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5.
Rev. bras. oftalmol ; 81: e0013, 2022. graf
Article in English | LILACS | ID: biblio-1365727

ABSTRACT

ABSTRACT To report a series of three cases (four eyes) of scleral necrosis after pterygium excision, in which the tarsoconjunctival flap technique was used as treatment. Three patients who progressed to scleral necrosis after surgical pterygium excision were selected. The first patient underwent excision using the bare sclera technique and developed scleral thinning in the immediate postoperative period. The second and third patients received beta irradiation and had late onset scleral necrosis. The tarsoconjunctival flap technique was performed by the same surgeon. Recovery was satisfactory from both anatomical and functional perspectives in all cases, and the technique was considered effective and safe. Although there are only few reports about this technique in the literature, it can be considered as a good alternative to treat scleral necrosis.


RESUMO O objetivo deste estudo foi relatar uma série de três casos (quatro olhos) de necrose escleral pós-exérese de pterígio, em que se utilizou como tratamento a técnica de retalho tarsoconjuntival. Foram selecionados três pacientes que evoluíram para necrose escleral após tratamento cirúrgico de exérese de pterígio: o primeiro caso após técnica de esclera nua, com evolução para afinamento escleral no pós-operatório imediato; o segundo e o terceiro fizeram uso de betaterapia e apresentaram necrose escleral tardiamente. A técnica de recobrimento tarsoconjuntival foi executada pelo mesmo cirurgião. A recuperação foi satisfatória em todos os casos, do ponto de vista anatômico e funcional, sendo eficiente e segura. Apesar das escassas menções na literatura, essa técnica pode ser considerada uma boa alternativa para tratamento da necrose escleral.


Subject(s)
Humans , Male , Female , Adult , Aged , Postoperative Complications/etiology , Surgical Flaps , Pterygium/surgery , Scleral Diseases/surgery , Necrosis , Sclera/surgery , Scleral Diseases/etiology , Conjunctiva/transplantation
6.
Rev. bras. oftalmol ; 81: e0008, 2022. graf
Article in English | LILACS | ID: biblio-1360919

ABSTRACT

ABSTRACT Minimally invasive glaucoma surgeries are surgical treatment alternatives for glaucoma aimed at reducing intraocular pressure with a better safety profile compared to traditional trabeculectomy. However, in spite of less invasive techniques, complications may develop in any surgical procedure. To the best of our knowledge, this is the first case report of anterior uveitis following combined treatment with cataract surgery and iStent inject® which addresses the management of postoperative inflammation.


RESUMO As cirurgias minimamente invasivas para glaucoma consistem em uma opção de tratamento cirúrgico para glaucoma, a qual promove redução da pressão intraocular com melhor perfil de segurança do que a trabeculectomia. Todavia, complicações são inerentes à realização de procedimentos cirúrgicos, apesar do uso de técnicas menos invasivas. Este é o primeiro relato que apresenta um caso de uveíte anterior após cirurgia combinada de catarata e iStent inject®, além de orientações quanto ao manejo do quadro inflamatório.


Subject(s)
Humans , Female , Middle Aged , Uveitis/drug therapy , Cataract Extraction/adverse effects , Uveitis, Anterior/etiology , Postoperative Complications , Titanium , Trabecular Meshwork/surgery , Tropicamide/administration & dosage , Dexamethasone/administration & dosage , Stents , Glaucoma, Open-Angle/surgery , Injections, Intraocular , Intraocular Pressure , Acetazolamide/administration & dosage
7.
Rev. bras. oftalmol ; 81: e0010, 2022. graf
Article in English | LILACS | ID: biblio-1360918

ABSTRACT

ABSTRACT Ophthalmologic complications of nonocular surgeries are rare events, but can lead to irreversible conditions of low visual acuity. They are often associated with spine, heart and neck surgery, however they can occur after procedures on other systems. The main local causes are ischemic optic neuropathies, vascular occlusions, cortical lesions, and acute angle-closure glaucoma. We report two cases of sudden low visual acuity secondary to vascular occlusions after gastrointestinal procedures. In the first case, a 57-year-old patient electively admitted for colon reconstruction after Hartmann's colostomy, progressed with intra- and postoperative complications and required subsequent complementary surgeries. Once month later he presented with sudden bilateral low visual acuity, painless and non-altitudinal, and was diagnosed as papillophlebitis, which resolved spontaneously with the progression of the condition. The second case, a 69-year-old patient with no comorbidities underwent rectal resection due to suspected malignant tumor, and progressed on the third postoperative day, with pain and bilateral low visual acuity secondary to acute angle-closure glaucoma, and branch retinal artery occlusion in right eye; treated with iridotomy and ocular hypotensive eye drops, with only slight recovery of vision. The article aims to discuss the etiological mechanisms of the reported conditions and present a literature review.


RESUMO Complicações oftalmológicas de cirurgias não oculares são raras, mas podem levar a condições irreversíveis de baixa acuidade visual. Em geral são associadas à cirurgia de coluna, coração ou pescoço, mas podem ocorrer após procedimentos em outros sistemas. As principais causas são neuropatias ópticas isquêmicas, oclusões vasculares, lesões corticais, e glaucoma agudo de ângulo fechado. Relatamos dois casos de baixa acuidade visual súbita, secundária a oclusões vasculares, após procedimentos cirúrgicos gastrointestinais. No primeiro caso, um paciente de 57 anos foi internado de forma eletiva para reconstrução do cólon após colostomia de Hartmann. Evoluiu com complicações nos períodos intra- e pós-operatório, e necessitou de outras cirurgias complementares. Um mês depois apresentou baixa acuidade visual bilateral súbita, indolor e não altitudinal, e foi diagnosticado como papiloflebite, com resolução espontânea na evolução. O segundo caso, uma paciente de 69 anos, sem comorbidades, foi submetida à ressecção do reto por suspeita de tumor maligno e, no terceiro dia de pós-operatório, evoluiu com dor e baixa acuidade visual bilateral, secundária a glaucoma agudo de ângulo fechado, e oclusão de ramo da artéria retiniana no olho direito; tratada com iridotomia e colírios hipotensores, com recuperação parcial da visão. O objetivo do artigo é discutir os mecanismos etiológicos das doenças relatadas, e apresentar uma revisão da literatura.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Digestive System Surgical Procedures/adverse effects , Retinal Vein Occlusion/etiology , Retinal Artery Occlusion/etiology , Postoperative Complications , Retinal Vein Occlusion/diagnosis , Retinal Artery Occlusion/diagnosis , Visual Acuity , Intraocular Pressure
8.
Article in Spanish | LILACS, BINACIS | ID: biblio-1358100

ABSTRACT

Introducción: Las fracturas del cuello del astrágalo son infrecuentes, pero la tasa de complicaciones y reintervenciones es alta. El objetivo de este estudio fue analizar y describir las complicaciones a mediano y largo plazo en 20 pacientes con fractura del cuello del astrágalo. Nuestra hipótesis fue que, en las lesiones graves, la reducción abierta y fijación interna genera una tasa alta de complicaciones que requerirán de nuevas intervenciones quirúrgicas. Materiales y métodos: Se evaluó a 20 pacientes con fractura del cuello del astrágalo: 6 Hawkins II (29%), 11 Hawkins III (52%) y 3 Hawkins IV (19%). El seguimiento promedio fue de 11 años. Se analizaron el tipo de fractura (simple o conminuta), las lesiones asociadas, las complicaciones y la necesidad o no de un nuevo procedimiento quirúrgico. Resultados: Once pacientes (55%) tenían lesiones asociadas y 14 (70%), conminución en el trazo de fractura. Quince (75%) sufrieron complicaciones. Nueve (45%) requirieron una segunda intervención para tratar la complicación. Conclusiones: Los factores más relacionados con el desarrollo de complicaciones y la necesidad de una nueva intervención son: conminución en el trazo de fractura, lesiones asociadas en el miembro inferior homolateral, fracturas tipos III y IV de Hawkins, y fracturas expuestas. Creemos que, en las lesiones graves del cuello del astrágalo (tipos III y IV de Hawkins) con uno o más de estos factores, la artrodesis primaria podría disminuir el riesgo de complicaciones y de nuevas cirugías, y acortar el tiempo de recuperación de los pacientes. Nivel de Evidencia: IV


Introduction: Talar neck fractures are rare but present a high rate of complications and reoperations. The objective of this work was to analyze and describe the complications in the medium and long term in 20 patients with talar neck fracture. Our hypothesis was that, in severe injuries, ORIF presents a high rate of complications that will require new surgical interventions. Materials and methods: We evaluated 20 patients with talar neck fracture: 6 Hawkins II (29%), 11 Hawkins III (52%), and 3 Hawkins IV (19%). The mean follow-up was 11 years. We analyzed the fracture pattern (simple or comminuted), the presence of associated injuries, complications, and the need to perform a new surgical procedure. Results: 11 (55%) had associated injuries and 14 (70%) had comminution in the fracture line. We presented complications in 15 patients (75%). 9 (45%) pa-tients required a second intervention to treat the complication. Conclusions: The factors most related to the development of complications and the need for a new intervention are: comminution in the fracture line, associated injuries in the ipsilateral lower limb, Hawkins type III and IV fractures, and exposed fractures. We believe that in severe talar neck injuries (Hawkins type III and IV) with one or more of these factors, primary arthrodesis reduces the risk of complications and new surgeries and shortens recovery time. Level of Evidence: IV


Subject(s)
Adult , Postoperative Complications , Talus/surgery , Talus/injuries , Treatment Outcome , Foot Injuries , Fractures, Bone
9.
Rev. enferm. UFSM ; 12: e4, 2022. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1358321

ABSTRACT

Objetivo: descrever os casos de óbitos notificados por complicações de assistência médica e cirúrgica no Brasil entre 2015 a 2018. Método: descritivo e retrospectivo conduzido entre junho e julho de 2020 com os registros de óbitos extraídos do Sistema de Informações sobre Mortalidade em Saúde. Os dados foram agrupados em dois biênios 2015-2016 e 2017-2018 e analisados por estatística descritiva e variações percentuais. Resultados: foram notificados 6.587 óbitos, com destaque para o biênio 2017-2018 (n=3.425;52%). Os óbitos ocasionados pelo uso de equipamentos médicos reduziram no Brasil, com variação percentual negativa de 15,4% entre os biênios. Houve aumento das mortes por efeitos adversos de drogas/medicamentos com variação percentual positiva de 12,2%. O número de óbitos por acidentes durante a assistência hospitalar se manteve estacionário. Conclusão: observaram-se alterações nos registros de óbitos notificados no Brasil, e expandir ações preventivas que visem reduzir os óbitos são necessárias em todos os grupos de notificação.


Objective: describing the cases of deaths reported due to complications of medical and surgical care in Brazil between 2015 to 2018. Method: a descriptive and retrospective conducted between June and July 2020 with the records of deaths extracted from the Health Mortality Information System. The data were grouped into two biennia, 2015-2016, and 2017-2018, and analyzed by descriptive statistics and percentage variations. Results: there were reported 6,587 deaths, especially the 2017-2018 biennium (n=3,425;52%). Deaths caused using medical equipment reduced in Brazil, with a negative percentage variation of 15.4% among the biennia. There was an increase in deaths from adverse effects of drugs/medications with a positive percentage variation of 12.2%. The number of deaths from accidents during hospital care remained stationary. Conclusion: changes were observed in the records of deaths notified in Brazil, and expanding preventive actions aimed at reducing deaths are necessary in all notification groups.


Objetivo: describir los casos de muertes reportadas por complicaciones de la atención médica y quirúrgica en Brasil entre 2015 y 2018. Método: descriptivo y retrospectivo realizado entre junio y julio de 2020 con los registros de defunciones extraídos del Sistema de Información de Mortalidad en Salud. Los datos se agruparon en dos bienios 2015-2016 y 2017-2018 y se analizaron mediante estadísticas descriptivas y variaciones porcentuales. Resultados: se reportaron 6.587 muertes, especialmente em el bienio 2017-2018 (n=3.425;52%). Las muertes causadas por el uso de equipo médico se redujeron en Brasil, con una variación porcentual negativa del 15,4% entre los bienios. Hubo un aumento en las muertes por efectos adversos de medicamentos con una variación porcentual positiva de 12.2%. El número de muertes por accidentes durante la atención hospitalaria se mantuvo estacionario. Conclusión: se observaron cambios en los registros de muertes notificadas en Brasil, y es necesario ampliar las acciones preventivas dirigidas a reducir las muertes en todos los grupos de notificación.


Subject(s)
Humans , Postoperative Complications , Unified Health System , Hospital Mortality , Patient Safety
10.
J. bras. pneumol ; 48(1): e20210280, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365051

ABSTRACT

ABSTRACT Objective: To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety. Methods: This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions. Results: Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed. Conclusions: BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.


RESUMO Objetivo: Avaliar o efeito da técnica de breath stacking (BS) associada à fisioterapia de rotina na função pulmonar, volumes pulmonares, pressões respiratórias máximas, sinais vitais, oxigenação periférica, mobilidade toracoabdominal e dor na incisão cirúrgica em pacientes no pós-operatório de cirurgia abdominal alta, bem como analisar a segurança do BS. Métodos: Trata-se de um ensaio clínico randomizado com 34 pacientes divididos em grupo controle (n = 16), que realizou apenas a fisioterapia convencional, e grupo BS (n = 18), que realizou a fisioterapia convencional e BS. Ambos os grupos realizaram duas sessões diárias desde o 2º dia do pós-operatório até a alta hospitalar. Os desfechos primários foram CVF e Vt. A segurança do BS foi avaliada pela incidência de repercussões gastrointestinais, hemodinâmicas e respiratórias. Resultados: Embora a CVF tenha aumentado significativamente no momento da alta hospitalar em ambos os grupos, o efeito foi maior no grupo BS. Aumentos significativos do VEF1, VEF1/CVF, PFE e FEF25-75% ocorreram apenas no grupo BS. Também houve aumentos significativos do Ve e do Vt no grupo BS, mas não em comparação com os valores do grupo controle no momento da alta. A PImáx e a PEmáx aumentaram significativamente em ambos os grupos, com efeito maior no grupo BS. Houve uma diminuição significativa da FR e um aumento significativo da SpO2 apenas no grupo BS. A SpO2 aumentou agudamente após o BS; entretanto, não foram observadas alterações no grau de dispneia, sinais vitais e sinais de desconforto respiratório, e não foram observadas repercussões gastrointestinais e hemodinâmicas. Conclusões: O BS mostrou-se seguro e eficaz na recuperação da função pulmonar; melhoria dos volumes pulmonares, pressões respiratórias máximas e oxigenação periférica; e redução do trabalho respiratório no pós-operatório de cirurgia abdominal alta.


Subject(s)
Humans , Dyspnea , Lung , Postoperative Complications , Postoperative Period , Lung Volume Measurements
11.
Rev. colomb. cir ; 37(2): 194-205, 20220316. tab, fig
Article in Spanish | LILACS | ID: biblio-1362907

ABSTRACT

Introducción. La infección de la malla en cirugía de reparación de hernias de pared abdominal es un desenlace pobre, asociado a un incremento en el riesgo de complicaciones. El objetivo del presente estudio fue analizar la incidencia, los factores asociados y desenlaces en pacientes llevados a herniorrafia incisional con malla con posterior diagnóstico de infección temprana. Métodos. Estudio de cohorte retrospectiva. Se utilizaron los datos de egresos hospitalarios de la National Inpatient Sample (NIS) de los Estados Unidos de América para identificar a todos los pacientes adultos llevados a herniorrafia incisional durante los años 2010 a 2015. Se utilizaron modelos de regresión logística bivariada y multivariada para evaluar los factores de riesgo en infección temprana de la malla, y finalmente, modelos de regresión logística y lineal, según el tipo de variable dependiente, de tipo stepwise forward para evaluar la asociación entre el diagnóstico de infección de malla y los desenlaces adversos. Resultados. En total se incluyeron 63.925 pacientes. La incidencia de infección temprana de la malla fue de 0,59 %, encontrando como factores asociados: comorbilidades (obesidad, desnutrición proteico calórica, anemia carencial y depresión), factores clínico-quirúrgicos (adherencias peritoneales, resección intestinal, cirugía laparoscópica y complicaciones no infecciosas de la herida) y administrativos o asistenciales. Conclusiones. La infección temprana, aunque infrecuente, se asocia con un aumento significativo en el riesgo de complicaciones. La optimización prequirúrgica con base en los factores de riesgo para este desenlace nefasto es un elemento clave para la reducción de la incidencia y mitigación del impacto de la infección en los pacientes con herniorrafía incisional con malla.


Introduction. Mesh infection in abdominal wall hernia repair surgery has poor outcome, associated with an increased risk of complications. The objective of this study was to analyze the incidence, associated factors, and outcomes in patients undergoing incisional herniorrhaphy with mesh and subsequent diagnosis of early infection.Methods. Retrospective cohort study. Hospital discharge data from the National Inpatient Sample (NIS) of the United States of America were used to identify all adult patients undergoing incisional herniorrhaphy during the years 2010 to 2015. Bivariate and multivariate logistic regression models were used to evaluate risk factors in early mesh infection, and finally, logistic and linear regression models, according to the type of dependent variable, of the stepwise forward type to evaluate the association between the diagnosis of mesh infection and adverse outcomes.Results. A total of 63,925 patients were included. The incidence of early infection of the mesh was 0.59%, finding as associated factors: comorbidities (obesity, protein-caloric malnutrition, deficiency anemia and depression), clinical-surgical factors (peritoneal adhesions, intestinal resection, laparoscopic surgery and surgical site complications) and administrative or healthcare.Conclusions. Early infection, although rare, is associated with a significantly increased risk of complications. Pre-surgical optimization based on risk factors for this poor outcome is a key element in reducing the incidence and mitigating the impact of infection in patients with mesh incisional herniorrhaphy.


Subject(s)
Humans , Postoperative Complications , Incisional Hernia , Incidence , Risk Factors , Herniorrhaphy
12.
Rev. colomb. cir ; 37(2): 226-236, 20220316. tab
Article in Spanish | LILACS | ID: biblio-1362949

ABSTRACT

Introducción. La hipocalcemia es la complicación más frecuente de la tiroidectomía. La profilaxis con calcio/calcitriol es una alternativa costo-efectiva, sencilla y expedita para disminuir esta situación, sin alterar la función paratiroidea residual. Lo que no está claro es si hay superioridad de una dosis frente a otra, por lo que el objetivo de este estudio fue evaluar el comportamiento entre diferentes esquemas de profilaxis para hipocalcemia. Métodos. Estudio de cohorte retrospectivo de adultos operados en un hospital de cuarto nivel, entre febrero de 2017 y diciembre de 2020. Se calculó la tasa de síntomas, la hipocalcemia e hipercalcemia bioquímica en el control postquirúrgico durante las siguientes dos semanas. Se hizo análisis bivariado y multivariado entre dosis de calcio/calcitriol, otros factores asociados y los desenlaces mencionados. Resultados. Se incluyeron 967 pacientes. El 10 % presentaron síntomas. No hubo diferencias significativas en el calcio sérico del control posquirúrgico entre los grupos con distintas dosis de calcio. La dosis de carbonato de calcio >3600 mg/día y el calcio en las primeras 24 horas de cirugía se asociaron a la presencia de síntomas. La dosis de calcitriol <1 mcg/día y el bocio aumentaron el riesgo de hipocalcemia bioquímica, mientras que la dosis de 1,5 mcg/día lo disminuyó. Ninguna variable evaluada se asoció a hipercalcemia bioquímica. Conclusiones. Podemos establecer que dosis altas de carbonato de calcio no se asocian con menos hipocalcemia bioquímica, lo cual está a favor de usar dosis intermedias (3600 mg/día). De forma similar, la dosis de calcitriol de 1,5 mcg/día disminuye el riesgo de este desenlace. La identificación de variables que aumentan o disminuyen el riesgo de hipocalcemia posterior a tiroidectomía, como bocio o el nivel de calcio en las primeras 24 horas para este estudio, pueden determinar ajustes individuales en la dosis rutinaria profiláctica de calcio/calcitriol.


Introduction. Hypocalcemia is the most frequent complication of thyroidectomy. Calcium/calcitriol prophylaxis is a cost-effective, simple and expeditious alternative to reduce this situation, without altering residual parathyroid function. It is not clear whether there is superiority of one dose over another, so the objective of this study was to evaluate the behavior between prophylaxis doses for hypocalcemia. Methods. Retrospective cohort study of adults operated in a fourth level hospital, between February 2017 and December 2020. The rate of symptoms, biochemical hypocalcemia and hypercalcemia was calculated in the post-surgical control during the following two weeks. Bivariate and multivariate analyses were performed between calcium/calcitriol dose, other associated factors, and the mentioned outcomes. Results. Out of the 967 patients included, 10% presented symptoms. There were no significant differences in postoperative control serum calcium between the groups with different doses of calcium. The dose of calcium carbonate > 3600 mg/day and calcium in the first 24 hours of surgery were associated with the presence of symptoms. The dose of calcitriol <1 mcg/day and goiter increased the risk of biochemical hypocalcemia, while the dose of 1.5 mcg / day decreased it. No variable evaluated was associated with biochemical hypercalcemia. Conclusion. We can establish that high doses of calcium are not less associated with biochemical hypocalcemia, which is in favor of intermediate doses (i.e. 3600mg/day). In a similar way, the calcitriol dose of 1.5mcg/day decreases the risk of this outcome. The identification of variables that increase or decrease the risk of this complication (goiter or the 24h serum calcium in this study) can decide settings in the rutinary prophylactic dose of calcium/calcitriol.


Subject(s)
Humans , Postoperative Complications , Thyroidectomy , Hypocalcemia , Calcitriol , Calcium Carbonate , Hypercalcemia
13.
Rev. bras. oftalmol ; 81: e0005, 2022. graf
Article in English | LILACS | ID: biblio-1360915

ABSTRACT

ABSTRACT Objective: To describe the upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture in order to evaluate the efficacy of the technique. Methods: This is a retrospective study in which the medical records of 5,882 patients who underwent this technique between January 1999 and July 2015 were evaluated. The frequency and main causes of clinical complications and surgical reoperation were analyzed. Results: The incidence of complications found was 12.7% (n=750), being 0.8% (n=47) due to persistent chemosis, 3% (n=176) due to poor lower eyelid positioning, 4.17% (n=245) due to mild eyelid retraction and 4.8% (n=282) because of mild to moderate chemosis. Conclusion: The technique appears to be effective as it is simple and practical, and capable of resulting in positive functional and aesthetic outcomes with low rates of complications.


RESUMO Objetivo: Descrever a técnica de blefaroplastia superior e inferior associada à cantopexia associada à dupla elevação do músculo orbicular pré-septal em uma única sutura e avaliar sua eficácia. Métodos: Trata-se de estudo retrospectivo, no qual foram avaliados 5.882 prontuários de pacientes submetidos à blefaroplastia superior e inferior com a utilização da cantopexia, entre janeiro de 1999 e julho de 2015. Taxas e principais causas de complicações clínicas e reintervenção cirúrgica foram analisadas. Resultados: A incidência de complicações encontradas foi de 12,7% (n=750), sendo 0,8% (n=47) de caso de quemose persistente, 3% (n=176) de mau posicionamento palpebral inferior (ectrópio), 4,17% (n=245) de leve retração pálpebra e 4,8% (n=282) de quemose leve a moderada. Conclusão: A técnica mostra-se eficaz por ser simples e prática, podendo ter resultados funcionais e estéticos positivos e com baixo índice de complicações.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Blepharoptosis/surgery , Suture Techniques , Blepharoplasty/adverse effects , Blepharoplasty/methods , Eyelid Diseases/surgery , Postoperative Complications/etiology , Skin Aging , Medical Records , Retrospective Studies , Conjunctival Diseases/etiology , Edema/etiology , Eyelids/surgery , Facial Muscles/surgery
14.
Rev. enferm. UERJ ; 29: e56924, jan.-dez. 2021.
Article in English, Portuguese | LILACS | ID: biblio-1224444

ABSTRACT

Objetivo: descrever a incidência de complicações em feridas operatórias de mastectomia e identificar fatores associados. Método: estudo retrospectivo desenvolvido em uma coorte hospitalar de 545 mulheres mastectomizadas por câncer de mama no ano 2018 em um centro de assistência de alta complexidade em oncologia da cidade do Rio de Janeiro, Brasil, após aprovação por Comitê de Ética em Pesquisa. Os dados foram coletados a partir dos prontuários, permitindo cálculos da taxa de incidência e da razão da taxa de incidência para cada complicação. Resultados: a complicação que apresentou maior taxa de incidência foi o sangramento (57,14/100 mastectomias-dia), tendo como fatores associados a raça/cor da pele não branca (Razão da Taxa de Incidência: 3,11) e a diabetes mellitus (Razão da Taxa de Incidência: 0,48). Conclusão: os fatores associados ao sangramento da ferida operatória apontam para a necessidade de novas práticas no cuidado ao pós-operatório de mulheres mastectomizadas.


Objective: to describe the incidence of complications in mastectomy surgical wounds and to identify associated factors. Method: this retrospective study was conducted in a hospital cohort of 545 women mastectomized for breast cancer in 2018 at a high-complexity cancer care center Rio de Janeiro City, Brazil, after approval by the research ethics committee. Data were collected from medical records, allowing incidence rate and incidence rate ratio to be calculated for each complication. Results: the complication with the highest incidence rate was bleeding (57.14/100 mastectomies-day), associated factors being non-white race/skin color (incidence rate ratio 3.11) and diabetes mellitus (incidence rate ratio 0.48). Conclusion: the factors associated with bleeding from the surgical wound point to the need for new practices in post-operative care for women with mastectomies.


Objetivo: describir la incidencia de complicaciones en heridas quirúrgicas de mastectomía e identificar factores asociados. Método: estudio retrospectivo desarrollado en una cohorte hospitalaria de 545 mujeres mastectomizadas por cáncer de mama en 2018 en un centro de atención de alta complejidad en oncología de la ciudad de Río de Janeiro, Brasil, previa aprobación del Comité de Ética en Investigación. Los datos se obtuvieron de las historias clínicas, lo que permitió calcular la tasa de incidencia y el cociente de la tasa de incidencia para cada complicación. Resultados: la complicación que presentó mayor tasa de incidencia fue el sangrado (57,14 / 100 mastectomías-día), con factores asociados a la raza / color de piel no blanca (índice de tasa de incidencia: 3,11) y diabetes mellitus (índice de tasa de incidencia: 0,48). Conclusión: los factores asociados al sangrado de la herida quirúrgica apuntan a la necesidad de nuevas prácticas en el cuidado al postoperatorio de las mujeres con mastectomía.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Postoperative Complications/epidemiology , Surgical Wound/complications , Mastectomy/adverse effects , Brazil/epidemiology , Breast Neoplasms/surgery , Incidence , Retrospective Studies , Risk Factors , Postoperative Hemorrhage/epidemiology
15.
Enferm. foco (Brasília) ; 12(3): 546-551, dez. 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1352830

ABSTRACT

Objetivo: identificar a associação entre os fatores de risco e as complicações pós-operatórias em pacientes submetidos a cirurgia cardíaca. Método: estudo documental, retrospectivo, com abordagem quantitativa, realizado com 388 prontuários de pacientes submetidos à cirurgia cardíaca. A coleta de dados foi realizada entre agosto e setembro de 2018. Para verificar associações entre fatores de risco e complicação no pós-operatório imediato utilizou-se o teste de Qui-quadrado de Pearson. Utilizou p-valor <0,05. Resultados: verificou-se associação estatística significativa entre os fatores de risco infarto agudo do miocárdio, insuficiência cardíaca, insuficiência renal crônica cardiopatia isquêmica, balão intra-aórtico, doença pulmonar obstrutiva crônica e diabetes mellitus com complicações no pós-operatório imediato. Conclusão: ao conhecer os fatores de risco dos pacientes submetidos à cirurgia cardíaca com associação nas complicações pós-operatórias os enfermeiros poderão realizar um plano de cuidados individual além de ações de prevenção dos fatores de risco. (AU)


Objective: To identify the association between risk factors and postoperative complications in patients undergoing cardiac surgery. Methods: Documentary, retrospective, analytical, quantitative study with 388 medical records of patients undergoing cardiac surgery. Data collection was carried out between August and September 2018. To check associations between risk factors and complications in the immediate postoperative period, Pearson's chi square test was used. It used a p-value <0.05. Results: There was a significant association between risk factors for acute myocardial infarction, heart failure, chronic renal failure, ischemic heart disease, intra-aortic balloon, chronic obstructive pulmonary disease and diabetes mellitus with complications in the immediate postoperative period. Conclusion: By knowing the risk factors of patients undergoing cardiac surgery with an association with postoperative complications, nurses will be able to carry out an individual care plan in addition to actions to prevent risk factors. (AU)


Objetivo: Identificar la asociación entre factores de riesgo y complicaciones posoperatorias en pacientes sometidos a cirugía cardíaca. Métodos: Estudio documental, retrospectivo, analítico y cuantitativo con 388 historias clínicas de pacientes sometidos a cirugía cardíaca. La recolección de datos se realizó entre agosto y septiembre de 2018. Para verificar las asociaciones entre factores de riesgo y complicaciones en el postoperatorio inmediato, se utilizó la prueba de chi-cuadrado de Pearson. Usó un valor de p <0.05. Resultados: Hubo asociación significativa entre los factores de riesgo de infarto agudo de miocardio, insuficiencia cardíaca, insuficiencia renal crónica, cardiopatía isquémica, balón intraaórtico, enfermedad pulmonar obstructiva crónica y diabetes mellitus con complicaciones en el postoperatorio inmediato. Conclusión: Al conocer los factores de riesgo de los pacientes sometidos a cirugía cardíaca con asociación a complicaciones postoperatorias, el enfermero podrá realizar un plan de cuidados individualizado además de acciones para prevenir los factores de riesgo. (AU)


Subject(s)
Thoracic Surgery , Postoperative Care , Postoperative Complications , Cardiology , Nursing
16.
Rev. colomb. cir ; 37(1): 60-71, 20211217. tab, fig
Article in Spanish | LILACS | ID: biblio-1355299

ABSTRACT

Introducción. El cáncer gástrico es el quinto cáncer diagnosticado con mayor frecuencia y la tercera causa de muerte por cáncer en el mundo. En el tratamiento quirúrgico, la evidencia actual apoya las medidas preoperatorias e índices pronósticos para mejorar la supervivencia. El índice nutricional pronóstico, que une los valores de los linfocitos circulantes en sangre periférica con los de la albúmina sérica, ha presentado características de ser un marcador nutricional e inmunológico con valor predictivo sobre complicaciones y mortalidad. El objetivo de este estudio fue determinar la relación entre el índice nutricional pronóstico con las complicaciones y mortalidad en pacientes con cáncer gástrico sometidos a gastrectomía. Métodos. Se llevó a cabo un estudio observacional descriptivo, de corte transversal, con componente analítico, mediante la revisión retrospectiva de las historias clínicas. Resultados. Se analizaron 113 pacientes sometidos a gastrectomía total o subtotal. Se encontró asociación entre el índice nutricional pronóstico y la mortalidad; todos los pacientes que murieron tenían un índice menor o igual a 46. También se encontró asociación inversa entre el valor del índice y la presentación de complicaciones posoperatorias, como sepsis, peritonitis, fuga de la anastomosis y sangrado. Discusión. Similar a nuestro análisis, varios estudios plantean que un índice nutricional pronóstico bajo podría tener un valor predictivo sobre la frecuencia de complicaciones y supervivencia global en pacientes con cáncer gástrico llevados a cirugía. Conclusión. El índice nutricional pronóstico se asocia con la mortalidad y complicaciones posoperatorias en pacientes sometidos a gastrectomía por cáncer gástrico.


Introduction. Gastric cancer is the fifth most frequently diagnosed cancer and the third cause of cancer death in the world. In surgical treatment, current evidence supports preoperative measures and prognostic index to improve survival. The prognostic nutritional index, which unites the values of circulating lymphocytes in peripheral blood with those of serum albumin, has presented characteristics of being a nutritional and immunological marker with predictive value on complications and mortality. The objective of this study was to determine the relationship between the prognostic nutritional index with complications and mortality in patients with gastric cancer undergoing gastrectomy.Methods. A descriptive, cross-sectional, observational study with an analytical component was carried out by a retrospective review of medical records. Results. A total of 113 patients who underwent total or subtotal gastrectomy were analyzed. An association was found between mortality and the prognostic nutritional index and mortality; all patients who died had an index ≤ 46. An inverse association was also found between the value of the index and the presentation of postoperative complications, such as sepsis, peritonitis, anastomotic leak, and bleeding.Discussion. Similar to our analysis, several studies suggest that a low prognostic nutritional index could have a predictive value on the frequency of complications and overall survival in patients with gastric cancer undergoing surgery.Conclusion. The prognostic nutritional index is associated with mortality and postoperative complications in patients undergoing gastrectomy for gastric cancer.


Subject(s)
Humans , Stomach Neoplasms , Nutrition Assessment , Postoperative Complications , Prognosis , Mortality , Gastrectomy
17.
Rev. colomb. cir ; 37(1): 72-82, 20211217. fig, tab
Article in Spanish | LILACS | ID: biblio-1355305

ABSTRACT

Introducción. El abdomen abierto es un recurso útil para el tratamiento de pacientes con patología abdominal compleja, con potencial de complicaciones. El objetivo de este estudio fue adaptar la guía de World Society of Emer-gency Surgery (WSES) 2018, en un hospital de nivel III de atención de la ciudad de Popayán, Colombia, y comparar los resultados obtenidos con los previos a su implementación. Métodos. Estudio cuasi-experimental en dos mediciones de pacientes con abdomen abierto y estancia en cuidado crítico, durante los meses de abril a octubre de los años 2018 y 2019, antes y después de la adaptación con el personal asistencial de la guía de práctica clínica WSES 2018. Se utilizó estadística descriptiva, prueba de Chi cuadrado y se empleó el software SPSS V.25. Resultados. Se incluyeron 99 pacientes críticos, con una edad media de 53,2 años, con indicación de abdomen abierto por etiología traumática en el 28,3 %, infecciosa no traumática en el 32,3 % y no traumática ni infecciosa en el 37,4 %. La mortalidad global fue de 25,3 %, de los cuales, un 68 % se debieron a causas ajenas a la patología abdominal. Las complicaciones postoperatorias se presentaron en 10 pacientes con infección de sitio operatorio y 9 pacientes con fístula enterocutánea. El uso del doble Viaflex se implementó en un 63,6 %, logrando un cierre de la pared abdominal en el 79,8 % de los casos (p=0,038). Conclusión. El abdomen abierto requiere de un abordaje multidisciplinar. El uso de doble Viaflex es una herramienta simple y efectiva. La implementación de la guía disminuyó el porcentaje de mortalidad, los días de abdomen abierto y la estancia en cuidados intensivos.


Introduction. The open abdomen is a useful resource for the treatment of patients with complex abdominal pathology, with the potential for complications. The aim of this study was to adapt the World Society of Emergency Surgery (WJES) 2018 guidelines, in a tertiary level hospital and compare the results obtained with those prior to its implementation. Methods. Experimental study in two measurements of patients with open abdomen and stay in critical care, during the months of April to October in 2018 and 2019, before and after the adaptation with the healthcare personnel of the WSES 2018 clinical practice guide. Descriptive statistics, Chi square test and SPSS V.25 software were used. Results. Ninety-nine critically ill patients were included, with a mean age of 53.2 years, with an indication of open abdomen due to traumatic etiology in 28.3%, infectious non-traumatic in 32.3%, and non-traumatic or infectious in 37.4 %. Overall mortality was 25.3%, of which 68% were due to causes other than abdominal pathology. Post-operative complications occurred in 10 patients with surgical site infection and 9 patients with enterocutaneous fistula. The use of the double Viaflex was implemented in 63.6%, achieving a closure of the abdominal wall in 79.8% (p=0.038) of the cases.Conclusion. The open abdomen requires a multidisciplinary approach. The use of double Viaflex is a simple and effective tool. The implementation of the guide decreased the percentage of mortality, the days of open abdomen and the stay in intensive care unit.


Subject(s)
Humans , Postoperative Complications , Open Abdomen Techniques , Wounds and Injuries , Damage Assessment , Emergencies , Infections
18.
J. coloproctol. (Rio J., Impr.) ; 41(4): 375-382, Out.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1356443

ABSTRACT

Introduction: The literature converges regarding the use of C-reactive protein (CRP) tests between postoperative days (PODs) 3 and 5 of elective procedures. In this period, they have great sensitivity and negative predictive value (NPV) for severe and anastomotic complications about two days before the first clinical sign. The few studies on colorectal urgency suggest that, despite the different initial values according to the surgical indication, following POD 3, the level of CRP is similar to that of elective procedures. However, given the heterogeneity of the studies, there is no consensus on the cutoff values for this use. Objective: To validate the use and propose a PO CRP cut-off value in urgent colorectal procedures as an exclusion criterion for complications of anastomosis or the abdominal cavity. Method: Retrospective analysis of the medical records of 308 patients who underwent urgent colorectal surgical procedures between January 2017 and December 2019. The following data were considered: age, gender, surgical indication, type of procedure performed, complications, CRP levels preoperatively and from POD 1 to 4, and the severity of the complications. We compared the CRP levels and the percentage variations between the preoperative period and PODs 1 to 4 as markers of severe complications using the receiver operating characteristic (ROC) curve. Results: The levels of CRP on POD4, and their percentage drops between PODs 2 to 4 and PODs 3 to 4, were better to predict severe complications. A cutoff of 7.45mg/dL on POD 4 had 91.7% of sensitivity and NPV. A 50% drop between PODs 3 and 4 had 100% of sensitivity and NPV. Conclusion: Determining the level of CRP is useful to exclude severe complications, and it could be a criterion for hospital discharge in POD 4 of emergency colorectal surgery. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications/diagnosis , C-Reactive Protein , Colorectal Surgery/adverse effects , Emergencies , Anal Canal/surgery , Rectum/surgery
19.
Femina ; 49(12): 648-657, 20211130. ilus
Article in Portuguese | LILACS | ID: biblio-1358200

ABSTRACT

O transplante de medula óssea (TMO) é um procedimento indicado para o tratamento de doenças hematológicas, que afetam muitas mulheres jovens. O aperfeiçoamento dos cuidados durante o TMO proporciona altos índices de cura e de sobrevida. No entanto, pode deixar sequelas em vários órgãos e sistemas, entre eles o sistema reprodutor e os órgãos genitais, impactando negativamente a qualidade de vida das receptoras do TMO. O objetivo desta publicação foi realizar uma revisão narrativa sobre o tema e propor um protocolo assistencial que torne acessível os cuidados relacionados à saúde sexual e reprodutiva a esse grupo especial de mulheres, baseado em dados clínicos de um ambulatório de assistência ginecológica às mulheres transplantadas no Hospital Amaral Carvalho, em Jaú, no interior de São Paulo.(AU)


Bone marrow transplantation (BMT) is indicated for the treatment of hematological diseases which affect many young women. The improvement of care during BMT procedures provides higher cure and survival rates. however, it can cause sequelae in various organs and systems, including the reproductive system and genitals, negatively impacting quality of life. The purpose of this publication is to present a narrative review related to this theme and to propose a healthcare protocol that allows sexual and reproductive care in this special group of patients, based on the clinical experience of a gynecological outpatient clinic at the Amaral Carvalho Hospital, in Jaú (SP) which specifically care for these women.(AU)


Subject(s)
Humans , Female , Postoperative Complications , Bone Marrow Transplantation/adverse effects , Clinical Protocols , Risk Factors , Immunosuppression/adverse effects , Primary Ovarian Insufficiency/physiopathology , Female Urogenital Diseases/physiopathology , Graft vs Host Disease/physiopathology
20.
Arq. Ciênc. Vet. Zool. UNIPAR (Online) ; 24(2, cont.): e2403, jul-dez. 2021. ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1348228

ABSTRACT

O procedimento cirúrgico eletivo realizado com maior frequência na rotina veterinária é a ovário-histerectomia (OVH), com isso há uma alta casuística de complicações pós-operatórias. Entre elas, pode-se citar piometra de coto, ligadura acidental de ureter, síndrome do ovário remanescente, formação de granulomas inflamatórios e aderências a órgãos. Os granulomas de coto ovariano são formados, geralmente por um fio de sutura utilizado inadequadamente, ou a um sítio de infecção. Tais granulomas podem levar à aderências, inclusive a órgãos próximos ao sítio cirúrgico. O presente relato refere-se a uma cadela, que apresentou granulomas ovarianos com aderências no pâncreas e em diversos órgãos após a ovário-histerectomia. Para a solução do caso, foi realizado uma celiotomia exploratória para avaliação da cavidade abdominal, retirada das aderências das estruturas e das formações granulomatosas, sendo necessária a realização de uma pancreatectomia parcial para a retirada completa do granuloma. Após a cirurgia, o paciente desenvolveu quadro de pancreatite, uma complicação muito comum em cirurgias pancreáticas. Ainda assim, o resultado foi considerado satisfatório, pois a pancreatite foi solucionada e os granulomas removidos, e até a última revisão pós-operatória, o paciente encontrava-se bem clinicamente. A OVH é uma das cirurgias mais realizadas na rotina médico veterinária, ainda assim é negligenciada em diversos quesitos. Portanto, há a necessidade dessa técnica cirúrgica e suas possíveis complicações serem realizadas de maneira correta e efetiva.(AU)


The most frequently elective surgical procedure performed in the veterinary routine is the ovary hysterectomy (OVH). As such, there is a high number of post-operative complications, which include stump pyometra, accidental ligation of the ureter, remnant ovary syndrome, formation of inflammatory granulomas, and organ adhesions. Ovarian stump granulomas are usually formed by suture which has been improperly used, or to infection. Such granulomas can lead to adhesions, also affecting organs close to the surgical site. This report refers to a female dog that presented ovarian granulomas with adhesions to the pancreas and to several organs after ovary-hysterectomy. In order to solve the case, an exploratory celiotomy was performed to assess the abdominal cavity, removing the adhesions of the structures and granulomatous formations, which required the performance of a partial pancreatectomy for the thorough removal of the granuloma. After surgery, the patient developed pancreatitis, a very common complication in pancreatic surgery. Even so, the result was considered satisfactory, as the pancreatitis was resolved and the granulomas removed and until the last post-operative review, the patient was clinically well. OVH is one of the most commonly performed surgeries in the veterinary medical routine, yet it is neglected in several aspects. Therefore, there is a need for the surgical technique and its possible complications to be performed correctly and effectively.(AU)


El procedimiento quirúrgico electivo que se realiza con mayor frecuencia en la rutina veterinaria es la ovario-histerectomía (OVH), con que existe un elevado número de complicaciones postoperatorias. Estos incluyen piometra del muñón, ligadura accidental del uréter, síndrome de ovario remanente, formación de granulomas inflamatorios y adherencias a órganos. Los granulomas del muñón ovárico se forman por lo general por una sutura mal utilizada o en un sitio de infección. Dichos granulomas pueden provocar adherencias, incluso a órganos cercanos al sitio quirúrgico. El presente informe se refiere a una perra, quien presentó granulomas ováricos con adherencias en el páncreas y en varios órganos tras ovario histerectomía. Para la solución del caso se realizó una celiotomía exploratoria para acceder la cavidad abdominal, removiendo las adherencias de las estructuras y formaciones granulomatosas, requiriendo la realización de una pancreatectomía parcial para la extirpación completa del granuloma. Después de la cirugía, la paciente desarrolló pancreatitis, una complicación muy común en la cirugía pancreática. Aun así, el resultado se consideró satisfactorio, ya que se resolvió la pancreatitis y se retiraron los granulomas, y hasta la última revisión postoperatoria la paciente se encontraba clínicamente bien. La OVH es una de las cirugías que se realizan con mayor frecuencia en la rutina médica veterinaria, pero se descuida en varios aspectos. Por tanto, existe la necesidad de que esta técnica quirúrgica y sus posibles complicaciones se realicen de forma correcta y eficaz.(AU)


Subject(s)
Animals , Female , Dogs , Ovary , Pancreatectomy , Postoperative Complications , Elective Surgical Procedures , Dogs/surgery , Granuloma , Hysterectomy
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