Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.928
Filtrar
1.
Medicine (Baltimore) ; 100(22): e25885, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087831

RESUMO

BACKGROUND: Long operation duration (>4 hours' anesthesia) of laparotomy in elderly patients would increase the risk of postoperative delirium (POD), which is characterized by acute cognitive dysfunction, changes in the level of consciousness, obvious attention disorder, emotional disorder, and sleep-waking cycle disorder. The occurrence of POD is closely related to the risk of death, and it will also seriously affect the cognitive function of patients, prolong postoperative hospital stays, and increase medical expenses. It is known that dexmetomidine could function in sedation, analgesia and anti-sympathetic effect, and it also could simulate the normal sleep state of human body, but there is still a lack of clinical study of dexmedetomidine on the incidence of POD in elderly patients undergoing long-term general anesthesia in laparotomy. METHODS: This is a single-center, double-blinded, randomized controlled study. With the approval of the Ethics Committee of Chongqing Shapingba District People's Hospital, participants who meet the requirements will be randomly divided into the treatment group (continuous infusion of dexmetomidine) and the control group (continuous infusion of 0.9% sodium chloride solution) in a ratio of 1:1. The incidence of delirium, cognitive function score, inflammatory factors, and adverse reactions will be evaluated after the operation. Finally, the data will be analyzed by SPSS 22.0. CONCLUSION: The results of this study will explore the efficacy and safety of dexmetomidine in reducing the incidence of postoperative delirium in elderly patients undergoing long-term general anesthesia in laparotomy. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/2GJY6.


Assuntos
Dexmedetomidina/uso terapêutico , Delírio do Despertar/prevenção & controle , Hipnóticos e Sedativos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Laparotomia/métodos , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Projetos de Pesquisa
2.
Eur Rev Med Pharmacol Sci ; 25(7): 3116-3121, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33877680

RESUMO

OBJECTIVE: Since minimally invasive surgery and general anesthesia are both aerosol-generating procedures, their use became controversial during the outbreak of coronavirus disease 2019 (COVID-19). Moreover, social distancing resulted in serious psychological consequences for inpatients. This case report investigates pain distraction during awake laparotomy, as well as new possibilities for emotional postoperative support to inpatients. PATIENTS AND METHODS: A 72-year-old man affected by middle rectal adenocarcinoma underwent lower anterior resection plus total mesorectal excision under combined spinal-epidural anesthesia. A 3D mobile theatre (3DMT) was intraoperatively used for pain distraction. A postoperative "Cuddle delivery" service was instituted: video-messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional correlations were investigated through a clinical interview by the psychologist of our Hospital. RESULTS: Intraoperative, as well as postoperative pain, resulted well-controlled: visual analogue scale (VAS) ≤3. Conversion to general anesthesia and postoperative intensive support/monitoring were unnecessary. The "Cuddle delivery" initiative positively fed our patient's mood and attitude, strengthening his bond to life. CONCLUSIONS: During pandemic, awake laparotomy under loco-regional anesthesia may be a crucial option in delivering acute care surgery to selected patients when intensive care beds are unavailable. Our procedure introduces potential ways to optimize this approach.


Assuntos
Adenocarcinoma/cirurgia , Computadores de Mão , Família , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Dor Processual/terapia , Neoplasias Retais/cirurgia , Gravação em Vídeo , Idoso , Anestesia Epidural/métodos , Raquianestesia/métodos , COVID-19/prevenção & controle , Humanos , Laparotomia/métodos , Masculino , Filmes Cinematográficos , Medição da Dor , Cuidados Pós-Operatórios , Protectomia/métodos , SARS-CoV-2 , Vigília
3.
Pan Afr Med J ; 38: 150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912320

RESUMO

We report a case of a 5-month-old female infant who presented with a cardiorespiratory distress and shock. After thoracic computed tomography (CT) scan, a right sided Bochdalek hernia was diagnosed with massive herniation of the abdominal viscera causing mediastinal shift. The girl underwent emergency laparotomy, which confirmed the right sided diaphragmatic hernia with herniation of small bowel and colon. After reduction of herniated contents, the defect in the diaphragm was closed. The patient had an uneventful post-operative cause. This case demonstrates that an undiagnosed Bochdalek hernia can appear with such a severe, life-threatening and misleading presentation.


