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1.
Anaesthesiologie ; 72(9): 662-676, 2023 09.
Artigo em Alemão | MEDLINE | ID: mdl-37552241

RESUMO

Electroencephalogram (EEG)-guided anesthesia is indispensable in modern operating rooms and has become established as the standard form of monitoring. Many anesthesiologists rely on processed EEG indices in the hope of averting anesthesia-related complications, such as intraoperative awareness, postoperative delirium and other cognitive complications in their patients. This educational review aims to provide information on the five most prevalent monitors used to guide depth of sedation during general anesthesia. This article elucidates the principles underpinning the application of these monitors where known, which are generally based on power in various EEG frequency bands and on the burst suppression pattern. Convinced that EEG-guided anesthesia has the potential of benefitting many surgical patients, it is felt that many basic principles and shortcomings of processed EEG indices need to be better understood in the clinical practice. After discussing the different monitors and clinically relevant data from the literature, the article gives a short practical guidance on how to critically interpret processed EEG information and troubleshooting of confounded indices in the context of clinical situations.


Assuntos
Anestésicos , Delírio do Despertar , Humanos , Anestesia Geral/efeitos adversos , Eletroencefalografia , Salas Cirúrgicas
2.
Int J Surg Case Rep ; 76: 305-309, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33068855

RESUMO

INTRODUCTION: Oncocytic adrenal neoplasms are rare and mostly benign lesions. Available literature supports indication for a surgical resection, but criteria to predict aggressive behavior are unreliable, thus making decision of surgical approach (laparotomy versus laparoscopy), and extent of resection, difficult to define. PRESENTATION OF CASE: This is the case of a 46-year-old male, with an incidental finding of a 10 cm asymptomatic tumor in the left adrenal gland identified by MRI, performed in the setting of the initial assessment of liver steatosis. Adrenal hormone levels were in the normal range, thus, a CT-guided needle biopsy was performed and showed an adrenocortical oncocytic neoplasm. A laparoscopic left adrenalectomy was performed sparing the adjacent left kidney. Histological examination of the resected tumor showed a 10 cm oncocytic adrenocortical neoplasm of uncertain malignant potential with negative resection margins. A follow-up MRI was scheduled at six months after surgery, and no recurrence was found. CONCLUSIONS: Although rare, oncocytic neoplasms should be included in the differential diagnosis of adrenal "incidentalomas". Determination of their malignant potential is difficult in the preoperatory setting. Final diagnosis is based on histological analysis of the whole surgical specimen. Laparoscopic complete excision with negative resection margins is feasible and safe.

3.
Transplant Proc ; 49(7): 1593-1595, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28838448

RESUMO

An 82-year-old man with a history of renal transplantation 14 years earlier presented with acute obstructive renal failure secondary to inguinal herniation of the urinary bladder complicated by ureteroneocystostomy entrapment. After percutaneous nephrostomy tube and endoscopic stent placement, the bladder was reduced and the hernia repaired with the use of a preperitoneal mesh. The postoperative course was uneventful and the renal function returned to normal. Inguinal herniation of the transplant ureter is a rare cause of hydronephrosis, but it has been described in the literature. Bladder hernias do usually not cause urologic complications in the nontransplanted patient, but they can present as an emergency after renal transplantation.


Assuntos
Hérnia Inguinal/complicações , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/etiologia , Obstrução Ureteral/etiologia , Ureterostomia/efeitos adversos , Doenças da Bexiga Urinária/complicações , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/cirurgia , Idoso de 80 Anos ou mais , Hérnia Inguinal/cirurgia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Ureter/transplante , Obstrução Ureteral/cirurgia , Ureterostomia/métodos , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia
4.
Transplant Proc ; 49(1): 210-212, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28104139

RESUMO

A rare type of acquired internal hernia, the renal paratransplant hernia (RPTH), of which only 11 cases have been reported in the literature so far, can follow renal transplantation. We report a patient who presented with acute abdominal pain and vomiting 6 weeks after renal transplantation in the right iliac fossa. A noncontrast abdominal computed tomography scan showed signs of small bowel obstruction. The patient was taken to the operating room for a midline laparotomy, and RPTH with incarcerated small bowel was diagnosed. The bowel loop was released and found to be viable. The postoperative course was unremarkable. It is unclear whether perioperative peritoneal defects or spontaneous ruptures of lymphoceles into the peritoneal cavity form the basis of this rare type of internal hernia. Surgeons should be aware of this entity and avoid both peritoneal defects and postoperative lymphoceles by paying careful attention to meticulous surgical technique.


Assuntos
Hérnia Abdominal/etiologia , Obstrução Intestinal/etiologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Feminino , Humanos , Intestino Delgado
5.
Swiss Med Wkly ; 144: w13958, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24706486

RESUMO

UNLABELLED: Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. METHODS: Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. RESULTS: Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. CONCLUSION: This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.


Assuntos
Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Escala Resumida de Ferimentos , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Lesões Encefálicas/epidemiologia , Queimaduras/epidemiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Estudos Prospectivos , Sistema de Registros , Traumatismos da Coluna Vertebral/epidemiologia , Suíça/epidemiologia , Traumatismos Torácicos/epidemiologia , Extremidade Superior/lesões , Ferimentos e Lesões/cirurgia , Ferimentos não Penetrantes/epidemiologia , Adulto Jovem
6.
Rev Med Suisse ; 6(233): 204-8, 2010 Jan 27.
Artigo em Francês | MEDLINE | ID: mdl-20214193

RESUMO

Despite advertising for NOTES in 2009, single trocart laparoscopic surgery is about to become a new standard in selected indications. As other important topics, the limits of oncological surgery are extended due to a systematic multidisciplinary approach. To discuss every publication would be difficult and our review will focus on a selected number of papers of importance for daily practice. As examples, the management of acute calculous cholecystitis, gastro-esophageal reflux, inguinal and incisional hernia repair as well as colorectal surgery are presented.


Assuntos
Doenças do Sistema Digestório/cirurgia , Laparoscopia , Doenças do Sistema Digestório/classificação , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Índice de Gravidade de Doença
7.
Rev Med Suisse ; 5(209): 1408-11, 2009 Jun 24.
Artigo em Francês | MEDLINE | ID: mdl-19715016

RESUMO

The widespread use of abdominal imaging technologies has led to an increase in the incidental finding of liver tumors. Most of these lesions are asymptomatic and will not require any treatment. With the use of contrast-enhanced radiological studies, most of the tumors can be reliably diagnosed by non-invasive means. In case of diagnostic uncertainty, patients should not undergo percutaneous biopsy but rather complete resection of the lesion for an unequivocal diagnosis. Such pathologies must be taken charge of in centers with expertise by interdisciplinary teams.


Assuntos
Hepatopatias/diagnóstico , Hepatopatias/terapia , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/terapia , Diagnóstico por Imagem , Hemangioma/diagnóstico , Hemangioma/terapia , Humanos
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