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1.
Neuroimaging Clin N Am ; 33(1): 185-206, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36404043

RESUMO

The complex anatomy and deep spaces of the head and neck limit physical examination while also offering many points for entry and spread of infection. Radiologic imaging plays a crucial role in managing head and neck infections by defining the location and extent of disease, facilitating abscess drainage, and identifying complications. This review provides essential background and examples for imaging infection throughout the head and neck region.


Assuntos
Doenças Transmissíveis , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos , Pescoço/diagnóstico por imagem , Cabeça/diagnóstico por imagem , Drenagem
2.
Medicine (Baltimore) ; 101(43): e31134, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316828

RESUMO

Simultaneous bilateral total hip arthroplasty (SBTHA) is an effective procedure for patients with disease bilaterally. But there is concern about increased blood loss and complications of SBTHA than staged total hip arthroplasty (THA). This study aimed to evaluate the differences in the clinical outcomes and complication rate of SBTHA with drainage and without drainage for reducing the concerns. Between October 2015 and April 2019, a retrospective cohort study was conducted with modified minimally invasive 2-incision method and a consecutive series of 41 SBTHA performed with drainage (Group I) were compared to 37 SBTHA performed without drainage (Group II). It was assessed clinically and radiographically for a mean of 2.1 ± 0.8 years (range, 1.0-4.8 years). Postoperative hematologic values (Hgb loss, total blood loss, transfusion rate), pain susceptibility, functional outcome (Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score) and complication were compared in the drained group and the non-drained group. Postoperative Hgb loss (I: 2163.2 ± 698.7 g, II: 1730.4 ± 572.5 g; P = .002), total blood loss (I: 1528.8 ± 421.7 mL, II: 1237.6 ± 325.9 mL; P = .001) and mean transfusion unit (I: 0.7 ± 1.0 IU, II: 0.1 ± 0.3 IU; P < .001) were significantly lower in the without drainage group than in the with drainage group. But the morphine equivalent (I: 132.7 ± 314.1 mg, II: 732.2 ± 591.5 mg; P < .001) was significantly larger in the without drainage group. No significant difference was found between the drainage group and without drainage group in Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score at final follow-up. SBTHA without drainage can reduce postoperative blood loss and the requirement for transfusion without increasing other complication. But SBTHA without drainage is more painful method than SBTHA with drainage. Therefore, SBTHA without drainage will be a good option to reduce the burden on the patient by reducing postoperative bleeding if it can control pain well after surgery. III, Retrospective case-control study.


Assuntos
Artroplastia de Quadril , Osteoartrite , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Estudos Retrospectivos , Estudos de Casos e Controles , Hemorragia Pós-Operatória , Drenagem , Dor , Resultado do Tratamento
3.
Medicine (Baltimore) ; 101(43): e31293, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316922

RESUMO

RATIONALE: Endoscopic treatment of a pancreatic pseudocyst complicated by pancreaticojejunostomy (PJ) stricture is challenging. PATIENT CONCERNS: A 76-year-old woman presented with worsening abdominal pain and dyspepsia. She had been receiving adjuvant chemotherapy (capecitabine and cisplatin) for 4 months after pylorus-preserving pancreaticoduodenectomy (PPPD) for the treatment of extrahepatic cholangiocarcinoma. DIAGNOSES: Laboratory findings included elevated serum amylase (145 U/L) and lipase (437 U/L) levels. Abdominal computed tomography (CT) showed a pancreatic pseudocyst of approximately 3 cm in size and pancreatic duct dilatation in the remnant pancreas. According to the Response Evaluation Criteria in Solid Tumors, cholangiocarcinoma is a stable disease. INTERVENTIONS AND OUTCOMES: Endoscopic drainage of the pancreatic pseudocyst was planned. Single-balloon enteroscopy (SBE)-guided endoscopic retrograde pancreatography (ERP) with endoscopic ultrasonography (EUS) using a mini probe demonstrated a membranous PJ stricture and a pancreatic pseudocyst. Endoscopic pseudocyst drainage using a 7-Fr plastic stent was successfully performed after needle-knife incision of the PJ stricture. Follow-up abdominal CT after 3 weeks showed complete resolution of the pseudocyst. Chemotherapy was resumed. LESSONS: SBE-guided ERP with EUS using a mini probe may be an effective and safe treatment in a patient with a pancreatic pseudocyst complicated by membranous PJ stricture after PPPD.


