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1.
An. bras. dermatol ; 93(2): 262-264, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-887177

ABSTRACT

Abstract: Leiomyosarcoma is a rare skin tumor, most common in white men in the fifth to eighth decades of life. Primary tumors are classified in dermal or subcutaneous, that differ by clinical and prognostic features. They may appear on any site of the body, but are rare on the face. A 54-year-old female was admitted with a 5cm exophytic nodular lesion of 8 months duration on the right cheek, site of previous chronic radiodermatitis. Histopathology revealed spindle-shaped cell neoplasia, positive for smooth muscle actin on immunohistochemistry. Cutaneous leiomyosarcomas on the face are rare and may occur in previously irradiated areas. Immunohistochemistry is mandatory for an accurate diagnosis. Its similarity with other tumors may complicate the diagnosis, with delay expansion of the tumor.


Subject(s)
Humans , Female , Middle Aged , Skin Neoplasms/pathology , Facial Neoplasms/pathology , Leiomyosarcoma/pathology , Skin Neoplasms/diagnosis , Facial Neoplasms/diagnosis , Immunohistochemistry , Actins/analysis , Rare Diseases/pathology , Diagnosis, Differential , Leiomyosarcoma/diagnosis , Muscle, Smooth/pathology
2.
An. bras. dermatol ; 92(2): 243-245, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-838052

ABSTRACT

Abstract: Vulvar cancer accounts for less than 1% of malignancies in women. Verrucous carcinoma of the vulva is a rare histological variation, comprising less than 1% of vulvar cancer cases. Although it is characterized as being locally invasive, the condition is not associated with metastatic spreading. Lesions present in the form of a verrucous, ulcerated, and bleeding tumor that can reach large dimensions. This type of tumor can be mistaken for condylomata, both macroscopically and microscopically. We report the case of an 81-year-old patient with a large vulvar tumor presented for eight years, initially considered as a Buschke-Löwenstein tumor. The patient underwent radical vulvectomy with a V-Y advancement flap technique. This type of tumor should be considered by clinicians dealing with condylomatous ulcerative lesions that do not respond to the usual treatment.


Subject(s)
Humans , Female , Aged, 80 and over , Vulvar Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Carcinoma, Verrucous/pathology , Buschke-Lowenstein Tumor/pathology , Surgical Flaps , Vulva/pathology , Vulvar Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Treatment Outcome , Carcinoma, Verrucous/surgery , Diagnosis, Differential
3.
Article in Chinese | WPRIM | ID: wpr-666417

ABSTRACT

Objective To evaluate the feasibility,safety and short-term fetal outcome of ultrasoundguided percutaneous microwave ablation for selective feticide in complicated monochorionic twin pregnancies.Methods Twenty-two patients who underwent microwave ablation for selective fetal reduction in Peking University Third Hospital between July 2015 and June 2016 were retrospectively studied.Surgical complications,fetal outcomes and neural development at age of 60 days were recorded.One-way ANOVA,Mann-Whitney U test,Chi-square or Fisher's exact test was used for statistical analysis.Results Indications of the 22 patients for selective feticide included five cases of twin pregnancy with one anomalous fetus,five cases of severe twintwin transfusion syndrome (TTTS),three cases of twin reserved arterial perfusion (TRAP) and nine cases of selective intrauterine growth restriction (sIUGR).All surgeries were successful under regional anesthesia.Four pregnancies (18.2%,4/22) ended in miscarriage following surgery,three of which were caused by intrauterine fetal death (13.6%,3/22) and one by premature rupture of membranes before 26 weeks of gestation (4.5%,1/22).Totally,18 babies were born alive at an average gestational age of (35.5 4.2) weeks (26~40 weeks+2) and with an average birth weight of (2 380.778) g (800~3 430 g),and four of them were preterm infants less than 32 weeks of gestation.Except for one extremely low birth weight infant,whose gestational age was 26 weeks at birth and birth weight was 800 g,died two days after birth,17 infants were discharged alive,giving an neonatal survival rate of 17/18.The total fetal survival rate was 77.3% (17/22).Polyhydramnios,placenta location,and position of the fetus being aborted showed no significant effect on miscarriage or fetal survival rate (all P>0.05).No severe maternal complications occurred.No brain injuries were detected by imaging examination in 17 infants who were followed up to 60 days of age.Conclusions Ultrasound-guided percutaneous microwave ablation can be used for selective feticide in complicated monochorionic twin pregnancies.Further studies are needed to evaluate its effects on long-term fetal outcome.

