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1.
Am J Emerg Med ; 34(3): 477-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26795889

RESUMO

INTRODUCTION: Small-bowel obstruction (SBO) is a common cause of admission to the surgical service. On rare occasions, a diagnosed SBO is actually due to large-bowel pathology combined with an incompetent ileocecal valve. The purpose of this study was to investigate this phenomenon. METHODS: We performed a retrospective medical record review of patients that were admitted with a diagnosis of SBO at University of Louisville hospital and the Veterans Affairs hospitals in Louisville, KY, from 2006 until 2014. RESULTS: A total of 498 patients were admitted with SBO during this time period. Forty-one patients were found to have an underlying large-bowel disease. The most common large-bowel pathologies included malignancy (51%), inflammation (15%), and infection (15%). Fifteen (43%) of these patients died during admission; 93% of these were due to either their bowel obstruction or the underlying disease state. This was significantly higher than the general population (9.4% mortality, 6% due to underlying disease). CONCLUSIONS: Patients that present with SBO due to a large-bowel source have a much higher mortality rate than those that present with other causes. Rapid identification of these patients will allow for more timely and appropriate treatment.


Assuntos
Neoplasias do Colo/complicações , Hérnia/complicações , Doenças Inflamatórias Intestinais/complicações , Obstrução Intestinal/etiologia , Intestino Grosso/patologia , Intestino Delgado/fisiopatologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/mortalidade , Feminino , Hérnia/diagnóstico , Hérnia/mortalidade , Mortalidade Hospitalar , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/mortalidade , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/mortalidade , Intestino Grosso/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Kentucky , Masculino , Prontuários Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Prognóstico , Estudos Retrospectivos , Distribuição por Sexo , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Am Surg ; 79(6): 641-3, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23711277

RESUMO

Small bowel obstruction is a common clinical occurrence, primarily caused by adhesions. The diagnosis is usually made on the clinical findings and the presence of dilated bowel loops on plain abdominal radiograph. Computed tomography (CT) is increasingly used to diagnose the cause and location of the obstruction to aid in the timing of surgical intervention. We used a retrospective chart review to identify patients with a diagnosis of small bowel obstruction between 2009 and 2012. We compared the findings on CT with the findings at operative intervention. Sixty patients had abdominal CT and subsequent surgical intervention. Eighty-three per cent of CTs were correct for small intestine involvement and 80 per cent for colon involvement. The presence of adhesions or perforation was correctly identified in 21 and 50 per cent, respectively. Sixty-four per cent correctly identified a transition point. The presence of a mass was correctly identified in 69 per cent. Twenty per cent of the patients who had ischemic small bowel at surgery were identified on CT. CT has a role in the clinical assessment of patients with small bowel obstruction, identifying with reasonable accuracy the extent of bowel involvement and the presence of masses and transition points. It is less reliable at identifying adhesions, perforations, or ischemic bowel.


Assuntos
Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
3.
World J Surg ; 36(9): 2045-50, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22538393

RESUMO

BACKGROUND: Many quality of life (QoL) and patient-reported outcomes (PRO) measures have been developed to assess the effects of disease processes and treatments. Although these instruments are valuable, the process is hampered because of their number and lack of interchangeability. METHODS: We identified a cohort of patients across a variety of operations within 3-12 months postoperatively. Patients completed the SF-36, measuring eight domains of QoL (physical functioning, role-physical, role-emotional, bodily pain, vitality, mental health, social functioning, and general health), plus a health transition item: Compared to one year ago, how would you rate your health in general now?. (1) Much better now than one year ago. (2) Somewhat better now than one year ago. (3) About the same as one year ago. (4) Somewhat worse than one year ago. (5) Much worse than one year ago. Additional data included improvement of preoperative symptoms, the occurrence of any postoperative symptoms, and the occurrence of any postoperative complications. RESULTS: Of 217 patients, 28 % were much better, 28 % somewhat better, 27 % unchanged, 13 % somewhat worse, and 3 % much worse. The health transition results were associated with all SF-36 domains, preoperative symptom change (p = 0.03) and persistent or new postoperative symptoms (p = 0.001), but not postoperative complications. Patients with persistent or new symptoms postoperatively had worse scores in the role-emotional (p = 0.01), bodily pain (p = 0.05), social functioning (p = 0.02), and mental health (p = 0.009) domains of the SF-36. CONCLUSIONS: This single, global assessment of health transition may be a promising practical alternative to assess postoperative patient-centered outcomes. Improved patients had better QoL scores, preoperative symptoms elimination, and no operation-related symptoms, but the occurrence of complications did not affect improvement.


Assuntos
Indicadores Básicos de Saúde , Qualidade de Vida , Procedimentos Cirúrgicos Operatórios , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Projetos Piloto , Período Pós-Operatório , Autorrelato , Resultado do Tratamento , Adulto Jovem
4.
Ann Thorac Surg ; 90(6): 2033-5, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21095359

RESUMO

Non-small cell pulmonary carcinomas represent the majority of tumors located in the superior sulcus. However, only 5% of all non-small cell pulmonary carcinomas present in the superior sulcus. Other causes of superior sulcus tumors include metastatic tumors, hematologic malignancies, infectious causes, and amyloid nodules, as well as other lesions. We report a case in which a venous hemangioma presented as a superior sulcus tumor.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Hemangioma/diagnóstico , Síndrome de Pancoast/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Hemangioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Síndrome de Pancoast/cirurgia , Pneumonectomia , Tomografia Computadorizada por Raios X
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