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1.
J Surg Res ; 246: 1-5, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31541708

RESUMO

BACKGROUND: Intestinal atresia is a congenital defect resulting in intestinal discontinuity and can be associated with significant morbidity related to intestinal failure. The bowel proximal to the atresia is often significantly dilated and dysfunctional. The treatment approaches of this dilated bowel include resection with primary anastomosis versus tapering enteroplasty with preservation of bowel length. The purpose of this study was to compare these two approaches in regard to bowel function as characterized by the time to full enteral feeding. METHODS: A retrospective review was performed of intestinal atresia repair performed at a tertiary referral pediatric hospital from 2007 to 2017. Length of stay, time to full enteral feeds, and complications were assessed in patients who underwent repair with tapering enteroplasty (n = 8) and compared with those who underwent resection and anastomosis (n = 39). RESULTS: The median age at surgery, gender distribution, weeks gestational age (WGA), location of the atresia, and comorbidities were similar between the two groups. Overall, there was no statistically significant difference in length of stay and time to full enteral feeds between groups. Three of eight (38%) patients in the tapered group and five of 39 patients (13%; P = 0.12) in the nontapered group underwent further surgical exploration because of bowel dysmotility. Factors associated with longer length of hospital stay were abdominal reoperation and WGA, and factors associated with longer time to full enteral feeds were WGA, abdominal reoperation, and gastroschisis. CONCLUSIONS: Tapering enteroplasty at initial operation for intestinal atresias preserves bowel length and has statistically equivalent outcomes to resection and anastomosis in regard to the length of stay and time to full enteral feeds.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Nutrição Enteral/estatística & dados numéricos , Atresia Intestinal/cirurgia , Intestino Delgado/anormalidades , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Feminino , Motilidade Gastrointestinal , Humanos , Lactente , Recém-Nascido , Atresia Intestinal/complicações , Intestino Delgado/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
2.
Eur J Ophthalmol ; 30(1): 125-131, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30384777

RESUMO

PURPOSE: To evaluate the visual, refractive, topographic, pachymetric, and biomechanical outcomes after intracorneal ring segment implantation in corneas with post-LASIK ectasia. METHODS: Retrospective longitudinal study enrolling 26 eyes of 22 patients with post-LASIK ectasia and undergoing intracorneal ring segment implantation (KeraRing®, Mediphacos) using a 60-kHz femtosecond laser (IntraLase®, IntraLase Corp.) for corneal tunnelization. Visual, refractive, anterior, and posterior corneal topographic (Pentacam HR, Oculus), pachymetric, and corneal biomechanical changes (Ocular response Analyzer, Reichert) were evaluated during a 12-month follow-up. Vector analysis of astigmatic changes was performed. RESULTS: A statistically significant reduction of sphere (p = 0.043) was observed at 1 month after surgery, with a significant improvement of uncorrected distance visual acuity associated (p = 0.019). Likewise, a significant reduction of anterior corneal power measurements (p ⩽ 0.014) and steepest posterior keratometric reading (p = 0.006) were observed at 1 month postoperatively, with no significant changes afterwards (p ⩾ 0.133). No significant changes were observed in manifest cylinder (p ⩾ 0.175), corrected distance visual acuity (p ⩾ 0.174), flattest posterior keratometric measurement (p ⩾ 0.282), volumetric measurements (p ⩾ 0.051), and corneal biomechanical parameters (p ⩾ 0.068). Vector analysis revealed an initial trend to overcorrection of astigmatism, with a trend to undercorrection at the end of follow-up and a significant variability in the outcome achieved in each patient. CONCLUSION: The implantation of KeraRing segments in post-LASIK corneal ectasia generates a significant modification of spherical refraction and a visual improvement due to a central corneal flattening generated. More refined nomograms of implantation in these cases should be developed to achieve a more predictable correction of astigmatism.


