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1.
Medisan ; 25(5)2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1346546

ABSTRACT

Se presenta el caso clínico de un anciano de 73 años de edad, que fue asistido en el Cuerpo de Guardia del Hospital General Docente Enrique Cabrera Cossío de La Habana por haber sido mordido en el rostro, en la región supraciliar derecha, por un perro, que le causó una herida avulsiva, con pérdida considerable de tejidos blandos, abundante sangrado y dolor. Luego de efectuar antisepsia del área y profilaxis con antibióticos, se practicó rápidamente el procedimiento quirúrgico, que consistió en desbridamiento de la herida y reconstrucción del defecto a través de plastia primaria con técnica de colgajos locales de avance y rotación, lo que permitió una evolución favorable, tanto estética como funcional, en el paciente.


The case report of a 73 years old man is presented. He was assisted in the Emergency Service of Enrique Cabrera Cossío Teaching General Hospital in Havana city, due to a dog bite in his face, in the right supraciliary region, that caused him a lacerated wound, with considerable loss of soft tissues, abundant bleeding and pain. After making antisepsis of the area and prevention with antibiotics, the surgical procedure was quickly practiced that consisted on debridement of the wound and reconstruction of the defect through primary plasty with technique of advance and rotation local flaps, that allowed a favorable clinical course in the patient, both cosmetic and functional.


Subject(s)
Bites and Stings/surgery , Aged , Dogs , Surgical Flaps , Debridement
2.
Rev. venez. cir. ortop. traumatol ; 53(1): 20-26, jun. 2021. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1252895

ABSTRACT

Cuando fracasa el tratamiento conservador en el Estadio I de Disfunción del Tendón Tibial posterior (DTTP), se debe indicar sinovectomía y debridamiento del tendón. En este estudio evaluamos la evolución con 8 años mínimo de seguimiento, de los pacientes con esta patología tratados vía tenoscópica. Este es un estudio retrospectivo de pacientes operados entre el año 2008 y el año 2011. En ese período de tiempo se intervinieron 11 pacientes con esta patología. Sólo 9 de los 11 pacientes operados pudieron ser evaluados. 7 pacientes mejoraron su sintomatología según el VAS y no progresaron a estadio II. En 3 pacientes se evidenció lesión tendinosa durante la tendoscopía y ameritaron reparación a cielo abierto. La sinovectomía tendoscópica del TTP es un procedimiento quirúrgico efectivo para tratar a los pacientes con DTTP Estadio I, rebeldes a tratamiento conservador(AU)


When conservative treatment fails for Stage I Posterior Tibial tendon dysfunction (PTTD), synovectomy and tendon debridement is indicated. In this study we evaluate tendoscopic treatment results for this pathology with a minimum of 8 years follow up. This is a retrospective study of patients after tendoscopic surgery performed between 2008 and 2011. 9 of the 11 patients were available for evaluation. 7 improved their symptoms according to VAS scale, and did not progress to stage II. In 3 patients tendon tear was visualized during tendoscopy and needed open repair. PTT tendoscopy is an effective surgical treatment to treat Stage I PTTD, failing to conservative treatment(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Flatfoot , Magnetic Resonance Spectroscopy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Posterior Tibial Tendon Dysfunction/pathology , Tendinopathy , Synovectomy , Ultrasonics , Cryotherapy , Diagnostic Techniques and Procedures , Debridement
3.
Medicina (B.Aires) ; 81(1): 115-118, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287251

ABSTRACT

Resumen El tratamiento escalonado de la pancreatitis aguda necrotizante infectada consiste en el uso de antibióticos de amplio espectro, drenaje y necrosectomía mínimamente invasiva, si fuese necesaria. Esto ha reemplazado a la cirugía abierta como el estándar de tratamiento. El desbridamiento retroperitoneal video asistido (VARD), es una forma de necrosectomía quirúrgica mínimamente invasiva. Presentamos una serie de 5 casos (2 mujeres y 3 varones) con pancreatitis aguda grave y necrosis pancreática infectada tratados de forma escalonada y VARD. El rango de edad fue de 27 a 60 años. Todos los pacientes tuvieron pancreatitis de etiología biliar. El rango del APACHE II fue de 16 a 20. El rango del tiempo para el drenaje percutáneo lumbar fue de 4 a 7 semanas. Hubo una complicación del drenaje percutáneo (fistula duodenal) que se resolvió con tratamiento médico. Los cultivos de todas las necrosis fueron positivos. El tiempo para la realización del VARD tuvo un rango de 6 a 10 semanas. Un paciente requirió dos procedimientos. Hubo dos fístulas pancreáticas tipo B asociadas al VARD, que se trataron conservadoramente. No hubo mortalidad. A largo plazo, dos pacientes fueron diagnosticados de insuficiencia pancreática exocrina y endocrina. Concluimos que en los pacientes con necrosis pancreática infectada que requieran desbridamiento, el VARD es una alternativa segura, efectiva y con buenos resultados a largo plazo.


