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1.
Khirurgiia (Mosk) ; (4): 53-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352669

RESUMO

Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.


Assuntos
Traqueia/cirurgia , Estenose Traqueal/cirurgia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Constrição Patológica/cirurgia , Dissecação , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/patologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Traqueotomia
2.
Rev. esp. enferm. dig ; 112(4): 284-289, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187507

RESUMO

INTRODUCCIÓN: existe poca evidencia científica sobre la eficacia de la dilatación endoscópica con balón (DEB) mediante enteroscopia en el tratamiento de las estenosis de intestino delgado (ID) en la enfermedad de Crohn (EC). OBJETIVO: evaluar la eficacia y la seguridad de la DEB mediante enteroscopia en pacientes con EC y estenosis en ID. MÉTODOS: estudio observacional retrospectivo en un centro de atención terciaria en pacientes con EC y estenosis de ID evaluadas por enteroTC o enteroRM. RESULTADOS: desde 2009 hasta 2019 se realizaron 205 dilataciones en 80 pacientes con EC; de ellos 17 (21,25 %) fueron pacientes con estenosis exclusivamente de ID (varones 70,6 %; edad media de 42,2 ± 14,4. El tiempo medio de seguimiento fue de 37,8 ± 28,7 meses. Se realizaron un total de 39 dilataciones. El 94,1 % eran nativas, con una longitud inferior que 5 cm y el 100 % estaban ulceradas. La tasa global de éxito técnico fue 82,4 %. El éxito clínico fue del 88,2 %. Durante el seguimiento, el 23,5 % de los sujetos requirieron de intervención quirúrgica (IQ), el 29,4 % de redilatación endoscópica y la eficacia a largo plazo fue del 76,5 %. No se produjeron complicaciones mayores. No se encontraron factores predictivos asociados con la necesidad de IQ tras la dilatación. CONCLUSIONES: las estenosis de ID pueden ser tratadas de forma segura y eficaz con DEB mediante enteroscopia asistida por balón (EAB) reduciend la necesidad de IQ a largo plazo


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Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doença de Crohn/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Endoscopia Gastrointestinal , Constrição Patológica/cirurgia , Estudos Retrospectivos , Seguimentos , Dilatação
4.
Artigo em Chinês | MEDLINE | ID: mdl-32074745

RESUMO

Objective: To assess the outcomes of partial cricotracheal resection (CTR) and extended cricotracheal resection (ECTR) for severe laryngotracheal stenosis. Methods: From November 2009 to September 2017, 18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively. There were 12-male and 6-female patients, with the age ranged from 4 to 56 years (median 25 years). The causes were postintubation in 11 cases, cervical trauma in 4, idiopathic in 3. The stenosis located in subglottic and tracheal (n=12), glottic and subglottic and tracheal (n=3), subglottic (n=2), and glottic and subglottic (n=1). Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction. The stenosis was graded according to modified Myer-Cotton classification as follows: Ⅲb (n=1), Ⅲc(n=1), Ⅳa (n=2), Ⅳb (n=12), Ⅳc (n=2). The surgical outcomes and complications were recorded. Results: Among 18 patients,11 of the 12 patients undergoing CTR were decannulated. Five of the 6 patients undergoing ECTR were decannulated. Resected airway length ranged from 1.5 to 4.0 cm (median 2.8 cm). Surgical complications included infection of incision wound in 2 cases, anastomotic granulation in 2, cervical subcutaneous emphysema in 1, aspiration in 1, and unilateral arytenoid prolapse in 1. No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred. The median follow up was 11 months. Conclusions: CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis. Both procedures also provide a salvage therapy for patients with previous failed treatments.


