Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 72
Filter
1.
Int. braz. j. urol ; 48(2): 363-364, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364954

ABSTRACT

ABSTRACT Background: Reports in the literature describe lymphocele formation in up to half of patients following pelvic lymph node dissection (PLND) (1) in robotic-assisted radical prostatectomy (RARP), with 1-2% requiring intervention (2). The advantage of surgical approach is permanent excision of the lymphocele capsule and fewer days with pelvic drains compared to percutaneous drainage. This study aims to describe the step-by-step surgical management of symptomatic lymphoceles using a less invasive robotic platform, the Da Vinci® Single Port (SP). Material and Methods: We describe the technique of lymphocelectomy and marsupialization with the Da Vinci® SP for symptomatic lymphocele. For this study, several treatment modalities for symptomatic lymphoceles were available, including percutaneous drainage, sclerosing agents, and surgical marsupialization. All the data for this study were obtained through the procedure via Da Vinci® SP. Results: Operative time for the case was 84 minutes. Blood loss was 25ml. No intra- or post- operative complications were reported. The patient had his drain removed in under 24 hours after surgery. The mean follow-up period was 7.7 months. There were no complications or lymphocele recurrence. Conclusion: Da Vinci® SP lymphocelectomy is safe and feasible with satisfactory outcomes. The SP enables definitive treatment of the lymphocele sac (3), reducing the number of days with abdominal drains and allows further decrease in surgical invasiveness with fewer incisions and better cosmesis.


Subject(s)
Humans , Male , Robotics , Lymphocele/surgery , Lymphocele/etiology , Robotic Surgical Procedures/adverse effects , Prostatectomy/methods , Drainage/adverse effects , Drainage/methods , Lymph Node Excision/methods
2.
Rev. Col. Bras. Cir ; 49: e20213139, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365379

ABSTRACT

ABSTRACT Objective: to assess safety, efficacy and quality of life in patients with benign pleural effusions undergong pleural drainage with Wayne pleural catheter (DW) in an outpatient setting. Method: this is a prospective study, in which 47 patients were evaluated between July 2017 and October 2018. Patients with non-malignant pleural effusions underwent pleural drainage with clinical evolution compatible with outpatient care were included. Patients who underwent drainage due to other conditions and patients were excluded. Results: after catheter placement, the mean length of hospital stay was 3.14 (± 3.85) days, and 21 patients (44.68%) were discharged within 24 hours. The mean time with the catheter was 12.63 (± 7.37) days. The analysis of the pleural fluid was transudate in 87.3% of cases and exudate in 12.3%. The causes of pleural effusion were heart failure (72.3%), renal failure (19.1%), liver failure (6.3%) and pneumonia (8.5%). The quality of life, analyzed according to the parameters of the questionnaire SF 36, showed low average values when compared to other studies. Analyzing each descriptor, the average was greater only in the limitation related to physical aspects. In the other descriptors, the results were similar, but smaller. Conclusion: the outpatient use of pleural catheters of the Wayne type (pigtail) proved to be feasible, safe and with a low associated infection rate. This is a viable option for selected patients.


RESUMO Objetivo: avaliar a segurança, a eficácia, as complicações e a qualidade de vida da alta precoce e acompanhamento ambulatorial de pacientes com derrames pleurais benignos submetidos à drenagem pleural com dreno de Wayne (DW). Método: estudo prospectivo, em que foram avaliados 47 pacientes entre julho de 2017 e outubro de 2018. Foram incluídos os pacientes com derrames pleurais não malignos, submetidos a drenagem pleural com evolução clínica compatível com o cuidado ambulatorial. Foram excluídos os pacientes submetidos a drenagem por outras afecções. Resultados: após a drenagem, a média do tempo de internação dos pacientes foi de 3,14 (±3,85) dias, sendo que 21 pacientes (44,68%) tiveram alta em até 24 horas após a drenagem. O tempo médio de permanência com o dreno foi de 12,63 (±7,37) dias. A análise do líquido pleural mostrou tratar-se de transudato em 87,3% dos casos e de exsudato em 12,3%. Dentre as causas do derrame pleural, destacaram-se insuficiência cardíaca (72,3%), insuficiência renal (19,1%), hepatopatias (6,3%) e pneumonias (8,5%). A qualidade de vida, analisada segundo os parâmetros do questionário SF 36, teve valores médios baixos, principalmente em relação a outros estudos. Na análise de cada descritor, a média apresentou-se maior somente na limitação por aspectos físicos. Nos demais descritores, os resultados foram semelhantes, mas menores. Conclusão: o uso ambulatorial de cateteres pleurais do tipo Wayne (pigtail) mostrou-se factível, seguro e com baixa taxa de infecções associadas. Trata-se de opção viável para pacientes selecionados.


Subject(s)
Humans , Pleural Effusion/therapy , Drainage/adverse effects , Drainage/methods , Catheters/adverse effects , Quality of Life , Prospective Studies , Retrospective Studies
3.
Säo Paulo med. j ; 137(1): 66-74, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004734

