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1.
Medicine (Baltimore) ; 100(9): e24975, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655966

RESUMO

RATIONALE: Jejunal varices are rare in portal hypertension and are often difficult to diagnose and treat. Herein, we present a case of gastrointestinal bleeding due to jejunal varices after hepatobiliary surgery. PATIENT CONCERNS: A 69-year-old man presented with recurrent massive gastrointestinal bleeding. He underwent partial right hepatectomy and cholangiojejunostomy 2 years prior to the first onset of bleeding. Two sessions of endoscopic vessel ligation for esophageal varices were performed afterwards, and hematemesis resolved completely, but massive melena still recurred during the following 5 years. DIAGNOSIS: The patient was diagnosed with jejunal varices caused by portal venous stenosis after hepatobiliary surgery. INTERVENTION: Portal venous angioplasty using balloon dilation and stent implantation was performed. OUTCOMES: After the intervention procedure, the patient did not experience any onset of gastrointestinal bleeding during follow-up. LESSONS: Hepatopancreatobiliary could lead to the formation of jejunal varices. The combined use of capsule endoscopy, contrast-enhanced computed tomography, and sometimes portal venography is a promising strategy to search for jejunal varices. Transcatheter angioplasty appears to be a safe and effective method for treatment of jejunal varices in certain appropriate cases.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hepatectomia/efeitos adversos , Jejunostomia/efeitos adversos , Litíase/cirurgia , Hepatopatias/cirurgia , Hemorragia Pós-Operatória/etiologia , Idoso , Endoscopia por Cápsula , Colonoscopia/métodos , Diagnóstico Diferencial , Endoscopia do Sistema Digestório/métodos , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Hemorragia Pós-Operatória/diagnóstico
2.
Chirurgia (Bucur) ; 116(1): 89-101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33638330

RESUMO

The aim of our study was to explore the feasibility of a novel fluorescence-guided laparoscopic technique to localize the obscure GI haemorrhage, using the vascular wash-out properties of indocyanine green (ICG). Method: The feasability study included patients with previous surgical modifications of the gut architecture, qualified as an overt obscure GI bleeding with an urgent need to be localized and controlled. Five mL of ICG was injected intravenously and laparoscopic infrared inspection was performed 30 minutes after the dye was eliminated from the bloodstream. The bleeding area mapping was demonstrated and the haemostasis was carefully performed using endoscopy or laparoscopic techniques. Results: A series of two cases were included in our fesability study so far. Case 1. A 43-year old male, who recently received a Laparoscopic Roux-en-Y gastric bypass (RYGB), developed a recurrent GI bleeding. Post dye wash-out intense signal was demonstrated at the level of duodenum and weaker at the gastric remnant. The laparoscopic trans-gastric exploration of the remnant identified an active bleeding source siding the stapled line and haemostasis was achieved with laparoscopic ligation using stitches. Case 2. A 66-year old male patient who underwent an open Whipple resection nine months before, was admitted for a repeated GI bleeding. The inspection of the biliopancreatic limb noticed an intense fluorescent signal toward the enteral proximal end. Upper digestive endoscopy confirmed the presence of an active bleeding source from ectopic jejunal varices siding the choledoco-jejunal anastomosis. Argon plasma coagulation was performed endoscopically and achieved hemostasis. Conclusions: A successful novel ICG fluorescence-guided laparoscopic mapping technique was used to localize the site of the obscure GI haemorrhage and to facilitate the prompt bleeding control. To the best of our knowledge these are the first published cases for which this technique was used.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Corantes Fluorescentes , Hemorragia Gastrointestinal/etiologia , Verde de Indocianina , Laparoscopia , Hemorragia Pós-Operatória/etiologia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Endoscopia , Estudos de Viabilidade , Derivação Gástrica/efeitos adversos , Hemorragia Gastrointestinal/cirurgia , Humanos , Laparoscopia/métodos , Ligadura , Masculino , Imagem Óptica , Pancreaticojejunostomia/efeitos adversos , Hemorragia Pós-Operatória/cirurgia , Recidiva , Resultado do Tratamento
3.
BMC Surg ; 21(1): 70, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530951