Abstract The step-up approach for infected necrotizing pancreatitis, consisting of broad-spectrum antibiotics, drainage followed, if necessary, by minimally invasive necrosectomy, has replaced open surgery as the standard of management. Video-assisted retroperitoneal debridement (VARD) is a surgical minimally invasive necrosectomy. This is a 5 cases series (2 female and 3 males) with severe acute pancreatitis and infected pancreatic necrosis who underwent step up approach and VARD. The age ranged from 27 to 60 years old. Al patients had biliary pancreatitis. APACHE II ranged from 16 to 20. The time to percutaneous lumbar drainage ranged from 4 to 7 weeks. There was one complication associated with percutaneous drainage (duodenal fistula) with nonoperative management. All necrotizing pancreatitis had positive cultures. The time to perform VARD ranged from 6 to 10 weeks. One patient required two procedures. There were two type B pancreatic fistulas associated with VARD, managed nonoperatively. There was no mortality. During long-term follow-up two patients were diagnosed with exocrine and endocrine pancreatic insufficiency. We conclude that VARD is a safe and effective procedure in patients with infected necrotizing pancreatitis requiring debridement, and with good long-term outcomes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pancreatitis, Acute Necrotizing/surgery , Retroperitoneal Space , Acute Disease , Treatment Outcome , Debridement
4.
Article in Chinese | WPRIM | ID: wpr-879420

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.@*METHODS@#From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.@*RESULTS@#The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (@*CONCLUSION@#The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.


Subject(s)
Aged , Bone Transplantation , Debridement , Female , Humans , Lumbar Vertebrae/surgery , Male , Pedicle Screws , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Treatment Outcome , Tuberculosis, Spinal/surgery
5.
Rev. bras. ortop ; 55(5): 625-628, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144203

ABSTRACT

Abstract Objective To investigate the incidence of infection in patients with gunshot-related fractures, and to correlate this finding with the occurrence of surgical debridement in the emergency room. Methods A retrospective, observational, descriptive study that included all cases of fractures caused by firearms between January 2010 and December 2014; 245 fractures in 223 patients were included. Results There was surgical-site infection in 8.5% of the fractures, and the mean number of debridements required to control the infectious process was of 1.273 ± 0.608. A correlation was identified between the surgical treatment chosen and the affected body segment (p< 0.001). The surgical treatment in the emergency room had a correlation with the occurrence of infection (p< 0.001; Chi-squared test). Conclusion Patients with gunshot injuries treated non-operatively presented less severe and stable lesions; thus, the incidence of complications in this group was found to be lower. On the other hand, those patients with complex lesions underwent debridement and external fixation. Therefore, a greater number of infectious complications in patients submitted to external fixation was found, as expected.


Resumo Objetivo Investigar a incidência de infecção em pacientes com fraturas por arma de fogo, e correlacionar esse achado com a ocorrência de desbridamento cirúrgico na sala de emergência. Métodos Estudo retrospectivo, observacional e descritivo, que incluiu todos os casos de fraturas causadas por armas de fogo entre janeiro de 2010 e dezembro de 2014; foram incluídas 245 fraturas em 223 pacientes. Resultados Houve infecção do local cirúrgico em 8,5% das fraturas, e a média de desbridamentos necessários para controlar o processo infeccioso foi de 1,273 ± 0,608. Foi identificada correlação entre o tratamento cirúrgico escolhido e o segmento corporal afetado (p< 0,001). O tratamento cirúrgico na sala de emergência teve correlação com a ocorrência de infecção (p< 0,001; teste do qui-quadrado). Conclusão Pacientes com ferimentos à bala tratados de forma não operatória apresentaram lesões menos graves e estáveis; portanto, a incidência de complicações nesse grupo foi menor. Por outro lado, os pacientes com lesões complexas foram aqueles submetidos a desbridamento e fixação externa. Portanto, como esperado, foi encontrado um maior número de complicações infecciosas em pacientes submetidos à fixação externa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Wound Infection/epidemiology , Wounds and Injuries , Wounds, Gunshot/epidemiology , Firearms , Debridement , Emergency Service, Hospital , Fractures, Bone , Control , Fires , Hand , Infections
6.
Rev. cir. traumatol. buco-maxilo-fac ; 20(3): 44-47, jul.-set. 2020. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1253322

