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1.
BMJ Case Rep ; 14(2)2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33597165

RESUMO

Placement of a double-lumen tube to achieve one lung ventilation is an aerosol-generating procedure. Performing it on a patient with COVID-19 will put healthcare workers at high risk of contracting the disease. We herein report a case of its use in a patient with traumatic diaphragmatic rupture, who was also suspected to have COVID-19. This article aims to highlight the issues, it presented and ways to address them as well as the perioperative impact of personal protective equipment.


Assuntos
/prevenção & controle , Pessoal de Saúde/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Ventilação Monopulmonar/normas , Equipamento de Proteção Individual/normas , Acidentes de Trânsito , Adulto , /transmissão , Diafragma/lesões , Diafragma/cirurgia , Humanos , Masculino , Ventilação Monopulmonar/instrumentação , Guias de Prática Clínica como Assunto , /etiologia , Ruptura/etiologia , Ruptura/terapia
2.
Eur J Med Res ; 26(1): 19, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557953

RESUMO

BACKGROUND: Diaphragmatic lesions as a result of blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare, but as in our patient can be serious. CASE PRESENTATION: A 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock, an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann-type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10 cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. CONCLUSION: This is the first report on a primarily established empyema at the time of first surgical intervention for feco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications.


Assuntos
Colo/patologia , Diafragma/lesões , Traumatismo Múltiplo/complicações , Pneumotórax/etiologia , Ciclismo , Colo/cirurgia , Diafragma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Pneumotórax/cirurgia , Prolapso , Ruptura/etiologia , Ruptura/cirurgia , Traumatismos Torácicos/etiologia
3.
Medicine (Baltimore) ; 99(44): e22763, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126314

RESUMO

Ultrasound guided percutaneous thermal ablation has been well acknowledged in treating hepatic malignancy. Although thermal ablation is safe for the treatment, it may induce some lethal complications such as diaphragmatic injury, bile-stained pleural fistula, and bilious pleuritis.We presented 2 cancer patients in hepatic diaphragmatic dome showed diaphragmatic injury, bile-stained pleural fistula, and bilious pleuritis after microwave ablation (MVA). The symptoms were attenuated after chest drainage and anti-infection therapy. In the literature review, 17 articles published in the recent 10 years on diaphragmatic injury after MVA for treating hepatic cancer were available. Twenty-three cases were obtained, among which 2 showed bilious pleuritis after radiofrequency treatment. Most of the lesions were adjacent to the diaphragma. Among the articles reporting the localization of lesions, most of the cases showed lesions in S8, 2 in S7, 3 in S4, and 3 in S5, respectively. Surgical recovery was required for the patients with massive diaphragmatic injury. Only 2 cases underwent thorascopic surgery. After chest drainage and anti-infection, their symptoms were attenuated to some extent.Radiofrequency or MVA may induce pleural effusion, and special attention should be paid to the diaphragmatic injury induced by thermal ablation.


Assuntos
Diafragma/lesões , Neoplasias Hepáticas/radioterapia , Micro-Ondas/efeitos adversos , Pleurisia/etiologia , Lesões por Radiação/etiologia , Ablação por Radiofrequência/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/etiologia , Fístula do Sistema Respiratório/etiologia
4.
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
5.
Am J Respir Crit Care Med ; 202(7): 950-961, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32516052

RESUMO

Mechanical ventilation can cause acute diaphragm atrophy and injury, and this is associated with poor clinical outcomes. Although the importance and impact of lung-protective ventilation is widely appreciated and well established, the concept of diaphragm-protective ventilation has recently emerged as a potential complementary therapeutic strategy. This Perspective, developed from discussions at a meeting of international experts convened by PLUG (the Pleural Pressure Working Group) of the European Society of Intensive Care Medicine, outlines a conceptual framework for an integrated lung- and diaphragm-protective approach to mechanical ventilation on the basis of growing evidence about mechanisms of injury. We propose targets for diaphragm protection based on respiratory effort and patient-ventilator synchrony. The potential for conflict between diaphragm protection and lung protection under certain conditions is discussed; we emphasize that when conflicts arise, lung protection must be prioritized over diaphragm protection. Monitoring respiratory effort is essential to concomitantly protect both the diaphragm and the lung during mechanical ventilation. To implement lung- and diaphragm-protective ventilation, new approaches to monitoring, to setting the ventilator, and to titrating sedation will be required. Adjunctive interventions, including extracorporeal life support techniques, phrenic nerve stimulation, and clinical decision-support systems, may also play an important role in selected patients in the future. Evaluating the clinical impact of this new paradigm will be challenging, owing to the complexity of the intervention. The concept of lung- and diaphragm-protective ventilation presents a new opportunity to potentially improve clinical outcomes for critically ill patients.


Assuntos
Diafragma/lesões , Atrofia Muscular/prevenção & controle , Respiração Artificial/métodos , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Consenso , Cuidados Críticos , Sistemas de Apoio a Decisões Clínicas , Terapia por Estimulação Elétrica , Oxigenação por Membrana Extracorpórea , Humanos , Atrofia Muscular/etiologia , Nervo Frênico , Respiração Artificial/efeitos adversos , Lesão Pulmonar Induzida por Ventilação Mecânica/etiologia
6.
Diving Hyperb Med ; 50(2): 178-180, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32557422

RESUMO

Occult diaphragmatic injury was uncovered in a patient who returned to scuba diving after a traumatic injury. Diaphragmatic injury can be a difficult diagnosis in the setting of trauma and a significant number of injuries are missed on the initial presentation. This has potential implications to those wishing to return to diving after trauma, and diving doctors must maintain a high degree of suspicion for such injuries.


Assuntos
Barotrauma , Diafragma , Mergulho , Acidentes , Adulto , Barotrauma/complicações , Diafragma/lesões , Mergulho/efeitos adversos , Feminino , Humanos
7.
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
8.
Ulus Travma Acil Cerrahi Derg ; 26(3): 486-488, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436979

RESUMO

Animal-related injuries should be analyzed based on the behavior and anatomy of the attacking animal. Rhinoceros-related injuries in humans are extremely rare. Hereby, we report a life-threatening traumatic diaphragmatic hernia in a woman who presented three years after a rhinoceros gored her chest. A 47-year-old lady presented with abdominal pain, bilious vomiting and obstipation of one-day duration. She had recurrent attacks of colicky abdominal pain for a week before that. The patient gave the history of being admitted to the ICU three years before, after being gored by a rhinoceros into her chest while working as a veterinary assistant in the zoo. On examination, the abdomen was distended but soft and lax. Bowel sounds were exaggerated. Abdominal x-rays showed multiple air-fluid levels. A gastrographin follow through study hold up in the small bowel and did not reach the colon after seven hours. Abdominal and chest CT scan showed the splenic colonic flexure to be located in the left chest through a left diaphragmatic hernia. Urgent laparotomy showed a healthy splenic flexure of the colon that herniated through a 4 cm postero-lateral defect in the left diaphragm. The colon was reduced, and the defect was repaired with non-absorbable sutures. Postoperative recovery was smooth. The patient was discharged home 10 days after the surgery. Rhinoceros-related injuries in humans are extremely rare. Life-threatening traumatic diaphragmatic herniation may be delayed for few years. High index of suspicion is needed for its diagnosis.


Assuntos
Diafragma , Hérnia Diafragmática Traumática , Perissodáctilos , Animais , Diafragma/diagnóstico por imagem , Diafragma/lesões , Feminino , Hérnia Diafragmática Traumática/diagnóstico , Hérnia Diafragmática Traumática/etiologia , Hérnia Diafragmática Traumática/cirurgia , Humanos , Pessoa de Meia-Idade
9.
Rev. esp. anestesiol. reanim ; 67(4): 195-203, abr. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-ET5-1114