Assuntos
Cartilagem Cricoide/cirurgia , Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traqueia/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
Urology ; 135: 57-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618656

RESUMO

OBJECTIVE: To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS: The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION: RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Obstrução Ureteral/epidemiologia , Derivação Urinária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cistectomia/métodos , Feminino , Humanos , Incidência , Intestinos/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
7.
Gastroenterology ; 158(1): 137-150.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31476299

RESUMO

BACKGROUND & AIMS: Stenosis is a common complication of Crohn's disease (CD) that has no effective medical therapy. Development of antifibrotic agents will require testing in randomized controlled trials. Computed tomography enterography- and magnetic resonance enterography-based technologies might be used to measure outcomes in these trials. These approaches have been validated in studies of patients with symptomatic strictures who underwent imaging evaluations followed by resection with histopathologic grading of the intestinal tissue for inflammation and/or fibrosis (the reference standard). Imaging findings have correlated with findings from quantitative or semiquantitative histologic evaluation of the degree of fibromuscular stenosis and/or inflammation on the resection specimen. However, it is not clear whether histologic findings are an accurate reference standard. We performed a systematic review of all published histologic scoring systems used to assess stenosing CD. METHODS: We performed a comprehensive search of Embase and MEDLINE of studies through March 13, 2019, that used a histologic scoring system to characterize small bowel CD and assessed inflammatory and fibrotic alterations within the same adult individual. All scores fitting the criteria were included in our analysis, independent of the presence of stricturing disease, as long as inflammation and fibrosis were evaluated separately but in the same scoring system. RESULTS: We observed substantial heterogeneity among the scoring systems, which were not derived from modern principles for evaluative index development. None had undergone formal validity or reliability testing. None of the existing indices had been constructed according to accepted methods for the development of evaluative indices. Basic knowledge regarding their operating properties were lacking. Specific indices for evaluating the important pathologic component of myofibroblast hypertrophy or hyperplasia have not been proposed. CONCLUSIONS: In a systematic review of publications, we found a lack of validated histopathologic scoring systems for assessment of fibromuscular stenosis. Data that describe the operating properties of existing cross-sectional imaging techniques for stenosing CD should be questioned. Development and validation of a histopathology index is an important research priority.


Assuntos
Constrição Patológica/diagnóstico , Doença de Crohn/complicações , Íleo/patologia , Índice de Gravidade de Doença , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Fibrose , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Imagem por Ressonância Magnética , Padrões de Referência , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X
8.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 826-829, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795543

RESUMO

Objective: To explore the application value of thyroid alar cartilage(TAC) in the laryngotracheal reconstruction of subglotticstenosis in the paediatric population. Methods: Twelve patients(7 males,5 females; range from 2.3 to 12.0 years) with subglotticstenosis who had undergone laryngotracheal reconstruction procedures at our hospital fromSeptember 2016 to July 2018 were analyzed retrospectively.The degree of stenosis was classified according to Myer-Cotton classification system:grade Ⅱ(n=4),grade Ⅲ(n=6) and grade Ⅳ(n=2). The stenosis planes were subglotticbut did not exceed the 3rd tracheal cartilage ring. Results: Of all 12 patients, 11 were decannulated and 1 failed. All patients with grade Ⅱ and Ⅲ patients were decannulated at one procedure. There were no severe complications such as tube dislogement,asphyxia and unhealed wound. Conclusions: The TAC for widening laryngotracheal lumen is relatively simple and reliable for laryngotracheal reconstruction in the pediatric population with subglottic stenosis. This would't cause any structural damage to the laryngeal cavity.


Assuntos
Cartilagens Laríngeas/transplante , Laringoestenose/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Criança , Pré-Escolar , Constrição Patológica/classificação , Constrição Patológica/cirurgia , Feminino , Humanos , Laringoestenose/classificação , Masculino , Estudos Retrospectivos
10.
BMC Surg ; 19(1): 176, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752907

RESUMO

BACKGROUND: This study aimed to propose a novel surgical reconstruction technique for complex high-location bile duct injury (CHBDI). METHODS: There were eight patients with CHBDI underwent the novel hepaticojejunostomy between Feb 2015 and Feb 2017. Seven patients underwent a primary operation and found CHBDI postoperatively in the inferior hospitals referred to our center. And four of them had received hepaticojejunostomy, but the results were not satisfying. One patient (No.8) with radiographically diagnosed hilar cholangiocarcinoma came to our center for surgical treatment and underwent the novel hepaticojejunostomy technique because CHBDI was found in operation. Perioperative and follow-up data of these patients were retrospectively reviewed. RESULTS: The mean age was 47.6 ± 10.7 years, and there was four female. The mean range of time between the injury and the repair operation in our center was 6.3 ± 4.8 months. All repair operations using the novel hepaticojejunostomy technique in our center were successfully performed. No postoperative complications, including biliary fistula, restenosis, peritonitis, and postoperative cholangitis was observed. Besides, no evidence of biliary stenosis or biliary complications happened during the follow-up (median 28 months). CONCLUSIONS: The novel hepaticojejunostomy is a reliable and convenient technique for surgical repair of multiple biliary ductal openings like CHBDI.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/lesões , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Adulto , Idoso , Anastomose Cirúrgica , Constrição Patológica/cirurgia , Feminino , Humanos , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31732546

