Treatment Diabetic Retinopathy Study (ETDRS) letters) 12 and 24 months after surgery. RESULTS: Mean BCVA was 0.66 ± 0.14 logMAR, 0.52 ± 0.21 logMAR, and 0.53 ± 0.21 logMAR (p<0.001) at baseline, 12 and 24 months, respectively. Shorter time from DME diagnosis until PPV (OR: 0.98, 95% CI: 0.97-0.99, p<0.001) was a predictor for good functional treatment response (area under the curve 0.828). For every day PPV is postponed, the patient's chances to gain ≥5 letters at 24 months decrease by 1.8%. Presence of SRF was identified as an anatomical predictor of a better visual outcome, (OR: 6.29, 95% CI: 1.16-34.08, p = 0.033). Safety profile was acceptable. CONCLUSIONS: Our results reveal a significant functional and anatomical improvement of DME 24 months after primary PPV, without the need for additional treatment. Early surgical intervention and presence of SRF predict good visual outcome. These biomarkers should be considered when treatment is chosen.


Assuntos
Complicações do Diabetes/diagnóstico , Complicações do Diabetes/cirurgia , Edema Macular/diagnóstico , Edema Macular/cirurgia , Vitrectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Olho/diagnóstico por imagem , Olho/patologia , Feminino , Seguimentos , Humanos , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prognóstico , Estudos Retrospectivos , Tempo para o Tratamento , Tomografia de Coerência Óptica
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