Assuntos
Córnea/cirurgia , Doenças da Córnea/cirurgia , Cirurgia da Córnea a Laser/efeitos adversos , Implante de Lente Intraocular/métodos , Complicações Pós-Operatórias/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Adulto , Córnea/patologia , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Topografia da Córnea , Dilatação Patológica/diagnóstico , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Desenho de Prótese , Reoperação , Estudos Retrospectivos
4.
BMJ Case Rep ; 12(8)2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31444255

RESUMO

Idiopathic localised dilatation of the intestine (ILDI) presenting in adults is rare and difficult to diagnose. Only 18 cases have been reported in the literature. We report a case of a 32-year-old woman presenting with abdominal pain and intermittent small bowel obstruction. After detailed radiological studies, the patient, known for Crohn's disease, was scheduled for laparoscopy in the suspicion of small bowel stricture. A localised dilatation of the ileum was found intraoperatively and subsequently resected. A systematic review of this rare pathology in adults is carried out. ILDI should be part of the differential diagnosis in patients with unexplained abdominal pain or gastrointestinal bleeding in the presence of segmental dilatation of the intestine. Surgical resection is the treatment of choice.


Assuntos
Doença de Crohn/diagnóstico , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Dor Abdominal/etiologia , Adulto , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/cirurgia , Diagnóstico Diferencial , Dilatação Patológica/diagnóstico , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Feminino , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Obstrução Intestinal/complicações , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Tomografia Computadorizada por Raios X
5.
Khirurgiia (Mosk) ; (6): 88-93, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317946

RESUMO

Optimal surgical strategy for secondary tricuspid regurgitation is still under discussion. First of all, this is due to rare organic disease of tricuspid valve and tricuspid regurgitation is almost always classified as secondary insufficiency. Fibrous annulus enlargement of tricuspid valve is the most common cause of tricuspid regurgitation. Annular dilatation may by the result of left ventricular failure due to myocardial or valvular diseases, right ventricular enlargement, pressure or volume overload. No surgical correction of tricuspid insufficiency during cardiac surgery for other leading disease aggravates short- and long-term results. Considering the wide interest and disputes around optimal surgical strategy for tricuspid regurgitation, this review is devoted to modern methods of surgical treatment of secondary tricuspid insufficiency.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Humanos , Insuficiência da Valva Tricúspide/etiologia
6.
Cir Cir ; 87(4): 466-469, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264980

RESUMO

Background: Anterior spinal artery syndrome, usually resulting in flaccid paraplegia, is a rare but disastrous complication that can occur after surgery of aortic aneurysms and aortic dissections. Spinal cord infarct as the initial clinical presentation of aortic dissection is a very rare finding. Case report: A 42-year-old male patient who comes to the emergency department due to severe chest pain associated with presyncope and paraplegia of the lower limbs in the context of type A aortic dissection. Conclusions: Recognizing this atypical clinical presentation of aortic dissection and knowing how to approach it is critical for an early diagnosis and to minimize the risk of spinal cord ischemia during surgery.


Assuntos
Aneurisma Dissecante/complicações , Síndrome da Artéria Espinal Anterior/etiologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Torácica/complicações , Paraplegia/etiologia , Adulto , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dor no Peito/etiologia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Artéria Renal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
J Cardiothorac Surg ; 14(1): 135, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319874

RESUMO

Concomitant replacement of the ascending aorta with the aortic valve in patients who have left ventricular dysfunction might carry high operative risks. Performing the conservative reduction aortoplasty was shown to have less complications in such patients. When combined with other concomitant cardiac procedures, the newly described "spiral" aortoplasty technique in this series allows for a mulitplanar wall tension reduction in moderately dilated ascending aorta.


Assuntos
Aorta/cirurgia , Doenças da Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Disfunção Ventricular Esquerda/cirurgia , Idoso , Doenças da Aorta/complicações , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
8.
Cardiol Young ; 29(5): 564-569, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31111802

RESUMO

INTRODUCTION: This research investigated patients who underwent surgery for a dilated aorta associated with a connective tissue disease or inflammatory vasculitis in children and adolescents. MATERIALS AND METHODS: The medical records of 11 patients who underwent aortic surgery for dilatation resulting from a connective tissue disease or inflammatory vasculitis between 2000 and 2017 were retrospectively reviewed. RESULTS: The median age and body weight of the patients were 9.6 years (range 5.4 months-15.5 years) and 25.8 kg (range 6.8-81.5), respectively. The associated diseases were Marfan syndrome (n = 3), Loeys-Dietz syndrome (n = 3), Kawasaki disease (n = 1), Takayasu arteritis (n = 1), PHACE syndrome (n = 1), tuberous sclerosis (n = 1), and unknown (n = 1). The most common initially affected area was the ascending aorta. During the 66.4 ± 35.9 months of follow-up, two Marfan syndrome patients died, and four patients (one Marfan syndrome and three Loeys-Dietz syndrome) had repeated aortic operation. Except for one patient, the functional class was well maintained in all patients who were followed up. CONCLUSION: Cases of surgical treatment for a dilated aorta associated with a connective tissue disease and inflammatory vasculitis are rare in children and adolescents at our institution. Most of the patients in this study showed a tolerable postoperative course. However, the aorta showed progressive dilation over time even after surgical treatment, especially in patients with Loeys-Dietz syndrome. In these patients, close and more frequent regular follow-up is required.


Assuntos
Aorta Torácica/patologia , Aorta Torácica/cirurgia , Doenças do Tecido Conjuntivo/complicações , Dilatação Patológica/cirurgia , Vasculite/complicações , Adolescente , Criança , Pré-Escolar , Doenças do Tecido Conjuntivo/fisiopatologia , Dilatação Patológica/etiologia , Feminino , Humanos , Masculino , Reoperação , República da Coreia , Estudos Retrospectivos , Vasculite/fisiopatologia
9.
Gen Thorac Cardiovasc Surg ; 67(12): 1014-1020, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31041727

RESUMO

OBJECTIVE: This study investigated the mid-term outcomes of simultaneous mitral valve repair in patients with mitral regurgitation (MR) and concomitant annulo-aortic ectasia. METHODS: The study included 26 patients with MR and annulo-aortic ectasia [mean age 46.0 ± 19.9 (10-86) years] who underwent simultaneous mitral valve repair between January 2007 and March 2018. Of these 26 patients, 11 (42.3%) were diagnosed with Marfan syndrome and 10 (38.5%) with Barlow's disease. All patients underwent complete ring annuloplasty; a semi-rigid ring was used in 14 (53.8%) and a semi-flexible ring (anterior-flexible) in 12 patients (46.2%). All patients underwent valve-sparing root replacement using the reimplantation technique. RESULTS: The overall 3-year survival rate was 95.7 ± 4.3%. The 3-year freedom from > moderate MR rate was 94.7 ± 5.1%, and the 3-year freedom from > moderate aortic regurgitation (AR) rate was 86.7 ± 7.3%. The 3-year freedom from reoperation rate was 100%. The 3-year freedom from > moderate MR rate was 100% in the semi-rigid ring group and 85.7 ± 13.2% in the semi-flexible ring group (log-rank test, p = 0.5371). The 3-year freedom from > moderate AR rate was 100% in the semi-rigid ring group and 72.9 ± 16.5% in the semi-flexible ring group (log-rank test, p = 0.0815). CONCLUSIONS: Simultaneous mitral valve repair in patients with MR and concomitant annulo-aortic ectasia showed favorable mid-term outcomes.


Assuntos
Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Dilatação Patológica/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/mortalidade , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardíacos , Criança , Dilatação Patológica/complicações , Dilatação Patológica/mortalidade , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
11.
J Coll Physicians Surg Pak ; 29(2): 178-180, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30700361

RESUMO

Ogilvie syndrome (acute colonic pseudo-obstruction) represents a clinical condition with symptoms of colonic obstruction without a distinct mechanical factor. The damage to the neural ganglia in the intestinal wall is the most likely etiology. A 62-year man was admitted to the Emergency Department due to acute dyspnea and vomiting. The patient had not defecated for 10 days prior to admission. An angio-CT revealed dilated colon, especially its left part, up to 85 mm with gas inside its lumen. During laparotomy, extremely dilated colon was confirmed with signs of the intestinal wall necrosis. A left sided hemicolectomy was performed. Despite the intensive treatment in the intensive care unit (ICU), the patient died on 3rd day after the surgery. In this case, the acute pseudo-obstruction of the large intestine was recognised late. This is due to overcrowding in this type of institution, overworked staff, and their inability to give individual attention to each patient.


Assuntos
Colectomia/métodos , Pseudo-Obstrução do Colo/diagnóstico por imagem , Pseudo-Obstrução do Colo/cirurgia , Dilatação Patológica/cirurgia , Doença Aguda , Pseudo-Obstrução do Colo/fisiopatologia , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Dilatação Patológica/diagnóstico por imagem , Progressão da Doença , Serviço Hospitalar de Emergência , Evolução Fatal , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Vômito/diagnóstico , Vômito/etiologia
12.
Eur J Radiol ; 110: 142-147, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599852

RESUMO

INTRODUCTION & OBJECTIVES: Percutaneous nephrostomy [1] has emerged as a pivotal approach in the therapeutic management of the obstructed urinary tract. A consecutive incorporation of ultrasonic and radiographic guidance, the approach experienced an almost ubiquitious distribution while most centers currently applying either one or both of these tools jointly. However, success of ultrasound-guidance is limited in obese patients and non-dilated uropathy. In turn, fluoroscopy usually requires an opacification of the urinary collecting system by intravenous or antegrade contrast media injection, which might be harmful for already impaired renal function, raise intrapelvic pressure and augment the risk of sepsis and hemorrhage. CT-guided PCN aids in overcoming these limitations. In the current study, we present the experience of a tertiary referral center with this technique. MATERIALS & METHODS: Epidemiological and clinical data of all patients treated with a CT-guided PCN of native kidneys at the University Hospital Frankfurt between October 2003 and October 2013 were retrospectively collected from the patient charts. Procedural parameters including radiological aspects, technical and therapeutic success, complication and mortality rate have been analyzed statistically. RESULTS: In total, 140 PCN procedures have been performed in 77 patients with a median age of 69 (± 13). The median body mass index was 27 with 66.6% of patients being overweight or obese. Charlson comorbidity index was 7 ranging 0-16. Indications for PCNs were obstructive uropathy (62.9), urine extravasation (22.9%), urinary tract fistulas (11.4%) and technical reasons (2.8%). In 68.8% of patients, initial diagnosis was malignancy. 56.4% of kidneys were non-dilated before puncture. In 78.4% prone position, otherwise supine oblique position (17.3%) or supine position (4.3%) was used. 71.4% of PCNs were carried out solely under local anesthesia. Technical success has been achieved in 90% with a complication rate of 3.6% (all grade minor B) and was not significantly different between dilated and non-dilated kidneys. 42.9% of fistulas and 64.3% of urinary tract leakages, healed after PCN placement. 30 days mortality rate was 5.2% without being directly associated with the PCN procedure itself. CONCLUSION: CT-guided PCN is a feasible approach associated with low morbidity. It is particularly useful in complex clinical scenarios e.g. critically ill, newly operated or obese patients as well as non-dilated kidneys. Moreover, it represents a minimally-invasive option for treating leakages and fistulas of the urinary tract.


Assuntos
Nefrostomia Percutânea/métodos , Doenças Urológicas/cirurgia , Idoso , Anestesia Local , Dilatação Patológica/cirurgia , Estudos de Viabilidade , Feminino , Fluoroscopia/métodos , Humanos , Rim/diagnóstico por imagem , Masculino , Obesidade/complicações , Sobrepeso/complicações , Radiografia Intervencionista , Insuficiência Renal/cirurgia , Estudos Retrospectivos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção , Doenças Uretrais/cirurgia
13.
J Gastrointest Surg ; 23(1): 58-66, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30215199

