Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.685
Filtrar
1.
BMC Surg ; 20(1): 270, 2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148241

RESUMO

BACKGROUND: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. METHODS: We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods. RESULTS: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). CONCLUSIONS: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.


Assuntos
Eventração Diafragmática , Toracoscopia , Toracotomia , Criança , Pré-Escolar , Diafragma/anormalidades , Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
2.
BMC Surg ; 20(1): 289, 2020 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-33213428

RESUMO

BACKGROUND: Schwannomas are nerve sheath tumors that commonly originate from the stomach and small intestine. A primary schwannoma of the diaphragm is rare and does not show any symptoms until it grows to a certain size. Hence, it is extremely rare that it was found at a size that allowed resection under videoscopic surgery. CASE PRESENTATION: A 77-year-old woman was referred to our department for surgical treatment of a tumor located near the gastric fornix. She underwent a routine esophagogastroduodenoscopy 2 years and 7 months prior to the referral. It was suspected that she had a submucosal tumor measuring 10 mm, located in the fornix, and was then referred to her previous physician. During her follow-up, endoscopic ultrasonography (EUS) revealed that the cystic structure had continued to grow toward the gastric wall, and she was then referred to the endoscopy division of our hospital. She continued to be followed-up, and it was noted that the tumor was gradually increasing in size. Therefore, she requested surgical resection, and was finally referred to our division. Since the tumor was rather small, we planned a laparoscopic surgery. An initial examination during the operation revealed that the tumor was located on the left diaphragm. Since the tumor was relatively small and visibility was good, we decided to continue with the laparoscopic surgery. Partial diaphragmectomy with complete inclusion of the tumor was performed, and the defect of the diaphragm was directly closed by a running suture. Pathological examination revealed a benign schwannoma that had originated from the diaphragm. To support our findings, we also reviewed the scientific literature on diaphragmatic schwannoma cases reported up to April 2020. CONCLUSIONS: In this extremely rare case, we successfully resected the diaphragmatic schwannoma using laparoscopic surgery.


Assuntos
Diafragma/cirurgia , Endoscopia do Sistema Digestório , Laparoscopia , Neurilemoma/cirurgia , Idoso , Diafragma/diagnóstico por imagem , Feminino , Humanos , Masculino , Neurilemoma/diagnóstico por imagem , Resultado do Tratamento
4.
BMC Surg ; 20(1): 172, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736550

RESUMO

BACKGROUND: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure. METHODS: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined. RESULTS: The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area. CONCLUSIONS: Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias do Colo/cirurgia , Hepatectomia , Neoplasias Hepáticas , Fígado/cirurgia , Peritônio/cirurgia , Idoso , Cadáver , Carcinoma Hepatocelular/patologia , Neoplasias do Colo/patologia , Diafragma/patologia , Diafragma/cirurgia , Dissecação , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia , Fígado/anatomia & histologia , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Peritônio/anatomia & histologia , Peritônio/patologia , Membrana Serosa/anatomia & histologia , Membrana Serosa/patologia , Membrana Serosa/cirurgia
6.
Am Surg ; 86(5): 493-498, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684037

RESUMO

BACKGROUND: Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI. METHODS: The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups. RESULTS: From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications (P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group. CONCLUSIONS: Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.


Assuntos
Diafragma/lesões , Diafragma/cirurgia , Laparoscopia , Tempo de Internação/estatística & dados numéricos , Ferimentos Penetrantes/cirurgia , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
J Thorac Cardiovasc Surg ; 160(5): 1291-1296.e1, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32713630

