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1.
Indian J Crit Care Med ; 22(7): 555-557, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30111936

RESUMO

Coagulopathy either from the use of anticoagulant, antiplatelet, or thrombolytic medications or from underlying medical conditions is considered one of the major risk factors for epidural hematoma formation related to epidural catheter placement or removal. The American Society of Regional Anesthesia and Pain Medicine (ASRA) has laid down guidelines regarding timing of neuraxial blockade or removal of neuraxial catheters in patients receiving either antithrombotic or thrombolytic therapy. We present a case of acute onset of paraplegia because of an epidural hematoma following removal of the epidural catheter in a patient who was given the first dose of antithrombotic therapy after the removal of the epidural catheter as per the ASRA guidelines. The epidural hematoma was diagnosed with an urgent magnetic resonance imaging, and the patient was urgently taken up for surgical evacuation of the hematoma. The patient made full recovery over 1 week period.

2.
Surg Endosc ; 26(2): 402-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21909859

RESUMO

BACKGROUND: Laparoscopic distal pancreatic surgery has gained popularity in the last decade. However, well-designed studies comparing laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP) are limited. We present a single-institution case-control study comparing outcomes of LDP to ODP. METHODS: From a prospectively accruing database, 104 patients who underwent distal pancreatectomy for pancreatic pathologies were eligible. Of these, 30 LDPs were matched with 30 ODPs using a 1:1 case-match design. Matching criteria were final histopathologic diagnosis and lesion size. Twelve LDPs were excluded from analysis because of lack of adequate ODP controls. In all cases, an attempt was made at conservation of the spleen. RESULTS: There were more females in the LDP group (p = 0.001). Other clinicopathologic characteristics of the LDP and ODP groups such mean age (52.4 ± 17.2 vs. 59 ± 12.8, p = 0.104), prior history of upper abdominal surgery (6.7% vs. 20.0%, p = 0.254) or pancreatitis (13.3% vs. 10.0%, p = 1.000), histopathologic diagnosis (p = 1.000), lesion size on imaging (3.7 ± 2.7 vs. 4.4 ± 2.4 cm, p = 0.170), and histopathology (3.8 ± 2.3 vs. 4.3 ± 2.3, p = 0.386) were comparable. There were no significant differences in postoperative complication rates (50.0% vs. 43.3%, p = 0.604), major complication rates (20% vs. 20%, p = 0.829), grade B/C pancreatic fistula rates (16.7% vs. 13.3%, p = 0.717), or reoperation rates (3.3% vs. 6.7%, p = 1.000) between LDP and ODP groups, respectively. There was a significantly higher rate of splenic conservation in the LDP group (70% vs. 30%, p = 0.002). The intraoperative blood loss (294 ± 245 vs. 726 ± 709 ml, p < 0.001) and mean duration of hospitalization (8.7 ± 4.2 vs. 12.6 ± 8.7 days, p = 0.009) were significantly lower in the LDP group compared to the ODP group. CONCLUSION: LDP is a safe and feasible option for distal pancreatic resections in experienced centers. The postoperative complication rate is comparable to that of ODP. LDP is associated with lower operative blood loss, higher rate of splenic conservation, and shorter duration of hospitalization. These encouraging results demand further validation in prospective randomized trials.


Assuntos
Laparoscopia/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Baço , Resultado do Tratamento
3.
Ann Surg ; 254(2): 294-301, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21772129

RESUMO

OBJECTIVE: To assess the perioperative and long-term results of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) using oxaliplatin+irinotecan (ox-irino) versus oxaliplatin alone (ox-alone). BACKGROUND: Treatment of peritoneal carcinomatosis (PC) of colorectal origin with CRS+HIPEC using mitomycin-C or oxaliplatin monotherapy has shown encouraging survival results. This bi-centric study evaluates an intensified intraperitoneal combination of ox-irino and compares it with ox-alone. PATIENTS AND METHODS: All consecutive patients with PC undergoing CRS+HIPEC using either ox-alone or ox-irino between 1998 and 2007 were evaluated. RESULTS: One hundred forty-six patients underwent CRS+HIPEC for PC, 103 received ox-irino and 43 received ox-alone. The median peritoneal carcinomatosis index (PCI) was 11 in both groups. 90.4% had complete cytoreduction. Overall mortality rate was 4.1%. The overall morbidity rate was 47.2% and was significantly lower with ox-alone (34.9% vs. 52.4%, P = 0.05). After a median follow-up of 48.5 months, the median overall survival (OS) was 41 months (95% CI, 32-60) and median relapse-free survival (RFS) was 15.7 months (95% CI, 12-18). The median RFS of ox-alone (16.8 months; 95% CI, 11-25) was not significantly different from ox-irino (15.7 months; 95% CI, 11-18; P = 0.93). There was no significant difference between median OS of ox-alone (40.83 months; 95% CI, 29-61) and ox-irino (47 months; 95% CI, 32-61; P = 0.94). At 5 years, OS and RFS rates were 41.8% and 13.8% in ox-alone and 42.4% and 14.2% in ox-irino, respectively. Prognostic factors confirmed on multivariate analysis were lymph node metastasis and PCI. CONCLUSION: Our study showed no advantage of intensification of HIPEC by adding irinotecan, contrary to the results obtained with IV combination. Ox-alone HIPEC should continue as one of the standard HIPEC regimens for PC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia do Câncer por Perfusão Regional/métodos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Hipertermia Induzida/métodos , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Cirurgia de Second-Look , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Camptotecina/administração & dosagem , Camptotecina/efeitos adversos , Camptotecina/análogos & derivados , Quimioterapia Adjuvante , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Terapia Combinada , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Seguimentos , Humanos , Irinotecano , Masculino , Pessoa de Meia-Idade , Inoculação de Neoplasia , Estadiamento de Neoplasias , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/efeitos adversos , Oxaliplatina , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/mortalidade , Estudos Prospectivos , Carga Tumoral , Adulto Jovem
4.
Ann Thorac Surg ; 111(1): e37-e39, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32599048

RESUMO

Primary squamous cell carcinoma of the sternum is very rare. Imaging features are not specific, and a biopsy specimen may help identify the pathology. Positron emission tomography scan helps rule out a primary focus elsewhere. The treatment will be surgical management, if operable. We encountered a patient with primary squamous cell carcinoma of the sternum with an unusual presentation. After the diagnostic workup, we managed the patient surgically with resection, followed by titanium mesh reconstruction and pectoralis major flap cover. We present the case in view of its rarity and to emphasize the key surgical points.


Assuntos
Neoplasias Ósseas , Carcinoma de Células Escamosas , Esterno , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Indian J Anaesth ; 63(12): 972-987, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31879421

RESUMO

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for primary peritoneal malignancies or peritoneal spread of malignant neoplasm is being done at many centres worldwide. Perioperative management is challenging with varied haemodynamic and temperature instabilities, and the literature is scarce in many aspects of its perioperative management. There is a need to have coalition of the existing evidence and experts' consensus opinion for better perioperative management. The purpose of this consensus practice guideline is to provide consensus for best practice pattern based on the best available evidence by the expert committee of the Society of Onco-Anaesthesia and Perioperative Care comprising perioperative physicians for better perioperative management of patients of CRS-HIPEC.

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