4.
Article in Chinese | WPRIM | ID: wpr-607616

ABSTRACT

Objective To investigate the safety of trial of labor after cesarean (TOLAC) and clinical factors associated with successful TOLAC and to compare TOLAC with elective repeat caesarean section (ERCS) in terms of obstetric and neonatal outcomes.Methods A prospective cohort study was conducted among gravidas who had a history of lower segment cesarean section and were hospitalized in the Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January to December 2014.Exclusion criteria included indications for caesarean section (such as placenta previa,placenta accreta,twin pregnancy,breech presentation and severe preeclampsia),serious maternal complications after cesarean section,lower uterine segment thinner than 3 mm and poor healing of uterine incision.Totally,287 gravidas were enrolled.Among them,142 chose TOLAC and the other 145 requested ERCS.Clinical data of those gravidas were collected and statistically analyzed by t-test,Log-rank test,Chi-square or Fisher's exact test.Results (1) The success rate of TOLAC was 90.8% (129/142).There was no significant difference in maternal age,gestational age,thickness of lower uterine segment,interval between the two deliveries and neonatal birth weight and asphyxia rate between the successful (n=129) and unsuccessful (n=13) groups (all P>0.05).Although the two groups had no significant difference in postpartum hemorrhage (PPH) rate,the gravidas who failed in TOLAC lost more blood than those who succeeded [425 (195-675) vs 200 (50-1 400) ml,P<0.05].Moreover,higher amniotic fluid contamination rate was observed in the unsuccessful group [6/13 vs 17.1% (22/129),P<0.05].In the TOLAC group,99.3% (141/142) were under continuous fetal heart rate monitoring.Incomplete uterine rupture occurred in one women without serious maternal or neonatal outcomes.The reasons for 13 failed TOLAC cases were unbearable pain during labor,abnormal labor,fetal distress and threatened rupture of uterus.(2) Compared with the ERCS group,the TOLAC group showed shorter interval from last cesarean section to the indexed delivery[5 (2-18) vs 6 (2-19) years],younger maternal age [(31±4) vs (33 ±4) years old] and less blood loss [200 (50-1 400) vs 300 (100-1 500) ml] (all P<0.05).Conclusion Our study shows that,those who preferred TOLAC were younger,or had shorter pregnancy interval from last cesarean section.The success rate of TOLAC is high for women undergoing systematic prenatal assessment and close management during labor with less blood loss and non-serious maternal and neonatal complications compared with ERCS.

5.
Article in Chinese | WPRIM | ID: wpr-502523

ABSTRACT

Objective To analyze the changes of cesarean section rate (CSR) and indications of cesarean section (CS) after implementation of responsible system of attending physician (RSAP) and new partogram.Methods Totally,11 814 women,who delivered in the Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University in the fourth quarter of 2012,2013 and 2014,were chosen.The mode of delivery,CSR,CS indications and matemal and fetal outcomes of these women were analyzed with Chi-square test.The RSAP was started in 2013,and both RSAP and the new partogram were applied in 2014 in our hospital.Results The CSRs in the fourth quarter of 2012,2013 and 2014 were 46.4%(1 502/3 235),40.4%(1 524/3 770) and 33.5%(1 612/4 809) (x2=138.312,P<0.05),and the converting CSR in the delivery room were 10.9%(212/1 945),7.8%(189/2 435) and 6.1%(208/3 414),respectively (x2=39.765,P<0.05).The proportion of assisted vaginal delivery in the fourth quarter of 2014 was higher than those of the former two years [4.9%(237/4 809) vs 3.4% (108/3 235) and 3.5%(131/3 770),x2=17.041,P<0.05].More and more CS deliveries emerged due to scarred uterus,multiple pregnancy,comorbidities and complications during pregnancy year by year,while those CS deliveries because of macrosomia,narrow pelvis,social factors,elderly primipara,umbilical cord entanglement,precious fetus and high myopia gradually decreased (all P<0.05).In the fourth quarter of 2014,the proportions of CS with fetal distress,abnormal labor,cephalopelvic disproportion and intrauterine infection were lower than those in 2013 (all P<0.05).No significant difference was shown in the proportion of postpartum hemorrhage and neonatal asphyxia among the three years (both P>0.05).In 2014,smaller percentage of neonates were transferred to the Pediatrics Department after birth than in 2012 and 2013 [10.2%(491/4 809) vs 12.0%(388/3 235) and 13.7%(516/3 770),x2=24.681,P<0.05].Conclusions The implementation of RSAP and the application of new partogram effectively reduce the CSR through strict control on indications of CS.

