Deformidad facial postraumática asociada a complicación por silastic orbitario 35 años después de implantado / Post-traumatic facial deformity associated with a complication caused by orbital silastic 35 years after implantation

Las alteraciones esqueléticas del macizo facial sin tratamiento quirúrgico o con un manejo inadecuado, pueden resultar en deformidad secundaria importante con implicaciones estéticas y funcionales que deben ser consideradas para su tratamiento. El objetivo de esta presentación fue caracterizar el caso de deformidad facial postraumática asociada a complicación por silastic orbitario, 35 años después de implantado este. Se trata de un paciente masculino de 67 años que refirió haber sido tratado al presentar enrojecimiento de un ojo y secreciones. Refiere que hace 35 años fue intervenido quirúrgicamente por fractura en la zona del ojo izquierdo, que le colocaron silastic, y que no había tenido problemas hasta el momento en esa área. En el examen físico facial se detectó asimetría facial: ligero enoftalmo del ojo izquierdo, con desnivel pupilar, disminución de la apertura palpebral, rasgo antimongoloide, con eritema de la conjuntiva, quémosis, y abundantes secreciones. Se comprobó limitación del movimiento súpero-externo. Se corrobora la presencia de una fístula en el fondo de saco del párpado inferior. Se diagnostica como deformidad facial postraumática complicada por reacción a cuerpo extraño (al silastic). Fue intervenido quirúrgicamente y se realizó la exéresis del material, y la reconstrucción de la antomía ausente en la zona con malla de titanio. Se obtuvo excelentes resultados. Las lesiones postraumáticas de la cara se asocian generalmente con grandes secuelas funcionales y estéticas. Si se añaden las complicaciones por el empleo de implantes de biomateriales, la determinación de la conducta terapéutica puede ser un reto(AU)

Skeletal facial alterations not treated surgically or inappropriately handled may result in considerable secondary deformity with esthetic and functional implications which should be considered for treatment. The purpose of the study was to characterize a case of post-traumatic facial deformity associated with a complication caused by orbital silastic 35 years after implantation. A male 67-year-old patient reported having been treated for redness of one eye and secretion. Thirty-five years before he had been operated on for a fracture in the area of the left eye. Silastic had been implanted and he had not had any problems until now. Physical examination revealed facial asymmetry: slight enophthalmos of the left eye with pupillary unevenness, reduced palpebral opening, antimongoloid feature, conjunctival erythema, chemosis and abundant secretion. Upper-outer movement was limited. A fistula was found in the bottom of the lower palpebral sac. It is diagnosed as post-traumatic facial deformity complicated by reaction to foreign body (silastic). Surgery was performed to remove the material and reconstruct the missing anatomy in the area with titanium mesh. Excellent results were obtained. Post-traumatic facial lesions are generally associated with large functional and esthetic sequelae. When complications are added due to the use of biomaterial implants, determination of the appropriate therapeutic management can be a challenge(AU)

Endourological Management of Forgotten Encrusted Ureteral Stents

PURPOSE: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. MATERIALS AND METHODS: From July 2006 to December 2008, 14 patients (11 men and 3 women) with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12). Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. RESULTS: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. CONCLUSION: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Corpo estranho iatrogênico: uma lição para todos / Iatrogenic foreign body: a lesson for all

Situação extremamente desagradável e difícil para o cirurgião que se depara com esta patologia durante o ato cirúrgico, devido ao envolvimento ético e judicial importantes, somado ao trauma psicológico junto ao paciente e aos seus familiares. O presente trabalho versa sobre o caso de uma paciente com situs inversus totalis, em preparo eletivo para ressecção de volumosa tumoração em flanco esquerdo.

Extremely unpleasant and difficult situation for the surgeon that come across this pathology during the surgical act, due to the ethical and judicial involvement added to the psychological trauma next to the patient and their family. In this case we have a patient with in situs inversus totalis, in prepare for a surgical procedure to remove a cystic tumor in left flank, and after the surgery,a surprise: a foreign body with 18 years old.

Cuerpo extraño rectal / Rectal foreign body

Los cuerpos extraños rectales (CER) representan un cuadro clínico poco frecuente. Un CER puede alcanzar el recto mediante tres mecanismos: la ingestión, la migración y la introducción por vía anal, esta última la causa más frecuente ya sea debido a procedimientos diagnósticos-terapéuticos, como acto criminal, o con fines de satisfacción sexual. Se revisaron retrospectivamente fichas de 20 pacientes atendidos en los servicios de Urgencia y Cirugía de nuestro Hospital en un período de 11 años (1988-1998). El 90 por ciento (18) de los pacientes fueron hombres y 10 por ciento (2) mujeres, con una edad promedio de 40 años (rango 16-63). El mecanismo fue introducción por vía anal en 17 pacientes (85 por ciento), por migración en 2 pacientes (10 por ciento) e ingesta en 1 paciente (5 por ciento)

Diagnóstico infrecuente de masa quística intratorácica / Ususual intrathoracic cystic mass diagnosis

A case of intrathoracic gossypiboma following a surgical technique of repair persistent arteriosus duct since 11 years before in 17-year-man; was still asymptomatic. The chest Rx was localized the cyst mass in the left costophrenic side. CT scan was seen as a heterogeneous cyts mass with calcified periphery. In the surgical session, purulent liquid intracavitary was seen. The cultures were negative. A gossypiboma ( retained surgical sponge of cotton) was removed. 15 postoperative day was seen without residual cavitation. This asymptomatic intrathoracic cyst mass do to thought in gossypiboma if exist the background of previous thoracic surgical operation though exist suspicion of hydatid disease

Endoscopic extraction of a pulmonary foreign body

A case of endoscopic estraction of a bronchial foregn body which had entered the chest through a penetrating wound is presented. The CT scan is a useful diagnostic method in blunt trauma if the presence of a foreign body is suspected and mainly if is caused by radiolucid objets. The endoscopic extraction of endobronchial foreign bodies which entered the chest through a penetrating wound is a therapeutic approach to be considered

Cuerpo extraño en el pericardio: extracción mediante videotoracoscopia / Foreign body in the pericardium: videothoracoscopic extraction

Se presenta el caso de un paciente con un cuerpo extraño -aguja de coser- en el pericardio, introducido de manera accidental al torax, 6 meses antes de la consulta. El caso fue resuelto con exito mediante toracoscopia videoasistida. El diagnostico se logro con la radiografia simple del torax y el estudio fluoroscopico.

Corpo estranho intra-abdominal iatrogênico / Intra-abdominal iatrogenic foreign bodies

Os autores relatam o caso de um paciente portador de tumoraçäo em fossa ilíaca esquerda, detectada em exame médico de rotina, sem nenhuma repercussäo digestiva ou sistêmica. O estudo ultra-sonográfico e a tomografia computadorizada mostraram imagem sugestiva de tumor benigno do intestino delgado. Foi submetido à laparotomia exploradora, que revelou tratar-se a referida tumoraçäo de um emaranhado de gaze cirúrgica envolvido por tecido fibroso. Enfatizam a raridade deste tipo de evoluçäo e valorizam o inventário e a revisäo da cavidade abdominal antes de sua oclusäo ou fechamento