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1.
Ann R Coll Surg Engl ; 101(8): e172-e177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672034

RESUMO

Intragastric balloons have been used as an invasive non-surgical treatment for obesity for over 30 years. Within the last 37 years, we have found only 27 cases reported in the literature of intestinal obstruction caused by a migrated intragastric balloon. We report the laparoscopic management of such a case and make observations from similar case presentations published in the literature. A 26-year-old woman had an intragastric balloon placed endoscopically for weight control 13 months previously. She presented to the emergency department with a four-day history of intermittent abdominal cramps and vomiting. Contrast enhanced computed tomography confirmed the presence of the intragastric balloon within the small bowel. At laparoscopic retrieval, the deflated intragastric balloon was found impacted in the terminal ileum approximately 15 cm from the ileocaecal valve. The balloon was retrieved by enterotomy and primary closure of the ileum without event. The risk of balloon deflation and subsequent migration increases over time but several published cases demonstrate that this complication can occur within six months of insertion. The initial approach to the treatment of migrated intragastric balloons causing small bowel obstruction should be determined by the location of impaction, severity of obstruction and the available skill set of the attending radiologist, endoscopist and/or surgeon. Balloons causing obstruction in the duodenum are likely amenable to endoscopic retrieval whereas impaction within the jejunum or ileum could be managed by percutaneous needle aspiration (in selected cases), endoscopy (double-balloon enteroscopy), laparoscopy or open surgery.


Assuntos
Migração de Corpo Estranho/cirurgia , Balão Gástrico/efeitos adversos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Laparoscopia/métodos , Adulto , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obesidade/cirurgia , Tomografia Computadorizada por Raios X
2.
Bone Joint J ; 101-B(10): 1192-1198, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564144

RESUMO

AIMS: Radiostereometric analysis (RSA) studies of vitamin E-doped, highly crosslinked polyethylene (VEPE) liners show low head penetration rates in cementless acetabular components. There is, however, currently no data on cemented VEPE acetabular components in total hip arthroplasty (THA). The aim of this study was to evaluate the safety of a new cemented VEPE component, compared with a conventional polyethylene (PE) component regarding migration, head penetration, and clinical results. PATIENTS AND METHODS: We enrolled 42 patients (21 male, 21 female) with osteoarthritis and a mean age of 67 years (sd 5), in a double-blinded, noninferiority, randomized controlled trial. The subjects were randomized in a 1:1 ratio to receive a reverse hybrid THA with a cemented component of either argon-gas gamma-sterilized PE component (controls) or VEPE, with identical geometry. The primary endpoint was proximal implant migration of the component at two years postoperatively measured with RSA. Secondary endpoints included total migration of the component, penetration of the femoral head into the component, and patient-reported outcome measurements. RESULTS: In total, 19 control implants and 18 implants in the VEPE group were analyzed for the primary endpoint. We found a continuous proximal migration of the component in the VEPE group that was significantly higher with a difference at two years of a mean 0.21 mm (95% confidence interval (CI) 0.05 to 0.37; p = 0.013). The total migration was also significantly higher in the VEPE group, but femoral head penetration was lower. We found no difference in clinical outcomes between the groups. CONCLUSION: At two years, this cemented VEPE component, although having a low head penetration and excellent clinical results, failed to meet noninferiority compared with the conventional implant by a proximal migration above the proposed safety threshold of RSA. The early proximal migration pattern of the VEPE component is a reason for continued monitoring, although a specific threshold for proximal migration and risk for later failure cannot be defined and needs further study. Cite this article: Bone Joint J 2019;101-B:1192-1198.


