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Medicina (B.Aires) ; 81(4): 649-651, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346520


Resumen La apendicitis del muñón es una complicación poco frecuente de la apendicectomía. Puede aparecer desde unas semanas a varios años luego del procedimiento quirúrgico. Para arribar a su diagnóstico es necesario un alto índice de sospecha. El objetivo de esta publicación es hacer una reseña de dos casos de esta entidad ocurridos en nuestra institución y mencionar sus hallazgos imagenológicos más frecuentes. La tomografía computarizada es un excelente método para valorar esta entidad, no solo para su diagnóstico sino también para descartar otras patologías que presentan un cuadro clínico similar.

Abstract Stump appendicitis is a rare complication of appendectomy. It may develop from a few weeks to several years after the surgical procedure. To achieve its diagnosis a high index of suspicion is necessary. The objective of this publication is to make a re view of two cases of this entity that occurred in our institution and to mention its most frequent imaging findings. Computed tomography is an excellent method to assess this entity, not only for its diagnosis but also to rule out other pathologies that present similar clinical features.

Humans , Appendicitis/surgery , Appendicitis/etiology , Appendicitis/diagnostic imaging , Appendectomy , Postoperative Complications/etiology , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed , Diagnosis, Differential
Rev. urug. cardiol ; 36(2): e702, ago. 2021. fot.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1290000


Un gossypiboma, oblitoma o textiloma se define como todo cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica. Representa una complicación posquirúrgica poco frecuente pero de consecuencias potencialmente graves. En general, se manifiesta con cuadros clínicos variables: una masa o pseudotumor, sangrados, fiebre, dolor, varios meses o años después de la cirugía original. También puede ser un hallazgo accidental. Describimos el caso clínico de una paciente con un gossypiboma vinculado a una cirugía cardíaca que se realizó 40 años antes al cuadro clínico actual, que se presenta con arritmia ventricular maligna.

A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.

Um gossypiboma, oblitoma ou textiloma está definido como todo corpo estranho esquecido no interior de um paciente durante um procedimento cirúrgico, representando uma complicação pos cirúrgica pouco frequente, mas com consequências potencialmente graves. Geralmente, se manifesta com quadros clínicos variáveis: uma massa ou pseudotumor, sangramentos, febre, dor, varios meses ou anos após a cirurgia original ou ser um hachado acidental. Descrevemos o caso clínico de uma paciente com um gossypiboma vinculado a uma cirurgia cardíaca realizada 40 anos antes do quadro clínico atual, que se apresenta com arritmia ventricular maligna.

Humans , Female , Middle Aged , Arrhythmias, Cardiac/etiology , Surgical Sponges , Foreign Bodies/diagnostic imaging , Postoperative Complications/surgery , Postoperative Complications/diagnostic imaging , Thoracic Surgery , Foreign Bodies/surgery
Rev. bras. cir. cardiovasc ; 35(3): 339-345, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137254


Abstract Objective: The current study aims to investigate the role of echocardiographically measured epicardial adipose tissue (EAT) thickness in the prediction of new-onset atrial fibrillation (AF) following coronary artery bypass grafting (CABG) surgery. Methods: One hundred and twenty-four patients scheduled to undergo isolated on-pump CABG due to coronary artery disease were enrolled to the current study. Patient characteristics, medical history and perioperative variables were prospectively collected. EAT thickness was measured using transthoracic echocardiography (TTE). Any documented episode of new-onset postoperative AF (POAF) until discharge was defined as the study endpoint. Fortyfour participants with POAF served as AF group and 80 patients without AF served as Non-AF group. Results: Two groups were similar in terms of baseline echocardiographic and laboratory findings. In laboratory findings, the groups were similar in terms of the studied parameters, except N-terminal pro-brain natriuretic peptide (NT Pro-BNP), which was higher in AF group than in Non-AF group (P=0.035). The number of left internal mammary artery (LIMA) grafts was not different in both groups. AF group had higher cross-clamp (CC) and cardiopulmonary bypass (CPB) times than Non-AF group (P=0.01 and P<0.001). In multivariate logistic regression analysis, EAT was found an independent predictor for the development of POAF (OR 4.47, 95% CI 3.07-5.87, P=0.001). Conclusion: We have shown that EAT thickness is associated with increased risk of AF development and can be used as a prognostic marker for this purpose.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/etiology , Atrial Fibrillation/diagnostic imaging , Cardiac Surgical Procedures , Postoperative Complications/etiology , Postoperative Complications/diagnostic imaging , Angiotensin-Converting Enzyme Inhibitors , Adipose Tissue/diagnostic imaging , Risk Factors , Angiotensin Receptor Antagonists
Rev. bras. cir. cardiovasc ; 34(3): 361-365, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013459


Abstract Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.