ABSTRACT

ABSTRACT BACKGROUND: The pleural drain insertion site after coronary artery bypass graft (CABG) surgery may alter lung function, especially respiratory muscle strength. The main objective of this study was to compare the effectiveness and safety of use of the left lateral intercostal region versus the subxiphoid position for pleural drainage during elective CABG surgery using extracorporeal circulation (ECC). DESIGN AND SETTING: Randomized trial conducted in a tertiary-level hospital in Porto Alegre, Brazil. METHODS: 48 patients were assigned to group 1 (pleural drain in the left lateral intercostal region) or group 2 (pleural drain in the subxiphoid position). Respiratory muscle strength was measured in terms of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24 and 72 hours after drain removal and before discharge from hospital. Painand dyspnea scales, presence of infections, pleural effusion and atelectasis, duration of drain use, drainage volumes and surgical reinterventions were also evaluated. RESULTS: After adjustments, there were no significant differences between the groups at the end of the study (before discharge), in predicted percentages either for MIP (delta group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP (delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere no differences between the groups in relation to other outcomes. CONCLUSION: There was no difference in maximal respiratory pressures in relation to the pleural drain insertion site among patients who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc V1111.1159.4447.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Drainage/instrumentation , Drainage/methods , Coronary Artery Bypass/methods , Pleural Cavity/surgery , Pleural Effusion/etiology , Pleural Effusion/prevention & control , Time Factors , Coronary Artery Disease/surgery , Pain Measurement , Drainage/adverse effects , Coronary Artery Bypass/adverse effects , Reproducibility of Results , Treatment Outcome , Elective Surgical Procedures/methods , Statistics, Nonparametric , Extracorporeal Circulation/methods , Maximal Respiratory Pressures
4.
ABCD arq. bras. cir. dig ; 32(3): e1454, 2019. tab, graf
Article in English | LILACS | ID: biblio-1038029

ABSTRACT

ABSTRACT Background: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. Aim: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. Methods : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. Results: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. Conclusion: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.


RESUMO Racional: A drenagem biliar percutânea é procedimento seguro. O risco de complicações hemorrágicas é aceitável. Frequentemente, os pacientes com obstruções biliares apresentam distúrbios de coagulação, aumentando o risco de sangramento. Por esse motivo, eles devem sempre ser adequados aos parâmetros da hemostasia. Objetivo: Determinar se a porcentagem de complicações hemorrágicas na drenagem biliar percutânea é maior em adultos com hemostasia corrigida antes do procedimento em relação àqueles que necessitaram nenhuma. Métodos: Estudo prospectivo, observacional, transversal, comparativo por amostras independentes (comparação não pareada). Oitenta e dois pacientes foram submetidos à drenagem biliar percutânea. A idade média foi de 64±16 anos (20-92), 38 eram homens e 44 mulheres. Os pacientes que apresentaram hemostasia alterada foram corrigidos, e a presença de complicações hemorrágicas foi avaliada com exames laboratoriais e ultrassonográficos. Resultados: Dos 82 pacientes, 23 necessitaram de correção da hemostasia. O acesso à direita foi em 41 casos, 30 à esquerda e 11 bilaterais. A quantidade de punções em média foi de 3±2. Houve 13 (15,8%) complicações hemorrágicas, 12 (20%) no grupo não corrigido e apenas uma (4,34%) no corrigido sem diferença estatística. Não houve diferenças no lado, no número de perfurações e no tipo de drenagem, mas o número de passagens e o tamanho da drenagem no lado direito foram diferentes. Não houve mortalidade. Conclusão: As complicações hemorrágicas em pacientes que necessitam de correção da hemostasia antes da drenagem biliar percutânea não são maiores do que naqueles que não a requerem.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Drainage/adverse effects , Cholestasis/surgery , Blood Loss, Surgical , Hemostasis , Intraoperative Complications/etiology , Punctures , Drainage/methods , Cholestasis/blood , Cross-Sectional Studies , Prospective Studies , Risk Factors , Catheters
5.
Rev. méd. Chile ; 146(11): 1343-1346, nov. 2018. graf
Article in Spanish | LILACS | ID: biblio-985708

ABSTRACT

Pulmonary expansion edema is a rare complication of the management of primary spontaneous pneumothorax. We report a 20 year old male admitted with a right primary spontaneous pneumothorax. A chest tube connected to a water seal was placed, achieving lung expansion. Immediately, the patient presented hypotension and a reduction in arterial oxygen saturation to 78%. Non-invasive ventilation was started. A chest X ray showed extensive right lung edema. The patient was managed with noradrenaline and albumin infusion with good response. Pulmonary edema resolved on day 3 but air leak was persistant so, the patient required surgery to excise apical bullae in the right lung. He was discharged during the following days in good condition.


Subject(s)
Humans , Male , Young Adult , Pneumothorax/complications , Pneumothorax/therapy , Pulmonary Edema/etiology , Pulmonary Edema/therapy , Drainage/adverse effects , Pulmonary Edema/diagnostic imaging , Radiography, Thoracic , Chest Tubes/adverse effects , Risk Factors , Treatment Outcome
6.
Rev. Col. Bras. Cir ; 45(2): e1543, 2018. tab, graf
Article in English | LILACS | ID: biblio-896650

ABSTRACT

ABSTRACT Objective: to identify predictors of chest drainage complications in trauma patients attended at a University Hospital. Methods: we conducted a retrospective study of 68 patients submitted to thoracic drainage after trauma, in a one-year period. We analyzed gender, age, trauma mechanism, trauma indices, thoracic and associated lesions, environment in which the procedure was performed, drainage time, experience of the performer, complications and evolution. Results: the mean age of the patients was 35 years and the male gender was the most prevalent (89%). Blunt trauma was the most frequent, with 67% of cases, and of these, 50% were due to traffic accidents. The mean TRISS (Trauma and Injury Severity Score) was 98, with a mortality rate of 1.4%. The most frequent thoracic and associated lesions were, respectively, rib fractures (51%) and abdominal trauma (32%). The mean drainage time was 6.93 days, being higher in patients under mechanical ventilation (p=0.0163). The complication rate was 26.5%, mainly poor drain positioning (11.77%). Hospital drainage was performed in 89% of cases by doctors in the first year of specialization. Thoracic drainage performed in prehospital care presented nine times more chances of complications (p=0.0015). Conclusion: the predictors of post-trauma complications for chest drainage were a procedure performed in an adverse site and mechanical ventilation. The high rate of complications demonstrates the importance of protocols of care with the thoracic drainage.


RESUMO Objetivo: identificar fatores preditores de complicações da drenagem torácica em pacientes vítimas de trauma, atendidos em um Hospital Universitário. Métodos: estudo retrospectivo de 68 pacientes submetidos à drenagem torácica pós-trauma, no período de um ano. Foram analisadas as seguintes variáveis: sexo, idade, mecanismo de trauma, índices de trauma, lesões torácicas e associadas, ambiente em que foi realizado o procedimento, tempo de permanência do dreno, grau de experiência do executor do procedimento, complicações e evolução. Resultados: a média de idade dos pacientes foi de 35 anos e o sexo masculino foi o mais prevalente (89%). O trauma contuso foi o mais frequente, com 67% dos casos, e destes, 50% por acidentes de trânsito. A média do TRISS (Trauma and Injury Severity Score) foi 98, com taxa de mortalidade de 1,4%. As lesões torácicas e associadas mais frequentes foram, respectivamente, fraturas de costelas (51%) e trauma abdominal (32%). A média de permanência do dreno foi de 6,93 dias, sendo maior nos pacientes sob ventilação mecânica (p=0,0163). A taxa de complicações foi de 26,5%, com destaque para o mau posicionamento do dreno (11,77%). A drenagem hospitalar foi realizada, em 89% dos casos, por médicos do primeiro ano de especialização. A drenagem torácica realizada no atendimento pré-hospitalar apresentou nove vezes mais chances de complicações (p=0,0015). Conclusão: os fatores preditores de complicações para drenagem torácica pós-trauma foram: procedimento realizado em local adverso e ventilação mecânica. A alta taxa de complicações demonstra a importância dos protocolos de cuidados com a drenagem torácica.


Subject(s)
Humans , Male , Female , Adult , Postoperative Complications/etiology , Thoracic Injuries/surgery , Drainage/adverse effects , Prognosis , Retrospective Studies
7.
Acta cir. bras ; 30(12): 844-851, Dec. 2015. tab
Article in English | LILACS | ID: lil-769503

ABSTRACT

ABSTRACT PURPOSE: To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS: A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS: The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION: The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Drainage/methods , Herniorrhaphy/rehabilitation , Incisional Hernia/surgery , Seroma/etiology , Surgical Wound Infection/etiology , Drainage/adverse effects , Follow-Up Studies , Hernia, Ventral/surgery , Incisional Hernia/complications , Reoperation , Seroma , Surgical Mesh/adverse effects , Suture Techniques/adverse effects
8.
Rev. bras. epidemiol ; 18(3): 525-537, Jul.-Sep. 2015. tab, ilus
Article in English | LILACS | ID: lil-756013

ABSTRACT

INTRODUCTION:

The pathogenic and consistent effect of discrimination on mental health has been largely documented in the literature. However, there are few studies measuring multiple types of discrimination, evaluating the existence of a dose-response relationship or investigating possible effect modifiers of such an association.

OBJECTIVE:

To investigate the association between experiences of discrimination attributed to multiple reasons and common mental disorders, including the adjustment for potential confounders, assessment of dose-response relations, and examination of effect modifiers in undergraduate students from southern Brazil.

METHODS:

In the first semester of 2012, 1,023 students from the Universidade Federal de Santa Catarina answered a self-administered questionnaire on socio-demographic characteristics, undergraduate course, experiences of discrimination and common mental disorders. Associations were analyzed through logistic regression models, estimation of Odds Ratios and 95% confidence intervals (95%CI).

RESULTS:

The study results showed that students reporting discrimination at high frequency and intensity were 4.4 (95%CI 1.6 - 12.4) times more likely to present common mental disorders. However, the relationship between discrimination and common mental disorders was protective among Electrical Engineering students, when compared to Accounting Sciences students who did not report discrimination.

CONCLUSION:

The findings suggest that the dose-response relationship between experiences of discrimination and common mental disorders reinforces the hypothetical causal nature of this association. Nevertheless, the modification of effect caused by the undergraduate course should be considered in future studies for a better understanding and measurement of both ...


INTRODUÇÃO:

O efeito deletério e consistente das experiências discriminatórias sobre a saúde mental tem sido amplamente documentado na literatura. No entanto, são escassos os trabalhos que aferem múltiplos tipos de discriminação, avaliam a existência de relação dose-resposta ou investigam possíveis modificadores de efeito dessa associação.

OBJETIVO:

Investigar a associação entre experiências discriminatórias por múltiplos motivos e sofrimento psíquico, incluindo a avaliação de efeito dose-resposta, o ajuste para potenciais confundidores e o exame de modificadores de efeito em estudantes universitários do sul do Brasil.

MÉTODOS:

No primeiro semestre de 2012, 1.023 graduandos da Universidade Federal de Santa Catarina responderam a um questionário autopreenchível sobre características sociodemográficas, curso de graduação, experiências discriminatórias e sofrimento psíquico. As associações foram analisadas com modelos de regressão logística, estimação de razões de chance e seus respectivos intervalos de confiança de 95% (IC95%).

RESULTADOS:

Observou-se que estudantes que relataram sofrer discriminação em alta frequência e intensidade apresentaram 4,4 (IC95% 1,6 - 12,4) vezes mais chance de apresentar sofrimento psíquico. Entretanto, a relação da discriminação com o sofrimento psíquico foi protetora em meio aos graduandos de Engenharia Elétrica, quando comparados aos de Ciências Contábeis não discriminados.

CONCLUSÃO:

A partir do estudo, concluiu-se que a relação dose-resposta entre experiências discriminatórias e sofrimento psíquico reforça a hipótese de natureza causal dessa associação. Contudo, a modificação de efeito ocasionada pelo curso de graduação deve ser considerada em investigações futuras para uma melhor compreensão de ambos os fenômenos e suas estratégias de mensuração.

.


Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Antisepsis , Breast Neoplasms/surgery , Catheters/microbiology , Mammaplasty , Mastectomy , Surgical Wound Infection/prevention & control , Breast Neoplasms/complications , Breast Neoplasms/pathology , Catheters/adverse effects , Drainage/adverse effects , Follow-Up Studies , Neoplasm Staging , Postoperative Care , Prognosis , Prospective Studies , Surgical Wound Infection/etiology
9.
São Paulo; s.n; 2015. [155] p. tab, ilus, graf.
Thesis in Portuguese | LILACS | ID: biblio-870843

ABSTRACT

Introdução: O acesso biliar ecoguiado é um método de drenagem alternativo à drenagem percutânea transhepática (DPTH) e à cirurgia em pacientes com obstrução biliar distal incurável que falharam drenagem por Colangiopancreatografia Endoscópica Retrógrada (CPRE). Nos casos em que a drenagem ecoguiada anterógrada transpapilar (ou transanastomótica) e o rendez-vous ecoguiado não podem ser realizados como primeira opção, a coledocoduodenostomia (CDT) e a hepaticogastrostomia (HPG) ainda podem ser realizadas em pacientes selecionados. Estas duas vias de drenagem não anatômicas criam uma fístula entra a via biliar e o estômago ou duodeno. Não há dados na literatura que determinem superioridade de uma ou outra técnica. Objetivo: Comparar o sucesso técnico, sucesso clínico e fatores associados entre as duas vias de drenagem em pacientes com obstrução da via biliar distal maligna incurável que não lograram sucesso na drenagem por CPRE ou rendez-vous ecoguiado. Métodos: Entre abril de 2010 e dezembro de 2013, 49 pacientes com obstrução biliar distal maligna incurável que falharam CPRE e rendez-vous ecoguiado foram randomizados para CDT ou HPG. Dados referentes ao sucesso técnico, sucesso clínico, tempo de procedimento, complicações, qualidade de vida e sobrevida foram coletados até três meses após o procedimento. Todos os procedimentos foram realizados em um centro terciário de endoscopia pelo mesmo endoscopista. Próteses biliares parcialmente recobertas (Boston Scientific, Wallflex, 10 mm, 8 cm ou 6 cm) foram utilizadas em todos os pacientes com sucesso técnico. Nos casos de HPG a punção ecoguiada foi intra-hepática no ducto hepático esquerdo. Nos casos de CDT a punção foi extra-hepática no segmento distal não obstruído do colédoco. Após a punção foi realizada colangiografia com introdução de um fio guia hidrofílico de 0,035 polegada. Dilatação com cateter e um dispositivo de needle knife foi realizada para permitir introdução do sistema de disparo da prótese biliar...


Background: EUS-guided biliary access is an alternative for percutaneous access or surgery in patients with malignant unresectable distal biliary obstruction and failed ERCP. When rendezvous or anterograde transpapillary/transanastomotic intervention fails as primary drainage options, a Choledochoduodenostomy (CDT) or a Hepaticogastrostomy (HGT) can still be performed in selected patients. This procedure creates a new " " y I w one route or the other should be recommended. Aim: To compare technical and clinical success and possible associated factors between the two different drainage routes CDT and HGT in patients with distal unresectable malignant biliary obstruction that failed standard ERCP and EUS-guided rendez vouz (RV) maneuver. Methods: Between April/2010 and December/2013 49 consecutive jaundiced patients with distal unresectable malignant biliary obstruction that failed previous ERCP and EUS-guided RV maneuver were elected randomly to undergo either EUS-guided CDT or HGT. Data including indications, clinical and technical success, procedural times and complications with a three-month follow-up were prospectively collected in a database. All procedures were performed in a tertiary center by the same endoscopist. A partially covered SEMS (Boston Scientific, Wallflex, 10 mm, 8 cm or 6 cm) was used in all technically successful procedures. After puncture of left hepatic duct in case of HGT or the distal unobstructed segment of common bile duct in case of CDT a cholangiogram was obtained followed by advancement of a 0,035-inch guide wire into the biliary system. Bougies and wire-guided needle-knife were used to perform track dilation to allow passage of an 8.5 Fr stent delivery system. Results: Forty-nine cases (25 HGT and 24 CDT) were performed. All patients had intra and extra hepatic biliary dilation. Technical success rate was 96 % for HGT and 91% for CDT (p = 0.609). Clinical success rate was 91% for HPG and 77% for CDT (p = 0.234)...


Subject(s)
Humans , Male , Female , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis , Drainage/adverse effects , Drainage/methods , Bile Ducts , Endoscopy , Endosonography , Jaundice, Obstructive , Pancreatic Neoplasms/therapy
10.
Rev. bras. cir. plást ; 30(3): 468-472, 2015. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-1160

ABSTRACT

A ocorrência de seroma como complicação tardia por implante de silicone mamário é de grande interesse, dadas as implicações estéticas, como assimetria, e a possível associação com infecções ou até mesmo malignidades. Acredita-se que esta complicação seja exclusiva de próteses texturizadas. Os autores fazem síntese da literatura a partir de pesquisa de dados em publicações disponíveis em MEDLINE com o termo "late breast seroma" em busca de maior esclarecimento da patologia. A etiologia é desconhecida na maioria dos casos. Nota-se que o tratamento definitivo de escolha é cirúrgico, sendo que grande parte dos autores recomenda a avaliação bacteriológica e citológica do seroma, preferencialmente guiado por ultrassonografia. O tratamento deve ser individualizado, de acordo com a clínica apresentada, antecipando a possibilidade de recorrência do evento e a sequela final, oferecendo, assim, o melhor tratamento à paciente.


The occurrence of seroma as a late complication of silicone breast implant is of great interest, given the aesthetic implications such as asymmetry and the possible association with infections or even malignancies. This complication is believed to be exclusive of textured prostheses. The present authors reviewed the literature by conducting a search of data in publications available in Medline by using the search term "late breast seroma" in order to clarify the pathological features of seroma. The etiology is unknown in most cases. The definitive treatment of choice is surgery, and most authors recommend bacteriological and cytological evaluations for seroma, preferably guided by ultrasonography. To provide patients with the best treatment, the treatment should be individualized according to clinical presentation, anticipating the possibility of recurrence and final sequelae.


Subject(s)
Humans , Female , Adult , Middle Aged , History, 21st Century , Prostheses and Implants , Recurrence , Silicones , Breast , Case Reports , Review Literature as Topic , Drainage , Mammaplasty , Breast Implants , Reconstructive Surgical Procedures , Evaluation Study , Seroma , Prostheses and Implants/adverse effects , Silicones/adverse effects , Silicones/therapeutic use , Breast/surgery , Drainage/adverse effects , Drainage/methods , Mammaplasty/adverse effects , Mammaplasty/methods , Breast Implants/adverse effects , Reconstructive Surgical Procedures/methods , Seroma/surgery , Seroma/complications
11.
Gut and Liver ; : 791-799, 2015.
Article in English | WPRIM | ID: wpr-67324

ABSTRACT

BACKGROUND/AIMS: Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma. METHODS: A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two groups: the PTBD group (n=62) and the EBD group (n=44). RESULTS: Successful drainage on the first attempt was achieved in 36 of 62 patients (58.1%) with PTBD, and in 25 of 44 patients (56.8%) with EBD. There were no significant differences in predrainage patient demographics and decompression periods between the two groups. Procedure-related complications, especially cholangitis and pancreatitis, were significantly more frequent in the EBD group than the PTBD group (PTBD vs EBD: 22.6% vs 54.5%, p<0.001). Two patients (3.8%) in the PTBD group experienced catheter tract implantation metastasis after curative resection during the follow-up period. CONCLUSIONS: EBD was associated with a higher risk of procedure-related complications than PTBD. These complications were managed properly without severe morbidity; however, in the PTBD group, there were two cases of cancer dissemination along the catheter tract.


Subject(s)
Aged , Aged, 80 and over , Bile Duct Neoplasms/surgery , Bile Ducts/surgery , Cholangitis/etiology , Drainage/adverse effects , Endoscopy, Gastrointestinal/adverse effects , Female , Humans , Klatskin Tumor/surgery , Liver/surgery , Male , Middle Aged , Pancreatitis/etiology , Postoperative Complications/etiology , Preoperative Care/adverse effects , Treatment Outcome
12.
Rev. bras. cir. cardiovasc ; 29(2): 266-271, Apr-Jun/2014. tab
Article in Portuguese | LILACS | ID: lil-719423

ABSTRACT

Revisão sistemática sobre drenagem assistida a vácuo na circulação extracorpórea, demonstrando seus benefícios, desvantagens, por relatos de casos e evidências sobre seus efeitos na microcirculação. Realizou-se pesquisa sistemática, no período de 1997-2012, nas bases de dados do PubMed-Medline, Lilacs e SciELO. Termos: "circulação extracorpórea", "vácuo", "drenagem", "cirurgia cardíaca" e suas correspondentes traduções, em condições variadas. Dos 70 artigos selecionados, 26 foram incluídos na revisão. Embora a drenagem assistida a vácuo possua potencial significante de complicações e exija tecnologia e profissionalismo respectivo adequado, prevaleceu na literatura revisada o conceito de que a drenagem assistida a vácuo contribuiu na redução no índice de transfusões, hemodiluições, melhor campo operatório, não aumento de hemólise significativa, redução de complicações pós-cirúrgicas, uso de menor prime e uso de cânulas de menor calibre.


Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.


Subject(s)
Humans , Cardiopulmonary Bypass/methods , Drainage/methods , Cardiopulmonary Bypass/adverse effects , Drainage/adverse effects , Postoperative Complications , Reproducibility of Results , Risk Assessment , Vacuum
13.
J. bras. pneumol ; 40(1): 6-12, jan-feb/2014. tab, graf
Article in English | LILACS | ID: lil-703609

ABSTRACT

OBJECTIVE: Thoracentesis is one of the bedside procedures most commonly associated with iatrogenic complications, particularly pneumothorax. Various risk factors for complications associated with thoracentesis have recently been identified, including an inexperienced operator; an inadequate or inexperienced support team; the lack of a standardized protocol; and the lack of ultrasound guidance. We sought to determine whether ultrasound-guided thoracentesis can reduce the risk of pneumothorax and improve outcomes (fewer procedures without fluid removal and greater volumes of fluid removed during the procedures). In our comparison of thoracentesis with and without ultrasound guidance, all procedures were performed by a team of expert pulmonologists, using the same standardized protocol in both conditions. METHODS: A total of 160 participants were randomly allocated to undergo thoracentesis with or without ultrasound guidance (n = 80 per group). The primary outcome was pneumothorax following thoracentesis. Secondary outcomes included the number of procedures without fluid removal and the volume of fluid drained during the procedure. RESULTS: Pneumothorax occurred in 1 of the 80 patients who underwent ultrasound-guided thoracentesis and in 10 of the 80 patients who underwent thoracentesis without ultrasound guidance, the difference being statistically significant (p = 0.009). Fluid was removed in 79 of the 80 procedures performed with ultrasound guidance and in 72 of the 80 procedures performed without it. The mean volume of fluid drained was larger during the former than during the latter (960 ± 500 mL vs. 770 ± 480 mL), the difference being statistically significant (p = 0.03). CONCLUSIONS: Ultrasound guidance increases the yield of thoracentesis and reduces the risk of post-procedure pneumothorax. (Chinese Clinical Trial Registry identifier: ChiCTR-TRC-12002174 [http://www.chictr.org/en/]) .


OBJETIVO: Dentre os procedimentos realizados à beira do leito, a toracocentese é um dos mais comumente associados a complicações iatrogênicas, particularmente pneumotórax. Foram recentemente identificados vários fatores de risco de complicações associadas à toracocentese: a inexperiência do operador, a inadequação ou inexperiência da equipe de apoio, a ausência de um protocolo padronizado e a ausência de ultrassonografia para guiar o procedimento. Nosso objetivo foi determinar se a toracocentese guiada por ultrassonografia pode reduzir o risco de pneumotórax e melhorar os desfechos (menos procedimentos sem remoção de líquido e maior volume de líquido removido durante os procedimentos). Para compararmos a toracocentese guiada por ultrassonografia à toracocentese sem ultrassonografia, todos os procedimentos foram realizados pela mesma equipe de pneumologistas especialistas, os quais usaram o mesmo protocolo padronizado em ambas as condições. MÉTODOS: Cento e sessenta pacientes foram aleatoriamente divididos em dois grupos: toracocentese guiada por ultrassonografia e toracocentese sem ultrassonografia (n = 80 por grupo). O desfecho primário foi pneumotórax após a toracocentese. Os desfechos secundários foram o número de procedimentos sem remoção de líquido e o volume de líquido drenado durante o procedimento. RESULTADOS: Houve pneumotórax em 1 dos 80 pacientes submetidos a toracocentese guiada por ultrassonografia e em 10 dos 80 submetidos a toracocentese sem ultrassonografia; a diferença foi estatisticamente significante (p = 0,009). Líquido foi removido em 79 dos 80 procedimentos guiados por ultrassonografia e em 72 dos 80 que não o foram. A média do volume de líquido drenado foi maior nos procedimentos guiados por ultrassonografia ...


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pleural Effusion/therapy , Pleural Effusion , Pneumothorax/prevention & control , Thoracic Surgical Procedures/adverse effects , Ultrasonography, Interventional/methods , Drainage/adverse effects , Postoperative Complications , Prospective Studies , Pneumothorax/etiology , Risk Factors
14.
Article in English | WPRIM | ID: wpr-108750

ABSTRACT

Hilar cholangiocarcinoma has an extremely poor prognosis and is usually diagnosed at an advanced stage. Palliative management plays an important role in the treatment of patients with inoperable hilar cholangiocarcinoma. Surgical, percutaneous, and endoscopic biliary drainage are three modalities available to resolve obstructive jaundice. Plastic stents were widely used in the past; however, self-expanding metal stents (SEMS) have become popular recently due to their long patency and reduced risk of side branch obstruction, and SEMS are now the accepted treatment of choice for hilar cholangiocarcinoma. Bilateral drainage provides more normal and physiological biliary flow through the biliary ductal system than that of unilateral drainage. Unilateral drainage was preferred until recently because of its technical simplicity. But, with advancements in technology, bilateral drainage now achieves a high success rate and is the preferred treatment modality in many centers. However, the choice of unilateral or bilateral drainage is still controversial, and more studies are needed. This review focuses on the endoscopic method and discusses stent materials and types of procedures for patients with a hilar cholangiocarcinoma.


Subject(s)
Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic/surgery , Cholangiocarcinoma/surgery , Cholangiopancreatography, Endoscopic Retrograde , Drainage/adverse effects , Endoscopy/adverse effects , Humans , Prosthesis Design , Stents , Treatment Outcome
15.
J. venom. anim. toxins incl. trop. dis ; 18(3): 344-348, 2012. ilus, graf
Article in English | LILACS | ID: lil-649481

ABSTRACT

Whenever humans come in touch with the sea, they become vulnerable to risks, most frequently on account of invading a habitat that belongs to potentially harmful aquatic animals. World literature shows a growing number of incidents in recent years with marine stingrays, despite the fact that these animals only attack when harassed. This report describes an accident in which an amateur fisherman was injured by a marine stingray, probably of the Dasyatis family, on his left forearm. The puncture wound was highly painful and progressed to rhabdomyolysis. It is conjectured that lymphatic drainage, applied in an attempt to reduce edema and its complications, may have contributed to rebound increase in serum creatine kinase levels (CK) and, thus, has exacerbated the intensity of rhabdomyolysis. Therefore, as a measure of caution, lymphatic drainage should not enter current treatment protocols for similar cases, until new studies are performed in order to clarify this issue.


Subject(s)
Humans , Male , Female , Middle Aged , Rhabdomyolysis , Skates, Fish/injuries , Drainage/adverse effects
16.
Cuad. cir ; 25(1): 11-17, 2011. ilus, tab
Article in Spanish | LILACS | ID: lil-695675

ABSTRACT

Introducción: Actualmente, no se conocen los factores de riesgo de morbimortalidad postoperatoria en los pacientes que son intervenidos por una hernia de pared abdominal complicada operada de urgencia mediante una hernioplastía con malla. El objetivo principal es determinar los factores de riesgo de presentar una complicación durante el postoperatorio, en pacientes operados de urgencia con diagnóstico de hernia de pared abdominal complicada mediante una hernioplastía con malla en el Hospital Base Osorno (HBO) entre los años 2002 y 2008. Material y métodos: Cohorte retrospectiva. Se seleccionaron los pacientes mayores de 14 años operados por patología herniaria del registro de cirugías del Servicio de Urgencia del Hospital Base Osorno (HBO) entre los años 2002 y 2008. Se excluyeron a aquellos operados sin malla. Se estimó el riesgo, mediante Odds ratio (OR) y su intervalo de confianza 95 por ciento. Software utilizado: Stata 10.0. Resultados: La cohorte incluyó 52 pacientes, mediana de edad 64 años (26-85). El 50 por ciento (26 pacientes) fueron de sexo masculino. La ubicación herniaria más frecuente fue la inguinal con 23 casos (44,23 por ciento). 49 (94,23 por ciento) hernias se catalogaron como atascadas y 3 (5,77 por ciento) como estranguladas. Morbilidad operatoria 17,31 por ciento (9 pacientes). Mediana de seguimiento, 32 (5-90) meses. Sólo la instalación de drenaje resultó ser significativa (p<0,05), esta variable resultó tener un OR de 4,7 (IC 95 por ciento:1,09-20,79). Conclusión: En este estudio la instalación de un drenaje al reparar una hernia de pared abdominal complicada con malla, actuaría como factor de riesgo de presentar una complicación durante el postoperatorio.


Introduction: Currently, there are no known risk factors for postoperative complications and mortality in patients who are undergoing surgery for a complicated abdominal wall hernia operated emergency through a hernioplasty with mesh. The main objective is to determine the risk factors for presenting a complication during the postoperative period in patients undergoing emergency with a diagnosis of complicated abdominal wall hernia by a hernioplasty with mesh in the Base Hospital Osorno (HBO) between the years 2002 and 2008. Material and methods: retrospective cohort study. We selected patients older than 14 years operated by hernial pathology of the registration of surgeries of the Emergency Service at the Hospital Base Osorno (HBO) between the years 2002 and 2008. We excluded those operated without mesh. It was felt the risk, using odds ratio (OR) and its confidence interval of 95 percent Software used: Stata 10.0. Results: The cohort included 52 patients, median age 64 years (26-85). The 50 percent (26 patients) were male. The most frequent location hernia was the groin with 23 cases (44.23 percent). 49 (94.23 percent) hernias were catalogd as stuck and 3 (5.77 percent) as being strangled. Operative morbidity 17.31 percent (9 patients). Median follow-up, 32 (5-90 percent) months. Only the installation of drainage turned out to be significant (p<0.05 ), this variable was found to have an OR of 4.7 (IC 95 percent:1,09-20,79). Conclusion: In this study, the installation of a drain after to repair an complicated abdominal wall hernia with mesh would act as a risk factor for presenting a complication during the postoperative period.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Aged, 80 and over , Postoperative Complications/epidemiology , Hernia, Abdominal/surgery , Hernia, Abdominal/complications , Surgical Mesh , Drainage/adverse effects , Emergencies , Length of Stay , Multivariate Analysis , Retrospective Studies , Risk Factors , Emergency Service, Hospital/statistics & numerical data
17.
Arq. bras. cardiol ; 95(4): 441-447, out. 2010. tab
Article in Portuguese | LILACS | ID: lil-568969

ABSTRACT

FUNDAMENTO: No período do peri-operatório, os cuidados têm sido cada vez mais criteriosos, entretanto, as complicações pulmonares após a abordagem cirúrgica ainda são frequentes, predispondo o paciente a um maior tempo de internação ou ao óbito. OBJETIVO: Descrever a incidência de complicações pulmonares e identificar a sua associação com tempos de circulação extracorpórea (CEC); cirurgia e isquemia; número de enxertos; localização e tempo de drenos após cirurgia de revascularização do miocárdio (CRM). MÉTODOS: Nesta coorte contemporânea, foram estudados 202 pacientes em hospital universitário de referência para cardiologia no sul do Brasil, submetidos à CRM eletiva com ponte safena e artéria mamária interna com CEC, no período de abril/2006 a novembro/2007. Os desfechos considerados foram: tempo de ventilação mecânica; surgimento de pneumonia; atelectasia; derrame pleural; hora da retirada e localização dos drenos; e tempo de internação. RESULTADOS: Observou-se algum tipo de complicação pulmonar em 90 dos 202 pacientes. A frequência de derrame pleural foi de 84 por cento e a de atelectasia foi de 65 por cento. Apresentaram associação com complicações pulmonares os tempos de CEC (p = 0,003), cirúrgico (p = 0,040) e isquemia (p = 0,001); o tempo de permanência de drenos (p = 0,050) e a localização pleural dos drenos (p = 0,033), além de idade (p = 0,001), fração de ejeção (p = 0,010), diagnóstico de asma (p = 0,047) e exame radiológico de tórax pré-operatório anormal (p = 0,029). CONCLUSÃO: Variáveis relacionadas à complexidade do ato cirúrgico e comorbidades pré-existentes estão associadas a uma alta incidência de complicações pulmonares no pós-operatório. Esses dados reforçam a importância da avaliação clínica peri-operatória para detecção precoce de complicação respiratória após CRM.


BACKGROUND: Despite the increasingly careful attempts to reduce perioperative risks, pulmonary complications following surgery are still very common, leading to longer length of hospital stays or death. OBJECTIVE: To describe the incidence of pulmonary complications and identify their association with duration of extracorporeal circulation (ECC), surgery and ischemia, number of bypass grafts performed, location of drains and length of drainage following myocardial revascularization (MRV). METHODS: This contemporaneous cohort consisted of 202 patients undergoing elective myocardial revascularization (MRV) with saphenous vein graft and internal mammary artery graft and ECC, at a referral university cardiology hospital in Southern Brazil, from April 2006 to November 2007. The following outcomes were analyzed: duration of mechanical ventilation; pneumonia onset; atelectasis; pleural effusion; location of drains and time of removal; and length of hospital stay. RESULTS: Of the 202 patients, 90 developed some sort of pulmonary complication. The incidence of pleural effusion was 84 percent, whereas atelectasis was 65 percent. The following variables were associated with pulmonary complications: duration of ECC (p = 0.003), surgery (p = 0.040) and ischemia (p = 0.001); length of drainage (p = 0.050) and location of pleural drains (p = 0.033); age (p = 0.001); ejection fraction (p = 0.010); diagnosis of asthma (p = 0.047) and preoperative abnormal chest X-ray findings (p = 0.029). CONCLUSION: Variables related to the complexity of the surgery and preexisting comorbidities are associated with a high incidence of postoperative pulmonary complications. These data reinforce the importance of having patients undergo perioperative clinical assessment to detect early respiratory complications after MRV.


FUNDAMENTO: En el período del peri-operatorio, los cuidados han sido cada vez más criteriosos, entre tanto, las complicaciones pulmonares después del abordaje quirúrgico aun son frecuentes, predisponiendo al paciente a un mayor tiempo de internación o al óbito. OBJETIVO: Describir la incidencia de complicaciones pulmonares y identificar su asociación con tiempos de circulación extracorporal (CEC); cirugía e isquemia; número de injertos; localización y tiempo de drenajes después de cirugía de revascularización del miocardio (CRM). MÉTODOS: En esta cohorte contemporánea, fueron estudiados 202 pacientes en hospital universitario de referencia para cardiología en el sur del Brasil, sometidos a la CRM electiva con puente safena y arteria mamaria interna con CEC, en el período de abril/2006 a noviembre/2007. Los desenlaces considerados fueron: tiempo de ventilación mecánica; surgimiento de neumonía; atelectasia; derrame pleural; hora de la retirada y localización de los drenajes; y tiempo de internación. RESULTADOS: Se observó algún tipo de complicación pulmonar en 90 de los 202 pacientes. La frecuencia de derrame pleural fue de 84 por ciento y la de atelectasia fue de 65 por ciento. Presentaron asociación con complicaciones pulmonares los tiempos de CEC (p = 0,003), quirúrgico (p = 0,040)e isquemia (p = 0,001); el tiempo de permanencia de drenajes (p = 0,050) y la localización pleural de los drenajes (p = 0,033), además de edad (p = 0,001), fracción de eyección (p = 0,010), diagnóstico de asma (p = 0,047) y examen radiológico de tórax pre-operatorio anormal (p = 0,029). CONCLUSIÓN: Variables relacionadas a la complejidad del acto quirúrgico y comorbilidades pre-existentes están asociadas a una alta incidencia de complicaciones pulmonares en el post-operatorio. Esos datos refuerzan la importancia de la evaluación clínica peri-operatoria para detección precoz de complicación respiratoria después de CRM.


Subject(s)
Female , Humans , Male , Middle Aged , Myocardial Revascularization/adverse effects , Respiratory Tract Diseases/epidemiology , Brazil/epidemiology , Drainage/adverse effects , Drainage/instrumentation , Extracorporeal Circulation/adverse effects , Incidence , Linear Models , Risk Factors , Respiration, Artificial/adverse effects , Respiration, Artificial/instrumentation , Respiratory Tract Diseases/etiology , Time Factors
18.
Int. braz. j. urol ; 36(1): 29-37, Jan.-Feb. 2010. ilus, tab
Article in English | LILACS | ID: lil-544071

ABSTRACT

Purpose: To compare the results of percutaneous and open drainage for perinephric abscess. MATERIALS AND METHODS: The files of 86 patients who underwent drainage for perinephric abscesses from April 2001 through March 2008 were evaluated. The method of drainage for each patient was performed according to the clinical decision of the treating physician. Percutaneous tube drain (PCD) was used for drainage of the abscess in 43 patients (group 1), while the other 43 patients were managed with open drainage (group 2). Cure was defined as complete obliteration of the abscess cavity. The cure rates, complications, and hospital stay were compared between both groups. Results: The study included 50 males and 36 females with mean age 44.2 ± 17.3. The most common predisposing factors were diabetes mellitus and/or stones. Open drainage of perinephric abscesses resulted in a statistically significant higher cure rate (98 percent versus 69 percent, p < 0.001) and shorter hospital stay than PCD (3.6 versus 6 days, p < 0.001). Failure of complete drainage of multilocular abscess was observed in 8 of 13 cases (61.5 percent) in group 1 and one of 38 cases (2.6 percent) in group 2 (P < 0.001). Complications were observed in 7 percent of group 1 and 11.5 percent in group 2 (P = 0.45). After mean follow-up of 19 months, 9 of 46 patients (19.6 percent) had recurrence; 7 of them were in group 1. CONCLUSIONS: Percutaneous drainage of perinephric abscess is an effective minimally invasive treatment. However, PCD is not the optimal method for drainage of multilocular abscess because open surgical drainage provided higher cure rates and shorter hospitalization than PCD.


Subject(s)
Adult , Female , Humans , Male , Abscess/therapy , Drainage/methods , Kidney Diseases/therapy , Drainage/adverse effects , Follow-Up Studies , Length of Stay , Treatment Outcome
20.
Rev. argent. resid. cir ; 14(1): 22-25, oct. 2009. tab
Article in Spanish | LILACS | ID: lil-563235

ABSTRACT

Antecedentes: La colecistectomía laparoscópica representa en la actualidad el tratamiento de elección para la litiasis vesicular sintomática. El diagnóstico temprano de las complicaciones permite la rápida resolución de los mismas disminuyendo la morbimortalidad. La utilización en forma sistemática de drenajes en la colecistectomía laparoscópica permitiría advertir pérdidas biliares o hemáticas en forma precoz. Objetivo: Demostrar la utilidad de los drenajes tubulares de pequeño calibre, utilizados sistemáticamente en la colecistectomía laparoscópica. Lugar de aplicación: Sanatorio Franchin. Obra Social del Personal de la Construcción (OSPECON). Diseño: Estudio retrospectivo. Período: Enero 2006 -Enero 2009. Conclusiones: La utilización de drenajes abdominales en las cirugías laparoscópicas analizadas en esta serie, no agregaron morbilidad, fueron útiles para la detección temprana de complicaciones postoperatorias inmediatas en la mitad de los casos.


Subject(s)
Humans , Male , Female , Case Reports , Urinary Bladder Calculi/surgery , Urinary Bladder Calculi/diagnosis , Cholecystectomy, Laparoscopic/methods , Cholecystectomy, Laparoscopic/trends , Drainage/adverse effects , Drainage
SELECTION OF CITATIONS
SEARCH DETAIL