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1.
Arch. argent. pediatr ; 119(5): e513-e517, oct. 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292683

ABSTRACT

La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento .Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.


Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes.Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.


Subject(s)
Humans , Male , Infant , Child , Duodenal Diseases/diagnosis , Duodenal Diseases/etiology , Graft vs Host Disease/diagnosis , Graft vs Host Disease/etiology , Endoscopy, Gastrointestinal , Hematoma/diagnosis , Hematoma/etiology , Gastrointestinal Hemorrhage
2.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1142105

ABSTRACT

La hemorragia posparto es una de las principales causas de muerte materna con una elevada morbimortalidad. El hematoma del ligamento ancho representa una entidad inusual, de difícil diagnóstico y alta sospecha clínica. Se presenta el caso clínico de una paciente con un hematoma del ligamento ancho espontáneo luego de un parto vaginal. Se optó por una conducta activa con laparotomía y antibioticoterapia obteniendo una buena evolución con egreso hospitalario a los 30 días. Se realiza la discusión del caso luego de revisar la bibliografía disponible.


Postpartum hemorrhage is one of the main causes of maternal death with high morbidity and mortality. The broad ligament hematoma represents an unusual entity, difficult to diagnose, in which clinical suspicion is determinant. The clinical case of a patient with a spontaneous broad ligament hematoma after a vaginal delivery is presented. An active management with laparotomy and antibiotic therapy was chosen, obtaining a satisfactory evolution with hospital discharge at 30 days. The case is discussed, after reviewing the available bibliography.


A hemorragia pós-parto é uma das principais causas de morte maternal com alta morbidade e mortalidade. O hematoma do ligamento largo representa uma entidade incomum, de difícil diagnóstico e alto suspeita clínica. A presentamos o caso clínico de uma paciente com hematoma espontâneo do ligamento largo, após parto vaginal. Foi optada por conduta ativa com laparotomía e antibioticoterapia, obtendo boa evolução com alta hospitalar após 30 dias. O caso é discutido depois de revisar a bibliografia disponível.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Broad Ligament/injuries , Hematoma/surgery , Hematoma/diagnostic imaging , Natural Childbirth/adverse effects , Parity , Pre-Eclampsia , Risk Factors , Episiotomy/adverse effects , Hematoma/etiology , Postpartum Hemorrhage
3.
Rev. bras. cir. cardiovasc ; 35(3): 396-398, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137278

ABSTRACT

Abstract Coronary artery bypass grafting is a commonly performed procedure for coronary revascularization. We describe the successful management of left ventricular dissecting hematoma, caused by the tissue stabilizer, while performing off-pump coronary artery bypass graft procedure.


Subject(s)
Humans , Coronary Artery Bypass, Off-Pump/adverse effects , Heart Ventricles/surgery , Treatment Outcome , Hematoma/surgery , Hematoma/etiology , Hematoma/diagnostic imaging
4.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(3): 5-9, dic.2019. tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1021561

ABSTRACT

La hemorragia postparto es una de las complicaciones obstétricas más temidas por los obstetras a nivel mundial, pudiendo causar la muerte de las puérperas. El objetivo de este estudio fue determinar las causas de las hemorragias y las patologías asociadas a estas en las pacientes atendidas en el Hospital Gineco-Obstétrico Enrique C. Sotomayor de Guayaquil, Ecuador en el periodo 2016­2018 y que estaban en su puerperio inmediato. Las mujeres atendidas en ese periodo en dicha institución fueron 528, de las cuales 160 presentaron hemorragias en el puerperio inmediato. Las hemorragias por desgarro del suelo pélvico representaron un 48,75% y se asociaron en un 35% a hematomas en las paredes del suelo, las causadas por retención de restos placentarios, constituyeron un 26,25% y el 20% presentó acretismo placentario y finalmente las ocasionadas por atonía uterina fueron de un 25%, correspondiendo un 25% a coagulopatías. Se concluyó que las hemorragias postparto por desgarro del suelo pélvico son la causa con mayor porcentaje en contraposición con otros estudios que indican que la atonía uterina es la causa más frecuente de hemorragias postparto inmediato(AU)


Postpartum hemorrhage is one of the obstetric complications most feared by obstetricians worldwide, and may cause the death of puerperal women. The objective of this study was to determine the causes of hemorrhages and the pathologies associated with these in the patients treated at the Enrique C. Sotomayor Obstetric Hospital of Guayaquil, Ecuador in the period 2016 - 2018 and that were in their immediate puerperium. The women who attended in that period were 528 women, 160 of them presented hemorrhages in the immediate puerperium. Hemorrhages by pelvic floor tearing represented 48.75% and 35% were associated to bruises in the floor walls, those caused by retention of placental remains constituted 26.25% and 20% presented accretism and finally those caused by uterine atony were 25% while 25% corresponded to coagulopathies. We concluded that the postpartum hemorrhages by tearing of the pelvic floor are the cause with the highest percentage; in contrast to other studies, which indicate that uterine aton is the most frequent cause of immediate postpartum hemorrhage(AU)