ABSTRACT

Introdução: A Fasceíte Necrotizante Cervical é uma infecção rara, geralmente com evolução rápida e progressiva da fáscia superficial e do tecido adiposo subcutâneo. Pode se desenvolver a partir de uma infecção odontogênica que se dissemina para os planos faciais e profundos. O presente trabalho tem por objetivo relatar um caso clínico de uma paciente do gênero feminino, 49 anos de idade, atendida na Emergência do Hospital Getúlio Vargas-PE, com quadro clínico sugestivo de Fasceíte Necrotizante Cervical de origem Odontogênica. Relato de caso: O tratamento proposto foi antibioticoterapia parenteral de amplo espectro, desbridamento cirúrgico radical com instalação de dreno de penrose transfixante submandibular direito, múltiplas exodontias para remoção do foco primário da infecção, além de curativos orientado pela equipe de infectologia. Considerações finais: Excepcionalmente, as Fasceítes Necrotizantes Cervicais devem ter diagnóstico e manejo imediato, devido aos altos índices de destruição, rápida progressão e mortalidade. Nos casos de Fasceíte Necrotizante de origem odontogênica, a antibioticoterapia, remoção do(s) focos(s) de infecção, desbridamento cirúrgico e monitoramento intensivo constituem a terapêutica adequada... (AU)


Introduction: Cervical Necrotizing Fasciitis is a rare infection, usually with rapid and progressive evolution of the superficial fascia and subcutaneous adipose tissue. It can develop from an odontogenic infection that spreads to the facial and deep planes. This study aims to report a clinical case of a 49-year-old female patient, seen at the Emergency Department of Hospital Getúlio Vargas-PE, with a clinical condition suggestive of Cervical Necrotizing Fasciitis of Odontogenic origin. Case report: The proposed treatment was broad-spectrum parenteral antibiotic therapy, radical surgical debridement with the installation of a right submandibular transfixing penrose drain, multiple extractions to remove the primary focus of the infection, in addition to curatives guided by the infectology team. Final considerations: Exceptionally, cervical necrotizing fasciitis must have an immediate diagnosis and management, due to the high rates of destruction, rapid progression and mortality. In cases of Necrotizing Fasciitis of odontogenic origin, antibiotic therapy, removal of the foci (s) of infection, surgical debridement and intensive monitoring constitute the appropriate therapy... (AU)


Subject(s)
Humans , Female , Middle Aged , Fasciitis, Necrotizing , Debridement , Fasciitis , Focal Infection, Dental , Bandages , Flood-Bypass Channel , Emergency Service, Hospital , Subcutaneous Fat , Infectious Disease Medicine , Anti-Bacterial Agents
7.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(3): 255-261, ago. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1352329

ABSTRACT

Las heridas crónicas de origen traumático, con exposición de tejidos, requieren de un desbridamiento adecuado, lavado y una pronta cubierta para evitar la infección y la desecación. A veces, incluso deben ser ampliadas para realizar un adecuado desbridamiento quirúrgico; por lo que, al intentar una cobertura completa, el resultado es una herida a tensión, que se complica con inflamación, infección y la dehiscencia que se acentúa aún más si está en una zona de flexión, como la rodilla. Se presenta el caso de una paciente de 28 años, que acudió a emergencias con un antecedente de herida traumática en la rodilla derecha, signos de retraso de la cicatrización, tejido de granulación friable, exposición de la rótula, abundante secreción serosa y dolor al movimiento con rango limitado. Se la trató en un solo tiempo quirúrgico con desbridamiento, irrigación y cobertura completa de la herida mediante la técnica de "pie-crusting". Nivel de Evidencia: IV


Chronic wounds of traumatic origin, with tissue exposure, require adequate debridement, lavage and prompt coverage to prevent infection and desiccation. Wounds may even require to be enlarged in order to perform an adequate surgical debridement. Enlarged wound attempts to perform a complete coverage may result in tension wound closures, which are complicated by inflammation, infection, and dehiscence and aggravated when located on flexure areas, such as on the knee. We report the case of a 28-year female patient, who presented to the Emergency Department with a history of traumatic wound in the right knee and signs of delayed healing, friable granulation tissue, exposed patella, increased serous drainage, and painful limited range of motion. She underwent a single surgical time procedure with debridement, irrigation, and complete coverage of the wound with the help of the pie-crusting technique. Level of Evidence: IV


Subject(s)
Adult , Debridement , Wound Closure Techniques , Surgical Wound , Knee Joint
8.
Rev. chil. ortop. traumatol ; 61(1): 23-27, mar. 2020. ilus, tab
Article in English | LILACS | ID: biblio-1291847

ABSTRACT

CASE PRESENTATION: A 42-year-old man was transferred to our institution after a highenergy accident (an explosion). He presented second-degree burns on 20% of the total body surface area (TBSA), affecting the lower hemiabdomen and the lower right limb. He also presented a supraintercondylar open fracture of the right femur (Gustilo I). The burns were treated with debridement and coverage withmesh graft, while the fracture required an early transitory transarticular external fixation with delayed definitive osteosynthesis. Our patient presented good local and systemic evolution. We can offer a eleven-month follow-up. DISCUSSION: The literature supports that the combination of trauma and burn injuries is a relatively rare pattern, which may explain the lack of knowledge and studies on this subject. This double injury has demonstrated a synergistic effect on mortality. The management of soft tissues in the coexistence of an open fracture and a burn in the same limb is a challenge. The method and timing of the treatment of the fracture directly impacts the treatment of the burn (and vice versa), and most authors tend to treat the fracture first. All of the studies reviewed emphasized the importance of the multidisciplinary approach. CONCLUSIONS: We have presented a complex case combining major trauma and severe burns. Although there is a lack of studies in the literature on this subject, the papers state that this is an unusual pattern with a synergistic effect on mortality. In our experience, the management of soft tissues and the multidisciplinary approach play a central role, as it is also stated in the literature. The management of these patients is still controversial, and more studies are needed.


