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ABSTRACT Objective: Identify the incidence and factors associated with reoperation due to bleeding in the postoperative of a cardiac surgery, in addition to the clinical outcomes of patients. Method: Prospective cohort study, conducted in an Intensive Care Unit (ICU), with adult patients undergoing cardiac surgery. Patients diagnosed with coagulopathies were excluded. The patients were followed up from hospitalization to hospital discharge. Results: A total of 682 patients were included, and the incidence of reoperation was 3.4%. The factors associated with reoperation were history of renal failure (p = 0.005), previous use of anticoagulant (p = 0.036), higher intraoperative heart rate (p = 0.015), need for transfusion of blood component during intraoperative (p = 0.040), and higher SAPS 3 score (p < 0.001). The outcomes associated with reoperation were stroke and cardiac arrest. Conclusão: Reoperation was an event associated with greater severity, organic dysfunction, and worse clinical outcomes, but there was no difference in mortality between the groups.
RESUMEN Objetivo: Identificar la incidencia y los factores asociados con la reintervención por sangrado en el postoperatorio de cirugía cardiaca, además de los resultados clínicos de los pacientes. Método: Estudio de cohorte prospectivo, realizado en una Unidad de Cuidados Intensivos, con pacientes adultos sometidos a cirugía cardiaca. Se excluyeron a los pacientes con diagnóstico de coagulopatías. Los pacientes tuvieron un seguimiento efectuado desde el ingreso hasta el alta hospitalaria. Resultados: Se incluyeron a 682 pacientes, y la incidencia de reintervención fue del 3,4%. Los factores asociados a la reintervención fueron antecedentes de insuficiencia renal (p = 0,005), uso previo de anticoagulante (p = 0,036), mayor frecuencia cardiaca intraoperatoria (p = 0,015), necesidad de transfusión de hemocomponentes en el intraoperatorio (p = 0,040) y mayor puntaje en SAPS 3 (p < 0,001). Los desenlaces asociados con la reintervención fueron accidente cerebrovascular y paro cardiorrespiratorio. Conclusión: La reintervención fue un evento asociado con mayor gravedad, disfunción orgánica y peores desenlaces clínicos, pero no hubo diferencia en la mortalidad entre los grupos.
RESUMO Objetivo: Identificar a incidência e os fatores associados à reoperação devido sangramento no pós-operatório de cirurgia cardíaca, além dos desfechos clínicos dos pacientes. Método: Estudo de coorte prospectivo, realizado em Unidade de Terapia Intensiva (UTI), com pacientes adultos submetidos à cirurgia cardíaca. Foram excluídos pacientes com diagnóstico de coagulopatias. Os pacientes foram acompanhados desde a internação até a saída hospitalar. Resultados: Foram incluídos 682 pacientes e a incidência de reoperação foi 3,4 %. Os fatores associados à reoperação foram: histórico de insuficiência renal (p = 0,005), uso prévio de anticoagulante (p = 0,036), maior frequência cardíaca intraoperatória (p = 0,015), necessidade de transfusão de hemocomponentes no intraoperatório (p = 0,040) e maior pontuação no SAPS 3 (p < 0,001). Os desfechos associados a reoperação foram: acidente vascular encefálico e parada cardiorrespiratória. Conclusão: A reoperação foi um evento associado a maior gravidade, disfunção orgânica, e piores desfechos clínicos, porém não houve diferença de mortalidade entre os grupos.
Subject(s)
Thoracic Surgery , Postoperative Hemorrhage , Reoperation , Outcome Assessment, Health Care , Second-Look SurgeryABSTRACT
Abstract Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points To date, TLM is the treatment of choice for Tis-T2 squamous cell glottic carcinomas. The CO2 laser beam could impair the histological assessment of the resection margins, which is the gold standard to confirm radical tumor resection. Second-look TLM is the most performed strategy in case of positive surgical margins. Close follow-up is the most shared policy in case of close or non-valuable resection margins. In cases of negative resection margins, follow-up represents the best approach.
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Peritoneal carcinomatosis (PC) is one of the difficult problems in the treatment of colorectal cancer (CRC). Based on several retrospective analyses of large samples and prospective randomized controlled studies (RCTs), NCCN and PSOGI recommend cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for selected CRC patients with mild to moderate PC. There are two important controversial issues in this field: the survival benefit of second-look surgery plus HIPEC for the patients with high risk of PC, and the specific benefit of HIPEC added to CRS for patients with PC. PROPHYLOCHIP found that second-look surgery plus HIPEC in patients at high risk of PC does not result in increased survival. PRODIGE 7 showed that overall survival (OS, 41.7 months vs. 41.2 months, P=0.99) and recurrence-free survival (RFS, 13.1 months vs. 11.1 months, P=0.43) were similar between the HIPEC group and non-HIPEC group, and suggested that HIPEC is not necessary for patients who underwent complete CRS. However, due to a series of problems in the design and implementation of this trial, the conclusion has caused great controversy and has not been widely recognized. Through detailed analysis and in-depth discussion, we believe that the benefit of HIPEC could not be denied according to PRODIGE 7. CRS + HIPEC is the embodiment and model of the concept of "Solid tumor treatment is surgery-based integrated treatment". CRS is the cornerstone of therapeutic strategies with curative intent for CRC PC and complete CRS is the key to improve the prognosis. Furthermore, HIPEC is an effective supplement to CRS.
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Humans , Antineoplastic Combined Chemotherapy Protocols , Chemotherapy, Cancer, Regional Perfusion , Colorectal Neoplasms/therapy , Combined Modality Therapy , Cytoreduction Surgical Procedures , Hyperthermia, Induced , Peritoneal Neoplasms/drug therapy , Retrospective Studies , Survival RateABSTRACT
Os cilindromas são tumores de apêndices cutâneos. Apresentamse normalmente na área da cabeça e pescoço. Muitas modalidades foram descritas para seu tratamento. Apresentamos aqui o caso de uma idosa que se apresentou com lesões recorrentes e que recebeu a opção de fazer uma excisão radical de todas as lesões versus a excisão das lesões sintomáticas. Ela optou por remover as lesões sintomáticas. A excisão cirúrgica das lesões sintomáticas é uma alternativa razoável para pacientes idosos.
Cylindromas are tumors of skin appendages. They present most commonly in the head and neck area. Many modalities have been described to treat them. We present a case of an elderly female who presented to us with recurrent lesions and was offered radical excision of all lesions versus excision of symptomatic lesions. She opted for the removal of symptomatic lesions. Surgical excision of symptomatic lesions is a reasonable alternative in elderly patients.
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Humans , Female , Middle Aged , History, 21st Century , Skin Neoplasms , Surgical Procedures, Operative , Neoplasms, Adnexal and Skin Appendage , Carcinoma, Adenoid Cystic , Skin Neoplasms/surgery , Surgical Procedures, Operative/methods , Neoplasms, Adnexal and Skin Appendage/surgery , Carcinoma, Adenoid Cystic/surgeryABSTRACT
Eight patients of advanced ovarian cancer were treated with monthly cycles of Ifosfamide, Adriamycin and Carboplatin. Debulking surgery was done in 7 cases. None of the patients had complete response. All eight patients had partial response. The follow-up was for 36 months. The present protocol appears to have an influence on initial control of disease but relapse continue to occur following the treatment. Cytoreductive surgery before or after three cycles of chemotherapy may have favourable influence on disease free survival (DFS). Second, third, fourth look surgeries have good results in many centers, which is not routinely practised at this center, might be the main reason for the poor outcome. Prolonged follow up along with second, third, fourth look surgeries will be necessary to determine the overall influence on long term survival.
