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1.
Cambios rev. méd ; 20(1): 80-86, 30 junio 2021. tabs., graf.
Article in Spanish | LILACS | ID: biblio-1292944

ABSTRACT

INTRODUCCIÓN. La fuga post manga gástrica es una complicación de los proce-dimientos bariátricos quirúrgicos, con prevalencia del 2,1%, en el que se emplea el abordaje endoscópico, describir su seguridad y éxito es relevante. OBJETIVO. Describir el abordaje endoscópico en el manejo de la fuga post manga gástrica. MATERIALES Y MÉTODOS. Revisión bibliográfica y análisis sistemático de artículos científicos. De un total de 384 artículos, 11 publicaciones de texto completo fueron seleccionados; 9 artículos fueron estudios retrospectivos y 2 revisiones sistemáticas. Los términos de búsqueda sobre el tratamiento endoscópico en fuga post manga gástrica se basaron en datos PubMed que cumplieron los criterios: leak, fístula, par-tial gastrectomy, gastrointestinal endoscopy. RESULTADOS. La literatura reportó se-guridad con cero mortalidad y tasa de éxito para sutura endoscópica del 80,0%, over the scope clip 86,3%, drenaje interno endoscópico 83,41%, septotomía endoscópica 100,0%, stents endoscópicos hasta del 95,0% y terapia vacuum endoscópica 87,5%. CONCLUSIÓN. Se evidenció que el abordaje endoscópico en el manejo de la fuga post manga gástrica fue seguro y exitoso; se necesita personal experto en las dife-rentes modalidades terapéuticas reportadas.


INTRODUCTION. Post gastric sleeve leakage is a complication of surgical bariatric procedures, with a prevalence of 2,1%, in which the endoscopic approach is used, describing its safety and success is relevant. OBJECTIVE. To describe the endos-copic approach in the management of post gastric sleeve leak. MATERIALS AND METHODS. Bibliographic review and systematic analysis of scientific articles. From a total of 384 articles, 11 full-text publications were selected; 9 articles were retrospective studies and 2 systematic reviews. Search terms on endoscopic treatment in postgastric sleeve leak were based on PubMed data that met the criteria: leak, fistula, partial gastrectomy, gastrointestinal endoscopy. RESULTS. The literature re-ported safety with zero mortality and success rate for endoscopic suture 80,0%, over the scope clip 86,3%, endoscopic internal drainage 83,41%, endoscopic septotomy 100,0%, endoscopic stents up to 95,0% and endoscopic vacuum therapy 87,5%. CONCLUSION. It was evidenced that the endoscopic approach in the management of post gastric sleeve leak was safe and successful; expert personnel are needed in the different therapeutic modalities reported


Subject(s)
Humans , Endoscopy, Gastrointestinal , Bariatric Surgery , Gastrectomy , Obesity , Sutures , Drainage , Anastomotic Leak , Fistula
2.
Medicina (B.Aires) ; 81(2): 282-285, June 2021. graf
Article in English | LILACS | ID: biblio-1287281

ABSTRACT

Abstract Total anomalous pulmonary venous drainage is a rare and diverse anomaly, accounting for 1% to 3% of patients with congenital heart disease. Newborns with diagnosis of an obstructed total anomalous pulmonary venous dainage are extremely ill soon after birth and often present with severe cyanosis, pulmonary hypertension and low cardiac output requiring urgent surgical intervention. Transcatheter palliative stenting of the obstructive vertical vein can be an acceptable alternative as a bailout intervention before complete surgical correction is undertaken. This report of two cases highlights the feasibility, safety and effectiveness of the inter ventional palliative procedure and confirms that this technique can be an acceptable and attractive bridge in the algorithm of medical decisions during the evaluation of these critical patients.


Resumen El drenaje venoso pulmonar anómalo total es una enfermedad poco frecuente y de presentación diversa y se observa en el 1% a 3% de las cardiopatías congénitas. Si se asocia a obstrucción, se convierte en una afección grave en el recién nacido, mostrando cianosis intensa, hipertensión arterial pulmonar y bajo gasto cardíaco con indicación de intervención quirúrgica de urgencia. El implante de stent por cateterismo de forma paliativa para aliviar la obstrucción puede ser una alternativa aceptable de tratamiento como intervención de rescate antes de la corrección quirúrgica definitiva. Presentamos dos casos de intervención percutánea paliativa mostrando que esta técnica puede ser eficaz como puente al tratamiento quirúrgico definitivo para ser incorporado en la toma de decisiones de estos pacientes críticos.


Subject(s)
Humans , Infant, Newborn , Pulmonary Veins/surgery , Pulmonary Veins/diagnostic imaging , Heart Defects, Congenital , Hypertension, Pulmonary , Stents , Drainage
4.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 77-82, 20210000.
Article in Spanish | LILACS | ID: biblio-1178631

ABSTRACT

El empiema es una colección de líquido purulento en el espacio pleural. La causa más común es la neumonía. Las opciones de tratamiento incluyen toracocentesis terapéutica, colocación de catéter de drenaje, terapia fibrinolítica, pleurodesis y cirugía, como la decorticación pleural. El drenaje pleural es eficaz en la etapa I y la cirugía está reservada para casos complicados (estadios II y III). En estos casos, es necesaria la decorticación pulmonar. Actualmente, el enfoque más favorecido para la decorticación es mediante una toracotomía abierta. Este es un estudio observacional, descriptivo, de corte transversal, retrospectivo, con un muestreo no probabilístico de casos consecutivos que tuvo como población accesible a pacientes con el diagnostico de empiema en quienes se realizó una decorticación pleural en el Hospital de Clínicas por el Departamento de Cirugía de Tórax durante el periodo de marzo 2016 a febrero 2019. Un total de 24 pacientes con el diagnóstico de empiema fueron sometidos a una decorticación pleural. La etiología de empiema más frecuente (75%) fue el derrame paraneumónico. Las complicaciones post quirúrgicas estuvieron presentes en 9 (37,5%) pacientes, de estos, 4 (17%) presentaron fuga aérea durante los primeros días postoperatorios. Se constató la resolución completa del cuadro en 21 (87,5%) pacientes y 3 (12,5%) pacientes presentaron colección residual pleural. Se constató recurrencia en 1 (4%) paciente, requiriendo un re intervención quirúrgica. En conclusión, la casuística de nuestro departamento de tórax coincide en cuanto a valores internacionales de complicaciones, resolución y mortalidad.


Empyema is a collection of purulent fluid in the pleural space. The most common cause is pneumonia. Treatment options include therapeutic thoracentesis, drainage catheter placement, fibrinolytic therapy, pleurodesis, and surgery, such as pleural decortication. Pleural drainage is effective in stage I and surgery is reserved for complicated cases (stages II and III). In these cases, pulmonary decortication is necessary. Currently, the most favored approach to decortication is by open thoracotomy. This is an observational, descriptive, cross-sectional, retrospective study, with a non-probabilistic sampling of consecutive cases that had as the accessible population, patients with the diagnosis of empyema in whom pleural decortication was performed at the Clinica´s Hospital of San Lorenzo, by the Department of Thoracic Surgery during the period from March 2016 to February 2019. A total of 24 patients with the diagnosis of empyema underwent pleural decortication. The most frequent aetiology of empyema (75%) was parapneumonic effusion. Post-surgical complications were present in 9 (37.5%) patients, of these, 4 (17%) presented air leakage during the first postoperative days. Complete resolution of the condition was verified in 21 (87.5%) patients and 3 (12.5%) patients presented residual pleural collection. Recurrence was found in 1 (4%) patient, requiring reoperation. In conclusion, the casuistry of our thoracic department coincides in terms of international values of complications, resolution and mortality.


Subject(s)
Pneumonia , Thoracic Surgery , Thoracotomy , Drainage , Pleurodesis , Thoracentesis , General Surgery , Thorax , Thrombolytic Therapy , Retrospective Studies , Catheters
5.
Rev. enferm. neurol ; 20(1): 66-76, ene.-abr. 2021. ilus, tab
Article in Spanish | LILACS, BDENF | ID: biblio-1349260

ABSTRACT

Los drenajes cerebrales son dispositivos utilizados como métodos terapéuticos, permitiendo la salida de líquido normal o patológico a personas que cursen por alguna enfermedad neurológica, convirtiéndose en uno de los procedimientos más comunes en el área de la enfermería neurológica. He aquí que los cuidados de enfermería deben ser considerados específicos para poder visualizar resultados satisfactorios en pacientes portadores de estos sistemas en áreas críticas. Por este motivo, las intervenciones especializadas de enfermería en el cuidado a los drenajes cerebrales se basaron en la necesidad de elaborar una guía de intervenciones específicas, y especializadas, para personas con uso de drenajes cerebrales siendo un tema de importancia en enfermería neurológica.


Brain drains are devices used as therapeutic methods, allowing the exit of normal or pathological fluid to people suffering from a neurological disease, becoming one of the most common procedures in the area of neurological nursing. Here, nursing care must be considered specific in order to visualize satisfactory results in patients with these systems in critical areas. For this reason, specialized nursing interventions in the care of brain drains were based on the need to develop a guide for specific and specialized interventions for people with use of brain drains, being a topic of importance in neurological nursing.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Subarachnoid Hemorrhage , Intracranial Pressure , Hematoma, Subdural , Persons , Nursing Care , Drainage , Catheters , Neuroscience Nursing
6.
J. coloproctol. (Rio J., Impr.) ; 41(1): 47-51, Jan.-Mar. 2021.
Article in English | LILACS | ID: biblio-1286966

ABSTRACT

Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.


Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.


Subject(s)
Humans , Male , Female , Pelvis/physiopathology , Rectum/diagnostic imaging , Vagina/diagnostic imaging , Drainage/methods , Pelvic Infection/etiology , Abscess/diagnostic imaging
7.
Article in Chinese | WPRIM | ID: wpr-878722

ABSTRACT

Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.


Subject(s)
Drainage , Humans , Length of Stay , Lung , Pleurodesis , Retrospective Studies
8.
Rev. Col. Bras. Cir ; 48: e20202914, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287891

ABSTRACT

ABSTRACT Objective: interstitial lung disease comprises a group of lung diseases with wide pathophysiological varieties. This paper aims to report the video thoracoscopic surgical biopsy in patients with interstitial lung disease through a single minimal chest incision, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers. Methods: this study is a series of 14 cases evaluated retrospectively, descriptively, where patients underwent a pulmonary surgical biopsy from January 2019 to January 2020. The patients included in the study had diffuse interstitial lung disease without a defined etiological diagnosis. Results: none of the patients had transoperative complications, there was no need for chest drainage in the postoperative period, and the patients pain, assessed using the verbal scale, had a mode of 2 (minimum value of 1 and maximum of 4) in the post immediate surgery and 1 (minimum value of 1 and maximum of 3) at the time of hospital discharge. The length of hospital stay was up to 24 hours, with 12 patients being discharged on the same day of hospitalization. Conclusion: therefore, it is concluded in this series of cases that the performance of uniportal video-assisted thoracoscopic surgery procedures to perform lung biopsies, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers, bring benefits to the patient without compromising his safety. Further larger studies are necessary to confirm the safety and efficiency of this method.


RESUMO Objetivo: a doença pulmonar intersticial compreende um grupo de doenças pulmonares com grandes variedades fisiopatológicas. Este trabalho objetiva relatar a biópsia cirúrgica videotoracoscópica em pacientes com doença pulmonar intersticial por meio de incisão torácica mínima única, sem intubação orotraqueal, sem drenagem torácica e sem uso de bloqueadores neuromusculares. Métodos: este estudo é uma série de 14 casos avaliados de forma retrospectiva, descritiva, onde no qual os pacientes foram submetidos a biópsia cirúrgica pulmonar no período de janeiro de 2019 a janeiro de 2020. Os pacientes incluídos na pesquisa, apresentavam doença pulmonar intersticial difusa sem diagnóstico etiológico definido. Resultados: nenhum dos pacientes apresentou complicações transoperatórias, não houve necessidade de drenagem torácica no período pós-operatório e a dor dos pacientes, avaliada por meio da escala verbal, teve moda de 2 (valores mínimos de 1 e máximo de 4) no período de pós-operatório imediato e 1 (valores mínimos de 1 e máximos de 3) no momento da alta hospitalar. O tempo de permanência hospitalar foi de até 24 horas, sendo que 12 pacientes receberam alta no mesmo dia da internação. Conclusão: conclui-se, assim, que nesta série de casos, a realização de procedimentos de cirurgia toracoscópica videoassistida uniportais para realização de biópsias pulmonares, sem intubação orotraqueal, sem drenagem torácica e sem uso de bloqueadores neuromusculares trazem benefícios para o paciente sem comprometer sua segurança. Estudos maiores são necessários para comprovar tanto a segurança quanto à eficácia deste método.