RESUMO

La disfunción diafragmática inducida por ventilación mecánica (DDVI) es la pérdida de la fuerza diafragmática relacionada al uso de ventilación mecánica y se observa con frecuencia en las primeras 24 a 48 h de asistencia ventilatoria controlada. La evidencia reciente relaciona esa pérdida de función diafragmática con alteraciones de la vía del factor de crecimiento insulínico/fosfoinositol 3-cinasas/proteína cinasa B (IGF/PI3K/AKT), sobreexpresión de FOXO, señalización NF-kB, mayor función de ligasas de ubiquitina muscular y activación de la caspasa-3. La DDVI tiene un impacto negativo en los días de ventilación mecánica, la retirada de la asistencia ventilatoria, la calidad de vida y los costos hospitalarios. Es importante realizar nuevos estudios encaminados a mitigar la aparición o incidencia de esta lesión. Esta es una revisión narrativa de la literatura no sistemática, tiene por objetivo explicar con detalle las vías moleculares implicadas en el desarrollo de la disfunción diafragmática asociada al soporte ventilatorio


Ventilator-induced diaphragm dysfunction (VIDD) is the loss of diaphragmatic muscle strength'related to of mechanical ventilation, noticed during the first day or 48hours after initiating controlled mechanical ventilation. This alteration has been related to disruption on the insulin growth factor/phosphoinositol 3-kinase/kinase B protein pathway (IGF/PI3K/AKT), in addition to an overexpression of FOXO, expression of NF-kB signaling, increase function of muscular ubiquitin ligase and activation of caspasa-3. VIDD has a negative impact on quality of life, duration of mechanical ventilation, and hospitalization stance and cost. More studies are necessary to understated the process and impact of VIDD. This is a narrative review of non-systematic literature, aiming to explain the molecular pathways involved in VIDD


Assuntos
Humanos , Diafragma/fisiopatologia , Ventiladores Mecânicos/efeitos adversos , Diafragma/lesões , Paralisia Respiratória/etiologia , Fatores de Risco , Comorbidade , Estado Nutricional , Fatores Etários
10.
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
11.
Rev. cuba. pediatr ; 92(1): e748, ene.-mar. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1093748

RESUMO

Introducción: La ruptura diafragmática es un reto diagnóstico y terapéutico para los médicos que se enfrentan al manejo de pacientes politraumatizados; debe sospecharse siempre en lesiones traumáticas de localización torácica o abdominal. Objetivo: Informar los elementos diagnósticos y terapéuticos seguidos ante ruptura diafragmática y esplénica de origen traumático. Presentación del caso: Se presenta el caso de un adolescente de 14 años que ingresa por presentar herida punzante por arma blanca de localización abdominal y manifestaciones clínicas que permiten hacer el diagnóstico de la afección tratada. Durante el acto quirúrgico se comprobó la ruptura del diafragma, hernia diafragmática y ruptura esplénica con salida de sangre hacia la cavidad abdominal. Se realizó reducción de la hernia, sutura del diafragma y extirpación del bazo por el estado del órgano en el momento de la cirugía. Conclusiones: La ruptura diafragmática postraumática es una entidad que cada vez se observa con mayor frecuencia en pacientes pediátricos. El examen clínico auxiliado por estudios imagenológicos resulta vital para su diagnóstico, tratamiento precoz y evitar complicaciones. Es importante mantener un alto índice de sospecha ante esta entidad poco frecuente, pero no rara en la edad pediátrica. El paciente tuvo una evolución favorable y fue egresado del servicio de cirugía luego de 10 días de hospitalización(AU)


Introduction: The diaphragmatic rupture is a diagnostic and a therapeutic challenge for physicians who have to face the management of polytraumatized patients; there must always be suspicion on traumatic injuries of thoracic or abdominal location. Objective: To inform the diagnostic and therapeutic elements followed in case of diaphragmatic and splenic rupture of traumatic origin. Presentation of the case: 14-year-old male teenager that was admitted for presenting stabbing wound by sharp weapon, with abdominal location and clinical manifestations that allow making the diagnosis of the condition being treated. During surgery, it was found the rupture of the diaphragm, a diaphragmatic hernia and splenic rupture with output of blood into the abdominal cavity. It was conducted the reduction of the hernia, the suture of the diaphragm and the removal of the spleen due to the state of the organ during the surgery. Conclusions: Post-traumatic diaphragmatic rupture is an entity that it is most often seen in pediatric patients. The clinical examination aided by imaging studies is vital for its diagnosis, early treatment and to avoid complications. It is important to maintain a high index of suspicion to face this rare entity, but not so rare in the pediatric age group. The patient had a favourable evolution and he was discharged of the surgery service after 10 days of hospitalization(AU)