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Objective To investigate the effect of damage control laparotomy in multiple trauma care.Methods A retrospective review was made on clinical data of 33 multiple trauma cases who received damage control laparotomy from January 2009 to June 2015.Twenty-four cases were males and 9 females, with the age range of 19-68 years(mean, 41.0 years).The trauma causes included traffic injury in 21 cases, high fall injury in 6 cases, falling object injury in 5 cases, and detonator blast injury in 1 case.Injury severity score (ISS) ranged from 14 to 64 points (mean, 27.0 points).All cases presented abdominal injury.Complicated injuries included brain injury in 10 cases, chest injury in 23 cases, and pelvic limb injury in 21 cases.All cases underwent damage control laparotomy, and then temporary abdominal closure after abdomen surgery.Abdominal closure time, intro-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS), related treatment methods, hospital length of stay, and complications were recorded after operation.Results Twenty-nine cases had primary fascial closure 5-12 d after surgery.Four cases were unable to complete definitive abdominal wall reconstruction within the short term, and underwent skin grafting to form planned ventral hernia.Twelve cases developed IAH or ACS, and were cured using intra-abdominal volume increment assisted by vacuum sealing draining (VSD).Hospital length of stay was 21-70 d (mean, 31.4 d).There were wound infections in 2 cases of open fractures and abdominal incision infections in 4 cases, but all were cured after debridement plus VSD treatment.Abdominal abscess occurred in 1 case, and was cured by abdominal puncture and drainage.All cases were discharged from hospital smoothly.Conclusion Rational application of damage control laparotomy is a safe and effective treatment method for multiple trauma combined with abdominal injury.
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El diagnóstico de colesteatoma es fundamentalmente clínico, pudiendo ser complementado con imágenes. Últimamente, el uso de resonancia magnética con secuencia HASTE ha surgido como herramienta diagnóstica sensible y específica para colesteatoma, permitiendo diferenciar éste del tejido inflamatorio-fibrótico presente en pacientes que han sido sometidos a cirugía de oído previa. En este trabajo se presentan cuatro casos de pacientes con antecedente de cirugía de oído y sospecha de colesteatoma en el mismo oído operado, realizándose RM HASTE y cirugía posterior. Obtuvimos una alta correlación entre la imagen y resultado quirúrgico. Se requiere mayor número de pacientes para determinar la sensibilidad y especificidad en el diagnóstico de colesteatoma en pacientes con cirugía de oídos previa.
The diagnosis of cholesteatoma is mainly established by clinical signs, and can be improved by radiological imaging. Recently, the use of magnetic resonance imaging (MRI) with HASTE sequence has emerged as a sensitive and specific diagnostic tool for cholesteatoma, which allows differentiating it from inflammatory-fibrotic tissue present in patients who have undergone previous surgery ear. Here, we present four cases of patients with a history of ear surgery and a suspected cholesteatoma in the same ear, performing HASTE MRI and subsequent surgery, presenting a high correlation between MRI and surgical outcome. More patients are needed to determine the sensitivity and specificity in the diagnosis of cholesteatoma inpatients with previous ear surgery.
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Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Magnetic Resonance Imaging/methods , Cholesteatoma, Middle Ear/diagnosis , Postoperative Period , Reoperation , Cholesteatoma, Middle Ear/surgeryABSTRACT
Objective To report the clinical features,management and prognosis of local recurrence with inferior vena cava tumor thrombus for renal cell carcinoma after laparoscopic partial nephrectomy.Methods A case of 37-year-old man was admitted to hospital for recurrent renal tumor in May 2013.The patient undervent laparoscopic partial nephrectomy for right kidney mass in June 2011,and renal cell carcinoma was diagnosed by pathological examination.The patient complained about pain of right flank in May 2013.Imaging examination (including CT,MRI and PET-CT) showed a 5 cm tumor on the upper-middle right kidney associated with inferior vena cava tumor thrombus,bulky retroperitoneal lymph nodes and extensive local invasion including psoas,ureter,perirenal fascia.Surgical excision of local recurrence,nephrectomy plus inferior vena eava thrombectomy was performed.Results Right nephrectomy and local recurrence incision plus inferior vena eava thrombectomy was performed successfully.The operation time was 360 min,blood loss was 4 000 ml.The patient was discharged on the 14th day after surgery.The pathological characteristics were as follows:the tumor was limited to the upper-middle right kidney,psoas,ureter,and inferior vena cava tumor thrombus,but carcinoma was not found in the lymph nodes,pelvis and others.The final pathological diagnosis was papillary renal cell carcinoma,type Ⅱ.Local recurrence and other distant metastasis were not demonstrated with CT in 12 months' follow-up.Conclusion Excision of locally recurrent renal cell carcinoma is possible,and complete surgical resection could lead to prolonged disease-free survival.