6.
Article in Chinese | WPRIM | ID: wpr-461118

ABSTRACT

Objective To investigate the factors influencing therapy decision of surgery or pessary in patients with severe pelvic organ prolapse (POP). Methods Totally 419 cases ofⅢtoⅣdegree POP patients were studied retrospectively. Patients were divided into surgery and pessary groups according to their own choice. Clinical characters were compared such as age, body mass index (BMI), age of onset and disease duration, POP stage, complications. Results 67.5%(283/419) patients were in the surgical group and 32.5%(136/419) patients in the pessary group. Patients in surgical group had higher BMI [(25.1 ± 3.5) versus (23.8±2.6) kg/m2], elder age of onset [(62±12) versus (57±11) years old], longer disease duration [(5± 8) versus (11±11) years] and higher POP staging of middle compartment and less cardiac disease [20.1%(57/283) versus 30.9% (42/136)] than those in pessary group, all had significant difference (P<0.05). Logistic regression analysis on the above factors showed a statistically significant difference between two groups, BMI, disease duration and POP staging of middle compartment were independent factors (OR=1.141, 0.932, 1.389;all P<0.01). Conclusions Patients with higher BMI, higher POP staging of middle compartment and less cardiac disease tended to choose surgery. Patients with younger age of onset and longer disease duration tended to choose pessary. Factors as age, POP staging of anterior and posterior compartment, history of POP surgery, complicated with hypertension and diabetes, showed no influence on treatment choice.

7.
Article in Chinese | WPRIM | ID: wpr-478044

ABSTRACT

Objective:To investigate the differences between emergency surgery and selective surgery treatment of ankle fractures with dislocation .Methods:In the study , 40 patients with ankle fracture and dislocation were treated and followed up from May 2013 to May 2014, and all the data were collected and analyzed .The subjects involved 29 male patients and 11 female patients .The patients were randomly separated into two groups , and the patients in group A were given surgical intervention within 6 hours af-ter injury , while those in group B were initially given close reduction and given selective operation when the soft tissue condition got better .Group A contained 13 male patients and 7 female patients with average age of 37.10;Group B consisted of 15 male and 5 female, with average age of 37.85.Results:The Baird-Jackson score was applied for assessment of the patients ’ outcomes.According to the score , the outcomes were classified into excellent , good, fair, and poor.In group A (emergency group), the outcomes were 13 (65.0%), 4 (20.0%), 3 (15.0%), and 0, respectively.In group B ( selective group), they were 11 (55.0%), 7 (35.0%), 2 (10.0%), and 0, respectively.The numbers of the patients from excellent to poor were 24 (55.0%), 11 (27.5%), 5 (12.5%), and 0, respectively. Conclusion: There is no significant difference in postoperative function between the two groups , however , early surgical intervention can benefit in accomplishing anatomical reduction much easier and shortening the time of hospitalization , which is cost-saving for the patients .

8.
Chinese Journal of Urology ; (12): 691-693, 2013.
Article in Chinese | WPRIM | ID: wpr-441338

ABSTRACT

Objective To discuss the curative effect of different operative methods for the treatment of urethrocutaneous fistula (UCF) after urethroplasty.Methods Clinical data of 54 cases of UCF from January 2003 to July 2011 were collected.Simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were performed according to the size,location,number and whether there was urethral stricture of UCF.The treatment effect was recored and analyzed.Results The success rate of UCF repair was 85% (46/54).There were 4 patients cured after second surgery.The success rates of repair of UCF with simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,tongue/buccal mucosa urethroplasty were 95%,76%,82%,and 83%,respectively.Postoperative recurrence was observed in 5 patients in 6 months after the surgery and 4 of them received the re-operation.Conclusion According to the principle and the individual circumstance,taking personalized operative methods may improve the success rate of the repair of all kinds of UCF.

9.
Arq. bras. oftalmol ; 75(5): 333-336, set.-out. 2012. tab
Article in Portuguese | LILACS | ID: lil-667577

ABSTRACT

OBJETIVO: Analisar a incidência e causas de cancelamento de cirurgias de catarata em um hospital público de referência. MÉTODOS: Trata-se de um estudo retrospectivo em que foram analisados o número de cancelamentos de facectomias durante o ano de 2009. Foram analisados sexo, idade, tipo de procedimento suspenso (facoemulsificação ou extração extracapsular do cristalino), tipo de anestesia, convênio (Sistema Único de Saúde ou convênio/particular) e motivo de suspensão da cirurgia (causas clínicas, institucionais ou pessoais). RESULTADOS: Foram agendadas no período 2.965 cirurgias de catarata, havendo 650 cancelamentos (21,92%). Dentre as principais razões para a suspensão do procedimento destacaram-se as causas clínicas (86,90%). Os meses de inverno apresentaram os maiores índices de suspensão de cirurgias de catarata. CONCLUSÃO: A taxa de cancelamento de cirurgia de catarata em serviços públicos parece ser a mesma que há 10 anos. A principal causa de suspensão deve-se por condições clínicas (hipertensão, diabetes, falta de exames, etc.).


