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1.
Thorac Surg Clin ; 33(1): 99-108, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36372538

RESUMO

Diaphragmatic paralysis is an elevation of the diaphragm caused by a lesion along the neuromuscular axis and may be either bilateral or unilateral. Most commonly, paralysis is unilateral and iatrogenic in nature. Symptoms of this disease may be life-limiting, and when conservative measures fail, surgical therapy may be of significant benefit to patients. With the advent of robotic minimally invasive techniques, diaphragm plication can be a useful therapy for patients with resolution of symptoms, reduced length of hospitalization, and quickened recovery. This article provides an overview of the disease, diagnosis, and current therapies including robotic techniques.


Assuntos
Diafragma , Paralisia Respiratória , Humanos , Diafragma/cirurgia , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , Paralisia Respiratória/cirurgia
2.
J Cardiothorac Surg ; 17(1): 259, 2022 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-36203167

RESUMO

BACKGROUND: Post-esophagectomy chylothorax is a relatively rare but potentially lethal complication. The treatment strategy of post-esophagectomy chylothorax remains a subject of debate which mainly focuses on the indication and timing of surgical intervention. For cases in which the leakage site is not localized, a mass ligation of the thoracic duct above diaphragm is advocated as the surgical procedure is believed to ensure sealing all the accessory ducts that could be the source of the chylothorax. But in this paper, we report a case of post-esophagectomy chylothorax which was refractory to mass ligation of thoracic duct above diaphragm. CASE PRESENTATION: A 59-year old man suffered from high output chylothorax (> 1000 ml/24 h for more than 30 days) after esophagectomy through left thoracotomy. Considering the failure of lymphangiography, we performed mass ligation of thoracic duct above diaphragm. However, we failed to close the chylous leakage. Finally, we found that a rare variated tributary of thoracic duct was the resource of the chylous output. Both the variation of lymphatic system and the coincidence of injured site lead to the invalidness of reoperation. After definitely ligating the variated tributary, chylothorax was cured. CONCLUSION: This case supplies a direct evidence that mass ligation of thoracic duct is of no avail in some refractory chylothorax, which indicates the importance of chylous leakage localization.


Assuntos
Quilotórax , Neoplasias Esofágicas , Quilotórax/etiologia , Quilotórax/cirurgia , Diafragma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Ducto Torácico/cirurgia
3.
Eur J Obstet Gynecol Reprod Biol ; 279: 88-93, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36283249

RESUMO

OBJECTIVE: To evaluate a novel technique for diaphragmatic full-thickness resection (DFTR) using a vascular stapler to perform cytoreductive surgeries in patients with advanced ovarian cancer. STUDY DESIGN: Single-center retrospective analysis of consecutive patients with advanced-stage ovarian cancer undergoing stapled diaphragmatic full-thickness resections (S-DFTRs) as part of cytoreductive surgeries between January 2018 and June 2022, according to the IDEAL recommendations. RESULTS: Fifteen patients underwent cytoreductive surgeries with S-DFTRs. The median operative time was 300 (114-547) minutes. Cytoreduction was considered complete in all cases. All S-DFTRs were performed on the right diaphragm. Concomitant left diaphragmatic peritoneal stripping was performed in 5 cases (33.3%) and was associated with a conventional DFTR in 1 case (6.7%). Prophylactic intraoperative tube thoracostomy was never required. Four patients (26.7%) were admitted to the intensive care unit. Pleural effusion was observed in 9 patients (60.0%), and 4 (26.7%) required a postoperative pigtail catheter thoracostomy. Three patients (20.0%) required catheter placement on the right hemithorax (ipsilaterally to the S-DFTR) and 2 patients (13.3%) required catheters on the left hemithorax (contralaterally to the S-DFTR). Pneumothorax requiring tube thoracostomy was observed in 1 case (6.7%) on the left hemithorax (contralaterally to the S-DFTR). Pulmonary embolism and pneumonia were both observed once (6.7%). The median hospitalization length was 14 (5-36) days. During the follow-up, 6 patients (40.0%) had a recurrence, but none involved the pleura or the diaphragm. According to the IDEAL classification, this study could be ranked as stage 2a (development). CONCLUSIONS: This technique appears to be a fast and safe method for performing diaphragmatic cytoreductive surgeries and could reduce postoperative complications.


Assuntos
Procedimentos Cirúrgicos de Citorredução , Neoplasias Ovarianas , Humanos , Feminino , Procedimentos Cirúrgicos de Citorredução/métodos , Diafragma/cirurgia , Estudos Retrospectivos , Carcinoma Epitelial do Ovário , Neoplasias Ovarianas/cirurgia
4.
Kyobu Geka ; 75(10): 872-877, 2022 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-36155585

RESUMO

Traumatic diaphragmatic injury( TDI) is rare in traumas, however TDI is associated with high mortality. We follow the notation method by The Japanese Association for The Surgery of Trauma. There are blunt trauma and penetrating trauma of TDI;blunt trauma causes mainly traffic accidents, and penetrating trauma is induced stub or gunshot. Penetrating trauma is more frequent than blunt trauma in Western countries, however there are mainly blunt traumas in Japan. The timing of diagnosis are three points;acute phase, subacute phase and delayed phase. In acute phase we often experienced unstable vital sign, so the patients of TDI need treatment immediately, however in delayed phase the patients of TDI are stable in vital signs. In order to diagnose for TDI, we use chest X-ray and computed tomography (CT), which is useful to diagnose by multi-planar reconstruction of multi-detector row CT. The ways to approach to TDI are from thoracotomy, laparotomy or both. When we repair the diaphragmatic injury, usually interrupted or horizontal mattress suture was applied with non-absorbable string. The mortality is about 8.8 to 19.8% by TDI, so we need to carefully diagnose TDI as soon as possible whether complication and abdominal viscera injury exist or not.


Assuntos
Transtornos Respiratórios , Traumatismos Torácicos , Ferimentos não Penetrantes , Ferimentos Penetrantes , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/cirurgia , Humanos , Estudos Retrospectivos , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/cirurgia
5.
J Cardiothorac Surg ; 17(1): 230, 2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068632

RESUMO

BACKGROUND: Osteochondromas, also known as exostoses, are the most common benign tumors of bone and can be classified into isolated and multiple osteochondromas. A great majority of osteochondromas is asymptomatic, painless, slow-growing mass, and incidentally found. However, osteochondromas occurring in adolescence or in adult patients can grow in size and become symptomatic as a result of mechanical irritation of the surrounding soft tissues or peripheral nerves, spinal cord compression, or vascular injury. CASE PRESENTATION: We present a case of a 13-year-old girl with spontaneous hemothorax, the cause of which was identified by limited thoracotomy with the aid of video-assisted thoracic surgery to be bleeding from a diaphragmatic laceration incurred by a costal exostosis on the left sixth rib. Preoperative chest computed tomography (CT) depicted a bony projection arising from the rib and bloody effusion in the intrathoracic cavity, but was unable to discern the bleeding cause from the lung or the diaphragm. This case will highlight our awareness that costal exostosis possibly results in bloody pleural effusion. Meanwhile, English literatures about solitary costal exostosis associated with hemothorax were searched in PubMed and nineteen case reports were obtained. Combined our present case with available literature, a comprehensive understanding of this rare disease entity will further be strengthened. CONCLUSIONS: Injury to the diaphragm is the primary cause of hemothorax caused by costal osteochondroma, including the present case. Thoracic CT scan can help establish a diagnosis of preoperative diagnosis of costal osteochondroma. Surgical intervention should be considered for those patients with symptomatic osteochondroma of the rib. Combined with our case and literature, prophylactic surgical removal of intrathoracic exostosis should be advocated even in asymptomatic patients with the presentation of an inward bony spiculation.


Assuntos
Neoplasias Ósseas , Exostose , Osteocondroma , Adolescente , Adulto , Neoplasias Ósseas/cirurgia , Diafragma/patologia , Diafragma/cirurgia , Exostose/complicações , Exostose/patologia , Feminino , Hemotórax/diagnóstico , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Osteocondroma/complicações , Osteocondroma/diagnóstico , Osteocondroma/cirurgia , Costelas/cirurgia
6.
Rozhl Chir ; 101(6): 284-288, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35973824

RESUMO

INTRODUCTION: Diaphragmatic rupture is a rare but life-threatening condition that occurs in 0.85% of surgically managed thoracoabdominal injuries. In most cases, the condition is accompanied by associated traumas responsible for poor prognosis. Signs of diaphragmatic rupture are often masked by more serious manifestations of the associated trauma. The rupture is usually revealed by an X-ray of the chest or CT scan. However, a minor defect may be missed, especially if the patient is not indicated for urgent surgery. METHODS: The authors present 2 case reports of patients treated for chronic diaphragmatic rupture at the Department of Surgery of the Faculty of Medicine, Charles University and University Hospital in Pilsen between 01 January 2009 and 31 December 2021. The aim was to analyze the clinical data and to compare this data with literature. RESULTS: Both patients with the chronic diaphragmatic rupture were men in their productive age. The mechanism of their primary trauma was a traffic accident. In the first case, the rupture was diagnosed 6 years after the trauma. The second case was diagnosed 14 years after the primary trauma. The diaphragmatic rupture was present on the left side in the first case and on the right in the other. Both patients underwent suture of the diaphragmatic defect via thoracotomy. CONCLUSION: Unrecognized diaphragmatic rupture is a severe condition that can result in a life-threatening complication, namely incarceration of abdominal organs dislocated to the chest. It is necessary to keep this diagnosis in mind in patients with gastrointestinal or respiratory problems after a previous high-energy, blunt-force abdominal and thoracic injury, even many years after the trauma.


Assuntos
Traumatismos Torácicos , Ferimentos não Penetrantes , Diagnóstico Tardio/efeitos adversos , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/cirurgia , Feminino , Humanos , Masculino , Ruptura/complicações , Ruptura/cirurgia , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
7.
Artigo em Inglês | MEDLINE | ID: mdl-35920785

RESUMO

Extreme mediastinal shift due to major diaphragm eventration is complex when mitral-valve repair is required. We report the case of a 59-year-old woman with diaphragmatic eventration who had 2 recent episodes of heart failure due to arrythmia associated with severe mitral-valve regurgitation (regurgitant orifice area 47 mm2). Forced expiratory flow-volume in the first second and vital capacity (VC) were at 32% and 33%, respectively,decreasing to 20% and 30% when she was in a supine position. We found it impossible to repair the valve first because of the extreme mediastinal shift and respiratory dysfunction. Therefore, we decided to perform diaphragm plication first followed 3 months later by mitral valve repair. Six months after the cardiac operation, the patient showed significant clinical improvement. Forced expiratory flow-volume in the first second and vital capacity increased to 58% and 55%, respectively. The decision to perform the thoracic operation first, followed by the cardiac operation, was the key to improving the patient's respiratory function and to medializing the heart to safely support cardiac surgery.


Assuntos
Eventração Diafragmática , Insuficiência Cardíaca , Insuficiência da Valva Mitral , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia
9.
Curr Opin Obstet Gynecol ; 34(4): 204-209, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35895962

RESUMO

PURPOSE OF REVIEW: Thoracic endometriosis is a rare disease that can lead to a variety of clinical manifestations. There are currently no guidelines for optimal diagnosis and management of the disease. The purpose of this review is to provide an overview of the diagnosis and surgical treatment of thoracic endometriosis. RECENT FINDINGS: Various imaging modalities, including computed tomography (CT), MRI and ultrasound, have been reported in the detection of thoracic endometriosis. MRI is the most sensitive imaging study and may aid in preoperative planning. Histopathology of a biopsied lesion remains the gold standard for diagnosis. Surgical management of thoracic endometriosis may involve laparoscopy and/or thoracoscopy, and surgical planning should include preparation for single ventilation capability. A multidisciplinary approach involving a gynaecologic surgeon and thoracic surgeon may be considered. Repairing diaphragm defects and pleurodesis are shown to decrease recurrent symptoms. SUMMARY: Although optimal diagnostic testing remains uncertain, a high clinical suspicion for thoracic endometriosis is critical to ensure prompt diagnosis and treatment in order to prevent recurrent symptoms and progression to more serious sequalae. Minimally invasive surgical techniques are becoming increasingly utilized and allow for thorough evaluation and treatment of thoracic endometriosis.


