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1.
Medicine (Baltimore) ; 100(31): e26691, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397802

RESUMO

BACKGROUND: Ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) remain the mainstay of idiopathic normal pressure hydrocephalus (INPH). There are no randomized controlled trials completed to compare the efficacy of these 2 shunt techniques. METHODS/DESIGN: We will conduct a monocentric, assessor-blinded, and randomized controlled trial titled "Comparison of Ventriculoperitoneal Shunt to Lumboperitoneal Shunt for the treatment of Idiopathic Normal Pressure Hydrocephalus: Phase I (COVLINPH-1)" trial and recruit patients at West China Hospital of Sichuan University since June 2021. And this trial is expected to end in December 2030. Eligible participants will be randomly assigned into LPS group and VPS group at ratio of 1:1 followed by evaluation before surgery, 1 month, 12 months, and 5 years after surgery. The primary outcome is the rate of shunt failure within 5 years. The secondary outcomes include modified Rankin Scale (mRS), INPH grading scale (INPHGS), mini-mental state examination (MMSE), and Evans index. We will calculate the rate of favorable outcome, which is defined as shunt success and an improvement of more than 1 point in the mRS at evaluation point. We will also analyze the complications throughout the study within 5 years after shunt insertion. DISCUSSION: The results of this trial will provide state-of-the-art evidence on the treatment option for patients with INPH, and will also generate the discussion regarding this subject. TRIAL REGISTRATION NUMBER: ChiCTR2000031555; Pre-results.


Assuntos
Hidrocefalia de Pressão Normal/cirurgia , Peritônio/cirurgia , Espaço Subaracnóideo/cirurgia , Derivação Ventriculoperitoneal , Drenagem/efeitos adversos , Drenagem/métodos , Humanos , Vértebras Lombares , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Derivação Ventriculoperitoneal/efeitos adversos
2.
J Cardiothorac Surg ; 16(1): 188, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225743

RESUMO

BACKGROUND: The usefulness of digital chest drain is still debated. We are carrying out a study to determine if the use of a digital system compared with a traditional system reduces the duration of chest drainage. To evaluate safety, benefit, or futility of this trial we planned the current interim analysis. METHODS: An interim analysis on preliminary data from ongoing investigator-initiated, multicenter, interventional, prospective randomized trial. Original protocol number: (NCT03536130). The interim main endpoint was overall complications; secondary endpoints were the concordance between the two primary endpoints of the RCT (chest tube duration and length of hospital stay). We planned the interim analysis when half of the patients have been randomised and completed the study. Data were described using mean and standard deviation or absolute frequencies and percentage. T-test for unpaired samples, Chi-square test, Poisson regression and absolute standardized mean difference (ASMD) were used. P-value < 0.05 was considered significant. RESULTS: From April 2017 to November 2018, out of 317 patients enrolled by 3 centers, 231 fulfilled inclusion criteria and were randomized. Twenty-two of them dropped out after randomization. Finally, 209 patients were analyzed: among them 94 used the digital device and 115 the traditional one. The overall postoperative complications were 35 (16.8%) including prolonged air leak (1.9%). Mean chest tube duration was 3.6 days (SD = 1.8), with no differences between two groups (p = 0.203). The overall difference between hospital stay and chest tube duration was 1.4 days (SD = 1.4). Air leak at first postoperative day detected by digital and traditional devices predicted increasing in tube duration of 1.6 day (CI 95% 0.8-2.5, p < 0.001) and 2.0 days (CI 95% 1.0-3.1, p < 0.001), respectively. CONCLUSIONS: This interim analysis supported the authors' will to continue with the enrollment and to analyze data once the estimated sample size will be reached. TRIAL REGISTRATION: Trial registration number NCT03536130 , Registered 24 May 2018 - Retrospectively registered.


Assuntos
Tubos Torácicos , Drenagem/instrumentação , Tempo de Internação , Idoso , Drenagem/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Dados Preliminares , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida , Fatores de Tempo , Resultado do Tratamento
3.
J Clin Neurosci ; 89: 389-396, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088580

RESUMO

BACKGROUND: The decision to resume antithrombotic therapy after surgical evacuation of chronic subdural hematoma (CSDH) requires judicious weighing of the risk of bleeding against that of thromboembolism. This study aimed to investigate the impact of time to resumption of antithrombotic therapy on outcomes of patients after CSDH drainage. METHODS: Data were obtained retrospectively from three tertiary hospitals in Singapore from 2010 to 2017. Outcome measures analyzed were CSDH recurrence and any thromboembolic events. Logistic and Cox regression tests were used to identify associations between time to resumption and outcomes. RESULTS: A total of 621 patients underwent 761 CSDH surgeries. Preoperative antithrombotic therapy was used in 139 patients. 110 (79.1%) were on antiplatelets and 35 (25.2%) were on anticoagulants, with six patients (4.3%) being on both antiplatelet and anticoagulant therapy. Antithrombotic therapy was resumed in 84 patients (60.4%) after the surgery. Median time to resumption was 71 days (IQR 29 - 201). Recurrence requiring reoperation occurred in 15 patients (10.8%), of which 12 had recurrence before and three after resumption. Median time to recurrence was 35 days (IQR 27 - 47, range 4 - 82 days). Recurrence rates were similar between patients that were restarted on antithrombotic therapy before and after 14, 21, 28, 42, 56, 70 and 84 days, respectively. Thromboembolic events occurred in 12 patients (8.6%), of which five had the event prior to restarting antithrombosis. CONCLUSIONS: Time to antithrombotic resumption did not significantly affect CSDH recurrence. Early resumption of antithrombotic therapy can be safe for patients with a high thromboembolic risk.


Assuntos
Anticoagulantes/administração & dosagem , Drenagem/métodos , Fibrinolíticos/administração & dosagem , Hematoma Subdural Crônico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Tromboembolia/epidemiologia , Adulto , Idoso , Anticoagulantes/uso terapêutico , Estudos de Coortes , Drenagem/efeitos adversos , Fibrinolíticos/uso terapêutico , Hematoma Subdural Crônico/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Tromboembolia/tratamento farmacológico
4.
Medicine (Baltimore) ; 100(23): e26322, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115046

RESUMO

RATIONALE: Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. PATIENT CONCERNS: A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. DIAGNOSIS: Emergency brain computed tomography revealed massive pneumocephalus. INTERVENTIONS: Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. OUTCOMES: Repeated computed tomography showed complete resolution of the pneumocephalus after five days. LESSONS: Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.


Assuntos
Neoplasias Ósseas , Descompressão Cirúrgica/efeitos adversos , Drenagem/efeitos adversos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Vértebras Torácicas , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Descompressão Cirúrgica/métodos , Diuréticos Osmóticos/administração & dosagem , Drenagem/métodos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Manitol/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neuroimagem/métodos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Pneumocefalia/diagnóstico , Pneumocefalia/etiologia , Pneumocefalia/fisiopatologia , Pneumocefalia/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Reoperação/efeitos adversos , Reoperação/métodos , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
5.
World Neurosurg ; 151: e771-e777, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33957282

RESUMO

INTRODUCTION: Placement of an external ventricular drain (EVD) is a common procedure routinely completed at bedside by neurosurgical residents. A standardized protocol for placement and maintenance of an EVD is potentially useful. METHODS: This single-institution retrospective review analyzed all patients who underwent placement of an EVD over a 5-year span using a standardized protocol. RESULTS: A total of 428 EVDs in 381 patients were placed as per this protocol. Overall compliance with the practice protocol was 98.7%. Overall, our infection rate was 1.86% (8 external ventricular drain-related infection [ERIs] over 428 EVDs). There was no difference in age for the ERI cases (median 55, range (50.5-60.5), compared with the non-ERI cases (median of 53, range [38-65]) (P = 0.512). Indications for placement of EVD were hemorrhage (51.9%, n = 198), tumor (16.2%, n = 62), trauma (12.8%, n = 49), hydrocephalus (11.5%, n = 44), cerebellar stroke (2.8%, n = 11), infection (3.1%, n = 12), unknown (1.3%, n = 5). Most EVDs (77.6%, n = 296) were placed bedside by second-year residents (median PGY level 2, interquartile range 1-2.75). Computed tomography confirmed placement in the ipsilateral frontal horn in 72% (n = 277) of EVDs. EVD-related complications were noted in 8.3% of EVDs (n = 32, with 8 infections and 24 tract hemorrhages). The median EVD duration was 10 days; duration of EVD had no statistically significant impact on the risk of an ERI (P = 1). Only replacement of an EVD was associated with an increased risk of infection. CONCLUSIONS: Adherence to a standard EVD placement protocol is useful in maintaining a low risk of ERI regardless of the duration of catheter utilization. Replacement of the catheter through the same access hole as the original catheter is associated with an increased risk of ERI.


Assuntos
Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Ventriculostomia/efeitos adversos , Ventriculostomia/métodos , Ventriculostomia/normas , Adulto , Idoso , Encefalopatias/cirurgia , Cateteres de Demora/efeitos adversos , Drenagem/efeitos adversos , Drenagem/métodos , Drenagem/normas , Feminino , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
J Trauma Acute Care Surg ; 90(5): 776-786, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33797499

RESUMO

BACKGROUND: Outcomes following pancreatic trauma have not improved significantly over the past two decades. A 2013 Western Trauma Association algorithm highlighted emerging data that might improve the diagnosis and management of high-grade pancreatic injuries (HGPIs; grades III-V). We hypothesized that the use of magnetic resonance cholangiopancreatography, pancreatic duct stenting, operative drainage versus resection, and nonoperative management of HGPIs increased over time. METHODS: Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018 was performed. Data were analyzed by grade and time period (PRE, 2010-2013; POST, 2014-2018) using various statistical tests where appropriate. RESULTS: Thirty-two centers reported data on 515 HGPI patients. A total of 270 (53%) had penetrating trauma, and 58% went directly to the operating room without imaging. Eighty-nine (17%) died within 24 hours. Management and outcomes of 426 24-hour survivors were evaluated. Agreement between computed tomography and operating room grading was 38%. Magnetic resonance cholangiopancreatography use doubled in grade IV/V injuries over time but was still low.Overall HGPI treatment and outcomes did not change over time. Resection was performed in 78% of grade III injuries and remained stable over time, while resection of grade IV/V injuries trended downward (56% to 39%, p = 0.11). Pancreas-related complications (PRCs) occurred more frequently in grade IV/V injuries managed with drainage versus resection (61% vs. 32%, p = 0.0051), but there was no difference in PRCs for grade III injuries between resection and drainage.Pancreatectomy closure had no impact on PRCs. Pancreatic duct stenting increased over time in grade IV/V injuries, with 76% used to treat PRCs. CONCLUSION: Intraoperative and computed tomography grading are different in the majority of HGPI cases. Resection is still used for most patients with grade III injuries; however, drainage may be a noninferior alternative. Drainage trended upward for grade IV/V injuries, but the higher rate of PRCs calls for caution in this practice. LEVEL OF EVIDENCE: Retrospective diagnostic/therapeutic study, level III.


Assuntos
Traumatismos Abdominais/cirurgia , Pâncreas/lesões , Pâncreas/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Traumatismos Abdominais/classificação , Traumatismos Abdominais/diagnóstico por imagem , Adulto , Colangiopancreatografia por Ressonância Magnética , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Humanos , Escala de Gravidade do Ferimento , Internacionalidade , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Ductos Pancreáticos/lesões , Ductos Pancreáticos/patologia , Ductos Pancreáticos/cirurgia , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X/métodos , Centros de Traumatologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/patologia , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/patologia , Adulto Jovem
9.
Curr Opin Infect Dis ; 34(3): 238-244, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33741795

RESUMO

PURPOSE OF REVIEW: To review recent data on the epidemiology, microbiology, diagnosis, and management of central nervous system (CNS) infections associated with neurologic devices. RECENT FINDINGS: The increasing use of implanted neurologic devices has led to an increase in associated infections. Cerebrospinal fluid (CSF) inflammation may be present after a neurosurgical procedure, complicating the diagnosis of CNS infection. Newer biomarkers such as CSF lactate and procalcitonin show promise in differentiating infection from other causes of CSF inflammation. Molecular diagnostic tests including next-generation or metagenomic sequencing may be superior to culture in identifying pathogens causing healthcare-associated ventriculitis and meningitis. SUMMARY: Neurologic device infections are serious, often life-threatening complications. Rapid recognition and initiation of antibiotics are critical in decreasing morbidity. Device removal is usually required for cure.


Assuntos
Infecções do Sistema Nervoso Central/microbiologia , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Drenagem/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/instrumentação , Infecções do Sistema Nervoso Central/etiologia , Drenagem/instrumentação , Humanos , Neuroestimuladores Implantáveis/efeitos adversos
10.
Am J Surg ; 221(6): 1252-1258, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33641940

RESUMO

INTRODUCTION: Patients with occult pneumothorax (OPTX) requiring positive-pressure ventilation (PPV) face uncertain risks of tension pneumothorax or chest drainage complications. METHODS: Adults with traumatic OPTXs requiring PPV were randomized to drainage/observation, with the primary outcome of composite "respiratory distress" (RD)). RESULTS: Seventy-five (75) patients were randomized to observation, 67 to drainage. RD occurred in 38% observed and 25% drained (p = 0.14; Power = 0.38), with no mortality differences. One-quarter of observed patients failed, reaching 40% when ventilated >5 days. Twenty-three percent randomized to drainage had complications or ineffectual drains. CONCLUSION: RD was not significantly different with observation. Thus, OPTXs may be cautiously observed in stable patients undergoing short-term PPV when prompt "rescue drainage" is immediately available. As 40% of patients undergoing prolonged (≥5 days) ventilation (PPPV) require drainage, we suggest consideration of chest drainage performed with expert guidance to reduce risk of chest tube complications. LEVEL OF EVIDENCE: Therapeutic study, level II.


Assuntos
Pneumotórax/terapia , Respiração Artificial , Adulto , Idoso , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/prevenção & controle , Conduta Expectante , Adulto Jovem
11.
J Vasc Interv Radiol ; 32(6): 890-895.e2, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33727151

RESUMO

PURPOSE: To evaluate the long-term outcomes of percutaneous treatment of renal cystic echinococcosis (CE) stratified by cyst stages according to the World Health Organization (WHO) classification. MATERIALS AND METHODS: Between January 1997 and February 2019, 34 patients with renal CE (18 women; mean age, 38 years) were treated with 3 different percutaneous techniques. According to the World Health Organization classification, the cysts were classified as CE1, CE2, CE3a, and CE3b. Puncture, aspiration, injection, reaspiration (PAIR) or standard catheterization was used for the dimension-based treatment of CE1 and CE3a cysts. Modified catheterization (MoCaT) was used to treat all CE2 and CE3b cysts. Technical and clinical success, complications, and reduction in cyst cavities were evaluated. RESULTS: The technical success rate was 100%. PAIR, standard catheterization, and MoCaT were used to treat 12, 9, and 13 cysts, respectively. The only severe adverse event was a bacterial superinfection that occured in the cyst cavity of a patient (3%) treated with MoCaT. Four patients (12%) experienced mild/moderate periprocedural allergic adverse events and were managed conservatively. The mean length of hospital stay was 1, 5, and 7 days for patients treated with PAIR, standard catheterization, and MoCaT, respectively. The clinical success rate was 97%. In 1 of 34 cysts (3%), recurrence was detected and the cyst was successfully re-treated. During the 10.5-year follow-up period, 95% volume reduction was achieved. The median final cyst volume was 10 mL. CONCLUSIONS: Renal CE can be successfully treated with minimum adverse events and recurrence rates using appropriate percutaneous techniques selected according to their stages as classified according to WHO.


Assuntos
Cateterismo , Drenagem , Equinococose/terapia , Doenças Renais Císticas/terapia , Adulto , Cateterismo/efeitos adversos , Drenagem/efeitos adversos , Equinococose/diagnóstico , Equinococose/parasitologia , Feminino , Humanos , Doenças Renais Císticas/diagnóstico , Doenças Renais Císticas/parasitologia , Tempo de Internação , Punções , Recidiva , Estudos Retrospectivos , Sucção , Fatores de Tempo , Resultado do Tratamento
13.
J Cardiothorac Surg ; 16(1): 52, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766053

RESUMO

BACKGROUND: Intrathoracic esophageal anastomotic leakage (AL) is one of the most fatal complications after esophagectomy. In this study, we placed an additional drainage tube in the esophagus bed and evaluated its effect in early diagnosis and treatment of AL. METHODS: From January 2010 to August 2020, 312 patients with esophageal or cardia carcinoma underwent esophageal resection with intrathoracic esophagogastric anastomosis. A total of 138 patients with only one pleural drainage tube were divided into the "Control Group" and 174 patients with a pleural drainage tube and an additional mediastinal drainage tube (MDT) were divided into the "Tube Group". For all patients, the incidence of postoperative AL, the time to diagnosis, time to recovery, and patient outcome were analyzed. RESULTS: No significant differences were observed in the AL rate (P = 0.837) and postoperative pain between two groups. However, in the Tube Group, almost all the patients were diagnosed prior to the appearance of hyperpyrexia, which was considered as the earliest and most common symptom after AL. In the Tube Group, a significant decrease was observed in the incidence of incurable fistula, which required re-operation or variable treatments under gastroscopy when compared to the Control Group (P = 0.032). Finally, patients in the Tube Group showed reduced post AL hospital day (P = 0.015) and a lower mortality, however, when compared to the Control Group, no significant differences were observed (P = 0.188). CONCLUSIONS: Placement of an MDT does not prevent AL, but it is an effective approach for earlier diagnosis of AL and facilitates fistula healing and patient recovery.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Drenagem/efeitos adversos , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Adulto , Idoso , Fístula Anastomótica/etiologia , Diagnóstico Precoce , Esofagoplastia , Feminino , Humanos , Masculino , Mediastino/cirurgia , Pessoa de Meia-Idade , Dor Pós-Operatória , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 100(10): e25029, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725885

RESUMO

ABSTRACT: The main purpose is to compare the efficacy of cystogastrostomy (CG) and Roux-en-Y-type cystojejunostomy (RCJ) in the treatment of pancreatic pseudocyst (PPC), and to explore the risk factors of recurrence and complications after internal drainage.Two hundred eight patients undergoing either CG or RCJ for PPC Between January 1, 2013and February 1, 2019, at West China Hospital of Sichuan University were retrospectively analyzed. The cure rate, complication rate and related factors were compared between the 2 groups.Two hundred eight patients with PPC underwent either a CG (n = 119) or RCJ (n = 89). The median follow-up time was 42.7 months. Between the 2 cohorts, there were no significant differences in cure rate, reoperation rate, and mortality (all P > .05). The operative time, estimated intraoperative blood loss, install the number of drainage tubes and total expenses in CG group were lower than those in RCJ group (all P < .05). The Logistic regression analysis showed that over twice of pancreatitis' occurrence was were independent risk factor for recurrence after internal drainage of PPC (OR 2.760, 95% CI 1.006∼7.571, P = .049). Short course of pancreatitis (OR 0.922, 95% CI 0.855∼0.994, P = .035), and RCJ (OR 2.319, 95% CI 1.033∼5.204, P = .041) were independent risk factors for complications after internal drainage of PPC.Both CG and RCJ are safe and effective surgical methods for treating PPC. There were no significant differences in cure rate, reoperation rate, and mortality between the 2 groups, while the CG group had a short operation time, less intraoperative bleeding and less cost.


Assuntos
Drenagem/métodos , Gastrostomia/métodos , Jejunostomia/métodos , Pseudocisto Pancreático/cirurgia , Pancreatite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Anastomose em-Y de Roux/efeitos adversos , Perda Sanguínea Cirúrgica , Drenagem/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Humanos , Jejunostomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/mortalidade , Pancreatite/complicações , Pancreatite/cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
15.
J Orthop Surg Res ; 16(1): 137, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588915

RESUMO

BACKGROUND: Periprosthetic infection is a major cause of failure after segmental endoprosthetic reconstruction. The purpose of this study is to determine whether certain aspects of drain output affect infection risk, particularly the 30 mL/day criterion for removal. METHODS: Two hundred and ninety-five patients underwent segmental bone resection and lower limb endoprosthetic reconstruction at one institution. Data on surgical drain management and occurrence of infection were obtained from a retrospective review of patients' charts and radiographs. Univariate and multivariate Cox regression analyses were performed to identify factors associated with infection. RESULTS: Thirty-one of 295 patients (10.5%) developed infection at a median time of 13 months (range 1-108 months). Staphylococcus aureus was the most common organism and was responsible for the majority of cases developing within 1 year of surgery. Mean output at the time of drain removal was 72 mL/day. Ten of 88 patients (11.3%) with ≤ 30 mL/day drainage and 21 of 207 patients (10.1%) with > 30 mL/day drainage developed infection (p = 0.84). In multivariate analysis, independent predictive factors for infection included sarcoma diagnosis (HR 4.13, 95% CI 1.4-12.2, p = 0.01) and preoperative chemotherapy (HR 3.29, 95% CI 1.1-9.6, p = 0.03). CONCLUSION: Waiting until drain output is < 30 mL/day before drain removal is not associated with decreased risk of infection for segmental endoprostheses of the lower limb after tumor resection. Sarcoma diagnosis and preoperative chemotherapy were independent predictors of infection.


Assuntos
Drenagem/métodos , Salvamento de Membro/efeitos adversos , Extremidade Inferior/cirurgia , Osteonecrose/cirurgia , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Drenagem/efeitos adversos , Feminino , Humanos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Risco , Adulto Jovem
16.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542000

RESUMO

Infected aortic aneurysm is a rare disease and is often overlooked as a source of infection in septic elderly patients. We present a case of a septic elderly man with a ruptured infected aortic aneurysm caused by Salmonella enteritidis This condition was treated non-surgically with percutaneous endovascular aneurysm repair and antibiotics. The postoperative recovery was complicated a month later by spondylodiscitis and psoas abscess. He underwent radiologically guided drainage of the psoas abscess and was placed on lifelong suppressive antibiotics. We discuss the aetiology, treatment options and complications of this condition.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal , Discite/etiologia , Procedimentos Endovasculares , Salmonella enteritidis/isolamento & purificação , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Dor nas Costas/etiologia , Ceftriaxona/uso terapêutico , Drenagem/efeitos adversos , Humanos , Masculino , Abscesso do Psoas/etiologia , Sepse , Tomografia Computadorizada por Raios X
17.
Br J Radiol ; 94(1120): 20200879, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33529044

RESUMO

Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm.


Assuntos
Cateterismo/efeitos adversos , Colestase/terapia , Drenagem/efeitos adversos , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Radiologia Intervencionista/educação , Angiografia , Ductos Biliares/diagnóstico por imagem , Cateterismo/métodos , Colangiografia , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Drenagem/métodos , Fluoroscopia , Hemorragia/etiologia , Humanos , Internato e Residência , Punções , Radiologia Intervencionista/métodos , Ultrassonografia
18.
BMC Surg ; 21(1): 74, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33541328

RESUMO

INTRODUCTION: Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value. OBJECTIVES: To determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors. METHODS: Retrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant. RESULTS: 388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes. CONCLUSIONS: In a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.


Assuntos
Drenagem/instrumentação , Cuidados Intraoperatórios/métodos , Transplante de Rim/métodos , Complicações Pós-Operatórias/prevenção & controle , Drenagem/efeitos adversos , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Transplantados , Resultado do Tratamento , Cicatrização
19.
Dis Colon Rectum ; 64(4): 438-445, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394781

RESUMO

BACKGROUND: Acute anorectal abscesses of cryptoglandular origin are commonly managed by incision and drainage, which results in fistula development in up to 73% of cases, requiring subsequent definitive fistula surgery. However, given that fistula tracts may already be present at the initial presentation, primary closure of the tract as secondary prevention of fistula formation, using ligation of intersphincteric fistula tract, may be useful. OBJECTIVE: This study aims to examine the feasibility and outcomes of performing intersphincteric exploration with ligation of intersphincteric fistula tract or attempted closure of internal opening for acute anorectal abscesses. DESIGN: This is a retrospective study of patients with acute anorectal cryptoglandular abscesses who underwent surgery between January 2014 and December 2016. SETTINGS: The patients were treated at a tertiary referral center in Thailand. PATIENTS: Eighty-six patients with acute anorectal abscesses without previous surgery were included. INTERVENTIONS: Intersphincteric dissection was performed. Further surgical intervention was dependent on the intersphincteric findings. MAIN OUTCOME MEASURE: The main outcome measure was the 90-day healed rate. RESULTS: Of the 86 patients, 3 had low intersphincteric abscesses, 26 had low transsphincteric abscesses, 25 had anterior high transsphincteric abscesses, 27 had posterior high transsphincteric abscesses, and 5 had high intersphincteric abscesses. Ligation of intersphincteric fistula tract was successfully performed in 66 patients with an identifiable intersphincteric tract. Intersphincteric exploration with attempted closure of the internal opening was performed in the remaining 20 patients. The success rates were 86% and 70%. Unidentified internal opening and intersphincteric pathology were risk factors for nonhealing. No patients reported fecal incontinence postoperatively. LIMITATIONS: The limitation of this study is its retrospective nature and that all operations were performed by a single surgeon; therefore, the results may vary according to the individual surgeon's expertise. CONCLUSIONS: Fistula tract formation was found in most cases of acute anorectal abscesses. Definitive surgery using this strategy provides promising results. See Video Abstract at http://links.lww.com/DCR/B451. EXPLORACIN INTERESFINTRICA CON LIGADURA DEL TRAYECTO EN LA FSTULA INTERESFINTRICA O INTENTO DE CIERRE DEL ORIFICIO INTERNO EN ABSCESOS ANORRECTALES AGUDOS: ANTECEDENTES:Los abscesos anorrectales agudos de origen criptoglandular, comúnmente se manejan mediante incisión y drenaje, lo que resulta en el desarrollo de una fístula hasta en un 73% de los casos, requiriendo posteriormente cirugía definitiva de la fístula. Sin embargo, dado que los trayectos de la fístula ya pueden estar inicialmente presentes, puede ser útil el cierre primario del trayecto, como prevención secundaria en la formación de la fístula, mediante la ligadura del trayecto de la fístula interesfintérica.OBJETIVO:El estudio tiene como objetivo, examinar la viabilidad y los resultados en realizar exploración interesfintérica, con ligadura del trayecto de fístula interesfintérica o intento de cierre del orificio interno para abscesos anorrectales agudos.DISEÑO:Se trata de un estudio retrospectivo de pacientes con abscesos criptoglandulares anorrectales agudos, que fueron operados entre enero de 2014 y diciembre de 2016.AJUSTES:Los pacientes fueron tratados en un centro de referencia terciario en Tailandia.PACIENTES:Se incluyeron 86 pacientes con abscesos anorrectales agudos, sin cirugía previa.INTERVENCIONES:Se realizó disección interesfintérica. La intervención quirúrgica adicional dependió de los hallazgos interesfintéricos.PRINCIPALES MEDIDAS DE RESULTADO:La principal medida de resultado, fue la tasa de cicatrización a 90 días.RESULTADOS:De los 86 pacientes, hubo 3 abscesos interesfintéricos bajos, 26 abscesos transesfintéricos bajos, 25 abscesos transesfintéricos anteriores altos, 27 abscesos transesfintéricos posteriores altos y 5 abscesos interesfintéricos altos. La ligadura del tracto de la fístula interesfintérica, con tracto interesfintérico identificable, se realizó con éxito en 66 pacientes. Se realizó exploración interesfintérica, con intento de cierre del orificio interno en los 20 pacientes restantes. Las tasas de éxito fueron 86% y 70% respectivamente. Orificio interno no identificado y patología interesfintérica, fueron factores de riesgo para la falta de cicatrización. Ningún paciente reportó incontinencia fecal posoperatoria.LIMITACIONES:La limitación de este estudio, es su naturaleza retrospectiva y que todas las operaciones fueron realizadas por un solo cirujano, por lo tanto, los resultados pueden variar según la experiencia de cada cirujano.CONCLUSIONES:En la mayoría de los casos de abscesos anorrectales agudos, se encontró formación de trayectos fistulosos. La cirugía definitiva con esta estrategia, proporciona resultados prometedores. Consulte Video Resumen en http://links.lww.com/DCR/B451.


Assuntos
Abscesso/cirurgia , Ligadura/métodos , Doenças Retais/patologia , Fístula Retal/cirurgia , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos , Doença Aguda , Adulto , Idoso , Canal Anal/patologia , Drenagem/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/microbiologia , Fístula Retal/epidemiologia , Fístula Retal/etiologia , Estudos Retrospectivos , Tailândia/epidemiologia , Resultado do Tratamento
20.
Acta Neurochir (Wien) ; 163(4): 1143-1151, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33387044

RESUMO

BACKGROUND: The need for external cerebrospinal fluid (CSF) drains in aneurysmal subarachnoid haemorrhage (aSAH) patients is common and might lead to additional complications. OBJECTIVE: A relation between the presence of an external CSF drain and complication risk is investigated. METHODS: A prospective complication registry was analysed retrospectively. We included all adult aSAH patients admitted to our academic hospital between January 2016 and January 2018, treated with an external CSF drain. Demographic data, type of external drain used, the severity of the aSAH and complications, up to 30 days after drain placement, were registered. Complications were divided into (1) complications with a direct relation to the external CSF drain and (2) complications that could not be directly related to the use of an external CSF drain referred to as medical complications RESULTS: One hundred and forty drains were implanted in 100 aSAH patients. In total, 112 complications occurred in 59 patients. Thirty-six complications were drain related and 76 were medical complications. The most common complication was infection (n = 34). Drain dislodgement occurred 16 times, followed by meningitis (n = 11) and occlusion (n = 9). A Poisson model showed that the mean number of complications raised by 2.9% for each additional day of drainage (95% CI: 0.6-5.3% p = 0.01). CONCLUSION: Complications are common in patients with aneurysmal subarachnoid haemorrhage of which 32% are drain-related. A correlation is present between drainage period and the number of complications. Therefore, reducing drainage period could be a target for further improvement of care.


Assuntos
Vazamento de Líquido Cefalorraquidiano/epidemiologia , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Drenagem/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
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