Subject(s)
Humans , Female , Pregnancy , Postpartum Period , Postpartum Hemorrhage/etiology , Obstetric Labor Complications/etiology , Placenta Accreta , Blood Coagulation Disorders/etiology , Retrospective Studies , Hematoma/etiology
5.
J. bras. nefrol ; 41(2): 185-192, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012527

ABSTRACT

Abstract Background: Arteriovenous fistula (AVF) maturation is one of the main concerns in patients with end-stage renal disease (ESRD) and finding a strategy for increasing success rate and accelerating fistula maturation is valuable. The aim of this study was to evaluate the effects of papaverine injection on AVF maturation and success rate. Method: This study was a randomized clinical trial that involved 110 patients with ESRD that were referred for AVF construction. Patients were allocated in papaverine group and control group with block randomization according to age and sex. In the case group, papaverine (0.1 or 0.2 cc) was injected locally within the subadventitia of artery and vein after proximal and distal control during AVF construction and in the control group, AVF construction was done routinely without papaverine injection. Results: Maturation time in case and control groups was 37.94 ± 11.49 and 44.23 ± 9.57 days, respectively (p=0.004). Hematoma was not seen in the case group but occurred in one patient in the control group. One patient of the case group developed venous hypertension. Four functional fistulas, 1 (1.8%) in the case group and 3 (5.5%) in the control group, failed to mature (p=0.618). Maturation rate did not differ between the two groups statistically (p=0.101). Conclusion: Local papaverine injection increased vessel diameter and blood flow, increasing shearing stress in both arterial and venous segment of recently created AVF. In this way, papaverine probably can decrease AVF maturation time without an increase in complications.


Resumo Introdução: A maturação da fístula arteriovenosa (FAV) é uma das principais preocupações em pacientes com doença renal terminal (DRT). Assim, é importante identificar estratégias para aumentar as taxas de sucesso e acelerar a maturação da fístula. O objetivo do presente estudo foi avaliar os efeitos da infiltração de papaverina sobre a maturação da FAV e suas taxas de sucesso. Método: O presente ensaio clínico randomizado incluiu 110 pacientes com DRT encaminhados para colocação de FAV. Os pacientes foram randomizados em bloco em função de idade e sexo e alocados nos grupos caso ou controle. Os indivíduos no grupo caso receberam infiltração local de papaverina (0,1 ou 0,2 ml) no plano da sub-adventícia da artéria e veia após o controle proximal e distal durante a construção da FAV. No grupo controle, a construção da FAV foi realizada rotineiramente sem infiltração de papaverina. Resultados: Os tempos de maturação dos grupos caso e controle foram 37,94 ± 11,49 e 44,23 ± 9,57 dias, respectivamente (p = 0,004). Foi observado hematoma em apenas um paciente do grupo controle. Um paciente do grupo caso desenvolveu hipertensão venosa. Quatro fístulas funcionais, uma (1,8%) no grupo caso e três (5,5%) no grupo controle, não amadureceram (p = 0,618). A taxa de maturação não diferiu estatisticamente entre os dois grupos (p = 0,101). Conclusão: A infiltração local de papaverina aumentou o diâmetro do vaso e o fluxo sanguíneo, elevando a tensão de cisalhamento nos segmentos arterial e venoso da FAV recentemente criada. Desta forma, a papaverina provavelmente consegue reduzir o tempo de maturação da FAV sem aumentar as complicações.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Papaverine/pharmacology , Vasodilator Agents/pharmacology , Arteriovenous Shunt, Surgical/methods , Kidney Failure, Chronic/surgery , Papaverine/administration & dosage , Thrombosis/etiology , Vasodilator Agents/administration & dosage , Venous Pressure , Arteriovenous Shunt, Surgical/adverse effects , Prospective Studies , Follow-Up Studies , Renal Dialysis , Treatment Outcome , Hematoma/etiology
6.
Rev. méd. Chile ; 147(4): 458-464, abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1014247

ABSTRACT

Background: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. Aim: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. Material and Methods: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. Results: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. Conclusions: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Catheterization, Central Venous/adverse effects , Renal Dialysis/adverse effects , Central Venous Catheters/adverse effects , Intraoperative Complications/etiology , Intraoperative Complications/epidemiology , Pneumothorax/etiology , Pneumothorax/epidemiology , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/methods , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Renal Dialysis/instrumentation , Renal Dialysis/methods , Ultrasonography, Interventional/methods , Sex Distribution , Hematoma/etiology , Hematoma/epidemiology
7.
Säo Paulo med. j ; 136(6): 597-601, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-991695

ABSTRACT

ABSTRACT CONTEXT: Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to describe a case of intramural duodenal hematoma caused by chronic exacerbation of pancreatitis. CASE REPORT: A 46-year-old male with chronic alcoholic pancreatitis was admitted to hospital due to abdominal pain, melena and low hemoglobin. An intramural duodenal hematoma with active bleeding was detected and selective angioembolization was warranted. The patient evolved with a perforated duodenum and underwent laparotomy with exclusion of the pylorus and Roux-en-Y gastrojejunostomy. He was discharged nine days later. CONCLUSION: Intramural duodenal hematoma is a rare complication of pancreatitis. Selective embolization is the preferred treatment for hemorrhagic complications of pancreatitis. However, the risk of visceral ischemia and perforation should be considered.


