RESUMEN
We report an unusual decompression sickness (DCS) incident in a commercial diving project. Eleven divers completed 91 dives to 23.5-36.2 m with bottom times ranging 23-67 min. The divers were breathing compressed air while immersed. Decompression was planned as surface decompression in a deck decompression chamber breathing oxygen typically for 15-30 min. Due to a technical error the divers breathed air rather than oxygen during the surface decompression procedure. Two divers suffered DCS. Both were recompressed on site with the same error resulting in them breathing compressed air rather than oxygen. One of them experienced a severe relapse with cardiovascular decompensation following recompression treatment. While DCS was expected due to the erroneous decompression procedures, it is noteworthy that only two incidents occurred during 91 dives with surface decompression breathing air instead of oxygen. Accounting for this error, the median omitted decompression time was 17 min (range 0-26 min) according to the Bühlmann ZHL-16C algorithm. These observations suggest that moderate omission of decompression time has a relatively small effect on DCS incidence rate. The other nine divers were interviewed in the weeks following completion of the project. None of them reported symptoms at the time, but five divers reported having experienced minor symptoms compatible with mild DCS during the project which was not reported until later.
Asunto(s)
Enfermedad de Descompresión , Buceo , Oxígeno , Enfermedad de Descompresión/terapia , Enfermedad de Descompresión/etiología , Humanos , Buceo/efectos adversos , Masculino , Oxígeno/administración & dosificación , Adulto , Factores de Tiempo , Descompresión/métodos , Aire Comprimido/efectos adversos , Persona de Mediana Edad , FemeninoRESUMEN
INTRODUCTION: Traditional anterior component separation during incisional hernia repair (IHR) is associated with a high rate of postoperative wound morbidity. Because extensive subcutaneous dissection is avoided by endoscopic anterior component separation (eACS) or open transversus abdominis release (TAR), we hypothesized that these techniques did not increase the incidence of surgical site occurrence (SSO) compared to IHR without component separation (CS). MATERIAL AND METHOD: This was a retrospective single-center cohort study of patients undergoing open retromuscular IHR comparing patients with or without the use of CS. Retromuscular mesh repair was performed in all patients, and CS was obtained by eACS or TAR. The primary outcome was 90-day incidence of postoperative SSO. Secondary outcomes included length of stay (LOS), 90-day readmission, 90-day reoperation rate and 3-year recurrence rate. RESULTS: A total of 321 patients underwent retromuscular repair, 168 (52.3%) of whom received either eACS or TAR. The addition of eACS or TAR was associated neither with development of SSO (odds ratio: 1.80, 95% confidence interval: 0.94-3.46, P = 0.077) nor with hernia recurrence (hazard ratio 0.77, 0.26-2.34, P = 0.648). There was no significant difference between the groups regarding the frequencies of 90-day readmission or 90-day reoperation. CONCLUSION: eACS or TAR as adjuncts to open retromuscular IHR were not associated with increased wound morbidity or hernia recurrence.
Asunto(s)
Hernia Ventral , Hernia Incisional , Humanos , Hernia Ventral/etiología , Músculos Abdominales/cirugía , Hernia Incisional/epidemiología , Hernia Incisional/etiología , Hernia Incisional/cirugía , Estudios de Cohortes , Estudios Retrospectivos , Resultado del Tratamiento , Herniorrafia/efectos adversos , Herniorrafia/métodos , Mallas Quirúrgicas/efectos adversos , Incidencia , RecurrenciaRESUMEN
Malignant transformation in pilonidal disease is rare and never reported in Denmark. There are 75 cases in the literature, mostly squamous cell carcinoma. The cost-benefit of routine histological examination of specimens from pilonidal surgery is questionable, as malignancy is extremely rare. Due to increased incidence of cancer, specimens from patients with many years of pilonidal disease, known immunodeficiencies and/or human papillomavirus infection or clinical abnormal presentation, should always be investigated.
Asunto(s)
Seno Pilonidal , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Papillomavirus/diagnóstico , Seno Pilonidal/complicaciones , Seno Pilonidal/economía , Seno Pilonidal/patología , Seno Pilonidal/cirugía , Recurrencia , Región Sacrococcígea/patología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patología , Factores de TiempoRESUMEN
Since perforated peptic ulcer is uncommon in children proton pump inhibitor prophylaxis is not routinely recommended when children are treated with high dose steroids. We describe a case of perforated ulcer in a six-year-old patient with nephrotic syndrome treated with high dose prednisolone. Initially, ulcer was not suspected due to uncharacteristic symptoms. The child developed peritoneal signs and surgery revealed a perforated peptic ulcer in the stomach. We recommend treatment with proton pump inhibitors if children, who are treated with high dose steroids develop abdominal symptoms, which can be caused by an ulcus.