Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.574
Filtrar
1.
Pan Afr Med J ; 35: 3, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32117519

RESUMO

Introduction: The aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of non-massive malignant/paramalignant pleural effusion. Methods: Forty-one patients with non-massive malignant and paramalignant pleural effusions were randomized into two groups. Group A (21patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Data obtained was analyzed with SPSS statistical package (version 16.0). Results: Breast cancer was the malignancy present at diagnosis in 24(58%) patients. Complication rates were similar, 9.5% in the underwater seal group and 10 % in the flutter bag drainage group. The mean duration to full mobilization was 35.0±20.0 hours in the flutter bag group and 52.7±18.5 hours in the underwater seal group, p-value 0.007. The mean length of hospital was 7.9±2.2 days in the flutter bag group and 9.8±2.7 days in the underwater seal group. This was statistically significant, p-value of 0.019. There was no difference in the effectiveness of drainage between both groups, complete lung re-expansion was observed in 16(80%) of the flutter bag group and 18(85.7%) of the underwater seal drainage group, p-value 0.70. Conclusion: The flutter valve drainage bag is an effective and safe alternative to the standard underwater seal drainage bottle in the management of non-massive malignant and paramalignant pleural effusion.


Assuntos
Drenagem/métodos , Derrame Pleural Maligno/terapia , Derrame Pleural/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos , Drenagem/efeitos adversos , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/fisiopatologia , Derrame Pleural Maligno/fisiopatologia , Fatores de Tempo , Adulto Jovem
2.
Medicine (Baltimore) ; 99(2): e18623, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914042

RESUMO

BACKGROUND: The surgical management of acute malignant left-sided bowel obstruction is associated with high morbidity and mortality. Recently, transanal drainage tubes (DTs) and metallic stents (MSs) used as a "bridge to surgery" have become widely used decompression methods compared with emergency surgery. This study aims to evaluate the efficacy and safety of DTs and MSs for the decompression of acute left-sided malignant colorectal obstruction. METHODS: All studies were acquired from PubMed, Medline, Embase, CNKI and the Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed with RevMan5.3. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the risk of bias. RESULTS: Eleven studies, which included three randomized controlled trials (RCTs) and 8 observational studies, were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of the technical success rate showed that the difference was not statistically significant between the2 devises. The differences in clinical success rate, operative time and complications were statistically significant between MSs and DTs, and MSs were associated with a better clinical success rate, increased operative time and fewer complications. Sensitivity analysis proved the stability of the pooled results, and the publication bias was low. CONCLUSION: MS insertion for acute left-sided malignant bowel obstruction is effective and safe with a better technical success rate and with fewer complications than decompression using a DT, and MS insertion can avoid stoma formation. Moreover, MS insertion appears to be a useful treatment strategy for malignant colonic obstruction even if the lesion is located in the right colon. More large-sample, multicenter, high-quality RCTs are needed to verify the outcomes of this meta-analysis.


Assuntos
Neoplasias Colorretais/complicações , Drenagem/instrumentação , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia
4.
World Neurosurg ; 133: e18-e25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394360

RESUMO

BACKGROUND: Intracranial pressure monitoring remains the foundation for prevention of secondary injury after traumatic brain injury and is most commonly performed using an external ventricular drain or intraparenchymal pressure monitor. The Integra Flex ventricular catheter combines an external ventricular catheter with a pressure transducer embedded in the tip of the catheter to allow continuous pressure readings while simultaneously draining cerebrospinal fluid. Discrepancies between measurements from the continuously reported internal pressure transducer and intermittently assessed and externally transduced ventricular drain prompted an analysis and characterization of pressures transduced from the same ventricular source. METHODS: More than 500 hours of high-resolution (125 Hz) continuous recordings were manually reviewed to identify 73 hours of simultaneous measurements (clamped external ventricular drain) from internal and external transducers in patients with traumatic brain injury. RESULTS: A significant positive bias was found in pressure readings obtained from external relative to internal measurements. The 2 methods of measurement generally correlated poorly with each other and variably. Although proportional bias was found with Bland-Altman analysis, coherence revealed rare shifts in the external transducer as a major source of discrepancy. Infrequent changes in the 0-level of the external transducer were found to be the primary source of discrepancy. Relative to the observed differences, no significant trend was observed over time between the 2 modalities. CONCLUSIONS: This study suggests that the internal pressure transducer may be a more reliable estimate of intracranial pressure relative to bedside external transducers due to the inherent behavioral requirement of leveling.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Erros de Diagnóstico , Drenagem/instrumentação , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Manometria/instrumentação , Transdutores de Pressão , Lesões Encefálicas Traumáticas/complicações , Cateteres , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transdutores de Pressão/classificação
5.
J Surg Res ; 245: 99-106, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415935