Assuntos
Humanos , Masculino , Adolescente , Baço/lesões , Ruptura Esplênica/cirurgia , Diafragma/lesões , Hérnia Diafragmática Traumática/cirurgia
12.
G Chir ; 41(1): 99-102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038019

RESUMO

Most diaphragmatic ruptures are due to the traumatic or penetrating injury, while the spontaneous diaphragmatic rupture is considered uncommon. The spontaneous transdiaphragmatic hernia is a consequence of violent coughing, vomiting that increase the thoracoabdominal pressure causing the diaphragmatic rupture. Even rarer is the concomitant prolapse of abdominal viscera into the thoracic subcutis through the chest wall, a condition known as spontaneous transdiaphragmatic intercostal hernia. Herein, we present a rare case of spontaneous transdiaphragmatic intercostal hernia presenting as a thoracoabdominal emergency.


Assuntos
Diafragma/lesões , Hérnia Diafragmática/etiologia , Doenças Raras/etiologia , Parede Torácica/lesões , Prolapso Visceral/etiologia , Tosse/complicações , Humanos , Ruptura Espontânea , Vômito/complicações
13.
Can Assoc Radiol J ; 71(2): 231-237, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32062986

RESUMO

PURPOSE: This study aims to evaluate the overall diagnostic accuracy of preoperative multidetector computed tomography (MDCT) in penetrating abdominal and pelvic injuries (PAPI). METHOD AND MATERIALS: We used our hospitals' trauma registry to retrospectively identify patients with PAPI from January 1, 2006, to December 31, 2016. Only patients who had a 64-MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in our study cohort. Each finding noted on MDCT was rated using a 5-point scale to indicate certainty of injury, with a score of 0 being definitive. Using surgical findings as the gold standard, the accuracy of radiology reports was analyzed in 2 ways. A κ statistic was calculated to evaluate each pair of values for absolute agreement, and ratings for all organ systems were analyzed using a repeated measures analysis of variance (ANOVA) to determine whether radiology and surgical findings were similar enough to be clinically meaningful. Qualitative review of the radiology and surgical reports focused on the gastrointestinal (GI) tract was conducted. RESULTS: Our cohort consisted of 38 males and 4 females with a median age of 29 years and a median injury severity score of 15.6. For this study, 12 different organ groups were categorized and analyzed. Of those organ groups, absolute agreement between MDCT and surgical findings was found only for liver and spleen (κ values ranging from 0.2 to 0.5). Additionally, the ANOVA revealed an interaction between finding type and organ system (F 1, 33 = 7.4, P < .001). The most clinically significant discrepancies between MDCT and surgical findings were for gallbladder, bowel, mesenteric, and diaphragmatic injuries. Qualitative review of the GI tract revealed that radiologists can detect significant findings such as presence of injury, however, localization and extent of injury pose a challenge. CONCLUSION: The detection of clinically significant injuries to solid organs in trauma patients with PAPI on 64-MDCT is adequate. However, detection of injury to the remaining organ groups on MDCT, especially bowel, mesentery, and diaphragm, remains a challenge.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Sistema Digestório/diagnóstico por imagem , Sistema Digestório/lesões , Tomografia Computadorizada Multidetectores , Pelve/lesões , Ferimentos Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Diafragma/diagnóstico por imagem , Diafragma/lesões , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Humanos , Escala de Gravidade do Ferimento , Intestinos/diagnóstico por imagem , Intestinos/lesões , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Mesentério/diagnóstico por imagem , Mesentério/lesões , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Baço/lesões , Ferimentos Penetrantes/cirurgia , Adulto Jovem
14.
J Cardiothorac Surg ; 15(1): 44, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103768

RESUMO

INTRODUCTION: Complications following Cardiopulmonary resuscitation (CPR) are rare and usually follows a vigorous CPR or in special cases like pregnancy are due to lack of knowledge and clinical practice of how to preform CPR in pregnancy. One of this complication is diaphragmatic rupture with herniation of abdominal organs. Surgical intervention needs to be planned carefully in multidisciplinary team approach and requires fine surgical techniques for better outcome. There are few reported cases of diaphragmatic rupture after Cardiopulmonary resuscitation but none in pregnant woman. CASE PRESENTATION: We report a rare case of diaphragmatic rupture in a 29-year-old pregnant patient who experienced a full-blown diaphragmatic defect and herniation of the abdominal organs into the thoracic cavity, as a complication of CPR. Following careful assessment and diagnosis, the patient underwent urgent laparotomy with reduction of the contents and primary closure of the defect. One year follow up was satisfactory. To the best of our knowledge, this is the first reported case of diaphragmatic rupture with herniation of the abdominal organs following CPR in a pregnant woman in the literature. CONCLUSION: The application of external cardiac massage through CPR is a life-saving procedure for the management of cardiac arrest. Common complications related to CPR include rib fractures, sternal fractures and haemothorax. Diaphragmatic rupture with herniation of the abdominal organs is a rare complication, having been reported only once in the literature (Sabzi F, Faraji R, Tanaffos 16:170-172, 2017); however, it represents a serious and life-threating event. Thus, careful evaluation of the patient by a multidisciplinary team and prompt intervention is recommended in order to improve outcomes.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Diafragma/lesões , Massagem Cardíaca/efeitos adversos , Hérnia Diafragmática Traumática/cirurgia , Ruptura/etiologia , Ruptura/cirurgia , Adulto , Feminino , Parada Cardíaca/terapia , Hérnia Diafragmática Traumática/etiologia , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/terapia
15.
Anesthesiology ; 132(2): 307-320, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31939846

RESUMO

BACKGROUND: Pressure-support ventilation may worsen lung damage due to increased dynamic transpulmonary driving pressure. The authors hypothesized that, at the same tidal volume (VT) and dynamic transpulmonary driving pressure, pressure-support and pressure-controlled ventilation would yield comparable lung damage in mild lung injury. METHODS: Male Wistar rats received endotoxin intratracheally and, after 24 h, were ventilated in pressure-support mode. Rats were then randomized to 2 h of pressure-controlled ventilation with VT, dynamic transpulmonary driving pressure, dynamic transpulmonary driving pressure, and inspiratory time similar to those of pressure-support ventilation. The primary outcome was the difference in dynamic transpulmonary driving pressure between pressure-support and pressure-controlled ventilation at similar VT; secondary outcomes were lung and diaphragm damage. RESULTS: At VT = 6 ml/kg, dynamic transpulmonary driving pressure was higher in pressure-support than pressure-controlled ventilation (12.0 ± 2.2 vs. 8.0 ± 1.8 cm H2O), whereas static transpulmonary driving pressure did not differ (6.7 ± 0.6 vs. 7.0 ± 0.3 cm H2O). Diffuse alveolar damage score and gene expression of markers associated with lung inflammation (interleukin-6), alveolar-stretch (amphiregulin), epithelial cell damage (club cell protein 16), and fibrogenesis (metalloproteinase-9 and type III procollagen), as well as diaphragm inflammation (tumor necrosis factor-α) and proteolysis (muscle RING-finger-1) were comparable between groups. At similar dynamic transpulmonary driving pressure, as well as dynamic transpulmonary driving pressure and inspiratory time, pressure-controlled ventilation increased VT, static transpulmonary driving pressure, diffuse alveolar damage score, and gene expression of markers of lung inflammation, alveolar stretch, fibrogenesis, diaphragm inflammation, and proteolysis compared to pressure-support ventilation. CONCLUSIONS: In the mild lung injury model use herein, at the same VT, pressure-support compared to pressure-controlled ventilation did not affect biologic markers. However, pressure-support ventilation was associated with a major difference between static and dynamic transpulmonary driving pressure; when the same dynamic transpulmonary driving pressure and inspiratory time were used for pressure-controlled ventilation, greater lung and diaphragm injury occurred compared to pressure-support ventilation.