PRESENTACIÓN DEL CASO: Hombre de 42 años trasladado a nuestra institución tras un accidente de alta energía (explosión). Presentaba quemaduras de segundo grado del 20% de la superficie corporal total (SCT), afectando el hemiabdomen inferior y la extremidad inferior derecha. También presentaba una fractura abierta supraintercondílea de fémur derecho (Gustilo I). Las quemaduras fueron tratadas mediante desbridamiento y cobertura mediante injerto mallado, mientras que la fractura requirió un fijador externo transarticular precoz de forma transitoria con una osteosíntesis definitiva diferida. Nuestro paciente presentó buena evolución local y sistémica. Podemos ofrecer un seguimiento a 11 meses. DISCUSIÓN: La bibliografía defiende que la lesión combinada de traumatismo y quemadura es un patrón relativamente raro, pudiendo explicar la falta de conocimiento y publicaciones al respecto. Este doble insulto ha demostrado un efecto sinérgico en la mortalidad. El manejo de las partes blandas cuando coexisten una fractura abierta y una quemadura en la misma extremidad es un desafío. El método y el momento de tratamiento de la fractura impactan de forma directa en el tratamiento de la quemadura (y viceversa); y la mayoría de los autores tienden a tratar en primer lugar la fractura. Todos los estudios analizados enfatizan la importancia del abordaje multidisciplinario. CONCLUSIONES: Hemos presentado un caso complejo combinando traumatismo grave y quemaduras severas. Aunque haya una falta de bibliografía, los estudios afirman que se trata de un patrón inusual con un efecto sinérgico sobre la mortalidad. En nuestra experiencia, el manejo de las partes blandas y el abordaje multidisciplinario tienen un rol central, tal y como defienden también los artículos publicados. El manejo de estos pacientes sigue siendo controvertido, y son necesarios más estudios.


Subject(s)
Humans , Male , Adult , Wounds and Injuries/surgery , Wounds and Injuries/complications , Burns/complications , Burns/therapy , Multiple Trauma , Lower Extremity , Debridement , Fracture Fixation, Internal
9.
J. coloproctol. (Rio J., Impr.) ; 40(1): 37-42, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090833

ABSTRACT

Abstract Introduction: Fournier's gangrene is a polymicrobial infection caused by aerobic and anaerobic microorganisms, which determine a fast and progressive necrotizing fasciitis, compromising mainly the perineal region and the genital region, being able to evolve to sepsis, multiple organ failure and death. Treatment consists of early surgical diagnosis and debridement, associated with broad-spectrum antibiotic therapy and hyperbaric oxygen therapy. Objective: Compare the most prevalent epidemiological data of patients with Fournier's Syndrome with the data examined in the literature in order to evaluate the incidence in the analyzed service, treatment form and evolution of the patients with the disease. Materials and methods: Observational transversal study from the medical records of patients diagnosed with the disease at the São Vicente de Paulo Charity Hospital in Jundiaí, SP, from October 2016 to October 2018. Results: 23 patients with Fournier's Syndrome, all included in the study, and were analyzed. The most prevalent epidemiological data on the disease, such as age, sex, association with other comorbidities, treatment performed, mortality and early surgical procedure, had obtained a similar data as compared as the medical literature that was in studied. Conclusion: Despite the recognized severity of Fournier's Syndrome, early diagnosis combined with extensive surgical debridement, broad-spectrum antibiotic therapy and measures and oxygen therapy when available are important measures to contain the rapid progression of the disease, thus decreasing its levels of mortality.


Resumo Introdução: A Gangrena de Fournier é uma infecção polimicrobiana ocasionada por microrganismos aeróbios e anaeróbios, que determinam uma fascite necrosante rápida e progressiva, comprometendo principalmente a região do períneo e a região genital, podendo evoluir para sepse, falência de múltiplos órgãos e óbito. O tratamento consiste no diagnóstico e desbridamento cirúrgico precoce, associado à antibioticoterapia de largo espectro e oxigenoterapia hiperbárica. Objetivo: Comparar dados epidemiológicos mais prevalentes dos pacientes diagnosticados com Síndrome de Fournier com os dados já descritos na literatura a fim de avaliar a incidência no serviço em questão analisado, forma de tratamento e evolução dos pacientes com a doença. Materiais e métodos: Estudo transversal observacional a partir da análise de prontuários de pacientes diagnosticados com a doença no Hospital de Caridade São Vicente de Paulo de Jundiaí-SP, no período entre Outubro de 2016 a Outubro de 2018. Resultados: Foram analisados 23 pacientes com diagnóstico de Síndrome de Fournier, todos incluídos na pesquisa. Avaliado os dados epidemiológicos mais prevalentes na doença, como faixa etária, sexo, associação com outras comorbidades, tratamento realizado, mortalidade decorrente da doença, período médio de internação, uso de antibioticoterapia e necessidade de procedimento cirúrgico, obtendo-se dados semelhantes com os já descritos na literatura médica. Conclusão: Apesar da reconhecida gravidade da Síndrome de Fournier, o diagnóstico precoce aliado ao desbridamento cirúrgico extenso, antibioticoterapia de amplo espectro e medidas e oxigenioterapia quando disponível são medidas importantes na contenção da rápida progressão da doença, diminuindo assim seus níveis de mortalidade.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Fournier Gangrene/epidemiology , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Fournier Gangrene/diagnosis , Fournier Gangrene/therapy , Debridement , Tertiary Care Centers
10.
Braz. j. otorhinolaryngol. (Impr.) ; 86(1): 38-43, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1089367

ABSTRACT

Abstract Introduction Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages. Objective The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion. Methods This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups. Results There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p < 0.001, p < 0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p = 0.376, p = 0.128). Conclusion Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.


Resumo Introdução A adenoidectomia pode ser realizada de várias maneiras, inclusive por curetagem e por microdebridador, assistida por endoscopia. Essas duas técnicas têm algumas vantagens e desvantagens. Objetivo O objetivo deste estudo foi investigar os efeitos da técnica de adenoidectomia por curetagem e da adenoidectomia por microdebridador assistida por endoscopia sobre a pressão timpânica em pacientes pediátricos com hipertrofia adenoideana sem otite média com efusão. Método Estudo descritivo prospectivo feito com 65 pacientes que apresentavam membrana timpânica e timpanograma normais, que foram então submetidos à adenoidectomia ou adenotonsilectomia por hipertrofia adenoamigdaliana. Os pacientes foram divididos aleatoriamente em dois grupos: grupo adenoidectomia por curetagem e grupo adenoidectomia por microdebridador assistida por endoscópio. Todos os pacientes fizeram timpanometria e os valores das pressões do tímpano pré-operatórios e pós-operatórios no 1º e 7º dias foram comparados intragrupos e entre os grupos. Resultados Foram incluídos 32 pacientes no grupo adenoidectomia por curetagem e 33 pacientes no grupo adenoidectomia com microdebridador. Diferenças estatisticamente significantes foram observadas na mediana da diferença entre a pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para ambas as orelhas, direita e esquerda, na adenoidectomia por curetagem (p < 0,001, p < 0,001). Essa diferença ocorreu no 1º dia do pós-operatório e o valor retornou ao normal no 7º dia. Não houve diferença significante na mediana entre pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para as orelhas direita e esquerda no grupo de adenoidectomia com microdebridador (p = 0,376, p = 0,128). Conclusão A disfunção tubária no pós-operatório é observada menos frequentemente com a técnica de adenoidectomia por microdebridador assistida por endoscopia quando comparada com a técnica convencional.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adenoidectomy/methods , Curettage/methods , Eustachian Tube/physiopathology , Postoperative Period , Pressure , Acoustic Impedance Tests , Single-Blind Method , Prospective Studies , Treatment Outcome , Video-Assisted Surgery/methods , Debridement/methods , Ear, Middle/physiopathology
12.
Chinese Journal of Traumatology ; (6): 149-151, 2020.
Article in English | WPRIM | ID: wpr-827841

ABSTRACT

Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient's morbidity or mortality.


Subject(s)
Adrenal Glands , Diagnostic Imaging , Wounds and Injuries , Adult , Debridement , Hemorrhage , Therapeutics , Hemostasis, Surgical , Humans , Laparotomy , Male , Multiple Trauma , Therapeutics , Organ Sparing Treatments , Methods , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Gunshot , Diagnostic Imaging , Therapeutics , Young Adult
13.
Nigerian Medical Practitioner ; 78(1-2): 24-32, 2020.
Article in English | AIM | ID: biblio-1267991

ABSTRACT

Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus dis­ease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery


Subject(s)
Crush Injuries , Debridement , Negative-Pressure Wound Therapy , Nutritional Sciences , Pressure Ulcer
14.
Article in Chinese | WPRIM | ID: wpr-828272