RESUMO

BACKGROUND: The present study aims to assess the preliminary outcomes of the effectiveness of wrapping the ligamentum teres hepatis (LTH) around the gastroduodenal artery stump for the prevention of erosion hemorrhage after laparoscopic pancreaticoduodenectomy (LPD). METHODS: We reviewed 247 patients who had undergone LPD between January 2016 and April 2019. The patients were divided into two groups according to whether LTH wrapped the stump of the gastroduodenal artery: group A (119 patients) who underwent the LTH wrapping procedure, and group B (128 patients) who did not undergo the procedure. The perioperative data from the two groups were reviewed to assess the effectiveness of the LTH procedure for the prevention of postpancreatectomy hemorrhage (PPH) and other complications. RESULTS: No differences were observed in the clinical characteristics between the two groups. The data from 247 patients were acceptable for analysis: 119 patients underwent wrapping, and 128 patients did not. The incidence of clinically relevant pancreatic fistula (8.4% vs 3.9%), biliary fistula (2.5% vs 1.6%), intra-abdominal infection (10.1% vs 3.9%) and delayed gastric emptying (13.4% vs 16.4%) showed no significant difference between group A and group B. The 90-day mortality and 90-day reoperation rates (0.8% vs 0.8% and 5.0% vs 3.1%) were also similar between group A and group B. Furthermore, postpancreatectomy hemorrhage of Grade B and C occurred in 0 patients (0.0%) in the wrapping group, which was significantly less frequent than the occurrence in the nonwrapping group (7 patients; 5.5%, P = 0.02). CONCLUSIONS: Wrapping the LTH around the gastroduodenal artery stump after LPD does not reduce the incidence of clinically relevant pancreatic fistula, biliary fistula or delayed gastric emptying. However, this procedure has a trend of reducing the rate of PPH of Grade B and C after LPD and is simple to perform.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Hemorragia Pós-Operatória/prevenção & controle , Ligamento Redondo do Fígado , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Ligamento Redondo do Fígado/cirurgia
4.
Medicine (Baltimore) ; 100(3): e23581, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545932

RESUMO

ABSTRACT: Partial nephrectomy (PN) has been established as the standard treatment for T1 renal tumors, and postoperative hemorrhage due to vascular complications is a rare but potentially life-threatening complication reported after PN. Thus, this study evaluated the imaging and surgical factors associated with postoperative hemorrhage after PN and the clinical results of trans-arterial embolization. A retrospective review of the institutional PN database was performed from May 2012 to January 2019, revealing that we performed 810 PN procedures at our institution. In total, 12 patients were referred to the interventional radiology department for vascular complications after the procedure. Patients with and without transarterial embolization (TAE) were age- and sex-matched with 56 patients. Preoperative imaging characteristics and operative details were considered. Univariable and multivariable analyses were used to test their eventual association with the occurrence of hemorrhage. Furthermore, renal functions at diagnosis, after operation or embolization for TAE cases, and at the last follow-up were recorded. A diagnosis of hemorrhage was made at a median of 4 (range, 0-25) days after surgery. The majority of patients (50%) presented with gross hematuria. T test revealed higher renal tumor-parenchyma contact area (TPA) (P = .0407), Length-A (P = .0136), Length-P (P = .0267), operation time (P = .0214) and estimated blood loss (P = .0043) in patients with hemorrhage than in controls. Binary logistic regression analysis identified TPA (P = .048) and estimated blood loss (P = .042) as independent predictors for postoperative hemorrhage with an area under the ROC curve of 0.705 (64% sensitivity and 79% specificity). In conclusion, the occurrence of hemorrhage after PN was associated with a larger TPA and more estimated blood loss during the procedure. In patients who underwent selective TAE, renal function remained comparable with that of controls.


