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1.
No Shinkei Geka ; 48(11): 1035-1042, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199661

RESUMO

A 69-year-old woman presented on an emergency basis, with headache and left hemiparesis. Initial head CT at the time of admission revealed a large subcortical hematoma with perihematomal edema extending from the right parietal to the occipital lobe. A small part of the hematoma extended toward the trigone of the right lateral ventricle. CT angiography revealed no vascular abnormalities. Emergency craniotomy was erformed, and the patient's initial postoperative course was unremarkable. However, the patient's neurological symptoms worsened 10 days postoperatively, and CT revealed a new low-density cystic lesion with perifocal edema at the site of hematoma removal, in addition to severe cerebral compression. We performed a reoperation, and intraoperatively we observed hematoma fluid mixed with cerebrospinal fluid without any abnormal blood vessels or neoplastic lesions in the hematoma cavity. We identified the choroid plexus deep within the surgical field, and slight leakage of cerebrospinal fluid was detected from the ventricular aspect, indicating the formation of a small passage between the hematoma cavity and the ventricle. After the second operation, her postoperative course was uneventful without recurrent cyst formation. An early symptomatic expanding porencephalic cyst in the hematoma cavity after removal of an intracerebral hematoma is rare, and only a few cases have been reported in the literature. Based on literature review and considering the likely mechanism of cyst development, we speculated that progressive cyst expansion could be attributed to a check valve mechanism between the ventricle and the cavity from which the hematoma was removed, as observed in the present case.


Assuntos
Cistos , Hematoma , Adulto , Idoso , Hemorragia Cerebral , Plexo Corióideo , Cistos/complicações , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Tomografia Computadorizada por Raios X
2.
Eur J Vasc Endovasc Surg ; 60(3): 386-393, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32741679

RESUMO

OBJECTIVE: The current treatment for acute retrograde type A intramural haematoma (IMH) remains challenging. Aortic remodelling in both the ascending aorta (AA) and descending thoracic aorta (DTA) was evaluated and the 30 day and mid term outcomes were determined in patients who underwent thoracic endovascular aneurysm repair (TEVAR) for retrograde type A IMH with a primary intimal tear or ulcer like projection in the DTA METHODS: This was a retrospective, multicentre observational study. Clinical data, including post-operative mortality and adverse event, aorta related re-intervention, aortic remodelling, and the survival rate of 18 non-consecutive patients with acute retrograde type A IMH undergoing TEVAR between June 2006 and March 2018 were reviewed. RESULTS: The median age at repair was 58.1 years (range 38-86) and 14 (78%) were men. Eight patients (44%) presented with haemopericardium, and 10 (56%) underwent TEVAR within 24 h. The mean IMH thickness and AA diameter were 10.4 ± 3.6 and 45.7 ± 4.6 mm, respectively. Among all patients with acute retrograde type A IMH, 11 patients presented with classical type B aortic dissection and seven with type B IMH. All procedures were technically successful. The median follow up was 28.7 months (range 7-78). No 30 day mortality was observed. Three patients developed post-procedure adverse events. Of these, two patients had neurological events, with one each having cerebrovascular and spinal cord infarction individually, and the third patient required long term haemodialysis with ventilator support. The overall survival rate was 100%. The maximum diameter of the AA and the IMH in the AA significantly decreased after TEVAR. Aortic remodelling was also observed in the DTA along the length of TEVAR coverage. CONCLUSION: In selected patients with acute retrograde type A IMH, TEVAR offered a treatment alternative to open surgical grafting and medical follow up.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Hematoma/cirurgia , Remodelação Vascular , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Stents , Taiwan , Fatores de Tempo , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 29(9): 105050, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807458

RESUMO

OBJECTIVES: Endoscopic hematoma removal is widely performed for the treatment of intracerebral hemorrhage. We investigated the factors related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. MATERIALS AND METHODS: From 2013 to 2019, we retrospectively analyzed 75 consecutive patients with hypertensive intracerebral hemorrhage who underwent endoscopic hematoma removal. Their characteristics, including neurological symptoms, laboratory data, and radiological findings were investigated using univariate and multivariate analysis. Complications during hospitalization, Glasgow Coma Scale (GCS) score on day 7, and modified Rankin Scale (mRS) score at 6 months were considered as treatment outcomes. RESULTS: The mean age of the patients (33 women, 42 men) was 71.8 (36-95) years. Mean GCS scores at admission and on day 7 were 10.3 ± 3.2 and 11.7 ± 3.8, respectively. The mean mRS score at 6 months was 3.8 ± 1.6, and poor outcome (mRS score ranging from 3 to 6 at 6 months) in 53 patients. Rebleeding occurred in 4 patients, and other complications in 15 patients. Multivariate analysis revealed that older age, hematoma in the basal ganglia, lower total protein level, higher glucose level, and absence of neuronavigation were associated with poor outcomes. Of the 75 patients, 9 had cerebellar hemorrhages, and they had relatively favorable outcomes compared to those with supratentorial hemorrhages. CONCLUSION: Several factors were related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. Lower total protein level at admission and absence of neuronavigation were novel factors related to poor outcomes of endoscopic hematoma removal for intracerebral hemorrhage.


Assuntos
Proteínas Sanguíneas/metabolismo , Endoscopia/efeitos adversos , Hematoma/cirurgia , Hemorragia Intracraniana Hipertensiva/cirurgia , Neuronavegação , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Hematoma/sangue , Hematoma/diagnóstico por imagem , Humanos , Hemorragia Intracraniana Hipertensiva/sangue , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
J Stroke Cerebrovasc Dis ; 29(8): 104931, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689636

RESUMO

BACKGROUND: Mesenchymal stem cells (MSCs) are multipotent stromal cells currently being tested as therapy for a variety of diseases. MSC therapy and hematoma evacuation using a minimally invasive approach are being studied separately to improve clinical outcomes after stroke. We report the first case of a patient with intracerebral hemorrhage (ICH) treated with combination MSC therapy and endoscopic hematoma evacuation. CASE REPORT: A 36-year-old woman with a past medical history of essential chronic hypertension and right lung bronchial atresia presented to the emergency department with acute neurologic decline (National Institute of Health Stroke Scale [NIHSS] score, 22). Computed tomography showed a 4.4 × 3.5 × 3.5 cm right basal ganglia hemorrhage with intraventricular extension. An external ventricular drain was placed, and she was enrolled in a Phase I clinical trial investigating intravenous MSC therapy for acute ICH. Continued neurologic deterioration due to increased intracranial pressure led to minimally invasive hematoma evacuation using the Artemis Neuro Evacuation Device (Penumbra, Inc.) on hospital day 4. Follow-up scans showed decreased density and extent of hemorrhage. She was discharged on day 41 with improved neurologic function scores (NIHSS score, 2). At 3-month follow-up, she was walking on her own, but had residual left arm and hand weakness (modified Rankin Score, 2). CONCLUSIONS: This case report suggests that the combination of MSC therapy and minimally invasive hematoma evacuation may be safe and well tolerated. Further larger randomized clinical trials are required to identify whether MSC therapy in combination with minimally invasive hematoma evacuation is safe, tolerable, and potentially improves outcomes than either alone.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Hematoma/cirurgia , Transplante de Células-Tronco Mesenquimais , Procedimentos Neurocirúrgicos , Adulto , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/fisiopatologia , Terapia Combinada , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Humanos , Pressão Intracraniana , Recuperação de Função Fisiológica , Resultado do Tratamento
7.
Niger J Clin Pract ; 23(6): 883-886, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525127

RESUMO

A complicated case of female genital mutilation (FGM) type 2b done in late-pregnancy is presented and the interplay of Yoruba and Kwale culture, in this case, is discussed. A Yoruba who grew up among Kwales/Urhobos had FGM at 38 weeks and 4 days gestation (to assure vaginal delivery) and presented with vulvar hematoma, septicemia, obstructed labor, and a distressed fetus. 5 days after FGM procedure, she had an emergency cesarean section (EmCS), repair of FGM site and baby was admitted in special care. There was the obvious synergy of the Yoruba culture of FGM in infancy and Kwale/Urhobo culture of FGM in pregnancy. The patient and her fetus/baby almost became mortalities but for prompt intervention. The role of sociocultural factors in the practice of FGM is recommended to be further investigated as FGM even in educated women and at the dangerous stage of term pregnancy is still prevalent.


Assuntos
Cesárea , Circuncisão Feminina/efeitos adversos , Hematoma/cirurgia , Complicações do Trabalho de Parto/etiologia , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Drenagem , Tratamento de Emergência , Feminino , Gentamicinas/uso terapêutico , Hematoma/reabilitação , Humanos , Metronidazol/uso terapêutico , Gravidez , Resultado da Gravidez , Sepse/tratamento farmacológico , Sepse/microbiologia , Toxoide Tetânico , Resultado do Tratamento , Doenças da Vulva/tratamento farmacológico , Doenças da Vulva/etiologia , Adulto Jovem
8.
Ann R Coll Surg Engl ; 102(8): e209-e212, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32538127

RESUMO

Idiopathic retroperitoneal haematoma is a rare clinical entity; resulting duodenal obstruction is even more occult. It can pose a diagnostic challenge due to variable presentations. Timely management requires a high index of suspicion and a multidisciplinary approach. Surgery is indicated in patients refractory to conservative treatment and failure of endoscopic or interventional radiology options. We report an interesting case illustrating the rarity and severity of this condition, with a review of the literature.


Assuntos
Obstrução Duodenal , Hematoma , Espaço Retroperitoneal , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia
9.
Medicine (Baltimore) ; 99(18): e19937, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358365

RESUMO

RATIONALE: We report a stroke patient who showed increased thalamocortical connectivity to the medial prefrontal cortex (mPFC) with recovery of impaired consciousness that was demonstrated on diffusion tensor tractography (DTT) of the ascending reticular activating system (ARAS). PATIENTS CONCERNS: A 48-year-old male patient underwent craniectomy and hematoma removal for spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. When he started rehabilitation at 5 weeks after onset he was in a vegetative state with a Coma Recovery Scale-Revised score of 6. DIAGNOSES: The patient was diagnosed spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. INTERVENTIONS: He underwent comprehensive rehabilitation including neurotropic durgs, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation of the left prefrontal lobe (Brodmann area 10). OUTCOMES: After 5 weeks of rehabilitation, the patient had recovered to a nearly normal conscious state with a Coma Recovery Scale-Revised score of 22. On 10-week DTT, thickening of the lower dorsal ARAS was observed on both sides compared with 5-week DTT. Decreased neural connectivity to the left PFC was observed on 5-week DTT whereas decreased neural connectivity to the left PFC was increased on 10-week DTT, especially the mPFC. LESSONS: Increased thalamocortical connectivity to the mPFC was demonstrated in a stroke patient who showed concomitant recovery from a vegetative state to a nearly normal conscious state. The results suggest that the increased neural connectivity to the mPMC contributed to recovery of consciousness in this patient.


Assuntos
Coma/fisiopatologia , Imagem de Tensor de Difusão/métodos , Estado Vegetativo Persistente/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Hemorragia Cerebral/complicações , Coma/diagnóstico por imagem , Coma/etiologia , Estado de Consciência , Craniotomia/métodos , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/diagnóstico por imagem , Estado Vegetativo Persistente/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Reabilitação do Acidente Vascular Cerebral/métodos
10.
Tunis Med ; 98(1): 80-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32395781

RESUMO

A 45 years old patient consulted for a sudden decrease in visual acuity in the right eye. Ophthalmological examination gave visual acuity limited to luminous perceptions with a calm anterior segment, a transparent lens and at the fundus examination a dense, massive, two-level intra-retinal and retro hyaloidal pigeon nest hemorrhage with a fusiform whitish lesion on the path of the upper temporal artery. The suspected diagnosis was a complicated ruptured retinal macroaneurysm with massive retinal and retro hyaloidal hemorrhage. Fluorescein angiography confirmed the diagnosis. Our course of action was an emergency programmed evacuation vitrectomy with gas tamponade. The evolution was marked by a clear improvement in visual acuity. The rupture of retinal macroaneurysm is a frequent and serious accident. The complications of this rupture can threat the vision. Care is still being discussed. Randomized studies on large series are necessary to decide on the best therapy.


Assuntos
Aneurisma Roto/complicações , Hematoma/complicações , Macroaneurisma Arterial Retiniano/complicações , Hemorragia Retiniana/complicações , Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Serviços Médicos de Emergência , Angiofluoresceinografia , Fundo de Olho , Hematoma/diagnóstico , Hematoma/cirurgia , Humanos , Pessoa de Meia-Idade , Macroaneurisma Arterial Retiniano/diagnóstico , Macroaneurisma Arterial Retiniano/cirurgia , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/cirurgia , Vitrectomia/métodos
11.
World Neurosurg ; 138: e955-e960, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-274866

RESUMO

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Assuntos
Aneurisma Roto/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Filtros de Ar , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Betacoronavirus , China , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/complicações , Craniotomia/métodos , Drenagem , Emergências , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pressão Intracraniana , Cuidados Intraoperatórios , Pulmão/diagnóstico por imagem , Monitorização Fisiológica , Salas Cirúrgicas , Pandemias , Assistência Perioperatória , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
12.
World Neurosurg ; 138: e955-e960, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-124982

RESUMO

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Assuntos
Aneurisma Roto/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Filtros de Ar , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Betacoronavirus , China , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/complicações , Craniotomia/métodos , Drenagem , Emergências , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pressão Intracraniana , Cuidados Intraoperatórios , Pulmão/diagnóstico por imagem , Monitorização Fisiológica , Salas Cirúrgicas , Pandemias , Assistência Perioperatória , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
13.
World Neurosurg ; 138: e955-e960, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32344132

RESUMO

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Assuntos
Aneurisma Roto/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Filtros de Ar , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Betacoronavirus , China , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/complicações , Craniotomia/métodos , Drenagem , Emergências , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pressão Intracraniana , Cuidados Intraoperatórios , Pulmão/diagnóstico por imagem , Monitorização Fisiológica , Salas Cirúrgicas , Pandemias , Assistência Perioperatória , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
14.
Trop Doct ; 50(3): 243-245, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32290760

RESUMO

A haemocholecyst is a clot-filled gallbladder caused by bleeding into its lumen. It is a rare entity with fewer than 50 cases reported in the English literature. Preoperative diagnosis is often not possible even with good quality cross-sectional imaging. Here, we present a case of a gallbladder mass, whose nature was only made clear at operation, where a hugely enlarged gallbladder was found filled with blood clots. There was neither liver infiltration nor regional lymphadenopathy. The clinical status of the patient demanded simple cholecystectomy. Histopathological examination, however, revealed a gallbladder adenocarcinoma, infiltrating the perimuscular connective tissue. Thus, more radical surgery was performed eight weeks later. At the 21-month follow-up, the patient was found to be well.


Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/patologia , Adenocarcinoma/cirurgia , Colecistectomia , Feminino , Neoplasias da Vesícula Biliar/cirurgia , Hematoma/diagnóstico , Hematoma/patologia , Hematoma/cirurgia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Craniofac Surg ; 31(5): 1404-1407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310891

RESUMO

When craniotomy complicated by secondary infection requires debridement and craniectomy, the bony defect is typically not reconstructed immediately. Due to concerns about placing a prosthetic material in an infected field, cranioplasty has traditionally been delayed by weeks or months after craniectomy. However, surgeons have begun performing single-stage cranioplasty after craniectomy in an effort to reduce the morbidity associated with multiple procedures and reduce overall healthcare costs. The purpose of this systematic review is to analyze outcomes of immediate cranioplasty performed after bone flap debridement secondary to infection. A literature review from January 1, 1998 through January 1, 2019 was conducted, examining the data on immediate titanium cranioplasty and its complication and reoperation rates. A meta-analysis of these articles was then performed. Variables studied included incidence of infection post-cranioplasty, wound healing complications, need for unplanned reoperation, and mortality. In total, there were 40 patients who underwent immediate cranioplasty after bone flap debridement. Overall, there was a 5% rate of postoperative infection, a 12.5% rate of unplanned return to the operating room, 7.5% rate of CSF fistula or leak, a 2.5% rate of hematoma, and a 2.5% rate of mortality within the immediate post-op period. Although there are insufficient data in the literature to rigorously compare these immediate cranioplasties in a direct way with the more traditional delayed type; the outcomes of immediate cranioplasty procedures secondary to craniectomy for infection were similar to the outcomes of delayed cranioplasty after craniectomy for any reason. Given these results, immediate titanium cranioplasty should be considered in select patients.


Assuntos
Craniotomia/efeitos adversos , Crânio/cirurgia , Infecção da Ferida Cirúrgica , Feminino , Fístula/cirurgia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Retalhos Cirúrgicos/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Titânio
18.
J Card Surg ; 35(5): 1110-1111, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32293043

RESUMO

We describe a case of a patient with acute aortic syndrome referred to an emergent surgery. Aortic dissection presented with all-in-one imaging and pathologic entities: aortic dissection with intimal flap and true/false lumen, intramural hematoma and penetrating aortic ulcer. Usually, only one of these entities is present in a single patient, but it is possible that one entity evolve into or coexist with another. Extended hemiarch replacement was performed and the patient was discharged in a good condition.


Assuntos
Aneurisma Dissecante/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/métodos , Hematoma/cirurgia , Úlcera/cirurgia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Emergências , Feminino , Humanos , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Úlcera/diagnóstico por imagem
19.
J Craniofac Surg ; 31(4): e375-e378, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32149983

RESUMO

BACKGROUND: Cephalohematoma is collection of blood between skull and periosteum that is confined by cranial sutures. Cephalohematomas usually resorb spontaneously within the first month of life; however, if it fails to resolve, ossified cephalohematoma may form. METHODS: Clinical archiving system and picture archiving and communication system were retrospectively reviewed for cases of birth-related cephalohematoma. Cases of ossified cephalohematomas identified on imaging were retrieved from this subset of patients. Cross-sectional imaging findings in patients with ossified cephalohematomas were evaluated for location, size of the hematoma, and contours of the inner lamella. RESULTS: Out of 115 cases of cephalohematoma, 7 cases had imaging findings consistent with ossified cephalohematoma. All ossified cephalohematomas were located parietally, with size ranging between 18 and 55 mm and the thickness of the outer rim of calcification ranging between 1.5 and 4.8 mm. The contour of inner lamella in relation to the surrounding normal cranial vault was normal in 5 cases, and inner lamella was depressed in 2 cases.Three patients had follow-up imaging available for demonstration of changes in ossified cephalohematoma. The first case was an 11 day-old boy with a cephalohematoma with no signs of calcification at the time of initial imaging. Follow-up at 2 months of age showed partial regression of hematoma cavity with marked calcification at the hematoma walls. The second case was a 3 month-old boy with ossified cephalohematoma at initial imaging. Follow-up imaging at 7 months of age showed almost total regression of hematoma cavity, and approximation of inner and outer lamella with increased thickness of the cranial vault. The third case was a 1 month-old boy with ossified cephalohematoma at initial imaging that totally resolved without residual increased bone thickness at 21-month follow-up. CONCLUSION: These 3 cases demonstrate the variability in temporal changes that may occur in ossified cephalohematomas.


Assuntos
Hematoma/cirurgia , Traumatismos do Nascimento/diagnóstico por imagem , Traumatismos do Nascimento/cirurgia , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Feminino , Hematoma/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Periósteo/diagnóstico por imagem , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Crânio/lesões , Crânio/cirurgia
20.
J Plast Reconstr Aesthet Surg ; 73(8): 1442-1447, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209324

RESUMO

BACKGROUND: Postoperative hematoma and venous congestion after free tissue transfer may occur independently or concurrently. We aimed to explore the association between these two events. METHODS: All free flap reconstructions for head and neck (HN) and breast from a single institution between 2004 and 2014 were retrospectively reviewed for reoperation for venous congestion and/or hematoma. RESULTS: There were 2985 free flap cases for HN reconstruction and 2345 cases for breast reconstruction. In HN, 100 patients developed a hematoma (3.4%) and 84 patients developed venous congestion (2.8%). The prevalence of hematoma was 17.8% and 2.9% in the presence and absence of congestion, respectively (p<0.001). Among the 15 patients who had both hematoma and venous congestion were separate events that occurred from 1 to 9 days apart in 8 patients. Hematoma caused the compression of the pedicle vein in 4 patients, while venous congestion possibly caused hematoma in 3 patients. In breast, 56 patients developed a hematoma (2.4%) and 64 patients developed venous congestion (2.7%). The prevalence of hematoma was 12.5% and 2.1% in the presence and absence of congestion, respectively (p<0.001). In the 8 patients who developed both, hematoma and congestion were separate events in 4 patients. Venous congestion caused hematoma in 3 patients, and hematoma caused venous congestion in 1 patient. CONCLUSIONS: Although postoperative hematoma and venous congestion often present concurrently, most events are not causally associated. When related, however, venous congestion leading to hematoma is more common in breast reconstruction, while hematoma preceding venous congestion is more common in HN reconstruction.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Hematoma/etiologia , Hiperemia/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Hematoma/cirurgia , Humanos , Hiperemia/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco
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