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1.
Ann R Coll Surg Engl ; 102(4): 263-270, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31909638

RESUMO

INTRODUCTION: The aim of this study was to study radiological assessment, management and outcome of traumatic splenic injury over 15 years in a UK district general hospital. METHOD: A retrospective database was established including all splenic injury cases from June 2002 to June 2017 by searching the clinical electronic database. We searched the radiological database for computed tomography reported phrases 'spleen injury', 'laceration', 'haematoma', 'trauma'. We interrogated theatre records for operations coded as splenectomy and cross-referenced this with pathology. Records were reviewed for demographics, vital observations, documentation of American Association for the Surgery of Trauma (AAST) grading of splenic injury, subsequent management and outcomes. RESULTS: There were 126 patients identified with traumatic splenic injury, with male to female ratio three to one. Operative management was undertaken in 54/126 (43%) patients and selective non-operative management in the remaining. Splenic artery embolisation was undertaken in 5/126 (4%) and 2/126 underwent splenorrhaphy. Computed tomography was undertaken in 109/126 (87%) patients and AAST grading was reported in 18 (17%) patients. AAST grade reporting did not improve significantly when comparing the first 7.5 years with the latter (2/30, 7%; 16/79, 20%), respectively; p = 0.09). Selective non-operative management increased significantly over the studied period (14/34, 42%; 58/93, 62%; p = 0.04). The overall hospital mortality was 10.3%. DISCUSSION AND CONCLUSION: AAST grade reporting of splenic injury has remained sub-optimal over 15 years. Despite progression towards selective non-operative management, operative intervention remained unacceptably high, with splenectomy being the main therapeutic modality. Standardisation through an integrated multidisciplinary diagnostic and management pathway offers the optimal strategy to reduce trauma-induced splenectomy.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Embolização Terapêutica/estatística & dados numéricos , Baço/lesões , Esplenectomia/estatística & dados numéricos , Esplenopatias/terapia , Técnicas de Sutura/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Mortalidade Hospitalar , Hospitais Gerais/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Baço/irrigação sanguínea , Baço/diagnóstico por imagem , Baço/cirurgia , Esplenectomia/normas , Artéria Esplênica , Esplenopatias/diagnóstico , Esplenopatias/etiologia , Esplenopatias/mortalidade , Tomografia Computadorizada por Raios X , Reino Unido , Adulto Jovem
2.
Urology ; 135: 82-87, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31618658

RESUMO

OBJECTIVE: To assess long-term outcome after selective arterial embolization (SAE) as first-line treatment for large or symptomatic AML. DESIGN, SETTING, AND PARTICIPANTS: Data from a prospectively maintained database on 71 patients who underwent SAE for large or symptomatic AML were reviewed. Patients with sporadic and tuberous-sclerosis-complex (TSC) were included. OUTCOME MEASUREMENTS: The main endpoints were re-embolization rates, occurrence of clinical events related to AML, size of AML, and renal function. RESULTS: Thirteen (19.1%) patients reported at least 1 major clinical event. Major complications affected 2 patients (2.9%), both ending in complete loss of renal unit function. Four renal units (5.9%) were eventually treated surgically. The re-embolization rate was 41.1%, with an average time from the initial to a repeat SAE of 2.18 years (range 0.31-10.65 years). The size of the tumor prior to SAE and after 5 and 10 years of follow-up were 8.9 cm (7-12), 6.5 cm (4-7.5), 7 cm (4-7.8), respectively [median (IQR)]. These results are translated to a size reduction of 27% in 10 years follow-up. Patients with TSC had larger tumors on long-term follow-up (77.8 vs 41.3 mm, P = .045). The long-term follow-up estimated average glomerular filtration rate was 81.97 (range 26-196). No patient needed renal replacement therapy, and disease-specific survival was 100%. CONCLUSIONS: SAE is a safe treatment option for patients with symptomatic or large AML. It represents a minimally invasive intervention with good long-term outcome. SAE may be offered as first-line treatment in most cases, though, it is associated with high retreatment rates.


Assuntos
Angiomiolipoma/terapia , Embolização Terapêutica/efeitos adversos , Neoplasias Renais/terapia , Complicações Pós-Operatórias/epidemiologia , Esclerose Tuberosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiomiolipoma/etiologia , Angiomiolipoma/mortalidade , Embolização Terapêutica/métodos , Embolização Terapêutica/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Neoplasias Renais/etiologia , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Esclerose Tuberosa/complicações , Esclerose Tuberosa/mortalidade , Adulto Jovem
3.
Int J Radiat Oncol Biol Phys ; 105(5): 968-976, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31536781

RESUMO

PURPOSE: With increasing use of radiation for hepatocellular carcinoma (HCC) through transarterial radioembolization (TARE) and stereotactic body radiation therapy (SBRT), there is concern for increased radiation-related complications when using SBRT after TARE. This study compares safety of SBRT after segmental TARE versus transarterial chemoembolization (TACE). METHODS AND MATERIALS: A retrospective review identified patients receiving SBRT after TACE or TARE for HCC from 2011 to 2017. TARE was delivered subselectively to individual segments using yttrium-90 with Theraspheres. Patients were assessed over time for Child-Turcott-Pugh (CTP)/albumin-bilirubin (ALBI) scores, and Common Terminology Criteria for Adverse Events version 4.0 grade ≥3 events. Linear mixed models were used to examine the trend of CTP and ALBI over time and compare groups. Secondary endpoints were objective response rate via modified Response Evaluation Criteria in Solid Tumors (RECIST), local control, and overall survival. RESULTS: Ninety-nine patients met criteria with median follow-up of 9.8 months (range, 0.9-47): 31 had SBRT after segmental TARE and 68 patients post-TACE. The groups were well balanced with regard to etiology of HCC, baseline CTP and ALBI scores, and SBRT dose, but there were significant differences in baseline Eastern Cooperative Oncology Group performance status, Barcelona Clinic Liver Cancer staging, and median follow-up. There was a significant increase in post-SBRT CTP and ALBI scores (P < .0001) for both groups. However, there was no significant difference in rise in CTP (P = .11) or ALBI score (P = .82) over time between SBRT post-TACE versus post-segmental TARE. There was no significant increase in ≥grade 3 toxicity postsegmental TARE. There was also no significant difference in local controls (P = 1.0) and overall survival (P = .26) between cohorts, but objective response rate was worse post-TARE. CONCLUSIONS: SBRT after segmental TARE with Theraspheres appears to have acceptable tolerability and is effective compared with SBRT after TACE. Longer follow-up with larger numbers is needed to verify these data.


Assuntos
Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Radiocirurgia/efeitos adversos , Radioisótopos de Ítrio/uso terapêutico , Albuminas/análise , Bilirrubina/análise , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/métodos , Quimioembolização Terapêutica/estatística & dados numéricos , Terapia Combinada/métodos , Fracionamento da Dose de Radiação , Embolização Terapêutica/estatística & dados numéricos , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Órgãos em Risco , Prognóstico , Radiocirurgia/estatística & dados numéricos , Critérios de Avaliação de Resposta em Tumores Sólidos , Segurança , Resultado do Tratamento
4.
Cir Pediatr ; 32(2): 93-98, 2019 Apr 22.
Artigo em Espanhol | MEDLINE | ID: mdl-31056870

RESUMO

OBJECTIVES: To present our experience of 23 years in the treatment of varicocele by embolization in pediatric age. MATERIAL AND METHODS: Observational descriptive study of all patients with varicocele treated by embolization after phlebography, by indication of the pediatric surgery service between 1995 and 2017. We performed descriptive statistical analysis and comparison between pain and testicular asymmetry before and after treatment (SPSSv22). RESULTS: Embolization was performed in 113 patients with left varicocele. The mean age of diagnosis was 12.4 years (5.2-15.5). The main clinical manifestations were: incidental finding (46.7%), increase in scrotal volume (28%) and testicular pain (15.9%). 61.5% were grade 3 and 38.5% grade 2. The selective embolization procedure was performed at an average age of 13.6 years (8-18). There were no serious complications of the procedure or reactive hydrocele. The overall success rate of endovascular treatment was 93.8%. In 85 patients (75.2%) a single procedure was performed and in 21, two procedures (18.6%). Only 4 patients required surgical intervention. The pain disappeared in all cases in which it presented and the testicular asymmetry decreased from 44.7% pre-treatment to 21.2% post-treatment (p<0.05). CONCLUSIONS: Endovascular treatment through embolization allows a selective varicocele management, after venous mapping, with an adequate effectiveness, without altering the arterial flow of the testicle or producing hydrocele. It is a minimally invasive treatment that could be considered the first choice in varicoceles of children and adolescents.


Assuntos
Embolização Terapêutica/métodos , Varicocele/terapia , Adolescente , Criança , Pré-Escolar , Embolização Terapêutica/estatística & dados numéricos , Humanos , Masculino , Dor/etiologia , Escroto/patologia , Doenças Testiculares/etiologia , Fatores de Tempo
5.
Eur Radiol ; 29(11): 5772-5783, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31076864

RESUMO

OBJECTIVES: To reappraise the rate of and risk factors for complications of targeted and non-targeted US-guided liver biopsy in a large series. METHODS: We analyzed 2405 liver biopsies performed in 2137 patients (58% males, mean age 54 ± 15 years old) between January 2010 and December 2015. Biopsies were performed for focal liver lesions characterization (targeted) or chronic liver disease assessment (non-targeted). Clinical, laboratory, and technical data were recorded. For targeted biopsies, we also recorded the largest diameter, location, enhancement pattern, and pathology. Advert events were divided into marked symptoms and complications. Those requiring specific treatment (embolization or surgery) were considered as severe. RESULTS: A total of 1283 (53%) targeted and 1122 (47%) non-targeted biopsies were performed. Marked symptoms occurred after 134 biopsies (5.6%) (95 (7.4%) targeted and 39 (3.5%) non-targeted, p < 0.001), the most common being pain (109/134). Complications occurred after 38 biopsies (1.6%) (24 (1.9%) targeted and 14 (1.2%) non-targeted, p = 0.253) and were severe in 13 patients. In univariate analysis, prothrombin time (p = 0.006), serum creatinine level (p < 0.001), largest lesion diameter (p < 0.001), and tumor pathology (p = 0.040) were associated with the occurrence of complications but not platelet count or lesion enhancement pattern. In multivariate analysis, only the largest lesion diameter was retained (OR 1.014 [1.002-1.026], p = 0.018). CONCLUSION: The rate of advert events after US-guided liver biopsy was low, with no difference between targeted and non-targeted biopsies. When focusing on targeted biopsies, the largest lesion diameter but not enhancement pattern appeared as the main risk factor. KEY POINTS: • Targeted and non-targeted liver biopsies are associated with the same observed risk of complication. • Arterial phase hyperenhanced tumors on contrast-enhanced CT or MRI are not associated with a higher risk of complication when compared with non-hyperenhanced ones. • A high serum creatinine level is associated with a higher risk of complication and should motivate strict post-biopsy surveillance.


Assuntos
Hepatopatias/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Doença Crônica , Embolização Terapêutica/estatística & dados numéricos , Feminino , Hepatectomia/estatística & dados numéricos , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Hepatopatias/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Tempo de Protrombina , Fatores de Risco , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos , Adulto Jovem
6.
World Neurosurg ; 122: e516-e529, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108070

RESUMO

BACKGROUND: We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular expertise. METHODS: From January 2005 to December 2011, 1297 consecutive patients presenting with ruptured (n=829) or unruptured (n=468) aneurysms were prospectively enrolled in our vascular database. The treatment modality was determined by consensus of the endovascular and microsurgical teams. The patients' medical and neurological conditions and aneurysm characteristics were compared against the postintervention complication rates and outcomes using multivariate analyses. RESULTS: The patients mostly underwent clipping for ruptured (63.7%) or unruptured (56.6%) aneurysms. For ruptured aneurysms, higher Hunt and Hess and Fisher grades on admission were key predictors of increased neurological (P < 0.001 and P < 0.001, respectively) and medical (P < 0.001 and P=0.041, respectively) complication rates. No significant differences in the outcomes were observed between the coiling or clipping groups during the follow-up period. For the unruptured group, a family history of intracranial aneurysms was the most relevant predictor for reducing neurological complication rates and increasing survival at 6 months. Hypertension was, however, the strongest factor associated with complications negatively affecting the outcomes. CONCLUSIONS: For the ruptured and unruptured groups both, the outcomes were generally good, although neurological and medical complications were reasonably more frequent for the ruptured aneurysms. Coiling provided a sustained benefit in lowering the complication rates only in the short term for the unruptured aneurysms. Smoking was associated, paradoxically, with improved outcomes.


Assuntos
Aneurisma Roto/cirurgia , Procedimentos Endovasculares/estatística & dados numéricos , Aneurisma Intracraniano/cirurgia , Microcirurgia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/estatística & dados numéricos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Hidrocefalia/etiologia , Hipertensão , Masculino , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia , Adulto Jovem
7.
Cir. Esp. (Ed. impr.) ; 97(5): 261-267, mayo 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-187272

RESUMO

Introducción: El tratamiento de las fracturas de pelvis con hematoma retroperitoneal (HRP) es controvertido. Especialmente la necesidad de angioembolización (AE) cuando no hay extravasación de contraste (EC) en la tomografía computarizada (TC) o angiografía. Otro aspecto relevante es el retraso hasta la misma. Nuestro objetivo ha sido determinar si existen diferencias en el tiempo hasta la AE entre los pacientes admitidos durante el horario laboral y los admitidos fuera del mismo y durante los fines de semana y festivos. Nuestra hipótesis era que la angiografía y AE serían más frecuentes en el horario laboral, y el tiempo hasta las mismas sería superior fuera del horario laboral habitual, con una mortalidad mayor en este grupo para una gravedad global similar. Un objetivo secundario ha sido valorar la correlación entre EC en la TC y la angiografía. Métodos: Análisis retrospectivo de 2 cohortes de pacientes con HRP por fractura de pelvis. Se estudia la realización de angiografía dividiendo a los pacientes según su hora de llegada a lo largo de un periodo de 24 años (grupo A: horario laboral, y grupo B: fuera del mismo). La indicación de angiografía y AE fue realizada por la guardia de cirugía general, en consenso con el radiólogo intervencionista. Se han analizado variables demográficas, mecanismo lesivo, lesiones asociadas, gravedad fisiológica y anatómica, EC en la TC y la angiografía, necesidad de AE, estancia en unidad de cuidados intensivos (UCI) y mortalidad. Resultados: Se admitió a 104 pacientes con diagnóstico de HRP por fractura pélvica. Se realizó angiografía, con AE en 63 casos (61%). Los grupos eran comparables en las variables analizadas. En el 70% de los pacientes del grupo A se realizó angiografía, frente al 57% del grupo B, sin diferencias en tiempo hasta la AE. Se demostró EC en la TC en 53 de los 96 pacientes en los que se hizo, lo que se confirmó mediante angiografía en el 85%. No hubo diferencias estadísticamente significativas de mortalidad entre ambos grupos. Conclusiones: Se demuestra un tiempo corto entre la admisión en Urgencias y la AE, sin relación con el momento del ingreso durante el día, y una buena correlación entre la EC en la TC y la angiografía


Introduction: Two areas of controversy in the management of bleeding pelvic fractures are the need to perform angioembolization (AE) in patients with a retroperitoneal hematoma (RPH) but no contrast extravasation (CE) on Computerized Tomography (CT) and/or angiography, and the delay to AE. Our main objective was to assess whether there had been differences in the percentage and delay to AE between patients admitted on weekdays versus off-hours (weekends and admission after 3pm) at our hospital. Our hypothesis was that angiography and AE would be more frequent on weekdays, and the time delay would be longer during off-hours, with a higher mortality in this latter group for a similar overall severity. A secondary objective was to assess the correlation between CE on CT scan and angiography. Methods: Retrospective review of two cohorts of patients with RPH from a pelvic fracture during a period of 24 years. Patients were divided depending on the time of arrival (Group A: weekdays, and Group B: off-hours). The decision to perform angiography and AE was made by the general surgeons on call, in consensus with the interventional radiologist. We analyzed demographics, mechanism of injury, associated injuries, physiologic and anatomic trauma scores, CE on CT scan, need of AE, Intensive Care Unit (ICU) stay and mortality. Results: 104 patients were admitted with RPH from a pelvic fracture. We performed AE in 63 cases (61%). The groups were comparable in the variables analyzed. In 70% of patients in group A, angiography was done, vs 57% in group B, with the same median time delay. CE on CT scan was seen in 53 out of 96 patients and confirmed by angiography in 45 (85%) of them. No significant differences were found in mortality between the two groups. Conclusions: There was a short delay from admission to AE, even during off-hours, and a good correlation of CE on CT scan and angiography


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/normas , Fraturas Ósseas/complicações , Hematoma/etiologia , Ossos Pélvicos/lesões , Embolização Terapêutica/estatística & dados numéricos , Hematoma/diagnóstico por imagem , Hematoma/terapia , Estudos Retrospectivos , Espaço Retroperitoneal/diagnóstico por imagem , Angiografia , Plantão Médico/estatística & dados numéricos , Plantão Médico/normas
8.
Radiology ; 291(3): 792-800, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30938624

RESUMO

Background Bariatric embolization is a new endovascular procedure to treat patients with obesity. However, the safety and efficacy of bariatric embolization are unknown. Purpose To evaluate the safety and efficacy of bariatric embolization in severely obese adults at up to 12 months after the procedure. Materials and Methods For this prospective study (NCT0216512 on ClinicalTrials.gov ), 20 participants (16 women) aged 27-68 years (mean ± standard deviation, 44 years ± 11) with mean body mass index of 45 ± 4.1 were enrolled at two institutions from June 2014 to February 2018. Transarterial embolization of the gastric fundus was performed using 300- to 500-µm embolic microspheres. Primary end points were 30-day adverse events and weight loss at up to 12 months. Secondary end points at up to 12 months included technical feasibility, health-related quality of life (Short Form-36 Health Survey ([SF-36]), impact of weight on quality of life (IWQOL-Lite), and hunger or appetite using a visual assessment scale. Analysis of outcomes was performed by using one-sample t tests and other exploratory statistics. Results Bariatric embolization was performed successfully for all participants with no major adverse events. Eight participants had a total of 11 minor adverse events. Mean excess weight loss was 8.2% (95% confidence interval [CI]: 6.3%, 10%; P < .001) at 1 month, 11.5% (95% CI: 8.7%, 14%; P < .001) at 3 months, 12.8% (95% CI: 8.3%, 17%; P < .001) at 6 months, and 11.5% (95% CI: 6.8%, 16%; P < .001) at 12 months. From baseline to 12 months, mean SF-36 scores increased (mental component summary, from 46 ± 11 to 50 ± 10, P = .44; physical component summary, from 46 ± 8.0 to 50 ± 9.3, P = .15) and mean IWQOL-Lite scores increased from 57 ± 18 to 77 ± 18 (P < .001). Hunger or appetite decreased for 4 weeks after embolization and increased thereafter, without reaching pre-embolization levels. Conclusion Bariatric embolization is well tolerated in severely obese adults, inducing appetite suppression and weight loss for up to 12 months. Published under a CC BY-NC-ND 4.0 license. Online supplemental material is available for this article.


Assuntos
Cirurgia Bariátrica , Embolização Terapêutica , Obesidade/cirurgia , Adulto , Idoso , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Embolização Terapêutica/estatística & dados numéricos , Endoscopia Gastrointestinal , Feminino , Fundo Gástrico/irrigação sanguínea , Fundo Gástrico/diagnóstico por imagem , Fundo Gástrico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Perda de Peso/fisiologia
9.
Cir Esp ; 97(5): 261-267, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30928125

RESUMO

INTRODUCTION: Two areas of controversy in the management of bleeding pelvic fractures are the need to perform angioembolization (AE) in patients with a retroperitoneal hematoma (RPH) but no contrast extravasation (CE) on Computerized Tomography (CT) and/or angiography, and the delay to AE. Our main objective was to assess whether there had been differences in the percentage and delay to AE between patients admitted on weekdays versus off-hours (weekends and admission after 3pm) at our hospital. Our hypothesis was that angiography and AE would be more frequent on weekdays, and the time delay would be longer during off-hours, with a higher mortality in this latter group for a similar overall severity. A secondary objective was to assess the correlation between CE on CT scan and angiography. METHODS: Retrospective review of two cohorts of patients with RPH from a pelvic fracture during a period of 24 years. Patients were divided depending on the time of arrival (Group A: weekdays, and Group B: off-hours). The decision to perform angiography and AE was made by the general surgeons on call, in consensus with the interventional radiologist. We analyzed demographics, mechanism of injury, associated injuries, physiologic and anatomic trauma scores, CE on CT scan, need of AE, Intensive Care Unit (ICU) stay and mortality. RESULTS: 104 patients were admitted with RPH from a pelvic fracture. We performed AE in 63 cases (61%). The groups were comparable in the variables analyzed. In 70% of patients in group A, angiography was done, vs 57% in group B, with the same median time delay. CE on CT scan was seen in 53 out of 96 patients and confirmed by angiography in 45 (85%) of them. No significant differences were found in mortality between the two groups. CONCLUSIONS: There was a short delay from admission to AE, even during off-hours, and a good correlation of CE on CT scan and angiography.


Assuntos
Embolização Terapêutica/normas , Fraturas Ósseas/complicações , Hematoma/etiologia , Ossos Pélvicos/lesões , Espaço Retroperitoneal , Adolescente , Adulto , Plantão Médico/normas , Plantão Médico/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Angiografia , Embolização Terapêutica/estatística & dados numéricos , Feminino , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Eur J Vasc Endovasc Surg ; 57(4): 477-486, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902606

RESUMO

OBJECTIVES: The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. METHODS: This is a systematic review and meta-analysis of 104 observational studies. RESULTS: Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79-2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91-4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5-31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42-14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92-3.82), increasing to 2.71% (95% CI 1.43-5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34-6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62-5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94-16.68) for Shamblin II, and 17.10% (95% CI 14.82-19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45-7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56-13.08) vs. no embolisation (5.82%; 95% CI 2.76-11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). CONCLUSIONS: This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Traumatismos dos Nervos Cranianos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Tumor do Corpo Carotídeo/mortalidade , Tumor do Corpo Carotídeo/terapia , Traumatismos dos Nervos Cranianos/etiologia , Embolização Terapêutica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/classificação , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/mortalidade
11.
Rev. méd. Urug ; 35(1): 66-70, mar. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-982123

RESUMO

La neurofibromatosis orbitotemporal es una enfermedad progresiva que comienza en la infancia y puede generar importantes alteraciones morfológicas y funcionales. Presentamos el caso de un paciente adulto con diagnóstico de neurofibromatosis orbitotemporal gigante, en el cual se realizó un tratamiento mediante embolización preoperatoria y resección quirúrgica con el fin de disminuir el tamaño tumoral.


Orbitotemporal neurofibromatosis is a progressive disease that begins in childhood and may cause important morphological and functional alterations. We present the case of an adult patient with a giant orbitotemporal neurofibromatosis, which was treated by preoperative embolization and a surgical resection to reduce the size of the tumor size.


A neurofibromatose órbito-temporal é uma enfermidade progressiva que começa na infância e pode gerar importantes alterações morfológicas e funcionais. Apresentamos o caso de um paciente adulto com diagnóstico de neurofibromatose órbito-temporal gigante, que foi submetido a tratamento com embolização pré-operatória e ressecção cirúrgica para diminuir o tamanho tumoral.


Assuntos
Humanos , Neurofibromatose 1/cirurgia , Neurofibroma Plexiforme/cirurgia , Embolização Terapêutica/estatística & dados numéricos
12.
Clin Exp Nephrol ; 23(6): 825-833, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30771042

RESUMO

PURPOSE: To assess the safety and effectiveness of transcatheter arterial embolization (TAE) with tris-acryl gelatin microspheres for patients with symptomatic enlarged polycystic liver disease (PCLD). MATERIALS AND METHODS: This prospective study was approved by our hospital's institutional review board and planned for patients with symptoms related to enlarged PCLD, such as distended abdomen, gastrointestinal obstruction and abdominal pain. Hemi-hepatic embolization with tris-acryl gelatin microspheres was performed in the hepatic artery supplying the hepatic lobe that showed the predominant presence of cysts. Each patient underwent an assessment of liver function, a questionnaire survey about symptoms, measurement of the estimated volume of the whole liver before and after TAE, and an assessment of complications associated with TAE. RESULTS: Five patients (four females, one male; mean age 52.6 ± 9.1 years) were treated. All five patients successfully completed TAE. The left lobe was treated in three patients and the right in two. After TAE, post-embolization syndrome and transient elevation of white blood cells, aspartate aminotransferase, and alanine aminotransferase occurred in all patients, but none developed hepatic insufficiency or severe complications. The mean whole liver volume was 7406 ± 2323 mL before TAE, and 6995 ± 2139 mL (95.1 ± 5.2% of the pre-therapeutic value) at 3 months and 6855 ± 2246 mL (93.3 ± 9.7%) at 12 months after TAE. Three of the five patients reported an improvement of clinical symptoms within 12 months after TAE. CONCLUSION: TAE with microspheres can be a safe and effective treatment for symptomatic enlarged PCLD.


Assuntos
Resinas Acrílicas/uso terapêutico , Cistos/terapia , Embolização Terapêutica/estatística & dados numéricos , Gelatina/uso terapêutico , Hepatopatias/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Ann Otol Rhinol Laryngol ; 128(5): 401-405, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30739476

RESUMO

OBJECTIVE: Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution's VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist. To assess financial feasibility, we conducted a cost analysis of our VACs comprised of 2 half-day multidisciplinary physician attended clinics (5 specialists at our main campus and 2 specialists at a satellite clinic) and a half-day nurse practitioner clinic. METHOD: Assessment of net revenue based on net collections for clinic, professional, operative, hospital setting, and facility charges generated during 12 consecutive monthly VACs beginning July 1, 2015. Expense calculations included provider and staff salaries, benefits, supply costs, and clinic leasing costs. RESULTS: There were 469 clinic visits, of which 202 were new patient evaluations. Sixty-eight patients underwent 93 procedures under general anesthesia, including procedures performed by our interventional radiologist, most commonly sclerotherapy or embolization (n = 37), surgical interventions including endoscopy (n = 36), or laser procedures (n = 20). Three patients were admitted. Fifty-seven patients received a new diagnosis different from that for which they were referred. Gross revenue was $1 810 525, and net revenue was 42.5%, or $783 152. Expenses totaled $453 415 for a net positive revenue of $329 737. CONCLUSION: When including direct downstream revenue, particularly from operative procedures, our VAC program operates on a net positive margin, making the program financially feasible.


Assuntos
Instituições de Assistência Ambulatorial/economia , Malformações Vasculares/terapia , Anestesia Geral/estatística & dados numéricos , Custos e Análise de Custo , Embolização Terapêutica/economia , Embolização Terapêutica/estatística & dados numéricos , Endoscopia/economia , Endoscopia/estatística & dados numéricos , Estudos de Viabilidade , Pessoal de Saúde/economia , Humanos , Terapia a Laser/economia , Terapia a Laser/estatística & dados numéricos , América do Norte , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Pediatria , Mecanismo de Reembolso , Estudos Retrospectivos , Salários e Benefícios/economia , Escleroterapia/economia , Escleroterapia/estatística & dados numéricos
14.
World J Surg ; 43(5): 1216-1225, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30610269

RESUMO

BACKGROUND: There have been recommendations for increased non-operative management (NOM) of abdominal trauma in adults. To assess the impact of this trend and changes in the epidemiology of trauma, we examined the management of serious abdominal injuries and mortality, in Victorian major trauma patients 16 years or older, between 2007 and 2016. METHODS: Using data from the population-based Victorian Trauma Registry, characteristics of patients who underwent laparotomy, embolisation, laparotomy and embolisation, or NOM, were compared with the Chi-square test. Poisson regression was used to determine whether the incidence of serious abdominal injury changed over time. Temporal trends in the management of abdominal injury and in-hospital mortality were analysed using, respectively, the Chi-square test for trend, and multivariable logistic regression. RESULTS: Of 2385 patients with serious abdominal injuries, 69% (n = 1649) had an intervention; predominantly a laparotomy (n = 1166). The proportion undergoing laparotomy decreased from 60% in 2007 to 44% in 2016 (p < 0.001), whilst embolisation increased from 6 to 20% (p < 0.001). Population-adjusted incidence of abdominal injury increased 1.6% per year (IRR 1.016, 95% CI 1.002-1.031; p < 0.024), predominantly in people aged 65 years and over (4.6% per year). Adjusted odds of in-hospital mortality declined 6.0% per year (adjusted odds ratio 0.94; 95% CI 0.89, 1.00; p = 0.04). CONCLUSIONS: Whilst the incidence of major abdominal trauma increased during the study period, there was a reduction in the proportion of patients managed with laparotomy and reduction in the adjusted odds of in-hospital mortality. Older patients, for whom management is influenced by the complex interplay of frailty and co-morbidities, had lower laparotomy rates.


Assuntos
Traumatismos Abdominais/terapia , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Comorbidade , Embolização Terapêutica/estatística & dados numéricos , Embolização Terapêutica/tendências , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Escala de Gravidade do Ferimento , Laparotomia/estatística & dados numéricos , Laparotomia/tendências , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Vitória/epidemiologia , Adulto Jovem
15.
World J Surg ; 43(2): 476-485, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30242456

RESUMO

BACKGROUND: Pelvic fracture with hypovolemic shock is a known crucial injury in trauma patients. Pelvic fracture with vessel injury often leads to hemodynamic complications; in a trauma scenario, evidence of other systems being affected is often absent. Bleeding cessation and resuscitation are important for these types of trauma patients. For this purpose, pelvic angiographic embolization is frequently used. Multiple studies have reported that angiographic embolization may cause erectile dysfunction (ED) in hemodynamically stable patients with pelvic fracture. However, no study has evaluated a large patient cohort with a long-term follow-up. We hypothesized that angiographic embolization to control bleeding may compromise blood supply to the genitourinary organs or cause secondary neurogenic injury that increases the risk of ED. Our goal was to evaluate the risk of ED following pelvic fractures in male patients treated with pelvic angiographic embolization. METHODS: We used data from the National Health Insurance Research Database (NHIRD) from 1997 to 2010 provided by the Bureau of National Health Insurance of the Department of Health in Taiwan. We collected disease histories from inpatient files. The disease diagnoses were based on the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification. These data were all deidentified, and we did not contact the patients. As such, informed consent was not needed. RESULTS: Eighty-five and 82,802 patients were included in the case and control cohorts, respectively. All patients were aged 15-45, and the proportion of pelvic fracture locations was equal between the groups. After investigating the causes of ED among male patients aged 15-45 with pelvic fractures using logistic regression analysis in a generalized estimating equations model and after adjusting for the influence of confounders, we found that these patients had high risks (odds ratio (OR): 32.637; 95% confidence interval: 14.137-75.346; P < 0.001) of developing ED post-angiographic embolization. CONCLUSIONS: Male patients in Taiwan with pelvic fractures who undergo angiographic embolization to control bleeding have a higher risk of ED than those who do not undergo the procedure. Physicians should practice caution and inform patients of this connection before the procedure.


Assuntos
Embolização Terapêutica/efeitos adversos , Disfunção Erétil/etiologia , Fraturas Ósseas/complicações , Hemorragia/terapia , Ossos Pélvicos/lesões , Adolescente , Adulto , Angiografia/efeitos adversos , Angiografia/estatística & dados numéricos , Estudos de Casos e Controles , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Embolização Terapêutica/métodos , Embolização Terapêutica/estatística & dados numéricos , Disfunção Erétil/epidemiologia , Fraturas Ósseas/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Taiwan/epidemiologia , Adulto Jovem
16.
World Neurosurg ; 122: e1388-e1397, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30458324

RESUMO

OBJECTIVE: Vertebrovertebral fistulas (VVFs) are uncommon lesions that can arise spontaneously or secondarily to iatrogenic or mechanical trauma. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, outcome, and complications associated with treatment. METHODS: A literature search was performed by a reference librarian and after screening, 128 case reports and 16 case series were left for inclusion in the review. All possible data were abstracted by 3 authors, results were tabulated, and descriptive statistics (mean, range, and proportions) were reported. No formal statistical analysis was performed as part of this study. RESULTS: A total of 280 patients were analyzed. VVFs can be categorized in 3 subgroups (iatrogenic, spontaneous, and traumatic), based on the mechanism of formation, and these different causes share different underlying demographics that bear important treatment considerations. Traumatic VVFs are more commonly seen in young men; the spontaneous form is more commonly seen in young women. Iatrogenic VVFs are more commonly seen in elderly people. Spontaneous VVFs are most commonly located between C1 and C2. Most iatrogenic (n = 39; 57%), spontaneous (n = 106; 82%), and traumatic (n = 53; 73%) VVFs were treated with deconstructive (defined as occlusion of fistula and feeding vessels) endovascular therapy. Overall treatment-related permanent morbidity was 3.3% (9/270) and mortality was 1.5% (4/270). CONCLUSIONS: VVFs are uncommon lesions, and treatment is often indicated, even in patients without retrograde venous drainage. When treatment is undertaken, the cause of presentation and associated patient demographics should be considered when planning the treatment strategy.


Assuntos
Fístula Arteriovenosa/etiologia , Artéria Vertebral/anormalidades , Adulto , Fístula Arteriovenosa/mortalidade , Embolização Terapêutica/mortalidade , Embolização Terapêutica/estatística & dados numéricos , Procedimentos Endovasculares/mortalidade , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Artéria Vertebral/lesões
17.
Diagn Interv Radiol ; 25(1): 81-89, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30582573

RESUMO

PURPOSE: Transcatheter arterial embolization (TAE) is increasingly used as the first-line treatment for hemorrhage complicating pancreatitis and post-pancreatectomy. However, the optimal therapeutic strategy remains unclear. METHODS: Among 1924 consecutive patients, 40 patients with severe pancreatic hemorrhage in Xuanwu Hospital were enrolled between 2005 and 2017. Patients underwent angiography and direct TAE for primary diagnosis and treatment of bleeding. Repeat TAE, watch and wait, and laparotomy were used as the other therapeutic options. Patient data, technical success, and 90-day survival were identified. RESULTS: Pancreatic diseases underlying hemorrhage included acute pancreatitis (n=19, 47.5%), chronic pancreatitis (n=12, 30%), and pancreatic cancer (n=9, 22.5%). A history of percutaneous catheter drainage or pancreatic surgery was seen in 29 patients (72.5%). There were 48 angiographies, 31 embolizations, and 5 laparotomies performed. Rebleeding occurred in 8 patients (20%); 4 of whom underwent re-embolization, 3 had laparotomy, and 1 had conservative treatment. Successful clinical hemostasis was achieved in 37 patients. Complications were observed in only 2 patients with renal failure and 1 patient with hepatic insufficiency. In total, 25 patients (62.5%) were alive at the 90-day follow-up. CONCLUSION: Endovascular management is effective for achieving hemostasis in severe pancreatic hemorrhage with a high success rate and low recurrence, and laparotomy is not suitable for rebleeding cases.


Assuntos
Angiografia/métodos , Embolização Terapêutica/métodos , Hemorragia/terapia , Pancreatectomia/efeitos adversos , Pancreatite/cirurgia , Adulto , Embolização Terapêutica/estatística & dados numéricos , Feminino , Seguimentos , Insuficiência Hepática/complicações , Insuficiência Hepática/epidemiologia , Humanos , Laparotomia/métodos , Laparotomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatopatias/patologia , Pancreatite/complicações , Pancreatite/patologia , Insuficiência Renal/complicações , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
18.
Am Surg ; 85(8): 848-850, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32051070

RESUMO

Although nonoperative management or embolization with preservation of splenic tissue is preferable, there is a significant risk of continued bleeding ultimately requiring splenectomy. It has been established that elderly patients on anticoagulation (AC) have an increased risk of splenic injury, but there are little data to show whether AC plays a role in outcomes of splenic injury in the setting of trauma. This is a retrospective cohort study, including 168 adults aged 50 to 79 years who presented as a trauma patient to Sentara Norfolk General Hospital from January 1, 2010, to March 31, 2018. The primary outcome is the management of the splenic injury. Of the 168 patients, 30 were presently taking AC at the time of their injury, and 138 were not taking any AC. These groups were similar in average Injury Severity Score, average grade of splenic injury, and average systolic blood pressure on arrival. However, the groups differed significantly in age and hemoglobin on arrival. We found that patients taking AC at the time of injury underwent splenectomy 23.3 per cent of the time, whereas patients not taking AC underwent splenectomy 11.6 per cent of the time (P = 0.045). Patients taking AC failed nonoperative management 20 per cent of the time, whereas patients not taking AC failed 0.7 per cent of the time (P < 0.05). We found that patients taking AC at the time of their traumatic injury were more likely to undergo splenectomy than patients not taking AC. We also found that patients taking AC were more likely to fail nonoperative management.


Assuntos
Anticoagulantes/administração & dosagem , Embolização Terapêutica/estatística & dados numéricos , Baço/lesões , Esplenectomia/estatística & dados numéricos , Idoso , Pressão Sanguínea , Feminino , Hematoma/terapia , Humanos , Escala de Gravidade do Ferimento , Lacerações/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de Tratamento
19.
J Neurosurg Pediatr ; 23(3): 325-332, 2018 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-30544333

RESUMO

OBJECTIVE Carotid body tumors (CBTs), extraadrenal paragangliomas, are extremely rare neoplasms in children that often require multimodal surgical treatment, including preoperative anesthesia workup, embolization, and resection. With only a few cases reported in the pediatric literature, treatment paradigms and surgical morbidity are loosely defined, especially when carotid artery infiltration is noted. Here, the authors report two cases of pediatric CBT and provide the results of a systematic review of the literature. METHODS The study was divided into two sections. First, the authors conducted a retrospective review of our series of pediatric CBT patients and screened for patients with evidence of a CBT over the last 10 years (2007­2017) at a single tertiary referral pediatric hospital. Second, they conducted a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of all reported cases of pediatric CBTs to determine the characteristics (tumor size, vascularity, symptomatology), treatment paradigms, and complications. RESULTS In the systematic review (n = 21 patients [includes 19 cases found in the literature and 2 from the authors' series]), the mean age at diagnosis was 11.8 years. The most common presenting symptoms were palpable neck mass (62%), cranial nerve palsies (33%), cough or dysphagia (14%), and neck pain (19%). Metastasis occurred only in 5% of patients, and 19% of cases were recurrent lesions. Only 10% of patients presented with elevated catecholamines and associated sympathetic involvement. Preoperative embolization was utilized in 24% of patients (external carotid artery in 4 and external carotid artery and vertebral artery in 1). Cranial nerve palsies (cranial nerve VII [n = 1], IX [n = 1], X [n = 4], XI [n = 1], and XII [n = 3]) were the most common cause of surgical morbidity (33% of cases). The patients in the authors' illustrative cases underwent preoperative embolization and balloon test occlusion followed by resection, and both patients suffered from transient Horner's syndrome after embolization. CONCLUSIONS Surgical management of CBTs requires an extensive preoperative workup, anesthesia, and multimodal surgical management. Due to a potentially high rate of surgical morbidity and vascularity, balloon test occlusion with embolization may be necessary in select patients prior to resection. Careful thorough preoperative counseling is vital to preparing families for the intensive management of these children. ABBREVIATIONS BTO = balloon test occlusion; CBT = carotid body tumor; CN = cranial nerve; ECA = external carotid artery; ICA = internal carotid artery; MIBG = iodine-123-meta-iodobenzylguanidine; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Adolescente , Anestesia , Tumor do Corpo Carotídeo/complicações , Tumor do Corpo Carotídeo/diagnóstico por imagem , Criança , Pré-Escolar , Terapia Combinada/métodos , Doenças dos Nervos Cranianos/etiologia , Transtornos de Deglutição/etiologia , Embolização Terapêutica/métodos , Embolização Terapêutica/estatística & dados numéricos , Feminino , Humanos , Masculino , Cervicalgia/etiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Doenças Raras/complicações , Doenças Raras/cirurgia , Estudos Retrospectivos
20.
Medicina (Kaunas) ; 54(3)2018 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-30344269

RESUMO

Background and objective: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. Materials and methods: A retrospective analysis of 29 patients treated for RSH in surgery departments of two medical centres from 1 January 2007 to 30 September 2017 was conducted. The patient's age, sex, ASA (American Society of Anesthesiologists; physical status classification system), use of anticoagulants, cause of haematoma, radiological data, vital signs, blood investigations, and type of treatment were extracted. The results were analysed according to the type of treatment. Results: The patients' mean age was 67.6 ± 14.3 years, and the mean duration of in-hospital stay was 10.7 ± 6.7 days. All patients were on anticoagulant treatment, and 82.8% of them had spontaneous haematoma. Nine patients (31%) needed transfusion of packed red blood cells with an average of 2.6 units (range: 1⁻4). Five patients (17.2%) presented with symptoms and signs of hypovolemic shock, and four of them underwent embolisation. Embolisation was successful in all cases. Open surgery was performed in 6 patients, 8 patients underwent percutaneous drainage, and 10 patients were treated conservatively. Two patients (6.7%) died in our series. Both of these patients had type III RSH. Patients in the conservatively treated group had the shortest hospital stay. There were no readmissions due to repeated haematoma or infection. Conclusions: Embolisation of epigastric arteries is a useful tool to stop bleeding into RSH in patients with unstable haemodynamics. Conservative treatment is comparable to ultrasound (US) drainage of RSH but results in a shorter hospital stay. Type III RSH is associated with a higher death rate.


Assuntos
Anticoagulantes/uso terapêutico , Drenagem/estatística & dados numéricos , Embolização Terapêutica/estatística & dados numéricos , Hemorragia Gastrointestinal/terapia , Hematoma/terapia , Doenças Musculares/terapia , Ultrassonografia de Intervenção/estatística & dados numéricos , Idoso , Drenagem/métodos , Embolização Terapêutica/métodos , Artérias Epigástricas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reto do Abdome , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
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