RESUMO

An otherwise healthy, 10-year-old boy presented with chronic, gross hematuria. This persisted daily for 5 years despite extensive multidisciplinary workup with renal biopsy and resulted in severe iron deficiency anemia. The extensive workup and requirement for routine follow-up, investigations, and procedures led to significant psychosocial distress for the patient. Initially, it was thought the patient had a nutcracker phenomenon, but on closer inspection of his ureters, an idiopathic, unilateral ureteric stricture was discovered and, after 8 weeks of stenting, resulted in complete resolution of the hematuria. Importantly, the patient's psychosocial distress resolved after resolution of the hematuria and with the closure that came with a diagnosis.


Assuntos
Hematúria/diagnóstico por imagem , Hematúria/cirurgia , Ureter/diagnóstico por imagem , Ureter/cirurgia , Adolescente , Criança , Doença Crônica , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Hematúria/etiologia , Humanos , Masculino
12.
J Surg Oncol ; 120(8): 1446-1449, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31733073

RESUMO

Pharyngoesophageal stenosis (PES) is a common and serious complication of head and neck cancer treatments such as radiation therapy, chemotherapy, tracheoesophageal puncture placement, and total laryngectomy surgery. Dilation-resistant stenosis requires surgical reconstruction, often with a radial forearm free flap (RFFF). With the present technique, the authors refine their previous bipaddled free flap design used to reconstruct a persistent tracheoesophageal fistulae (TEF) in combination with PES. Accordingly, we present a novel bipaddled triangular RFFF design ideally suited to address the shape of the defect in the posterior tracheal wall that results when the TEF is opened and the esophageal and tracheal components are restored.


Assuntos
Constrição Patológica/cirurgia , Estenose Esofágica/cirurgia , Antebraço/cirurgia , Retalhos de Tecido Biológico , Doenças Faríngeas/cirurgia , Fístula Traqueoesofágica/cirurgia , Constrição Patológica/etiologia , Estenose Esofágica/etiologia , Feminino , Humanos , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Pessoa de Meia-Idade , Doenças Faríngeas/etiologia , Fístula Traqueoesofágica/etiologia
13.
Khirurgiia (Mosk) ; (11): 5-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714523

RESUMO

OBJECTIVE: To analyze early and delayed results of various variants of circular tracheal resection (CTR) with anastomosis, to determine the safest approach, dates and conditions of correction, features of postoperative period in patients after previous tracheal surgery. MATERIAL AND METHODS: There were 831 patients with cicatricial tracheal stenosis. CTR was made in 330 (39.7%) patients. Most patients had previous prolonged ICU-stay. The patients were divided into 4 groups. Group 1 consisted of 61 (18.5%) patients after previous prolonged tracheal stenting. Group 2 included 45 (13.6%) patients who underwent circular tracheal resection with a functioning tracheostomy. Tracheostomy tube served as a stent in these patients. Group 3 enrolled 32 (9.7%) patients with previous staged reconstructive plastic surgeries on cranial segment of the respiratory tract. Tracheostomy or stent were absent in 192 (58.2%) patients who underwent circular tracheal resection at the first hospitalization. These patients were enrolled into the fourth (control) group. Favorable outcomes (without complications and mortality) were achieved in 85.5% (n=282) of patients. Postoperative complications occurred in 48 (14.5%) patients. Mortality rate was 0.6% (n=2). The greatest number of complications including anastomositis and restenosis was noted in patients after CTR and previous tracheoplasty with T-tube (n=8, 25%). The most common complication in patients after tracheal resection and previous stenting was anastomositis (14.7%). Long-term results depended on postoperative complications and methods of their correction. Recurrent stenosis occurred in 5 (1.5%) patients within the period of 3 months - 8 years. CTR after previous tracheoplasty with T-tube was carried out in 4 of these patients. CONCLUSION: Tracheal resection after preliminary stenting or tracheostomy is quite safe and technically feasible. Stenting allows postponing radical surgery for correction of concomitant diseases and closure of tracheostomy as a focus of infection within the surgical approach and further tracheal anastomosis. Tracheal resection with simultaneous closure of tracheostomy results a higher rate of postoperative complications compared with preliminary stenting.


