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1.
S D Med ; 73(3): 102-105, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32142227

RESUMO

INTRODUCTION: Gallbladder trauma is an uncommon occurrence, most commonly found incidentally at the time of laparotomy for associated injuries following abdominal trauma. It is even more rare in blunt abdominal trauma, with one of the rarest forms being an isolated injury to the gallbladder. Awareness for this type of injury should not be forgotten by emergency personal when evaluating someone with a history of recent trauma. CASE DESCRIPTION: A 44-year-old male who works as a construction worker fell from a roof, landing on his right side. Upon evaluation by the emergency department, emergency personnel combined the history, abnormal laboratory values and imaging including ultrasound (U/S) and computed tomography (CT) to assess and diagnose a concern for gallbladder perforation. He was treated with a diagnostic laparoscopy, laparoscopic cholecystectomy, and intraoperative choleangiogram. The patient tolerated the procedure well and discharged home on postoperative day 1. DISCUSSION: Gallbladder trauma can be seen in all population types. As the gallbladder is fairly protected, it is rare to have an isolated injury. A detailed history as described can tip off practitioners to the diagnosis, but is also missed or delayed due to occasionally vague symptoms. Imaging studies can be used adjunctively to assist in diagnosis and may include CT, U/S, color Doppler, or HIDA scans. These can also fail to give a diagnosis leading to a missed injury and further morbidity and mortality. Perforated gallbladders can safely be treated laparoscopically as well as other options depicted. CONCLUSION: Awareness of isolated and rare injuries in trauma, such as those to the gallbladder, enables many types of emergency personnel to recognize and treat patients and consequently prevent the morbidity and mortality of a missed injury.


Assuntos
Traumatismos Abdominais , Vesícula Biliar , Ferimentos não Penetrantes , Traumatismos Abdominais/complicações , Adulto , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Humanos , Masculino , Ruptura , Ultrassonografia
2.
Bone Joint J ; 102-B(3): 388-393, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114818

RESUMO

AIMS: To validate the Sydney Hamstring Origin Rupture Evaluation (SHORE), a hamstring-specific clinical assessment tool to evaluate patient outcomes following surgical treatment. METHODS: A prospective study of 70 unilateral hamstring surgical repairs, with a mean age of 47.3 years (15 to 73). Patients completed the SHORE preoperatively and at six months post-surgery, and then completed both the SHORE and Perth Hamstring Assessment Tool (PHAT) at three years post-surgery. The SHORE questionnaire was validated through the evaluation of its psychometric properties, including; internal consistency, reproducibility, reliability, sensitivity to change, and ceiling effect. Construct validity was assessed using Pearson's correlation analysis to examine the strength of association between the SHORE and the PHAT. RESULTS: The SHORE demonstrated an excellent completion rate (100%), high internal consistency (Cronbach's alpha 0.78), and good reproducibility (intraclass correlation coefficient (ICC) 0.82). The SHORE had a high correlation with the validated PHAT score. It was more sensitive in detecting clinical change compared to the PHAT. A ceiling effect was not present in the SHORE at six months; however, a ceiling effect was identified in both scores at three years post-surgery. CONCLUSION: This study has validated the SHORE patient reported outcome measure (PROM) as a short, practical, reliable, valid, and responsive tool that can be used to assess symptom and function following hamstring injury and surgical repair. Cite this article: Bone Joint J 2020;102-B(3):388-393.


Assuntos
Tendões dos Músculos Isquiotibiais/lesões , Procedimentos Ortopédicos/métodos , Medidas de Resultados Relatados pelo Paciente , Traumatismos dos Tendões/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Tendões dos Músculos Isquiotibiais/diagnóstico por imagem , Tendões dos Músculos Isquiotibiais/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Reprodutibilidade dos Testes , Ruptura , Inquéritos e Questionários , Traumatismos dos Tendões/diagnóstico , Fatores de Tempo , Adulto Jovem
5.
Lancet ; 395(10222): 441-448, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-32035553