Assuntos
Diafragma/lesões , Diafragma/fisiopatologia , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Respiração com Pressão Positiva/efeitos adversos , Respiração com Pressão Positiva/métodos , Animais , Masculino , Respiração com Pressão Positiva/normas , Ratos , Ratos Wistar , Mecânica Respiratória/fisiologia , Volume de Ventilação Pulmonar/fisiologia
16.
J Card Surg ; 35(3): 683-685, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31971268

RESUMO

A 66-year-old female patient was admitted with abdominal bleeding as an unexpected complication of robotic surgery. Assessments included the patient's medical history, physical examination, laboratory data, and abdominal ultrasound scan results. In our case, laparotomy revealed an injury to the diaphragm and liver of the patient caused by the previous robotic surgery. In conclusion, although abdominal bleeding is a rare condition, it should be taken into consideration as a complication of robotic cardiac surgery.


Assuntos
Abdome , Hemorragia/etiologia , Anuloplastia da Valva Mitral/métodos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Diafragma/lesões , Feminino , Humanos , Laparotomia , Fígado/lesões , Procedimentos Cirúrgicos Robóticos/métodos
18.
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
19.
Am J Case Rep ; 21: e919442, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31896740

RESUMO

BACKGROUND Diaphragmatic rupture is a rare pathology that reported in less than 0.5% of all trauma cases, with signs and symptoms that can easily be misdiagnosed. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this pathology. We present a rare case of a large diaphragmatic rupture with transthoracic gastric and colon herniation that was successfully repaired, along with a literature review. CASE REPORT A 59-year-old woman presented to our Trauma Center after being involved in a motor vehicle collision. She complained of chest and abdominal pain, with decreased breath sounds on the left side. CT imaging revealed discontinuity of the left hemidiaphragm, with intrathoracic herniation of stomach and colon with multiple other injuries. The patient was taken for an emergent laparotomy. The diaphragmatic rupture measured 20 cm in length, with a stellate component. After ensuring complete reduction of the herniated organs, the diaphragmatic defect was primarily repaired. The patient recovered from her injuries and was doing well at last follow-up in the clinic. CONCLUSIONS This case highlights the importance of diaphragmatic rupture and its associated intra-abdominal injuries when treating trauma patients. With missed diaphragmatic injuries leading to a potential morbidity rate of 30% and mortality rate as high as 10%, the clinician must have a high index of suspicion to correctly diagnose and manage this pathology in a timely fashion. More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.


Assuntos
Diafragma/lesões , Hérnia Diafragmática Traumática/diagnóstico , Hérnia Diafragmática Traumática/cirurgia , Ruptura/cirurgia , Lesões Acidentais/diagnóstico por imagem , Acidentes de Trânsito , Colo/lesões , Colo/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Estômago/lesões , Estômago/cirurgia , Cirurgia Torácica Vídeoassistida
20.
Ulus Travma Acil Cerrahi Derg ; 26(1): 80-85, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31942746

RESUMO

BACKGROUND: This study aims to investigate the factors associated with mortality in patients with traumatic diaphragmatic rupture (TDR). METHODS: The records of patients who were operated on at a single hospital with the indication of blunt or penetrating thoracoabdominal injuries between January 2010 and June 2018 and who were perioperatively diagnosed with a diaphragmatic injury were evaluated retrospectively. The details of demographic characteristics, the type and localization of the trauma, presence and number of associated organ injuries, vital signs at admission, time from admission until surgery, type of operation, type of diaphragmatic repair, therapeutic approach, complications and Injury Severity Score (ISS) were analyzed. RESULTS: A total of 92 patients were included in this study. The mortality rate throughout the postoperative period was 15.2%. A penetrating injury was detected in 77.2% of the patients. Associated organ injury was most frequently in the liver, which was significant as a factor that increased mortality (p=0.020). The mortality rate was significantly lower among patients who underwent repair of diaphragmatic rupture when compared with untreated patients (p=0.003). Atelectasis was the most common complication. An ISS ≥24 points in patients with TDR was found to be an independent risk factor associated with mortality (p=0.003). CONCLUSION: Other organs are frequently involved in cases of TDR, and mortality increased significantly in cases with associated liver injury. An ISS of ≥24 was determined to be an independent risk factor associated with mortality. Since the main determinant of mortality was the presence or absence of additional organ injuries, it is important that this should be taken into consideration in these patients.


Assuntos
Diafragma/lesões , Traumatismos Torácicos/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Humanos , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Ruptura
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