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3.
Medicine (Baltimore) ; 98(48): e18182, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770271

RESUMO

RATIONALE: Rupture of an unscarred uterus after in vitro fertilization-embryo transfer (IVF-ET) in a primiparous woman is rare. Assisted reproductive technology (ART)-induced rupture of an unscarred uterus is usually attributable to increased dizygotic twinning rates. Salpingectomy can result in cornual scarring and increase the risk of uterine rupture as well as the mortality rate in a subsequent ectopic pregnancy. Here, we present the first reported case of a spontaneous, third-trimester, uterine rupture in a primiparous woman after IVF-ET due to a history of bilateral salpingectomy because of bilateral oviduct and ovarian cysts; the patient did not have an ectopic pregnancy or any cornual or other uterine scarring during this pregnancy after IVF-ET. PATIENT CONCERNS: A 24-year-old woman with a history of IVF-ET and bilateral salpingectomy was admitted to our hospital with unexplained acute upper abdominal pain during the third trimester. DIAGNOSIS: The fetal heart rate was abnormal. Abdominal ultrasonography was negative. Computed tomography revealed a small amount of abdominal and pericardial effusion. Laboratory tests revealed increased white blood cells. A diagnosis of pregnancy complicated by acute abdomen was considered. Emergent exploratory laparotomy revealed a uterine rupture at the right fundus adjacent to the right cornual area. INTERVENTIONS: The patient was successfully managed with simultaneous exploratory laparotomy and lower-segment cesarean section. The rupture site was repaired. OUTCOMES: Two live infants were uneventfully delivered. Follow-up assessments of the mother and the female baby on the 42nd postpartum day yielded normal results. The male infant was diagnosed with left hydronephrosis and required an operation. LESSONS: We conclude that the ART-associated increase in dizygotic twinning rates may be a neglected risk factor for spontaneous rupture of the unscarred uterus, especially in patients who have undergone salpingectomy. Uterine rupture should be considered in a patient with multiple pregnancy following IVF-ET who presents with acute abdominal pain and abnormal fetal heart rate. Timely exploratory laparotomy is the key to a good prognosis.


Assuntos
Dor Abdominal , Cesárea/métodos , Transferência Embrionária , Fertilização In Vitro , Frequência Cardíaca Fetal , Ruptura Espontânea , Ruptura Uterina , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Monitorização Fetal/métodos , Humanos , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Gravidez de Gêmeos , Fatores de Risco , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Salpingectomia/efeitos adversos , Ruptura Uterina/diagnóstico , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia , Adulto Jovem
4.
Pan Afr Med J ; 34: 63, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762927

RESUMO

Bleeding during pregnancy may not be due to obstetric causes. Pregnancy is a predisposing factor for some disorders due to physiological changes. These obstetric bleedings are rare but are responsible for high materno-fetal mortality. Prognosis depends on the speed of diagnosis as well as on multidisciplinary management. Splenic artery aneurysm (SAA) rupture during pregnancy is rare with a dreadful prognosis. Common clinical signs including abdominal pain associated with hypotension and anemia are very misleading for the obstetrician who usually suspects retroplacental hematoma or uterine rupture. We report the case of a pregnant patient requiring emergency laparotomy due to the detection of splenic artery aneurysm rupture on imaging test.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Aneurisma Roto/cirurgia , Feminino , Humanos , Laparotomia/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
5.
Eklem Hastalik Cerrahisi ; 30(3): 325-8, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650933

RESUMO

Alkaptonuria is an autosomal recessive disease caused by the accumulation of homogentisic acid (HGA) products in the ligament, cartilage, skin and various organs due to the lack of HGA oxidase enzyme. In this article, we present a 61-year-old male patient operated on due to a diagnosis of spontaneous Achilles tendon rupture and diagnosed as alkaptonuria due to the intraoperative color of the tissues and the subsequent examinations. We also reviewed alkaptonuria and its accompanying pathologies in light of the literature.


Assuntos
Tendão do Calcâneo/lesões , Alcaptonúria/diagnóstico , Ocronose/diagnóstico , Acidentes por Quedas , Tendão do Calcâneo/cirurgia , Alcaptonúria/urina , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Ocronose/patologia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
6.
G Chir ; 40(3): 238-242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484016

RESUMO

Visceral artery aneurysms represent a very rare condition. The affected patients usually present as emergency secondary to the sudden rupture of the aneurysm or as an incidental finding on imaging. In this setting, gastric and gastroepiploic aneurysms account for only about 4% of all the splancnic aneurysms. Since ruptured visceral aneurysms present a high mortality, a prompt and adequate (surgical or radiological interventional) treatment is mandatory. Due to the difficulty in achieving an adequate transcatheter access in some cases the emergency laparotomy may represent the only chance for the recover of the affected patients. We report two cases of ruptured left gastroepiploic aneurysms occurred in two young male patients, treated respectively with emergency laparotomy and laparoscopy.


Assuntos
Aneurisma Roto/complicações , Artéria Gastroepiploica/lesões , Hemorragia/etiologia , Doenças Raras/complicações , Adulto , Aneurisma Roto/cirurgia , Emergências , Hemorragia/cirurgia , Humanos , Laparoscopia , Laparotomia , Masculino , Doenças Raras/cirurgia , Espaço Retroperitoneal , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Adulto Jovem
7.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527205

RESUMO

Simple hepatic cysts are usually asymptomatic but can rarely result in life-threatening complications such as haemoperitoneum secondary to rupture. A 70-year-old woman with known simple hepatic cyst presented with acute chest pain and dyspnoea. The initial diagnosis was pulmonary embolism, and anticoagulation was commenced. However, she subsequently collapsed with haemodynamic instability. CT revealed a large hepatic cyst haematoma with rupture into the peritoneal cavity. The patient underwent emergency laparotomy, haemostasis and partial deroofing of the cyst. Retrospective review of CT scans suggested that the bleed had begun on presentation but was exacerbated by anticoagulation. To our knowledge, this is the first report of haemorrhagic hepatic cyst associated with acute anticoagulation. We discuss several important clinical lessons including cyst rupture as a possible cause of chest pain, the need for careful review of imaging and the choice of anticoagulation in patients with known simple hepatic cyst.


Assuntos
Anticoagulantes/efeitos adversos , Hemoperitônio/etiologia , Ruptura Espontânea/induzido quimicamente , Idoso , Dor no Peito , Cistos/diagnóstico por imagem , Cistos/cirurgia , Diagnóstico Diferencial , Dispneia , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
8.
Transplant Proc ; 51(8): 2845-2847, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471013

RESUMO

BACKGROUND: Several surgical strategies have been introduced for spontaneous kidney rupture. Herein, we report on a case in which temporary artery clamping with hemostatic materials was performed. CASE PRESENTATION: A 52-year-old man underwent renal transplant from a living donor (his 20-year-old son). Spontaneous allograft rupture occurred 6 days after transplant. He developed severe abdominal pain, hypotension, and mental changes. His blood hemoglobin level was 3.6 g/dL, which was indicative of severe hemorrhage. Immediate re-exploration revealed a large hematoma in the iliac fossa and that the renal allograft had ruptured, with multiple fracture lines on the entire surface. Because of diffuse surface rupture, surgical suture was not attempted. For manual compressive hemostasis, temporary artery clamping with hemostatic materials was performed. First, we identified the graft artery for temporary clamping, similar to the method in partial nephrectomy. Second, at the time of temporary clamping, the hemostatic matrix was sprayed on the surface of the renal graft. Third, we compressed the whole renal parenchyma with both hands and a dry pad for 5 minutes. After removing the clamp, successful bleeding control was confirmed. Finally, the graft was wrapped with oxidized cellulose. Renal biopsy in the operating room revealed the cause of rupture as acute rejection type IIB. CONCLUSION: Spontaneous renal allograft rupture is a rare but serious complication. When surgical suture is not appropriate for the repair of the ruptured allograft, temporary artery clamping with hemostatic materials can be considered an alternative.


Assuntos
Hematoma/tratamento farmacológico , Hemostáticos/uso terapêutico , Nefropatias/cirurgia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Ruptura Espontânea/cirurgia , Constrição , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Homólogo/efeitos adversos
9.
Medicine (Baltimore) ; 98(33): e16900, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415435

RESUMO

RATIONALE: Spontaneous closed extensor tendon rupture is a rare complication of Kienböck disease with only 23 cases reported in the English literature. PATIENT CONCERNS: We present a case of painless attritional rupture of the extensor tendons of the right fourth finger in a 69-year-old woman with Kienböck disease and review reported cases of Kienböck disease with subcutaneous closed tendon rupture. DIAGNOSES: Physical examination had shown mild painless swelling of the dorsum of the right hand. Plain radiographs showed a dorsally displaced fragment of collapsed lunate bone fracture (Lichtman grade IIIb). Although surgery was recommended, the patient did not desire surgery because she had no pain and no interference with the activities of daily living. Six months later, however, the patient returned to our hospital with complaints of loss of spontaneous extension of the fourth finger. CT and MRI showed aseptic necrosis and large dorsally displaced fragments of the lunate under the extensor tendons of the fingers, suggesting a subcutaneous fourth extensor tendon rupture. INTERVENTIONS: Surgery was performed to achieve functional recovery of the ring extensor and to prevent further subcutaneous tendon rupture. The extensor digitorum communis (EDC) of the ring finger was found to be ruptured and the EDCs to the third and fifth fingers were frayed due to attrition from the protrusion of the dorsal fragmented lunate bone. Inspection of the floor of the compartment revealed that the dorsally displaced fragment of the lunate bone had perforated the wrist capsule and protruded into the fourth compartment. The dorsal and volar fragments of the lunate bone were excised completely and scaphocapitate arthrodesis followed by the reconstruction of the fourth extensor tendon was performed. OUTCOMES: A year after the surgery, radiography showed complete union of the scaphocapitate arthrodesis. The joint motion reached 45% of normal without any pain and there was full active extension of the fourth finger. LESSONS: Because dorsally displacement of collapsed lunate bone fragments is a risk factor for attritional closed rupture of tendons, radiography, and MRI are essential to diagnose and to treat any closed tendon rupture.


Assuntos
Fraturas Ósseas/etiologia , Osso Semilunar/lesões , Osteonecrose/complicações , Ruptura Espontânea/etiologia , Idoso , Doenças Assintomáticas , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tendões/cirurgia , Tomografia Computadorizada por Raios X
10.
Medicine (Baltimore) ; 98(34): e16837, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441856

RESUMO

INTRODUCTION: Alkaptonuria (AKU) is a rare disease caused by deficiency of homogentisate 1,2-dioxygenase which results in deposition of homogentisic acid (HGA). Ochronotic arthritis, the deposition of excess oxidized HGA in the connective tissues, causes pigmentation and degeneration of the joint tissues ultimately resulting in chronic inflammation and osteoarthritis. The ochronotic arthritis has similar clinical features with osteoarthritis. There is currently no specific treatment for AKU and management is usually symptomatic. In severe cases, total joint arthroplasty is the major treatment approaches. It is rarely reported in China. PATIENT CONCERNS: Here we reported a case of a patient with bilateral knee pain for more than 1 year. He complained of a 20-year history of chronic, nonspecific low back pain and stiffness. His urine was black since he was a child. Six years after the knee surgery, his Achilles tendon ruptured. DIAGNOSIS: Specific radiographic and magnetic resonance imaging manifestations were observed. Darkly pigmented full-thickness cartilage and subchondral bone were found during the operation. Histological investigation also manifested dark stains in meniscus and synovial tissues. Black-denatured tendon tissue was also found during the operation. The patient was diagnosed as AKU. INTERVENTIONS: Total knee arthroplasty and Achilles tendon repair were operated separately after the disease was diagnosed. OUTCOMES: The patient recovered very well after the second surgery. He returned to full activities, described no knee pain, and presented to the clinic walking without any aid. Physical examination revealed 0 to 20 of plantar flexion and 0 to 15 of dorsiflexion of the ankle. CONCLUSIONS: Ochronosis is a very rare disease in Asia. This paper supplies new information for study of this disease. The mechanism is still unknown right now. Further studies will be necessary.


Assuntos
Tendão do Calcâneo/lesões , Alcaptonúria/complicações , Ocronose/complicações , Tendão do Calcâneo/cirurgia , Alcaptonúria/urina , Artroplastia do Joelho , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Progressão da Doença , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia
11.
Eur Arch Otorhinolaryngol ; 276(10): 2881-2886, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31289851

RESUMO

PURPOSE: It is aimed to present endovascular treatment of carotid blowout syndrome (CBS) in patients with head and neck cancer. METHODS: A retrospective review was performed on patients with carotid blowout syndrome between 2012 and 2018 in our hospital. A total of ten patients with prior history of head and neck cancer surgery and radiation therapy were investigated with clinical, postoperative and follow-up findings as well as technical outcome. Digital subtraction angiography of the carotid arteries was performed in all the cases for the diagnosis of the source of bleeding. Detachable coils and covered stents were used in endovascular treatment of carotid blowout syndrome. After the procedures, all patients were admitted to the intensive care unit for the follow-up of both hemodynamic and neurologic conditions. RESULTS: Thirteen diagnostic and endovascular treatment sessions were performed in 10 patients. Seven patients had major surgery for head and neck cancer and all patients were treated with chemoradiotherapy. Head and neck cancers in seven of the ten patients were persistent and pharyngocutaneous fistula developed in five patients. Two patients had impending CBS and eight patients had acute CBS. A total number of 19 vascular lesions in 10 patients were detected and 4 patients had multiple lesions. In three patients, additional endovascular treatment of stent-graft deployment had required due to recurrent hemorrhage after a mean time of 5.33 days (range 1-11 days). CONCLUSIONS: As a conclusion, covered stent application with or without coil embolization is a safe and efficient technique in treatment of CBS secondary to head and neck cancers.