Assuntos
Artroplastia de Quadril/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Polietilenos/química , Desenho de Prótese , Falha de Prótese/tendências , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Método Duplo-Cego , Feminino , Migração de Corpo Estranho/epidemiologia , Prótese de Quadril , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Prognóstico , Análise Radioestereométrica , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Suécia , Vitamina E/farmacologia
3.
Orv Hetil ; 160(42): 1677-1681, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31608692

RESUMO

Migration of swallowed foreign bodies from the gastrointestinal tract is a rare phenomenon compared with the total number of ingestions. In the reported two cases, the serious septic condition indicated urgent surgical intervention. We found a piece of wire swallowed a few months earlier in the right lobe of the liver and the retroperitoneum in case one, and a piece of wire in the pericardium, which migrated from the stomach through the left lobe of the liver, in case two. Abscesses and phlegmonae were found in the retroperitoneum and then in the femoral region requiring a reoperation in case one, and in the liver and pericardium in case two. After the evacuation of abscesses, both patients made full recovery. Diagnostic difficulties and therapeutic challenges served the reasons to present these cases. Orv Hetil. 2019; 160(42): 1677-1681.


Assuntos
Abscesso/complicações , Corpos Estranhos/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Fígado/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Trato Gastrointestinal Superior/diagnóstico por imagem , Abscesso/cirurgia , Adulto , Feminino , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/cirurgia , Trato Gastrointestinal , Humanos , Pessoa de Meia-Idade , Radiografia , Estômago , Resultado do Tratamento , Trato Gastrointestinal Superior/cirurgia
5.
Medicine (Baltimore) ; 98(34): e16835, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441855

RESUMO

RATIONALE: The penetration of a foreign body through the stomach wall and causing liver abscess is rare. A case of liver abscess caused by secondary bacterial infection was reported in the current study. PATIENT CONCERNS: A 58-year-old male patient had a history of eating fish and presented with recurrent fever with chills. The patient had a previous fever for 9 days without any obvious inducement and the highest body temperature rose to 40.8°C, along with fear of cold and chills. Body temperature declined to normal value after 5 days of infusion treatment (drugs were unknown) in the local clinic. Two days afterward, his body temperature again rose to 40.3°C at its highest. DIAGNOSIS AND INTERVENTION: Abdominal computed tomography (CT) showed that there was a quasicircular low-density focus in the left hepatic lobe which was most likely a liver abscess. A dense strip was found in proximity to the left hepatic lobe, implying the retention of a catheter in the upper abdominal cavity or a foreign body. On conditions of related preoperative preparations and general anesthesia, the left hepatic lobe was resected with the laparoscope. During the operation, a fish bone was found in the liver. Postoperative symptomatic and supportive treatment was carried out without antibiotics for liver protection. OUTCOMES: The patient was cured through surgical treatment and found to be in a good condition. The patient was successfully discharged and recovered well in the follow-up visit 3 months after the operation. LESSONS: Liver abscess caused by fish spines is rare. The contrast-enhanced CT of the abdomen and the minimally invasive abdominal operation both played critical roles in the diagnosis and treatment of the case. The general population, who mistakenly eat fish bones, should seek medical treatment as soon as possible.


Assuntos
Migração de Corpo Estranho/complicações , Abscesso Hepático/etiologia , Animais , Peixes , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
7.
J Craniofac Surg ; 30(3): e243-e244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048620

RESUMO

The authors report an unusual case of distal ventriculoperitoneal shunt catheter into the pulmonary vasculature. The migrated catheter was extracted through a thoracotomy and venotomy, with the cooperation of Neuroneurosurgery and Cardiovascular team. This rare complication after ventriculoperitoneal shunt surgery should be paid enough attention. There were 2 possible mechanisms. To solve the problem, multidisciplinary cooperation should be applied.


Assuntos
Cateteres/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Coração/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Derivação Ventriculoperitoneal/efeitos adversos , Migração de Corpo Estranho/etiologia , Humanos , Hidrocefalia/terapia , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Ann Vasc Surg ; 59: 307.e13-307.e16, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075468

RESUMO

We report an unusual case of a 53-year-old male patient, previously undergone an extra-anatomic right-to-left iliofemoral bypass graft, who has developed gross hematuria after 4 months. The cystoscopic examination revealed a wall injury due to the presence of the graft crossing the bladder. Iatrogenic bladder injuries during vascular surgery are extremely rare. In the literature, only 11 cases of transvesical graft are reported. The complication has been resolved with the removal of the misplaced graft and the reconstruction of the bypass with silver-coated Dacron prosthesis. Despite the rarity of this complication, postoperative ultrasound of the bladder is recommended to timely detect any injury and adopt a correct surgical strategy.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Migração de Corpo Estranho/cirurgia , Doença Iatrogênica , Doença Arterial Periférica/cirurgia , Bexiga Urinária/cirurgia , Angiografia por Tomografia Computadorizada , Cistoscopia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Desenho de Prótese , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/lesões
9.
Medicine (Baltimore) ; 98(20): e15668, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096497

