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1.
Medicine (Baltimore) ; 99(10): e19404, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150089

RESUMO

INTRODUCTION: Colonic intramural hematomas are rarely encountered clinical entity. Colonic intramural hematomas are frequently associated with blunt trauma, and they could occur spontaneously in patients under anticoagulant therapy or with bleeding diathesis. There were few reports on synchronous colon cancer and intramural hematoma. Intramural hematomas of gastrointestinal tract in those patients undergoing anticoagulation treatment often occurred at the esophagus, duodenum, and small intestine, while colon was rarely affected site. Clinical symptoms of colonic intramural hematomas may include abdominal pain, lower gastrointestinal bleeding, and occasionally bowel obstruction. PATIENT CONCERNS: We herein report 2 cases of colonic intramural hematomas. Case 1 presented with abdominal pain and decreased defecation. Colonoscopy and contrast-enhanced computed tomography (CT) revealed intramural hematoma proximal to the neoplasm at ascending colon. Case 2 was a patient under regular anticoagulation therapy after coronary arterial stent implantation. His chief complaints were intermittent abdominal pain and distension. Colonoscopy and contrast-enhanced CT demonstrated intramural hematoma at sigmoid colon. DIAGNOSIS: Case 1 was diagnosed synchronous colonic intramural hematoma and colon cancer at ascending colon via surgery. Case 2 was diagnosed intramural hematoma of sigmoid colon through colonoscopy and follow-up CT. INTERVENTIONS: Case 1 underwent right hemicolectomy. Case 2 received conservative treatment including anticoagulation discontinuation, total parenteral nutrition, and intravenous hydration. OUTCOMES: They both had a good recovery. CONCLUSION: Colonoscopy and CT are useful in diagnosing colonic intramural hematoma. The optimal treatment should be individualized according to different etiologies causing hematoma.


Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças do Colo/terapia , Hematoma/diagnóstico por imagem , Hematoma/terapia , Dor Abdominal/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Anticoagulantes/efeitos adversos , Colectomia , Doenças do Colo/etiologia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Colonoscopia , Constipação Intestinal/etiologia , Hidratação , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Tomografia Computadorizada por Raios X
3.
Khirurgiia (Mosk) ; (2): 84-88, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105261

RESUMO

A 55-year-old patient M. with compression fractures of Th7-Th8 underwent Th7-Th8 decompressive laminectomy, Th6-Th9 transpedicular spine fusion procedure on January 31, 2017. After that, multiple myeloma was diagnosed at the National Research Center for Hematology. Computed tomography revealed misplacement of a left Th6 screw, its anterior cortical perforation and penetration into the aorta. Signs of intramural hematoma were noticed in this area. The patient was referred to the Petrovsky National Research Center of Surgery. Two-stage surgical approach was preferred. Endovascular repair of the thoracic aorta (TEVAR) was followed by revision of transpedicular fusion system and reinstallation of the screw. Operation was performed on July 14, 2017. Postoperative period was uneventful.


Assuntos
Aorta Torácica , Hematoma , Fraturas da Coluna Vertebral , Fusão Vertebral , Hematoma/etiologia , Humanos , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
J Cardiothorac Surg ; 15(1): 12, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924238

RESUMO

BACKGROUND: Mediastinal hematoma rarely occurs after a minor traffic injury. CASE PRESENTATION: A woman in her forties was transferred to the emergency room by ambulance due to a traffic accident. Computed tomography (CT) revealed no abnormal findings, and she went home. Two days after the accident, the contrast-enhanced CT was repeated, which revealed cervical and mediastinal hematomas. Because it was possible that there was active bleeding from the right inferior thyroid artery, embolization of the right inferior thyroid artery was performed; however, her condition further deteriorated, so we performed emergency surgery to achieve hemostasis and remove the hematoma. Because of oozing from the right thyroid lobe, we performed right hemithyroidectomy and drainage of mediastinal space and right thoracic cavity. Since there was no bleeding site in the mediastinum, we thought that the mediastinal hematoma was due to bleeding from the thyroid gland. Her postoperative course was uneventful, and she is doing well at 9 months of follow-up after surgery. CONCLUSIONS: It is possible that mediastinal hematoma might be caused by a minor traffic injury.


Assuntos
Acidentes de Trânsito , Hematoma/etiologia , Hemorragia/etiologia , Doenças do Mediastino/etiologia , Lesões do Pescoço/complicações , Doenças Faríngeas/etiologia , Glândula Tireoide/lesões , Adulto , Drenagem , Embolização Terapêutica/efeitos adversos , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/cirurgia , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/cirurgia , Artéria Subclávia , Doenças da Glândula Tireoide/diagnóstico por imagem , Doenças da Glândula Tireoide/etiologia , Doenças da Glândula Tireoide/cirurgia , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X
5.
J Cardiothorac Surg ; 15(1): 8, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915025

RESUMO

BACKGROUND: Bleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare. CASE PRESENTATION: A 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space. CONCLUSIONS: This report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.


Assuntos
Embolização Terapêutica , Hematoma/etiologia , Hematoma/terapia , Pneumotórax/cirurgia , Artéria Subclávia , Aderências Teciduais/complicações , Idoso , Angiografia , Circulação Colateral , Hematoma/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
6.
World Neurosurg ; 133: e187-e196, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493611

RESUMO

OBJECTIVE: To investigate outcomes and prognostic factors of ruptured middle cerebral artery (MCA) aneurysms, treated via endovascular approach, with improving treatment materials and techniques. PATIENTS AND METHODS: A total of 185 consecutive patients, admitted with acutely ruptured MCA aneurysms and treated by endovascular methods between 2006 and 2016, were retrospectively reviewed. Their baseline characteristics, procedure-related complications, and angiographic and clinical outcomes were collected. Univariate analysis and logistic regression analysis were completed to identify any association between procedure-related complications or clinical outcomes and potential risk factors. RESULTS: Procedure-related complications occurred in 28 patients (15.1%), including aneurysm rebleeding in 7 (3.8%), hematoma expansion in 10 (5.4%), and ischemia in 13 (7.0%) (concurrent hemorrhage and ischemia in 2 patients), which resulted in morbidity/mortality of 7% and 1.4%. Final evaluations indicated that 153 patients (82.7%, 153/185) had a good outcome (modified Rankin Scale score 0-2). Among 120 (69.4%) who underwent angiographic follow-up, 89 (74.2%) were completely occluded and 20/120 (16.7%) were recanalized. Multivariate analysis of clinical outcome indicated that a high preoperative Hunt and Hess grade (IV-V), intrasylvian/intracerebral hematoma, and early period treatment (2006-2013) were associated with unfavorable outcomes. CONCLUSIONS: Endovascular treatment for patients with ruptured middle cerebral artery aneurysms may offer favorable clinical and angiographic outcomes. With the evolution of treatment materials and updated techniques, treatment complications have become less common than previously reported in literature, and clinical outcomes have been improved in recent years.


Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Angiografia Cerebral , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Prognóstico , Recidiva , Estudos Retrospectivos , Stents , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento
7.
Radiol Med ; 125(1): 24-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531810

RESUMO

PURPOSE: The increasing number of computed tomography (CT) performed allows the more frequent identification of small, solid pulmonary nodules or ground-glass opacities. Video-assisted thoracic surgery (VATS) represents the standard in most lung resections. However, since VATS limit is the digital palpation of the lung parenchyma, many techniques of nodule localization were developed. The aim of this study was to determine the feasibility and safety of CT-guided microcoil insertion followed by uniportal VATS wedge resection (WR). MATERIALS AND METHODS: Retrospective study in a single institution, including patients undergone CT-guided microcoil insertion prior to uniportal VATS resection between May 2015 and December 2018. The lesion was identified using fluoroscopy. RESULTS: Forty-six consecutive patients were enrolled (22 male and 24 female). On CT: 5 cases of GGO, 2 cases of semisolid nodules, 39 cases of solid nodules. The median pathologic tumor size was 1.21 cm. Neither conversion to thoracotomy nor microcoil dislodgement was recorded. All patients underwent uniportal VATS WR (9/46 underwent completion lobectomy after frozen section). WR median time was 105 min (range 50-150 min). No patients required intraoperative re-resection for positive margins. After radiological procedure, 1 case of hematoma and 2 cases of pneumothorax were recorded. Four complications occurred in the postoperative period. The mean duration of chest drain and length of stay were 2.9 and 4.6 days, respectively. CONCLUSIONS: CT-guided microcoil insertion followed by uniportal VATS resection was a safe and feasible procedure having a minimal associated complications rate and offering surgeons the ease of localization of small intrapulmonary nodules.


Assuntos
Marcadores Fiduciais , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Radiografia Intervencionista/métodos , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Duração da Cirurgia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adulto Jovem
8.
Vasc Endovascular Surg ; 54(2): 169-171, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31714183

RESUMO

Retroperitoneal haemorrhage is a rare but potentially life-threatening event. It may occur either spontaneously or secondary to percutaneous vascular access procedures, trauma, or ruptured aortic, iliac, or mesenteric aneurysms. As a result, the clinical presentation is variable. Computed tomography and/or angiography are vital for diagnosis. Management may range from conservative treatment for stable patients to emergency laparotomy or embolization for catastrophic haemorrhage. Direct percutaneous puncture of a deep intra-abdominal pseudoaneurysm is an accepted but infrequently performed technique due to a number of diagnostic and technical challenges. We describe the successful percutaneous transabdominal angioembolization of a superior mesenteric artery rupture in a 77-year-old woman with a large retroperitoneal haematoma. This was performed after a conventional femoral transarterial approach was unsuccessful.


Assuntos
Falso Aneurisma/terapia , Aneurisma Roto/terapia , Embolização Terapêutica , Hemorragia/terapia , Artéria Mesentérica Superior , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/fisiopatologia , Feminino , Hematoma/etiologia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Espaço Retroperitoneal , Circulação Esplâncnica , Resultado do Tratamento
10.
Surgery ; 167(1): 117-123, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31582306

RESUMO

BACKGROUND: Overnight hospitalization after thyroid surgery has been a widely adopted practice because of the concern for complications such as hypocalcemia and hematoma. Same-day discharge, however, has become popular in recent years. METHODS: The American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy database (2016-2017) was used to identify patients who underwent thyroid resections. A 1:1 propensity score matching was used to match patients who were discharged on postoperative day 0 and those discharged on postoperative days 1 or 2. Multivariable logistic regression models were constructed to assess the association between discharge timing and postoperative outcomes. RESULTS: Of the 10,502 patients, 2,776 (26.4%) were discharged on postoperative day 0, and 7,726 (73.6%) were discharged on postoperative days 1 or 2. After propensity score matching, 1,977 matched pairs were created. In this matched cohort, the rates of readmission were similar when comparing patients discharged on postoperative day 0 with those discharged on postoperative days 1 or 2 (odds ratio 1.26, 95% confidence interval 0.78-2.05). Likewise, no differences were observed in the rates of surgical site infection, clinically severe hypocalcemia, neck hematoma, or recurrent laryngeal nerve injury. CONCLUSION: In a national cohort of patients undergoing thyroid surgery, same-day discharge was not associated with greater rates of readmission or complications when compared with discharge 1 or 2 days after thyroid surgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Tempo de Internação , Alta do Paciente/normas , Complicações Pós-Operatórias/epidemiologia , Tireoidectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pescoço , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Fatores de Risco , Tireoidectomia/métodos , Tireoidectomia/normas
11.
Cardiovasc Pathol ; 44: 107151, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31760241

RESUMO

Intramyocardial dissection or intramyocardial dissecting hematoma is uncommon complication either of myocardial infarction or severe thoracic injury. Intramyocardial dissecting hematoma is caused by intersecting bleeding between the layers of myocardial fibers. In contrast to cardiac rupture, the myocardial wall maintains its integrity. In this paper, we present a case of patient suffering with ischemic heart disease, reporting worsening chest pain and dyspnea 2 months after autovenous graft bypass surgery. The coronary angiography revealed severe stenosis of the autovenous graft, which was treated by stent implantation. Three hours after intervention, the patient showed signs of cardiogenic shock with clinical suspicion of heart tamponade because of ventricular wall rupture. The patient died despite the surgical drainage of the hematoma and blood transfusions. In the necropsy, the large intramyocardial dissecting hematoma in the very superficial layer of the left ventricular myocardium was found, accompanied with very small extent of necrotic myocardium in the neighborhood of the intramyocardial dissecting hematoma. The prevailing majority of the left ventricle thickness was vital. The lack of developed transmural infarction in our case leads us to hypothesis that the increased intravascular pressure during the reperfusion is the main contributor to the intramyocardial dissecting hematoma development, together with reduced biomechanical resistance of the capillaries affected by chronic ischemia.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Oclusão de Enxerto Vascular/terapia , Hematoma/etiologia , Infarto do Miocárdio/cirurgia , Traumatismo por Reperfusão Miocárdica/etiologia , Miocárdio/patologia , Intervenção Coronária Percutânea/efeitos adversos , Idoso de 80 Anos ou mais , Autopsia , Causas de Morte , Evolução Fatal , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Hematoma/patologia , Humanos , Masculino , Traumatismo por Reperfusão Miocárdica/patologia , Intervenção Coronária Percutânea/instrumentação , Stents
12.
World Neurosurg ; 135: 63-67, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31841722

RESUMO

BACKGROUND: While prior studies reporting de novo arteriovenous malformations after birth are not uncommon, reports of ectopic recurrence of arteriovenous malformation after radiotherapy are scarce. CASE DESCRIPTION: An 8-year-old girl with a ruptured cerebellar arteriovenous malformation was treated with stereotactic radiosurgery. The nidus was completely obliterated 17 months after stereotactic radiosurgery; however, 20 years later she had a rupture of a recurrent nidus that occurred adjacent to the original nidus, accompanied by a radiation-induced cyst. Surgical resection was performed, and subsequent pathologic examination revealed 2 different compartments: a typical nidus and a postirradiated degenerated nidus with an encapsulated hematoma. Immunohistochemical stains showed increased expression of Ki-67 and decreased expression of endoglin in endothelial cells in the recurrent nidus. CONCLUSIONS: Depletion in endoglin may lead to the formation of vessel malformations in the presence of angiogenic stimuli. This case serves as a strong reminder of the importance of long-term follow-up after stereotactic radiosurgery, especially for pediatric cases.


Assuntos
Malformações Arteriovenosas Intracranianas/etiologia , Malformações Arteriovenosas Intracranianas/terapia , Radiocirurgia , Adulto , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Hematoma/etiologia , Hematoma/patologia , Hematoma/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/patologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/cirurgia , Recidiva , Ruptura Espontânea/etiologia , Ruptura Espontânea/patologia , Ruptura Espontânea/radioterapia
13.
Ann Vasc Surg ; 62: 191-194, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449950

RESUMO

BACKGROUND: Percutaneous endovascular aortic repairs (pEVARs) are associated with access site complications. Two-device technique using 2 Perclose devices has been well established. Combined Perclose and Angioseal technique has been described as well. We sought to determine whether a hybrid Perclose and Angioseal closure technique would safely and effectively establish hemostasis in large-bore arteriotomies up to 20F. METHODS: Patients were identified as candidates for percutaneous access based on preoperative computed tomography findings, perioperative ultrasound of femoral vessels, or a combination of the 2 modalities. Prior to sheath insertion, 1 Perclose device was predeployed. At the end of pEVAR, device sheath and introducer were withdrawn over a 0.035″ wire, and partially deployed Perclose was fully deployed. The sheath and introducer were fully withdrawn and the arteriotomy was closed with a 6F Angioseal vascular closure device and completion deployment of the Perclose. Patients were followed at day 1 and day 30 and at least 1 year postintervention. RESULTS: A composite end point of complications was defined as an access site-related bleed or hematoma that required blood transfusion or an extended hospital stay, pseudoaneurysm, arteriovenous fistula, dissection, or retroperitoneal hematoma. The combined technique was initially successful in 44/45 arteriotomies (97.8%) in 24/25 patients (96.0%) with no conversions to cutdown. Sheath sizes ranged from 10F to 20F outer diameter (OD), with an average of 15.89F OD. The single-device failure was caused by a failure of the footplate to catch during deployment in the Angioseal with a 20F arteriotomy. Consequently, that was the only patient in which this closure was attempted for an arteriotomy larger than 19F. There were no early or late complications in this series. CONCLUSIONS: Large-bore arteriotomies may be safely and effectively closed using a hybrid percutaneous closure technique for sheaths up to 19F OD. Evaluation of this technique in closure of large-bore arteriotomies is ongoing and further investigation is needed to assess the value of this closure in 20F OD sheaths and above.


Assuntos
Doenças da Aorta/cirurgia , Cateterismo Periférico , Procedimentos Endovasculares , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular , Doenças da Aorta/diagnóstico por imagem , Transfusão de Sangue , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Hematoma/etiologia , Hematoma/prevenção & controle , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Tempo de Internação , Punções , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle
14.
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
17.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(3): 5-9, dic.2019. tab
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1021561

RESUMO

La hemorragia postparto es una de las complicaciones obstétricas más temidas por los obstetras a nivel mundial, pudiendo causar la muerte de las puérperas. El objetivo de este estudio fue determinar las causas de las hemorragias y las patologías asociadas a estas en las pacientes atendidas en el Hospital Gineco-Obstétrico Enrique C. Sotomayor de Guayaquil, Ecuador en el periodo 2016­2018 y que estaban en su puerperio inmediato. Las mujeres atendidas en ese periodo en dicha institución fueron 528, de las cuales 160 presentaron hemorragias en el puerperio inmediato. Las hemorragias por desgarro del suelo pélvico representaron un 48,75% y se asociaron en un 35% a hematomas en las paredes del suelo, las causadas por retención de restos placentarios, constituyeron un 26,25% y el 20% presentó acretismo placentario y finalmente las ocasionadas por atonía uterina fueron de un 25%, correspondiendo un 25% a coagulopatías. Se concluyó que las hemorragias postparto por desgarro del suelo pélvico son la causa con mayor porcentaje en contraposición con otros estudios que indican que la atonía uterina es la causa más frecuente de hemorragias postparto inmediato(AU)


Postpartum hemorrhage is one of the obstetric complications most feared by obstetricians worldwide, and may cause the death of puerperal women. The objective of this study was to determine the causes of hemorrhages and the pathologies associated with these in the patients treated at the Enrique C. Sotomayor Obstetric Hospital of Guayaquil, Ecuador in the period 2016 - 2018 and that were in their immediate puerperium. The women who attended in that period were 528 women, 160 of them presented hemorrhages in the immediate puerperium. Hemorrhages by pelvic floor tearing represented 48.75% and 35% were associated to bruises in the floor walls, those caused by retention of placental remains constituted 26.25% and 20% presented accretism and finally those caused by uterine atony were 25% while 25% corresponded to coagulopathies. We concluded that the postpartum hemorrhages by tearing of the pelvic floor are the cause with the highest percentage; in contrast to other studies, which indicate that uterine aton is the most frequent cause of immediate postpartum hemorrhage(AU)


Assuntos
Humanos , Feminino , Gravidez , Período Pós-Parto , Hemorragia Pós-Parto/etiologia , Complicações do Trabalho de Parto/etiologia , Placenta Acreta , Transtornos da Coagulação Sanguínea/etiologia , Estudos Retrospectivos , Hematoma/etiologia
18.
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
19.
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
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