Assuntos
Doenças das Artérias Carótidas , Procedimentos Endovasculares , Neoplasias de Cabeça e Pescoço , Angiografia Digital/métodos , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Turquia
12.
World Neurosurg ; 130: 157-159, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295587

RESUMO

BACKGROUND: Although vascular abnormality is an uncommon comorbidity of neurofibromatosis type 1 (NF1), it is potentially fatal. We present spontaneous hemothorax caused by rupture of a vertebral artery (VA) aneurysm in a patient with NF1. CASE DESCRIPTION: A 36-year-old man with a history of NF1 was transferred to the emergency department with dyspnea. Chest computed tomography scan revealed hemothorax in the left lung field with mediastinal shifting and aneurysmal dilatation of the left VA at the C6 vertebra level. Immediate drainage of the hematoma by chest tube insertion was performed. Diagnostic angiogram showed a 3- to 4-cm fusiform aneurysm of the VA. After the angiogram, cardiopulmonary arrest occurred after a rebleed of the VA aneurysm. The aneurysmal segment of the VA was urgently occluded with detachable coils. Postoperatively, the patient was in intensive care for 1 month because of fulminant pneumonia. After the patient regained consciousness, he was found to have right hemiparesis from a small infarction at the pons. The patient's function improved to near normal after 1 year of recovery. CONCLUSIONS: Hemothorax caused by VA rupture in a patient with NF1 is an extremely rare condition that can be fatal. Careful examination with suspicion for early detection and treatment is required for this urgent condition. Endovascular coiling was safe even for an unstable patient with massive bleeding.


Assuntos
Aneurisma Roto/complicações , Hemotórax/etiologia , Hemotórax/cirurgia , Neurofibromatose 1/cirurgia , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Hemotórax/diagnóstico , Humanos , Masculino , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico , Ruptura Espontânea/complicações , Ruptura Espontânea/cirurgia , Artéria Vertebral/cirurgia
13.
Am J Case Rep ; 20: 816-821, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31178585

RESUMO

BACKGROUND The diagnosis of Boerhaave's syndrome is often missed or delayed. This subsequently leads to a high mortality rate, which could be greatly reduced if treatment is instituted early, within 24 hours of perforation. Treatment ranges from conservative management to operative intervention depending on the time of presentation and the patient's clinical condition. Endoscopic intervention in the form of over-the-scope clip (OTSC) application is gaining popularity with very promising results. CASE REPORT A 43-year-old male was diagnosed with Boerhaave's syndrome and treated initially by insertion of bilateral chest drainage, intravenous broad-spectrum antibiotics, and total parenteral nutrition. He was transferred to our facility 9 days later. Upper gastrointestinal endoscopy revealed a 1.5 cm deep longitudinal ulcer involving the distal esophagus and extending to the Z-line. Due to the perforation site, a size 12 OTSC clip was used. Application of a second clip was needed to achieve complete closure of the perforation site. Contrast swallow was done 4 days later showed no leak. The patient was started on oral intake and was discharged home in good general condition after a hospital stay of 16 days. CONCLUSIONS Delayed presentation of Boerhaave's syndrome can be treated safely by an over-the-scope clip. This endoscopic method hastens recovery and shortens the hospital stay.


Assuntos
Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/cirurgia , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Ruptura Espontânea/cirurgia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Tardio , Esofagoscopia/métodos , Seguimentos , Gastroscopia/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças Raras , Ruptura Espontânea/diagnóstico por imagem , Índice de Gravidade de Doença , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
J Card Surg ; 34(7): 645-646, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212383

RESUMO

Spontaneous rupture of the left subclavian artery is a rare condition that requires immediate surgical intervention. A 21-year-old man with a history of membranoproliferative glomerulonephritis, failed kidney transplant, and history of a type A aortic dissection that was surgically repaired was admitted with altered mental status and hypotension. He was found to have a left subclavian artery rupture. This was successfully managed with emergent thoracic endovascular aortic repair and carotid-subclavian bypass.


Assuntos
Procedimentos Endovasculares/métodos , Artéria Subclávia/cirurgia , Adulto , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Artérias Carótidas/cirurgia , Humanos , Masculino , Ruptura Espontânea/cirurgia , Resultado do Tratamento , Adulto Jovem
15.
J Pediatr Surg ; 54(10): 2092-2098, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31072679

RESUMO

PURPOSE: The provision of neonatal intensive care to infants born at 23 or 24 weeks' gestation poses medical, surgical and ethical challenges. Gastrointestinal perforation is a well-recognized complication of preterm birth, occurring most often as a result of necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). Given the risk of morbidity and mortality in these 'periviable' infants, this complication may prompt transition from active management to palliative care. In our institution, the surgical care of periviable infants with gut perforation has not been dictated by gestational age. This study reports our outcomes. METHODS: A retrospective cohort analysis of integrated neonatal medical and surgical care of all infants born between 23+0 and 24+6 weeks' gestation admitted to a tertiary level neonatal intensive care unit (NICU) during a 16 year period (2002-2017). RESULTS: A total of 198 periviable neonates (73 born at 23 weeks' gestation and 125 born at 24 weeks) were admitted during the 16-year period; most were inborn with only 26 retrieved from regional centers. Twenty-six of these infants developed gut perforation: 14 SIP, 8 NEC, 3 esophageal perforation and one after reduction of an incarcerated inguinal hernia. Twelve (46%) periviable infants with gut perforation survived to discharge home, seven of whom had no/mild disability at 2-3 years corrected gestational age. Of the 198 periviable infants admitted to NICU, 116 (58%) were alive at a corrected gestational age of 2-3 years and 29 of the 56 (51%) assessed had mild or no disability. CONCLUSIONS: In the setting of combined medical and surgical care in a tertiary level NICU almost half of all periviable infants with a gut perforation survived, many with no/mild disability at 2-3 years corrected gestational age. Rigid protocols that rely on gestational age alone to guide treatment are not appropriate. These results support the contention that, when possible, extremely preterm infants should be born and cared for in units with combined medical and surgical expertise. LEVEL OF EVIDENCE: Level III cohort study.


Assuntos
Lactente Extremamente Prematuro , Perfuração Intestinal/cirurgia , Enterocolite Necrosante/complicações , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Ruptura Espontânea/cirurgia , Resultado do Tratamento
16.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040140

RESUMO

The association between intracranial arachnoid cyst rupture and mild brain trauma is infrequently reported. The purpose of this case report is to describe the case of a child with a left temporal arachnoid cyst who suffered rupture with haemorrhage after mild trauma during a football match. The child presented with chronic headache of mild intensity that progressed to a more intense headache after a traumatic event. He underwent surgical intervention after diagnosis of chronic haemorrhage in an arachnoid cyst in the ipsilateral subdural space. The risk of intracranial arachnoid cyst rupture should be considered during the evaluation of oligosymptomatic patients because it is a potentially catastrophic event.


Assuntos
Cistos Aracnóideos/diagnóstico por imagem , Concussão Encefálica/complicações , Craniotomia/métodos , Diplopia/etiologia , Cefaleia/etiologia , Hematoma Subdural Crônico/diagnóstico por imagem , Ruptura Espontânea/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Traumatismos em Atletas , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/cirurgia , Criança , Diplopia/diagnóstico por imagem , Drenagem , Cefaleia/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Ruptura Espontânea/cirurgia , Resultado do Tratamento
17.
BMC Musculoskelet Disord ; 20(1): 209, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31084618

RESUMO

BACKGROUND: Repair of rotator cuff tears has yielded excellent functional outcomes in recent decades; however, poor outcomes and dissatisfaction have been noted in specific groups. Spontaneous tendon rupture has been reported in patients receiving long-term hemodialysis owing to alteration of tendon structure, which might impede functional recovery after rotator cuff repair. The purpose of the present study was to compare the clinical outcomes between hemodialysis and non-hemodialysis patients after rotator cuff repair. METHODS: We retrospectively reviewed patients who underwent mini-open rotator cuff repair from Jan 2013 to Jan 2017. A total of 14 patients under chronic hemodialysis (HD) were matched to non-hemodialysis (NHD) patients at a 1:2 ratio according to age, gender, tear size, severity of fatty infiltration and history of diabetes. Pre- and post-operative functional outcome was assessed using the simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES), Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and visual analog scale (VAS) scores. Clinical functional outcome at the last follow-up was adopted for comparison of the HD and NHD groups. RESULTS: A total of 42 patients were enrolled in this comparative study, with a mean age of 66.64 ± 1.68 years in the HD group and 65.71 ± 5.40 years in the NHD group. At the final clinical assessment, the post-operative functional outcome was significantly improved in both groups (p < 0.001). However, the functional outcome of the HD group was significantly inferior to that of the NHD group in terms of the SST score (6.50 ± 2.24 vs 9.39 ± 1.87, p < 0.001), ASES score (63.17 ± 15.93 vs 86.96 ± 11.43, p < 0.001), UCLA score (20.14 ± 7.71 vs 29.82 ± 5.08, p < 0.001) and VAS score (3.00 ± 0.96 vs 1.21 ± 1.03, p < 0.001). CONCLUSION: The improvement of pain and functional improvement of long-term hemodialysis patients were inferior to those of patients without hemodialysis after mini-open rotator cuff repair.


Assuntos
Artroplastia , Diálise Renal/efeitos adversos , Lesões do Manguito Rotador/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Lesões do Manguito Rotador/etiologia , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Fatores de Tempo , Resultado do Tratamento
18.
Jpn J Clin Oncol ; 49(9): 839-844, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31135919

RESUMO

BACKGROUND: Carotid blowout syndrome (CBS) is among the fatal complications in head and neck cancer treatment. However, the optimal treatment for CBS has not been established yet. This study aimed to describe our experience with two patients at high risk of CBS who underwent common carotid artery (CCA) ligation at the proximal side of the bleeding point under local anesthesia and before CCA rupture, and to review and compare the medical records of these two patients against 10 CBS cases treated in our department. METHODS: The institutional electronic medical record was searched, and clinical information was extracted for all patients who showed CBS from 2007 to 2017. Our treatment method was performed as follows. Ligation of the proximal side of the CCA was performed under local anesthesia. The CCA was identified and clamped with two bulldog forceps for 10 minutes to check for any adverse neurological symptoms. Subsequently, the CCA was ligated using 2-0 silk threads and sutured with an absorbable suture between the silk threads. However, ligation or occlusion of the external carotid artery by previous treatment is a prerequisite for this method. RESULTS: Eight patients received interventions, with six patients undergoing prophylactic interventions before rupture. Four patients who did not undergo treatment died owing to CBS. Two patients who underwent treatment with the novel method did not experience re-bleeding, but their conditions deteriorated owing to cancer progression. CONCLUSION: The present method is one of the treatment choices for CBS, especially in patients with an 'impending' risk of CBS.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Externa/cirurgia , Neoplasias de Cabeça e Pescoço/complicações , Ligadura , Ruptura Espontânea/cirurgia , Idoso , Doenças das Artérias Carótidas/etiologia , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea/etiologia
19.
Acta Biomed ; 90(2): 339-342, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31125016

RESUMO

A 56-year man with multiple comorbidities and recent septic embolization presented claudication intermittens (Rutherford3) at right lower limb and complaint in right lower quadrant at abdominal palpation. Duplex and computed tomography angiogram (CTA) showed a 64mm-pseudo-aneurysm (PA) originating from right common iliac artery, occlusion of external iliac and patency of hypogastric artery. An urgent endovascular approach was preferred. By left brachial percutaneous access, coil embolization (Balt SPI™ and Cook MReye™) of hypogastric and common iliac artery and deployment of Amplatzer Vascular PlugII™ into the common iliac artery were performed. Completion angiography showed exclusion of PA. One-day, 3­day and 1-month CTA proofed no vascularization of PA. No fever, no leukocytosis, no signs of infection occurred during follow-up and 10-month CTA showed the complete resolution of pseudoaneurysm.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Embolia/complicações , Procedimentos Endovasculares/métodos , Artéria Ilíaca/cirurgia , Sepse/complicações , Angiografia por Tomografia Computadorizada/métodos , Embolia/diagnóstico por imagem , Embolia/terapia , Seguimentos , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Medição de Risco , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Dispositivo para Oclusão Septal , Resultado do Tratamento
20.
BMJ Case Rep ; 12(5)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142483

RESUMO

Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.


Assuntos
Laparoscopia , Ruptura Espontânea/cirurgia , Ruptura Uterina/cirurgia , Adulto , Cicatriz , Diagnóstico Diferencial , Emergências , Tratamento de Emergência/métodos , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Cuidado Pré-Natal/métodos , Doenças Raras
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