RESUMO

INTRODUCTION: Intravascular migration of a double J stent into the inferior vena cava is an uncommon complication. The management of such complication is less reported in the literature. This study aimed to reveal the diagnosis and treatment process of migration of a double J stent into the inferior vena cava. PATIENT CONCERNS: A 53-year-old male patients was transferred to our hospital because of migration of a double J stent into the inferior vena cava after left-side pyelolithotomy. DIAGNOSIS: In accordance with manifestations on computed tomography urography, the patient was diagnosed with migration of a double J stent into the inferior vena cava. INTERVENTIONS: Percutaneous nephroscope under C-arm guidance was performed to remove the migrated stent. After the operation, the patient was treated with continued anticoagulants and antibiotics. OUTCOMES: The migrated stent was removed successfully without any complications, and a new double J stent was placed and its location was confirmed under C-arm. The patient was discharged in good condition and the follow-up was uneventful. CONCLUSION: Intravascular migration of a double J stent into the inferior vena cava is an uncommon complication. Radiologic imaging after placement of ureteral stent is critical for prevention of this complication. Percutaneous nephroscope under C-arm guidance is a safe and effective approach to remove the migrated DJS in the IVC.


Assuntos
Migração de Corpo Estranho/cirurgia , Stents , Veia Cava Inferior/cirurgia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem
10.
BMJ Case Rep ; 12(4)2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-30988106

RESUMO

Vaginal pessary is a practical and effective tool for pelvic organ prolapse management. Nevertheless, serious complications can occur in neglected patients such as vesicovaginal and rectovaginal fistula, erosion and impaction in adjacent structures. We report a case of neglected pessary found in the uterine cavity. The patient was treated with abdominal hysterectomy with in situ doughnut pessary. Proper pessary care and regular follow-up should be emphasised among patients, caregivers and related healthcare personnel to early detect as well as to avoid complications.


Assuntos
Dor Abdominal/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Prolapso de Órgão Pélvico/terapia , Pessários/efeitos adversos , Dor Abdominal/patologia , Idoso , Feminino , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Humanos , Histerectomia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
11.
Ann Vasc Surg ; 59: 313.e11-313.e17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009719

RESUMO

Percutaneous angioplasty and stenting is nowadays the treatment of choice for atherosclerotic stenotic lesions of the supraaortic trunks. Stent migration is a seldom published complication that can alter the short-term results of these procedures. Herein, we report three cases, from three different institutions, of secondary autoexpandable stent migration, after endovascular treatment of major arch vessel stenosis, and their subsequent endovascular management using three different retrieval techniques. Technical success was achieved in all cases. There were no immediate complications related to the retrieval of the migrated stents. A late complication of iliac thrombosis required complementary surgical intervention. Percutaneous retrieval of migrated self-expanding stents is feasible and can be effectively performed with few complications as a first-line option.


Assuntos
Angioplastia com Balão/efeitos adversos , Aorta Torácica , Doenças da Aorta/terapia , Remoção de Dispositivo/métodos , Migração de Corpo Estranho/terapia , Stents , Idoso , Angioplastia com Balão/instrumentação , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Constrição Patológica , Remoção de Dispositivo/instrumentação , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Dispositivos de Acesso Vascular
12.
Ann Vasc Surg ; 59: 91-101, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009727

RESUMO

BACKGROUND: Migration of the iliac limb after endovascular abdominal aortic aneurysm repair (EVAR) can result in type 1b and 3 endoleaks, which are relatively common causes of reintervention after EVAR. The aim of the present study was to investigate the factors influencing migration of the iliac limb and methods of treatment. METHODS: From April 2012 to September 2017, 4 patients experienced migration of the iliac limb, requiring additional iliac stent graft implantation intraoperatively or at follow-up at our institute. Patient 1 was a 74-year-old man in whom preoperative computed tomography angiography (CTA) revealed a large aneurysm. The patient underwent EVAR with a bifurcated stent graft, and the left iliac stent graft migrated into the aneurysm sac. Patient 2 was a 53-year-old man in whom CTA revealed a large abdominal aortic aneurysm (AAA) involving the bilateral common iliac artery (CIA), with occlusion of the left hypogastric artery. An iliac stent graft was deployed to the right CIA to preserve the hypogastric artery. CTA, at 5 years of follow-up, showed migration of the right iliac limb and impending rupture. Patient 3 was a 61-year-old man with a ruptured AAA, and CTA revealed a large AAA and dilated CIA. The patient underwent EVAR with a bifurcated stent graft. Three years after EVAR, CTA showed that the right iliac limb migrated and kinked, with rupture of the stent graft. Patient 4 was an 80-year-old man with a ruptured AAA and aortocaval fistula. CTA revealed a large aneurysm involving the bilateral CIA. The patient underwent urgent EVAR with a bifurcated stent graft, and a cuff was deployed to seal the landing zone of the left CIA to preserve the hypogastric artery. Type 3 endoleak occurred because of the migration and detachment of the left iliac limb. All 4 patients underwent additional iliac stent graft implantation to connect or reline the iliac limb. RESULTS: The mean diameter of the aneurysms was 85.3 ± 18.9 mm, and 2 patients were diagnosed with ruptured AAAs. The mean diameter, length, and proportional engagement rate of the CIA that experienced migration of the iliac limb were 25.50 ± 11.1 mm, 32.8 ± 6.6 mm, and 72.75% ± 17.88%, respectively. Oversizing of the iliac stent graft was 10-20% in 2 patients and was less than 10% in the other 2 patients. The migrated iliac limbs were bell-bottom stent grafts. All patients underwent additional iliac stent graft implantation successfully, and there were no deaths or complications perioperatively. The patients were followed up from 7 months to 3 years and remained in good condition. CONCLUSIONS: Migration of the iliac limb after EVAR was influenced by a complex combination of several factors including a large aneurysm (>60 mm in diameter), dilated or aneurysmal CIA (>18 mm in diameter), short length of fixation (<70%), lower degree of iliac limb oversizing (<10-20%), and bell-bottom of the iliac limb. Patients with these factors require more vigorous surveillance after EVAR. The implantation of an additional stent graft is effective and is the most common reintervention procedure.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/cirurgia , Artéria Ilíaca/cirurgia , Stents/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/instrumentação , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
Vasc Endovascular Surg ; 53(5): 433-436, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31010401

RESUMO

We describe renal stent migration following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. A 68-year-old male presented with type B aortic dissection. His course was complicated by renal and lower extremity malperfusion. Thoracic endovascular aortic repair was performed and completion angiogram showed no flow in the left renal artery. A renal stent was deployed with the proximal margin of the stent 1 mm into the aortic true lumen, providing improved renal perfusion. One week after TEVAR, contrast-enhanced computed tomography (CT) revealed that the renal stent had embolized to the aortic bifurcation. Additional endovascular therapy successfully crushed the renal stent against the iliac artery wall utilizing a larger bare metal stent. At 3 year follow-up, contrast-enhanced CT demonstrated good patency of the left renal artery and right iliac artery. This complication alerts physicians to consider subsequent aortic remodeling during endovascular intervention for acute aortic dissection with malperfusion.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Migração de Corpo Estranho/etiologia , Obstrução da Artéria Renal/cirurgia , Artéria Renal/cirurgia , Stents , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aorta/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Remoção de Dispositivo , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/terapia , Humanos , Masculino , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(2): 87-93, mar.-abr. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-182007

RESUMO

Microsurgical clipping is still regarded as the gold-standard treatment for broad-neck intracranial aneurysms. New endovascular techniques like balloon or stent assisted coiling are quickly rising to the challenge and showing promising outcomes. As a result, broad-neck aneurysms are increasingly addressed by these techniques despite they have not been tested against clipping in a randomized controlled trial and long-term complications might be unknown yet. Intraprocedural coil migration has been well documented in the literature, but the same complication in a delayed fashion is scarcely reported. We present a case of delayed coil migration occurring after a balloon-assisted embolization of a wide-necked intracranial aneurysm and we perform a literature review for similar cases. We discuss how, despite seeming an extremely rare complication, with new endovascular techniques increasingly perceived as the safer option in any aneurysm, potential adverse events may become more frequent. Strategies proposed to address this developing scenario are also reviewed


El clipaje microquirúrgico todavía se considera el tratamiento de elección para los aneurismas intracraneales de cuello ancho. Técnicas de embolización asistida por balón o stent se han desarrollado para estas lesiones y muestran resultados prometedores. Como consecuencia, los aneurismas de cuello ancho se abordan cada vez más mediante estas técnicas, a pesar de que no existen ensayos controlados aleatorizados al respecto, y las complicaciones a largo plazo podrían ser desconocidas. La migración intraprocedimiento de un coil está bien documentada, pero la misma complicación de forma tardía apenas está descrita. Presentamos un caso de migración tardía de un coil tras embolización asistida con balón de un aneurisma intracraneal de cuello ancho y revisamos la literatura para casos similares. Argumentamos que, a pesar de parecer una complicación extremadamente rara, con la creciente percepción de que las nuevas técnicas endovasculares son la opción más segura en cualquier aneurisma, los potenciales eventos adversos pueden aumentar. También revisamos las estrategias propuestas para abordar este nuevo escenario


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Oclusão com Balão/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Stents , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia
16.
BMC Musculoskelet Disord ; 20(1): 118, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894158

RESUMO

BACKGROUND: We report a case of hardware failure after distal femoral osteotomy (DFO) with a broken screw pulled out from the locking hole and positioned within the knee joint. CASE PRESENTATION: A 57-year-old man presented to our orthopedic outpatient department with 3-months history of an unusual painful swelling at the operated area following DFO. The leakage of joint fluid from the penetrated suprapatellar pouch was assumed to be the reason for this complication. CONCLUSIONS: The overall aim of this case report is to provide a lesson to budding surgeons who might experience a similar situation that cannot be easily explained, like the unexpected complication in the present case.


Assuntos
Parafusos Ósseos/efeitos adversos , Fêmur/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteotomia/efeitos adversos , Falha de Prótese/efeitos adversos , Fêmur/cirurgia , Migração de Corpo Estranho/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/instrumentação , Resultado do Tratamento
19.
Pediatr Emerg Care ; 35(5): 382-384, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30829842

RESUMO

Point-of-care ultrasound can be used as an assessment tool during the evaluation of children with renal colic. We discuss the case of a 7-year-old girl presenting to the pediatric emergency department with left flank pain, vomiting, and urinary incontinence status post-left renal stent placement. Renal ultrasound revealed ureteral obstruction caused by renal stent displacement. Point-of-care ultrasound performed by pediatric emergency department physicians was used to assess renal stent location, repositioning, and confirmation of the new location by the urology team. We discuss the role of transabdominal point-of-care ultrasound for the evaluation and treatment of the symptomatic child with recent ureter stent placement.


Assuntos
Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Sistemas Automatizados de Assistência Junto ao Leito , Cólica Renal/diagnóstico por imagem , Cólica Renal/cirurgia , Stents/efeitos adversos , Ultrassonografia/métodos , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/cirurgia , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Reoperação
20.
Medicine (Baltimore) ; 98(11): e14705, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882633

RESUMO

RATIONALE: Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare. PATIENT CONCERNS: A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months. DIAGNOSIS: A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy. INTERVENTIONS: The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length. OUTCOMES: The patient recovered uneventfully and was discharged on day 5 after surgery. LESSONS: This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.


Assuntos
Migração de Corpo Estranho/diagnóstico por imagem , Reação a Corpo Estranho/diagnóstico por imagem , Laparoscopia , Neoplasias Hepáticas/diagnóstico , Fígado , Adulto , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Migração de Corpo Estranho/cirurgia , Reação a Corpo Estranho/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X
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