ABSTRACT
OBJETIVO: Desde el inicio de nuestra actividad de Cirugía Sin Ingreso hemos tratado lapatología del sinus pilonidal. En el presente trabajo analizamos los resultados obtenidos y las técnicas empleadas para ello. MATERIAL Y MÉTODOS: Desde enero de1998 a enero 2003 hemos realizado Cirugía Sin Ingreso en nuestro Servicio de Cirugía General y del Aparato Digestivo y desde entonces hemos intervenido a 320 pacientes afectos de sinus pilonidal. La técnica empleada hasta junio de 1998fue la exéresis y cierre primario de la herida, aplicada a 31 pacientes. A partir de julio de 1998 hasta la actualidad, a los 289 pacientes restantes hemos realizado la exéresis en bloque y cierre por segunda intención. Se han controlado las complicaciones aparecidas. RESULTADOS: La técnica de cierre primario de la herida ha cursado con un 71% de seromas postoperatorios que requirieron drenaje y también1 herida infectada (3.2%) que precisó ingreso demorado. Con el cierre por segunda intención se han realizado 4 ingresos inmediatos(1,3%) debidos a una herida quirúrgica más amplia de la prevista. En urgencias se ha atendido a 3 pacientes(0.9%) por hemorragia de la herida, resueltas con cura tópica. No se presentaron otras complicaciones CONCLUSIONES: Nosotros iniciamos la actividad con el cierre primario, pero el alto número de seromas aparecidos que precisaron control y desbridamiento nos indujo al cambio a la técnica con cierre por segunda intención que ha permitido obtener hasta la actualidad unas cifras de complicaciones comparables a las aparecidas en la bibliografía consultada, y el tiempo de baja laboral no es mucho mayor al resto de técnicas descritas (AU)
INTRODUCTION: Since we started our activity in ambulatory surgery we have operated the pathology of pilonidal disease. In the present study we analyze the results obtained and the technique used for it. MATERIAL AND METHODS: From January1998 to January 2003 we have operated on 320patients with pilonidal sinus. The technique used until June 1998 was excision and primary closure of the wound, applied to 31 patients. From July 1998 to the present time, the excision and second intention. healing technique was performed on the remaining 289 patients The complications which appeared have been controlled. RESULTS: Primary closure of the injury presented a 71% of postoperative seromas that needed drainage and also 1 infected wound (3.2%)which required delayed hospitalization. With the second intention closure, there were 4 immediate hospitalizations (1.3%) due to a wound that was larger than predicted. In the emergency area we attended 3 patients (0.9%) for hemorrhage, which was resolved with simple wound packing. There were no other complications, CONCLUSIONS: We started our activity using the primary closure but the high number of seromas that needed control and drainage induced us to change to the healing by second intention technique. With this technique we have obtained, so far, a number of complications comparable to those discribed in the bibliography consulted, and the length of time off work is nogreater than that described with the remainder of techniques (AU)
Subject(s)
Humans , Ambulatory Surgical Procedures/methods , Pilonidal Sinus/surgery , Postoperative Complications , Treatment OutcomeABSTRACT
AIM: to reduction the TPN-related hepatic toxicity with an anaerobicidal therapy (ornidazole in our case). PATIENT: a 24-year-old male surgically treated for intestinal occlusion. He had been treated with abdominal radiotherapy for rabdomyosarcoma of embryonic urogenital sinus when he was five months old. It was found a great abdominal radiotherapy sequelae and occluded and perforated small-bowel loop that was resected. Postoperative time developed pelvic abscess and reoperation was performed. Severe intraabdominal inflammatory-adhesive process was noticed which included all the intestinal loops with multiple perforations. Attempts to release this situation was unsuccessful and several anastomoses, with some loop exclusions and a diverting loop jejunostomy were performed. In postoperative period he developed an enterocutaneous fistula and TPN was initiated. Higher and higher hepatic marker values were detected suggesting a progressive hepatotoxicity. METHODS: anaerobicidal agent (ornidazole) and cyclic total parenteral nutrition as a therapy design were prescribed. RESULTS: there were satisfactory showing a reduction in hepatic marker values (72.5% fall in alanine aminotransferase). CONCLUSIONS: bearing in mind that some theories suggest that total parenteral nutrition may cause atrophic changes in the gut mucosa so giving rise to bacterial translocation, this anaerobicidal treatment designed could be assumed effective for attenuating TPN-related liver damage.
Subject(s)
Anti-Infective Agents/therapeutic use , Chemical and Drug Induced Liver Injury/drug therapy , Chemical and Drug Induced Liver Injury/etiology , Ornidazole/therapeutic use , Parenteral Nutrition/adverse effects , Adult , Humans , Liver Function Tests , Long-Term Care , MaleABSTRACT
Hemangiopericytoma (HP) is a rare tumoral neoplasm of the soft tissues. Here, we report a case of HP that appeared in a young woman in a very uncommon location (perianal). Initially it was considered as a perianal abscess: arteriography, CT-scan and, eventually, histological studies, confirmed the diagnosis of HP. The tumoral mass was first embolized and thereafter was resected through a double approach (abdominal and perineal). One and a half years after surgery, the patient remains asymptomatic.
Subject(s)
Anus Neoplasms/diagnostic imaging , Hemangiopericytoma/diagnostic imaging , Ischium , Adult , Angiography , Anus Neoplasms/pathology , Anus Neoplasms/surgery , Diagnosis, Differential , Female , Follow-Up Studies , Hemangiopericytoma/pathology , Hemangiopericytoma/surgery , Humans , Tomography, X-Ray ComputedABSTRACT
Avaliaram-se os efeitos da lotaçäo e do manejo sobre a qualidade e a disponibilidade da braquiária (Brachiaria decumbens), e seus diversos componentes. Foram usados quatro a seis bovinos azebuados por piquete, dependendo da taxa de lotaçäo e da área da pastagem. As lotaçöes usadas com pastejo contínuo foram: 1,43; 2,14 e 3,00 cabeças/hectare, envolvendo 45 bovinos e três manejos, A = braquiária, B = braquiária mais pastejo de soja na época seca e C = braquiária mais feno de soja na seca. As avaliaçöes da braquiária foram realizadas durante 315 dias, sendo a quantidade de forragem no pasto representada pela média ponderada de 15 estimativas visuais do melhor observador e mais 10 observaçöes reais de cada piquete. Utilizou-se análise de variância e teste "t" para comparaçäo entre médias. A maior disponibilidade de forragem foi verificada nos piquetes com as menores cargas. Houve diferença significativa entre os três manejos empregados, com maior disponibilidade no manejo A. A medida que se aumentou a lotaçäo, as quantidades de folha e talo da braquiária em todos os manejos diminuíram. As porcentagens de proteína bruta da folha de braquiária foram superiores aos outros componentes da planta. A partir de outubro, com o início das chuvas, essas porcentagens aumentaram em todos os componentes da braquiária
Subject(s)
Animals , Cattle , Dietary Fiber/analysis , Animal Feed/analysisABSTRACT
Avaliaram-se os efeitos da lotaçäo e do manejo sobre o ganho de peso de animais, assim como sobre a qualidade e a disponibilidade da braquiária (Brachiaria decumbens), e suas diferentes fraçöes. Foram usados quatro a seis bovinos azebuados por piquete, dependendo da taxa de lotaçäo e da área da pastagem. As lotaçöes usadas com pastejo contínuo foram: 1,43; 2,14 e 3,00 cabeças/hectare, envolvendo 45 bovinos e três manejos, A = brachiaria, B = brachiaria mais pastejo de soja na época seca e C = brachiaria mais feno de soja na seca. As avaliaçöes da braquiária foram realizadas durante 315 dias, sendo a quantidade de forragem no pasto representada pela média ponderada de 15 estimativas visuais do melhor observador e mais 10 observaçöes reais de cada piquete. Utilizou-se análise de variância e teste "t" para a comparaçäo entre médias. A soja usada para pastejo era avaliada a cada 15 dias, através de gaiolas, durante quatro meses. Em março, os piquetes A, B e C de soja foram fenados para suplementar os animais do manejo C durante o inverno. A medida que se aumentou a lotaçäo, o ganho de peso diminuiu. Os ganhos de peso por hectare, no entanto, foram maiores com o aumento da lotaçäo. As porcentagens de digestibilidade in vitro da matéria orgânica e de conteúdo celular da folha de braquiária foram superiores aos outros componentes da planta. A partir de outubro, com o início das chuvas, essas porcentagens aumentaram em todas as fraçöes da braquiária
Subject(s)
Animals , Dietary Fiber/analysis , Digestion , Animal Feed/analysis , Weight GainABSTRACT
O experimento teve por finalidade avaliar a produçäo de matéria seca e o teor de proteína bruta da Brachiaria decumbens stapf após quatro períodos de vedaçäo. Associados ao valor nutritivo, foi estimado o rendimento, na base da matéria seca, da parte aérea, folhas verdes, folhas secas, hastes verdes e hastes secas, em intervalos de 28 dias, a partir de cada data de início de vedaçäo. O delineamento foi o de blocos ao acaso com parcelas subdivididas, no qual os tratamentos foram constituídos por épocas de vedaçäo e os subtratamentos por cortes manuais feitos rente ao solo, em intervalos de 28 dias (seca e início da próxima estaçäo chuvosa). Estimaram-se as equaçöes de regressäo linear para matéria seca e proteína bruta, em funçäo da idade, para as diferentes partes da planta. O tratamento com vedaçäo em janeiro apresentou maior rendimento de matéria seca. Com o avanço da idade, houve queda acentuada nos teores de proteína bruta. A forragem da área diferida em abril e coletada em julho apresentou maior teor de proteína bruta que as forragens produzidas nas áreas vedadas em janeiro, fevereiro e março
Subject(s)
Dietary Fiber , PlantsABSTRACT
O experimento teve por finalidade avaliar quatro períodos de vedaçäo sobre a produçäo e qualidade da Brachiaria decumbens stapf. Estimaram-se os teores de fibra detergente neutro, fibra detergente ácido, celulose, lignina e digestibilidade in vitro da matéria seca da parte aérea, folhas verdes, folhas secas, hastes verdes e hastes secas, a partir de cada data de início de vedaçäo. O delineamento foi o de blocos ao acaso com parcelas subdivididas, no qual os tratamentos foram constituídos por épocas de vedaçäo e os subtratamentos por cortes manuais feitos rente ao solo, em intervalos de 28 dias (seca e início da estaçäo chuvosa seguinte). Foram estimadas equaçöes de regressäo linear, em funçäo da idade, para as diferentes fraçöes da planta. Näo houve aumento das fraçöes fibrosas com o avançar da idade. Näo houve diferença significativa na digestibilidade in vitro da matéria seca segundo a época de vedaçäo
Subject(s)
Dietary Fiber , PlantsABSTRACT
We report a case of tumor embolism of the lower right extremity after right pneumonectomy. This is an infrequent complication and in most cases occurs during the intraoperative or immediate postoperative period. Our patient underwent surgery for primary pulmonary neoplasia (squamous cell carcinoma) and 4 hours later showed clinical signs of acute arterial occlusion in the lower right extremity. An emergency embolectomy was performed and a thrombus with tumor characteristics was extracted from the right common femoral artery. The pathologic features of this thrombus were identical to those of the pulmonary tumor.
Subject(s)
Carcinoma, Squamous Cell/surgery , Lung Neoplasms/surgery , Neoplastic Cells, Circulating/pathology , Pneumonectomy/adverse effects , Aged , Carcinoma, Squamous Cell/pathology , Embolectomy , Humans , Leg/blood supply , Lung Neoplasms/pathology , Male , Postoperative Complications/pathology , Postoperative Complications/surgeryABSTRACT
A prospective, controlled, and randomized clinical study was carried out with the purpose of evaluating the influence of somatostatin in the evolution of acute pancreatitis. One hundred patients were randomly divided into two groups, a control group (n = 50 patients) and a somatostatin group (n = 50 patients to whom a dosage of 250 micrograms/h was administered for 48 h following a bolus of 250 micrograms at the beginning of therapy). The two groups were homogeneous in age, sex, etiology, and severity of clinical picture (on admission). The following parameters were compared in the two groups: 1. Evolution of the Computerized Axial Tomography (CT) findings on admission and after 48 h; 2. Length of hospital stay; 3. Need for surgery; and 4. Mortality. The results from the CT scans showed a significant statistical difference in favor of somatostatin regarding the evolution of pancreatic lesions and length of stay in the hospital. Another study using a larger sample would be required in order to evaluate the rest of the parameters.
Subject(s)
Pancreatitis/drug therapy , Somatostatin/therapeutic use , Acute Disease , Alcoholism/complications , Biliary Tract Diseases/complications , Depression, Chemical , Female , Humans , Male , Middle Aged , Pancreatic Juice/metabolism , Pancreatitis/etiology , Pancreatitis/mortality , Pancreatitis/physiopathology , Pancreatitis/surgery , Pancreatitis/therapy , Parenteral Nutrition, Total , Prospective Studies , Secretory Rate/drug effects , Somatostatin/pharmacologySubject(s)
Gallbladder Diseases/diagnosis , Aged , Aged, 80 and over , Female , Gallbladder Diseases/surgery , HumansABSTRACT
A case is reported of leiomyoma of rectum, a rare tumor since it is detected in 2 of 3000 rectal tumors. It occurs principally in patients between 40 and 50 years. The tumor is submucosal, is difficult to diagnose and biopsy is often valueless since it does not involve the tumor mass. The interest of the present case is that trans-rectal ultrasound imaging of the leiomyoma was performed. Differential histologic diagnosis between benign and malignant forms is a dilemma, these tumors being of slow growth with a marked tendency for recurrence and malignant degeneration. Treatment should always be surgical, with local resection if histology has excluded malignancy, followed by periodic surveillance. Radical surgery is indicated in malignant forms or for local recurrence of benign tumors.