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1.
J Int Med Res ; 49(4): 3000605211001989, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33853431

RESUMO

Anesthetic management for patients with a giant emphysematous bulla (GEB) is challenging. This case report describes a patient who developed 95% pulmonary compression by a GEB. A 14-Ga indwelling catheter was placed in the GEB before surgery to allow for slow re-expansion of the collapsed lung tissue. This prevented rupture of the GEB during anesthesia. Additionally, positive-pressure ventilation was performed to reduce the risk of re-expansion pulmonary edema. This respiratory management strategy may be beneficial for patients with a GEB who develop pulmonary dysfunction during thoracic surgery.


Assuntos
Anestésicos , Pneumopatias , Pneumotórax , Enfisema Pulmonar , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Humanos , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/cirurgia
2.
Dermatol Ther ; 34(2): e14750, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33403790

RESUMO

Vitiligo is a prevalent destructive melanocyte skin disease that negatively affects the patients' life in terms of self-esteem. Suction blister and dermabrasion plus 5-fluorouracil are effective treatments for vitiligo. The present study was conducted to compare the outcomes of these two techniques. The present clinical trial was conducted on 36 patients with persistent refractory vitiligo which defined as the lack of any new or progressed lesion during the previous year as well as no responding to conventional therapies of vitiligo including topical treatments and phototherapy. Individuals with two vitiligo patches, with similar baseline Vitiligo Area Severity Index (VASI) scores were randomly allocated to dermabrasion plus 5-fluorouracil or suction blister treatments. VASI and repigmentation scores were measured and compared at the baseline, four, and 12 weeks after performing the procedures. Both of the approaches accompanied with significant improvement in both entities of VASI and repigmentation scores (P value < .05) at the end of the study, besides the trend of VASI and repigmentation scores between the two groups revealed insignificant difference (P > .05). The short-term follow-up of the patients was the limitation of this study. The present findings suggested that both surgical techniques of dermabrasion plus 5-fluorouracil and suction blister posed acceptable outcomes within 12-week follow-up.


Assuntos
Vitiligo , Vesícula/cirurgia , Vesícula/terapia , Dermabrasão , Fluoruracila/efeitos adversos , Humanos , Pigmentação da Pele , Sucção , Resultado do Tratamento , Vitiligo/cirurgia , Vitiligo/terapia
3.
PLoS One ; 15(3): e0230419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226050

RESUMO

BACKGROUND: The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. METHODS AND FINDINGS: We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. CONCLUSIONS: Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers.


Assuntos
Vesícula/fisiopatologia , Fumar Maconha/efeitos adversos , Pneumotórax/fisiopatologia , Fumar Tabaco/efeitos adversos , Adulto , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Cannabis/efeitos adversos , Feminino , Alucinógenos/efeitos adversos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/fisiopatologia , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/cirurgia , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/fisiopatologia , Índice de Gravidade de Doença , Fumantes , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
J Thorac Cardiovasc Surg ; 159(3): 1120-1127.e3, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31606164

RESUMO

OBJECTIVE: Contralateral recurrence in patients with primary spontaneous pneumothorax is approximately 15%. If positive for blebs, the recurrence rate increases to 26%. This study seeks to determine whether simultaneous contralateral video-assisted thoracic surgery blebs excision would effectively lower the contralateral incidence of pneumothorax in patients undergoing surgery for ipsilateral primary spontaneous pneumothorax. METHODS: Between January 2009 and December 2015, 335 patients with primary spontaneous pneumothorax, surgically treated in a single institution, were retrospectively studied. The median follow-up was 75 (50-99) months. All patients received video-assisted thoracic surgery blebectomy/bullectomy with pleural abrasions. They were classified into 3 groups: (1) ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae included 142 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs/bullae only receiving ipsilateral video-assisted thoracic surgery; (2) ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae included 123 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving only ipsilateral video-assisted thoracic surgery; and (3) bilateral video-assisted thoracic surgery with contralateral blebs/bullae included 70 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving 1-stage bilateral video-assisted thoracic surgery. Demographic data, perioperative details, recurrence patterns, recurrence-free survivals, and risk factors were compared. RESULTS: The percentage of contralateral recurrence for the ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae, ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae, and bilateral video-assisted thoracic surgery with contralateral blebs/bullae groups differed significantly (0.7%, 14.6%, and 2.9%, respectively; P = .002). Multivariate analysis using the Cox proportional hazard model revealed that age less than 18 years (hazard ratio, 2.71; 95% confidence interval, 1.14-6.44; P = .024) and ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae (hazard ratio, 22.13, 95% confidence interval, 2.96-165, P = .003) were predictors of contralateral recurrence, of which recurrence-free survival was notably different among groups as determined by Kaplan-Meier analysis (P < .0001). CONCLUSIONS: Simultaneous contralateral blebectomy in patients with primary spontaneous pneumothorax receiving ipsilateral video-assisted thoracic surgery significantly lowered future contralateral recurrence.