RESUMO

BACKGROUND: Weight regain and dumping after Roux-en-Y gastric bypass (RYGB) are long-term challenges thought to be due to dilation of the gastrojejunal anastomosis. The aim of this study was to analyze the feasibility, safety, and outcomes of endoscopic gastrojejunal revisions (EGRs) after its introduction in a tertiary bariatric surgery center. METHODS: From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing EGR with the OverStitch suturing device. Demographics, procedure details, and outcomes were recorded. RESULTS: There were 107 patients (M:F = 29:78) treated with 133 EGR procedures for weight regain (n = 81), dumping syndrome (n = 13), or both (n = 13) with mean age 47.3 years (R 22.0-72.9) and mean BMI 32.9 kg/m2 (R 22.2-49.8) at time of procedure. Mean procedure time was 17.8 min (R 12-41), with median 1 suture used (R 1-2). No intra-operative or 30-day complications were recorded. Mean follow-up time was 9.2 months (R 1-26.8). Patients lost a mean of 4.1, 5.8, and 8.0 kg at 3, 6, and 12 months, respectively, after the procedure. Weight loss outcomes were significantly better when two compared to one suture was used (p = 0.036), and for patients with higher starting BMI (p = 0.047). For patients with dumping syndrome, 90-100% had treatment response after one or two EGRs. CONCLUSION: EGR is feasible and safe for weight regain and dumping syndrome after RYGB. It can stabilize weight regain and improve dumping symptoms. Around 20% of patients will need repeat EGR within 1 year to achieve sufficient narrowing of the anastomosis.


Assuntos
Endoscopia Gastrointestinal/métodos , Derivação Gástrica/efeitos adversos , Jejuno/cirurgia , Reoperação , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Síndrome de Esvaziamento Rápido/etiologia , Síndrome de Esvaziamento Rápido/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Duração da Cirurgia , Reoperação/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos , Suturas , Ganho de Peso , Perda de Peso , Adulto Jovem
14.
J Robot Surg ; 13(5): 703-705, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30542788

RESUMO

Ovarian vein syndrome is a rare cause of ureteral obstruction. Most of these cases occur during pregnancy likely from the gravid uterus causing ovarian vein dilatation and valvular incompetence. Hormonal changes associated with pregnancy also affect the muscular wall of ureter, causing decrease in tone and may facilitate compression as well. There is a predilection for right side and in thin females. The traditional treatment has been the ligation of ovarian vein and ureterolysis. We report a case of ovarian vein syndrome in a young female which was managed by robot-assisted laparoscopic ovarian vein ligation, resection of stenosed ureteric segment and end-to-end ureterostomy.


Assuntos
Laparoscopia/métodos , Ovário/irrigação sanguínea , Complicações na Gravidez/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Ureterostomia/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Veias/patologia , Adulto , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Feminino , Humanos , Ligadura/métodos , Gravidez , Síndrome , Resultado do Tratamento , Obstrução Ureteral/etiologia
17.
J Refract Surg ; 34(10): 664-670, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30296327

RESUMO

PURPOSE: To compare posterior corneal features and their discriminating power for differentiating normal corneas from subclinical keratoconus using the Placido dual-Scheimpflug analyzer. METHODS: Patients were retrospectively included in the study. The preoperative normal right eyes of 79 patients imaged with a Placido dual-Scheimpflug system and with a stable postoperative LASIK follow-up of a minimum of 36 months were included in the normal group and were compared to 39 contralateral topographically normal eyes with clinically evident keratoconus in the fellow eye. The posterior surface variables measured were categorized according to the feature of the corneal shape they were characterizing (curvature, elevation, asymmetry, and eccentricity) and compared between the two groups using the Student's two-sample t test. The discriminating ability of the posterior surface variables was compared by receiver operator characteristics curves. RESULTS: Variables that related to asymmetry and elevation of the posterior surface were statistically significantly different between groups (P < .05), whereas eccentricity and curvature-related parameters were not. Receiver operator characteristics curves analysis showed that the maximum posterior elevation over the best-fit toric and aspheric surface reference shape had the highest discriminating ability for distinguishing normal corneas from subclinical keratoconus, with an area under the curve of 0.877, followed by the asphericity asymmetry index, with an area under the curve of 0.871, and posterior inferior-superior value, with an area under the curve of 0.851. CONCLUSIONS: Posterior cornea measured with a dual-Scheimpflug analyzer provides useful parameters for differentiating normal corneas from subclinical keratoconus. Of the posterior surface parameters, asymmetry and elevation seem to be the most sensitive shape modifications for differentiating both populations. [J Refract Surg. 2018;34(10):664-670.].


