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1.
Khirurgiia (Mosk) ; (9): 123-129, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030013

RESUMO

Exocrine drainage is an Achilles heel of pancreas transplantation. The author analyzed the outcomes of pancreas transplantations with different types of exocrine drainage in various centers (n=93). The article will ensure insight into evolution of techniques of exocrine drainage within the historical context and current state of this issue.


Assuntos
Transplante de Pâncreas , Drenagem , Humanos
2.
Rozhl Chir ; 99(8): 364-367, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33032442

RESUMO

Our case report describes a patient with recurrent stenoses in both the right and left hepaticojejunoanastomoses due to an injury to the bile ducts during cholecystectomy several years ago. The anastomoses could not be reached endoscopically.  EUS-guided hepaticogastrostomy would be a solution only for the left hepatic duct anastomosis. As the patient refused percutaneous transhepatic drainage (PTD) of both intrahepatic ducts and dilation of both anastomoses, endoscopic ultrasound-guided jejunoduodenostomy was performed using a lumen apposing metal stent (LAMS). This method provides repeated endoscopic access to the anastomoses of both hepatic ducts, allowing for their treatment.


Assuntos
Drenagem , Endossonografia , Constrição Patológica , Endoscopia , Humanos , Stents
3.
Kyobu Geka ; 73(8): 636-639, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32879297

RESUMO

Birt-Hogg-Dubé (BHD) syndrome is an autosomal and predominantly inherited disorder. We report 3 cases of BHD syndrome. Case 1:A 24-year-old man was admitted to our hospital due to left-sided spontaneous pneumothorax. He had a previous drainage history of right-sided spontaneous pneumothorax. In operation, we resected the cyst at segment 8 of the left lung and covered the lung using polyglycolic acid( PGA) sheet. Case 2:A 47-year-old man was admitted to our hospital due to right-sided spontaneous pneumothorax. He had a previous surgical history of right-sided spontaneous pneumothorax and left-sided spontaneous pneumothorax. In operation, we resected the cyst at segment 8 of the right lung and covered the lung using fibrin glue-coated collagen fleece. Case 3:A 60-year-old man was admitted to our hospital due to left-sided spontaneous pneumothorax. He had 2 times of previous drainage history of left-sided spontaneous pneumothorax. In operation, we resected the cysts at lingular division of the lung and covered the lung using PGA sheet. On genetic analysis, all 3 cases were diagnosed with the BHD syndrome.


Assuntos
Síndrome de Birt-Hogg-Dubé , Cistos , Pneumopatias , Pneumotórax , Adulto , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
Zhongguo Gu Shang ; 33(8): 716-20, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875760

RESUMO

OBJECTIVE: To study and compare the effect of indwelling drainage tube and extubation time on occult hemorrhage and functional recovery after total hip arthroplasty(THA). METHODS: From July 2017 to June 2018, 123 patients who underwent THA in our hospital for the first time were selected as the subjects of study. According to whether the drainage tube was retained or not and the time of extubation, they were divided into three groups:in group A, 41 patients (24 males, 17 females, age 53 to 77 years) did not put drainage tube after THA;in group B, 41 patients were removed 24 hours after THA, 26 males and 15 females, aged 55 to 74 years;in group C, 41 patients were removed 48 hours after THA, 25 males and 16 females, aged 52 to 75 years. The VAS score of pain 72 hours after THA, the total and recessive blood loss, the time of starting functional exercise, and the incidence of postoperative limb swelling were recorded. All the patients were followed up for one year after discharge. Harris hip score was used to evaluate the degree of hip function recovery one year after operation. RESULTS: The occult blood loss of group A, B and C were(513.6±25.3), (521.7±33.4), (519.3±29.8) ml, respectively, with no significant difference(P>0.05). There was no significant difference in blood loss in operation among the three groups(P>0.05). In group B and C, the postoperative apparent blood loss was more than that in group A (P<0.05). There was no significant difference in VAS scores of the three groups before and 72 hours after operation (P>0.05). The time of getting out of bed in group A was shorter than that in group B and C (P<0.05), and that in group B was shorter than that in group C(P<0.05). The Harris hip score at 1 year after operationof the three groups was significantly higher than that of before operation (P<0.05). There was no significant difference in Harris hip score before and after operation among three groups (P>0.05). There was no significant difference in the incidence of complications among three groups (P>0.05). CONCLUSION: Whether the drainage tube is left or not and the time of extubation have no significant effect on the latent blood loss and functional recovery after THA, but without drainage tube after THA can reduce the apparent blood loss, patients can get out of bed at 6 hours after THA, which is more conducive to the recovery and nursing of patients.


Assuntos
Artroplastia de Quadril , Idoso , Extubação , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
5.
Zhongguo Gu Shang ; 33(9): 873-7, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32959578

RESUMO

OBJECTIVE: To explore the clinical effect of vacuum sealing drainage (VSD) technique and Bing Shi Yu Shang Ointment in the treatment of foot skin defect. METHODS: From November 2017 to April 2019, 21 patients (21 feet) with foot skin defect were treated with VSD technique and Bing Shi Yu Shang Ointment. There were 17 males and 4 females, aged from 24 to 60 years old with an average of (37.8±11.2) years, 9 cases caused by traffic accident injury, 6 cases by heavy injury, 6 cases by falling injury. The time from injury to operation was for 3 to 36 (8.6±7.2) h, and the area of foot skin defect was for 20.35 to 83.43(47.2±19.5) cm2. All patients underwent debridement or phaseⅠtemporary fixation in emergency, and three-dimensional imagingof the foot was performed by using Mimics software, and the defect area was rendered. The quality of wound healing and complications were observed, and the clinical effect was evaluated by Maryland foot function score. RESULTS: All the 21 patients were followed up for 7 to 17 (10.8±2.7) months. There was no infection or nonunion in all patients. At the final follow-up, the skin margin of the healing site grew tightly, the skin was elastic, the texture was tough, the appearance was no obvious carbuncle. The time of wound healing was for 18 to 63 (41.2±13.3) days. Eight patients underwent stageⅡfixation or/and fusion, and all incisions healed by stageⅠ. According to Maryland's foot scoring, 9 cases got excellent results, 11 good, and 1 middle. CONCLUSION: VSD can effectively remove the necrotic tissue of the wound, provide a smooth drainage of the wound, combine with Bing Shi Yu Shang Ointment to prevent infection and promote the rapid growth of granulation tissue, whose whole treatment cycle was short, the wound healing site was highquality, the limb function was good, and the clinical effect was satisfactory.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Lesões dos Tecidos Moles/cirurgia , Adulto , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Resultado do Tratamento , Adulto Jovem
6.
BMC Infect Dis ; 20(1): 662, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907540

RESUMO

BACKGROUND: The outbreak of the novel coronavirus (COVID-19) that was firstly reported in Wuhan, China, with cases now confirmed in more than 100 countries. However, COVID-19 pneumonia with spontaneous pneumothorax is unknown. CASE PRESENTATION: We reported a case of 66-year-old man infected with COVID-19, presenting with fever, cough and myalgia; The patient received supportive and empirical treatment including antiviral treatment, anti-inflammatory treatment, oxygen supply and inhalation therapy; The symptoms, CT images, laboratory results got improved after the treatments, and a throat swab was negative for COVID-19 PCR test; However, on the hospital day 30, the patient presented with a sudden chest pain and dyspnea. CT showed a 30-40% left-sided pneumothorax. Immediate thoracic closed drainage was performed and his dyspnea was rapidly improved. With five more times negative PCR tests for SARS-CoV-2 virus, the patient was discharged and home quarantine. CONCLUSION: This case highlights the importance for clinicians to pay attention to the appearance of spontaneous pneumothorax, especially patients with severe pulmonary damage for a long course, as well as the need for early image diagnose CT and effective treatment once pneumothorax occurs.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/complicações , Idoso , Betacoronavirus/patogenicidade , Dor no Peito/complicações , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Tosse/complicações , Drenagem , Dispneia/complicações , Febre/complicações , Humanos , Masculino , Pandemias , Alta do Paciente , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Pneumotórax/terapia
7.
Lancet ; 396(10253): 786-798, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-32919518

RESUMO

Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.


Assuntos
Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/terapia , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Criança , Terapia Combinada , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/terapia , Drenagem , Humanos , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/epidemiologia , Fatores de Risco , Resultado do Tratamento
8.
Hinyokika Kiyo ; 66(9): 283-287, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32993271

RESUMO

Sixty eight patients had robot-assisted radical prostatectomy (RARP) from January 2016 to April 2017 with estimated blood loss of less than 500 ml. We compared the postoperative complication rates and the length of hospital stay between 34 of these patients who had pelvic drain placement (PD group), and the remaining 34 patients who had no drain placement (ND group). The approach was intraperitoneal in 25 patients in each group. The PD and ND groups were comparable for age (69.5 vs 70 yrs, P=0.459), clinical Gleason Score (6/7/≧8) 2/17/15 vs 3/8/23 (P=0.077), clinical stage (1c/2/3) 3/25/6 vs 1/25/8 (p=0. 539), operative time (311 vs 309 min, P=0.868), and estimated blood loss (p=0.166). The PD group had significantly higher median PSA level than the ND group (8.01 vs 6.25 ng/ml, P=0.023). Incidence of 30- day overall complications in the PD group (35 events) was lower than that in the ND group (38 events). All complications were classified as Clavien Dindo grade I. The postoperative hospital stay was 8 days in the PD group and 7 days in the ND group, showing no prolongation in the ND group. Pelvic drainage may be omitted after RARP without increasing postoperative complications or prolonging the hospital stay.


Assuntos
Neoplasias da Próstata/cirurgia , Robótica , Drenagem , Humanos , Masculino , Pelve/cirurgia , Prostatectomia
9.
Adv Respir Med ; 88(4): 366-368, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32869274

RESUMO

We discuss the hypothesis that common Chest Drain Systems collected to a COVID-19 patient, could be a possible source of contamination for health care staff in a Thoracic Surgery ward and we propose an alternative way to minimize this further risk of transmission.


Assuntos
Tubos Torácicos/efeitos adversos , Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Torácicos/métodos , Competência Clínica , Infecções por Coronavirus/prevenção & controle , Drenagem/efeitos adversos , Humanos , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral/prevenção & controle , Medição de Risco , Toracostomia/métodos
10.
Khirurgiia (Mosk) ; (8): 88-102, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869621

RESUMO

Exocrine drainage is an Achilles heel of pancreas transplantation. The author analyzed the outcomes of pancreas transplantations with different types of exocrine drainage in various centers (n=93). The article will ensure insight into evolution of techniques of exocrine drainage within the historical context and current state of this issue.


Assuntos
Drenagem/métodos , Transplante de Pâncreas/métodos , Pâncreas Exócrino/cirurgia , Humanos , Pâncreas/cirurgia
11.
Lancet ; 396(10252): 726-734, 2020 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891214

RESUMO

Acute pancreatitis is an unpredictable and potentially lethal disease. The prognosis mainly depends on the development of organ failure and secondary infection of pancreatic or peripancreatic necrosis. In the past 10 years, treatment of acute pancreatitis has moved towards a multidisciplinary, tailored, and minimally invasive approach. Despite improvements in treatment and critical care, severe acute pancreatitis is still associated with high mortality rates. In this Seminar, we outline the latest evidence on diagnostic and therapeutic strategies for acute pancreatitis.


Assuntos
Antibacterianos/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Hidratação , Apoio Nutricional , Pancreatite/diagnóstico , Pancreatite/terapia , Amilases/sangue , Colecistectomia , Diabetes Mellitus/etiologia , Diabetes Mellitus/terapia , Insuficiência Pancreática Exócrina/etiologia , Insuficiência Pancreática Exócrina/terapia , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Lipase/sangue , Imagem por Ressonância Magnética , Pancreatite/sangue , Pancreatite/etiologia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/terapia , Pancreatite Alcoólica/diagnóstico , Pancreatite Alcoólica/terapia , Prevenção Secundária , Stents , Tomografia Computadorizada por Raios X , Ultrassonografia
12.
N Z Med J ; 133(1520): 133-136, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994604

RESUMO

Fistula-in-ano is a very common surgical condition, caused by anal cryptoglandular inflammation. Most cases are idiopathic. Other causes such as Crohn's disease, trauma and malignancy are well known. Management of fistula-in-ano is largely surgical, especially if the patient is symptomatic. The goal of surgical therapy is sepsis drainage, delineate anatomy and eradicate the fistula while preserving faecal continence. Establishing the aetiology is also crucial as often a combination of specialist medical therapy is required, for example, in Crohn's disease. We report an extremely unusual case of fistula-in-ano on an elderly man with chronic lymphocytic leukaemia (CLL). Histology from the fistula track demonstrated CLL infiltration. This case, not previously reported on PubMed search, illustrates a good example of joint specialist medical (a haematologist) and surgical effort in successfully treating this symptomatic fistula-in-ano.


Assuntos
Drenagem/métodos , Leucemia Linfocítica Crônica de Células B/complicações , Fístula Retal/etiologia , Fístula Retal/cirurgia , Abscesso/etiologia , Idoso , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Períneo/diagnóstico por imagem , Períneo/microbiologia , Fístula Retal/patologia , Conduta Expectante/métodos
13.
Rev Med Suisse ; 16(708): 1822-1826, 2020 Sep 30.
Artigo em Francês | MEDLINE | ID: mdl-32997454

RESUMO

Pyogenic-liver abscess is a relatively rare entity in Europe. Due to unspecific clinical and biological findings, the diagnosis can be difficult. Imaging by ultrasound, CT-scan or MRI is important to confirm the diagnosis and to determine further investigations and treatment. According to the characteristics of the abscess, a surgical intervention may be necessary, particularly is the abscess diameter is bigger than 5 cm. This can be done either by surgery or by percutaneous drainage (needle aspiration versus catheter drainage). Obtaining adequate microbiologic cultures is important to identify the responsible pathogens and their resistance profile before starting broad spectrum antibiotics. Antibiotic treatment should be adapted to microbiologic results. The recommended treatment duration is usually between 4 and 6 weeks according to clinical evolution.


Assuntos
Abscesso Hepático Piogênico , Drenagem , Europa (Continente)/epidemiologia , Humanos , Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/microbiologia , Abscesso Hepático Piogênico/cirurgia , Abscesso Hepático Piogênico/terapia
14.
Medicine (Baltimore) ; 99(35): e21683, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871883

RESUMO

Several studies have reported short-term results for post-cholecystectomy symptoms and quality of life (QoL). However, reports on long-term results are still limited. This study aimed to identify risk factors affecting short- and long-term patient-reported outcome (PRO) following laparoscopic cholecystectomy.From 2016 to 2017, a total of 476 patients from 5 institutions were enrolled. PRO was examined using the Numeric Rating Scale (NRS) pain score and the Gastrointestinal (GI) QoL Index questionnaire at postoperative 1 month and 1 year.Most of patients recovered well at postoperative 1 year compared to postoperative 1 month for the NRS pain score, QoL score, and GI symptoms. A high operative difficulty score (HR 1.740, P = .031) and pathology of acute or complicated cholecystitis (HR 1.524, P = .048) were identified as independent risk factors for high NRS pain scores at postoperative 1 month. Similarly, female sex (HR 1.571, P = .003) at postoperative 1 month and postoperative complications (HR 5.567, P = .001) at postoperative 1 year were independent risk factors for a low QoL. Also, age above 50 (HR 1.842, P = .001), female sex (HR 1.531, P = .006), and preoperative gallbladder drainage (HR 3.086, P = .001) were identified as independent risk factors for GI symptoms at postoperative 1 month.Most patients showed improved long-term PRO measurement in terms of pain, QoL, and GI symptoms. There were no independent risk factors for long-term postoperative pain and GI symptoms. However, postoperative complications were identified to affect QoL adversely at postoperative 1 year. Careful and long-term follow up is thus necessary for patients who experienced postoperative complications.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar/cirurgia , Gastroenteropatias/etiologia , Dor Pós-Operatória/etiologia , Qualidade de Vida , Adulto , Fatores Etários , Colecistectomia Laparoscópica/efeitos adversos , Colecistite/complicações , Colecistite/cirurgia , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Cuidados Pré-Operatórios , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Fatores de Tempo
15.
Medicine (Baltimore) ; 99(35): e21872, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871913

RESUMO

BACKGROUND: External lumbar drainage (ELD) remains the most common used methods with a higher sensitivity before lumboperitoneal shunt (LPS) implantation to predict the shunt outcomes in the treatment of idiopathic normal pressure hydrocephalus. However, the benefits of such supplemental test have not been tested in the treatment of post-hemorrhagic hydrocephalus (PHH). METHODS AND DESIGN: In the current trial, 100 eligible patients with PHH will be recruited and randomly assigned to the ELD group (study group) and non-ELD group (control group). Lumbar puncture (LP) will be performed for participants in non-ELD group. LP plus ELD will be performed for participants in ELD group, those who will then be investigated the suitability of potential LPS 4 days after ELD. Two independent and practiced assessors will collect the baseline data and evaluate each participant 4 days after ELD or LP, 1 day after LPS, at the time of discharge and 1 month after LPS. The primary outcome is the shunting outcomes 1 month after surgery. The secondary outcomes include the complications related to ELD, complications related to LPS, and Evens index at each evaluation point. Meanwhile, serious adverse events occurring at any time is recorded to determine the safety of this trial. DISCUSSION: The results of this trial will demonstrate whether preoperative evaluation using temporary ELD for patients with PHH could attenuate the risk of LPS failure. TRIAL REGISTRATION NUMBER: ChiCTR2000034094; Pre-results.


Assuntos
Drenagem , Hidrocefalia/terapia , Hemorragia Intracraniana Traumática/complicações , Punção Espinal , Humanos , Hidrocefalia/etiologia , Cuidados Pré-Operatórios , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Ther Umsch ; 77(5): 207-212, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32870097

RESUMO

Treatment of Skin Abscesses in the Emergency Department Abstract. Skin abscesses are a common cause for presentation in the emergency department and are in most cases treated by incision and drainage. The diagnosis is usually based upon clinical manifestation. If there is uncertainty regarding the presence of an abscess, bedside ultrasonography is suggested to identify the presence, size and location of the abscess. Uncomplicated abscesses < 5 cm in diameter often can be treated under local or regional anesthesia with or without additional procedural sedation within the emergency department. Sufficient anesthesia and analgesia are essential to avoid undertreatment of the abscess. Certain abscess localizations or conditions require referral to a surgeon and / or operation of the abscess in the operating room. Alternative to the classic incision and drainage the minimal invasive Loop Drainage Technique may be considered. A postoperative systemic antibiotic treatment is only indicated under certain conditions.


Assuntos
Abscesso/diagnóstico , Abscesso/terapia , Dermatopatias , Drenagem , Serviço Hospitalar de Emergência , Humanos , Manejo da Dor
17.
Rev Assoc Med Bras (1992) ; 66(8): 1082-1086, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32935802

RESUMO

OBJECTIVE: Perianal abscesses are frequently seen in clinical practice, and perianal fistulas develop in 30%-50% of cases after treatment. This study investigated whether the type of dressing applied after abscess drainage is correlated with fistula development. Prevention of fistula formation would reduce both the loss of work and healthcare costs. METHODS: The records of patients who underwent drainage of perianal abscesses between January 2015 and January 2018 were retrospectively reviewed. Patients with postoperative dressings changed with washing of the area in the hospital were included as Group 1. Patients with dressings changed at home and the area bathed in 10% povidone-iodine sitz bath were included as Group 2. The frequency and time of fistula formation, age, sex, cost, and workdays lost in the two groups were compared. RESULTS: Between-group differences in age, sex, body mass index, and type of fistula that developed after months and 1 year of the abscess drainage were not statistically significant (p > 0.05). During follow-up, fistula development was significantly lower in Group 1 than in Group 2 (p < 0.001). The risk of perianal fistula development was significantly increased in those with a body mass index (BMI) > 30 (p = 0.004). CONCLUSIONS: After perianal abscess drainage, in-hospital washing and dressing of the abscess area until abscess closure reduced the risk of perianal fistula, lost work time, and cost. The risk of perianal fistula development appeared to increase with BMI. A large, prospective study is needed for confirmation.


Assuntos
Abscesso , Drenagem , Fissura Anal , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
18.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784238

RESUMO

The COVID-19 pandemic has had a significant impact on the structure and operation of healthcare services worldwide. We highlight a case of a 64-year-old man who presented to the emergency department with acute dyspnoea on a background of a 2-week history of fever, dry cough and shortness of breath. On initial assessment the patient was hypoxic (arterial oxygen saturation (SaO2) of 86% on room air), requiring 10 L/min of oxygen to maintain 98% SaO2 Examination demonstrated left-sided tracheal deviation and absent breath sounds in the right lung field on auscultation. A chest radiograph revealed a large right-sided tension pneumothorax which was treated with needle thoracocentesis and a definitive chest drain. A CT pulmonary angiogram demonstrated segmental left lower lobe acute pulmonary emboli, significant generalised COVID-19 parenchymal features, surgical emphysema and an iatrogenic pneumatocoele. This case emphasises the importance of considering coexisting alternative diagnoses in patients who present with suspected COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/complicações , Embolia Pulmonar/complicações , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Drenagem , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumotórax/diagnóstico por imagem , Pneumotórax/terapia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Radiografia Torácica , Tinzaparina/uso terapêutico , Tomografia Computadorizada por Raios X
19.
Zhonghua Shao Shang Za Zhi ; 36(8): 671-678, 2020 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-32829606

RESUMO

Objective: To develop a wireless sensor module for wound temperature and pressure (hereinafter referred to as wireless sensor module), and to carry out related characteristic test and biosafety evaluation. Methods: (1) The structure and working mode of the wireless sensor module were designed. The temperature and humidity sensor welded at one end of the flexible cable and the pressure sensor were simultaneously connected with the printed circuit board, which was welded with the Bluetooth transmitter, microprocessor, and power interface to establish a wireless sensor module. A mobile data receiving application was developed and the monitoring values of the wireless sensor module exposed to the air were read through the Bluetooth function on the smart phone. (2) The temperature of a 35-42 ℃ hot water bag was measured by the wireless sensor module and an infrared thermometer at the same time, and 30 pairs of data were compared with correlation analysis performed. (3) The vacuum sealing drainage material was pasted on the arm of the second author, and the wireless sensor module was placed in the condition of negative pressure. The negative pressure values measured by the wireless sensor module and the negative pressure meter values were recorded at the same time, and 14 pairs of data were compared with correlation analysis performed. (4) The corresponding material extract was prepared by adding 1 mL normal saline per 3 square centimeters surface area of the pressure sensor or flexible cable with temperature and humidity sensor welded respectively. Twenty 6-8 week-old female C57BL/6 mice were weighed before experiment and divided into pressure sensor extract group, flexible cable extract group, mixed extract group, and normal saline group according to the random number table (n=5). The abnormal toxic reactions of mice were observed after intraperitoneal injection of pressure sensor extract, flexible cable with temperature and humidity sensor welded extract, 1∶1 mixed extract of pressure sensor extract and flexible cable with temperature and humidity sensor welded extract, and normal saline for 50 mL/kg in corresponding groups. The body mass of mice was weighed at 24, 48, and 72 hours after injection, and the toxicity of the materials was evaluated comprehensively. (5) Four Japanese big ear white rabbits aged 3-6 months were selected, and there was no limit between male and female. Two regions on the left side of the spine were applied with aseptic gauze as aseptic gauze group, and two areas on the right side of the spine were applied with wireless sensor module as wireless sensor module group. The skin status of each region was evaluated at 1, 12, 24, 48 hours after application, and the score according to the skin irritation score standard was recorded. (6) The corresponding material extract was prepared by adding 1 mL serum-free Dulbecco's modification of Eagle's medium (DMEM) per 1 square centimeter surface area of the pressure sensor or flexible cable with temperature and humidity sensor welded respectively. L-929 fibroblasts were divided into pressure sensor extract group, flexible cable extract group, phenol control group, and medium control group. The corresponding extract was added in the first two groups, the phenol control group was added with 64 g/L phenol, and the medium control group was cultured with serum-free DMEM. The total volumes of the above four groups were all 100 µL. The absorbance values on the 2nd, 4th, 7th day of culture were detected by methyl thiazolyl tetrazolium method to calculate the cell proliferation rate (n=6 at each time point) and to grade the cytotoxicity. Data were statistically analyzed with paired samples t test, Wilcoxon signed rank test, Pearson correlation analysis, Spearman correlation analysis, Mann-Whitney U test, analysis of variance for repeated measurement, analysis of variance for factorial design, one-way analysis of variance, and Bonferroni correction. Results: (1) The smart phone successfully received the air temperature, humidity, and pressure information detected by the wireless sensor module through the Bluetooth function. (2) The temperature of the hot water bag measured by the wireless sensor module was (37.7±1.7) ℃, which was close to (37.7±1.7) ℃ of the infrared thermometer (t=-0.112, P>0.05), and there was a significant positive correlation between them (r=0.996, P<0.01). (3) The negative pressure of arm under negative pressure material measured by the wireless sensor module was -36.7 (-38.8, -27.4) kPa, which was significantly lower than -22.7 (-32.7, -12.5) kPa of negative pressure meter (Z=-3.235, P<0.01), but there was a significant positive correlation between their absolute values (ρ=1.000, P<0.01). (4) There was no abnormal toxic reaction in all groups of rats, and there was no statistically significant difference in body mass among the four groups of mice (F=3.132, P>0.05). (5) The scores of skin irritation in application region of rats in the two groups were similar at 1, 12, 24, 48 hours after application (Z=-1.000, <0.001, -0.620, <0.001, P>0.05). (6) At each time point of culture, compared with that of medium control group, the cell proliferation rate increased significantly in pressure sensor extract group and flexible cable extract group (P<0.01) but decreased significantly in phenol control group (P<0.01). On the 2nd, 4th, 7th day of culture, the cytotoxicity grade of phenol control group was 1, 1, and 2 respectively, and the cytotoxicity grade of each extract group was 0. Conclusions: The wireless sensor module integrates temperature, humidity, and pressure sensors, which can monitor local temperature and pressure and realize the visualization of parameters on the mobile application program. The measurement of temperature is accurate and the pressure measurement results are consistent with the values of the negative pressure meter with good biosafety. It possesses a big value in clinical application and prospects for development.


Assuntos
Drenagem , Animais , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Coelhos , Ratos , Temperatura , Vácuo
20.
Zhonghua Shao Shang Za Zhi ; 36(8): 718-721, 2020 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-32829611

RESUMO

Objective: To investigate the application effects of self-made simple vacuum sealing drainage (VSD) device in the postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle. Methods: From January 2017 to January 2019, 36 patients with foot and ankle skin defects and bone exposure admitted to People's Hospital of Xinjiang Uygur Autonomous Region met the inclusion criteria, and a retrospective cohort study was conducted. According to the bandaging method of the operative area, simple negative pressure group and antibacterial dressing group were both allocated with 18 patients, with 12 males and 6 females in the former group, 14 males and 4 females in the latter group, aged (41.6±2.8) and (42.3±2.6) years, respectively. Patients in the two groups all received sural neurocutaneous flap transplantation. Patients in antibacterial dressing group received nano silver antibacterial dressing change in the operative area, and the dressing was changed once every 3 days. In simple negative pressure group, the operative area was sealed with a simple VSD device made of gauze, silicone sputum suction tube with holes cut out, and biological permeable membrane, etc., which was connected with the wall central negative pressure suction system for continuous VSD treatment of -40.0 to -16.6 kPa. The negative pressure material was changed once every 5 days. The number of dressing change, the pain score evaluated by Numeric Rating Scale during each dressing change, the cost of dressing change, and the degree of flap swelling evaluated on the 3rd and 5th day after surgery were recorded, and the flap survival was observed. Data were statistically analyzed with independent sample t test, Wilcoxon rank sum test, and chi-square test. Results: The number of dressing change of patients in simple negative pressure group was (3.4±0.5) times, which was significantly less than (7.0±0.8) times in antibacterial dressing group (t=15.338, P<0.01). The pain score during dressing change of patients in simple negative pressure group was (4.3±0.8) points, which was significantly lower than (6.8±0.7) points in antibacterial dressing group (t=10.168, P<0.01). The cost of dressing change of patients was similar between the two groups. On the 3rd and 5th day after surgery, the degrees of flap swelling of patients in simple negative pressure group were significantly superior to those in antibacterial dressing group (Z=4.448, 2.395, P<0.05 or P<0.01). The flap survival of patients in simple negative pressure group was significantly superior to that in antibacterial dressing group (χ(2)=4.500, P<0.05). Conclusions: Compared with the traditional dressing bandage, the self-made simple VSD device used after sural neurocutaneous flap transplantation can reduce the frequency of dressing change, relieve the pain of dressing change and the swelling of flap, and promote the flap survival, which is worth popularizing and applying in clinic.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Adulto , Tornozelo , Drenagem , Feminino , Humanos , Masculino , Estudos Retrospectivos , Transplante de Pele , Resultado do Tratamento
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