Hipertensão intra-abdominal e síndrome compartimental abdominal: repercussões e tratamento clínico no paciente crítico / Intra-abdominal hypertension and abdominal compartment syndrome: repercussions and clinical treatment in critically ill patients

A hipertensão intra-abdominal e a síndrome compartimental abdominal foram durante muitas décadas mal compreendidas e dissociadas de suas repercussões clínicas. Trata-se de um distúrbio que pode levar à disfunção de múltiplos órgãos devido ao desequilíbrio circulatório desencadeado pelo aumento de pressão no compartimento abdominal. As manifestações envolvem os sistemas cardiovascular, respiratório, renal, nervoso e gastrintestinal e estão largamente relacionadas com o fator de morbimortalidade no paciente crítico. A despeito da importância clínica, a hipertensão intra-abdominal e à síndrome compartimental abdominal ainda são temas pouco dominados pelos médicos, e fazem-se necessários o reconhecimento precoce e o estabelecimento de estratégias clínicas objetivas no contexto de uma síndrome com desfecho tão desfavorável. Portanto, foi realizada uma revisão da literatura não sistematizada com objetivo de compreender os principais pontos sobre definições, prevalência, fatores de risco, fisiopatologia, diagnóstico e tratamento acerca da hipertensão intra-abdominal e a síndrome compartimental abdominal.

Intra-abdominal hypertension and abdominal compartment syndrome have been, for many decades, poorly understood and dissociated from their clinical repercussions. It is a disorder that can lead to organ dysfunction due to circulatory impairment triggered by increased pressure in the abdominal compartment. The manifestations involve cardiovascular, respiratory, renal, nervous, and gastrointestinal systems, and are widely associated with significant morbidity and mortality in critically ill patients. Despite their clinical importance, intra-abdominal hypertension and abdominal compartment syndrome are still not sufficiently known by physicians and, early recognition and the establishment of objective clinical strategies for managing these highly morbid syndromes are required. Therefore, a non-systematized review was carried out to understand the main points about definitions, prevalence, risk factors, pathophysiology, diagnosis, and treatment of intra-abdominal hypertension and abdominal compartment syndrome.

Evaluating the short-term effect of delivery mode on female anterior compartment of pelvic floor / 中华超声影像学杂志

Objective To dynamically observe and evaluate the position and movement of anterior pelvic floor organs in vaginal delivery and selective caesarean section primipara with translabial two-dimensional 2D ultrasound and discuss the short-term effect of delivery mode on the anterior compartment of pelvic floor Methods Translabial 2D ultrasound was performed on selective caesarean section and vaginal delivery primipara in 6-8 weeks The position of bladder the existence of bladder neck funneling were observed and the mobility of bladder neck and the urethral rotation angle were measured during maximum Valsalva maneuver Results The mobility of bladder neck was larger in vaginal delivery group than selective caesarean section group during maximum Valsalva maneuver The rates of bladder neck funneling cystocele and stress urinary incontinence were higher in vaginal delivery group Conclusions Translabial 2D ultrasound could dynamically observe and evaluate the position and movement of anterior pelvic floor organ which could be used to assess the effect of delivery mode on anterior compartment of pelvic floor The short-term effect of vaginal delivery on anterior compartment of pelvic floor is greater than that of selective cesarean delivery.

Delayed Onset of Acute Limb Compartment Syndrome With Neuropathy After Venoarterial Extracorporeal Membrane Oxygenation Therapy

Acute limb compartment syndrome (ALCS) is defined as compound symptoms resulting from poor oxygenation and decreased nutrition supply to muscles and nerves in a tightly confined compartment. The most common cause of ALCS is tibia fracture, followed by blunt trauma to soft tissue. However, non-traumatic causes are rare. We report an iatrogenic, non-traumatic ALCS case after venoarterial extracorporeal membrane oxygen (VA-ECMO) therapy. A 14-year-old male received VA-ECMO therapy due to cardiorespiratory failure after drowning. Although he had no symptoms during therapy, leg swelling appeared 10 hours after ECMO treatment. Two days after the leg swelling, the patient underwent a fasciotomy. Unfortunately, nerve conduction studies and electromyography showed multiple neuropathies in the lower leg. Despite 2 weeks of rehabilitation with electrical stimulation, an exercise program, and physical therapy, there was no definite change in muscle strength. To our knowledge, this is the first reported case of non-traumatic ALCS after VA-ECMO therapy in Korea.

Clinical application of transperineal ultrasonography in diagnosis of anterior compartment dysfunctional disease / 中国介入影像与治疗学

The rapid development of ultrasonographic technology,especially the three-dimensional ultrasonographic technology has brought new opportunities to pelvic imaging.The anatomy and related diseases of the anterior compartment of female pelvic floor,and the recent application and development of transperineal ultrasonography in the anterior compartment were reviewed in this article.

Tendinopatia do compartimento anterior do tornozelo / Tendinopathy of the anterior compartment of the ankle

OBJETIVO: Análise retrospectiva da etiopatogenia, diagnóstico e opções de tratamento nos casos de tendinopatias do compartimento anterior do tornozelo (TCAT). MÉTODO: No período de setembro de 1998 a fevereiro de 2009, 13 pacientes foram operados por tendinopatia do compartimento anterior do tornozelo. A casuística constou de 10 pacientes do sexo masculino e três do feminino. O lado direito foi acometido em 12 pés e um do esquerdo. A média de idade foi de 35 anos (15-67). A etiologia foi traumática em oito pacientes e em cinco, degenerativa (atraumática). O tempo médio do diagnóstico ao tratamento foi de 19 meses (1-60) e o seguimento foi de 34 meses (4-127). O diagnóstico foi feito através da história e exame clínico. A ressonância magnética foi realizada em nove pacientes para estadiamento e planejamento. O tratamento cirúrgico foi personalizado para cada caso (sinovectomia, ressecção de ventre muscular, solidarização com o tendão adjacente e enxerto livre de tendão semitendíneo). Para a avaliação dos resultados foram utilizadas as escalas: 1) graduação subjetiva de satisfação, 2) AOFAS e 3) Maryland. RESULTADO: Em relação à escala de graduação subjetiva de satisfação, 12 pacientes satisfeitos e um paciente insatisfeito. A média da escala AOFAS foi de 80 pontos, a média da escala Maryland foi de 86 pontos. CONCLUSÃO: O tratamento cirúrgico é eficaz para recuperação funcional. As técnicas cirúrgicas devem ser personalizadas. A opção do enxerto livre de tendão semitendíneo é eficiente nas falhas maiores que cinco centímetros.

OBJECTIVE: To carry out a retrospective analysis of the etiopathogeny, diagnosis and therapeutic options in cases of tendinopathies of the anterior compartment of the ankle. METHOD: 13 patients underwent surgery between September 1998 and February 2009; ten men and three women. The right side was involved in twelve patients and the left in one. The averaging age was 35 years of age (15-67). The etiology was traumatic in eight patients and degenerative (non-traumatic) in five. The average time to diagnosis was 19 months (1 - 60) and the average follow-up time was 34 months (4 - 127). The diagnosis was made by anamnesis and clinical findings. Magnetic resonance imaging was performed in nine patients, for staging and planning. The surgical treatment was personalized in each case (debridement, resection of the muscle, grafting with the adjacent tendon, and free graft of the semitendinosus tendon). The following scales were used for the evaluation: 1) subjunctive satisfaction scale, 2) AOFAS and 3) Maryland. RESULTS: In relation to the subjective satisfaction scale, 12 patients were satisfied and one was dissatisfied. The average AOFAS scale was 80 points, and the average Maryland scale was 86 points. CONCLUSION: Surgical treatment is effective for restoring function. The surgical techniques must also be personalized. The free graft of the semitendinosus tendon option is effective for gaps larger than five centimeters.

Síndrome compartimental agudo en lesiones de la tibia / Acute compartmental syndrome in tibia lesions

Se realizó una revisión bibliográfica y actualización sobre la etiología, fisiopatología, diagnóstico diferencial y tratamiento del síndrome compartimental agudo en lesiones de la tibia. En el cuadro clínico se describe la presentación según el compartimento afectado. El diagnóstico diferencial lo enfatizamos con respecto a la oclusión arterial y la neuropraxia. En el tratamiento se resalta la importancia de las medidas a tomar y la forma de manejo, lo cual se facilita mediante la exposición de un algoritmo de tratamiento, en este aspecto planteamos las indicaciones específicas para el tratamiento quirúrgico mediante fasciotomías descompresivas.

Anterior Compartment Syndrome after Surgery of Bosworth Fracture-Dislocation of the Ankle: A Case Report / 대한족부족관절학회지

Bosworth fracture-dislocation of ankle is very rare, occurred by eversion and external rotation force. It is known as irreducible fracture by closed method. Also, compartment syndrome after ankle fracture are exceedingly rare. There are only a few reported cases of compartment syndrome after ankle fracture and compartment syndrome are involved commonly deep posterior compartment. We present a case in which a patient had a Bosworth fracturedislocation of the ankle underwent open reduction with internal fixation and subsequently occurred an anterior compartment syndrome of the leg.

A Clinical study of the Coexistion Thyroid Carcinoma in Hashimoto's Thyroiditis ( HT )

Being described first 1912 by Hashimoto, Chronic lymphocytic thyroiditis has been most commonly diagnosed as inflammatory thyroid disease. Despite of worldwide reports about the concomitant malignancy with Hashimoto's thyroiditis, the definite incidence of coexsiting malignancy and the etiologic relationship between these different pathologic conditions remains to be brought out. Analyzing 18 cases of coexisting thyroid carcinoma among 80 cases of Hashimoto's thyroiditis, confirmed by pathologic study at Presbyterian medical center in Chonju between 1991 and 1995, the authors intended to make guideline of management for them. The results are as follows: 1. The incidence of coexisting carcinoma with HT was 18/80(22.5%). 2. The average age of patients with coexisting carcinoma was 44.1 years and all of them were female.3. Cold nodules on thyroid scan were noticed in 23 cases(22.7%) of HT and 7 cases(33.8%) of coexisting carcinoma with HT. 4. Calcified lesions on thyroid sonography were detected in 0 cases of HT and 4 cases(50%) of coexisting carcinoma. 5. The pathologic types of carcinoma were papillary(17/18, 94.4%) and follicular(1/18, 5.6%). 6. 3 cases of coexisting carcinoma had metastatic lesions on peritracheal lymph nodes and another 3 cases had on ipsilateral jugular nodes. 7. The carcinoma of smaller than 0.5cm were 7 cases, of 0.6-1.0cm were 3 cases, of 1.1-1.5cm were 5 cases, and so 15 cases(83.3%) were occult carcinoma. Only 3 cases were larger than 1.6cm. 8. Coexisting carcinoma patients with HT underwent subtotal thyroidectomy (4 cases), subtotal thyroidectomy & anterior compartment dissection (ACD, 6 cases), subtotal thyroidectomy & modified RND (2 cases), thyroid lobectomy & ACD (4 cases), thyroid lobectomy & modified RND (1 cases), or near total thyroidectomy & ACD (1 case).