RESUMEN
We describe a rare case of post-infarction myocardial rupture leading to communication between the left ventricle and coronary sinus, which eventually led to a left-to-right shunt. The observation was made in an elderly woman with subacute infero-posterior myocardial infarction. Diagnosis was initially made by transthoracic echocardiography (elicited by the finding of high-velocity flow within a dilated coronary sinus), and was confirmed in greater detail at cardiac magnetic resonance. This description adds to the list of known post-infarction mechanical complications. The finding of high-velocity flow within the coronary sinus after myocardial infarction suggests the possibility of myocardial rupture leading to left ventricle to coronary sinus communication; an unusual but potentially treatable complication.
Asunto(s)
Seno Coronario , Rotura Cardíaca Posinfarto/diagnóstico , Ventrículos Cardíacos , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo/fisiología , Diagnóstico Diferencial , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Resultado Fatal , Femenino , Estudios de Seguimiento , Rotura Cardíaca Posinfarto/fisiopatología , Humanos , Imagen por Resonancia MagnéticaRESUMEN
The use of totally implantable systems (TIS) has noticeably reduced risks and enhanced quality of life for cancer patients undergoing long-term chemotherapy. One aspect remains open to discussion: site of venous access and placement procedure. Opinions are divided between two techniques: percutaneous access by direct puncture of the subclavian vein or surgical access through the veins afferent to the subclavian: the cephalic, the jugular, or other minor veins. We report our experience with 63 patients undergoing surgical placement of TIS through the cephalic vein. The operatory procedure is divided into four phases: 1) Preparation of vein and cannulation; 2) X-ray control; 3) creation of subcutaneous sheath; 4) reconstruction. None of the 63 patients developed immediate complications. 46 patients are currently using TIS for a period ranging from 17 to 1862 days. 16 patients died during the time their TIS was in place. In only one patient was the TIS removed after treatment was completed. From our results it is clear that the surgical access through the cephalic vein is the most reliable method of TIS placement, with fewer risks concerning immediate and post operatory complications.
Asunto(s)
Catéteres de Permanencia , Neoplasias/tratamiento farmacológico , Adulto , Anciano , Catéteres de Permanencia/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos VascularesRESUMEN
The authors report their experience in the treatment of hemorrhoids by rubber band ligation according to Barron's modified technique which foresees that the ligation is performed thanks to the suction of the hemorrhoidal node through the shaft of the band applicator connected with an aspirator. Eighty-four patients underwent consecutively this treatment over a 18-month period; all were performed with a minimum follow-up of 6 months. Forty male patients (mean age 46.6 years) showed symptoms lasting since 9 years. Forty-four female patients (mean age 42.6 years) showed such pathology since 8.9 years. 70.2% of the patients were classified as III stage of disease, 19% II stage and 10.7% I stage. Thirty-four patients had anal pain, 49 bleeding, 5 anemia, 21 thrombosis of the hemorrhoidal plexus, 54 prolapse of the ano-rectal mucosa. These symptoms and signs were present in most of the patients contemporaneously. Three patients had previously received rubber band ligations, 4 hemorrhoidectomy, 1 sclerotherapy and 1 rubber band ligation and sclerotherapy. In the whole we performed 285 sessions and 304 rubber band ligations. Each treatment consisted of 3.4 sessions and 3.6 rubber band ligations. Recovery was achieved with only one session in 9 patients; 66.7% of them showed 1st degree disease. Multiple sessions were necessary in patients with advanced disease degree; 100% at stage II and 94.9% at stage III. Sixty-five patients did not refer immediate and long-term significant complications. The remaining patients complained during the first hours about heavy feeling and/or tenesmus and two, 2 weeks after the end of treatment, showed bleeding episodes, which cleared up spontaneously. In 5 cases it was necessary, during follow-up, to carry out a completion rubber band ligation and in 3 we performed trimming surgery at the out-patients' department by resection of the exceeding skin and anal mucosa. The technique enables to achieve results just as valid as those of traditional methods in the treatment of hemorrhoidal pathology with the advantage that it can be performed in an out-patient's department, it does not need local anesthesia, it enables the patient to immediately return to his normal working activity and, restricted to the observation period (6- and 12-month follow-up) it allows a satisfactory control of the disease.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Hemorroides/cirugía , Adulto , Anciano , Femenino , Hemorroides/complicaciones , Humanos , Ligadura/métodos , Masculino , Persona de Mediana Edad , ProlapsoRESUMEN
The authors have developed a simple and accurate technique of excisional biopsy for non-palpable breast nodes using an intraoperative sonographic technique. Identification, localization and exeresis of the lesions are guided by means of a sterilized transducer introduced through the surgical wound. The confirmation of the correct biopsy is evaluated by scanning the specimen gowned with a surgical glove and comparing the intra- and postoperative ultrasonographic images. The results of analysis showed that in all cases the altered area was removed with extreme accuracy and the ultrasonography is reliable in identifying pathological or suspicious areas since the dimensions of the lesion measured with the scanner correspond significantly to the dimensions of the lesions when measured histologically.
Asunto(s)
Biopsia/métodos , Enfermedades de la Mama/diagnóstico por imagen , Enfermedades de la Mama/cirugía , Mama/patología , Enfermedades de la Mama/patología , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Cuidados Intraoperatorios , UltrasonografíaRESUMEN
The restoration of continence is a fundamental step in the rehabilitation of stomised patients. The latest generation of continence prosthesis, represented by Conseal must be seen in this context. The authors performed a multicentre study based on a protocol using Conseal Uni in patients with low terminal digestive stomies (ileum or colostomy). The only criteria for patient selection was the absence of marked stomal and peristomal pathologies (large prolapse, fistula). The three centres taking part in the study inserted the new device in 50 patients (25 M; 25 F) with a mean age of 57.5 years (range 18-87) of whom 45 had undergone left terminal colostomy and 5 terminal ileostomy. A weekly evaluation was made of the use of the prosthesis for 4 weeks and a follow-up control was performed after 24 months in 22 patients. The results obtained shown that Conseal received a positive judgement in 88% of patients, better results were obtained in colostomized patients receiving irrigation (positive judgement in 100% of cases), whereas the success rate in non-irrigated patients only amounted to 50%. An additional application for the use of Conseal emerged from the study, namely its utilisation by ileostomised patients. Using various technical procedures, it was possible to obtain 8-hour continence in ileostomised patients. This result is of considerable importance since it shows the research, technological and clinical effort that has been made to achieve a form of continence in ileostomised patients.