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iple occurrence of the tumor, which can decline its recurrence and postpone its progression.
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OBJETIVO: Avaliar a possibilidade de perda de extensão do joelho, após artroplastias de revisão, realizadas com acessos do tipo quadriceps snip e osteotomia do tubérculo anterior da tíbia (TAT), comparativamente, entre ambos e com um grupo controle, em que foi utilizado o acesso parapatelar medial convencional. MÉTODO: Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do INTO. A perda de extensão do joelho foi avaliada em pacientes submetidos a artroplastias de revisão, unilaterais, realizadas pelo Grupo de Joelho do Instituto Nacional de Traumatologia e Ortopedia - INTO, em que foram utilizados um dos seguintes acessos: convencional - parapatelar medial, snip do quadríceps ou osteotomia do tubérculo anterior da tíbia. A amostra foi composta por 26 indivíduos, cuja idade variou entre 52 e 80 anos, distribuídos em três grupos: grupo I: acesso parapatelar medial convencional (n = 10); grupo II: quadriceps snip (n = 8); e grupo III: osteotomia do TAT (n = 8). O tempo de seguimento médio foi de 18,57 meses. A perda da extensão do joelho foi determinada pela diferença entre o grau de extensão ativa pré e pós-operatória. Na avaliação estatística, foi utilizado o teste de análise de variância ANOVA, de fator único, com o nível de significância a = 0,05 (5 por cento). RESULTADOS: A perda média de extensão da série foi igual a 8,57º, variando entre 2º e 30º. O p-valor obtido foi igual a 0,112, o que permite assumir a hipótese de igualdade entre os grupos. CONCLUSÃO: No presente estudo, não foi observada diferença significativa entre os grupos compostos pelos três tipos de acesso utilizados para as revisões de artroplastias, no que tange ao parâmetro perda de extensão.
OBJECTIVE: To assess the possibility of extension loss of the knee after revision arthroplasties performed with approaches like quadriceps snip and TAT osteotomy, comparing the two methods and using a control group in who the conventional medial parapatellar approach was used. METHOD: This study was approved by the INTO Research Ethics Committee. The loss of extension of the knee was evaluated in patients submitted to unilateral revision arthroplasties of the knee conducted by the Knee Group of the INTO - National Institute of Traumatology and Orthopedics, the following approaches having been used: conventional - medial parapatellar, quadriceps snip, or anterior tibial tubercle osteotomy. The series included 26 individuals, ages ranging from 52 to 80, distributed into three groups: Group I: conventional - medial parapatellar approach (n = 10); Group II: quadriceps snip (n = 8); and Group III: TAT osteotomy (n = 8). Mean follow-up was 18.57 months. Extension loss of the knee was determined by the difference between the range of active extension before and after surgery. In the statistical assessment, the ANOVA variance analysis test was used, with a single factor, with significance level a = 0,05 (5 percent). RESULTS: Mean extension loss in the series was equal to 8.57º, varying between 2º and 30º. The p-value obtained was equal to 0.112, which leads to presume the hypothesis that groups are equal to one another. CONCLUSION: No significant difference was observed among the groups made up by the three types of approach used for arthroplasty revisions in terms of the loss of extension parameter.