Assuntos
Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Laparotomia/métodos , Feminino , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Lactente , Choque/etiologia , Tomografia Computadorizada por Raios X
4.
J Cardiothorac Surg ; 16(1): 57, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33771196

RESUMO

BACKGROUND: Spontaneous esophageal rupture, also called Boerhaave's syndrome, is relatively uncommon but may result in high morbidity and mortality. Synchronous presentation of spontaneous esophageal rupture and perforated peptic ulcer was rare and may contribute to the difficulty of achieving a correct diagnosis. CASE PRESENTATION: We reported two patients with spontaneous esophageal rupture following perforated peptic ulcer. Both patients were successfully treated with thoracoscopic primary repair of esophageal rupture. The first patient underwent peptic ulcer repair via laparotomy. The second patient underwent laparoscopic duodenorrhaphy. Both patients resumed oral intake smoothly and were discharged uneventfully. CONCLUSION: Minimally invasive approaches are safe and feasible for both esophageal rupture and perforated peptic ulcer in patients diagnosed within 24 h and without shock.


Assuntos
Perfuração Esofágica/etiologia , Laparoscopia/métodos , Laparotomia/métodos , Doenças do Mediastino/etiologia , Úlcera Péptica/complicações , Idoso , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/cirurgia , Humanos , Masculino , Doenças do Mediastino/diagnóstico , Doenças do Mediastino/cirurgia , Úlcera Péptica/cirurgia , Ruptura Espontânea
5.
Medicine (Baltimore) ; 100(11): e25205, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726015

RESUMO

ABSTRACT: One-stage resections of primary colorectal cancer and liver metastases have been reported to be feasible and safe. Minimally invasive approaches have become more common for both colorectal and hepatic surgeries. This study aimed to investigate outcomes of these combined surgical procedures among different approaches.We retrospectively analyzed patients diagnosed as having primary colorectal cancer with synchronous liver metastases and who underwent 1-stage primary resection and hepatectomy with curative intent in our hospital. According to the surgical approach for the primary tumor and hepatic lesions, namely open laparotomy (Op) or laparoscopic approach (Lap), patients were classified into Op-Op, Lap-Op (laparoscopic colorectal resection plus open hepatectomy), and Lap-Lap groups, respectively. Clinicopathological factors were reviewed, and short- and long-term outcomes were compared among the groups.The Op-Op, Lap-Op, and Lap-Lap groups comprised 36, 18, and 17 patients, respectively. The superior/posterior hepatic segments were more frequently resected via an open approach. There was no laparoscopic major hepatectomy. The median volume of intraoperative blood loss was smaller in the Lap-Lap and Lap-Op groups (290 and 270 mL) than in the Op-Op group (575 mL, P = .008). The hospital stay after surgery was shorter in the Lap-Lap and Lap-Op groups (median: 17 days and 15 days, vs 19 days for the Op-Op group, P = .033). The postoperative complication rates and survivals were similar among the groups.Application of laparoscopy to 1-stage resections of primary colorectal cancer and liver metastases may offer advantages of enhanced recovery from surgical treatment, given appropriate patient selection.


Assuntos
Neoplasias Colorretais/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Colectomia/métodos , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Protectomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
6.
Ann R Coll Surg Engl ; 103(5): 354-359, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33682443

RESUMO

INTRODUCTION: The initial intercollegiate surgical guidance from the UK during the COVID-19 pandemic resulted in significant changes to practice. Avoidance of laparoscopy was recommended, to reduce aerosol generation and risk of virus transmission. Evidence on the safety profile of laparoscopy during the pandemic is lacking. This study compares patient outcomes and risk to staff from laparoscopic and open gastrointestinal operations during the COVID-19 pandemic. METHODS: Single-centre retrospective study of gastrointestinal operations performed during the peak of the COVID-19 pandemic. Demographic, comorbidity, perioperative and survival data were collected from electronic medical records and supplemented with patient symptoms reported at telephone follow up. Outcomes assessed were: patient mortality, illness among staff, patient COVID-19 rates, length of hospital stay and postdischarge symptomatology. RESULTS: A total of 73 patients with median age of 56 years were included; 55 (75%) and 18 (25%) underwent laparoscopic and open surgery, respectively. All-cause mortality was 5% (4/73), was related to COVID-19 in all cases, with no mortality after laparoscopic surgery. A total of 14 staff members developed COVID-19 symptoms within 2 weeks, with no significant difference between laparoscopic and open surgery (10 vs 4; p=0.331). Median length of stay was shorter in the laparoscopic versus the open group (4.5 vs 9.9 days; p=0.011), and postdischarge symptomatology across 15 symptoms was similar between groups (p=0.135-0.814). CONCLUSIONS: With appropriate protective measures, laparoscopic surgery is safe for patients and staff during the COVID-19 pandemic. The laparoscopic approach maintains an advantage of shorter length of hospital stay compared with open surgery.


Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Gastroenteropatias/cirurgia , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Conversão para Cirurgia Aberta/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Emergências , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Laparotomia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Mortalidade , Duração da Cirurgia , Estudos Retrospectivos , Risco , SARS-CoV-2 , Resultado do Tratamento , Reino Unido , Adulto Jovem
7.
Pain Res Manag ; 2021: 8763429, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33688385

RESUMO

Background: During the outbreak of coronavirus disease 2019 (COVID-19), allocating intensive care beds to patients needing acute care surgery became a very difficult task. Moreover, since general anesthesia is an aerosol-generating procedure, its use became controversial. This strongly restricted therapeutic strategies. Here, we report a series of undeferrable surgical cases treated with awake surgery under neuraxial anesthesia. Contextual benefits of this approach are deepened. Methods: During the first pandemic surge, thirteen patients (5 men and 8 women) with a mean age of 80 years, needing undelayable surgery due to abdominal emergencies, underwent awake open surgery at our Hospital. Prior to surgery, all patients underwent nasopharyngeal swab tests for COVID-19 diagnosis. In all cases, regional anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain intensities have been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. Postoperative course has been examined. Results: The mean operative time was 87 minutes (minimum 60 minutes; maximum 165 minutes). In one case, conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien-Dindo ≥3) occurred. Early readmission after surgery never occurred. All nasopharyngeal swabs resulted negative. Conclusions: In our experience, awake laparotomy under regional anesthesia resulted feasible, safe, painless, and, in specific cases, was the only viable option. This approach allowed prevention of the need of postoperative intensive monitoring during the COVID-19 era. In such a peculiar time, we believe it could become part of an ICU-preserving strategy and could limit viral transmission inside theatres.


Assuntos
Anestesia por Condução/métodos , COVID-19 , Laparotomia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , SARS-CoV-2 , Vigília
8.
Ann R Coll Surg Engl ; 103(3): 197-202, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645283

RESUMO

INTRODUCTION: Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre. METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival. RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups. CONCLUSIONS: Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.


Assuntos
Ingestão de Alimentos , Derivação Gástrica/métodos , Obstrução da Saída Gástrica/cirurgia , Trânsito Gastrointestinal , Neoplasias/complicações , Cuidados Paliativos/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Neoplasias Duodenais/complicações , Feminino , Neoplasias da Vesícula Biliar/complicações , Obstrução da Saída Gástrica/etiologia , Humanos , Laparoscopia/métodos , Laparotomia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Neoplasias Pancreáticas/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/complicações , Taxa de Sobrevida , Resultado do Tratamento
10.
Saudi Med J ; 42(3): 332-337, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33632913

RESUMO

Pancreatic neuroendocrine tumors are rare with an incident rate of 5 cases per million individuals. Tuberous sclerosis complex is an autosomal dominant disease. This disease involves multisystem and occurs in one out of every 6,000-10,000 individuals. In this study, we describe a 47-year-old male known tuberous sclerosis patient with an insulinoma. The tumor was incidentally detected in follow-up imaging for a previous ampulla of Vater tubular adenoma. However, the patient reported symptoms of hypoglycemia. The insulinoma was enucleated successfully. Histopathology revealed a well-differentiated, grade one neuroendocrine tumor measuring around 2 cm in diameter. Seven cases were reported in the literature of tuberous sclerosis-associated insulinoma. The 7 reported cases had different hypoglycemia related symptoms. The reported tumors varied in size and location on the pancreas. This paper details the eighth case worldwide where an insulinoma occurred in a tuberous sclerosis patient.


Assuntos
Insulinoma/diagnóstico , Insulinoma/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Esclerose Tuberosa/complicações , Ampola Hepatopancreática , Humanos , Hipoglicemia/etiologia , Achados Incidentais , Insulinoma/etiologia , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/métodos , Neoplasias Pancreáticas/etiologia , Cirurgia Assistida por Computador
11.
Khirurgiia (Mosk) ; (2): 94-100, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570362

RESUMO

OBJECTIVE: Systematic review and metaanalysis of the effectiveness of open and minimally invasive laparoscopic suturing of perforated peptic ulcer. MATERIAL AND METHODS: Searching for Russian and English language reports included Scientific Electronic Library, Cochrane Collaboration Library and PubMed databases. We have analyzed contents of specialized journals, reviews and their references. Unpublished data were obtained via communication with chiefs of national surgical hospitals. RevMan 5.3 software was used for metaanalysis. RESULTS: We found no international randomized trials in available literature. Metaanalysis was based on national non-randomized studies. Total sample was 1177 cases. Laparoscopic minimally invasive surgery was performed in 43% of cases (n=503), open suturing - in 57% (n=674) of patients. Choice of these procedures is not currently not standardized. Minimally invasive procedures are shorter in time (mean difference -8.02, 95% CI -11.26 - -4.77, p<0.00001) and ensure less hospital-stay (mean difference -1.93, 95% CI -2.97 - -0.88, p=0.0003). Complications were less common (OR 0.14, 95% CI 0.07-0.27, p<0.00001) after minimally invasive operations (2.4%, 12/503) compared to laparotomy (11.4%, 77/674). Incidence of suture failure was similar (OR 0.4, 95% CI 0.1-1.6, p=0.2) (0.4% (2/503) vs. 0.7% (5/674)). Postoperative mortality was higher (OR 0.14, 95% CI 0.05-0.37, p<0.0001) after laparotomy (8%, 54/674) compared to laparoscopy (0.8%, 4/503). CONCLUSION: A metaanalysis indicates the advantage of laparoscopy-assisted suturing of perforated ulcer via minimally invasive approach over laparotomy. The absence of a standardized approach in choosing of minimally invasive laparotomy and conventional approach is a limitation of these results.


Assuntos
Laparoscopia , Laparotomia , Úlcera Péptica Perfurada , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparotomia/efeitos adversos , Laparotomia/métodos , Tempo de Internação , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Úlcera Péptica Perfurada/diagnóstico , Úlcera Péptica Perfurada/cirurgia , Resultado do Tratamento
12.
Afr J Paediatr Surg ; 18(1): 18-23, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33595536

RESUMO

Background: There are no standard criteria to select patients for thoracoscopic repair of congenital diaphragmatic hernia (CDH). The objective of this study was to compare open laparotomy versus thoracoscopic repair of CDH in neonates. Patients and Methods: This retrospective study included 41 patients who had repair of CDH from 2011 to 2019. Patients were divided into two groups according to the surgical approach; open laparotomy (n = 30) and thoracoscopic repair (n = 11). Study endpoints were duration of post-operative mechanical ventilation, hospital stay and the return to full enteral feeding. Results: Patients who had thoracoscopic repair were significantly younger (3 [25th- 75th percentiles: 3-3] vs. 4 [3-5] days; P = 0.004). Other pre-operative variables were comparable between both groups. The duration of surgery was significantly longer in the thoracoscopic repair (174 [153-186] vs. 91 (84-99) min; P < 0.001). The use of pre-operative nitrous oxide inhalation was associated with prolonged ventilation (P = 0.004), while the thoracoscopic repair was associated with shorter mechanical ventilation (P = 0.006). Hospital stay is lower in the thoracoscopic approach but did not reach a significant value (P = 0.059). The use of pre-operative nitrous oxide was associated with a prolonged hospital stay (P = 0.002). Younger age (HR: 1.33, P = 0.014) and open approach (HR: 3.56, P = 0.004) were significantly associated with delayed feeding. Conclusions: The thoracoscopic approach is safe and effective for repairing the CDH. It is associated with shorter mechanical ventilation and rapid return to enteral feeding. Proper patient selection is essential to achieve good outcomes.


Assuntos
Hérnias Diafragmáticas Congênitas/cirurgia , Laparotomia/métodos , Toracoscopia/métodos , Feminino , Humanos , Recém-Nascido , Tempo de Internação , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
Vet Surg ; 50(3): 600-606, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33624855

RESUMO

OBJECTIVE: To describe a modified celiotomy to improve access to cranial abdominal structures in horses. ANIMALS: Four horses. STUDY DESIGN: Short case series. METHODS: Three horses with gastric impactions were treated with gastrotomies. One horse was treated for a diaphragmatic hernia with herniorrhaphy and mesh augmentation. In all horses, the ventral midline celiotomy was modified cranially with a J-incision through the body wall, along the paracostal arch. RESULTS: The only surgical complications were midline incisional infections in all horses. Three of the four horses had good long-term outcomes; the remaining horse underwent euthanasia for reasons likely unrelated to incisional complications. CONCLUSION: The J-incision improved access to the stomach and diaphragm in these horses. The paracostal component healed in all cases without evidence of infection or dehiscence. CLINICAL SIGNIFICANCE: This modified celiotomy may be considered to improve access during gastrotomy and repair of dorsally located diaphragmatic hernias.


Assuntos
Abdome/cirurgia , Laparotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Ferida Cirúrgica/veterinária , Animais , Hérnia Diafragmática/cirurgia , Hérnia Diafragmática/veterinária , Cavalos , Laparotomia/métodos , Masculino , Estômago/cirurgia , Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/etiologia
14.
J Cardiothorac Surg ; 16(1): 18, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608021

RESUMO

BACKGROUND: Pulmonary metastasectomy was performed in the early twentieth century and ever since, it has evolved to be one of the main treatment options for certain metastatic malignancies. The advancement of minimally invasive procedures enabled new techniques to minimize morbidity and improve patient quality of care and overall outcome. CASES PRESENTATION: Herein we present three patients, aged 53, 48, and 27 years, known to have sigmoid, rectal, and non-seminomatous germ cell tumors respectively. All patients were diagnosed to have metastatic lung nodules and underwent laparotomy to excise abdominal tumors followed by trans-diaphragmatic single-port video-assisted thoracoscopic pulmonary metastasectomy. All patients achieved complete surgical tumor excision, and none had pulmonary related complications on follow-up. CONCLUSION: Our prescribed novel trans-diaphragmatic single-port video-assisted thoracoscopic surgery (VATS) technique for synchronous pulmonary metastasectomy and intra-abdominal tumor resection is safe and can achieve complete resection with negative margins.


Assuntos
Laparotomia/métodos , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Neoplasias Embrionárias de Células Germinativas/cirurgia , Pneumonectomia/métodos , Neoplasias Testiculares/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514623

RESUMO

Acute confusion in pregnancy is generally uncommon, given the relatively young and healthy population obstetricians care for. We present an unusual and rare case of acute confusion in a term pregnancy with antecedent history of gastrointestinal (GI) bleeding. A primigravida with no medical history of note, was found to have a haemoglobin of 67 g/L at booking and was commenced on oral iron supplementation. In the third trimester, she presented with haematochezia and had several admissions, requiring 18 units of red blood cells during her pregnancy. At term, she was admitted with acute confusion and GI bleeding, and was subsequently delivered by caesarean section to facilitate ongoing investigation and management of her symptoms. She was diagnosed postnatally with an arteriovenous malformation in the jejunum which required interventional radiology and surgical management for symptom resolution. Her confusion was attributed to hyperammonaemic levels secondary to her high protein load.


Assuntos
Malformações Arteriovenosas/complicações , Confusão/etiologia , Hemorragia Gastrointestinal/etiologia , Jejuno/irrigação sanguínea , Doença Aguda , Malformações Arteriovenosas/terapia , Cesárea/métodos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Embolização Terapêutica/métodos , Feminino , Humanos , Hiperamonemia/complicações , Jejuno/diagnóstico por imagem , Jejuno/patologia , Jejuno/cirurgia , Laparotomia/métodos , Gravidez , Resultado do Tratamento , Adulto Jovem
16.
Transplant Proc ; 53(1): 371-378, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33419574

RESUMO

BACKGROUND: Simultaneous pancreas-kidney (SPK) transplantation can be complicated by thrombosis in the early post-transplant period. METHODS: We performed a single-center retrospective study examining risk factors, management, and outcomes of modern era SPK transplants. We reviewed 235 recipients over 10 years (January 1, 2008, to September 1, 2017). We used multivariate analysis to examine donor, recipient, and operative risk factors for thrombosis. RESULTS: Forty-one patients (17%) had a thrombosis diagnosed on postoperative imaging, but 61% of these patients (n = 25/41) did not lose their graft secondary to the thrombosis. Nine patients (22%) were managed with watchful waiting and serial imaging, 12 (29%) were managed with therapeutic anticoagulation, and 4 (10%) required laparotomy and graft thrombectomy. Sixteen of 235 pancreas grafts (6.8%) required pancreatectomy, and 10 of these cases occurred in the first half of the study, before 2012. The risk of thrombosis leading to graft loss increased 11.2-fold in recipients with a body mass index (calculated as weight in kilograms divided by height in meters squared) > 25 compared with others (odds ratio, 11.2; 95% CI, 1.1-116.7; P = .043). CONCLUSIONS: The majority of SPK transplants (61%) complicated by thrombosis of the pancreatic graft were salvaged by use of imaging, anticoagulation, and in select cases, laparotomy and graft thrombectomy.


Assuntos
Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Trombose/etiologia , Trombose/terapia , Adolescente , Adulto , Anticoagulantes/uso terapêutico , Feminino , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Trombectomia/métodos , Conduta Expectante , Adulto Jovem
17.
Neurosurgery ; 88(4): 812-818, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475722

RESUMO

BACKGROUND: Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy. OBJECTIVE: To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population. METHODS: Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Demographic data including age, sex, comorbidities, and indications were collected. Six- and twelve-month complication rates were analyzed. RESULTS: A total of 1966 (3.2%) patients underwent laparoscopic-assisted VPS and 60 030 (96.8%) patients underwent nonlaparoscopic-assisted VPS placement. Compared with traditional open VPS placement, the laparoscopic approach was associated with decreased odds of distal revision at 6- and 12-mo postoperatively (6 mo: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.21-0.74; 12 mo: OR = 0.60, 95% CI: 0.39-0.94). At 6- and 12-mo postoperatively, multivariable regression analysis demonstrated increased odds of distal revision in patients with a body mass index (BMI) > 30 Kg/M2, history of open abdominal surgery, and history of laparoscopic abdominal surgery. Additionally, history of prior abdominal surgery and BMI > 30 Kg/M2 were significantly associated with increase odds of shunt infection at 6 and 12-mo, respectively. CONCLUSION: In the largest retrospective analysis to date, patients with a history of abdominal surgery and obesity were found to be at increased risk of infection and distal revision after VPS placement. However, the laparoscopic approach for abdominal placement of the distal catheter was associated with reduced rates of distal revision in this population, suggesting an avenue for reducing complications in well-selected patients.


Assuntos
Laparoscopia/métodos , Laparotomia/métodos , Medicare , Derivação Ventriculoperitoneal/métodos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/cirurgia , Peritônio/diagnóstico por imagem , Peritônio/cirurgia , Estudos Retrospectivos , Estados Unidos/epidemiologia
18.
Pediatr Surg Int ; 37(2): 261-266, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33388964

RESUMO

PURPOSE: The aim of this study was to evaluate the materials used for abdominal esophageal banding, and to evaluate the complications associated with abdominal esophageal banding. METHODS: The medical records of seven patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) who underwent abdominal esophageal banding between December 2009 and January 2020 were retrospectively reviewed. RESULTS: The patients were banded with vinyl tape (n = 1), silicone tape (n = 2), polyacetal resin clips (n = 1), or an expanded polytetrafluoroethylene (ePTFE) sheet (n = 3). Banding with vinyl tape resulted in banding failure at postoperative day (POD) 89. One patient with silicone tape developed banding failure at POD 177. In the other patient, it was discovered during radical surgery that the silicone tape had slipped through the abdominal esophagus. Polyacetal resin clip banding resulted in esophageal wall perforation at POD 27. One patient banded with an ePTFE sheet underwent upper gastric transection at POD 650, while another underwent TEF resection at POD 156; in the third patient, the banding condition was maintained for more than 100 days. CONCLUSION: Abdominal esophageal banding is useful as a palliative treatment for EA/TEF with severe associated anomalies. Surgeons should plan the next surgery depending on the patient's condition.


Assuntos
Endoscopia Gastrointestinal/métodos , Atresia Esofágica/cirurgia , Esôfago/cirurgia , Laparotomia/métodos , Fístula Traqueoesofágica/cirurgia , Anastomose Cirúrgica/métodos , Atresia Esofágica/complicações , Atresia Esofágica/diagnóstico , Feminino , Humanos , Recém-Nascido , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Índice de Gravidade de Doença , Fístula Traqueoesofágica/complicações , Fístula Traqueoesofágica/diagnóstico
19.
Arch Gynecol Obstet ; 303(5): 1295-1304, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33389113

RESUMO

PURPOSE: The aim of our study was to assess concordance of staging laparoscopy and cytoreductive surgery (CRS) peritoneal cancer index (PCI) when applying a two-step surgical protocol. We also aimed to evaluate the accuracy of diagnostic laparoscopy to triage patients for complete cytoreduction, and to define optimal time between staging laparoscopy and CRS. METHODS: We designed a retrospective review of prospectively collected data from patients with advanced ovarian cancer who underwent a diagnostic laparoscopy followed by a CRS a few weeks later (two-step surgical protocol), from January 2010 to April 2019. Only patients selected for complete cytoreduction, and with available PCI score from both surgeries were included. PCI concordance was assessed using intraclass correlation coefficient (ICC). RESULTS: During the study period 543 patients underwent a laparoscopic staging for ovarian carcinomatosis. Among them, 43 patients fulfilled inclusion criteria. ICC between laparoscopic and laparotomic PCI was 0.54. After applying the linear regression equation: laparoscopic PCI + 0.2 x [days between surgeries] + 2, ICC increased to 0.79. Completeness cytoreduction score and laparoscopic PCI were significantly associated (OR 1.27, 95% CI 1.03-1.57, p = 0.03). AUC of laparoscopic PCI to predict complete cytoreduction was 0.90. CONCLUSION: Concordance between laparoscopic PCI assessment and PCI score at the end of CRS is fair within a two-step surgical management. Laparoscopic assessment underestimates final PCI score by two points, and this difference increases with the delay between both surgeries. Diagnostic laparoscopy can adequately select patients for CRS, and optimal time to perform it is no more than 10 days after laparoscopy.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Laparoscopia/métodos , Laparotomia/métodos , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Estudos Prospectivos , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...