Assuntos
Endometriose , Laparoscopia , Doenças Musculares , Diafragma/patologia , Diafragma/cirurgia , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças Musculares/cirurgia
10.
Asian J Endosc Surg ; 15(4): 854-858, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35726353

RESUMO

We encountered a case of high insertion of the right diaphragm complicated with congenital diaphragmatic hernia that was diagnosed based on thoracoscopic findings. A full-term male baby was suspected of having right congenital diaphragmatic hernia or diaphragmatic eventration on postnatal imaging. He only had episodes of mild but prolonged symptoms following upper respiratory tract infection and his course was otherwise uneventful during outpatient monitoring. At 1 year old, the elevated liver volume remained large, which might eventually interfere with his lung growth, so thoracoscopic exploration was planned. Thoracoscopy revealed liver prolapse from a diaphragmatic defect. In addition, the anterior to lateral inserted part of the diaphragm was high, with the anterior part reaching the fourth rib. We repaired only the diaphragmatic defect without repositioning the diaphragm, and the postoperative course was uneventful. High insertion of the diaphragm should be considered as a differential diagnosis of congenital diaphragmatic eventration.


Assuntos
Eventração Diafragmática , Hérnias Diafragmáticas Congênitas , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Lactente , Masculino , Toracoscopia/métodos , Tórax
11.
J Cardiothorac Surg ; 17(1): 145, 2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672705

RESUMO

BACKGROUND: The incidence of diaphragmatic rupture is low; however, it may be life threatening. Normally caused by blunt trauma, some cases are reported after pulmonary infections with extensive coughing. Covid 19 causes pulmonary infections and pneumonia and has been associated with weakening of the diaphragm after prolonged ventilation. We present a patient who suffered from diaphragmatic rupture 2 months after recovering from a severe Covid 19 pneumonia. CASE: A 71 years old male patient presented with massive thoraco-abdominal pain and severe dyspnea. At the time of admission, the patient was diagnosed with rupture of the diaphragm and developed cardiogenic shock. Intraoperatively there was a 4 cm diameter large rupture of the diaphragm with enterothorax (transverse colon, stomach, spleen, parts of the jejunum). Avulsion of the mesenteric arteries made a segmental resection of the jejunum together with the spleen necessary. A jejuno-jejunostomy was performed and organs were replaced into the abdomen. The rupture of the diaphragm underwent primary closure with non-resorbable suture material. The patient has shown an uneventful post-operative course, fully recovered and was discharged on day 11 after surgery. CONCLUSION: Covid 19 is a disease that is known to have various effects on different organs. The diaphragm is only paid heed in case of dysfunction. Also in the setting of Covid 19 it is not known as prominent effector organ. Nevertheless its affection by coughing caused by Covid 19 can lead to life threatening complications.


Assuntos
COVID-19 , Hérnia Diafragmática Traumática , Traumatismos Torácicos , Ferimentos não Penetrantes , Idoso , COVID-19/complicações , Diafragma/cirurgia , Hérnia Diafragmática Traumática/etiologia , Humanos , Masculino , Ruptura/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações
15.
J Med Case Rep ; 16(1): 228, 2022 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-35637533