ABSTRACT

OBJECTIVE@#To evaluate the clinical outcomes of one-stage transpedicular debridement, posterior internal fixation, RBK mixed streptomycin filled bone grafting for the treatment of elderly patients with thoracolumbar tuberculosis.@*METHODS@#The clinical data of 20 elderly patients with thoracolumbar tuberculosis underwent one stage transpedicular debridement, posterior internal fixation, OSTEOSET RBK mixed streptomycin-filled bone grafting from September 2006 to July 2017 were retrospectively analyzed. There were 12 males and 8 females, aged from 62 to 83 years with an average of (72.4±6.9) years old. Visual analogue scale (VAS), Oswestry Disability Index (ODI)were used to evaluate the pain and spinal function. The kyphosis angle (Cobb angle) of the lesion segment and the bone growth of the lesion area were observed by the X-ray films.@*RESULTS@#All the operations were successful, the operation time was (160.9±23.8) min, and the intraoperative blood loss was (317.9± 112.7) ml. The incisions were healed by first intention, and no sinus and incision were delayed. Spinal tuberculosis was completely cured, Frankel grade has one or more improvements. The VAS score decreased from (7.50±1.15) points before surgery to (1.70±1.39) points at 12 months after surgery (<0.05). The ODI score decreased from preoperative (92.50±1.17)% to (12.80±0.89)% at the final follow up (<0.05). The sagittal Cobb angle of the lesion segment decreased from preoperative (24.2±1.6)° to (8.3±0.7)°at 12 months after surgery(<0.05), the kyphosis deformity was significantly corrected. In all cases, bone fusion was achieved in bone graft area, without bone nonunion and device fracture complications.@*CONCLUSION@#One-stage transpedicular debridement, posterior internal fixation, RBK mixed streptomycin filled bone grafting is suitable for thoracolumbar tuberculosis patients with good general condition and less vertebral destruction.


Subject(s)
Aged , Aged, 80 and over , Bone Transplantation , Debridement , Female , Fracture Fixation, Internal , Humans , Lumbar Vertebrae , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Treatment Outcome , Tuberculosis, Spinal
15.
Article in Chinese | WPRIM | ID: wpr-828249

ABSTRACT

OBJECTIVE@#To investigate the therapeutic effects of vacuum sealing drainage (VSD) combined with antibiotics in treating acute periprosthetic joint infection (PJI).@*METHODS@#From March 2012 to December 2018, there were 11 patients with acute PJI underwent debridement, VSD, antibiotics and retention of implant, including 7 males and 4 females, with an average age of 72.5 years old (ranged, 58 to 88 years old). There were 8 hips and 3 knees. Three patients had sinus tract.@*RESULTS@#There were 2 patients with negative culture result and 9 patients with positive culture result, including 5 cases of methicillin sensitive staphylococcus aureus, 2 cases of methicillin-resistant staphylococcus aureus (MRSA), 2 cases of staphylococcus epidermidis. The mean follow up duration was 28 months (ranged from 8 to 52 months). One case of infection around hip prosthesis failed to be debrided. The time of debridement and replacement of the calcar joint was 84 days. Debridement was successful in 10 cases. At the latest follow up, Harris score of patients with successful debridement of hip periprosthetic infection ranged from 74 to 93, with an average score of 84.1;Knee Society scores of patients with periprosthetic infection were 84, 84, 89.@*CONCLUSION@#For acute infection around the prosthesis within 1 month after knee replacement and 6 weeks after hip replacement, and for bleeding around the prosthesis with acute infection caused by anticoagulant drugs, satisfactory results can be obtained by debridement, VSD and sensitive antibiotics.


Subject(s)
Aged , Aged, 80 and over , Anti-Bacterial Agents , Arthroplasty, Replacement, Hip , Debridement , Drainage , Female , Hip Prosthesis , Humans , Male , Methicillin-Resistant Staphylococcus aureus , Middle Aged , Negative-Pressure Wound Therapy , Prosthesis-Related Infections , Retrospective Studies , Treatment Outcome
16.
Article in Chinese | WPRIM | ID: wpr-879338

ABSTRACT

Diabetic foot ulcers (DFUs) is a severe complication of the diabetes mellitus, which is the first leading cause of non-traumatic lower limbs amputations. The pathogenesis of diabetic foot involves a variety of mechanisms, treatment involves the department of foot and ankle surgery, department of vascular surgery, endocrinology, and infection control. Treatment need multidisciplinary diagnosis and treatment. Debridement is the basis of treating diabetic foot ulcers, and the normal anatomical structure should be maintained during the process. Vacuum sealing drainage (VSD) and antibiotic-laden bone cement (ALBC) have more advantages of controlling infection and ulceration wound healing, which could receive good clinical effect. Tendon lengthening could alleviate the problem of ulcer occurrence and progression caused by stress concentration on the bottom of foot, which has widely application and has advantages of preventing formation of foot ulcers. Flap transplantation could solve the problem of wound healing, but it is necessary to consider whether the transplanted flap could bear the same function as plantar tissue. Tibial bone transverse distraction is a relatively new technique, and the mechanism is not clear, but it has certain application prospects from the perspective of clinical efficacy.


Subject(s)
Debridement , Diabetes Mellitus , Diabetic Foot/surgery , Foot Ulcer , Humans , Salvage Therapy , Wound Healing
17.
Rev. Assoc. Med. Bras. (1992) ; 65(11): 1405-1412, Nov. 2019. graf
Article in English | LILACS | ID: biblio-1057075

ABSTRACT

SUMMARY OBJECTIVE: to identify, through an integrative review, national studies published over the last ten years highlighting products and therapies used in burns. METHODS: integrative research with studies published in the last ten years. Including clinical studies describing the use of the already established or innovative therapies in burns and the results obtained, published in national journals in the last ten years. Excluding articles published before 2007 and those that did not present results regarding the use of products in burns. RESULTS: ten articles that met the inclusion criteria were selected. Collagenase, 1% silver sulfadiazine, and porous cellulose membrane were some of the therapies cited. CONCLUSION: the casuistry was low; however, the good results obtained with porous cellulose membrane and silver nanocrystalline dressing are highlighted, since they were used in a larger number of patients in the studies evaluated.


RESUMO OBJETIVO: Identificar, por meio de revisão integrativa, estudos nacionais publicados nos últimos dez anos que destaquem produtos e terapêuticas utilizados nas queimaduras. MÉTODOS: Pesquisa integrativa com estudos publicados nos últimos dez anos. Incluídos os estudos clínicos que descreveram a utilização de terapias já consagradas ou inovadoras em queimaduras e os resultados obtidos e publicados em periódicos nacionais nos últimos dez anos. Excluídos os artigos publicados antes de 2007 e os que não apresentaram resultados quanto ao uso de produtos nas queimaduras. RESULTADOS: Selecionados dez artigos que atenderam aos critérios de inclusão, sendo colagenase, sulfadiazina de prata 1% e membrana celulósica porosa algumas das terapias descritas. CONCLUSÕES: A casuística foi baixa, porém, ressaltam-se os bons resultados obtidos com a membrana celulósica porosa e o curativo com prata nanocristalina, em virtude de terem sido utilizados em um maior número de pacientes nos estudos avaliados.


Subject(s)
Humans , Silver Sulfadiazine/administration & dosage , Bandages , Burns/therapy , Collagenases/administration & dosage , Debridement , Membranes, Artificial
18.
Rev. pediatr. electrón ; 16(3): 2-11, oct. 2019. tab
Article in Spanish | LILACS | ID: biblio-1046276

ABSTRACT

INTRODUCCIÓN: La Infección Necrotizante de tejidos blandos (INTB) tiene una elevada morbimortalidad. El objetivo de este trabajo es describir del manejo perioperatorio de menores de 15 años que cursaron con INTB durante 15 años en un Hospital pediátrico. MATERIAL Y MÉTODOS: serie de pacientes identificados INTB entre 2000 y 2015 en el Hospital Roberto del Río. Se describen variables demográficas, clínicas, vacuna, tratamiento, cirugías, complicaciones, microorganismos, seguimiento, y fallecimientos. RESULTADOS: 22 pacientes, con mediana de 2 años y 9 meses de edad. 50% estaban cursando con una varicela. Dos fallecieron. Ninguno era previamente vacunado contra el virus varicela zoster. La localización fue tronco (14), extremidades (7), cuello (1). Los pacientes conscientes presentaron hiperestesia cutánea. Se realizó aseo quirúrgico con una mediana de 6,8 horas desde el inicio de la hiperestesia y 2 horas desde la sospecha diagnóstica. Los microorganismos fueron: S. pyogenes (38%) y E. coli (31%). Los antibióticos más frecuentes fueron penicilina más clindamicina. La herida se manejó con cierre primario, injertos y/o colgajos. Cinco evolucionaron con secuelas que necesitaron tratamiento. CONCLUSIÓN: Se identificó que la INTB puede presentarse con varicela. Debe sospecharse en lesiones cutáneas e hiperestesia desproporcionada. Resección amplia y precoz son fundamentales para el tratamiento.


INTRODUCTION: Necrotizing soft tissue infection (NSTI) has a high morbidity and mortality. The objective of this study is to describe the perioperative management of children under 15 years of age who have had this condition for 15 years in a pediatric hospital. MATERIAL AND METHODS: cases series of patients identified by Pathological Anatomy with NSTI during 2000 and 2015 at the Dr. Roberto del Río Hospital. Demographic variables, treatment, antecedents of vaccination, surgeries, complications, microorganisms, follow-up, and deaths are described. RESULTS: 22 patients were identified, with a median of 2 years 9 months of age (interquartile range: 13 months to 5 years y 10 months). 50% of the cases were associated to chickenpox. Two died. No patient was previously vaccinated against varicella zoster virus. The location was trunk (14), extremities (7) and neck (1). All conscious patients presented cutaneous hyperesthesia. Surgical debridement was performed with a median of 6.8 hours from the onset of hyperesthesia and 2 hours from diagnostic suspicion. The most frequent microorganisms were: Streptococcus pyogenes (38%) and Escherichia coli (31%). The most frequent antibiotics used were penicillin plus clindamycin. The wound was handled with primary closure, grafts and / or flaps. Five patients evolved with sequelae that needed treatment. CONCLUSION: It was identified that STNI in children is associated with chickenpox. It should be suspected in cutaneous lesions and disproportionate hyperesthesia. Aggressive resection is essential for treatment