Assuntos
Pseudocisto Pancreático , Enteroscopia de Balão Único , Feminino , Humanos , Idoso , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/diagnóstico por imagem , Pancreaticojejunostomia/efeitos adversos , Constrição Patológica/cirurgia , Constrição Patológica/complicações , Pâncreas , Endossonografia/efeitos adversos , Drenagem/métodos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 101(43): e31211, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316943

RESUMO

RATIONALE: We describe a case of insulinoma located extremely close to the accessory pancreatic duct (APD), but away from the main pancreatic duct (MPD). Previous studies showed insulinoma enucleation is a safe procedure for small benign tumors >3 mm distant from the MPD. However, in this case enucleation of the tumor led to unanticipated APD injury and grade B post-operative pancreatic fistula (POPF). We provide detailed records of clinical management and argue that enucleation of tumors near APD needs to be carefully weighed. PATIENT CONCERNS: The patient experienced a sudden increase of abdominal drain fluid and prolonged drainage time after a regular insulinoma enucleation surgery. DIAGNOSIS: APD damage during the enucleation. INTERVENTIONS: Drain fluid amylase concentration were regularly recorded and prolonged somatostatin analogs were administered. OUTCOMES: Amount of abdominal drain gradually decreased and the drain tube was removed on postoperative 37. LESSONS: Benign pancreatic tumor close to the APD need to be evaluated carefully and clinical evidence is warranted to affirm the necessity of placing a pancreatic duct stent before the surgery.


Assuntos
Insulinoma , Neoplasias Pancreáticas , Humanos , Insulinoma/patologia , Pancreatectomia/métodos , Resultado do Tratamento , Fístula Pancreática/etiologia , Fístula Pancreática/cirurgia , Fístula Pancreática/patologia , Ductos Pancreáticos/cirurgia , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia , Stents/efeitos adversos , Drenagem/métodos , Complicações Pós-Operatórias/cirurgia
5.
Fluids Barriers CNS ; 19(1): 89, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348424

RESUMO

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a multifactorial disease presenting with a classical symptom triad of cognitive decline, gait disturbance and urinary incontinence. The symptoms can be alleviated with shunt surgery but the etiology of the symptoms remains unclear. Navigated transcranial magnetic stimulation (nTMS) was applied to characterize corticospinal excitability and cortical motor function before and after shunt surgery in order to elucidate the pathophysiology of iNPH. We also aimed to determine, whether nTMS could be applied as a predictive tool in the pre-surgical work-up of iNPH. METHODS: 24 patients with possible or probable iNPH were evaluated at baseline, after cerebrospinal fluid drainage test (TAP test) and three months after shunt surgery (follow-up). Symptom severity was evaluated on an iNPH scale and with clinical tests (walking test, Box & Block test, grooved pegboard). In the nTMS experiments, resting motor threshold (RMT), silent period (SP), input-output curve (IO-curve), repetition suppression (RS) and mapping of cortical representation areas of hand and foot muscles were assessed. RESULTS: After shunt surgery, all patients showed improved performance in gait and upper limb function. The nTMS parameters showed an increase in the RMTs (hand and foot) and the maximum value of the IO-curve increased in subject with a good surgical outcome. The improvement in gait correlated with an increase in the maximum value of the IO-curve. SP, RS and mapping remained unchanged. CONCLUSION: The excitability of the motor cortex and the corticospinal tract increased in iNPH patients after shunt surgery. A favorable clinical outcome of shunt surgery is associated with a higher ability to re-form and maintain neuronal connectivity.