Subject(s)
Humans , Lung Diseases, Interstitial , Thoracic Surgery, Video-Assisted , Biopsy , Drainage , Retrospective Studies , Intubation, Intratracheal
9.
Rev. bras. cir. cardiovasc ; 35(6): 913-917, Nov.-Dec. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1144009

ABSTRACT

Abstract Objective: To compare immediate postoperative results in patients receiving heparin-albumin-coated and non-coated circuits. Methods: A total of 241 patients undergoing on-pump cardiac surgery were divided into two groups: those receiving heparin-coated circuits (Bioline®, Maquet Cardiopulmonary AG., Hirrlingen, Germany) and those receiving non-coated circuits (Maquet Cardiopulmonary AG., Hirrlingen, Germany). Results: Activated clotting times (ACT) during cardiopulmonary bypass (CPB) were significantly shorter in the heparin-albumin-coated group than in the non-coated group (355.64±34.12 vs. 560.38±90.20, respectively, P=0.001). In-hospital mortality and postoperative stroke rates and lengths of intensive care unit stay were similar between the groups; in contrast, in the heparin-albumin-coated group, patients had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion. Conclusion: Heparin-coated circuits and reduced level of systemic heparinization with 300 seconds of target ACT level in cardiac surgery under CPB are safe and result in a very satisfactory clinical course.


Subject(s)
Humans , Male , Heparin , Cardiac Surgical Procedures , Cardiopulmonary Bypass , Drainage , Length of Stay
10.
Rev. argent. cir ; 112(4): 445-449, dic. 2020. graf, il
Article in Spanish | LILACS, BINACIS | ID: biblio-1288156

ABSTRACT

RESUMEN Se presenta el caso clínico de un paciente con traumatismo abdominal por herida de arma de fuego (HAF). En otra institución se realizó cirugía de exclusión pilórica y hepatorrafia por lesión hepatoduo denal. Fue derivado a nuestra institución a las 12 horas posoperatorias. Intercurre en el posoperatorio con neumonía grave por COVID-19 y complicaciones de su cirugía ini cial. La presentación severa de la enfermedad nos inclina por el manejo no operatorio. La utilización de drenajes percutáneos permitió el manejo de colecciones evitando una cirugía mayor inicial. La recuperación pulmonar facilitó la cirugía definitiva. La neumonía severa por COVID-19 en un paciente con lesión duodenal grave por HAF condiciona la toma de decisiones.


ABSTRACT We report the case of a patient with an abdominal gunshot trauma with liver and duodenal injury who underwent pyloric exclusion and liver repair in another institution. The patient was transferred to our institution 12 hours after surgery. During hospitalization, severe pneumonia due to COVID-19 and complications of the initial surgery developed. Non-surgical management was decided due to the severity of the disease. Percutaneous drainage allowed for the management of the collections avoiding a major initial surgery. Once he recovered from the pneumonia, the definite surgery was performed. Severe COVID-19 pneumonia in a patient with serious duodenal shotgun injury is a determining factor for decision-making of treatment options.


Subject(s)
Humans , Male , Middle Aged , COVID-19/complications , Abdominal Injuries/therapy , Pneumonia/complications , Pneumonia/diagnostic imaging , Tracheostomy , Drainage/methods , SARS-CoV-2 , COVID-19/diagnosis
11.
Rev. méd. Urug ; 36(4): 156-184, dic. 2020. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1144756

ABSTRACT

Resumen: El drenaje lumbar externo es un procedimiento invasivo de extracción de líquido cefalorraquídeo del espacio espinal cuyo uso se ha incrementado en los últimos años en el contexto de la medicina neurocrítica. Si bien no es recomendado por las guías o consensos internacionales, tiene un lugar en el manejo de algunas situaciones clínicas específicas vinculadas a diferentes tipos de neuroinjuria grave. Se realiza una revisión no sistemática de la literatura, a lo que se suma la experiencia de los autores. Se plantean las principales indicaciones actuales, se detallan las características de su manejo en los distintos escenarios clínicos y se señalan las contraindicaciones y complicaciones del procedimiento.


Summary: The placement of an external lumbar drainage (ELD), an invasive procedure to extract cerebrospinal fluid (CSF) from the spinal space, has gradually increased in practice in recent years within the context of neurocritical medicine. Despite it not being recommended by international guidelines or consensus, it is used for the handling of a few specific clinical situations in connection with different types of severe brain injury. The study consists of a non-systematic review of the literature, along with the authors' experience, presenting the main current indications and details for its handling in the different clinical scenarios and describing side effects and complications of the procedure.


Resumo: A drenagem lombar externa é um procedimento invasivo para extração do líquido cefalorraquidiano do espaço espinhal, cujo uso tem aumentado nos últimos anos no contexto da medicina neurocrítica. Embora não seja recomendado por consensos ou diretrizes internacionais, tem lugar no manejo de algumas situações clínicas específicas ligadas a diferentes tipos de dano neurológico grave. Realiza-se uma revisão não sistemática da literatura, à qual se soma a experiência dos autores. Apresentam-se as principais indicações atuais, detalham-se as características de seu manejo nos diferentes cenários clínicos e apontam-se as contraindicações e complicações do procedimento.


Subject(s)
Subarachnoid Hemorrhage , Cerebrospinal Fluid , Drainage , Intracranial Hypertension
12.
Rev. colomb. gastroenterol ; 35(4): 527-532, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1156335

ABSTRACT

Resumen El tratamiento actual para la obstrucción biliar maligna es la derivación biliar no quirúrgica con propósito paliativo. La cirugía tiene indicaciones específicas en pacientes con patología maligna con propósito curativo. Sin embargo, la obstrucción duodenal y del conducto biliar intra o extrahepático no dilatado hace que esta cirugía y el procedimiento endoscópico guiado por ultrasonografía endoscópica (USE) sean difíciles de realizar. Presentamos nuestra experiencia con el primer caso en Colombia, un país latinoamericano del tercer mundo. Consistió en una colecistogastrostomía guiada por USE, a partir de la utilización de una endoprótesis luminal (Lumen-apposing metal stents, LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos) de 15 mm × 10 mm, en un paciente masculino con cáncer pancreático inoperable e invasión duodenal con conducto colédoco dilatado. La colecistogastrostomía guiada por USE podría ser considerada como una opción de más importancia para la descompresión biliar que el drenaje percutáneo, ya que es superior en términos de viabilidad técnica, seguridad y eficacia en casos específicos de estenosis ampular e invasión duodenal. Además, puede ser realizada en países del tercer mundo, cuando se cuenta con el entrenamiento y los instrumentos adecuados. La endoprótesis metálica totalmente recubierta, aplicada a luz (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos), es ideal para la colecistogastrostomía guiada por USE, a fin de minimizar complicaciones como fugas biliares. Se necesitan estudios comparativos adicionales para validar los beneficios de esta técnica.


Abstract The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent. The surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia, a third-world country in Latin America, of a cholecystogastrostomy guided by endoscopic ultrasound (EUS) in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) 15 mm × 10 mm. EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.


Subject(s)
Humans , Male , Aged , Pancreatic Neoplasms , Therapeutics , Bile Ducts, Extrahepatic , Common Bile Duct , Endosonography , Methods , Drainage , Efficacy , Decompression
13.
J. coloproctol. (Rio J., Impr.) ; 40(4): 386-389, Oct.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1143174

ABSTRACT

ABSTRACT We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann's procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The key to management of rectal stump leak is the early and aggressive drainage of the associated collection and continued irrigation of the stump.


RESUMO Relatamos o tratamento de três casos de vazamento de coto retal e sepse após o procedimento de urgente de Hartmann para diverticulite sigmoide perfurada ou obstrução do intestino grosso. Dois pacientes apresentaram fatores de risco significativos para uma má cicatrização tecidual. Todos os pacientes desenvolveram características de sepse e tomografia computadorizada demonstraram vazamento de coto retal com coleções adjacentes. Todos os pacientes necessitaram de reoperação para drenagem e lavagem do abscesso. Um sistema de cateter intraperitoneal foi introduzido junto com os drenos para continuar na enfermaria até a formação do trato. Não houve mortalidade e morbidade mínima. A chave para o gerenciamento do vazamento de coto retal é a drenagem precoce e agressiva da coleta associada e a irrigação contínua do coto.


Subject(s)
Humans , Male , Aged , Sigmoid Diseases/pathology , Diverticulitis, Colonic/pathology , Proctectomy/adverse effects , Postoperative Complications , Drainage/methods
14.
Int. j. odontostomatol. (Print) ; 14(4): 685-693, dic. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134558

ABSTRACT

ABSTRACT: The purpose of this study was to evaluate the changes in vital signs and laboratory tests of patients with odontogenic infections who required hospitalization as well as checking their effectiveness in determining the severity of the case and possible correlations with the length of stay. Patients with odontogenic infections who required hospitalization were assessed prospectively between October 2016 and April 2018. The patients were divided into two groups considered as simple (Group 1) or complex (Group 2) cases according to the length of stay. The personal data, comorbidities, signs and symptoms, vital signs and laboratory tests were analyzed. In this study, 84 cases of maxillofacial infections were detected and 50 cases of odontogenic infections were included. There were significant increases in heart rate (p = 0.012), leukocytosis (p = 0.037), neutrophilia (p = 0.021), neutrophil/lymphocyte (N/L) ratio (p = 0.044) and C-reactive protein (CRP) levels (p = 0.004) in Group 2. Additionally, there were positive correlations between the length of stay and the following variables: heart rate (p = 0.028), leukocytosis (p = 0.045), neutrophilia (p = 0.033), N/L ratio (p = 0.041) and CRP level (p = 0.003). The N/L ratio was found to have a greater value in regression analysis. It was concluded that there were significant increases in heart rate, leukocytosis, neutrophilia, N/L ratio and CRP levels for the complex cases. There were also positive correlations between the length of stay and the following variables: heart rate, leukocytosis, neutrophilia, N/L ratio and CRP level.


RESUMEN: El propósito de este estudio fue evaluar los cambios en los signos vitales y las pruebas de laboratorio de pacientes con infecciones odontogénicas que requirieron hospitalización, así como verificar su efectividad para determinar la gravedad del caso y las posibles correlaciones con la duración de la internación. Pacientes con infecciones odontogénicas que requirieron hospitalización fueron evaluados prospectivamente entre octubre de 2016 y abril de 2018. Los pacientes se dividieron en dos grupos considerados como casos simples (Grupo 1) o complejos (Grupo 2) según la duración de la internación. Se analizaron los datos personales, comorbilidades, signos y síntomas, signos vitales y pruebas de laboratorio. En este estudio, se detectaron 84 casos de infecciones maxilofaciales y se incluyeron 50 casos de infecciones odontogénicas. Hubo aumentos significativos en la frecuencia cardíaca (p = 0,012), leucocitosis (p = 0,037), neutrofilia (p = 0,021), relación neutrófilos / linfocitos (N/L) (p = 0,044) y niveles de proteína C reactiva (PCR) (p = 0,004) en el Grupo 2. Además, hubo correlaciones positivas entre la duración de la internación y las siguientes variables: frecuencia cardíaca (p = 0,028), leucocitosis (p = 0,045), neutrofilia (p = 0,033), relación N/L (p = 0,041) y nivel de PCR (p = 0,003). Se encontró que la relación N/L tenía un mayor valor en el análisis de regresión. En conclusión, hubo aumentos significativos en la frecuencia cardíaca, leucocitosis, neutrofilia, relación N/L y niveles de PCR para los casos complejos. También hubo correlaciones positivas entre la duración de la internación y las siguientes variables: frecuencia cardíaca, leucocitosis, neutrofilia, relación N/L y nivel de PCR.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Vital Signs , Focal Infection, Dental/therapy , Severity of Illness Index , C-Reactive Protein , Drainage , Prospective Studies , Risk Factors , Statistics, Nonparametric , Age and Sex Distribution , Hospitalization , Length of Stay
15.
Neumol. pediátr. (En línea) ; 15(3): 411-413, sept. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1127614

ABSTRACT

Lung abscess is a rare entity in pediatric age, but it generates significant morbidity. Even less frequent is the presence of this with spontaneous drainage to the skin, generating an abscess in the chest wall, reason for consultation, of the present clinical case. Subsequently, the presence of lung abscess with extension to the chest wall without pleural involvement was documented by imaging studies, an extremely rare and unusual entity, with only one case described in the world literature within our reach and in an adult patient.


El absceso pulmonar es una entidad infrecuente en la edad pediátrica, pero que genera una morbilidad importante. Aún menos frecuente es la presencia de este con drenaje espontáneo a piel, generando un absceso en pared torácica, motivo de consulta, del presente caso clínico. Posteriormente y por estudios imagenológicos se documentó la presencia de absceso pulmonar con extensión a pared torácica sin afectación pleural, una entidad extremadamente rara e inusual, con un solo caso descrito en la literatura mundial a nuestro alcance y en un paciente adulto.


Subject(s)
Humans , Male , Child, Preschool , Fistula/complications , Fistula/diagnostic imaging , Lung Abscess/complications , Lung Abscess/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Drainage , Thoracic Wall
16.
Rev. Assoc. Med. Bras. (1992) ; 66(8): 1082-1086, Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136343

ABSTRACT

SUMMARY OBJECTIVE Perianal abscesses are frequently seen in clinical practice, and perianal fistulas develop in 30%-50% of cases after treatment. This study investigated whether the type of dressing applied after abscess drainage is correlated with fistula development. Prevention of fistula formation would reduce both the loss of work and healthcare costs. METHODS The records of patients who underwent drainage of perianal abscesses between January 2015 and January 2018 were retrospectively reviewed. Patients with postoperative dressings changed with washing of the area in the hospital were included as Group 1. Patients with dressings changed at home and the area bathed in 10% povidone-iodine sitz bath were included as Group 2. The frequency and time of fistula formation, age, sex, cost, and workdays lost in the two groups were compared. RESULTS Between-group differences in age, sex, body mass index, and type of fistula that developed after months and 1 year of the abscess drainage were not statistically significant (p > 0.05). During follow-up, fistula development was significantly lower in Group 1 than in Group 2 (p < 0.001). The risk of perianal fistula development was significantly increased in those with a body mass index (BMI) > 30 (p = 0.004). CONCLUSIONS After perianal abscess drainage, in-hospital washing and dressing of the abscess area until abscess closure reduced the risk of perianal fistula, lost work time, and cost. The risk of perianal fistula development appeared to increase with BMI. A large, prospective study is needed for confirmation.


RESUMO OBJETIVO Abscessos perianais são vistos com freqüência na clínica e uma fístula perianal se desenvolve em 30% a 50% dos casos após o tratamento. Este estudo investigou se o tipo de curativo aplicado após a drenagem do abscesso está correlacionado com o desenvolvimento da fístula. A prevenção da formação de fístulas reduziria a perda de trabalho e os custos com saúde. MÉTODOS Os prontuários de pacientes com drenagem de abscessos perianais entre janeiro de 2015 e janeiro de 2018 foram revisados retrospectivamente. Os pacientes com curativos pós-operatórios trocados com a lavagem da área no hospital foram incluídos no grupo 1. Os pacientes com curativos trocados em casa e a área banhada em 10% de banho de povidona com iodo povidona-Sitz foram incluídos no grupo 2. A frequência e o tempo de fístula formação, idade, sexo, custo e dias de trabalho perdidos nos dois grupos foram comparados. RESULTADOS As diferenças entre os grupos em idade, sexo, índice de massa corporal e o tipo de fístula que se desenvolveu após 3 meses e 1 ano após a drenagem do abscesso não foram estatisticamente significantes (p> 0,05). Durante o acompanhamento, o desenvolvimento da fístula foi significativamente menor no grupo 1 do que no grupo 2 (p <0,001). O risco de desenvolvimento de fístula perianal aumentou significativamente naqueles com índice de massa corporal (IMC)> 30 (p = 0,004). CONCLUSÕES Após a drenagem do abscesso perianal, a lavagem hospitalar e o curativo da área do abscesso até o fechamento do abscesso reduziram o risco de fístula perianal, perda de tempo de trabalho e custo. O risco de desenvolvimento de fístula perianal pareceu aumentar com o IMC. Um grande estudo prospectivo é necessário para confirmação.


Subject(s)
Humans , Abscess , Drainage , Prospective Studies , Retrospective Studies , Risk Factors , Fissure in Ano
17.
Rev. bras. cir. cardiovasc ; 35(4): 584-588, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137310

ABSTRACT

Abstract Chylous ascites is the pathologic accumulation of chylous fluid in the peritoneal cavity, caused by lymphomas, metastatic malignancies, and abdominal surgeries, rarely due to surgical trauma of the cisterna chyli or its major branches. A 24-year-old man with history of Marfan syndrome presented to our hospital with abdominal distention, abdominal pain, fluid in the incision region, and weakness. He had underwent an elective open aneurysm repair surgery nine days before for thoracoabdominal aortic aneurysm. Computed tomography revealed massive fluid collection in the abdominal cavity, which was drained surgically. He was diagnosed with chylous ascites and was discharged after conservative treatment.


Subject(s)
Humans , Male , Young Adult , Chylous Ascites/etiology , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/etiology , Aortic Aneurysm, Thoracic/diagnostic imaging , Marfan Syndrome/surgery , Marfan Syndrome/complications , Drainage , Elective Surgical Procedures
18.
Rev. argent. cir ; 112(1): 23-29, mar. 2020. ilus, tab
Article in English, Spanish | LILACS | ID: biblio-1125778

ABSTRACT

Antecedentes: el absceso del psoas ilíaco es una entidad poco frecuente y de etiología variable. Su ubicación y cuadro clínico inespecífico la convierte en una entidad de difícil diagnóstico para el cirujano general. La oportunidad de tratar una serie de casos en un período de tiempo relativamente corto para este tipo de patología motivan esta comunicación. Objetivo: a partir de una serie consecutiva de casos, analizar etiología, clínica, y enfoque diagnóstico terapéutico, con especial énfasis en el drenaje percutáneo , como así también una sucinta revisión de la bibliografía reciente. Material y métodos: estudio observacional retrospectivo de una serie consecutiva de casos Resultados: la serie consta de 6 casos, 5 de tipo primario y 1 de tipo secundario. La signos más frecuentes fueron el dolor, la impotencia funcional y la leucocitosis. La Tomografía axial computada de abdomen con y sin contraste fue el método diagnóstico de elección. El drenaje percutáneo fue el tratamiento de elección en 5 casos (83,3%) mientras que en el restante se optó por antibioticoterapia y el drenaje de una colección adyacente. La evolución de todos los casos fue favorable. Conclusión: el absceso de psoas ilíaco es una patología que necesita un alto nivel de sospecha dada su clínica inespecífica. Para su diagnóstico, junto acon la clínica la Tomografía es el método de elección. El drenaje percutáneo de las colecciones bajo control tomográfico es un opción segura y eficaz para el tratamiento de esta entidad.


Background: The of the iliopsoas abscess is a rare entity with a variable etiology. Its location and nonspecific clinical features makes it becomes a diagnostic and therapeutic challenge for the general surgeon. The opportunity to treat a series of cases in a relatively short period of time motivates this communication. Objective: From a consecutive case series, we analyze etiology, clinical features , as well as diagnostic and therapeutic approaches, with special emphasis on percutaneous drainage, as well as a brief review of recent literature. Material and methods: Retrospective analysis of a consecutive series of six patients diagnosed with an ilipsoas abscess in a tertiary care center. Results: The series consists of 6 cases, 5 of primary type and 1 of secondary type. Pain, Limp and leucocitosis were the more prevalent signs; computed tomography of the abdomen was the diagnostic method of choice. Percutaneous drainage was the therapeutic option in 5 cases (83.3%), while in the remaining, antibiotic therapy and the drainage of an adjacent collection were indicated. The evolution of all cases was favorable with no mortality nor morbidity. Conclusion: The iliac psoas abscess is a pathology that needs a high level of suspicion given its nonspecific presentation. For diagnosis, together with the clinic, computed tomography is the method of choice. Percutaneous drainage of collection under tomographic control is a safe and effective option for the treatment of this entity.


Subject(s)
Humans , Male , Adult , Middle Aged , Psoas Abscess/diagnosis , Psoas Abscess/etiology , Psoas Abscess/drug therapy , Argentina/epidemiology , Administration, Cutaneous , Tomography, X-Ray Computed/methods , Drainage , Retrospective Studies , Ultrasonography/methods
19.
Alerta (San Salvador) ; Vol.3(2): 3-8, ene. 27, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1050912

ABSTRACT

La pielonefritis enfisematosa, más que una entidad poco frecuente, se considera subdiagnosticada, pues requiere gran agudeza clínica para su identificación. Se define como una complicación necrotizante del riñón, que pone en peligro la vida del paciente y que se caracteriza por la acumulación de gas en el parénquima renal y los tejidos vecinos. Este caso se presentó de forma epidemiológicamente atípica por tratarse de un hombre con una anomalía renal y del tracto urinario, el riñón en herradura, lo que vuelve aún más complejo el abordaje diagnóstico y manejo de esta patología. Este caso es una referencia de la experiencia en el abordaje con catéter percutáneo como opción no tradicional de tratamiento. Se realizó una revisión de la literatura para tratar de comprender mejor las opciones en estudios de imagen para su diagnóstico y las características clínicas de esta afección, la cual sigue siendo controversial por tener una mortalidad tan alta.


Emphysematous pyelonephritis, rather than a rare entity, is considered underdiagnosed because it requires great clinical acuity for its identification; It is defined as a necrotizing complication of the kidney, which threats the life of the patient and is characterized by the accumulation of gas in the renal parenchyma and neighboring tissues. This case was presented epidemiologically atypical because it is a man with an abnormality of the kidney and urinary tract, such as the horseshoe kidney, which makes the diagnostic approach and management of this pathology even more complex. This case is a reference of the experience in the approach with percutaneous catheter as a non-traditional treatment option; conducting a review of the literature to try to better understand the options in imaging studies for diagnosis and the clinical characteristics of this condition, which remains controversial for having such a high mortality.


Subject(s)
Humans , Male , Aged , Pyelonephritis , Drainage , Kidney , Hydronephrosis
20.
Article in English | WPRIM | ID: wpr-787233

ABSTRACT

Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdominal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient's quality of life was accomplished.


Subject(s)
Abdominal Wall , Aged , Bile Ducts, Extrahepatic , Biopsy , Catheter Ablation , Catheters , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystectomy , Cholecystitis , Common Bile Duct , Cystic Duct , Drainage , Ethanol , Fever , Gallbladder , Humans , Male , Mesentery , Mucous Membrane , Nausea , Necrosis , Palliative Care , Quality of Life , Stents , Tomography, X-Ray Computed
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