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1.
Arq Bras Cir Dig ; 32(3): e1447, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644667

RESUMO

BACKGROUND: The pilonidal cyst is an infection of the skin and the subcutaneous tissue, secondary to a chronic inflammation with a greater frequency in the sacrococcygeal region, and associated to the presence of hair. The treatment is eminently surgical. AIM: To demonstrate the endoscopic treatment of pilonidal cyst. METHOD: Prospective study with 67 patients who had as surgical indication the diagnosis of pilonidal cyst. They were submitted to a surgical procedure from June 2014 to March 2018. The equipment used was the Meinero fistuloscope, a shutter, a monopolar electrode, a brush and endoscopic forceps. RESULTS: Of the 67 patients, 67% (n=45) were male and 33% (n=22) female, with a mean age of 25 years (17-45). Surgical time in average was 40 min (20-120) and mean healing time of four weeks (3-12). Surgical complications were presented in 7% cases (n=5) and recurrences in 9% (n=6). CONCLUSION: The endoscopic treatment of the pilonidal cyst is feasible and presents good surgical results.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Seio Pilonidal/cirurgia , Adolescente , Adulto , Argentina , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Duração da Cirurgia , Estudos Prospectivos , Região Sacrococcígea/cirurgia , Resultado do Tratamento , Adulto Jovem
2.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511270

RESUMO

A 29-year-old woman with recurrent pelvic pain that progressed post partum was diagnosed with a multicystic pararectal lesion on ultrasound and CT scan. Physiology was conducted to establish a preoperative function and pudendal nerve integrity. The lesion was resected using a Da Vinci Xi robotic system. She recovered uneventfully with complete resolution of her symptoms. Hindgut cysts most often arise in the presacral space as the result of incomplete embryogenesis. Patients may present with various non-specific symptoms. Although the majority are benign, resection is recommended, as there is a 30%-43% risk of malignancy.


Assuntos
Cistos/cirurgia , Hamartoma/cirurgia , Procedimentos Cirúrgicos Robóticos , Adulto , Cistos/diagnóstico por imagem , Feminino , Hamartoma/diagnóstico por imagem , Humanos , Reto , Região Sacrococcígea , Vagina
3.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(3): 127-130, jul.-sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-182719

RESUMO

El teratoma sacrococcígeo es el tumor más común en recién nacidos, con incidencia reportada de uno por cada 40.000 nacidos vivos, habitualmente en fetos del sexo femenino, su mortalidad va del 15 al 35%, condicionada por el tamaño de la lesión, la extensión y el subtipo histológico. Se presenta un caso de teratoma sacrococcígeo diagnosticado en forma prenatal. En la región sacra se observó una imagen redondeada de bordes regulares, definidos, heterogénea, de 8,8×6,9×8,4cm, con un volumen de 266cc. El beneficio más importante es la prevención de distocias, por cesárea


Sacrococcygeal teratoma is the most common tumour found in newborns, with a reported incidence of one per 40,000 live births. It usually appears in female foetuses, with a mortality ranging from 15 to 35%, depending on the size of the lesion, extension, and histological subtype. The case is presented of a sacrococcygeal teratoma found in the prenatal diagnosis. It was observed in the sacral region as a rounded image with regular, defined, heterogeneous borders of 8.8×6.9×8.4cm, with a volume of 266cc. The most important action is the prevention of dystocia either by elective or emergency caesarean section


Assuntos
Humanos , Feminino , Gravidez , Adulto , Teratoma/diagnóstico por imagem , Diagnóstico Pré-Natal , Teratoma/complicações , Região Sacrococcígea/diagnóstico por imagem , Região Sacrococcígea/patologia , Distocia/diagnóstico por imagem , Distocia/prevenção & controle , Teratoma/cirurgia , Diagnóstico Diferencial , Angiografia
4.
Pediatr Surg Int ; 35(10): 1109-1114, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31392503

RESUMO

PURPOSE: Many kinds of operative procedures have been proposed for anorectal malformation (ARM) patients. At our institution, sacroperineal or sacroabdominoperineal anorectoplasty (SP-SAP) have been performed from 1984 to 2007. The aim of this study is clarify the change over the time in the postoperative bowel function in male ARM patients. METHODS: Patient data were collected from 1984 to 2007. Fifty-two male patients with high- and intermediate-type ARM were enrolled. The patients' characteristics and bowel function were reviewed and analyzed retrospectively. The bowel function was evaluated according to the evacuation score (ES) of the Japan Society of ARM Study Group. RESULTS: The operative procedures were SP-SAP in 52 male patients. The total ES improved chronologically and significantly until 11 years of age. Regarding the clinical stratification of the ES, the ratio of "excellent" and "good" results was over 91.9% at 11 years of age. A satisfactory bowel movement score was achieved by 9 years of age. The constipation, incontinence and soiling scores improved slowly but continuously until 11 years of age. CONCLUSION: The ES showed continuous improvement after a definitive operation. An understanding of the characteristics of improvement is very important in managing the postoperative bowel function in ARM patients.


Assuntos
Abdominoplastia/métodos , Canal Anal/anormalidades , Malformações Anorretais/cirurgia , Defecação/fisiologia , Períneo/cirurgia , Reto/anormalidades , Região Sacrococcígea/cirurgia , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Malformações Anorretais/diagnóstico , Malformações Anorretais/fisiopatologia , Seguimentos , Humanos , Lactente , Masculino , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reto/diagnóstico por imagem , Reto/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
World Neurosurg ; 132: 408-420.e1, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31465853

RESUMO

OBJECTIVE: This systematic review and meta-analysis aims to assess and compare the postoperative outcomes of iliac screw (IS) fixation versus sacral 2 alar iliac (S2AI) screw fixation in the adult and pediatric populations. METHODS: We searched all comparative studies that compared postoperative outcomes of IS and S2AI fixation techniques for pelvic fixation from the PubMed and Scopus databases up to June 23, 2019. RESULTS: Eleven of 951 studies (N = 632 patients) were eligible; 8, 10, 5, 6, 3, 7, 2, and 2 studies were included in pooling of postoperative complications, revisions, implant failure, screw breakage, screw prominence, wound dehiscence, wound infection, visual analog scale (VAS), and ambulatory status (AS), respectively. The IS technique had a statistically significant higher chance of postoperative complications, revisions, implant failure, screw breakage, screw prominent, wound dehiscence, and wound infection by 1.89 (95% confidence interval [CI], 1.48-2.40), 1.91 (95% CI, 1.29-2.82), 2.28 (95% CI, 1.55-3.35), 3.96 (95% CI, 1.46-10.75), 6.83 (95% CI, 2.54-18.37), 4.62 (95% CI, 1.32-16.25), and 3.03 (95% CI, 1.62-5.66), respectively compared with the S2AI fixation technique. In subgroup analysis, the IS technique had a statistically significant higher chance of postoperative complications and revisions of 1.65 (95% CI, 1.25-2.16) and 1.71 (95% CI, 1.03-2.84) in pediatric populations and 2.32 (95% CI, 1.60-3.38) and 1.94 (95% CI, 1.00-3.73) in the adult populations compared with the S2AI fixation technique. IS screw fixation had a lower AS of -0.40 (95% CI, -0.76 to -0.15) than did S2AI fixation in the adult and pediatric populations. However, there was no difference in pain VAS between both groups. CONCLUSIONS: Sacropelvic fixation with IS screw fixation had more postoperative complications and revisions and lower AS than did S2AI fixation.


Assuntos
Parafusos Ósseos , Ílio/cirurgia , Pelve/cirurgia , Região Sacrococcígea/cirurgia , Adulto , Criança , Humanos , Fixadores Internos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação , Fusão Vertebral , Resultado do Tratamento
6.
World Neurosurg ; 130: 254-258, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299309

RESUMO

BACKGROUND: Filum terminale arteriovenous fistulae (FTAVFs) are rare entities. For those with the fistulous point located in the lower sacral region (below S2), neither surgical nor endovascular strategies are the optimal treatment. CASE DESCRIPTION: We describe 2 FTAVF cases with the fistulous point below S2: one had the anterior spinal artery (ASA) as a single feeder with a long distance to the fistula and the other developed an inaccessible feeder after the initial non-ASA feeder embolization. In a hybrid operating room, through an L4 laminectomy, we surgically exposed and cannulated the cephalad draining vein, other than the feeding arteries, to retrograde occlude the proximal draining vein along with the fistulous point and feeders using Onyx. All shunt points were obliterated with the help of intraoperative digital subtraction angiography. CONCLUSIONS: Retrograde embolization of the draining vein to obliterate FTAVFs in the lower sacral region is feasible and complete. This technique may provide a new treatment option for FTAVFs.


Assuntos
Fístula Arteriovenosa/cirurgia , Cateterismo , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Região Sacrococcígea/cirurgia , Angiografia Digital/métodos , Fístula Arteriovenosa/diagnóstico , Cateterismo/métodos , Cauda Equina/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Embolização Terapêutica/métodos , Humanos , Laminectomia/métodos , Masculino , Pessoa de Meia-Idade , Artéria Vertebral/cirurgia
7.
Pediatr Surg Int ; 35(9): 979-983, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256295

RESUMO

PURPOSE: Presacral masses associated with anorectal malformations (ARM) are most frequently dermoid or teratomas. Sacrococcygeal teratoma (SCT), in isolation, is a different condition. There are limited data comparing the two. The aim of this study was to compare presacral masses associated with ARM and isolated SCTs. METHODS: A retrospective review was performed from 1979 to 2018. Patients with presacral masses and associated ARM (n = 39) were identified and compared to patients with isolated SCTs (n = 32). RESULTS: Those with presacral mass and ARM had a lower proportion of immature and mixed teratomas by pathology and a longer time to mass resection. They had higher percentages of sacral anomalies (76% versus 9%), tethered cord (50% versus 6%), and other anomalies (51% versus 9%). For long-term bowel function, patients with presacral mass and ARM were more likely to be fecally incontinent and require enemas (59% versus 11%). Regarding isolated SCTs, 4% recurred with a time to recurrence of 7 months. CONCLUSIONS: Compared to patients with isolated SCT, patients with presacral mass and ARM had lower grade tumors. In addition, they had a higher proportion of sacral defects and other congenital defects, as well as worse bowel function outcomes.


Assuntos
Malformações Anorretais/complicações , Malformações Anorretais/patologia , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/patologia , Teratoma/complicações , Teratoma/patologia , Malformações Anorretais/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Região Sacrococcígea/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Teratoma/diagnóstico
8.
J Zhejiang Univ Sci B ; 20(8): 670-678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31273964

RESUMO

OBJECTIVE: To determine the clinical, imaging, and histological features, and surgical resection modalities and outcomes of adult sacrococcygeal teratoma (SCT). METHODS: Adult patients with histopathologically diagnosed SCT were enrolled in our hospital between August 2010 and August 2018. Each patient's characteristics and clinical information were reviewed. RESULTS: There were 8 patients in the study (2 males, 6 females) with a median age of 34 years (range, 18-67 years). The time to clinical symptoms was 14 d to 35 years, with a median time of 4 years. Six patients presented with symptoms of sacrococcygeal pain, and four with signs of sacrococcygeal mass and ulceration in the sacrococcygeal region. Six patients were evaluated using a combination of computed tomography (CT) and magnetic resonance imaging (MRI). All patients showed a presacral tumor with heterogeneous intensity on CT images. All patients underwent surgical treatment, including 6 parasacral, 1 transabdominal, and 1 combined anterior-posterior surgery cases. Seven patients were histopathologically diagnosed with benign mature SCT, and have shown no recurrence. One patient had malignant SCT, with recurrence at 84 months after surgery. After a second surgery, the patient had no recurrence within 6 months follow-up after re-resection. CONCLUSIONS: Our retrospective study demonstrated: (1) adult SCT is difficult to diagnose because of a lack of typical clinical symptoms and signs; (2) a combination of CT and MRI examination is beneficial for preoperative diagnosis; (3) the choice of surgical approach and surgical resection modality depends on the size, location, and components of the tumor, which can be defined from preoperative CT and MRI evaluation; (4) most adult SCTs are benign; the surgical outcome for the malignant SCT patient was good after complete resection. Even for the patient with recurrent malignant SCT, the surgical outcome was good after re-resection.


Assuntos
Região Sacrococcígea/diagnóstico por imagem , Região Sacrococcígea/cirurgia , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Medição da Dor , Estudos Retrospectivos , Teratoma/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
10.
Int J Paleopathol ; 26: 93-103, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31351222

RESUMO

OBJECTIVE: To document sacral spina bifida occulta (SSB0) prevalence in a population sample from the Dakhleh Oasis, Egypt, and address methodological issues in recording and quantifying SSBO variations. MATERIALS: 442 adult sacra from two temporally disjunct samples from the same deme traversing the 3rd intermediate (TIP) and the Roman Periods. METHODS: Sacra were scored for SSBO, excluding the sacral hiatus. Risk of SSBO was calculated with the common odds ratio and statistical significance by X2. Data were compared to other archaeological SSBO data. RESULTS: SSBO was present in 15.6% of the sample with a slight, but not significant, temporal increase (TIP to Roman Period) in males, and a significant age-correlated increase in both sexes. Most open sacra occurred in young adults. CONCLUSIONS: Data support that SSBO can be considered as a morphogenetic variant. Dakhleh data fall within the prevalence range for most populations, however inter-population comparisons are complicated by methodological inconsistencies. SIGNIFICANCE: SSBO can be used in paleogenetic research. LIMITATIONS: Methodological differences in scoring SSBO prevent effective comparative study. SUGGESTED FUTURE RESEARCH: Future studies require more rigorous and standardized scoring methods. aDNA may be used to corroborate the morphogenetic value of SSBO and determine its clinical significance.


Assuntos
Paleopatologia , Espinha Bífida Oculta/epidemiologia , Espinha Bífida Oculta/história , Adulto , Egito , Feminino , História Antiga , Humanos , Masculino , Prevalência , Região Sacrococcígea , Adulto Jovem
11.
Ceska Gynekol ; 84(2): 140-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238684

RESUMO

OBJECTIVE: Description of newborn with early prenatal diagnosis of sacrococcygeal teratomia. Desing: Case report. SETTING: Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol Prague. CASE REPORT: In this case report a term neonate with a massive sacrococcygeal teratoma was delivered by a cesarean section (approach by Geppert) with an intrapartal relieving punction of the tumor. It was a type II SCT with both pelvic end extracorporal component with a size of 60×35 centimeters. The tumor was completely resected during the first day of life and was followed by a normal function of lower extremities, normal bowel function and only transitional urinary tract symptoms. CONCLUSION: A sacrococcygeal teratoma (SCT) is the most common congenital tumor in newborns with reported incidence of 1:35000-40000 live births affecting more frequently females (4:1). This germinal tumor is either benign (mature) or malignant (immature), mature types are more common in neonates. A SCT is usually diagnosed by prenatal ultrasound, magnetic resonance is performed to characterize its size and content, type of tumor (type I-IV Altman classification) and relation to surrounding tissues. Preemptive early delivery by cesarean section is recommended when the tumor exceeds the diameter of 5 centimeters to avoid complications during vaginal delivery (rupture, bleeding etc.). The primary treatment of SCT is an early surgical resection with a complete resection of the coccyx („en bloc“ resection), malignant tumors are indicated for adjuvant chemotherapy. Long term complications can be urinary tract or bowel dysfunctions, lower extremity muscle weakness or paralysis and recurrence of the tumor with potential malignancy.


Assuntos
Doenças Fetais/patologia , Região Sacrococcígea , Neoplasias da Coluna Vertebral/patologia , Teratoma/patologia , Feminino , Humanos , Recém-Nascido , Gravidez , Neoplasias da Coluna Vertebral/cirurgia , Teratoma/cirurgia
12.
Pol Przegl Chir ; 91(3): 38-42, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-31243172

RESUMO

Autorzy przedstawiaja u 73 letniej kobiety torbiel ogonowo-jelitowa przestrzeni pozaodbytniczej, która ulegla zezlosliwieniu. Juz w trzecim roku zycia byla leczona, jako przetoka ropna posladka prawego, która sie okresowo uaktywniala. W 2016roku zglosila sie do Poardni Chirurgicznej w Gorlicach z olbrzymim ropniakiem posladka prawego z przetoka ropna . Na oddziale chirurgicznym w Gorlicach operacyjnie usunieto ropniak o scianach dobrze uksztaltowanych razem z przetoka. Torbiel zawierala ponad litr ropy. Po wygojeniu w bliznie pojawila sie przetoka sluzowa .Badaniem histologicznym rozpoznano retrocecal cyst hamartoma z komórkami mucinos adenocarcinoma. W czasie nasteponego pobytu chorej w szpitalu po wykonaniu rezonansu magnetycznego stwierdzono resztkowa zmiane w okolicy przedkrzyzowej siegajaca do trzeciego kregu krzyzowego. Zmiane usunieto radykalnie potwierdzona badaniem histopatologicznym. U chorej nawrotu nie zaobserwowano.


Assuntos
Adenocarcinoma/cirurgia , Nádegas/cirurgia , Cistos/cirurgia , Região Sacrococcígea/cirurgia , Adenocarcinoma/patologia , Idoso , Nádegas/patologia , Cistos/patologia , Feminino , Humanos , Região Sacrococcígea/patologia , Resultado do Tratamento
13.
World Neurosurg ; 129: 210-215, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203077

RESUMO

BACKGROUND: Sacral schwannomas are very rare nerve sheath tumors. Patients usually present with a variety of nonspecific symptoms, which often lead to a delay in diagnosis. Although most schwannomas are benign, they present surgical challenges owing to their proximity to neurologic and other anatomic structures. CASE DESCRIPTION: This 58-year-old female presented with a 2-month old history of left-sided perineal and radicular pain secondary to a right S2 sacral nerve root schwannoma. The sacral mass demonstrated homogenous enhancement with cystic changes in a T2-weighted magnetic resonance imaging sequence. The patient underwent S1-S3 laminectomy and tumor excision through a posterior surgical approach. Intraoperative monitoring was used to distinguish nonfunctional tissue during tumor resection. The patient had an unremarkable postoperative course. CONCLUSIONS: Sacral schwannomas can present with a variety of nonspecific symptoms. They pose unique challenges given their location, size, and involvement of surrounding structures. Complete surgical resection is the main goal of sacral schwannoma treatment. A combined anterior-posterior surgical approach and a multidisciplinary surgical team are associated with improved outcomes.


Assuntos
Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Raízes Nervosas Espinhais/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neuralgia/etiologia , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Região Sacrococcígea , Raízes Nervosas Espinhais/cirurgia
14.
Neuropathology ; 39(4): 313-318, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31243802

RESUMO

Giant cell ependymoma (GCE) is a very uncommon variant of ependymoma, known for having varying degrees of nuclear pleomorphism. There are only 34 reported cases of GCE in the English literature. We describe an additional case of a young woman who presented with a tumor located in sacral soft tissue, which was not connected to the spinal cord and did not show additional lesions in the central nervous system. Complete tumor resection was performed and no recurrences or metastasis were detected after 5 months of follow-up. Only one of all the reported GCE was located in the sacral subcutaneous region, where ependymomas are rarely found and usually have myxopapillary histology. Ours is the second report showing microscopic features of GCE in the soft-tissue region. GCE should be considered in the differential diagnosis of lumbosacral subcutaneous tumors to avoid misdiagnosing it as a malignant lesion. Since GCE could be an extraspinal extension of an intraneural ependymoma, it would be important to evaluate whether it is connected to the spinal cord.


Assuntos
Ependimoma/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias da Medula Espinal/patologia , Adulto , Diagnóstico Diferencial , Ependimoma/complicações , Ependimoma/diagnóstico , Feminino , Humanos , Região Sacrococcígea , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico
15.
Lakartidningen ; 1162019 May 15.
Artigo em Sueco | MEDLINE | ID: mdl-31192393

RESUMO

The main, but not sole, indication for an Ex-utero Intrapartum Treatment (EXIT) delivery is an airway obstruction due to either laryngeal atresia or tumors in the head and neck region. Here we present our Institution's experience with eleven cases: three teratomas, four lymphatic malformations, two laryngeal atresias and two dermoid cysts. The EXIT procedure was used to secure the fetal airway while maintaining uteroplacental gas exchange and fetal hemodynamic stability through the umbilical circulation. Five fetuses required tracheostomy. Only one fetal death occurred due to extensive growth of a teratoma preventing us from establishing an airway. No other fetal or major maternal complication occurred. The EXIT procedure is a complex procedure and these rare cases should be referred to a center with a dedicated and experienced multidisciplinary team.


Assuntos
Obstrução das Vias Respiratórias , Histerotomia/métodos , Laparotomia/métodos , Adulto , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/cirurgia , Cesárea , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Hospitais Universitários , Humanos , Recém-Nascido , Intubação Intratraqueal/métodos , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Laringe/anormalidades , Laringe/cirurgia , Anormalidades Linfáticas/cirurgia , Equipe de Assistência ao Paciente , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Região Sacrococcígea/patologia , Região Sacrococcígea/cirurgia , Suécia , Teratoma/congênito , Teratoma/cirurgia , Traqueotomia/métodos
16.
J Wound Care ; 28(6): 409-415, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166863

RESUMO

OBJECTIVE: To analyse the treatment of pressure ulcers (PU) in long-term care. METHOD: In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment. RESULTS: In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs. CONCLUSION: PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.


Assuntos
Casas de Saúde , Padrões de Prática em Enfermagem/estatística & dados numéricos , Lesão por Pressão/terapia , Idoso , Idoso de 80 Anos ou mais , Tornozelo , Bandagens , Curativos Hidrocoloides , Nádegas , Estudos Transversais , Desbridamento , Feminino , Finlândia/epidemiologia , Calcanhar , Quadril , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/epidemiologia , Prevalência , Qualidade da Assistência à Saúde , Região Sacrococcígea , Creme para a Pele , Irrigação Terapêutica
17.
Zhonghua Shao Shang Za Zhi ; 35(5): 367-370, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154735

RESUMO

Objective: To explore the clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer. Methods: From May 2012 to May 2017, 20 patients with sacral pressure ulcers (14 males and 6 females, aged 27 to 67 years) were admitted to our department. According to the consensus staging system of National Pressure Ulcer Advisory Panel in 2016, 6 cases were in 3 stages, 14 cases were in 4 stages, with the area of pressure ulcers ranging from 5.0 cm×4.0 cm to 10.0 cm×8.0 cm. After debridement and vacuum sealing drainage, the superior gluteal artery perforator island flaps were used to repair the pressure wounds, with the area of flaps ranging from 6 cm×5 cm to 13 cm×8 cm. The donor sites were sutured directly. The survival of flaps after operation, the healing of wounds, and the follow-up of patients were observed. Results: After surgery, flaps of 20 patients survived well without reoperation. The length of hospital stay of patients was 20 to 40 days, with an average of 25 days. Eighteen patients were followed up for 6 to 24 months, with an average of 12.2 months. The flaps were in good shape and elastic recovery. There were no complications such as seroma or hematoma in the donor sites. Both the patients and family members expressed satisfaction with the shape and texture of the flap and shape of hip. Conclusions: The superior gluteal artery perforator island flap is reliable in blood supply and easy to rotate. The flap can carry a little muscle to increase the anti-infective ability. Moreover, the donor site can be directly sutured with slight damage. Thus, it is one of the good methods for repairing sacral pressure ulcers.


Assuntos
Artérias/transplante , Retalho Perfurante/irrigação sanguínea , Lesão por Pressão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Região Sacrococcígea , Retalhos Cirúrgicos , Cicatrização
18.
Vet Anaesth Analg ; 46(4): 510-515, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155379

RESUMO

OBJECTIVE: To compare the cranial spread of epidural injectates between lumbosacral (LS) and sacrococcygeal (SCo) approaches in order to guide volume selection for SCo epidural anaesthesia in the dog. STUDY DESIGN: Prospective, randomized cadaveric experimental study. ANIMAL: A group of 13 adult greyhound cadavers. METHODS: The greyhound cadavers were randomly allocated to receive an epidural injection of diluted contrast via the LS or SCo approach. Incremental volumes (0.1, 0.2, 0.4 and 0.6 mL kg-1) were injected consecutively, and a computed tomography (CT) scan was completed following every volume increment. Cranial spread of contrast was recorded by counting the number of vertebrae cranial to the LS space that the injectate had reached, expressed as a vertebral value (n). This vertebral value was measured taking into consideration the percentage of the cord surrounded by contrast (vertebral canal coverage, %). RESULTS: The cranial spread of contrast was similar at 0.1 mL kg-1 [1 (0-3) versus 2 (1-3) n], 0.2 mL kg-1 [3 (0-10) versus 3 (1-5) n], 0.4 mL kg-1 [12 (9-18) versus 11 (3-19) n] and 0.6 mL kg-1 [18 (12-20) versus 15 (10-23) n] for the LS and SCo injections, respectively (p = 0.945). There was a significant interaction between the volume injected and vertebral canal coverage (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE: The cranial spread of contrast was similar, independent of whether the epidural injection was performed in the LS or SCo intervertebral space. Current volume guidelines used for the LS approach may produce similar distribution patterns when the SCo approach is used. Further studies are required in order to evaluate the in vivo effectiveness and the adequacy in differently sized dogs of the results found herein.


Assuntos
Meios de Contraste/administração & dosagem , Cães , Injeções Epidurais/veterinária , Região Lombossacral , Região Sacrococcígea , Animais , Cadáver , Espaço Epidural , Estudos Prospectivos
19.
Rev. chil. radiol ; 25(2): 75-78, jun. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1013853

RESUMO

Los quistes aracnoideos corresponden a lesiones benignas expansivas del canal medular secundarias a defectos anatómicos durales, mientras que los meningoceles anteriores consisten en la herniación de la duramadre hacia la pelvis a través de forámenes dilatados o defectos óseos. Ambas entidades son infrecuentes y sus manifestaciones clínicas puede variar de acuerdo a estructuras anatómicas que comprimen. Una historia clínica completa, la pesquisa diagnóstica y la adecuada interpretación de imágenes orientan al diagnóstico y manejo de estos pacientes. Se presenta el caso de una paciente adulta mayor con historia de masa pélvica, dolor lumbar severo y monoparesia en quien se realizó el diagnóstico incidental de quiste aracnoideo sacro y meningioma sacro anterior.


Arachnoid cysts are benign expansive lesions of the spinal canal secondary to dural defects, whereas the anterior meningoceles consist of the herniation of the dura into the pelvis through dilated foramina or bone defects. Both pathologies are infrequent and its clinical manifestations vary according to compressed anatomical structures. A complete clinical history, the diagnostic investigation and the correct imaging studies interpretation guide the diagnosis and management of these patients. We present the case of an elderly adult patient with a history of pelvic mass, severe lumbar pain and monoparesis in whom the incidental diagnosis of sacral arachnoid cyst and anterior sacral meningioma was performed.


Assuntos
Humanos , Feminino , Idoso , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Meningocele/complicações , Meningocele/diagnóstico por imagem , Recidiva , Região Sacrococcígea , Imagem por Ressonância Magnética , Cistos Aracnóideos/cirurgia , Meningocele/cirurgia
20.
N Z Vet J ; 67(5): 241-248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31081479

RESUMO

AIMS: To develop a technique for the injection of local anaesthetic into the spinal canal of broiler chickens by first determining the ideal location for needle placement based on anatomy and histology, and then using the developed technique to assess the onset and duration of action of three doses of lidocaine. METHODS: Two-month-old Ross broiler chickens (n = 30) were used in this study. Computed tomography imaging followed by anatomical examination of fresh cadavers (n = 6) were used to identify a suitable intervertebral space for injection of local anaesthetic, and landmarks to locate this space. Histological evaluation of the microanatomy of the caudal vertebral column in another six birds was used to examine the position of the spinal cord within the canal. Spinal anaesthesia was attempted using injection of lidocaine at 0.5 mg/kg (n = 6), 1 mg/kg (n = 6), and 2 mg/kg (n = 6) via the selected intervertebral space. Analgesia was tested by pinching the skin of the pericloacal area with thumb forceps to determine the onset and duration of analgesia. Respiratory rate, and cloacal temperature were measured at 0 minutes and every 10 minutes after injection until sensation returned. RESULTS: The space between synsacrum and first free coccygeal vertebra (synsacrococcygeal space) was selected as the most suitable site for spinal injection. In this region, the dura mater adhered to the internal wall of the spinal canal, and the subarachnoid space was large indicating that injection would be into the subarachnoid rather than the epidural space. The interval to onset of analgesia was similar for all doses of lidocaine (1.5 (SD 0.7), 2 (SD 1) and 1.3 (SD 0.5) minutes for 0.5, 1 and 2 mg/kg, respectively; p = 0.604). Duration of analgesia was longer following injection with 2 than 0.5 or 1 mg/kg lidocaine (21.3 (SD 2.5) vs. 4.5 (SD 3.5) vs. 11.3 (SD 2) minutes, respectively; p = 0.002). Mean cloacal temperature decreased between 0 and 20 minutes after injection with all doses of lidocaine (p = 0.021). CONCLUSIONS AND CLINICAL RELEVANCE: Spinal anaesthesia in chickens is feasible and is a practical, inexpensive and simple technique for regional anaesthesia of the pericloacal area.


Assuntos
Raquianestesia/veterinária , Anestésicos Locais/administração & dosagem , Galinhas , Lidocaína/administração & dosagem , Dor/veterinária , Análise de Variância , Raquianestesia/métodos , Animais , Feminino , Disco Intervertebral , Dor/tratamento farmacológico , Região Sacrococcígea/diagnóstico por imagem , Coluna Vertebral/anatomia & histologia , Coluna Vertebral/citologia , Coluna Vertebral/diagnóstico por imagem
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