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1.
Chest ; 165(6): e163-e167, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852972

RESUMO

This novel report presents the first known case, to our knowledge, of a 16-year-old male patient who experienced intraventricular thrombosis and pulmonary embolism after a Nuss procedure for pectus excavatum, attributed to chronic bar displacement. Two years after the operation, the patient experienced post-exercise cough and hemoptysis, which led to his admission. Imaging revealed pulmonary embolism, thrombosis in the right ventricular outflow tract, and lung infiltrative lesions. We hypothesize that the chronic bar displacement led to its embedment in the right ventricle, resulting in thrombus formation, which subsequently contributed to partial pulmonary embolism. Surgery revealed the bars' intrusion into the right ventricle and lung. This case highlights the risk of severe complications from bar displacement in the Nuss procedure, which necessitates long-term follow-up evaluation, caution against strenuous activities after surgery, and use of thoracoscopic guidance during bar implantation and removal. It underscores the importance of vigilant evaluation for late-stage complications in patients with respiratory distress or thrombosis after a Nuss procedure.


Assuntos
Tórax em Funil , Embolia Pulmonar , Trombose , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/diagnóstico , Masculino , Adolescente , Tórax em Funil/cirurgia , Trombose/etiologia , Trombose/diagnóstico por imagem , Trombose/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Tomografia Computadorizada por Raios X
3.
Pediatr Transplant ; 28(5): e14802, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38853134

RESUMO

BACKGROUND: Limited research exists on the influence of social determinants of health (SDOH) on outcomes in pediatric patients with advanced heart failure receiving mechanical circulatory support. METHODS: Linkage of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) and Society of Thoracic Surgeon's Congenital Heart Surgery Database (STS-CHSD) identified pediatric patients who underwent ventricular assist device (VAD) implantation from 2012 to 2022 with available residential zip codes. Utilizing the available zip codes, each patient was assigned a Childhood Opportunity Index (COI) score. Level of childhood opportunity, race, and insurance type were used as proxies for SDOH. Major outcomes included death, transplant, alive with device, and recovery. Secondary outcomes were adverse events. Statistical analyses were performed using the Kaplan-Meier survival, competing risk analyses, and multivariable Cox proportional hazards model. RESULTS: Three hundred seventeen patients were included in the study. Childhood opportunity level and insurance status did not significantly impact morbidity or mortality after VAD implantation. White race was associated with reduced 1-year survival (71% in White vs. 87% in non-White patients, p = 0.05) and increased risk of pump thrombosis (p = 0.02). CONCLUSION: Childhood opportunity level and insurance status were not linked to morbidity and mortality in pediatric patients after VAD implantation. Notably, White race was associated with higher mortality rates. The study underscores the importance of considering SDOH in evaluating advanced therapies for pediatric heart failure and emphasizes the need for accurate socioeconomic data collection in future studies and national registries.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Sistema de Registros , Determinantes Sociais da Saúde , Humanos , Feminino , Masculino , Criança , Insuficiência Cardíaca/cirurgia , Insuficiência Cardíaca/terapia , Pré-Escolar , Lactente , Adolescente , Estudos Retrospectivos , Estimativa de Kaplan-Meier , Resultado do Tratamento , Estados Unidos/epidemiologia , Modelos de Riscos Proporcionais , Recém-Nascido
4.
Acta Neurochir (Wien) ; 166(1): 258, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38853198

RESUMO

BACKGROUND: During pituitary surgery, CSF leaks are often treated by intrasellar packing, using muscle or fat grafts. However, this strategy may interfere with the interpretation of postoperative MRI and may impact the quality of resection in cases of second surgery, due to the existence of additional fibrous tissue. We present an alternative technique, using a diaphragm reconstruction with a heterologous sponge combining fibrinogen and thrombin (TachoSil), applied in selected patients with low-flow CSF leaks. This study investigates the surgical outcome of patients treated with this strategy. METHODS: From a cohort of 2231 patients treated from June 2011 to June 2023 by endoscopic endonasal approach for pituitary surgery, the surgical technique of diaphragm repair with TachoSil patch performed in 55 patients (2.6%) was detailed, and the rate of closure failure was analyzed at 6 months postoperatively. No intrasellar packing was used and sellar floor reconstruction was performed whenever possible. The rate of postoperative CSF leak was compared with that reported in three previous publications that also used the TachoSil patch technique. RESULTS: Patients were mostly women (F/M ratio: 1.2) with a median age of 53.6 years. Surgery was indicated for non-functioning adenomas, Cushing's disease, acromegaly, and Rathke's cleft cysts in 38/55 (69.1%), 6/55 (10.9%), 5/55 (9.1%) and 6/55 (10.9%) patients respectively. The rate of postoperative CSF leak was 1.8% (n = 1/55), which was not significantly different from that reported in the three cohorts from the literature (2.8%, p > 0.05). No postoperative meningitis was recorded. CONCLUSIONS: In highly selected patients with low-flow CSF leaks related to small focal diaphragm defects, diaphragm reconstruction using a TachoSil patch can be a safe and valuable alternative to intrasellar packing.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Combinação de Medicamentos , Fibrinogênio , Procedimentos de Cirurgia Plástica , Trombina , Humanos , Feminino , Pessoa de Meia-Idade , Trombina/uso terapêutico , Masculino , Fibrinogênio/uso terapêutico , Adulto , Vazamento de Líquido Cefalorraquidiano/cirurgia , Idoso , Procedimentos de Cirurgia Plástica/métodos , Estudos de Coortes , Diafragma/cirurgia , Complicações Pós-Operatórias , Neoplasias Hipofisárias/cirurgia , Resultado do Tratamento , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Hipófise/cirurgia , Tampões de Gaze Cirúrgicos
5.
Ann Saudi Med ; 44(3): 135-140, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38853477

RESUMO

BACKGROUND: Anastomotic leakage (AL) represents a severe complication after rectal surgery, leading to significant morbidity, mortality, and increased healthcare costs. Despite improvements in surgical methods and perioperative care, the challenge of AL persists. OBJECTIVES: Explore the impact of body mass index (BMI) on the risk of AL following curative treatment for rectal cancer, providing insight into its predictive value. DESIGN: Retrospective review. SETTINGS: Data were collected from a single tertiary center, emphasizing the specialized postoperative outcomes in a high-care setting. PATIENTS AND METHODS: The study population was comprised patients who underwent sphincter-saving surgery combined with neoadjuvant chemoradiation for rectal cancer from 2001 to 2011. Patients with anastomotic stenosis were excluded. MAIN OUTCOME MEASURES: The primary outcome investigated was the occurrence of AL post-surgery. Secondary outcomes included the assessment of local cancer recurrence rates within the AL group. SAMPLE SIZE: 224; 13 excluded. RESULTS: Of 237 patients who underwent surgery, 13 with anastomotic stenosis were excluded from this study. Of the remaining 224, 15 individuals (6.3%) developed AL. A potential association between higher BMI and increased AL risk was identified. Additionally, the study noted a higher incidence of local rectal cancer recurrence in the group that developed leakage. CONCLUSION: The findings suggest BMI as a significant predictive factor for AL after curative rectal cancer treatment. This emphasizes the need for heightened awareness and possible preoperative counseling for obese patients regarding their increased risk of postoperative leakage. LIMITATIONS: The study was retrospective with all the inherit biases of such studies. The sample size was small and this may have introduced a type 2 statistical error.


Assuntos
Fístula Anastomótica , Índice de Massa Corporal , Neoplasias Retais , Humanos , Neoplasias Retais/cirurgia , Fístula Anastomótica/etiologia , Fístula Anastomótica/epidemiologia , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Idoso , Fatores de Risco , Recidiva Local de Neoplasia , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/efeitos adversos , Adulto
6.
Ann Saudi Med ; 44(3): 141-145, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38853473

RESUMO

BACKGROUND: Medical treatment, expectant approaches, and surgical treatment options are available in the treatment of ectopic pregnancy. Regardless of the treatment, in addition to its effectiveness, the main concern is to limit the risk of relapse and preserve fertility. OBJECTIVES: Determine the impact of medical or surgical treatment for ectopic pregnancy on future fertility. DESIGN: Retrospective. SETTING: Department of obstrtrics and gynecolgy at Ankara Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. PATIENTS AND METHODS: Patients who were treated for ectopic pregnancy between June 2016 and November 2019 were allocated into two groups. Expectant approach or medical treatment by methotrexate constituted the conservative treatment group while salpingectomy by laparoscopy indicated the surgical treatment group. MAIN OUTCOME MEASURES: Fertility rates within two years following treatment were evaluated according to treatment options. SAMPLE SIZE: 202 patients. RESULTS: Of the 202 patients, 128 had medical treatment and 74 patients had surgical treatment for ectopic pregnancy. Of 272 diagnosed with ectopic pregnancy, 70 were excluded for various reasons. Parity and unemployment rate was significantly higher in the surgical treatment (P=.006 and P=.12, respectively). Moreover, ectopic mass size and serum ß-hCG levels were significantly higher in the surgical treatment group (P<.001 and P<.001, respectively). There were no significant differences between the conservative and surgical treatment groups in time to pregnancy (17.0 months vs 19.0 months, P=.255). Similarly, there was no significant difference between the conservative and surgical treatment groups with respect to history of infertility (P=.12). There were no significant differences between the conservative and surgical treatment groups in terms of live birth (51.6% vs 44.6%) and ectopic pregnancy (2.3% vs 1.4%) (P=.72 for both). There was no significant difference between the conservative and surgical treatment groups with respect to infertility rate (35.9% vs 41.9%, P=.72) and admittance to the IVF program (3.9% vs 6.8%, P=.39) following ectopic pregnancy treatment. CONCLUSIONS: Reproductive outcomes did not differ significantly in women undergoing expectant management, medical treatment, and surgery for ectopic pregnancy. This finding suggests that clinicians should not hesitate to act in favor of surgical treatment for ectopic pregnancy even if there were concerns for future fertility. LIMITATIONS: Retrospective study.


