Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.795
Filtrar
1.
World Neurosurg ; 133: e551-e557, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562966

RESUMO

OBJECTIVE: Although external landmarks and trajectories for external ventricular drainage have been described for the freehand-guided method, no standard trajectory has been reported for deep-seated intracerebral hemorrhage (ICH). This article presents a freehand-guided catheter insertion technique for deep-seated spontaneous ICH using external landmarks. METHOD: Freehand-guided hematoma aspiration using Kocher's point and the external auditory canal as landmarks was performed in 32 patients with a diagnosis of spontaneous ICH in basal ganglia treated between May 2015 and July 2018 at the author's institute. RESULTS: In computed tomographic images, the mean actual to planned catheter tip distance was 16.1 ± 7.7 mm, the mean right-left deviation was 4.6 ± 5.2 mm, the mean anterior-posterior deviation was 11.1 ± 9.5 mm, and the mean superior-inferior deviation was 8.7 ± 4.4 mm. On largest hematoma slice, the mean distance from hematoma centers to inserted catheter was 9.8 ± 4.9 mm, and the mean horizontal and vertical distances were 4.0 ± 4.7 mm and 7.7 ± 4.8 mm, respectively. In 29 of the 32 patients, all the catheter holes contacted hematomas, whereas in the other 3 patients, 1 or more holes were in contact with brain parenchymal tissue. CONCLUSION: For patients with basal ganglia hemorrhage, freehand-guided catheter insertion and hematoma aspiration with subsequent fibrinolysis is a feasible procedure that shortens procedural times. The described technique could be used as an alternative method because it can be performed when the patient is in a critical state without additional equipment.


Assuntos
Hemorragia Cerebral/cirurgia , Procedimentos Neurocirúrgicos/métodos , Paracentese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos
2.
J Surg Res ; 245: 99-106, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415935

RESUMO

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


Assuntos
Hemorragia Cerebral/cirurgia , Drenagem/instrumentação , Hematoma/cirurgia , Modelos Anatômicos , Impressão Tridimensional , Punções/instrumentação , Adulto , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Drenagem/métodos , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções/métodos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Rev. bras. cir. plást ; 34(4): 452-457, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047899

RESUMO

Introdução: Abdominoplastia é um procedimento não apenas com características estéticas, mas também de reconstrução estrutural da parede abdominal. O objetivo do trabalho é mostrar a experiência dos autores em abdominoplastias, enfocando nos resultados estéticos da cicatriz e a evolução destes pacientes, aplicando as técnicas de ressecção em bloco do Professor Ronaldo Pontes (RP). Métodos: O estudo foi uma série retrospectiva de casos de 124 pacientes, entre março de 2014 a março de 2017, submetidos à abdominoplastia em bloco pela técnica RP. Resultados: Na nossa casuística, demonstrou-se uma mínima incidência de complicações encontradas com a técnica em Bloco RP, em comparação às encontradas na literatura, e, também, demonstrou um número pífio de casos de alterações na cicatrização. Conclusão: A técnica descrita e suas variantes atendem a necessidade de diversos tipos de casos e garantem cirurgias seguras e eficazes, com resultados muito satisfatórios, sendo uma técnica reprodutível.


Introduction: Abdominoplasty involves not only aesthetic characteristics but abdominal wall structural reconstruction. This study aimed to illustrate the authors' experience with abdominoplasty, focusing on the scar's aesthetic results and the evolution of application of the block resection technique of Professor Ronaldo Pontes (RP). Methods: The study included a series of retrospective cases of 124 patients treated between March 2014 and March 2017 who underwent RP block abdominoplasty. Results: In our studies, a minimal incidence of complications and a small number of healing alterations were noted with the RP block technique compared to those found in the literature. Conclusion: A técnica descrita e suas variantes atendem a necessidade de diversos tipos de casos e garantem cirurgias seguras e eficazes, com resultados muito satisfatórios, sendo uma técnica reprodutível.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Complicações Pós-Operatórias , Cicatriz Hipertrófica , Seroma , Estética , Abdominoplastia , Hematoma , Complicações Pós-Operatórias/cirurgia , Cicatriz Hipertrófica/cirurgia , Cicatriz Hipertrófica/complicações , Seroma/cirurgia , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Hematoma/cirurgia
5.
Medicine (Baltimore) ; 98(51): e18287, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860976

RESUMO

RATIONALE: Airway management of patients in a lateral decubitus position (LDP), who cannot lie supine is challenging for anesthesiologists. In a previous study, laryngeal mask airway (LMA) was found to be superior to conventional endotracheal intubation in LDP. PATIENT CONCERNS: A 38-year-old man diagnosed with type I neurofibromatosis presented with pain caused by a large hematoma (28 × 8 cm) located in the left upper back. On arrival at the operating theater, he was in a right LDP because of the aggravation of pain in the supine position. DIAGNOSES: Laryngoscopy-guided endotracheal intubation was expected to be difficult in LDP. INTERVENTIONS: After the induction of anesthesia, a non-inflatable LMA was introduced into the laryngopharynx with the patient in LDP. He was then maneuvered into a supine position and removal of the LMA was followed by endotracheal intubation. OUTCOMES: The surgery for the removal of the hematoma was performed in a prone position. The airway intubated with an endotracheal tube was well maintained during the entire surgery. LESSONS: LMA is a useful device for airway management in patients in LDP who cannot lie supine.


Assuntos
Manuseio das Vias Aéreas/métodos , Máscaras Laríngeas , Posicionamento do Paciente/métodos , Adulto , Manuseio das Vias Aéreas/instrumentação , Dorso/cirurgia , Hematoma/cirurgia , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Masculino , Neurofibromatose 1/terapia , Decúbito Dorsal
6.
Pan Afr Med J ; 33: 257, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692822

RESUMO

Penile fracture is a rare urologic emergency, defined as a traumatic rupture of the tunica albuginea of the corpus cavernosum. It mainly affects the young subjects during sexual intercourse. The purpose of this study was to report treatment outcomes in 6 patients with penile fracture observed in the Department of Urology-Andrology, Souro Sanou University Hospital of Bobo-Dioulasso. The study involved six patients with an average age of 38.3 years admitted in the hospital with painful penile swelling (4 cases) and persistent urethrorragia (2 cases) after wrong coital movement or forced manipulation of the penis. Painful swelling of the penis with penis simulating the appearance of an aubergine was the main sign found. Treatment was based on evacuation of the intracavernous haematoma followed by albuginorraphy in 5 cases and conservative treatment in 1 case. All patients had an uneventful postoperative course.


Assuntos
Coito , Hematoma/etiologia , Pênis/lesões , Adulto , Burkina Faso , Hematoma/cirurgia , Hospitais Universitários , Humanos , Masculino , Pênis/cirurgia , Estudos Retrospectivos , Ruptura , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(46): e17998, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725667

RESUMO

Giant abdominal hemophilic pseudotumor is exceedingly rare, thus may bring great challenges to the timely and proper diagnosis and treatment of clinicians. The only definitive management is complete removal of the abdominal hemophilic pseudotumor. The objective of this article is to report surgical treatment and follow-up outcomes of three unusual cases with giant abdominal hemophilic pseudotumor.We describe 3 patients with giant hemophilic pseudotumor involving the abdomen who were successfully treated with tumor resection. On presentation to our institution, the patients all had signs of giant cystic lesions in abdomen, and the patients' most outstanding complaints were aggravated abdominal pain. All of three patients underwent complete excision of abdominal hemophilic pseudotumor. The patients showed adequate pain relief compared with the previous status.Surgical resection is the most effective treatment option for patients with giant abdominal hemophilic pseudotumor who can undergo appropriate surgical treatment. This represents a safe and reasonable approach to sustainably relieve pain and other symptoms with giant hemophilic pseudotumor in the abdomen. Perioperative coagulation factor replacement therapy is also of great significance in reducing the risks and complications.


Assuntos
Hematoma/complicações , Hematoma/cirurgia , Hemofilia A/complicações , Adulto , Humanos , Masculino , Pessoa de Meia-Idade
10.
Transplant Proc ; 51(9): 3084-3086, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627914

RESUMO

A 72-year-old man with a past medical history notable for deceased renal transplant presented to the interventional radiology department for routine right lower quadrant renal transplant nephroureteral catheter exchange. The nephroureteral catheter was placed in 2016 because of the presence of a hematoma causing partial page kidney and hydronephrosis. An antegrade nephrostogram was notable for opacification of the small bowel instead of the renal collecting system. The patient then subsequently developed urinary retention and intractable abdominal pain. Because of the combination of events, it was deemed necessary for laparotomy and surgical repair of the small bowel. Intraoperative findings were notable for small bowel adhesion to the abdominal wall but otherwise no evidence of acute inflammatory changes. In this case report, we describe the first case of an idiopathically dislodged nephrostomy catheter to the small bowel from a transplanted kidney and its successful management.


Assuntos
Migração de Corpo Estranho , Intestino Delgado/patologia , Transplante de Rim/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Cateteres Urinários/efeitos adversos , Idoso , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Masculino , Nefrostomia Percutânea/instrumentação
11.
Medicine (Baltimore) ; 98(39): e17130, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574813

RESUMO

Animal studies have demonstrated that autophagy was involved in neuronal damage after intracerebral hemorrhage (ICH). Several studies showed thrombin-antithrombin (TAT) plasma levels were elevated in patients with ICH. In this study, we aimed to evaluate if autophagy occurred in patients with ICH; and the relationship between the severity of brain injury and plasma TAT levels.A novel tissue harvesting device was used during hematoma removal surgery to collect loose fragments of tissue surrounding the affected brain area in 27 ICH patients with hematoma volumes of >30 mL in the basal ganglia. Control tissues were obtained from patients who underwent surgery for arteriovenous malformation (n = 25). Transmission electron microscopy (TEM) and immunohistochemistry for autophagy-related proteins were used to evaluate the ultrastructural and morphologic cellular characteristics; and the extent of autophagy in the recovered tissue specimens. Stroke severity was assessed by using the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS). An enzyme-linked immunosorbent assay (ELISA) was used to measure plasma TAT levels.Transmission electron microscopy showed autophagosomes and autolysosomes exist in neurons surrounding the hematoma, but not in the control tissues. The number of cells containing autophagic vacuoles correlated with the severity of brain injury. Immunohistochemistry showed strong LC3, beclin 1, and cathepsin D staining in ICH tissue specimens. Plasma TAT levels correlated positively with autophagic cells and ICH severity (P < .01).Autophagy was induced in perihematomal neurons after ICH. Autophagy and plasma TAT levels correlated positively with severity of brain injury. These results suggest that autophagy and increased plasma TAT levels may contribute to the secondary damage in ICH patients.


Assuntos
Autofagia , Hemorragia Cerebral/sangue , Hematoma/sangue , Neurônios/fisiologia , Peptídeo Hidrolases/sangue , Adulto , Idoso , Antitrombina III , Gânglios da Base/metabolismo , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/cirurgia , Feminino , Escala de Coma de Glasgow , Hematoma/fisiopatologia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
12.
Medicine (Baltimore) ; 98(38): e17247, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567991

RESUMO

RATIONALE: Retropharyngeal hematoma (RH) is an infrequent but potentially life-threatening complication of anterior cervical spine surgeries (ACSS). Challenging situations might be confronted and catastrophic events or even deaths still occurred occasionally during the treatment. Currently, no widely accepted protocol has been developed. PATIENT CONCERNS: A 55 years old male underwent ACSS due to cervical myelopathy. Thirty-three hours after surgery the patient presented cervical swelling and obstructive dysphagia. Conservative treatment resulted in no recovery and cervical swelling progressed. DIAGNOSES: Emergent magnetic resonance imaging and plain radiograph established massive incisional and RHs. RH was shown to extend from the base of the skull to T1. INTERVENTIONS: An emergent surgery was performed under local anesthesia and cervical hematoma was evacuated. Nonetheless, evacuation of the blood clots in the vision field resulted into incomplete recovery of throat blockage. A gloved finger was used to explore the retropharyngeal space and some hidden blood clots were found and evacuated, then the patient obtained complete relief of the symptoms. OUTCOMES: Normal respiration and swallowing functions were obtained after the surgery. Obviously, recovery of motor function was noted while no other complication was found at 3-month follow-up LESSONS:: Our case illustrated that dysphagia was an early symptom of RH. Posterior compression from RH could cause obstruction of the pharyngeal airway and lead to difficulty of intubation. Hematoma could spread through the retropharyngeal space, a hematoma exploration beyond the visual range might be necessary in some cases for fear of the hidden hematoma.


Assuntos
Vértebras Cervicais/cirurgia , Hematoma/etiologia , Transtornos de Deglutição/etiologia , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia , Doenças da Medula Espinal/cirurgia
13.
Medicine (Baltimore) ; 98(41): e17553, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593138

RESUMO

RATIONALE: Intraspinal anesthesia, the most common anesthesia type of orthopedic operation, is regarded as safe and simple. Despite of the rare incidence, puncture related complication of intraspinal anesthesia is catastrophic for spinal cord. Here we present an intradural hematoma case triggered by improper anesthesia puncture. The principal reason of this tragedy was rooted in the neglect of spine deformities diagnosis before anesthesia. To the best of our knowledge, there is no specific case report focusing on the intradural hematoma triggered by improper anesthesia puncture. PATIENT CONCERNS: Hereby a case of thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture was reported. The presenting complaint of the patient was little neurologic function improvement after surgery at 6-month follow-up. DIAGNOSES: Emergency MRI demonstrated that massive spindle-like intradural T2-weighted image hypointense signal masses from T12 to S2 badly compressed the dural sac ventrally, and his conus medullaris was at L3/4 intervertebral level with absence of L5 vertebral lamina. Hereby, the diagnoses were congenital spinal bifida, tethered cord syndrome, spine intradural hematoma, and paraplegia. INTERVENTIONS: Urgent surgical interventions including laminectomy, spinal canal exploration hematoma removal, and pedicle fixation were performed. The patient received both medication (mannitol, mecobalamin, and steroids) and rehabilitation (neuromuscular electric stimulation, hyperbaric oxygen). OUTCOMES: Postoperation, he had regained only hip and knee flexion at II grade strength. His neurologic function was unchanged until 3 weeks postoperation. Six-month follow-up showed just little neurologic function improvement, and the American Spinal Injury Association grade was C. LESSONS: By presenting an intradural hematoma case triggered by improper anesthesia puncture, we shared the treatment experience and discussed the potential mechanism of neurologic compromise. The principal reason for this tragedy is preanesthesia examination deficiency. Necessary radiology examinations must be performed to prevent misdiagnosis for spinal malformation.


Assuntos
Anestesia/efeitos adversos , Hematoma/etiologia , Punções/efeitos adversos , Adulto , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Hematoma/diagnóstico por imagem , Hematoma/patologia , Hematoma/cirurgia , Humanos , Doença Iatrogênica/epidemiologia , Injeções Espinhais , Laminectomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Medula Espinal/irrigação sanguínea , Medula Espinal/patologia , Doenças da Medula Espinal/patologia , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
14.
JAMA ; 322(14): 1392-1403, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31593272

RESUMO

Importance: The association of surgical hematoma evacuation with clinical outcomes in patients with cerebellar intracerebral hemorrhage (ICH) has not been established. Objective: To determine the association of surgical hematoma evacuation with clinical outcomes in cerebellar ICH. Design, Setting, and Participants: Individual participant data (IPD) meta-analysis of 4 observational ICH studies incorporating 6580 patients treated at 64 hospitals across the United States and Germany (2006-2015). Exposure: Surgical hematoma evacuation vs conservative treatment. Main Outcomes and Measures: The primary outcome was functional disability evaluated by the modified Rankin Scale ([mRS] score range: 0, no functional deficit to 6, death) at 3 months; favorable (mRS, 0-3) vs unfavorable (mRS, 4-6). Secondary outcomes included survival at 3 months and at 12 months. Analyses included propensity score matching and covariate adjustment, and predicted probabilities were used to identify treatment-related cutoff values for cerebellar ICH. Results: Among 578 patients with cerebellar ICH, propensity score-matched groups included 152 patients with surgical hematoma evacuation vs 152 patients with conservative treatment (age, 68.9 vs 69.2 years; men, 55.9% vs 51.3%; prior anticoagulation, 60.5% vs 63.8%; and median ICH volume, 20.5 cm3 vs 18.8 cm3). After adjustment, surgical hematoma evacuation vs conservative treatment was not significantly associated with likelihood of better functional disability at 3 months (30.9% vs 35.5%; adjusted odds ratio [AOR], 0.94 [95% CI, 0.81 to 1.09], P = .43; adjusted risk difference [ARD], -3.7% [95% CI, -8.7% to 1.2%]) but was significantly associated with greater probability of survival at 3 months (78.3% vs 61.2%; AOR, 1.25 [95% CI, 1.07 to 1.45], P = .005; ARD, 18.5% [95% CI, 13.8% to 23.2%]) and at 12 months (71.7% vs 57.2%; AOR, 1.21 [95% CI, 1.03 to 1.42], P = .02; ARD, 17.0% [95% CI, 11.5% to 22.6%]). A volume range of 12 to 15 cm3 was identified; below this level, surgical hematoma evacuation was associated with lower likelihood of favorable functional outcome (volume ≤12 cm3, 30.6% vs 62.3% [P = .003]; ARD, -34.7% [-38.8% to -30.6%]; P value for interaction, .01), and above, it was associated with greater likelihood of survival (volume ≥15 cm3, 74.5% vs 45.1% [P < .001]; ARD, 28.2% [95% CI, 24.6% to 31.8%]; P value for interaction, .02). Conclusions and Relevance: Among patients with cerebellar ICH, surgical hematoma evacuation, compared with conservative treatment, was not associated with improved functional outcome. Given the null primary outcome, investigation is necessary to establish whether there are differing associations based on hematoma volume.


Assuntos
Doenças Cerebelares/cirurgia , Hemorragia Cerebral/cirurgia , Tratamento Conservador , Hematoma/cirurgia , Idoso , Doenças Cerebelares/terapia , Cerebelo/cirurgia , Hemorragia Cerebral/terapia , Feminino , Hematoma/terapia , Humanos , Masculino , Estudos Observacionais como Assunto , Resultado do Tratamento
15.
Clin Sports Med ; 38(4): 619-638, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472770

RESUMO

Athletic trainers, physical therapists, and team physicians have differing roles when providing care, yet often need to collaborate. Athletic trainers and physical therapists use a variety of therapeutic modalities and manual therapy techniques in conjunction with rehabilitation exercises to improve outcomes. Clinicians must be knowledgeable of the scientific rationale for each modality to choose the most effective treatment for the specific condition and stage of recovery. The team physician should be familiar with the use of common procedures in an athletic training room. Here, we review the most current evidence and the basic methods encountered in athletic training room settings.


Assuntos
Traumatismos em Atletas/terapia , Otopatias/cirurgia , Hematoma/cirurgia , Lacerações/terapia , Unhas/cirurgia , Modalidades de Fisioterapia , Traumatismos em Atletas/reabilitação , Bandagens Compressivas , Crioterapia , Terapia por Estimulação Elétrica , Terapia por Exercício , Humanos , Hipertermia Induzida , Massagem , Unhas/lesões , Técnicas de Sutura , Terapia por Ultrassom
16.
World Neurosurg ; 131: e543-e549, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398520

RESUMO

OBJECTIVE: To test whether robot-assisted surgery can improve prognosis of small-volume thalamic hemorrhage and to provide a surgical basis for treatment of small-volume thalamic hemorrhage. METHODS: This retrospective study included patients with thalamic hemorrhage and hematoma volume of 5-15 mL treated from December 2015 to December 2018. Patients were divided into an operation group and a nonoperation group. General data, types of hematoma, incidence of complications, Scandinavian Stroke Scale score, and modified Rankin Scale score were recorded and analyzed. RESULTS: Retrospectively, 84 cases met inclusion criteria: 35 cases in operation group and 49 cases in nonoperation group. At 90 days after onset, mortality was 11.4% in the operation group and 4.1% in the nonoperation group (P > 0.05). The Scandinavian Stroke Scale score in the operation group (43.3 ± 8.5) was higher than in the nonoperation group (36.1 ± 10.0) (P < 0.05). The modified Rankin Scale score in the operation group (2.9 ± 0.3) was lower than in the nonoperation group (3.7 ± 0.2) (P < 0.05). The incidence of pneumonia (8.6%) and renal dysfunction (14.3%) was lower in the operation group than in the nonoperation group (28.6% and 34.7%, respectively) (P < 0.05). There was no significant difference between the 2 groups in the incidence of central fever (5.7% vs. 12.2%), stress ulcer (11.4% vs. 16.3%), and ion balance disturbance (20.0% vs. 26.5%) (P > 0.05). CONCLUSIONS: Robot-assisted drainage of thalamic hemorrhage can improve prognosis and reduce the incidence of pneumonia and renal dysfunction.


Assuntos
Hematoma/cirurgia , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Doenças Talâmicas/cirurgia , Idoso , Drenagem/métodos , Feminino , Hematoma/diagnóstico por imagem , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Mortalidade , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/epidemiologia , Doenças Talâmicas/diagnóstico por imagem , Resultado do Tratamento
17.
World Neurosurg ; 131: 177-179, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31421300

RESUMO

This report portrays an unusual presentation of a dysembryoplastic neuroepithelial tumor characterized by a chronic, enlarging, heterogeneously enhancing organizing hematoma. Differential diagnoses included the malignant transformation of a low-grade glioma, radiation necrosis, and radiation-induced cavernoma. A dysembryoplastic neuroepithelial tumor may have atypical characteristics and behavior, so continued follow-up with serial imaging is recommended.


Assuntos
Encefalopatias/diagnóstico por imagem , Hematoma/complicações , Hematoma/diagnóstico por imagem , Neoplasias Neuroepiteliomatosas/complicações , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Adulto , Encefalopatias/complicações , Encefalopatias/patologia , Encefalopatias/cirurgia , Diagnóstico Diferencial , Hematoma/patologia , Hematoma/cirurgia , Humanos , Masculino , Neoplasias Neuroepiteliomatosas/patologia , Neoplasias Neuroepiteliomatosas/cirurgia
18.
World Neurosurg ; 131: e562-e569, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400527

RESUMO

BACKGROUND: Minimally invasive surgical techniques may have beneficial effects on spontaneous intracerebral hemorrhage. Accurate localization of the hematoma and real-time guided puncture are more important in minimally invasive surgical procedures than in traditional craniotomy. Here, we introduce a novel simple puncture positioning and guidance system for intracerebral hematoma and demonstrate its utility for hematoma puncture surgery in a simulation experiment and series of patients. METHODS: We describe the device and use of the technique for hematoma puncture surgery in basal ganglia hematomas and report on the precision of the simulation experiments compared to that of freehand puncture, as well as its clinical application in 16 cases. RESULTS: The accuracy of this technique was superior to that of freehand puncture. All 16 patients underwent successful puncturing of the hematoma cavity or ventricles only once without any related complications. CONCLUSIONS: We demonstrate a novel simple puncture positioning and guidance system that has the advantages of simplicity, low-cost, device availability, and individual real-time guidance. We believe this system may be useful in resource-limited centers where navigation is not available.


Assuntos
Hemorragia dos Gânglios da Base/cirurgia , Hemorragia Cerebral Intraventricular/cirurgia , Drenagem/métodos , Hematoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Punções/métodos , Adulto , Idoso , Hemorragia Cerebral/cirurgia , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Cirurgia Assistida por Computador
19.
BMC Surg ; 19(1): 98, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340806

RESUMO

BACKGROUND: In this systematic review and meta-analysis, we aimed to determine the risk factors associated with neck hematoma requiring surgical re-intervention after thyroidectomy. METHODS: We systematically searched all articles available in the literature published in PubMed and CNKI databases through May 30, 2017. The quality of these articles was assessed using the Newcastle-Ottawa Quality Assessment Scale, and data were extracted for classification and analysis by focusing on articles related with neck hematoma requiring surgical re-intervention after thyroidectomy. Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS: Of the 1028 screened articles, 26 met the inclusion criteria and were finally analyzed. The factors associated with a high risk of neck hematoma requiring surgical re-intervention after thyroidectomy included male gender (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.60-2.17, P < 0.00001), age (MD: 4.92, 95% CI: 4.28-5.56, P < 0.00001), Graves disease (OR: 1.81, 95% CI: 1.60-2.05, P < 0.00001), hypertension (OR: 2.27, 95% CI: 1.43-3.60, P = 0.0005), antithrombotic drug use (OR: 1.92, 95% CI: 1.51-2.44, P < 0.00001), thyroid procedure in low-volume hospitals (OR: 1.32, 95% CI: 1.12-1.57, P = 0.001), prior thyroid surgery (OR: 1.93, 95% CI: 1.11-3.37, P = 0.02), bilateral thyroidectomy (OR: 1.19, 95% CI: 1.09-1.30, P < 0.0001), and neck dissection (OR: 1.55, 95% CI: 1.23-1.94, P = 0.0002). Smoking status (OR: 1.19, 95% CI: 0.99-1.42, P = 0.06), malignant tumors (OR: 1.00, 95% CI: 0.83-1.20, P = 0.97), and drainage used (OR: 2.02, 95% CI: 0.69-5.89, P = 0.20) were not significantly associated with postoperative neck hematoma. CONCLUSION: We identified certain risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy, including male gender, age, Graves disease, hypertension, antithrombotic agent use, history of thyroid procedures in low-volume hospitals, previous thyroid surgery, bilateral thyroidectomy, and neck dissection. Appropriate intervention measures based on these risk factors may reduce the incidence of postoperative hematoma and yield greater benefits for the patients.


Assuntos
Doença de Graves/cirurgia , Hematoma/cirurgia , Tireoidectomia/efeitos adversos , Drenagem , Doença de Graves/complicações , Hematoma/etiologia , Humanos , Pescoço/cirurgia , Reoperação , Fatores de Risco
20.
J Craniofac Surg ; 30(7): e667-e671, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306386

RESUMO

Spontaneous intracerebral hemorrhage (ICH) is a vascular brain disease that causes very high rates of death and disability. Whether surgical or medical treatment is more appropriate is controversial.The purpose of the study was to examine the morbidity and mortality rates of surgical and medical therapy and their differences in order to determine which patients should be operated.In our study, the authors selected randomly and evaluated retrospectively 49 patients who were operated in Haydarpasa Numune Research and Education Hospital Neurosurgery Clinic and 51 patients who received medical therapy at Neurology Clinic for spontaneous supratentorial ICH between January 2007 and December 2011.The authors documented a detailed history of each patient featuring their neurological examination, Glasgow Coma Scale (GCS), Modified Rankin Disability Scale (MRDS), imaging, age, gender, and history of stroke, hypertension, diabetes mellitus, smoking and alcohol use, aspirin, or coumadin usage.As a result, the mortality rate found in our study was similar to previous studies (49%). Mortality of patients who underwent surgery (63%) found a higher rate of disability. This is because hematoma of the patients who were operated on larger volumes and diameters, GCS lower than and the higher MRDS scores, higher rates of herniation is connected. The authors concluded that very early operation does not create a difference in treatment between mortality rates. The authors observed that the most important factors for the prognosis of ICH patients whether operated or not are the GCS of patients at the time of arrival to the hospital and the nature of the hematoma.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Feminino , Escala de Coma de Glasgow , Hematoma/cirurgia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA