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1.
Braz. j. otorhinolaryngol. (Impr.) ; 88(2): 235-242, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1374731

ABSTRACT

Abstract Introduction: Fibrous dysplasia is a benign disorder, in which normal bone is replaced by fibrosis and immature bone trabeculae, showing a similar distribution between the genders, and being more prevalent in the earlier decades of life. Fibrous dysplasia of the temporal bone is a rare condition, and there is no consensus as to whether it is more common in monostotic or polyostotic forms. External auditory meatus stenosis and conductive dysacusis are the most common manifestations, with cholesteatoma being a common complication, whereas the involvement of the otic capsule is an unusual one. Surgical treatment is indicated to control pain or dysacusis, otorrhea, cholesteatoma, and deformity. Objectives: To describe the clinical experience of a tertiary referral hospital with cases of fibrous dysplasia of the temporal bone. Methods: Sampling of patients diagnosed with fibrous dysplasia of the temporal bone, confirmed by tomography, treated at the pediatric otology and otorhinolaryngology outpatient clinics, between 2015 and 2018. The assessed variables were age, gender, laterality, external auditory meatus stenosis, deformity, hearing loss, presence of secondary cholesteatoma of the external auditory meatus, lesion extension and management. Results: Five patients were included, four females and one male, with age ranging from 13 to 34 years. Three had the polyostotic form and two the monostotic form of fibrous dysplasia of the temporal bone. Four patients had local deformity and external auditory meatus stenosis, two of which progressed to cholesteatoma. All patients showed some degree of hearing impairment. All had preserved otic capsule at the tomography. Two patients are currently undergoing clinical observation; two were submitted to tympanomastoidectomy due to secondary cholesteatoma; one was submitted to lesion resection, aiming to control the dysacusis progression. Conclusion: Five cases of fibrous dysplasia of the temporal bone were described, a rare disorder of which the otologist should be aware.


Resumo Introdução: Displasia fibrosa é uma desordem benigna, na qual o osso é substituído por fibrose e trabeculado ósseo imaturo, com distribuição semelhante entre sexos, mais comum nas primeiras décadas de vida. O acometimento do osso temporal pela displasia fibrosa é raro, não há consenso se é mais comum nas formas monostóticas ou poliostóticas. Estenose do meato acústico externo e disacusia condutiva são as manifestações mais comuns. Colesteatoma é também uma complicação comum e o acometimento da cápsula ótica incomum. O tratamento cirúrgico está indicado para controle de dor ou disacusia, otorreia, colesteatoma, deformidade. Objetivos: Descrever a experiência clínica de hospital terciário de referência com casos de displasia fibrosa do osso temporal. Método: Amostragem dos pacientes com diagnóstico de displasia fibrosa do osso temporal, confirmado pela tomografia, atendidos nos ambulatórios de otologia e otorrinolaringologia pediátrica, entre 2015 e 2018. As variáveis avaliadas foram idade, gênero, lateralidade, estenose do meato acústico externo, deformidade, perda auditiva, presença de colesteatoma secundário de meato acústico externo, extensão da lesão e conduta adotada. Resultados: Foram incluídos cinco pacientes, quatro do sexo feminino e um masculino, de 13-34 anos. Três apresentaram a forma poliostótica da displasia fibrosa do osso temporal e dois a forma monostótica. Quatro apresentaram deformidade local e estenose do meato acústico externo, dois desses evoluíram com colesteatoma. Todos manifestaram algum grau de comprometimento auditivo. Todos apresentaram cápsula ótica preservada na tomografia. Duas pacientes estão em observação clínica; duas foram submetidas a timpanomastoidectomia devido a colesteatoma secundário; um foi submetido a ressecção da lesão para controle de progressão da disacusia. Conclusão: Foram descritos cinco casos de displasia fibrosa do osso temporal, desordem rara para a qual o otologista deve estar atento.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Cholesteatoma/complications , Cholesteatoma/pathology , Fibrous Dysplasia of Bone/surgery , Fibrous Dysplasia of Bone/diagnosis , Fibrous Dysplasia of Bone/pathology , Temporal Bone/pathology , Temporal Bone/diagnostic imaging , Constriction, Pathologic/etiology , Hearing Disorders
2.
Rev. bras. oftalmol ; 81: e0033, 2022. tab, graf
Article in Portuguese | LILACS | ID: biblio-1376776

ABSTRACT

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.


ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.


Subject(s)
Humans , Radiotherapy/adverse effects , Iodine Radioisotopes/adverse effects , Lacrimal Duct Obstruction/etiology , Lacrimal Duct Obstruction/chemically induced , Lacrimal Duct Obstruction/therapy , Antineoplastic Agents/adverse effects , Dacryocystorhinostomy , Drainage , Constriction, Pathologic/etiology , Lacrimal Apparatus Diseases/prevention & control , Nasolacrimal Duct/drug effects , Nasolacrimal Duct/radiation effects
6.
ABCD arq. bras. cir. dig ; 29(1): 57-59, Jan.-Mar. 2016. graf
Article in English | LILACS | ID: lil-780017

ABSTRACT

Mannose binding lectin is a lectin instrumental in the innate immunity. It recognizes carbohydrate patterns found on the surface of a large number of pathogenic micro-organisms, activating the complement system. However, this protein seems to increase the tissue damage after ischemia. In this paper is reviewed some aspects of harmful role of the mannose binding lectin in ischemia/reperfusion injury.


Lectina de ligação à manose é uma lectina instrumental na imunidade inata. Ela reconhece padrões de hidratos de carbono encontrados na superfície de um grande número de microrganismos patogênicos, que ativam o sistema complemento. No entanto, esta proteína parece aumentar o dano tecidual após isquemia. Neste trabalho são revisados alguns aspectos do papel nocivo da lectina de ligação à manose na lesão de isquemia/reperfusão.


Subject(s)
Humans , Reperfusion Injury/etiology , Coronary Restenosis/etiology , Mannose-Binding Lectin/physiology , Constriction, Pathologic/etiology , Coronary Stenosis/etiology
7.
Rev. chil. cir ; 67(3): 306-308, jun. 2015. ilus
Article in Spanish | LILACS | ID: lil-747506

ABSTRACT

Background: Median arcuate ligament syndrome (SLAM) is caused by extrinsic compression of the celiac artery by fibrous bands of this ligament and periaortic lymph node tissue. Case report: We report a 59 years old man with a history of weight loss, epigastric pain and a postprandial murmur. The syndrome was diagnosed by CT angiography. The patient was operated, performing a midline laparotomy and releasing the extrinsic compression. An early and sustained remission of symptoms was achieved.


Introducción: El síndrome del ligamento arcuato medio (SLAM), es causado por la compresión extrínseca del tronco celíaco por bandas fibrosas de este ligamento y tejido ganglionar periaórtico. Caso clínico: Reportamos el caso de un hombre de 59 años con historia de baja de peso, dolor postprandial y soplo epigástrico, al cual se le diagnostica SLAM por medio de angioTC. Se realiza abordaje quirúrgico, con laparotomía media y liberación de la compresión extrínseca, logrando remisión de los síntomas de forma inmediata y sostenida. El SLAM es una causa infrecuente de dolor abdominal, requiere estudio por imágenes para su diagnóstico, la resolución quirúrgica constituye su tratamiento.


Subject(s)
Humans , Male , Middle Aged , Celiac Artery/surgery , Celiac Artery/pathology , Constriction, Pathologic/surgery , Constriction, Pathologic/etiology , Ligaments/surgery , Ligaments/pathology , Angiography , Tomography, X-Ray Computed
8.
Article in English | WPRIM | ID: wpr-39279