Assuntos
Abortivos não Esteroides , Tratamento Conservador , Laparoscopia , Metotrexato , Gravidez Tubária , Salpingectomia , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Adulto , Metotrexato/uso terapêutico , Metotrexato/administração & dosagem , Salpingectomia/métodos , Tratamento Conservador/métodos , Gravidez Tubária/cirurgia , Laparoscopia/métodos , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/uso terapêutico , Turquia , Fertilidade , Gonadotropina Coriônica Humana Subunidade beta/sangue , Preservação da Fertilidade/métodos
7.
Ann Saudi Med ; 44(3): 146-152, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38853476

RESUMO

BACKGROUND: Femoral and tibial fractures may result in delayed union and nonunion, posing significant challenges in orthopedic practice. The Ilizarov technique has emerged as a promising solution for managing these complex cases. OBJECTIVES: Evaluate the radiographic and functional results of Ilizarov fixation in the treatment of nonunion of tibia and femur fractures. DESIGN: Retrospective. SETTINGS: Hospitals affiliated with a university hospital. PATIENTS AND METHODS: Patient demographics, fracture characteristics, and treatment details were analyzed for the period from October 2015 to September 2022 in patients who were treated for nonunion of the tibia and femur using the Ilizarov fixator. Clinical and radiological assessments were performed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. The study focused on assessing the average duration for union and frame removal, bone results, successful union rates, and functional results using the ASAMI criteria, obtaining data from the existing medical records, spanning various medical facilities treating nonunion fractures. SAMPLE SIZE: 126 patients. RESULTS: The average duration for union and frame removal was 8 months, with excellent bone results observed in 60.32% of cases. Out of 126 patients, 118 achieved successful union, while there were 2 failure cases necessitating amputation (1.52%). Functional results revealed excellent outcomes in 39.68% of cases. Complications included pin tract infections, ankle and knee stiffness, and limb shortening. External fixation duration and infection eradication were consistent with previous research, emphasizing the technique's effectiveness. CONCLUSIONS: The Ilizarov technique proved highly effective in managing nonunion tibia and femur fractures, offering favorable outcomes in terms of union, infection control, pain relief, and functional recovery. While excellent bone outcomes do not guarantee optimal function, this method remains a reliable approach for complex cases. LIMITATIONS: Potential biases inherent in retrospective analyses and the need for further randomized controlled trials to comprehensively compare treatment modalities.


Assuntos
Fraturas do Fêmur , Fraturas não Consolidadas , Técnica de Ilizarov , Fraturas da Tíbia , Humanos , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Masculino , Feminino , Adulto , Fraturas do Fêmur/cirurgia , Fraturas não Consolidadas/cirurgia , Pessoa de Meia-Idade , Adulto Jovem , Resultado do Tratamento , Radiografia , Consolidação da Fratura , Adolescente , Idoso
8.
Echocardiography ; 41(6): e15822, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38853621

RESUMO

BACKGROUND: Balloon sizing (BS) has been used for device size selection in percutaneous atrial septal defect (ASD) closure. Due to its limitations, alternative imaging techniques like three-dimensional transesophageal echocardiography (3D-TEE) are valuable for guiding ASD device size selection during ASD closure procedures. The purpose of this study was to compare ASD sizing using measurements obtained from 3D-TEE to those utilizing the standard balloon sizing method. METHODS: We identified 53 patients with single secundum type ASD without PFO who underwent percutaneous closure at the Tehran Heart Center between 2019 and 2022. Balloon sizing was performed in all patients with the stop-flow technique, and the choice of device size was determined based on the sizing derived from BS. 3D-TEE imaging was performed before the intervention, and the ASD shape and quality of ASD rims were assessed. RESULTS: Among the 53 patients who underwent single ASD device closure, multiple 3D TEE measurements significantly correlated with balloon sizing results. This included defect area, perimeter, and diameter obtained from 3D-TEE images multi-planar reconstruction. ASD perimeter detected by 3D TEE had the best correlation with BS results. When divided by the shape of ASD, there was no significant difference between our 3D-images data and BS in round or oval-shaped ASDs. CONCLUSION: The 3D-TEE study is reliable for assessing ASD configurational characteristics in percutaneous device closure candidates. 3D-TEE has the potential to accurately determine the appropriate device size and reduce complications, costs, and procedural duration. Further research is needed to validate these findings and establish the role of 3D-TEE measurements in guiding the best treatment decisions for ASD closure.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Comunicação Interatrial , Dispositivo para Oclusão Septal , Humanos , Ecocardiografia Transesofagiana/métodos , Ecocardiografia Tridimensional/métodos , Masculino , Comunicação Interatrial/cirurgia , Comunicação Interatrial/diagnóstico por imagem , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Desenho de Prótese , Cateterismo Cardíaco/métodos , Reprodutibilidade dos Testes , Adulto Jovem
9.
Echocardiography ; 41(6): e15861, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38853674

RESUMO

BACKGROUND: Transesophageal echocardiography (TEE) is primarily used to guide transcatheter structural heart interventions, such as tricuspid transcatheter edge-to-edge repair (TEER). Although TEE has a good safety profile, it is still an invasive imaging technique that may be associated with complications, especially when performed during long transcatheter procedures or on frail patients. The aim of this study was to assess TEE-related complications during tricuspid TEER. METHODS: This is a prospective study enrolling 53 patients who underwent tricuspid TEER for severe tricuspid regurgitation (TR). TEE-related complications were assessed clinically and divided into major (life-threatening, major bleeding requiring transfusions or surgery, organ perforation, and persistent dysphagia) and minor (perioral hypesthesia, < 24 h dysphagia/odynophagia, minor intraoral bleeding and hematemesis not requiring transfusion) RESULTS: The median age of the patient population was 79 years; 43.4% had severe, 39.6% massive, and 17.6% torrential TR. 62.3% of patients suffered from upper gastrointestinal disorders. Acute procedural success (APS) was achieved in 88.7% in a median device time of 36 min. A negative association was shown between APS and lead-induced etiology (r = -.284, p = .040), baseline TR grade (r = -.410, p = .002), suboptimal TEE view (r = -.349, p = .012), device time (r = -.234, p = .043), and leaflet detachment (r = -.496, p < .0001). We did not observe any clinical manifest major or minor TEE-related complications during the hospitalization. CONCLUSIONS: Our study reinforces the good safety profile and efficacy of TEE guidance during tricuspid TEER. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious complications. Furthermore, suboptimal intraprocedural TEE views are associated with lower TR reduction rates. HIGHLIGHTS: Transesophageal echocardiography is a crucial and safe technique for guiding transcatheter structural heart interventions. A mix of mid/deep esophageal and trans gastric views, as well as real-time 3D imaging is generally used to guide the procedure. Adequate preoperative management and intraprocedural precautions are mandatory in order to avoid serious problems. A shorter device time is associated with more rarely probe-related complications. Suboptimal intraprocedural TEE views are associated with lower TR reduction rates.


Assuntos
Ecocardiografia Transesofagiana , Insuficiência da Valva Tricúspide , Valva Tricúspide , Humanos , Ecocardiografia Transesofagiana/métodos , Feminino , Masculino , Estudos Prospectivos , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/efeitos adversos , Resultado do Tratamento , Idoso de 80 Anos ou mais
10.
Int J Med Robot ; 20(3): e2650, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38856120

RESUMO

BACKGROUND: The purpose of this study was to compare one-year patient reported outcome measures between a novel fluoroscopy-based robotic-assisted (FL-RTHA) system and an existing computerised tomography-based robotic assisted (CT-RTHA) system. METHODS: A review of 85 consecutive FL-RTHA and 125 consecutive CT-RTHA was conducted. Outcomes included one-year post-operative Veterans RAND-12 (VR-12) Physical (PCS)/Mental (MCS), Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function (PS)/Joint replacement, and University of California Los Angeles (UCLA) Activity scores. RESULTS: The FL-RTHA cohort had lower pre-operative VR-12 PCS, HOOS Pain, HOOS-PS, HOOS-JR, and UCLA Activity scores compared with patients in the CT-RTHA cohort. The FL-RTHA cohort reported greater improvements in HOOS-PS scores (-41.54 vs. -36.55; p = 0.028) than the CT-RTHA cohort. Both cohorts experienced similar rates of major post-operative complications, and had similar radiographic outcomes. CONCLUSIONS: Use of the fluoroscopy-based robotic system resulted in greater improvements in HOOS-PS in one-year relative to the CT-based robotic technique.


Assuntos
Artroplastia de Quadril , Procedimentos Cirúrgicos Robóticos , Tomografia Computadorizada por Raios X , Humanos , Fluoroscopia , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Masculino , Artroplastia de Quadril/métodos , Pessoa de Meia-Idade , Idoso , Resultado do Tratamento , Estudos Retrospectivos , Articulação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem
11.
Eur Rev Med Pharmacol Sci ; 28(10): 3532-3541, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856128

RESUMO

OBJECTIVE: Free tissue transfer has an established place in oncologic head and neck surgery. However, the necessity and specific regimen of perioperative thromboprophylaxis remain controversial. Here, the risk of postoperative hemorrhage contrasts with vascular pedicle thrombosis and graft loss. This work compares three different heparin protocols (A-C) with regard to postoperative complications. PATIENTS AND METHODS: A retrospective analysis of our free flap transplants between 2004 and 2023 was conducted. Inclusion criteria were thromboprophylaxis with (A) 500 IU/h unfractionated heparin (UFH), (B) low-molecular-weight heparin (LMWH) once daily, and (C) LMWH once daily with additional immediate preoperative administration. Primary endpoints were the incidence of postoperative bleeding and hematoma and the appearance of flap thrombosis. RESULTS: We evaluated 355 cases, 87 in group A, 179 in group B, and in group C 89 patients. Overall, postoperative bleeding occurred in 8.7% of patients, and 83% underwent hemostasis under intubation anesthesia, with no significant difference between groups (p = 0.784). Hematoma formation requiring revision was found in 3.7% of patients (p = 0.660). We identified postoperative hematoma as a significant influencing factor for venous pedicle thrombosis (OR 3.602; p = 0.001). Venous and arterial flap thrombosis in the graft vessel showed no difference between the groups (p = 0.745 and p = 0.128). CONCLUSIONS: The three anticoagulation regimens appear to be equivalent therapy for the prevention of thrombosis without significant differences in postoperative bleeding. The use of LMWH with additional preoperative administration can, therefore, be administered in free flap reconstruction.


Assuntos
Anticoagulantes , Retalhos de Tecido Biológico , Heparina de Baixo Peso Molecular , Procedimentos de Cirurgia Plástica , Humanos , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Estudos Retrospectivos , Pessoa de Meia-Idade , Feminino , Masculino , Procedimentos de Cirurgia Plástica/efeitos adversos , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Idoso , Trombose/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Heparina/administração & dosagem , Heparina/uso terapêutico , Adulto , Neoplasias de Cabeça e Pescoço/cirurgia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle
12.
Eur Rev Med Pharmacol Sci ; 28(10): 3583-3589, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856133

RESUMO

OBJECTIVE: The primary surgical techniques used to treat localized renal tumors are laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN). Obese patients have more intra-abdominal fat accumulation, which may make the localization and operation in minimally invasive surgery more complicated. Currently, limited research has been conducted on which method is more suitable for performing a partial nephrectomy on obese individuals. The aim of our investigation was to analyze and compare the perioperative results associated with both approaches to offer valuable information about the selection of LPN or RAPN as an optimal choice when performing a partial nephrectomy in obese patients. PATIENTS AND METHODS: We retrospectively collected clinical data from 78 cases of obese individuals [Body mass index (BMI) > 28] who underwent RAPN, as well as 50 cases of obese individuals (BMI > 28) who underwent LPN. The analysis covered various aspects, including initial patient characteristics, glomerular filtration rate (GFR), warm ischemia time (WIT), operation time, volume of blood loss during the surgical procedure, time taken to recover bowel function, positive surgical margin rate, incidence of postoperative complications, and postoperative hospital stay. RESULTS: We observed that RAPNs exhibited shorter warm ischemia time and reduced intraoperative blood loss in obese patients, along with decreased postoperative duration of abdominal drainage and hospitalization periods compared to LPNs. CONCLUSIONS: In obese patients, RAPN demonstrates advantages over LPN in minimizing intraoperative blood loss, WIT, and facilitating postoperative recovery. These findings may serve as valuable evidence when considering the choice between LPN or RAPN for partial nephrectomy in obese individuals.


Assuntos
Neoplasias Renais , Laparoscopia , Nefrectomia , Obesidade , Procedimentos Cirúrgicos Robóticos , Humanos , Nefrectomia/métodos , Nefrectomia/efeitos adversos , Obesidade/cirurgia , Obesidade/complicações , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Neoplasias Renais/cirurgia , Resultado do Tratamento , Idoso , Complicações Pós-Operatórias/epidemiologia , Adulto , Tempo de Internação , Duração da Cirurgia
13.
Eur Rev Med Pharmacol Sci ; 28(10): 3590-3597, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856134

RESUMO

BACKGROUND: Recently, the infiltration of a subpopulation of cells represented by mononucleated cells extracted from peripheral blood [Peripheral Blood-Mononuclear Cells (PB-MNCs)] is becoming a useful technique for medical and surgical regenerative procedures. Due to the angiogenetic and regenerative properties of PB-MNCs, the infiltration of these cells is, in our opinion, a new option indicated in the treatment of pathologies characterized by tissue dystrophy, loss of vascularization, and non-healing wounds. CASE PRESENTATION: A 25-year-old active smoker patient was diagnosed with Rhabdomyosarcoma of the anterior tibial muscle of his left leg and treated with neoadjuvant chemo- and radiotherapy (RT). After the tumor excision, the patient developed wound dehiscence with bone exposure and a perilesional radiation-induced chronic dermatitis characterized by skin dyschromia and hair thinning along the treated area. The patient underwent surgical debridement and reconstruction with autologous skin grafts and dermal substitutes, with poor outcomes due to graft failure. The patient was subsequently treated with surgical debridement and coverage with a reverse sural fascia-cutaneous flap. After 13 days, wound dehiscence was observed, and reconstruction of the dehiscent areas was performed with a split-thickness autologous skin graft with no success. After wound debridement, a new split-thickness skin graft was performed, and a concentrate of autologous PB-MNCs was injected in the flap and perilesional skin. After 14 days, graft take was reached, and improvements in perilesional tissue tropism were noted. At 2 months follow-up, the patient appeared completely healed. CONCLUSIONS: In our opinion, the use of PB-MNCs to treat conditions characterized by tissue dystrophy, which require neoangiogenesis and cell regeneration, can be a useful and unconsidered technique that could be utilized to improve tissue tropism. Furthermore, prospective trials are necessary to validate our observations.


Assuntos
Leucócitos Mononucleares , Humanos , Masculino , Adulto , Leucócitos Mononucleares/transplante , Procedimentos de Cirurgia Plástica/métodos , Extremidade Inferior , Rabdomiossarcoma/terapia , Rabdomiossarcoma/cirurgia , Cicatrização
14.
Eur Rev Med Pharmacol Sci ; 28(10): 3683-3696, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856144

RESUMO

OBJECTIVE: Monocyte count and red cell distribution width (RDW) have shown prognostic potential in patients with fibrotic lung diseases. Their kinetics and prognostic usefulness of peripheral blood indices in patients with interstitial lung diseases (ILDs) undergoing surgical lung biopsy for diagnostic reasons have not been studied. PATIENTS AND METHODS: We retrospectively included consecutive patients with ILD who underwent surgical lung biopsy for diagnostic purposes Between 07/11/2019 and 11/10/2022. RESULTS: Fifty-five (n=55) patients were included in the study. Median age was 65.0 years (95% CI: 63.0 to 66.0). Postoperative peripheral blood monocyte count on Day 1 was significantly higher compared to preoperative, perioperative, and postoperative values on Day 90 (repeated measures ANOVA, p<0.0001). Patients in the high postoperative monocyte count group had significantly increased length of postoperative hospital stay [Mann-Whitney test, p=0.007] and significantly lower Forced Vital Capacity (FVC)% predicted 3 months after surgery [Mann-Whitney test, p=0.029] compared to patients in the low postoperative monocyte count group. Postoperative RDW on Day 90 was significantly higher compared to preoperative, perioperative and postoperative-Day 1 RDW (repeated measures ANOVA, p=0.008, p=0.006, p<0.0001, respectively). Patients in the high postoperative RDW group did not have increased hospital stay (Mann-Whitney test, p=0.49) or decreased FVC% predicted at 3 months compared to patients in the low postoperative RDW group (Mann-Whitney test, p=0.91). CONCLUSIONS: Peripheral blood monocyte count could be a prognostic biomarker for patients with ILDs undergoing diagnostic surgical lung biopsies. RDW does not seem to represent an acute phase biomarker but seems to increase over time following disease progression. Larger studies are urgently required.


Assuntos
Doenças Pulmonares Intersticiais , Monócitos , Humanos , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Monócitos/patologia , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/cirurgia , Doenças Pulmonares Intersticiais/patologia , Estudos Retrospectivos , Contagem de Leucócitos , Biópsia , Pulmão/patologia , Pulmão/cirurgia , Tempo de Internação , Índices de Eritrócitos , Período Pós-Operatório
15.
Eur Rev Med Pharmacol Sci ; 28(10): 3642-3649, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856140

RESUMO

OBJECTIVE: Anastomosis leakage in laparoscopic surgery for rectal cancer is still a serious problem affecting the patient's treatment outcome. This study aimed to evaluate the role of a transanal drainage tube compared with a diverting stoma in reducing the rate of anastomosis leakage and limiting surgical complications. PATIENTS AND METHODS: A retrospective study was conducted on 196 rectal cancer patients undergoing laparoscopic low anterior resection from July 2018 to October 2022 at 108 Central Military Hospital. The transanal drainage tube was placed in 133 patients (group A), and diverting stoma was performed in 63 patients (group B). RESULTS: There was no difference between the two groups regarding age, sex, comorbidities, distance from the tumor to the anal verge, and preoperative stage. The amount of blood loss, the method of performing the anastomosis, and the distance from the anastomosis to the anal verge did not differ between the two groups. However, the surgical time was longer in the group with diverting stoma (138.3 ± 25.1 minutes vs. 127.6 ± 31 minutes, p = 0.018). The rate of anastomosis was not significantly different between groups A and B (8.3% in group A and 7.9% in group B, p = 0.936). The proportion of patients with anastomosis requiring reoperation in group A was higher than in group B. However, the difference was not statistically significant (8/11 patients in group A and 2/5 patients in group B, p = 0.29). CONCLUSIONS: Placing a transanal drainage tube in laparoscopic surgery for rectal cancer to reduce the rate of anastomosis can be considered an alternative method for diverting stoma with complications related to the stoma.


Assuntos
Fístula Anastomótica , Drenagem , Laparoscopia , Neoplasias Retais , Humanos , Neoplasias Retais/cirurgia , Fístula Anastomótica/etiologia , Laparoscopia/efeitos adversos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Estomas Cirúrgicos/efeitos adversos , Canal Anal/cirurgia , Anastomose Cirúrgica/efeitos adversos , Adulto
16.
J Vis Exp ; (207)2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38856208

RESUMO

Balloon venoplasty is a commonly used clinical technique to treat deep vein stenosis and occlusion as a consequence of trauma, congenital anatomic abnormalities, acute deep vein thrombosis (DVT), or stenting. Chronic deep venous obstruction is histopathologically characterized by thrombosis, fibrosis, or both. Currently, no direct treatment is available to target these pathological processes. Therefore, a reliable in vivo animal model to test novel interventions is necessary. The rodent survival inferior vena cava (IVC) venoplasty balloon model (VBM) allows the study of balloon venoplasty in non-thrombotic and post-thrombotic conditions across multiple time points. The local and systemic effect of coated and uncoated venoplasty balloons can be quantified via tissue, thrombus, and blood assays such as real-time polymerase chain reaction (RT-PCR), western blot, enzyme-linked immunosorbent assay (ELISA), zymography, vein wall and thrombus cellular analysis, whole blood and plasma assays, and histological analysis. The VBM is reproducible, replicates surgical human interventions, can identify local vein wall-thrombi protein changes, and allows multiple analyses from the same sample, decreasing the number of animals required per group.


Assuntos
Modelos Animais de Doenças , Veia Cava Inferior , Trombose Venosa , Veia Cava Inferior/cirurgia , Animais , Ratos , Trombose Venosa/patologia , Camundongos
17.
J Vis Exp ; (207)2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38856217

RESUMO

Partial 2/3 hepatectomy in mice is used in research to study the liver's regenerative capacity and explore outcomes of liver resection in a number of disease models. In the classical partial 2/3 hepatectomy in mice, two of the five liver lobes, namely the left and median lobes representing approximately 66% of the liver mass, are resected en bloc with an expected postoperative survival of 100%. More aggressive partial hepatectomies are technically more challenging and hence, have seldom been used in mice. Our group has developed a mouse model of an extended hepatectomy technique in which three of the five liver lobes, including the left, median, and right upper lobes, are resected separately to remove approximately 78% of the total liver mass. This extended resection, in otherwise healthy mice, leaves a remnant liver that cannot always sustain adequate and timely regeneration. Failure to regenerate ultimately results in 50% postoperative lethality within 1 week due to fulminant hepatic failure. This procedure of extended 78% hepatectomy in mice represents a unique surgical model for the study of small-for-size syndrome and the evaluation of therapeutic strategies to improve liver regeneration and outcomes in the setting of liver transplantation or extended liver resection for cancer.


Assuntos
Hepatectomia , Regeneração Hepática , Modelos Animais , Animais , Hepatectomia/métodos , Camundongos , Regeneração Hepática/fisiologia , Fígado/cirurgia , Modelos Animais de Doenças
18.
Langenbecks Arch Surg ; 409(1): 181, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38856758

RESUMO

PURPOSE: Mesopancreas resection is a crucial but difficult procedure when performing pancreaticoduodenectomy. This study evaluated the influence of mesopancreas thickness on surgical outcomes in patients undergoing pancreaticoduodenectomy. METHODS: We measured the thickness of the fat tissue on the right side of the superior mesenteric artery from the dorsal margin of the confluence of the superior mesenteric vein and portal vein to the ventral margin of the left renal vein on preoperative contrast-enhanced computed tomography and defined it as the mesopancreas thickness. We evaluated the correlation between mesopancreas thickness and intraoperative and postoperative variables in 357 patients who underwent pancreaticoduodenectomy. RESULTS: Multivariate analysis revealed that a thick mesopancreas was significantly associated with a long operative time (ß = 10.361; 95% confidence interval, 0.370-20.353, p = 0.042), high estimated blood loss (ß = 36.038; 95% confidence interval, -27.192-99.268, p = 0.013), and a low number of resected lymph nodes (ß = -1.551; 95% confidence interval, -2.662--0.439, p = 0.006). This analysis further revealed that thick mesopancreas was a significant risk factor for overall morbidity (odds ratio 2.170; 95% confidence interval 1.340-3.520, p = 0.002), major morbidity (odds ratio 2.430; 95% confidence interval 1.360-4.340, p = 0.003), and a longer hospital stay (ß = 2.386; 95% confidence interval 0.299-4.474, p = 0.025). CONCLUSION: A thick mesopancreas could predict a longer operation time, higher estimated blood loss, fewer resected lymph nodes, more frequent overall and major morbidities, and a longer hospital stay in patients who underwent pancreaticoduodenectomy more precisely than the body mass index.


Assuntos
Duração da Cirurgia , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Humanos , Pancreaticoduodenectomia/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Resultado do Tratamento , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Adulto , Pâncreas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Artéria Mesentérica Superior/cirurgia , Artéria Mesentérica Superior/diagnóstico por imagem , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia
19.
Ann Plast Surg ; 92(6S Suppl 4): S379-S381, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38856999

RESUMO

ABSTRACT: Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children's hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.


Assuntos
Fenda Labial , Procedimentos de Cirurgia Plástica , Reoperação , Humanos , Fenda Labial/cirurgia , Masculino , Feminino , Lactente , Procedimentos de Cirurgia Plástica/métodos , Pré-Escolar , Criança , Estudos Retrospectivos , Resultado do Tratamento , Estética
20.
Ann Plast Surg ; 92(6S Suppl 4): S387-S390, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38857000

RESUMO

ABSTRACT: Accessing treatment at ACPA (American Cleft Palate-Craniofacial Association)-approved centers is challenging for individuals in rural communities. This study aims to assess how pediatric plastic surgery outreach clinics impact access for patients with orofacial cleft and craniosynostosis in Mississippi. An isochrone map was used to determine mean travel times from Mississippi counties to the sole pediatric hospital and the only ACPA-approved team in the state. This analysis was done before and after the establishment of two outreach clinics to assess differences in travel times and cost of travel to specialized plastic surgery care. Two sample t-tests were used for analysis.The addition of outreach clinics in North and South Mississippi led to a significant reduction in mean travel times for patients with cleft and craniofacial diagnoses across the state's counties (1.81 hours vs 1.46 hours, P < 0.001). Noteworthy travel cost savings were observed after the introduction of outreach clinics when considering both the pandemic gas prices ($15.27 vs $9.80, P < 0.001) and post-pandemic prices ($36.52 vs $23.43, P < 0.001).The addition of outreach clinics in Mississippi has expanded access to specialized healthcare for patients with cleft and craniofacial differences resulting in reduced travel time and cost savings for these patients. Establishing specialty outreach clinics in other rural states across the United States may contribute significantly to reducing burden of care for patients with clefts and craniofacial differences. Future studies can further investigate whether the inclusion of outreach clinics improves follow-up rates and surgical outcomes for these patients.


Assuntos
Fenda Labial , Fissura Palatina , Acessibilidade aos Serviços de Saúde , Humanos , Mississippi , Fissura Palatina/cirurgia , Fissura Palatina/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Fenda Labial/cirurgia , Fenda Labial/economia , Craniossinostoses/cirurgia , Craniossinostoses/economia , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/economia , Relações Comunidade-Instituição , Masculino , Criança , Viagem/estatística & dados numéricos
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