RESUMO
OBJECTIVES: To perform a retrospective review in patients undergoing urologic operations during a 10-year period. Patient positioning is important before surgery to avoid pressure sores and other iatrogenic injuries. The reported risk factors have included a long operative time, diabetes, and malignancy. We have noted skin breakdown in patients placed on stabilizing devices and in patients with germline von Hippel-Lindau (VHL) gene mutations (a gene important in angiogenesis). METHODS: We performed a retrospective review in patients undergoing urologic operations during a 10-year period. Patient sex, age, blood loss, position, use of belt or Vac Pac, and diagnosis of VHL were correlated with skin breakdown. RESULTS: During a 10-year period, 382 patients underwent primarily renal and adrenal surgery. Fifty-five patients (14.4%) developed skin breakdown after surgery. Ninety-six patients had VHL gene mutations. Patient position and operative time were both significantly related to skin breakdown (both P <0.0001). The odds ratio for the position effect indicated that patients in the lateral position were at much greater risk than patients in the supine position (estimated odds ratio 8.1, P <0.0001). The odds ratio for operative time confirmed that patients experiencing longer operative times were also at increased risk of skin breakdown (estimated odds ratio 3.7 for each doubling of the operative time, P <0.0001). Patient sex, patient age, estimated blood loss, diagnosis of VHL, and use of belt or Vac Pac were not associated with an increased risk of skin breakdown. CONCLUSIONS: Patients with longer operative times were at greater risk of skin breakdown and required greater care during preoperative positioning. The other factors studied were not significantly associated with skin breakdown.
Assuntos
Adrenalectomia , Imobilização/instrumentação , Complicações Pós-Operatórias/epidemiologia , Úlcera Cutânea/epidemiologia , Procedimentos Cirúrgicos Urológicos , Adolescente , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Idoso , Criança , Suscetibilidade a Doenças , Feminino , Humanos , Imobilização/efeitos adversos , Período Intraoperatório/estatística & dados numéricos , Neoplasias Renais/genética , Neoplasias Renais/cirurgia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Complicações Pós-Operatórias/etiologia , Postura , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/etiologia , Úlcera por Pressão/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Úlcera Cutânea/etiologia , Úlcera Cutânea/prevenção & controle , Decúbito Dorsal , Doença de von Hippel-Lindau/complicações , Doença de von Hippel-Lindau/cirurgiaRESUMO
The finding of a serum testosterone level greater than 200 ng/dl in a woman with virilization raises concerns about an androgen producing tumor. This case report demonstrates that chronic annovulation in association with insulin resistance can cause significant elevations in the level of serum testosterone, and describes the therapeutic benefit of insulin sensitizing agents in reversing hyperandrogenemia.