ABSTRACT

OBJECTIVE: To assess actual rates of late vaginal stenosis and identify predisposing factors for complications among patients with previously untreated cervical cancer following high-dose-rate brachytherapy. METHODS: We performed longitudinal analyses of 57 patients using the modified Dische score at 6, 12, 18, 24, 36, and 60 months after treatment, which consisted of 15 interstitial brachytherapys and 42 conventional intracavitary brachytherapys, with a median follow-up time of 36 months (range, 6 to 144 months). RESULTS: More than half of the patients developed grade 1 (mild) vaginal stenosis within the first year of follow-up, and grade 2 (97.5%, moderate) to grade 3 (severe) stenosis gradually increased with time. Actual stenosis rates for grade 1, 2, and 3 were 97.5% (95% confidence interval [CI], 92.7 to 97.5), 60.7% (95% CI, 42.2 to 79.3), and 7.4% (95% CI, 0 to 18.4) at 3 years after treatment. Pallor reaction grade 2-3 at 6 months was only a statistically significant predisposing factor for grade 2-3 late vaginal stenosis 3 years or later with a hazard ratio of 3.48 (95% CI, 1.32 to 9.19; p=0.018) by a multivariate Cox proportional hazard model. Patients with grade 0-1 pallor reaction at 6 months showed a grade > or =2 vaginal stenosis rate of 53%, whereas the grade 2-3 pallor reaction group achieved a grade > or =2 vaginal stenosis rate at 3 years at 100% (p=0.001). CONCLUSION: High-dose-rate brachytherapy was associated with high incidence of late vaginal stenosis. Pallor reaction grade 2-3 at 6 months was predictive of late grade 2-3 vaginal stenosis at 3 years after treatment. These findings should prove helpful for patient counseling and preventive intervention.


Subject(s)
Adult , Aged , Aged, 80 and over , Brachytherapy/adverse effects , Constriction, Pathologic/etiology , Female , Humans , Iridium Radioisotopes/therapeutic use , Middle Aged , Pallor , Prognosis , Prospective Studies , Radiopharmaceuticals/therapeutic use , Retrospective Studies , Uterine Cervical Neoplasms/radiotherapy , Vaginal Diseases/etiology
9.
Article in English | WPRIM | ID: wpr-157421

ABSTRACT

OBJECTIVE: Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. MATERIALS AND METHODS: A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. RESULTS: Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. CONCLUSION: Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.


Subject(s)
Animals , Constriction, Pathologic/etiology , Disease Models, Animal , Embolization, Therapeutic/adverse effects , Gelatin , Gelatin Sponge, Absorbable/chemistry , Kidney/blood supply , Male , Porifera , Rabbits , Renal Artery/pathology , Swine
10.
Rev. chil. cardiol ; 33(3): 228-233, dic. 2014. ilus
Article in Spanish | LILACS | ID: lil-743827

ABSTRACT

Introducción: El balón intraaórtico de contrapulsación (BIAC) puede utilizarse como soporte circulatorio en pacientes cuyo tratamiento definitivo no está en el hospital de ingreso y es necesario hacer un traslado pensando en el mejor resultado final para el paciente. No existen reportes nacionales de este tipo de traslado Presentación del caso: Paciente mujer de 62 años con múltiples antecedentes mórbidos fue trasladada desde Tocopilla al Hospital Regional de Antofagasta (HRA), consultando por cuadro de disnea progresiva y dolor en hemiabdomen superior de 72 horas de evolución. Se planteó un síndrome coronario agudo y se solicitó co-ronariografía que reveló una estenosis de la arteria descendente anterior en su 1/3 medio en un 80%. Se realizó una angioplastía con Stent DES. Al llegar a UCI destaca soplo pansistólico en foco mitral solicitándose ecocar-diograma Doppler Color que mostró una comunicación interventricular (CIV) (Figura 1). Se instaló un balón de contrapulsación intra aórtico (Figura 2) y se planificó el traslado aéreo al Hospital Gustavo Fricke (HGF) que se efectuó sin incidentes (Figura 3). Tres días después se cerró la CIV manteniendo el balón de contrapulsación intra aórtico. Un ecocardiograma de control mostró una CIV residual de 0,7 mm y la evolución clínica posterior fue satisfactoria. Al 13er día post operación se constató una infección de la herida operatoria. Se trató con an-tibióticoterapia y aseo quirúrgico en 4 oportunidades, evolucionando satisfactoriamente. Se trasladó de regreso al Hospital de Antofagasta sin complicaciones y finalmente se dio de alta.


