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1.
Klin Lab Diagn ; 64(11): 644-648, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31747490

RESUMO

The aim of the study was to assess the information content of volatile fatty acid parameters for the differential diagnosis of infected and sterile pancreatic necrosis. The work is based on the results of examination and treatment of 34 patients with pancreatic necrosis. The analysis of concentrations of volatile fatty acids: acetic, propionic, butyric and isovaleric was carried out on an automated gas chromatograph «Crystallux-4000¼ with a capillary column «HP-FFAP¼ and flame ionization detector. The indicators of acetic, propionic, butyric, isovaleric acid and the sum of volatile fatty acids are statistically significantly higher in patients with infected pancreatic necrosis compared with the indicators of volatile fatty acids in patients with sterile pancreatic necrosis. Volatile fatty acid values can be used for the differential diagnosis of infected and sterile pancreatic necrosis.


Assuntos
Ácidos Graxos Voláteis/análise , Necrose/diagnóstico , Pâncreas/patologia , Cromatografia Gasosa , Diagnóstico Diferencial , Humanos
3.
BMC Infect Dis ; 19(1): 485, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146691

RESUMO

BACKGROUND: Bordetella trematum is an infrequent Gram-negative coccobacillus, with a reservoir, pathogenesis, a life cycle and a virulence level which has been poorly elucidated and understood. Related information is scarce due to the low frequency of isolates, so it is important to add data to the literature about this microorganism. CASE PRESENTATION: We report a case of a 74-year-old female, who was referred to the hospital, presenting with ulcer and necrosis in both legs. Therapy with piperacillin-tazobactam was started and peripheral artery revascularization was performed. During the surgery, a tissue fragment was collected, where Bordetella trematum, Stenotrophomonas maltophilia, and Enterococcus faecalis were isolated. After surgery, the intubated patient was transferred to the intensive care unit (ICU), using vasoactive drugs through a central venous catheter. Piperacillin-tazobactam was replaced by meropenem, with vancomycin prescribed for 14 days. Four days later, levofloxacin was added for 24 days, aiming at the isolation of S. maltophilia from the ulcer tissue. The necrotic ulcers evolved without further complications, and the patient's clinical condition improved, leading to temporary withdrawal of vasoactive drugs and extubation. Ultimately, however, the patient's general condition worsened, and she died 58 days after hospital admission. CONCLUSIONS: Despite being a rare finding, B. trematum is typically associated with the clinical manifestation of disorders that predispose to ulcer development, which can be infected by microorganisms. The combination of antibiotic therapy and surgical debridement plays a key role in preventing systemic infections. Monitoring the appearance of new cases of B. trematum is essential, since it can be an emerging microorganism. Isolating and defining the clinical relevance of unusual bacteria yields a more accurate perspective in the development of new diagnostic tools and allows for assessment of proper antimicrobial therapy.


Assuntos
Infecções por Bordetella/diagnóstico , Bordetella , Idoso , Antibacterianos/uso terapêutico , Bordetella/isolamento & purificação , Infecções por Bordetella/tratamento farmacológico , Infecções por Bordetella/microbiologia , Coinfecção , Pé Diabético/complicações , Pé Diabético/diagnóstico , Pé Diabético/tratamento farmacológico , Pé Diabético/microbiologia , Enterococcus faecalis/isolamento & purificação , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Necrose/diagnóstico , Necrose/microbiologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Stenotrophomonas maltophilia/isolamento & purificação , Úlcera/diagnóstico , Úlcera/microbiologia
4.
Infection ; 47(4): 677-679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077024

RESUMO

AIMS: Necrotizing soft-tissue infections (NSTI) are rare but severe diseases with rapid progression. Rates of mortality and morbidity are high and early diagnosis, immediate surgical intervention and antibiotic treatment are essential to improve prognosis. Thus, our commentary emphasizes important information in the management of NSTI. METHODS: We describe the essentials in the management of necrotizing soft-tissue infections. RESULTS: Six essentials were identified: 1. Necrotizing soft-tissue infections (NSTI) are primarily diagnosed clinically; pain out of proportion, rapid progression of skin infection and systemic signs should alert clinicians. 2. Early diagnosis can be rather delayed by several factors such as absence of fever, significant cutaneous manifestations, elevation of inflammatory parameters, systemic signs, and non-specific imaging tests. 3. NSTI can occur both in the elderly or patients with underlying diseases after major trauma (usually polymicrobial Gram-negative and Gram-positive pathogens) but also in healthy patients after minor trauma (often monomicrobial; most common among Gram-positive organisms: group A Streptococcus). 4. Immediate and radical debridement (incl. re-debridement after 24 h) remains the cornerstone of surgical therapy. 5. Empirical broad-spectrum antimicrobial treatment has to be administered shortly after admission. After isolation of the causative bacteria therapy should be tailored. 6. The value of adjunctive measures (hyperbaric oxygen therapy, intravenous immunoglobulines) is uncertain and their routine use cannot be recommended. Further efforts should be undertaken to increase the awareness for and the adherence to the essentials in the management of necrotizing soft-tissue infections.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/terapia , Necrose/terapia , Infecções dos Tecidos Moles/terapia , Desbridamento , Diagnóstico Diferencial , Bactérias Gram-Negativas/fisiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/microbiologia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/microbiologia
6.
Clin Dermatol ; 37(2): 99-108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981299

RESUMO

When confronted with an existent or evolving eschar, the history is often the most important factor used to put the lesion into proper context. Determining whether the patient has a past medical history of significance, such as renal failure or diabetes mellitus, exposure to dead or live wildlife, or underwent a recent surgical procedure, can help differentiate between many etiologies of eschars. Similarly, the patient's overall clinical condition and the presence or absence of fever can allow infectious processes to be differentiated from other causes. This contribution is intended to help dermatologists identify and manage these various dermatologic conditions, as well as provide an algorithm that can be utilized when approaching a patient presenting with an eschar.


Assuntos
Exantema/patologia , Pele/patologia , Antraz/complicações , Anticoagulantes/efeitos adversos , Calciofilaxia/complicações , Embolia de Colesterol/complicações , Exantema/etiologia , Fasciite Necrosante/complicações , Gangrena de Fournier/complicações , Humanos , Mucormicose/complicações , Necrose/diagnóstico , Necrose/etiologia , Necrose/patologia , Tifo por Ácaros/complicações , Sepse/complicações , Mordeduras de Serpentes/complicações , Picaduras de Aranhas/complicações , Retalhos Cirúrgicos/patologia , Tularemia/complicações , Vibrioses/complicações
7.
J Med Case Rep ; 13(1): 49, 2019 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-30825875

RESUMO

BACKGROUND: For patients with complicated generator pocket infection, expert consensuses universally advocate complete device and leads removal followed by delayed replacement on the contralateral side. We cured our patient by partial generator removal and reimplantation of sterilized pulse generator on the ipsilateral side. We also performed a literature review about incomplete removal therapy for the management of cardiac implantable electronic device infection. CASE PRESENTATION: An 86-year-old Chinese Han man was diagnosed as having third-degree atrioventricular block and received a permanent double-chamber pacemaker in his left prepectoral area 15 years ago. Nine years later, the entire system was removed because of confirmed infection, and a new device was reimplanted in the contralateral area. He developed skin necrosis around the pacemaker pocket after 1 year, and his generator was renewed without leads extraction at another medical center. He was subsequently admitted several times for surgical tissue debridement at another institution due to extended skin necrosis. At the time of the new admission, he had severe infection, heart failure, and hypoalbuminemia. He was diagnosed as having complicated pacemaker pocket infection. Our preferred treatment strategy was for complete removal of both the generator and transvenous pacing leads, and we intended to implant an epicardial pacemaker in our patient if necessary. However, he rejected the treatment strategy and firmly refused to replace his generator. We had to attempt a novel pacemaker-preserving strategy considering our patient's severe comorbidities. Finally, we cured him by partial generator removal and reimplantation of the sterilized pulse generator on the ipsilateral side. There was no sign of wound dehiscence or infection during a 6-month follow-up. CONCLUSIONS: We would posit that partial removal of infected generators combined with conservative treatment may be a proper treatment of complicated generator pocket infection, especially for those who are susceptible to cardiac complications. Reimplantation of a sterilized pulse generator on the ipsilateral side may be an option if patients reject a new device and contralateral vascular condition is not really suitable. Opting for such treatment should be at the consideration of the primary care physician based on the condition of the patient.


Assuntos
Anti-Infecciosos/uso terapêutico , Tratamento Conservador , Remoção de Dispositivo/métodos , Necrose/diagnóstico , Marca-Passo Artificial/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Retalhos Cirúrgicos/patologia , Idoso de 80 Anos ou mais , Terapia Combinada , Humanos , Imunoglobulinas/uso terapêutico , Masculino , Necrose/terapia , Infecções Relacionadas à Prótese/terapia , Reimplante/métodos , Albumina Sérica Humana/uso terapêutico , Retalhos Cirúrgicos/microbiologia , Resultado do Tratamento
8.
Rev. bras. cir. plást ; 34(1): 156-162, jan.-mar. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-994624

RESUMO

Introdução: Os preenchedores permanentes, apesar de resultados duradouros, são verdadeiros problemas quando causam complicações. No Brasil, o PMMA é um produto aprovado pela Anvisa, mas seu uso extrapola suas indicações, levando a complicações graves. Há mais de uma década, existem recomendações sobre sua restrição, mas casos com consequências graves do seu uso irresponsável são atuais. Objetivo: Relatar complicação grave do uso irregular do PMMA e discutir a realidade brasileira atual baseado em determinações das entidades médicas, assim como dos órgãos reguladores. Métodos: É relatado um caso de necrose extensa da região glútea após a injeção de PMMA por profissional não qualificado e discutida a situação brasileira atual do produto com base nas entidades médicas e revisão da literatura do Brasil. Discussão: Apesar do esforço das entidades médicas, são inúmeros os casos de complicações agudas e crônicas relatados na literatura brasileira. No ano de 2016, foram registradas mais de 17 mil complicações relacionadas ao PMMA, mesmo assim, é difícil estabelecer dados epidemiológicos confiáveis, pois não há controle do número de aplicações, da qualidade do produto utilizado e da capacitação dos profissionais que o utilizam. Conclusão: No Brasil, há um número expressivo de procedimentos reparadores para correção de complicações decorrentes do uso do PMMA. A gravidade do caso relatado traz à tona a necessidade de combate à má prática por profissionais não capacitados, assim como um controle mais rigoroso da comercialização do produto por entidades reguladoras.(AU)


Introduction: Use of permanent fillers can lead to significant complications. In Brazil, polymethylmethacrylate (PMMA) is a product approved by the Agência Nacional de Vigilância Sanitária (ANVISA), but its use exceeds its indications, leading to serious complications. Recommendations for restricted use have been in place for more than a decade, but cases with serious consequences due to inappropriate use are still seen. Objective: To report a serious complication due to inappropriate use of PMMA and discuss the current status of PMMA use in Brazil based on recommendations of medical societies and regulatory agencies. Methods: This report describes a case of extensive necrosis of the gluteal region after injection of PMMA by a non-qualified practitioner; the report also reviews the literature on the current status of PMMA use in Brazil. Discussion: Despite the efforts of medical societies, acute and chronic complications are still reported in the Brazilian literature. In 2016, more than 17,000 PMMArelated complications were reported; nevertheless, reliable epidemiological data remain unavailable because the number of treatments, the quality of the product, and the training of practitioners remain unregulated. Conclusion: A significant number of repair procedures are performed in Brazil to correct complications resulting from the use of PMMA. The severity of the reported case highlights the need to combat bad practice by untrained professionals, as well as the need for greater control of PMMA marketing by regulatory agencies.(AU)


Assuntos
Humanos , Feminino , Adulto , Polimetil Metacrilato/análise , Polimetil Metacrilato/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Necrose/diagnóstico
11.
Cytopathology ; 30(1): 74-81, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30417954

RESUMO

OBJECTIVE: This study aimed to determine the reliability of imprint cytology (IC) for intraoperative diagnosis of pulmonary lesions. METHODS: We reviewed 113 cases of pulmonary lesion resection for which a scratch imprint was made intraoperatively. We divided the specimens into two groups (benign and malignant) and compared the scratch IC-based diagnoses against the final histopathological diagnoses in each group for concordance. We also analysed those cases in which the scratch IC preparation was classified as inadequate. RESULTS: The sensitivity, specificity, positive and negative predictive values, and accuracy of IC diagnoses among the patient cohort were 87.7% (72/82), 100% (7/7), 100% (72/72), 41.2% (7/17) and 88.8% (79/89), respectively. IC yielded some false-negative results in terms of malignancy, although most of these imprints were of early cancer or cancer with mild cytological atypia. Five (41.6%) of 12 lesions for which the imprint was deemed inadequate were diagnosed histologically as granulomas with caseous necrosis. CONCLUSION: IC-based diagnoses of pulmonary lesions as malignant corresponded well with the final histopathological diagnoses, but IC-based diagnoses of negative (ie, without malignant cells) were not as reliable. Thus, pathologists should recognise the limitations of IC, especially for identifying malignant lesions. Also, the possibility of latent bacterial infection in a granuloma with caseous necrosis indicates that an IC preparation deemed inadequate for diagnosis should not be ignored.


Assuntos
Citodiagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias/diagnóstico , Adulto , Idoso , Biópsia por Agulha , Feminino , Granuloma/diagnóstico , Granuloma/patologia , Humanos , Cuidados Intraoperatórios , Pulmão/patologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/patologia , Neoplasias/patologia
12.
Leg Med (Tokyo) ; 36: 85-88, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30448603

RESUMO

We report a case of sudden death in a patient who developed extensive gastric necrosis secondary to acute gastric dilatation. A 36-year-old man with mental retardation (but without difficulties in activities of daily living), developed an illness after a meal out with friends, necessitating 3 hospital visits. He returned home after receiving drug therapy; however, his condition deteriorated, and he was transferred to our hospital via ambulance. Whole-body computed tomography performed upon admission revealed gastric dilatation. A stomach tube was inserted, and 2000 mL of gastric aspirate was obtained. The patient died approximately 5 h later despite receiving treatment. Autopsy revealed 1000 mL of gastric contents and extensive gastric necrosis. He was diagnosed with extensive gastric necrosis secondary to acute gastric dilatation.


Assuntos
Dilatação Gástrica/complicações , Estômago/patologia , Doença Aguda , Adulto , Autopsia , Evolução Fatal , Dilatação Gástrica/diagnóstico por imagem , Dilatação Gástrica/patologia , Humanos , Masculino , Necrose/diagnóstico , Necrose/etiologia , Tomografia Computadorizada por Raios X
13.
Poult Sci ; 98(4): 1575-1588, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30508160

RESUMO

Bacterial chondronecrosis with osteomyelitis (BCO) is a leading cause of lameness in broilers. Infrared thermography (IRT) is a noninvasive technique for measuring infrared radiation from an object and can be used to evaluate clinical health. Two replicated studies compared the effect of light intensity on broilers grown on a wire flooring model that experimentally increased their susceptibility to and incidence of BCO lameness. Day-of-hatch male broiler chickens were placed into 6 pens on wood shavings litter, and at 1 wk one of 3 light intensity treatments (2, 5, or 10 lux) was allotted. At 4 wk half of the population from each pen was moved to a pen with wire flooring and the same light intensity. At 1, 4, 5, and 8 wk, an IRT image of the legs of 5 clinically healthy broilers from each pen was taken. The right and left proximal femora and tibiae of sound and lame broilers were scored for femoral head necrosis (FHN) and tibial head necrosis (THN) lesion severity. There were minimal effects of light intensity and flooring. In Study 1, but not Study 2, broilers on wire flooring weighed less on day 38 (P = 0.007) and days 57 to 58 (P = 0.003) compared to those on litter. The proportion of broilers that became lame on wire flooring was 52% in Study 1 and 14% in Study 2. The proportion of sound broilers from litter and wire flooring pens with subclinical signs of BCO in their right or left proximal growth plates was over 45% for FHN and 92% for THN, and lame broilers had more severe (P < 0.0001) FHN and THN compared to sound broilers. IRT surface temperatures of the hock joint, shank, and foot were consistently lower (P < 0.0001) in broilers that became lame when compared to sound. Therefore, IRT surface temperatures of broiler leg regions may be useful for detecting lesions attributed to BCO.


Assuntos
Raios Infravermelhos , Coxeadura Animal/diagnóstico , Necrose/veterinária , Osteomielite/veterinária , Doenças das Aves Domésticas/diagnóstico , Termografia/veterinária , Animais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/veterinária , Membro Posterior/fisiologia , Abrigo para Animais/estatística & dados numéricos , Coxeadura Animal/microbiologia , Masculino , Necrose/diagnóstico , Necrose/microbiologia , Osteomielite/diagnóstico , Osteomielite/microbiologia , Doenças das Aves Domésticas/microbiologia , Temperatura Ambiente , Termografia/métodos
17.
Interact Cardiovasc Thorac Surg ; 28(1): 9-16, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29945176

RESUMO

There are few cases in the literature reporting dysphagia caused by oesophageal compression by the aorta due to acute or chronic aortic pathology. This type of dysphagia is called dysphagia aortica. Thoracic endovascular aortic repair is nowadays the treatment of choice for anatomically suitable patients experiencing complicated Type B aortic dissection. Oesophageal necrosis is a rare but fatal complication following thoracic endovascular aortic repair. Extrinsic oesophageal compression by the thrombosed aneurysmal sac, a mediastinal haematoma or extensive thrombosis in the false lumen of a dissected aorta and acute vascular occlusion of the oesophageal supply are possible mechanisms. When oesophageal necrosis is suspected, endoscopic examination and computed tomography imaging should be performed repeatedly. Oesophagoscopy will confirm the diagnosis revealing a black, diffusely necrotic and ulcerated oesophageal mucosa. It is critical to intervene before full-thickness oesophageal wall necrosis and mediastinitis occur. Guidelines are absent because of the rarity of this complication. Moreover, lack of a large series does not permit the establishment of guidelines either. However, oesophagectomy of the impaired oesophagus is the only chance for survival. Unfortunately, survival rates are disappointing. Prevention and awareness is the cornerstone of success. Early endoscopic examination when oesophageal necrosis is suspected due to even minimal symptoms will detect this fatal menace on time.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Transtornos de Deglutição/etiologia , Procedimentos Endovasculares/efeitos adversos , Esôfago/patologia , Complicações Pós-Operatórias , Trombose/etiologia , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/cirurgia , Humanos , Necrose/diagnóstico , Necrose/etiologia , Trombose/diagnóstico , Tomografia Computadorizada por Raios X
19.
J Int Med Res ; 47(1): 76-83, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30514138

RESUMO

OBJECTIVE: This study aimed to compare the results of the pectoralis major myocutaneous (PMM) flap in primary and salvage head and neck cancer surgery. METHODS: A total of 160 patients were enrolled in this study. The salvage group consisted of 30 patients who received immediate PMM flap surgery following free flap failure. In the primary group, the PMM flap was primarily chosen for 130 patients. Related information was collected and analysed. The University of Washington (UW)-Quality of Life questionnaire, version 4, was mailed to every patient. RESULTS: Partial necrosis was significantly lower in the primary group (n = 13, 10.0%) than in the salvage group (n = 7, 23.3%). Surgical site infection was found in 10 (7.8%) patients in the primary group and in six (20.0%) patients in the salvage group. The mean composite quality of life scores were 66.8 ± 20.5 and 66.2 ± 22.1 in the two groups, respectively. Differences in scores for domains of activity, mood, and anxiety were significant. Disease-specific survival and recurrence-free survival rates were not different between the two groups. CONCLUSION: PMM flap salvage reconstruction has a higher complication rate and poorer functional results, but similar survival prognosis, compared with primary surgery.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Retalho Miocutâneo/cirurgia , Necrose/diagnóstico , Músculos Peitorais/cirurgia , Qualidade de Vida/psicologia , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Miocutâneo/efeitos adversos , Retalho Miocutâneo/transplante , Necrose/etiologia , Necrose/mortalidade , Necrose/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia de Salvação/métodos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/mortalidade , Infecção da Ferida Cirúrgica/patologia , Inquéritos e Questionários , Análise de Sobrevida , Falha de Tratamento
20.
Pituitary ; 22(1): 13-28, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30390276

RESUMO

PURPOSE: Coagulative necrotic pituitary apoplexy (CNPA) is a clinical entity with unique intraoperative and histopathological manifestations. We aimed to improve the knowledge of this rare disease through the largest case series published to date. METHODS: A retrospective review of 21 CNPA patients was performed from among 5095 patients who underwent surgery for pituitary adenomas at a single institution between January 2009 and June 2017. The demographic, clinical, endocrine, neuroimaging, intraoperative, and histopathological findings, management and prognosis were summarized. RESULTS: Headache was the most common symptom that was observed in 21 patients, followed by visual disturbances (17/21, 81.0%), nausea and vomiting (16/21, 76.2%), electrolyte disturbance (13/21, 61.9%), and oculomotor palsies (10/21, 47.6%). Hypopituitarism with at least one anterior pituitary deficiency, especially panhypopituitarism (10/21, 47.6%), was present in 81.0% of patients. Most patients (81.0%) showed typical MRI appearances. All 21 patients underwent transsphenoidal surgery (TSS), and 16 patients had total tumor resection demonstrated by postoperative MRI. Cottage cheese-like necrosis was observed in 16 patients (76.2%) intraoperatively. Histopathology showed large areas of pink, acellular, coagulative necrotic areas in the central zone, and a pseudocapsule in the border zone. After follow-up for 4.3 ± 2.3 years, only 28.6% of patients still suffered from corticotropic deficiency, and 9.5% of patients had gonadotropic deficiency. These patients were administered the appropriate corresponding hormones for life. CONCLUSIONS: CNPA can be correctly diagnosed preoperatively by typical clinical and MRI characteristics. Early surgery combined with hyperbaric oxygen therapy early postoperatively usually yields satisfactory endocrine and neuro-ophthalmic outcomes.


Assuntos
Apoplexia Hipofisária/patologia , Neoplasias Hipofisárias/patologia , China , Cefaleia/patologia , Humanos , Oxigenação Hiperbárica , Imagem por Ressonância Magnética , Necrose/diagnóstico , Necrose/patologia , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Estudos Retrospectivos
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