Giant Pseudoaneurysm as a delayed Surgical Complication in a Patient Operated on a Giant Neuroma of the Vagus Nerve: Case Report and Management Considerations / Pseudoaneurisma gigante como complicação cirúrgica em paciente operado com neuroma gigante do nervo vago: relato de caso e considerações

The vertebral artery has four segments. The horizontal portion of the V3 segment is the most exposed portion of the vertebral artery to potential iatrogenic injuries during surgical approaches to the posterior fossa.We present an unusual case of a patient who was operated on a giant neuroma of the left vagus nerve, with incidental vertebral artery iatrogenic injury, the development of a delayed giant pseudoaneurysm, and the treatment for this complication. We conclude that endovascular treatment may be a good option for the management of this serious surgical complication.

A artéria vertebral tem quarto segmentos. A porção horizontal do segmento V3 é a mais exposta a potenciais lesões iatrogênicas durante procedimento cirúrgico de acesso à fossa posterior. Apresentamos caso incomum de paciente submetido à cirurgia para neuroma gigante no nervo vago esquerdo, com acidental lesão da artéria vertebral iatrogênica, desenvolvimento de posterior pseudoaneurisma gigante e tratamento para esta complicação. Concluímos que o tratamento endovascular pode ser uma boa opção para o cuidado desta grave complicação cirúrgica.

Violencia obstétrica: percepción de las usuarias / Obstetric violence: perceptions of users

OBJETIVO: Evaluar la percepción de las usuarias sobre la atención recibida en relación con prácticas consideradas como violencia obstétrica. MÉTODOS: Estudio prospectivo, descriptivo, exploratorio, de corte transversal por medio de una encuesta anónima a 425 puérperas atendidas en la Maternidad “Concepción Palacios” entre mayo y agosto de 2011, sobre aspectos relativos a violencia obstétrica. RESULTADOS: El 66,8 % manifestó la realización de procedimientos médicos sin consentimiento informado, 49,4 % fue objeto de algún tipo de trato deshumanizante, solo 20,5 % percibió trato no violento. Entre los reportes de trato deshumanizante predominó el obstaculizar el apego precoz (23,8 %). El trato deshumanizante fue percibido con más frecuencia por las gestantes tardías y las adolescentes (P<0,0001). Los principales perpetradores señalados son las enfermeras y los médicos. Entre los procedimientos sin consentimiento el más frecuentemente reportado fue la realización de múltiples tactos (37,2 %) y la administración de oxitócicos (31,3 %). Este tipo de violencia fue percibido con más frecuencia por las adolescentes (P<0,0002). A más alto nivel de educación se observó menor percepción de violencia (P<0,0059). Una de cada 4 usuarias conoce el término violencia obstétrica, y 1 de cada 5 sabe donde denunciarla. Solo 12 % recibió información sobre el consentimiento informado y 17 % firmó un formulario. CONCLUSIONES: Existe una elevada percepción de violencia en la atención obstétrica dada por la realización de procedimientos médicos sin consentimiento informado y trato deshumanizante por parte del personal de salud. No se aplica de manera sistemática la obtención del consentimiento informado.

OBJECTIVE: To evaluate the perception of the users on the attention received in relation to considered practices obstetric violence. METHOD: Prospective, descriptive, exploratory, transverse- court study by means of an anonymous opinion poll to 425 women in postpartum period attended in Concepción Palacios Maternity between May and August 2011, on relative aspects to obstetric violence. RESULTS: 66.8 % manifested the realization of medical procedures without informed consent, 49.4 % it was some kind of dehumanizing deal’s object, only 20.5 % perceived deal I do not force. The reports of dehumanizing deal predominated to obstruct the precocious attachment (23.8 %). The dehumanizing deal was perceived with more frequency by the overdue pregnant and teens (P 0.0001). The principal marked perpetrators are nurses and doctors. In the procedures without consent the more frequently reported was the realization of multiple vaginal touches (37.2 % ) and oxytocin administration (31.3 % ). This type of violence was perceived with more frequency by the teens (P 0.0002). Minor perception of violence was observed to higher level of education (P 0.0059). One out of every 4 users knows the term obstetric violence, and 1 out of every 5 knows where to denounce her. Only 12 % received information on the informed consent and 17 % signed a fill-out form. CONCLUSIONS: There is an elevated perception of violence in the obstetric attention given the realization of medical procedures without informed consent and dehumanizing deal for part of the staff of health. The obtaining of the informed consent is not applicable of systematic way.