Assuntos
Constrição Patológica/cirurgia , Stents/efeitos adversos , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Constrição Patológica/etiologia , Humanos , Estudos Retrospectivos , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/etiologia
14.
Medicine (Baltimore) ; 98(45): e17877, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702657

RESUMO

RATIONALE: Budd-Chiari syndrome (BCS), which causes congestive hepatopathy and aggravates cirrhosis, is typically treated by interventional angioplasty to ameliorate blood flow. X-ray venography is useful for the evaluation of inferior vena cava (IVC) stenosis and determination of treatment timing, but it is invasive and thus unsuitable for repeated examinations. The development of a simple method for the prediction of IVC stenosis would reduce the burden on patients with BCS. PATIENT CONCERNS: We report here our experience of 2 patients with BCS who underwent percutaneous transluminal angioplasty (PTA). The first patient was a 39-year-old male who underwent PTA to expand his stenotic IVC. The second patient was a 19-year-old male who underwent PTA 3 times due to restenosis of his IVC. DIAGNOSES: Both patients were diagnosed with BCS with severe obstruction of the IVC. INTERVENTIONS: We evaluated the hepatic vein (HV) waveform by Doppler ultrasonography and measured liver stiffness (LS) using transient elastography (TE) before and after PTA. OUTCOMES: In case 1, the phasic oscillation of the HV waveform recovered and the LS value decreased after PTA. Both improvements were maintained for ∼3 years, reflecting the long-term patency of the IVC. In case 2, the HV waveform and the LS value improved temporarily after PTA, but then deteriorated gradually. Monitoring of the HV waveform and LS value allowed retreatment prior to total occlusion of the IVC and abrogated the risk of intravascular needle puncture. LESSONS: Monitoring of the HV waveform and the LS value enables safe management of patients with BCS who may require PTA.


Assuntos
Síndrome de Budd-Chiari/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Veias Hepáticas/diagnóstico por imagem , Adulto , Angioplastia com Balão , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Veias Hepáticas/cirurgia , Humanos , Masculino , Ultrassonografia Doppler , Adulto Jovem
15.
Rev Med Suisse ; 15(665): 1765-1768, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580021

RESUMO

Congenital tracheal stenosis is a rare malformation of the fibrino-cartilaginous tracheal skeleton, frequently associated with cardiac malformations. The symptoms and the age of presentation varie according to the severity of the stenosis. There is a risk of airway obstruction. The diagnosis is based on endoscopy and surgery is usually required.


Assuntos
Constrição Patológica/congênito , Constrição Patológica/cirurgia , Traqueia/anormalidades , Obstrução das Vias Respiratórias , Constrição Patológica/diagnóstico , Humanos , Traqueia/cirurgia , Estenose Traqueal/congênito , Estenose Traqueal/diagnóstico , Estenose Traqueal/cirurgia
16.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 243-249, sept.-oct. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-183879

RESUMO

Depressed fractures that occur on the superior sagittal sinus (SSS) cause stenosis or thrombosis of the sinus in 11.5% of cases. Despite this, the appearance of signs and symptoms derived from high intracranial pressure is an infrequent event. So far, only 17 cases of venous sinus injury causing intracranial hypertension have been documented. It is necessary to establish treatment immediately before clinical suspicion. Surgical treatment by craniectomy is a fast, effective and safe alternative according to the series. However, it is necessary to anticipate the possibility of haemorrhage in the operating room. The case of a 7-year-old girl admitted for traumatic brain injury (TBI) with the diagnosis of a left parasagittal occipital sinus fracture that stenosed the posterior third of the superior sagittal sinus is presented. Upon arrival, she was asymptomatic, and conservative management was selected. Subsequently, the patient began to present with headache, nausea, vomiting and diplopia associated with bradycardia and apnoea pauses of central origin. She underwent surgery with a craniectomy with satisfactory clinical and radiological evolution and normalization of the intracranial pressure (ICP) registry