Introduction: Intra-aortic balloon counterpulsation (IABC) has been used for many years. IABC serves as circulatory support in patients where definitive care is not in the admission hospital. There are not reports of air transport with IABC in our national reality. Case report: A 62 year old patient with multiple morbid history was derived from Tocopilla to Antofagasta's Regional Hospital (ARH), she consulted for progressive dyspnea and abdominal pain 72 hours ago. We diagnosed acute coronary syndrome and the coronariography informs coronary stenosis of the anterior descending artery in the middle third about 80%. Angioplasty with stent is performed. The patient arrived to UCI, in the physical examination stands mitral pansystolic murmur. Color doppler echocardiography was requested: highlight interventricular comunication (IVC). Counterpulsation balloon is positioned and we planned the air transport to Gustavo Fricke Hospital (HGF). Transfer HRA-HGF was performed uneventfully with stable patient. 3 days after, IVC is closed and maintains IABC. Control echocardiography reports 0.7 mm residual IVC with satisfactory clinical course. At the 13th post-surgical day, the wound becomes infected and she is treated with antibiotic therapy and surgical toilet in 4 opportunities to evolve successfully. The HGF-HRA transfer is done without complications, his recuperation is satisfactory and she is discharged from the ARH. Discussion: There is evidence that the air tranfers with BIAC are safe, always considering factors such as the expansion of gases and electronic failures.


Subject(s)
Humans , Female , Middle Aged , Air Ambulances , Intra-Aortic Balloon Pumping , Heart Injuries/etiology , Heart Injuries/therapy , Transportation of Patients/methods , Constriction, Pathologic/etiology , Emergency Medical Services , Myocardial Infarction/complications , Heart Septum/injuries , Patient Transfer/methods
11.
Rev. chil. pediatr ; 85(5): 594-598, oct. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-731648

ABSTRACT

Introduction: The most common congenital malformations of the bile duct are biliary atresia and choledochal cyst. In addition, the most common liver anatomical variation is the right hepatic artery aberration. The goal of this study is to characterize a patient with this disease and propose the hepatoduodenal anastomosis as surgical treatment. Case report: One-month-old patient with suspected congenital biliary atresia due to progressive jaundice and acholia since birth. Liver tests consistent with a cholestatic pattern and brain MRI scan consistent with biliary atresia. Periods of decreased bilirubin and sporadic slight pigmentation of depositions were described. The surgical finding was a bile duct stricture due to a vascular ring caused by aberrant right hepatic artery. Resection of bile duct and hepatic-duodenal bypass were performed. The patient evolved satisfactorily from this condition. Conclusion: There are few reports of biliary obstruction due to vascular malformations. It is important to keep in mind that not all neonatal jaundice episodes are caused by biliary atresia or choledo-chal cyst. The clinical course, laboratory tests and imaging should be considered and in the case of suspicion, further exploration should take place.


Introducción: Las malformaciones congénitas de la vía biliar más frecuentes son la atresia de vías biliares y quiste de colédoco. Por otro lado, la variante anatómica hepática más común es la aberración de la arteria hepática derecha. El objetivo es caracterizar un paciente portador de esta patología y plantear la hepato-duodeno anastomosis como tratamiento quirúrgico. Caso clínico: Paciente de 1 mes de edad, con sospecha de Atresia de Vía Biliar congénita por ictericia progresiva y acolia desde recién nacido. Pruebas hepáticas concordantes con un patrón colestásico y resonancia magnética compatible con atresia de vías biliares. Evolucionó con períodos de descenso de bilirrubina y leve pigmentación, esporádica, de deposiciones. El hallazgo quirúrgico fue una estenosis crítica de vía biliar a nivel del conducto hepático común debido a un anillo vascular por una arteria hepática derecha aberrante. Se realizó una sección de vía biliar y una derivación hepato-duodenal. Evolucionó con una resolución completa de su patología. Conclusión: Existen pocos reportes de obstrucción de vía biliar por malformaciones vasculares. Es importante tener presente que no todas las ictericias neonatales son por atresia de vías biliares o quiste de colédoco. Se debe considerar la evolución clínica, laboratorio e imágenes, y si existen sospechas, explorar.


Subject(s)
Female , Humans , Infant , Common Bile Duct Diseases/diagnosis , Constriction, Pathologic/diagnosis , Hepatic Artery/abnormalities , Vascular Diseases/diagnosis , Biliary Atresia/diagnosis , Common Bile Duct Diseases/etiology , Common Bile Duct Diseases/surgery , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Hepatic Artery/surgery , Treatment Outcome , Vascular Diseases/complications , Vascular Diseases/surgery
12.
Medicina (B.Aires) ; 74(4): 303-306, ago. 2014. ilus
Article in Spanish | LILACS | ID: lil-734389

ABSTRACT

El aislamiento de las venas pulmonares mediante la aplicación de radiofrecuencia es un tratamiento efectivo de la fibrilación auricular. Una de las complicaciones potenciales y de mayor compromiso clínico de esta técnica invasiva es la estenosis de una o varias venas pulmonares. Esta complicación puede ser tratada mediante angioplastia con o sin colocación de stent, logrando una adecuada mejoría clínica, aunque con un alto índice de recurrencia por re-estenosis.


Isolation of the pulmonary veins by applying radiofrequency is an effective treatment for atrial fibrillation. One of the potential complications with higher clinical compromise utilizing this invasive technique is the occurrence of stenosis of one or more pulmonary veins. This complication can be treated by angioplasty with or without stent implantation, with an adequate clinical improvement, but with a high rate of restenosis.


Subject(s)
Humans , Male , Middle Aged , Angioplasty , Catheter Ablation/adverse effects , Pulmonary Veins/pathology , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Stents
13.
Rev. chil. cir ; 66(1): 15-21, feb. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-705547

ABSTRACT

Introducción: La cirugía bariátrica revisional se realiza para modificar o reparar alguno de los tipos de cirugía para perder peso, entre ellos la gastrectomía vertical laparoscópica (GVL). La revisión de procedimientos bariátricos se hace necesaria entre el 10 al 25 por ciento de los pacientes, ya sea por baja de peso insuficiente o por complicaciones, siendo la estenosis una de ellas. Posterior a una GVL, el bypass gástrico en Y de Roux (BPG) es la intervención quirúrgica más requerida para la conversión. El objetivo de este estudio fue describir una serie de 5 pacientes que tuvieron cirugía revisional por estenosis posterior a una GVL. Material y Métodos: Entre enero de 2006 y marzo de 2013, en 770 pacientes consecutivos se realizó GVL. Los pacientes fueron incluidos en un protocolo prospectivo. Cinco pacientes tuvieron cirugía revisional con conversión a BPG por estenosis posterior a la GVL. Tres pacientes fueron operados de GVL en nuestro hospital, los otros 2 provenían de otros centros hospitalarios. Resultados: En los 5 pacientes con cirugía revisional la edad promedio fue 39,8 +/- 15,7 años. Cuatro pacientes fueron mujeres (80 por ciento). El promedio IMC antes de GVL fue 37,0 +/- 2,1 kg/m² y del IMC antes del BPG fue 29,4 +/- 5,4 kg/m². El BPG fue laparoscópico en 3 casos y abierto en 2. No hubo complicaciones, ni mortalidad. Conclusiones: La conversión a bypass gástrico en Y de Roux es un tratamiento efectivo para la estenosis posterior a una GVL.