PURPOSE: To report the incidence and causes of cataract surgery cancellations in a public hospital. METHODS: This is a retrospective study, which examined the number of cancellations of cataract surgery during 2009. We analyzed the type of procedure suspended (phacoemulsification or extracapsular extraction), type of anesthesia, gender, age, covenant (public/private) and the main reasons for suspension of the surgeries (clinical causes, institutional or personal). RESULTS: We analyzed 2,965 scheduled cataract surgeries, with 650 cancellations (21.92%). The main reason for the suspension of the procedure was clinical causes (86.90%). The winter months had the highest suspension rates of cataract surgery. CONCLUSION: The cancellation rate of cataract surgery in Brazilian public system seems to be the same as 10 years ago. The main cause of the suspension should be in clinical conditions (hypertension, diabetes, lack of exams, etc.).


Subject(s)
Aged , Humans , Middle Aged , Cataract Extraction/statistics & numerical data , Efficiency, Organizational , Refusal to Treat/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Brazil , Hospitals, Public/statistics & numerical data , Retrospective Studies
10.
Chinese Journal of Trauma ; (12): 638-643, 2012.
Article in Chinese | WPRIM | ID: wpr-426733

ABSTRACT

Objective To discuss the clinical significance of internal fixation through anterolaterel and posteromedial approaches in the treatment of closed sagittal Pilon fractures of Topliss classification and compare the effects of the two approaches.Methods The study involved 57 patients with closed sagittal Pilon fractures treated with open reduction and internal fixation from 2007 to 2010,including 29 patients treated through anterolateral approach (Group A) and 28 through posteromedial approach (Group B).All patients were with closed fractures,and all surgery time windows were 10-19 days.The two groups were compared in aspects of gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window,operation time,intra-operative blood loss,ambulation time,infection and necrosis rate of skin and soft tissue,length of stay,ankle joint function recovery after internal fixation,and intra-operative X-ray reduction.Results All patients were followed up for 12-26 months (mean,20 months) except for one patient in the Group A,with total follow-up rate of 98%.The two groups showed no significant differences regarding the gender,age,type of fractures,soft tissue graduation,injury factors,condition of combined fibula fracture,surgery time window selection,operation time,intra-operative blood loss,and ambulation time (P >0.05).While,the infection and necrosis incidence of skin and soft tissue,and the hospital stay we re significantly lower and shorter in the Group A than that in the Group B (P < 0.05 ).Two patients in the Group A were complicated with toe extensor tendon adhesion,which was released by removing the fixation.Fifteen patients had wound infection during hospitalization,including three patients in the Group A and 12 in the Group B,but they were all cured after treatments like dressing.Fifteen patients were treated with stage Ⅰ allogeneic bone graft and 11 with autologous iliac bone graft.All the patients obtained bone union.Conclusions Topliss classification of closed sagittal Pilon fractures has clear clinical significance in surgical plan selection and operative procedures.Both of the anterolateral and posteromedial approaches can achieve good effects in the treatment of closed sagittal Pilon fractures due to high energy injury.However,the anterolateral approach is relatively a better choice,for it brings in a lower incidence of infection and necrosis of skin and soft tissue and a shorter length of hospital stay.

