RESUMO
BACKGROUND: Multimodal protocols such as Acceleration of Total Postoperative Recovery and Enhanced Recovery After Surgery propose a set of pre- and post-operative care to accelerate the recovery of surgical patients. However, in clinical practice, simple care such as early refeeding and use of drains are often neglected by multidisciplinary teams. AIMS: Investigate whether early postoperative refeeding determines benefits in colorectal oncological surgery; whether the patients' clinical conditions preoperatively and the use of a nasogastric tube and abdominal drain delay their recovery. METHODS: Retrospective cohort carried out at the Cascavel Uopeccan Cancer Hospital, including adult cancer patients (age ≥18 years), from the Unified Health System (SUS), who underwent colorectal surgeries from January 2018 to December 2021. RESULTS: 275 patients were evaluated. Of these, 199 (75.4%) were refed early. Late refeeding (odds ratio - OR=2.1; p=0.024), the use of nasogastric tube (OR=2.72; p=0.038) and intra-abdominal drain (OR=1.95; p=0.054) increased the chance of infectious complication. Multivariate analysis showed that receiving a late postoperative diet is an independent risk factor for infectious complications. Late refeeding (p=0.006) after the operation and the placement of an intra-abdominal drain (p=0.007) are independent risk factors for remaining hospitalized for more than five days postoperatively. CONCLUSIONS: Refeeding early in the postoperative period reduces the risk of infectious complications. Using abdominal drains and refeeding late (>48h) for cancer patients undergoing colorectal surgery are risk factors for hospital stays longer than five days.
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Neoplasias Colorretais , Tempo de Internação , Complicações Pós-Operatórias , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Colorretais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Idoso , Cuidados Pós-Operatórios/métodos , Fatores de Tempo , Fatores de Risco , Adulto , Drenagem , Intubação GastrointestinalRESUMO
AIM: To assess the changes of intracranial pressure waveforms (ICPW) acquired noninvasively in a set of acute hydrocephalus patients prior to and posterior to interventions. MATERIAL AND METHODS: Patients with clinical and radiological diagnosis of hydrocephalus were evaluated for alterations in ICPW by means of a system that detects cranial micro expansions just before and immediately after interventions. The system quantified the difference between ICPW peaks (P1 and P2), providing the P2/P1 ratio. RESULTS: Fourteen patients aged from 26 to 73 years old met the inclusion criteria. Hydrocephalus etiologies were normal pressure hydrocephalus, post-traumatic and all patients had an abnormal intracranial compliance waveform, with P2 > P1 before the procedure (5 external ventricular drains (EVD) and 9 ventriculoperitoneal shunts (VPS). Immediately after, 75% of the patients changed to a standard pattern with P1 > P2. CONCLUSION: In this exploratory study using a novel noninvasive technique, rapid cerebrospinal fluid drainage by means of EVD and VPS was effectively assessed and had a positive impact on intracranial compliance.
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Hidrocefalia , Pressão Intracraniana , Derivação Ventriculoperitoneal , Humanos , Projetos Piloto , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Adulto , Pressão Intracraniana/fisiologia , Hidrocefalia/cirurgia , Hidrocefalia/fisiopatologia , Derivação Ventriculoperitoneal/métodos , Hidrocefalia de Pressão Normal/cirurgia , Hidrocefalia de Pressão Normal/fisiopatologia , Drenagem/métodosRESUMO
BACKGROUND AND AIMS: Pancreatic fluid collections (PFCs), including walled-off necrosis (WON), are significant complications of acute pancreatitis, and their management often involves drainage, although the optimal type of stent for this purpose remains uncertain. This meta-analysis aimed to compare metal versus plastic stents for endoscopic ultrasound (EUS)-guided drainage of PFCs. METHODS: We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing metal with plastic stents for drainage of PFCs. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). RESULTS: This study included eight RCTs and over 500 patients. Procedure duration was shorter in the metal stent arm compared with the plastic stent arm (MD - 10.63; 95% CI - 16.12 to - 5.15, p < 0.001). However, there was no statistically significant difference between metal and plastic stents in clinical success (OR 1.10; 95% CI 0.56 to 2.14), technical success (OR 1.53; 95% CI 0.23 to 10.0), overall mortality (OR 0.75; 95% CI 0.34 to 1.67), recurrence (OR 1.76; 95%CI 0.70 to 4.44), total number of interventions (MD 0.06; 95% CI - 0.52 to 0.64), need of necrosectomy (OR 1.27; 95% CI 0.77 to 2.11), length of hospitalization (MD - 0.41; 95% CI - 5.10 to 4.27), exocrine insufficiency (OR 1.37; 95% CI 0.50 to 3.71), endocrine insufficiency (OR 1.11; 95% CI 0.57 to 2.16), and adverse events (OR 0.74; 95% CI 0.39 to 1.41). CONCLUSION: Metal stents for EUS-guided drainage of WON are associated with a shorter procedure duration. Besides that, it may not improve other clinically relevant outcomes in comparison with plastic stents.
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Drenagem , Metais , Plásticos , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents , Humanos , Drenagem/métodos , Drenagem/instrumentação , Pancreatite , Pancreatite Necrosante Aguda/cirurgia , EndossonografiaRESUMO
BACKGROUND AND AIM: Endoscopic biliary drainage with placement of a self-expanding metal stent (SEMS) is the preferred palliative treatment of malignant biliary obstruction. Recent advances in the treatment have prolonged survival, thus, increasing the chance of recurrent biliary obstruction (RBO) after SEMS placement. The aim of this study was to compare different endoscopic approaches in patients with a SEMS and RBO, regarding clinical success and time to RBO. METHODS: This retrospective study included all patients with a SEMS placed because of malignant biliary strictures who underwent endoscopic retrograde cholangiopancreatography between January 2011 and December 2018. We evaluated the results of different endoscopic interventions to RBO, including insertion of a new SEMS, stent cleaning, and insertion of a plastic stent (PS). RESULTS: From January 2011 to December 2018, 70 (22.4%) patients developed RBO requiring endoscopic reintervention (n = 105 sessions). From the 105 ERCPs, technical success, clinical success, and adverse events rates were 91,4%, 71,8%, and 7,8%, respectively. Younger age (OR = 1.11 95%CI: 1.03-1.19) and the finding of a patent SEMS (OR = 0.17 95%CI: 0.04-0.08) were predictors of clinical failure (P = 0.006 and P = 0.024, respectively). The mean patency time (in days) after endoscopic reintervention was greater for SEMSs than for PSs (417.2 [95% CI: 250.0-584.4] vs 175.2 [95% CI: 124.0-226.5], P = 0.002). CONCLUSIONS: Correct identification and treatment of the causal factor of RBO typically lead to technical and clinical success. Placement of a second SEMS provides longer patency compared to a plastic stent if ingrowth (overgrowth) occurs.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colestase , Recidiva , Stents Metálicos Autoexpansíveis , Humanos , Masculino , Feminino , Colestase/etiologia , Colestase/cirurgia , Idoso , Estudos Retrospectivos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Cuidados Paliativos/métodos , Drenagem/métodos , Drenagem/instrumentaçãoRESUMO
Purulent pericarditis is rare condition in the modern era of antibiotics. However, it is a serious condition as it has an accelerated progression and is difficult to diagnose due to its nonspecific clinical presentation, resulting in high mortality. Herein, we present a case in which a 36-year-old male patient with otherwise unremarkable medical history developed abdominal sepsis complicated by purulent pericarditis post-appendectomy. While the initial clinical presentation was not compatible with the classic signs of purulent pericarditis, the diagnosis was made using electrocardiography (ST elevation/PR depression) and point-of-care ultrasonography (pericardial effusion). The condition was successfully managed with pericardial drainage and broad-spectrum antibiotics. The present case reinforces and reiterates the need for high diagnostic suspicion and careful clinical reasoning in the diagnosis of purulent pericarditis. Furthermore, it highlights the applicability of point-of-care ultrasonography in the diagnosis of the same.
Assuntos
Apendicectomia , Pericardite , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Humanos , Masculino , Adulto , Pericardite/diagnóstico por imagem , Pericardite/etiologia , Ultrassonografia/métodos , Apendicectomia/efeitos adversos , Eletrocardiografia , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Antibacterianos/uso terapêutico , Drenagem , Complicações Pós-Operatórias/diagnóstico por imagem , Apendicite/diagnóstico por imagem , Apendicite/cirurgiaRESUMO
OBJECTIVE: To structure a proposal for implementing and monitoring the nursing care protocol for the safety of adult patients with external ventricular drains. METHOD: Descriptive exploratory research based on Implementation Science, with intentional sampling. Carried out in a hospital complex in southern Brazil, between May and December 2022, in four stages: online questionnaire on knowledge of care for patients with external ventricular shunt for nurses; matrix of proposed indicators with key actors; self-instructional online course for nurses; synthesis of the existing protocol. Contextualized instructional design was used to develop the course. RESULTS: Six nurses from the operating room and intensive care unit participated, identifying knowledge gaps, pointing out the need for specific training; four key actors in the neurosurgery service defined six indicators. An online course was created and made available on the platform of the institution with two modules, including eight videos. Protocol synthesis was adapted to the standards of the institution's quality sector. CONCLUSION: A report regarding the implementation of the nursing care protocol for patients with external ventricular drains was delivered for the nurse who was the technical responsible. Future studies should evaluate the implementation and impacts it will generate. This model can be adapted by other institutions.