Las fracturas por hundimiento que acontecen sobre el seno sagital superior (SSS) ocasionan estenosis o trombosis del seno en el 11,5% de los casos. Sin embargo, en raras ocasiones ocasionan hipertensión intracraneal. La revisión de la literatura aporta únicamente 17 casos de fractura sobre senos venosos provocando cuadro de hipertensión intracraneal, aunque posiblemente se trata de una entidad más frecuente de lo que cabría esperar sobre lo publicado. Es necesario establecer un tratamiento de forma inmediata ante la sospecha clínica. El tratamiento quirúrgico mediante craniectomía es una alternativa rápida, eficaz y segura según las series. Sin embargo, es necesario estar anticipado en el quirófano ante la posibilidad de sufrir hemorragia. Se presenta el caso de una niña de 7 años que ingresa por traumatismo craneoencefálico con el diagnóstico de fractura por hundimiento occipital parasagital izquierda que estenosa el tercio posterior del SSS. A su llegada se encuentra asintomática y se decide manejo conservador. Posteriormente comienza con cefalea, náuseas, vómitos y diplopía asociado a bradicardia y pausas de apnea de origen central. Es intervenida mediante craniectomía con posterior evolución clínica y radiológica satisfactoria, y normalización de la presión intracraneal


Assuntos
Humanos , Feminino , Criança , Hipertensão Intracraniana/complicações , Seio Sagital Superior/lesões , Seio Sagital Superior/cirurgia , Craniotomia/métodos , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Cefaleia/diagnóstico por imagem , Cefaleia/etiologia
17.
World J Gastroenterol ; 25(34): 5210-5219, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558868

RESUMO

BACKGROUND: Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction. No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting. AIM: To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction. METHODS: PubMed, Embase, Scopus, and Cochrane databases, as well as secondary sources (bibliographic review of selected articles and major GI proceedings), were searched through January 2019. The primary outcome was the re-intervention rate. Secondary outcomes were a technical success, early and late complications, and stent malfunction rate. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome. RESULTS: A total of 9 studies were included (2 prospective Randomized Controlled Study, 5 retrospective studies, and 2 abstracts), involving 782 patients with malignant hilar obstruction. Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage (OR = 0.59, 95%CI: 0.40-0.87, P = 0.009). There was no difference in the technical success rate (OR = 0.7, CI: 0.42-1.17, P = 0.17), early complication rate (OR = 1.56, CI: 0.31-7.75, P = 0.59), late complication rate (OR = 0.91, CI: 0.58-1.41, P = 0.56) and stent malfunction (OR = 0.69, CI: 0.42-1.12, P = 0.14) between bilateral and unilateral stenting for malignant hilar biliary strictures. CONCLUSION: Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures, with no significant difference in technical success, and early or late complication rates.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/cirurgia , Drenagem/métodos , Tumor de Klatskin/complicações , Cuidados Paliativos/métodos , Neoplasias dos Ductos Biliares/cirurgia , Colestase/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Drenagem/efeitos adversos , Drenagem/instrumentação , Ducto Hepático Comum/patologia , Ducto Hepático Comum/cirurgia , Humanos , Tumor de Klatskin/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
18.
Cardiovasc Intervent Radiol ; 42(12): 1745-1750, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493058