Assuntos
Córnea/anatomia & histologia , Córnea/patologia , Técnicas de Diagnóstico Oftalmológico , Ceratocone/diagnóstico , Adulto , Paquimetria Corneana , Topografia da Córnea , Dilatação Patológica/diagnóstico , Dilatação Patológica/cirurgia , Feminino , Humanos , Ceratocone/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ , Lasers de Excimer/uso terapêutico , Masculino , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
19.
Pediatr Surg Int ; 34(10): 1079-1086, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30076449

RESUMO

PURPOSE: This study aimed to investigate the clinical features and risk factors of bile duct perforation in pediatric congenital biliary dilatation (CBD) patients. METHODS: CBD patients, whose initial symptom was abdominal pain, were enrolled in this study and were divided into perforated and non-perforated groups. The clinical features of the perforated group were investigated. Moreover, the age at operation, sex, and morphologic features of the extrahepatic bile duct were compared between the groups. RESULTS: Fifteen cases of bile duct perforation (10.4%) were identified among the 144 CBD patients who had abdominal pain. Majority of bile duct perforation occurred in patients aged < 4 years. The median duration from onset of abdominal pain to bile duct perforation was 6 (4-14) days. Age at onset [< 4 years old; P = 0.02, OR 13.9, (1.663, 115.3)], shape of extrahepatic bile duct [non-cystic type; P = 0.009, OR 8.36, (1.683, 41.5)], and dilatation of the common channel [P = 0.02, OR 13.6, (1.651, 111.5)] were risk factors of bile duct perforation. CONCLUSIONS: Emergent bile duct drainage might be planned to prevent bile duct perforation if CBD patients have the abovementioned risk factors and experience persistent abdominal pain lasting for a few days from onset.


Assuntos
Doenças dos Ductos Biliares/congênito , Doenças dos Ductos Biliares/complicações , Perfuração Espontânea/etiologia , Dor Abdominal/etiologia , Adolescente , Adulto , Doenças dos Ductos Biliares/cirurgia , Ductos Biliares Extra-Hepáticos/cirurgia , Dilatação Patológica/complicações , Dilatação Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
20.
Gen Thorac Cardiovasc Surg ; 66(12): 692-699, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30078149

RESUMO

OBJECTIVE: This study aimed to evaluate the outcomes of repeat interventions on the aorta and aortic valve after surgery for acute Stanford type A aortic dissection. METHODS: The hospital records of patients who underwent repeat surgical intervention between April 2011 and March 2017 for late complications after acute type A aortic dissection repair were retrospectively reviewed. RESULTS: We identified 17 patients with mean age of 62 ± 8 years; 13 were men. The mean interval from the initial emergency aortic repair to the repeat intervention was 5.8 ± 5.4 years (range 133 days-16.6 years). Ten patients had dilatation or rupture of the residual type B aortic dissection; six of them had retrograde type A aortic dissection at the onset and did not undergo resection of the primary entry. Five patients had a pseudoaneurysm at the anastomosis; four of them were receiving anticoagulation medication. Three patients had aortic regurgitation; two of them were associated with the gelatin-resorcinol-formaldehyde glue that was used during the initial surgery. There was no early mortality after repeat intervention and no late death after a mean follow-up period of 3.3 ± 2.0 years. CONCLUSIONS: Repeat surgical intervention on the aorta and aortic valve after repair of acute type A aortic dissection had favorable early and mid-term outcomes and was not associated with early or late death. Long-term follow-up with imaging and echocardiography was considered to be essential for early detection of residual type B dilatation, anastomotic pseudoaneurysm, and aortic regurgitation after initial aortic repair.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda , Idoso , Anastomose Cirúrgica/efeitos adversos , Aneurisma Dissecante/fisiopatologia , Aorta/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Dilatação Patológica/cirurgia , Dissecação , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos
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