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1.
BMC Surg ; 21(1): 197, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865363

RESUMO

BACKGROUND: Surgical wound infection contributes to prolonged recovery time after pilonidal sinus excision. As a standard procedure after surgery, we recommend our patients to perform water irrigations in the intergluteal cleft 4 to 6 times a day during the post-operative period. Our hypothesis is that this should reduce healing time and complication rates. The aim of this study was to measure the importance of sacro coccygeal hygiene in the management of pilonidal sinus disease. METHODS: We retrospectively collected data after surgical management of pilonidal sinus (sinusectomy procedures) in our division over a 10-year period. Patients were divided into three groups according to their local hygiene during postoperative follow-up and scored one (G1: good hygiene) to three (G3: poor hygiene). Primary outcome was complication rates. Secondary endpoints were, healing time, follow-up, time off work, and recurrence rate. RESULTS: In G1 (N = 112), complication rate was 3.6%. In G2 (N = 109), it was 5.5%, whereas in G3 (N = 71), it reached 7.03%. However, there were no statistically significant differences between hygiene groups regarding complication rates in both univariate and multivariable analysis. Regarding secondary outcomes, there were significant differences between hygiene groups concerning median follow-up (p = 0.0001) and median time off work (p = 0.0127). CONCLUSION: Good hygiene of wound is essential for optimal, rapid healing without complications. The importance of this report is to show that thanks to our hygiene follow-up strategy with frequent perineal irrigations and regular follow-up checks, patients with at a first glance "unclean local conditions", reached similar complications, median healing time and recurrences rates to patients with medium and good wound hygiene level.


Assuntos
Higiene , Seio Pilonidal/cirurgia , Região Sacrococcígea , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Recidiva , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento , Cicatrização , Adulto Jovem
2.
Ann R Coll Surg Engl ; 103(4): e114-e115, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33661045

RESUMO

Neuropathic bladder may be a co-associated morbidity in newborn babies following resection of a sacrococcygeal teratoma. We report a case of a male newborn showing features of incomplete urinary voiding requiring intermittent catheterisation after operation for bladder emptying. Videourodynamic assessment excluded neuropathic bladder and posterior urethral valves were demonstrated on micturating cystography. Urology outcomes have been excellent following curative valve ablation. This report highlights the crucial importance of being aware of the rare coexistence of lower urinary tract pathology in male babies with sacrococcygeal teratoma. Routine urodynamic assessment should be considered in all children following sacrococcygeal teratoma resection.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Teratoma/cirurgia , Uretra/anormalidades , Bexiga Urinaria Neurogênica/diagnóstico , Anormalidades Urogenitais/diagnóstico , Cistografia , Diagnóstico Diferencial , Humanos , Recém-Nascido , Masculino , Região Sacrococcígea , Teratoma/complicações , Teratoma/diagnóstico , Uretra/diagnóstico por imagem , Anormalidades Urogenitais/etiologia
3.
Medicine (Baltimore) ; 100(4): e24323, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530223

RESUMO

ABSTRACT: Although the incidence of malignant sacrococcygeal germ cell tumors (MSGCTs) is high in the East Asian countries, information about MSGCTs from this region is limited. This report aimed to analyze the data of children with MSGCTs in a single medical center in Taiwan.Patients aged 18 years or younger with primary MSGCTs or malignant recurrence of a sacrococcygeal teratoma who underwent surgery during the neonatal period between January 1999 and December 2016 were identified from the Linkou Chang Gung Cancer Center registry. The clinical features, laboratory data, and treatment outcomes were reviewed.Fifteen children (1 man and 15 women) with MSGCTs were identified. Sacrococcygeal tumors were present at birth in 7 patients. All patients presented with a bulging mass at the buttock region and they had normal alpha-fetoprotein levels at the time of diagnosis. They underwent primary excision of the tumor. Immature teratoma was histologically diagnosed in 5 neonates, and mature teratoma in 2. Only 1 patient with grade 3 immature teratoma received adjuvant chemotherapy. Two patients with mature teratoma developed malignant recurrence 1.6 and 2.1 years later, respectively. Eight patients were diagnosed with MSGCTs after the neonatal period. The common presenting symptoms included buttock asymmetry (37.5%), abdominal distension (25%), and constipation (12.5%). Seven patients had elevated alpha-fetoprotein levels for their age. They were administered neoadjuvant chemotherapy followed by tumor excision if a residual tumor was present. The histology of the excised tumor included mature teratoma (66.7%) and necrosis (33.3%). One patient with a normal alpha-fetoprotein level underwent primary tumor excision followed by adjuvant chemotherapy. Grade 2 immature teratoma with embryonal carcinoma was diagnosed histologically. Among the 15 patients with MSGCTs, 3 had a recurrence (at age of 2.1, 0.5, and 2.4 years, respectively) and 1 died (at age of 6.1 years) of disease progression. The 5-year overall and event-free survival rates were 90% and 80%, respectively.Children with MSGCTs had good overall prognoses in this case series. For those with sacrococcygeal mature teratoma or low-grade immature teratoma in the neonatal period, we recommend close follow-up for at least 3 years after surgery to detect malignant recurrence.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias da Coluna Vertebral/patologia , Teratoma/patologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias Embrionárias de Células Germinativas/terapia , Estudos Retrospectivos , Região Sacrococcígea/patologia , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/terapia , Taiwan/epidemiologia , Teratoma/epidemiologia , Teratoma/terapia , Resultado do Tratamento
4.
Crit Rev Oncol Hematol ; 156: 103140, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33142194

RESUMO

BACKGROUND AND AIMS: Sacrococcygeal teratoma (SCT) is a rare extragonadal germ cell tumour mostly diagnosed during infancy and early childhood. Neonatal SCTs are mostly mature, but can also contain immature and/or malignant components. Recurrence of an SCT alters prognosis, especially when it is malignant, of which its mechanism is not yet fully understood. This study is a review and meta-analysis of the literature on malignant recurrences after an initially mature SCT. METHODS: A literature search was performed to identify studies describing children with SCT and presenting specific information on histology of the initial tumour as well as the recurrence. Random effect models for mature recurrence and malignant recurrence after an initially mature SCT were employed to pool study-specific percentages in order to estimate an overall percentage and its associated 95 % confidence intervals (CI). Inverse variance method, which gives more weight to larger studies, was used to pool outcomes for the different studies. RESULTS: A total of 22 articles, comprising 1516 patients with SCT, were included in the meta-analysis. The pooled proportions of mature and malignant recurrences after mature SCT were 3 % (95 % CI 1-4 %) and 5% (95 % CI 3-6 %), respectively. Fifty-seven (56 %) of a total of 102 recurrences after resection of an initially mature SCT were malignant, mostly yolk sac tumour (YST). Many recurrences occurred within 1-6 years, however some occurred as long as 20 years after initial diagnosis. CONCLUSIONS: A substantial number of recurrences of mature SCT present as a malignant tumour. Overlooking malignant components on initial pathological evaluation and the progression of mature SCT cells to malignant cells may play a role. Treatment of mature SCTs with resection alone requires thorough follow-up of at least 6 years. Future research is needed to determine whether SCTs with malignant microfoci should be treated or followed-up differently from mature or immature SCTs. In addition, the value of serum biomarkers in follow-up after SCT needs to be further evaluated.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Teratoma , Criança , Pré-Escolar , Humanos , Recidiva Local de Neoplasia , Prognóstico , Região Sacrococcígea , Teratoma/diagnóstico
5.
Zhonghua Shao Shang Za Zhi ; 36(8): 726-729, 2020 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-32829613

RESUMO

Objective: To investigate the clinical effects of superior gluteal artery perforator " buddy flap" in repairing pressure ulcer in sacrococcygeal region. Methods: From January 2017 to December 2018, 13 patients (8 males and 5 females) aged 24-79 years with stage 4 pressure ulcers in sacrococcygeal region were admitted to the First Affiliated Hospital of Zhengzhou University, with wound area from 5 cm×4 cm to 12 cm×10 cm. After thorough debridement and vacuum sealing drainage, the superior gluteal artery perforator " buddy flap" was designed to repair the pressure ulcer in sacrococcygeal region. The pressure ulcer was repaired by the main flap with area from 7.0 cm×5.0 cm to 18.0 cm×12.0 cm; the main flap's donor area was covered by the auxiliary flap with area from 5.0 cm×3.0 cm to 11.0 cm×7.0 cm; the auxiliary flap's donor area was covered by the connecting flap between the main flap and the auxiliary flap. The remaining wound without covering was directly closed by suturing. The postoperative flap survival and complications were observed. The appearance and function of flaps and the recurrence of pressure ulcer were followed up. Results: The flaps of 12 patients survived after operation without complications of infection, fat liquefaction, or poor flap survival. A small area of superficial necrotic skin at the distal end of flap was observed in one case, which was healed after dressing change. All the patients were followed up for 6 months without recurrence of pressure ulcer, and the operation area was naturally full in appearance, which was pressure and wear resistant. Conclusions: Superior gluteal artery perforator " buddy flap" is an effective method for the treatment of pressure ulcer in sacrococcygeal region. The effect of tension-free repair of the pressure ulcer and main flap donor area can be achieved in one operation. The operation is simple, the curative effect is accurate, and it has certain clinical value.


Assuntos
Retalho Perfurante , Lesão por Pressão , Procedimentos Cirúrgicos Reconstrutivos , Região Sacrococcígea , Lesões dos Tecidos Moles , Adulto , Idoso , Artérias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Resultado do Tratamento , Adulto Jovem
6.
Zhonghua Shao Shang Za Zhi ; 36(7): 540-546, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842400

RESUMO

Objective: To investigate the effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area. Methods: From January 2015 to June 2019, 20 patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area were admitted to Department of Burns and Plastic Surgery and Cosmetology of Linyi People's Hospital. Among them, there were 11 males and 9 females, aged 48 to 88 years. The wounds of 13 patients were located in the sacrococcygeal region, and 8 of them had exposed sacrococcyx. The wounds of 4 patients were located in the greater trochanter area of femur, and the wounds of 3 patients were located in the ischial tuberosity area. All the patients had fever in different degree, bacterial infection, hypoproteinemia, and electrolyte imbalance, etc. at admission. After thorough debridement and dressing change, routine negative-pressure wound therapy with negative pressure value of -16.6 kPa was performed according to the scope of lesions in period Ⅰ. When granulation tissue was fresh with less exudate and without residual necrotic tissue, modified double negative-pressure wound therapy in combination with debridement and tension-reduced suture was performed immediately in period Ⅱ. Modified double negative-pressure wound therapy were persistently performed through negative pressure drainage tube inserted into deep part of wounds and negative pressure drainage tube on surface at the same time, with superficial negative pressure value of -19.9 kPa. Meanwhile, systemic anti-infection and nutritional supports were given. The wounds were monitored for the grade of wound healing and whether skin necrosis, split, or fluid accumulation develop at the suture site. The patients were followed up for 1 to 6 months after discharge to monitor wound healing. Length of hospital stay, infection condition before and after the debridement and tension-reduced suture, and complications during treatment were recorded. Results: All wounds achieved first grade healing, with the skin at the suture site healed without split, fluid accumulation, or necrosis. The patients were followed up for 1 to 6 months after discharge, with good shape of surgical incision, little pigmentation on the skin, no hypertrophic scar or contracture, and no recurrence of pressure sores. Length of hospital stay of patients was 24 to 33 d, with an average of 28.5 d. Before debridement and tension-reduced suture, 2 cases were infected with Pseudomonas aeruginosa, 1 case was infected with Escherichia coli and Staphylococcus aureus, and 1 case was infected with Proteus mirabilis. The results of bacterial culture were all negative after debridement and tension-reduced suture. During the treatment, all patients were not complicated with bone or joint infection, necrotizing fasciitis, septicemia, etc. Conclusions: Modified double negative-pressure wound therapy combined with debridement and tension-reduced suture for treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area is easy to operate with minimal injury, easy for patients to accept with a very high level of satisfaction, and is suitable to popularize and applicate for primary hospitals.


Assuntos
Infecções , Tratamento de Ferimentos com Pressão Negativa , Lesão por Pressão , Idoso , Idoso de 80 Anos ou mais , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/terapia , Região Sacrococcígea , Transplante de Pele , Suturas , Resultado do Tratamento
7.
Rev. cir. (Impr.) ; 72(4): 328-336, ago. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1138718

RESUMO

Resumen Introducción: La enfermedad pilonidal sacrocoxígea (EPSC) es una patología crónica de resorte quirúrgico. Para su tratamiento se han descrito múltiples técnicas quirúrgicas, existiendo 2 grandes grupos: las técnicas abiertas y las cerradas. El objetivo del presente trabajo es comparar y analizar los resultados quirúrgicos de 2 técnicas, una abierta (marsupialización) y otra cerrada (Karydakis). Materiales y Método: Estudio de cohorte retrospectivo de pacientes operados electivamente con diagnóstico de quiste pilonidal por un único cirujano, entre julio de 2013 y julio de 2017 utilizando estas dos técnicas. Resultados: Se incluyeron 71 pacientes. 30 pacientes con marsupialización y 41 con Karydakis. Todos hospitalizados. Todos de alta al día siguiente de la cirugía. Ningún paciente requirió rehospitalización ni cirugías adicionales. En el análisis estadístico se identifican beneficios de la técnica de Karydakis en cuanto a complicaciones, dolor postoperatorio, dolor para sentarse, incapacidad laboral y tiempo de cicatrización. Conclusiones: En este artículo la cirugía con técnica de Karydakis tiene ventajas en relación a la marsupialización, considerándola como primera opción para la EPSC simple.


Introduction: Sacrocoxygeal pilonidal disease (EPSC) is a chronic pathology of surgical solution. For its treatment, multiple surgical techniques have been described, there being 2 large groups: open and closed techniques. The aim of the present study is to compare and analyze the surgical results of 2 techniques, one open (Marsupialization) and another closed (Karydakis). Materials and Method: Retrospective cohort study of electively operated patients with diagnosis of pilonidal cyst by a single surgeon, between July 2013 and July 2017 using these two techniques. Results: 71 patients were included. 30 patients with marsupialization and 41 with Karydakis. All hospitalized. All discharge the day after surgery. No patient required rehospitalization or additional surgeries. In the statistical analysis, benefits of the Karydakis technique are identified in terms of complications, postoperative pain, sitting pain, work incapacity and healing time. Conclusions: In this study, surgery with Karydakis technique has advantages in relation to Marsupialization, considering it as the first option for simple EPSC.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Seio Pilonidal/cirurgia , Seio Pilonidal/diagnóstico , Região Sacrococcígea , Procedimentos Cirúrgicos Operatórios , Estudos Retrospectivos , Ultrassonografia
8.
Health Qual Life Outcomes ; 18(1): 102, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32303229

RESUMO

AIM: The aims of this study were to evaluate health-related quality of life (HRQoL) in children with sacrococcygeal teratoma and to explore the effect of the scar on physical, emotional and behavioral aspects. METHODS: A cohort of children operated on for sacrococcygeal teratoma between 2000 and 2013 at Lund University Hospital, Sweden, and their parents were interviewed. HRQoL was evaluated with PedsQL, and scar satisfaction was estimated through Patient Observer Scar Assessment Score (POSA). RESULTS: All eligible children (n = 17) were included (100% response rate). Median age was 7.3 years (range 3.5-16.0). Mean total PedsQL score was 92.3 (range 72.0 to 99.0). Patients with comorbidity scored lower (87.5) than those without (95.0) (p < 0.05). Pain during sitting down was reported by two (20%) patients, and itching was reported by another two patients (20%) aged > 8 years. No children reported that they avoided situations due to the scar, and most (80% of children and 90% of parents) reported absent or only mild negative emotions when considering the scar. CONCLUSION: Children with sacrococcygeal teratoma had a good overall HRQoL, but comorbidity reduced the outcome. A few children reported scar-related impact on physical, behavioral and emotional aspects.


Assuntos
Cicatriz/psicologia , Qualidade de Vida , Região Sacrococcígea/cirurgia , Teratoma/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Satisfação do Paciente , Suécia
9.
Int J Hyperthermia ; 37(1): 404-413, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32347132

RESUMO

Objective: To evaluate the magnetic resonance (MR) signal intensity changes in the sacrococcygeal region of patients with uterine fibroids treated with high intensity focused ultrasound (HIFU).Materials and Methods: Two hundred and sixty-seven patients with uterine fibroids treated with HIFU between January and December 2016 were retrospectively reviewed. All patients underwent enhanced pre- and post-HIFU MRI. Multivariate analysis was used to assess the relationship between the factors and the signal intensity changes in the sacrum and the soft tissue adjacent to the sacrum.Results: Among the 267 patients, 122 (46%) had MR signal intensity changes in the sacrum and/or the soft tissue adjacent to the sacrum after HIFU. Multivariate analysis showed that the position of the uterus, the distance from the dorsal side of the fibroid to the sacrum, and the ablation efficiency were significantly correlated with MR signal intensity changes in the sacrum and the soft tissue adjacent to the sacrum. Further analysis showed a significant relationship between the location of the MR signal intensity changes and uterine size, the enhancement degree of the uterus. Leg pain was only seen in patients with MR signal intensity changes both in the sacrum and the soft tissue adjacent to the sacrum.Conclusions: The location of the uterus, the distance between the dorsal side of the fibroids to the sacrum, and ablation efficiency have a significant relationship with the MR signal intensity changes. The size of the uterus and the degree of enhancement are related to the locations of MR signal changes.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Leiomioma/terapia , Imagem por Ressonância Magnética/métodos , Região Sacrococcígea/diagnóstico por imagem , Adulto , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Estudos Retrospectivos , Região Sacrococcígea/patologia
11.
Cir. pediátr ; 33(2): 95-98, abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-190849

RESUMO

El teratoma sacrococcígeo (TSC) es el tumor congénito de células germinales más frecuente. Los pacientes afectados tienen un mayor riesgo de complicaciones perinatales y muerte, siendo la hemorragia y la descompensación cardiaca las causas más comunes de mortalidad neonatal. Presentamos el caso de un recién nacido pretérmino de 35 semanas con un TSC de gran tamaño diagnosticado por ecografía en el segundo trimestre. La embolización selectiva preoperatoria de la arteria sacra media y la resección quirúrgica total postnatal se realizaron con una mínima pérdida de sangre. El paciente fue dado de alta a los 25 días de vida con un examen físico normal. La embolización selectiva antes de la cirugía de resección del TSC gigante es factible y aparece como una técnica segura y útil en el control del sangrado perioperatorio


Sacrococcygeal teratoma (SCT) is the most frequent congenital germ cell tumor. Patients have a higher risk of perinatal complications and death, with bleeding and cardiac decompensation being the most common causes of neonatal mortality.This is the case of a 35-week preterm newborn with a large SCT diagnosed at ultrasound screening in the second trimester. Preoperative selective embolization of the middle sacral artery and total surgical resection were performed postnatally with minimal blood loss. The patient was discharged at 25 days of life with a normal physical examination. Selective embolization prior to giant SCT resection is feasible and appears as a safe and useful technique in the control of perioperative bleeding


Assuntos
Humanos , Masculino , Recém-Nascido , Teratoma/cirurgia , Região Sacrococcígea , Embolização Terapêutica , Cuidados Pré-Operatórios , Recém-Nascido Prematuro , Resultado do Tratamento
15.
World Neurosurg ; 136: e322-e327, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931233

RESUMO

OBJECTIVE: There is currently no consensus regarding surgical indications for symptomatic sacral perineural cysts. METHODS: Nine patients with symptomatic sacral perineural cysts underwent microsurgery. All patients fulfilled the following criteria: (1) cyst sizes larger than 15 mm; (2) cysts show the "delayed inflow" and/or "delayed outflow" of contrast on myelographic computed tomography (CT), and (3) neurological symptoms correlate with the primary cyst. RESULTS: On myelographic CT, all primary cysts showed the "delayed inflow" of contrast; the average cyst/thecal sac Hounsfield units (HU) ratio was 0.17. In 7 patients, the primary cyst showed "delayed outflow"; the average cyst/thecal sac HU ratio increased to 3.12 on images obtained 24 hours after contrast injection. Regarding the modified Rankin Scale, 67% of patients reported that their overall symptoms improved to normal activities after surgery. The most improved symptom was coccydynia (75% improvement, P = 0.017), followed by leg radiation pain (67% improvement, P = 0.027) and buttock pain (50% improvement, P = 0.068). Bowel/bladder dysfunction improved in 100% of patients, but newly developed in 1 patient (P = 0.32). Perineal pain only decreased in 33% (P = 0.41). CONCLUSIONS: To the best of our knowledge, this is the first study to have performed a quantitative analysis of the dynamics of cerebrospinal fluid in sacral perineural cysts using myelographic CT. Sixty-seven percent of patients benefited from surgery; however, our criteria may not be a necessary and sufficient condition for patient selection because 33% did not respond to surgery despite the successful elimination of the check-valve.


Assuntos
Mielografia/métodos , Cistos de Tarlov/diagnóstico por imagem , Cistos de Tarlov/patologia , Cistos de Tarlov/cirurgia , Adulto , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Região Sacrococcígea , Tomografia Computadorizada por Raios X/métodos
16.
BMJ Case Rep ; 13(1)2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31900294

RESUMO

Ependymomas are neoplasms which arise from the radial glial cells, which many recent studies have proposed are neural stem cells. Extracranial ependymomas are rare. We present the case report and supporting multimedia of a 37-year-old man who presented with a painless intergluteal swelling which was diagnosed clinically as a pilonidal cyst. However, on excision, he was found to have a subcutaneous sacrococcygeal myxopapillary ependymoma based on histological findings. His management and follow-up are presented and discussed. Given the rare nature of this condition, there is a lack of published guidelines on management and follow-up protocols. Supporting evidence is limited to sporadic case reports. This case highlights the diagnostic challenges and management strategies adopted supported by the best available evidence.


Assuntos
Ependimoma/diagnóstico , Ependimoma/cirurgia , Região Sacrococcígea/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/cirurgia , Tela Subcutânea/cirurgia , Adulto , Erros de Diagnóstico , Humanos , Masculino , Seio Pilonidal , Doenças Raras
17.
J Vet Diagn Invest ; 32(1): 132-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31838959

RESUMO

The naked mole-rat (NMR; Heterocephalus glaber)-a small, eusocial, subterranean rodent native to East Africa-is distinguished by its capability to live long and resist changes associated with the aging process. Notably, a growing amount of research has been dedicated to NMRs' multifactorial capacity to resist cancer. Since 2016, however, zoos have begun to document various neoplasms in a handful of individuals. We present herein radiographic, gross anatomic, and histopathologic features of a case of a sacral chordoma in a geriatric female. Chordomas originate in notochordal remnants. These spinal tumors are most commonly seen in ferrets; chordomas are rare in humans, can be difficult to treat, and need wide surgical margins.


Assuntos
Cordoma/veterinária , Ratos-Toupeira , Doenças dos Roedores/diagnóstico , Neoplasias da Coluna Vertebral/veterinária , Envelhecimento , Animais , Cordoma/diagnóstico , Cordoma/patologia , Eutanásia Animal , Feminino , Doenças dos Roedores/patologia , Região Sacrococcígea , Sacro , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologia
18.
Neurourol Urodyn ; 39(2): 695-701, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31804759

RESUMO

AIM: The aim of this study is to evaluate the acute effects of sacral neuromodulation (SNM) on various urodynamic parameters. METHODS: Patients with overactive bladder and detrusor overactivity (DO) who were planned for percutaneous nerve evaluation (PNE) were included. Directly after the PNE, a urodynamic study (UDS) was performed. The stimulation was turned off during the first UDS (UDS 1), and during the second filling cycle, stimulation was turned on (UDS 2). The UDS was followed by a test phase of 1 week and the bladder diaries were evaluated during an outpatient clinic visit. Primary outcome measures were the differences in UDS parameter values with SNM off and on. RESULTS: Ten female patients were included in the study and completed the study protocol. Eight patients showed ≥50% improvement of symptoms following a test phase. There were no differences between UDS 1 and UDS 2 in the UDS parameters; bladder volume at first sensation, bladder volume at first DO, highest DO pressure, bladder capacity, maximum flow rate, and pressure at maximum flow rate. DISCUSSION: None of the aforementioned urodynamic parameters was influenced by acute SNM in patients who responded to SNM. To the best of our knowledge, this is the first study investigating the acute effects of SNM on bladder function.


Assuntos
Terapia por Estimulação Elétrica/métodos , Região Sacrococcígea , Bexiga Urinária Hiperativa/terapia , Urodinâmica , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária/etiologia
19.
J Plast Reconstr Aesthet Surg ; 73(2): 255-268, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757686

RESUMO

BACKGROUND: Following the excision of sacral tumors, plastic surgeons are often faced with a large soft tissue defect that necessitates flap coverage to promote wound healing and obliterate the resulting dead space. We aimed to evaluate the outcomes and complications following soft tissue reconstruction of sacrectomy defects. METHODS: Applying the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), a comprehensive search of several databases was performed from 1950 to 2019 for articles reporting outcomes of soft tissue flap reconstruction after sacrectomy. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS: A total of 544 articles were identified in the initial search, out of which 26 met our inclusion criteria. Gluteal-based flap was the most commonly used (50%), followed by the vertical rectus abdominis myocutaneous (VRAM) flap (38%) and free latissimus dorsi (5%). Patients who underwent high sacrectomy had significantly higher local complications than those who underwent low sacrectomy [OR: 2.57(1.12,5.92); p = 0.03]. Patients who received preoperative radiation had a significantly higher complication rate than those who did not [OR: 2.91(1.25,6.79); p = 0.01]. The pooled local complication rate was 37% in the gluteal-based flap group and 50% in the VRAM flap group. Total flap loss was identified in 1 gluteal and 2 VRAM flaps. CONCLUSION: Gluteal-based and VRAM flaps are the two most common options for soft tissue reconstruction after sacrectomy. Both flaps demonstrate a high complication rate after this morbid procedure; however, total flap loss seems to be a rare occurrence. Most patients can achieve good functional outcome following reconstruction.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Região Sacrococcígea/cirurgia , Sacro/cirurgia , Retalhos Cirúrgicos , Humanos
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