RESUMO
BACKGROUND: Surgical excision of hemorrhoids remains the gold standard for patients who have grade III or IV hemorrhoids. The complication rate is low and success rate is high. In this case, we describe a 44-year-old male with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy. METHODS: In this case report, we describe the case of a patient with septic shock and small liver abscesses as a rare complication after Milligan-Morgan hemorrhoidectomy. A search in the PubMed database showed only three publications describing patients with liver abscesses after hemorrhoidectomy and some more cases after rubber band ligation. RESULTS: The patient was admitted at the intensive care unit and received intravenous antibiotics. He could leave the hospital in good condition after 17 days. He received antibiotics for six weeks in total. CONCLUSION: Pyogenic liver abscess after open hemorrhoidectomy is a rare complication after Milligan-Morgan hemorrhoidectomy and rubber band ligation. Pyogenic liver abscesses can be treated with antibiotics, sometimes associated with percutaneous drainage or surgeryIn patients with predisposing factors prophylactic use of antibiotics could be considered on a case-by-case basis.
Assuntos
Hemorroidectomia , Hemorroidas , Abscesso Hepático Piogênico , Choque Séptico , Masculino , Humanos , Adulto , Hemorroidectomia/efeitos adversos , Hemorroidas/cirurgia , Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/etiologia , Abscesso Hepático Piogênico/terapia , Choque Séptico/complicações , Dor Pós-Operatória , Antibacterianos/uso terapêuticoRESUMO
INTRODUCTION: Use of patch angioplasty in carotid endarterectomy (CEA) is suggested to reduce the risk of restenosis and recurrent ipsilateral stroke. The objective is to conduct a systematic review with meta-analysis and trial sequential analysis as well as Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments comparing the benefits and harms of CEA with primary closure of the arterial wall versus CEA with patch angioplasty in patients with a symptomatic and significant carotid stenosis. METHODS AND ANALYSIS: The review shall be conducted according to this published protocol following the recommendations of the 'Cochrane' and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Randomised clinical trials comparing CEA with primary closure of the arterial wall versus CEA with patch angioplasty (regardless of used patch materials) in human adults with a symptomatic and significant carotid stenosis will be included. Primary outcomes are all-cause mortality at maximal follow-up, health-related quality of life and serious adverse events. Secondary outcomes are symptomatic or asymptomatic arterial occlusion or restenosis, and non-serious adverse events. We will primarily base our conclusions on meta-analyses of trials with overall low risk of bias. However, if pooled point estimates of all trials are similar to pooled point estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the precision achieved in all trials as the result of our meta-analyses. ETHICS AND DISSEMINATION: The proposed systematic review will collect and analyse secondary data from published studies therefor ethical approval is not required. The results of the systematic review will be disseminated by publication in a peer-review journal and submitted for presentation at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42014013416.
Assuntos
Angioplastia/métodos , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Estenose das Carótidas/diagnóstico , HumanosRESUMO
BACKGROUND: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legflow(®) paclitaxel-coated balloon (Cardionovum Sp.z.o.o., Warsaw, Poland) (LPEB) has been introduced. This balloon is covered with shellac, a Food and Drug Administration (FDA) approved natural resin, to obtain an equally distributed tissue concentration of paclitaxel. The RAPID trial is designed to assess restenosis after PTA using the Legflow balloon combined with nitinol stenting versus uncoated balloons with nitinol stenting in SFA lesions >5 cm. METHODS/DESIGN: A total of 176 adult patients with Rutherford class 2 to class 6 symptoms due to intermediate (5-15 cm) or long (>15 cm) atherosclerotic lesions in the SFA will be randomly allocated for treatment with LPEB with nitinol stenting or uncoated balloon angioplasty with stenting. Stenting will be performed using the Supera(®) stent in both groups (IDEV Technologies Inc., Webster, TX). The primary endpoint is the absence of binary restenosis of the treated SFA segment. Secondary outcomes are target lesion revascularization (TLR), clinical and hemodynamic outcome, amputation rate, mortality rate, adverse events, and device-specific adverse events. Follow up consists of four visits in which ankle-brachial indices (ABI), toe pressure measurements, and duplex ultrasound (DUS) will be performed. Furthermore, a peripheral artery questionnaire (PAQ) will be completed by the patients at each follow-up. In the event that DUS reveals a symptomatic >50% restenosis, or a >75% asymptomatic restenosis, additional digital subtraction angiography will be performed with any necessary re-intervention. DISCUSSION: The RAPID trial is a multicenter randomized controlled patient blind trial that will provide evidence concerning whether the use of the Legflow paclitaxel/shellac coated balloons with nitinol stenting significantly reduces the frequency of restenosis in intermediate and long SFA lesions compared to standard PTA and stenting. TRIAL REGISTRATION: ISRCTN47846578.