RESUMO

BACKGROUND: Adenomatoid mesothelioma is a rare subtype of malignant mesothelioma that can be confused with adenomatoid tumors, which are classified as benign. The clinical features and optimal management of adenomatoid mesothelioma have not been elucidated in the literature. In this report, we present an extremely rare case of adenomatoid mesothelioma that developed on the peritoneal surface of the diaphragm as well as a literature review of adenomatoid mesothelioma in the abdominal cavity. CASE PRESENTATION: The patient was a 61-year-old Japanese woman who had undergone resection of a malignant peripheral nerve sheath tumor of the hand 18 years prior. She was diagnosed with clinical stage I lung adenocarcinoma on follow-up chest radiography. Simultaneously, a 20-mm enhancing nodule with slow growth on the right diaphragm was detected on contrast-enhanced computed tomography. She presented no specific clinical symptoms. At this point, the lesion was suspected to be a hypervascular tumor of borderline malignancy, such as a solitary fibrous tumor. After a left upper lobectomy for lung adenocarcinoma, she was referred to our department, and laparoscopic tumor resection was performed. Adenomatoid tumors were also considered based on the histopathological and immunohistochemical analyses, but we made the final diagnosis of adenomatoid mesothelioma using the results of the genetic profile. The patient remains alive, with no recurrence noted 6 months after surgery. CONCLUSION: We encountered a valuable case of adenomatoid mesothelioma of peritoneal origin. There are some previously reported cases of adenomatoid mesothelioma and adenomatoid tumors that may need to be recategorized according to the current classification. It is important to accumulate and share new findings to clarify the clinicopathological characteristics and genetic status of adenomatoid mesothelioma.


Assuntos
Adenocarcinoma de Pulmão , Adenoma , Tumor Adenomatoide , Neoplasias Pulmonares , Mesotelioma Maligno , Mesotelioma , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Mesotelioma/diagnóstico por imagem , Mesotelioma/cirurgia , Pessoa de Meia-Idade
16.
Artigo em Inglês | MEDLINE | ID: mdl-35616979

RESUMO

Diaphragm paralysis is a rare complication in pediatric heart surgery (0.28%-5.6%, depending on the procedure). When unilateral paralysis happens in adults, it is rarely symptomatic. However, it can cause respiratory distress syndrome when it happens in newborn or young children. The clinical diagnosis comes with a failure to wean from ventilation. The chest X-ray shows the ascension of the concerned hemidiaphragm. The goal of the surgical treatment is to pull down the paralyzed diaphragm and to increase the ventilating capacity. The classical surgical approach is a posterior-lateral thoracotomy in the 5th intercostal space of the concerned paralyzed hemidiaphragm. This approach has several drawbacks such as requiring drainage, reopening the chest after heart surgery, the high level of pain, and the cosmetic side effects. The subcostal approach is a good alternative because it is less time- consuming, it does not require any drainage, and it is less painful. This video-tutorial describes the abdominal approach and provides its advantages compared to a thoracotomy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Paralisia Respiratória , Adulto , Criança , Pré-Escolar , Diafragma/cirurgia , Humanos , Recém-Nascido , Paralisia/complicações , Paralisia/cirurgia , Paralisia Respiratória/etiologia , Paralisia Respiratória/cirurgia , Toracotomia/métodos
17.
Innovations (Phila) ; 17(3): 180-190, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35549933

RESUMO

Objective: Diaphragm paralysis is a relatively uncommon entity that can be both congenital and acquired in nature. While commonly asymptomatic, it can also cause a significant decrease in pulmonary function and reserve, particularly in patients with underlying pulmonary diseases. Our aim was to summarize the current literature regarding the minimally invasive techniques used in the surgical correction of acquired diaphragm paralysis via traditional and robotic minimally invasive approaches. Methods: We conducted a systematic review of available literature using the Cochrane methodology and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 6,561 citations were identified through initial database and reference searches, of which 90 articles met the inclusion criteria for review. After further assessment, 33 appropriate full-text studies were selected for the review. Of the selected publications, the majority represented case reports and single-center retrospective studies with level of evidence 4. Only 1 level 2b study (individual cohort study) was identified, comparing minimally invasive and open approaches. Conclusions: Each of the minimally invasive approaches has its unique benefits and disadvantages, which are summarized and delineated in this article. Ultimately, no preferred method of diaphragm plication for diaphragm paralysis can be recommended at this time based on clinical data. The choice of procedure and surgical approach continues to be selected based on the surgeon's experience and preference.