Subject(s)
Humans , Male , Middle Aged , Pancreatitis/complications , Duodenal Diseases/etiology , Duodenal Diseases/therapy , Embolization, Therapeutic , Hematoma/etiology , Pancreatitis/diagnostic imaging , Tomography, X-Ray Computed , Acute Disease , Chronic Disease , Endoscopy, Digestive System , Duodenal Diseases/diagnostic imaging , Hematoma/therapy , Gastrointestinal Hemorrhage
8.
Arch. argent. pediatr ; 116(3): 204-209, jun. 2018. tab, ilus, graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950011

ABSTRACT

Introducción. La canalización vascular central en niños presenta alta complejidad técnica y dificultades. La ecografía vascular puede facilitar este procedimiento. Objetivo. Describir las características de las canalizaciones vasculares ecoguiadas en el paciente pediátrico crítico. Población y métodos. Las variables de interés registradas prospectivamente fueron los vasos más comúnmente canalizados, su localización, la medición del diámetro/profundidad, la tasa de éxito y las complicaciones presentadas, entre otras. Resultados. En 86 pacientes pediátricos, se realizaron 124 punciones vasculares. Los accesos vasculares fueron la vena femoral (39,7%), seguida de la arteria femoral (27,2%) y la vena yugular interna (14,7%). Los vasos femorales se localizaron a una profundidad de 0,75 ± 0,25 mm con un diámetro medio de 0,31 ± 0,16 mm. La profundidad de los vasos venosos yugulares fue menor (0,64 ± 0,24 mm) y su diámetro global, mayor (0,44 ± 0,19 mm). El número medio de intentos en las canalizaciones vasculares ecoguiadas fue de 2,2 ± 1,3. La tasa de éxito fue del 79% asociada a un mayor diámetro del vaso (0,39 ± 0,20 mm vs. 0,28 ± 0,13 mm, p 0,01) y un menor número de intentos (1,90 ± 1,16 vs. 3,45 ± 1,77, p= 0,001). Las complicaciones, fueron la punción accidental de otro vaso (5,3%) y el desarrollo de un hematoma durante la punción (2,3%). Conclusiones. La canalización vascular ecoguiada en los pacientes pediátricos estudiados permite visualizar los vasos y medir su profundidad y diámetro; presenta una alta tasa de éxito y se asocia a una baja tasa de complicaciones.


Introduction. Central vascular cannulation in children is a highly complex technique and poses many difficulties. Vascular ultrasound can make this procedure easier. Objective. To describe the characteristics of ultrasound-guided vascular cannulation in critically-ill pediatric patients. Population and methods. Outcome measures prospectively recorded were vessels most frequently cannulated, their localization, the measurement of their diameter/depth, the success rate and complications developed, among others. Results. One hundred and twenty four vascular punctures were performed in 86 pediatric patients. Vascular accesses were the femoral vein (39.7%), followed by the femoral artery (27.2%) and the internal jugular vein (14.7%). Femoral vessels were localized at a depth of 0.75 ± 0.25 mm, with a mean diameter of 0.31 ± 0.16 mm. The depth of jugular vein vessels was smaller (0.64 ± 0.24 mm) and their overall diameter, larger (0.44 ± 0.19 mm). The mean number of attempts in ultrasound-guided cannulations was 2.2 ± 1.3. The success rate was 79% and was associated to a larger vessel diameter (0.39 ± 0.20 mm vs. 0.28 ± 0.13 mm, p= 0.01) and a lower number of attempts (1.90 ± 1.16 vs. 3.45 ± 1.77, p= 0.001). Complications were accidental puncture of another vessel (5.3%) and hematoma formation during puncture (2.3%). Conclusions. In the pediatric patients studied, ultrasound-guided vascular cannulation allowed vessel visualization and measurement of their depth and diameter; the success rate was high and it was associated to a low complication rate.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Catheterization, Central Venous/methods , Ultrasonography, Interventional/methods , Femoral Artery/diagnostic imaging , Femoral Vein/diagnostic imaging , Jugular Veins/diagnostic imaging , Catheterization, Central Venous/adverse effects , Prospective Studies , Outcome Assessment, Health Care , Critical Illness , Hematoma/etiology , Hematoma/epidemiology
9.
Rev. méd. Chile ; 146(6): 753-761, jun. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961456

ABSTRACT

Background: Ruptured subscapular liver hematoma in context of HELLP syndrome is a rare complication with high mortality. Clinical presentation is nonspecific: epigastric pain, right upper quadrant pain and shoulder pain, should however provide high index of suspicion. Termination of pregnancy is the only definitive treatment with a beneficial effect on the mother and the fetus. According to the hemodynamic status of the patient, treatment can be conservative through hepatic artery embolization, or surgical management, via contained packing of the bleeding area. Aim: To report seven cases of ruptured subscapular liver hematomas treated in a period of 13 years. Material and Methods: Review of medical records of patients discharged with the diagnosis from 2002 to 2015. Results: We identified seven women aged 30 to 44 years, for a total of 86,858 live births. At presentation, mean gestational age was 36 weeks. Five patients reported epigastric pain and three shoulder pain. All patients met the criteria for HELPP syndrome. All patients were operated on, and packing of the bleeding zone was carried out in six. One patient died. Two newborns died. Conclusions: The features of these patients may help in the management of this uncommon but severe condition.


