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1.
Medicine (Baltimore) ; 99(30): e21120, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791686

RESUMO

INTRODUCTION: Pancreaticoduodenectomy (PD) has been widely applied as a standard surgical procedure to treat periampullary diseases. The placement of a pancreaticojejunal anastomotic stent is considered an effective and safe method for preventing pancreatic fistula after PD. Recently, the role of pancreaticojejunal anastomotic stents has been challenged, as gradually increasing complications have been observed. Stent-related small bowel perforation has only occurred in 2 cases as long-term complications but has not been reported to occur within 1 week after surgery. PATIENT CONCERNS: Here, we report the case of a 71-year-old female patient complaining of painless jaundice who underwent PD with a pancreaticojejunal anastomotic stent for a duodenal papillary adenocarcinoma (T4N1M0). Four days after surgery, she had a sudden rise in temperature, high white blood cell count, significantly elevated C-reactive protein and 400 ml green-brown drainage fluid. Enhanced computed tomography showed hydrops abdominis. DIAGNOSIS: Small bowel perforation caused by stent migration was considered first. INTERVENTIONS: An emergency exploratory laparotomy was performed. We located the pancreaticojejunal anastomotic stent, which extended 2 cm from the small bowel, and sutured the jejunum hole after cutting away the protruding part of the stent. OUTCOMES: The patient recovered smoothly and was discharged on the 7th day after the second surgery. After more than 12 months of follow-up, the patient is doing well and is free of any symptoms related to the procedure. CONCLUSION: We caution that stent-related complications can occur when perioperative patients suffer from unexplained or sudden changes in vital signs after PD. In addition, the function of the pancreaticojejunal anastomotic stent needs to be reevaluated by future studies.


Assuntos
Perfuração Intestinal/etiologia , Doenças do Jejuno/etiologia , Falha de Prótese/efeitos adversos , Stents/efeitos adversos , Idoso , Feminino , Humanos , Pancreaticoduodenectomia/efeitos adversos , Pancreaticojejunostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia
2.
J Card Surg ; 35(10): 2829-2831, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32678968

RESUMO

BACKGROUND: Surgery for failed homograft aortic root replacement with extensive calcification in the setting of endocarditis alone is very challenging. CASE SUMMARY: We report the case of redo aortic valve replacement and mitral valve replacement, in a 39 years old presenting with a rare Streptococcus constellatus endocarditis of a previously implanted homograft root and native mitral valve, where conventional valve replacement proved nonfeasible. S. constellatus had caused severe tissue destruction and the extensive calcification in the homograft prevented conventional valve replacement with sutures. In this case, a sutureless valve provided a useful alternative surgical strategy. DISCUSSION: We consider heavily calcified failed homografts to be a good indication for sutureless (rapid deployment) valves.


Assuntos
Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Endocardite Bacteriana/complicações , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Desenho de Prótese , Falha de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Infecções Estreptocócicas/cirurgia , Streptococcus constellatus , Procedimentos Cirúrgicos sem Sutura/métodos , Adulto , Aloenxertos , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Resultado do Tratamento
3.
Cardiol Young ; 30(9): 1358-1359, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32624054

RESUMO

A 16-year-old girl with history of treated congenital mitral valve disease and signs of respiratory infection was admitted to our paediatric cardiology department. She was tested positive for severe acute respiratory syndrome coronavirus 2. Despite her severe pre-existing cardiac conditions with pulmonary hypertension, atrial arrhythmias and mitral valve stenosis, the infection did not lead to any cardiac or pulmonary deterioration. In adults, cardiac co-morbidities are known risk factors for a severe course of coronavirus disease 2019 infections. This case illustrates that in children even severe cardiac disease is not necessarily associated with a severe course of coronavirus disease 2019.


Assuntos
Infecções por Coronavirus , Átrios do Coração , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Estenose da Valva Mitral , Pandemias , Pneumonia Viral , Falha de Prótese/efeitos adversos , Adolescente , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Ecocardiografia/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Valva Mitral/patologia , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/congênito , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/congênito , Estenose da Valva Mitral/cirurgia , Tamanho do Órgão , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Resultado do Tratamento
4.
J Am Acad Orthop Surg ; 28(22): 907-913, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32694319

RESUMO

Adverse local tissue reaction (ALTR) associated with mechanically assisted crevice corrosion of metal-on-polyethylene (MoP) head-neck modular total hip arthroplasty (THA), similarly observed in the metal-on-metal bearing, is a growing concern in MoP THA patients. Given the complex pathogenesis as well as variable clinical presentation, the diagnosis can be challenging. This article focuses on providing surgeons with an evidence-based update on (1) implant, surgical, and patient risk factors associated with ALTRs; (2) clinical systematic evaluation; and (3) surgical management options for ALTRs in MoP THA patients based on the currently available evidence.


Assuntos
Artroplastia de Quadril/efeitos adversos , Metais/efeitos adversos , Polietileno/efeitos adversos , Desenho de Prótese/efeitos adversos , Falha de Prótese/efeitos adversos , Corrosão , Medicina Baseada em Evidências , Humanos , Reoperação , Fatores de Risco
5.
J Card Surg ; 35(7): 1746-1748, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557822

RESUMO

Left ventricular assist devices (LVADs) are used in patients with advanced heart failure. Infections are common complications following device placement; however, the efficacy of chronic antimicrobial suppression therapy for deep-seated infections is not well characterized. We report the case of a 49-year-old male with a HeartMate II LVAD who presented with a methicillin-sensitive Staphylococcus aureus pump pocket infection that was subsequently treated with antibiotics and HeartMate III pump exchange. A vancomycin-resistant Enterococcus faecium (VRE) pump pocket infection then developed and responded to surgical drainage followed by long-term suppression with daptomycin then linezolid for over 870 days. A second pump exchange was not required. To our knowledge, this represents the longest reported use of daptomycin (341 days) without symptomatic adverse events. Managing infections caused by multidrug-resistant pathogens presents a clinical challenge. This case demonstrates the potential for antimicrobial suppression therapy to allow for successful retention of a VRE-infected LVAD.


Assuntos
Antibacterianos/administração & dosagem , Daptomicina/administração & dosagem , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Coração Auxiliar/efeitos adversos , Coração Auxiliar/microbiologia , Linezolida/administração & dosagem , Falha de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Quimioterapia Combinada , Infecções por Bactérias Gram-Positivas/etiologia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Fatores de Tempo , Resultado do Tratamento , Resistência a Vancomicina
6.
Jt Dis Relat Surg ; 31(2): 377-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584740

RESUMO

Ceramic acetabular liner fracture is a rare complication and requires early revision surgery to avoid abrasive damaging of metal components by ceramic particles. Chromium-cobalt femoral head can be used in revision surgery if only fractured ceramic particles are completely removed because the abrasive effect of ceramic debris is more pronounced on metal head compared to ceramic head. In this article, we report a 50-year-old male patient of delayed acetabular liner fracture in which we used a ceramic head that is more resistant to residue ceramic particles. We assessed the patient by using computed tomography (CT) to locate the ceramic particles. By using CT imaging, we can detect which ceramic particles pose high morbidity risk for debridement.


Assuntos
Acetábulo , Artroplastia de Quadril , Remoção de Dispositivo/métodos , Ajuste de Prótese/métodos , Reoperação/métodos , Tomografia Computadorizada por Raios X/métodos , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cerâmica/uso terapêutico , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia , Resultado do Tratamento
7.
Acta Orthop ; 91(4): 420-425, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32420778

RESUMO

Background and purpose - Registries report high revision rates after unicompartmental knee replacement (UKR) due, in part, to aseptic loosing. In an attempt to improve Oxford UKR femoral component fixation a new design was introduced with a Twin rather than a Single peg. We used the National Joint Registry (NJR) to compare the 5-year outcomes of the Single and Twin Peg cemented Oxford UKRs.Patients and methods - We performed a retrospective observational study using NJR data on propensity score matched Single and Twin Peg UKRs (matched for patient, implant and surgical factors). Data on 2,834 Single Peg and 2,834 Twin Peg were analyzed. Cumulative implant survival was calculated using the Kaplan-Meier method and comparisons between groups performed using Cox regression models.Results - In the matched cohort, the mean follow up for both Single and Twin Peg UKRs was 3.3 (SD 2) and 3.4 years (SD 2) respectively. The 5-year cumulative implant survival rates for Single Peg and Twin Peg were 94.8% (95% CI 93.6-95.8) and 96.2% (CI 95.1-97.1) respectively. Implant revision rates were statistically significantly lower in the Twin Peg (hazard ratio [HR)] = 0.74; p = 0.04). The revision rate for femoral component aseptic loosening decreased significantly (p = 0.03) from 0.4% (n = 11) with the Single Peg to 0.1% (n = 3) with the Twin Peg. The revision rate for pain decreased significantly (p = 0.01) from 0.8% (n = 23) with the Single Peg to 0.3% (n = 9) with the Twin Peg. No other reasons for revision had significant differences in revision rates.Interpretation - The revision rate for the cemented Twin Peg Oxford UKR was 26% less than the Single Peg Oxford UKR. This was mainly because the revision rates for femoral loosening and pain more than halved. This suggests that the Twin Peg component should be used in preference to the Single Peg design.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Prótese do Joelho/efeitos adversos , Reoperação/estatística & dados numéricos , Idoso , Artroplastia do Joelho/instrumentação , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Irlanda do Norte/epidemiologia , Falha de Prótese/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Reino Unido/epidemiologia , País de Gales/epidemiologia
8.
Acta Orthop ; 91(3): 279-285, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32233815

RESUMO

Background and purpose - The introduction of new total hip replacements (THRs) is known to be associated with an increased risk for complications. On completion of a competitive procurement process, a new uncemented cup system was introduced into general use at our institution in 2016. We launched this study after the introduction to assess (1) the incidence of early dislocations of the old (Pinnacle) and the new (Continuum) cup systems, and (2) whether the cup design would affect the risk for dislocation.Patients and methods - We assessed the incidence of dislocations after 1,381 primary THRs performed at our institution during 2016. Also, the effect of the cup system (Pinnacle, Continuum with neutral liner, Continuum with elevated rim liner) on dislocation rates was analyzed using a multivariable regression model.Results - 47 (3.4%) early dislocations were identified. The incidence of dislocations was 1.3% for the Pinnacle, 5.1% for the Continuum with neutral liner, and 1.2% for the Continuum with elevated rim liner. The Continuum with neutral liner was found to have an increased risk for dislocations compared with the Pinnacle (aOR 5, 95% CI 1.4-17). However, when an elevated rim liner was used with the Continuum, the risk for dislocation between the Continuum and the Pinnacle was similar.Interpretation - Our results emphasize the need for both careful consideration before the introduction of new implants and the systematic monitoring of early outcomes thereafter. The elevated rim liner should be preferred for use with the Continuum cup because of the poor coverage of the neutral liner that may result in dislocations.


Assuntos
Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Falha de Prótese/etiologia , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese/efeitos adversos , Fatores de Risco
9.
Acta Orthop ; 91(4): 444-449, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32285738

RESUMO

Background and purpose - Total ankle arthroplasties (TAAs) have larger revision rates than hip and knee implants. We examined the survival rates of our primary TAAs, and what different factors, including the cause of arthritis, affect the success and/or revision rate.Patients and methods - From 2004 to 2016, 322 primary Hintegra TAAs were implanted: the 2nd generation implant from 2004 until mid-2007 and the 3rd generation from late 2007 to 2016. A Cox proportional hazards model evaluated sex, age, primary diagnosis, and implant generation, pre- and postoperative angles and implant position as risk factors for revision.Results - 60 implants (19%) were revised, the majority (n = 34) due to loosening. The 5-year survival rate (95% CI) was 75% (69-82) and the 10-year survival rate was 68% (60-77). There was a reduced risk of revision, per degree of increased postoperative medial distal tibial angle at 0.84 (0.72-0.98) and preoperative talus angle at 0.95 (0.90-1.00), indicating that varus ankles may have a larger revision rate. Generation of implant, sex, primary diagnosis, and most pre- and postoperative radiological angles did not statistically affect revision risk.Interpretation - Our revision rates are slightly above registry rates and well above those of the developer. Most were revised due to loosening; no difference was demonstrated with the 2 generations of implant used. Learning curve and a low threshold for revision could explain the high revision rate.


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Prótese Articular , Falha de Prótese/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/estatística & dados numéricos , Feminino , Humanos , Prótese Articular/efeitos adversos , Prótese Articular/estatística & dados numéricos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
Acta Orthop ; 91(4): 365-371, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32285741

RESUMO

Background and purpose - There is limited amount of evidence about optimal revision indications, technique, and implants when performing revision surgery for metal-on-metal (MoM) hip replacements due to adverse reaction to metal debris (ARMD). We assessed which factors are related to re-revisions and complications after a revision of MoM hip arthroplasty because of ARMD. We also aimed to provide information on optimal implants for these revisions.Patients and methods - 420 MoM total hip arthroplasties (THA) and 108 MoM hip resurfacings were implanted and later revised at our institution. We used Cox regression to analyze the factors associated with re-revisions and complications after a revision for ARMD.Results - A re-revision was performed on 27 THAs (6%) and 9 resurfacings (8%). The most common indication for re-revision was recurrent dislocation (20 hips, 4%). Complications not leading to re-revision were seen in 21 THAs (5%) and 6 resurfacings (6%). The most common complication was dislocation treated with closed reduction in 13 hips (2%). Use of revision head size > 36mm was associated with decreased risk for dislocations. Presence of pseudotumor, pseudotumor grade, pseudotumor size, or the choice of bearing couple were not observed to affect the risk for re-revision. Non-linear association was observed between preoperative cobalt and risk for re-revision.Interpretation - As dislocation was the most frequent post-revision complication, large head sizes should be used in revisions. Because size or type of pseudotumor were not associated with risk of re-revision, clinicians may have to reconsider, how much weight is put on the imaging findings when deciding whether or not to revise. In our data blood cobalt was associated with risk for re-revision, but this finding needs further assessment.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Prótese de Quadril/efeitos adversos , Próteses Articulares Metal-Metal/efeitos adversos , Metais/efeitos adversos , Reoperação/estatística & dados numéricos , Idoso , Artroplastia de Quadril/efeitos adversos , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Falha de Prótese/efeitos adversos , Reoperação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia
11.
World Neurosurg ; 139: 4-6, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298817

RESUMO

BACKGROUND: Ventriculopleural (VPL) shunts are used infrequently in management of hydrocephalus. The main complication associated with these shunts is pleural effusion. CASE DESCRIPTION: A 28-year-old man with a history of congenital hydrocephalus had a VPL shunt inserted. Two years later, he noticed a soft bulging in the surgical scar area of the chest, suggestive of fluid accumulation. The scar subsequently opened up spontaneously exposing the distal catheter, which extruded through the opening. Chest radiographs and computed tomography scan showed an important pleural effusion on the same side. The VPL shunt was removed, and a contralateral shunt was inserted. CONCLUSIONS: To our knowledge, spontaneous extrusion of the distal catheter of a VPL shunt has not been previously reported in the literature. Physicians treating patients with hydrocephalus must be aware of this potential complication when a VPL shunt is inserted.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Hidrocefalia/cirurgia , Derrame Pleural/etiologia , Complicações Pós-Operatórias/etiologia , Falha de Prótese/efeitos adversos , Adulto , Humanos , Hidrocefalia/congênito , Masculino , Pleura , Derrame Pleural/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Tomografia Computadorizada por Raios X
13.
Ann Thorac Surg ; 110(4): e311-e313, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32240643

RESUMO

Inferior vena cava filter placement for venous thromboembolism has increased by 25-fold in the past two decades. Timely retrieval of these filters is often not executed, resulting in long-term complications. We report a case of 44-year-old male patient who underwent inferior vena cava filter placement for chronic venous thromboembolism after presenting with hemoptysis. The results of chest computed tomographic angiography were negative for active bleeding, but imaging revealed multiple fragments of fractured filter in the infrarenal inferior vena cava and one fragment extravascular in left lower lobe of the lung causing massive hemoptysis. Endovascular technique was unsuccessful in retrieving the extravascular fragment; hence, he underwent left lower lobe wedge resection with no further episodes of hemoptysis postoperatively.


Assuntos
Brônquios , Migração de Corpo Estranho/complicações , Hemoptise/etiologia , Falha de Prótese/efeitos adversos , Embolia Pulmonar/etiologia , Filtros de Veia Cava , Adulto , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Embolia Pulmonar/complicações , Índice de Gravidade de Doença , Tromboembolia Venosa
14.
Ann Thorac Surg ; 110(3): e199-e200, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32114040

RESUMO

Cardiogenic shock is a life-threatening condition requiring fast and efficient diagnostic and therapeutic measures. In this case, the history of several cardiac surgeries hindered finding the correct diagnosis initially. After an ultima ratio cardiac redo operation the underlying cause was found intraoperatively: a defective mechanical valve prosthesis with migration of one of the two leaflets. Strikingly, this happened with a contemporary On-X prosthesis only 4 years after implantation. Timely echocardiography is of utmost importance in patients with prosthetic heart valves presenting in heart failure.


Assuntos
Migração de Corpo Estranho/diagnóstico por imagem , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Falha de Prótese/efeitos adversos , Choque Cardiogênico/etiologia , Adulto , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Desenho de Prótese , Choque Cardiogênico/diagnóstico por imagem , Choque Cardiogênico/cirurgia
16.
Spine Deform ; 8(1): 135-138, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31950479

RESUMO

STUDY DESIGN: Case report. OBJECTIVE: To describe the importance of preoperative halo-gravity traction and posterior vertebral column resection (PVCR) for severe proximal thoracic kyphoscoliosis associated with Desbuquois dysplasia, after breakage of a growing rod construct. Desbuquois dysplasia is a rare, autosomal recessive chondrodysplasia characterized by short stature, joint laxity, kyphoscoliosis, and characteristic facial dysmorphism. Our 8-year-old patient developed severe, progressive, infantile-onset kyphoscoliosis and had been initially treated with Vertical Expandable Prosthetic Titanium Rib (VEPTR) rods. She subsequently underwent growing rod placement, but the eventual rod fracture resulted in a severe angular kyphosis. METHODS: Clinical and radiographic case review. RESULTS: The broken implants were removed, and she was treated with 2.5 months of preoperative halo-gravity traction. She then underwent a T4 PVCR and C7-L4 instrumented posterior spinal fusion. The patient had an uneventful postoperative course without any neurologic problems. Two years postoperatively, correction was well maintained with appropriate alignment and balance without implant breakage. CONCLUSION: To our knowledge, this is the first report of treatment of spinal deformity associated with Desbuquois dysplasia. Our results suggest that preoperative halo-gravity traction and PVCR are safe and efficacious techniques for severe rigid kyphoscoliosis in the cervicothoracic region associated with broken growing rods in a patient with Desbuquois dysplasia. LEVEL OF EVIDENCE: Level IV.


Assuntos
Anormalidades Craniofaciais/cirurgia , Nanismo/cirurgia , Instabilidade Articular/cirurgia , Cifose/cirurgia , Ossificação Heterotópica/cirurgia , Polidactilia/cirurgia , Próteses e Implantes/efeitos adversos , Falha de Prótese/efeitos adversos , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Criança , Anormalidades Craniofaciais/complicações , Remoção de Dispositivo , Nanismo/complicações , Feminino , Gravitação , Humanos , Instabilidade Articular/complicações , Cifose/complicações , Ossificação Heterotópica/complicações , Polidactilia/complicações , Escoliose/complicações , Índice de Gravidade de Doença , Tração/métodos , Resultado do Tratamento
17.
World Neurosurg ; 136: 83-89, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931241

RESUMO

BACKGROUND: Given recent positive safety evidence, ventriculoatrial (VA) shunt placement may increase in popularity once more. We describe a rare case of Tricuspid regurgitation due to VA shunt catheter tip traversing the valve. CASE DESCRIPTION: A woman aged 42 years with a preexisting VA shunt was referred to this center with 3 months of orthostatic headache, nausea, and palpitations that occurred while sleeping on her right side. An echocardiogram demonstrates a VA shunt catheter in the right atrium during cardiac diastole, which traversed the tricuspid annular plane during cardiac systole. The echocardiogram revealed mild to moderate tricuspid regurgitation. She had no clinical evidence of cardiac failure or arrhythmia and had normal electrocardiogram findings. The catheter tip appeared to be adhered to the underside of the leaflets or to the chordae tendineae. Pulling the catheter tip back could therefore cause irreversible damage to the tricuspid valve. For this reason, the catheter was not removed, and the patient was referred for close follow-up with cardiologists. A literature review was performed to determine where this rare complication fits into the spectrum of VA shunt distal catheter complications, and what techniques can be done to avoid similar occurrences. CONCLUSIONS: This report reiterates the importance of ensuring the tip is carefully placed within the atrium, under fluoroscopic guidance. Although rare, the described complication is difficult to manage once it has occurred.


Assuntos
Cateteres de Demora , Derivações do Líquido Cefalorraquidiano , Falha de Prótese/efeitos adversos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Diástole , Ecocardiografia , Feminino , Cefaleia/etiologia , Humanos , Náusea/etiologia , Sístole , Insuficiência da Valva Tricúspide/etiologia
19.
World Neurosurg ; 134: e249-e255, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629142

RESUMO

OBJECTIVE: To analyze hardware-related problems and their prognoses after anterior cervical discectomy and fusion (ACDF) using cages and plates for degenerative and traumatic cervical disc diseases. METHODS: The study included 808 patients who underwent anterior cervical discectomy and fusion for degenerative and traumatic disc diseases with >1 year of follow-up. We investigated time of onset and progression of problems associated with instrumentation and cage usage. The mean follow-up time was 3.4 years. Type of plate, range and level of fusion, patient factors (age, sex, body mass index, and bone mineral density), and local kyphosis were evaluated. RESULTS: Complications were found in 132 cases (16.5%), including subsidence in 69 cases, plate loosening in 8 cases, screw loosening in 8 cases, screw breakage in 1 case, and multiple complications in 36 cases. In 3 cases, additional posterior cervical surgery was performed. One case needed hardware revision. There were no esophageal, tracheal, or neurovascular structural injuries secondary to metal failure. There were no significant differences in type of plate, level of surgery, or patient factors. The greater the number of fusion segments, the greater the incidence of complications (P = 0.001). The clinical outcomes improved regardless of the complications (P = 0.083). CONCLUSIONS: Most hardware-related complications are not symptomatic and can be treated conservatively. Only a few cases need revision surgery. Precise surgical techniques are needed in multilevel anterior cervical discectomy and fusion (>3 levels) because of the increased complication rate.


Assuntos
Placas Ósseas/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/efeitos adversos , Falha de Prótese/efeitos adversos , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/tendências , Vértebras Cervicais/cirurgia , Discotomia/instrumentação , Discotomia/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Falha de Prótese/tendências , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Fusão Vertebral/tendências , Adulto Jovem
20.
Eur J Ophthalmol ; 30(1): 221-223, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31177825

RESUMO

PURPOSE: To present our experience treating hypotony maculopathy with a simple, minimally invasive, and removable ab interno tube Ahmed glaucoma valve occlusion. METHODS: Under topical anesthesia a 5-0 polypropylene suture (Prolene; Ethicon) was inserted into the Ahmed glaucoma valve tube. The length of the tube was measured, and an external suture cauterization was performed to allow an easier and safer fixation in the tube. The suture was introduced into the tube itself with the viscoelastic 27-gauge cannula. RESULTS: This technique was performed in three cases of hypotony maculopathy with a complex history of medical treatments: a 4-year-old boy with Donnai-Barrow syndrome and previous pars plana vitrectomy that developed hypotony maculopathy the day after Ahmed glaucoma valve insertion and two male patients (69 and 49 years old) that underwent hypotony maculopathy after cyclophotocoagulation as a last option to reduce intraocular pressure. One of the men had three filtering surgeries, two 5-fluorouracil needlings and Ahmed glaucoma valve insertion. The other male patient had keratoplasty and posterior Ahmed glaucoma valve insertion. In the three cases, both hypotony and maculopathy were reversed within a week and a month, respectively, after Ahmed glaucoma valve occlusion with no complications. When hypotony maculopathy develops it seems suitable to occlude completely the Ahmed glaucoma valve tube to swiftly reverse clinical and anatomic changes. CONCLUSION: Intraluminal Ahmed glaucoma valve occlusion with cauterized suture is a simple, quick, reversible, and effective technique that may offer a minimally invasive way to resolve hypotony maculopathy in complex cases and avoid severe loss of vision.


Assuntos
Cauterização/métodos , Implantes para Drenagem de Glaucoma , Degeneração Macular/cirurgia , Hipotensão Ocular/cirurgia , Falha de Prótese/efeitos adversos , Técnicas de Sutura , Idoso , Pré-Escolar , Cirurgia Filtrante , Humanos , Pressão Intraocular/fisiologia , Degeneração Macular/etiologia , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hipotensão Ocular/etiologia , Hipotensão Ocular/fisiopatologia , Implantação de Prótese , Tonometria Ocular , Resultado do Tratamento
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