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1.
Medicine (Baltimore) ; 99(5): e18924, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000405

RESUMO

Adiponectin is an adipose tissue-derived cytokine that exerts its antiinflammatory effects by binding to 2 adiponectin receptors, adiponectin receptor 1 (ADIPOR1) and adiponectin receptor 2 (ADIPOR2). However, the role of these adiponectin receptors on inflammatory pain remains unclear. We investigated the association between single nucleotide polymorphisms (SNPs) of these genes and inflammatory pain, such as postoperative pain and cancer pain.We analyzed 17 SNPs of the ADIPOR1 gene and 27 SNPs of the ADIPOR2 gene in 56 adult patients with postlaparotomy pain. We compared these genotypes with pain intensity and opioid consumption, adjusting for multiple testing. We analyzed the genotypes of 88 patients with cancer pain and examined the association of the relevant SNP(s) with pain intensity and opioid consumption.One variant of the ADIPOR1 gene (rs12045862) showed significant association with postoperative pain intensity; patients with minor allele homozygote (n = 7) demonstrated significantly worse pain intensity than that of combined patient group exhibiting major allele homozygote or the heterozygote (n = 49; Mann-Whitney test, P < .00002), although their opioid consumptions were comparable. Cancer pain intensity between minor allele homozygote patients (n = 7) and other 2 genotype patients (n = 81) were comparable.The rs12045862 SNP of the ADIPOR1 gene was associated with postoperative pain but not cancer pain. This might result from functional alteration of the ADIPOR1 signalling pathways, which influence the inflammatory process. ADIPOR1 may be a novel potential target for developing analgesics of postoperative pain.


Assuntos
Dor do Câncer/genética , Dor Pós-Operatória/genética , Polimorfismo de Nucleotídeo Único , Receptores de Adiponectina/genética , Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Neoplasias Colorretais/genética , Neoplasias Colorretais/cirurgia , Feminino , Estudos de Associação Genética , Humanos , Inflamação/genética , Laparotomia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico
2.
Khirurgiia (Mosk) ; (1): 40-45, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994498

RESUMO

OBJECTIVE: To improve the results of treatment of patients undergoing laparotomy by using of a new method of aponeurosis suturing after laparotomy. MATERIAL AND METHODS: Training process for a new method of aponeurosis suturing after laparotomy was organized on the patented medical simulator for learning the technique of laparotomy closure. The method was introduced into surgical practice later. The study involved 130 patients who underwent emergency abdominal surgery through median laparotomy. The main group consisted of 70 patients (laparotomy closure using the proposed method (RF patent No.2644846 dated 02/14/18). Interrupted sutures were applied for aponeurosis suturing in the control group. RESULTS: Duration of laparotomy closure was similar in both groups. Postoperative ventral hernias in 1 year after surgery occurred in 5 (8%) patients of the main group and in 11 (18%) patients of the control group. CONCLUSION: The proposed method of aponeurosis suturing after laparotomy is mastered by students and serves as effective method for prevention of postoperative ventral hernias and eventration.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/educação , Aponeurose/cirurgia , Hérnia Ventral/prevenção & controle , Hérnia Incisional/prevenção & controle , Laparotomia/efeitos adversos , Técnicas de Sutura/educação , Fáscia , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Laparotomia/educação , Modelos Anatômicos
3.
Anticancer Res ; 40(1): 253-259, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892574

RESUMO

BACKGROUND/AIM: The aim of the study was to compare the MDA (malonidialdehyde) plasma concentrations versus CAT (catalase)/NT (nitrotyrosine) plasma concentrations, patient satisfaction and pain score at rest/pressure to the wound area in laparotomy patients with rectus sheath block (RSB) analgesia. PATIENTS AND METHODS: Initially, 56 patients were randomized to four groups; control group (n=12), single-dose (n=16), repeated-dose (n=12) and continuous infusion (n=16) RSB analgesia groups. The plasma concentrations of CAT, NT and MDA markers were measured just before, immediately after and 24 h after operation. RESULTS: The RSB analgesia enhanced significantly patient satisfaction (p=0.001). The plasma MDA decreased immediately after operation (POP1) and the postoperative decrease between the preoperative and the POP1 values in the MDA marker were statistically significant (p<0.001). In linear mixed model, the time effect in both the single group and in the benign group in plasma NT biomarker was statistically significant (p=0.001, p=0.013, respectively). The median plasma MDA concentrations (ng/ml) following surgery were significantly lower in patients with cancer versus patients with benign disease (589 vs. 852, p=0.021). Jitterplots of the individual plasma NT versus plasma MDA showed that there was significant correlation in benign and cancer patients (r=0.347, p<0.001). CONCLUSION: Plasma MDA decreased significantly after operation in all patients and cancer patients had significantly lower MDA concentrations following surgery than patients with benign disease.


Assuntos
Analgesia , Laparotomia , Malondialdeído/sangue , Neoplasias/sangue , Bloqueio Nervoso , Catalase/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tirosina/análogos & derivados , Tirosina/sangue
4.
Anaesthesia ; 75(1): 54-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31531978

RESUMO

Patients eligible for emergency laparotomy who do not proceed to surgery are not as well characterised as patients who do proceed to surgery. We studied patients eligible for laparotomy, as defined by National Emergency Laparotomy Audit criteria, from August 2015 to October 2016. We analysed the association of individual variables with survival and two composite scores: P-POSSUM and a general survival model. Out of 314 patients, 214 (68%) underwent laparotomy and 100 (32%) did not. Median (IQR [range]) follow-up was 1.3 (0.1-1.8 [0.0-2.5]) years for the cohort, 1.5 (1.1-2.0 [0.0-2.6]) years after laparotomy and 0.0 (0.0-1.1 [0.0-2.2]) years without laparotomy. There were 126/314 (40%) deaths in the follow-up period, 52/214 (24%) deaths after laparotomy and 74/100 (74%) deaths without surgery. Ninety out of 126 deaths (71%) were within one month of hospital admission. Patient variables were different for the two groups, which when combined in the general survival model generated background median (IQR [range]) life expectancies of 12 (6-21 [0-49]) and 4 (2-6 [0-36]) years, respectively, p < 0.0001. 'Poor fitness' precluded laparotomy in 74/100 (74%) patients. The decision to not operate involved a consultant less often than the decision to operate: 66/100 (66%) vs. 178/214 (83%), p = 0.001. Our study supports the contention that survival beyond 30 postoperative days could be predicted reasonably accurately. Survival in patients who did not have laparotomy was shorter than expected. Emergency laparotomy might have prolonged survival in some patients.


Assuntos
Laparotomia/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso , Estudos de Coortes , Emergências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Reino Unido
5.
Br J Anaesth ; 124(1): 73-83, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860444

RESUMO

BACKGROUND: Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. METHODS: This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. RESULTS: Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. CONCLUSIONS: More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.


Assuntos
Serviços Médicos de Emergência , Laparotomia/mortalidade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/mortalidade , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Inglaterra/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/economia , Assistência Perioperatória/normas , Pobreza , Risco Ajustado , Medicina Estatal , Adulto Jovem
6.
Anticancer Res ; 39(12): 6751-6757, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810940

RESUMO

BACKGROUND/AIM: Our original hypothesis was that the rectus sheath block (RSB) analgesia could enhance patient satisfaction and decrease pain following midline laparotomy. PATIENTS AND METHODS: Initially, 56 patients were randomized into four groups; control group (n=12), single-dose (n=16), repeated-dose (n=12) and continuous infusion (n=16) RSB analgesia groups. The BPI (Brief Pain Inventory) survey was conducted preoperatively and at one and four weeks and 12 months postoperatively. The patients pain 24 h postoperatively and satisfaction 48 h postoperatively was filled on an 11-point numeric rating scale (NRS). RESULTS: The repeated-dose group had lower BPI severity score (p=0.045) and BPI interference score (p=0.043) mean values postoperatively compared to the three other groups separately. Also, the time effect on the linear mixed model in BPI interference score mean values was statistically significant (p=0.008), which means that in the repeated dose group preoperative BPI severity score [2.7 (3.9)] and interference score [4.3 (4.2)] mean (SD) values were significantly higher than the BPI severity score [1.3 (0.8)] and interference score [1.5 (1.8)] mean (SD) values following surgery. CONCLUSION: The higher elevation in BPI severity score and decrease in interference score values in the repeated dose group and also the time effect in a linear mixed model in BPI interference score were statistically significant.


Assuntos
Laparotomia/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Atividades Cotidianas , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Laparotomia/métodos , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Reto do Abdome/inervação , Índice de Gravidade de Doença
7.
Rozhl Chir ; 98(10): 399-403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842569

RESUMO

INTRODUCTION: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20-30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. METHODS: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs.


Assuntos
Ablação por Cateter , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/cirurgia , Idoso , Feminino , Humanos , Laparotomia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Pan Afr Med J ; 34: 63, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762927

RESUMO

Bleeding during pregnancy may not be due to obstetric causes. Pregnancy is a predisposing factor for some disorders due to physiological changes. These obstetric bleedings are rare but are responsible for high materno-fetal mortality. Prognosis depends on the speed of diagnosis as well as on multidisciplinary management. Splenic artery aneurysm (SAA) rupture during pregnancy is rare with a dreadful prognosis. Common clinical signs including abdominal pain associated with hypotension and anemia are very misleading for the obstetrician who usually suspects retroplacental hematoma or uterine rupture. We report the case of a pregnant patient requiring emergency laparotomy due to the detection of splenic artery aneurysm rupture on imaging test.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Aneurisma Roto/cirurgia , Feminino , Humanos , Laparotomia/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
10.
BMC Surg ; 19(1): 165, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699083

RESUMO

BACKGROUND: Pancreatic resection and radiotherapy are powerful tools in the multidisciplinary local treatment of pancreatic ductal adenocarcinoma (PDAC). However, 10-20% of patients with preoperatively resectable PDAC have radiographically occult metastases, which results in laparotomy without resection. This study aims to explore the utility of intraoperative near-infrared (NIR) imaging with indocyanine green (ICG) during staging laparoscopy to detect PDAC metastasis. METHODS: This prospective study will evaluate patients with radiographically non-metastatic PDAC before they undergo planned pancreatic resection or chemoradiotherapy. Enrolled patients will receive ICG intravenously (0.5 mg/kg) before the staging laparoscopy. During the staging laparoscopy, the abdominal cavity will be observed using standard white-light laparoscopic imaging and then using NIR-ICG imaging. Suspicious lesions that are detected using standard imaging and/or NIR-ICG imaging will be examined intraoperatively using frozen sections and permanent specimens. We will evaluate the benefit of NIR-ICG imaging based on its ability to identify additional liver or peritoneal lesions that were not detected during standard white-light imaging. DISCUSSION: This study will help establish the clinical utility of NIR-ICG imaging to more precisely identify metastases from radiographically non-metastatic PDAC. This approach may help avoid needless major surgery or radiotherapy. TRIAL REGISTRATION: This protocol was registered on April 1, 2017 on the UMIN Clinical Trials Registry: UMIN000025900 and February 26, 2019 on the Japan Registry of Clinical Trials: jRCT1051180076.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Verde de Indocianina/química , Laparoscopia/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Fluorescência , Humanos , Japão , Laparotomia/métodos , Imagem Óptica/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Estudos Prospectivos
11.
Pan Afr Med J ; 33: 283, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692896

RESUMO

Pseudomyxoma peritonei (PMP), also referred to as gelatinous ascites, is a rare disorder, described for the first time by R. Wyerth in 1884. It is characterized by diffuse peritoneal involvement, composed of mucinous ascites and multifocal mucinous epithelial implants. This disease mainly affects women. Its incidence is estimated at 2 cases per one million inhabitants. Pseudomyxoma peritonei can be asymptomatic, discovered during a laparotomy. The most common symptom is abdominal distension associated with diffuse abdominal pain. Abdominal CT scan is the most specific diagnostic tool. It shows pathognomonic signs of gelatinous ascites. Mucinous neoplasms of the appendix are the most frequent cause of pseudomyxoma peritonei accounting for 90% of cases. Pseudomyxoma peritonei of ovarian origin is very rare. There are essentially two types of treatment: multiple debulking surgery and cytoreductive surgery with perioperative intraperitoneal chemotherapy consisting of hyperthermic intraperitoneal chemotherapy with or without immediate postoperative intraperitoneal chemotherapy. We report a case of pseudomyxoma peritonei secondary to mucinous carcinoma of the left ovary.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico , Neoplasias Ovarianas/diagnóstico , Pseudomixoma Peritoneal/etiologia , Dor Abdominal/etiologia , Adenocarcinoma Mucinoso/patologia , Feminino , Humanos , Laparotomia/métodos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Pseudomixoma Peritoneal/diagnóstico
13.
Pan Afr Med J ; 34: 35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762903

RESUMO

Abdominal pregnancy is a rare form of ectopic pregnancy with very high morbidity and mortality for both the mother and the fetus. Diagnosis and management can pose some difficulties especially in low-resource centers. We report a case of abdominal pregnancy with a healthy newborn. A 34-year-old Moroccan woman, G4P3 (3 alive children), presented with shortness of breath and progressive abdominal distension and pain at 37 weeks' gestation. An emergency laparotomy was performed with the impression of abdominal pregnancy. Intraoperatively, the fetus was seen in an intact amniotic sac in her abdomen, the placenta was strongly adhered to the fundus and enveloped the left adnexa. A total hysterectomy with a left adnexectomy was performed. The patient and neonate progressed well and were discharged. Term abdominal pregnancy is an extremely rare diagnosis. The life-threatening complication is bleeding from the detached placental site. High index of suspicion is vital in making prompt diagnosis in such situations.


Assuntos
Abdome/cirurgia , Placenta/metabolismo , Resultado da Gravidez , Gravidez Abdominal/diagnóstico , Feminino , Idade Gestacional , Humanos , Histerectomia , Recém-Nascido , Laparotomia , Gravidez , Nascimento a Termo
14.
Am Surg ; 85(9): 973-977, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638509

RESUMO

Failure to rescue (FTR), defined as death after a major complication in surgical patients, is being used to measure outcomes for quality improvement. Major complications frequently occur in patients undergoing damage control laparotomy (DCL). No previous FTR studies have looked specifically into DCL patients. The aim of this study was to examine risk factors of FTR and identify potential areas for targeted quality improvement in DCL patients. A 10-year retrospective review of all consecutive adult trauma patients who underwent DCL at a Level I trauma center was performed. Demographic and clinical variables were examined for association with FTR. Multivariate regression analysis was performed to identify risk factors of FTR in DCL patients. A total of 199 DCL patients were analyzed. Overall DCL mortality observed was 11.1 per cent (n = 22/199) and overall FTR for the cohort was n = 16/199. FTR represented 72 per cent (n = 16/22) of the total mortality. The significantly increased risk of FTR was associated with older age (P = 0.027), lower initial Glasgow Coma Scale score (P = 0.037), more units of packed red blood cells (P = 0.028), and respiratory complications (P = 0.035). Renal and infectious complications did not significantly increase the risk of FTR in this population. FTR is an important benchmark of quality for trauma patients. This study elucidates potential initial characteristics and complications related to FTR in DCL patients. Efforts in achieving zero death from FTR can potentially improve overall mortality in this subset of patients. Future quality interventions to help minimize FTR should target these specific areas.


Assuntos
Falha da Terapia de Resgate , Laparotomia/efeitos adversos , Laparotomia/normas , Melhoria de Qualidade , Ferimentos e Lesões/cirurgia , Adulto , Fatores Etários , Transfusão de Eritrócitos , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Complicações Pós-Operatórias , Transtornos Respiratórios , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia/normas , Estados Unidos
15.
Am Surg ; 85(9): 998-1000, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638513

RESUMO

Tension is one of the most discussed terms related to hernia surgery and repair. Despite the universally accepted opinion that tension and reduction of tension are important concepts in hernia repair, there is very little known about the physiologic tension of the abdominal wall related to ventral hernia repair. The purpose of this project was to attempt to measure physiologic tension in patients without hernia repair and help determine a normal baseline tension. Patients were enrolled in a prospective institutional review board-approved protocol to measure abdominal wall tension from February 2014 to present. Patients undergoing abdominal surgery without hernia repair were included. Demographic information and operative details were documented. Abdominal wall tensions were measured using scales attached to Kocher clamps that are clamped to the fascia and then brought together in the midline. Total tension, surgeon's estimation of tension, and grading of the fascia were recorded. Descriptive statistics were calculated. Eleven patients met the inclusion criteria and had tension measurements performed during surgery. The average age was 58 years, with 55 per cent of them being white and 82 per cent being male, with an average BMI of 27. Operations included exploratory laparotomy for small bowel pathology in six patients, colorectal surgery in three patients, and splenectomy in a trauma patient. Average tension measurements for these patients were 1.9 lbs. Surgeon grading of tension was an average of 2.2 (range, 1-5). Obtaining tension measurements is feasible during abdominal surgery. Physiologic tension seems to be approximately 2 pounds. Further study is needed with a larger sample of patients.


Assuntos
Parede Abdominal/fisiologia , Tono Muscular/fisiologia , Adulto , Idoso , Fáscia/fisiologia , Feminino , Hérnia Ventral/fisiopatologia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Período Intraoperatório , Laparotomia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência
16.
BMC Surg ; 19(1): 158, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664984

RESUMO

BACKGROUND: Intussusception in adult patient is rare. Gastroduodenal intussusception due to the gastrointestinal stromal tumors is infrequently described in the literature. Authors present a case of gastroduodenal intussusception due to the low-risk gastrointestinal stromal tumor of the lesser curvature of the gastric body with literature review. CASE PRESENTATION: Sixty-two-year-old male was admitted to our hospital with symptoms of acute gastric outlet obstruction. Imaging studies confirmed a lesion of the gastric wall producing gastroduodenal intussusception with pylorus obstruction. Upon laparotomy a tumor mass of the lesser curvature of the gastric body that invaginated through the pylorus into the duodenum was found. Desinvagination and resection of the tumor with the adequate resection margins were performed. Histology reveled a low-risk gastrointestinal stromal tumor. Due to favorable outcome only observation was suggested by the multidisciplinary team. CONCLUSIONS: Gastroduodenal intussusception due to the gastrointestinal stromal tumor of the gastric wall is a rare event. Surgical resection is the treatment of choice. In selected cases laparosopic resection of the tumor can be performed.


Assuntos
Duodenopatias/diagnóstico , Tumores do Estroma Gastrointestinal/patologia , Intussuscepção/diagnóstico , Neoplasias Gástricas/patologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Piloro/patologia , Neoplasias Gástricas/cirurgia
17.
Wiad Lek ; 72(9 cz 2): 1736-1739, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622257

RESUMO

OBJECTIVE: Introduction: The issue of surgical treatment of acute pancreatitis, in particular the choice of operative technique, is becoming increasingly relevant. The aim: To work out surgical approach in patients with acute complicated pancreatitis (ACP) using minimally invasive and traditional operative techniques. PATIENTS AND METHODS: Materials and methods: 170 patients underwent surgery for ACP. The main group (109 subjects) had minimally invasive techniques (MIT) dominated, the comparative group (61 subjects) - traditional operations. RESULTS: Results: MIT performed "as final" in 62 (69%), "stage"- in 16 (18%) and "stabilizing patient condition" - in 12 (13%) of observations. The number of combined interventions predominated in the main group - 26% and 12% (χ2=4.002; р=0.04), traditional in comparative groups - 67% and 17% cases (χ2=40.291; р<0.0001). Primary laparotomy operations were used in 41 (67%) patients from comparative and 19 (17%) patients from the main group (χ2=40.291; р<0.0001). The extent of traditional operations in the maingroup consisted predominantly of necrosequestrectomy with Beger closed drainage - in 26 (55%) and 15 (31%) observations, respectively (χ2=5.018; р=0.02). Necrosequestrectomy with subsequent stage lavage performed in common purulent-necrotic lesions were comparable in both groups - in 11 (23%) and 13 (26%) observations (χ2=0.0013; р>0.05). CONCLUSION: Conclusions: The worked out surgical treatment approach in ACP with individual and combined use of MIT and traditional operations resulted in decreased rates of postoperative complications from 13.1% to 8.3% and mortality from 14.8% to 9.2%.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Pancreatite Necrosante Aguda/cirurgia , Doença Aguda , Drenagem , Humanos , Laparotomia
18.
Transplant Proc ; 51(9): 2977-2980, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31607626

RESUMO

AIM: We aimed to analyze the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV-infected patients submitted to liver transplantation. METHODS: We performed a retrospective study on a nationwide multicenter cohort of 157 HIV-infected patients submitted to liver transplantation in 6 Italian transplant units between 2004 to 2014. RESULTS: The median preoperative model for end-stage liver disease score was 18 (interquartile range 12-26.5). An early relaparotomy was performed in 24.8% of patients, and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%), and suspected vascular complications (3.8%). The OS at 1, 3, and 5 years was 74.3%, 68.0%, and 60.0%, respectively, and an early relaparotomy was not a prognostic factor itself, but an increasing number of relaparotomies was associated with decreased survival (hazard ratio = 1.40, 95% confidence interval [CI] 1.07-1.81, P = .01). In the multivariate analysis, preoperative refractory ascites (odds ratio 3.32, 95% CI 1.18-6.47, P = .02) and Roux-en-Y choledochojejunostomy reconstruction (odds ratio 12.712, 95% CI 2.47-65.38, P ≤ .01) were identified as significant risk factors for early relaparotomy. CONCLUSIONS: In HIV-infected liver transplant recipients, an increasing number of early relaparotomies due to surgical complications did negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy were associated with an increased risk of early relaparotomy.


Assuntos
Infecções por HIV/complicações , Transplante de Fígado , Complicações Pós-Operatórias/cirurgia , Reoperação/mortalidade , Adulto , Feminino , Humanos , Laparotomia/mortalidade , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
19.
Niger J Clin Pract ; 22(10): 1408-1411, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607731

RESUMO

Objective: To study the clinical effect of ultrasound-guided microwave ablation on primary hepatic carcinoma. Method: The subjects comprised 94 patients with primary hepatic carcinoma who were admitted to our hospital between August 2014 and November 2016. They were divided into two groups in accordance with a random-number table. The control (n = 47) and study (n = 47) groups received conventional surgical excision and ultrasound-guided microwave ablation, respectively. The operation duration, clinical effect, complication occurrence rates, and hepatic functions of the two groups were compared. Results: The control group exhibited longer duration of operation and length of stay but significantly lower quantities of intraoperative bleeding and blood transfusion (P < 0.05) than the study group. The study group demonstrated significantly higher (P < 0.05) effective rate of treatment but significantly lower (P < 0.05) occurrence rate of complications than the control group. The study group exhibited significantly higher (P < 0.05) albumin and total bilirubin levels but significantly lower alanine aminotransferase and aspartate transaminase levels than the control group. No difference was observed in prothrombin time between the two groups (P > 0.05). Conclusion: Ultrasound-guided microwave ablation treatment offers the advantages of minor injury and low complication occurrence rates. Moreover, it is associated with faster postoperative recovery and improved hepatic function. Thus, it is worthy as a clinical option and must be promoted and applied.


Assuntos
Técnicas de Ablação , Carcinoma Hepatocelular/cirurgia , Laparotomia/métodos , Neoplasias Hepáticas/cirurgia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/métodos , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Tempo de Internação , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Pan Afr Med J ; 33: 161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565123

RESUMO

We present a histologically proven mucinous adenocarcinoma of the colon in a 40 year old female from Gulu, Northern Uganda. Her elder sister died at 25 years with advanced adenocarcinoma of colon similarly with her mother who died of the same illness 10 years apart. Using the Amsterdam criteria for the diagnosis of the carcinoma of the colon, this is descriptive of Hereditary Non Polyposis Colorectal Carcinoma (HNPCC). Blood examinations revealed microcytic hypochromic anaemia. The Renal and Liver function parameters were essentially normal. The abdominal ultrasonography showed an ill-defined mass in the right hypochondrial region which was heterogeneous with central echogenicity approximately 7.2cm wide and with no intra-abdominal lymphadenopathy or ascitis. At laparotomy, the sonographic findings were confirmed with a demonstrable mass in the hepatic flexure of the colon with hyperemic areas on its serosa. Macroscopically, there was an annular fungating mass with a central necrosis in the hepatic flexure measuring over 7.0cm. Histology of the colonic tumour showed a mucinous adenocarcinoma of the colon (Duke's B). This finding highlights the occurrence of colonic adenocarcinoma in the young person in Northern Uganda, a finding which draws the attention of the medical community towards having a higher index of suspicion for carcinoma of the colon in patients with similar presentation.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico , Anemia Hipocrômica/diagnóstico , Neoplasias do Colo/diagnóstico , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/cirurgia , Adulto , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Laparotomia/métodos , Uganda
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