Assuntos
Vesícula/cirurgia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/epidemiologia , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Adulto Jovem
8.
Sci Rep ; 9(1): 19288, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31848363

RESUMO

Treatments for refractory glaucoma include trabeculectomy, in which a filtering bleb is created to reduce aqueous pressure. Mitomycin C (MMC) is often used as an adjuvant to reduce post-trabeculectomy bleb scarring and consequent failure. However, scarring sometimes still occurs. Thus, we searched for more effective trabeculectomy adjuvants with high-throughput screening (HTS) of a library of 1,165 off-patent drug compounds. This revealed that amsacrine (AMSA), a DNA topoisomerase II (TOP2) inhibitor, was the top candidate. Compared to MMC, rabbits that underwent trabeculectomy with 10% AMSA had lower IOP at 42, 56, and 70 days (P < 0.01 at all measurement points) and a higher bleb score at 28, 42, 56, and 70 days (P = < 0.01, 0.04, 0.04, and < 0.01, respectively). Compared to saline, rabbits that received 1% AMSA also had lower IOP and better bleb score at all time points, without a sharp drop in IOP just after surgery (all P < 0.01). Both effects were milder than MMC at 7 days (P = 0.02 and <0.01, respectively). Thus, this study showed that HTS may help identify new, promising uses for off-patent drugs. Furthermore, trabeculectomy with AMSA at a suitable concentration may improve the prognosis after trabeculectomy compared to MMC.


Assuntos
Amsacrina/farmacologia , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma/cirurgia , Trabeculectomia/efeitos adversos , Animais , Vesícula/tratamento farmacológico , Vesícula/patologia , Vesícula/cirurgia , Callithrix , Cicatriz/prevenção & controle , Túnica Conjuntiva/efeitos dos fármacos , DNA Topoisomerases Tipo II/efeitos dos fármacos , DNA Topoisomerases Tipo II/genética , Modelos Animais de Doenças , Cirurgia Filtrante , Glaucoma/tratamento farmacológico , Glaucoma/patologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Cultura Primária de Células , Inibidores da Topoisomerase II/farmacologia
9.
BMC Ophthalmol ; 19(1): 245, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31795968

RESUMO

BACKGROUND: The placement of a XEN gel stent is an ab-interno, minimally invasive glaucoma surgery which provides a subconjunctival drainage pathway and decreases intraocular pressure (IOP). CASE PRESENTATION: A 75-year-old male patient who had undergone XEN45 gel implantation after phacoemulsification and intraocular lens implantation appealed to the clinic. A filtration bleb was seen that extended through the nasal 180 degrees of the eye which caused ectropion of the lower eyelid. The value of the IOP was 12 mm Hg (mmHg). By the "Drainage Channel with Sutures" method this complication was effectively treated. As with every new method, there is a lack of knowledge about long-term outcomes in terms of effectiveness, technique and complications. CONCLUSION: The "Drainage Channel with Sutures" method has not been described in the literature yet. By this minimal invasive method, hypertrophic bleb complication of XEN gel implant has been successfully treated.


Assuntos
Vesícula/cirurgia , Drenagem/métodos , Cirurgia Filtrante/efeitos adversos , Implantes para Drenagem de Glaucoma/efeitos adversos , Técnicas de Sutura , Idoso , Glaucoma/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/cirurgia
10.
J Med Case Rep ; 13(1): 211, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31291972

RESUMO

BACKGROUND: Giant bleb formation after glaucoma tube shunt surgery is a rare condition and consensus regarding its management has not been established. CASE PRESENTATION: A 66-year-old Japanese man with primary open-angle glaucoma underwent implantation of an Ahmed glaucoma valve to reduce the intraocular pressure in his left eye. At 4 weeks postoperatively, he presented with a foreign body sensation in his left eye. A slit-lamp examination revealed a giant conjunctival cyst at the superotemporal quadrant and dellen formation at the corneal limbus/conjunctiva adjacent to the anterior border of the giant cyst. Ocular pain was due to a giant bleb that bulged anteriorly from the Ahmed glaucoma valve plate. Eight days after the referral, he underwent surgery to reduce the bleb volume in his left eye. To recess the bleb, the anterior edge of the dissected bleb capsule was sutured using two interrupted 10-0 absorbable sutures back to the sclera to the anterior edge of the Ahmed glaucoma valve plate. Three months postoperatively, there was no bleb around the corneal limbus, but the bleb was present around the plate. CONCLUSIONS: The surgical technique reported here can be an option to relieve dellen-associated ocular pain due to a bleb formed after tube shunt surgery.


Assuntos
Vesícula/cirurgia , Doenças da Túnica Conjuntiva/cirurgia , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Idoso , Túnica Conjuntiva/patologia , Humanos , Pressão Intraocular , Masculino , Complicações Pós-Operatórias/cirurgia
11.
J Glaucoma ; 28(7): e126-e127, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31274705

RESUMO

Large avascular blebs need to be repaired especially if they are associated with leaks or have had episodes of bleb-related infections. We describe a new technique of using an amniotic membrane graft, that is inserted into the bleb through a small incision, helping to reduce the size of the avascularity, providing support to the bleb, and preventing extraneous infections.


Assuntos
Âmnio/transplante , Vesícula/fisiopatologia , Vesícula/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Alquilantes/administração & dosagem , Humanos , Pressão Intraocular/fisiologia , Masculino , Mitomicina/administração & dosagem , Complicações Pós-Operatórias , Trabeculectomia/métodos
12.
Neuroradiol J ; 32(5): 353-365, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271334

RESUMO

INTRODUCTION: Blister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging. PURPOSE: The purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms. METHODS: We retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004-2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed. RESULTS: Thirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy (n = 9), stent-assisted coiling (n = 7), flow diverting stents (n = 13) and coiling + Onyx embolization (n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%. CONCLUSION: Treatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.


Assuntos
Aneurisma Dissecante/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Vesícula/cirurgia , Embolização Terapêutica/instrumentação , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
J Surg Res ; 243: 206-212, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31195349

RESUMO

BACKGROUND: Giant pulmonary bullae (GPB) is rare. The aim of this study was to evaluate the functional results of video-assisted thoracic surgery (VATS) in the treatment of GPB and the factors associated with complications following VATS resection for GPB. MATERIALS AND METHODS: From January 2010 to January 2015, 44 GPB patients underwent surgery with VATS. Individual GPB patient characteristics and surgical outcomes were evaluated. The patients were separated into two groups (an emphysematous group and a nonemphysematous group), and differences between the respective groups were investigated. RESULTS: Although there were no mortalities within a 30-d postoperative period among the 44 GPB patients treated surgically with VATS, 28 experienced postoperative complications, of which the most common were air leaks. VATS for GPB resulted in obvious improvements in symptoms and lung function in the majority of cases. Among 26 patients with preoperative dyspnea, the symptoms of 22 patients (84.62%) improved after treatment with VATS resection for GPB, and the mean forced expiratory volume in 1 s increased from 2.24 L preoperatively to 2.5 L postoperatively (P = 0.02). The complication rate of patients aged >48 y, who smoked and had emphysema, was significantly higher than that of those who did not smoke and did not have emphysema (79.2% versus 45%, P = 0.019; 85.7% versus 25%, P < 0.05; 88% versus 31.6%, P < 0.05). These characteristics could be associated with complications. CONCLUSIONS: VATS resection is a safe and effective treatment for GPB and leads to improvements in symptoms and lung function. Patients >48 y, who smoked and had emphysema, were more likely to experience postoperative complications. There could be a relationship between these characteristics and the patients' postoperative complications.


Assuntos
Vesícula/complicações , Pneumotórax/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Idoso , Vesícula/cirurgia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/complicações , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
Radiol Med ; 124(9): 833-837, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31134432

RESUMO

OBJECTIVES: Chest computed tomography is commonly used in patients with primary spontaneous pneumothorax to detect the presence of pulmonary blebs or bullae. The aim of this study is to calculate the accuracy of chest computed tomography to detect surgically resectable blebs or bullae in patients with primary spontaneous pneumothorax. METHODS: This is a retrospective study includes all patients with primary spontaneous pneumothorax who underwent chest computed tomography evaluation for their disease over the period from January 2005 to December 2015. Patients who underwent surgical exploration were sub-grouped to calculate the sensitivity and the specificity of the chest computed tomography to detect surgically resectable pulmonary blebs or bullae. RESULTS: A total of 143 patients were included in the study. Among them, 120 patients underwent surgical exploration with the finding of 95.7% sensitivity and 42.3% specificity for the chest computed tomography in detection of surgically resectable pulmonary blebs or bullae. CONCLUSION: The sensitivity of the chest computed tomography scan is high in detecting surgically resectable pulmonary blebs or bullae. However, the specificity is low. This may lead to overdiagnosis of the patients to have pulmonary blebs and bullae. Therefore, the routine use of chest computed tomography scan before the surgical exploration in patients with primary spontaneous pneumothorax should depend on the clinical judgment.


Assuntos
Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Feminino , Humanos , Masculino , Pneumotórax/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
15.
J Glaucoma ; 28(8): 732-736, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31135591

RESUMO

PRECIS: Wider area bleb revision using bleb knife with adjunctive mitomycin C (MMC) had a good success rate, according to strict success criteria, except in patients with neovascular glaucoma (NVG). PURPOSE: We determined the efficacy of wider area bleb revision after filtering surgery using bleb knife with adjunctive MMC. PATIENTS AND METHODS: In this retrospective single-center study, we analyzed 86 patients with glaucoma (46 primary open-angle, 18 exfoliations, 13 secondary, and 9 neovascular) after bleb revision using bleb knife with adjunctive MMC after a minimum follow-up of 6 months. A Kaplan-Meier survival analysis with log-rank tests and Cox proportional hazards regression analyses were performed. The main outcome measure was a successful initial bleb revision using bleb knife with adjunctive MMC, arbitrarily defined as intraocular pressure (IOP) control <15 mm Hg without any IOP-lowering medication, additional bleb revision, or glaucoma surgery. RESULTS: The mean time since the initial filtering surgery was 243.8 days, and the mean prebleb revision IOP was 22.0±4.8 mm Hg. The total cumulative success rate of the bleb revision using bleb knife with MMC was 49% at 6 months and 30% at 1 year. Patients with primary open-angle glaucoma had the best success rate (64% at 6 mo and 40% at 1 y). Log-rank tests revealed that patients with NVG had the worst prognosis (P<0.01). NVG was the only significant risk factor identified for short survival time (odds ratio, 167.10; 95% confidence interval, 1.78-15620.44; P=0.027). CONCLUSION: Wider area bleb revision using bleb knife with adjunctive MMC had a good success rate, according to strict success criteria, except in patients with NVG.


Assuntos
Vesícula/cirurgia , Cirurgia Filtrante , Glaucoma/tratamento farmacológico , Glaucoma/cirurgia , Mitomicina/administração & dosagem , Complicações Pós-Operatórias/cirurgia , Reoperação , Adulto , Idoso , Vesícula/mortalidade , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Cirurgia Filtrante/efeitos adversos , Cirurgia Filtrante/instrumentação , Cirurgia Filtrante/métodos , Glaucoma/mortalidade , Glaucoma/patologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Reoperação/efeitos adversos , Reoperação/instrumentação , Reoperação/métodos , Estudos Retrospectivos , Trabeculectomia/efeitos adversos , Trabeculectomia/instrumentação , Trabeculectomia/métodos , Resultado do Tratamento
16.
World Neurosurg ; 128: e956-e965, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100528

RESUMO

BACKGROUND: Microsurgical management of blood blister aneurysms of the internal carotid artery is challenging because of the special characteristics of these aneurysms. We reviewed our diverse surgical methods with long-term clinical and radiologic follow-up. METHODS: We retrospectively reviewed all patients with blood blister aneurysms presenting with subarachnoid hemorrhage that were treated with microsurgical obliteration between 1993 and 2017. Baseline characteristics of patients and aneurysms, surgical methods, and clinical and radiologic outcomes were analyzed. RESULTS: This study included 36 patients. The patients were treated using microsurgery with direct clipping (2 patients; 5.6%), cotton-assisted clipping (24 patients; 66.7%), wrapping-clipping (5 patients; 13.9%), or wrapping-clipping with suturing (5 patients; 13.9%). Complete occlusion of aneurysm was achieved in 34 of 36 patients (94.4%). Severe vasospasm developed in 18 of 36 patients (50%). Ischemic events occurred in 8 patients (22.2%), 2 of whom remained with severe disability. Regrowth or recurrence occurred in 1 patient (0.28%), which required additional stent-assisted coil embolization. Mean modified Rankin Scale score was 2.0 (median, 1.0; range, 0-4) at discharge and 1.3 (median, 1.0; range, 0-4) at the last follow-up. CONCLUSIONS: Direct clipping is ideal if possible; however, direct clipping is challenging in most blood blister aneurysms. Assisted clipping with cotton is mainly used and could be an effective technique for reinforcement of the friable wall, with good clinical outcomes in our series. Moreover, suturing followed by wrapping-clipping is also useful for managing intraoperative rupture.


Assuntos
Aneurisma Roto/cirurgia , Vesícula/cirurgia , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Adolescente , Adulto , Idoso , Embolização Terapêutica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Hemorragia Subaracnóidea/cirurgia , Instrumentos Cirúrgicos , Suturas , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/terapia , Adulto Jovem
17.
Medicine (Baltimore) ; 98(20): e15661, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096495

RESUMO

RATIONALE: At present, data regarding refractory pneumothorax treated with video-assisted thoracic surgery (VATS) in combination with extracorporeal membrane oxygenation (ECMO) in critically ill patients with H7N9 pneumonia have never been reported. PATIENT CONCERNS: A laboratory-confirmed case of human infection with avian influenza A (H7N9) virus was treated in our hospital. Acute respiratory distress syndrome (ARDS) developed and the patient was oxygenated via veno-venous ECMO due to the failure of mechanical ventilation. Unfortunately, a right refractory pneumothorax occurred. Despite treatment with pleural drainage and select bronchial occlusion, the patient still failed to improve. DIAGNOSIS: Fatal H7N9 pneumonia complicated with severe ARDS, pulmonary bullae, and refractory pneumothorax. INTERVENTIONS: Successful combination of ECMO with VATS of pulmonary bullae resection was performed and pneumothorax was cured. OUTCOMES: One week after the operation, ECMO was removed. However, the patient finally developed multiorgan failure (MOF) complicated by refractory hypoxemia due to progressive lung fibrosis and died 36 days after admission. LESSONS: Although the patient died of MOF triggered by severe lung fibrosis at last, the successful treatment of refractory pneumothorax by combination of ECMO with VATS is encouraging. Thus, when refractory pneumothorax in a patient with severe pulmonary dysfunction fails to improve through routine therapy, the treatment of pneumothorax by VATS based on ECMO support can be considered as a feasible selection.


Assuntos
Vesícula/complicações , Estado Terminal , Oxigenação por Membrana Extracorpórea/métodos , Pneumonia Viral/complicações , Pneumotórax/complicações , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Vesícula/cirurgia , Humanos , Subtipo H7N9 do Vírus da Influenza A , Masculino , /complicações
18.
BMC Pulm Med ; 19(1): 92, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088437

RESUMO

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD), bronchoscopic lung volume reduction (BLVR) techniques using unidirectional endobronchial valves improve lung function and increase exercise tolerance. BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines for COPD patients without interlobar collateral ventilation. However, BLVR using an endobronchial valve has not been attempted in patients with giant bullae. CASE PRESENTATION: We report successful and safe BLVR using an endobronchial valve in a patient with a huge bullous emphysema in the right middle lobe. A 65-year-old male was diagnosed with COPD 5 years prior and had a large bullae in the right middle lobe at that time. During regular follow-up, the symptoms of respiratory distress gradually worsened, and the size of the bullae gradually increased on computed tomography (CT). Therefore, we decided to treat the patient via BLVR using an unidirectional endobronchial valve. The Chartis system (Pulmonx, Inc., Palo Alto, CA) confirmed the absence of collateral ventilation of the right middle lobe. We successfully inserted an endobronchial valve into the right middle bronchus. After insertion, the bullae decreased dramatically in size, and the patient's symptoms and quality of life improved markedly. CONCLUSION: This case supports recent suggestions that BLVR can serve as a good alternative treatment for appropriately selected patients.


Assuntos
Vesícula/cirurgia , Broncoscopia , Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/cirurgia , Idoso , Vesícula/diagnóstico por imagem , Humanos , Pulmão/fisiopatologia , Medidas de Volume Pulmonar , Masculino , Pneumonectomia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/etiologia , Qualidade de Vida , Tomografia Computadorizada por Raios X
19.
J Cardiothorac Surg ; 14(1): 71, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971282

RESUMO

BACKGROUND: Rapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP. METHODS: From November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae. RESULTS: Fifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively. CONCLUSIONS: Tubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.


Assuntos
Pneumopatias/cirurgia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Mediastino/cirurgia , Duração da Cirurgia , Dor Pós-Operatória , Pneumotórax/diagnóstico por imagem , Recidiva , Cirurgia Torácica Vídeoassistida/efeitos adversos , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
World Neurosurg ; 128: 376-380, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30986585

RESUMO

BACKGROUND: The optimal approach of blood blister-like aneurysms (BBAs) is debated. Wrapping has been reported to be an effective strategy, but artificial materials have often been used. In addition, perforator protection is difficult using this technique. In this case, we report a ruptured BBA of the left internal carotid artery (ICA) treated with a clip-reinforced wrapping technique using Y-shaped autologous temporalis fascia to protect the posterior communicating artery (PComA). The outcome was favorable. CASE DESCRIPTION: A 48-year-old woman was admitted for subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed a BBA located opposite the PComA origin. A frontotemporal craniotomy was performed. The temporalis fascia was isolated from the temporalis muscle, and then tailored into a Y shape for the PComA to pass through. The diseased segment and the BBA were then wrapped by the Y-shaped temporalis fascia circumferentially. Two clips were applied to the fascia to reinforce the wrapping to fit snugly enough around the parent artery subsequently. DSA and computed tomography angiography scan postoperation showed that the BBA had not recurred, the supraclinoid segment of the left ICA had reconstructed well, and the PComA was unobstructed. The patient recovered without any sequelae during the 1-year follow-up period. CONCLUSIONS: A clip-reinforced wrapping technique using Y-shaped temporalis fascia may be an effective method for treating BBAs located opposite the PComA origin. Long-term follow-up and large sample size studies, however, are necessary to validate this approach.


Assuntos
Vesícula/cirurgia , Aneurisma Intracraniano/cirurgia , Instrumentos Cirúrgicos , Angiografia Digital , Artéria Carótida Interna/cirurgia , Craniotomia , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Ruptura/cirurgia , Resultado do Tratamento
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