Introduction: Revisional bariatric surgery is performed to alter or repair one of the many types of weight loss surgery, including laparoscopic sleeve gastrectomy (LSG). The revision of bariatric procedures is required between 10 to 25% of patients operated, either by insufficient weight loss or complications, including stenosis. After a LSG, the Roux- en- Y gastric bypass (RYGBP) is the most requested surgery for conversion. The aim of this study was to describe a series of 5 patients who had revisional surgery for stenosis following LSG. Material and Method: Between January 2006 and March 2013, in 770 consecutive patients was performed LSG. Patients were included in a prospective protocol. Five patients had revisional surgery with conversion to RYGBP for stenosis following LSG. In three patients the initial LSG was performed in our hospital, the other 2 were from other hospitals. Results: In the 5 patients with revisional surgery mean age was 39.8 ± 15.7 years. Four patients were women (80%). The average BMI before LSG was 37.0 ± 2.1 kg/m2 and BMI before RYGBP was 29.4 ± 5.4 kg/m2. The RYGBP was laparoscopic in 3 cases and opened in two. There were no complications, and no mortality. Conclusions: Conversion to RYGBP is an effective treatment for stenosis following a LSG.


Subject(s)
Humans , Male , Adult , Female , Aged , Constriction, Pathologic/surgery , Constriction, Pathologic/etiology , Gastrectomy/adverse effects , Laparoscopy , Bariatric Surgery/adverse effects , Gastrectomy/methods , Obesity, Morbid/surgery , Reoperation
14.
Article in English | WPRIM | ID: wpr-203183

ABSTRACT

Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.


Subject(s)
Aged , Brachiocephalic Veins , Central Venous Catheters/adverse effects , Constriction, Pathologic/etiology , Female , Humans , Jugular Veins , Renal Dialysis/instrumentation , Stents , Superior Vena Cava Syndrome/etiology , Vena Cava, Superior
15.
Gut and Liver ; : 394-399, 2014.
Article in English | WPRIM | ID: wpr-175282

ABSTRACT

BACKGROUND/AIMS: The aim of this study was to evaluate the outcome of endoscopic dilation for benign anastomotic stricture after radical gastrectomy in gastric cancer patients. METHODS: Gastric cancer patients who underwent endoscopic balloon dilation for benign anastomosis stricture after radical gastrectomy during a 6-year period were reviewed retrospectively. RESULTS: Twenty-one patients developed benign strictures at the site of anastomosis. The majority of strictures occurred within 1 year after surgery (95.2%). The median duration to stenosis after surgery was 1.70 months (range, 0.17 to 23.97 months). The success rate of the first endoscopic dilation was 61.9%. Between the restenosis group (n=8) and the no restenosis group (n=13), there were no significant differences in the body mass index (22.82 kg/m2 vs 22.46 kg/m2), interval to symptom onset (73.9 days vs 109.3 days), interval to treatment (84.6 days vs 115.6 days), maximal balloon diameter (14.12 mm vs 15.62 mm), number of balloon dilation sessions (1.75 vs 1.31), location of gastric cancer or type of surgery. One patient required surgery because of stricture refractory to repeated dilation. CONCLUSIONS: Endoscopic dilation is a highly effective treatment for benign anastomotic strictures after radical gastrectomy for gastric cancer and should be considered a primary intervention prior to proceeding with surgical revision.


Subject(s)
Anastomosis, Surgical/adverse effects , Constriction, Pathologic/etiology , Dilatation/methods , Female , Gastrectomy/adverse effects , Gastroscopy/methods , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Stomach Neoplasms/surgery , Treatment Outcome
16.
GEN ; 67(2): 96-100, jun. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-690969

ABSTRACT

La obstrucción del tracto de salida gástrico es poco frecuente en la infancia; su etiología es diversa e incluye causas congénitas y adquiridas. Las manifestaciones clínicas son variadas e inespecíficas como dolor y/o distensión abdominal, vómitos y pérdida de peso. El diagnóstico se realiza por la anamnesis apoyada en estudios de imágenes como radiología simple y contrastada y, en ocasiones, ecografía y TAC abdominal. La endoscopia digestiva superior confirma el diagnóstico y proporciona valor pronóstico y terapéutico. El tratamiento, desde hace muchos años ha sido la cirugía, con espectro variable de técnicas quirúrgicas y morbilidad y mortalidad asociada. Desde el advenimiento de las técnicas endoscópicas y la aparición del balón "through-the-scope", la terapia endoscópica constituye la primera línea de tratamiento. Se presentan dos pacientes de 2 y 5 años de edad que consultaron a nuestro Servicio por presentar vómitos, distensión abdominal y pérdida de peso de un mes de evolución, recibiendo tratamientos adecuados sin mejoría, en quienes se diagnosticó inicialmente obstrucción del tracto de salida gástrico asociado a úlcera prepilórica cicatrizada. En uno de ellos se reportó el antecedente de ingestión de golosina ácida y en el segundo no se encontró causa aparente. La resolución fue satisfactoria en ambos por dilatación endoscópica antropilórica con balón neumático, sin complicaciones


The tractus gastric obstruction of exit is frequent in infancy; its etiology is diverse and includes congenital causes and adquired. the clinical manifestations are varied and specific like pain And or abdominal distension, vomiting, and weight loss the diagnosis is carry out through anamnesis backed up in studies of images like simple radiology, and contrasted and at times, echography and abdominal TAC. The digestive superior endoscopy confirms the diagnosis and provides value forecast and therapeutic. The treatment, has been surgery eversince with variable specter of surgical technologists and morbidity and mortality associated however, since the arrival of the endoscopic techniques and the appearing of the baron "through-the-scope", the endoscopic treatment constitutes the front line of treatment. Two patients of 2 and 5 years old that consulted our service for presenting vomiting, abdominal distension and weight loss of a month of evolution, receiving appropriate treatment without improvement, whose obstruction of exit was diagnosed initially gastric prepyloric ulcer healedwas associated. In one of them the antecedent of ingestion of acid sweet was yielded and in the second one there was not anhy cause. Resolution was satisfactory in both for dilatation endoscopic antropyloric with pneumatic ball, without complications


Subject(s)
Humans , Male , Child, Preschool , Medical History Taking/methods , Catheterization/methods , Constriction, Pathologic/complications , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Constriction, Pathologic , Endoscopy, Digestive System , Gastroenterology , Pediatrics
18.
Rev. Col. Bras. Cir ; 39(2): 99-104, mar.-abr. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-626627

ABSTRACT

OBJETIVO: Avaliar uma série de casos de estenose cicatricial de vias biliares pós-colecistectomia submetidos à reconstrução cirúrgica. MÉTODOS: Foi realizado estudo retrospectivo de 27 pacientes submetidos à reconstrução cirúrgica da via biliar por estenose cicatricial. O tipo de colecistectomia que resultou na lesão, idade e sexo, sinais e sintomas, o momento do diagnóstico, se precoce ou tardio, presença de cirurgias prévias na tentativa de reconstruir a árvore biliar, classificação das estenoses, e tipo de operação empregada para o tratamento da injúria foram analisados. RESULTADOS: Vinte e seis lesões ocorreram durante laparotomia e uma durante vídeolaparoscopia. Dezesseis pacientes (59%) tiveram as lesões diagnosticadas no transoperatório ou nos primeiros dias de pós-operatório, sete (26%) dos quais já submetidos à reoperação no hospital de origem, evoluindo mal; nove pacientes desse grupo (33%) não tinham reoperação. Onze pacientes (41%) apresentaram a forma clássica de estenose cicatricial, sem acidentes transoperatórios aparentes, com desenvolvimento de obstrução biliar tardia. Todos os pacientes foram submetidos à anastomose hepático-jejunal em "Y" de Roux, sendo que em dois casos os ductos hepáticos direito e esquerdo foram implantados separadamente na alça exclusa de jejuno. Vinte e seis pacientes (96,3%) evoluíram bem inicialmente, um paciente teve fístula biliar e foi a óbito. Uma paciente com bom resultado inicial apresentou recidiva da anastomose, cirrose secundária e está aguardando transplante hepático. CONCLUSÃO: A maioria das lesões foi diagnosticada durante a colecistectomia ou nos primeiros dias de pós-operatório, sete pacientes já tinham sido operados na tentativa de reconstruir o trato biliar. A hepaticojejunostomia em "Y" de Roux empregada mostrou-se segura e efetiva em recanalizar a via biliar a curto e longo prazos.


OBJECTIVE: To evaluate a series of cases of cicatricial stenosis of the biliary tract after cholecystectomy undergoing surgical reconstruction. METHODS: We conducted a retrospective study with 27 patients who underwent surgical reconstruction of the biliary tree for cicatricial stenosis. We analyzed the type of cholecystectomy that resulted in injury, age, gender, signs and symptoms, time of diagnosis, early or late, presence of previous surgery in an attempt to reconstruct the biliary tree, classification of stenosis and type of operation used for treatment of the injury. RESULTS: Twenty-six injuries occurred during a laparotomy and one during laparoscopy. Sixteen (59%) lesions were diagnosed intraoperatively or within the first postoperative day, seven (26%) havinh been submitted to reoperation at the local hospital, with poor results; nine patients in this group (33%) had no reoperation. Eleven patients (41%) had the classic form of cicatricial stenosis, without apparent intraoperative accidents and late development of biliary obstruction. All patients underwent Roux-en-Y hepatic-jejunal anastomosis; in two cases the right and left hepatic ducts were implanted separately in the excluded jejunal loop. Twenty-six patients (96.3%) had no early complications; one patient had biliary fistula and died. One patient presented with stenosis recurrence, secondary cirrhosis and is awaiting liver transplantation. CONCLUSION: Most injuries were diagnosed during cholecystectomy within the first postoperative days; seven patients had been reoperated in an attempt to reconstruct the biliary tract. Roux-en-Y hepaticojejunostomy proved safe and effective in draining the bile duct in the short and long term.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Biliary Tract Diseases/etiology , Biliary Tract Diseases/surgery , Cholecystectomy/adverse effects , Cicatrix/etiology , Cicatrix/surgery , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Retrospective Studies
19.
Article in English | WPRIM | ID: wpr-39910

ABSTRACT

We present a case of pulmonary vein (PV) stenosis after radio-frequency (RF) ablation, in which a hemodynamic change in the pulmonary artery was similar to that of congenital PV atresia on time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA). A 48-year-old man underwent RF ablation due to atrial fibrillation. The patient subsequently complained of hemoptysis, dyspnea on exertion, and right chest pain. Right PV stenosis after catheter ablation was diagnosed through chest computed tomography and lung perfusion scan. Pulmonary TR-MRA revealed the pulmonary artery via systemic arterial collaterals and draining systemic collateral veins. On a velocity-encoded cine image, the flow direction of the right pulmonary artery was reversed in the diastolic phase and the left pulmonary artery demonstrated continuous forward flow throughout the cardiac cycle. These hemodynamic changes were similar to those seen in congenital unilateral PV atresia.


Subject(s)
Atrial Fibrillation/surgery , Blood Flow Velocity , Catheter Ablation/adverse effects , Constriction, Pathologic/etiology , Contrast Media , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Pulmonary Artery/pathology , Pulmonary Circulation , Pulmonary Veins/pathology
20.
Rev. bras. cir. cardiovasc ; 26(3): 504-507, jul.-set. 2011.
Article in Portuguese | LILACS | ID: lil-624535

ABSTRACT

Cistos pericárdicos são raros, comumente congênitos, com localização mais frequente no ângulo cardiofrênico direito. O diagnóstico é suspeitado pela radiografia de tórax anormal. O presente relato descreve um caso de cisto pericárdico com aspecto radiográfico atípico, em um paciente atleta, manifestando-se clinicamente com sintomas de insuficiência ventricular direita. O diagnóstico foi sugerido pelo ecocardiograma transesofágico e confirmado pelo estudo anatomopatológico.


Pericardial cysts are rare, usually congenital. Cysts frequently occur in the right cardiophrenic angle and their diagnosis is usually suspected after an abnormal chest X ray. The present case report shows a case of pericardial cyst with atypical radiographic aspect in an athletic patient who presented clinical with symptoms of right ventricular failure. The diagnosis was suggested by echocardiogram and subsequently was confirmed by pathologic examination.


Subject(s)
Adult , Humans , Male , Mediastinal Cyst/complications , Ventricular Dysfunction, Right/etiology , Weight Lifting/injuries , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Mediastinal Cyst/surgery , Ventricular Dysfunction, Right/surgery
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