RESUMO

INTRODUCTION: Biliary duct injuries pose a significant management challenge due to the propensity for recurrent biliary strictures. Development of a modified Roux-en-Y hepaticojejunostomy known as a Hutson-Russell Pouch (HRP) provides a point of entry for repetitive access to the biliary tree. We aim to highlight the effectiveness of using the HRP as an access point for the long-term management of anastomotic and distal biliary strictures, thereby showcasing the value in potential widespread adoption of this modification to a standard surgical procedure. MATERIALS AND METHODS: IRB-approved retrospective study of 36 patients (10 M, 26 F; mean age 55.19 ± 13.94; 15-83) underwent a total of 110 transjejunal cholangiograms. Indications for cholangiogram included cholangitis (n = 38), surveillance (n = 36), and elevated liver enzymes (n = 36). Technical success was defined by the ability to access and intervene in the biliary tree via HRP access. In case of stenosis, the ability to successfully dilate (< 30%) residual stenosis was considered a technically successful procedure. Clinical success was defined by normalization of the liver function tests or resolution of cholangitis. RESULTS: Technical success was achieved in 83/110 (75.45%) of the cases, and clinical success was achieved in 102/110 (98.2%). Transhepatic access was needed in 27/110 (24.5%) of the cases. Interventions performed included balloon cholangioplasty in 104/110 (94.5%), biliary stone removal in 2/110 (1.8%), biliary stent placement in 2/110 (1.8%), and biliary drain placement in 4/110 (3.6%). There were a total of 9/110 complications (8.2%). CONCLUSION: The HRP was an effective access point in the management of recurrent benign biliary strictures in this cohort.


Assuntos
Anastomose em-Y de Roux/métodos , Doenças dos Ductos Biliares/patologia , Doenças dos Ductos Biliares/cirurgia , Colangiografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Estudos de Coortes , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
19.
In Vivo ; 33(5): 1641-1644, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471417

RESUMO

BACKGROUND: An open-label, single-arm study was conducted to assess the safety of a cryosurgery unit named CRYO2 for debulking at the site of obstruction or stenosis. PATIENTS AND METHODS: In order to treat central airway tumor-related stenosis, debulking at the stenotic site of the airway was performed using CRYO2 under general or local anesthesia. The primary endpoint was the incidence of moderate to massive hemorrhage. RESULTS: Incidence of moderate to massive hemorrhage during surgery was 3.8% (1/26) (95% confidence interval(CI)=0.1-19.6%). Technical success was 96.2% (25/26), with a 95% confidence interval of 80.4-99.9%. CONCLUSION: CRYO2 for debulking at the site of obstruction or stenosis can be performed safely.


Assuntos
Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos de Citorredução , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Criocirurgia/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Neoplasias do Sistema Respiratório/complicações , Neoplasias do Sistema Respiratório/diagnóstico , Neoplasias do Sistema Respiratório/terapia , Resultado do Tratamento
20.
Int J Pediatr Otorhinolaryngol ; 127: 109672, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31539787

RESUMO

INTRODUCTION: Congenital tracheal stenosis (CTS) is a rare airway condition characterized by complete tracheal rings. Most patients undergo a slide tracheoplasty, which greatly reduces mortality but significant morbidity remains. The assessment of sleep disordered breathing (SDB) and use of non-invasive ventilation (NIV) in these children has not been described. AIM: To describe the presence of SDB and use of NIV in children diagnosed with CTS over a 10-year period (2005-2015). DESIGN: Retrospective case series at a tertiary children's hospital. RESULTS: There were 16 patients identified with CTS with a median [range] age at diagnosis of 2.5 months (0-9 months). One child died in the immediate post-operative period following a slide tracheoplasty, leaving 15 survivors. There were no later deaths during follow-up while using NIV for up to 3 years after surgery. Slide tracheoplasty was undertaken in (12/15) with long-segment tracheal stenosis. 3/15 patients had a short-segment tracheal stenosis and were managed conservatively. The use of NIV occurred in 10/15 (66.67%) patients, all of whom had long-segment CTS. Pre-operative polysomnography (PSG) showed a median (±SD) obstructive apnoea/hypopnoea index (OAHI) of 14.6/hr (±6.2) which reduced to 7.2/hour (±4.2) on NIV prior to slide tracheoplasty. The median oxygen desaturation index (ODI) before NIV use was 15.3 (±19.4) episodes/hour, which reduced to 6.3 (±11) on NIV. The median period of NIV use was 5 [1-24 months] months. CONCLUSION: Patients with CTS have obstructed sleep disordered breathing. Trials of NIV are well-tolerated and improve sleep disordered breathing.


Assuntos
Constrição Patológica/complicações , Constrição Patológica/cirurgia , Ventilação não Invasiva , Síndromes da Apneia do Sono/terapia , Traqueia/anormalidades , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Polissonografia , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Índice de Gravidade de Doença , Traqueia/cirurgia , Resultado do Tratamento
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