Assuntos
Nefrectomia/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/prevenção & controle , Valor Preditivo dos Testes , Procedimentos Cirúrgicos Vasculares
5.
Khirurgiia (Mosk) ; (2): 53-57, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570355

RESUMO

OBJECTIVE: To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. MATERIAL AND METHODS: The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. RESULTS: Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). CONCLUSION: Omentoplasty reduces duration of treatment and risk of arrosive bleeding.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fixação Interna de Fraturas/métodos , Mediastinite/cirurgia , Omento , Esterno/cirurgia , Cicatrização , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Humanos , Mediastinite/etiologia , Mediastinite/prevenção & controle , Omento/cirurgia , Omento/transplante , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Recidiva , Irrigação Terapêutica
6.
Khirurgiia (Mosk) ; (1): 77-82, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395516

RESUMO

Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic surgery requiring a clear classification and surgical strategy. According to literature data, postoperative hemorrhage occurs in 3-30% of cases. Incidence of hemorrhages depends on intraoperative, anamnestic, histological and postoperative factors. Early postoperative hemorrhage (within 24 hours after surgery) is usually a consequence of technical errors in intraoperative hemostasis, perioperative coagulation disorders. The mechanism of delayed bleeding is more complex and often associated with various arrosive factors: pancreatic fistula, biliary fistula, abscess. Currently, there is no a single treatment algorithm for patients with postpancreatectomy hemorrhage. According to various researchers, contrast-enhanced CT is preferred for diagnosis. In recent years, the role of endovascular hemostasis has significantly increased. This problem requires further study and development of a single treatment and diagnostic algorithm that will reduce mortality in these patients.


Assuntos
Pancreatectomia , Pancreatopatias , Hemorragia Pós-Operatória , Humanos , Incidência , Pancreatectomia/efeitos adversos , Pancreatopatias/cirurgia , Fístula Pancreática , Pancreaticoduodenectomia , Hemorragia Pós-Operatória/classificação , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia
7.
Compend Contin Educ Dent ; 42(1): 18-24; quiz 25, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33481622

RESUMO

During and after commonly performed dental surgical procedures, hemorrhaging that is greater than normal can occur in patients who do not have bleeding disorders. This article discusses the management of various potential hemorrhagic scenarios with respect to extractions and periodontal and implant surgeries. Protocols for controlling bleeding are delineated for primary and postoperative hemorrhaging. Background information is provided with respect to blood vessels, hemostatic mechanisms, patient evaluations, and drugs that may need to be suspended prior to dental surgical procedures.


Assuntos
Implantes Dentários , Hemostáticos , Implantes Dentários/efeitos adversos , Hemostáticos/uso terapêutico , Humanos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Extração Dentária
8.
Med. clín (Ed. impr.) ; 156(1): 1-6, ene. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198541

RESUMO

ANTECEDENTES Y OBJETIVOS: El retrasplante pulmonar (RTP) es un tratamiento válido en pacientes con disfunción pulmonar, pero con una elevada morbimortalidad. Nuestro objetivo es analizar nuestra experiencia en RTP en supervivencia y función pulmonar. PACIENTES Y MÉTODOS: Estudio retrospectivo de pacientes con RTP (1990-2019). VARIABLES: receptores y procedimiento, mortalidad precoz, supervivencia y función pulmonar en pacientes CLAD. Variables cuantitativas (media±DE); cualitativas (%). Se utilizó el test t de Student o χ2. La supervivencia se estimó mediante Kaplan-Meier, comparándose con Log Rank. Se estableció como significativa p < 0,05. RESULTADOS: De 784 pacientes trasplantados, 25 pacientes (edad media 38,41 ± 16,3 años, 12 hombres y 13 mujeres) fueron RTP; CLAD (n = 19), infarto pulmonar (n = 2), complicaciones de vía aérea (n = 2), disfunción del injerto (n = 1), rechazo hiperagudo (n = 1). Tiempo medio hasta el retrasplante: 5,41 ± 3,87 años en CLAD y 21,2 ± 21,4 días en no CLAD. La mortalidad a 90 días fue del 52% y 36,8% en el segundo periodo (p = 0,007), siendo mayor en pacientes que precisaron ECMO preoperatorio (80 vs. 20%, p = 0,04). La supervivencia a 1 y 5 años fue del 53,9% y 37,7%, respectivamente (p = 0,016). La supervivencia del grupo CLAD fue mayor (p = 0,08). El ECMO pre RTP disminuyó la supervivencia (p = 0,032). FEV1 mejoró una media de 0,98 ± 0,13L (25,6 ± 18,8%) (p = 0,001). CONCLUSIONES: El RTP es un procedimiento de elevada mortalidad que obliga a una cuidadosa selección de los pacientes, con mejores resultados en aquellos con CLAD. La función pulmonar de los pacientes con CLAD mejoró significativamente


BACKGROUND: Lung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung transplantation. Our goal is to analyse our experience in LR in terms of survival and lung function. METHODS: Retrospective study of patients undergoing LR (1990-2019). VARIABLES: recipients and procedure, early mortality, survival and lung function in patients with CLAD. Quantitative variables (mean±SD); qualitative (%). Student's t test or χ2 was used. Survival was estimated using Kaplan-Meier, compared with Log Rank. A p < 0.05 was established as significant. RESULTS: Of 784 transplanted patients, 25 patients (mean age 38.41-16.3 years, 12 men and 13 women) were LR; (CLAD (n = 19), pulmonary infarction (n = 2), airway complications (n = 2), graft dysfunction (n = 1), hyperacute rejection (n = 1), mean time to retransplantation: 5.41 ± 3.87 years in CLAD and 21.2 ± 21.4 days in non-CLAD. The 90-day mortality was 52% and 36.8% in the second period (p = 0.007), being higher in patients who required preoperative ECMO (80 vs. 20%, p = 0.04). The 1- and 5-year survival was 53.9% and 37.7%, respectively (p = 0.016). Survival of the CLAD group was greater (p = 0.08). Pre LR ECMO decreased survival (p = 0.032). After LR, FEV1 improved an average of 0.98 ± 0.13L (25.6 ± 18.8%) (p = 0.001). CONCLUSIONS: LR is a high mortality procedure that requires careful selection of patients with better results in patients with CLAD. The lung function of patients with CLAD improved significantly


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Transplante de Pulmão , Reoperação/métodos , Instalações de Saúde , Intervalo Livre de Doença , Estudos Retrospectivos , Testes de Função Respiratória , Estimativa de Kaplan-Meier , Transplante de Pulmão/mortalidade , Modelos Lineares , Modelos Logísticos , Sepse/mortalidade , Hemorragia Pós-Operatória/etiologia
9.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514621

RESUMO

Around the world, with the availability of factor concentrates, patients with haemophilia have undergone major and minor surgeries. Inhibitor development in early postoperative period leading to inadequate factor recovery and ongoing bleeding is a nightmare for both operating surgeon as well as haematologists. We describe a case of an elderly man with mild haemophilia A, who was diagnosed with pancreatic carcinoma and underwent Whipple's procedure. After an uneventful procedure, he developed high-titre inhibitors and bleeding a week after surgery posing major challenges in his management. The case highlights the importance of experienced surgeons, trained haematologists, regular monitoring of factor assay/inhibitors, adequate factor and bypassing-agent support while performing such procedures.


Assuntos
Fatores de Coagulação Sanguínea/antagonistas & inibidores , Hemofilia A/imunologia , Neoplasias Pancreáticas/cirurgia , Hemorragia Pós-Operatória/tratamento farmacológico , Idoso , Formação de Anticorpos/imunologia , Fatores de Coagulação Sanguínea/imunologia , Fator VIII/administração & dosagem , Fator VIII/uso terapêutico , Evolução Fatal , Hematologia/normas , Hemofilia A/complicações , Humanos , Fragmentos Fc das Imunoglobulinas/administração & dosagem , Fragmentos Fc das Imunoglobulinas/uso terapêutico , Hemorragias Intracranianas/complicações , Masculino , Neoplasias Pancreáticas/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/imunologia , Hemorragia Pós-Operatória/etiologia , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/uso terapêutico , Fatores de Risco , Cirurgiões/estatística & dados numéricos
10.
Cochrane Database Syst Rev ; 1: CD011490, 2021 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-33471373

RESUMO

BACKGROUND: Pancreatic and periampullary adenocarcinomas account for some of the most aggressive malignancies, and the leading causes of cancer-related mortalities. Partial pancreaticoduodenectomy (PD) with negative resection margins is the only potentially curative therapy. The high prevalence of lymph node metastases has led to the hypothesis that wider excision with the removal of more lymphatic tissue could result in an improvement of survival, and higher rates of negative resection margins. OBJECTIVES: To compare overall survival following standard (SLA) versus extended lymph lymphadenectomy (ELA) for pancreatic head and periampullary adenocarcinoma. We also compared secondary outcomes, such as morbidity, mortality, and tumour involvement of the resection margins between the two procedures. SEARCH METHODS: We searched CENTRAL, MEDLINE, PubMed, and Embase from 1973 to September 2020; we applied no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCT) comparing PD with SLA versus PD with ELA, including participants with pancreatic head and periampullary adenocarcinoma. DATA COLLECTION AND ANALYSIS: Two review authors independently screened references and extracted data from study reports. We calculated pooled risk ratios (RR) for most binary outcomes except for postoperative mortality, for which we estimated a Peto odds ratio (Peto OR), and mean differences (MD) for continuous outcomes. We used a fixed-effect model in the absence of substantial heterogeneity (I² < 25%), and a random-effects model in cases of substantial heterogeneity (I² > 25%). Two review authors independently assessed risk of bias, and we used GRADE to assess the quality of the evidence for important outcomes. MAIN RESULTS: We included seven studies with 843 participants (421 ELA and 422 SLA). All seven studies included Kaplan-Meier curves for overall survival. There was little or no difference in survival between groups (log hazard ratio (log HR) 0.12, 95% confidence interval (CI) -3.06 to 3.31; P = 0.94; seven studies, 843 participants; very low-quality evidence). There was little or no difference in postoperative mortality between the groups (Peto odds ratio (OR) 1.20, 95% CI 0.51 to 2.80; seven studies, 843 participants; low-quality evidence). Operating time was probably longer for ELA (mean difference (MD) 50.13 minutes, 95% CI 19.19 to 81.06 minutes; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 88%; P < 0.00001). There may have been more blood loss during ELA (MD 137.43 mL, 95% CI 11.55 to 263.30 mL; two studies, 463 participants; very low-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P = 0.02). There may have been more lymph nodes retrieved during ELA (MD 11.09 nodes, 95% CI 7.16 to 15.02; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P < 0.00001). There was little or no difference in the incidence of positive resection margins between groups (RR 0.81, 95% CI 0.58 to 1.13; six studies, 783 participants; very low-quality evidence). AUTHORS' CONCLUSIONS: There is no evidence of an impact on survival with extended versus standard lymph node resection. However, the operating time may have been longer and blood loss greater in the extended resection group. In conclusion, current evidence neither supports nor refutes the effect of extended lymph lymphadenectomy in people with adenocarcinoma of the head of the pancreas.


Assuntos
Adenocarcinoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/mortalidade , Adulto , Perda Sanguínea Cirúrgica , Neoplasias do Ducto Colédoco/mortalidade , Intervalos de Confiança , Esvaziamento Gástrico , Humanos , Estimativa de Kaplan-Meier , Excisão de Linfonodo/mortalidade , Margens de Excisão , Duração da Cirurgia , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
J Surg Oncol ; 123(4): 1121-1125, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33368348

RESUMO

INTRODUCTION: Advances in the care of cancer patients have resulted in increased survival. The proximal femur is a common site for metastatic disease, often requiring surgical intervention. Tranexamic acid (TXA) has proven to be safe in elective and traumatic femoral hemiarthroplasty; however, its use has not been investigated in oncologic patients. METHOD: We reviewed 66 patients (37 males) with a mean age of 64 ± 3 years undergoing a hemiarthroplasty for metastatic disease in the femoral neck. A total of 22 (33%) patients received intraoperative TXA. Primary outcomes included postoperative blood loss, intraoperative and postoperative transfusion requirement, and postoperative complications. RESULTS: There was no difference in the baseline characteristics between the TXA and non-TXA groups. When comparing the TXA and non-TXA groups, there were no differences in 72 h postoperative blood loss between groups (1.21 L vs. 1.33 L, p = 0.61), percentage of patients requiring transfusion (36.4% vs. 36.4%, p = 1.0), or the incidence of postoperative complications including venous thromboembolism (14% vs. 11%, p = 0.70) and pulmonary embolism (0% vs. 5%, p = 1.0). CONCLUSION: Oncology patients are a high-risk population for thromboembolic events. This initial study supports the safe use of TXA intraoperatively in femoral hemiarthroplasty performed for metastatic disease.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Neoplasias Femorais/cirurgia , Colo do Fêmur/cirurgia , Hemiartroplastia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Antifibrinolíticos/uso terapêutico , Feminino , Neoplasias Femorais/complicações , Neoplasias Femorais/tratamento farmacológico , Neoplasias Femorais/secundário , Colo do Fêmur/patologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
13.
PLoS One ; 15(10): e0239909, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002066

RESUMO

OBJECTIVE: Robotic surgery (RS) has been increasingly used for the resection of rectal cancer, and its advantages over laparoscopic surgery (LS) have been demonstrated. However, few studies focused on the severity of postoperative complications. This study aimed to compared the postoperative complications within 30 days after RS over LS according to the Clavien-Dindo (C-D) classification. METHODS: A literature research of PubMed, Embase, Cochrane Library and Web of Science were systematically performed. The studies comparing the complications of RS and LS for rectal cancer based on the C-D classification were enrolled. Primary outcomes were C-D grade III, IV, V, III-V (severe complications). RESULTS: Seventeen studies (3193 patients) were included in the final analysis: 1554 underwent RS and 1639 underwent LS. The RS group was associated with significantly lower rates of severe complications (OR = 0.69, 95% CI 0.53-0.90, P = 0.005), C-D grade IV (OR = 0.69, 95% CI 0.53-0.90, P = 0.005), and anastomotic leak (OR = 0.66, 95% CI 0.48-0.91, P = 0.01). There was no significant difference in C-D grade III, C-D grade I, II, I-II (minor complications), overall complications, bleeding, wound complications, postoperative ileus, urinary retention, readmission, reoperation between two groups. CONCLUSIONS: Robotic surgery is safe for rectal cancer and may be an effective alternative to laparoscopic surgery, with lower rates of severe complications, C-D grade IV, and anastomotic leak. Further large randomized controlled trials are necessary to confirm this conclusion.


Assuntos
Fístula Anastomótica/epidemiologia , Laparoscopia/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Infecção dos Ferimentos/epidemiologia , Fístula Anastomótica/etiologia , Laparoscopia/métodos , Hemorragia Pós-Operatória/etiologia , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Infecção dos Ferimentos/etiologia
14.
Asian Cardiovasc Thorac Ann ; 28(9): 607-609, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32883098

RESUMO

A 47-year-old man was admitted to the clinic with histologically diagnosed thymoma of the anterior mediastinum, pT3N0M1a, stage IYA, type B3. He underwent surgery for primary tumor resection through a median sternotomy and left thoracotomy at the 7th intercostal space to remove pleural metastases. On the first postoperative day, massive bleeding occurred, a resternotomy was carried out but failed to save the patient. A fracture of the right first rib, which injured the right vertebral artery, had caused massive bleeding and was diagnosed at autopsy. Surgeons should keep in mind this potentially fatal complication of a median sternotomy.


Assuntos
Hemorragia Pós-Operatória/etiologia , Fraturas das Costelas/etiologia , Esternotomia/efeitos adversos , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Lesões do Sistema Vascular/etiologia , Dissecação da Artéria Vertebral/etiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Timoma/patologia , Neoplasias do Timo/patologia , Resultado do Tratamento
15.
PLoS One ; 15(9): e0239114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956379

RESUMO

BACKGROUND: In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES: We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD: Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS: Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS: Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02464592.


Assuntos
Broncoscopia/instrumentação , Criocirurgia/instrumentação , Fluoroscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Idoso , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/métodos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos
16.
PLoS One ; 15(9): e0238387, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870937

RESUMO

OBJECTIVE: Anticoagulation (AC) is a critical topic in perioperative and post-bleeding management. Nevertheless, there is a lack of data about the safe, judicious use of prophylactic and therapeutic anticoagulation with regard to risk factors and the cause and modality of brain tissue damage as well as unfavorable outcomes such as postoperative hemorrhage (PH) and thromboembolic events (TE) in neurosurgical patients. We therefore present retrospective data on perioperative anticoagulation in meningioma surgery. METHODS: Data of 286 patients undergoing meningioma surgery between 2006 and 2018 were analyzed. We followed up on anticoagulation management, doses and time points of first application, laboratory values, and adverse events such as PH and TE. Pre-existing medication and hemostatic conditions were evaluated. The time course of patients was measured as overall survival, readmission within 30 days after surgery, as well as Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS). Statistical analysis was performed using multivariate regression. RESULTS: We carried out AC with Fraxiparin and, starting in 2015, Tinzaparin in weight-adapted recommended prophylactic doses. Delayed (216 ± 228h) AC was associated with a significantly increased rate of TE (p = 0.026). Early (29 ± 21.9h) prophylactic AC, on the other hand, did not increase the risk of PH. We identified additional risk factors for PH, such as blood pressure maxima, steroid treatment, and increased white blood cell count. Patients' outcome was affected more adversely by TE than PH (+3 points in modified Rankin Scale in TE vs. +1 point in PH, p = 0.001). CONCLUSION: Early prophylactic AC is not associated with an increased rate of PH. The risks of TE seem to outweigh those of PH. Early postoperative prophylactic AC in patients undergoing intracranial meningioma resection should be considered.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragias Intracranianas/etiologia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Idoso , Anticoagulantes/administração & dosagem , Esquema de Medicação , Feminino , Alemanha/epidemiologia , Humanos , Hemorragias Intracranianas/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/efeitos adversos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/epidemiologia , Tromboembolia/etiologia
17.
Eur J Vasc Endovasc Surg ; 60(3): 469-478, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32620348

RESUMO

OBJECTIVE: In vascular and cardiac surgery, the ability to maintain haemostasis and seal haemorrhagic tissues is key. Fibrin and thrombin based sealants were introduced as a means to prevent or halt bleeding during surgery. Whether fibrin and thrombin sealants affect surgical outcomes is poorly established. A systematic review and meta-analysis was performed to examine the impact of fibrin or thrombin sealants on patient outcomes in vascular and cardiac surgery. DATA SOURCES: Cochrane CENTRAL, Embase, and MEDLINE, as well as trial registries, conference abstracts, and reference lists of included articles were searched from inception to December 2019. REVIEW METHODS: Studies comparing the use of fibrin or thrombin sealant with either an active (other haemostatic methods) or standard surgical haemostatic control in vascular and cardiac surgery were searched for. The Cochrane risk of bias tool and the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) were used to assess the risk of bias of the included randomised and non-randomised studies; quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two reviewers screened studies, assessed risk of bias, and extracted data independently and in duplicate. Data from included trials were pooled using a random effects model. RESULTS: Twenty-one studies (n = 7 622 patients) were included: 13 randomised controlled trials (RCTs), five retrospective, and three prospective cohort studies. Meta-analysis of the RCTs showed a statistically significant decrease in the volume of blood lost (mean difference 120.7 mL, in favour of sealant use [95% confidence interval {CI} -150.6 - -90.7; p < .001], moderate quality). Time to haemostasis was also shown to be reduced in patients receiving sealant (mean difference -2.5 minutes [95% CI -4.0 - -1.1; p < .001], low quality). Post-operative blood transfusions, re-operation due to bleeding, and 30 day mortality were not significantly different for either RCTs or observational data. CONCLUSION: The use of fibrin and thrombin sealants confers a statistically significant but clinically small reduction in blood loss and time to haemostasis; it does not reduce blood transfusion. These Results may support selective rather than routine use of fibrin and thrombin sealants in vascular and cardiac surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos , Adesivo Tecidual de Fibrina/administração & dosagem , Hemostasia , Hemostáticos/administração & dosagem , Hemorragia Pós-Operatória/prevenção & controle , Trombina/administração & dosagem , Adesivos Teciduais/administração & dosagem , Procedimentos Cirúrgicos Vasculares , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adesivo Tecidual de Fibrina/efeitos adversos , Hemostáticos/efeitos adversos , Humanos , Hemorragia Pós-Operatória/etiologia , Fatores de Risco , Trombina/efeitos adversos , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
19.
Arterioscler Thromb Vasc Biol ; 40(9): 2187-2194, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32640909

RESUMO

OBJECTIVE: Aortic stenosis may be complicated by an acquired von Willebrand syndrome that rarely causes significant bleeding, raising the question of why it does so in a few cases. To seek an explanation, we studied 5 severe bleeder aortic stenosis patients in a cohort of 49 patients, using the flowchart for inherited von Willebrand disease. Approach and Results: All 5 patients were lacking in large and intermediate VWF (von Willebrand factor) multimers, 3 had reduced plasma and platelet VWF levels, and none showed PFA100 closure. Two patients (those with most multimers missing) also had a short VWF half-life. Genetic analyses on the 3 patients with reduced platelet VWF levels revealed that one carried both the c.1164C>G and the c.7880G>A mutations, and another carried the c.3390C>T mutation, while the third had one of the 2 VWF alleles relatively less expressed than the other (25% versus 75%). No genetic alterations emerged in the other 2 patients. Successful replacement of the stenotic aortic valve, performed in the 2 patients with VWF mutations, did not correct their abnormal VWF multimer picture-unlike what happened in the aortic stenosis patients without bleeding symptoms. CONCLUSIONS: Our findings suggest that acquired von Willebrand syndrome can develop in patients with hitherto-undiagnosed inherited von Willebrand disease. Since von Willebrand disease is the most common bleeding disorder, this possibility should be considered in aortic stenosis patients-especially those with a more severe bleeding history and more disrupted VWF laboratory patterns-because they risk hemorrhage during aortic valve replacement.


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Hemostasia , Hemorragia Pós-Operatória/etiologia , Doenças de von Willebrand/complicações , Fator de von Willebrand/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença , Meia-Vida , Hemostasia/genética , Humanos , Masculino , Mutação , Fenótipo , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/diagnóstico , Valor Preditivo dos Testes , Multimerização Proteica , Estabilidade Proteica , Proteólise , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Doenças de von Willebrand/sangue , Doenças de von Willebrand/diagnóstico , Doenças de von Willebrand/genética , Fator de von Willebrand/genética
20.
J Stroke Cerebrovasc Dis ; 29(8): 104926, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689637

RESUMO

BACKGROUND AND PURPOSE: Early venous filling after endovascular mechanical thrombectomy in acute ischemic stroke (AIS) is a specific finding that may serve as a biomarker for intracranial hemorrhage. However, the pathophysiology of early venous filling and postoperative hemorrhage remains unclear. The aim of this study was to investigate correlation between early venous filling and various factors involving patient demographics and perioperative imaging. METHODS: We prospectively analyzed 35 patients with AIS due to cardioembolism (CE) who underwent successful acute revascularization (TICI ≥2). Ischemic lesions were scored by magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Outcomes were assessed using the modified Rankin Scale (mRS) 90 days after stroke onset. Blood flow analysis was evaluated by MRI with arterial spin labeling (ASL). Early venous filling was assessed by digital subtraction angiography (DSA). Univariate analysis was performed to investigate correlations between early venous filling and patient demographics and imaging findings. RESULTS: Early venous filling was observed in 22 of 35 (66%) patients after reperfusion therapy. There was a significant correlation between early venous filling and DWI-ASPECTS (6.2 vs 8.8, p=0.0003), outcome (5 vs 9, p=0.006), hyperperfusion (17 vs 1, p< 0.0001), and hemorrhagic transformation (17 vs 1, p=0.005). CONCLUSIONS: This comprehensive study revealed that early venous filling after reperfusion therapy is associated with postoperative hyperperfusion. Early venous filling may be a marker of the process of hyperperfusion, leading to hemorrhage and an unfavorable outcome. Detection of early venous filling may be an important finding on DSA for subsequent intensive perioperative management.


Assuntos
Isquemia Encefálica/cirurgia , Veias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Hemorragias Intracranianas/etiologia , Hemorragia Pós-Operatória/etiologia , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Angiografia Cerebral , Veias Cerebrais/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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