Humans , Prosthesis Failure/adverse effects , Heart Valve Prosthesis/adverse effects , Transcatheter Aortic Valve Replacement/adverse effects , Postoperative Complications/mortality , Postoperative Complications/diagnostic imaging , Severity of Illness Index , Risk Factors , Treatment Failure , Risk Assessment , Transcatheter Aortic Valve Replacement/mortality
Clin. biomed. res ; 39(3)2019.
Article in English | LILACS | ID: biblio-1053180


One of the rarest complications of the hepatic trauma is a biloma, defined as an abnormal bile collection outside the biliary tree, with intra or extrahepatic localization. Patients with biloma do not present with specific clinical features, which demands a challenging radiological diagnosis. In this report, we present a case of biloma due to blunt hepatic trauma, in which the patient experienced a changing symptomatic spectrum after surgery and had an interesting radiological investigation. The clinical course, imaging features, and management of this case are discussed. (AU)

Humans , Male , Adult , Postoperative Complications/diagnostic imaging , Biliary Tract/injuries , Suction/methods , Biliary Tract/diagnostic imaging , Ultrasonography, Interventional/methods , Minimally Invasive Surgical Procedures/methods
Arq. bras. cardiol ; 111(2): 193-202, Aug. 2018. tab, graf
Article in English | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-950218


Abstract Background: Balloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation is associated with poor outcome and mortality. Quantitative assessment of PVL severity before and after BPD is mandatory to properly assess PVL, thus improving implantation results and outcomes. Objective: To investigate a quantitative angiographic assessment of aortic regurgitation (AR) by videodensitometry before and after BPD. Methods: Videodensitometric-AR assessments (VD-AR) before and after BPD were analysed in 61 cases. Results: VD-AR decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p < 0.001, a two-tailed p < 0.05 defined the statistical significance). The relative delta of VD-AR after BPD ranged from -100% (improvement) to +40% (deterioration) and its median value was -46.2%. The frequency of improvement, no change, and deterioration were 70% (n = 43), 25% (n = 15) and 5% (n = 3), respectively. Significant AR (VD-AR > 17%) was observed in 47 patients (77%) before and in 19 patients (31%) after BPD. Conclusions: VD-AR after THV implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy.

Resumo Fundamento: A pós-dilatação com balão (PDB) é normalmente necessária para otimização do implante da válvula cardíaca transcateter (THV), uma vez que o "escape" ou leak paravalvar (PVL) após implante de valva aórtica transcateter está associada com desfecho ruim e mortalidade. A avaliação quantitativa da gravidade do PVL antes e após a PDB é mandatória para se avaliar adequadamente o PVL e, assim, melhorar os resultados e os desfechos do implante. Objetivo: Investigar uma avalição angiográfica quantitativa da regurgitação aórtica (RA) por videodensitometria (VD-RA) antes e após a PDB. Métodos: Resultados da VD-RA antes e após a PDB foram analisados em 61 casos. Resultados Houve diminuição significativa da VD-RA de 24,0(18,0-30,5)% para 12,0(5,5-19,0)% (p < 0,001; p < 0,05 bilateral foi definido como significância estatística). O delta relativo de VD-RA após a PDB variou de -100% (melhora) a +40% (piora) e o valor mediano foi -46,2%. As frequências de melhora, ausência de mudança, e piora foram 70% (n = 43), 25% (n = 15) e 5% (n = 3), respectivamente. Observou-se RA significativo (VD-RA > 17%) em 47 pacientes (77%) antes e em 19 pacientes (31%) após a PDB. Conclusões: A VD-RA após o implante de THV possibilita a avaliação quantitativa da regurgitação pós-TAVI, e pode auxiliar na tomada de decisão quanto à realização ou não da PDB, bem como na avaliação de sua eficácia.

Humans , Male , Female , Aged, 80 and over , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/diagnostic imaging , Transcatheter Aortic Valve Replacement , Postoperative Complications/diagnostic imaging , Video Recording , Severity of Illness Index , Aortography , Densitometry , Transcatheter Aortic Valve Replacement/adverse effects
Rev. chil. pediatr ; 89(3): 361-367, jun. 2018. tab
Article in Spanish | LILACS | ID: biblio-959534


INTRODUCCIÓN: La tetralogía de Fallot (TF) es la cardiopatía congénita cianótica más frecuente. La insuficiencia pulmonar (IP) y dilatación del ventrículo derecho (VD) son las complicaciones más frecuentes a largo plazo. La resonancia magnética cardiaca (RMC) es el "gold standard" para la evaluación del VD. OBJETIVO: Analizar la información obtenida de las RMC en el seguimiento de pacientes con TF. PACIENTES Y MÉTODO: Se incluyeron RMC realizadas entre 2007 y 2012 a pacientes con TF, reparados con parche transanular (PTA) o ampliación infundibular (AInf) y sin recambio valvular pulmonar (RVP). La fracción de regurgitación pulmonar (FRP), el volumen y función ventricular fueron evaluados. RESULTADOS: Se realizaron 122 RMC a 114 pacientes. Edad promedio al examen 15,4 ± 7,4 años. 53,3% presentó IP severa (> 40%). La media del volumen de fin de diástole del VD (VFDVD) fue 157,3 ± 38,6 ml/m2, fin de sístole (VFSVD) de 85,3 ± 27 ml/m2 y fracción de eyección (FEVD) 46,4 ± 7,1%. 48,4% presentaba un VFDVD mayor de 150 ml/m2 y el 32,8% mayor a 170 ml/ m2. El PTA se relacionó con mayores volúmenes de VD que la AInf. VFDVD mayor a 170 ml/m2 mostraron peor FEVD (FEVD 47,9 ± 7% vs 43,2 ± 6,4%, p < 0,01). DISCUSIÓN: Casi la mitad mostró una significativa dilatación del VD demostrando que la indicación de RMC es tardía en el seguimiento. El PTA se asoció con mayores VFDVD y VFSVD pero no a peor FEVD.

INTRODUCCIÓN: Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart disease. Pulmonary regurgitation (PR) and right ventricle (RV) enlargement and dysfunction are the most common long-term complications. Cardiac magnetic resonance (CMR) is the gold standard for RV evaluation. OBJECTIVE: To analyze CMR results in the follow-up of TOF patients. PATIENTS AND METHOD: All CMR performed between 2007 and 2012 in TOF patients with transannular patch (TAP) repair or infundibular widening, and without pulmonary valve replacement (PVR) were included. Pulmonary regurgitant fraction (PRF), ventricular end-diastolic (EDV) and end-systolic volume (ESV), and ejection fraction (EF) were examined. RESULTS: 122 CMR were performed in 114 patients. Average age at CMR was 15.4±7.4 years. 53.3% of them presented severe PR (> 40%). RVEDV was 157.3 ± 38.6 ml/m2, RVESV was 85.3 ± 27 ml/m2 and RVEF was 46.4 ± 7.1%. RVEDV was > 150 ml/ m2 in 48.4% and > 170 ml/m2 in 32.8% of patients. Patients with TAP showed larger RV volumes compared with those with infundibular widening. RVEDV > 170 ml/m2 showed worse RVEF that those with lower RVEDV (47.9 ± 7% vs 43.2 ± 6.4%, p < 0.01). CONCLUSION: Almost half of the pa tients showed significant RV enlargement, demonstrating that the indication of CMR is late in their follow-up. TAP was associated with higher RVEDV and RVESV, but no worse RVEF.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Postoperative Complications/diagnostic imaging , Tetralogy of Fallot/surgery , Magnetic Resonance Imaging , Hypertrophy, Right Ventricular/diagnostic imaging , Ventricular Dysfunction, Right/diagnostic imaging , Tetralogy of Fallot/diagnostic imaging , Retrospective Studies , Follow-Up Studies , Hypertrophy, Right Ventricular/etiology , Ventricular Dysfunction, Right/etiology
J. bras. nefrol ; 40(1): 86-90, Jan.-Mar. 2018. graf
Article in English | LILACS | ID: biblio-893820


Abstract Renal oncocytoma is an infrequently reported renal neoplasm, often asymptomatic, which usually behaves as a benign entity and is identified accidentally on radiological imaging. Transplant patients under long-term immunosuppressive drugs have a high prevalence of cancers, such as skin cancers, lymphoproliferative disorders, and renal carcinomas. We present a case report of an asymptomatic renal oncocytoma in a kidney transplant recipient presenting persistent hematuria. The features of computed tomography and contrast-enhanced ultrasound (CEUS) are presented. This was the first time we used CEUS in a transplant kidney recipient presenting a renal mass, allowing the real-time visualization of contrast-enhancement patterns during all vascular phases for the differential diagnosis of renal tumors. Although the pattern of intense vascularization could mislead to an early judgment as a malignant lesion, it could help to exclude other renal lesions without inducing nephrotoxicity.

Resumo O oncocitoma renal é uma neoplasia renal raramente relatada, muitas vezes assintomática, que geralmente se comporta como uma entidade benigna e é identificada acidentalmente em imagens radiológicas. Pacientes transplantados em regimes imunossupressores de longa duração apresentam alta prevalência de neoplasias tais como câncer de pele, distúrbios linfoproliferativos e carcinomas renais. Apresentamos o relato de um caso de oncocitoma renal assintomático em receptor de transplante renal com hematúria persistente. São apresentados os achados de imagens de tomografia computadorizada e ultrassonografia (US) com contraste. Foi a primeira vez que utilizamos a US com contraste em um receptor de transplante renal que apresentava massa renal, permitindo a visualização em tempo real dos padrões de realce do contraste em todas as fases vasculares para o diagnóstico diferencial dos tumores renais. Embora o padrão de vascularização intensa possa induzir uma avaliação precoce de lesão maligna, o exame ajuda a excluir outras lesões renais sem induzir nefrotoxicidade.

Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Kidney Transplantation , Adenoma, Oxyphilic/diagnostic imaging , Contrast Media , Kidney Neoplasms/diagnostic imaging , Ultrasonography/methods
Rev. chil. radiol ; 24(1): 34-39, mar. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-959571


El trasplante de páncreas es una alternativa terapéutica para pacientes diabéticos con complicaciones metabólicas severas y/o enfermedad renal crónica terminal. En el 80% de los casos, se realiza trasplante simultáneo de páncreas y riñón. El ultrasonido (US) es la técnica de elección para una primera evaluación del injerto, principalmente el modo Doppler espectral. Este último permite la evaluación de la vasculatura y perfusión de injerto. La tomografía computada (TC) y resonancia magnética (RM) se reservan para la evaluación de complicaciones (Tabla 1). Se realizó una revisión retrospectiva de una serie casos de trasplante páncreas-riñón realizada en nuestra institución entre los años 2014 y 2017, con un total de 12 casos.

Pancreas transplantation is a therapeutic alternative for diabetic patients with severe metabolic complications and/or terminal chronic kidney disease. In 80% of cases, a simultaneous transplant of pancreas and kidney is performed. Ultrasound (US) is the technique of choice for a first evaluation of the implant, mainly the spectral Doppler mode, which allows evaluation of the graft vasculature and perfusion. Computed tomography (CT) and magnetic resonance imaging (MRI) are reserved for the evaluation of complications (Table). A retrospective review of a series of cases of pancreas-kidney transplantation performed at our institution between 2014 and 2017 was carried out, with a total of 12 cases.

Humans , Male , Female , Adult , Middle Aged , Postoperative Complications/diagnostic imaging , Kidney Transplantation/methods , Pancreas Transplantation/methods , Tomography, X-Ray Computed , Retrospective Studies , Kidney Transplantation/adverse effects , Pancreas Transplantation/adverse effects , Ultrasonography, Doppler , Diabetes Mellitus/surgery , Renal Insufficiency, Chronic/surgery
Rev. chil. pediatr ; 89(1): 79-85, feb. 2018. tab
Article in Spanish | LILACS | ID: biblio-900072


Resumen: Introducción: La evaluación ecocardiográfica de pacientes post-trasplante cardiaco pediátrico es una herramienta útil. Sin embargo, aún es necesario definir un protocolo óptimo de seguimiento. Obje tivo: Caracterizar los resultados de la aplicación de un protocolo de evaluación ecocardiográfica fun cional en pacientes en control post-trasplante cardiaco pediátrico ortotópico. Pacientes y Método: Posterior al trasplante cardiaco pediátrico se realizó una ecocardiografía con un protocolo funcional que incluyó strain longitudinal global. Se evaluaron además los datos de la biopsia endomiocárdica y del estudio hemodinámico contemporáneos. Resultados: De un total de 9 pacientes sólo 1 presentó disfunción sistólica de ventrículo izquierdo según parámetros clásicos, pero casi la totalidad presentó un strain longitudinal global alterado. No se observaron episodios de rechazo moderado o severo en estos pacientes. Todos los pacientes presentaban disfunción sistólica ventricular derecha. No se ob servó correlación entre estos parámetros y la presión de arteria pulmonar. Conclusiones: Se observó disfunción sistólica biventricular subclínica en la mayoría de los pacientes de esta serie. No hubo aso ciación con episodios de rechazo o con hipertensión pulmonar, lo que podría estar en relación con la ausencia de episodios de rechazo moderado o severo en la biopsia contemporánea y con el reducido tamaño muestral. Sólo el seguimiento a largo plazo de estos pacientes permitirá definir la relevancia clínica de los hallazgos descritos.

Abstract: Introduction: The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol. Objective: To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation. Patients and Method: Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain. Contemporaneous endomyocardial biopsy results and hemodynamic data were recorded. Results: 9 patients were evaluated with our echocardiographic functional protocol. Of these patients, only 1 showed systolic left ventricular dysfunction according to classic parameters. However, almost all patients had an abnormal global longitudinal strain. Right ventricular systolic dysfunction was observed in all patients. No epidodes of moderate to severe rejectiom were recorded. No correlation was observed between these parameters and pulmonary artery pressure. Conclusions: Subclinical biventricular systolic dysfunction was observed in the majority of the patients in this study. No association with rejection episodes or pulmonary hypertension was observed, which may be related to the absence of moderate or severe rejection episodes during the study period, and to the small sample size. Long term follow-up of these patients may better define the clinical relevance of our findings.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Postoperative Care/methods , Postoperative Complications/diagnostic imaging , Echocardiography, Doppler/methods , Heart Transplantation , Aftercare/methods , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Postoperative Care/standards , Echocardiography, Doppler/standards , Pilot Projects , Clinical Protocols , Prospective Studies , Follow-Up Studies , Aftercare/standards , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Left/etiology
Rev. bras. cir. cardiovasc ; 32(4): 283-287, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-897931


Abstract Objective: In this study, the efficacy of thoracic ultrasonography during echocardiography was evaluated in newborns. Methods: Sixty newborns who had undergone pediatric cardiac surgery were successively evaluated between March 1, 2015, and September 1, 2015. Patients were evaluated for effusion, pulmonary atelectasis, and pneumothorax by ultrasonography, and results were compared with X-ray findings. Results: Sixty percent (n=42) of the cases were male, the median age was 14 days (2-30 days), and the median body weight was 3.3 kg (2.8-4.5 kg). The median RACHS-1 score was 4 (2-6). Atelectasis was demonstrated in 66% (n=40) of the cases. Five of them were determined solely by X-ray, 10 of them only by ultrasonography, and 25 of them by both ultrasonography and X-ray. Pneumothorax was determined in 20% (n=12) of the cases. Excluding one case determined by both methods, all of the 11 cases were diagnosed by X-ray. Pleural effusion was diagnosed in 26% (n=16) of the cases. Four of the cases were demonstrated solely by ultrasonography, three of them solely by X-ray, and nine of the cases by both methods. Pericardial effusion was demonstrated in 10% (n=6) of the cases. Except for one of the cases determined by both methods, five of the cases were diagnosed by ultrasonography. There was a moderate correlation when all pathologies evaluated together (k=0.51). Conclusion: Thoracic ultrasonography might be a beneficial non-invasive method to evaluate postoperative respiratory problems in newborns who had congenital cardiac surgery.

Humans , Male , Female , Infant, Newborn , Pleural Effusion/diagnostic imaging , Postoperative Complications/diagnostic imaging , Pulmonary Atelectasis/diagnostic imaging , Cardiac Surgical Procedures/adverse effects , Pulmonary Atelectasis/etiology , Transposition of Great Vessels/surgery , Echocardiography/methods , Radiography, Thoracic/methods , Ultrasonography/methods , Sensitivity and Specificity , Hypoplastic Left Heart Syndrome/surgery
Int. braz. j. urol ; 43(2): 367-370, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-840820


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.

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
Rev. bras. cir. cardiovasc ; 31(5): 406-408, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: biblio-829753


Abstract We present a case of a 41-year-old female with deep vein thrombosis after abdominal surgery. The patient quickly developed severe pulmonary embolism and stroke representative of paradoxical embolism. Echocardiography showed a thrombus straddling a patent foramen ovale, which was confirmed intraoperatively. An accurate diagnosis and rapid treatment decisions are crucial for preventing patient deterioration in the form of new pulmonary embolisms or stroke.

Humans , Female , Adult , Postoperative Complications/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Foramen Ovale, Patent/diagnostic imaging , Postoperative Complications/surgery , Pulmonary Embolism/surgery , Venous Thrombosis/surgery , Foramen Ovale, Patent/surgery , Abdomen/surgery
ABCD arq. bras. cir. dig ; 29(1): 33-37, Jan.-Mar. 2016. tab, graf
Article in English | LILACS | ID: lil-780018


Background : Bariatric operations have variable range of complications and postoperative benefits. Gastroesophageal reflux is considered potential factor that may result in damage to the esophageal mucosa and this subject is quite controversial in the literature. Aim: To evaluate patients who underwent to Roux-en-Y gastrojejunal bypass correlating epidemiologic and endoscopic findings in pre and postoperative periods. Method: A retrospective, paired study which evaluated 110 patients. Inclusion criteria were formal indication for bariatric surgery and patients with pre and postoperative endoscopy. Exclusion criteria were previous bariatric surgery, patients subjected to other types of bariatric surgery and those who had no pre or postoperative upper digestive endoscopy. The epidemiological variables were: sex, age, body mass index, type 2 diabetes mellitus or impaired glucose tolerance, and preoperative dyslipidemia. Results: The preoperative upper endoscopy was normal in 26.4% of the patients. Among endoscopic alterations, the hiatus hernia was the most prevalent followed by non-erosive gastritis. The postoperative upper endoscopy was normal in 40.9% and stenosis was the most prevalent followed by marginal ulcer. Correlation on pre and postoperative endoscopies, was found 100% reduction of hiatal hernias and 88% of esophagitis. There was no statistical significance in relationship to anastomotic stenosis with preoperative other variables. Conclusions . There was significant decrease in postoperative hiatus hernia, erosive esophagitis, non-erosive esophagitis, erosive gastritis and non-erosive gastritis with the operation. Stenosis of the gastrojejunostomy anastomosis was the most prevalent postoperative complication with no correlation with preoperative variables.

Racional: As operações bariátricas apresentam gama variável de complicações e benefícios pós-operatórios. O refluxo gastroesofágico é considerado potencial fator que pode produzir lesões na mucosa esofágica e este tema é bastante controverso na literatura. Objetivos: Correlacionar dados epidemiológicos e sua relação com achados endoscópicos no pré e pós-operatórios de pacientes submetidos ao bypass gastrojejunal em Y-de-Roux. Métodos: Estudo retrospectivo, pareado no qual foram avaliados 110 pacientes. Os critérios de inclusão foram indicação formal à cirurgia bariátrica e possuir endoscopias digestivas altas do pré e pós-operatório. Foram excluídos pacientes submetidos a operações bariátricas prévias; a outros métodos cirúrgicos bariátricos; que não possuíssem endoscopia digestiva alta pré e pós-operatórias. As variáveis epidemiológicas estudadas foram: sexo, idade, IMC, diabete melito tipo 2 ou tolerância à glicose diminuída, e dislipidemia no pré-operatório. Resultados: O sexo feminino foi prevalente em 73,6% da amostra, a idade média de 37,3 anos; o IMC foi de 40,3 kg/m2. O diabete melito tipo 2 ou tolerância à glicose diminuída foi diagnosticada em 38,2% dos pacientes e a dislipidemia em 53,6%. A endoscopia digestiva alta pré-operatória foi normal em 26,4%. A hérnia de hiato foi alteração mais prevalente, seguida pela gastrite não erosiva. No pós-operatório a endoscopia foi normal em 40,9%, a estenose da anastomose gastrojejunal foi a alteração mais prevalente, seguida da úlcera marginal. Correlacionando-se as endoscopias pré e pós-operatórias encontrou-se redução de 100% das hérnias de hiato e 88% das esofagites. As demais variáveis não apresentaram significância estatística. Conclusões: A correlação entre os achados pré e pós-operatórios das endoscopias digestivas altas indicou diminuição no pós-operatório de hérnia hiatal, esofagite erosiva, esofagite não erosiva, gastrite erosiva e gastrite não erosiva. A estenose da anastomose gastrojejunal foi a complicação pós-operatória mais prevalente sem correlação com as variáveis pré-operatórias estudadas.

Humans , Male , Female , Adult , Postoperative Care , Preoperative Care , Gastric Bypass , Endoscopy, Digestive System , Obesity/surgery , Postoperative Complications/diagnostic imaging , Retrospective Studies , Follow-Up Studies , Obesity/complications
Femina ; 43(2): 59-63, mar-abril 2015. ilus
Article in Portuguese | LILACS | ID: lil-756155


Dispositivo intrauterino pode sofrer expulsão da cavidade uterina. Objetivo: Descrever um caso de tratamento videolaparoscópico para retirada de dispositivo intrauterino de fossa ilíaca direita. Material e Métodos: Jovem do sexo feminino apresentou dor em fossa ilíaca direita de quatro dias de duração. No exame físico, apresentava dor abdominal localizada em fossa ilíaca direita, com discreta resistência de parede e dor à percussão e descompressão brusca na região. Em tomografia computadorizada, evidenciou-se dispositivo intrauterino fora do útero, na fossa ilíaca direita. Foram utilizadas as bases de dados SciELO, MedLine, Sobracil e PubMed no período compreendido de Abril a Junho de 2014. Vinte e dois artigos foram relacionados, entretanto somente os 10 artigos que compõem as referências bibliográficas foram selecionados por conter informações relevantes acerca do tema. Resultados: Na videolaparoscopia, pôde ser observado DIU em fossa ilíaca direita, próximo ao intestino, fora do útero, sem aderência, sem perfurações evidentes ou maiores complicações. Conclusão: A videolaparoscopia permite a retirada adequada de dispositivo intrauterino localizado indevidamente fora da cavidade uterina; permite inclusive avaliação adequada de toda a região pélvica para excluir lesões associadas.(AU)

Intrauterine device may suffer expulsion of the uterine cavity. Objective: To describe a laparoscopic treatment of the case for removal of intrauterine device right iliac fossa. Material and Methods: Young female presented pain in the right iliac fossa of four days. On physical examination, showed abdominal pain localized in the right iliac fossa, with thin wall of resistance and pain on percussion and rebound in the region. In CT scan it was seen an intrauterine device outside the uterus, in the right iliac fossa. The SciELO, MedLine, Sobracil and PubMed databases were used in the period April to June 2014. Twenty-two articles were related, though only 10 articles that make up the references were selected because they contain important information about the theme. Results: In the laparoscopy it could be observed the IUD in the right iliac fossa, near the intestine, outside the uterus, without grip, with no obvious or larger perforations complications.Conclusion: Laparoscopy allows adequate removal of intrauterine device located improperly outside the uterine cavity; even allows proper evaluation of the entire pelvic region to rule out associated injuries.(AU)

Female , Laparoscopy/methods , Video-Assisted Surgery/methods , Device Removal/methods , Intrauterine Device Migration/adverse effects , Intrauterine Device Migration/etiology , Abdomen/diagnostic imaging , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography