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2.
J Pediatr Surg ; 43(5): E19-21, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18485930

RESUMO

Chronic abdominal pain is a common complaint in children. Pain originating from the abdominal wall is often overlooked. Nevertheless, recognizing this type of pain prevents unnecessary examinations (Editorial: Abdominal wall tenderness test: could Carnett cut costs? Lancet. 1991, 337:1134). Abdominal cutaneous nerve entrapment syndrome (ACNES) is a relatively unknown cause of abdominal wall pain in children. Simple questions and clinical tests, which are discussed in this report, can give a direct clue to this disease. The treatment also is equally simple and effective. We describe an 11-year-old girl with ACNES after blunt abdominal trauma, what we believe has not been reported before. Abdominal wall pain, for example, caused by ACNES, as other types of chronic pain, has a serious impact on a child's well-being and future coping mechanisms with disease and health behavior.


Assuntos
Traumatismos Abdominais/complicações , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Pele/inervação , Ferimentos não Penetrantes/complicações , Dor Abdominal/etiologia , Dor Abdominal/prevenção & controle , Parede Abdominal/inervação , Acidentes por Quedas , Amidas/uso terapêutico , Criança , Doença Crônica , Feminino , Humanos , Síndromes de Compressão Nervosa/tratamento farmacológico , Ropivacaina
3.
Obes Surg ; 18(12): 1644-6, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18443886

RESUMO

A patient with a history of a laparoscopic gastric bypass presented with a perforated duodenal ulcer. The ulcer was laparoscopically oversewn, and an omentoplasty was performed. Postoperatively, a broad spectrum antibiotic and a proton pump inhibitor were administrated. Several questions arise regarding the diagnosis and treatment of duodenal ulcers after gastric bypass. What are the diagnostic tools to detect a duodenal ulcer, and how should Helicobacter pylori be diagnosed after gastric bypass? The key question is whether the bypassed stomach should be resected as a definitive treatment for complicated duodenal ulcers.


Assuntos
Úlcera Duodenal/complicações , Derivação Gástrica , Úlcera Péptica Perfurada/etiologia , Complicações Pós-Operatórias/cirurgia , Adulto , Feminino , Derivação Gástrica/métodos , Humanos , Laparoscopia , Omento/transplante , Reoperação
5.
Surg Endosc ; 22(4): 1014-8, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17943380

RESUMO

BACKGROUND: Gastric restrictive procedures such as laparoscopic gastric banding or vertical banded gastroplasty show, at longer follow up, more and more failures and complications. This study focuses on the results of Roux-en-Y gastric bypass procedure (RYGBP) done as a re-do procedure, both after a technically failed restrictive procedure or when the restrictive procedure failed to obtain substantial weight loss. METHODS: We reviewed data concerning the postoperative complications and weight loss of 36 patients undergoing re-do surgery for failed restrictive procedures. RESULTS: Over a period of two years, 36 patients with a mean age of 40.9 years were converted to a RYGBP. Median time to conversion was 4.9 years, median follow up after conversion was 6.6 months. Early postoperative complications (less than 30 days postoperatively) were noted in 11 patients (30%). A greater number of early complications were noticed in group A (technical complications) compared to group B (insufficient weight loss) (39% vs. 22%). Late postoperative complications were seen in six patients (16%). In this relatively short follow up period we noticed a drop in body mass index (BMI) from a mean of 38.8kg/m(2) to 30.9 kg/m(2) with a mean excess body weight loss (EBWL) of 33.1% after the re-do procedure. Body mass index decreased from a mean preoperative value of 37.6kg/m(2) to 28.9 kg/m(2) in group A patients with an EBWL 36%, while group B patients had a change in BMI from 40.1kg/m(2) to 32.9 kg/m(2) with a mean EBWL of 30%. CONCLUSION: Based on the literature, we can presume that restrictive surgery for morbidly obese patients will require many reoperations in the future. The standard operation of choice is RYGBP. In our study this procedure showed a higher, but not significantly early morbidity rate when the indication for re-do surgery was a technical complication of the initial procedure.


Assuntos
Derivação Gástrica , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica , Índice de Massa Corporal , Feminino , Humanos , Modelos Logísticos , Masculino , Complicações Pós-Operatórias , Reoperação , Falha de Tratamento , Resultado do Tratamento
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