Assuntos
Diafragma , Paralisia Respiratória , Estudos de Coortes , Diafragma/cirurgia , Humanos , Paralisia Respiratória/etiologia , Paralisia Respiratória/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
Asian J Endosc Surg ; 15(4): 805-808, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35445564

RESUMO

Non-congenital, non-traumatic spontaneous diaphragmatic liver hernia in adults is extremely rare and sometimes misdiagnosed as a thoracic tumor. Almost all previous reports with a definitive diagnosis reported preservation; thus, differential diagnosis is extremely important for planning optimal management of such clinical conditions. An abnormal shadow in the right lower lung field was detected on chest radiography in a 61-year-old woman. Further imaging study revealed a 33-mm diameter mass adjacent to the right diaphragm. Thoracoscopic surgery was performed as diagnostic treatment. We found a pale hemispherical herniated liver on the central tendon of the diaphragm. After repositioning the herniated liver, the orifice was closed with a non-absorbable suture, and the surface of the liver returned to being a perfectly smooth surface. With this result, we believe that repair of diaphragmatic liver hernia through a minimally invasive procedure has great benefits for patients.


Assuntos
Hérnia Hiatal , Hérnias Diafragmáticas Congênitas , Neoplasias Torácicas , Adulto , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Feminino , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Fígado/cirurgia , Pessoa de Meia-Idade , Toracoscopia
19.
Cancer Rep (Hoboken) ; 5(9): e1622, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35488382

RESUMO

BACKGROUND: Primary diaphragmatic synovial sarcoma is a rare clinical entity with only few cases reported in the literature. It is found mainly in young adults, in the limbs. However, the name is a misnomer as it probably arises from primitive mesenchyme rather than articular surfaces of the joints. CASE: We report a case of 21-year-old patient with synovial sarcoma of the diaphragm, treated by complete surgical excision of the tumor with diaphragmatic reconstruction and confirmed on immunohistopathology. The peculiarity of this case stems from the atypical location of the tumor with complete surgical resection and thereby providing a better quality of life for the patient. CONCLUSION: Synovial sarcoma of the diaphragm is a rare malignancy and more data and research is needed for defining the best management for this tumor.


Assuntos
Sarcoma Sinovial , Adulto , Diafragma/patologia , Diafragma/cirurgia , Humanos , Qualidade de Vida , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/patologia , Sarcoma Sinovial/cirurgia , Adulto Jovem
20.
World J Surg ; 46(8): 1872-1877, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35430645

RESUMO

BACKGROUND: This study aimed to investigate the consequences of repairing versus not repairing diaphragmatic injury caused by penetrating left thoracoabdominal stab wounds. METHODS: Diagnostic laparoscopy was performed to evaluate the left diaphragm in patients with penetrating left thoracoabdominal stab wounds who did not have an indication for emergency laparotomy. Patients who did not consent to laparoscopy were discharged without undergoing surgery. Post-discharge radiological images of patients who underwent diaphragmatic repair and radiological images of patients who could not undergo laparoscopy, both during hospitalization and after discharge, were evaluated and compared. RESULTS: Diagnostic laparoscopy was performed on 109 patients. Diaphragmatic injuries were detected and repaired in 32 (29.36%) of these patients. Seventeen patients were lost to follow-up. After a mean follow-up of 57.67 months, none of the remaining 15 patients developed a diaphragmatic hernia. On the other hand, 43 patients refused to undergo diagnostic laparoscopy. Twenty of them were lost from follow-up. The diaphragmatic injury was detected in seven of the remaining 23 patients (30.44%) during initial computed tomography (CT) examinations. In this group, the mean follow-up time was 42.57 months, and delayed diaphragmatic hernia developed in one patient (14.30%). Patients who underwent diaphragmatic repair were compared to patients who did not undergo diagnostic laparoscopy but had diaphragmatic injuries detected on their CT. No statistical differences were detected. CONCLUSIONS: Diaphragmatic injuries caused by penetrating stab wounds can sometimes heal spontaneously. However, diagnostic laparoscopy is still relevant for revealing and repairing possible diaphragmatic injuries.


Assuntos
Traumatismos Abdominais , Hérnia Hiatal , Hérnias Diafragmáticas Congênitas , Laparoscopia , Traumatismos Torácicos , Ferimentos Penetrantes , Ferimentos Perfurantes , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Assistência ao Convalescente , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/cirurgia , Hérnia Hiatal/cirurgia , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Laparoscopia/métodos , Alta do Paciente , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia
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