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Soft Tissue Infections/pathology , Soft Tissue Infections/therapy , Fasciitis, Necrotizing/pathology , Fasciitis, Necrotizing/therapy , Staphylococcus aureus/isolation & purification , Streptococcus pyogenes/isolation & purification , Soft Tissue Infections/surgery , Soft Tissue Infections/microbiology , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/microbiology , Perioperative Care , Debridement , Escherichia coli/isolation & purification , Anti-Bacterial Agents/therapeutic use
19.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(3): 366-373, set. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058709

ABSTRACT

RESUMEN La rinosinusitis fúngica invasiva aguda (RSFIA) es una enfermedad poco frecuente caracterizada por una infiltración fúngica de la submucosa y vasos sanguíneos de las cavidades nasal y paranasal. Afecta a pacientes con grados variables de inmunosupresión, destacando entre estas patologías subyacentes la diabetes mellitus y las neoplasias malignas hematológicas. Presenta una alta tasa de mortalidad, pudiendo reducirse significativamente si el diagnóstico y el tratamiento se realizan precozmente. Este artículo tiene por objetivo presentar una revisión actualizada de la literatura respecto a la presentación clínica, microbiología, factores de riesgos, métodos diagnósticos, tratamiento y pronóstico de la RSFIA, tanto en adultos como en niños.


ABSTRACT Acute invasive fungal rhinosinusitis (AIFS) is a rare disease characterized by fungal infiltration of the submucosa and blood vessels of the nasal y paranasal cavities. It affects almost exclusively patients with different degrees of immunosuppression, with underlying pathologies such as diabetes mellitus and hematological malignancies. AIFS has a high mortality rate, but it can be significantly reduced if the diagnosis and treatment are carried out early in the course of disease. This article aims to present an updated literature review regarding clinical presentation, microbiology, risk factors, diagnostic methods, treatment and prognosis of AIFS, both in adults and children.


Subject(s)
Humans , Child , Adult , Sinusitis/diagnosis , Sinusitis/microbiology , Sinusitis/therapy , Rhinitis/diagnosis , Rhinitis/microbiology , Rhinitis/therapy , Prognosis , Acute Disease , Risk Factors , Immunocompromised Host , Debridement , Mycoses , Antifungal Agents/therapeutic use
20.
Rev. chil. obstet. ginecol. (En línea) ; 84(3): 225-230, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1020640

ABSTRACT

RESUMEN La Gangrena de Fournier es una infección necrotizante que afecta al área genitourinaria, perineal y perianal. Se trata de una infección muy grave con una rápida evolución a estadios avanzados y una elevada tasa de morbimortalidad asociada. Sin embargo, con frecuencia tiende a ser infradiagnosticada. Es vital en su manejo un diagnóstico basado en la sospecha clínica e inicio del tratamiento quirúrgico precoz con desbridamiento y exéresis de los tejidos afectos. Además, es crucial la asociación de antibioterapia de amplio espectro y el apoyo nutricional de soporte en el pronóstico de dicha entidad. En este artículo se revisa un caso clínico de Gangrena de Fournier, en una paciente con antecedentes de osteítis púbica y cistitis derivadas del tratamiento mediante radioterapia pélvica, diagnosticado y tratado con una hemivulvectomía radical, antibioterapia y lavados quirúrgicos en nuestro Hospital.


ABSTRACT The Fournier's Gangrene is a necrotizing infection which is located in the perineal area. It´s a severe infection, which involves a quick evolution to advanced stages where a high morbimortality rate is associated. However, it often tends to be underdiagnosed in early stages. The most important in the diagnosis is a high clinical suspicion and subsequent surgical treatment which is base on a desbridalment and exeresis of the affected tissues. In addition, the association of broad-spectrum antibiotic therapy and nutritional support are crucial. This report reviews a clinical case of Fournier's Gangrene, in a patient with a history of radiation induced cystitis and pubic osteitis after pelvic radiotherapy, diagnosed and treated with a radical hemivulvectomy, antibiotic therapy and lavages in our Hospital.


Subject(s)
Humans , Female , Aged , Fournier Gangrene/surgery , Fournier Gangrene/diagnosis , Fournier Gangrene/therapy , Prognosis , Radiotherapy , Debridement
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