11.
Chinese Journal of Urology ; (12): 386-389, 2012.
Article in Chinese | WPRIM | ID: wpr-425940

ABSTRACT

ObjectiveTo explore the importance and significance of classification diagnosis and treatment of chordee among hypospadias in children.MethodsA random sample review and controlled study was made in patients with hypospadias and chordee from 1989 to 2011 in First Affiliated Hospital of Sun Yat-Sen University,and the patients were divided into 2 groups.There were 232 cases in group A,who were all diagnosed as chordee only on the basis of clinical symptoms or an erection induced by artificial stimulation before operation.All the 232 cases were corrected empirically without objective assessment by degloving the penis,dissecting superficial and deep fascia,and cutting off the urethral plate,and so on during operation.There were 25 cases in group B,who were all strictly implemented on classification diagnosis and treatment of chordee,in sponge saline injection test during operation and correction effect evaluation after operation.Chordee was classified according to different etiology and pathology:skin type,fascia-type,urethra type,sponge type and the glans of penis type.There were different operating methods in different ways of folding tunica albuginea.ResultsIn group A,86 patients (37%) had postoperative recurrence of chordee,25 patients ( 11% ) had pain during erection after surgery,183 patients were satisfied with correction of chordee (79%).In group A,25 patients were in their adulthood when followed up,and 7 patients had IIEF-5 score <21 points.In group B,the single type of chordee among hypospadias were 7/25 (28%),merged type were 18/25 (72%).All patients were followed up without chordee recurrence or painless erection,and 100% patients or families were satisfied with correction of chordee.The efficacy difference were statistically significant between the two groups in chordee correction.In folding tunica albuginea group in group B,the penile erection length was (4.58 ± 1.59) cm before the correction,and (6.16 ±2.54) cm after correction.In non-folding tunica albuginea group,penile erection length was (4.O1 ± 1.18 ) cm before correction,and (5.82 ± 1.51 ) cm after correction.The difference was not significant between the 2 groups in penile erection length (P > 0.05 ).ConclusionsSurgeon should pay more attention to the correction,effect evaluated,classified etiology and pathological diagnosis of hypospadias and chordee.And the targeted selection of the correct treatment of chordee can further improve the therapeutic effect.Chordee of hypospadias can exist in single or merged according to the pathological classification.Chordee correction surgery can increase length of penis,and dorsal tunica albuginea plication had no significantly different effect on the length of the penis compared to other chordee corrective surgery.

12.
Chinese Journal of Urology ; (12): 203-205, 2012.
Article in Chinese | WPRIM | ID: wpr-425125

ABSTRACT

ObjectiveTo evaluate the diagnosis methods and surgical treatment of renal hydatid cyst.MethodsEighty-six cases of renal Echinococcosis were diagnosed and treated in the Urological Department of the First Affiliated Hospital,Xinjiang Medical University,the People's Hospital Of Xinjiang Uygur Autonomous Region and the Friendship Hospital of Yili from Feb.1985 to Apr.2010 were reviewed and analyzed.ResultsAbdominal ultrasonography,CT scan and laboratory immunological tests of renal Echinococcosis showed positive diagnosis rates of 88%,81% and 85%,respectively.Eighty-five cases were accepted for surgical intervention including; 39 endocystectomies,14 endocystectomies after needle aspiration,15 partial nephrectomies,five intact ectocystectomies and 12 nephrectomies.Fifty-three cases were followed-up from two to 15 years and recurrence was found in seven cases.ConclusionsAbdominal ultrasonography,CT scan and immunological tests are the main methods in the diagnosis of renal Echinococcosis.Surgical management is still the most effective approach in the treatment of renal Echinococcosis.The surgical strategy depends on residual renal function,cyst size,numbers and position of the hydatid cyst.The intact ectocystectomy is the ideal treatment for renal hydatid cyst.

13.
Chinese Journal of Urology ; (12): 196-198, 2012.
Article in Chinese | WPRIM | ID: wpr-425051

ABSTRACT

Objective To discuss the indication for kidney-sparing surgery (KSS) on primary urothelial carcinoma of the distal ureter.MethodsClinical data of 108 patients with primary urothelial carcinoma of the distal ureter in our hospital from 2001 to 2009 were analyzed retrospectively.There were 75 males and 33 females with mean age of 62 ( range from 42 to 85 ) years old in this study.The patients were divided into KSS group and RNU group according to the operation methods.The recurrence rate of radical nephroureterectomy (RNU) and KSS were evaluated.Results The recurrence was seen none with T,stage,1 (12.5%) with T1 stage,4 (36.4%) with T2 stage and 4 (80%) with T3 stage in KSS group.In RNU group,there was none with Ta stage,4 ( 15.4% ) with T1 stage,10 (33.3%) with T2 stage and 7 (36.8%) with T3 stage recurred.There was no difference between patients with Ta to T2 stages in KSS and RNU group (P >0.05 ) on recurrence,but there was a significant difference between patients with T3 stage (P<0.05).There was 1 (33.3%) case with G1 grade,3 (18.8%) with G2 grade and 5 (62.5%) with G3 grade recurred in KSS group,while 2 (22.2%) cases with G1 grade,9 (20%) with G2 grade and 10 (37.0%) with G3 grade recurred in RNU group.There was no difference between patients with G1 to G2 grades in KSS and RNU group (P>0.05),but there was a significant difference between patients with G3 stage in the two groups ( P < 0.05 ).Conclusion KSS seems to be safe for patients with low stage and low grade primary urothelial carcinoma of the distal ureter.

