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2.
Eur J Pain ; 20(2): 186-95, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25828692

RESUMO

BACKGROUND: Pre-emptive analgesia in perioperative care has potential benefits for patients. The pre-emptive and postoperative analgesic effects of the cyclooxygenase-2 inhibitor etoricoxib have been investigated using a 2 × 2 factorial trial design. METHODS: According to the 2 × 2 factorial study design, 103 patients scheduled for visceral surgery, were randomly allocated to two groups prior to surgery. Patients could receive either etoricoxib or placebo (to investigate pre-emptive analgesia). Subsequent to surgery, patients randomly received either etoricoxib or placebo, again. It follows, that four treatment modalities (continuous or replaced intervention) result, to investigate postoperative analgesia. Main Outcome Measure was the cumulative morphine use 48 h post-surgery. Other outcomes included pain intensities, pain thresholds and sensory detection. RESULTS: Eighty-six patients (female n = 42; mean age 53.82 ± 13.61 years) were evaluated on the basis of an intention to treat analysis. Pre-emptive administration of 120 mg etoricoxib did not significantly reduce the cumulative morphine dose within the first 48 h after surgery, when compared to the administration of placebo. The analysis of the post-operative treatment groups showed a non-significant 8% reduction in morphine dose during the continuous administration of etoricoxib. There were no changes in sensory perception as detected with QST before and after surgery or between groups. CONCLUSIONS: The effect of administering etoricoxib was not superior to placebo in reducing the morphine dose required for postoperative analgesia. The lack of changes in peripheral nociception suggests that central algetic mechanisms are of higher impact in the development of postoperative pain following abdominal or thoracic surgery.


Assuntos
Abdome/cirurgia , Analgesia/métodos , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Limiar da Dor/efeitos dos fármacos , Dor Pós-Operatória/tratamento farmacológico , Piridinas/uso terapêutico , Sulfonas/uso terapêutico , Adulto , Idoso , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Método Duplo-Cego , Etoricoxib , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/uso terapêutico , Entorpecentes/administração & dosagem , Entorpecentes/uso terapêutico , Medição da Dor , Piridinas/administração & dosagem , Sulfonas/administração & dosagem
3.
Surg Endosc ; 27(2): 494-500, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23052490

RESUMO

BACKGROUND: Parastomal hernia is a frequent complication of intestinal stomata. Mesh repair gives the best results, with the mesh inserted via laparotomy or laparoscopically. It was the aim of this retrospective multicenter study to determine the early and late results of the laparoscopically performed, modified Sugarbaker technique with ePTFE mesh. METHODS: From 2005 to 2010, a total of 61 consecutive patients (mean age = 61 years), with a symptomatic parastomal hernia, underwent laparoscopic repair using the modified Sugarbaker technique with ePTFE mesh. Fifty-five patients had a colostomy, 4 patients an ileostomy, and 2 a urostomy according to Bricker. The records of the patients were reviewed with respect to patient characteristics, postoperative morbidity, and mortality. All patients underwent physical examination after a follow-up of at least 1 year to detect a recurrent hernia. Morbidity rate was 19 % and included wound infection (n = 1), ileus (n = 2), trocar site bleeding (n = 2), reintervention (n = 2), and pneumonia (n = 1). One patient died in the postoperative period due to metastasis of lung carcinoma that caused bowel obstruction. Concomitant incisional hernias were detected in 25 of 61 patients (41 %) and could be repaired at the same time in all cases. A recurrent hernia was found in three patients at physical examination, and in one patient an asymptomatic recurrence was found on a CT scan. The overall recurrence rate was 6.6 % after a mean follow-up of 26 months. CONCLUSION: The laparoscopic Sugarbaker technique is a safe procedure for repairing parastomal hernias. In our study, the overall morbidity was 19 % and the recurrence rate was 6.6 % after a mean follow-up of 26 months. Moreover, the laparoscopic approach revealed concomitant hernias in 41 % of the patients, which could be repaired successfully at the same time.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Enterostomia/efeitos adversos , Feminino , Hérnia Ventral/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos
4.
Exp Clin Endocrinol Diabetes ; 119(4): 208-13, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21374545

RESUMO

Primary adrenal lymphoma (PAL) is an extremely rare entity, with approximately 70 cases reported in the English literature and 120 cases worldwide. Here we report the cases of a 53-year-old and a 62-year-old male patient and a 60-year-old female patient affected by large B-cell non-Hodgkin lymphoma of the adrenal gland. We summarize the diagnostic approaches that confirmed the diagnosis of PAL and describe individual treatment outcomes after therapy. Based on these case reports and a review of the literature patients are usually in the 6th or 7th decade of life and present with B-symptoms or rapidly progressive adrenal insufficiency in case of bilateral involvement. The identification of bilateral adrenal masses often causes a severe diagnostic problem. An etiological approach with assessment of the hormonal profile and detailed diagnostic imaging should be aimed at. Furthermore, if PAL is suspected biopsy of the adrenal mass should be performed after biochemical exclusion of a pheochromocytoma. Once the diagnosis is established further treatment decisions should be made in a multi-disciplinary setting in specialized centers.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/terapia , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/terapia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Surg Endosc ; 24(12): 3156-60, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20490562

RESUMO

BACKGROUND: The availability of intraoperative intact parathyroid hormone monitoring allows the success of minimally invasive parathyroidectomy to be ensured during the operation. However, false-negative results leading to unnecessary explorations and difficulties in interpreting the data raise concern about the effectiveness of the method. METHODS: Patients with primary hyperparathyroidism (pHPT) and one unequivocally enlarged parathyroid gland on preoperative ultrasound or (99m)Tc-SestaMIBI scintigraphy underwent minimally invasive video-assisted parathyroidectomy according to the technique initially described by Miccoli. Intraoperatively, rapid electrochemiluminescence immunoassay was used to measure intact parathyroid hormone (iPTH) levels before the operation, after complete mobilization of the adenoma (preexcision value), and 5, 10, and 15 min after the excision. The operation was considered successful when more than a 50% decrease in preexcision iPTH levels and subsequent attainment of the normal range within 15 min were observed. RESULTS: Between November 1999 and November 2009, 235 (43%) of 546 patients with pHPT were eligible for a minimally invasive approach. Intraoperative iPTH monitoring showed 221 true-positive, 1 false-positive, 6 false-negative, and 7 true-negative results. This calculated to a sensitivity of 97% and a specificity of 88%. CONCLUSIONS: Despite the availability of high-resolution ultrasound and (99m)Tc-SestaMIBI scintigraphy, the presence of multiple glandular disease cannot be ruled out completely. Although the authors observed six false-negative results, they believe that intraoperative iPTH monitoring represents a valuable asset for minimally invasive parathyroidectomy because it identifies sporadic hyperplasia.


Assuntos
Monitorização Intraoperatória/métodos , Hormônio Paratireóideo/sangue , Paratireoidectomia/métodos , Cirurgia Vídeoassistida , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Reprodutibilidade dos Testes , Fatores de Tempo
6.
Abdom Imaging ; 35(2): 224-31, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19305941

RESUMO

BACKGROUND: To non-invasively identify incisional hernia repair implanted synthetic meshes with MRI, and also focusing on the evaluation of postsurgical complications such as adhesions. METHODS: A total of 43 patients underwent either laparoscopic intraperitoneal onlay-mesh or open abdominal wall repair using preperitoneal layers. The patients were examined using a true-fast-imaging-with-steady-state-precession (trueFISP)-sequence in transverse/sagittal orientation with a section-by-section dynamic depiction of induced visceral slide. A 9-segment-abdominal-map was used to document the adhesion location/type. The MR-images were analysed regarding hernia relapse, layer-morphology, rectus-abdominis muscle-condition, and abdominal wall mobility. In 12 patients pre- and postsurgery-MRI was performed. RESULTS: Time range between surgery and examination was 6-36 months. In all laparoscopy-patients the meshes were identified. For open surgery the mesh was not visualized in 20, but was seen in 6 cases. A total of 11 cases showed a recurrent hernia. Seventy intraabdominal adhesions were detected. Fifteen patients had restricted mobility. 20 patients showed an rectus-abdominis-muscle-asymmetry. Comparing pre- and post-op-MRI, 6 out of 8 patients with open repair showed thick scar-plaques. Three patients with open repair had new adhesion-formations postoperatively. CONCLUSION: Functional cine MRI is suitable for follow-up studies in patients after hernia repair to detect and evaluate the implanted meshes. Typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed as well.


Assuntos
Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Imagem Cinética por Ressonância Magnética/métodos , Complicações Pós-Operatórias/diagnóstico , Telas Cirúrgicas , Aderências Teciduais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Polipropilenos , Politetrafluoretileno , Recidiva
7.
Eur J Med Res ; 13(11): 517-24, 2008 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-19073388

RESUMO

INTRODUCTION: In trauma patients, injury of solid abdominal organs secondary to blunt trauma is a major source of morbidity and mortality. Different diagnostic options such as FAST sonography or CT scan have been described. METHODS: Our trauma registry was used to identify multiple injured patients with blunt abdominal trauma during 2001 to 2006. Patient demographics, diagnostic and operative findings, treatment, complications, length of stay and mortality were reviewed. RESULTS: Of 438 multiple injured patients, 58 patients were diagnosed with blunt abdominal trauma. During examination, free fluid or organ injury could be seen in 72.4% during sonography and in 84.3% of the patients who received CT scan, giving a sensitivity of 92% for initial FAST Sonography. Nevertheless, CT scan showed a higher sensitivity in detecting bowel (84%) or mesenteric (75%) injuries, if compared to FAST. 30 (51.7%) of the 58 patients had to undergo laparotomy because of blunt abdominal trauma, giving a laparotomy rate of 6.8% because of blunt abdominal trauma in multiple injured patients. CONCLUSION: Sonography is the method of choice for initial screening and CT scan in detecting bowel or mesenteric injuries. A large intraperitoneal fluid accumulation during initial sonography in combination with unstable vital signs should lead to an immediate exploratory laparotomy.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Laparotomia , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adulto , Serviços Médicos de Emergência , Humanos , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Sistema de Registros , Sensibilidade e Especificidade , Ultrassonografia , Ferimentos não Penetrantes/cirurgia
8.
Unfallchirurg ; 111(11): 898-904, 2008 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-18806975

RESUMO

BACKGROUND: The aim of the study was to quantify the occurrence of progressive intracranial bleeding (PIB) and to identify concomitant parameters in patients suffering from traumatic brain injury (TBI). METHODS: TBI patients were included if initial and serial cranial computed tomography (CCT) scans were conducted within 24 h after trauma. A progression of > or =25% was considered as PIB. Patients with progression were compared to those with constant bleeding regarding clinical parameters, time lapse and coagulation status. RESULTS: A total of 98 patients with TBI and intracranial hemorrhaging were analyzed. PIB was detected in 45 patients showing significantly more intracerebral bleeding as well as fractures to the skull (p<0.05), compared to patients with constant bleeding. No significant differences between the groups regarding demographic and clinical parameters, time interval between trauma and initial CCT, and coagulation status were found. CONCLUSIONS: Early progression of intracranial hemorrhaging occurs in nearly every second TBI patient and is recognized frequently in cerebral contusions and after fractures to the skull. Hence, early repeated CT scanning is indicated in all TBI patients suffering from intracranial bleeding.


Assuntos
Hemorragia Encefálica Traumática/diagnóstico por imagem , Hemorragia Encefálica Traumática/epidemiologia , Angiografia Cerebral/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
10.
Eur J Med Res ; 13(5): 185-91, 2008 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-18559298

RESUMO

OBJECTIVE: The aim of this study was to evaluate the technique of prosthetic mesh fixation in laparoscopic intraperitoneal incisional and ventral hernia repair using cyanoacrylat glue (Glubran GEM, Viareggio, Italy) in comparison with fixation methods using spiral tacks (Protack 5mm, Tyco) or transabdominal Prolene 4/0 sutures respectively. METHOD: Through a midline laparotomy 3 pieces (3 x 3cm) of mesh (n = 60) where fixed onto the intact peritoneum on either side of a midline laparotomy in 10 New Zealand White rabbits. Two types of meshes where compared: ePTFE meshes (Gore-Tex Dual Mesh W.L. Gore and Associates, Inc. Medical Products Division, Flagstaff, Arizona, USA) and polypropylene/ polyvinylfluorid meshes (Dyna Mesh - IPOM P.J. Dahlhausen and Co. GmbH, Germany). All animals were killed after 12 weeks. Upon scoring of the adhesions the prosthetic materials were excised en bloc with the anterior abdominal wall for tensile strength analysis and histologic evaluation. RESULTS: In contrast to ePTFE meshes fixed with cyanoacrylat glue, PP meshes fixed with transabdominal sutures as well as with spiral tacks showed the highest percentage and tenacity of adhesions (p<0.033). Independent of the method of fixation, ePTFE meshes revealed a significantly higher shrinkage than PP prosthesis (41% vs 17% related to original mesh surface; p<0.033). The strength of the mesh incorporation was significantly higher in PP meshes (p<0.033). Fixation of PP meshes with cyanoacrylat glue showed an equivalent tensile strength as ePTFE meshes fixed with spiral tacks (6.6 +/- 2.7 N vs 6.6 +/- 3.1N). CONCLUSION: In this rabbit model, intraabdominal fixation of PP composite meshes with cyanoacrylat glue was equivalent to ePTFE mesh fixation with spiral tacks concerning tensile strength analysis. Adhesions between mesh and abdominal wall were found more frequently after PP fixation. In contrast, mesh shrinkage was more evident after ePTFE mesh implantation.


Assuntos
Cianoacrilatos , Hérnia Abdominal/cirurgia , Laparoscopia/métodos , Telas Cirúrgicas , Aderências Teciduais/epidemiologia , Animais , Politetrafluoretileno , Coelhos , Suturas , Resistência à Tração , Aderências Teciduais/prevenção & controle
11.
Eur J Med Res ; 13(5): 221-8, 2008 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-18559306

RESUMO

Primary adrenal non-Hodgkin's lymphoma (PAL) is a rare neoplastic disease. Clinical symptoms are often related to the presence of lymphoma or adrenal insufficieny. Diagnostic strategies include endocrine evaluation, imaging studies and histopathological examination. In case of suspicious PAL, percutaneous CT or US-guided needle biopsy is recommended to rapidly establish diagnosis before starting chemotherapy. We report about an 84-year-old male who presented with significant weight loss and chronic lumbar pain. Abdominal CT scans revealed bilateral masses highly suggestive of malignancy. After open bilateral adrenalectomy with abdominal lymphadenectomy, histological examination showed bilateral PAL. Five months after surgery, the patient died due to progressive tumor disease.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Linfoma não Hodgkin/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/terapia , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Diagnóstico Diferencial , Humanos , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/terapia , Masculino , Tomografia Computadorizada por Raios X
12.
Eur J Med Res ; 13(4): 182-4, 2008 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-18504175

RESUMO

Ischemic colitis results from insufficient blood supply to the large intestine and is often associated with hypercoagulable states. The condition comprises a wide range presenting with mild to fulminant forms. Diagnosis remains difficult because these patients may present with non-specific abdominal symptoms. We report a 51- year-old female patient with known Leiden factor V mutation as well as systemic lupus erythematous along with antiphospholipid syndrome suffering from recurrent ischemic colitis. At admission, the patient complained about abdominal pain, diarrhea and rectal bleeding lasting for 24 hours. Laboratory tests showed an increased C-reactive protein (29.5 mg/dl), while the performed abdominal CT-scan revealed only a dilatation of the descending colon along with a thickening of the bowel wall. Laparotomy was performed showing an ischemic colon and massive peritonitis. Histological examination proved the suspected ischemic colitis. Consecutively, an anti-coagulation therapy with coumarin and aspirin 100 was initiated. Up to the time point of a follow up examination no further ischemic events had occurred. This case illustrates well the non-specific clinical presentation of ischemic colitis. A high index of suspicion, recognition of risk factors and a history of non-specific abdominal symptoms should alert the clinicians to the possibility of ischemic disease. Early diagnosis and initiation of anticoagulation therapy or surgical intervention in case of peritonitis are the major goals of therapy.


Assuntos
Síndrome Antifosfolipídica/complicações , Colite/complicações , Fator V/genética , Isquemia/complicações , Lúpus Eritematoso Sistêmico/complicações , Síndrome Antifosfolipídica/genética , Síndrome Antifosfolipídica/imunologia , Colite/genética , Colite/imunologia , Feminino , Humanos , Isquemia/genética , Isquemia/imunologia , Lúpus Eritematoso Sistêmico/genética , Lúpus Eritematoso Sistêmico/imunologia , Pessoa de Meia-Idade , Mutação , Recidiva
13.
Hernia ; 12(5): 549-52, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18401545

RESUMO

We present the case of a 60-year-old man who presented with a left hypochondrial swelling first noticed 4 weeks prior to admission to our clinic. Based on the findings of the ultrasound and magnetic resonance imaging investigation, a tumour of uncertain origin of the abdominal wall was suspected, also involving the small bowel. The swelling, including the affected lateral and transverse oblique muscles as well as the subcutaneous tissue and the adjacent omentum majus, was completely excised. The resulting myoaponeurotic defect of the left lateral abdominal wall was closed with interrupted Vicryl sutures and stabilised with a PTFE prosthesis (20 x 10 cm) that was placed intraabdominally and secured by spiral tackers and interrupted transfascial monofilament Prolene sutures. Microscopic examination of the excised specimen revealed an actinomycosis of the anterior abdominal wall, which is extremely rare. The surgical treatment was followed by antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications.


Assuntos
Parede Abdominal , Actinomicose/diagnóstico , Actinomicose/terapia , Parede Abdominal/cirurgia , Actinomicose/cirurgia , Antibacterianos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes
14.
Eur J Med Res ; 12(6): 273-6, 2007 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-17666318

RESUMO

An 89-year-old female presented with typical symptoms of acute diverticulitis. Abdominal CT revealed an abdominal wall hernia with signs of acute incarceration in the lateral part of the transverse abdominis muscle and rupture of the transversalis fascia. The findings were confirmed intraoperatively. The present case underlines the diagnostic importance of abdominal CT, especially in patients with acute abdomen, allowing for selection of appropriate therapy options.


Assuntos
Doença Diverticular do Colo/diagnóstico por imagem , Hérnia Abdominal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Parede Abdominal , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos
15.
Vox Sang ; 92(1): 69-78, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17181593

RESUMO

BACKGROUND AND OBJECTIVES: About 15% of polytrauma patients receive massive blood transfusion (MBT) defined as > or = 10 units of packed red blood cells (PRBC). In general, the prognosis of trauma patients receiving MBT is considered to be poor. The purpose of this study was to investigate the impact of MBT on the outcome of polytrauma patients. MATERIALS AND METHODS: Records of 10 997 patients in the Trauma Registry of the German Trauma Society were analysed. Transfusion data were available from 8182 severe trauma patients with a mean injury severity score of 24.5 and, of these 8182 patients, 1062 received > or = 10 units of PRBC. First, a logistic regression model for the predictors of mortality was performed. Second, incidences of organ failure and sepsis as well as survival rates were analysed. RESULTS: The highest risk for mortality was age over 55 years (odds ratios [OR] 4.7; confidence intervals [CI 95%], 3.5-6.5) followed by Glasgow Coma Scale < or = 8 (OR 4.6; 3.4-6.1), MBT > or = 20 units of PRBC (OR 3.3; 2.1-5.4), thromboplastin time < 50% (OR 3.2; 2.2-4.4) and injury severity score > or = 24 (OR 2.9; 2.1-4.1). Transfusion of 10-19 PRBC was identified as the variable with the lowest risk for mortality (OR 1.5; 1.0-2.3). Risk of organ failure, sepsis and death correlated with increasing transfusion amount. For the MBT patients, the survival rate was 56.9% (CI 95%, 53.9-59.9%) compared to 85.2% (84.4-86.0%) of non-MBT patients (P < 0.001). In the MBT group with > 30 PRBC (mean 40.6 PRBC) 39.6% survived (31.7-47.5%). CONCLUSION: Massive blood transfusion is one main prognostic factor for mortality in trauma. Although MBT is generally considered to be critical, every second trauma patient with MBT survived. A cut-off value for the number of PRBC could not be determined. Extended transfusion management even with high amounts of PRBC seems to be justified.


Assuntos
Hemorragia/terapia , Insuficiência de Múltiplos Órgãos/etiologia , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/terapia , Sepse/etiologia , Reação Transfusional , Adulto , Transfusão de Sangue/mortalidade , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Feminino , Alemanha/epidemiologia , Hemorragia/complicações , Hemorragia/mortalidade , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Razão de Chances , Prognóstico , Estudos Prospectivos , Sistema de Registros , Análise de Regressão , Fatores de Risco , Análise de Sobrevida
16.
Eur J Med Res ; 11(7): 279-84, 2006 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-16899421

RESUMO

Morbidity of colorectal cancer is still accreting; therefore in 2003 a total of 57000 patients fell ill and about 28000 died due to colorectal carcinoma. According to the etiology, many different factors are currently in discussion. However, as in about 25-30% of the cases familial clustering can be observed one of the most probable might be the genetic predisposition. Nevertheless only in 3% of all cases this predisposition is also scientifically assured. The high average age of manifestation raised the question if there might be also an occupational relationship for colorectal carcinoma in tense of an occupational disease. Therefore there is sight for occupational health to contribute to early diagnosis of colorectal carcinoma within the scope of routine check-up, health management and research of occupational diseases.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Doenças Profissionais/diagnóstico , Doenças Profissionais/prevenção & controle , Saúde Ocupacional , Neoplasias Colorretais/epidemiologia , Diagnóstico Diferencial , Saúde Global , Humanos , Incidência , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Fatores de Tempo
17.
Eur J Med Res ; 11(3): 128-34, 2006 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-16751114

RESUMO

Chondroblastoma is a benign bone tumor, accounting for approximately one percent of all benign bone tumors. It mostly occurs in typical locations such as long bones. Malignant transformation including metastasis has been described in only a few cases. Therefore, we report a unique case of chondroblastoma with tumor manifestation in the 7th decade of life, location of the tumor in the scapula and occurrence of metastasis in the soft tissue of the mandible branch. Due to aggravation of the clinical course, a scapula en bloc resection was performed. The differential diagnosis is discussed and the current literature concerning malignant transformation of chondroblastoma is reviewed.


Assuntos
Neoplasias Ósseas , Condroblastoma/secundário , Idoso , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/patologia , Condroblastoma/diagnóstico , Condroblastoma/patologia , Humanos , Masculino , Neoplasias Mandibulares/secundário , Escápula
18.
Eur J Med Res ; 11(4): 170-3, 2006 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-16720283

RESUMO

Gluteal compartment syndrome is an uncommon and rare disease. Most reasonable causes for the development of this disease are trauma, drug induced coma, Ehlers-Danlos syndrome, sickle cell associated muscle infarction, incorrect positioning during surgical procedures and prolonged pressure in patients with altered consciousness levels. The diagnosis requires a high index of suspicion, especially in postoperative patient where sedation or peridural anaesthesia can confound the neurological examination. Early signs include gluteal tenderness, decrease in vibratory sensation during clinical examination and increasing CK in laboratory findings. We present a case of a 52 year-old patient, who developed gluteal compartment syndrome after radical prostatectomy in lithotomic position. After operation, diuresis decreased [<50 ml/h] and CK [93927 U/l], LDH [1528 U/l], creatinin [1.5 mg/dl] and urea [20 mg/dl] increased in laboratory findings. Despite peridural anaesthesia, the patient complained about increasing pain in the gluteal region and both thighs. His thighs and the gluteal region were swollen. Passive stretch of the thighs caused enormous pain. The compartment pressure was 92 mmHg. Therefore, emergency fasciotomy was performed successfully. The gluteal compartment syndrome was most likely caused by elevated pressure on the gluteal muscle during operation. We suggest heightened awareness of positioning the patient on the operating table is important especially in obese patients with lengthy operating procedures.


Assuntos
Nádegas , Síndromes Compartimentais/etiologia , Complicações Pós-Operatórias , Postura , Prostatectomia , Síndromes Compartimentais/cirurgia , Desbridamento , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Músculo Esquelético/cirurgia , Pressão/efeitos adversos , Decúbito Dorsal , Resultado do Tratamento
19.
Surg Endosc ; 20(3): 410-3, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16424985

RESUMO

BACKGROUND: The objective of this matched control study in patients suffering from incisional hernia was to compare laparoscopic open repair (LHR) with open hernia repair (OHR) in terms of long-term health-related quality of life (HRQL) according to the SF-36 Health Survey. METHODS: Twenty-four consecutive patients (18 male, six female; mean age, 55 years) prospectively underwent LHR using expanded polytetrafluoroethylene mesh. The second group, which was matched for age and gender, was subjected to OHR using large pore-sized, low-weight polypropylene meshes. Before and after surgery, HRQL was assessed by the SF-36 Health Survey, which measures eight different health-quality domains, and the SF-36 Physical (PCS) and Mental Component Summary (MCS) score. The SF-36 values were compared to the scores of age-stratified German population controls. RESULTS: The patients were reevaluated 16 months (range, 12-25) after LHR and 28 months (range, 18-52) after OHR, respectively. Before surgery, all of the eight health-quality domains as well as the PCS and MCS scores of both study groups were significantly lower than the corresponding scores of the age-stratified healthy German population. However, the OHR patients had significantly higher physical functioning and vitality scores than the LHR patients. After LHR and OHR, the scores for all eight SF-36 domains significantly increased but were still lower than those of the controls. The LHR patients were still worse than the norm population on both PCS and MCS scores, whereas OHR patients were worse only on PCS but not on MCS. In the long-term follow-up, none of the SF-36 Health Survey domains or the PCS and the MCS scores revealed significant differences between LHR and OHR patients. CONCLUSIONS: LHR was not different from OHR for selected indications that measure long-term outcome and HRQL. SF-36 appears to be an appropriate instrument to measure postoperative HRQL, showing responsiveness to changes in objective outcome measures.


Assuntos
Endoscopia do Sistema Digestório , Indicadores Básicos de Saúde , Hérnia Abdominal/cirurgia , Laparoscopia , Qualidade de Vida , Adulto , Idoso , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Telas Cirúrgicas , Técnicas de Sutura
20.
Eur J Med Res ; 10(11): 495-7, 2005 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-16354604

RESUMO

Pneumobilia is a rare pathological finding, which denotes an abnormal connection between the gastrointestinal and the biliary tract. In the absence of surgically created anastomosis between the bowel and the bile duct, the most common causes for pneumobilia are gallstone obstruction, endoscopic interventions, or emphysematous cholecystitis. We present this case of a middle-aged multiple-injured male who developed traumatic pneumobilia after cardiopulmonary resuscitation. We suppose that chest compression in combination with a sphincter of Oddi (SO) dysfunction forced intraluminal air retrograde through the SO into the biliary tract, since intraabdominal injury as well as former biliary pathology, inflammation, or biliary-enteric fistula were excluded.


Assuntos
Reanimação Cardiopulmonar , Oscilação da Parede Torácica/métodos , Parada Cardíaca/complicações , Traumatismo Múltiplo/etiologia , Traumatismo Múltiplo/fisiopatologia , Sistema Biliar/diagnóstico por imagem , Sistema Biliar/fisiopatologia , Cardiotônicos/uso terapêutico , Epinefrina/uso terapêutico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/tratamento farmacológico , Traumatismo Múltiplo/cirurgia , Esfíncter da Ampola Hepatopancreática/fisiopatologia , Tomografia Computadorizada Espiral , Resultado do Tratamento , Fibrilação Ventricular/fisiopatologia
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