RESUMO

BACKGROUND: Patients with Achilles tendon rupture who have non-operative treatment have traditionally been treated with immobilisation of the tendon in plaster casts for several weeks. Functional bracing is an alternative non-operative treatment that allows earlier mobilisation, but evidence on its effectiveness and safety is scarce. The aim of the UKSTAR trial was to compare functional and quality-of-life outcomes and resource use in patients treated non-operatively with plaster cast versus functional brace. METHODS: UKSTAR was a pragmatic, superiority, multicentre, randomised controlled trial done at 39 hospitals in the UK. Patients (aged ≥16 years) who were being treated non-operatively for a primary Achilles tendon rupture at the participating centres were potentially eligible. The exclusion criteria were presenting more than 14 days after injury, previous rupture of the same Achilles tendon, or being unable to complete the questionnaires. Eligible participants were randomly assigned (1:1) to receive a plaster cast or functional brace using a centralised web-based system. Because the interventions were clearly visible, neither patients nor clinicians could be masked. Participants wore the intervention for 8 weeks. The primary outcome was patient-reported Achilles tendon rupture score (ATRS) at 9 months, analysed in the modified intention-to-treat population (all patients in the groups to which they were allocated, excluding participants who withdrew or died before providing any outcome data). The main safety outcome was the incidence of tendon re-rupture. Resource use was recorded from a health and personal social care perspective. The trial is registered with ISRCTN, ISRCTN62639639. FINDINGS: Between Aug 15, 2016, and May 31, 2018, 1451 patients were screened, of whom 540 participants (mean age 48·7 years, 79% male) were randomly allocated to receive plaster cast (n=266) or functional brace (n=274). 527 (98%) of 540 were included in the modified intention-to-treat population, and 13 (2%) were excluded because they withdrew or died before providing any outcome data. There was no difference in ATRS at 9 months post injury (cast group n=244, mean ATRS 74∙4 [SD 19∙8]; functional brace group n=259, ATRS 72∙8 [20∙4]; adjusted mean difference -1∙38 [95% CI -4∙9 to 2∙1], p=0·44). There was no difference in the rate of re-rupture of the tendon (17 [6%] of 266 in the plaster cast group vs 13 [5%] of 274 in the functional brace group, p=0·40). The mean total health and personal social care cost was £1181 for the plaster cast group and £1078 for the functional bract group (mean between-group difference -£103 [95% CI -289 to 84]). INTERPRETATION: Traditional plaster casting was not found to be superior to early weight-bearing in a functional brace, as measured by ATRS, in the management of patients treated non-surgically for Achilles tendon rupture. Clinicians may consider the use of early weight-bearing in a functional brace as a safe and cost-effective alternative to plaster casting. FUNDING: UK National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Tendão do Calcâneo/lesões , Braquetes , Moldes Cirúrgicos , Adulto , Braquetes/efeitos adversos , Braquetes/economia , Moldes Cirúrgicos/efeitos adversos , Moldes Cirúrgicos/economia , Análise Custo-Benefício , Feminino , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ruptura/terapia , Suporte de Carga
6.
Einstein (Sao Paulo) ; 18: eRC4778, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994610

RESUMO

This is a case report of a previously healthy athlete who did not use oral anticoagulant, suffered a rupture of the distal biceps brachii tendon, and evolved with arm compartment syndrome. An emergency fasciotomy and the repair of the tendon were performed. After surgery the patient had a good recovery of the paresthesia and sensibility. This complication is rare and, when reported, is usually associated with patients who use anticoagulant therapy. Due to growth of rupture of distal biceps tendon cases, physicians should be aware that this complication must be treated as an emergency.


Assuntos
Traumatismos do Braço/complicações , Síndromes Compartimentais/etiologia , Traumatismos dos Tendões/complicações , Idoso , Traumatismos do Braço/cirurgia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/cirurgia , Síndromes Compartimentais/cirurgia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Fasciotomia/métodos , Humanos , Masculino , Ruptura , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
8.
J Shoulder Elbow Surg ; 29(1): 132-138, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521526

RESUMO

BACKGROUND: The aim of this study was to determine the lateral ulnar collateral ligament (LUCL) injury associated with isolated radial head fracture (RHF) and the relationship of the ligament injury with the displacement of the fragment-loss of contact-in unstable displaced partial articular RHF in individuals without any history of ulnohumeral dislocation. METHODS: We retrospectively identified 131 consecutive patients who underwent open reduction and internal fixation of isolated closed Mason type II RHF performed at our institution. We identified 3 subsets by the pattern of RHF and the position of the unstable fragment (anterior or posterior) relative to the capitulum humeri: displaced stable (group I), displaced anterior unstable (group II), and displaced posterior unstable (group III). Standard radiographs were obtained preoperatively and postoperatively. The pattern of lateral collateral ligament avulsion and its distribution were inferred from intraoperative records. RESULTS: Preoperative radiographs of the 131 patients showed 101 nonseparated fractures (77%, group I) and 30 unstable fractures (23%). Anterior displacement of the fragment was found in 18 elbows (14%, group II) and posterior displacement in 12 (9%, group III). LUCL avulsion was found in 18 of 30 unstable RHFs (60%) and in 1 of 60 stable RHFs (1.6%). CONCLUSION: RHF is a complex fracture often associated with soft tissue lesions. It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. The RHF pattern and classification as stable or unstable can help the surgeon in the identification and treatment of LUCL lesions.


Assuntos
Ligamento Colateral Ulnar/diagnóstico por imagem , Ligamento Colateral Ulnar/lesões , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Adulto , Idoso , Ligamento Colateral Ulnar/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Epífises/lesões , Feminino , Fixação Interna de Fraturas , Humanos , Fraturas Intra-Articulares/complicações , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Redução Aberta , Período Pré-Operatório , Radiografia , Fraturas do Rádio/complicações , Estudos Retrospectivos , Ruptura/complicações , Ruptura/cirurgia , Adulto Jovem
9.
Orthop Clin North Am ; 51(1): 121-130, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739875

RESUMO

Peroneal tendon pathology is becoming an increasingly recognized source of lateral-sided ankle pain. High clinical suspicion, along with judicious physical examination coupled with confirmatory advanced imaging modalities, are necessary to make an accurate diagnosis and aid in guiding treatment. Peroneal pathology encompasses several distinct conditions. Peroneal tendon tears and injuries to the peroneal retinaculum must be identified to guide treatment. Patients with peroneal pathology report high levels of satisfaction after surgical management with most returning to their preinjury level of function. An early and accurate diagnosis, along with treatment tailored to the individual, is necessary to obtain optimal outcomes.


Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Tornozelo/anatomia & histologia , Tornozelo/diagnóstico por imagem , Tornozelo/patologia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/patologia , Fenômenos Biomecânicos , Cadáver , Humanos , Incidência , Instabilidade Articular/epidemiologia , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Medidas de Resultados Relatados pelo Paciente , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Ruptura , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/patologia , Tendões/anatomia & histologia , Tendões/patologia
10.
J Shoulder Elbow Surg ; 29(1): 12-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31627964

RESUMO

BACKGROUND: The patient-related factors for the perceived need for surgery for degenerative rotator cuff tears are not known. The purpose of this study is to examine patient- and tear-specific factors leading to surgery in newly painful degenerative rotator cuff tears. METHODS: Asymptomatic, degenerative rotator cuff tears were followed prospectively to identify the onset of pain and tear enlargement. Newly painful tears were continually monitored with a focus on identifying patient-specific (age, occupation, activity level) and tear-specific (tear type and size, tear progression, American Shoulder and Elbow Surgeons score, muscle degeneration) factors that are associated with surgical intervention. RESULTS: Forty-eight of 169 newly painful shoulders were eventually managed surgically. Factors associated with surgical treatment included younger age (P = .0004), pain development earlier in surveillance (P = .0002), a greater increase in pain (P = .0001), a decline in American Shoulder and Elbow Surgeons score (P < .0001), and a history of contralateral shoulder surgery (P = .0006). Eighty-five of the 169 tears (50%) enlarged either before or within 2 years of pain development. Neither tear type (P = .13), tear enlargement (P = .67) nor tear size (P = .51) was associated with surgery. Neither the severity of muscle degeneration, occupational status, hand dominance, Shoulder Activity Score, nor changes in RAND-12 mental or physical scales differed between groups. DISCUSSION: For newly painful rotator cuff tears, patient-specific factors such as younger age and prior surgery on the contralateral shoulder are more predictive of future surgery than tear-specific factors or changes in tear size over time.


Assuntos
Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Fatores Etários , Idoso , Doenças Assintomáticas , Tomada de Decisões , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/fisiopatologia , Ruptura/complicações , Ruptura/cirurgia , Articulação do Ombro/fisiopatologia , Ultrassonografia
11.
J Shoulder Elbow Surg ; 29(1): 113-120, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31399270

RESUMO

BACKGROUND: Further studies are required to determine the effectiveness of conservative treatment of partial-thickness rotator cuff tear (PTRCT). Here, we aim to identify the predictors of failure after conservative treatment in a large series of patients with symptomatic PTRCT. METHODS: The outcome of conservative treatment in a retrospective cohort of 272 patients with symptomatic PTRCT was evaluated. Demographic, clinical, and radiographic characteristics were extracted from the patients' medical records. Subjective assessments included Constant Shoulder Score (CSS), visual analog scale for pain (VAS pain), activities of daily living (ADL) score, and American Shoulder and Elbow Surgeons (ASES) score, all performed at the first visit. The association of treatment failure with the patient/tear characteristics was assessed. RESULTS: The bursal-type PTRCT was associated with male gender (P = .02), earlier referral of the patients (P = .001), more nonsteroidal anti-inflammatory drug consumption (P = .004), more positive painful arc syndrome (P = .006), and lower CSS (P < .001). These symptoms subsided completely or considerably in 172 (63.2%) patients after the conservative treatment, from which the disease relapsed in 21 (12.2%) patients at the mean follow-up of 22.2 ± 8.8 months. The symptoms led to surgery in the remaining 100 (36.8%) patients. The failure rate of conservative treatment was significantly higher in the dominant injuries (P = .015), the bursal type (P < .001), and tears involving more than 50% of the depth of the tendon (P < .001). CONCLUSION: The bursal type tear, dominant tears, and tears involving >50% of the tendon depth are factors capable of predicting failure after conservative management of PTRCT.


Assuntos
Tratamento Conservador , Lesões do Manguito Rotador/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Lesões do Manguito Rotador/diagnóstico por imagem , Ruptura/terapia , Falha de Tratamento
12.
Ceska Gynekol ; 84(4): 289-292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31818112

RESUMO

OBJECTIVE: The aim of this work is to present a case of traumatic bladder rupture in a patient with total uterine prolapse. Additionally, we provide a brief description of this issue. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague; Departement of Radiology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague. RESULTS: We present a case report of a patient with a total uterine prolapse that has been examined for a lower abdominal pain, hematuria and difficulties with urination. The problems arose suddenly after the fall on the ground. These symptoms are typical for bladder rupture, but other more frequent causes have to be ruled out. CT scan showed a contrast agent leak from the bladder. The patient was indicated for surgical revision and suture of the bladder wall. CONCLUSION: Separately, rupture of the bladder occurs rarely. Most often, this injury is part of a wider trauma - especially after car crashes. However, our case report suggests that this option should be considered.


Assuntos
Acidentes por Quedas , Doenças da Bexiga Urinária , Bexiga Urinária , Prolapso Uterino , Feminino , Humanos , Gravidez , Ruptura , Doenças da Bexiga Urinária/etiologia
13.
Medicine (Baltimore) ; 98(50): e18409, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852162

RESUMO

RATIONALE: Acute rupture of the flexor halluces longus (FHL) tendon due to trauma or laceration is a well-known phenomenon. Partial rupture of the FHL tendon caused by tendinitis or stenosing tenosynovitis is common in ballet dancers and athletes. However, atraumatic complete rupture of the FHL is rare: as of 2018, only 7 cases of closed atraumatic complete rupture of the FHL tendon have been reported in the literature. Here, we report on a patient who presented with a closed atraumatic complete rupture of the FHL tendon during a forward lunge exercise. PATIENT CONCERNS: A 35-year-old female visited the clinic with pain in the plantar medial aspect of the left foot, along with weakness and loss of great toe flexion. The patient had a normal foot structure and no history of trauma or systemic disease. She performed a forward lunge exercise more than 50 times on 1 leg per day, more than once a week to strengthen her leg muscles. She reported that she felt a slight pain in her left, great toe while exercising for 3 weeks prior to her visit. One week prior to presentation, severe pain occurred suddenly when her left hallux dorsiflexed strongly during an anterior lunge exercise motion. DIAGNOSIS: Magnetic resonance imaging revealed complete rupture of the FHL tendon near the level of the metatarsal head and neck junction. The lesion was prolonged, with the proximal end displaced to the metatarsal shaft region. INTERVENTIONS: Complete rupture of the FHL tendon was treated with a primary suture. OUTCOMES: At the 1-year follow-up, active plantar flexion of the interphalangeal joint was possible but joint function had a range of 0° to 25°. Flexion strength was reduced slightly, measuring about 70% when compared to the contralateral side, but flexion strength of the metatarsophalangeal joint was normal. LESSONS: We describe an extremely rare case of complete rupture of the FHL tendon at the level of metatarsal head and neck junction. It should be understood that this injury can occur not only in professional athletes but also in the general public, and we recommend educating personal trainers on how to prevent it.


Assuntos
Hallux/lesões , Ruptura/etiologia , Traumatismos dos Tendões/etiologia , Adulto , Exercício , Feminino , Hallux/diagnóstico por imagem , Hallux/cirurgia , Humanos , Ruptura/diagnóstico , Ruptura/cirurgia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(52): e18428, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876720

RESUMO

RATIONALE: The plantar fascia (PF) is an important anatomical structure that stabilizes the longitudinal arch of the foot. While plantar fasciitis is a common pathology affecting the foot, tears of the PF are uncommon injuries characterized by acute pain in the plantar aspect of the foot. The main purpose of this paper was to describe, in detail, how the ultrasonographic pattern of PF rupture can be combined with the clinical features to define the prognosis and promptly plan the therapeutic approach. PATIENT CONCERNS: In the first case, a 39-year-old male patient was seen due to acute pain in the mid plantar foot which appeared 3 days after a tennis match. The pain was accompanied by a "snap" noise and intense pain. In the second case, a 44-year-old male patient was seen due to pain in the heel region which appeared 2 days after a running session. DIAGNOSIS: One case of noninsertional complete tear of the central bundle of the PF with retraction of the 2 stumps and 1 case of partial tear of the central bundle of the PF at the level of the insertional region. INTERVENTIONS: Both patients were treated with conservative therapies including load management, oral nonsteroidal anti-inflammatory drugs, foot orthosis, and restriction of sport activities. OUTCOMES: At follow-up, the patient with spontaneous complete tear of the PF (noninsertional area) showed a small fibrous bridge between the 2 stumps, with partial alignment of the proximal and distal portions, the ability to walk for a medium to long-distance, and difficulty going up and downstairs. The patient with the spontaneous partial tear (insertional area) showed complete fibrous scar tissue with restoration of the fascial continuity, and the ability to walk for a long-distance and go up and downstairs without pain. LESSONS: Based on the clinical and ultrasonographic findings, we suggest that partial tear of the PF in the insertional region presents a favorable prognosis with complete recovery, both clinically and anatomically, while a complete tear in the noninsertional region is associated with partial functional and histological recovery when managed with a conservative approach. Therefore, coupling the clinical findings with the sonohistologic pattern is a valuable approach to plan the most suitable treatment for patients with spontaneous PF tear.


Assuntos
Fáscia/lesões , Traumatismos do Pé/terapia , Ruptura/terapia , Adulto , Tratamento Conservador/métodos , Fáscia/diagnóstico por imagem , Traumatismos do Pé/diagnóstico por imagem , Humanos , Masculino , Ruptura/diagnóstico por imagem , Ultrassonografia
16.
Pan Afr Med J ; 33: 257, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692822

RESUMO

Penile fracture is a rare urologic emergency, defined as a traumatic rupture of the tunica albuginea of the corpus cavernosum. It mainly affects the young subjects during sexual intercourse. The purpose of this study was to report treatment outcomes in 6 patients with penile fracture observed in the Department of Urology-Andrology, Souro Sanou University Hospital of Bobo-Dioulasso. The study involved six patients with an average age of 38.3 years admitted in the hospital with painful penile swelling (4 cases) and persistent urethrorragia (2 cases) after wrong coital movement or forced manipulation of the penis. Painful swelling of the penis with penis simulating the appearance of an aubergine was the main sign found. Treatment was based on evacuation of the intracavernous haematoma followed by albuginorraphy in 5 cases and conservative treatment in 1 case. All patients had an uneventful postoperative course.


Assuntos
Coito , Hematoma/etiologia , Pênis/lesões , Adulto , Burkina Faso , Hematoma/cirurgia , Hospitais Universitários , Humanos , Masculino , Pênis/cirurgia , Estudos Retrospectivos , Ruptura , Resultado do Tratamento
17.
Pan Afr Med J ; 33: 256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692849

RESUMO

A rare case series of traumatic right diaphragmatic rupture with hepatothorax in Ghana is reported. The first case involved a middle-aged man who sustained a penetrating chest injury following an unprovoked attack by a wild bull. The second case was a young woman who sustained a blunt chest injury after being knocked down by a moving vehicle whiles crossing the road. Both presented with ruptured right diaphgramatic rupture and had to undergo repair through thoracotomy after stabilization and the two had been well one year after surgery without any complications or sequelae.


Assuntos
Diafragma/lesões , Fígado/patologia , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Diafragma/cirurgia , Feminino , Gana , Hérnia Diafragmática Traumática/etiologia , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Ruptura , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia , Toracotomia/métodos , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
18.
Ulus Travma Acil Cerrahi Derg ; 25(6): 631-634, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701505

RESUMO

Globe rupture is a major postoperative complication after penetrating keratoplasty (PK). Because the corneal wound is never comparable with that of healthy corneal tissue, globe rupture following blunt trauma occurs at the corneal graft-host junction. In this study, we report a case of scleral rupture that arose from blunt trauma occurring after PK. A 60-year-old female presented with loss of vision, redness and pain in the left eye, which was the consequence of blunt trauma, was our case in this study. Slit-lamp examination revealed ecchymosis on the eyelids, diffuse subconjunctival hemorrhage and total hyphema. The donor cornea was intact. The right eye showed PK, the cornea was transparent, and the sclera was blue. A 2 mm rupture behind the limbus extending from 3 o'clock to 9 o'clock in the upper half of the sclera was observed during exploratory surgery. She did not report any coexisting medical conditions except for systemic hypertension. The differential diagnosis of the bluish discoloration of her sclera was investigated. In detailed anamnesis, the patient reported that she had been treated for severe allergic eye disease during childhood. Vernal keratoconjunctivitis complication was diagnosed. It should be kept in mind that closed scleral perforation may occur in the patient with PK and blue sclera due to blunt trauma.


Assuntos
Traumatismos Oculares , Ceratoplastia Penetrante , Ruptura , Esclera , Ferimentos não Penetrantes , Acidentes , Traumatismos Oculares/patologia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ruptura/patologia , Ruptura/cirurgia , Esclera/lesões , Esclera/patologia , Esclera/cirurgia , Acuidade Visual , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia
19.
Ulus Travma Acil Cerrahi Derg ; 25(6): 567-574, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31701506

RESUMO

BACKGROUND: Traumatic diaphragm ruptures (TDR) are rarely seen. Although TDR does not cause morbidity in the acute period, undiagnosed TDR may cause clinical states, such as herniation, strangulation, pneumonia, pleural effusion, empyema, and cardiac tamponade, which have high morbidity and mortality rates in the late period. This study aims to evaluate the epidemiology, clinical characteristics, diagnosis and treatment methods of TDR encountered in thoracoabdominal trauma and to identify the factors affecting mortality. METHODS: A retrospective examination was carried out on the patients who were operated in our clinic because of traumatic diaphragm injury between January 2012 and December 2017. Each patient operated because traumatic diaphragm injury was evaluated in respect of age, gender, manner of injury, preoperative examination findings, laboratory test results, imaging methods, time of diagnosis, operation findings, concomitant injuries to other organs, operations performed, length of stay in hospital, the development of postoperative morbidity and mortality, and the calculated Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). RESULTS: Between January 2012 and December 2017, a total of 1066 patients were operated in our clinic because of thoracoabdominal trauma, and of 1066 patients, 45 of the patients were determined with TDR. Of the 45 patients, surgery was applied because of penetrating trauma in 32 cases (7 firearms injuries, 25 penetrating cutting injuries), blunt trauma in nine cases, and in four cases, diaphragm rupture was seen to have developed associated with iatrogenic injury during an operation. The most common injuries concomitant to traumatic diaphragm rupture were hemopneumothorax (70%), liver (43%), spleen (32%), colon (20%), stomach (17%) injuries and rib fractures (15%), respectively. Mortality developed in seven (17%) patients; five patients were lost because of hemorrhagic shock intraoperatively or in the early postoperative hours, and two because of multiorgan failure during follow-up in the intensive care unit. CONCLUSION: In high energy blunt and penetrating thoracoabdominal traumas, diaphragm injuries should be suspected. Factors affecting mortality were found to be the AISS, ISS, number of concomitant organ injuries and the combination with pneumohemothorax.


Assuntos
Diafragma/lesões , Traumatismos Torácicos , Traumatismos Abdominais/complicações , Humanos , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Fatores de Risco , Ruptura , Traumatismos Torácicos/complicações , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/fisiopatologia
20.
Medicine (Baltimore) ; 98(45): e17878, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702658

RESUMO

RATIONALE: Donor-derived bacterial infection is a rare cause of morbidity after solid organ transplantation (SOT) but associated with significant morbidity and mortality, deaths caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) infection account for a considerable proportion of postoperation mortality rate in liver and kidney recipients. The arterial rupture as a result of fungal arteritis is occasionally described, while the rupture of graft vascular anastomosis after SOT due to donor-derived CRKP infection is rarely reported. PATIENTS CONCERNS: We reported 1 patient with donor-derived CRKP infection following liver transplantation and 2 patients following renal transplantation (1 liver and 2 kidneys were from the same donor), who experienced sudden abdominal pain and abdominal hemorrhage almost at the same time after organ transplantation. DIAGNOSIS: The patients were diagnosed as graft arteries rupture due to corrosion caused by CRKP infection based on computed tomography scan, blood culture, laparotomy, and pulse-field gel electrophoresis. INTERVENTIONS: Anti-shock treatment, exploratory laparotomy, broad-spectrum antibiotics, and abdominal puncture and drainage were given. OUTCOMES: The liver recipient survived as well as the liver graft, still under treatment of multiple abdominal infections. The 2 renal recipients were alive after resection of the renal grafts and underwent hemodialysis. LESSONS: Rupture of graft artery should be foreseen when donor-derived CRKP infection was confirmed and broad-spectrum antibiotics and other interventions need to be considered.


Assuntos
Transplante de Rim/efeitos adversos , Infecções por Klebsiella/etiologia , Transplante de Fígado/efeitos adversos , Adulto , Antibacterianos , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Ruptura/etiologia , Doadores de Tecidos
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