Subject(s)
Humans , Female , Pregnancy , Adult , HELLP Syndrome/diagnosis , Hematoma/surgery , Hematoma/etiology , Liver Diseases/surgery , Liver Diseases/etiology , Pre-Eclampsia , Rupture, Spontaneous/surgery , Rupture, Spontaneous/etiology , Time Factors , Severity of Illness Index , Pregnancy Outcome , Medical Records , Retrospective Studies , Gestational Age , Treatment Outcome , Length of Stay
10.
Rev. bras. anestesiol ; 68(2): 194-196, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-897831

ABSTRACT

Abstract Background: Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm. Case report: A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started. Following standard monitoring and anesthesia induction, the patient's trachea was intubated with a 7.5 mm endotracheal tube and the procedure was completed without any complications. Three hours later, dyspnea developed and physical examination revealed progressive swelling and stiffness in the neck. Endotracheal intubation was performed with a 6 mm diameter uncuffed tube with the aid of sedation. The vocal cords were completely closed due to compression. There was no leak around the endotracheal tube. The rapidly performed computerized tomography scans showed an enormous hematoma around the neck and extravasation of contrast medium through superior thyroid artery. After coil embolization of superior thyroid artery, she was taken to the intensive care unit as intubated and sedated. Surgical exploration of the hematoma was not recommended by the surgeons, because she was on clopidogrel. After two days, the patient's trachea was extubated safely ensuring that the swelling was sufficiently ceased and leak detected around the endotracheal tube. Conclusions: Securing the airway rapidly by endotracheal intubation is the most crucial point in the management of cervical hematomas. Diagnostic and therapeutic procedures should be performed only afterwards.


Resumo Justificativa: Hematomas cervicais podem levar ao comprometimento das vias aéreas, uma condição de risco para a vida, independentemente da causa. O presente caso é a primeira apresentação de hematoma cervical como uma complicação do tratamento endovascular de aneurisma da artéria cerebral média. Relato de caso: Uma mulher de 49 anos foi agendada para a colocação do stent sob anestesia geral para aneurisma da artéria cerebral média. Poucos dias antes da intervenção, um tratamento com ácido acetilsalicílico e clopidogrel foi iniciado. Após a indução da anestesia e o monitoramento padrão, a traqueia da paciente foi intubada com um tubo endotraqueal de 7,5 mm e o procedimento foi concluído sem quaisquer complicações. Três horas mais tarde, a paciente desenvolveu dispneia e o exame físico revelou edema progressivo e rigidez do pescoço. A intubação endotraqueal foi feita com um tubo de calibre 6 mm sem balonete com o auxílio de sedação. As pregas vocais estavam completamente fechadas devido à compressão. Não houve vazamento ao redor do tubo endotraqueal. Tomografias computadorizadas feitas rapidamente mostraram um enorme hematoma no pescoço e extravasamento do meio de contraste através da artéria tireoidiana superior (ATS). Após embolização com molas da ATS, a paciente foi levada para a unidade de terapia intensiva intubada e sedada. A exploração cirúrgica do hematoma não foi recomendada pelos cirurgiões porque a paciente tomava clopidogrel. Depois de dois dias, a traqueia da paciente foi extubada com segurança. Isso garantiu que o edema havia cessado o suficiente e o vazamento detectado ao redor do tubo endotraqueal também. Conclusões: Proteger as vias aéreas rapidamente por meio de intubação endotraqueal é a conduta mais crucial no manejo de hematomas cervicais. Os procedimentos diagnósticos e terapêuticos devem ser feitos somente após essa conduta.


Subject(s)
Humans , Female , Postoperative Complications/etiology , Intracranial Aneurysm/surgery , Endovascular Procedures/adverse effects , Hematoma/etiology , Neck , Disease Progression , Middle Aged
11.
Rev. medica electron ; 40(1): 99-109, ene.-feb. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-902272