14.
Chinese Journal of Urology ; (12): 672-674, 2012.
Article in Chinese | WPRIM | ID: wpr-424021

ABSTRACT

Objective To evaluate the efficacy and safety of tension free vaginal tape obturator technique (TVT-O) in females stress urinary incontinence (SUI).Methods From June 2008 to May 2012,156 cases of female SUI were treated with TVT-O procedure in our hospital.The mean age is 56.3 ±13.9 years.There were 79.5% patients who suffered simple SUI while 20.5% patients with SUI and urge urinary incontinence (UUI).The mean follow-up time was 16.5 months.All patient’s ICI-Q-SF scores and I-QOL scores were collected.The efficacy and safety of TVT-O were analyzed.Results The mean operative time was 34 ± 11 minutes and the mean estimated blood loss were 15 ± 9 ml.One hundred and forty-five cases were cured with TVT-O (92.9%) while 8 cases were improved (5.1%).The preoperative and postoperative ICI-Q-SF symptom scores were 8.2 ± 2.1 and 0.5 ± 1.3 while the I-QOL life quality scores were 28.5 ± 10.3 and 69.8 ± 9.9 respectively.There was statistical difference between the preoperative and postoperative scores (P < 0.05 ).No bladder injury was recorded during the procedures.There were two cases whose vaginal walt were injured and repaired intraoperatively.No pelvic hematoma,long-term pain,sling erosion,infection and fistula were found in all cases.Three cases ( 1.9% ) suffered temporary urinary retention and were cured by two weeks urethral catheterization.Conclusions TVT-O technique seems to be an easy and minimally invasive procedu(r)e with less complication,which supports its safety and reliability in the treatment of female SUI.

15.
Article in Chinese | WPRIM | ID: wpr-429468

ABSTRACT

Objective To investigate the safety and efficiency of radiofrequency ablation (RFA) in the treatment of complicated multifetal gestations.Methods There were 6 multifetal pregnant women (gestational age ranged from 14+6 to 27 +2 weeks) diagnosed in the Department of Obstetrics,Provincial Hospital Affiliated to Shandong University:two with twin-twin transfusion syndrome (TTTS) stage Ⅳ,one with reversed arterial perfusion sequence,one with dichorionic triamniotic triplets,one with absence of a lower limb,one with severe intrauterine growth restriction.All of them accepted ultrasound-guided selective fetocide by RFA.Results (1) Blood flow of three reduced fetuses stopped completely after one RFA circulation,whereas the other three stopped after two circulations.One reduced fetus stopped heartbeating in 10 minutes after RFA; three reduced fetuses' heartbeats slowed down and stopped completely in 35 minutes after RFA ; and the heartbeats of the other two cases stopped completely within 3 to 7 minutes after RFA.The heartbeats of the reserved fetuses were normal.All of the operations succeeded.(2) The reserved fetuses received a series of ultrasound examinations after the operations.In Case 1,the ascites of the reserved fetus,which was 4.0 cm× 2.3 cm before RFA,disappeared two weeks later; and the umbilical artery systolic/diastolic (S/D) ratio,which was 3.35 before the operation,decreased to 2.70 six weeks later.Amniotic fluid depth decreased from 44.6 cm to normal two weeks after RFA.The reserved fetus received brain MRI three weeks after RFA and no abnormality was detected.In Case 2,the increased heart size (cardiothoracic ratio > 0.35) of the reserved fetus recovered to normal size ten days after the operation ; and the umbilical artery S/D decreased from 4.69 to 3.39 seven days after the operation.Reserved fetuses of the other three cases were normal on ultrasound and MRI after the operations.In Case 6,the ascites of the reserved fetus,which was 2.3 cm × 1.5 cm before RFA,disappeared sixteen days after the operation.The brain MRI suggested normal three weeks after the procedure.Amniotic fluid depth reduced from 11.0 cm to normal two weeks after the operation.(3) Three women delivered normal premature babies,and the other three got healthy mature infants.At present,all children are still in follow-up,and their physical examinations suggest normal.Conclusions RFA is a safe,efficient,minimal invasive treatment,which provides a new choice for fetocide,especially for complicated monochorionic multifetal gestations.Fetocide by RFA can effectively improve the life quality of the reserved fetuses.

16.
Acta paul. enferm ; 25(5): 653-659, 2012. tab
Article in Portuguese | LILACS, BDENF | ID: lil-653421

ABSTRACT

OBJETIVO: Identificar a ocorrência de úlcera por pressão em pacientes submetidos a cirurgias eletivas de porte II, III e IV. MÉTODOS: Estudo de abordagem quantitativa, com delineamento de pesquisa não experimental, tipo descritivo e prospectivo. A amostra foi composta por 148 pacientes adultos, de ambos os gêneros, submetidos à cirurgia eletiva, conforme os critérios de seleção determinados previamente. RESULTADOS: Da amostra avaliada, 108 pacientes receberam alta hospitalar, três faleceram e 37 desenvolveram úlceras por pressão. Esses pacientes apresentaram 44 lesões, sendo a maioria diagnosticada de estágio II (56,8%), seguida por lesões de estágio I (40,9%) e estágio III (2,3%). As áreas corporais mais acometidas foram a região sacro/glútea (68,2%), calcâneos (18,1%), região dorsal (9%) e o pavilhão auricular (4,6%). CONCLUSÃO: A ocorrência de úlcera por pressão foi de 25% indicando a necessidade de implementação de intervenções efetivas para a prevenção desse evento adverso no perioperatório.


OBJECTIVE: To identify the occurrence of stages II, III and IV pressure ulcers in patients undergoing elective surgery. METHODS: A quantitative approach, with non-experimental research design, of a descriptive and prospective type. The sample consisted of 148 adult patients of both genders, undergoing elective surgery, according to predetermined selection criteria. RESULTS: Of the sample evaluated, 108 patients were discharged from hospital, three patients died and 37 developed pressure ulcers. These patients presented 44 lesions, the majority of which were diagnosed as stage II (56.8%), followed by stage I (40.9%) and stage III (2.3%) lesions. The body areas most affected were the sacral / gluteal region (68.2%), the heels (18.1%), dorsal region (9%) and the external ear (4.6%). CONCLUSION: The occurrence of pressure ulcers was 25%, indicating the need for implementation of effective interventions for the prevention of these adverse events in the perioperative period.


OBJETIVO: Identificar la ocurrencia de úlcera por presión en pacientes sometidos a cirugías electivas de porte II, III y IV. MÉTODOS: Estudio de abordaje cuantitativo, con delineamiento de investigación no experimental, tipo descriptivo y prospectivo. La muestra estuvo compuesta por 148 pacientes adultos, de ambos géneros, sometidos a la cirugía electiva, conforme los criterios de selección determinados previamente. RESULTADOS: De la muestra evaluada, 108 pacientes recibieron alta hospitalaria, tres fallecieron y 37 desarrollaron úlceras por presión. Esos pacientes presentaron 44 lesiones, siendo la mayoría diagnosticada de estadío II (56,8%), seguida por lesiones de estadío I (40,9%) y estadío III (2,3%). Las áreas corporales más afectadas fueron la región sacro/glútea (68,2%), calcáneos (18,1%), región dorsal (9%) y el pabellón auricular (4,6%). CONCLUSIÓN: La ocurrencia de úlcera por presión fue del 25% indicando la necesidad de implementación de intervenciones efectivas para la prevención de ese evento adverso en el perioperatorio.


Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Young Adult , Perioperative Nursing , Elective Surgical Procedures/adverse effects , Pressure Ulcer/epidemiology , Epidemiology, Descriptive , Incidence , Prospective Studies , Evaluation Studies as Topic
17.
Chinese Journal of Urology ; (12): 392-395, 2011.
Article in Chinese | WPRIM | ID: wpr-416788

ABSTRACT

Objective To evaluate the of the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy (PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indication for bilateral PCNL were enrolled in the study from Jan. 2008 to Dec. 2008. The decision to perform staged or synchronous bilateral PCNL was based on the initial side operative time, the changes of hemoglobin level and systolic arterial pressure, the results of blood gas analysis and the patient′s tolerance at the end of initial side operation. The patients were divided into two groups, patients who underwent synchronous bilateral PCNL were in group one. Patients where the PCNL procedure was stopped after the initial side and subsequently underwent staged bilateral PCNL three to six weeks later were placed in group two. The success and complication rates of two groups were compared and analyzed. Results Of 60 planned simultaneous bilateral PCNLs, nine were stopped after the initial side, due to prolonged operative time in four cases, a hemoglobin level <100 g/L or the decrease of more than 30 g/L in three cases, a systolic arterial pressure lower than 90 mm Hg or the decrease more than 30 mm Hg in two cases, an arterial blood pH lower than 7.35 or the arterial oxygen saturation lower than 95% in two cases or the patients were intolerant to the surgery in three cases. Between the two groups, the differences of patient gender, age, BMI, preoperative hemoglobin level, the total hemoglobin decrease, the side initiated operation, stone number and second side stone burden were insignificant. However, there were significant differences in the first operative side stone burden, total stone burden, the first operative side operative time and total operative time. The stone-clearance rate was 87.3% in group one and 88.9% in group two. There was no difference in complication rate of two groups. Conclusions Prolonged operative time, large blood loss during the first operation side and patient intolerance are the main causes of staged bilateral PCNL.

