RESUMO
Shoulder arthroplasty (SA) is commonly performed in patients with rheumatoid arthritis (RA) who have been treated with long-term immunosuppressive medication. RA is associated with an increased risk of neoplasms of the immune system. A case of non-Hodgkin's lymphoma as an unexpected diagnosis after the routine pathologic examination of the soft tissues after SA was detected in a 54-year-old woman with long-standing RA and prolonged immunosuppressive therapy. Although this case does not support the cost-effectiveness of routine specimen evaluation during SA, we suggest that histological analysis of the surgical tissues is appropriate and should be performed in all patients who have been treated with prolonged immunosuppressive medication, especially RA patients as well as patients who have suspicious surgical findings.
Assuntos
Artrite Reumatoide/complicações , Artroplastia de Substituição , Linfoma não Hodgkin/complicações , Articulação do Ombro , Feminino , Humanos , Linfoma não Hodgkin/patologia , Pessoa de Meia-Idade , Radiografia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgiaRESUMO
We describe 3 cases of cerebral fat embolism associated with cardiac surgery. The autopsy findings suggested that in 2 cases, the embolic fat globules entered the systemic circulation directly as a result of protrusion of epicardial fat into the left atrial chamber along the suture line in one case, and through an atrial septal defect in the other. The characteristic latent interval between surgical trauma and onset of neurologic manifestations was lacking in both cases. The evolution of neurologic manifestations and the pathologic findings in the third case were similar to those usually seen in posttraumatic fat embolism. This study suggests that the pathogenetic mechanisms of cerebral fat embolism following cardiac surgery may vary in different cases. Also, it emphasizes the importance of autopsy in the investigation of this serious but preventable complication.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Embolia Gordurosa/etiologia , Embolia e Trombose Intracraniana/etiologia , Adulto , Idoso , Embolia Gordurosa/diagnóstico , Humanos , Embolia e Trombose Intracraniana/diagnóstico , Masculino , Complicações Pós-Operatórias/diagnósticoRESUMO
Pulmonary hypertension is a contraindication to pregnancy, as there is a very high mortality in the puerperium, when fluid balance is most tenuous. There is a fine line between sufficient fluid to maintain pulmonary perfusion and too much fluid, triggering pulmonary overload. Surgical sterilization is strongly advised in this patient population.