ABSTRACT

Introducción: la artrosis de rodilla puede llegar a ser una patología muy invalidante por sus síntomas, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa que ha aumentado su prevalencia en las últimas décadas, muy ligada al envejecimiento poblacional. Objetivo: validar la técnica de la ostectomía del peroné en el genu varo doloroso como nueva opción de tratamiento. Materiales y Métodos: se realizó un estudio, prospectivo y lineal en el Hospital Militar "Dr. Mario Muñoz Monroy" de Matanzas, desde abril del 2016 hasta agosto del 2017. Se aplicó la nueva técnica del Dr. Ying-Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China. En la actualidad ya existe una casuística de 75 pacientes, con 84 rodillas operadas de los cuales se presentan los resultados de los primeros 11 pacientes, posterior al año de operado. Resultados: el promedio de edad fue de 64,3 años, (45 años el menor y 84 años el mayor); de los cuales 8 eran hombres y 3 mujeres. Se aplicó la escala visual analógica para el dolor pre y post-operatorio en cuanto a la marcha y al subir escalones; estando todos los pacientes al caminar, por encima de 6 y al subir escaleras por encima de 7. Después de un año de operados 10 pacientes se encontraban evaluados al caminar entre 0 y 3 puntos, y al subir escalones 9 en igual puntuación; 1 en 5, y solamente 1 paciente mantuvo igual puntuación antes de operarse. Valorando estas puntuaciones se evaluaron 9 pacientes de bien, 2 de regular, y se presentaron 3 complicaciones. Conclusiones: al año de seguimiento ocurre gran mejoría del dolor, mejorando la seguridad del paciente durante la marcha (AU).


Introduction: the fibular osteoarthritis could be a very invalidating disease due to its symptoms, characterized by pain, insecurity and functional loss. It is a degenerative disease whose prevalence has increased during the last decades, tightly linked to population ageing. Objective: to validate the technique of fibular ostectomy in the painful genu varum as a new treatment option. Materials and Methods: a prospective, lineal study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy", of Matanzas, from April 2016 to August 2017. It was used the new technique of Dr. Ying-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of Hebei Medical University in Shijiazhuang, China. Currently there is a series of cases of 75 patients, with 84 operated knees; the results of the first 11 operated patients, are presented here after a year of the surgery. Results: the average age was 64.3 years, 45 years the youngest and 84 years the eldest; from them, 8 were men and 3 women. The analogical visual scale for the pre and post-surgical pain was applied during the gait and when going upstairs. During the gait all the patients were above 6, and when climbing upstairs above 7. After a year from the operation 10 patients got an evaluation between 0 and 3 points during the gait, and 9 got the same score when climbing steps; one got 5, and only 1 patient kept the same score than before the operation. Taking into account these scores, 9 patients were evaluated as good, 2 regular, and there were 3 complications. Conclusions: after a one-year follow-up, the pain greatly improves, improving patients' security during the gait (AU).


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/etiology , Osteoarthritis, Knee/genetics , Osteoarthritis, Knee/epidemiology , Genu Varum/surgery , Genu Varum/complications , Genu Varum/diagnosis , Fibula/surgery , Prospective Studies , Peroneal Neuropathies/etiology , Active Life Expectancy , Overweight/complications , Overweight/epidemiology , Patient Safety , Microtrauma, Physical/complications , Microtrauma, Physical/epidemiology , Hematoma/etiology
12.
Arch. argent. pediatr ; 116(1): 82-84, feb. 2018. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887433

ABSTRACT

La macrosomía es un factor de riesgo de traumatismos obstétricos y se asocia con morbimortalidad neonatal. El cefalohematoma y la fractura clavicular son los más frecuentes. Los traumatismos intrabdominales son poco frecuentes. El hematoma de la vaina de los rectos es una acumulación de sangre en la vaina del músculo recto mayor del abdomen. Se asocia con traumatismos, cirugías y tratamiento anticoagulante, en especial en los adultos y las personas de edad avanzada. En este artículo presentamos el caso de un recién nacido de sexo masculino con parto vaginal distócico. Durante el examen físico se observó un hematoma periumbilical de 1 x 1 cm y un cefalohematoma parietal de 1 x 1 cm. En la ecografía abdominal y la tomografía computada del abdomen se observó un hematoma de la vaina del recto derecho de 7 x 4 x 2 cm.


Macrosomia is a risk factor for birth injuries and is associated with neonatal morbidity and mortality. Cephalohematoma and clavicular fracture are the most frequent birth injuries. Intraabdominal injuries are uncommon birth injuries. Rectus sheath hematoma (RSH) is an accumulation of blood in the sheath of rectus abdominis muscle. It is associated with trauma, operations and anticoagulant therapy, especially in adults and elders. We present a macrosomic male neonate with difficult vaginal delivery, who had in the physical examination periumblical ecchymose of 1x1 cm and a parietal cephalohametoma of 1x1 cm. The abdominal ultrasonogram and the computed tomography scan of the abdomen showed a 7x4x2 cm right rectus sheath hematoma.


Subject(s)
Humans , Male , Infant, Newborn , Birth Injuries/etiology , Fetal Macrosomia/complications , Rectus Abdominis/injuries , Hematoma/etiology , Gastrointestinal Hemorrhage , Obstetric Labor Complications
13.
Rev. latinoam. enferm. (Online) ; 26: e3060, 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-961183

ABSTRACT

ABSTRACT Objective: to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. Method: a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. Results: 237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. Conclusion: the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.


RESUMO Objetivo: analisar as complicações vasculares de pacientes submetidos a procedimentos cardiológicos endovasculares em laboratório de hemodinâmica de três centros de referência. Método: estudo de coorte multicêntrico, em três instituições de referência, sendo a amostra constituída de 2.696 pacientes, incluindo pacientes adultos que realizaram procedimento percutâneo cardiológico em caráter eletivo ou urgente. Foram considerados como desfechos a presença de complicações vasculares, como hematoma no local da punção arterial, sangramento maior e menor e correção cirúrgica para hemorragia retroperitoneal, pseudoaneurisma ou formação de fístula arteriovenosa. Resultados: dos 2.696 pacientes, 237 (8,8%) apresentaram algum tipo de complicação vascular no sítio de punção arterial. O número total de complicações vasculares foi 264: hematoma menor <10 cm (n=135), sangramento estável (n=86), hematoma maior ≥10 cm (n=32) e sangramento instável (n=11). Não ocorreu evento de hematoma retroperitoneal, pseudoaneurisma ou fístula arteriovenosa. Majoritariamente, tanto as complicações maiores como as menores ocorreram nas primeiras seis horas após o procedimento. Conclusão: os resultados das complicações no cenário atual da cardiologia intervencionista indicam que a incidência dessas ocorre predominantemente nas primeiras seis horas após os procedimentos, considerando a avaliação até 48 horas. Medidas preventivas imediatas aos procedimentos devem ser planejadas e implementadas pela equipe.


RESUMEN Objetivo: analizar las complicaciones vasculares de pacientes sometidos a procedimientos cardiológicos endovasculares en laboratorio de hemodinámica, en tres centros de referencia. Método: fue diseñado un estudio de cohorte multicéntrica en tres instituciones de referencia. La muestra estuvo constituida por 2.696 pacientes; fueron incluidos pacientes adultos que realizaron procedimiento percutáneo cardiológico en carácter electivo o urgente; los que fueron considerados como resultado de la presencia de complicaciones vasculares, como: hematoma en el local de la punción arterial; hemorragia mayor y menor y corrección quirúrgica para hemorragia retroperitoneal, pseudoaneurisma o formación de fístula arterial venosa. Resultados: de los 2.696 pacientes, 237(8,8%) presentaron algún tipo de complicación vascular en el sitio de la punción arterial. El número total de complicaciones vasculares fue 264: hematoma menor <10cm (n=135), hemorragia estable (n=86), hematoma mayor ≥10cm (n=32) y hemorragia inestable (n=11). No ocurrió evento de hematoma retroperitoneal, pseudoaneurisma o fístula arterial venosa. En su mayoría, tanto las complicaciones mayores como las menores ocurrieron en las primeras seis horas después del procedimiento. Conclusión: los resultados de las complicaciones, en el escenario actual de la cardiología intervencionista, indican que la incidencia de ellas ocurre predominantemente en las primeras seis horas después de los procedimientos, considerando la evaluación hasta 48h. Medidas preventivas inmediatas a los procedimientos deben ser planificadas e implementadas por el equipo.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cardiac Catheterization/adverse effects , Postoperative Hemorrhage/ethnology , Syncope, Vasovagal/ethnology , Endovascular Procedures/adverse effects , Percutaneous Coronary Intervention/adverse effects , Postoperative Period , Time Factors , Hematoma/etiology
15.
Einstein (Säo Paulo) ; 16(3): eAO4241, 2018. tab, graf
Article in English | LILACS | ID: biblio-953176

ABSTRACT

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.


RESUMO Objetivo Avaliar as complicações pós-operatórias de postectomia que necessitaram de reintervenção cirúrgica. Métodos Estudo retrospectivo com análise de prontuários de pacientes submetidos à postectomia entre 1o de maio de 2015 a 31 de Maio de 2016. Resultados Foram realizadas 2.441 postectomias no período, sendo 501 utilizando a técnica clássica e 1.940 utilizando o dispositivo Plastibell. Apresentaram complicações que necessitaram reintervenção cirúrgica 3,27% dos pacientes. Quando separados por técnica operatória, 3,4% das postectomias com Plastibell foram reoperadas, comparando com 3% das postectomias convencionais (p=0,79). A estenose de prepúcio foi mais frequentemente encontrada na técnica clássica, com significância estatística (p<0,001). Sangramento foi mais frequente nos casos com uso do Plastibell, porém sem diferença significativa (p=0,37). A idade dos pacientes também foi avaliada para investigar se esta variável influenciou na taxa de complicações pós-operatórias, porém não houve diferença significativa. Conclusão Não houve diferença estatisticamente significativa quando comparadas as complicações entre as diferentes técnicas cirúrgicas utilizadas neste serviço. A estenose de prepúcio foi mais frequentemente encontrada nos pacientes operados pela técnica convencional enquanto demonstrou-se tendência a maior sangramento com uso do Plastibell. A idade dos pacientes não influenciou na presença de complicações.


Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Postoperative Complications/surgery , Reoperation , Circumcision, Male/adverse effects , Paraphimosis/surgery , Paraphimosis/etiology , Penis/surgery , Postoperative Complications/etiology , Retrospective Studies , Age Factors , Circumcision, Male/instrumentation , Treatment Outcome , Constriction, Pathologic , Hematoma/etiology
16.
Rev. bras. anestesiol ; 67(5): 548-551, Sept-Oct. 2017. graf
Article in English | LILACS | ID: biblio-897753

ABSTRACT

Abstract A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25 mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure.


Resumo Paciente do sexo masculino, 68 anos, hospitalizado para prostatectomia radical. O paciente não tinha história médica anormal, inclusive nem déficit neurológico, antes da operação. Antes da anestesia geral, um cateter peridural foi inserido no espaço intermédio L3-4 para analgesia no intra e pós-operatório. Após a cirurgia, que durou nove horas, o paciente desenvolveu confusão e paralisia flácida bilateral dos membros inferiores. Tomografia computadorizada de crânio e imagem de difusão por ressonância magnética não detectaram lesão. Os achados nas imagens de ressonância magnética torácica/lombar eram normais. A pressão intra-abdominal era de 25 mmHg e o ultrassom abdominal revelou progressão de inflamação/edema/hematoma na região perirrenal. O escore de Bromage voltou a 1 no pé direito na 24a hora e no pé esquerdo na 26a hora. A paraplegia desenvolvida nos pacientes após a infusão epidural pode ter sido causada por um efeito potencializado do anestésico local devido a hematoma retroperitoneal e/ou pressão intra-abdominal elevada.


Subject(s)
Humans , Male , Aged , Paralysis/etiology , Postoperative Complications , Prostatectomy , Sensation Disorders/etiology , Hematoma/complications , Anesthesia, Epidural/adverse effects , Retroperitoneal Space , Hematoma/etiology
17.
Rev. chil. cir ; 69(5): 416-420, oct. 2017. ilus
Article in Spanish | LILACS | ID: biblio-899627

ABSTRACT

Resumen Introducción: El hematoma retroperitoneal (HR) es una enfermedad infrecuente con una elevada morbimortalidad, siendo complicado cuando se presenta con dolor y shock hipovolémico. Presentación del caso: Paciente del sexo masculino, de 20 años de edad, sin antecedentes mórbidos. Ingresa en Urgencias por dolor abdominal en el flanco izquierdo, irradiado a dorso y testículo ipsilateral, de 6 h de evolución, de inicio súbito e intensidad severa; el paciente está pálido, hemodinámicamente estable, sin signos de irritación peritoneal. Se solicita pielo-TC por sospecha de litiasis ureteral, que muestra un extenso HR, probable aneurisma aórtico roto. Una angio-TC informa HR adyacente y anterior a psoasilíaco izquierdo, de20 × 11 × 8,5 cm, volumen 972 cc, adenopatías retroperitoneales paraaórticas bilaterales sangrantes y múltiples nódulos pulmonares bilaterales indicativos de diseminación secundaria. Se constata testículo derecho duro, de tamaño normal, eco testicular con masa sólida quística, que indica de lesión orgánica. Discusión: Trauma y enfermedad tumoral son las principales causas de HR. El cáncer testicular suele presentarse en pacientes jóvenes, requiriendo una pronta derivación y estudio debido a su rápida progresión. En nuestro caso, el HR fue un hallazgo imagenológico, destacando que el sangrado de un conglomerado de adenopatías es anecdótico.


Abstract Introduction: Retroperitoneal hematoma (RH) is a rare disease with high morbidity, being complicated when presented with pain and hypovolemic shock. Case report: Male, 20 years old, no morbid history. Arrive to Emergency Service for abdominal pain in the left flank radiating to the back and ipsilateral testis, 6 h of evolution, sudden onset, high intensity; pacient pale, hemodynamically stable without signs of peritoneal irritation. Pielo-TC is requested on suspicion of ureteral stones showing extensive RH, likely ruptured aortic aneurysm. CT angiography reports RH and adjacent preceding left iliopsoas, 20 × 11 × 8.5 cm, volume 972 cc, retroperitoneal bleeding bilateral para-aortic lymphadenopathy and multiple bilateral pulmonary nodules suggestive of secondary spread. Hard right testicle with normal size, testicular ultrasound pointing solid cystic mass, suggestive of organic lesion. Discussion: Trauma and tumor pathology are the main causes of RH. Testicular cancer usually occurs in young patients, requiring early referal and study because of its rapid progression. In our case, the HR was an imaging finding, highlighting that the bleeding of a cluster of lymph nodes is anecdotal.


Subject(s)
Humans , Male , Young Adult , Retroperitoneal Space , Testicular Neoplasms/complications , Carcinoma, Embryonal/complications , Hematoma/etiology , Hematoma/diagnostic imaging , Testicular Neoplasms/therapy , Testicular Neoplasms/diagnostic imaging , Abdominal Pain/etiology , Carcinoma, Embryonal/therapy , Carcinoma, Embryonal/diagnostic imaging , Computed Tomography Angiography
18.
Int. braz. j. urol ; 43(2): 367-370, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-840820

ABSTRACT

ABSTRACT A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.