18.
Chinese Journal of Urology ; (12): 365-367, 2011.
Article in Chinese | WPRIM | ID: wpr-416781

ABSTRACT

Objective To evaluate the efficacy of laparoscopic adrenalectomy and open adrenalectomy in treating recurrent Cushing′s disease. Methods Forty-three patients (29 females and 14 males) with recurrent Cushing′s disease treated with laparoscopic adrenalectomy (LA, n=32) or open (OA, n=11) adrenalectomy from 2000 to 2008 were retrospectively analyzed. Patients completed the follow-up survey including a 36 item short-form (SF-36) health survey. Results All 43 patients achieved successful adrenalectomies without intraoperative complication. The duration of the LA was significantly shorter than that for the OA. Intraoperative blood loss was low in both groups. Median length of hospital stay was shorter in the laparoscopic adrenalectomy group, P200 ng/ml and six (27.3%) had clinical Nelson syndrome. Thirty-four patients who completed the SF-36 survey reported that they felt their health status had changed from good to excellent after adrenalectomy. However, except for social activity, they showed significantly lower SF-36 scores compared with the general population, P<0.05. No statistical difference was found in SF-36 scores between the laparoscopic and open groups. Conclusions Adrenalectomy is safe and an effective option in the treatment of recurrent Cushing′s disease. It can help patients to improve both survival rate and quality of life.

19.
Chinese Journal of Trauma ; (12): 428-430, 2011.
Article in Chinese | WPRIM | ID: wpr-412830

ABSTRACT

Objective To investigate the selection and curative effect of surgical approach for thoracolumbar fractures. Methods A retrospective analysis was conducted on 212 patients with thoracolumbar fractures treated surgically from January 1995 to January 2009 to observe the spinal column and the neurological function recovery. Results Anterior surgery was performed in 73 patients and posterior surgery in 139. The patients were followed up for average 23.7 months ( range, 12-52 months). The height of injury vertebral, the Cobb' s angle and the volume of vertebral canal were improved significantly (P <0.01 ). The patients with incomplete paralysis all got nerve function recovery at different extents ( from one grade to three grades). Conclusions Surgical treatment for thoracolumbar fractures can effectively recover the spine structure and promote the nerve function recovery. The surgical approach should be selected based on the fracture type.

20.
Chinese Journal of Urology ; (12): 416-419, 2010.
Article in Chinese | WPRIM | ID: wpr-389454

ABSTRACT

Objective To evaluate the diagnosis and treatment of urinary tract endometriosis.Methods Retrospective review of 10 female cases of urinary tract endometriosis was carried out. All cases age was from 28-49, and the average age was 39-year-old. The course of this disease was from 6 months to 3 years. Four of 10 cases were bladder endometriosis. The clinical presentations included the urgency, frequency, pain at micturition and lower abdomen pain during menstruation, gross hematuria coinciding with menstruation 1 case. B-ultrasound and CT showed the mass of bladder from 2. 0 -3.5 cm but were not specific. Four of 6 cases ureteral endometriosis were the left side and 2 cases were the right side. This clinical presentation included non-specific flank or abdomenal discomfort in 4 cases, intermittent gross hematuria in 1 case and 1 case renal hydronephrosis was found incidentally by B-ultrasound. B-ultrasound indicated unilateral upper urinary tract dilation and hydrops in all cases,with pyelic separation from 2.0-4.5 cm and ureteral separation from 1-2 cm. CT indicated stenosis of the lower ureter in 5 cases, ureter tumor in 1 case. Results All cases were treated surgically.Partial cystectomy were performed in 4 cases of bladder endometriosis, of which, 1 case bilateral oophorectomy and hysterectomy. Five cases were performed ureteral segmental resection, of which, 3 ureterocystostomy and 2 terminoterminal anastomosis. 1 case was performed radical nephrectomy and ureterectomy. Postoperative pathological findings confirmed the diagnosis of endometriosis. Postoperative oral hormone therapy was given to 9 cases for 6-12 months. All cases were followed for 12-60months. 2 cases ureteral endometriosis had recurrent hydronephrosis in 18-24 months. The 2 cases received ureteral stent and cured by oral hormone therapy or goserelin subcutaneous injection for 3 months. Conclusions Urinary tract endometriosis usually shows non-specific symptoms. The diagnosis can be missed on both clinical examination and preoperative work-up. Surgical treatment is effective and adjuvant hormone therapy is often recommended to prevent the recurrence.

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