Assuntos
Protocolos Clínicos , Drenagem , Humanos , Drenagem/enfermagem , Brasil , AdultoRESUMO
INTRODUCTION: Encapsulated pancreatic necrosis, is a complication of acute necrotizing pancreatitis, being an entity of difficult management both clinically and surgically. Treatment includes several approaches, being drainage by endosonography (EUS) one of the most recommended, since it has improved patient outcomes. OBJECTIVE: To review the literature and report a clinical case of encapsulated necrosis (WON), treated by EUS at the Regional Hospital of Talca. MATERIAL AND METHODS: Patient with a history of acute pancreatitis due to choledocholithiasis treated by ERCP, who evolved with persistent abdominal pain and vomiting with all ingestion, a diagnosis of encapsulated necrosis (WON) was confirmed by CT scan of the abdomen and pelvis with contrast. The patient was treated with cystogastroanastomosis with LAMS prosthesis guided by endosonography, for the discussion the most relevant literature is reviewed. RESULTS: Excellent postoperative clinical results, microbiological study of pancreatic fluid showed infected necrosis. At one year of follow-up the patient remains asymptomatic. DISCUSSION: Recognizing the evolution of acute pancreatitis and diagnosing its local complications is key to offer the best treatment available in each institution.
INTRODUCCIÓN: La necrosis pancreática encapsulada, es una complicación de la pancreatitis aguda necrotizante, siendo una entidad de difícil manejo tanto clínico como quirúrgico. El tratamiento incluye varios enfoques, siendo el drenaje por endosonografía (USE) uno de los más recomendados, ya que ha permitido mejorar los resultados en los pacientes. OBJETIVO: Revisión de la literatura y reporte de un caso clínico de necrosis encapsulada (WON), tratado por USE en el Hospital Regional de Talca. MATERIAL Y MÉTODOS: Paciente con antecedentes de pancreatitis aguda por coledocolitiasis tratado mediante ERCP, que evolucionó con dolor abdominal persistente y vómitos a toda ingesta, mediante tomografía de abdomen y pelvis con contraste se confirmó diagnóstico de necrosis encapsulada (WON). El paciente fue tratado con cistogastroanastomosis con prótesis LAMS guiado por endosonografía, para la discusión se revisa la literatura más relevante. RESULTADOS: Excelente resultados clínicos posoperatorios, el estudio microbiológico del líquido pancreático demostró necrosis infectada. Al año de seguimiento paciente permanece asintomático. DISCUSIÓN: Reconocer la evolución de la pancreatitis aguda y diagnosticar sus complicaciones locales, es clave para ofrecer el mejor tratamiento disponible en cada institución.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/cirurgia , Pâncreas/diagnóstico por imagem , Tomografia , Drenagem , Pancreatite Necrosante Aguda/diagnóstico , Endossonografia , Técnicas de Laboratório Clínico , Abdome/diagnóstico por imagemRESUMO
La infección es la complicación más frecuente de los dis-positivos de líquido cefalorraquídeo (LCR). Los organis-mos se adhieren a la superficie del mismo y forman un biofilm, lo que dificulta el diagnóstico clínico, laboratorio y tratamiento. Objetivos: Incidencia de infección, microorganismos ais-lados, factores de riesgo, tasa reinfección y mortalidad en hospital de referencia neuroquirúrgico. Materiales y métodos: Estudio de cohorte retrospectivo, analítico, observacional. Criterios de inclusión: mayores de 15 años, con dispositivos de derivación de LCR: DVE y DVI. Período: 1 junio de 2020 hasta 1 junio de 2022. p< 0,05. Se realizó análisis multivariado. Epi Info 7. Resultados: 104 procedimientos quirúrgicos (57 pacien-tes); 62% hombres. Edad promedio: 37 años. Motivo de colocación dispositivo: 57% hemorragia ventricular, 43% traumatismo encefalocraneano, 24% fístula LCR. 20% episodios de infección: 15% ventriculitis (incidencia: 17.33/1000 días dispositivo) y 5% infecciones asociadas a DVP. Factores de riesgo más frecuentes: fístula LCR (OR 4,75), hemorragia ventricular (OR 3,65), permanencia dis-positivo mayor a 5 días (OR 3,76), recambio de dispositi-vo (OR 2,76), revisión DVP (OR 3,15). Gérmenes más fre-cuentes Staphylococcus epidermidis meticilino resistente (19%) y MOMR 24%. Reinfección: 28%. Mortalidad 10%. Conclusión: Tasa de infección del 20% (valores de refe-rencia según literatura van de 0 a 22%). Informes de Ar-gentina escasos. Factores de riesgo y mortalidad simila-res a lo reportado. Es importante implementar medidas de prevención e intervención a fin de minimizar el riesgo RESUMENARTÍCULO ORIGINALLaura Flores , Cynthia Rivero , Melisa Martínez Ríos , Myrna Cabral , María Laura Vernazzi .de infección para disminuir la morbimortalidad y el uso inadecuado de antimicrobianos. Es fundamental el cono-cimiento de datos locales
Infection is the most common complication of cerebros-pinal fluid (CSF) devices. The organisms adhere to the surface and form a biofilm, which difficults clinical diag-nosis, laboratory and treatment. Objectives: Incidence of infection, isolated microorganis-ms, risk factors, reinfection rate and mortality in a neuro-surgical reference hospital. Material and methods: Retrospective, analytical, observa-tional cohort study. Inclusion criteria: over 15 years old, with CSF devices: EVD and IVD. Period: From June 1, 2020 to June 1, 2022. p<0.05. Multivariate analysis was perfor-med. Epi Info 7. Results: 104 surgical procedures (57 patients); 62% men. Average age: 37 years. Reason for device placement: 57% ventricular hemorrhage, 43% brain trauma, 24% CSF fistu-la. 20% episodes of infection: 15% ventriculitis (incidence: 17.33/1000 device days) and 5% infections associated with IVD. Most frequent risk factors: CSF fistula (OR 4.75), ventricular hemorrhage (OR 3.65), device stay longer than 5 days (OR 3.76), device replacement (OR 2.76), DVP revi-sion (OR 3.15). Most frequent germs methicillin resistant Staphylococcus epidermidis (19%) and MOMR 24%. Rein-fection: 28%. Mortality 10%.Conclusion:Infection rate of 20% (reference values accor-ding to the literature range from 0 to 22%). Limited reports from Argentina. Risk factors and mortality are similar to those reported in the literature. It is very important to im-plement prevention and intervention measures in order to minimize the risk of infection to reduce morbidity and mortality and the inappropriate use of antimicrobials. The knowledgement of local data is important
Assuntos
Humanos , Masculino , Feminino , Líquido Cefalorraquidiano/fisiologia , Drenagem , Fatores de Risco , Infecções Relacionadas a Cateter/líquido cefalorraquidianoRESUMO
INTRODUCTION: Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta-analysis evaluates their efficacy. METHODS: We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random-effects model. We also performed a trial sequential analysis (TSA). RESULTS: We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25 mL; 95% CI 35.72-172.77 mL; p = 0.003; I2 = 0%). In children, saline reduced hospitalization duration (MD -1.26 days; 95% CI -1.98 to -0.55 days; p = 0.0006; I2 = 0%), whereas FA increased drainage volume (MD 84.66 mL; 95% CI 5.77-153.54 mL; p = 0.04; I2 = 0%). In adults, FA significantly reduced hospitalization duration (MD -11.12 days; 95% CI -15.16 to -7.08 days; p < 0.00001; I2 = 0%) and duration of drainage (MD -6.53 days; 95% CI -9.25 to -3.81 days; p < 0.00001; I2 = 0%) while increasing drainage volume (MD 164.47 mL; 95% CI 26.16-302.78 mL; p = 0.02; I2 = 0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration. CONCLUSION: In adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age-specific treatments and further research, especially in the pediatric population.
Assuntos
Abscesso Abdominal , Drenagem , Fibrinolíticos , Ensaios Clínicos Controlados Aleatórios como Assunto , Solução Salina , Irrigação Terapêutica , Humanos , Drenagem/métodos , Fibrinolíticos/uso terapêutico , Fibrinolíticos/administração & dosagem , Abscesso Abdominal/terapia , Solução Salina/administração & dosagem , Solução Salina/uso terapêutico , Irrigação Terapêutica/métodos , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricosRESUMO
BACKGROUND: In the past decades, endoscopic ultrasound has developed from a diagnostic tool to a platform for many therapeutic interventions. Various technological advancements have emerged since the last Brazilian Consensus, demanding a review and update of the recommendations based on the best scientific evidence. METHODS: A group of 32 renowned echoendoscopists selected eight relevant topics to be discussed to generate clinical questions. After that, a literature review was conducted to answer these questions based on the most updated evidence. RESULTS: Thirty-three statements were formulated and voted on by the experts to reach a consensus. The Oxford System was used to grade the level of evidence. CONCLUSION: There is mo-derate evidence to support that the needle shape, gauge, or aspiration technique does not influence the yield of endoscopic ultrasound (EUS)-guided tissue sampling of pancreatic solid lesions. There is moderate evidence to support using EUS-TTNB of the cyst wall to differentiate between mucinous and non-mucinous cystic neoplasms. There is little evidence to support the EUS-guided treatment of gastric varices. There is a high level of evidence to support that EUS-guided biliary drainage and ERCP present similar outcomes in patients with distal malignant biliary obstruction. There is a high level of evidence for using EUS to diagnose neoplastic pancreatic cysts and detect necrosis before indicating drainage. There is moderate evidence to support EUS-GE over duodenal stent for malignant gastric outlet obstruction in patients with a life expectancy higher than 2 months. There is a high level of evidence to support the use of RFA in treating both functioning and non-functioning types of NET.
Assuntos
Endossonografia , Pancreatopatias , Humanos , Brasil , Consenso , Drenagem/métodos , Endossonografia/métodos , Endossonografia/normas , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/patologia , Literatura de Revisão como AssuntoRESUMO
OBJECTIVE: To create an educational intervention for health professionals and test its effectiveness in implementing the use of CPAP in hospitalized patients with pleural effusion undergoing thoracic drainage. METHODS: This implementation study was developed in 5 hospitals in Brazil and one in Belgium within four phases: (I) Situational diagnosis (professionals and patients' knowledge about CPAP usage for drained pleural effusion and checking medical records for the last 6 months); (II) Education and training of professionals; (III) New situational diagnosis (equal to phase I); (IV) Follow-up for two years. RESULTS: 65 professionals, 117 patients' medical records, and 64 patients were enrolled in this study. Initially, only 72% of medical records presented a description of interventions. CPAP usage was mentioned in only one patient with a chest tube. After phase III, the number of professionals who used CPAP for their patients with drained pleural effusion increased from 28.8% to 66.7%, p < 0.001. Similarly, the acceptability of this therapy for this clinical situation also increased among professionals from 6.4 ± 1.3 to 7.8 ± 1.4, p < 0.001. However, before the implementation, only one medical record described the use of CPAP in one patient with drained pleural effusion. After two years, the use of CPAP therapy by healthcare professionals for patients with drained thoracic drainage was sustained in 3 hospitals. CONCLUSIONS: The educational intervention for the use of CPAP in patients with drained pleural effusion was effective for health professionals. Results were sustained after two years in three of the six hospitals.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Drenagem , Derrame Pleural , Humanos , Derrame Pleural/terapia , Masculino , Feminino , Drenagem/métodos , Pessoa de Meia-Idade , Brasil , Idoso , Bélgica , Adulto , Prática Clínica Baseada em Evidências , Resultado do Tratamento , Pessoal de Saúde/educaçãoRESUMO
El neumatocele es una lesión cavitada llena de aire de carácter adquirido que se encuentra en el interior del parénquima pulmonar. Aunque las causas pueden variar, el origen infeccioso bacteriano es lo más frecuente. Los cambios en los serotipos de neumococo y el aumento de las neumonías necrotizantes observado en las últimas décadas hacen de este tipo de lesiones algo cada vez más frecuente. Es importante conocer la evolución esperable, así como también saber qué paciente se beneficia de intervención para evitar secuelas a largo plazo y complicaciones graves. En este artículo se exponen las causas, epidemiología, orientación diagnóstica y una propuesta de manejo para el neumatocele.
A pneumatocele is an air-filled cavitary lesion of acquired nature located within the pulmonary parenchyma. Although causes can vary, bacterial infectious origin is the most common. Changes in pneumococcal serotypes and the increase in necrotizing pneumonia observed in recent decades have made these lesions increasingly frequent. It is important to know the expected evolution and to identify which patients would benefit from intervention to prevent long-term sequelae and severe complications. This article exposes the causes, epidemiology, diagnostic approach, and a management proposal for pneumatocele.
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Humanos , Criança , Pneumopatias/etiologia , Pneumopatias/terapia , Pneumopatias/diagnóstico por imagem , Traumatismos Torácicos , Drenagem , Pneumonia NecrosanteRESUMO
OBJECTIVE: This study aims to evaluate the role of TUSG in the postoperative period and the detection of early complications after surgical treatment, pulmonary resection, or decortication for infectious and inflammatory thoracic diseases, comparing with the standard method (Chest Radiography â CXR). METHODS: Prospective non-randomized self-controlled study. Twenty-one patients over 16 years of age have undergone surgical treatment of inflammatory and infectious lung diseases. These patients were followed up with CXR and TUSG (performed on the 1st and 3rd postoperative days and/or after the chest tube removal). RESULTS: Both exams demonstrated similar results regarding their ability to safely predict the adequate moment for chest drain removal. TUSG allowed chest drain removal in 30% of cases and CXR in 34%. Statistical analysis demonstrates that both exams have similar capabilities in detecting postoperative changes in the pleural space. However, the authors report that TUSG is statistically more accurate in detecting subcutaneous emphysema than CXR (p = 0.037, Kappa [κ = 0.3068]). The analysis of other parameters showed no statistical difference. CONCLUSION: The authors conclude that TUSG in trained hands is equivalent to CXR in searching for postoperative complications regarding the surgical treatment of infectious and inflammatory thoracic diseases and can be used as a complement, and not a substitute, to CXR, when CCT is not feasible, or a more urgent diagnosis is needed.
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Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Período Pós-Operatório , Adulto , Idoso , Ultrassonografia/métodos , Adulto Jovem , Radiografia Torácica , Pneumopatias/cirurgia , Pneumopatias/diagnóstico por imagem , Drenagem/métodos , Fatores de Tempo , Tubos Torácicos , Reprodutibilidade dos TestesRESUMO
Hepatic hydrothorax is a transudative pleural effusion in patients with cirrhosis. A 56-year-old cirrhotic patient presented with dyspnea and desaturation; his chest images showed a right pleural effusion. Another 66-year-old woman with cirrhosis, developed during her hospitalization acute respiratory failure, and her chest X- ray showed left pleural effusion. Initially, both patients were prescribed a dietary sodium restriction and diuretics. Nevertheless, they didn't have a good response so a chest tube was placed, and an octreotide infusion partially reduced the volume of the pleural drainage allowing a pleurodesis. We report two cases of refractory hepatic hydrothorax with multiple treatments including octreotide and pleurodesis.
Assuntos
Hidrotórax , Cirrose Hepática , Octreotida , Humanos , Hidrotórax/etiologia , Hidrotórax/terapia , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Cirrose Hepática/complicações , Octreotida/uso terapêutico , Pleurodese/métodos , Fármacos Gastrointestinais/uso terapêutico , Drenagem/métodosRESUMO
OBJECTIVE: To compare the short and long-term benefits (the length of hospital stay, surgical complications, and early clinical improvement) of adding early ultrasound-guided drainage to broad-spectrum antibiotic treatment. METHODOLOGY: Patients undergoing tubo-ovarian abscess treatment between January 2017 and June 2022 in a tertiary hospital were retrospectively evaluated. Of the patients studied, 50 subjects were treated with antibiotics alone and 63 underwent guided drainage. Twenty-one individuals underwent early drainage within 72 hours of admission, and 42 underwent guided drainage after this period. RESULTS: There was no statistical difference in the length of hospital stay between the groups simultaneously, averaging 6.4 days for the controls, 5.1 days for the early drainage group, and 9.6 days for the late drainage group (p = 0.290). In the multiple linear regression with the length of hospital stay outcome and adjusting for potential confounding factors, there was an average reduction of 2.9 days in the hospital stay (p = 0.04) for the early drainage group (< 72 hours) compared to the controls. Early clinical improvement and an expected drop in CRP were more frequent in patients who underwent drainage. Length of hospital stay increases with abscess diameter: 0.4 [(95% CI 0.1 - 0.7) (p = 0.05)] days per centimeter, regardless of other variables. CONCLUSIONS: Ultrasound-guided drainage of tubo-ovarian abscesses associated with antibiotic therapy is an effective treatment, with few complications, and may lead to clinical improvement especially when performed early.
Assuntos
Abscesso , Antibacterianos , Drenagem , Tempo de Internação , Doenças Ovarianas , Humanos , Feminino , Estudos Retrospectivos , Drenagem/métodos , Adulto , Estudos Transversais , Abscesso/terapia , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Doenças Ovarianas/terapia , Doenças Ovarianas/diagnóstico por imagem , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/cirurgia , Pessoa de Meia-Idade , Tratamento Conservador/métodos , Doenças das Tubas Uterinas/terapia , Doenças das Tubas Uterinas/diagnóstico por imagem , Doenças das Tubas Uterinas/cirurgia , Ultrassonografia de Intervenção/métodos , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative for biliary drainage in patients with obstructive pancreaticobiliary pathology when endoscopic retrograde cholangiopancreatography (ERCP) is not feasible. Despite its effectiveness, EUS-HGS is associated with a significant risk of adverse events. This study aimed to evaluate the feasibility and safety of a newly designed dedicated cautery-enhanced tubular self-expandable metal stent (SEMS) for EUS-HGS. METHODS: This multicenter prospective study included patients with malignant biliary obstruction in whom ERCP had failed because of tumor infiltration, inability to drain the intrahepatic ducts, or surgically altered anatomy. A dedicated cautery-enhanced tubular SEMS was used for EUS-HGS. Technical and clinical success rates, procedure times, and adverse events were evaluated. RESULTS: 20 patients underwent EUS-HGS with the dedicated stent. Technical and clinical success rates of 100% were achieved, with no reported severe adverse events or mortality. The median procedure time was 16 minutes. Recurrent biliary obstruction was observed in 1 patient. CONCLUSIONS: The dedicated cautery-enhanced tubular SEMS for EUS-HGS can simplify the procedure and enhance its safety and efficacy. This innovation shows promise for improving patient outcomes, although further studies are needed to validate these findings in a broader patient population.
Assuntos
Colestase , Endossonografia , Estudos de Viabilidade , Stents Metálicos Autoexpansíveis , Ultrassonografia de Intervenção , Humanos , Masculino , Feminino , Idoso , Estudos Prospectivos , Pessoa de Meia-Idade , Colestase/cirurgia , Colestase/etiologia , Idoso de 80 Anos ou mais , Cauterização/métodos , Drenagem/métodos , Drenagem/instrumentação , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Duração da CirurgiaRESUMO
Nocardia pyomyositis in immunocompetent patients is a rare occurrence. The diagnosis may be missed or delayed with the risk of progressive infection and suboptimal or inappropriate treatment. We present the case of a 48-year-old immunocompetent firefighter diagnosed with pyomyositis caused by Nocardia brasiliensis acquired by direct skin inoculation from gardening activity. The patient developed a painful swelling on his right forearm that rapidly progressed proximally and deeper into the underlying muscle layer. Ultrasound imaging of his right forearm showed a 7-mm subcutaneous fluid collection with surrounding edema. Microbiologic analysis of the draining pus was confirmed to be N brasiliensis by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry. After incision and drainage deep to the muscle layer to evacuate the abscess and a few ineffective antibiotic options, the patient was treated with intravenous ceftriaxone and oral linezolid for 6 weeks. He was then de-escalated to oral moxifloxacin for an additional 4 months to complete a total antibiotic treatment duration of 6 months. The wound healed satisfactorily and was completely closed by the fourth month of antibiotic therapy. Six months after discontinuation of antibiotics, the patient continued to do well with complete resolution of the infection. In this article, we discussed the risk factors for Nocardia in immunocompetent settings, the occupational risks for Nocardia in our index patient, and the challenges encountered with diagnosis and treatment. Nocardia should be included in the differential diagnosis of cutaneous infections, particularly if there is no improvement of "cellulitis" with traditional antimicrobial regimens and the infection extends into the deeper muscle tissues.
Assuntos
Antibacterianos , Jardinagem , Imunocompetência , Nocardiose , Nocardia , Piomiosite , Humanos , Masculino , Pessoa de Meia-Idade , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Nocardia/isolamento & purificação , Antibacterianos/uso terapêutico , Piomiosite/tratamento farmacológico , Piomiosite/diagnóstico , Piomiosite/microbiologia , Ceftriaxona/uso terapêutico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Drenagem , Moxifloxacina/uso terapêutico , Moxifloxacina/administração & dosagem , Linezolida/uso terapêuticoRESUMO
Reports of pancreatic pseudocyst drainage during metabolic bariatric surgery are extremely rare. Our patient is a 38-year-old female suffering from obesity grade IV and presents a persistent symptomatic pancreatic pseudocyst 8 months after an episode of acute biliary pancreatitis. After an extensive evaluation and considering other treatment options, our multidisciplinary team and the patient decided to perform a one-stage procedure consisting of laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass. After bringing the patient to the operating room, the surgeon performed an anterior gastrostomy to access the stomach's posterior wall, followed by a 6-cm cystogastrostomy on both the stomach's posterior wall and the cyst. Next, a cholecystectomy which involved dissecting the triangle of Calot was performed. Then, an 18-cm gastric pouch using a 36-Fr calibration tube was created. The cystogastrostomy was left in the remaining stomach. Finally, gastrojejunal anastomosis is done. The patient's postoperative course proceeded smoothly, leading to her home discharge on the third postoperative day. At the 1-year follow-up, the patient had lost 56 kg and was symptom-free; a computer tomography scan showed that the pancreatic pseudocyst had resolved. This case shows a video of a successful laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass (OAGB) used to treat persistent abdominal pain and obesity grade IV. We also conduct a bibliographic review.
Assuntos
Derivação Gástrica , Gastrostomia , Obesidade Mórbida , Pseudocisto Pancreático , Humanos , Feminino , Pseudocisto Pancreático/cirurgia , Adulto , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Gastrostomia/métodos , Drenagem/métodos , Resultado do Tratamento , Laparoscopia/métodosRESUMO
OBJECTIVE: The effect of a pre-operative biliary stent on complications after pancreaticoduodenectomy (PD) remains controversial. MATERIALS AND METHOD: We conducted a meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses guidelines, and PubMed, Web of Science Knowledge, and Ovid's databases were searched by the end of February 2023. 35 retrospective studies and 2 randomized controlled trials with a total of 12641 patients were included. RESULTS: The overall complication rate of the pre-operative biliary drainage (PBD) group was significantly higher than the no-PBD group (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.22-1.74; p < 0.0001), the incidence of post-operative delayed gastric emptying was increased in patients with PBD compared those with early surgery (OR 1.21, 95% CI: 1.02-1.43; p = 0.03), and there was a significant increase in post-operative wound infections in patients receiving PBD with an OR of 2.2 (95% CI: 1.76-2.76; p < 0.00001). CONCLUSIONS: PBD has no beneficial effect on post-operative outcomes. The increase in post-operative overall complications and wound infections urges the exact indications for PBD and against routine pre-operative biliary decompression, especially for patients with total bilirubin < 250 umol/L waiting for PD.
OBJETIVO: El efecto de una endoprótesis biliar pre-operatoria sobre las complicaciones después de la pancreaticoduodenectomía sigue siendo controvertido. MATERIALES Y MÉTODO: Se llevó a cabo un metaanálisis siguiendo las directrices PRISMA y se realizaron búsquedas en PubMed, Web of Science Knowledge y la base de datos de Ovid hasta finales de febrero de 2023. Se incluyeron 35 estudios retrospectivos y 2 ensayos controlados aleatorizados, con un total de 12,641 pacientes. RESULTADOS: La tasa global de complicaciones del grupo drenaje biliar pre-operatorio (PBD) fue significativamente mayor que la del grupo no-PBD (odds ratio [OR]: 1.46; intervalo de confianza del 95% [IC 95%]: 1.22-1.74; p < 0.0001), la incidencia de vaciado gástrico retardado posoperatorio fue mayor en los pacientes con PBD en comparación con los de cirugía precoz (OR: 1.21; IC95%: 1.02-1.43; p = 0.03), y hubo un aumento significativo de las infecciones posoperatorias de la herida en los pacientes que recibieron PBD (OR: 2.2; IC 95%: 1.76-2.76; p < 0.00001). CONCLUSIONES: El drenaje biliar pre-operatorio no tiene ningún efecto beneficioso sobre el resultado posoperatorio. El aumento de las complicaciones posoperatorias globales y de las infecciones de la herida urge a precisar las indicaciones de PBD y a desaconsejar la descompresión biliar pre-operatoria sistemática, en especial en pacientes con bilirrubina total inferior a 250 µmol/l en espera de pancreaticoduodenectomía.