Subject(s)
Humans , Female , Adult , Ureteroscopy/adverse effects , Ureteroscopes/adverse effects , Ureterolithiasis/surgery , Parenchymal Tissue/injuries , Hematoma/etiology , Kidney Diseases/etiology , Postoperative Complications/diagnostic imaging , Pressure , Stents/adverse effects , Ureterolithiasis/complications , Parenchymal Tissue/diagnostic imaging , Hematoma/diagnostic imaging , Kidney Diseases/diagnostic imaging
19.
Acta ortop. mex ; 30(3): 154-157, may.-jun. 2016. graf
Article in Spanish | LILACS | ID: biblio-837777

ABSTRACT

Resumen: Antecedentes: La lesión traumática del músculo ilíaco es rara; generalmente es causada por trauma o ejercicio intenso, que ocasiona hematoma del músculo con neuropatía del nervio femoral como complicación. Los hematomas espontáneos del mismo ocurren en pacientes con trastornos de la coagulación. Caso clínico: Masculino de 45 años con 18 días de evolución, con dolor intenso en la nalga, ingle y fosa ilíaca derechas e incapacidad de realizar flexión de la cadera, originados durante la realización de movimientos repetitivos (flexión de la cadera con elevación bilateral de las extremidades inferiores en posición supina). A la exploración: dolor a la flexión y/o rotación interna de la cadera derecha, maniobra Thomas positiva, cuádriceps con fuerza muscular 2/5; zona de parestesias en el territorio del nervio femoral derecho. La resonancia magnética de pelvis mostró ruptura parcial del músculo ilíaco, con sangre entre sus fibras. El paciente fue tratado con reposo y analgésicos durante ocho días, extensión gradual de la cadera, muletas axilares con apoyo parcial; a los ocho días se inició con diatermia a fosa ilíaca, ejercicios activos asistidos de flexión-extensión de cadera, bicicleta ergométrica y fortalecimiento del cuádriceps. La evolución fue satisfactoria; fue dado de alta asintomático a las seis semanas.


Abstract: Background: Traumatic iliacus muscle injury is rare; it is usually caused by trauma or intense exercise involving the pelvic girdle; it can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders. Clinical case: A 45-year-old male with 18 days of evolution, with an intense pain in the right buttock, groin and iliac fossa, with an inability for hip flexion and ambulation caused by inadequate exercise (supine double leg lifts). On the physical examination: intense pain with bending and/or internal rotation of the right hip, positive Thomas maneuver, quadriceps rated 3/5; area of paresthesia in the right femoral nerve territory. Pelvic magnetic resonance imaging showed: right iliacus muscle tear with blood between its fibers. Initial treatment was rest and analgesics for eight days and gradual extension of the hip, axillary crutches with partial weight bearing and diathermy on the right abdominal lower quadrant, active hip exercises, bicycle and right quadriceps strengthening. The evolution was satisfactory, with full recovery in six weeks.


Subject(s)
Humans , Male , Muscle, Skeletal/injuries , Thigh , Femoral Neuropathy , Femoral Nerve/injuries , Hematoma/etiology , Middle Aged , Muscular Diseases
20.
Rev. Nac. (Itauguá) ; 8(1): 78-82, jun 2016.
Article in Spanish | LILACS, BDNPAR | ID: biblio-884718

ABSTRACT

El hematoma subcapsular es una complicación grave elevado riesgo de mortalidad materna y neonatal, se observa como complicación de patologías hipertensivas más frecuentemente, además de otras patologías graves como hígado graso agudo del embarazo, traumatismos, patologías infecciosas. Se instala durante el embarazo o post parto, con manifestaciones clínicas inespecíficas, con grave y rápido deterioro materno que de no diagnosticar y tratar en tiempo y forma. Produce muerte materna en un 75% y fetal 60%. Se presenta un caso de hematoma hepático como complicación de una eclampsia y síndrome de Hellp, que evolucionó en forma favorable. Tratada con electrocoagulación el cual usamos para tratamiento de la hemorragia.


The subcapsular hematoma is a serious complication, with high risk of maternal and neonatal mortality, it is seen as a complication of hypertensive diseases more frequently, busides another serious diseases such as acute fatty liver of pregnancy, trauma, infectious diseases. It is onset occurs during pregnancy or postpartum, with nonspecific clinical manifestations, with severe and rapid material deterioration which of not diagnosed and treated from the beginning could produce maternal death in 75% and fetal 60%. We present a case of liver hematoma as a complication of eclampsia and Hellp syndrome, whose evolution was favorable, treated with electrocoagulation which we use for the treatment of hemorrhage.


Subject(s)
Humans , Female , Pregnancy , Adult , HELLP Syndrome , Eclampsia , Hematoma/surgery , Liver Diseases/surgery , Hematoma/etiology , Liver/pathology , Liver Diseases/etiology
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