RESUMO

BACKGROUND: Brainstem hemorrhage is an acute and severe neurosurgical disease. Cerebral hemorrhage is surgically treated via hematoma puncture drainage because of its minimally invasive nature. However, the placement of puncture must be extremely accurate due to the special anatomical location of the brainstem and its physiological functions. The present study aimed to evaluate whether the application of a three-dimensional (3D)-printed navigation mold achieved good outcomes in the surgical treatment of brainstem hemorrhage. MATERIAL AND METHODS: The present study included seven patients (three men and four women aged 40-56 y) who underwent 3D print-assisted hematoma puncture drainage between June 2016 and March 2018 at Binzhou Medical University Hospital. The amount of brainstem hemorrhage was 15-47 mL. We analyzed the basic surgical conditions, deviation distance, and postoperative clinical improvement. RESULTS: In all cases, the operation was completed successfully; no patient died or contracted an infection intraoperatively. The end of the puncture tube was located in the hematoma cavity in all cases. The deviation distance ranged from 2.5 to 7.2, and this distance gradually reduced with improvements in the technique. The hematoma drainage achieved satisfactory postoperative outcomes, with improvements in symptoms such as respiratory failure and hyperthermia. CONCLUSIONS: Use of a 3D-printed navigation mold for puncture drainage of brainstem hemorrhage realized the purpose of individualized and precision medicine, which is important in maintaining the vital signs of patients with severe brainstem hemorrhage.


Assuntos
Hemorragia Cerebral/cirurgia , Drenagem/instrumentação , Hematoma/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Punções/instrumentação , Adulto , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Drenagem/métodos , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções/métodos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Gastroenterology ; 158(1): 67-75.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31479658

RESUMO

DESCRIPTION: The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update is to review the available evidence and expert recommendations regarding the clinical care of patients with pancreatic necrosis and to offer concise best practice advice for the optimal management of patients with this highly morbid condition. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology. This review is framed around the 15 best practice advice points agreed upon by the authors, which reflect landmark and recent published articles in this field. This expert review also reflects the experiences of the authors, who are advanced endoscopists or hepatopancreatobiliary surgeons with extensive experience in managing and teaching others to care for patients with pancreatic necrosis. BEST PRACTICE ADVICE 1: Pancreatic necrosis is associated with substantial morbidity and mortality and optimal management requires a multidisciplinary approach, including gastroenterologists, surgeons, interventional radiologists, and specialists in critical care medicine, infectious disease, and nutrition. In situations where clinical expertise may be limited, consideration should be given to transferring patients with significant pancreatic necrosis to an appropriate tertiary-care center. BEST PRACTICE ADVICE 2: Antimicrobial therapy is best indicated for culture-proven infection in pancreatic necrosis or when infection is strongly suspected (ie, gas in the collection, bacteremia, sepsis, or clinical deterioration). Routine use of prophylactic antibiotics to prevent infection of sterile necrosis is not recommended. BEST PRACTICE ADVICE 3: When infected necrosis is suspected, broad-spectrum intravenous antibiotics with ability to penetrate pancreatic necrosis should be favored (eg, carbapenems, quinolones, and metronidazole). Routine use of antifungal agents is not recommended. Computed tomography-guided fine-needle aspiration for Gram stain and cultures is unnecessary in the majority of cases. BEST PRACTICE ADVICE 4: In patients with pancreatic necrosis, enteral feeding should be initiated early to decrease the risk of infected necrosis. A trial of oral nutrition is recommended immediately in patients in whom there is absence of nausea and vomiting and no signs of severe ileus or gastrointestinal luminal obstruction. When oral nutrition is not feasible, enteral nutrition by either nasogastric/duodenal or nasojejunal tube should be initiated as soon as possible. Total parenteral nutrition should be considered only in cases where oral or enteral feeds are not feasible or tolerated. BEST PRACTICE ADVICE 5: Drainage and/or debridement of pancreatic necrosis is indicated in patients with infected necrosis. Drainage and/or debridement may be required in patients with sterile pancreatic necrosis and persistent unwellness marked by abdominal pain, nausea, vomiting, and nutritional failure or with associated complications, including gastrointestinal luminal obstruction; biliary obstruction; recurrent acute pancreatitis; fistulas; or persistent systemic inflammatory response syndrome. BEST PRACTICE ADVICE 6: Pancreatic debridement should be avoided in the early, acute period (first 2 weeks), as it has been associated with increased morbidity and mortality. Debridement should be optimally delayed for 4 weeks and performed earlier only when there is an organized collection and a strong indication. BEST PRACTICE ADVICE 7: Percutaneous drainage and transmural endoscopic drainage are both appropriate first-line, nonsurgical approaches in managing patients with walled-off pancreatic necrosis (WON). Endoscopic therapy through transmural drainage of WON may be preferred, as it avoids the risk of forming a pancreatocutaneous fistula. BEST PRACTICE ADVICE 8: Percutaneous drainage of pancreatic necrosis should be considered in patients with infected or symptomatic necrotic collections in the early, acute period (<2 weeks), and in those with WON who are too ill to undergo endoscopic or surgical intervention. Percutaneous drainage should be strongly considered as an adjunct to endoscopic drainage for WON with deep extension into the paracolic gutters and pelvis or for salvage therapy after endoscopic or surgical debridement with residual necrosis burden. BEST PRACTICE ADVICE 9: Self-expanding metal stents in the form of lumen-apposing metal stents appear to be superior to plastic stents for endoscopic transmural drainage of necrosis. BEST PRACTICE ADVICE 10: The use of direct endoscopic necrosectomy should be reserved for those patients with limited necrosis who do not adequately respond to endoscopic transmural drainage using large-bore, self-expanding metal stents/lumen-apposing metal stents alone or plastic stents combined with irrigation. Direct endoscopic necrosectomy is a therapeutic option in patients with large amounts of infected necrosis, but should be performed at referral centers with the necessary endoscopic expertise and interventional radiology and surgical backup. BEST PRACTICE ADVICE 11: Minimally invasive operative approaches to the debridement of acute necrotizing pancreatitis are preferred to open surgical necrosectomy when possible, given lower morbidity. BEST PRACTICE ADVICE 12: Multiple minimally invasive surgical techniques are feasible and effective, including videoscopic-assisted retroperitoneal debridement, laparoscopic transgastric debridement, and open transgastric debridement. Selection of approach is best determined by pattern of disease, physiology of the patient, experience and expertise of the multidisciplinary team, and available resources. BEST PRACTICE ADVICE 13: Open operative debridement maintains a role in the modern management of acute necrotizing pancreatitis in cases not amenable to less invasive endoscopic and/or surgical procedures. BEST PRACTICE ADVICE 14: For patients with disconnected left pancreatic remnant after acute necrotizing mid-body necrosis, definitive surgical management with distal pancreatectomy should be undertaken in patients with reasonable operative candidacy. Insufficient evidence exists to support the management of the disconnected left pancreatic remnant with long-term transenteric endoscopic stenting. BEST PRACTICE ADVICE 15: A step-up approach consisting of percutaneous drainage or endoscopic transmural drainage using either plastic stents and irrigation or self-expanding metal stents/lumen-apposing metal stents alone, followed by direct endoscopic necrosectomy, and then surgical debridement is reasonable, although approaches may vary based on the available clinical expertise.


Assuntos
Gastroenterologia/normas , Pancreatite Necrosante Aguda/terapia , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Desbridamento/instrumentação , Desbridamento/métodos , Drenagem/instrumentação , Drenagem/métodos , Endoscopia/instrumentação , Endoscopia/métodos , Nutrição Enteral , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents Metálicos Autoexpansíveis , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Estados Unidos
8.
J Cardiothorac Surg ; 14(1): 192, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703606

RESUMO

BACKGROUND: Chest tubes are routinely used to evacuate shed mediastinal blood in the critical care setting in the early hours after heart surgery. Inadequate evacuation of shed mediastinal blood due to chest tube clogging may result in retained blood around the heart and lungs after cardiac surgery. The objective of this study was to compare if active chest tube clearance reduces the incidence of retained blood complications and associated hospital resource utilization after cardiac surgery. METHODS: Propensity matched analysis of 697 consecutive patients who underwent cardiac surgery at a single center. 302 patients served as a baseline control (Phase 0), 58 patients in a training and compliance verification period (Phase 1) and 337 were treated prospectively using active tube clearance (Phase 2). The need to drain retained blood, pleural effusions, postoperative atrial fibrillation, ICU resource utilization and hospital costs were assessed. RESULTS: Propensity matched patients in Phase 2 had a reduced need for drainage procedures for pleural effusions (22% vs. 8.1%, p < 0.001) and reduced postoperative atrial fibrillation (37 to 25%, P = 0.011). This corresponded with fewer hours in the ICU (43.5 [24-79] vs 30 [24-49], p = < 0.001), reduced median postoperative length of stay (6 [4-8] vs 5 [4-6.25], p < 0.001) median costs reduced by $1831.45 (- 3580.52;82.38, p = 0.04) and the mean costs reduced by an average of $2696 (- 6027.59;880.93, 0.116). CONCLUSIONS: This evidence supports the concept that efforts to actively maintain chest tube patency in early recovery is useful in improving outcomes and reducing resource utilization and costs after cardiac surgery. TRIAL REGISTRATION: Clinicaltrial.gov, NCT02145858, Registered: May 23, 2014.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tubos Torácicos , Drenagem/métodos , Custos Hospitalares/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Drenagem/economia , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
9.
J Cardiothorac Surg ; 14(1): 190, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699118

RESUMO

BACKGROUND: Intermediate bronchial fistula formation caused by mediastinal drainage tube compression and fungal infection is rare. CASE PRESENTATION: A 50-year-old male patient with type 2 diabetes was observed air filling in mediastinal drainage tube, 12 days after esophagectomy for esophageal squamous carcinoma. Based on the results of computed tomography, bronchoscopy and pathology, the diagnosis of intermediate bronchial fistula caused by mediastinal drainage tube compression and fungal infection was made. Anti-fungal drug and temporary covered metallic stent was used. After stent removed, the fistula was healed with some granulation hyperplasia. He was free from respiratory symptom during 1 year follow-up. CONCLUSION: Intermediate bronchial fistula caused by the combination of mediastinal drainage tube compression and fungal infection is rare. Timely stenting could boost the healing of fistula via granulation tissue proliferation.


Assuntos
Fístula Brônquica/etiologia , Drenagem/instrumentação , Micoses/etiologia , Cuidados Pós-Operatórios/instrumentação , Complicações Pós-Operatórias/etiologia , Doenças da Traqueia/etiologia , Fístula Brônquica/diagnóstico , Fístula Brônquica/terapia , Drenagem/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/terapia , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Stents Metálicos Autoexpansíveis , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/terapia
10.
Tech Vasc Interv Radiol ; 22(3): 127-134, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31623752

RESUMO

Intraductal biliary stones can result in significant acute and long-term complications. When patients' anatomy precludes more traditional management, the interventional radiologist may be called upon to provide well-established techniques for percutaneous biliary drainage and stone removal. This can be particularly challenging when the patient has excessively mobile, impacted, large or multiple stones. Percutaneous biliary endoscopy with adjunct interventional techniques can successfully treat these patients avoiding the patient dreaded "tube for life" scenario. Direct percutaneous visualization of the biliary tree can also diagnose and provide symptomatic relief for stone-mimicking pathologic conditions such as biliary tumors. This article will review the role, technique, and considerations for percutaneous biliary endoscopy and adjunct interventions in patients with isolated and complex, biliary stone disease and stone-mimicking pathologies.


Assuntos
Colelitíase/terapia , Drenagem/métodos , Endoscopia do Sistema Digestório/métodos , Radiografia Intervencionista/métodos , Colelitíase/diagnóstico por imagem , Diagnóstico Diferencial , Drenagem/efeitos adversos , Drenagem/instrumentação , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/instrumentação , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/instrumentação , Fatores de Risco , Resultado do Tratamento
11.
Int J Surg ; 71: 175-181, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31600570

RESUMO

BACKGROUND: Routine intraoperative ureteric stenting lowers the rate of urological complications after kidney transplantation. However, there is no consensus about the optimal stent design and duration. The aim of this prospective cohort study was to compare the influence of double J (JJ) stents and externally draining percutaneous (PC) stents on the early quality of recovery after living donor kidney transplantation. MATERIALS AND METHODS: A prospective cohort study was performed in two consecutive cohorts of 40 patients who underwent living donor kidney transplantation at the Radboud university medical center between April 2016 and October 2017. The first cohort of 40 patients received a 6-French externally draining PC stent. The second cohort of 40 patients received a 6-French/14 cm JJ stent. We compared the influence of the stent design on the quality of early post-operative recovery (measured by the Quality of Recovery-40 questionnaire) and the length of hospital stay. RESULTS: Patients with a JJ stent scored significantly better on the Quality of Recovery score on the third and fifth postoperative day, when compared to patients with a PC stent. Furthermore, in comparison to patients with a PC stent, patients with a JJ stent were earlier mobilising and independent in daily activities, resulting in a shorter length of hospital stay. The number of postoperative urological complications was comparable between the two groups. CONCLUSION: The use of JJ stents during living donor kidney transplantations improves the postoperative recovery and shortens the length of hospital stay, when compared to PC stents without compromising the number of postoperative urological complications.


Assuntos
Drenagem/instrumentação , Transplante de Rim/efeitos adversos , Stents/efeitos adversos , Ureter/cirurgia , Adulto , Drenagem/métodos , Feminino , Humanos , Transplante de Rim/métodos , Transplante de Rim/reabilitação , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(39): e17365, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574884

RESUMO

RATIONALE: Periorbital cellulitis or an orbital abscess caused by acute sinusitis is a serious acute infectious disease. If not treated in time, serious complications may occur. PATIENT CONCERNS: A 16-year-old girl with a history of right-sided proptosis, periorbital swelling, chemosis, hypophasis, restricted ocular movement in the upward direction, and diminution of vision was referred to our institution. The clinic, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate right orbital abscess in the upper quadrant and sinusitis. DIAGNOSES: She was diagnosed with orbital abscess, acute sinusitis. INTERVENTIONS: She underwent medical management, transnasal endoscopic surgery and then ultrasound-guided fine needle aspiration (FNA) and catheter drainage. OUTCOMES: She was completely cured without any complications or sequelae. LESSONS: Performance of surgical drainage in a timely manner and administration of effective antibiotic treatment according to bacterial culture can reduce the complications of orbital abscesses. Ultrasound-guided FNA and catheter drainage is a safe, simple, and effective method for the treatment of orbital abscess.


Assuntos
Abscesso/cirurgia , Drenagem/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Doenças Orbitárias/cirurgia , Sinusite/cirurgia , Abscesso/microbiologia , Doença Aguda , Adolescente , Cateteres , Drenagem/instrumentação , Feminino , Humanos , Doenças Orbitárias/microbiologia , Sinusite/microbiologia
13.
Cir Cir ; 87(S1): 28-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501620

RESUMO

Background: The successful performance of ostomies for the treatment of different diseases has been described since 1706. We report herein the first case of successful ostomy utilizing a synthetic stoma created in a patient with peritoneal carcinomatosis. Clinical case: A 40-year-old woman presented with abdominal carcinomatosis due to psammomatous papillotubular adenocarcinoma consistent with primary ovarian carcinoma. The patient had negative estrogen and progesterone receptors and Ki-67 proliferative activity was 83%. She was initially treated with cytoreduction therapy, chemotherapy, and hyperthermic intraperitoneal chemotherapy. Because the patient presented with enteric perforations and the extensive tumor invasion and adhesions in all the intestinal segments made it impossible to create autologous decompression stomas, a synthetic stoma was constructed. Conclusions: Synthetic stomas can be a good treatment option when autologous stomas can not be created.


Assuntos
Adenocarcinoma Papilar/secundário , Drenagem/instrumentação , Neoplasias Intestinais/secundário , Perfuração Intestinal/cirurgia , Neoplasias Ovarianas/cirurgia , Estomas Cirúrgicos , Adenocarcinoma Papilar/tratamento farmacológico , Adenocarcinoma Papilar/etiologia , Adenocarcinoma Papilar/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Coagulação com Plasma de Argônio , Bevacizumab/administração & dosagem , Carboplatina/administração & dosagem , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Docetaxel/administração & dosagem , Doxorrubicina/administração & dosagem , Doxorrubicina/análogos & derivados , Evolução Fatal , Feminino , Humanos , Hipertermia Induzida , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/etiologia , Neoplasias Intestinais/cirurgia , Perfuração Intestinal/etiologia , Mitomicina/administração & dosagem , Polietilenoglicóis/administração & dosagem
14.
J Surg Oncol ; 120(7): 1162-1168, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31556139

RESUMO

BACKGROUND: Vascularized lymph node transfer (VLNT) is an effective surgery for extremity lymphedema. This study evaluated a lymphatic drainage device (LDD) for the drainage of accumulated fluid into the venous system. METHODS: Micropore filtering membranes with pore sizes of 5, 0.65, and 0.22 µm polyvinylidene difluoride, and 0.8 µm Nylon Net Filter were evaluated to determine the in vitro efficiency of drainage flow of an LDD. The two superior membranes were further used for the evaluation of the inflow and outflow of the LDD in vivo using 5% albumin. RESULTS: At 5 minutes, the volumes drained with 5, 0.65, and 0.22 µm polyvinylidene difluoride and 0.8 µm nylon membranes were 15.2, 2.77, 2.37, and 0.59 mL, respectively (P < .01). At 10 minutes, the collected volumes of 5 and 0.65 µm polyvinylidene difluoride were 1788 and 1051 µL (P = .3). The indocyanine green fluorescence was detected at 50 seconds for the 5 µm polyvinylidene difluoride membrane but not for the 0.65 µm membrane. CONCLUSIONS: The study successfully demonstrated the proof-of-concept of the LDD prototype that mimicked VLNT with drainage of 5% albumin into the venous system in a rat model.


Assuntos
Modelos Animais de Doenças , Drenagem/instrumentação , Drenagem/métodos , Linfedema/terapia , Animais , Desenho de Equipamento , Verde de Indocianina/metabolismo , Bombas de Infusão Implantáveis , Masculino , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica
15.
World J Gastroenterol ; 25(34): 5210-5219, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558868

RESUMO

BACKGROUND: Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction. No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting. AIM: To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction. METHODS: PubMed, Embase, Scopus, and Cochrane databases, as well as secondary sources (bibliographic review of selected articles and major GI proceedings), were searched through January 2019. The primary outcome was the re-intervention rate. Secondary outcomes were a technical success, early and late complications, and stent malfunction rate. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome. RESULTS: A total of 9 studies were included (2 prospective Randomized Controlled Study, 5 retrospective studies, and 2 abstracts), involving 782 patients with malignant hilar obstruction. Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage (OR = 0.59, 95%CI: 0.40-0.87, P = 0.009). There was no difference in the technical success rate (OR = 0.7, CI: 0.42-1.17, P = 0.17), early complication rate (OR = 1.56, CI: 0.31-7.75, P = 0.59), late complication rate (OR = 0.91, CI: 0.58-1.41, P = 0.56) and stent malfunction (OR = 0.69, CI: 0.42-1.12, P = 0.14) between bilateral and unilateral stenting for malignant hilar biliary strictures. CONCLUSION: Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures, with no significant difference in technical success, and early or late complication rates.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/cirurgia , Drenagem/métodos , Tumor de Klatskin/complicações , Cuidados Paliativos/métodos , Neoplasias dos Ductos Biliares/cirurgia , Colestase/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Drenagem/efeitos adversos , Drenagem/instrumentação , Ducto Hepático Comum/patologia , Ducto Hepático Comum/cirurgia , Humanos , Tumor de Klatskin/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
16.
Dis Colon Rectum ; 62(10): 1259-1262, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31490837

RESUMO

INTRODUCTION: The vacuum-assisted drainage has many applications in managing complex wound healing. It quickens the recovery period by its hyperemic effect on the exposed zone, decreasing bacterial colonization, preventing tissue edema, and promoting granulation of the wound. However, its use in anastomotic leak after IPAA is scarcely studied, especially because a proprietary endoluminal vacuum-assisted closure system was removed from the US market. TECHNIQUE: We applied a hand-crafted endoluminal vacuum-assisted closure system using the existing standard wound vacuum-assisted closure supplies to 2 patients who developed an anastomotic leak with a presacral abscess after completion proctectomy with J-pouch construction. RESULTS: We changed the endoluminal vacuum-assisted closure drain every 2 to 3 days, and both patients had substantial improvements in their abscess cavity after the seventh and ninth applications. CONCLUSIONS: Anastomotic leak at the IPAA traditionally takes up to a year to heal, which causes a significant toll on the psychosocial life of the patient and delayed stoma closure. Therefore, we believe that facilitating the healing process by using our hand-crafted endoluminal vacuum-assisted closure drain might provide a great value to patients' quality of life.


Assuntos
Fístula Anastomótica/cirurgia , Drenagem/instrumentação , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Protectomia/efeitos adversos , Adulto , Fístula Anastomótica/diagnóstico , Desenho de Equipamento , Humanos , Masculino , Reoperação , Tomografia Computadorizada por Raios X
17.
World Neurosurg ; 132: 343-346, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505285

RESUMO

BACKGROUND: Chronic subdural hematoma (cSDH) is an intracranial pathology most commonly affecting elderly patients. Patients may present with worsening headache, seizures, weakness, balance and gait problems, and memory deficits. Even in patients undergoing hematoma evacuation, there is a substantial risk for recurrence. The authors present the first use of an irrigating external ventricular drain in the United States in the perioperative management of a patient with cSDH treated with craniotomy (IRRAS, Stockholm, Sweden). CASE DESCRIPTION: An 82-year-old male presented with right-sided weakness, confusion, and right-sided neglect with expressive aphasia. He was found to have a large 2.5-cm cSDH with a 9-mm left-to-right midline shift. The patient was treated with a minicraniotomy to evacuate the hematoma and placement of an irrigating drain in the subdural space. The patient was discharged home on postoperative day 3 without complication. He was at neurologic baseline 2 weeks later on follow-up. CONCLUSIONS: The use of an irrigating drain for perioperative management of cSDH is a novel means to prevent recurrence and warrants further exploration.


Assuntos
Cateterismo , Cateteres , Drenagem/métodos , Hematoma Subdural Crônico/terapia , Irrigação Terapêutica/métodos , Idoso de 80 Anos ou mais , Craniotomia , Drenagem/instrumentação , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Masculino , Assistência Perioperatória , Irrigação Terapêutica/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
World Neurosurg ; 131: e392-e401, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369879

RESUMO

BACKGROUND: Although the use of a postoperative drain after burr-hole evacuation of chronic subdural hematoma (CSDH) is known to improve surgical outcomes, the superiority of subdural over subperiosteal drains has not been firmly established. Evidence comparing these 2 drain types is largely restricted to single-center series with limited numbers. Using a multicenter cohort study, we aimed to show noninferiority of subperiosteal drains vis-à-vis subdural drains after burr-hole evacuation of CSDH. METHODS: We performed a retrospective analysis of all consecutive patients with CSDH aged 21 years and older who had undergone burr-hole craniostomy across 3 tertiary hospitals from 2010 to 2017. Primary outcome measures included CSDH recurrence and modified Rankin Scale (mRS) score at 6 months. Outcomes of patients in the subdural and subperiosteal drain groups were analyzed and confounders were adjusted for using multivariate logistic regression. RESULTS: Of the 570 cases analyzed, 329 (57.7%) received a subdural drain and 241 (42.3%) received a subperiosteal drain. There was no significant difference between the 2 drain groups in CSDH recurrence (13.1% in the subdural group vs. 11.2% in the subperiosteal group; P = 0.502) or 6-month mRS score (27.2% with mRS 4-6 in the subdural group vs. 20.4% in the subperiosteal group; P = 0.188). Independent predictors of CSDH recurrence identified on multivariate analysis included premorbid mRS score 0-3 (P = 0.021), separated CSDH type on preoperative computed tomography scan (P = 0.002), and postoperative pneumocephalus of ≥15 mm (P = 0.005). CONCLUSIONS: Outcomes of subdural and subperiosteal drains after burr-hole craniostomy for CSDH are largely equivalent based on our findings.


Assuntos
Craniotomia/métodos , Drenagem/métodos , Hematoma Subdural Crônico/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Drenagem/instrumentação , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Periósteo , Espaço Subdural , Resultado do Tratamento
19.
World J Gastroenterol ; 25(29): 3857-3869, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31413524

RESUMO

In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUS-guided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and EC-LAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.


Assuntos
Colestase/terapia , Drenagem/métodos , Endossonografia/métodos , Stents Metálicos Autoexpansíveis , Ultrassonografia de Intervenção/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestase/etiologia , Neoplasias do Ducto Colédoco/complicações , Neoplasias do Ducto Colédoco/patologia , Drenagem/efeitos adversos , Drenagem/instrumentação , Eletrocoagulação/efeitos adversos , Eletrocoagulação/instrumentação , Eletrocoagulação/métodos , Humanos , Invasividade Neoplásica/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Resultado do Tratamento
20.
World J Gastroenterol ; 25(29): 4019-4042, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31413535

RESUMO

BACKGROUND: Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.AIMSTo study the published evidence and systematically review the literature on the prevention and treatment for PEP. METHODS: A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms "Post endoscopic retrograde cholangiopancreatography pancreatitis" AND "prevention" through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies. RESULTS: 726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results. CONCLUSION: Prevention of PEP involves multifactorial aspects, including assessment of patients with high risk factors for alternative therapeutic and diagnostic techniques, administration of pharmacological agents and procedural techniques with highly precise results in the literature.


Assuntos
Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Pancreatite/terapia , Complicações Pós-Operatórias/terapia , Administração Retal , Anti-Inflamatórios/administração & dosagem , Cateterismo/instrumentação , Cateterismo/métodos , Drenagem/instrumentação , Drenagem/métodos , Humanos , Pâncreas/efeitos dos fármacos , Pâncreas/metabolismo , Pâncreas/cirurgia , Pancreatite/etiologia , Inibidores da Fosfodiesterase 5/administração & dosagem , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Medição de Risco , Fatores de Risco , Somatostatina/administração & dosagem , Esfíncter da Ampola Hepatopancreática/efeitos dos fármacos , Esfíncter da Ampola Hepatopancreática/cirurgia , Stents
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA