RESUMEN
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.
Asunto(s)
Síndrome de Hiperestimulación Ovárica/complicaciones , Derrame Pleural/etiología , Adulto , Drenaje/métodos , Femenino , Humanos , Derrame Pleural/diagnóstico , Derrame Pleural/terapiaRESUMEN
A síndrome de hiperestimulação ovariana (SHEO) é uma complicação iatrogênica que ocorre na fase lútea de um ciclo hormonal induzido. Na maioria dos casos, os sintomas são autolimitados e regridem espontaneamente. Entretanto, casos graves comumente cursam com desconforto respiratório agudo. O objetivo deste estudo foi descrever a apresentação clínica, o tratamento e os desfechos de derrame pleural associado a SHEO em três pacientes submetidas a fertilização in vitro. A idade das pacientes variou de 27 a 33 anos, e o aparecimento do derrame pleural sintomático (bilateral em todos os casos) ocorreu, em média, 43 dias (variação: 27-60 dias) após o início da terapia hormonal para a indução da ovulação. Todas as pacientes necessitaram de internação hospitalar para reposição volêmica maciça, e duas delas necessitaram de ventilação mecânica não invasiva. Embora todas as pacientes tenham sido inicialmente submetidas à toracocentese, a recidiva precoce dos sintomas e do derrame pleural fez com que se optasse pela drenagem pleural com cateter do tipo pigtail. Apesar do alto débito de drenagem (média de 1.000 mL/dia na primeira semana) e do tempo de drenagem prolongado (9-22 dias), os desfechos foram excelentes (alta hospitalar). Embora o derrame pleural secundário a SHEO seja provavelmente subdiagnosticado, a morbidade associada não deve ser subestimada, principalmente devido a seus efeitos em pacientes potencialmente gestantes. Nesta série de casos, o diagnóstico precoce e as medidas de suporte clínico adequadas permitiram uma evolução favorável, limitando a abordagem cirúrgica a uma drenagem pleural adequada.
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.
Asunto(s)
Adulto , Femenino , Humanos , Síndrome de Hiperestimulación Ovárica/complicaciones , Derrame Pleural/etiología , Drenaje/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/terapiaRESUMEN
INTRODUCTION: Pneumothorax is a rare but dangerous complication of acupuncture. Because of its rarity, there are few reports in literature and, therefore little information regarding clinical and therapeutic aspects. This article aims to analyze the clinical presentation, management and follow-up of patients with pneumothorax after acupuncture. METHODS: Retrospective study of patients with post-acupuncture pneumothorax evaluated in a tertiary hospital during a five-year period (2001-2006). RESULTS: Five patients (3 male and 2 female), mean age 46 years (30-73) were included. All patients but one (who had a bilateral pneumothorax) had left-sided pneumothorax . Chest pain, which was the initial symptom in all patients was severe in three cases and mild in two. Four patients underwent tube thoracostomy (pig-tail catheter), three of them immediately after admission and the other after a failed 12-hour conservative treatment period. One patient had a successful conservative management. All had an excellent outcome and were asymptomatic and exhibited a normal chest X-ray at 6-month follow-up CONCLUSION: In all patients, the initial symptom was chest pain, of varying intensity. Tube thoracostomy was the therapeutic modality most frequently employed. All patients had a successful outcome with no further complications.
Asunto(s)
Terapia por Acupuntura/efectos adversos , Neumotórax/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Neumotórax/diagnóstico , Neumotórax/terapiaRESUMEN
BACKGROUND: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. OBJECTIVE: To determine the safety of open bedside tracheostomy (OBT) as a routine intensive care units (ICU) procedure without any selection criteria, considering its peri and postoperative complications. METHOD: Retrospective medical chart review of all patients that underwent elective tracheostomy between April 1999 and December 2005 at ICU of three private hospitals. RESULTS: The study group comprised 552 patients with a mean age of 69.6 +/- 15.8 years. The incidence of significant complications (until 30 days after the procedure) was 4.34% (24 cases): 9 minor bleeding, 9 major bleeding, 2 subcutaneous emphysema, 4 stomal infections. Late complications were: laryngotracheal stenosis in 2 and tracheoinomminate fistula in 1 patient. CONCLUSIONS: OBT seems to be a safe and simple procedure, when performed by a team of experienced physicians under controlled circumstances, and should be considered as an option for ICU patients.
Asunto(s)
Procedimientos Quirúrgicos Electivos , Unidades de Cuidados Intensivos , Traqueostomía , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Traqueostomía/efectos adversos , Traqueostomía/métodos , Traqueostomía/estadística & datos numéricosRESUMEN
OBJETIVOS: Apesar de raro, o pneumotórax é um evento adverso da acupuntura potencialmente grave. Visto sua baixa freqüência, apenas relatos de casos são disponíveis e faltam informações quanto os seus aspectos clínicos e terapêuticos. O objetivo deste trabalho é avaliar apresentação clínica, tratamento e evolução do pneumotórax pós-acupuntura. MÉTODOS: Análise retrospectiva de pacientes com pneumotórax pós-acupuntura tratados em hospital terciário no período 2001 2006. RESULTADOS: Cinco pacientes (Três homens e duas mulheres) com idade média de 46 anos (30 73) foram incluídos. Com exceção de um caso em que houve pneumotórax bilateral, em todos houve perfuração pleural à esquerda. Dor torácica foi o sintoma inicial em todos os pacientes, sendo intensa em três casos, levando a procura imediata por serviço de emergência; e leve em dois casos. Quatro pacientes foram tratados com drenagem pleural (três imediatamente após a admissão e uma após falha de tratamento conservador), devido à sintomatologia exuberante e/ou volume do pneumotórax, e um paciente foi tratado conservadoramente. Todos os pacientes apresentaram evolução clínica satisfatória após resolução do pneumotórax e, em seguimento de 6 meses após o evento, apresentavam-se assintomáticos e sem alterações significativas à radiografia de tórax. CONCLUSÃO: Dor torácica ocorreu em todos os casos, em intensidade variável; a drenagem pleural foi a terapêutica mais frequentemente instituída; e todos os casos evoluíram satisfatoriamente, sem complicações.
INTRODUCTION: Pneumothorax is a rare but dangerous complication of acupuncture. Because of its rarity, there are few reports in literature and, therefore little information regarding clinical and therapeutic aspects. This article aims to analyze the clinical presentation, management and follow-up of patients with pneumothorax after acupuncture. METHODS: Retrospective study of patients with post-acupuncture pneumothorax evaluated in a tertiary hospital during a five-year period (2001-2006). RESULTS: Five patients (3 male and 2 female), mean age 46 years (30 73) were included. All patients but one (who had a bilateral pneumothorax) had left-sided pneumothorax . Chest pain, which was the initial symptom in all patients was severe in three cases and mild in two. Four patients underwent tube thoracostomy (pig-tail catheter), three of them immediately after admission and the other after a failed 12-hour conservative treatment period. One patient had a successful conservative management. All had an excellent outcome and were asymptomatic and exhibited a normal chest X-ray at 6-month follow-up CONCLUSION: In all patients, the initial symptom was chest pain, of varying intensity. Tube thoracostomy was the therapeutic modality most frequently employed. All patients had a successful outcome with no further complications.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Terapia por Acupuntura/efectos adversos , Neumotórax/etiología , Neumotórax/diagnóstico , Neumotórax/terapiaRESUMEN
BACKGROUND: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. OBJECTIVE: To determine the safety of open bedside tracheostomy (OBT) as a routine intensive care units (ICU) procedure without any selection criteria, considering its peri and postoperative complications. METHOD: Retrospective medical chart review of all patients that underwent elective tracheostomy between April 1999 and December 2005 at ICU of three private hospitals. RESULTS: The study group comprised 552 patients with a mean age of 69.6 ± 15.8 years. The incidence of significant complications (until 30 days after the procedure) was 4.34 percent (24 cases): 9 minor bleeding, 9 major bleeding, 2 subcutaneous emphysema, 4 stomal infections. Late complications were: laryngotracheal stenosis in 2 and tracheoinomminate fistula in 1 patient. CONCLUSIONS: OBT seems to be a safe and simple procedure, when performed by a team of experienced physicians under controlled circumstances, and should be considered as an option for ICU patients.
INTRODUÇÃO: A traqueostomia é um procedimento eletivo realizado em pacientes de unidades de terapia intensiva sob ventilação mecânica prolongada. O risco associado ao transporte, custos e dificuldades de agendamento cirúrgico são alguns obstáculos para uma maior aceitação da traqueostomia. O uso de rígidos critérios de seleção para a realização deste procedimento a beira do leito exclui muitos pacientes que se beneficiariam deste método. OBJETIVO: Determinar à segurança da traqueostomia convencional a beira do leito como procedimento de rotina (sem a utilização dos critérios de seleção) em unidades de terapia intensiva, considerando as complicações intra e pós-operatórias. MÉTODO: Revisão retrospectiva de prontuários de pacientes submetidos à traqueostomia eletiva nas unidades de terapia intensiva de três hospitais privados no período de abril de 1999 a dezembro de 2005. RESULTADOS: Foram incluídos 552 pacientes com idade media de 69.6 ± 15.8 anos. A incidência de complicações pós-operatórias (até o 30° pós-operatório) foi 4.34 por cento (24 casos): 9 sangramentos leves, 9 sangramentos importantes, 2 enfisemas subcutâneos, 4 infecções do estoma. As complicações tardias observadas foram: estenose laringotraqueal em 2 pacientes e fistula traqueo-inominada em 1 paciente. CONCLUSÃO: A traqueostomia convencional a beira do leito parece ser um procedimento simples e seguro quando realizado por equipe experiente em condições controladas, deve, portanto ser considerada como uma opção para pacientes em terapia intensiva sob ventilação prolongada.