RESUMO

BACKGROUND: Phrenic nerve injury is a known cause of morbidity after single ventricle palliation. Previous studies have shown that hemidiaphragm plication improves short-term outcomes. The effect of plication on the outcomes of subsequent stages of single ventricle palliation is unknown. METHODS: From 1997 to 2015, 1146 patients underwent surgical management of single ventricle physiology at our institution. We reviewed the records of 30 patients who had undergone diaphragm plication for phrenic nerve injury before Fontan completion. Each patient was compared with 2 propensity-matched controls identified from patients who underwent the Glenn or Fontan procedure during the same period without diaphragm plication. Propensity matching was achieved for each test subject using the nearest neighbor algorithm. Data are presented as the median and quartiles or numbers and percentages. RESULTS: The cohort included 18 boys (60%). Of the 30 patients, 19 (63%) had undergone plication after first-stage palliation. Of these, 13 have undergone completion Fontan, 5 were awaiting Fontan at the last follow-up, and 1 had died. An additional 11 patients had undergone plication after Glenn and proceeded to Fontan completion. Thus, 24 patients with diaphragm plication have undergone Fontan completion. No difference was found in pulmonary pressure or resistance between the plicated patients and their propensity-matched controls. Both groups had comparable chest tube output and hospital lengths of stay. Equal proportions of patients in both groups required pulmonary vasodilator therapy and/or supplemental oxygen at hospital discharge. CONCLUSIONS: Prior diaphragm plication does not adversely affect Fontan completion in children with single ventricle physiology. The hospital course during subsequent stages of palliation for plicated patients was no different than that of matched controls.


Assuntos
Diafragma/cirurgia , Ventrículos do Coração/cirurgia , Cuidados Paliativos , Reoperação , Coração Univentricular/cirurgia , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
8.
Zentralbl Chir ; 145(3): 303-320, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32498112

RESUMO

Due to its importance as a central respiratory muscle as well as a separating layer between the thorax and abdomen, the functional integrity of the diaphragm is crucial in any case of surgical intervention. High demands are placed on surgical interventions regarding the functional integrity of the diaphragm. The aim of surgery may even be an improvement in the functional status of the patient. The surgery of the diaphragm is performed according to the same basic principles, regardless of the indication and the extent of the surgery. One of the most important principles concerns the suturing of the diaphragm. Regardless of whether it is a large or small defect, a tension-free suture is always required to prevent a secondary rupture or tearing of the suture and thus of the diaphragm. If necessary, a non-resorbable patch should be used to achieve a stress-free reconstruction. Because of the high physiological stress on the suture, the use of a non-resorbable suture with a high tear strength is recommended. Due to the position of the diaphragm between the thorax and the abdomen, a multidisciplinary surgical team may be necessary in surgical interventions depending on the state of the disease or the involvement of abdominal or thoracic organs.


Assuntos
Diafragma , Diafragma/cirurgia , Humanos , Ruptura
9.
Khirurgiia (Mosk) ; (5): 76-80, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500693

RESUMO

In this article is described a rare postoperative complication: epiphrenal diverticulum of the esophagus of the lower third of the esophagus in patient after antireflux surgery. Brief description of the main stages of surgical treatment. 96 patients with cardiofundal, subtotal or total hiatal hernias underwent operation. There were complications of I-II degree according to Clavien-Dindo in the early postoperative period in 11 patients (11.4%). Complications of IIIb degree were revealed in 2 patients (2.1%) in the early postoperative period and in 1 patient (1.0%) in the late postoperative period (2 months after hospitalization) - epiphrenal diverticulum of the esophagus. Laparotomy, the sagittal diafragmalnaya, diverticulectomy, valisesta pyloroplasty were performed. Postoperative period without complications. The patient's nutrition through the mouth is restored on the 5-th day. No dysphagia and reflux esophagitis were detected radiologically and endoscopically.


Assuntos
Divertículo Esofágico/etiologia , Divertículo Esofágico/cirurgia , Fundoplicatura/efeitos adversos , Hérnia Hiatal/cirurgia , Diafragma/cirurgia , Humanos , Laparotomia , Piloro/cirurgia
10.
PLoS One ; 15(6): e0234919, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559223

RESUMO

BACKGROUND: The ribcage and diaphragm are mechanical barriers for laparoscopic access during hepatectomy. Here, we introduce the varied application of intercostal trans-diaphragmatic ports during laparoscopic hepatectomy, and describe the management of intercostal ports with key technical points. METHODS: From January 2013 to December 2017, 180 patients underwent laparoscopic hepatectomy. In 32 of these patients (17.8%), intercostal ports (31 right and one left) were applied, and we analyzed the feasibility and safety of intercostal ports during laparoscopic hepatectomy. RESULTS: The main tumor location was segment VII and VIII (78%). The major type of laparoscopic hepatectomy was partial hepatectomy (91%). In the majority of cases (66%) the number and size of intercostal trocars was a single 5-mm port. The median operative time and blood loss were 232 min and 50 mL, respectively. A chest drain was placed via the hole of the intercostal port on the chest wall in two cases (6.3%). The median duration of the post-operative hospital stay was 6 days. There was no conversion, and a pure laparoscopic hepatectomy was achieved in all cases. There was no mortality. As for complications due to the application of intercostal ports, an asymptomatic pneumothorax was detected in only one case, and it was cured by conservative treatment. CONCLUSIONS: The ribcage and diaphragm could be overcome as barriers to laparoscopic access by the placement of intercostal ports with minimal access during laparoscopic hepatectomy. The use of an intercostal port and proper management allows for a feasible approach and safe resection during laparoscopic hepatectomy.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Diafragma/cirurgia , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/instrumentação , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Costelas/cirurgia
11.
Ulus Travma Acil Cerrahi Derg ; 26(3): 469-474, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436965

RESUMO

BACKGROUND: Diaphragmatic injuries, which can be seen after penetrating thoracic traumas, have some difficulties in diagnosis. Undiagnosed small diaphragmatic lacerations may lead to serious health problems. This study aims to evaluate the role of VATS (Video Assisted Thoracoscopic Surgery) in the diagnosis and treatment of diaphragmatic injuries after penetrating thoracic traumas. METHODS: Among 268 penetrating thoracic trauma patients, we retrospectively evaluated a total of 22 patients performed VATS due to suspected diaphragmatic injury in our department between June 2008 and June 2018. RESULTS: Twenty (91%) patients were male, and two (9%) patients were female with a mean age of 28.01±6.4 (18-42) years. In 11 (50%) patients, VATS was performed on the right side and the others on the left side according to the penetrating area of trauma. In 10 (45%) patients, diaphragmatic laceration was detected and was repaired. In six cases (27%) in which diaphragmatic laceration detected with VATS, preoperative traumatic pathologies were detected radiologically. The missed injury rate was 18%. VATS had a specificity, sensitivity, positive predictive value and negative predictive value of 75%, 71.5%, 60% and 83.3%, respectively. There was no significant statistical difference between types of penetrating trauma, ages and gender of cases (p>0.05). No complication was detected during the mean follow up period of 36.2±9.3 (range 9-62) months. CONCLUSION: Our opinion is that VATS is important and feasible in hemodynamically stable patients with suspected isolated diaphragmatic laceration after penetrating thoracic trauma that cannot be determined by radiologically.


Assuntos
Traumatismos Abdominais , Diafragma , Traumatismos Torácicos , Cirurgia Torácica Vídeoassistida , Ferimentos Penetrantes , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/cirurgia , Feminino , Humanos , Masculino , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto Jovem
13.
Anticancer Res ; 40(4): 2331-2336, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234934

RESUMO

BACKGROUND/AIM: To assess the perioperative outcomes of cholecystectomy in cytoreductive procedures for epithelial ovarian cancer (EOC). PATIENTS AND METHODS: Prospectively collected perioperative data of patients that underwent cytoreduction for advanced EOC, between 2014 and 2018, were analysed. Patients were divided in two groups on the basis of whether cholecystectomy was performed. RESULTS: A total of 144 patients with stage IIIC/IV EOC were included. Cholecystectomy was performed in 22 (15.3%) patients. Those who underwent cholecystectomy more likely required diaphragmatic peritonectomy, splenectomy, lesser omentectomy, excision of disease from the porta hepatis and liver's capsule (p<0.001). There was no difference in the cytoreductive outcomes (complete or optimal) and the rate of grade 3-5 complications between the two groups (p=0.10 & p=0.06, respectively). No direct complications related to cholecystectomy were observed. CONCLUSION: A significant percentage of patients with advanced EOC require cholecystectomy. Gynecologic oncologists should embrace the opportunity to develop advanced surgical skills including cholecystectomy.


Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Colecistectomia/métodos , Procedimentos Cirúrgicos de Citorredução/métodos , Idoso , Carcinoma Epitelial do Ovário/patologia , Diafragma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Período Perioperatório
14.
Ann R Coll Surg Engl ; 102(6): e130-e132, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326737

RESUMO

Minimally invasive oesophagectomy has become popular, but studies showed a higher rate of postoperative hiatus hernia compared with open oesophagectomy. Our video presents the laparoscopic biosynthetic mesh repair of a symptomatic giant hiatus hernia in a 71-year-old man who had undergone minimally invasive oesophagectomy one year earlier for distal adenocarcinoma of the oesophagus. The operative time was 120 minutes. The patient started oral intake on postoperative day one and was discharged on postoperative day three. Postoperative computed tomography at six months showed no signs of recurrence. In the setting of a symptomatic hiatus hernia post-minimally invasive oesophagectomy, we suggest an initial laparoscopic approach, because of its countless advantages.


Assuntos
Esofagectomia/efeitos adversos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Toracoscopia/efeitos adversos , Adenocarcinoma/terapia , Idoso , Quimiorradioterapia Adjuvante , Colo Transverso/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Neoplasias Esofágicas/terapia , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/etiologia , Herniorrafia/instrumentação , Humanos , Intestino Delgado/diagnóstico por imagem , Laparoscopia/instrumentação , Masculino , Terapia Neoadjuvante , Readmissão do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Can Assoc Radiol J ; 71(3): 313-321, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32157897

RESUMO

Traumatic diaphragmatic injury (TDI) is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The initial injury is often obscured by concurrent thoracic and abdominal injuries. Traumatic diaphragmatic injury itself is rarely lethal at initial presentation, however associated injuries and complications of untreated TDI such as herniation and strangulation of abdominal viscera have serious clinical consequences. There are 2 primary mechanisms of TDIs: penetrating TDI which tend to be smaller, more difficult to detect, and result in fewer complications; and blunt TDIs which are larger and have higher overall mortality due to associated injuries or delayed complications. The anatomy of thoracic and abdominal cavities distinguishes the epidemiology, pathophysiology, symptoms, treatment, and prognosis of right versus left TDI. Although there is no definitive radiologic sign for diagnosing TDI, many signs have been introduced in the literature and the concurrent presence of multiple signs increases the sensitivity of TDI detection. Conservative versus surgical management depends on mechanism of TDI, side, and most importantly the associated injuries.


Assuntos
Diafragma/diagnóstico por imagem , Diafragma/lesões , Hérnia Diafragmática Traumática/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Acidentes de Trânsito , Autopsia , Meios de Contraste , Diagnóstico Diferencial , Diafragma/cirurgia , Hérnia Diafragmática Traumática/cirurgia , Humanos , Imageamento Tridimensional , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/diagnóstico por imagem
16.
J Laparoendosc Adv Surg Tech A ; 30(6): 692-694, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32155102

RESUMO

Background: To present a case series of children with eventration of diaphragm who underwent thoracoscopic repair highlighting the technical points and surgical modifications to prevent a recurrence. Settings and Design: This is an observational study of patients with diaphragmatic eventration admitted to a tertiary care institute. The study was designed following CARE guidelines endorsed by EQUATOR Network. Pediatric patients who had undergone thoracoscopic repair between January 2010 and March 2019 were included in the study. Materials and Methods: Age at surgery, gender, weight, site of the lesion, operating time, need for postoperative drain, and complications were assessed. Results: Twenty-six patients had thoracoscopic repair of the eventration of diaphragm. The male-female ratio was 12:1 and mean weight at the time of surgery was 6.3 kg (2.2-22 kg) with most patients having left side congenital diaphragmatic eventration (n = 21) as compared with the right side (n = 5). The average operating time was 66 minutes (37-144 minutes). Conclusions: Diaphragm plication by a thoracoscopic approach is safe and feasible in neonates and pediatric patients.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Toracoscopia/métodos , Criança , Pré-Escolar , Feminino , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Duração da Cirurgia , Recidiva
18.
World Neurosurg ; 137: e75-e82, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31982596

RESUMO

BACKGROUND: Diaphragmatic paralysis after phrenic nerve injury is an infrequent but serious condition. The destruction of respiratory function after unilateral phrenic nerve injury has been the subject of many investigations. METHODS: In this study, we used a rat model of complete paralysis of the unilateral diaphragm to observe changes in pulmonary function. RESULTS: We found in young rats with complete paralysis of the unilateral diaphragm, the vital capacity and total lung capacity show compensation after 4 weeks, and contralateral phrenic nerve transfer can enhance pulmonary function. However, in the aged rats, respiratory function parameters do not show compensation until 16 weeks after injury. CONCLUSIONS: These findings suggest that contralateral phrenic nerve end-to-side anastomosis is a promising therapeutic strategy. In general, our results suggest that this surgical method may hold great potential to be a secure, feasible, and effective technique to rescue diaphragmatic function.


Assuntos
Diafragma/inervação , Transferência de Nervo/métodos , Nervo Frênico/lesões , Nervo Frênico/transplante , Paralisia Respiratória/cirurgia , Animais , Diafragma/fisiopatologia , Diafragma/cirurgia , Feminino , Pulmão/fisiopatologia , Ratos , Ratos Sprague-Dawley
20.
J Pak Med Assoc ; 70(Suppl 1)(2): S122-S124, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31981351

RESUMO

Our case report evaluates a 2½ year old boy who presented to emergency care, following multiple gunshot injuries and was managed emergently using a multidisciplinary surgical approach at our center. The patient was unresponsive, had poor perfusion, bilaterally decreased air entry, a distended abdomen, and multiple entry and exit wounds. A multidisciplinary team including Paediatric Surgery, Cardiothoracic Surgery, Paediatric anaesthesiology team and Orthopaedic surgery were taken on board. Following effective immediate management and stabilization, the patient was admitted to the ward under careful observation. He was discharged on post-operative day 28 after a successful recovery and on his 6 month follow-up, the patient had shown significant improvement, with normal bowel and pulmonary function. Rapid intervention along with a multidisciplinary surgical approach helped ensure the success of the treatment. Prior permission from the patient's guardians was acquired before the preparation of this manuscript.


Assuntos
Traumatismos Abdominais/cirurgia , Perfuração Intestinal/cirurgia , Traumatismo Múltiplo/cirurgia , Traumatismos Torácicos/cirurgia , Fraturas da Tíbia/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Anestesiologia , Antibacterianos/uso terapêutico , Pré-Escolar , Colo Sigmoide/lesões , Colo Sigmoide/cirurgia , Desbridamento , Diafragma/lesões , Diafragma/cirurgia , Humanos , Jejuno/lesões , Jejuno/cirurgia , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Masculino , Staphylococcus aureus Resistente à Meticilina , Ortopedia , Osteomielite/tratamento farmacológico , Equipe de Assistência ao Paciente , Pediatria , Modalidades de Fisioterapia , Contenções , Infecções Estafilocócicas/tratamento farmacológico , Estômago/lesões , Estômago/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Cirurgia Torácica , Cirurgia Torácica Vídeoassistida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA