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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.
Anticancer Res ; 41(7): 3649-3656, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34230163

RESUMO

BACKGROUND/AIM: Postoperative pancreatic fistula after distal pancreatectomy represents the most frequent procedure-related complication; however, a standard treatment is currently not available. CASE REPORT: We herein report a case of postoperative pancreatic fistula after distal pancreatectomy and splenectomy in a patient affected by a platinum-sensitive ovarian cancer recurrence. The 59-year-old patient developed a pancreatic fistula on postoperative day 4. An endoscopic transgastric double-pigtail drainage was placed on postoperative day 13. The patient was discharged after 5 days and referred to adjuvant medical treatment. A month later, computed tomography revealed complete resolution of the fistula, the drainage was removed, and the patient continued chemotherapy. She recovered uneventfully at a 3-month follow-up. CONCLUSION: EUS-guided drainage is a viable option in the management of postoperative pancreatic fistula, which can lead to a rapid resolution of peripancreatic fluid collections and to initiation of adjuvant chemotherapy with the slightest delay in ovarian cancer patients.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Recidiva Local de Neoplasia/terapia , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/terapia , Fístula Pancreática/cirurgia , Fístula Pancreática/terapia , Drenagem/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Pâncreas/cirurgia , Pancreatectomia/métodos , Período Pós-Operatório , Esplenectomia/métodos
3.
Emerg Med Clin North Am ; 39(3): 529-554, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215401

RESUMO

Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.


Assuntos
Medicina de Emergência Pediátrica , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia de Intervenção , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Artrocentese/métodos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Criança , Drenagem/métodos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Articulação do Quadril/diagnóstico por imagem , Humanos , Intubação Intratraqueal/métodos , Bloqueio Nervoso/métodos , Paracentese/métodos , Nervos Periféricos/diagnóstico por imagem , Abscesso Peritonsilar/diagnóstico por imagem , Abscesso Peritonsilar/terapia , Punção Espinal/métodos
5.
Medicine (Baltimore) ; 100(23): e26074, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114991

RESUMO

ABSTRACT: To compare the clinical effect of Bulldog clamps with traditional Pringle for vascular occlusion during laparoscopic hepatectomy.One hundred ten patients were retrospectively investigated in this research from December 2014 to January 2019 in the second hospital of Anhui Medical University, who underwent laparoscopic liver resection using Bulldog (modified group, n = 54) and cotton tourniquet (traditional group, n = 56) for blocking the liver inflow-blood. Intraoperative blood loss, duration of the operation time, clamping time, postoperative outcomes were analyzed.All the operations were accomplished successfully without conversion to laparotomy, perioperative period clinical date was calculated. Intraoperative operative time, blood loss and resection sections had no statistical significance, but the clamping time (36.2 ±â€Š5.6 vs 277.3 ±â€Š88.4 s, P < .001) was significantly shorter in the bulldog group. Albumin, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin had no statistical differences in postoperative day (POD) 1and 3, but POD 5 alanine aminotransferase (71.0 ±â€Š46.8vs 105.8 ±â€Š61.7IU/L P = .018) and aspartate aminotransferase (72.8 ±â€Š39.7 vs 100.2 ±â€Š16.7 IU/L P = .028). The postoperative hospital stays (7.02 ±â€Š1.56 vs 8.50 ±â€Š2.35 days P = .026) in bulldog group were lower than cotton group and differences had statistical significance. The C-reactive protein levels were significantly higher in the traditional group than in the modified group on POD 3 (46.3 ±â€Š19.2 vs 57.7 ±â€Š23.9 mg/L P = .019), and POD5 (13.3 ±â€Š4.2 vs 17.5 ±â€Š7.3 mg/L P = .001). There were 8 postoperative complications occurred in cotton group, while there was 5 in Bulldog group, all patients with complications were discharged after adequate drainage and symptomatic treatment.Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle maneuver.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Carcinoma Hepatocelular , Hepatectomia , Laparoscopia , Neoplasias Hepáticas , Complicações Pós-Operatórias , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , China/epidemiologia , Constrição , Drenagem/métodos , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/instrumentação , Hepatectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Testes de Função Hepática/métodos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Torniquetes
6.
Am J Gastroenterol ; 116(7): 1381-1386, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183576

RESUMO

Spontaneous pancreatic fistula (PF) is a rare but challenging complication of acute pancreatitis (AP). The fistulae could be internal (draining into another viscera or cavity, e.g., pancreaticocolonic, gastric, duodenal, jejunal, ileal, pleural, or bronchial) or external (draining to skin, i.e., pancreaticocutaneous). Internal fistulae constitute the majority of PF and will be discussed in this review. Male sex, alcohol abuse, severe AP, and infected necrosis are the major risk factors for development of internal PF. A high index of suspicion is required to diagnose PF. Broad availability of computed tomography makes it the initial test of choice. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography have higher sensitivity compared with computed tomography scan and also allow for assessment of pancreatic duct for leak or disconnection, which affects treatment approaches. Certain complications of PF including hemorrhage and sepsis could be life-threatening and require urgent intervention. In nonurgent/chronic cases, management of internal PF involves control of sepsis, which requires effective drainage of any residual pancreatic collection/necrosis, sometimes by enlarging the fistula. Decreasing fistula output with somatostatin analogs (in pancreaticopleural fistula) and decreasing intraductal pressure with endoscopic retrograde cholangiopancreatography or endoscopic ultrasound/interventional radiology-guided interventions or surgery are commonly used strategies for management of PF. More than 60% of the internal PF close with medical and nonsurgical interventions. Colonic fistula, medical refractory-PF, or PF associated with disconnected pancreatic duct can require surgical intervention including bowel resection or distal pancreatectomy. In conclusion, AP-induced spontaneous internal PF is a complex complication requiring multidisciplinary care for successful management.


Assuntos
Fístula Pancreática/diagnóstico , Fístula Pancreática/terapia , Alcoolismo/epidemiologia , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Drenagem/métodos , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Pancreatite/complicações , Fatores de Risco , Sepse/etiologia , Sepse/terapia , Índice de Gravidade de Doença , Fatores Sexuais , Somatostatina/análogos & derivados , Tomografia Computadorizada por Raios X
8.
Medicine (Baltimore) ; 100(25): e25912, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160380

RESUMO

ABSTRACT: The incidence of granulomatous mastitis (GLM) in multiparae as seriously affected the quality of life and breastfeeding of pregnant women after delivery, but the treatment is rarely reported. In this article, the development, healing, and lactation of 13 cases were reported and a retrospective analysis was performed. 10 cases of GLM were treated at the Breast Disease Prevention and Treatment Center of Haidian Maternal & Child Health Hospital of Beijing and 3 cases of GLM were treated in the Breast Department of Weihai Municipal Hospital of Shandong province from February 2017 to May 2019.Among the 13 patients, conservative symptomatic treatment was adopted during pregnancy and lactation: anti-infective therapy consisting of oral cephalosporin antibiotic for patients; ultrasound-guided puncture and drainage of pus or incision and drainage after abscess formation. Observation continued during the sinus tract phase. Postpartum breastfeeding was encouraged, especially on the affected side. In this study, the median healing time was 20 months and the average healing time was 30.4 months in 5 healthy breast lactation cases. In 8 cases of bilateral breast lactation, the median healing time was 30 months and the average healing time was 26.5 months. Linear regression test analysis: whether the affected breast was breast-fed after delivery had no effect on the postpartum wound healing time, P = .792. The wounds of 13 patients healed well after lactation, and none of them recurred since the last follow-up visit. There were no adverse events in all infants.Conservative symptomatic treatment for GLM of multiparous women during pregnancy and lactation and encouraging breastfeeding after delivery have no effect on infant health and the recovery time of patients.


Assuntos
Antibacterianos/administração & dosagem , Tratamento Conservador/métodos , Drenagem/métodos , Mastite Granulomatosa/terapia , Complicações na Gravidez/terapia , Administração Oral , Adulto , Mama/diagnóstico por imagem , Mama/cirurgia , Aleitamento Materno , Cefalosporinas/administração & dosagem , Feminino , Seguimentos , Idade Gestacional , Mastite Granulomatosa/diagnóstico , Mastite Granulomatosa/epidemiologia , Mastite Granulomatosa/fisiopatologia , Humanos , Lactente , Recém-Nascido , Lactação/fisiologia , Paridade/fisiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
9.
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
10.
Pan Afr Med J ; 38: 274, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122701

RESUMO

Spontaneous hemopneumothorax is a rare encountered entity in clinical practice. It can be life threatening, so a prompt diagnosis and therapeutic intervention are required. We report a case of a right spontaneous hemopneumothorax in a 31-year-old man, complicated with hemorrhagic shock. Conservative therapy with only thoracic drainage with close monitoring of outflow and hemodynamic parameters was performed. In front of hemodynamic instability, an emergency video-assisted thoracoscopic surgery was performed. An apical bulla adhering to the parietal pleura has been identified as the source of the bleeding. The resection of the bullae and electrocauterization of the bleeding adhesion were effectuated. The hemostasis was easily achieved. The actual experience suggests that video-assisted thoracoscopic surgery should be performed as soon as possible after the diagnosis of spontaneous hemopneumothorax. Indeed, conservative therapy with chest drainage should only be performed as bridge to recovery for the stabilization before the video-assisted thoracoscopic surgery.


Assuntos
Hemopneumotórax/terapia , Choque Hemorrágico/terapia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Drenagem/métodos , Eletrocoagulação/métodos , Hemopneumotórax/diagnóstico , Humanos , Masculino , Choque Hemorrágico/diagnóstico , Tunísia
11.
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
12.
J Ayub Med Coll Abbottabad ; 33(2): 226-230, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137534

RESUMO

BACKGROUND: Although conservative treatment has shown a good reduction in mortality and morbidity the majority of patients still need definitive surgery to get rid of the disease completely. It is of note that immediate laparotomy in high-risk patients who have a prolonged history or have multiple comorbidities or in organ failure is not advisable as it is associated with higher morbidity and mortality, besides improved postoperative intensive care. METHODS: We categorized these high-risk patients based on their comorbidities and then performed percutaneous peritoneal lavage to reduce the septic load from the peritoneal cavity before performing the definite procedure. RESULTS: Out of the high-risk patients who survived after the PPD and underwent definitive surgery, 61% survived (n=8/13) while the rest of these, 38.5% expired (n=5). CONCLUSION: Percutaneous peritoneal drainage initially instituted in high-risk patients to optimize their pre-op condition significantly, improves the outcome and has better results than to operate on such patients straightaway.


Assuntos
Drenagem/métodos , Peritonite/terapia , Adulto , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Paquistão , Lavagem Peritoneal , Centros de Atenção Terciária
14.
Pan Afr Med J ; 38: 195, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33995801

RESUMO

Introduction: the treatment of large biliocystic fistulas is not unanimous among authors in the absence of consensus or a high level of evidence. There is a controversy over the use of a radical approach which allows the fistula to be sutured in a healthy area or conservative treatment that poses repair issues. The purpose of this study is to compare different conservative techniques to treat large biliocystic fistulas. Methods: we conducted a retrospective study of 54 patients with large fistulas in the Department of General Surgery at the Habib Bourguiba University Hospital in Sfax over a period of 9 years (2010 - 2018). Results: fourty-four patients were enrolled in the study. Abdominal ultrasound suggested opening of the bile ducts in 18 cases (47.4%) while computed tomography (CT) scan suggested opening in 28 patients (68.3%). The treatment of fistulas was based on DITFO (internal trans-fistulary drainage) in 18 cases (33.3%), cystobiliary disconnection (PERDROMO) in 11 cases (20.4%) and bipolar drainage in 25 cases. Specific surgical morbidity rate was 31.5% and it was dominated by postoperative biliary fistula in 18.5% of cases. DITFO technique was associated with shorter hospital stay (p=0.028) and lower morbidity rates (22.2%) with no statistically significant difference. Conclusion: DITFO technique is the gold standard technique in the treatment of biliocystic fistula because it is associated with lower morbidity rates and the shortest hospital stay.


Assuntos
Fístula Biliar/terapia , Drenagem/métodos , Equinococose Hepática/cirurgia , Adolescente , Adulto , Idoso , Fístula Biliar/diagnóstico por imagem , Tratamento Conservador , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto Jovem
15.
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
16.
AJR Am J Roentgenol ; 217(2): 404-410, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34036810

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of percutaneous drainage of peripancreatic fluid collections after pancreas transplant and to determine factors predicting a successful clinical outcome. MATERIALS AND METHODS. This single-center retrospective study included 28 patients who underwent percutaneous drainage for peripancreatic collections after transplant between January 2008 and December 2018. Clinical success was defined as drainage resulting in resolution of symptoms. Primary clinical success was defined as symptom resolution after the initial drainage procedure, and secondary success was defined as symptom resolution after additional drainage procedures. Operative intervention or death was considered clinical failure. Patient, collection, and procedural factors were assessed for their potential impact on the clinical outcome. RESULTS. Clinical success was achieved in 23 of 28 drainage procedures (82.1%), with primary success in 15 procedures. Of the five patients with failed drainage procedures, three required pancreatectomies, one required surgical washout, and one died from a disseminated infection. The median duration of drainage in the clinical success group was 25 days (range, 3-136 days), and patients with longer drainage periods had more successful outcomes (p = .04). Graft pancreatitis was diagnosed in five patients (17.9%) and was not associated with drainage outcome (p = .21). Collections were positive for bacterial growth in 13 patients (46.4%) and were high in amylase in 12 (42.9%). We observed drainage failure in collections with polymicrobial growth and in the presence of fistulas (p = .05 and p = .07, respectively). Patients with successful outcomes had smaller collection volumes (p = .045). No complications attributed to drainage were encountered. CONCLUSION. Percutaneous drainage is safe and effective for management of peripancreatic fluid collections after pancreas transplant.


Assuntos
Líquidos Corporais , Drenagem/métodos , Transplante de Pâncreas , Complicações Pós-Operatórias/terapia , Adulto , Feminino , Humanos , Masculino , Pâncreas/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
17.
BMC Infect Dis ; 21(1): 493, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044785

RESUMO

INTRODUCTION: Cronobacter sakazakii is an opportunistic Gram-negative, rod-shaped bacterium which may be a causative agent of meningitis in premature infants and enterocolitis and bacteremia in neonates and adults. While there have been multiple cases of C. sakazakii infections, there have been no acute cholangitis cases reported in humans. CASE PRESENTATION: An 81-year-old male with a past medical history of basal cell carcinoma, alcoholic liver cirrhosis, transjugular intrahepatic portosystemic shunt procedure, complicated by staphylococcus bacteremia, pituitary tumor, glaucoma, and hypothyroidism presented to the emergency room with the complaint of diffuse and generalized 10/10 abdominal pain of 1 day's duration. There was a concern for pancreatitis, acute cholangitis, and possible cholecystitis, and the patient underwent a percutaneous cholecystostomy tube placement. Blood cultures from admission and biliary fluid cultures both grew C. sakazakii. The patient was treated with a carbapenem and clinically improved. CONCLUSIONS: The case study described a patient with multiple medical comorbidities that presented with C. sakazakii bacteremia and cholangitis. While this bacterium has been implicated in other infections, we believe this is the first time the bacteria is being documented to have caused acute cholangitis.


Assuntos
Bacteriemia/diagnóstico , Colangite/diagnóstico , Cronobacter sakazakii/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/terapia , Carbapenêmicos/uso terapêutico , Colangite/microbiologia , Colangite/terapia , Colecistostomia/métodos , Cronobacter sakazakii/patogenicidade , Drenagem/métodos , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/terapia , Humanos , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/terapia , Reação em Cadeia da Polimerase/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 100(20): e25828, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011047

RESUMO

OBJECTIVE: The aim of this study was to determine the best thickness of corneal slices acquired from femtosecond laser surgery-small incision lenticule extraction (SMILE surgery) as patch graft in glaucoma drainage implantation surgery. METHODS: This study is a prospective randomized study. Patients who received glaucoma drainage implantation from September 2016 to November 2018 were observed. The patients were randomly divided into 3 groups. Group A included 102 cases (104 eyes), receiving 1 layer (120-150 µm) of allogeneic lamellar corneal tissue as the graft. Group B included 117 cases (120 eyes), receiving 2 layers of lamellar corneal tissue from one donor. Group C included 109 cases (111 eyes), using 3 layers of lamellar corneal tissue from 2 donors. The intraocular pressure, corneal graft, conjunctiva stromalysis, drainage tube exposure, and drainage plate were observed. RESULTS: Patients were followed up for 6 to 33 months. The intraocular pressure was significantly reduced after surgery in all three groups. Conjunctiva stromalysis and drainage tubes were exposed in 3 eyes (3%) in group A and 1 eye (0.8%, a special case which has nystagmus and the plate was placed infratemporally) in group B, whereas no conjunctiva stromalysis or tube exposure was reported in group C. CONCLUSIONS: The corneal graft acquired from SMILE surgery can effectively prevent drainage tube exposure and give patients a better cosmetic appearance. Two layers of lamellar corneal tissue (240-300 µm) may be the best suitable thickness because it can effectively reduce tube exposure and rejection. In some special cases, 3 layers of lamellar corneal tissue are needed.


Assuntos
Transplante de Córnea/métodos , Drenagem/métodos , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Transplante de Córnea/instrumentação , Drenagem/instrumentação , Estudos de Viabilidade , Feminino , Seguimentos , Glaucoma/diagnóstico , Glaucoma/etiologia , Humanos , Lactente , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tonometria Ocular , Resultado do Tratamento , Adulto Jovem
19.
Am J Gastroenterol ; 116(4): 666-668, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33982932

RESUMO

Nearly 25 years after its initial description, endoscopic therapy of walled-off pancreatic necrosis has become widely accepted. Endoscopic therapy is composed of transmural placement of stents, now most commonly lumen-apposing metal stents and removal of solid debris, if needed. Removal of solid debris can be achieved with irrigation provided by percutaneously or endoscopically placed (nasocystic) tubes or by mechanically through direct necrosectomy. This editorial provides commentary on the use of hydrogen peroxide instilled at the time of direct necrosectomy for treatment of walled-off pancreatic necrosis.


Assuntos
Drenagem/métodos , Endoscopia do Sistema Digestório/métodos , Peróxido de Hidrogênio/uso terapêutico , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/terapia , Anti-Infecciosos Locais/uso terapêutico , Endossonografia , Humanos , Período Intraoperatório , Pancreatite Necrosante Aguda/diagnóstico
20.
Am J Gastroenterol ; 116(4): 700-709, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33982939

RESUMO

INTRODUCTION: Endoscopic necrosectomy has emerged as the preferred treatment modality for walled-off pancreatic necrosis. This study was designed to evaluate the safety and efficacy of direct endoscopic necrosectomy with and without hydrogen peroxide (H2O2) lavage. METHODS: Retrospective chart reviews were performed for all patients undergoing endoscopic transmural management of walled-off pancreatic necrosis at 9 major medical centers from November 2011 to August 2018. Clinical success was defined as the resolution of the collection by imaging within 6 months, without requiring non-endoscopic procedures or surgery. RESULTS: Of 293 patients, 204 met the inclusion criteria. Technical and clinical success rates were 100% (204/204) and 81% (166/189), respectively. For patients, 122 (59.8%) patients had at least one H2O2 necrosectomy (H2O2 group) and 82 (40.2%) patients had standard endoscopic necrosectomy. Clinical success was higher in the H2O2 group: 106/113 (93.8%) vs 60/76 (78.9%), P = 0.002. On a multivariate analysis, the use of H2O2 was associated with higher clinical success rate (odds ratio 3.30, P = 0.033) and earlier resolution (odds ratio 2.27, P < 0.001). During a mean follow-up of 274 days, 27 complications occurred. Comparing procedures performed with and without H2O2 (n = 250 vs 183), there was no difference in post-procedure bleeding (7 vs 9, P = 0.25), perforation (2 vs 3, P = 0.66), infection (1 vs 2, P = 0.58), or overall complication rate (n = 13 [5.2%] vs 14 [7.7%], P = 0.30). DISCUSSION: H2O2-assisted endoscopic necrosectomy had a higher clinical success rate and a shorter time to resolution with equivalent complication rates relative to standard necrosectomy.See the visual abstract at http://links.lww.com/AJG/B714.(Equation is included in full-text article.).


Assuntos
Endoscopia do Sistema Digestório/métodos , Peróxido de Hidrogênio/uso terapêutico , Pancreatite Necrosante Aguda/terapia , Anti-Infecciosos Locais/uso terapêutico , Drenagem/métodos , Endossonografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico , Estudos Retrospectivos
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