Assuntos
Hidrocefalia de Pressão Normal , Córtex Motor , Humanos , Estimulação Magnética Transcraniana , Tratos Piramidais/cirurgia , Drenagem
6.
J Ayub Med Coll Abbottabad ; 34(3): 550-556, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36377174

RESUMO

Subdural hematoma is an encapsulated collection of blood under the dura matter. This commonly encountered neurosurgical disorder is best managed by surgical evacuation; however, contemporary neurosurgery lacks a consensus regarding surgical technique of choice. Due to high incidence of the condition and associated complications, vast amount of literature is available on the subject; including studies comparing efficacy of various available treatment modalities. Herein, literature on surgical techniques employed for management of Chronic Subdural Hematoma (CSDH) has been reviewed to provide an evidence-based review on best surgical practices. Following conclusions can be made on basis of evidence of various levels provided in the studied literature: (1) Twist-drill craniostomy is a relatively safe technique that can be employed under local anaesthesia, thus can be considered as first line treatment in high risk surgical candidates. (2) Single and double burr-hole craniostomies have shown comparable results. (3) Intraoperative irrigation during burr-hole craniostomy doesn't affect outcome. (4) Drain insertion after hematoma evacuation lowers recurrence risk. (5) Position of drain is not significant but early drain removal is associated with higher recurrence rates. (6) Craniotomy is associated with high morbidity and mortality, hence should be reserved for recurrent and large septate hematoma cases. (7) Head elevation in postoperative period reduces recurrence. (8) Embolization of middle meningeal artery (EMMA): A novel treatment modality, is promising but requires further approval in terms of large sample sized multicenter randomized control trials. In conclusion further research is required on the subject to formulate guidelines regarding management of this common neurosurgical emergency.


Assuntos
Hematoma Subdural Crônico , Humanos , Hematoma Subdural Crônico/cirurgia , Resultado do Tratamento , Craniotomia/métodos , Drenagem/métodos , Procedimentos Neurocirúrgicos
7.
Medicine (Baltimore) ; 101(44): e31545, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343043

RESUMO

This study aimed to evaluate the feasibility of performing endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge fine-needle aspiration needle. This was a single-center retrospective study. Fourteen patients who underwent endoscopic ultrasound-guided hepaticogastrostomy with a 22-gauge fine-needle aspiration needle were examined. Fourteen eligible patients were included in this study. The age of patients ranged from 55 to 93 years, with a median of 76 years. Of patients with existing underlying diseases, there were 8 cases of pancreatic cancer (57.1%), 2 cases of metastatic liver tumor (14.3%), 2 cases of bile duct stones (14.3%), 1 case of hilar cholangiocarcinoma (7.1%), and 1 case of gallbladder cancer (7.1%). Regarding gastrointestinal anatomy, there were 11 cases (78.6%) of normal and 3 cases (21.4%) of gastric resection with Roux-en-Y. Reasons for endoscopic ultrasound-guided hepaticogastrostomy were duodenal obstruction in 7 cases (50.0%), surgically altered anatomy in 3 cases (21.4%), and 4 cases (28.6%) of failed endoscopic retrograde cholangiopancreatography. Technical success was achieved in 11 cases (78.6%). Subsequently, 11 cases of technical success were analyzed. There were 5 cases of puncturing B2 (45.5%). The puncture bile duct diameter ranged from 3.1 to 5.7 mm, with a median of 4.4 mm. endoscopic ultrasound-guided antegrade procedures was combined with endoscopic ultrasound-guided hepaticogastrostomy in 2 cases (18.2%). Clinical success was achieved in all the cases. The procedure time ranged from 15 to 93 minutes, with a median duration of 35 minutes. Regarding the type of stent placed in hepaticogastrostomy, a plastic stent was placed in 10 cases (90.9%) and a metal stent was placed in 1 case (9.1%). Early adverse events occurred in 4 cases (36.4%), and all of these cases developed biliary peritonitis, late adverse events occurred in 1 case (9.1%), this was biloma. A change to a 0.025-inch guidewire during the procedure was required in 8 cases (72.7%). Esophageal puncture was not performed. endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge fine-needle aspiration needle is effective. However, in 72.7% of the cases started using the 0.018-inch guidewire, the guidewire was exchanged for a 0.025-inch guidewire during procedure.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Endossonografia , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Estudos de Viabilidade , Resultado do Tratamento , Endossonografia/métodos , Stents , Ultrassonografia de Intervenção , Drenagem/métodos
8.
Zhonghua Yan Ke Za Zhi ; 58(11): 917-919, 2022 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-36348529

RESUMO

A 66-year-old woman presented with recurrent erythema, swelling and pain in her right eye. She had a history of extraction of the right upper second molar 5 months ago with subsequent development of an abscess which was incised and drained 4 months ago. Orbital CT scan revealed the formation of subperiosteal sinus cavity with an abscess in the right maxillary sinus and infraorbital foramen. The diagnosis was orbital honeycombing caused by odontogenic maxillary sinus septum infection. Utilizing the anterior lacrimal recess approach under nasal endoscope,incision and drainage of ocular abscess and debridement and drainage of right orbital abscess plus partial resection of the inner wall of the jaw were performed successfully with maxillary sinus septal drainage and maxillary sinus opening. The patient improved significantly after the operation.


Assuntos
Celulite Orbitária , Doenças Orbitárias , Humanos , Feminino , Idoso , Celulite Orbitária/complicações , Celulite Orbitária/diagnóstico , Celulite Orbitária/cirurgia , Abscesso/etiologia , Seio Maxilar , Drenagem/efeitos adversos , Tomografia Computadorizada por Raios X/efeitos adversos , Doenças Orbitárias/diagnóstico
9.
Can J Gastroenterol Hepatol ; 2022: 9250370, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36345379

RESUMO

Background: The lumen-apposing metal stent (LAMS) has been increasingly used for EUS-guided drainage of symptomatic walled-off pancreatic fluid collection (WOPFC) in recent years. Nevertheless, some WOPFCs may require additional drainage methods including another LAMS as a result of complexity of the lesions. This current study aimed to compare clinical parameters of patients with complex WOPFC requiring LAMS with additional methods (complex WOPFC: group A) versus single LAMS alone (noncomplex WOPFC; group B). Method: Medical records of patients with complex (group A) versus noncomplex WOPFCs (group B) were reviewed and compared in three centers in Thailand and Malaysia, between January 2016 to December 2020. Result: 31 patients with WOPFCs were recruited. 6 of 31 (19%) patients were in group A. Multivariate analysis showed that the maximal diameter of WOPFCs in group A was significantly larger than that of group B (18 ± 6 versus 13 ± 3 cm in diameter, respectively, p = 0.021). Solid component proportion was higher in group A versus B (35.8% versus 17.8%, respectively, p = 0.025). The prevalence of pancreatic duct leakage was significantly higher in group A (67% versus 20%, p = 0.23). The need of direct endoscopic necrosectomy (DEN) and the number of DEN sessions were higher in group A versus B (100% vs. 48%, p = 0.020 and 3.5 vs 0 p = 0.031, respectively). Conclusions: Complex WOPFC had larger diameter of lesions, higher proportion of solid component, higher prevalence of pancreatic duct leakage, and higher number of DEN is required than group noncomplex lesions. Trial Registration. This trial is registered with TCTR20180223004.


Assuntos
Drenagem , Pancreatopatias , Humanos , Resultado do Tratamento , Drenagem/métodos , Stents , Pancreatopatias/cirurgia , Endossonografia
10.
Folia Neuropathol ; 60(3): 355-361, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36382489

RESUMO

INTRODUCTION: Lumbar stenosis has become a common disease. Controversies exist regarding fusion surgery. MATERIAL AND METHODS: The patients were divided into groups per the method of fusion received: the posterolateral fusion group (group P) and the intervertebral fusion group (group I). The patients were further divided into groups based on the number of fusion segments: the 2-segment group (P2 and I2), the 3-segment group (P3 and I3), and the 4-segment group (P4 and I4). The operative time, intraoperative blood loss, blood transfusion volume, and postoperative drainage volume were summarized. In particular, wound healing appearance and management were observed. RESULTS: The operation time and blood transfusion volume of the P2 and P3 groups were significantly less than those of the I2 and I3 groups (p < 0.05). The postoperative drainage volume of group I4 was less than that of group P4 (p < 0.05). Postoperative numeric rating scale (NRS) scores of P2 and P3 groups were lower than those of I2 and I3 groups (p < 0.05), while the NRS scores of P4 group were higher than those of I4 group (p < 0.05). CONCLUSIONS: Posterolateral and intervertebral fusion techniques can be used in the surgical treatment of elderly patients with lumbar spinal stenosis. The posterolateral fusion method should be used when three or fewer segments require surgery. The intervertebral fusion method should be used when four segments require surgery.


Assuntos
Fusão Vertebral , Estenose Espinal , Humanos , Idoso , Estenose Espinal/cirurgia , Fusão Vertebral/métodos , Vértebras Lombares/cirurgia , Dor , Drenagem , Resultado do Tratamento , Estudos Retrospectivos
11.
World J Emerg Surg ; 17(1): 57, 2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36324150

RESUMO

INTRODUCTION: Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years. METHODS: Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature. RESULTS: Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported. CONCLUSIONS: Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Cálculos Biliares/cirurgia , Cálculos Biliares/complicações , Complicações Pós-Operatórias/etiologia , Drenagem
12.
Khirurgiia (Mosk) ; (11): 23-28, 2022.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-36398951

RESUMO

OBJECTIVE: To develop an effective minimally invasive method for the treatment of infected pancreatic necrosis. MATERIAL AND METHODS: There were 168 patients with infected pancreatic necrosis who were treated at the Regional Clinical Hospital No. 2 between 2011 and 2018. Eighty-seven (51.8%) patients underwent primary drainage with large-diameter double-lumen drains 28-32 Fr, and original technique of transfistulous endoscopic sequestrectomy was used. Puncture-drainage interventions with transfistulous endoscopic sequestrectomy were used in 23 (26.4%) patients with local and 64 (73.6%) patients with widespread purulent-necrotic parapancreatitis. RESULTS: Percutaneous channels are accesses to purulent-necrotic cavity and used for transfistulous endoscopic sequestrectomy. This procedure was performed 98 times. Time of primary sanitation in patients with 3 accesses in omental bursa was significantly less compared to 2 accesses (62±4.3 vs. 89±8.2 min, p<0.05). In case of repeated sanitation, time of intervention did not depend on the number of accesses. Incidence of local complications was 9.1%, extra-abdominal complications - 19.4%. Mortality rate was 12.6%. CONCLUSION: Original technique of transfistulous endoscopic sequestrectomy increases efficiency of sanitation of infected parapancreatitis, improves treatment outcomes and reduces mortality to 12.3%.


Assuntos
Infecções Intra-Abdominais , Procedimentos Ortopédicos , Pancreatite Necrosante Aguda , Humanos , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/cirurgia , Infecções Intra-Abdominais/etiologia , Endoscopia/efeitos adversos , Drenagem/efeitos adversos , Drenagem/métodos , Procedimentos Ortopédicos/efeitos adversos
13.
BMC Surg ; 22(1): 399, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401215

RESUMO

BACKGROUND: Biliary obstruction which is a major complication of pancreas and periampullary tumors could result in cholangitis, coagulopathies, gastrointestinal symptoms, and impaired wound healing. Pancreaticoduodenectomy (PD) is still the standard approach for pancreas resection and imposes high risk of morbidity and mortality to patients. To reduce the high risk of PD and address the biliary obstruction, the use of preoperative biliary stenting was increased. However, available literature doubts its efficiency. METHODS: A total of 147 patients who underwent PD between September 2012, and February 2022, at three medical centers were identified. Patients were grouped based on biliary stent placement. Non-jaundiced patients with and without preoperative biliary drainage (PBD) were compared. RESULTS: The incidence of overall complications (34.2% versus 45.8%) and mortality (17.8% versus 24.3%) did not differ in the PBD group compared to the no PBD group. There was no difference in complications and mortality in non-jaundiced patients with and without PBD. Patients with drainage duration of > 30 days experienced more overall complications compared to patients with less than 30 days drainage duration (12 (50.0%) and three (15.8%) patients, respectively, p-value = 0.019). CONCLUSIONS: PBD does not significantly increase the post-operative burden on patients who undergo PD. However, we cannot overlook the financial burden that PBD places on the patient and the healthcare system, as well as the difficulties related to endoscopic retrograde cholangiopancreatography (ERCP). Therefore, biliary stenting should not be routinely practiced in the absence of a valid indication, such as severe jaundice, pruritus, cholangitis, delayed surgery for neoadjuvant treatment, or referral to a tertiary facility.


Assuntos
Colangite , Colestase , Icterícia , Humanos , Pancreaticoduodenectomia/efeitos adversos , Pancreatectomia/efeitos adversos , Estudos Retrospectivos , Cuidados Pré-Operatórios , Drenagem/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Colangite/etiologia
14.
BMJ Open ; 12(11): e067970, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36351727

RESUMO

INTRODUCTION: Perianal fistula is a burdening disease with an annual incidence of 6-12/100 000 in Western countries. More than 90% of crypto-glandular fistulas originate from perianal abscess. Despite adequate drainage, up to 83% recur or result in an anal fistula, the majority developing within 12 months. There is some evidence that gut-derived bacteria play a role in the development of perianal fistula. Up till now, it is not common practice to routinely administer prophylactic antibiotics to prevent anal fistula development. There is a need for a study to establish whether adding antibiotic treatment to surgical drainage of perianal abscess results in a reduction in perianal fistulas. METHODS AND ANALYSIS: This multicentre, double-blind, randomised, placebo-controlled trial investigates whether addition of antibiotics (ciprofloxacin and metronidazole) to surgical drainage of a perianal abscess is beneficial compared with surgical drainage alone. The primary outcome is the development of a perianal fistula within 1 year. Secondary outcomes include quality of life, treatment costs, need for repeated drainage, patient-reported outcomes and other clinical outcomes. Participants are recruited in one academic and seven peripheral Dutch clinics. To demonstrate a reduction of perianal fistula from 30% to 15% when treated with adjuvant antibiotics with a two-sided alpha of 0.05, a power of 80% and taking a 10% loss to follow-up percentage into account, the total sample size will be 298 participants. Data will be analysed according to the intention-to-treat principle. ETHICS AND DISSEMINATION: The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers (nr. 2021_010). Written consent is obtained from each participant prior to randomisation into the study. The results of this trial will be submitted for publication in international peer-reviewed journals, presented at conferences and spread to coloproctological associations. TRIAL REGISTRATION NUMBERS: 2020-004449-35; NCT05385887.


Assuntos
Doenças do Ânus , Fístula Retal , Dermatopatias , Humanos , Abscesso/complicações , Qualidade de Vida , Doenças do Ânus/cirurgia , Fístula Retal/cirurgia , Drenagem/métodos , Antibacterianos/uso terapêutico , Dermatopatias/tratamento farmacológico , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
15.
Retina ; 42(12): 2307-2314, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36394886

RESUMO

PURPOSE: To identify risk factors for recurrent retinal detachment after uncomplicated pars plana vitrectomy in patients with primary rhegmatogenous retinal detachment (RRD). METHODS: This single-center retrospective study included patients with primary RRD who underwent 23-gauge and 25-gauge pars plana vitrectomy at Hiroshima University Hospital between January 2016 and May 2021. All patients had ≥3 months of follow-up. Patients were excluded if they had preoperative proliferative vitreoretinopathy worse than Grade C1; giant retinal tears; tractional, exudative, or traumatic retinal detachment; or the use of perfluorocarbon liquid. Factors that influenced RRD treatment outcome and postoperative complications were evaluated. RESULTS: We analyzed 519 eyes of 509 patients who underwent pars plana vitrectomy for primary RRD. The primary and final success rates were 93.8% and 99.8%, respectively. Drainage retinotomy was a risk factor for surgical failure in both multivariate analysis (odds ratio 2.36, 95% confidence interval 1.08-5.15, P = 0.0314) and a propensity score-matching analysis (odds ratio 3.20, 95% confidence interval 1.14-9.04, P = 0.0277). Postoperative epiretinal membrane was associated with drainage retinotomy in multivariate analysis (odds ratio 1.93, 95% confidence interval 1.04-3.57, P = 0.0358). CONCLUSION: The avoidance of drainage retinotomy during small-gauge pars plana vitrectomy in patients with RRD may lead to better surgical success and less frequent epiretinal membrane formation.


Assuntos
Membrana Epirretiniana , Descolamento Retiniano , Humanos , Vitrectomia/efeitos adversos , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Membrana Epirretiniana/cirurgia , Estudos Retrospectivos , Acuidade Visual , Drenagem , Fatores de Risco
16.
PLoS One ; 17(11): e0277272, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36331963

RESUMO

Percutaneous transhepatic biliary drainage (PTBD) has been an effective treatment to access the biliary tree, especially in case of endoscopically inaccessible biliary tree. In general, PTBD techniques are divided into two methods: fluoroscopy-guided PTBD and ultrasound (US)-guided PTBD. This study aimed to evaluate the effectiveness of US-guided PTBD, focusing on radiation exposure according to intrahepatic duct (IHD) dilatation degree, differences between right- and left-sided approaches and differences between benign and malignant biliary stenosis/obstruction. We evaluated technical success, clinical success, procedural data (the number of liver capsule punctures, procedural time, fluoroscopy time and radiation dose), and procedure-related complications. During the study period, a total of 123 patients with biliary stenosis/obstruction or bile leakage were initially eligible. We excluded 76 patients treated with only ERCP or initially treated with ERCP followed underwent PTBD insertion. Finally, a total of 50 procedures were performed in 47 patients. Of the 47 patients, 8 patients had anatomical alteration due to previous surgery, 6 patients refused ERCP, and 3 patients failed ERCP. For the remaining 30 patients, PTBD was performed on weekend or at night, 11 of whom had poor general condition, 10 patients underwent ERCP 3 to 4 days later after PTBD insertion, 6 patients improved after PTBD insertion without ERCP, 1 patient died, and 1 patient was referred to other hospital. Remaining 1 patient underwent surgery due to Mirizzi syndrome. All procedures were performed by two interventional radiologists. Technical success rate was 100%, clinical success was 94%, and the complication rate was 10%. Fluoroscopy time and the reported radiation dose were significantly lower in patients with dilated bile ducts than in those with non-dilated bile ducts, when biliary puncture under US guidance was performed initially. However, even in patients with non-dilated bile ducts undergoing initial trials of biliary puncture under US guidance, the fluoroscopy time and the reported radiation dose were low, based on current studies. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures and benign and malignant biliary stenosis/obstruction. Thus, US-guided PTBD was found to be a safe and effective technique that significantly reduced fluoroscopy time and radiation doses.


Assuntos
Colestase , Neoplasias , Humanos , Drenagem/métodos , Constrição Patológica/etiologia , Colestase/etiologia , Neoplasias/etiologia , Ultrassonografia de Intervenção/efeitos adversos , Estudos Retrospectivos
17.
Surg Clin North Am ; 102(6): 973-987, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36335932

RESUMO

Breast surgeons are well poised to promote evidence-based recommendations for lactation-related breast disorders and clarify existing misconceptions in traditional care. Surgeons can resolve lactational fluid collections and avoid milk fistula development during drainage and/or other procedures on the breast. Using principles of surgical wound management, they can provide effective care of nipple trauma. They can distinguish between inflammatory and infectious mastitis and promote delicate tissue handling to prevent breast injury and phlegmon. Finally, breast surgeons can debunk the myth of fungal infections occurring on the highly vascularized nipple and recognize common presentations of conditions such as dermatitis.


Assuntos
Mastite , Cirurgiões , Feminino , Humanos , Lactação , Aleitamento Materno , Mastite/terapia , Mastite/complicações , Drenagem/métodos
18.
Medicine (Baltimore) ; 101(43): e31634, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316850

RESUMO

Seroma is the most common wound complication due to dead space remaining after mastectomy and axillary dissection. Seroma formation, which causes pain and tension, together with the limitations of shoulder and arm movements, can cause wound healing problems that can progress to wound dehiscence and flap necrosis. The aim of our study was to investigate the effects of continuous drainage and negative pressure wound therapy (NPWT) in breast cancer patients with refractory postmastectomy seroma. This retrospectively designed study was conducted with 27 patients who were referred to our center between 2018 and 2021 due to refractory seroma after mastectomy. The inclusion criteria of the study were the cases who were planned minimally invasive debridement and NPWT due to having refractory seroma formation with at least 200 cc and having interventions more than 1 month after modified radical mastectomy (MRM), despite conventional treatment methods. All patients' demographics, disease stage, history of possible neoadjuvant therapy, comorbidities, body mass index (BMI), number of wound dressings with NPWT, and total amount of NPWT accumulation were enrolled and compared statistically. Twenty-seven patients included in the study underwent continuous drainage after debridement, and 5 (3-9) dressings were treated with NPWT. None of the patients experienced complications after debridement and NPWT administration. In refractory seroma cases seen after postmastectomy, NPWT especially for the management of debridement and dead space can be evaluated as an appropriate treatment method in patients with high flow rate seroma.


Assuntos
Neoplasias da Mama , Desbridamento , Mastectomia , Tratamento de Ferimentos com Pressão Negativa , Seroma , Retalhos Cirúrgicos , Feminino , Humanos , Neoplasias da Mama/cirurgia , Desbridamento/efeitos adversos , Desbridamento/métodos , Mastectomia/efeitos adversos , Mastectomia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Seroma/etiologia , Seroma/cirurgia , Pele , Axila/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/cirurgia , Drenagem/métodos
19.
Sci Rep ; 12(1): 19983, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36411290

RESUMO

There is an ongoing debate whether a surgical drainage is beneficial to prevent local accumulation of hematoma and to reduce the rate of wound infections, and neurological deficits. Data from the German Spine Society (DWG) registry were filtered for surgically treated spine tumor cases between 2017 and 2021. Cases were categorized into with (Group I) and without (Group II) placement of a surgical drainage. Subgroups were compared for demographic data, type of surgery, experience of the surgeon and postoperative surgical complications. 10,029 cases were included into final analysis (Group I: 3007; Group II: 7022). There was no significant difference between both groups regarding age or gender distribution. Average morbidity of patients was significantly elevated in Group I (p < 0.05) and the rates of invasive surgery were significantly increased in this group (p < 0.001). Overall complication rates were reported with 12.0% (Group I) and 8.5% (Group II). There were significantly more epidural hematoma (p < 0.001) and motor dysfunction (p = 0.049) as well as deep wound infections (p < 0.001) and implant failures (p = 0.02) in Group I. A surgical wound drainage cannot prevent epidural hematoma.


Assuntos
Hematoma Epidural Craniano , Neoplasias , Infecção dos Ferimentos , Humanos , Sistema de Registros , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Drenagem/efeitos adversos , Neoplasias/complicações
20.
Niger J Clin Pract ; 25(11): 1928-1930, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36412302

RESUMO

Interventional radiology is a minimally invasive therapeutic approach that may be of benefit for some gynecological conditions. We present the case of a 40-year-old nulliparous woman with postoperative pyometra following open myomectomy who was considered for a hysterectomy, but the gynecologist requested that an attempt be made at percutaneous drainage of the abscess to salvage her uterus. We achieved a successful computed-tomography-guided percutaneous drainage of the abscess.


Assuntos
Abscesso , Radiologia Intervencionista , Humanos , Feminino , Adulto , Drenagem , Tomografia Computadorizada por Raios X , Útero/diagnóstico por imagem , Útero/cirurgia
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